Lancet Global Health最新文献

{"title":"Global and regional causes of maternal deaths 2009-20: a WHO systematic analysis.","authors":"Jenny A Cresswell, Monica Alexander, Michael Y C Chong, Heather M Link, Marija Pejchinovska, Ursula Gazeley, Sahar M A Ahmed, Doris Chou, Ann-Beth Moller, Daniel Simpson, Leontine Alkema, Gemma Villanueva, Yanina Sguassero, Özge Tunçalp, Qian Long, Shaoming Xiao, Lale Say","doi":"10.1016/S2214-109X(24)00560-6","DOIUrl":"10.1016/S2214-109X(24)00560-6","url":null,"abstract":"<p><strong>Background: </strong>Maternal mortality is not on track to meet Sustainable Development Goal (SDG) target 3.1 of a global maternal mortality ratio below 70 per 100 000 livebirths by 2030. Updated evidence on causes of death is needed to accelerate progress.</p><p><strong>Methods: </strong>We conducted a multi-strategy systematic review to identify causes of maternal deaths occurring in 2009-20. Data sources included civil registration and vital statistics systems data from the WHO Mortality Database, reports published by Member States, and national and subnational journal articles identified via bibliographic databases. We used a Bayesian hierarchical model to estimate the maternal cause of death distribution by SDG regions and worldwide. Given the paucity of data on maternal suicide and late maternal deaths occurring beyond 42 days postpartum, additional analyses were conducted to estimate the proportion of maternal deaths from suicide and the ratio of maternal to late maternal deaths (all cause).</p><p><strong>Findings: </strong>Globally, the most common cause of maternal death was haemorrhage (27%; 80% uncertainty interval 22-32), followed by indirect obstetric deaths (23%, 18-30), and hypertensive disorders (16%, 14-19). The proportion of haemorrhage deaths varied substantially by region and was highest in sub-Saharan Africa and Western Asia and Northern Africa. The proportion of maternal deaths from hypertensive disorders was highest in Latin America and the Caribbean. Most maternal deaths from haemorrhage and sepsis occurred during the postpartum period. Only 12 countries recorded one or more maternal suicides; of those countries, the proportion of deaths from suicide ranged from below 1% to 26% of maternal deaths. For countries reporting at least one late maternal death (ie, deaths that occur more than 42 days but less than 1 year after the termination of pregnancy), the ratio of late maternal deaths to maternal deaths up to 42 days ranged from <0·01 to 0·07.</p><p><strong>Interpretation: </strong>Haemorrhage remains the leading cause of death, despite the existence of effective clinical interventions, emphasising the need for improved access to quality health care. The timing of most deaths in the postpartum period demands renewed commitment to improving the provision of postpartum care in addition to intrapartum care. Indirect causes of death require health system approaches to integrate obstetric and non-obstetric care.</p><p><strong>Funding: </strong>USAID; US Fund for UNICEF via the Bill & Melinda Gates Foundation; and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development, and Research Training in Human Reproduction (HRP).</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e626-e634"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11946934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strengthening the paediatric clinical trial ecosystem to better inform policy and programmes.","authors":"James A Berkley, Judd L Walson, Glenda Gray, Fiona Russell, Zulfiqar Bhutta, Per Ashorn, Shane A Norris, Ebunoluwa A Adejuyigbe, Rebecca Grais, Bernhards Ogutu, Jun Zhang, Guillermo L Chantada, Sharon Nachman, Edward Kija, Fyezah Jehan, Carlo Giaquinto, Nigel C Rollins, Martina Penazzato","doi":"10.1016/S2214-109X(24)00511-4","DOIUrl":"https://doi.org/10.1016/S2214-109X(24)00511-4","url":null,"abstract":"<p><p>The first WHO Global Clinical Trials Forum was convened in November, 2023 to develop a shared vision of an effective global clinical trial infrastructure. The Paediatric Clinical Trials Working Group was formed to provide perspectives, identify challenges, and propose solutions to strengthen the paediatric clinical trials ecosystem. Participants represented paediatric disciplines, including infectious diseases, nutrition, neonatology, pharmacology, oncology, neurodevelopment, public health, and policy. Childhood diseases have profound lifelong effects on health, livelihoods, and societies. Investment in early childhood results in highly cost-effective changes to lifelong health, productivity, and human capital returns. Yet, there remain substantial gaps in knowledge on the efficacy and safety of many paediatric interventions, which represents a failure to establish shared priorities and alignment across governments, researchers, communities, and funders. Children are frequently marginalised from clinical trials, which is an issue of equity. Challenges include mismatched priorities and funding, risk adversity, poor design, power imbalances, and inadequate infrastructure. Solutions include aligning on and tracking local and global child health priorities against funding and supporting regional consortia to pool resources for larger, more consequential trials. We propose actions and responsibilities for global, regional, and national institutions for prioritisation, coordination, enabling paediatric trials consortia, funding, and tracking progress.</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 4","pages":"e732-e739"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eliminate prescribers' uncertainty to catalyse the impact of vaccines on antibiotic use.","authors":"Brecht Ingelbeen, Nandini Sreenivasan, Annick Lenglet","doi":"10.1016/S2214-109X(25)00018-X","DOIUrl":"10.1016/S2214-109X(25)00018-X","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e621"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Redefining implementation science for global health decolonisation.","authors":"The Lancet Global Health","doi":"10.1016/S2214-109X(25)00116-0","DOIUrl":"https://doi.org/10.1016/S2214-109X(25)00116-0","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 4","pages":"e599"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The coming of age of in-country laboratory testing for Ebola virus disease in Uganda.","authors":"Misaki Wayengera","doi":"10.1016/S2214-109X(25)00073-7","DOIUrl":"https://doi.org/10.1016/S2214-109X(25)00073-7","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 4","pages":"e624"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of intrapartum azithromycin to prevent maternal infection, sepsis, or death in low-income and middle-income countries: a modelling analysis of data from a randomised, multicentre, placebo-controlled trial.","authors":"Jackie K Patterson, Simon Neuwahl, Sydney Kirsch, Janet L Moore, Alan T N Tita, Waldemar A Carlo, Adrien Lokangaka, Antoinette Tshefu, Musaku Mwenechanya, Elwyn Chomba, Avinash Kavi, Mrityunjay C Metgud, Shivaprasad S Goudar, Richard J Derman, Poonam Shivkumar, Manju Waikar, Archana Patel, Patricia L Hibberd, Paul Nyongesa, Fabian Esamai, Osa A Ekhaguere, Sherri Bucher, Saleem Jessani, Shiyam S Tikmani, Sarah Saleem, Blair J Wylie, Robert L Goldenberg, Sk Masum Billah, Ruth Lennox, Rashidul Haque, William A Petri, Manolo Mazariegos, Nancy F Krebs, Jennifer J Hemingway-Foday, Denise Babineau, Marion Koso-Thomas, Elizabeth M McClure, Melissa Bauserman","doi":"10.1016/S2214-109X(24)00517-5","DOIUrl":"https://doi.org/10.1016/S2214-109X(24)00517-5","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Sepsis is one of the leading causes of maternal mortality globally. In 2023, the Azithromycin Prevention in Labor Use (A-PLUS) trial showed intrapartum azithromycin for women planning a vaginal birth reduced the risk of maternal sepsis or death and infection. We aimed to evaluate the cost-effectiveness of intrapartum azithromycin for pregnant people planning a vaginal birth in low-income and middle-income countries (LMICs) using A-PLUS trial data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We compared the benefits and costs of intrapartum azithromycin versus standard care across 100 000 model simulations using data from the A-PLUS trial and a probabilistic decision tree model that included 24 mutually exclusive scenarios. A-PLUS was a randomised, double-blind, placebo-controlled trial that enrolled 29 278 women in labour at 28 weeks' gestation or more at eight sites in the Democratic Republic of the Congo, Kenya, Zambia, Bangladesh, India, Pakistan, and Guatemala. Women randomly assigned to azithromycin received a single intrapartum 2 g oral dose. In this cost-effectiveness analysis, we considered the cost of azithromycin treatment and its effects on a composite outcome of maternal infection, sepsis, or death and its individual components, and health-care use. Our analysis had a health-care sector perspective. We summarised results as an average and 95% CI of the model simulations. We also conducted sensitivity analyses. A-PLUS was registered at ClinicalTrials.gov, number NCT03871491.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;In model simulations, intrapartum azithromycin resulted in 1592·0 (95% CI 1139·7 to 2024·1) cases of maternal infection, sepsis, or death averted per 100 000 pregnancies, yielding 248·5 (95·3 to 403·7) facility readmissions averted, 866·8 (537·8 to 1193·2) unplanned clinic visits averted, and 1816·2 (1324·5 to 2299·7) antibiotic regimens averted. Using mean health-care costs across the A-PLUS sites, intrapartum azithromycin resulted in net savings of US$32 661 (-52 218 to 118 210) per 100 000 pregnancies and 13·2 (8·3 to 17·9) disability-adjusted life-years averted. The cost of facility readmission, cost of azithromycin, and probability of infection had the greatest impact on the incremental cost.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;In most cases, intrapartum azithromycin is a cost-saving intervention for the prevention of maternal infection, sepsis, or death in LMICs. This evidence supports global consideration of intrapartum azithromycin as an economically efficient preventive therapy to reduce infection, sepsis, or death among women planning a vaginal birth in LMICs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Funding: &lt;/strong&gt;Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Foundation for the National Institutes of Health through the Maternal, Newborn, and Child Health Discovery and Tools Initiative of the Bill & Melinda Gates Foundation TRANSLATIONS: For the French and Spanish translations of th","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 4","pages":"e679-e688"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11950424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epilepsy in the Indigenous peoples in Canada, Australia, New Zealand, and the USA: a systematic scoping review.","authors":"Ngaire F Keenan, Sean G Aitchison, Nathalie Jetté, Karen L Parko, Pamela Roach, Angela Dos Santos, John Archer, Erik Andersen, Jeannine L Stairmand, James Stanley, Lynette G Sadleir","doi":"10.1016/S2214-109X(24)00507-2","DOIUrl":"https://doi.org/10.1016/S2214-109X(24)00507-2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Indigenous peoples have inequitable health access and outcomes yet are under-represented in health research and policy. The Intersectoral Global Action Plan on Epilepsy and other Neurological Disorders 2022-2031 highlights Indigenous peoples as high priority groups. We aimed to provide a summary of existing knowledge regarding epilepsy among Indigenous peoples in Canada, Australia, New Zealand, and the USA (CANZUS).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this systematic scoping review, we searched Embase, MEDLINE, APA PsychInfo, Cochrane, Scopus, CINAHL databases and grey literature for reports published in any language between Jan 1, 1985, and April 16, 2023, using search terms related to seizures, epilepsy, and Indigenous peoples. Studies were assessed independently by three reviewers. Articles including epilepsy data in an Indigenous group were included. Articles were excluded if they combined Indigenous and non-Indigenous peoples as one population or if the outcomes did not include a separate analysis by Indigenous group. Case reports were also excluded. We extracted data on epilepsy epidemiology, access to health care, treatment, and health outcomes in Indigenous people. The methodological quality of studies was assessed through a methodological appraisal and an Indigenous perspective appraisal. This study is registered with Open Science Framework, https://doi.org/10.17605/OSF.IO/9JRHG.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Our search identified 2037 studies, of which 42 peer-reviewed articles and nine grey literature reports met inclusion criteria: these studies were in Canada (n=3), Australia (n=17), New Zealand (n=9), and the USA (n=22). With the exception of Māori children in New Zealand, who seem to have similar rates of epilepsy to children of European ancestry, the incidence and prevalence of epilepsy seemed to be higher in Indigenous peoples in these regions than non-Indigenous populations. In the included studies, Indigenous peoples showed a higher number of epilepsy hospital presentations, decreased access to specialists, decreased access and longer waits for antiseizure medication, and increased prescriptions for enzyme-inducing antiseizure medications when compared with non-Indigenous peoples. In Australia, the number of disability-adjusted life years among Aboriginal and Torres Strait Islander peoples with epilepsy was double that for non-Indigenous people with epilepsy. Mortality rates for Indigenous peoples with epilepsy in New Zealand and Australia were higher than in non-Indigenous people with epilepsy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;Although Indigenous people from CANZUS have unique cultural identities, this review identified similar themes and substantial disparities experienced by Indigenous versus non-Indigenous people in these nations. Concerningly, there were relatively few studies, and these were of variable quality, leaving substantial knowledge gaps. Epidemiological epilepsy research i","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 4","pages":"e656-e668"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the clinical trial environment and infrastructure: moving from global resolution to action.","authors":"Vasee Moorthy, Nandi Siegfried, John Amuasi, Jing Li, Michael Makanga, Karla Soares-Weiser, Sheamini Sivasampu, Denis Xavier, Faiez Zannad, Valerie Snewin","doi":"10.1016/S2214-109X(25)00012-9","DOIUrl":"https://doi.org/10.1016/S2214-109X(25)00012-9","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 4","pages":"e608-e610"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indonesia's first nationwide health screening programme.","authors":"Aqsha Nur, Dante Harbuwono","doi":"10.1016/S2214-109X(25)00071-3","DOIUrl":"10.1016/S2214-109X(25)00071-3","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e620"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Democratising clinical trials research to strengthen primary health care.","authors":"Christopher C Butler, Robert Mash, Nina Gobat, Paul Little, Mpundu Makasa, Martha Makwero, Edward J Mills, Regina Wing-Shan Sit, Max O Bachmann","doi":"10.1016/S2214-109X(24)00513-8","DOIUrl":"https://doi.org/10.1016/S2214-109X(24)00513-8","url":null,"abstract":"<p><p>The World Health Assembly has called for clinical trials to be strengthened, with broader demographic and geographical inclusion of populations. The objective of this paper is to highlight the importance of rigorous evidence to maximise the health gains of primary health care, and to identify strategies for strengthening clinical trials in primary care. Clinical trials should evaluate interventions of all kinds, including preventive manoeuvres, diagnostics, health service research questions, behavioural and educational interventions, vaccines, therapeutics, and policies. Single question trials can be inefficient and seldom strengthen health systems. New approaches that develop or strengthen health research infrastructure and embed research in primary care will identify effective interventions faster, how to deliver them better, and more accurately determine to whom they should be applied. When patients and community members, together with researchers, contribute to conception, design, and delivery, research will result in more useful, relevant evidence. Traditional site-based recruitment (where the participant comes to the trial) can be complemented by approaches that give people the opportunity to contribute regardless of where they live and receive their health care (taking the trials to the people). However, this cannot be done until regulation is modernised to make it easier for health-care professionals, researchers, and research participants to co-design, deliver, and implement such trials, and to develop processes to coordinate and monitor progress against goals for budget shifts, delivery, engagement, trials activity, and impact. Strengthening primary care trials is especially important in those regions where primary care is most under-resourced and is key to pandemic preparedness. Not doing so risks widening inequities further.</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 4","pages":"e749-e758"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11950428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}