Lancet Global Health最新文献

{"title":"Multidrug-resistant sepsis in special newborn care units in five district hospitals in India: a prospective cohort study.","authors":"Kajal Jain, Vivek Kumar, Nishad Plakkal, Deepak Chawla, Atul Jindal, Reeta Bora, Neeraj Gupta, Apurba Sastry, Nidhi Singla, Anudita Bhargava, Reema Nath, Vijayalakshmi Nag, Sarita Mohapatra, Nitya Wadhwa, Ramesh Agarwal, M Jeeva Sankar","doi":"10.1016/S2214-109X(24)00564-3","DOIUrl":"10.1016/S2214-109X(24)00564-3","url":null,"abstract":"<p><strong>Background: </strong>Neonatal sepsis epidemiology has been adequately reported in tertiary-care hospitals. However, such data are scarce from district hospitals in low-income and middle-income countries. This study aimed to evaluate the incidence of sepsis, pathogen profile, and antimicrobial resistance among neonates admitted to the special newborn care units in district hospitals in India.</p><p><strong>Methods: </strong>We prospectively enrolled neonates admitted to newborn units in five district hospitals in India between October, 2019, and December, 2021. Blood cultures were obtained from neonates who met prespecified criteria and were processed at the laboratories of the tertiary-care hospitals linked to each district hospital. Identification of pathogens and antimicrobial susceptibility testing was performed using the automated system; all isolates were confirmed using matrix-assisted laser desorption-ionisation-time of flight. The primary outcome was the incidence of culture-positive sepsis. The final label of culture-positive sepsis was assigned based on culture reports and clinical course. Multidrug resistance was defined as resistance to antibiotics in at least three of the six antibiotic classes, including third generation cephalosporins, carbapenems, and aminoglycosides.</p><p><strong>Findings: </strong>The study enrolled 6612 neonates (3972 inborn [born at the same hospital] and 2640 outborn [referred from other hospitals or homes]). Mean gestation was 37·1 weeks and mean birthweight was 2540 g. 3357 (50·8%) neonates met clinical sepsis criteria. The overall incidence of culture-positive sepsis was 213 (3·2%; 95% CI 0·6-14·4); ranging from 0·6% to 10·0% across the five sites. The incidence was higher in outborn neonates than inborn neonates: 132 [5·0%] versus 81 [2·0%]. The case-fatality rate of culture-positive sepsis was 36·6% (95% CI 12·1-71·0). Gram-negative bacilli accounted for 156 (70·0%) of 223 organisms isolated: Klebsiella pneumoniae (51 [22·9%]), Escherichia coli (33 [14·8%]), and Enterobacter spp (26 [11·7%]) were the most common Gram-negative organisms. 75%-88% of isolates of K pneumoniae, E coli, Enterobacter spp, and Acinetobacter baumannii were multidrug resistant.</p><p><strong>Interpretation: </strong>The high incidence of culture-positive sepsis, case-fatality rates, and multidrug resistance among common pathogens underscores an urgent need to strengthen infection prevention and control practices, establish blood culture facilities, and implement antimicrobial stewardship programmes in district-level hospitals in India.</p><p><strong>Funding: </strong>Bill & Melinda Gates Foundation.</p><p><strong>Translation: </strong>For the Hindi translation of the abstract see Supplementary Materials section.</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e870-e878"},"PeriodicalIF":19.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12021664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537931","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":"Improving primary health-care services in LMIC cities.","authors":"Richard J Lilford,Benjamin Daniels,Barbara McPake,Zulfiqar A Bhutta,Robert Mash,Frances Griffiths,Akinyinka Omigbodun,Elzo Pereira Pinto,Radhika Jain,Gershim Asiki,Eika Webb,Katie Scandrett,Peter J Chilton,Jo Sartori,Yen-Fu Chen,Peter Waiswa,Alex Ezeh,Catherine Kyobutungi,Gabriel M Leung,Cristiani Machado,Kabir Sheikh,Sam I Watson,Jishnu Das","doi":"10.1016/s2214-109x(24)00537-0","DOIUrl":"https://doi.org/10.1016/s2214-109x(24)00537-0","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"7 1","pages":"e795-e796"},"PeriodicalIF":34.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143885524","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":"Fexinidazole for human African trypanosomiasis: the challenge of accessibility.","authors":"Erick Mwamba Miaka,Christopher P Pasi,Epco Hasker","doi":"10.1016/s2214-109x(25)00068-3","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00068-3","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"19 1","pages":"e789-e790"},"PeriodicalIF":34.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143885504","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":"Policy and service delivery proposals to improve primary care services in low-income and middle-income country cities.","authors":"Richard J Lilford,Benjamin Daniels,Barbara McPake,Zulfiqar A Bhutta,Robert Mash,Frances Griffiths,Akinyinka Omigbodun,Elzo Pereira Pinto,Radhika Jain,Gershim Asiki,Eika Webb,Katie Scandrett,Peter J Chilton,Jo Sartori,Yen-Fu Chen,Peter Waiswa,Alex Ezeh,Catherine Kyobutungi,Gabriel M Leung,Cristiani Machado,Kabir Sheikh,Sam I Watson,Jishnu Das","doi":"10.1016/s2214-109x(24)00536-9","DOIUrl":"https://doi.org/10.1016/s2214-109x(24)00536-9","url":null,"abstract":"The landscape of primary care services in low-income and middle-income country cities is diverse and dynamic, yet the quality of care received is too often low and the financial cost to the patient high. In the second Paper in this Series, we argue that shaping the primary care market is likely to provide larger returns to scale than individual quality improvement initiatives. Among other things, the market can be shaped by regulation and targeted public investment to crowd out poor providers and motivate those that remain to improve. Additional supply-side initiatives for which there is evidence include measures to educate and motivate the workforce, skill substitution and formation of clinical primary care teams, information technology, and improving the supply of medicines and diagnostics. Demand-side measures include reducing out-of-pocket expenses and promoting health literacy and user advocacy. Research is urgently needed into access for people who are unregistered (eg, those who sleep on the streets), those in peri-urban areas and towns, and on cost-effectiveness, and sustainability of beneficial interventions.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"9 1","pages":"e954-e966"},"PeriodicalIF":34.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143885511","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":"Fexinidazole as a new oral treatment for human African trypanosomiasis due to Trypanosoma brucei rhodesiense: a prospective, open-label, single-arm, phase 2-3, non-randomised study.","authors":"Enock Matovu,Westain Nyirenda,Anthony Eriatu,Deolinda Alves,Christelle Perdrieu,Marshal Lemerani,Charles Wamboga,Veerle Lejon,Jorge Seixas,Aita Signorell,Anne Reymondier,Elisabeth Baudin,Bruno Scherrer,Olaf Valverde Mordt","doi":"10.1016/s2214-109x(25)00016-6","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00016-6","url":null,"abstract":"BACKGROUNDRhodesiense human African trypanosomiasis is a neglected disease with epidemic potential that can rapidly become lethal if left untreated. The aim of this study was to show that fexinidazole could offer an alternative to existing treatments (melarsoprol for stage 2 and suramin for stage 1 rhodesiense human African trypanosomiasis), using a benchmark study design.METHODSThis was a prospective, open-label, single-arm, phase 2-3, non-randomised study done in two centres (Lwala, Uganda and Rumphi, Malawi). Participants were enrolled if they were aged 6 years or older, weighed 20 kg or more, had parasitologically confirmed rhodesiense human African trypanosomiasis, were able to swallow fexinidazole tablets with a meal, and had a Karnofsky score of 40 or more. Pregnant or breastfeeding women were eligible after the first trimester of pregnancy. While admitted to hospital, participants received oral fexinidazole for 10 days at the recommended dosage according to bodyweight and were followed up for 12 months. The fatality and non-response to treatment rates observed with fexinidazole were compared with predefined rates based on literature. The primary endpoint was the fatality rate at end of hospital admission (EoH) in participants with stage 2 rhodesiense human African trypanosomiasis (considering only deaths possibly related to the disease or fexinidazole), to be compared with 8·5%, an approximation of the fatality rate obtained with melarsoprol. This study is registered with ClinicalTrials.gov, NCT03974178.FINDINGSBetween Sept 29, 2019, and Oct 12, 2022, 46 participants with rhodesiense human African trypanosomiasis were screened, of whom 45 were included and treated (35 with stage 2 and ten with stage 1 disease). One death occurred during treatment but was considered unrelated to rhodesiense human African trypanosomiasis or fexinidazole and excluded from the efficacy analysis. No other deaths had occurred by EoH in participants with stage 2 rhodesiense human African trypanosomiasis, giving a fatality rate of 0 (0%) of 34 (90% CI 0-8·43), which was lower than the predefined 8·5% rate (p=0·0488). One participant with stage 2 rhodesiense human African trypanosomiasis had a relapse at week 9. No failures were reported in participants with stage 1 rhodesiense human African trypanosomiasis. No unexpected safety signals were identified on the basis of standard assessments and electrocardiograms.INTERPRETATIONFexinidazole is a safe and easy-to-use treatment, and is a better-accepted alternative to existing treatments for rhodesiense human African trypanosomiasis, such as melarsoprol or suramin.FUNDINGEDCTP and various donors through the Drugs for Neglected Diseases initiative.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"95 1","pages":"e910-e919"},"PeriodicalIF":34.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143885519","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":"Patient outcomes after surgery in 17 Latin American countries.","authors":"Nicolas Avellaneda,Antonio Caycedo Marulanda","doi":"10.1016/s2214-109x(25)00123-8","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00123-8","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"42 1","pages":"e793-e794"},"PeriodicalIF":34.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143885523","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":"Africa's defining moment: the time to lead the HIV response is now.","authors":"Mumbi Chola, Izukanji Sikazwe, Magda Robalo, Pokuaa Oduro-Bonsrah, Alex Coutinho, Robb Sheneberger, Jekwu Ozoemene, Pierre M'pele, Damaris Nyamweya, Sasha Stevenson, Yvette Raphael, Sesupo Makakole Nene, John Ataguba, Mohamed Chakroun, Michel Sidibe","doi":"10.1016/S2214-109X(25)00102-0","DOIUrl":"10.1016/S2214-109X(25)00102-0","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e801-e802"},"PeriodicalIF":19.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630963","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":"Correction to Lancet Glob Health 2025; 13: e392-93.","authors":"","doi":"10.1016/S2214-109X(25)00142-1","DOIUrl":"https://doi.org/10.1016/S2214-109X(25)00142-1","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 5","pages":"e807"},"PeriodicalIF":19.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055071","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":"Addressing the menstrual health of secondary school girls in Uganda.","authors":"Adesola Olumide,Olutosin Sanyaolu","doi":"10.1016/s2214-109x(25)00067-1","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00067-1","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"42 1","pages":"e787-e788"},"PeriodicalIF":34.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143885466","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":"Supply-side and demand-side factors affecting allopathic primary care service delivery in low-income and middle-income country cities.","authors":"Richard J Lilford,Benjamin Daniels,Barbara McPake,Zulfiqar A Bhutta,Robert Mash,Frances Griffiths,Akinyinka Omigbodun,Elzo Pereira Pinto,Radhika Jain,Gershim Asiki,Eika Webb,Katie Scandrett,Peter J Chilton,Jo Sartori,Yen-Fu Chen,Peter Waiswa,Alex Ezeh,Catherine Kyobutungi,Gabriel M Leung,Cristani Machado,Kabir Sheikh,Sam I Watson,Jishnu Das","doi":"10.1016/s2214-109x(24)00535-7","DOIUrl":"https://doi.org/10.1016/s2214-109x(24)00535-7","url":null,"abstract":"Most people in low-income and middle-income countries (LMICs) now live in cities, as opposed to rural areas where access to care and provider choice is limited. Urban health-care provision is organised on very different patterns to those of rural care. We synthesise global evidence to show that health-care clinics are plentiful and easily accessible in LMIC cities and that they are seldom overcrowded. The costs that patients incur when they seek care are highly variable and driven mostly by drugs and diagnostics. We show that citizens have agency, often bypassing cheaper facilities to access preferred providers. Primary care service delivery in cities is thus best characterised as a market with a diverse range of private and public providers, where patients make active choices based on price, quality, and access. However, this market does not deliver high-quality consultations on average and does not provide continuity or integration of services for preventive care or long-term conditions. Since prices play a key role in accessing care, the most vulnerable groups of the urban population often remain unprotected.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"42 1","pages":"e942-e953"},"PeriodicalIF":34.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143885510","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}