Lancet Global Health最新文献

{"title":"Cost-effectiveness of the hepatitis B birth-dose vaccine in South Africa: a mathematical modelling analysis.","authors":"Chris Seaman, Christopher Bailie, C Wendy Spearman, Mark Sonderup, Jess Howell, Margaret Hellard, Nick Scott","doi":"10.1016/j.langlo.2026.103975","DOIUrl":"10.1016/j.langlo.2026.103975","url":null,"abstract":"<p><strong>Background: </strong>In 2022, South Africa had an estimated hepatitis B prevalence of 4·7-6·0%. In an effort to eliminate viral hepatitis as a public health threat, a targeted (ie, selective) hepatitis B birth-dose vaccination (HepB-BD) policy was introduced in 2023. Under this policy, only infants born to mothers with confirmed hepatitis B positivity are eligible for HepB-BD, which is given in addition to peripartum antiviral prophylaxis (PAP) for mothers from the second or third trimester of pregnancy. This policy differs from the WHO recommendation that all newborns should receive a HepB-BD vaccine (ie, a universal HepB-BD policy). We aimed to assess comparative costs and benefits of this and alternate policies in South Africa.</p><p><strong>Methods: </strong>A validated model of transmission, disease progression, and mortality was used to simulate the ongoing hepatitis B epidemic in South Africa. We projected outcomes from the current South African policy (ie, selective PAP plus selective HepB-BD), a universal HepB-BD-only policy, and the WHO-endorsed selective PAP plus universal HepB-BD policy. Health and economic impacts were compared with a baseline of no HepB-BD coverage, over a 2025-100 time horizon. Costs were reported in consumer price index-adjusted 2024 ZAR and outcomes discounted at 3% per annum.</p><p><strong>Findings: </strong>The current South African HepB-BD policy required fewer vaccinations per outcome averted, with the number needed to vaccinate per vertically acquired chronic hepatitis B infection averted found to be six (95% uncertainty interval 3-15), compared with 462 (223-1479) under a universal HepB-BD-only policy or 77 (38-240) under a selective PAP plus universal HepB-BD policy. Despite incurring the greatest programmatic costs, a selective PAP plus universal HepB-BD policy averted the greatest disease burden and was modelled to be the most cost-effective option at a willingness-to-pay threshold of 0·5 × per-capita gross domestic product (ZAR 57 281).</p><p><strong>Interpretation: </strong>Our findings support implementation of a universal HepB-BD policy alongside South Africa's current hepatitis B viral transmission elimination efforts.</p><p><strong>Funding: </strong>Vaccine Impact Modelling Consortium.</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"103975"},"PeriodicalIF":22.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882510","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":"Causes of mortality and severe morbidity in young children in Sierra Leone: a prospective cohort study.","authors":"Kwabena Owusu-Kyei, Maria Cussó, Augustin Eric Fombah, Llorenç Quintó, Andreu Bofill, Alba Morató, Victoria Fumadó, Mohamed Samai, Clara Menéndez","doi":"10.1016/j.langlo.2026.104025","DOIUrl":"10.1016/j.langlo.2026.104025","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Accurate data on morbidity and mortality in children younger than 2 years remain scarce in many low-income and middle-income countries. We aimed to examine the causes and risk factors for severe morbidity and mortality in young children in Sierra Leone.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a prospective cohort study nested within a randomised controlled trial (NCT04235816). The study was done in 14 primary health facilities in three districts in Sierra Leone. We enrolled infants aged 6-10 weeks, eligible for pentavalent vaccine dose 1 through the EPI programme, weighing at least 2·5 kg, resident in the study area, without known contraindications to macrolides or sulfadoxine-pyrimethamine, between March 17, 2021, and April 25, 2024. The objective was to assess causes of hospital admission and death through to Dec 31, 2024, when approximately 80% of children had completed 18-month follow-up. Hospital admissions, deaths, and immunisation status were captured through facility surveillance, household visits, telephone follow-ups, and community informants. Causes of death were classified using ICD-10 and the WHO 2016 verbal autopsy tool (InSilicoVA). Incidence rates were expressed per 1000 child-months at risk. Morbidity was analysed using negative binomial regression; in-hospital mortality was analysed using penalised logistic regression, and post-discharge mortality was analysed using Cox proportional hazards regression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Data on severe morbidity and mortality were collected from 20 560 children, of whom 10 644 (52%) were male and 9916 (48%) were female; the most common ethnicity was Temne (14 048 [68%] of 20 551 children with available data). Median follow-up was 16·6 months (IQR 16·0-16·7). There were 2688 hospital admissions (excluding readmissions and in-hospital deaths), yielding an incidence of 8·67 per 1000 child-months at risk (95% CI 8·35-9·00). Malaria (1459 [54·3%] of 2688 admissions), lower respiratory tract infections including pneumonia (449 [16·7%]), diarrhoea (259 [9·6%]), undernutrition (198 [7·4%]), and sepsis (128 [4·8%]) were the leading causes of admission. The leading causes of in-hospital deaths were malaria (122 [50·6%] of 241), lower respiratory tract infections (41 [17·0%]), sepsis (33 [13·7%]), undernutrition (17 [7·1%]), and diarrhoea (nine [3·7%]). The leading causes of community deaths for which a verbal autopsy was performed were malaria (103 [24·2%] of 425), lower respiratory tract infections (76 [17·9%]), other infectious diseases (73 [17·2%]), and diarrhoea (54 [12·7%]). Post-discharge mortality was 33·8 per 1000 child-months at risk (95% CI 27·08-42·20). Being underweight was associated with higher in-hospital mortality compared with not being underweight (adjusted odds ratio [OR] 1·60 [95% CI 1·21-2·12]). Full immunisation was associated with lower overall mortality (adjusted hazard ratio [HR] 0·65 [95% CI 0·55-0·76]), lower in-hospital mortali","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"104025"},"PeriodicalIF":22.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708164","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":"Sustainability and adherence to behaviour change: a cross-sectional 3-year follow-up survey of an innovative Community Mobilisation and Community Incentivisation strategy (CoMIC trial) for child health in rural Pakistan.","authors":"Jai K Das, Rehana A Salam, Zahra Ali Padhani, Arjumand Rizvi, Sana Khatoon, Mushtaq Mirani, Imran Ahmed, Rasool Bux, Fariha Shaheen, Sajid Muhammad, Simon Cousens, Zulfiqar A Bhutta","doi":"10.1016/j.langlo.2026.104019","DOIUrl":"10.1016/j.langlo.2026.104019","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Infectious diseases remain the leading cause of death among children younger than 5 years due to disparities in access and acceptance of essential interventions. The Community Mobilisation and Community Incentivisation (CoMIC) trial was designed to evaluate a customised community mobilisation and incentivisation strategy for improving coverage of evidence-based interventions for child health in Pakistan. This unplanned follow-up study was designed to assess the health effects, adherence to behaviour change, and sustainability of this strategy 3 years after the completion of the trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A cross-sectional follow-up study was conducted 3 years after the completion of the CoMIC trial. CoMIC was a three-group, cluster-randomised, controlled trial in rural areas of the Tando Muhammad Khan district in Pakistan. Clusters were randomly assigned (1:1:1) to either community mobilisation and incentivisation, community mobilisation, or the control group. Community mobilisation included formation of village committees who conducted awareness activities, whereas clusters in the community mobilisation and incentivisation group were provided with a novel conditional, collective, community-based incentive (C3I) in addition to community mobilisation. C3I, chosen by the village committees, were conditioned on serial incremental targets for collective improvement in coverage at cluster level of three primary outcomes: proportion of fully immunised children, use of oral rehydration solution, and sanitation index. For this follow-up study 3 years after the cessation of original trial activities, survey data were collected between Sept 4 and Nov 24, 2023 on all outcomes from the mothers or caregivers of children younger than 5 years in selected households. Analyses followed the intention-to-treat approach (ie, all eligible participants were analysed according to the original cluster randomisation irrespective of intervention uptake or participation status). Additional survey and observational data were collected from the village committees to assess the usage and sustainability of the incentive. The trial is registered at ClinicalTrials.gov, NCT03594279, and is completed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Between Sept 4 and Nov 24, 2023, a total of 5658 children younger than 5 years from 3906 households in 48 clusters (villages) were included in the follow-up survey. 451 (88%) of the 514 water and sanitation facilities constructed as incentives in the trial and 221 (56%) of the 397 village committees remained functional 3 years after they were created as a part of community mobilisation and incentivisation group. Multivariable analysis indicated a higher proportion of fully immmunised children (adjusted risk ratio [RR] 1·20 [95% CI 1·00-1·43]) and a better sanitation index (mean difference 1·12 [95% CI 0·81-1·43]) in the community mobilisation and incentivisation group compared with the control group. There w","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"104019"},"PeriodicalIF":22.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762967","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":"Interpreting the lifetime risk of maternal near miss","authors":"Ursula Gazeley,Antonino Polizzi,Julio Romero Prieto,José Manuel Aburto,Georges Reniers,Veronique Filippi","doi":"10.1016/j.langlo.2026.104103","DOIUrl":"https://doi.org/10.1016/j.langlo.2026.104103","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"30 1","pages":"104103"},"PeriodicalIF":34.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149150264","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":"Prevalence, characteristics, and clinical course of mpox-related ophthalmic disease (MBOTE-EYE): a prospective cohort study in South Kivu, Democratic Republic of the Congo.","authors":"Theophile Kabesha, Christophe Van Dijck, Samuel Mudwanga, Sarah Houben, Yves Mujula, Papy Munganga, Jean-Claude Tshomba, Guy Mukari, Tony Wawina-Bokalanga, Eddy Kinganda-Lusamaki, Bart K Jacobs, Achilleas Tsoumanis, Emmanuel Hasivirwe Vakaniaki, Anne W Rimoin, Isabel Brosius, Elise De Vos, Eugene Bangwen, Stefanie Bracke, Koen Vercauteren, Jean-Claude Mwanza, Deogratias B Ngoma, Patrick Katoto, Steven Yeh, Nelly N Kabedi, Veronique Nussenblatt, Olivier Tshiani-Mbaya, Ian Crozier, Sabin Sabiti Nundu, Jason Kindrachuk, Laurens Liesenborghs, Placide Mbala-Kingebeni","doi":"10.1016/j.langlo.2026.104054","DOIUrl":"10.1016/j.langlo.2026.104054","url":null,"abstract":"<p><strong>Background: </strong>Systematic longitudinal ophthalmologist-led assessment of mpox-related ophthalmic disease (MPOXROD) is rarely reported. We aimed to characterise the prevalence and clinical course of MPOXROD under supportive management during a clade Ib outbreak.</p><p><strong>Methods: </strong>MBOTE-EYE was a substudy nested within a prospective cohort in South Kivu, Democratic Republic of the Congo. All hospitalised patients with PCR-confirmed mpox (within the last 48 h) were eligible. Participants underwent ophthalmological examination at enrolment, discharge, and days 29 and 59. Conjunctival swabs were collected for monkeypox virus PCR. Risk factors for MPOXROD were assessed using mixed-effects Poisson regression.</p><p><strong>Findings: </strong>Between Oct 28, 2024, and June 30, 2025, 310 participants were enrolled (median age 14·0 years [IQR 2·5-25·0]; 166 [54%] female). At enrolment, conjunctival disease was present in 112 (36% [95% CI 31-42]) participants, corneal disease in 24 (8% [5-11]), and anterior uveitis in two (1% [0-2]). Overall, 134 (43% [38-49]) participants developed MPOXROD during follow-up, most often bilaterally. Blindness following ulcerative keratitis occurred in two (1% [0-3]) of 224 participants. Periorbital lesions (adjusted risk ratio [aRR] 3·65 [95% CI 2·42-5·49]) and severe acute malnutrition (aRR 3·16 [1·22-8·22]) were associated with MPOXROD. PCR was done among 89 patients and cycle threshold values below 25 occurred exclusively during active MPOXROD.</p><p><strong>Interpretation: </strong>Ophthalmic involvement in clade Ib mpox is common and frequently bilateral, with a substantial burden of keratitis and risk of vision loss. Systematic eye examinations should be integrated into mpox care, and targeted ophthalmic therapies should be developed.</p><p><strong>Funding: </strong>Canadian Institutes of Health Research and the International Development Research Centre, the European & Developing Countries Clinical Trials Partnership, and the Belgian Directorate-General for Development Cooperation and Humanitarian Aid.</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"104054"},"PeriodicalIF":22.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841762","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":"Beyond diagnostic accuracy: defining the role of tongue swabs in decentralised tuberculosis screening","authors":"Shannon Bosman,Douglas Wilson","doi":"10.1016/j.langlo.2026.104092","DOIUrl":"https://doi.org/10.1016/j.langlo.2026.104092","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 1","pages":"104092"},"PeriodicalIF":34.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088068","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":"How to find panellists for a global health conference.","authors":"Madeleine Ballard, Margaret Odera, Ari Johnson, Daniel Palazuelos, Niloofar Ganjian, James Nardella","doi":"10.1016/j.langlo.2026.104050","DOIUrl":"10.1016/j.langlo.2026.104050","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"104050"},"PeriodicalIF":22.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814588","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":"Optimising pneumonia vaccine programmes: a strategic opportunity for child survival and lifelong lung health.","authors":"Leith Greenslade","doi":"10.1016/j.langlo.2026.104064","DOIUrl":"10.1016/j.langlo.2026.104064","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"104064"},"PeriodicalIF":22.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765409","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":"Children with arthritis: orphans of the NCD agenda?","authors":"The Lancet Glob Health","doi":"10.1016/j.langlo.2026.104106","DOIUrl":"https://doi.org/10.1016/j.langlo.2026.104106","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"14 10","pages":"104106"},"PeriodicalIF":22.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148830","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":"Structural silencing and the elephant in the room in global health.","authors":"Wei-Hsiang Liao","doi":"10.1016/j.langlo.2026.104049","DOIUrl":"10.1016/j.langlo.2026.104049","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"104049"},"PeriodicalIF":22.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814646","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}