Lancet Global Health最新文献

{"title":"Impact of scaling up breastfeeding on reducing the global burden of non-communicable diseases in mothers and children: a population-based modelling analysis for 132 low-income and middle-income countries.","authors":"Divya Bhandari,Wafaie W Fawzi,Mandana Arabi,Goodarz Danaei","doi":"10.1016/s2214-109x(25)00300-6","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00300-6","url":null,"abstract":"BACKGROUNDGrowing evidence suggests breastfeeding offers long-term protective effects against non-communicable diseases (NCDs) later in life in mothers and their offspring. These benefits could be substantial at the population level but have not yet been rigorously quantified. We aimed to estimate the population-level effect of scaling up exclusive breastfeeding on long-term NCD burden in mothers and their offspring in 132 low-income and middle-income countries (LMICs).METHODSIn this population-based modelling analysis, we developed mathematical simulation models based on the population impact fraction estimator and leveraging available effect estimates and global input data. We conducted umbrella reviews to obtain pooled effect estimates from high-quality meta-analyses, with quality assessed using AMSTAR-2. Input data included cause-specific mortality (Global Burden of Diseases, Injuries, and Risk Factors Study), diabetes and hypertension prevalence (NCD Risk Factor Collaboration), baseline exclusive breastfeeding coverage (WHO-UNICEF), and demographics (UN Population Division). We quantified delayed cause-specific NCD deaths, averted diabetes and hypertension cases, and years of life gained (YLG) across four exclusive breastfeeding coverage scenarios. All future benefits were discounted (3% rate).FINDINGSScaling up exclusive breastfeeding coverage to 90% in 132 LMICs could delay 0·17% of NCD deaths across the two generations, equivalent to 72 300 delayed NCD deaths annually, yielding 1·04 million YLG. It substantially reduced type 2 diabetes prevalence by 1·29% (10 million cases averted across the lifespan of the cohort) and moderately reduced hypertension prevalence by 0·17% (3·8 million averted cases). The maternal generation constituted 42% of delayed deaths, 23% of averted diabetes cases, and approximately half of the total YLG. Regionally, southeast Asia, east Asia, and Oceania followed by south Asia had the largest absolute benefits due to population size; however, after adjusting for cohort and population size, sub-Saharan Africa and north Africa and the Middle East showed the largest benefits per million intervened mothers. Most delayed deaths were from ischaemic heart disease (43%) and stroke (33%), with cancer accounting for 18%.INTERPRETATIONScaling up exclusive breastfeeding coverage could lead to benefits in reducing NCDs, complementing its established benefits for child mortality and early childhood development.FUNDINGNutrition International.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"65 1","pages":"e1817-e1827"},"PeriodicalIF":34.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314616","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":"A landscape analysis of the vaccine ecosystem in Africa: research and development funding, clinical trials, regulation, and manufacturing readiness.","authors":"Catherine Fleck-Vidal,Amelie Le Moal,Ondari D Mogeni,Douglas Shaffer,Vincent Canouet,Nicaise Ndembi,T Anh Wartel,Laura Plant,Jerome H Kim","doi":"10.1016/s2214-109x(25)00314-6","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00314-6","url":null,"abstract":"Vaccines are vital for global health, and despite bearing the highest burden of infectious diseases, Africa manufactures less than 1% of its vaccine needs. This Health Policy paper offers an overview of Africa's vaccine ecosystem, examining research and development funding, clinical trials, regulatory maturity, and manufacturing readiness with publicly available data. Funding for research and development (2007-23) was analysed with data from the G-FINDER database, which focuses on diseases disproportionately affecting low-income and middle-income countries. Clinical trial activity (2007-24) was assessed with data from multiple sources. Disease burden context was provided by the Global Burden of Disease Study 2021, and regulatory maturity levels were obtained from WHO's list of National Regulatory Authorities. Findings show that Africa received less than 2% of global vaccine research and development funding, with 95% of that funding channelled through high-income countries. Only 8% of global vaccine clinical trials included sites in Africa. Progress in regulatory and manufacturing capacity is emerging, with eight countries reaching WHO maturity level 3 and several countries planning vaccine production facilities. Our findings highlight the need for better vaccine data in Africa and the opportunity to build on existing strengths to reach enhanced sovereignty and resilient health systems.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"43 1","pages":"e1983-e1990"},"PeriodicalIF":34.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314621","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: e1349-57.","authors":"","doi":"10.1016/S2214-109X(25)00398-5","DOIUrl":"10.1016/S2214-109X(25)00398-5","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e1816"},"PeriodicalIF":19.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103127","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 of non-communicable disease risk factors and chronic conditions among middle-aged and older adults in extreme poverty: a nationally representative cross-sectional study in India.","authors":"Nandita Krishnan,Hunter Green,Jinkook Lee,David Flood,Kavita Singh,T V Sekher,David E Bloom,Pascal Geldsetzer","doi":"10.1016/s2214-109x(25)00351-1","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00351-1","url":null,"abstract":"BACKGROUNDEvidence on non-communicable disease (NCD) prevalence among adults in extreme poverty is sparse. We aimed to determine the national and subnational prevalence of NCD risk factors and chronic conditions among middle-aged and older adults in extreme poverty in India, where a large share of the global population in extreme poverty in this age group lives.METHODSIn this cross-sectional study, we analysed baseline data (2017-19) from the Longitudinal Ageing Study in India using the World Bank's international poverty line set at $1·90 in 2011 purchasing power parity dollars to define extreme poverty. Outcomes included metabolic (eg, hypertension) and behavioural (eg, tobacco use) risk factors, and chronic conditions (eg, depression). We conducted weighted descriptive analyses to obtain prevalence estimates and multivariable Poisson regression to estimate differences in the relative risk of all outcomes by sex and residence among participants in extreme poverty (n=11 243). We also estimated the relative risk of all outcomes by poverty levels by categorising all participants (n=66 617) into mutually exclusive groups based on the three World Bank poverty line cutoffs (≤$1·90, $1·91-3·20, and $3·21-5·50 versus >$5·50).FINDINGSIn this nationally representative sample of 66 617 adults aged 45 years and older, 53·4% were male, 46·6% were female, and 39·2% were aged 45-54 years. Among participants in extreme poverty (11 243 [18·1%]), the most prevalent risk factors and chronic conditions were tobacco use (40·3% [95% CI 39·2-41·5]), frailty (39·0% [37·9-40·2]), and hypertension (28·7% [27·7-29·8]). The prevalence of specific outcomes varied across states and territories, and the relative risk differed by residence, sex, and poverty levels.INTERPRETATIONMiddle-aged and older adults in extreme poverty in India have a high prevalence of some NCD risk factors and chronic conditions than those not in extreme poverty, but prevalence varies substantially across states and territories and subgroups, calling for more targeted public health policies for specific geographical areas and subgroups.FUNDINGUS National Institute on Aging, National Institutes of Health.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"19 1","pages":"e1955-e1963"},"PeriodicalIF":34.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314608","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 burden of chronic liver disease in Malawi.","authors":"Catherine Wendy Spearman","doi":"10.1016/s2214-109x(25)00354-7","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00354-7","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"39 1","pages":"e1788-e1789"},"PeriodicalIF":34.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314618","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":"Malaria burden in a region under long-term chemoprevention.","authors":"Doudou Sow,Amélé Nyedzie Wotodjo","doi":"10.1016/s2214-109x(25)00375-4","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00375-4","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"2 1","pages":"e1790-e1791"},"PeriodicalIF":34.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314635","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":"When are postpartum haemorrhages diagnosed? A nested observational study within the E-MOTIVE cluster-randomised trial.","authors":"Kristie-Marie Mammoliti,James Martin,Adam Devall,Christina Easter,Fernando Althabe,Adeosun Love Funmi,Rahmatu Yusuf,Fatima Abubakar,Lolade Christiana Arigbede,Jim Kelly Mugambi,Polycarp Oyoo,Masumbuko Sambusa,Akwinata Banda,Fawzia Samuels,Sara Willemse,Sibongile Doris Khambule,Hilal Mukhtar Shu'aib,Aminu Ado Wakili,Jenipher Okore,Ard Mwampashi,Mandisa Singata-Madliki,Edna Arends,Elani Muller,Hadiza Galadanci,Zahida Qureshi,Fadhlun Alwy Al-Beity,G Justus Hofmeyr,Sue Fawcus,Neil Moran,Alfred Osoti,George Gwako,Ioannis Gallos,Arri Coomarasamy","doi":"10.1016/s2214-109x(25)00302-x","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00302-x","url":null,"abstract":"BACKGROUNDThe definition of primary postpartum haemorrhage as blood loss of 500 mL or more within 24 h after vaginal birth underemphasises the early postpartum hours due to limited data on the timing of postpartum haemorrhage diagnosis. Understanding postpartum haemorrhage diagnosis timing and diagnostic methods is important for guiding diagnostic and therapeutic strategies. The E-MOTIVE trial evaluated early postpartum haemorrhage diagnosis and a bundled treatment approach, which resulted in a 60% relative reduction in adverse outcomes from bleeding compared with usual care. We aimed to compare timing from vaginal birth to postpartum haemorrhage diagnosis and the diagnostic methods used among four African countries implementing the intervention from the E-MOTIVE trial.METHODSNested within the E-MOTIVE trial (NCT04341662), we conducted direct observations of health-care workers providing clinical care to postpartum women at 39 hospitals implementing the E-MOTIVE intervention across Nigeria, Kenya, Tanzania, and South Africa. One to two weeks of continuous observations were conducted from vaginal birth up to 2 h, between June 27, and Dec 18, 2022. Health-care workers were trained to use clinical judgement (ie, heavy vaginal blood loss, large blood clots expelled, or constant trickle) and various objective blood loss thresholds to diagnose postpartum haemorrhage. The objective blood loss thresholds used in Nigeria, Kenya, and Tanzania were 300 mL or more with at least one abnormal clinical sign (ie, pulse, blood pressure, uterine tone, and vaginal blood flow) or 500 mL or more. The objective blood loss threshold in South Africa was 500 mL or more. We descriptively analysed and compared timing from vaginal birth to postpartum haemorrhage diagnosis and diagnostic methods used between countries.FINDINGSOf 2578 women, 295 postpartum haemorrhages were diagnosed. The median time from vaginal birth to postpartum haemorrhage diagnosis was 15 min in Nigeria and Tanzania, 17 min in Kenya, and 30 min in South Africa. Diagnosis within 30 min ranged from 58% in South Africa to 86% in Tanzania. By 60 min, 96% to 100% of postpartum haemorrhages were diagnosed across all countries. All postpartum haemorrhages that required an intervention were diagnosed within 90 min. Nigeria, Kenya, and Tanzania commonly used blood loss of 300 mL or more combined with at least one abnormal clinical sign (47%, 65%, and 68%, respectively) while South Africa relied on a definition of 500 mL or more (81%) as the dominant diagnostic strategy.INTERPRETATIONIn countries where an objective blood loss threshold of 300 mL or more with at least one abnormal clinical sign was used, women received earlier interventions for postpartum bleeding, with a median time to diagnosis of 15-17 min. This was notably faster than in the country that predominantly used a 500 mL or more threshold, where the median time to diagnosis was 30 min. Regardless of whether the threshold was 300 mL or more with abno","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"12 1","pages":"e1946-e1954"},"PeriodicalIF":34.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314606","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":"Inpatient versus outpatient management of young infants with a single low-mortality-risk sign of possible serious bacterial infection in sub-Saharan Africa and south Asia: an open-label, multicentre, two-arm, randomised controlled trial.","authors":" ","doi":"10.1016/s2214-109x(25)00243-8","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00243-8","url":null,"abstract":"BACKGROUNDResearch has shown low mortality in young infants with a single low-mortality-risk possible serious bacterial infection (PSBI) sign. Outpatient treatment of young infants (age <2 months) with a single low-mortality-risk PSBI sign might be as effective and safe as hospitalisation. Outpatient treatment overcomes the challenges of hospitalisation and improves access in low-resource settings. Our aim was to assess clinical outcomes in patients with one low-mortality-risk PSBI sign treated as outpatients compared with inpatient treatment.METHODSWe did an open-label, multicentre, two-arm, randomised controlled trial at seven sites across Bangladesh, Ethiopia, India, Nigeria, Pakistan, and Tanzania. Young infants presenting to study hospitals with one of three low-mortality-risk PSBI signs (ie, fast breathing if age <7 days, body temperature ≥38°C, or severe chest indrawing) were randomly assigned (1:1) to the outpatient treatment group (2-day injectable gentamicin plus 7-day oral amoxicillin) or the inpatient treatment group (7-day injectable ampicillin plus gentamicin, with supportive care). The primary outcome was poor clinical outcome, which was a composite of any one of the following: death, critical illness, signs of other serious infections, new PSBI signs on days 2, 4, 8, and 15 or persistence of the presenting sign on day 8 after randomisation. We evaluated superiority and non-inferiority using the Farrington-Manning score test. The trial is registered with the ISRCTN Registry (ISRCTN44033252).FINDINGSBetween June 24, 2021, and April 26, 2024, 7001 young infants were enrolled and randomly assigned to the outpatient treatment group (n=3501) or the inpatient treatment group (n=3500), and were part of the intention-to-treat (ITT) population. Poor clinical outcomes occurred in 269 (7·7%) of 3501 outpatients and 272 (7·8%) of 3500 inpatients in the ITT analysis (risk difference -0·0009 [95% CI -0·0134 to 0·0116]; p=1·0000 for superiority analysis). Deaths were significantly lower in the outpatient group (nine [0·3%] of 3501) than in the inpatient group (23 [0·7%] of 3500; risk difference -0·0040 [-0·0072 to -0·0008]). In the per-protocol analysis, outpatient treatment (266 [7·7%] of 3455) was non-inferior to inpatient treatment (269 [7·9%] of 3416) for poor clinical outcomes (risk difference -0·0018 [-0·0144 to 0·0109]; p=0·0012 for non-inferiority). Apart from deaths, there were no treatment-related serious adverse events.INTERPRETATIONOutpatient treatment (gentamicin injection and oral amoxicillin) for infants with a single low-mortality-risk PSBI sign was non-inferior to standard inpatient treatment, with significantly lower mortality in the outpatient treatment group.FUNDINGBill and Melinda Gates Foundation.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"126 1","pages":"e1892-e1902"},"PeriodicalIF":34.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314607","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":"Quartile-based risk exposure in global IHD and ischaemic stroke - Authors' reply.","authors":"Xuanqi An,Jingmei Jiang,Xiangbin Pan","doi":"10.1016/s2214-109x(25)00359-6","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00359-6","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"126 1","pages":"e1810"},"PeriodicalIF":34.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314625","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":"Strategic autonomy in global women's health research: necessity not luxury.","authors":"Gayathri Delanerolle,Peter Phiri,Sohier Elneil, ","doi":"10.1016/s2214-109x(25)00360-2","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00360-2","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"11 1","pages":"e1805-e1806"},"PeriodicalIF":34.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314627","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}