Lancet Global Health最新文献

{"title":"Personalised risk-prediction tools for cryptococcal meningitis mortality to guide treatment stratification in sub-Saharan Africa: a prognostic modelling study based on pooled analysis of two randomised controlled trials.","authors":"Thomas H A Samuels,Sile F Molloy,David S Lawrence,Angela Loyse,Cecilia Kanyama,Robert S Heyderman,Wai Shing Lai,Sayoki Mfinanga,Sokoine Lesikari,Duncan Chanda,Charles Kouanfack,Elvis Temfack,Olivier Lortholary,Mina C Hosseinipour,Adrienne K Chan,David B Meya,David R Boulware,Henry C Mwandumba,Graeme Meintjes,Conrad Muzoora,Mosepele Mosepele,Chiratidzo E Ndhlovu,Nabila Youssouf,Thomas S Harrison,Joseph N Jarvis,Rishi K Gupta","doi":"10.1016/s2214-109x(25)00010-5","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00010-5","url":null,"abstract":"BACKGROUNDCryptococcal meningitis is a major driver of global HIV-related mortality, and validated approaches to stratify mortality risk could help to target effective treatment strategies. We aimed to develop and validate models to predict risk of all-cause mortality in people with HIV-associated cryptococcal meningitis in sub-Saharan African countries.METHODSFor this prediction modelling study, we pooled individual-level data from the ACTA (ISRCTN45035509) and AMBITION-cm (ISRCTN72509687) randomised controlled trials. Data in ACTA were collected between Feb 12, 2013, and Jan 10, 2017, and data in AMBITION-cm were collected between Jan 31, 2018, and June 11, 2021. Adults aged 18 years or older with a first episode of HIV-associated cryptococcal meningitis were recruited to both trials. Exclusion criteria included pregnancy or lactation; receipt of high-dose anti-fungal treatment doses before screening; and contraindications to trial medication. Participants were recruited from nine hospitals across Cameroon, Malawi, Tanzania, and Zambia in ACTA and eight hospitals across Botswana, Malawi, South Africa, Uganda, and Zimbabwe in AMBITION-cm. We developed two primary multivariable logistic-regression models for the primary outcome of 2-week mortality: a basic model for use in a resource-limited setting that contained only candidate predictors that are routinely, programmatically obtained at hospital admission and a research model for which all predefined candidate predictors were considered for inclusion. We used internal-external cross-validation to evaluate model performance across countries within the development cohort (ie, data from all countries except Malawi participants in AMBITION-cm), before validation of discrimination, calibration, and net benefit in held-out data from Malawi.FINDINGSWe included 674 eligible participants from ACTA and 814 from AMBITION-cm in the pooled analysis (total sample size 1488). 1263 participants were included in model development, with 225 from the Malawi site in AMBITION-cm held out for validation. 222 (17·6%) of 1263 participants in the development set and 21 (9·3%) of 225 participants in the validation set met the primary model outcome of 2-week mortality. We retained five predictors in the basic model and seven in the research model. Predictors in both models were Glasgow Coma Scale score, Eastern Cooperative Oncology Group performance status, haemoglobin, blood neutrophil count, and treatment. Additional predictors in the research model were cerebrospinal fluid opening pressure and log10 cerebrospinal fluid quantitative cryptococcal culture. Discrimination was relatively consistent between study sites for both models (pooled C statistic 0·75 [95% CI 0·68-0·82] for the basic model and 0·78 [0·75-0·82] for the research model), but calibration was more heterogeneous (pooled calibration slope 0·87 [95% CI 0·57 to 1·17] and 0·83 [0·69 to 0·97], pooled calibration in the large 0·00 [-0·54 to 0·55] and -0·02 [-0·4","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"18 1","pages":"e920-e930"},"PeriodicalIF":34.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143885512","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":"No health without aid and development.","authors":"Charlotte Hanlon, Martyn Pickersgill, Seth Amanfo, Harry Campbell, Anna Chiumento, Jeff Collin, Michael Eddleston, Liz Grant, Ewen Harrison, Aisha Holloway, Sumeet Jain, Stephen Lawrie, Angus Macbeth, Chelsea Morroni, Lotte Segal, Nadine Seward, Rosie Stenhouse, Robert C Stewart, Harish Nair","doi":"10.1016/S2214-109X(25)00111-1","DOIUrl":"10.1016/S2214-109X(25)00111-1","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e803"},"PeriodicalIF":19.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694189","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":"Equitable engagement for African researchers globally.","authors":"Elliot Koranteng Tannor,Fatiu Arogundade","doi":"10.1016/s2214-109x(25)00103-2","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00103-2","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"36 1","pages":"e806"},"PeriodicalIF":34.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143885522","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":"Co-occurrence patterns and related risk factors of ischaemic heart disease and ischaemic stroke across 203 countries and territories: a spatial correspondence and systematic analysis.","authors":"Xuanqi An,Zeye Liu,Luwen Zhang,Jing Zhao,Qing Gu,Wei Han,Yaoda Hu,Fang Xue,Fengwen Zhang,Shouzheng Wang,Wenbin Ouyang,Yanmin Yang,Rui Fu,Weixian Yang,Sean X Leng,Jue Liu,Jingmei Jiang,Xiangbin Pan","doi":"10.1016/s2214-109x(25)00013-0","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00013-0","url":null,"abstract":"BACKGROUNDIschaemic heart disease (IHD) and ischaemic stroke are leading causes of death worldwide. Although extensively studied, previous research has predominantly addressed these two diseases in isolation. Comorbidity research faces challenges both at the patient level and in terms of study methods. We aimed to characterise the global co-occurrence pattern of IHD and ischaemic stroke from a spatial perspective and to identify the corresponding risk factors of the comorbidity.METHODSUsing data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 database, we extracted incidence rates of IHD and ischaemic stroke and exposure rates of the 68 most detailed risk factors among individuals aged 25 years or older from 203 countries and territories. Based on the four quartiles of global incidence rates for both diseases, we proposed the comorbidity's co-occurrence patterns and classified the 203 countries or territories into three distinct regions (consistent, IHD-dominant, and ischaemic stroke-dominant areas). We used machine learning and negative binomial regression to screen and quantify the effects of corresponding risk factors and computed the population-attributable fraction and composite risk index to evaluate the global disease burden of IHD and ischaemic stroke.FINDINGS89 countries were classified as consistent, 59 as IHD-dominant, and 55 as ischaemic stroke-dominant. The spatial distribution of the three co-occurrence patterns overlapped with exposure to environmental, dietary, and behavioural risk factors. Nine risk factors were identified and functionally classified into common and specific features. Most countries are simultaneously exposed to the combined effects of multiple risk factors. Overall, 45·43% of IHD incidence and 38·53% of ischaemic stroke incidence is attributable to cumulative exposure to the respective risk factors, with specific combinations and variations of these factors greatly influencing the global disparities and patterns of incidence.INTERPRETATIONThe comorbidity of IHD and ischaemic stroke is a pervasive global health issue. Intervening corresponding modifiable risk factors can fundamentally reduce the global burden of these diseases.FUNDINGNational High Level Hospital Clinical Research Funding.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"95 1","pages":"e808-e819"},"PeriodicalIF":34.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143885537","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":"Mitigating antimicrobial resistance, a critical step towards saving newborns: still miles to go.","authors":"Sulagna Basu, Arun K Singh","doi":"10.1016/S2214-109X(25)00060-9","DOIUrl":"10.1016/S2214-109X(25)00060-9","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e783-e784"},"PeriodicalIF":19.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537929","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":"Getting long-term oxygen therapy right.","authors":"Masooma Aqeel, Karen Czischke, Ayham Daher, Mike Hess, Chidiamara Maria Njoku, Yet Khor, Siân Williams, Neelima Navuluri","doi":"10.1016/S2214-109X(25)00120-2","DOIUrl":"https://doi.org/10.1016/S2214-109X(25)00120-2","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":""},"PeriodicalIF":19.9,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002311","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":"Safety of RTS,S/AS01E malaria vaccine up to 1 year after the third dose in Ghana, Kenya, and Malawi (EPI-MAL-003): a phase 4 cohort event monitoring study.","authors":"Valérie Haine,Martina Oneko,Muriel Debois,Latif Ndeketa,Prince Darko Agyapong,Owusu Boahen,Samuel B E Harrison,Elisha Adeniji,Seyram Kaali,Kingsley Kayan,Seth Owusu-Agyei,Neil French,Simon Kariuki,Raghavendra Devadiga,Bernhards Ogutu,Nana Akosua Ansah,Mattea Orsini,Patrick Odum Ansah,Kenneth Maleta,John Michael Ong'echa,Vincent Katunga Phiri,Phylis Mzanga,Tikhala Makhaza Jere,Daniel K Azongo,Donnie Mategula,John Orimbo,Abraham Rexford Oduro,Walter Otieno,Michael Bandasua Kaburise,Lucy Osei Ababio,Peter M Sifuna,Stellah Kevyne Amoit,Fredrick Olewe,Janet Nyawira Oyieko,Esther Achieng Oguk,Yolanda Guerra Mendoza,Denis Awuni,Valentine Sing'oei,Irene Onyango,Lode Schuerman,Benard Omondi Ochieng,George Odhiambo Okoth,Wongani Nyangulu,Reuben Yego Cherop,Patricia Odera-Ojwang,Cristina Cravcenco,Raphael Chipatala,François Roman,Miloje Savic,Kwaku Poku Asante","doi":"10.1016/s2214-109x(25)00096-8","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00096-8","url":null,"abstract":"BACKGROUNDRTS,S/AS01E has been successfully administered to over two million children since 2019 through the Malaria Vaccine Implementation Programme (MVIP). In this Article, we report the safety results of a study evaluating RTS,S/AS01E safety and effectiveness in real-world settings.METHODSEPI-MAL-003 is an ongoing phase 4 disease surveillance study with prospective cohort event monitoring and hospital-based surveillance, done in the setting of routine health-care practice in Ghana, Kenya, and Malawi and fully embedded in the MVIP. The study design was dependent on the cluster-randomised vaccine implementation. In active surveillance, we enrolled children younger than 18 months from exposed (where RTS,S/AS01E was offered) and unexposed clusters. The coprimary endpoints were the occurrence of predefined adverse events of special interest and aetiology-confirmed meningitis. We report primary and secondary safety results up to 1 year after the primary vaccine schedule (three doses). The study is registered with ClinicalTrials.gov, NCT03855995.FINDINGSThe first participant was enrolled on March 21, 2019. The cutoff date for the current analysis was 1 year after the third RTS,S/AS01E dose for each participant. In total, 44 912 children (19 993 in Ghana, 11 990 in Kenya, and 12 929 in Malawi) were included in the analysis set for the cluster-randomised comparison: 22 508 from exposed clusters and 22 404 from unexposed clusters. Incidence rates (expressed per 100 000 person-years) for generalised convulsive seizures and intussusception were similar between vaccinated and unvaccinated children. Aetiology-confirmed meningitis was reported in two children: one case of bacterial meningitis due to Streptococcus pneumoniae in an RTS,S/AS01E-vaccinated child in the exposed clusters, and one case of viral meningitis due to human herpesvirus 6 in an unvaccinated child in the unexposed clusters. Both cases occurred within 12 months after vaccination in children in the cluster-design analysis set, leading to incidence rates of 4·1 (95% CI 0·1-23·0) per 100 000 person-years in RTS,S/AS01E-vaccinated children and 4·0 (0·1-22·6) per 100 000 person-years in unvaccinated children, and a country-adjusted incidence rate ratio (IRR) of 0·96 (95% CI 0·06-15·34; p=0·98). Cerebral malaria cases were reported for four (<0·1%) of 20 639 RTS,S/AS01E-vaccinated children in the exposed clusters and two (<0·1%) of 22 137 unvaccinated children in the unexposed clusters. These included three and two cases occurring within 12 months after the primary vaccination, in RTS,S/AS01E-vaccinated children and unvaccinated children, respectively (IRR 1·43, 95% CI 0·24-8·58, p=0·70). Incidence rates for all-cause mortality were 659·7 (95% CI 561·5-770·3) in vaccinated children versus 724·5 (622·3-838·8) in unvaccinated children, with similar incidence rates for boys and girls.INTERPRETATIONWe found no evidence of vaccination being associated with an increased risk of meningitis, cerebral mal","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"8 1","pages":""},"PeriodicalIF":34.3,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143885464","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":"Top ten research priorities in global burns care: findings from the James Lind Alliance Global Burns Research Priority Setting Partnership.","authors":"Hollie Sarah Richards,Robert M T Staruch,Suzannah Kinsella,Jelena Savovic,Riaz Qureshi,Daisy Elliott,Leila Rooshenas,Anni King,Amy Acton,Jonathan Bayuo,Simon Booth,Shobha Chamania,Le Quoc Chieu,Charlotte Coates,Declan Collins,Lise Deguire,Baljit Dheansa,Roy Dudley-Southern,Ian Easton,Dale Edgar,Janine Evans,Sian Falder,Emilio Gonzalez,Alex Holley,Catrina Holley,Ivette L Icaza,Claire Jowett,Jane Leaver,Alice Lee,Niall Martin,Jill Meirte,Nguyen Nh Lam,Catrin Pugh,Mamta Shah,Krissie Stiles,Marielle Vehmeijer,Tanveer Ahmed,Nikki Allorto,Murat Ali Cinar,Lewis Allen Dingle,Orlando Flores,Vincent Gabriel,Dhruv Ghosh,Jotham Gondwe,Teruichi Harada,Jagnoor Jagnoor,Vikash Ranjan Keshri,Goaxing Luo,Andrea Mc Kittrick,Natalie Meyers,Pinki Pargal,Carisa Parrish,Marie-Claude Pelchat,Mohsen Rezaeian,Edrisa Sanyang,Atul Suroy,Khaled Taibi,Leila Ait Abderrahim,Luiz Philipe Molina Vana,Katie Wang,Nukhba Zia,Jane M Blazeby,Amber Young","doi":"10.1016/s2214-109x(25)00059-2","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00059-2","url":null,"abstract":"Burns are a global issue that can result in lifelong multimorbidities and disproportionately affect people in low-resource settings. Prioritising research of importance to patients and health-care professionals improves evidence-based care. This prioritisation setting partnership was undertaken in global burn care (focusing on thermal non-electrical burns) by establishing a James Lind Alliance research priority setting partnership. Over 2 years, two online multilingual surveys with patients, carers, and clinicians, 16 interviews, and a virtual priority setting workshop were conducted to identify and prioritise questions for research. Survey responses were received from participants in 88 countries (1617 survey one respondents; 630 survey two respondents). A short-list of 19 research priorities were ranked at an online workshop attended by 28 participants (14 health-care professionals, ten burn survivors, and four carers or advocates) from 15 countries to produce the final top ten research priorities. These priorities provide opportunities for researchers, funders, and clinicians to shape the future of burns research and improve burns care globally.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"47 1","pages":""},"PeriodicalIF":34.3,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143885463","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; published online April 22. https://doi.org/10.1016/S2214-109X(25)00054-3.","authors":"","doi":"10.1016/S2214-109X(25)00177-9","DOIUrl":"https://doi.org/10.1016/S2214-109X(25)00177-9","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":""},"PeriodicalIF":19.9,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052908","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; published online April 22. https://doi.org/10.1016/S2214-109X(25)00055-5.","authors":"","doi":"10.1016/S2214-109X(25)00176-7","DOIUrl":"https://doi.org/10.1016/S2214-109X(25)00176-7","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":""},"PeriodicalIF":19.9,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002340","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}