Lancet Global Health最新文献

{"title":"Burden of non-communicable diseases and their attributable risk factors in Africa from 1990 to 2023: a systematic analysis for the Global Burden of Disease Study 2023.","authors":"","doi":"10.1016/j.langlo.2026.103964","DOIUrl":"https://doi.org/10.1016/j.langlo.2026.103964","url":null,"abstract":"<p><strong>Background: </strong>The rapid rise in the burden of non-communicable disease (NCDs) in African communities has resulted in a considerable mortality, disability, and economic burden. A comprehensive evaluation of incidence, deaths, disability-adjusted life-years (DALYs), and attributable risk factors related to NCDs by sex, and geographical location is essential for informing policy decisions aimed at controlling these diseases.</p><p><strong>Methods: </strong>This study used a comprehensive analysis based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 methodology to estimate the incidence, mortality, DALYs (estimated as the sum of years of life lost and years lived with disability [YLDs]), and attributable risk factors of NCDs in Africa. Data were systematically searched for and extracted from various sources, including vital registration, verbal autopsy, surveillance systems, police reports, censuses, surveys, minimally invasive tissue sampling, and sibling history. The analysis employed the Cause of Death Ensemble model, DisMod-MR 2.1, and spatiotemporal Gaussian process regression to estimate both fatal and non-fatal health metrics associated with NCDs in Africa overall, and by region and country.</p><p><strong>Findings: </strong>In 2023, NCDs in Africa accounted for an estimated 2·33 billion (95% uncertainty interval 2·22-2·50) incident cases, 4·70 million (4·47-4·93) deaths, and 263 million (234-293) DALYs. Although absolute numbers increased between 1990 and 2023, age-standardised rates (per 100 000 population) decreased modestly: incidence rate by 2·7% (0·2-5·0), mortality rate by 9·0% (2·5-15·5), and DALY rate by 6·4% (1·2-12·0). The five leading Level 3 causes of death in Africa in 2023 were ischaemic heart disease (801 000 [653 000-965 000]), stroke (700 000 [544 000-863 000]), chronic kidney disease (293 000 [224 000-359 000], hypertensive heart disease (246 000 [170 000-337 000]), and diabetes (245 000 [190 000-314 000]) for all sexes and ages. Leading Level 2 causes of YLDs were mental disorders (30·9 million [22·0-42·2]) and musculoskeletal disorders (17·1 million [12·5-22·7]). Overall, 35·1% (32·4-38·2) of DALYs and 57·4% (54·2-60·4) of deaths due to NCDs were attributable to the 88 GBD 2023 risk factors. High systolic blood pressure contributed the largest proportion at 26·2% (21·6-30·9) of all NCD deaths in Africa, followed by dietary risks (14·7% [5·1-21·6]) and air pollution (14·2% [11·6-16·9]).</p><p><strong>Interpretation: </strong>Our findings underscore the complex and evolving nature of the NCD burden in Africa, where modest declines in age-standardised mortality and DALY rates since 1990 have been substantially offset by rising absolute counts of deaths and DALYs-a paradox driven predominantly by rapid population growth and demographic changes. That more than half of all NCD deaths and over a third of DALYs remain attributable to modifiable risk factors-principally high systolic ","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"103964"},"PeriodicalIF":22.5,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018446","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":"Global inequalities in cardiometabolic care and achievable cardiovascular risk reduction by wealth, region, and sex: a pooled analysis of individual participant data from 76 countries.","authors":"Bamba Gaye, Gurbinder Singh, Elisabeth L P Sattler, Moustafa I Morsy, Ahmed Abdelnoor, Liliana Aguayo, Jennifer Carter, Robert J Clarke, Sokhna Dieng, Hassim Bachir Diop, Anastase Dzudie, Johann Edjimbi, Tiffany L Gary-Webb, Ngone Diaba Gaye, Bartlomiej Guzik, Tomasz J Guzik, Mohamed B Jalloh, Mame Madjiguene Ka, Hubert Lam, Camille Lassale, Sarah Lewington, Eloi Marijon, Kevin Marsh, Ntobeko A B Ntusi, Christian Diomu Okitondo, Isaac Sekitoleko, Papa Salif Sow, Gabriel S Tajeu, Modou Jobe, Thiess Lorenz, Pasquale Maffia, Ibrahima Socé Fall","doi":"10.1016/j.langlo.2026.104082","DOIUrl":"https://doi.org/10.1016/j.langlo.2026.104082","url":null,"abstract":"<p><strong>Background: </strong>Wealth-related inequalities affect cardiometabolic health worldwide, but their implications for cardiometabolic care and potentially preventable cardiovascular disease remain poorly understood. We aimed to quantify wealth-related inequalities in the care cascade for hypertension, diabetes, and hypercholesterolaemia by wealth quintile, region, and sex.</p><p><strong>Methods: </strong>In this cross-sectional, individual-level analysis, we analysed harmonised, nationally representative health examination surveys conducted in five WHO regions. Adults aged 18 years or older with data on age, sex, wealth, and at least one cardiometabolic outcome were eligible. All variables in the surveys were obtained from standardised in-person examinations. We evaluated hypertension, diabetes, and hypercholesterolaemia and applied a care cascade of disease awareness, treatment, and control for each condition uniformly across all surveys. Disease status was defined from measured biomarkers, self-reported diagnosis, or current medication; awareness and treatment were based on self-reported information, and control on measured biomarkers. Each indicator was expressed as the proportion of all individuals with the corresponding condition. Socioeconomic position was assessed using household wealth indices derived within each survey, and participants were ranked within each country and categorised into country-specific quintiles (quintile 1 to quintile 5), with quintile 1 including those with the least household wealth. Inequality was quantified by the quintile 5 minus quintile 1 difference, the slope index of inequality (SII), and relative index of inequality (RII). Predicted 10-year cardiovascular risk was estimated with the Globorisk equations, and trial-derived relative risk reductions were applied to estimate achievable absolute risk reduction. The ASANDE consortium is registered with ClinicalTrials.gov (NCT07427355).</p><p><strong>Findings: </strong>We analysed data from 109 surveys conducted in 76 countries between 2002 and 2024. 315 403 (65·9%) of 478 947 survey participants with available data were included in this analysis (median age 40 years [IQR 30-52], 185 209 [58·7%] women, and 130 194 [41·3%] men). Inequalities widened progressively across the care cascade in all regions and were most pronounced for disease control. Pooled across regions, the SII for control was 4·4% (95% CI 2·4-6·4) for hypertension (RII 1·1, 1·1-1·2), 4·8% (0·6-9·0) for diabetes (RII 1·1, 1·0-1·2), and 6·5% (3·8-9·2) for hypercholesterolaemia (RII 1·1, 1·0-1·1). However, regional patterns varied substantially. In the region of the Americas, disease control consistently favoured wealthier individuals (SII 9·2% for hypertension, 4·8-13·5; RII 1·2, 1·1-1·3). In the African region, coverage was uniformly low, and the largest absolute inequality favoured individuals with the least wealth, particularly for hypercholesterolaemia treatment (SII -37·6%, -49·7 to -25","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"104082"},"PeriodicalIF":22.5,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991912","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":"External validation of a treatment decision algorithm for tuberculosis in children living with HIV: a diagnostic cohort study.","authors":"Celso Khosa, Minh Huyen Ton Nu Nguyet, Juliet Mwanga-Amumpaire, Chishala Chabala, Raoul Moh, Clementine Roucher, Denis Nansera, Bwendo Nduna, Eugenia Macassa, Madeleine Amorissani Folquet, Dalila Rego, Gae Mundundu, Naome Natukunda, Perfect Shankalala, Saniata Cumbe, Eric Komena, Andrew P Steenhoff, Anneke C Hesseling, James A Seddon, Eric Wobudeya, Maryline Bonnet, Olivier Marcy","doi":"10.1016/j.langlo.2026.104012","DOIUrl":"https://doi.org/10.1016/j.langlo.2026.104012","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis is the leading cause of death in children living with HIV, and is challenging to diagnose owing to the limitations of microbiological approaches. The Pediatric Asian African Network for Tuberculosis and HIV Research (PAANTHER) treatment decision algorithm (TDA) was previously developed to improve the diagnosis of tuberculosis in children living with HIV, but has not yet been validated. We aimed to externally validate this TDA in a prospective cohort of children from four countries in Africa.</p><p><strong>Methods: </strong>The TB-Speed HIV study was a prospective diagnostic cohort study conducted in seven tertiary hospitals: two in Côte d'Ivoire, two in Mozambique, one in Uganda, and two in Zambia. Eligible participants were children living with HIV, aged 1 month to 14 years, with presumptive tuberculosis. Children who were currently receiving tuberculosis treatment, or who had received treatment within the past 3 months, were excluded. At enrolment, children were evaluated for suggestive tuberculosis symptoms (fever for >2 weeks, unremitting cough, haemoptysis and/or weight loss in the past 4 weeks, and tachycardia) and underwent Xpert MTB/RIF Ultra testing on respiratory and stool samples, chest radiography, and abdominal ultrasonography. Children were given a PAANTHER TDA score, with a score of less than 100 defined as negative and a score of 100 or higher defined as positive and prompting the initiation of treatment. At the end of the study, children were retrospectively classified by an endpoint review committee as having confirmed, unconfirmed, or unlikely tuberculosis, forming the composite reference standard against which diagnostic accuracy was assessed. The primary outcome was the proportion of children with missed tuberculosis (false negatives) among those who were not initiated on treatment as per the PAANTHER TDA. We assessed the diagnostic accuracy (sensitivity, specificity, and negative and positive predictive values) and feasibility (uptake and time to treatment initiation) of the PAANTHER TDA. The protocol-defined negative predictive value threshold for validation was 75%. This study is registered at ClinicalTrials.gov, NCT04121026, and is complete.</p><p><strong>Findings: </strong>From Oct 2, 2019, to Dec 31, 2021, 1706 children were prescreened for eligibility, of whom 713 children living with HIV were screened for tuberculosis symptoms; 423 were eligible for the study and 277 were enrolled. Of these 277 children, 272 (98%) had a complete TDA evaluation: 215 (79%) had a score of 100 or higher, including 24 (9%) with a positive Xpert MTB/RIF Ultra test. Treatment was initiated in 185 (86%) of 215 children with a positive score and 12 (20%) of 60 children with a negative score, at a median of 1 day [IQR 0-4] after inclusion. After assessment by the endpoint review committee, the proportion of children with tuberculosis in the classifiable study population (n=273) was 56·8% (95% CI 50·9","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"104012"},"PeriodicalIF":22.5,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971858","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":"Why the health community should care about the next UN Secretary-General.","authors":"Kent Buse, Sarah Hawkes","doi":"10.1016/j.langlo.2026.104089","DOIUrl":"https://doi.org/10.1016/j.langlo.2026.104089","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"104089"},"PeriodicalIF":22.5,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921407","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":"From commitment to governance: what should the 2026 UN high-level meeting on pandemic preparedness deliver?","authors":"Nelson Aghogho Evaborhene, Maureen Luba, Hawi Getnet Degu, Marc Bosonkie, Douglas Muthinji Wanja, Pimchanok Ratanapises, Mutiara Indriani, Emma Sandvik Ling, Nasser Kasadha","doi":"10.1016/j.langlo.2026.104070","DOIUrl":"https://doi.org/10.1016/j.langlo.2026.104070","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"104070"},"PeriodicalIF":22.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892594","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":"Beyond the metrification of diversity: compositional and relational equity in global health representation.","authors":"Aaron Koay, Audrey Prost","doi":"10.1016/j.langlo.2026.104078","DOIUrl":"https://doi.org/10.1016/j.langlo.2026.104078","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"104078"},"PeriodicalIF":22.5,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882525","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":"Embedding social and behavioural science across and beyond Ebola clinical trials: a critical research priority.","authors":"Esaie L Kindombe, Placide Mbala-Kingebeni, Donald Skinner, Karen A-A R Coker, Nadia A Sam-Agudu, Alimuddin Zumla, Jean-Jacques Muyembe-Tamfum, Jean B Nachega","doi":"10.1016/j.langlo.2026.104077","DOIUrl":"https://doi.org/10.1016/j.langlo.2026.104077","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"104077"},"PeriodicalIF":22.5,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882552","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":"Methodological concerns regarding the use of automated visual evaluation without HPV testing for cervical screening.","authors":"Mark Schiffman, Jayashree Kalpathy-Cramer","doi":"10.1016/j.langlo.2026.104022","DOIUrl":"10.1016/j.langlo.2026.104022","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"104022"},"PeriodicalIF":22.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671055","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":"Chewing tobacco: the neglected component of the tobacco epidemic","authors":"Palash Chandra Banik,Mohammad Mostafa Zaman","doi":"10.1016/j.langlo.2026.104067","DOIUrl":"https://doi.org/10.1016/j.langlo.2026.104067","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"11 1","pages":"104067"},"PeriodicalIF":34.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088075","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 overlooked role of local frontline health workers in the Bundibugyo Ebola response.","authors":"Serge Tonen-Wolyec","doi":"10.1016/j.langlo.2026.104036","DOIUrl":"10.1016/j.langlo.2026.104036","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"104036"},"PeriodicalIF":22.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632335","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}