Lancet Global Health最新文献

{"title":"A rapid facility-level assessment of oxygen systems in 39 low-income and middle-income countries: a cross-sectional study.","authors":"Nadir Ijaz, Tamsin Lee, Nicholas Furtado, Emilie Macher, Zipporah Muitheri, Benjamin J Park, David Lowrance","doi":"10.1016/S2214-109X(24)00561-8","DOIUrl":"10.1016/S2214-109X(24)00561-8","url":null,"abstract":"<p><strong>Background: </strong>Unequal access to medical oxygen is a key driver of global inequities in morbidity and mortality. We aimed to describe reliable oxygen availability (ie, whether availability is uninterrupted) and functional availability (ie, whether oxygen system components are in working order) in 39 low-income and middle-income countries and to compare across WHO subregions.</p><p><strong>Methods: </strong>We report cross-sectional survey data from primary, secondary, and tertiary level health facilities across six WHO subregions. Facilities were selected via purposive and stratified random sampling. Data collectors visited facilities from September 2022, to February 2023, to administer a standardised questionnaire to facility leadership. All approached facilities responded. Questions assessed reliable oxygen availability over the preceding 3 months and the functional availability of system components: oxygen sources (ie, cylinders, concentrators, plants, and liquid oxygen), distribution systems (ie, piping, cylinder transport, and respiratory tubing), delivery devices (ie, nasal interfaces, face masks, and advanced modalities), monitoring devices (ie, pulse oximeters and multiparameter monitors), and quality assurance (ie, oxygen concentration control and maintenance schedule). We report descriptive statistics and compare across subregions using χ² and Fisher exact tests.</p><p><strong>Findings: </strong>Of 2884 surveyed facilities, 304 (24·5%) of 1241 primary facilities, 558 (52·4%) of 1064 secondary facilities, and 387 (66·8%) of 579 tertiary facilities reported reliable oxygen availability. Facilities across levels and subregions lacked system components, with statistically significant (p<0·05) differences in functional availability of all oxygen system components across subregions at all levels. For example, functional availability of cylinders ranged from 56·7% to 100·0%, piping from 7·5% to 94·6%, nasal cannulae from 56·3% to 96·4%, and pulse oximeters ranged from 47·8% to 96·4%, depending on level and subregion.</p><p><strong>Interpretation: </strong>Reliable oxygen availability was low across facility levels and subregions. There were significant disparities in the functional availability of oxygen system components across subregions, with important implications for global health equity and financing.</p><p><strong>Funding: </strong>The Global Fund to Fight AIDS, Tuberculosis, and Malaria; the Yale National Clinician Scholars Program; the US National Center for Advancing Translational Sciences; the US National Heart, Lung, and Blood Institute; and the Yale Institute for Global Health.</p><p><strong>Translations: </strong>For the French translation of the abstract see Supplementary Materials section.</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e646-e655"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537928","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":"Global and regional causes of maternal deaths 2009-20: a WHO systematic analysis.","authors":"Jenny A Cresswell, Monica Alexander, Michael Y C Chong, Heather M Link, Marija Pejchinovska, Ursula Gazeley, Sahar M A Ahmed, Doris Chou, Ann-Beth Moller, Daniel Simpson, Leontine Alkema, Gemma Villanueva, Yanina Sguassero, Özge Tunçalp, Qian Long, Shaoming Xiao, Lale Say","doi":"10.1016/S2214-109X(24)00560-6","DOIUrl":"10.1016/S2214-109X(24)00560-6","url":null,"abstract":"<p><strong>Background: </strong>Maternal mortality is not on track to meet Sustainable Development Goal (SDG) target 3.1 of a global maternal mortality ratio below 70 per 100 000 livebirths by 2030. Updated evidence on causes of death is needed to accelerate progress.</p><p><strong>Methods: </strong>We conducted a multi-strategy systematic review to identify causes of maternal deaths occurring in 2009-20. Data sources included civil registration and vital statistics systems data from the WHO Mortality Database, reports published by Member States, and national and subnational journal articles identified via bibliographic databases. We used a Bayesian hierarchical model to estimate the maternal cause of death distribution by SDG regions and worldwide. Given the paucity of data on maternal suicide and late maternal deaths occurring beyond 42 days postpartum, additional analyses were conducted to estimate the proportion of maternal deaths from suicide and the ratio of maternal to late maternal deaths (all cause).</p><p><strong>Findings: </strong>Globally, the most common cause of maternal death was haemorrhage (27%; 80% uncertainty interval 22-32), followed by indirect obstetric deaths (23%, 18-30), and hypertensive disorders (16%, 14-19). The proportion of haemorrhage deaths varied substantially by region and was highest in sub-Saharan Africa and Western Asia and Northern Africa. The proportion of maternal deaths from hypertensive disorders was highest in Latin America and the Caribbean. Most maternal deaths from haemorrhage and sepsis occurred during the postpartum period. Only 12 countries recorded one or more maternal suicides; of those countries, the proportion of deaths from suicide ranged from below 1% to 26% of maternal deaths. For countries reporting at least one late maternal death (ie, deaths that occur more than 42 days but less than 1 year after the termination of pregnancy), the ratio of late maternal deaths to maternal deaths up to 42 days ranged from <0·01 to 0·07.</p><p><strong>Interpretation: </strong>Haemorrhage remains the leading cause of death, despite the existence of effective clinical interventions, emphasising the need for improved access to quality health care. The timing of most deaths in the postpartum period demands renewed commitment to improving the provision of postpartum care in addition to intrapartum care. Indirect causes of death require health system approaches to integrate obstetric and non-obstetric care.</p><p><strong>Funding: </strong>USAID; US Fund for UNICEF via the Bill & Melinda Gates Foundation; and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development, and Research Training in Human Reproduction (HRP).</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e626-e634"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11946934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597925","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":"Better engagement, better evidence: working in partnership with patients, the public, and communities in clinical trials with involvement and good participatory practice.","authors":"Nina Gobat, Catherine Slack, Stacey Hannah, Jessica Salzwedel, Georgia Bladon, Juan Garcia Burgos, Becky Purvis, Barbara Molony-Oates, Nandi Siegfried, Phaik Yeong Cheah, Magda Conway, Dorcas Kamuya, Alun Davies, Tian Johnson, Martha Tholanah, Stephen Mugamba, Naigaga Lillian Mutengu, Shingai Machingaidze, Lisa Schwartz, Lembit Rägo, Kai von Harbou","doi":"10.1016/S2214-109X(24)00521-7","DOIUrl":"10.1016/S2214-109X(24)00521-7","url":null,"abstract":"<p><p>In May 2022, member states of WHO adopted the World Health Assembly WHA75.8 resolution on strengthening clinical trials to provide high-quality evidence on health interventions and to improve research quality and coordination. The resolution recognises the central role of community stakeholders in the clinical trial ecosystem. This paper aims to take stock of the state of the field and define key actions from stakeholders across the clinical trial ecosystem for systematic engagement of patient, public, and community stakeholders in clinical trials. Upfront, sustained, inclusive, and meaningful engagement with patients, public, and community stakeholders intended to benefit from trial outcomes is crucial for several reasons. First, better engagement ensures that trials are well designed and well implemented by considering the unique perspectives and experiences of those they aim to benefit. Second, better engagement enhances the scientific, ethical, and pragmatic value of trials by improving the acceptability, feasibility, and relevance of trial design, implementation, and outcome dissemination. Lastly, improving engagement fosters trust in science and scientists, strengthens research literacy, and contributes to greater trust in research processes. This trust is particularly important in public health emergencies where the urgency for identifying effective interventions, including new vaccines and medicines, often results in limited engagement. In practice, engagement involves activities throughout the trial lifecycle, including research agenda setting, protocol development, trial conduct, and outcome dissemination. Key stakeholders, such as researchers, funders, research ethics committees, and regulators play crucial roles in enabling and implementing engagement via participatory practices. Despite some key markers of progress, challenges remain, including systemic gaps, limited engagement beyond tokenistic involvement, and structural inequities. Addressing these challenges requires action across the clinical trial ecosystem, including strengthening policies, enhancing funding mechanisms, improving regulatory oversight, advocacy, and education of all stakeholders about engagement, and promoting a strong culture of engagement. Advancing the agenda for engagement can promote trust, ethical research conduct, and improve outcomes and wider uptake of findings.</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 4","pages":"e716-e731"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744242","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":"Reporting summary results in clinical trial registries: updated guidance from WHO.","authors":"An-Wen Chan, Ghassan Karam, Justin Pymento, Lisa M Askie, Luiza R da Silva, Ségolène Aymé, Christopher Marc Taylor, Lotty Hooft, Anna Laura Ross, Vasee Moorthy","doi":"10.1016/S2214-109X(24)00514-X","DOIUrl":"10.1016/S2214-109X(24)00514-X","url":null,"abstract":"<p><p>The importance of publicly registering clinical trials and reporting their results in registries is widely recognised. While substantial progress has been made with registering trials before enrolment, the availability of results in registries remains uncommon despite expanding legislative and funder requirements-leading to an incomplete evidence base and avoidable waste of resources, particularly for unpublished trials. This paper discusses the rationale for reporting summary results in trial registries, reviews the current landscape of registry policies, and presents new WHO guidance for reporting results in registries. The 2025 WHO guidance was developed after consultation with relevant parties, including researchers, patients, sponsors, funders, regulators, journal editors, registry administrators, and the public. The guidance defines eight minimum items that are essential for understanding and interpreting the summary results for all trials. Implementation of the WHO guidance by trial registries, broad adherence by investigators and sponsors, and endorsement by funders, regulators, legislators, research ethics committees, patient organisations, and journals can help enhance the contribution of trials to scientific knowledge, patient care, and health policy.</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 4","pages":"e759-e768"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744234","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":"Strengthening the paediatric clinical trial ecosystem to better inform policy and programmes.","authors":"James A Berkley, Judd L Walson, Glenda Gray, Fiona Russell, Zulfiqar Bhutta, Per Ashorn, Shane A Norris, Ebunoluwa A Adejuyigbe, Rebecca Grais, Bernhards Ogutu, Jun Zhang, Guillermo L Chantada, Sharon Nachman, Edward Kija, Fyezah Jehan, Carlo Giaquinto, Nigel C Rollins, Martina Penazzato","doi":"10.1016/S2214-109X(24)00511-4","DOIUrl":"10.1016/S2214-109X(24)00511-4","url":null,"abstract":"<p><p>The first WHO Global Clinical Trials Forum was convened in November, 2023 to develop a shared vision of an effective global clinical trial infrastructure. The Paediatric Clinical Trials Working Group was formed to provide perspectives, identify challenges, and propose solutions to strengthen the paediatric clinical trials ecosystem. Participants represented paediatric disciplines, including infectious diseases, nutrition, neonatology, pharmacology, oncology, neurodevelopment, public health, and policy. Childhood diseases have profound lifelong effects on health, livelihoods, and societies. Investment in early childhood results in highly cost-effective changes to lifelong health, productivity, and human capital returns. Yet, there remain substantial gaps in knowledge on the efficacy and safety of many paediatric interventions, which represents a failure to establish shared priorities and alignment across governments, researchers, communities, and funders. Children are frequently marginalised from clinical trials, which is an issue of equity. Challenges include mismatched priorities and funding, risk adversity, poor design, power imbalances, and inadequate infrastructure. Solutions include aligning on and tracking local and global child health priorities against funding and supporting regional consortia to pool resources for larger, more consequential trials. We propose actions and responsibilities for global, regional, and national institutions for prioritisation, coordination, enabling paediatric trials consortia, funding, and tracking progress.</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 4","pages":"e732-e739"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744235","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 coming of age of in-country laboratory testing for Ebola virus disease in Uganda.","authors":"Misaki Wayengera","doi":"10.1016/S2214-109X(25)00073-7","DOIUrl":"10.1016/S2214-109X(25)00073-7","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 4","pages":"e624"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744236","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":"Eliminate prescribers' uncertainty to catalyse the impact of vaccines on antibiotic use.","authors":"Brecht Ingelbeen, Nandini Sreenivasan, Annick Lenglet","doi":"10.1016/S2214-109X(25)00018-X","DOIUrl":"10.1016/S2214-109X(25)00018-X","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e621"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075976","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":"Redefining implementation science for global health decolonisation.","authors":"The Lancet Global Health","doi":"10.1016/S2214-109X(25)00116-0","DOIUrl":"10.1016/S2214-109X(25)00116-0","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 4","pages":"e599"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744233","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":"Improving the clinical trial environment and infrastructure: moving from global resolution to action.","authors":"Vasee Moorthy, Nandi Siegfried, John Amuasi, Jing Li, Michael Makanga, Karla Soares-Weiser, Sheamini Sivasampu, Denis Xavier, Faiez Zannad, Valerie Snewin","doi":"10.1016/S2214-109X(25)00012-9","DOIUrl":"10.1016/S2214-109X(25)00012-9","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 4","pages":"e608-e610"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744285","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":"Cost-effectiveness of intrapartum azithromycin to prevent maternal infection, sepsis, or death in low-income and middle-income countries: a modelling analysis of data from a randomised, multicentre, placebo-controlled trial.","authors":"Jackie K Patterson, Simon Neuwahl, Sydney Kirsch, Janet L Moore, Alan T N Tita, Waldemar A Carlo, Adrien Lokangaka, Antoinette Tshefu, Musaku Mwenechanya, Elwyn Chomba, Avinash Kavi, Mrityunjay C Metgud, Shivaprasad S Goudar, Richard J Derman, Poonam Shivkumar, Manju Waikar, Archana Patel, Patricia L Hibberd, Paul Nyongesa, Fabian Esamai, Osa A Ekhaguere, Sherri Bucher, Saleem Jessani, Shiyam S Tikmani, Sarah Saleem, Blair J Wylie, Robert L Goldenberg, Sk Masum Billah, Ruth Lennox, Rashidul Haque, William A Petri, Manolo Mazariegos, Nancy F Krebs, Jennifer J Hemingway-Foday, Denise Babineau, Marion Koso-Thomas, Elizabeth M McClure, Melissa Bauserman","doi":"10.1016/S2214-109X(24)00517-5","DOIUrl":"10.1016/S2214-109X(24)00517-5","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Sepsis is one of the leading causes of maternal mortality globally. In 2023, the Azithromycin Prevention in Labor Use (A-PLUS) trial showed intrapartum azithromycin for women planning a vaginal birth reduced the risk of maternal sepsis or death and infection. We aimed to evaluate the cost-effectiveness of intrapartum azithromycin for pregnant people planning a vaginal birth in low-income and middle-income countries (LMICs) using A-PLUS trial data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We compared the benefits and costs of intrapartum azithromycin versus standard care across 100 000 model simulations using data from the A-PLUS trial and a probabilistic decision tree model that included 24 mutually exclusive scenarios. A-PLUS was a randomised, double-blind, placebo-controlled trial that enrolled 29 278 women in labour at 28 weeks' gestation or more at eight sites in the Democratic Republic of the Congo, Kenya, Zambia, Bangladesh, India, Pakistan, and Guatemala. Women randomly assigned to azithromycin received a single intrapartum 2 g oral dose. In this cost-effectiveness analysis, we considered the cost of azithromycin treatment and its effects on a composite outcome of maternal infection, sepsis, or death and its individual components, and health-care use. Our analysis had a health-care sector perspective. We summarised results as an average and 95% CI of the model simulations. We also conducted sensitivity analyses. A-PLUS was registered at ClinicalTrials.gov, number NCT03871491.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;In model simulations, intrapartum azithromycin resulted in 1592·0 (95% CI 1139·7 to 2024·1) cases of maternal infection, sepsis, or death averted per 100 000 pregnancies, yielding 248·5 (95·3 to 403·7) facility readmissions averted, 866·8 (537·8 to 1193·2) unplanned clinic visits averted, and 1816·2 (1324·5 to 2299·7) antibiotic regimens averted. Using mean health-care costs across the A-PLUS sites, intrapartum azithromycin resulted in net savings of US$32 661 (-52 218 to 118 210) per 100 000 pregnancies and 13·2 (8·3 to 17·9) disability-adjusted life-years averted. The cost of facility readmission, cost of azithromycin, and probability of infection had the greatest impact on the incremental cost.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;In most cases, intrapartum azithromycin is a cost-saving intervention for the prevention of maternal infection, sepsis, or death in LMICs. This evidence supports global consideration of intrapartum azithromycin as an economically efficient preventive therapy to reduce infection, sepsis, or death among women planning a vaginal birth in LMICs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Funding: &lt;/strong&gt;Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Foundation for the National Institutes of Health through the Maternal, Newborn, and Child Health Discovery and Tools Initiative of the Bill & Melinda Gates Foundation TRANSLATIONS: For the French and Spanish translations of th","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 4","pages":"e679-e688"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11950424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744201","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}