The Lancet regional health. Southeast Asia最新文献

{"title":"Within-laboratory SARS-CoV-2 real time PCR testing operations in Nepal: a simulation-based analysis","authors":"Fannie L. Côté ,&nbsp;Nadia Lahrichi ,&nbsp;Erica Gralla ,&nbsp;Hannah Bakker ,&nbsp;Parvathy Krishnan Krishnakumari ,&nbsp;Joaquim Gromicho ,&nbsp;Arunkumar Govindakarnavar ,&nbsp;Runa Jha ,&nbsp;Lilee Shrestha ,&nbsp;Nirajan Bhusal ,&nbsp;Saugat Shrestha ,&nbsp;Rashmi Mulmi ,&nbsp;Priya Jha ,&nbsp;Reuben Samuel ,&nbsp;Dhamari Naidoo ,&nbsp;Victor J. del Rio Vilas","doi":"10.1016/j.lansea.2025.100584","DOIUrl":"10.1016/j.lansea.2025.100584","url":null,"abstract":"<div><h3>Background</h3><div>COVID-19 has challenged entire health systems, including laboratories. To address the increasing demand for tests to inform the epidemiology of the disease and for case management purposes, many countries made significant investments to rapidly expand laboratory capacity for detecting SARS-CoV-2. In this study, we used a simulated laboratory environment, based on a model of operating laboratories in Nepal, to identify opportunities for improvement.</div></div><div><h3>Methods</h3><div>We developed a discrete event simulation (DES) model, based on data from and in collaboration with Nepali health authorities, to analyse laboratory operations in Nepal. We used a series of “what-if” scenarios under different levels of testing demand and staffing to investigate bottlenecks in the processing of COVID-19 samples in a simulated laboratory environment, assess the impact of potential reagent shortages and increased automation, and more generally, explore the key factors that drive the performance and resilience of the testing system.</div></div><div><h3>Findings</h3><div>Suboptimal staff allocation and scheduling can limit the timely return of laboratory results; however, better staff allocation can mitigate bottlenecks and reduce the impact of reagent shortages. For example, when the demand is 720 samples per day and seven staff members are on duty, adding one additional staff member improves reporting time (reduction from 48 h to approximately 32 h). However, changes in scheduling can increase the average time to return the results to over 200 h. A one-day reagent shortage appears to have minimal impact, but a delay of five days significantly increases the reporting time, reaching nearly 150 h. Increasing automation or better process coordination for sample registration can also lead to better performance, reducing the average reporting time from over 60 h to just under 24 h.</div></div><div><h3>Interpretation</h3><div>Our findings identify important bottlenecks and challenges, along with ways to address them, and thus provide important lessons for improving disease testing operations for this and future pandemics.</div></div><div><h3>Funding</h3><div><span>WHO Special Programme for Research and Training in Tropical Diseases (TDR)</span>.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"36 ","pages":"Article 100584"},"PeriodicalIF":5.0,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143874409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cause of death in people living with HIV who initiated antiretroviral therapy after enrolling to the Thai National AIDS Program from 2008 to 2021","authors":"Cheewanan Lertpiriyasuwat ,&nbsp;Stephen J. Kerr ,&nbsp;Sairat Noknoy ,&nbsp;Patiphak Namahoot ,&nbsp;Niramon Punsuwan ,&nbsp;Tanakorn Apornpong ,&nbsp;Jiratchaya Sophonphan ,&nbsp;Napon Hiranburana ,&nbsp;Ploenchan Chetchotisakd ,&nbsp;Opass Putcharoen ,&nbsp;Kiat Ruxrungtham ,&nbsp;Anchalee Avihingsanon","doi":"10.1016/j.lansea.2025.100576","DOIUrl":"10.1016/j.lansea.2025.100576","url":null,"abstract":"<div><h3>Background</h3><div>Widespread access to antiretroviral therapy (ART) has led to near-normal life expectancies for people living with HIV (PLHIV), shifting the leading cause of death (COD) from AIDS-related to non-AIDS-related mortality. We assessed trends in COD among PLHIV who initiated ART in Thai National AIDS Program (NAP).</div></div><div><h3>Methods</h3><div>We analysed NAP data from PLHIV aged ≥15 at ART initiation, who started ART under Thailand’s universal health coverage from 2008 to 2021. Individual data was linked with the National Death Registration system, and a rule-based algorithm applied text mining to classify COD as AIDS-related, non-AIDS-related and uncertain. Competing risk models examined associations between demographic and clinical characteristics and COD. Standardized mortality ratios (SMR) were calculated using mortality rate from the general Thai population.</div></div><div><h3>Findings</h3><div>Among 398,182 PLHIV (37.1% females) enrolled, the median (IQR) age was 35 (28–43) years, 43.6% commenced ART with CD4 counts &lt;200 cells/mm3. Over 2,631,435 person years of follow-up, 73,768 (18.5%) deaths occurred: 56% AIDS-related, 40% non-AIDS-related and 4% uncertain. The cumulative incidence of AIDS-related mortality at 14 years was 14.74%, non-AIDS-related 12.04% and all-cause mortality 27.93%. AIDS-related deaths declined from 60% to 50% over the study period. Low CD4 counts, permanently loss to care and treatment at non-capital city were significantly associated with higher AIDS-related mortality. The SMR was higher in females [9.08 (95% CI 8.97–9.20] compared to males [5.83 (95% CI 5.78–5.88).</div></div><div><h3>Interpretation</h3><div>AIDS-related mortality decreased over time, but continued efforts are needed to improve earlier diagnosis, and equitable outcomes for women and those residing outside major cities.</div></div><div><h3>Funding</h3><div>Supported by <span>National Institute of Health</span> (IeDEA:<span><span>U01AI069907</span></span>).</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"36 ","pages":"Article 100576"},"PeriodicalIF":5.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“Miles to go before I seek”: distance to the health facility and health care use among older adults in India","authors":"Sheuli Misra ,&nbsp;Jeetendra Yadav ,&nbsp;Abhinav Sinha ,&nbsp;Krushna Chandra Sahoo ,&nbsp;Shweta Tanwar ,&nbsp;Sneh Shalini ,&nbsp;Arohi Chauhan ,&nbsp;Sanghamitra Pati","doi":"10.1016/j.lansea.2025.100579","DOIUrl":"10.1016/j.lansea.2025.100579","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"37 ","pages":"Article 100579"},"PeriodicalIF":5.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143838680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive function and associations with demographic, socioeconomic, health and behavioural factors among older adult men and women in rural Bangladesh: a population-based cross-sectional study","authors":"Edward Fottrell ,&nbsp;Harry Costello ,&nbsp;Naveed Ahmed ,&nbsp;Carina King ,&nbsp;Sanjit Kumer Shaha ,&nbsp;Tasmin Nahar ,&nbsp;Malini Pires ,&nbsp;Andrew Copas ,&nbsp;Hassan Haghparast-Bidgoli ,&nbsp;Joanna Morrison ,&nbsp;Abdul Kuddus ,&nbsp;Kishwar Azad","doi":"10.1016/j.lansea.2025.100575","DOIUrl":"10.1016/j.lansea.2025.100575","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Cognitive impairment has a major impact on health, quality of life and survival and its increasing burden presents a critical global health challenge. Empirical population-based studies of cognitive function and its association with demographic, socioeconomic, health and behavioural factors among older adults in low-resource setting are rare. This study describes the burden of cognitive impairment and associations with demographic, health and behavioural factors among older adults in rural Bangladesh.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted a population-based cross-sectional study of a random sample of men and women aged 60 years and above in 96 rural villages in Bangladesh. Cognitive function was measured using the Bangla Adaptation of the Mini-mental State Examination (BAMSE), where higher score indicates higher function. Blood pressure, height and weight were measured using standard protocols and fasting glucose and 2-h oral glucose test were used to identify diabetes risk. Interviewer administered survey questionnaires assessed depressive symptoms, anxiety and self-reported health behaviours. Analyses were carried out separately for men and women and examined associations between sociodemographic, health and behaviour factors with BAMSE scores using robust Poisson regression.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Data were gathered from 403 (216 female, 187 male) eligible participants. More than 50% of the population had at least mild cognitive impairment and women had lower cognitive scores than men. Younger age, higher education, wealth, and literacy were significantly associated with higher BAMSE scores among women and men. Associations with marital status varied between men and women, with being married having a positive association with BAMSE among women, i.e. higher cognitive function (relative score ratio (95% CI) 1.08 (1.02, 1.15), p = 0.013), but no association among men (0.94 (0.87, 1.02), p = 0.13). No clear associations were observed with diabetes or hypertension, but overweight and obesity were associated with an increased BAMSE score among women (1.10 (1.02, 1.19), p = 0.011) but not men (1.01 (0.94, 1.10), p = 0.70). Moderate and severe depressive symptoms were associated with lower BAMSE scores among men (0.90 (0.82, 0.99), p = 0.037), but not women (0.94 (0.83, 1.06), p = 0.31). Physical activity was associated with a relative increase in BAMSE score (1.08 (1.01, 1.16), p = 0.020) among women, though no association was seen in men (1.01 (0.95, 1.07), p = 0.76). The consumption of betel was associated with lower BAMSE among women (0.94 (0.89, 1.00), p = 0.056), but there was no evidence of association among men (1.01 (0.96, 1.07), p = 0.61).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;A large proportion of older adults in rural Bangladesh have impaired cognitive function and there are important gender differences in the distribution of cognitive scores and their association with demograph","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"36 ","pages":"Article 100575"},"PeriodicalIF":5.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143785557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From periodontal inflammation to oral cancer: the impact of smokeless tobacco","authors":"Delfin Lovelina Francis ,&nbsp;Saravanan Sampoornam Pape Reddy ,&nbsp;Manish Rathi ,&nbsp;Sukhbir Singh Chopra","doi":"10.1016/j.lansea.2025.100574","DOIUrl":"10.1016/j.lansea.2025.100574","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"36 ","pages":"Article 100574"},"PeriodicalIF":5.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global health: time to move beyond the USA?","authors":"The Lancet Regional Health – Southeast Asia","doi":"10.1016/j.lansea.2025.100577","DOIUrl":"10.1016/j.lansea.2025.100577","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"35 ","pages":"Article 100577"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resurgence of syphilis among blood donors in a single institute in Eastern India: a looming threat to public health and transfusion services","authors":"Suvro Sankha Datta ,&nbsp;Aniruddha Hazra ,&nbsp;Najla Haneefa Basheela ,&nbsp;Sanjay Bhattacharya ,&nbsp;Soumyadip Chatterji","doi":"10.1016/j.lansea.2025.100572","DOIUrl":"10.1016/j.lansea.2025.100572","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"36 ","pages":"Article 100572"},"PeriodicalIF":5.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143739864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of low-cost techniques to detect sickle cell disease and β-thalassemia: an open-label, international, multicentre study","authors":"Pranav Shrestha ,&nbsp;Hendrik Lohse ,&nbsp;Christopher Bhatla ,&nbsp;Heather McCartney ,&nbsp;Alaa Alzaki ,&nbsp;Navdeep Sandhu ,&nbsp;Pardip Kumar Oli ,&nbsp;Sanjeev Chaudhary ,&nbsp;Ali Amid ,&nbsp;Rodrigo Onell ,&nbsp;Nicholas Au ,&nbsp;Hayley Merkeley ,&nbsp;Videsh Kapoor ,&nbsp;Rajan Pande ,&nbsp;Boris Stoeber","doi":"10.1016/j.lansea.2025.100571","DOIUrl":"10.1016/j.lansea.2025.100571","url":null,"abstract":"<div><h3>Background</h3><div>Sickle cell disease (SCD) persists as a major global health problem, disproportionately affecting children in low- and middle-income countries (LMIC). Accurate and low-cost point-of-care techniques are urgently needed in LMIC to detect carrier or disease forms with haemoglobin S (HbS) and other variants like β-thalassemia.</div></div><div><h3>Methods</h3><div>An open-label, international, multicentre study was conducted at clinical sites in Nepal and Canada. Blood samples were collected from healthy volunteers (HbAA) and participants with known haemoglobinopathies (HbA/β-thalassemia, HbAS, HbS/β-thalassemia, HbSS). The performance of six low-cost tests (Conventional sickling test; HbS solubility test; HemoTypeSC; Sickle SCAN; Gazelle Hb variant test; Automated sickling test using automated microscopy and machine learning) was evaluated against HPLC (<span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> Identifier: <span><span>NCT05506358</span><svg><path></path></svg></span>).</div></div><div><h3>Findings</h3><div>Between September 2022 and March 2023, we enrolled 138 participants (aged 2–74 years; 59% female, 41% male) at clinical sites in Nepal and Canada. Four low-cost tests (HemoTypeSC, Sickle SCAN, Gazelle, and automated sickling), which could identify phenotypes, detected severe SCD (HbSS, HbS/β-thalassemia) accurately (sensitivity &gt;96%; specificity &gt;99%). In contrast, for carrier forms, HemotypeSC and Sickle SCAN only detected HbAS (sensitivity &gt;97%; specificity 100%) and not HbA/β-thalassemia (sensitivity 0%; specificity 100%), while Gazelle detected HbAS (sensitivity 100%, specificity 100%) and HbA/β-thalassemia (sensitivity 91%, specificity 99%), and automated sickling test detected both trait conditions (HbAS and HbA/β-thalassemia; sensitivity 85%, specificity 85%).</div></div><div><h3>Interpretation</h3><div>When HbS co-exists with β-thalassemia, Gazelle and automated sickling test accurately identify severe SCD and carrier forms. However, HemotypeSC and Sickle SCAN miss β-thalassemia trait, and need to be complemented with other low-cost tests.</div></div><div><h3>Funding</h3><div><span>UBC</span> <span>PSI</span>, <span>Canada Research Chairs</span>, <span>UBC</span> HIFI Awards, <span>UBC</span> 4YF, Naiman Vickars Endowment fund.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"35 ","pages":"Article 100571"},"PeriodicalIF":5.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Updated cholangiocarcinoma incidence trends and projections in Thailand by region based on data from four population-based cancer registries","authors":"Oraya Sahat ,&nbsp;Surichai Bilheem ,&nbsp;Apiradee Lim ,&nbsp;Siriporn Kamsa-ard ,&nbsp;Apiporn Thinkhamrop Suwannatrai ,&nbsp;Surin Uadrang ,&nbsp;Atit Leklob ,&nbsp;Wasan Chansaard ,&nbsp;Nithima Sriket ,&nbsp;Chalongpon Santong ,&nbsp;Karnchana Daoprasert ,&nbsp;Supot Kamsa-ard","doi":"10.1016/j.lansea.2025.100569","DOIUrl":"10.1016/j.lansea.2025.100569","url":null,"abstract":"<div><h3>Background</h3><div>Cholangiocarcinoma (CCA) is a significant health concern in Thailand, as the age-standardized rates (ASR) and other trends fluctuate across different regions. However, comprehensive national estimates are lacking. This study examined the Thai ASR of CCA trends from 2012 to 2021 and projected the incidence rates to 2026.</div></div><div><h3>Methods</h3><div>This retrospective cohort analysis examined 6379 CCA cases from population-based cancer registries (PBCRs) in the northern, central, northeastern, and southern regions for the time period January 1, 2012, to December 31, 2021. The Joinpoint, age-period-cohort, and Nordpred models were used to assess CCA incidence trends and predictions.</div></div><div><h3>Findings</h3><div>CCA incidence trends in Thailand showed a decrease, with an average annual percentage change (AAPC) of −7.20% (95% CI: −11.04 to −3.19) for males, and −5.81% (95% CI: −10.81 to −0.54) for females. The projected incidence rate per 100,000 person-years for 2026 varied slightly according to the model: Joinpoint (males: 6.1, females: 3.4), age-period-cohort (males: 6.0, females: 3.3), and Nordpred (males: 5.5, females: 3.4). Regional analyses revealed decreasing trends in the northern and northeastern regions, with 2026 projections indicating further declines exceeding the 10-year trends. Owing to the small sample size, trends in the central and southern regions could not be determined.</div></div><div><h3>Interpretation</h3><div>Thailand's CCA rate has generally decreased but varies geographically; the northern and northeastern regions remain at high risk. To minimize CCA nationally, initiatives should be maintained, new risk factors explored, diagnostics improved, and regional variances addressed.</div></div><div><h3>Funding</h3><div>The <span>Graduate School of Khon Kaen University</span>.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"35 ","pages":"Article 100569"},"PeriodicalIF":5.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in enteric fever trends during the COVID-19 pandemic from the Surveillance for Enteric Fever in Asia Project: a cross-sectional study","authors":"Sira Jam Munira ,&nbsp;Shiva R. Naga ,&nbsp;Irum Fatima Dehraj ,&nbsp;Kate Doyle ,&nbsp;Naito Kanon ,&nbsp;Mohammad Tahir Yousafzai ,&nbsp;Dipesh Tamrakar ,&nbsp;Afshan Piyar Ali ,&nbsp;Annaya Barman Jui ,&nbsp;Alice S. Carter ,&nbsp;Dipu Chandra Das ,&nbsp;Surrendar Dawani ,&nbsp;Khalid Iqbal ,&nbsp;Seema Irfan ,&nbsp;Mohammad Shahidul Islam ,&nbsp;Muhammad Ashraf Memon ,&nbsp;Tuba Khan ,&nbsp;Shamsun Nahar ,&nbsp;Md. Hafizur Rahman ,&nbsp;Nasir Saleem Saddal ,&nbsp;Senjuti Saha","doi":"10.1016/j.lansea.2025.100562","DOIUrl":"10.1016/j.lansea.2025.100562","url":null,"abstract":"<div><h3>Background</h3><div>The Surveillance for Enteric Fever in Asia Project (SEAP) conducted blood culture surveillance for <em>Salmonella enterica</em> serotype Typhi (<em>S</em>. Typhi) and Paratyphi (<em>S</em>. Paratyphi) to provide an evidence base for prevention and control measures in Bangladesh, Nepal, and Pakistan.</div></div><div><h3>Methods</h3><div>From October 2020 to September 2022, we conducted prospective clinical surveillance and retrospective laboratory surveillance at health facilities in Dhaka, Bangladesh; Kathmandu and Kavrepalanchok, Nepal; and Karachi, Pakistan. Patients were eligible if they were outpatients with three or more days of fever in the last week. In Nepal and Pakistan, inpatients were eligible if they had suspected or confirmed enteric fever; in Bangladesh, only inpatients with confirmed enteric fever were enrolled. Patients with blood culture–confirmed enteric fever identified by hospital laboratories and laboratory network sites were also enrolled. Patients completed interviews and medical records were reviewed and abstracted. All enrolled patients had blood cultures performed. Antibiograms were performed to characterize drug sensitivity. We summarized the data descriptively.</div></div><div><h3>Findings</h3><div>A total of 17,593 patients were enrolled from 19 facilities. Of these, 8410 patients had culture-confirmed enteric fever. Case counts in all countries decreased in the early stages of the COVID-19 pandemic, but increased over time in Bangladesh and Pakistan. Case counts remained low throughout the study period in Nepal. In all countries, typhoid was more common than paratyphoid; the proportion of paratyphoid cases ranged from 8.4% in Pakistan to 16% in Nepal. Extensively drug-resistant typhoid was common in Pakistan (69%), but was not detected in Bangladesh or Nepal.</div></div><div><h3>Interpretation</h3><div>Cases of enteric fever decreased during the COVID-19 pandemic, though it is not clear how much of this decrease relates to true changes in transmission versus health-seeking behavior.</div></div><div><h3>Funding</h3><div>This project was funded by the <span>Gates Foundation</span> through INV-008335.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"35 ","pages":"Article 100562"},"PeriodicalIF":5.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}