Adrian P. Mundt , S.M. Yasir Arafat , Chencho Dorji , Avinash Desousa , Rakesh K. Chadda , Guru S. Gowda , Cristian Orus , Muralidharan Kesavan , Athifa Ibrahim , Nagendra P. Luitel , Harischandra Gambheera , Phunnapa Kittirattanapaiboon , Stefan Priebe , Enzo Rozas-Serri
{"title":"Indicators of psychiatric institutionalization in Southeast Asia between 1990 and 2024","authors":"Adrian P. Mundt , S.M. Yasir Arafat , Chencho Dorji , Avinash Desousa , Rakesh K. Chadda , Guru S. Gowda , Cristian Orus , Muralidharan Kesavan , Athifa Ibrahim , Nagendra P. Luitel , Harischandra Gambheera , Phunnapa Kittirattanapaiboon , Stefan Priebe , Enzo Rozas-Serri","doi":"10.1016/j.lansea.2025.100690","DOIUrl":"10.1016/j.lansea.2025.100690","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to assess indicators of psychiatric institutionalization and their changes over time across the Southeast Asia Region (SEAR).</div></div><div><h3>Methods</h3><div>We collected numbers of psychiatric beds, specialized forensic psychiatric beds, beds in residential facilities for people living with chronic mental illness and prison populations in the 11 SEAR member states between 1990 and 2024 using primary and secondary data sources. We calculated median rates per 100,000 population, as well as percent changes of the median rates between the first and last available data points. We also compared findings in SEAR with OECD countries.</div></div><div><h3>Findings</h3><div>Psychiatric bed numbers and prison population were available from 10 countries. Bed prevalence increased in seven countries, but decreased in three. The median psychiatric bed prevalence was 1.5 at the first and 2.9 per 100,000 population at the last data point (+94%). The prison population increased in nine countries, with the median rate changing from 60 to 123 (+106%). Data on specialized forensic psychiatric beds were available from seven countries, with a range of 0.0–0.5 beds at the last data point. Based on data from five countries, the median prevalence of beds in residential facilities increased from 1.3 to 2.3. Psychiatric bed prevalence was on average about 5% of that in the OECD, while prison population rates were similar to those in OECD countries.</div></div><div><h3>Interpretation</h3><div>Psychiatric bed provision in the SEAR is among the lowest worldwide. In contrast, incarceration rates are similar to those in high-income regions. Most countries have increased the prevalence of psychiatric beds over the past three decades, but they remain scarce, and further investments need consideration.</div></div><div><h3>Funding</h3><div><span>Agencia Nacional de Investigación y Desarrollo</span> (ANID), Chile.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"42 ","pages":"Article 100690"},"PeriodicalIF":6.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145418014","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}
Surender Grover, Jadeer K. Muhammed, Atul Ambekar, Priyanka Saha
{"title":"Should pregabalin be regulated under the Narcotic Drugs and Psychotropic Substances (NDPS) Act of India?","authors":"Surender Grover, Jadeer K. Muhammed, Atul Ambekar, Priyanka Saha","doi":"10.1016/j.lansea.2025.100687","DOIUrl":"10.1016/j.lansea.2025.100687","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"42 ","pages":"Article 100687"},"PeriodicalIF":6.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145417967","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":"Characteristics of long term survivors of multiple myeloma after autologous stem cell transplantation: a retrospective analysis from a tertiary care centre in India","authors":"Lalit Kumar , Rajegowda Chethan , Prabhat Singh Malik , Raja Pramanik , Ranjit Sahoo , Ahitagni Biswas , Omdutt Sharma , Ritu Gupta , Atul Sharma , Saumya Ranjan Mallick , AIIMS Myeloma Group","doi":"10.1016/j.lansea.2025.100680","DOIUrl":"10.1016/j.lansea.2025.100680","url":null,"abstract":"<div><h3>Background</h3><div>Outcome of newly diagnosed, transplant eligible, multiple myeloma (MM) patients have improved significantly during the past two decades. A small proportion of patients are long term survivors beyond 10 years. We evaluated clinical and laboratory characteristics of these long term survivors.</div></div><div><h3>Methods</h3><div>Four hundred and thirty eight consecutive MM patients underwent autologous stem cell transplantation (ASCT) between 1995 and 2019. Patients median age was 52 years, (range, 20–73) and 291 (66.4%) were males. 35.3% had ISS stage III disease. 96 (21.9%) patients were long term survivors (LTS), defined as those alive 120 months or more.</div></div><div><h3>Findings</h3><div>Compared to others, LTS patients more frequently had ISS stage I (42% vs 28.5%, p < 0.001), serum albumin ≥3.5 g/dl (72% vs 57%, p < 0.005), platelet count ≥150,000/μL (88% vs 71%, p < 0.001), eGFR ≥40 ml/min (85.4% vs 75%, p < 0.01), and bone marrow plasma cells ≤40% (60% vs 49%, p < 0.03). Transplant within 12 months of diagnosis (73% vs 51.5%, p < 0.001) and in first remission (89.6% vs 71.3%, p < 0.001) were more common in LTS. Post-ASCT response was superior: CR (80% vs 65.5%, p < 0.004), CR + VGPR (94.8% vs 82.5%, p < 0.001). At median follow-up of 115 months, median overall survival was 264 months and progression-free survival 158 months.</div></div><div><h3>Interpretation</h3><div>This study identifies a distinct subgroup of MM patients with long-term survival, characterized by favourable baseline features, early and effective treatment, and deep post-transplant responses, with a median progression-free survival exceeding 13 years.</div></div><div><h3>Funding</h3><div>No funding was received for present study.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"42 ","pages":"Article 100680"},"PeriodicalIF":6.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145417969","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}
Nisaa Wulan , Lekey Khandu , Debra Ten Brink , Gyambo Sithey , Tashi Dendup , Ye Yu Shwe , Anna Bowring , Nick Scott , Kelvin Burke , Rowan Martin-Hughes
{"title":"Establishing HIV transmission pathways in Bhutan: a modelling study","authors":"Nisaa Wulan , Lekey Khandu , Debra Ten Brink , Gyambo Sithey , Tashi Dendup , Ye Yu Shwe , Anna Bowring , Nick Scott , Kelvin Burke , Rowan Martin-Hughes","doi":"10.1016/j.lansea.2025.100676","DOIUrl":"10.1016/j.lansea.2025.100676","url":null,"abstract":"<div><h3>Background</h3><div>There are limited and conflicting data regarding HIV transmission and behavioural risk factors, particularly among groups with increased risk of exposure to HIV in Bhutan. This study aims to explore comprehensive pathways to HIV infections among key populations in Bhutan.</div></div><div><h3>Methods</h3><div>Demographic, epidemiological, and behavioural data were collated to inform an Optima HIV model for Bhutan. The model was calibrated for a period 1990 and 2021 to align with emerging national research into risk attribution of HIV infections and behavioural dynamics of key populations. This was supplemented by qualitative feedback from stakeholder consultations throughout January–June 2022, while maintaining the consistency of the country-accepted output from the 2022 Estimation and Projection Package (EPP-Spectrum model) across all years.</div></div><div><h3>Findings</h3><div>In 2021, sex work was directly associated with 54% of new HIV infections. In total, 86% of new HIV infections were estimated to be among key and vulnerable populations, their direct partners, and their children. HIV prevalence remained low, ranging from 0.7% to 3.1% among key populations. Due to the relatively short duration of risk activity (average of three years among female sex workers [FSW]), only an estimated 9.7% of undiagnosed people living with HIV could be reached through interventions focused on key populations.</div></div><div><h3>Interpretation</h3><div>Greater efforts in developing strategies that can prevent new HIV infections among individuals currently at risk—and identifying undiagnosed HIV infections among those with historic risk who are not currently accessing HIV services—could help achieve the elimination of HIV transmission in Bhutan.</div></div><div><h3>Funding</h3><div>This analysis was funded through The Sustainability of HIV Services for Key Populations in Southeast Asia (SKPA-1) project, funded by the <span>Global Fund to Fight AIDS</span>, <span>Tuberculosis and Malaria under agreement QMZ-H-AFAO</span>, with Health Equity Matters as Principal Recipient. Save the Children is the sub-recipient of SKPA in Bhutan.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"42 ","pages":"Article 100676"},"PeriodicalIF":6.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183447","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}
Bayu Satria Wiratama , Vicka Oktaria , Khoriah Indrihutami , Muhammad Hardhantyo , Ahmad Watsiq Maula , Hanevi Djasri , Rizka Dinari , Muhammad Syairaji , Suwarti , Ariel Pradipta , Dwi Utomo Nusantara , Ardiana Kusumaningrum , Andrew , Marillyn Mariana Tamburian , Ilma Safira Baehaqi , Rebecca Merrill , Henry Surendra , Fetty Wijayanti , Benjamin A. Dahl , Raph L. Hamers
{"title":"Durability of protection of ancestral-strain COVID-19 third- and fourth-dose vaccine boosters against Omicron XBB/XBB.1 and JN.1 symptomatic infection, hospitalisation and mortality in Indonesian adults (2023–2024): a test-negative case–control study","authors":"Bayu Satria Wiratama , Vicka Oktaria , Khoriah Indrihutami , Muhammad Hardhantyo , Ahmad Watsiq Maula , Hanevi Djasri , Rizka Dinari , Muhammad Syairaji , Suwarti , Ariel Pradipta , Dwi Utomo Nusantara , Ardiana Kusumaningrum , Andrew , Marillyn Mariana Tamburian , Ilma Safira Baehaqi , Rebecca Merrill , Henry Surendra , Fetty Wijayanti , Benjamin A. Dahl , Raph L. Hamers","doi":"10.1016/j.lansea.2025.100689","DOIUrl":"10.1016/j.lansea.2025.100689","url":null,"abstract":"<div><h3>Background</h3><div>SARS-CoV-2 ancestral-strain vaccines have effectively reduced SARS-CoV-2-related severe illness and death worldwide. However, waning immunity over time has warranted revaccination to boost immunity. Indonesia, like most low- and middle-income countries, has not provided regular vaccine boosters post-pandemic. This study assessed the longer-term durability of protection from ancestral-strain third- and fourth-dose boosters.</div></div><div><h3>Methods</h3><div>We conducted a test-negative case–control study among symptomatic adults seeking SARS-CoV-2 testing at 14 purposely selected test sites in the major cities of Yogyakarta and Jakarta (March 2023–May 2024). Test-positive individuals were cases and test-negative individuals were controls. SARS-CoV-2 variants were identified using whole genome sequencing. We used multivariable logistic regression to estimate absolute or incremental vaccine effectiveness (VE) against symptomatic infection and COVID-19-related hospitalisation or death, adjusted for main confounders.</div></div><div><h3>Findings</h3><div>Of 2439 participants (median age 35 years, 56.2% female), 388 were cases and 2051 controls. Vaccination with two primary doses, a third-dose or fourth-dose booster did not provide sustained protection against Omicron XBB/JN.1 symptomatic infection up to median 27, 20 or 13 months since administration, respectively. However, there was sustained incremental protection from the third-dose booster (administered median 20 month prior) against hospitalisation (VE 38.3% [95% CI 3.9–60.3]) and death (55.2% [17.7–75.6]) for older individuals (aged >50 years), and against death (55.2% [12.8–76.9]) for individuals with one or more comorbidities. There was also sustained incremental protection from the fourth-dose booster (administered median 13 months prior) against hospitalisation for older individuals (50.2% [10.3–72.3]) and individuals with one or more comorbidities (74.4% [49.2–87.1]).</div></div><div><h3>Interpretation</h3><div>Ancestral-strain vaccine boosters provided durable, moderate protection against severe or fatal outcomes from Omicron XBB/JN.1 infection for older and comorbid individuals. The findings highlight the benefits of improving access to revaccination for vulnerable groups in Indonesia.</div></div><div><h3>Funding</h3><div>US <span>Centers for Diseases Control and Prevention.</span></div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"42 ","pages":"Article 100689"},"PeriodicalIF":6.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466923","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":"A missing piece in Bangladesh's nutrition agenda: indigenous children and adolescents in the Chittagong Hill Tracts","authors":"Satyajit Kundu , Rajat Das Gupta","doi":"10.1016/j.lansea.2025.100685","DOIUrl":"10.1016/j.lansea.2025.100685","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"42 ","pages":"Article 100685"},"PeriodicalIF":6.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145364242","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":"CKDu-AGRI Study—a population-based cross-sectional study of chronic kidney disease and chronic kidney disease of unknown aetiology among agricultural workers in Tamil Nadu, India","authors":"Natarajan Gopalakrishnan , Subramaniam Sudharshini , Ramanathan Sakthirajan , Thanigachalam Dineshkumar , Tanuj Moses Lamech , Anavarathan Somasundaram , Seshadri Jayalakshmi , Uma Maheswari , Sivadoss Raju , Mookaiah Seenivasan , Venkatesh Arumugam , Nandakumar Nachimuthu , Janani Surya , Suliankatchi Abdulkader Rizwan , Vishwanathan Ramasubramaniam , Rajendran Kasirajan Manorajan , Ayyakkannu Indirani Nigazh , Sivaprakasam T. Selvavinayagam","doi":"10.1016/j.lansea.2025.100683","DOIUrl":"10.1016/j.lansea.2025.100683","url":null,"abstract":"<div><h3>Background</h3><div>Chronic kidney disease of unknown cause (CKDu) has been reported in “hotspots” around the world and linked to occupational heat stress, exposure to agrochemicals and environmental toxins. This was a systematic, statewide, population-based, observational study of agricultural workers in Tamil Nadu, to estimate the prevalence of chronic kidney disease (CKD) and CKDu.</div></div><div><h3>Methods</h3><div>The state of Tamil Nadu was divided into five agroclimatic zones and stratified multi-stage cluster sampling was performed to select a representative study population. All participants underwent clinical evaluation and laboratory testing (Phase 1). Repeat sampling was performed after 3 months for all individuals with an eGFR <60 mL/min per 1.73 m<sup>2</sup> during initial sampling (Phase 2).</div></div><div><h3>Findings</h3><div>Among 3350 participants who were screened, the number of participants with eGFR ≤60 mL/min per 1.73 m<sup>2</sup> at the end of Phase 1 and Phase 2 were 584 and 178, respectively. The overall prevalence of CKD was therefore 5.31% (95% CI 4.58–6.13), with the prevalence of CKDu being 2.66% (95% CI 2.14–3.26). The factors that were significantly associated with CKD were increased age, diabetes, hypertension, absence of formal education, anaemia, smokeless tobacco use, and weekly hours of outdoor work. Notably, 406 participants with an eGFR ≤60 mL/min per 1.73 m<sup>2</sup> during Phase 1 had a normal eGFR when re-measured during Phase 2. These episodes of transient subclinical AKI could potentially contribute to CKD.</div></div><div><h3>Interpretation</h3><div>The prevalence of CKD among agricultural workers in Tamil Nadu is 5.31%, with about half of these due to CKDu. The effect of transient subclinical AKI on CKD progression needs further study.</div></div><div><h3>Funding</h3><div><span>Tamil Nadu Health System Reform Program</span>, <span>Department of Health and Family Welfare</span>, <span>Government of Tamil Nadu</span>.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"42 ","pages":"Article 100683"},"PeriodicalIF":6.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145417966","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}
Sandersan Onie , Patrick Berlinquette , Stephanie Onie , Jessica Nilam , Jiemi Ardian , Anna Surti Ariani , Juneman Abraham , Daiane B. Machado , Mark Sinyor , Michelle Torok , Fiona Shand , Mark Larsen
{"title":"Search engine ads for suicide prevention: analysis of engagement from Indonesia relative to Australia, the USA, and the medical industry standards","authors":"Sandersan Onie , Patrick Berlinquette , Stephanie Onie , Jessica Nilam , Jiemi Ardian , Anna Surti Ariani , Juneman Abraham , Daiane B. Machado , Mark Sinyor , Michelle Torok , Fiona Shand , Mark Larsen","doi":"10.1016/j.lansea.2025.100681","DOIUrl":"10.1016/j.lansea.2025.100681","url":null,"abstract":"<div><h3>Background</h3><div>Suicide is a global public health issue, with over 75% of deaths occurring in low- and middle-income countries (LMICs), where access to mental health services is often limited. In Indonesia, where stigma is high and professional support scarce, there is a critical need for scalable, non-traditional approaches to reach individuals at risk. One such approach is using online search engine advertisements to engage individuals searching for suicide-related content and encourage help-seeking.</div></div><div><h3>Methods</h3><div>This study analysed data from an online Google Ads campaign conducted in Indonesia in March 2023, targeting individuals searching for suicide-related keywords. The campaign was co-designed with local experts and people with lived experience. We compared its engagement and cost-effectiveness to similar campaigns previously conducted in the USA and Australia. The primary outcome was total engagement rate (engagements/impressions), and the secondary outcome was effective cost per engagement (adjusted for purchasing power and inflation).</div></div><div><h3>Findings</h3><div>The Indonesian campaign achieved an engagement rate of 11.04%, which was 18 times higher than the US campaign (0.61%) and 15 times higher than the Australian campaign (0.72%). It also had an effective cost per engagement five times lower than those in the USA and Australia. All campaigns outperformed industry standards for health and medical advertising.</div></div><div><h3>Interpretation</h3><div>Search engine advertising is a rapid, cost-effective, and scalable tool to connect individuals in Indonesia with suicide prevention support. These findings underscore the importance of context-specific research in LMICs, where interventions may have greater impact than predicted from high-income country data.</div></div><div><h3>Funding</h3><div>The study was funded by the <span>Australian Department of Foreign Affairs and Trade</span>, <span>Australian-Indonesian Institute</span> (<span><span>AII2020322</span></span>), an <span>NHMRC Investigator Grant</span> (<span><span>GNT2034904</span></span>), <span>Suicide Prevention Australia Innovation Grant</span>, and the <span>Lynch Family Foundation Research Fellowship in Global Health Equity</span>.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"42 ","pages":"Article 100681"},"PeriodicalIF":6.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145270150","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}