The Lancet regional health. Southeast Asia最新文献

{"title":"A service evaluation of weight management for glycaemic control and remission of type 2 diabetes using traditional food in Nepal (Ho-DIRECT NEPAL): a single-arm trial","authors":"Biraj Karmacharya ,&nbsp;Sujata Sapkota ,&nbsp;Prasanna Rai ,&nbsp;Charoula Nikolaou ,&nbsp;Roshan Kasti ,&nbsp;Jyoti Bhattarai ,&nbsp;Rashmi Maharjan ,&nbsp;Abha Shrestha ,&nbsp;Archana Shrestha ,&nbsp;Binaya Bhattarai ,&nbsp;Anthony R. Leeds ,&nbsp;Alasdair McIntosh ,&nbsp;Michael E.J. Lean","doi":"10.1016/j.lansea.2024.100465","DOIUrl":"10.1016/j.lansea.2024.100465","url":null,"abstract":"<div><h3>Background</h3><p>Remission of early type 2 diabetes (T2D) is possible; however, diet programmes proven effective are unaffordable in many southeast Asian populations where T2D is more frequent and more aggressive at lower body weight and younger age. We evaluate an entirely food-based service.</p></div><div><h3>Methods</h3><p>This study employed a single-arm intervention and follow-up design for intervention evaluation in existing hospital people with T2D of under 5 years known duration. Individuals attending a diabetes clinic in Kathmandu with early T2D (&lt;5 years) aged 30–70 years, BMI ≥23 kg/m², were offered a low-cost nutritionally complete diet-programme, using traditional Nepali foods to provide 8-weeks ∼850 kcal/day weight loss induction, and then weight maintenance. The participants received 4-weekly dietetic appointments (30–45 min) and verbo-pictorial leaflets using household measures. Glucose-lowering medications (49/70 at baseline) were stopped at baseline or soon after. The study was registered as ISRCTN10671396, testing a traditional food-based intervention for weight loss and T2D remission.</p></div><div><h3>Findings</h3><p>For 70 individuals (45 female) invited between March 19, 2022 and September 19, 2023, baseline mean (SD) age was 48.6 (9.9) years, bodyweight 74.6 (9.5) kg, BMI 29.7 (3.6) kg/m², known diabetes duration 2.5 (1.9) years, HbA1c on treatment 8.1 (1.6) %. At 12, 24 and 52 weeks respectively, evaluating n = 44, 46, 45, bodyweight was 70.1 (8.5), 69.8 (8.9), 70.0 (8.8) kg, HbA1c 6.8 (0.9), 6.9 (1.5), 7.1 (1.3) %; HbA1c &lt;6.5% was recorded for 46%, 48% and 36% and remission of T2D (HbA1c &lt;6.5% off medication &gt;3 months) in 43%, 39% and 29%. The main reported adherence barriers were fears of weakness, hunger, and inconvenience during travel. Incentives were ease of the diet, reduced doses and costs of medications, and improved appearance.</p></div><div><h3>Interpretation</h3><p>Traditional food-based weight management can valuably improve control, reduce medication needs, and generate remissions of established T2D, but adherence barriers must be overcome to optimise outcomes.</p></div><div><h3>Funding</h3><p><span>All Saints Educational Trust</span>, England.</p></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"29 ","pages":"Article 100465"},"PeriodicalIF":5.0,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S277236822400115X/pdfft?md5=c24df53c6de2b6e97499bde5004ee94a&pid=1-s2.0-S277236822400115X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141998306","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":"Drug development in LMICs: could the emerging Indian model usher the southeast Asian region?","authors":"Bharat Pant ,&nbsp;Jayant Goda ,&nbsp;Vikram Gota","doi":"10.1016/j.lansea.2024.100464","DOIUrl":"10.1016/j.lansea.2024.100464","url":null,"abstract":"<div><p>Low-income and middle-income countries (LMICs) of southeast Asia are passing through a similar phase as India in their tryst with the development of novel drugs. They are beginning to break away from their dependency on the institutions of our developed world. Over the past few years, Tata Memorial Centre—India's premier cancer centre—has shown the tenacity to develop drugs within the national frontiers. By collaborating with the domestic pharmaceutical industries, it has been able to have a steady pipeline of drugs under development, with two of them receiving marketing authorization recently. Lately, Indonesia and Vietnam have also shown an inclination towards public-private partnerships for similar motives. However, due to prolonged innovative stagnation, the entire drug development machinery faces challenges stretching all the way from arranging funds to persuading regulatory bodies. In this Viewpoint, we have tried to address a few of those issues and their potential solutions, with the intention to share our own experience which might be useful to other LMICs in connecting some adamant dots.</p></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"29 ","pages":"Article 100464"},"PeriodicalIF":5.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772368224001148/pdfft?md5=014550b5a314b34e13043cee606cd304&pid=1-s2.0-S2772368224001148-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141992590","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":"Empowering communities: implementing a COPD self-management program in Nepal","authors":"Saroj Adhikari ,&nbsp;Bhuvan Saud ,&nbsp;Pravin Kumar Yadav","doi":"10.1016/j.lansea.2024.100469","DOIUrl":"10.1016/j.lansea.2024.100469","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"29 ","pages":"Article 100469"},"PeriodicalIF":5.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772368224001197/pdfft?md5=c68902eca41c62391d4160231ebc2821&pid=1-s2.0-S2772368224001197-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141992589","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":"Impact of a community health worker led intervention for improved blood pressure control in urban Nepal: an open-label cluster randomised controlled trial","authors":"Sanju Bhattarai ,&nbsp;Eva Skovlund ,&nbsp;Archana Shrestha ,&nbsp;Bente Prytz Mjølstad ,&nbsp;Bjørn Olav Åsvold ,&nbsp;Abhijit Sen","doi":"10.1016/j.lansea.2024.100461","DOIUrl":"10.1016/j.lansea.2024.100461","url":null,"abstract":"<div><h3>Background</h3><p>Effective control of hypertension remains challenging in low and middle-income countries. We tested the effectiveness of comprehensive approaches to hypertension management including six home visits by community health workers with regular follow up by a trained healthcare provider on blood pressure levels in Nepal.</p></div><div><h3>Methods</h3><p>We implemented a non-blinded, open-label, parallel-group, two-arm cluster randomised controlled trial, with 1:1 allocation ratio in Budhanilakantha municipality, Kathmandu, Nepal. Ten public health facilities and their catchment area were randomly allocated to receive comprehensive intervention or only usual hypertension care. We recruited 1252 individuals aged 18 years and older with hypertension. The primary outcome was systolic blood pressure. Secondary outcomes were diastolic blood pressure, proportion with controlled blood pressure, waist to hip ratio, body mass index, physical activity, diet quality score, daily salt intake, adherence to antihypertensives, hypertension knowledge and perceived social support. Primary analysis was by intention-to-treat using a linear mixed model.</p></div><div><h3>Findings</h3><p>Participants were, on average 57 years old, 60% females, 84% married, 54% Brahmin/Chettri ethnicity and 33% were illiterate. The decrease in mean systolic blood pressure (1.7 mm Hg, 95% CI −0.1, 3.4) and diastolic blood pressure (1.6 mm Hg, 95% CI 0.5, 2.6) was more in the intervention arm compared to the control. The proportion with blood pressure control (OR 1.5 95% CI 1.0, 2.1) and engaging in adequate physical activity (≥600 Metabolic equivalents of task per week) (OR 2.2, 95% CI 1.6, 3.1) were higher in the intervention arm compared to control. The change in hypertension knowledge score was higher and daily salt intake was lower in the intervention arm compared to control. Waist to hip ratio increased more and global dietary requirement scores decreased more in the intervention group and there was no effect on the body mass index and adherence to antihypertensives.</p></div><div><h3>Interpretation</h3><p>Community health workers facilitated home support and routine follow-up care by healthcare providers was effective in controlling blood pressure in urban Nepal. These findings suggest comprehensive interventions targeting individual, community and health system barriers are feasible in low resource settings, but larger implementation trials are needed to inform future scale-up.</p></div><div><h3>Funding</h3><p>This work was supported by <span>Norwegian University of Science and Technology</span>, Trondheim, Norway (Project number 981023100).</p></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"29 ","pages":"Article 100461"},"PeriodicalIF":5.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772368224001112/pdfft?md5=4e5a2ddf1ee35d40ccf2ece03b3979d9&pid=1-s2.0-S2772368224001112-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141953081","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":"Metabolic syndrome among marginalised school-going adolescents: a call for clarity","authors":"Ajeet Singh Bhadoria ,&nbsp;Archisman Mohapatra ,&nbsp;Vineet Kumar Pathak ,&nbsp;Mohan Kumar","doi":"10.1016/j.lansea.2024.100458","DOIUrl":"10.1016/j.lansea.2024.100458","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"29 ","pages":"Article 100458"},"PeriodicalIF":5.0,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772368224001082/pdfft?md5=60f4e0686ea9906c23c833b52d509ef8&pid=1-s2.0-S2772368224001082-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141949810","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":"Addressing health inequities in Southeast Asia: challenges and opportunities","authors":"Natarajan Sisubalan ,&nbsp;Bhagavathi Sundaram Sivamaruthi ,&nbsp;Periyanaina Kesika ,&nbsp;Chaiyavat Chaiyasut","doi":"10.1016/j.lansea.2024.100455","DOIUrl":"10.1016/j.lansea.2024.100455","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"28 ","pages":"Article 100455"},"PeriodicalIF":5.0,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772368224001057/pdfft?md5=999fb776431bd3ca750832461079fb70&pid=1-s2.0-S2772368224001057-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961613","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":"Uniqueness of lung cancer in Southeast Asia","authors":"Vanita Noronha ,&nbsp;Atul Budukh ,&nbsp;Pankaj Chaturvedi ,&nbsp;Srikanth Anne ,&nbsp;Anshu Punjabi ,&nbsp;Maheema Bhaskar ,&nbsp;Tarini P. Sahoo ,&nbsp;Nandini Menon ,&nbsp;Minit Shah ,&nbsp;Ullas Batra ,&nbsp;Shrinidhi Nathany ,&nbsp;Rajiv Kumar ,&nbsp;Omshree Shetty ,&nbsp;Trupti Pai Ghodke ,&nbsp;Abhishek Mahajan ,&nbsp;Nivedita Chakrabarty ,&nbsp;Supriya Hait ,&nbsp;Satyendra C. Tripathi ,&nbsp;Anuradha Chougule ,&nbsp;Pratik Chandrani ,&nbsp;Kumar Prabhash","doi":"10.1016/j.lansea.2024.100430","DOIUrl":"10.1016/j.lansea.2024.100430","url":null,"abstract":"<div><p>Lung cancer varies between Caucasians and Asians. There have been differences recorded in the epidemiology, genomics, standard therapies and outcomes, with variations according to the geography and ethnicity which affect the decision for optimal treatment of the patients. To better understand the profile of lung cancer in Southeast Asia, with a focus on India, we have comprehensively reviewed the available data, and discuss the challenges and the way forward. A substantial proportion of patients with lung cancer in Southeast Asia are neversmokers, and adenocarcinoma is the common histopathologic subtype, found in approximately a third of the patients. <em>EGFR</em> mutations are noted in 23–30% of patients, and <em>ALK</em> rearrangements are noted in 5–7%. Therapies are similar to global standards, although access to newer modalities and molecules is a challenge. Collaborative research, political will with various policy changes and patient advocacy are urgently needed.</p></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"27 ","pages":"Article 100430"},"PeriodicalIF":5.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772368224000805/pdfft?md5=e1a7cdce2e63c2597732016a9ec5d32e&pid=1-s2.0-S2772368224000805-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141694923","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":"Patient advocacy and support groups in India: focus on lung cancer","authors":"Vanita Noronha ,&nbsp;Vandana Mahajan ,&nbsp;Ravi Prakash ,&nbsp;Sanjeev Sharma ,&nbsp;Kumar Prabhash","doi":"10.1016/j.lansea.2024.100429","DOIUrl":"10.1016/j.lansea.2024.100429","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"27 ","pages":"Article 100429"},"PeriodicalIF":5.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772368224000799/pdfft?md5=f0b9bab521b6a1f04f215e65682c887e&pid=1-s2.0-S2772368224000799-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141703887","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":"Rabies control in Bangladesh and prediction of human rabies cases by 2030: a One Health approach","authors":"Sumon Ghosh ,&nbsp;Mohammad Nayeem Hasan ,&nbsp;Nirmalendu Deb Nath ,&nbsp;Najmul Haider ,&nbsp;Daleniece Higgins Jones ,&nbsp;Md. Kamrul Islam ,&nbsp;M. Mujibur Rahaman ,&nbsp;Hasan Sayedul Mursalin ,&nbsp;Nadim Mahmud ,&nbsp;Md. Kamruzzaman ,&nbsp;Md. Fazlay Rabby ,&nbsp;Shotabdi Kar ,&nbsp;Sayed Mohammed Ullah ,&nbsp;Md. Rashed Ali Shah ,&nbsp;Afsana Akter Jahan ,&nbsp;Md. Sohel Rana ,&nbsp;Sukanta Chowdhury ,&nbsp;Md. Jamal Uddin ,&nbsp;Thankam S. Sunil ,&nbsp;Be-Nazir Ahmed ,&nbsp;Md. Nazmul Islam","doi":"10.1016/j.lansea.2024.100452","DOIUrl":"10.1016/j.lansea.2024.100452","url":null,"abstract":"<div><h3>Background</h3><p>Bangladesh is making progress toward achieving zero dog-mediated rabies deaths by 2030, a global goal set in 2015.</p></div><div><h3>Methods</h3><p>Drawing from multiple datasets, including patient immunisation record books and mass dog vaccination (MDV) databases, we conducted a comprehensive analysis between 2011 and 2023 to understand the effectiveness of rabies control programmes and predict human rabies cases in Bangladesh by 2030 using time-series forecasting models. We also compared rabies virus sequences from GenBank in Bangladesh and other South Asian countries.</p></div><div><h3>Findings</h3><p>The estimated dog population in Bangladesh was determined to be 1,668,140, with an average dog population density of 12.83 dogs/km² (95% CI 11.14–14.53) and a human-to-dog ratio of 86.70 (95% CI 76.60–96.80). The MDV campaign has led to the vaccination of an average of 21,295 dogs (95% CI 18,654–23,935) per district annually out of an estimated 26,065 dogs (95% CI 22,898–29,230). A declining trend in predicted and observed human rabies cases has been identified, suggesting that Bangladesh is poised to make substantial progress towards achieving the ‘Zero by 30’ goal, provided the current trajectory continues. The phylogenetic analysis shows that rabies viruses in Bangladesh belong to the Arctic-like-1 group, which differs from those in Bhutan despite sharing a common ancestor.</p></div><div><h3>Interpretation</h3><p>Bangladesh's One Health approach demonstrated that an increase in MDV and anti-rabies vaccine (ARV) resulted in a decline in the relative risk of human rabies cases, indicating that eliminating dog-mediated human rabies could be achievable.</p></div><div><h3>Funding</h3><p>The study was supported by the <span>Communicable Disease Control</span> (CDC) Division of the <span>Directorate General of Health Services</span> (DGHS) of the People's Republic of Bangladesh.</p></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"27 ","pages":"Article 100452"},"PeriodicalIF":5.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772368224001021/pdfft?md5=01bd8e5471b75251dc72c5c660f802b6&pid=1-s2.0-S2772368224001021-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141949909","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":"Time to bring patients to the core of care","authors":"The Lancet Regional Health – Southeast Asia","doi":"10.1016/j.lansea.2024.100459","DOIUrl":"10.1016/j.lansea.2024.100459","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"27 ","pages":"Article 100459"},"PeriodicalIF":5.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772368224001094/pdfft?md5=656334310ddd74bd2d7bcdf1dc32c005&pid=1-s2.0-S2772368224001094-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141953359","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}