The Lancet regional health. Southeast Asia最新文献

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Zoonotic disease outbreaks reported under India's Integrated Disease Surveillance Programme, 2018–2023: a cross-sectional analysis of national surveillance data 2018-2023年印度疾病综合监测规划报告的人畜共患疾病暴发:国家监测数据的横断面分析
IF 5
The Lancet regional health. Southeast Asia Pub Date : 2025-05-20 DOI: 10.1016/j.lansea.2025.100601
Mogan Kaviprawin , Mohankumar Raju , Manikandanesan Sakthivel , Archana Ramalingam
{"title":"Zoonotic disease outbreaks reported under India's Integrated Disease Surveillance Programme, 2018–2023: a cross-sectional analysis of national surveillance data","authors":"Mogan Kaviprawin ,&nbsp;Mohankumar Raju ,&nbsp;Manikandanesan Sakthivel ,&nbsp;Archana Ramalingam","doi":"10.1016/j.lansea.2025.100601","DOIUrl":"10.1016/j.lansea.2025.100601","url":null,"abstract":"<div><h3>Background</h3><div>Timely analysis of zoonotic outbreak surveillance data is critical for assessing the effectiveness of outbreak detection and reporting systems, a priority for global health security. We described the zoonotic disease outbreaks notified under the Integrated Disease Surveillance Program (IDSP) in India between 2018 and 2023 to identify temporal trends and spatial variation.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional study by reviewing zoonotic disease outbreak line-list data from IDSP weekly outbreak reports and analyzed by year, region, and timeliness of reporting. We conducted a mixed Poisson regression to estimate the change (β coefficient) in outbreaks over the years and visualized maps in R software.</div></div><div><h3>Findings</h3><div>Of the 6948 outbreaks reported in IDSP, 583 (8.3%) were zoonotic, with a median of seven monthly zoonotic outbreaks. Outbreaks significantly increased over the years (β coefficient = 0.07 [0.02–0.12]). Japanese encephalitis accounted for 29.5% of zoonotic outbreaks, followed by leptospirosis (18.7%) and scrub typhus (13.9%). The northeast region contributed 35.8% of zoonotic disease outbreaks, followed by the southern (31.7%) and western regions (15.4%). One-third (34.6%) of outbreaks were reported late, and they declined over the years (52.6% in 2019, 40.9% in 2021, and 5.2% in 2023). The follow-up reports were unavailable for 97.2% of zoonotic outbreaks notified.</div></div><div><h3>Interpretation</h3><div>We documented the regions with high notification of zoonotic disease outbreaks under India's national-level outbreak surveillance system. Critical gaps in weekly outbreak reports were identified, particularly the lack of follow-up documentation. To address these gaps, we recommend strengthening disease-specific surveillance systems in hotspot regions.</div></div><div><h3>Funding</h3><div>The present study is non-funded.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"37 ","pages":"Article 100601"},"PeriodicalIF":5.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089387","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}
引用次数: 0
Addressing influenza in Bangladesh: closing evidence and policy gaps with strategic interventions 解决孟加拉国流感问题:通过战略干预措施缩小证据和政策差距
IF 5
The Lancet regional health. Southeast Asia Pub Date : 2025-05-19 DOI: 10.1016/j.lansea.2025.100592
Md Zakiul Hassan , Saleh Haider , Mohammad Abdul Aleem , Md Ariful Islam , Tanzir Ahmed Shuvo , Saju Bhuiya , Mahbubur Rahman , Mahmudur Rahman , Tahmina Shirin , Fahmida Chowdhury
{"title":"Addressing influenza in Bangladesh: closing evidence and policy gaps with strategic interventions","authors":"Md Zakiul Hassan ,&nbsp;Saleh Haider ,&nbsp;Mohammad Abdul Aleem ,&nbsp;Md Ariful Islam ,&nbsp;Tanzir Ahmed Shuvo ,&nbsp;Saju Bhuiya ,&nbsp;Mahbubur Rahman ,&nbsp;Mahmudur Rahman ,&nbsp;Tahmina Shirin ,&nbsp;Fahmida Chowdhury","doi":"10.1016/j.lansea.2025.100592","DOIUrl":"10.1016/j.lansea.2025.100592","url":null,"abstract":"<div><div>Since the establishment of the National Influenza Surveillance Program in 2007, Bangladesh has significantly progressed in monitoring influenza through national and international collaboration. However, this collaboration has not been translated into actionable control policies, which coupled with low vaccination coverage, impose a substantial health and economic burden in Bangladesh. Critical gaps remain in understanding the influenza burden among high-risk populations and the barriers influencing their vaccine uptake. These gaps hinder the development of evidence-based strategies for prevention and control, consequently leaving the country vulnerable to a potentially catastrophic influenza epidemic. These challenges require a multifaceted approach, including continuous local data collection on disease burden and vaccine barriers, vaccine cost-effectiveness analyses, and the design of context-specific interventions. Leveraging existing infrastructures offers opportunities to develop tailored strategies for high-risk populations. A robust national influenza policy is imperative to mitigate the burden and reduce future pandemic threats.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"37 ","pages":"Article 100592"},"PeriodicalIF":5.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144084259","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}
引用次数: 0
Clinical challenges, controversies, and regional strategies in snakebite care in India 印度蛇咬伤护理的临床挑战、争议和区域策略
IF 5
The Lancet regional health. Southeast Asia Pub Date : 2025-05-15 DOI: 10.1016/j.lansea.2025.100598
Siju V. Abraham , Deo Mathew , Aravind Sreekumar , Akhil V. George , Vijay Chanchal , Purushothaman Kuzhikkathu Kandiyil , Punchalil Chathappan Rajeev , Udaya Bhaskaran Valuvil , Jayesh Kumar , Kuruvath Bahuleyan Mohan , Joe Thomas , Manu Ayyan , Sandeep Das , Freston Marc Sirur , Indira Madhavan , Aboobacker Mohamed Rafi , Pradeoth Korambayil Mukundan , Kartik Sunagar , Vimal Krishnan S , Babu Urumese Palatty
{"title":"Clinical challenges, controversies, and regional strategies in snakebite care in India","authors":"Siju V. Abraham ,&nbsp;Deo Mathew ,&nbsp;Aravind Sreekumar ,&nbsp;Akhil V. George ,&nbsp;Vijay Chanchal ,&nbsp;Purushothaman Kuzhikkathu Kandiyil ,&nbsp;Punchalil Chathappan Rajeev ,&nbsp;Udaya Bhaskaran Valuvil ,&nbsp;Jayesh Kumar ,&nbsp;Kuruvath Bahuleyan Mohan ,&nbsp;Joe Thomas ,&nbsp;Manu Ayyan ,&nbsp;Sandeep Das ,&nbsp;Freston Marc Sirur ,&nbsp;Indira Madhavan ,&nbsp;Aboobacker Mohamed Rafi ,&nbsp;Pradeoth Korambayil Mukundan ,&nbsp;Kartik Sunagar ,&nbsp;Vimal Krishnan S ,&nbsp;Babu Urumese Palatty","doi":"10.1016/j.lansea.2025.100598","DOIUrl":"10.1016/j.lansea.2025.100598","url":null,"abstract":"<div><div>Snakebite envenomation remains a significant public health issue, particularly in southeast Asia, where diverse venomous snake species and resource-limited healthcare settings complicate effective management. This Health Policy employed thematic analysis of a panel discussion involving multidisciplinary experts with over 300 years of combined experience. Four key themes were identified: (i) the evolution of snakebite treatment paradigms, (ii) clinical and procedural challenges, (iii) debates over controversial practices, and (iv) the role of policy and research in improving outcomes. The findings emphasise the need for region-specific antivenoms, enhanced peripheral healthcare capabilities, and evidence-based treatment protocols. This work provides actionable insights to inform health policy, guide targeted training initiatives, and prioritise research on neglected areas in the management of snakebite.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"37 ","pages":"Article 100598"},"PeriodicalIF":5.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144068203","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}
引用次数: 0
Clinician and policymaker perspectives on the barriers and enablers to implementing and scaling up integrated postpartum intrauterine contraceptive services within maternity care in Nepal: a qualitative study 临床医生和政策制定者对尼泊尔产科护理中实施和扩大综合产后宫内避孕服务的障碍和促进因素的看法:一项定性研究
IF 5
The Lancet regional health. Southeast Asia Pub Date : 2025-05-14 DOI: 10.1016/j.lansea.2025.100599
Pramila Rai , Denise A. O'Connor , Ilana N. Ackerman , Ganesh Dangal , Surya Prasad Rimal , Pabitra Rai , Rachelle Buchbinder
{"title":"Clinician and policymaker perspectives on the barriers and enablers to implementing and scaling up integrated postpartum intrauterine contraceptive services within maternity care in Nepal: a qualitative study","authors":"Pramila Rai ,&nbsp;Denise A. O'Connor ,&nbsp;Ilana N. Ackerman ,&nbsp;Ganesh Dangal ,&nbsp;Surya Prasad Rimal ,&nbsp;Pabitra Rai ,&nbsp;Rachelle Buchbinder","doi":"10.1016/j.lansea.2025.100599","DOIUrl":"10.1016/j.lansea.2025.100599","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Integrating postpartum family planning services within maternity care, specifically counselling about family planning and postpartum intrauterine contraceptive device (PPIUCD) insertion, may help reduce unintended pregnancies and related complications. This study explored factors affecting the implementation and scale-up of integration of these services within maternity care in Nepal from the perspectives of healthcare providers and policymakers.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;For this qualitative study, we conducted in-depth, semi-structured interviews remotely with healthcare providers and policymakers across all seven provinces of the Nepali maternal healthcare sector until theme saturation was achieved. Potentially eligible participants were invited through publicly available e-mail addresses, personal contacts, snowball sampling, and social media advertisements. Respondents were assessed for eligibility and subsequently recruited. The Consolidated Framework for Implementation Research and Theoretical Domains Framework guided our inquiry and analysis. We transcribed the interviews verbatim, translated the transcripts into English and analysed them using thematic analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Based on 26 interviews, we identified five major barrier themes relating to care recipients, healthcare providers, health facilities and the health system. The themes included: (i) the perceived inadequate awareness and low desire for PPIUCDs among care recipients, (ii) PPIUCD-specific issues, (iii) inadequate capacity and capability to deliver the services, (iv) inadequate investment and priority, and (v) contextual factors such as pelvic inflammatory diseases and hygiene considerations. Some contrasting views were reported between healthcare providers and policy participants. Policy participants emphasised insufficient efforts by healthcare providers to provide counselling and PPIUCD, while healthcare providers identified PPIUCD-related issues (e.g., complexity of the insertion procedure) as a significant barrier hindering their efforts. Both healthcare providers and policy participants identified inadequate investment in and priority on integrating postpartum contraceptive services, including PPIUCD, as another important factor. Participants indicated that there is an urgent need to implement effective integrated counselling and contraception services.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;Greater investment is needed to address multilevel barriers to implementing and scaling up integrated postpartum family planning services, particularly PPIUCD insertion within maternity services in Nepal. Priority should be given to health education for care recipients and the community, capacity building (ensuring care providers are capable), and upgrading of health facilities.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Funding&lt;/h3&gt;&lt;div&gt;Monash International Postgraduate Research Scholarship and Monash Graduate Scholarship.&lt;/div&gt;&lt;/","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"37 ","pages":"Article 100599"},"PeriodicalIF":5.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143942282","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}
引用次数: 0
Risk stratified treatment for childhood acute lymphoblastic leukaemia: a multicentre observational study from India 儿童急性淋巴细胞白血病的风险分层治疗:来自印度的一项多中心观察性研究
IF 5
The Lancet regional health. Southeast Asia Pub Date : 2025-05-13 DOI: 10.1016/j.lansea.2025.100593
Manash Pratim Gogoi , Parag Das , Nandana Das , Soumyadeep Das , Gaurav Narula , Amita Trehan , Sameer Bakhshi , Venkatraman Radhakrishnan , Rachna Seth , Prashant Tembhare , Man Updesh Singh Sachdeva , Anita Chopra , Shirley Sundersingh , Mayur Parihar , Rahul Bhattacharya , Shripad Banavali , Vaskar Saha , Shekhar Krishnan
{"title":"Risk stratified treatment for childhood acute lymphoblastic leukaemia: a multicentre observational study from India","authors":"Manash Pratim Gogoi ,&nbsp;Parag Das ,&nbsp;Nandana Das ,&nbsp;Soumyadeep Das ,&nbsp;Gaurav Narula ,&nbsp;Amita Trehan ,&nbsp;Sameer Bakhshi ,&nbsp;Venkatraman Radhakrishnan ,&nbsp;Rachna Seth ,&nbsp;Prashant Tembhare ,&nbsp;Man Updesh Singh Sachdeva ,&nbsp;Anita Chopra ,&nbsp;Shirley Sundersingh ,&nbsp;Mayur Parihar ,&nbsp;Rahul Bhattacharya ,&nbsp;Shripad Banavali ,&nbsp;Vaskar Saha ,&nbsp;Shekhar Krishnan","doi":"10.1016/j.lansea.2025.100593","DOIUrl":"10.1016/j.lansea.2025.100593","url":null,"abstract":"<div><h3>Background</h3><div>Overall survival rates of children with acute lymphoblastic leukaemia (ALL) in high-income countries approach 90%. Treated on the same protocols, outcomes in India, were ∼65%.</div></div><div><h3>Methods</h3><div>The Indian Childhood Collaborative Leukaemia (ICiCLe) group used genetics and measurable residual disease (MRD) to categorise B-cell precursor (BCP) ALL as standard (SR), intermediate (IR) and high-risk (HR) to receive increasing intensity of therapy. T-ALL were treated uniformly. Data on risk stratification, deaths and relapses were collected annually.</div></div><div><h3>Findings</h3><div>2695 patients aged 1–18 years were enrolled between January 2013 and May 2018. Induction deaths were significantly lower in SR patients (p = 0·002) compared to others. At a median 61 (59–62) months, the 4-year event free and overall survival was 76% (72–79%) and 88% (85–90%) in SR; 70% (66–74%) and 80% (77–83%) in IR; 61% (51–64%) and 73% (70–76%) in HR; and 69% (62–75%) and 77% (70–83%) in T-ALL patients (p &lt; 0·0001). For BCP-ALL, regression analyses showed age, white cell count, bulky disease, high risk genetics and treating centre as independent prognostic variables. The cumulative incidence of treatment deaths (TRD) and relapses at centres varied from 2% (1–5) to 13% (10–17) (p ≤ 0·0001); and 21% (17–26) to 45% (39–51) (p ≤ 0·0001) respectively with significant differences in proportion of BCP-ALL patients with MRD ≥ 0·01% (p = 0·0007) and time to relapse (p = 0·0001).</div></div><div><h3>Interpretation</h3><div>Risk stratified directed reduced intensity treatment and collaboration decreases treatment deaths and relapses. Standardisation of genetic and MRD tests across centres and access to high quality drugs will lead to further improvements in survival.</div></div><div><h3>Funding</h3><div><span>DBT-Wellcome</span>; <span>UKIERI</span>, <span>TCS Foundation</span>.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"37 ","pages":"Article 100593"},"PeriodicalIF":5.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143934669","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}
引用次数: 0
Scaling up childhood epilepsy management: lessons from India's school health program 扩大儿童癫痫管理:来自印度学校卫生项目的经验教训
IF 5
The Lancet regional health. Southeast Asia Pub Date : 2025-05-07 DOI: 10.1016/j.lansea.2025.100591
Sulena Sulena , Gagandeep Singh , Preeti Padda , Marami Das , Shikha Jain , Jitendra Kumar Sahu , Hobinder Arora
{"title":"Scaling up childhood epilepsy management: lessons from India's school health program","authors":"Sulena Sulena ,&nbsp;Gagandeep Singh ,&nbsp;Preeti Padda ,&nbsp;Marami Das ,&nbsp;Shikha Jain ,&nbsp;Jitendra Kumar Sahu ,&nbsp;Hobinder Arora","doi":"10.1016/j.lansea.2025.100591","DOIUrl":"10.1016/j.lansea.2025.100591","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"37 ","pages":"Article 100591"},"PeriodicalIF":5.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143916593","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}
引用次数: 0
Distribution of government health financing benefits among women who delivered in public institutions in Bangladesh: a nationally representative cross-sectional study 孟加拉国在公共机构分娩的妇女中政府保健筹资福利的分配:一项具有全国代表性的横断面研究
IF 5
The Lancet regional health. Southeast Asia Pub Date : 2025-05-03 DOI: 10.1016/j.lansea.2025.100590
Md. Abdur Rafi , Urby Saraf Anika , Dewan Tasnia Azad , Shafiun Nahin Shimul , Mohammad Jahid Hasan , Md. Golam Hossain
{"title":"Distribution of government health financing benefits among women who delivered in public institutions in Bangladesh: a nationally representative cross-sectional study","authors":"Md. Abdur Rafi ,&nbsp;Urby Saraf Anika ,&nbsp;Dewan Tasnia Azad ,&nbsp;Shafiun Nahin Shimul ,&nbsp;Mohammad Jahid Hasan ,&nbsp;Md. Golam Hossain","doi":"10.1016/j.lansea.2025.100590","DOIUrl":"10.1016/j.lansea.2025.100590","url":null,"abstract":"<div><h3>Background</h3><div>Equitable access to institutional delivery care is crucial for reducing maternal mortality. Although Bangladesh has made progress in this regard, significant challenges persist in achieving equitable access to institutional delivery care, particularly for economically disadvantaged populations. The objective of this study was to investigate the distribution of public health financing benefits among women who delivered in public facilities in Bangladesh.</div></div><div><h3>Methods</h3><div>This study was conducted based on the data from the Bangladesh Demographic and Health Survey (BDHS) 2022, which includes a sample of 3360 women (age 15–49 years) who had a history of institutional delivery during two years preceding the survey. Descriptive and econometric analyses, including Benefit Incidence Analysis (BIA), Concentration Curves (CC), and Concentration Indices (CIX), were employed to assess the distribution of public subsidies for delivery care among different socio-economic groups. Socioeconomic inequality in utilisation of delivery care services was evaluated using concentration curves, while BIA estimated the distribution of public healthcare benefits across wealth quintiles. Logistic regression was used to determine the factors associated with distress financing—whether the household of the women had to sell their assets or had to resort of borrowing to avail services.</div></div><div><h3>Findings</h3><div>Among the poorest quintile, 38% utilised public facilities, compared to 17% of the women with highest income. The concentration curve for public facility use indicated a pro-poor distribution (CIX −0.031). BIA revealed that the poorest quintile received 24.5% of public subsidies, whereas the wealthiest quintile received 13.7%. However, in tertiary care facilities and for caesarean delivery, the wealthiest group benefitted the most, receiving 23.5% and 26% of the subsidies, respectively. Odds of distress financing was significantly higher among women from poorer or poorest households compared to the richest group (aOR 4.35, 95% CI 3.16–6.03 for poorest and aOR 2.74, 95% CI 2.00–3.77 for poorer).</div></div><div><h3>Interpretation</h3><div>Public health subsidies in Bangladesh equitably benefit women with lower income, though inequities remain, particularly in tertiary care facilities and for caesarean deliveries. Despite this, women with lower income are more vulnerable to distress financing for delivery care.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"37 ","pages":"Article 100590"},"PeriodicalIF":5.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143899646","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}
引用次数: 0
Nepal’s mental health system from public health perspective: a thematic synthesis based on health system building blocks 从公共卫生角度看尼泊尔的精神卫生系统:基于卫生系统构建模块的专题综合
IF 5
The Lancet regional health. Southeast Asia Pub Date : 2025-05-01 DOI: 10.1016/j.lansea.2025.100588
Shishir Paudel , Anisha Chalise , Dhurba Khatri , Sujan Poudel , Aagya Khanal
{"title":"Nepal’s mental health system from public health perspective: a thematic synthesis based on health system building blocks","authors":"Shishir Paudel ,&nbsp;Anisha Chalise ,&nbsp;Dhurba Khatri ,&nbsp;Sujan Poudel ,&nbsp;Aagya Khanal","doi":"10.1016/j.lansea.2025.100588","DOIUrl":"10.1016/j.lansea.2025.100588","url":null,"abstract":"<div><div>This study evaluates Nepal’s mental health system through the World Health Organization’s six building blocks: governance, financing, workforce, service delivery, essential medicines, and information systems. Despite policy advances toward integrating mental health services within primary care, significant challenges persist, including governance fragmentation, workforce shortages, insufficient funding, inconsistent availability of essential psychotropic medications, and a weak health information infrastructure. Federalization has introduced both opportunities and challenges for mental health governance across the different tiers of government. Stigma, resource constraints, and limited coordination further hinder service accessibility. This study identifies actionable priorities, including strengthening workforce capacity, expanding community-based services, enhancing inter-sectoral collaboration, and improving access to essential medicines. Addressing these issues through targeted policies and increased funding is crucial to build a more equitable and effective mental health system in Nepal, capable of addressing the rising burden of mental health disorders.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"36 ","pages":"Article 100588"},"PeriodicalIF":5.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143888194","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}
引用次数: 0
Cost-effectiveness of maintaining an active hospital microbiology laboratory service in Timor-Leste 在东帝汶维持活跃的医院微生物实验室服务的成本效益
IF 5
The Lancet regional health. Southeast Asia Pub Date : 2025-05-01 DOI: 10.1016/j.lansea.2025.100582
Cherry Lim , Myo Maung Maung Swe , Angela Devine , Tessa Oakley , Karen Champlin , Pyae Sone OO , Nevio Sarmento , Ismael Da Costa Barreto , Rodney C. Givney , Jennifer Yan , Joshua R. Francis , Ben S. Cooper
{"title":"Cost-effectiveness of maintaining an active hospital microbiology laboratory service in Timor-Leste","authors":"Cherry Lim ,&nbsp;Myo Maung Maung Swe ,&nbsp;Angela Devine ,&nbsp;Tessa Oakley ,&nbsp;Karen Champlin ,&nbsp;Pyae Sone OO ,&nbsp;Nevio Sarmento ,&nbsp;Ismael Da Costa Barreto ,&nbsp;Rodney C. Givney ,&nbsp;Jennifer Yan ,&nbsp;Joshua R. Francis ,&nbsp;Ben S. Cooper","doi":"10.1016/j.lansea.2025.100582","DOIUrl":"10.1016/j.lansea.2025.100582","url":null,"abstract":"<div><h3>Background</h3><div>Maintaining an active hospital microbiology laboratory allows definitive antibiotic treatment for bacterial infections to be given in a timely manner. This would be expected to improve patient outcomes and shorten length of hospital stay. However, many hospitals in low- and middle-income countries lack access to microbiology services, and the cost-effectiveness of an active microbiology service is unknown.</div></div><div><h3>Methods</h3><div>We constructed a decision tree model and performed a cost-effectiveness analysis to determine whether maintaining an active microbiology laboratory service would be cost-effective in Timor-Leste, a lower middle-income country. The model was informed by local microbiology data, local patient treatment costs, results of an expert elicitation exercise and data from literature reviews.</div></div><div><h3>Findings</h3><div>Compared with no active microbiology laboratory, average patient care costs would be reduced by $165,469 (IQR: $134,834–200,902) for every 1000 hospitalised patients with suspected bloodstream infection. Maintaining an active microbiology laboratory was estimated to reduce deaths by between 34 and 51 per 1000 hospitalised patients. Similar results were found under various one-way sensitivity analyses. Accordingly, our results indicate that there is a high probability that maintaining an active microbiology laboratory is a cost-effective intervention that would both improve patient outcomes and reduce net costs (due to reduced intensive care admissions) compared to no microbiological testing, especially for the hospitalised paediatric patients with suspected primary bacteraemia.</div></div><div><h3>Interpretation</h3><div>Our findings indicate that investment in the maintenance and expansion of local diagnostic capacity is likely to be cost-effective in resource-limited settings.</div></div><div><h3>Funding</h3><div>This project is funded by the <span>Department of Health and Social Care</span> (DHSC)'s Fleming Fund using UK aid.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"36 ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143888195","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}
引用次数: 0
Optimizing pre-conception care in South Asia 优化南亚的孕前护理
IF 5
The Lancet regional health. Southeast Asia Pub Date : 2025-05-01 DOI: 10.1016/j.lansea.2025.100586
Zulfiqar A. Bhutta , Nadia Diamond-Smith , Prabhat Lamichhane
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