The Lancet regional health. Southeast Asia最新文献

{"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 , Denise A. O'Connor , Ilana N. Ackerman , Ganesh Dangal , Surya Prasad Rimal , Pabitra Rai , Rachelle Buchbinder","doi":"10.1016/j.lansea.2025.100599","DOIUrl":"10.1016/j.lansea.2025.100599","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Findings</h3><div>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.</div></div><div><h3>Interpretation</h3><div>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.</div></div><div><h3>Funding</h3><div>Monash International Postgraduate Research Scholarship and Monash Graduate Scholarship.</div></","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}

{"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}

{"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}

{"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}

{"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}

{"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}

{"title":"Optimizing pre-conception care in South Asia","authors":"Zulfiqar A. Bhutta ,&nbsp;Nadia Diamond-Smith ,&nbsp;Prabhat Lamichhane","doi":"10.1016/j.lansea.2025.100586","DOIUrl":"10.1016/j.lansea.2025.100586","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"36 ","pages":"Article 100586"},"PeriodicalIF":5.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143936926","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":"Preconception malnutrition among women and girls in south Asia: prevalence, determinants, and association with pregnancy and birth outcomes","authors":"Faith Miller ,&nbsp;Vani Sethi ,&nbsp;Danielle Schoenaker ,&nbsp;Ranadip Chowdhury ,&nbsp;Raj Kumar Verma ,&nbsp;Jane Hirst ,&nbsp;Manisha Nair ,&nbsp;Chiara Benedetto ,&nbsp;Usha Sriram ,&nbsp;Zivai Murira ,&nbsp;Naomi M. Saville","doi":"10.1016/j.lansea.2025.100573","DOIUrl":"10.1016/j.lansea.2025.100573","url":null,"abstract":"<div><div>This review highlights the growing double burden of malnutrition among women of reproductive age in South Asia. Using nationally-representative survey data, we highlight that the prevalence of overweight now exceeds that of underweight, while anaemia remains persistently high despite intervention efforts. Underweight and anaemia are more common among unmarried women, whereas overweight is more prevalent among parous women, underscoring the need for life-stage-specific preconception nutrition programs. In our systematic review, micronutrient deficiencies vary widely between and within countries, reflecting regional disparities in nutritional status and inconsistencies in diagnostic methods. Associations of preconception underweight, overweight, anaemia and micronutrient deficiencies with health, nutrition, socio-demographic, and WASH indicators are mixed, emphasising the need for tailored, context-specific interventions. The lack of longitudinal studies limits our understanding of associations between preconception nutritional status and subsequent birth outcomes, underscoring the need for comprehensive, longitudinal studies across South Asia to inform and monitor targeted nutrition programs.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"36 ","pages":"Article 100573"},"PeriodicalIF":5.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937736","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":"Nutrition during preconception: laying the foundation","authors":"The Lancet Regional Health – Southeast Asia","doi":"10.1016/j.lansea.2025.100596","DOIUrl":"10.1016/j.lansea.2025.100596","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"36 ","pages":"Article 100596"},"PeriodicalIF":5.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937737","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":"Effects of preconception nutrition interventions on pregnancy and birth outcomes in South Asia: a systematic review","authors":"Naomi M. Saville ,&nbsp;Sophiya Dulal ,&nbsp;Faith Miller ,&nbsp;Danielle Schoenaker ,&nbsp;Ranadip Chowdhury ,&nbsp;Avishek Hazra ,&nbsp;Jane Hirst ,&nbsp;Zivai Murira ,&nbsp;Vani Sethi","doi":"10.1016/j.lansea.2025.100580","DOIUrl":"10.1016/j.lansea.2025.100580","url":null,"abstract":"<div><div>Undernutrition amongst reproductive age women, low birth weight, small for gestational age and preterm birth present significant health burdens in South Asia which interventions in pregnancy alone have not resolved. Effectiveness of preconception nutrition interventions is not well-documented. This systematic review summarises evidence on the effect of preconception nutrition interventions on pregnancy and birth outcomes in South Asia. We found highly heterogeneous evidence across four micronutrient supplementation, two food supplementation, and three complex interventions trials. Preconception micronutrient supplementation alone did not affect birth size, but food supplementation was effective with and without multiple micronutrients, especially when initiated at least 90 days before conception. Combined health, nutrition, psychosocial care, and WaSH interventions addressing determinants at multiple levels were most effective. However intensive delivery by project employees poses problems for scale-up. More robust South Asian preconception intervention trials to identify scalable interventions that are effective in real-world delivery settings are needed.</div></div><div><h3>Funding</h3><div><span>UNICEF Regional Office for South Asia</span> contract number 43384734.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"36 ","pages":"Article 100580"},"PeriodicalIF":5.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937738","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}