Ramya Madhavan , Jackwin Sam Paul , Sudhir Babji , Isai Thamizh , Dilesh Kumar , Shainey Alokit Khakha , Aarene Rennie , Keerthana Kumar , Pavithra Dhanapal , Poornima Saravanan , Ajith Kumar , Sushil Immanuel , Vaishnavi Gandhi , Anand Kumar , Johnson John Babu , Nandu Thrithamarassery Gangadharan , Premkumar Jagadeesan , Elizabeth John , Colin Jamora , Dasaradhi Palakodeti , Jacob John
{"title":"SARS-CoV-2 infections before, during, and after the Omicron wave: a 2-year Indian community cohort study","authors":"Ramya Madhavan , Jackwin Sam Paul , Sudhir Babji , Isai Thamizh , Dilesh Kumar , Shainey Alokit Khakha , Aarene Rennie , Keerthana Kumar , Pavithra Dhanapal , Poornima Saravanan , Ajith Kumar , Sushil Immanuel , Vaishnavi Gandhi , Anand Kumar , Johnson John Babu , Nandu Thrithamarassery Gangadharan , Premkumar Jagadeesan , Elizabeth John , Colin Jamora , Dasaradhi Palakodeti , Jacob John","doi":"10.1016/j.lansea.2024.100470","DOIUrl":"10.1016/j.lansea.2024.100470","url":null,"abstract":"<div><h3>Background</h3><p>We measured the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and re-infections in an adult community-based cohort in southern India.</p></div><div><h3>Methods</h3><p>We conducted a 2-year follow-up on 1229 participants enrolled between May and October 2021. Participants provided vaccination histories, weekly saliva samples, and blood samples at 0, 6, 12, and 24 months. Salivary reverse transcription polymerase chain reaction (RT-PCR) and Meso-Scale Discovery panels were used for SARS-CoV-2 detection and anti-spike, anti-nucleocapsid immunoglobulin G quantification. Whole genome sequencing was performed on a subset of positive samples. SARS-CoV-2 infection incidence was measured across Pre-Omicron (May–December 2021), Omicron-I (December 2021–June 2022), and Omicron-II (July 2022–October 2023) periods.</p></div><div><h3>Findings</h3><p>In total, 1166 (95%) participants with 83% seropositivity at baseline completed the follow-up, providing 2205 person-years of observation. Utilizing both RT-PCR and serology we identified 1306 infections and yielded an incidence rate of 591.3 per 1000 person-years (95% confidence interval, 559.6–624.3), which peaked during Omicron-I at 1418.1 per 1000 person-years (95% confidence interval, 1307.4–1535.6). During Omicron-I and II, neither prior infection nor vaccination conferred protection against infection. Overall, 74% of infections were asymptomatic.</p></div><div><h3>Interpretation</h3><p>Integrated RT-PCR and serology revealed significant SARS-CoV-2 infection frequency, highlighting the prevalence of asymptomatic cases among previously infected or vaccinated individuals. This underscores the effectiveness of combining surveillance strategies when monitoring pandemic trends and confirms the role of non-invasive sampling in ensuring participant compliance, reflecting national transmission patterns.</p></div><div><h3>Funding</h3><p>The study was funded by the <span>Bill and Melinda Gates Foundation</span>.</p></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"28 ","pages":"Article 100470"},"PeriodicalIF":5.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772368224001203/pdfft?md5=c3864fd2aa99a4d9e88e4913505bfa3c&pid=1-s2.0-S2772368224001203-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142021579","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 health benefit package policy interventions on service utilisation under government-funded health insurance in Punjab, India: analysis of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY)","authors":"Shankar Prinja , Jyoti Dixit , Ruby Nimesh , Basant Garg , Rupinder Khurana , Amit Paliwal , Arun Kumar Aggarwal","doi":"10.1016/j.lansea.2024.100462","DOIUrl":"10.1016/j.lansea.2024.100462","url":null,"abstract":"<div><h3>Background</h3><p>The design of health benefits package (HBP), and its associated payment and pricing system, is central to the performance of government-funded health insurance programmes. We evaluated the impact of revision in HBP within India’s <em>Pradhan Mantri Jan Arogya Yojana</em> (PM-JAY) on provider behaviour, manifesting in terms of utilisation of services.</p></div><div><h3>Methods</h3><p>We analysed the data on 1.35 million hospitalisation claims submitted by all the 886 (222 government and 664 private) empanelled hospitals in state of Punjab, from August 2019 to December 2022, to assess the change in utilisation from HBP 1.0 to HBP 2.0. The packages were stratified based on the nature of revision introduced in HBP 2.0, i.e., change in nomenclature, construct, price, or a combination of these. Data from National Health System Cost Database on cost of each of the packages was used to determine the cost-price differential for each package during HBP 1.0 and 2.0 respectively. A dose–response relationship was also evaluated, based on the multiplicity of revision type undertaken, or based on extent of price correction done. Change in the number of monthly claims, and the number of monthly claims per package was computed for each package category using an appropriate seasonal autoregressive integrated moving average (SARIMA) time series model.</p></div><div><h3>Findings</h3><p>Overall, we found that the HBP revision led to a positive impact on utilisation of services. While changes in HBP nomenclature and construct had a positive effect, incorporating price corrections further accentuated the impact. The pricing reforms highly impacted those packages which were originally significantly under-priced. However, we did not find statistically significant dose–response relationship based on extent of price correction. Thirdly, the overall impact of HBP revision was similar in public and private hospitals.</p></div><div><h3>Interpretation</h3><p>Our paper demonstrates the significant positive impact of PM-JAY HBP revisions on utilisation. HBP revisions need to be undertaken with the anticipation of its long-term intended effects.</p></div><div><h3>Funding</h3><p><span>Deutsche Gesellschaft für Internationale Zusammenarbeit</span> (GIZ).</p></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"28 ","pages":"Article 100462"},"PeriodicalIF":5.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772368224001124/pdfft?md5=34e44f2ff7fa3b019fe9b116c38bccf3&pid=1-s2.0-S2772368224001124-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142006728","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}
Biraj Karmacharya , Sujata Sapkota , Prasanna Rai , Charoula Nikolaou , Roshan Kasti , Jyoti Bhattarai , Rashmi Maharjan , Abha Shrestha , Archana Shrestha , Binaya Bhattarai , Anthony R. Leeds , Alasdair McIntosh , Michael E.J. Lean
{"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 , Sujata Sapkota , Prasanna Rai , Charoula Nikolaou , Roshan Kasti , Jyoti Bhattarai , Rashmi Maharjan , Abha Shrestha , Archana Shrestha , Binaya Bhattarai , Anthony R. Leeds , Alasdair McIntosh , 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 (<5 years) aged 30–70 years, BMI ≥23 kg/m<sup>2</sup>, 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/m<sup>2</sup>, 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 <6.5% was recorded for 46%, 48% and 36% and remission of T2D (HbA1c <6.5% off medication >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 , Jayant Goda , 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}
Sanju Bhattarai , Eva Skovlund , Archana Shrestha , Bente Prytz Mjølstad , Bjørn Olav Åsvold , Abhijit Sen
{"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 , Eva Skovlund , Archana Shrestha , Bente Prytz Mjølstad , Bjørn Olav Åsvold , 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":"Uniqueness of lung cancer in Southeast Asia","authors":"Vanita Noronha , Atul Budukh , Pankaj Chaturvedi , Srikanth Anne , Anshu Punjabi , Maheema Bhaskar , Tarini P. Sahoo , Nandini Menon , Minit Shah , Ullas Batra , Shrinidhi Nathany , Rajiv Kumar , Omshree Shetty , Trupti Pai Ghodke , Abhishek Mahajan , Nivedita Chakrabarty , Supriya Hait , Satyendra C. Tripathi , Anuradha Chougule , Pratik Chandrani , 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}