The Lancet regional health. Southeast Asia最新文献

{"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}

{"title":"Bridging the gaps: advancing preconception nutrition in South Asia through evidence, policy, and action","authors":"Faith Miller ,&nbsp;Vani Sethi ,&nbsp;Avishek Hazra ,&nbsp;Danielle Schoenaker ,&nbsp;Ranadip Chowdhury ,&nbsp;Jane Hirst ,&nbsp;Zivai Murira ,&nbsp;Naomi M. Saville","doi":"10.1016/j.lansea.2025.100585","DOIUrl":"10.1016/j.lansea.2025.100585","url":null,"abstract":"<div><div>This paper summarises the research, policy, and program gaps impeding the advancement of preconception nutrition in South Asia. In line with our evidence reviews, qualitative semi-structured interviews with researchers and programme implementers identified gaps in our understanding of the prevalence and burden of preconception malnutrition due to limited survey and programme data, poor coverage of recommended interventions, and gaps in programme knowledge on effective intervention mechanism. Key barriers identified were the lack of evidence linking preconception care with long-term maternal and child health and nutrition outcomes and how to integrate preconception nutrition interventions into national health systems. We highlight the need for evidence-based, context-specific interventions which utilise effective delivery platforms and engage appropriate actors to reach diverse groups of women and men during the preconception period. We, as part of the South Asia Preconception Nutrition Collective, present actionable recommendations to address these gaps.</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 100585"},"PeriodicalIF":5.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937739","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":"Maintaining nutrition as a woman’s right through the life course","authors":"Sapna Desai ,&nbsp;Sabina Faiz Rashid","doi":"10.1016/j.lansea.2025.100587","DOIUrl":"10.1016/j.lansea.2025.100587","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"36 ","pages":"Article 100587"},"PeriodicalIF":5.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143936927","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":"Policies and programmes to improve preconception nutrition in South Asia","authors":"Avishek Hazra ,&nbsp;Tashi Choedon ,&nbsp;Monica Shrivastav ,&nbsp;Raj Kumar Verma ,&nbsp;Cheshta Gulati ,&nbsp;Dhammica Rowel ,&nbsp;Abner Daniel ,&nbsp;Preetu Mishra ,&nbsp;Naveen Paudyal ,&nbsp;Naureen Arshad ,&nbsp;Muhammad Salman ,&nbsp;Wisal Khan ,&nbsp;Khadija Khalif Osman Warfa ,&nbsp;Muhammad Amin ,&nbsp;Ahmadwali Aminee ,&nbsp;Ireen Akhter Chowdhury ,&nbsp;Kinley Dorji ,&nbsp;Indrani Chakma ,&nbsp;Aishath Shahula Ahmed ,&nbsp;Hari Prasad Pokhrel ,&nbsp;Vani Sethi","doi":"10.1016/j.lansea.2025.100589","DOIUrl":"10.1016/j.lansea.2025.100589","url":null,"abstract":"<div><div>The health and health behaviours of women before conception significantly influence maternal and child health outcomes. Despite growing evidence supporting preconception nutrition care, data on the implementation of related policies and programmes remains limited. This paper reviews public policies and programmes delivering preconception nutrition interventions in eight South Asian countries, targeting married pre-pregnant women aged 15–49 years and identifies the systems bottlenecks in programme implementation. Most countries, except Sri Lanka, lack universal programmes for health and nutrition screening, provision of essential micronutrients, counselling on healthy eating and treatment for at-risk women. Even in countries, where supportive policies exist, implementation of comprehensive nutrition services for pre-pregnant women faces significant bottlenecks across six health system building blocks. Addressing these barriers is critical to improving intervention effectiveness, programme implementation, and informed decision-making. Further testing of a proposed comprehensive algorithm for preconception nutrition in diverse country contexts across South Asia is necessary.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"36 ","pages":"Article 100589"},"PeriodicalIF":5.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937740","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":"Modeling the initial impact and predicted future benefits of TCV from two Pakistani provinces","authors":"Alicia N.M. Kraay ,&nbsp;Mohammad T. Yousafzai ,&nbsp;Sonia Qureshi ,&nbsp;Jillian Gauld ,&nbsp;Farah N. Qamar","doi":"10.1016/j.lansea.2025.100581","DOIUrl":"10.1016/j.lansea.2025.100581","url":null,"abstract":"<div><h3>Background</h3><div>While trials have demonstrated high efficacy of typhoid conjugate vaccine (TCV), data on effectiveness are limited. We report initial impacts and predict future benefits of TCV from two provinces in Pakistan.</div></div><div><h3>Methods</h3><div>We used blood culture-confirmed typhoid cases from the Surveillance for Enteric Fever in Asia Project (SEAP) and Impact assessment of Typhoid conjugate vaccine following a catch-up campaign and introduction in Routine Immunization Program of Pakistan (ITRIPP) to estimate the population-level impact of vaccination (2018–2023). We used regression models to estimate initial impacts and an agent-based model to predict future benefits.</div></div><div><h3>Findings</h3><div>In Sindh, typhoid incidence was higher and cases occurred in younger children compared with Punjab. TCV reduced incidence by 48.9% in Sindh (95% CI: 47.3–50.3%) and 66.2% in Punjab (95% CI: 64.7%, 67.6%) over the first 2 years after vaccine rollout but declined each year. In Sindh, waning was quicker and models predicted that population incidence would stabilize near pre-vaccine levels in 2024. An additional campaign could provide short-term, but not long-term, benefits. In contrast, in Punjab, incidence is projected to remain low for several years, and the catch-up campaign with routine immunization at 9 months of age may be sufficient. However, follow up data from Punjab are needed to better characterize waning immunity.</div></div><div><h3>Interpretation</h3><div>TCV has reduced incidence in Pakistan, but protection varies by site. Routine immunization at 9 months of age along with a catch-up campaign may be sufficient to control incidence in settings with moderate transmission. However, in settings with particularly high incidence and/or short duration of protection, alternative strategies to reduce the force of infection may be needed.</div></div><div><h3>Funding</h3><div><span>Bill &amp; Melinda Gates Foundation</span>.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"36 ","pages":"Article 100581"},"PeriodicalIF":5.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143879094","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":"Within-laboratory SARS-CoV-2 real time PCR testing operations in Nepal: a simulation-based analysis","authors":"Fannie L. Côté ,&nbsp;Nadia Lahrichi ,&nbsp;Erica Gralla ,&nbsp;Hannah Bakker ,&nbsp;Parvathy Krishnan Krishnakumari ,&nbsp;Joaquim Gromicho ,&nbsp;Arunkumar Govindakarnavar ,&nbsp;Runa Jha ,&nbsp;Lilee Shrestha ,&nbsp;Nirajan Bhusal ,&nbsp;Saugat Shrestha ,&nbsp;Rashmi Mulmi ,&nbsp;Priya Jha ,&nbsp;Reuben Samuel ,&nbsp;Dhamari Naidoo ,&nbsp;Victor J. del Rio Vilas","doi":"10.1016/j.lansea.2025.100584","DOIUrl":"10.1016/j.lansea.2025.100584","url":null,"abstract":"<div><h3>Background</h3><div>COVID-19 has challenged entire health systems, including laboratories. To address the increasing demand for tests to inform the epidemiology of the disease and for case management purposes, many countries made significant investments to rapidly expand laboratory capacity for detecting SARS-CoV-2. In this study, we used a simulated laboratory environment, based on a model of operating laboratories in Nepal, to identify opportunities for improvement.</div></div><div><h3>Methods</h3><div>We developed a discrete event simulation (DES) model, based on data from and in collaboration with Nepali health authorities, to analyse laboratory operations in Nepal. We used a series of “what-if” scenarios under different levels of testing demand and staffing to investigate bottlenecks in the processing of COVID-19 samples in a simulated laboratory environment, assess the impact of potential reagent shortages and increased automation, and more generally, explore the key factors that drive the performance and resilience of the testing system.</div></div><div><h3>Findings</h3><div>Suboptimal staff allocation and scheduling can limit the timely return of laboratory results; however, better staff allocation can mitigate bottlenecks and reduce the impact of reagent shortages. For example, when the demand is 720 samples per day and seven staff members are on duty, adding one additional staff member improves reporting time (reduction from 48 h to approximately 32 h). However, changes in scheduling can increase the average time to return the results to over 200 h. A one-day reagent shortage appears to have minimal impact, but a delay of five days significantly increases the reporting time, reaching nearly 150 h. Increasing automation or better process coordination for sample registration can also lead to better performance, reducing the average reporting time from over 60 h to just under 24 h.</div></div><div><h3>Interpretation</h3><div>Our findings identify important bottlenecks and challenges, along with ways to address them, and thus provide important lessons for improving disease testing operations for this and future pandemics.</div></div><div><h3>Funding</h3><div><span>WHO Special Programme for Research and Training in Tropical Diseases (TDR)</span>.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"36 ","pages":"Article 100584"},"PeriodicalIF":5.0,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143874409","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}