Bulletin of the World Health Organization最新文献

{"title":"Helping people to die.","authors":"","doi":"10.2471/BLT.24.020924","DOIUrl":"https://doi.org/10.2471/BLT.24.020924","url":null,"abstract":"<p><p>As an increasing number of jurisdictions legalize assisted dying, attention is focusing on palliative care clinicians' role in service delivery. Gary Humphreys reports.</p>","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"102 9","pages":"626-627"},"PeriodicalIF":8.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11362692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug-resistant tuberculosis treatments, the case for a phase III platform trial.","authors":"Tom A Yates, Samara Barnes, Martin Dedicoat, Onn Min Kon, Heinke Kunst, Marc Lipman, Kerry A Millington, Andrew J Nunn, Patrick Pj Phillips, Jessica L Potter, S Bertel Squire","doi":"10.2471/BLT.23.290948","DOIUrl":"10.2471/BLT.23.290948","url":null,"abstract":"<p><p>Most phase III trials in drug-resistant tuberculosis have either been underpowered to quantify differences in microbiological endpoints or have taken up to a decade to complete. Composite primary endpoints, dominated by differences in treatment discontinuation and regimen changes, may mask important differences in treatment failure and relapse. Although new regimens for drug-resistant tuberculosis appear very effective, resistance to new drugs is emerging rapidly. There is a need for shorter, safer and more tolerable regimens, including those active against bedaquiline-resistant tuberculosis. Transitioning from multiple regimen A versus regimen B trials to a single large phase III platform trial would accelerate the acquisition of robust estimates of relative efficacy and safety. Further efficiencies could be achieved by adopting modern adaptive platform designs. Collaboration among trialists, affected community representatives, funders and regulators is essential for developing such a phase III platform trial for drug-resistant tuberculosis treatment regimens.</p>","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"102 9","pages":"657-664"},"PeriodicalIF":8.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11362690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142117039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 vaccination campaigns in fragile and conflict-affected settings, Somalia.","authors":"Muhammad Farid, Abdulrazak Ibrahim, Hamayoun Mohammad, Quamrul Hassan, Mohamed Abdullahi Omar, Mohamed Abdulrahman Ismael, Abdifatah Mohamed Shidane, Mohamed Farah Mohamud, Mukhtar Shube, Mustafe Awil Jama, Patience Musanhu, Rehan Hafiz, Sk Md Mamunur Rahman Malik","doi":"10.2471/BLT.23.291105","DOIUrl":"10.2471/BLT.23.291105","url":null,"abstract":"<p><strong>Problem: </strong>By 31 December 2021, only 5.5% (861 879/15 670 530) of the Somali population had been fully vaccinated against coronavirus disease 2019 (COVID-19).</p><p><strong>Approach: </strong>To rapidly increase COVID-19 vaccine coverage in 2022, the health ministry and its partners (World Health Organization and United Nations Children's Fund) adopted a more responsive strategy. This strategy included careful microplanning, better targeting of populations and providing people-centred vaccination services close to their homes. These services were combined with childhood vaccination and basic health-care provision using the existing polio network and community health workers. Additionally, a digital tool for recording COVID-19 vaccination data and a mobile phone-based electronic registration system were introduced.</p><p><strong>Local setting: </strong>Somalia, a fragile and conflict-affected state, faced challenges when implementing COVID-19 vaccination, including inexperience in managing mass adult vaccination, inadequate infrastructure and health workforce. Furthermore, insecurity in some areas and severe drought resulted in large-scale displacement of people.</p><p><strong>Relevant changes: </strong>The implementation of a more context-specific strategy helped Somalia reach substantially more people with COVID-19 vaccination and 42.1% coverage by 31 December 2022. Additionally, 84 600 zero-dose children received their first childhood vaccine during the integrated campaigns. The increased coverage has led to public health benefits that outweigh the investment in the COVID-19 vaccination campaigns.</p><p><strong>Lessons learnt: </strong>Successful roll-out of adult vaccination is achievable even in a fragile and conflict-affected setting through implementation of a tailored contextualized approach. Key factors include good microplanning, use of digital tools, better population-targeting, bundling vaccines together and delivering vaccination services close to people's homes.</p>","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"102 9","pages":"674-680"},"PeriodicalIF":8.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11362698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Home visits versus fixed-site care by community health workers and child survival: a cluster-randomized trial, Mali.","authors":"Jenny Liu, Emily Treleaven, Caroline Whidden, Saibou Doumbia, Naimatou Kone, Amadou Beydi Cisse, Aly Diop, Mohamed Berthé, Mahamadou Guindo, Brahima Mamadou Koné, Michael P Fay, Ari D Johnson, Kassoum Kayentao","doi":"10.2471/BLT.23.290975","DOIUrl":"10.2471/BLT.23.290975","url":null,"abstract":"<p><strong>Objective: </strong>To test the effect of proactive home visits by trained community health workers (CHWs) on child survival.</p><p><strong>Methods: </strong>We conducted a two arm, parallel, unmasked cluster-randomized trial in 137 village-clusters in rural Mali. From February 2017 to January 2020, 31 761 children enrolled at the trial start or at birth. Village-clusters received either primary care services by CHWs providing regular home visits (intervention) or by CHWs providing care at a fixed site (control). In both arms, user fees were removed and primary health centres received staffing and infrastructure improvements before trial start. Using lifetime birth histories from women aged 15-49 years surveyed annually, we estimated incidence rate ratios (IRR) for intention-to-treat and per-protocol effects on under-five mortality using Poisson regression models.</p><p><strong>Findings: </strong>Over three years, we observed 52 970 person-years (27 332 in intervention arm; 25 638 in control arm). During the trial, 909 children in the intervention arm and 827 children in the control arm died. The under-five mortality rate declined from 142.8 (95% CI: 133.3-152.9) to 56.7 (95% CI: 48.5-66.4) deaths per 1000 live births in the intervention arm; and from 154.3 (95% CI: 144.3-164.9) to 54.9 (95% CI: 45.2-64.5) deaths per 1000 live births in the control arm. Intention-to-treat (IRR: 1.02; 95% CI: 0.88-1.19) and per-protocol estimates (IRR: 1.01; 95% CI: 0.87-1.18) showed no difference between study arms.</p><p><strong>Conclusion: </strong>Though proactive home visits did not reduce under-five mortality, system-strengthening measures may have contributed to the decline in under-five mortality in both arms.</p>","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"102 9","pages":"639-649"},"PeriodicalIF":8.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11362699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alka Dwivedi: developing a cancer therapy for all.","authors":"","doi":"10.2471/BLT.24.030924","DOIUrl":"10.2471/BLT.24.030924","url":null,"abstract":"<p><p>Alka Dwivedi talks to Gary Humphreys about developing a new form of CAR T-cell therapy in collaboration with clinicians with a view to improving treatment outcomes and lowering costs.</p>","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"102 9","pages":"628-629"},"PeriodicalIF":8.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11362696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of two survey methods for estimating unplanned pregnancy, Bangladesh.","authors":"Md Nuruzzaman Khan, Shimlin Jahan Khanam, Melissa L Harris","doi":"10.2471/BLT.23.290262","DOIUrl":"10.2471/BLT.23.290262","url":null,"abstract":"<p><strong>Objective: </strong>To compare the prevalence of unintended pregnancy measured by the Demographic and Health Survey (DHS) and the London Measure of Unplanned Pregnancy in Bangladesh, and explore the extent of discordance between the measures and the factors associated with the discordance.</p><p><strong>Methods: </strong>In 2023, we conducted a cross-sectional survey in four randomly selected districts in Bangladesh: Kurigram, Mymensingh, Pabna and Satkhira. We randomly selected 20 hospitals, five from each district. We collected data from 1200 women who had recently delivered a baby and were visiting the hospitals for postnatal care. We interviewed the women about their pregnancy intention in their last pregnancy using questions in the DHS and the London Measure of Unplanned Pregnancy and examined the discordance in their responses. We used multivariable logistic regression analysis to identify factors associated with discordant responses in reported pregnancy intention.</p><p><strong>Findings: </strong>The prevalence of unintended pregnancy was 24.3% (292/1200) using the DHS measure and 31.0% (373/1200) using the London Measure of Unplanned Pregnancy. Discordance in responses to pregnancy intention between the two measures was 27.1% (325/1200). Factors associated with discordance were older age, female sex of the last child born, having more than two children, being in a poorer wealth quintile, living in a rural area and living in Kurigram district.</p><p><strong>Conclusion: </strong>The prevalence of unintended pregnancy in Bangladesh measured by the DHS measure may be an underestimate, suggesting that the adverse effects of unintended pregnancy are greater than realized and emphasizing the need to bolster Bangladesh's family planning programme.</p>","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"102 8","pages":"562-570"},"PeriodicalIF":8.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11276160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Water and sanitation in urban India.","authors":"","doi":"10.2471/BLT.24.020824","DOIUrl":"https://doi.org/10.2471/BLT.24.020824","url":null,"abstract":"<p><p>Two of the world's biggest sanitation initiatives are approaching their 10-year anniversaries, offering insights into challenges faced worldwide. Gary Humphreys reports.</p>","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"102 8","pages":"558-559"},"PeriodicalIF":8.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11276156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What's needed to achieve zero leprosy.","authors":"Yohei Sasakawa","doi":"10.2471/BLT.24.292037","DOIUrl":"10.2471/BLT.24.292037","url":null,"abstract":"","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"102 8","pages":"554-554A"},"PeriodicalIF":8.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11276162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring access to essential medicines in the sustainable development goals.","authors":"Kristina Jenei, Veronika J Wirtz","doi":"10.2471/BLT.24.291399","DOIUrl":"10.2471/BLT.24.291399","url":null,"abstract":"","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"102 8","pages":"555-555A"},"PeriodicalIF":8.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11276153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New WHO classification of genetic variants causing G6PD deficiency.","authors":"Lucio Luzzatto, Germana Bancone, Pierre-Antoine Dugué, Weiying Jiang, Angelo Minucci, Caterina Nannelli, Daniel Pfeffer, Josef Prchal, Mahmoud Sirdah, Olugbemiro Sodeinde, Tom Vulliamy, Wanchai Wanachiwanawin, Jane Cunningham, Andrea Bosman","doi":"10.2471/BLT.23.291224","DOIUrl":"10.2471/BLT.23.291224","url":null,"abstract":"","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"102 8","pages":"615-617"},"PeriodicalIF":8.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11276151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}