The Lancet Regional Health: Western Pacific最新文献

{"title":"Clinical decision rules for diagnosis of Streptococcus pyogenes sore throat in Fiji: a prospective diagnostic accuracy study","authors":"John D. Hart ,&nbsp;Jimaima Kailawadoko ,&nbsp;Tria Williams ,&nbsp;Jyotishna Mani ,&nbsp;Ilikena Malo ,&nbsp;Tuliana Cua ,&nbsp;Natalie Caltabiano ,&nbsp;Jasmyn Voss ,&nbsp;Kristy Azzopardi ,&nbsp;Matthew G. Parnaby ,&nbsp;Sanjeshni Autar ,&nbsp;Komal Chand ,&nbsp;Lavenia Lagilagi ,&nbsp;Jessica Paka ,&nbsp;Eric Rafai ,&nbsp;Joseph Kado ,&nbsp;Hannah Frost ,&nbsp;Andrew C. Steer","doi":"10.1016/j.lanwpc.2025.101763","DOIUrl":"10.1016/j.lanwpc.2025.101763","url":null,"abstract":"<div><h3>Background</h3><div>Acute rheumatic fever is an immune-mediated condition triggered by <em>Streptococcus pyogenes</em> sore throat and possibly skin infection, with a substantial burden in resource-limited settings. Clinical decision rules (CDRs) are commonly used to guide antibiotic treatment of sore throat based on signs and symptoms, but their diagnostic accuracy varies by study and setting. This work aimed to assess the accuracy of multiple CDRs in Fiji to diagnose <em>S. pyogenes</em> sore throat.</div></div><div><h3>Methods</h3><div>We conducted a prospective diagnostic accuracy study at two primary healthcare centres in Suva, Fiji, enrolling children aged 5–15 years presenting with sore throat. Clinical features were assessed, and two throat swabs were collected from each participant for <em>S. pyogenes</em> detection using culture and a point-of-care nucleic acid amplification test (NAAT). Six CDRs were evaluated against NAAT and culture as reference standards.</div></div><div><h3>Findings</h3><div>Of 250 participants, <em>S. pyogenes</em> was detected among 31.7% (95% CI: 26.0–37.9) by NAAT and 10.4% (95% CI: 7.6–15.8) by culture. The Fiji CDR demonstrated high sensitivity (98.7%, 95% CI: 93.1–100 vs. NAAT; 100%, 95% CI: 86.8–100 vs. culture) but very low specificity (4.7% (95% CI: 2.1–9.1) vs. NAAT; 4.0% (95% CI: 1.9–7.5) vs. culture). All CDRs had poor discriminatory power (area under receiver operating characteristic curve: 0.48–0.55).</div></div><div><h3>Interpretation</h3><div>CDRs cannot accurately diagnose <em>S. pyogenes</em> sore throat in this tropical setting where rheumatic fever is common. There appears to be a high burden of <em>S. pyogenes</em> sore throat in Fiji, apparently underestimated when traditional culture-based methods are used. Although NAAT testing offers higher sensitivity than culture, the costs remain high. There is an urgent need for accurate, affordable diagnostics to guide sore throat management in resource-limited settings.</div></div><div><h3>Funding</h3><div>This project was funded by a <span>New Zealand Aid Programme grant</span>, awarded to <span>Cure Kids</span> (NZ research charity). Funds covered all costs pertaining to the study, including research personnel, data collection, patient recruitment and analysis.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101763"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building AI readiness for health in Southeast Asia","authors":"Mengji Chen ,&nbsp;Clive Tan ,&nbsp;Muhamad Noor Alfarizal Kamarudin ,&nbsp;Vivek Jason Jayaraj ,&nbsp;Premikha M ,&nbsp;Muhammad Taufeeq Wahab ,&nbsp;Anthony Li ,&nbsp;Kidong Park","doi":"10.1016/j.lanwpc.2025.101762","DOIUrl":"10.1016/j.lanwpc.2025.101762","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101762"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early performance of a decentralised, primary-care hepatitis C programme in Cambodia: a retrospective programme evaluation, 2024","authors":"Chansovannara Soputhy ,&nbsp;Florian Girond ,&nbsp;Samley Keo ,&nbsp;Kolveasna Kim ,&nbsp;Luis Sagaon-Teyssier ,&nbsp;Capucine Penicaud ,&nbsp;Sovann Ly ,&nbsp;Emilie Mosnier","doi":"10.1016/j.lanwpc.2025.101758","DOIUrl":"10.1016/j.lanwpc.2025.101758","url":null,"abstract":"<div><h3>Background</h3><div>Real-world evidence on decentralised, primary-care delivery for hepatitis C virus (HCV) in the Western Pacific is limited. We evaluated Cambodia's national, primary care–led HCV programme in 2024.</div></div><div><h3>Methods</h3><div>We analysed facility-level data from 256 health facilities in 15 operational districts to assess six HCV cascade steps: screening, anti-HCV positivity, RNA testing, viraemia, treatment initiation, and treatment completion. Design-based survey estimators were used to estimate proportions with 95% confidence intervals (CIs). To account for multi-stage design (clustering within operational districts), design-based generalised linear models were utilised to assess the factors associated with viraemia, treatment initiation and completion.</div></div><div><h3>Findings</h3><div>HCV testing coverage among adults (≥18 years; denominator 2,196,351) was 3·5% (95% CI 2·5–4·4). Of 76,512 adults tested, 3213 (4·2%; 95% CI 3·1–5·6) were anti-HCV-positive; 2628/3213 (81·8%) received RNA testing, and 1446/2628 (55·0%; 95% CI 49·5–60·3) were viraemic (1·9% of all tested). Among RNA-positive individuals, 1345/1446 (93·0%) initiated direct-acting antivirals and 1289/1345 (95·8%) completed treatment. Viraemia was higher among men (adjusted odds ratio [aOR] 1·40; 95% CI 1·05–1·86), varied by province (Takeo aOR 2·79, Kampong Cham aOR 2·11 versus Battambang), and elevated in October–December (Q4; aOR 1·79) versus January–March. Treatment initiation and completion surpassed 90% across facilities. The principal gap was confirmatory testing (18·2% of anti-HCV-positive individuals lacked RNA testing).</div></div><div><h3>Interpretation</h3><div>A decentralised, primary-care model achieved high linkage and treatment completion in the first year. Closing the confirmatory testing gap (reflex RNA/core antigen from same encounter), prioritising low-coverage/high-burden districts, and establishing patient-level linkage to capture sustained virologic response at week 12 are priorities to accelerate elimination.</div></div><div><h3>Funding</h3><div><span>ANRS MIE</span> (<span><span>ANRS0689b</span></span>).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101758"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heterogeneous determinants of falling birth rates in the Western Pacific","authors":"The Lancet Regional Health – Western Pacific","doi":"10.1016/j.lanwpc.2025.101785","DOIUrl":"10.1016/j.lanwpc.2025.101785","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101785"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leveraging managed access with life-cycle reassessment in Asia-Pacific: advancing the learning of health system matters for innovative medicines in oncology","authors":"Yuanshi Jiao ,&nbsp;Zonglin Dai ,&nbsp;Jiangnan Zhu ,&nbsp;Manuel A. Espinoza ,&nbsp;Xue Li","doi":"10.1016/j.lanwpc.2025.101769","DOIUrl":"10.1016/j.lanwpc.2025.101769","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101769"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socio-economic inequality underpins inequity in influenza vaccination uptake between public and private secondary schools: an Australian population-based study","authors":"Huong Le ,&nbsp;Christopher C. Blyth ,&nbsp;Clement Schlegel ,&nbsp;Jo-Anne Morgan ,&nbsp;Francis Mitrou ,&nbsp;Ha Nguyen ,&nbsp;Rachel Foong ,&nbsp;Samantha Carlson ,&nbsp;Catherine Hughes ,&nbsp;Bette Liu ,&nbsp;Hannah C. Moore","doi":"10.1016/j.lanwpc.2025.101761","DOIUrl":"10.1016/j.lanwpc.2025.101761","url":null,"abstract":"<div><h3>Background</h3><div>Socio-economic inequality and vaccination inequity have long been critical issues. However, no studies have explored the gap in influenza vaccination uptake between public and private schools. Importantly, the extent to which socio-economic inequality translates into vaccination uptake inequity has not been quantified. We investigate influenza vaccination uptake among school-aged Australian children in 2023, compare uptake between public and private schools, and assess the role of socio-economic inequality in vaccination uptake inequity.</div></div><div><h3>Methods</h3><div>We analysed whole-of-population linked immunisation, census, and administrative data. Multivariable logistic regression was used to identify key uptake predictors, and the Oaxaca-Blinder decomposition was used to identify factors driving uptake inequity between public and private schools.</div></div><div><h3>Findings</h3><div>Of 9.5 million influenza vaccination doses administered, only 0.7 million (7%) were given to school-aged children (5–&lt;18 years), who represent 16% of the population. Coverage among school-aged children was low. Secondary school-aged children had the lowest uptake, with a significant gap between public and private schools. Children in private secondary schools, who demonstrate greater socio-economic advantage, had higher uptake than their public peers (unadjusted OR = 1.47; 95% CI: 1.45–1.57). Two-thirds of the uptake gap is driven by differences in cultural, linguistic, and socio-economic characteristics, with parental education, parental income, and socio-economic characteristics of residential area being the strongest contributors.</div></div><div><h3>Interpretation</h3><div>Addressing socio-economic inequality among parents could reduce vaccination uptake inequity for children. Future influenza vaccination campaigns should consider tailored strategies for specific cultural, linguistic, and socio-economic groups.</div></div><div><h3>Funding</h3><div><span>Wesfarmers Centre of Vaccines and Infectious Diseases</span>; <span>Western Australian’s Future Health Research and Innovation Fund</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101761"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Women's health and female fertility: current evidence and knowledge gaps in the Asia–Pacific region","authors":"Jiaxi Yang ,&nbsp;Wei Wei Pang ,&nbsp;Guoqi Yu ,&nbsp;Juliana Antero ,&nbsp;Ling-Jun Li ,&nbsp;Zhongwei Huang ,&nbsp;Cuilin Zhang","doi":"10.1016/j.lanwpc.2025.101710","DOIUrl":"10.1016/j.lanwpc.2025.101710","url":null,"abstract":"<div><div>In the face of declining global birth rates, women's health status remains a critical yet often overlooked determinant. This review summarises evidence on how various aspects of women's health, including nutrition and lifestyle, socioeconomic status, environmental pollutants, and metabolic and reproductive health are related to birth rates and female fertility. A healthy lifestyle, including a balanced, nutrient-rich diet, regular physical activity, adequate sleep, and mental wellbeing along with optimal metabolic and reproductive health, supports women's health. Meanwhile, broader determinants, such as socioeconomic status and environmental pollutants, also shape women's health and reproductive wellbeing. Collectively, these individual and systemic factors influence female fertility and birth outcomes, and subsequently, population-level birth rates. However, most existing evidence is based on White populations, underscoring the need for more inclusive research, particularly in the Asia–Pacific region. Improving women's health and fertility outcomes requires a holistic approach, with coordinated efforts across research, education, and policy domains.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101710"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indigenous people's perspectives on sharing health data for service delivery purposes: an inquiry using Indigenous methodologies","authors":"Kristie Watego ,&nbsp;Morgan Brodhurst-Hill ,&nbsp;Cherilda Murray ,&nbsp;Clare Mangoyana ,&nbsp;Alynta Emery ,&nbsp;Jayde Woon ,&nbsp;Kara Williams ,&nbsp;Natasha Reid ,&nbsp;Teyl Engstrom ,&nbsp;Carmel Nelson ,&nbsp;Clair Sullivan ,&nbsp;Jenny Setchell","doi":"10.1016/j.lanwpc.2025.101753","DOIUrl":"10.1016/j.lanwpc.2025.101753","url":null,"abstract":"<div><h3>Background</h3><div>With healthcare's accelerating digital transformation and expanding data-sharing capabilities, it is essential to uphold Indigenous Data Sovereignty (IDSov)—which affirms Indigenous ownership and authority over health data relating to Indigenous communities. Indigenous Data Governance (IDGov) provides the mechanisms through which IDSov is enacted, ensuring Indigenous Peoples lead decisions about how data are collected, accessed, and used. Our research investigates a local enactment of IDGov, discussing how custodial stewardship is enacted in data-sharing arrangements between an Aboriginal and Torres Strait Islander community-controlled health organisation and a government birthing facility. The research aimed to understand Aboriginal and Torres Strait Islander service users' and health workers' perspectives on how/whether to share data between services.</div></div><div><h3>Methods</h3><div>Led by a community-controlled organisation, the study used Indigenous methodologies, including ‘yarning’—a traditional knowledge-sharing practice. An Aboriginal researcher conducted yarns with Aboriginal and/or Torres Strait Islander staff and perinatal service users. Collaborative analysis was undertaken using an adapted ‘Thought Ritual’, an Indigenous analytical framework.</div></div><div><h3>Findings</h3><div>Analysis identified four domains: 1) Power and Control in Data Sharing—Data sharing can shift power dynamics, affecting sovereignty and community control, 2) Safety Concerns—Participants cited legal, cultural, and psychosocial risks tied to stigma and systemic racism, 3) Ability to Do My Job—Limited data access can hinder effective service delivery, and 4) Not Everything Should Be Shared—There is a clear preference for consent-based, selective data sharing.</div></div><div><h3>Interpretation</h3><div>Honouring Indigenous perspectives in data-sharing arrangements is an ethical obligation. In perinatal settings, upholding custodial stewardship helps safeguard sovereignty, safety, and equitable outcomes.</div></div><div><h3>Funding</h3><div>Funding was received from the Australian Government through the <span>Medical Research Future Fund</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101753"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “Adverse health outcomes among migrant workers and transnational families in the Asia–Pacific: a systematic review and meta-analysis” [The Lancet Regional Health–Western Pacific 2025;64: 101720]","authors":"Rosita Chia-Yin Lin ,&nbsp;Karen Lau ,&nbsp;Kathryn Mackey ,&nbsp;Natasha Roya Matthews ,&nbsp;Maushmi Selvamani ,&nbsp;Beatriz Morais ,&nbsp;Oumnia Bouaddi ,&nbsp;Chaelin Kim ,&nbsp;Azusa Iwamoto ,&nbsp;Masami Fujita ,&nbsp;Ursula Trummer ,&nbsp;Tran Ngoc Dang ,&nbsp;Alena Kamenshchikova ,&nbsp;Cathy Zimmerman ,&nbsp;Sally Hargreaves","doi":"10.1016/j.lanwpc.2025.101774","DOIUrl":"10.1016/j.lanwpc.2025.101774","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101774"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social determinants of low fertility in Asia: a comparative review of trends in East, Southeast and South Asia","authors":"Wei-Jun Jean Yeung ,&nbsp;Jeofrey Bautista Abalos","doi":"10.1016/j.lanwpc.2025.101724","DOIUrl":"10.1016/j.lanwpc.2025.101724","url":null,"abstract":"<div><div>Asia, home to nearly 60% of the world's population, is central to global demographic change. Fertility trajectories shape population growth, aging, and decline, with implications for labor supply, economic development, family structures, and caregiving. Studying these patterns offers critical insights into the future of population size, structure, and human potential both regionally and globally. This paper addresses gaps in the largely snapshot, country-specific literature by providing a six-decade comparative overview of fertility trends in East, Southeast, and South Asia, with emphasis on their social determinants. Fertility is shaped not only by individual choice or biology but also by broader socioeconomic, cultural, and policy contexts that influence proximate factors of fertility such as union patterns, contraception, postpartum infecundability, and abortion. We identify distinct regional trajectories of fertility decline, examine their underlying drivers, assess the applicability of prevailing theories, and propose an Asymmetric Adaptation Framework to explain Asia's fertility transitions. While socioeconomic development and ideational change have shaped fertility behavior, cultural factors—such as religion, colonial legacies, kinship systems, and family policy—are pivotal in Asia. Certain trends cannot be explained by socioeconomic development alone, reflecting deeper historical and cultural roots. The Asian experience highlights the limits of prevailing Eurocentric, unidirectional theories and underscores the need for regionally grounded explanations that account for the interplay of structural forces, cultural norms, historical contexts, and policy in shaping fertility decline.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101724"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}