Pub Date : 2026-01-01Epub Date: 2025-11-26DOI: 10.1016/j.lanwpc.2025.101756
Anna Ugalde , Hannah Jongebloed , Charlene Wright , Helena Rodi , Anna Chapman , Skye Marshall , Drew Aras , Rebecca J. Bergin , Sophie Boffa , Anna Boltong , Michele Conlin , Fiona Crawford–Williams , Carl de Wet , Wasek Faisal , Lan Gao , Harry Gasper , Kate Gunn , Nicolas H. Hart , Theresa Hayes , Florian Honeyball , Laura Alston
People living in rural and remote areas continue to face significant inequities in cancer outcomes compared to their metropolitan counterparts. Despite advances in cancer control, these disparities persist across the cancer trajectory. This personal view consolidates findings from our Equitable Cancer Outcomes for Rural and Remote Communities series, highlighting survival disadvantages, challenges in measuring and reporting rurality, barriers to implementing evidence-based interventions, and shortcomings in historical policy. We argue for place-based, system-level reform that genuinely partners with rural communities, leverages local strengths, and embeds rural voices in research, policy, and service delivery. Key recommendations include adopting a formal partnership position statement to guide collaboration across sectors, strengthening rural data infrastructure, harmonising rural-urban classifications, tailoring implementation strategies, and prioritising geographical equity within cancer policy. Achieving meaningful progress requires coordinated cross-sector action and sustained investment in rural capacity. Equitable cancer outcomes will only be achieved by recognising and addressing the responsibility to deliver best practice care for all people affected by cancer, regardless of where they live.
{"title":"Towards equitable cancer outcomes for rural and remote communities: reflections, lessons and recommendations","authors":"Anna Ugalde , Hannah Jongebloed , Charlene Wright , Helena Rodi , Anna Chapman , Skye Marshall , Drew Aras , Rebecca J. Bergin , Sophie Boffa , Anna Boltong , Michele Conlin , Fiona Crawford–Williams , Carl de Wet , Wasek Faisal , Lan Gao , Harry Gasper , Kate Gunn , Nicolas H. Hart , Theresa Hayes , Florian Honeyball , Laura Alston","doi":"10.1016/j.lanwpc.2025.101756","DOIUrl":"10.1016/j.lanwpc.2025.101756","url":null,"abstract":"<div><div>People living in rural and remote areas continue to face significant inequities in cancer outcomes compared to their metropolitan counterparts. Despite advances in cancer control, these disparities persist across the cancer trajectory. This personal view consolidates findings from our <em>Equitable Cancer Outcomes for Rural and Remote Communities</em> series, highlighting survival disadvantages, challenges in measuring and reporting rurality, barriers to implementing evidence-based interventions, and shortcomings in historical policy. We argue for place-based, system-level reform that genuinely partners with rural communities, leverages local strengths, and embeds rural voices in research, policy, and service delivery. Key recommendations include adopting a formal partnership position statement to guide collaboration across sectors, strengthening rural data infrastructure, harmonising rural-urban classifications, tailoring implementation strategies, and prioritising geographical equity within cancer policy. Achieving meaningful progress requires coordinated cross-sector action and sustained investment in rural capacity. Equitable cancer outcomes will only be achieved by recognising and addressing the responsibility to deliver best practice care for all people affected by cancer, regardless of where they live.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101756"},"PeriodicalIF":8.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077536","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}
Pub Date : 2026-01-01Epub Date: 2026-01-30DOI: 10.1016/j.lanwpc.2026.101810
The Lancet Regional Health – Western Pacific
{"title":"HPV vaccine for adolescents in China: what is the next step?","authors":"The Lancet Regional Health – Western Pacific","doi":"10.1016/j.lanwpc.2026.101810","DOIUrl":"10.1016/j.lanwpc.2026.101810","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101810"},"PeriodicalIF":8.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077540","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}
Pub Date : 2026-01-01Epub Date: 2026-01-06DOI: 10.1016/j.lanwpc.2025.101783
Xiaoran Yu , Huan Wang , Jian Wang , Xin Yuan , Xiaoding Zhou , Qiushui He , Igor Mokrousov , Lin Sun , Yanhui Dong , Zhiyong Zou
The WHO Southeast Asia and Western Pacific regions, home to more than half of the world's population, bear a disproportionate burden of antimicrobial resistance (AMR), including some of the most severe resistance patterns. The convergence of rapidly growing economies and persistent health system challenges in these regions creates a critical platform for understanding the dynamics of AMR and developing scalable governance approaches relevant to other low- and middle-income countries. This Viewpoint reviews current progress in AMR governance globally and study regions, with a focus on country-specific National Action Plans, and highlights the discrepancies between policy intentions and actual implementation. Implementation science, developed to address research-to-practice gaps, provides a systematic framework for identifying and overcoming barriers to implementation, thereby translating political commitments into actionable interventions. Given the cross-sectoral complexity of AMR, we propose novel strategic priorities to enhance AMR governance by embedding implementation science within the One Health approach. This involves a four-step process: selecting and adapting evidence-based practices, assessing multilevel barriers and enablers, selecting, using and adapting implementation strategies, and evaluating and sustaining their impact. Together, this framework provides a blueprint for localising and operationalising overarching policy concepts into concrete, context-specific actions, with potential lessons for other regions globally.
{"title":"Using implementation science to bridge the gaps between political commitment and action in antimicrobial resistance governance under the one health approach in the WHO Southeast Asia and Western Pacific regions","authors":"Xiaoran Yu , Huan Wang , Jian Wang , Xin Yuan , Xiaoding Zhou , Qiushui He , Igor Mokrousov , Lin Sun , Yanhui Dong , Zhiyong Zou","doi":"10.1016/j.lanwpc.2025.101783","DOIUrl":"10.1016/j.lanwpc.2025.101783","url":null,"abstract":"<div><div>The WHO Southeast Asia and Western Pacific regions, home to more than half of the world's population, bear a disproportionate burden of antimicrobial resistance (AMR), including some of the most severe resistance patterns. The convergence of rapidly growing economies and persistent health system challenges in these regions creates a critical platform for understanding the dynamics of AMR and developing scalable governance approaches relevant to other low- and middle-income countries. This Viewpoint reviews current progress in AMR governance globally and study regions, with a focus on country-specific National Action Plans, and highlights the discrepancies between policy intentions and actual implementation. Implementation science, developed to address research-to-practice gaps, provides a systematic framework for identifying and overcoming barriers to implementation, thereby translating political commitments into actionable interventions. Given the cross-sectoral complexity of AMR, we propose novel strategic priorities to enhance AMR governance by embedding implementation science within the One Health approach. This involves a four-step process: selecting and adapting evidence-based practices, assessing multilevel barriers and enablers, selecting, using and adapting implementation strategies, and evaluating and sustaining their impact. Together, this framework provides a blueprint for localising and operationalising overarching policy concepts into concrete, context-specific actions, with potential lessons for other regions globally.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101783"},"PeriodicalIF":8.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926783","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}
Pub Date : 2026-01-01Epub Date: 2025-11-26DOI: 10.1016/j.lanwpc.2025.101731
Helena Rodi , Anna Chapman , Rebecca J. Bergin , Paul Grogan , Megan Varlow , Anna Boltong , Anna Ugalde , Skye Marshall
Australia's cancer policy has progressed from fragmented, disease-specific initiatives in the 1960s–70s to coordinated national frameworks that aim to prioritise equity and patient-centred care. Early policies focused on treatment and prevention, with limited attention to disparities affecting different communities and population groups. This review aimed to examine the historical development of cancer policy in Australia and assess the impact of key initiatives on equity outcomes. A narrative review methodology was employed, drawing on policy documents, government reports, and peer-reviewed literature. Key milestones, systemic gaps, and strategies addressing disparities were identified and discussed. The review found a growing policy focus on addressing socioeconomic, geographic, and cultural barriers to care, reflected in initiatives such as the Australian Cancer Plan and Optimal Care Pathways. However, persistent challenges in implementation, resource allocation, and adherence monitoring limit progress. Strengthening monitoring systems and investing in prevention, early detection, high-quality care, and inclusive research remain critical to reducing the cancer burden and achieving equitable outcomes.
{"title":"Examining the historical evolution of cancer policy in Australia: impact of key initiatives on equity and outcomes","authors":"Helena Rodi , Anna Chapman , Rebecca J. Bergin , Paul Grogan , Megan Varlow , Anna Boltong , Anna Ugalde , Skye Marshall","doi":"10.1016/j.lanwpc.2025.101731","DOIUrl":"10.1016/j.lanwpc.2025.101731","url":null,"abstract":"<div><div>Australia's cancer policy has progressed from fragmented, disease-specific initiatives in the 1960s–70s to coordinated national frameworks that aim to prioritise equity and patient-centred care. Early policies focused on treatment and prevention, with limited attention to disparities affecting different communities and population groups. This review aimed to examine the historical development of cancer policy in Australia and assess the impact of key initiatives on equity outcomes. A narrative review methodology was employed, drawing on policy documents, government reports, and peer-reviewed literature. Key milestones, systemic gaps, and strategies addressing disparities were identified and discussed. The review found a growing policy focus on addressing socioeconomic, geographic, and cultural barriers to care, reflected in initiatives such as the Australian Cancer Plan and Optimal Care Pathways. However, persistent challenges in implementation, resource allocation, and adherence monitoring limit progress. Strengthening monitoring systems and investing in prevention, early detection, high-quality care, and inclusive research remain critical to reducing the cancer burden and achieving equitable outcomes.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101731"},"PeriodicalIF":8.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077465","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}
The growing diabetes burden in Indonesia necessitates a comprehensive understanding of national diabetes care performance, which remains inadequately characterized. Evaluating care quality across domains is essential to inform chronic disease policy and improve health outcomes. This study assesses trends in behavioral, clinical, and laboratory outcomes of diabetes care in Indonesia from 2013 to 2023.
Methods
We conducted a serial cross-sectional analysis of pooled data from the 2013, 2018, and 2023 Indonesian national health surveys (N = 42,224 for behavioral-clinical and N = 2957 for laboratory outcomes). Diabetes care performance was assessed across behavioral (treatment, smoking, diet, activity), clinical (blood pressure, BMI, waist length), and laboratory (glucose, lipids, renal function) domains. Composite scores and multilevel models were used to identify geographic and sociodemographic disparities.
Findings
Although linkage to diabetes care significantly improved from 68% to 92% between 2013 and 2023, performance in most other indicators remained stagnant or declined. In 2023, only 2.9% (95% CI 2.5–3.3%) met dietary fiber intake targets, 62.4% (95% CI 61.2–63.6%) achieved physical activity goals, and 83.9% (95% CI 82.9–84.8%) abstained from smoking. Clinical control was suboptimal, with 43.5% (95% CI 42.3–44.8%) meeting blood pressure targets and only 26.7% (95% CI 25.6–27.9%) and 33.1% (95% CI 32.0–34.3%) achieving BMI and waist circumference goals, respectively. Laboratory control was limited: only 25.2% (21.6–28.8%) achieved fasting glucose targets, 32.0% (95% CI 27.6–36.3%) had HbA1c <7%, and only 22.6% (95% CI 19.1–26.2%) met LDL-C goals. Fewer than 5% of participants met all behavioral-clinical or laboratory composite targets. Composite performance declined in nearly all provinces, with disparities linked to older age, male sex, lower education, and rural residence.
Interpretation
Despite expanded healthcare coverage, Indonesia's diabetes care performance remains critically inadequate, particularly for achieving multiple targets. Strengthening national guidelines, embedding structured chronic care, and addressing social determinants are essential to improving diabetes outcomes.
Funding
None.
印度尼西亚日益增长的糖尿病负担需要对国家糖尿病护理绩效进行全面了解，但仍未充分表征。评估跨领域的护理质量对于为慢性病政策提供信息和改善健康结果至关重要。本研究评估了2013年至2023年印度尼西亚糖尿病护理的行为、临床和实验室结果趋势。方法：我们对2013年、2018年和2023年印度尼西亚国家健康调查的汇总数据进行了连续横断面分析（N = 42,224例行为-临床调查，N = 2957例实验室调查）。通过行为（治疗、吸烟、饮食、活动）、临床（血压、BMI、腰围）和实验室（葡萄糖、脂质、肾功能）对糖尿病护理表现进行评估。综合得分和多层次模型被用于识别地理和社会人口差异。研究发现，尽管在2013年至2023年期间，与糖尿病护理的联系从68%显著提高到92%，但大多数其他指标的表现仍然停滞不前或有所下降。2023年，只有2.9% （95% CI 2.5-3.3%）的人达到了膳食纤维摄入目标，62.4% （95% CI 61.2-63.6%）的人达到了体育锻炼目标，83.9% （95% CI 82.9-84.8%）的人戒烟。临床控制是次优的，43.5% （95% CI 42.3-44.8%）达到血压目标，分别只有26.7% （95% CI 25.6-27.9%）和33.1% （95% CI 32.0-34.3%）达到BMI和腰围目标。实验室控制是有限的：只有25.2%（21.6-28.8%）达到空腹血糖目标，32.0% （95% CI 27.6-36.3%）的HbA1c和lt达到7%，只有22.6% （95% CI 19.1-26.2%）达到LDL-C目标。不到5%的参与者符合所有行为-临床或实验室复合目标。几乎所有省份的综合表现都有所下降，差异与年龄较大、男性、受教育程度较低和农村居住有关。尽管扩大了医疗保健覆盖范围，但印度尼西亚的糖尿病护理表现仍然严重不足，特别是在实现多个目标方面。加强国家指南、纳入有组织的慢性护理和解决社会决定因素对于改善糖尿病结局至关重要。
{"title":"Diabetes care performance in Indonesia: a serial cross-sectional analysis of behavioral, clinical, and laboratory outcomes from 2013 to 2023","authors":"Farizal Rizky Muharram , Julian Benedict Swannjo , Dicky Lavenus Tahapary , Sally Aman Nasution , Delvac Oceandy","doi":"10.1016/j.lanwpc.2025.101759","DOIUrl":"10.1016/j.lanwpc.2025.101759","url":null,"abstract":"<div><h3>Background</h3><div>The growing diabetes burden in Indonesia necessitates a comprehensive understanding of national diabetes care performance, which remains inadequately characterized. Evaluating care quality across domains is essential to inform chronic disease policy and improve health outcomes. This study assesses trends in behavioral, clinical, and laboratory outcomes of diabetes care in Indonesia from 2013 to 2023.</div></div><div><h3>Methods</h3><div>We conducted a serial cross-sectional analysis of pooled data from the 2013, 2018, and 2023 Indonesian national health surveys (N = 42,224 for behavioral-clinical and N = 2957 for laboratory outcomes). Diabetes care performance was assessed across behavioral (treatment, smoking, diet, activity), clinical (blood pressure, BMI, waist length), and laboratory (glucose, lipids, renal function) domains. Composite scores and multilevel models were used to identify geographic and sociodemographic disparities.</div></div><div><h3>Findings</h3><div>Although linkage to diabetes care significantly improved from 68% to 92% between 2013 and 2023, performance in most other indicators remained stagnant or declined. In 2023, only 2.9% (95% CI 2.5–3.3%) met dietary fiber intake targets, 62.4% (95% CI 61.2–63.6%) achieved physical activity goals, and 83.9% (95% CI 82.9–84.8%) abstained from smoking. Clinical control was suboptimal, with 43.5% (95% CI 42.3–44.8%) meeting blood pressure targets and only 26.7% (95% CI 25.6–27.9%) and 33.1% (95% CI 32.0–34.3%) achieving BMI and waist circumference goals, respectively. Laboratory control was limited: only 25.2% (21.6–28.8%) achieved fasting glucose targets, 32.0% (95% CI 27.6–36.3%) had HbA1c <7%, and only 22.6% (95% CI 19.1–26.2%) met LDL-C goals. Fewer than 5% of participants met all behavioral-clinical or laboratory composite targets. Composite performance declined in nearly all provinces, with disparities linked to older age, male sex, lower education, and rural residence.</div></div><div><h3>Interpretation</h3><div>Despite expanded healthcare coverage, Indonesia's diabetes care performance remains critically inadequate, particularly for achieving multiple targets. Strengthening national guidelines, embedding structured chronic care, and addressing social determinants are essential to improving diabetes outcomes.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101759"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615707","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}
Pub Date : 2025-12-01Epub Date: 2025-11-27DOI: 10.1016/j.lanwpc.2025.101754
Amanda Gwee , Sarah Bannister , Emma Best , Jeremy Carr , Kiera Harwood , Tony Lai , Alice Lei , Flora Lutui , Brendan McMullan , Mona Mostaghim , Lesley Voss , Heather Weerdenburg , Phoebe Williams , Amanda Wilkins , Daniel Yeoh , KIDS DOSE group
Antimicrobial resistance poses a significant threat to children's health, with up to 20% of 1.27 million deaths attributable to bacterial AMR annually, occurring in children <5 years. The WHO 2024 Bacterial Priority Pathogens List identifies methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium (VRE) as critical pathogens. This review examines the epidemiology, treatment recommendations, dosing strategies, efficacy, and safety data for antibiotics targeting MRSA and VRE infections in children in Oceania. Paediatric MRSA infections are prevalent (13–43%) across Oceania, while VRE infections remain uncommon (3–5%). Disparate access to recommended treatments, particularly in Pacific Island Countries and Territories, highlights the need for paediatric licensing. Paediatric trials primarily assess safety, with efficacy data limited to vancomycin, teicoplanin, and daptomycin. Pharmacokinetic/pharmacodynamic studies show standard dosing in children under 12 years often fails to achieve therapeutic targets, highlighting the need for dedicated dosing studies. Addressing these gaps is essential to advancing paediatric access to optimal treatment for drug-resistant infections in the region.
{"title":"Methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium infections in children in the Oceania region: review of the epidemiology, antimicrobial availability, treatment, clinical trial and pharmacokinetic data and key evidence gaps","authors":"Amanda Gwee , Sarah Bannister , Emma Best , Jeremy Carr , Kiera Harwood , Tony Lai , Alice Lei , Flora Lutui , Brendan McMullan , Mona Mostaghim , Lesley Voss , Heather Weerdenburg , Phoebe Williams , Amanda Wilkins , Daniel Yeoh , KIDS DOSE group","doi":"10.1016/j.lanwpc.2025.101754","DOIUrl":"10.1016/j.lanwpc.2025.101754","url":null,"abstract":"<div><div>Antimicrobial resistance poses a significant threat to children's health, with up to 20% of 1.27 million deaths attributable to bacterial AMR annually, occurring in children <5 years. The WHO 2024 Bacterial Priority Pathogens List identifies methicillin-resistant <em>Staphylococcus aureus</em> (MRSA) and vancomycin-resistant <em>Enterococcus faecium</em> (VRE) as critical pathogens. This review examines the epidemiology, treatment recommendations, dosing strategies, efficacy, and safety data for antibiotics targeting MRSA and VRE infections in children in Oceania. Paediatric MRSA infections are prevalent (13–43%) across Oceania, while VRE infections remain uncommon (3–5%). Disparate access to recommended treatments, particularly in Pacific Island Countries and Territories, highlights the need for paediatric licensing. Paediatric trials primarily assess safety, with efficacy data limited to vancomycin, teicoplanin, and daptomycin. Pharmacokinetic/pharmacodynamic studies show standard dosing in children under 12 years often fails to achieve therapeutic targets, highlighting the need for dedicated dosing studies. Addressing these gaps is essential to advancing paediatric access to optimal treatment for drug-resistant infections in the region.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101754"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615708","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}
Pub Date : 2025-12-01Epub Date: 2025-12-08DOI: 10.1016/j.lanwpc.2025.101716
David A. Skerrett-Byrne , Lee M. Ashton , Brett Nixon , Philip J. Morgan
Over the past half-century, global fertility rates have declined, with the Western Pacific Region (WPR) experiencing a particularly notable drop. A recent World Health Organisation-commissioned report identified the WPR as exhibiting the highest infertility prevalence at 23.2%, compared to the global average of 17.5%. While the drivers of this decline are complex, one key contributor is male infertility, yet it remains under addressed in research and policy. In this paper, we synthesise current evidence on male infertility with a focus on the WPR. Specifically, we explore environmental, biological, and demographic correlates of male infertility, examine molecular mechanisms regulating sperm function and assess the impact of lifestyle interventions. Our findings highlight significant gaps in regional evidence, advocating for targeted research and culturally tailored interventions to enhance preconception male health within the WPR. Based on this synthesis, we propose preventive strategies and evidence-based recommendations to improve male preconception health in the region.
{"title":"Determinants of male fertility in the Western Pacific Region: environmental, biological, and lifestyle influences","authors":"David A. Skerrett-Byrne , Lee M. Ashton , Brett Nixon , Philip J. Morgan","doi":"10.1016/j.lanwpc.2025.101716","DOIUrl":"10.1016/j.lanwpc.2025.101716","url":null,"abstract":"<div><div>Over the past half-century, global fertility rates have declined, with the Western Pacific Region (WPR) experiencing a particularly notable drop. A recent World Health Organisation-commissioned report identified the WPR as exhibiting the highest infertility prevalence at 23.2%, compared to the global average of 17.5%. While the drivers of this decline are complex, one key contributor is male infertility, yet it remains under addressed in research and policy. In this paper, we synthesise current evidence on male infertility with a focus on the WPR. Specifically, we explore environmental, biological, and demographic correlates of male infertility, examine molecular mechanisms regulating sperm function and assess the impact of lifestyle interventions. Our findings highlight significant gaps in regional evidence, advocating for targeted research and culturally tailored interventions to enhance preconception male health within the WPR. Based on this synthesis, we propose preventive strategies and evidence-based recommendations to improve male preconception health in the region.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101716"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839286","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}
Pub Date : 2025-12-01Epub Date: 2025-12-06DOI: 10.1016/j.lanwpc.2025.101763
John D. Hart , Jimaima Kailawadoko , Tria Williams , Jyotishna Mani , Ilikena Malo , Tuliana Cua , Natalie Caltabiano , Jasmyn Voss , Kristy Azzopardi , Matthew G. Parnaby , Sanjeshni Autar , Komal Chand , Lavenia Lagilagi , Jessica Paka , Eric Rafai , Joseph Kado , Hannah Frost , Andrew C. Steer
Background
Acute rheumatic fever is an immune-mediated condition triggered by Streptococcus pyogenes 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 S. pyogenes sore throat.
Methods
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 S. pyogenes detection using culture and a point-of-care nucleic acid amplification test (NAAT). Six CDRs were evaluated against NAAT and culture as reference standards.
Findings
Of 250 participants, S. pyogenes 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).
Interpretation
CDRs cannot accurately diagnose S. pyogenes sore throat in this tropical setting where rheumatic fever is common. There appears to be a high burden of S. pyogenes 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.
Funding
This project was funded by a New Zealand Aid Programme grant, awarded to Cure Kids (NZ research charity). Funds covered all costs pertaining to the study, including research personnel, data collection, patient recruitment and analysis.
{"title":"Clinical decision rules for diagnosis of Streptococcus pyogenes sore throat in Fiji: a prospective diagnostic accuracy study","authors":"John D. Hart , Jimaima Kailawadoko , Tria Williams , Jyotishna Mani , Ilikena Malo , Tuliana Cua , Natalie Caltabiano , Jasmyn Voss , Kristy Azzopardi , Matthew G. Parnaby , Sanjeshni Autar , Komal Chand , Lavenia Lagilagi , Jessica Paka , Eric Rafai , Joseph Kado , Hannah Frost , 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}
Pub Date : 2025-12-01Epub Date: 2025-11-21DOI: 10.1016/j.lanwpc.2025.101755
Winnie Chen , Kirsten Howard , Sarah Norris , Natasha Nassar , Maria E. Craig , Kirstine J. Bell
Background
Type 1 diabetes (T1D) is an autoimmune condition affecting children. We aimed to investigate the costs and cost-effectiveness of potential national childhood screening strategies for T1D compared to no screening (usual care).
Methods
Screening costs were obtained from trial-based estimates. A Markov microsimulation model was developed to identify the most cost-effective childhood T1D screening strategy. The three screening strategies modelled were: Strategy 1) newborn genetic risk-stratification with bloodspot sampling, followed by autoantibody screening in at-risk children; Strategy 2) infant genetic risk-stratification using saliva sampling, followed by autoantibody screening in at-risk children; Strategy 3) population-wide autoantibody screening at two childhood ages. The model tracked 100,000 individuals from birth to 30 years of age. One-way and probabilistic sensitivity analyses were conducted.
Findings
Newborn bloodspot genetic risk-stratified screening (strategy 1) was the most cost-effective strategy. Incremental cost-effectiveness ratios (ICERs) were $50,682 per quality-adjusted life year (QALY) gained for strategy 1, $85,440 per QALY gained for strategy 2, and $133,285 per QALY gained for strategy 3. In the optimal strategy (strategy 1), the cost was $480,798 per screen-detected T1D and $12,183 per episode of diabetic ketoacidosis avoided. Results were sensitive to changes in time horizon, discount rates, and cost of the screening tests.
Interpretation
Of the three modelled T1D screening strategies, newborn bloodspot genetic risk-stratified screening was the most cost-effective. Varying cost inputs may change this hierarchy. Our economic evaluation will be useful for informing future T1D childhood screening policy in Australia and other high-income countries.
{"title":"Economic evaluation of potential national childhood screening strategies for type 1 diabetes in Australia","authors":"Winnie Chen , Kirsten Howard , Sarah Norris , Natasha Nassar , Maria E. Craig , Kirstine J. Bell","doi":"10.1016/j.lanwpc.2025.101755","DOIUrl":"10.1016/j.lanwpc.2025.101755","url":null,"abstract":"<div><h3>Background</h3><div>Type 1 diabetes (T1D) is an autoimmune condition affecting children. We aimed to investigate the costs and cost-effectiveness of potential national childhood screening strategies for T1D compared to no screening (usual care).</div></div><div><h3>Methods</h3><div>Screening costs were obtained from trial-based estimates. A Markov microsimulation model was developed to identify the most cost-effective childhood T1D screening strategy. The three screening strategies modelled were: Strategy 1) newborn genetic risk-stratification with bloodspot sampling, followed by autoantibody screening in at-risk children; Strategy 2) infant genetic risk-stratification using saliva sampling, followed by autoantibody screening in at-risk children; Strategy 3) population-wide autoantibody screening at two childhood ages. The model tracked 100,000 individuals from birth to 30 years of age. One-way and probabilistic sensitivity analyses were conducted.</div></div><div><h3>Findings</h3><div>Newborn bloodspot genetic risk-stratified screening (strategy 1) was the most cost-effective strategy. Incremental cost-effectiveness ratios (ICERs) were $50,682 per quality-adjusted life year (QALY) gained for strategy 1, $85,440 per QALY gained for strategy 2, and $133,285 per QALY gained for strategy 3. In the optimal strategy (strategy 1), the cost was $480,798 per screen-detected T1D and $12,183 per episode of diabetic ketoacidosis avoided. Results were sensitive to changes in time horizon, discount rates, and cost of the screening tests.</div></div><div><h3>Interpretation</h3><div>Of the three modelled T1D screening strategies, newborn bloodspot genetic risk-stratified screening was the most cost-effective. Varying cost inputs may change this hierarchy. Our economic evaluation will be useful for informing future T1D childhood screening policy in Australia and other high-income countries.</div></div><div><h3>Funding</h3><div>JDRF Australia.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101755"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145577790","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}
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