Pub Date : 2026-02-02DOI: 10.1016/s2214-109x(26)00008-2
Andrea Ferreira da Silva, Rodrigo Volmir Rezende Anderle, Gonzalo Barreix Sibils, Lucas de Oliveira Ferreira de Sales, Daiana Pena, Caterina Monti, Claudia Garcia Vaz, Hugo-Alejandro Santa-Ramírez, Gabriela Dos Santos de Jesus, Daniella Medeiros Cavalcanti, Ariel Nhacolo, Ivalda Macicame, Quique Bassat, Davide Rasella
{"title":"Impact of two decades of humanitarian and development assistance and the projected mortality consequences of current defunding to 2030: retrospective evaluation and forecasting analysis","authors":"Andrea Ferreira da Silva, Rodrigo Volmir Rezende Anderle, Gonzalo Barreix Sibils, Lucas de Oliveira Ferreira de Sales, Daiana Pena, Caterina Monti, Claudia Garcia Vaz, Hugo-Alejandro Santa-Ramírez, Gabriela Dos Santos de Jesus, Daniella Medeiros Cavalcanti, Ariel Nhacolo, Ivalda Macicame, Quique Bassat, Davide Rasella","doi":"10.1016/s2214-109x(26)00008-2","DOIUrl":"https://doi.org/10.1016/s2214-109x(26)00008-2","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"14 1","pages":""},"PeriodicalIF":34.3,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146109971","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}
Although researchers have called for participatory, equitable, and decolonial global implementation research to be conducted, practical examples on how to do so are scarce, particularly in partnership with historically marginalised groups. In this Viewpoint, we share four recommendations on how to instil systems thinking principles into global implementation research to make it more participatory and equitable. Our recommendations centre around co-learning with community partners to gain a deep understanding of their preferences and the system, to then co-creating interventions and implementation strategies that consider structural drivers of health and centre around Indigenous knowledges and practices. For each recommendation, we contrast the traditional implementation science approach with our participatory systems thinking approach. We also suggest eight phases inspired by systems thinking principles and tools that researchers can follow to align with our recommendations. We share practical examples emerging from our experiences collaborating with policy makers and Maya Indigenous community partners with lived mental health experience in co-creating mental health interventions in rural Guatemala. Drawing from our team's discussions, we reflect on the ways in which our participatory systems thinking approach has brought us closer to conducting equitable implementation research. We also reflect on how historical and structural determinants of social inequities permeate our efforts to ensure research relevance, participation, and trust among partners.
{"title":"Integrating systems thinking with global implementation science to co-learn and co-create mental health interventions and strategies with Maya Indigenous community partners.","authors":"Alejandra Paniagua-Avila,Diego Sapalú,Michelle Pieters,Alex Petzey,Karla Paniagua,Aracely Tellez,Meredith Fort,Charles Branas,Ezra Susser,Jeremy Kane","doi":"10.1016/s2214-109x(25)00495-4","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00495-4","url":null,"abstract":"Although researchers have called for participatory, equitable, and decolonial global implementation research to be conducted, practical examples on how to do so are scarce, particularly in partnership with historically marginalised groups. In this Viewpoint, we share four recommendations on how to instil systems thinking principles into global implementation research to make it more participatory and equitable. Our recommendations centre around co-learning with community partners to gain a deep understanding of their preferences and the system, to then co-creating interventions and implementation strategies that consider structural drivers of health and centre around Indigenous knowledges and practices. For each recommendation, we contrast the traditional implementation science approach with our participatory systems thinking approach. We also suggest eight phases inspired by systems thinking principles and tools that researchers can follow to align with our recommendations. We share practical examples emerging from our experiences collaborating with policy makers and Maya Indigenous community partners with lived mental health experience in co-creating mental health interventions in rural Guatemala. Drawing from our team's discussions, we reflect on the ways in which our participatory systems thinking approach has brought us closer to conducting equitable implementation research. We also reflect on how historical and structural determinants of social inequities permeate our efforts to ensure research relevance, participation, and trust among partners.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"8 1","pages":"e302-e307"},"PeriodicalIF":34.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947452","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 : 2026-02-01DOI: 10.1016/s2214-109x(25)00476-0
BACKGROUNDMinimally invasive surgery is rapidly expanding globally, yet there is insufficient knowledge of how to scale this technology safely and equitably across diverse health systems. We aimed to identify health-system factors associated with safe implementation of minimally invasive surgery globally, using minimally invasive cholecystectomy as a tracer procedure.METHODSWe conducted a multicentre, prospective cohort study of consecutive adults undergoing cholecystectomy between July 31 and Nov 19, 2023, in 1218 hospitals across 109 countries. Data were collected by more than 10 000 health-care workers using a core measurement set mapped to the WHO Health System Building Blocks and the Global Patient Safety Action Plan. The primary outcome was 30-day procedure-specific complications, with multilevel logistic regression used to examine associations between health-system features and patient outcomes. This study is registered on ClinicalTrials.gov (NCT06223061).FINDINGSAmong 52 187 included patients, the adjusted procedure-specific complication rate varied 40-fold between hospitals, from 0·3% in the lowest risk quintile to 12·1% in the highest risk quintile. Despite large structural differences across income groups in access to minimally invasive surgery, diagnostics, and emergency services, country income level was not independently associated with complication rates (adjusted odds ratio [OR] 0·81 [95% CI 0·59-1·10] for upper-middle income vs high income and 0·99 [0·70-1·39] for lower-middle income or low income vs high income). Three modifiable hospital-level factors were strongly associated with safer outcomes: establishment of local simulation-based training facilities (adjusted OR 0·78 [0·71-0·86]; p<0·0001), adoption of intraoperative safety and communication strategies (0·87 [0·79-0·96]; p=0·0046), and on-site CT diagnostics (0·79 [0·65-0·97]; p=0·0220). Training facilities showed the greatest benefit in hospitals with limited infrastructure and an inexperienced workforce: the number needed to treat to prevent a procedure-specific complication was 21 (95% CI 14-35; p<0·0001).INTERPRETATIONSafe implementation of minimally invasive surgery varies widely worldwide but is not defined by national income level; differences in outcomes reflect the ability of health systems to adopt and safely deploy new surgical techniques. We identified for the first time that the presence of local simulation-based training facilities is independently associated with improved patient outcomes. Simulation appears to be fundamental to the safe delivery of minimally invasive surgery, particularly in resource-constrained settings. Together with safety systems and diagnostic capacity, these findings offer actionable targets for health systems seeking to equitably scale up essential surgical technologies.FUNDINGNIHR Global Health Research Unit and Wellcome Leap SAVE Programme.
{"title":"Safety and equity in scaling minimally invasive surgery worldwide in 109 countries using cholecystectomy as a tracer procedure: a prospective cohort study.","authors":" ","doi":"10.1016/s2214-109x(25)00476-0","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00476-0","url":null,"abstract":"BACKGROUNDMinimally invasive surgery is rapidly expanding globally, yet there is insufficient knowledge of how to scale this technology safely and equitably across diverse health systems. We aimed to identify health-system factors associated with safe implementation of minimally invasive surgery globally, using minimally invasive cholecystectomy as a tracer procedure.METHODSWe conducted a multicentre, prospective cohort study of consecutive adults undergoing cholecystectomy between July 31 and Nov 19, 2023, in 1218 hospitals across 109 countries. Data were collected by more than 10 000 health-care workers using a core measurement set mapped to the WHO Health System Building Blocks and the Global Patient Safety Action Plan. The primary outcome was 30-day procedure-specific complications, with multilevel logistic regression used to examine associations between health-system features and patient outcomes. This study is registered on ClinicalTrials.gov (NCT06223061).FINDINGSAmong 52 187 included patients, the adjusted procedure-specific complication rate varied 40-fold between hospitals, from 0·3% in the lowest risk quintile to 12·1% in the highest risk quintile. Despite large structural differences across income groups in access to minimally invasive surgery, diagnostics, and emergency services, country income level was not independently associated with complication rates (adjusted odds ratio [OR] 0·81 [95% CI 0·59-1·10] for upper-middle income vs high income and 0·99 [0·70-1·39] for lower-middle income or low income vs high income). Three modifiable hospital-level factors were strongly associated with safer outcomes: establishment of local simulation-based training facilities (adjusted OR 0·78 [0·71-0·86]; p<0·0001), adoption of intraoperative safety and communication strategies (0·87 [0·79-0·96]; p=0·0046), and on-site CT diagnostics (0·79 [0·65-0·97]; p=0·0220). Training facilities showed the greatest benefit in hospitals with limited infrastructure and an inexperienced workforce: the number needed to treat to prevent a procedure-specific complication was 21 (95% CI 14-35; p<0·0001).INTERPRETATIONSafe implementation of minimally invasive surgery varies widely worldwide but is not defined by national income level; differences in outcomes reflect the ability of health systems to adopt and safely deploy new surgical techniques. We identified for the first time that the presence of local simulation-based training facilities is independently associated with improved patient outcomes. Simulation appears to be fundamental to the safe delivery of minimally invasive surgery, particularly in resource-constrained settings. Together with safety systems and diagnostic capacity, these findings offer actionable targets for health systems seeking to equitably scale up essential surgical technologies.FUNDINGNIHR Global Health Research Unit and Wellcome Leap SAVE Programme.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"6 1","pages":"e199-e212"},"PeriodicalIF":34.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947427","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}
In this Viewpoint, we argue that the project to decolonise implementation science is an important and much needed endeavour, but should move beyond a focus on equity to a more disruptive decolonial approach that interrogates the field's methodological and epistemological foundations. Methodological pluralism in implementation science-one that integrates diverse ways of knowing-is not only more just, but also more effective and scientifically robust. Achieving this requires uncomfortable confrontation with the colonial architecture of academic research and accepted ways of knowing.
{"title":"Decolonising implementation science: a call for methodological pluralism.","authors":"Sali Hafez,Agata Pacho,Ruth Ponsford,Meghna Ranganathan,Mitzy Gafos,Seyi Soremekun","doi":"10.1016/s2214-109x(25)00477-2","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00477-2","url":null,"abstract":"In this Viewpoint, we argue that the project to decolonise implementation science is an important and much needed endeavour, but should move beyond a focus on equity to a more disruptive decolonial approach that interrogates the field's methodological and epistemological foundations. Methodological pluralism in implementation science-one that integrates diverse ways of knowing-is not only more just, but also more effective and scientifically robust. Achieving this requires uncomfortable confrontation with the colonial architecture of academic research and accepted ways of knowing.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"25 1","pages":"e281-e285"},"PeriodicalIF":34.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947428","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 : 2026-02-01DOI: 10.1016/s2214-109x(25)00469-3
Christopher G Kemp,Lauren White,Emily E Haroz,Donald Warne
Implementation science is a diverse and evolving field that draws on multiple epistemologies and methods. However, the dominant foundations of implementation science remain settler colonial, biomedical, and positivist. In Indigenous and other marginalised settings, these foundations can result in poor epistemological, ethical, and practical fit. We argue that a paradigm shift that is grounded in Indigenous values, sovereignty, relationality, and epistemologies is needed. We propose seven guiding principles for a decolonising implementation science. Drawing from emerging scholarship and innovative Indigenous-led frameworks from the USA, Aotearoa New Zealand, and Australia, these principles centre sovereignty, strengths-based approaches, and relational accountability. These principles also offer a roadmap to redefine rigour, expand what counts as evidence, and ensure genuine community control over the research process. Although born from Indigenous experience, these principles provide a framework for transforming implementation science to be more just, equitable, and effective for marginalised communities globally.
{"title":"Towards a decolonising implementation science: principles from Indigenous leadership.","authors":"Christopher G Kemp,Lauren White,Emily E Haroz,Donald Warne","doi":"10.1016/s2214-109x(25)00469-3","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00469-3","url":null,"abstract":"Implementation science is a diverse and evolving field that draws on multiple epistemologies and methods. However, the dominant foundations of implementation science remain settler colonial, biomedical, and positivist. In Indigenous and other marginalised settings, these foundations can result in poor epistemological, ethical, and practical fit. We argue that a paradigm shift that is grounded in Indigenous values, sovereignty, relationality, and epistemologies is needed. We propose seven guiding principles for a decolonising implementation science. Drawing from emerging scholarship and innovative Indigenous-led frameworks from the USA, Aotearoa New Zealand, and Australia, these principles centre sovereignty, strengths-based approaches, and relational accountability. These principles also offer a roadmap to redefine rigour, expand what counts as evidence, and ensure genuine community control over the research process. Although born from Indigenous experience, these principles provide a framework for transforming implementation science to be more just, equitable, and effective for marginalised communities globally.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"29 1","pages":"e296-e301"},"PeriodicalIF":34.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947429","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 : 2026-02-01DOI: 10.1016/s2214-109x(25)00479-6
Gnanaraj Jesudian
{"title":"Safe scale-up of simulation-based training for minimally invasive surgery.","authors":"Gnanaraj Jesudian","doi":"10.1016/s2214-109x(25)00479-6","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00479-6","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"254 1","pages":"e174-e175"},"PeriodicalIF":34.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947460","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 : 2026-02-01DOI: 10.1016/s2214-109x(25)00444-9
Tara Pattilachan Menon,Aju Mathew,Puneeth Iyengar,Bishal Gyawali,C S Pramesh,Edward Christopher Dee
Member states of the South Asian Association for Regional Cooperation (SAARC), home to over 2 billion people, carry a disproportionate cancer burden shaped by stark heterogeneity in risk, access, and outcomes. Beyond large proportions of people living in poverty in the context of frail infrastructure, inequities are compounded by intersecting identities, including gender, caste, religion, language, geography, and sexual or gender minority status. Commonly, women face delayed diagnosis amid low human papillomavirus vaccination and screening; rural communities confront distance and cost; Dalit, indigenous, and refugee groups experience structural exclusion; and language discordance and cultural beliefs impede timely care. Financial toxicity is pervasive, pushing households into poverty despite emerging insurance schemes. Drawing on targeted literature from SAARC countries, we argue for an intersectionality-informed agenda: strengthen registries and national cancer control programmes with disaggregated data; expand equitable financing and workforce deployment; embed cultural competence and bias mitigation in clinical training; and prioritise research that models intersecting risks. Implementing context-appropriate strategies will be essential for achieving equitable cancer control across the region.
{"title":"Intersectionality of cancer disparities in south Asia.","authors":"Tara Pattilachan Menon,Aju Mathew,Puneeth Iyengar,Bishal Gyawali,C S Pramesh,Edward Christopher Dee","doi":"10.1016/s2214-109x(25)00444-9","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00444-9","url":null,"abstract":"Member states of the South Asian Association for Regional Cooperation (SAARC), home to over 2 billion people, carry a disproportionate cancer burden shaped by stark heterogeneity in risk, access, and outcomes. Beyond large proportions of people living in poverty in the context of frail infrastructure, inequities are compounded by intersecting identities, including gender, caste, religion, language, geography, and sexual or gender minority status. Commonly, women face delayed diagnosis amid low human papillomavirus vaccination and screening; rural communities confront distance and cost; Dalit, indigenous, and refugee groups experience structural exclusion; and language discordance and cultural beliefs impede timely care. Financial toxicity is pervasive, pushing households into poverty despite emerging insurance schemes. Drawing on targeted literature from SAARC countries, we argue for an intersectionality-informed agenda: strengthen registries and national cancer control programmes with disaggregated data; expand equitable financing and workforce deployment; embed cultural competence and bias mitigation in clinical training; and prioritise research that models intersecting risks. Implementing context-appropriate strategies will be essential for achieving equitable cancer control across the region.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"254 1","pages":"e272-e280"},"PeriodicalIF":34.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947453","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 : 2026-02-01DOI: 10.1016/s2214-109x(25)00449-8
,
BACKGROUNDWomen with anaemia have a higher risk of postpartum haemorrhage than those without anaemia. We examined the association between episiotomy and postpartum haemorrhage in women with moderate or severe anaemia.METHODSWe conducted a cohort analysis using data from the World Maternal Antifibrinolytic-2 (WOMAN-2) trial. Women with moderate or severe anaemia who were giving birth vaginally were recruited from 34 hospitals in Nigeria, Pakistan, Tanzania, and Zambia. On arrival at hospital, the participants' haemoglobin concentration was measured with a validated point-of-care haemoglobin test. Moderate anaemia was defined as a haemoglobin concentration of 70-99 g/L and severe anaemia as a haemoglobin concentration lower than 70 g/L. Episiotomy was defined as any perineal incision during delivery. Women were excluded from the WOMAN-2 trial if they were younger than 18 years and lacked consent from a guardian, had a known allergy to the trial intervention, had an indication or contraindication to the intervention, or were diagnosed with postpartum haemorrhage before the umbilical cord was clamped. The primary outcome was a clinical diagnosis of postpartum haemorrhage (estimated blood loss ≥500 mL or any blood loss causing haemodynamic instability), and the secondary outcome was calculated postpartum haemorrhage (estimated from peripartum change in haemoglobin concentration). We modelled the outcomes with multilevel logistic regression, adjusting for confounders with inverse probability of treatment weighting.FINDINGSBetween Aug 24, 2019, and Sept 19, 2023, 4355 (28·9%) of the 15 068 women recruited to the WOMAN-2 trial had an episiotomy. In primiparous women who had non-instrumental births, the incidence of episiotomy was 81·1% in Pakistan (2703 of 3335), 63·3% (307 of 485) in Nigeria, 28·5% (69 of 242) in Zambia, and 15·1% (111 of 735) in Tanzania. Clinically diagnosed postpartum haemorrhage occurred in 1034 (6·9%) of 15 066 participants, and calculated postpartum haemorrhage occurred in 1417 (9·5%) of 14 863. After adjustment for confounders, episiotomy was associated with clinically diagnosed postpartum haemorrhage (odds ratio 1·88, 95% CI 1·33-2·66) and calculated postpartum haemorrhage (1·63, 1·14-2·34).INTERPRETATIONAlthough WHO recommends against the routine use of episiotomy, many first-time mothers were given this procedure. Episiotomy might increase the risk of postpartum haemorrhage in women with moderate or severe anaemia. As anaemia is known to worsen the life-threatening complications of postpartum haemorrhage, the risks of routine episiotomy could be even greater in women with anaemia.FUNDINGWellcome and the Bill & Melinda Gates Foundation.TRANSLATIONSFor the Swahili, Urdu, Yoruba, Hausa and Igbo translations of the abstract see Supplementary Materials section.
{"title":"Episiotomy and postpartum haemorrhage in women with moderate or severe anaemia: a cohort analysis of data from the WOMAN-2 trial.","authors":" , ","doi":"10.1016/s2214-109x(25)00449-8","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00449-8","url":null,"abstract":"BACKGROUNDWomen with anaemia have a higher risk of postpartum haemorrhage than those without anaemia. We examined the association between episiotomy and postpartum haemorrhage in women with moderate or severe anaemia.METHODSWe conducted a cohort analysis using data from the World Maternal Antifibrinolytic-2 (WOMAN-2) trial. Women with moderate or severe anaemia who were giving birth vaginally were recruited from 34 hospitals in Nigeria, Pakistan, Tanzania, and Zambia. On arrival at hospital, the participants' haemoglobin concentration was measured with a validated point-of-care haemoglobin test. Moderate anaemia was defined as a haemoglobin concentration of 70-99 g/L and severe anaemia as a haemoglobin concentration lower than 70 g/L. Episiotomy was defined as any perineal incision during delivery. Women were excluded from the WOMAN-2 trial if they were younger than 18 years and lacked consent from a guardian, had a known allergy to the trial intervention, had an indication or contraindication to the intervention, or were diagnosed with postpartum haemorrhage before the umbilical cord was clamped. The primary outcome was a clinical diagnosis of postpartum haemorrhage (estimated blood loss ≥500 mL or any blood loss causing haemodynamic instability), and the secondary outcome was calculated postpartum haemorrhage (estimated from peripartum change in haemoglobin concentration). We modelled the outcomes with multilevel logistic regression, adjusting for confounders with inverse probability of treatment weighting.FINDINGSBetween Aug 24, 2019, and Sept 19, 2023, 4355 (28·9%) of the 15 068 women recruited to the WOMAN-2 trial had an episiotomy. In primiparous women who had non-instrumental births, the incidence of episiotomy was 81·1% in Pakistan (2703 of 3335), 63·3% (307 of 485) in Nigeria, 28·5% (69 of 242) in Zambia, and 15·1% (111 of 735) in Tanzania. Clinically diagnosed postpartum haemorrhage occurred in 1034 (6·9%) of 15 066 participants, and calculated postpartum haemorrhage occurred in 1417 (9·5%) of 14 863. After adjustment for confounders, episiotomy was associated with clinically diagnosed postpartum haemorrhage (odds ratio 1·88, 95% CI 1·33-2·66) and calculated postpartum haemorrhage (1·63, 1·14-2·34).INTERPRETATIONAlthough WHO recommends against the routine use of episiotomy, many first-time mothers were given this procedure. Episiotomy might increase the risk of postpartum haemorrhage in women with moderate or severe anaemia. As anaemia is known to worsen the life-threatening complications of postpartum haemorrhage, the risks of routine episiotomy could be even greater in women with anaemia.FUNDINGWellcome and the Bill & Melinda Gates Foundation.TRANSLATIONSFor the Swahili, Urdu, Yoruba, Hausa and Igbo translations of the abstract see Supplementary Materials section.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"41 1","pages":"e224-e232"},"PeriodicalIF":34.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947455","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 : 2026-02-01DOI: 10.1016/s2214-109x(25)00499-1
Francesco Di Gennaro,Luigi Pisani,Giacomo Guido,Annalisa Saracino
{"title":"Proximity as core to co-design in global health.","authors":"Francesco Di Gennaro,Luigi Pisani,Giacomo Guido,Annalisa Saracino","doi":"10.1016/s2214-109x(25)00499-1","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00499-1","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"264 1","pages":"e197"},"PeriodicalIF":34.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947468","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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