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Proximity as core to co-design in global health. 邻近性是全球卫生共同设计的核心。
IF 34.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2026-02-01 DOI: 10.1016/s2214-109x(25)00499-1
Francesco Di Gennaro,Luigi Pisani,Giacomo Guido,Annalisa Saracino
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引用次数: 0
Medical oxygen and respiratory support requirements for patients hospitalised with COVID-19 in 23 low-income and middle-income countries: a prospective, observational cohort study. 23个低收入和中等收入国家COVID-19住院患者的医用氧气和呼吸支持需求:一项前瞻性观察性队列研究
IF 34.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2026-02-01 DOI: 10.1016/s2214-109x(25)00480-2
Pryanka Relan,Jamie Rylance,Yaseen M Arabi,Pauline Convocar,Matthieu Rolland,Janet V Diaz,
BACKGROUNDThe COVID-19 pandemic highlighted a global shortage of, and inequity of access to, medical oxygen. Understanding patient outcomes and the capacities of health facilities to provide respiratory support including oxygen is key to matching need and demand. We report results from a global study including 23 low-income and middle-income countries.METHODSFor this prospective, observational cohort study, consecutive patients aged 12 years or older with suspected or confirmed COVID-19 and evidence of respiratory distress were prospectively recruited within 24 h of hospital admission. Hospitals from 23 low-income and middle-income countries were included, representing all WHO regions. Baseline demographic and clinical data were collected, and daily follow-ups were recorded for in-hospital outcomes and respiratory support types. At the facility level, we assessed sources of oxygen and electricity, infrastructural and staffing capacity for critical care provision, and the capabilities of the facility for advanced respiratory support. The primary outcome was 30-day in-hospital mortality. This study was registered on ClinicalTrials.gov (NCT04918875).FINDINGSBetween Jan 24 and Nov 22, 2022, 56 sites took part. Of 53 726 patients screened, 3070 were enrolled. 1814 (61·6%) of 2947 patients had two or more underlying medical conditions and initially received oxygen through nasal cannula or non-rebreather face masks with reservoir. Invasive mechanical ventilation was most frequently used in patients recruited in the Americas (75 [26·4%] of 284 patients) and in the Eastern Mediterranean (90 [18·0%] of 499 patients). The overall mortality was 649 (23·4%) of 2779 patients, varying by region from 53 (10·5%) of 506 patients in South-East Asia to 286 (37·6%) of 760 patients in Africa. Mortality was associated with the maximum level of respiratory support received: from 17 (8·6%) of 198 patients who received no oxygen, 99 (38·4%) of 258 patients for non-rebreather reservoir bags, and 205 (62·9%) of 326 for invasive ventilation.INTERPRETATIONThe availability and use of oxygen support options in low-income and middle-income countries are highly variable but appear significantly less in the African region. Mortality might be associated with a lack of access to oxygen, which varied across WHO regions but was highest in Africa. Despite many lessons learned from the COVID-19 pandemic, inequity in access to medical oxygen remains a challenge that WHO and partners must address in the post-pandemic era to avoid preventable deaths.FUNDINGUNITAID.
2019冠状病毒病大流行凸显了全球医用氧气短缺和获取不公平的问题。了解患者的结果和卫生机构提供包括氧气在内的呼吸支持的能力是匹配需求的关键。我们报告了一项包括23个低收入和中等收入国家的全球研究的结果。方法在这项前瞻性观察性队列研究中,前瞻性招募住院24小时内12岁及以上疑似或确诊COVID-19并有呼吸窘迫证据的连续患者。包括来自23个低收入和中等收入国家的医院,代表世卫组织所有区域。收集基线人口统计学和临床数据,并记录每日随访的住院结果和呼吸支持类型。在设施层面,我们评估了氧气和电力来源、提供重症监护的基础设施和人员配备能力,以及设施提供高级呼吸支持的能力。主要终点是30天住院死亡率。该研究已在ClinicalTrials.gov注册(NCT04918875)。在2022年1月24日至11月22日期间,56个地点参与了调查。在53 726名接受筛查的患者中,有3070名患者入组。2947例患者中,1814例(61.6%)有两种或两种以上基础疾病,最初通过鼻插管或带储氧器的非换气面罩吸氧。美洲(284例患者中有75例[26.4%])和东地中海(499例患者中有90例[18.0%])招募的患者最常使用有创机械通气。总死亡率为2779例患者中的649例(23.4%),从东南亚506例患者中的53例(10.5%)到非洲760例患者中的286例(37.6%)不等。死亡率与所接受的最大呼吸支持水平相关:198例无氧患者中有17例(8.6%),258例无呼吸储气袋患者中有99例(38.4%),326例有创通气患者中有205例(62.9%)。在低收入和中等收入国家,氧气支持方案的可得性和使用情况差异很大,但在非洲地区明显较少。死亡率可能与缺乏氧气有关,这在世卫组织各区域有所不同,但在非洲最高。尽管从2019冠状病毒病大流行中吸取了许多教训,但在获得医用氧气方面的不平等仍然是世卫组织及其合作伙伴在大流行后时代必须解决的挑战,以避免可预防的死亡。
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引用次数: 0
HbA1c alone might not reliably indicate India's diabetes prevalence. 单独的糖化血红蛋白可能无法可靠地显示印度的糖尿病患病率。
IF 34.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2026-02-01 DOI: 10.1016/s2214-109x(25)00485-1
Lovely Gupta,Irshad Ahmad Ansari,Amerta Ghosh,Anoop Misra
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引用次数: 0
HbA1c alone might not reliably indicate India's diabetes prevalence - Authors' reply. 单独的HbA1c可能不能可靠地表明印度的糖尿病患病率——作者的答复。
IF 34.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2026-02-01 DOI: 10.1016/s2214-109x(25)00530-3
T V Sekher,David Flood,Peifeng Hu,Mohammed K Ali,Ashwini Shete,Sarang Pedgaonkar,Kenneth M Langa,Eileen M Crimmins,David E Bloom,Jinkook Lee
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引用次数: 0
Incidence and prevalence of orphanhood in Rakai, Uganda: a population-based cohort study, 1995-2022. 1995-2022年乌干达拉凯地区孤儿发生率和流行率:一项基于人群的队列研究
IF 34.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2026-02-01 DOI: 10.1016/s2214-109x(25)00440-1
Aleya Khalifa,Debbie E Malden,Oliver Ratmann,Yu Chen,M Kate Grabowski,Larry W Chang,Fred Nalugoda,Godfrey Kigozi,Tom Lutalo,Nelson K Sewankambo,Anthony Ndyanabo,Philip Kreniske,Fredrick Makumbi,David Serwadda,Robert Ssekubugu,Absalom Ssettuba,Hadijja Nakawooya,Susan Hillis,John S Santelli
BACKGROUNDThe introduction and scale-up of HIV treatment and prevention programmes have resulted in steady declines in orphanhood prevalence in sub-Saharan Africa, but orphanhood incidence and its associated factors are less understood. We aimed to describe the incidence and prevalence of orphanhood after HIV treatment and prevention programmes became available in Rakai, Uganda.METHODSIn this population-based cohort study, we used data from all children and adolescents younger than 18 years with censused parents residing in 28 continuously surveyed Rakai Community Cohort Study (RCCS) communities from 1995 to 2022 (N=92 441), to calculate maternal, paternal, and double orphanhood prevalence by census round. Orphanhood incidence was estimated by use of a non-parametric hierarchical Bayesian model over time among children whose parents were alive during their first census interview and who were censused at least twice without missing more than two consecutive census visits (N=54 411). Poisson regression models estimated incidence rate ratios of orphanhood and 95% CIs by time period (pre-antiretroviral therapy [ART; 1995-2003], ART partial availability [2004-14], and ART full availability [2015-22]), age at orphanhood, and socioeconomic status of the household. Population attributable fractions of incident orphanhood due to parents' HIV-positive status were estimated among those with surveyed parents who were tested for HIV.FINDINGSOrphanhood prevalence declined considerably over the study period, with steepest declines after ART became available; from 21·5% (3421 of 15 941 individuals) in 2003-04 to 6·3% (1449 of 23 082 individuals) in 2020-22. In adolescents aged 15-17 years, orphanhood prevalence declined from 49·4% (1057 of 2138) in 2002-03 to 14·4% (526 of 3661 individuals) in 2020-22. Incidence rates declined sharply; double orphanhood declined from 5·13 (95% CI 4·02-6·45) per 1000 person-years in 2003-04 to 0·68 (0·42-1·05) per 1000 person-years in 2020-22. The proportion of new cases of orphanhood attributed to parental HIV status declined from 67% in 2004 to 11% in 2022 for paternal orphanhood and from 71% to 12% for maternal orphanhood.INTERPRETATIONScale-up of ART in this Ugandan setting drove substantive declines in orphanhood incidence. Yet, a considerable burden of orphanhood persisted in 2022, particularly among adolescents. To consolidate these gains, sustained investment and adaptation of HIV programmes are crucial to mitigate the ongoing risk of orphanhood for this vulnerable population.FUNDINGNational Institute of Allergy and Infectious Diseases, National Institute of Child Health and Development, Gates Foundation, National Institute of Mental Health, and National Institutes of Health Fogarty International Center.
背景:艾滋病毒治疗和预防规划的引入和扩大已经导致撒哈拉以南非洲地区的孤儿率稳步下降,但孤儿发生率及其相关因素尚不清楚。我们的目的是描述在乌干达拉凯开展艾滋病毒治疗和预防项目后孤儿的发生率和流行程度。方法在这项以人口为基础的队列研究中,我们使用了1995年至2022年期间居住在28个连续调查的Rakai社区队列研究(RCCS)社区的所有18岁以下儿童和青少年的数据(N=92 441),通过人口普查来计算母亲、父亲和双孤儿的患病率。通过使用非参数分层贝叶斯模型,在父母在第一次人口普查访问时还活着,并且至少两次人口普查且没有错过超过两次连续人口普查访问的儿童中,随着时间的推移估计孤儿发生率(N=54 411)。泊松回归模型按时间段(抗逆转录病毒治疗前[ART; 1995-2003年]、抗逆转录病毒治疗部分可用性[2004-14年]和抗逆转录病毒治疗完全可用性[2015-22年])、孤儿年龄和家庭社会经济地位估算了孤儿发生率和95% ci。在接受调查的父母接受艾滋病毒检测的人群中,估计由于父母艾滋病毒阳性而导致的意外孤儿的人口归因比例。研究发现:在整个研究期间,孤儿患病率显著下降,在获得抗逆转录病毒治疗后下降幅度最大;从2003-04年的21.5%(15941只中的3421只)到2020-22年的6.3%(23082只中的1449只)。在15-17岁的青少年中,孤儿率从2002-03年的49.4%(2138人中的1057人)下降到2020-22年的14.4%(3661人中的526人)。发病率急剧下降;双孤儿从2003-04年的每千人年5.13 (95% CI 4.02 - 6.45)下降到2020-22年的每千人年0.68(0.42 - 0.05)。由于父母感染艾滋病毒而导致的新孤儿比例在父亲孤儿中从2004年的67%下降到2022年的11%,在母亲孤儿中从71%下降到12%。在乌干达这种环境中,艺术的扩大推动了孤儿发生率的实质性下降。然而,2022年仍存在相当大的孤儿负担,尤其是在青少年中。为了巩固这些成果,持续投资和适应艾滋病毒规划对于减轻这一弱势群体持续存在的成为孤儿的风险至关重要。资助:美国国家过敏和传染病研究所、美国国家儿童健康与发展研究所、盖茨基金会、美国国家心理健康研究所、美国国家卫生研究院福格蒂国际中心。
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引用次数: 0
7-year trend of timely hepatitis B birth dose vaccination coverage in The Gambia: a retrospective, population-based analysis. 冈比亚及时乙肝出生剂量疫苗接种覆盖率的7年趋势:一项基于人群的回顾性分析
IF 34.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2026-02-01 DOI: 10.1016/s2214-109x(25)00270-0
Gibril Ndow,Isatou Cham,Rohey Bangura,Sainabou Drammeh,Cecile de Bezenac,Sarwar Golam S,Esu Ezeani,Pierre Gomez,Sheriff Badjie,Sidat Fofana,Mustapha Bittaye,Grant Mackenzie,Julien Randon-Furling,Umberto D'Alessandro,Yusuke Shimakawa,Maud Lemoine
BACKGROUNDAccording to WHO and UNICEF, Africa has the lowest coverage (18%) of timely (within the first 24 h) hepatitis B birth dose (HepB-BD) vaccination worldwide. To eliminate hepatitis B by 2030, 90% vaccination coverage is required. Experiences from The Gambia, the first African country to adopt HepB-BD vaccination in 1990, could guide HepB-BD implementation and scale-up in Africa. We aimed to assess the trend of, and barriers to, timely HepB-BD vaccination coverage over a 7-year period in The Gambia.METHODSIn this retrospective analysis, 2015-21 data were extracted from population-based Health and Demographic Surveillance Systems in three rural areas (Basse, Bansang, and Farafenni) in The Gambia. Fluctuation tests and Bayesian analysis using Markov chain Monte Carlo methods assessed the rate of timely (within days 0-1 of birth) and delayed HepB-BD vaccination coverage, change points (abrupt variation between two stable periods) in the average coverage of timely HepB-BD vaccination, and the factors associated with delayed HepB-BD vaccination during the first 7 years following the WHO recommendations on hepatitis B elimination.FINDINGSBetween Jan 1, 2015, and Dec 31, 2021, 4560 of 71 088 livebirths (6·4%, 95% CI 6·2-6·6) received a timely HepB-BD. Timely HepB-BD vaccination coverage increased from 1·7% (95% CI 1·3-2·0) in the first half of 2015 (ie, January to June) to 22·4% (21·3-23·6) in the second half of 2021 (ie, July to December; p<0·0001). Delayed HepB-BD administration was associated with being born on Friday (odds ratio [OR] 3·51 [95% CI 3·03-4·08]; p<0·0001) or Saturday (5·93 [4·96-7·13]; p<0·0001) compared with Tuesday; being born in Basse (2·03 [95% CI 1·83-2·25]; p<0·0001) or Farafenni (1·84 [1·63-2·08]; p<0·0001); and being born during the rainy season (1·16 [1·08-1·25]; p<0·0001). Average timely HepB-BD vaccination coverage significantly decreased from 10·1% (95% CI 9·5-10·6) pre-COVID-19 pandemic to 5·4% (4·5-6·3) during the first COVID-19 wave (p<0·0001). After adjusting for all other factors, being born during the first COVID-19 wave was associated with delayed HepB-BD vaccination (OR 1·41 [1·22-1·64]; p<0·0001).INTERPRETATION30 years after the adoption of HepB-BD in The Gambia, the rate of vaccination coverage remains low and was significantly affected by the COVID-19 pandemic, highlighting the challenges for its implementation.FUNDINGNone.
根据世卫组织和联合国儿童基金会的数据,非洲在世界范围内及时(在最初24小时内)接种乙型肝炎出生疫苗的覆盖率(18%)最低。为了到2030年消除乙型肝炎,需要90%的疫苗接种覆盖率。冈比亚是1990年第一个采用乙型肝炎疫苗接种的非洲国家,其经验可以指导乙型肝炎疫苗在非洲的实施和推广。我们的目的是评估冈比亚7年期间乙肝- bd疫苗及时覆盖的趋势和障碍。方法回顾性分析2015-21年冈比亚三个农村地区(Basse、Bansang和Farafenni)基于人口的健康和人口监测系统的数据。使用马尔科夫链蒙特卡罗方法的波动试验和贝叶斯分析评估了及时(出生后0-1天内)和延迟乙肝疫苗接种覆盖率,平均及时乙肝疫苗接种覆盖率的变化点(两个稳定时期之间的突变),以及在世卫组织建议消除乙肝后的前7年内延迟乙肝疫苗接种的相关因素。结果:2015年1月1日至2021年12月31日期间,71,088例活产婴儿中有4560例(6.4%,95% CI 6.2 - 6.6)及时接受了HepB-BD治疗。乙肝疫苗的及时接种率从2015年上半年(即1月至6月)的1.7% (95% CI 1·3-2·0)增加到2021年下半年(即7月至12月,p< 0.0001)的22.4%(21·3-23·6)。与周二相比,延迟给药与出生在周五(比值比[OR] 3.51 [95% CI 3.03 -4·08],p< 0.0001)或周六(比值比[5.93 [4.96 - 7.13],p< 0.0001)相关;出生在Basse (2.03 [95% CI 1.83 - 2.25], p< 0.0001)或Farafenni (1.84 [1.63 - 2.08], p< 0.0001);在雨季出生(1.16 [1.08 - 1.25];p< 0.0001)。平均及时HepB-BD疫苗接种率从COVID-19大流行前的10.1% (95% CI 9.5 - 10.6)显著下降到第一波COVID-19期间的5.4% (4.5 - 6.3)(p< 0.0001)。在对所有其他因素进行调整后,在第一次COVID-19浪潮期间出生与延迟接种HepB-BD相关(OR为1.41[1.22 -1·64];p< 0.0001)。在冈比亚采用乙型肝炎疫苗接种30年后,疫苗接种率仍然很低,并受到COVID-19大流行的严重影响,这凸显了实施该疫苗接种所面临的挑战。
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引用次数: 0
Converging global crises and the re-emergence of neglected tropical diseases: the case of noma 全球危机趋同和被忽视的热带病重新出现:以坏疽性口炎为例
IF 34.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2026-01-30 DOI: 10.1016/s2214-109x(26)00020-3
Marta Ribes, Claudia García-Vaz, Carlos Chaccour, Eldo Elobolobo, Larraitz Ventoso, Anna Roca, Anna Dimitrova
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引用次数: 0
Correction to Lancet Glob Health 2025; 13: e1869–79 《柳叶刀全球健康2025》更正;13: e1869 - 79
IF 34.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2026-01-27 DOI: 10.1016/s2214-109x(26)00025-2
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引用次数: 0
Correction to Lancet Glob Health 2026; 14: e4–5 《柳叶刀全球健康》2026版更正;14: e4-5
IF 34.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2026-01-16 DOI: 10.1016/s2214-109x(26)00007-0
{"title":"Correction to Lancet Glob Health 2026; 14: e4–5","authors":"","doi":"10.1016/s2214-109x(26)00007-0","DOIUrl":"https://doi.org/10.1016/s2214-109x(26)00007-0","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"39 1","pages":""},"PeriodicalIF":34.3,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145995283","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}
引用次数: 0
Understanding the WHO global strategy to accelerate cervical cancer elimination 了解世卫组织加速消除子宫颈癌的全球战略
IF 34.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2026-01-16 DOI: 10.1016/s2214-109x(26)00004-5
Victoire Fokom Defo, Joël Fokom Domgue
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引用次数: 0
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Lancet Global Health
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