Lancet Global Health最新文献

{"title":"Medical oxygen: a necessity or a luxury in humanitarian settings?","authors":"Aurélie Godard, Revati Phalkey, Susan Shepherd, Sara Rossi, Mesfin Teklu Tessema, James S Lee","doi":"10.1016/S2214-109X(24)00509-6","DOIUrl":"https://doi.org/10.1016/S2214-109X(24)00509-6","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":""},"PeriodicalIF":19.9,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469610","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":"Emergence and spread of the SARS-CoV-2 omicron (BA.1) variant across Africa: an observational study.","authors":"Carlo Fischer, Tongai Gibson Maponga, Anges Yadouleton, Nuro Abílio, Emmanuel Aboce, Praise Adewumi, Pedro Afonso, Jewelna Akorli, Soa Fy Andriamandimby, Latifa Anga, Yvonne Ashong, Mohamed Amine Beloufa, Aicha Bensalem, Richard Birtles, Anicet Luc Magloire Boumba, Freddie Bwanga, Mike Chaponda, Paradzai Chibukira, R Matthew Chico, Justin Chileshe, Wonderful Choga, Gershom Chongwe, Assana Cissé, Fatoumata Cissé, Umberto D'Alessandro, Xavier de Lamballerie, Joana F M de Morais, Fawzi Derrar, Ndongo Dia, Youssouf Diarra, Lassina Doumbia, Christian Drosten, Philippe Dussart, Richard Echodu, Abdelmajid Eloualid, Ousmane Faye, Torsten Feldt, Anna Frühauf, Simani Gaseitsiwe, Afiwa Halatoko, Etuhole Iipumbu, Pauliana-Vanessa Ilouga, Nalia Ismael, Ronan Jambou, Sheikh Jarju, Antje Kamprad, Ben Katowa, John Kayiwa, Leonard King'wara, Ousmane Koita, Vincent Lacoste, Adamou Lagare, Olfert Landt, Sonia Etenna Lekana-Douki, Jean-Bernard Lekana-Douki, Hugues Loemba, Tom Luedde, Julius Lutwama, Santou Mamadou, Issaka Maman, Brendon Manyisa, Pedro A Martinez, Japhet Matoba, Lusia Mhuulu, Andrés Moreira-Soto, Sikhulile Moyo, Judy Mwangi, Nadine N'dilimabaka, Charity Angella Nassuna, Mamadou Ousmane Ndiath, Emmanuel Nepolo, Richard Njouom, Jalal Nourlil, Steven Ger Nyanjom, Eddy Okoth Odari, Alfred Okeng, Jean Bienvenue Ouoba, Michael Owusu, Irene Owusu Donkor, Karabo Kristen Phadu, Richard Odame Phillips, Wolfgang Preiser, Pierre Roques, Vurayai Ruhanya, Fortune Salah, Sourakatou Salifou, Amadou Alpha Sall, Augustina Angelina Sylverken, Paul Alain Tagnouokam-Ngoupo, Zekiba Tarnagda, Francis Olivier Tchikaya, Noël Tordo, Tafese Beyene Tufa, Jan Felix Drexler","doi":"10.1016/S2214-109X(24)00419-4","DOIUrl":"https://doi.org/10.1016/S2214-109X(24)00419-4","url":null,"abstract":"<p><strong>Background: </strong>In mid-November, 2021, the SARS-CoV-2 omicron variant (B.1.1.529; BA.1 sublineage) was detected in southern Africa, prompting international travel restrictions. We aimed to investigate the spread of omicron BA.1 in Africa.</p><p><strong>Methods: </strong>In this observational study, samples from patients infected with SARS-CoV-2 from 27 laboratories in 24 African countries, collected between June 1, 2021 and April 14, 2022, were tested for omicron BA.1 and delta (B.1.617.2) variants using real-time RT-PCR. Samples that tested positive for BA.1 by RT-PCR and were collected before estimated BA.1 emergence according to epidemiological properties were excluded from downstream analyses. The diagnostic precision of the assays was evaluated by high-throughput sequencing of samples from four countries. The observed spread of BA.1 was compared with mobility-based mathematical simulations and entries for SARS-CoV-2 in the Global Initiative on Sharing All Influenza Data (GISAID) genomic database. We estimated the effective reproduction number (R<sub>t</sub>) at the country level considering the BA.1 fraction and the reported numbers of infections. Phylogeographical analyses were done in a Bayesian framework.</p><p><strong>Findings: </strong>Through testing of 13 294 samples from patients infected with SARS-CoV-2, we established that, by November-December, 2021, omicron BA.1 had replaced the delta variant of SARS-CoV-2 in all African subregions, following a south-north gradient, with a median R<sub>t</sub> of 2·60 (95% CI 2·46-2·71). This south-north spread, established on the basis of PCR data, was substantiated by phylogeographical reconstructions, ancestral state reconstructions, and GISAID data. PCR-based reconstructions of country-level BA.1 predominance and the availability of BA.1 genomic sequences in GISAID correlated significantly in time (p=0·0002, r=0·78). The first detections of BA.1 in high-income settings beyond Africa were predicted accurately in time by mobility-based mathematical simulations (p<0·0001). Comparing PCR-based reconstructions with mobility-based mathematical simulations suggested that SARS-CoV-2 infections in Africa were under-reported by approximately ten times. Inbound travellers infected with BA.1, departing from five continents, were identified in six African countries by early December, 2021.</p><p><strong>Interpretation: </strong>Omicron BA.1 was widespread in Africa when travel bans were implemented, limiting their effectiveness. Combined with genomic surveillance and mobility-based mathematical modelling, PCR-based strategies can inform R<sub>t</sub> and the geographical spread of emerging pathogens in a cost-effective and timely manner, and can guide evidence-based, non-pharmaceutical interventions such as travel restrictions or physical distancing.</p><p><strong>Funding: </strong>Bill & Melinda Gates Foundation.</p><p><strong>Translations: </strong>For the French, Portugese and Spanish t","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 2","pages":"e256-e267"},"PeriodicalIF":19.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075644","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 detection and a treatment bundle strategy for postpartum haemorrhage: a mixed-methods process evaluation.","authors":"Meghan A Bohren, Suellen Miller, Kristie-Marie Mammoliti, Hadiza Galadanci, Sue Fawcus, Neil Moran, G Justus Hofmeyr, Zahida Qureshi, Fadhlun Alwy Al-Beity, Gillian Forbes, Shahinoor Akter, Alfred Osoti, George Gwako, Thiago Melo Santos, Cherrie Evans, Aminu Ado Wakili, Maisaratu Bakari, Idris Usman Takai, Mohammad Umar, Mandisa Singata-Madliki, Elani Muller, Sibongile Mandondo, Jenipher Okore, Akwinata Banda, Masumbuko Sambusa, Kulandaipalayam N Sindhu, Leanne Beeson, Christina Louise Easter, Adam Devall, A Metin Gülmezoglu, Fernando Althabe, Olufemi T Oladapo, Ioannis Gallos, Arri Coomarasamy, Fabiana Lorencatto","doi":"10.1016/S2214-109X(24)00454-6","DOIUrl":"10.1016/S2214-109X(24)00454-6","url":null,"abstract":"<p><strong>Background: </strong>Postpartum haemorrhage is a leading cause of maternal mortality. A multicountry, cluster-randomised trial (E-MOTIVE) demonstrated a 60% reduction in adverse postpartum haemorrhage outcomes. The E-MOTIVE intervention included early postpartum haemorrhage detection using calibrated blood-collection drapes, followed by a postpartum haemorrhage treatment bundle (ie, uterine massage, oxytocics, tranexamic acid, intravenous fluids, examination and escalation [MOTIVE]), supported by implementation strategies. We report a mixed-methods process evaluation assessing the implementation of the E-MOTIVE intervention in Kenya, Nigeria, South Africa, and Tanzania.</p><p><strong>Methods: </strong>In this mixed-methods process evaluation, data sources were observations of health workers providing clinical care to pregnant women and pregnant people during vaginal birth and postpartum haemorrhage at intervention sites, and surveys and qualitative interviews with health workers at intervention and control sites. Intervention sites received the calibrated drapes, MOTIVE bundle, and implementation strategies and control sites used uncalibrated drapes. Primary implementation outcomes included fidelity, adoption, adaptation, acceptability, feasibility, and contamination to the calibrated drape, MOTIVE bundle, and implementation strategies.</p><p><strong>Findings: </strong>Between June 1, 2022, and Jan 31, 2023, 2578 births were observed, 295 pregnant women and people had postpartum haemorrhage, 47 qualitative interviews were done, and 889 surveys were completed. Fidelity to calibrated drape use was high (birth observations 2578 [100%] of 2578; survey 451 [98·3%] of 459). Among health workers, calibrated drape acceptability was high; however, they reported barriers to pregnant women's and people's acceptability. Fidelity to postpartum haemorrhage treatment bundle delivery was high (birth observations 286 [96·9%] of 295), with moderate to high fidelity in median time from postpartum haemorrhage diagnosis to final treatment initiation (≤15 min initiation time in 191 [66·8%] of 295 birth observations, 16-20 min in 42 [14·7%] birth observations), and high acceptability and feasibility. Research midwives participated in clinical assessments after birth and bundle delivery in some sites (mixed fidelity).</p><p><strong>Interpretation: </strong>This process evaluation shows generally high levels of fidelity, feasibility, and acceptability of the calibrated drape and treatment bundle across evaluation methods and countries. The E-MOTIVE intervention should be included in national policies, with consideration for health workforce, supplies, and medication issues, which might need addressing for successful implementation.</p><p><strong>Funding: </strong>The Bill and Melinda Gates Foundation and the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, a co-sponsored programme of WHO.<","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 2","pages":"e329-e344"},"PeriodicalIF":19.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of prenatal multiple micronutrient supplementation and small-quantity lipid-based nutrient supplementation on small vulnerable newborn types in low-income and middle-income countries: a meta-analysis of individual participant data.","authors":"Dongqing Wang, Enju Liu, Nandita Perumal, Uttara Partap, Ilana R Cliffer, Janaína Calu Costa, Molin Wang, Wafaie W Fawzi","doi":"10.1016/S2214-109X(24)00449-2","DOIUrl":"10.1016/S2214-109X(24)00449-2","url":null,"abstract":"<p><strong>Background: </strong>Small vulnerable newborn types, defined by combinations of being born too soon or too small, have distinct determinants and health consequences. We aimed to assess the effects of prenatal multiple micronutrient supplementation (MMS) and small-quantity lipid-based nutrient supplementation (SQ-LNS) on small vulnerable newborn types, which are currently unknown.</p><p><strong>Methods: </strong>In this meta-analysis, individual participant data from randomised controlled trials of MMS and randomised controlled trials of SQ-LNS in low-income and middle-income countries were used. We systematically searched the literature using PubMed, Embase, and Web of Science to identify randomised controlled trials of prenatal nutritional supplementation using MMS or SQ-LNS among pregnant people published between Jan 1, 2000, and Dec 31, 2021. Studies were excluded if they were conducted exclusively among participants selected by pre-existing health conditions, such as anaemia status, HIV infection, or diabetes. We contacted the corresponding authors of all identified studies to seek data contribution. As individual participant data became available, we mapped relevant variables and harmonised the data across studies. Iron and folic acid supplementation was the control group in most studies. Newborns were classified into ten groups through the combinations of preterm or term birth, small, appropriate, and large for gestational age, and low birthweight (LBW) or non-LBW. Newborns were also analysed using a four-group categorisation of preterm or term and LBW or non-LBW. Log-binomial models were used to estimate study-specific risk ratios (RRs), which were pooled using meta-analyses.</p><p><strong>Findings: </strong>14 randomised controlled trials of MMS (n=42 618; the mean maternal age at study enrolment was 24·3 years [SD 5.6]; 22 086 [51·8%] male neonates and 20 532 [48·2%] female neonates) and four randomised controlled trials of SQ-LNS (n=6246; the mean maternal age at study enrolment was 23·3 years [SD 5·3]; 3137 [50·2%] male neonates and 3109 [49·8%] female neonates) were used. In the ten-group categorisation of small vulnerable newborns, prenatal MMS reduced the risk of preterm-small for gestational age (SGA)-LBW (RR 0·73, 95% CI 0·64-0·84; p=0·0003); preterm-appropriate for gestational age (AGA)-LBW (0·82, 0·74-0·91; p=0·0010); preterm-AGA-non-LBW (0·89, 0·80-0·98; p=0·019); term-SGA-LBW (0·91, 0·85-0·96; p=0·0046); and term-SGA-non-LBW (0·95, 0·90-1·00; p=0·050). In the four-group categorisation, prenatal MMS reduced the risk of preterm-SGA (0·71, 0·62-0·82; p=0·0002) and term-SGA (0·93, 0·89-0·98; p=0·0066). Prenatal SQ-LNS had no significant effects on the risk of giving birth to small vulnerable newborns except for preterm-large for gestational age-non-LBW in the ten-group categorisation (0·78, 0·65-0·94; p=0·023).</p><p><strong>Interpretation: </strong>Prenatal MMS and SQ-LNS reduce the risk of giving birth to small vulner","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 2","pages":"e298-e308"},"PeriodicalIF":19.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variability and social patterning of cancer mortality in 343 Latin American cities: an ecological study.","authors":"Tania Alfaro, Kevin Martinez-Folgar, Dalia Stern, Maria A Wilches-Mogollon, María Pía Muñoz, Harrison Quick, Marcio Alazraqui, Manuel Ramirez-Zea, J Jaime Miranda, Mariana Lazo, Waleska Teixeira Caiaffa, Ana V Diez Roux, Usama Bilal","doi":"10.1016/S2214-109X(24)00446-7","DOIUrl":"10.1016/S2214-109X(24)00446-7","url":null,"abstract":"<p><strong>Background: </strong>Understanding between-city variations in cancer mortality is crucial to inform national and subnational cancer prevention strategies. However, studies at the city level in Latin America are scarce. As part of the Salud Urbana en América Latina (SALURBAL) project, we aimed to describe the variability in cancer mortality rates across 343 cities in nine Latin American countries and the associations of these rates with city-level socioeconomic development.</p><p><strong>Methods: </strong>This ecological study used data from cities in Argentina, Brazil, Chile, Colombia, Costa Rica, El Salvador, Guatemala, Mexico, and Panama. Vital registration and population data from Jan 1, 2015 to Dec 31, 2019 were used to estimate sex-specific and age-standardised cancer mortality rates for each city, overall and for seven cancer sites (breast, lung, colorectal, stomach, liver, prostate, and cervical), and the associations of these rates with city-level socioeconomic development.</p><p><strong>Findings: </strong>We found wide variability in cancer mortality by city (overall age-adjusted cancer mortality rates varied by almost three times), sex, and cancer site. Variability between cities within the same country was highest for cervical and prostate cancer. The most common causes of cancer deaths were breast cancer (305 cities) for females and prostate cancer (167 cities) and lung cancer (132 cities) for males. Liver and cervical cancer were the primary cause of cancer mortality in fewer than ten cities each, most of which were in Guatemala and Mexico. Lower city-level socioeconomic development was associated with higher mortality from liver, stomach, cervical, and prostate cancers and lower mortality from breast, colorectal, and lung cancers, with variations by sex.</p><p><strong>Interpretation: </strong>We found considerable heterogeneity in cancer mortality between cities, geographical patterning, and associations between cancer mortality rates and socioeconomic development. Our results highlight the need to consider city contexts when planning interventions to reduce cancer mortality and when guiding future cancer prevention and control efforts in urban areas within the region.</p><p><strong>Funding: </strong>Wellcome Trust.</p><p><strong>Translations: </strong>For the Spanish and Portuguese translations of the abstract see Supplementary Materials section.</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 2","pages":"e268-e276"},"PeriodicalIF":19.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between childhood trauma and adolescent psychiatric disorders in Brazil: a longitudinal, population-based birth cohort study.","authors":"Megan Bailey, Graeme Fairchild, Gemma Hammerton, Andreas Bauer, Marina X Carpena, Joseph Murray, Ina S Santos, Aluísio J D Barros, Luciana Tovo-Rodrigues, Andrea Danese, Sarah L Halligan, Alicia Matijasevich","doi":"10.1016/S2214-109X(24)00452-2","DOIUrl":"https://doi.org/10.1016/S2214-109X(24)00452-2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The mental health consequences of exposure to childhood trauma have been little studied among adolescents in low-income and-middle-income countries (LMICs), despite a relatively high burden of trauma in LMIC populations. We investigated associations between trauma and adolescent psychiatric disorders in the 2004 Pelotas Birth Cohort, Brazil.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In the 2004 Pelotas Birth Cohort, current psychiatric diagnoses (anxiety, mood, attention-hyperactivity, and conduct-oppositional disorders) were assessed at age 15 years (caregiver-report Development and Well-being Assessment), and age 18 years (self-report Mini-International Neuropsychiatric Interview). Lifetime cumulative trauma was assessed via caregiver report up to age 11 years and combined self-report and caregiver-report thereafter. Exposure to 12 trauma types were assessed (serious accident, fire, other disaster, attack or threat, physical abuse, sexual abuse, witnessed domestic violence, witnessed attack, witnessed accident, heard about attack, heard about accident, and parental death). Due to the high prevalence of trauma exposure in the sample, the number of different types of trauma exposure reported was extracted as a proxy for cumulative trauma load. We assessed both cross-sectional and longitudinal associations between cumulative trauma load and psychiatric disorders during adolescence using logistic regression, adjusting for confounders and pre-existing child psychopathology at 48 months. We also computed population attributable fractions (PAFs) for trauma-mental health associations at age 18 years.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;4229 adolescents (51·9% male, 48·1% female) were included in logistic regression analyses based on imputed data. Trauma exposure affected 81·2% of adolescents by age 18 years. At age 15 years, the odds of any disorder (adjusted odds ratio [aOR] 1·19 [95% CI 1·03-1·38]), anxiety disorders (1·45 [1·21-1·75]), and conduct-oppositional disorders (1·60 [1·13-2·27]) increased for each category increase in cumulative trauma, but mood and attention-hyperactivity disorders were not related to cumulative trauma. At age 18 years, the odds of any disorder (1·34 [1·24-1·44]), anxiety disorders (1·23 [1·13-1·34]), mood disorders (1·33 [1·22-1·46]), attention-hyperactivity disorders (1·24 [1·09-1·41]), and conduct-oppositional disorders (1·59 [1·36-1·86]) all increased for each category increase in cumulative trauma. In longitudinal analyses, each category increase in cumulative trauma by age 11 years was associated with an increased odds of any disorder (aOR 1·26 [95% CI 1·11-1·44]), anxiety disorders (1·27 [1·04-1·56]), and conduct-oppositional disorders (1·43 [1·04-1·97]) at 15 years; and trauma up to age 15 years was associated with increased odds of any disorder (1·32 [1·21-1·45]), anxiety disorders (1·27 [1·14-1·40]), mood disorders (1·26 [1·12-1·41]), and conduct-oppositional disorders (1·52 [1·24-1·87]) at ag","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 2","pages":"e309-e318"},"PeriodicalIF":19.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076013","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":"Contextual factors influencing bubble continuous positive airway pressure implementation for paediatric respiratory distress in low-income and middle-income countries: a realist review.","authors":"Nadir Ijaz, Marie Nader, Matthew Ponticiello, Ashlee J Vance, Brittney J van de Water, Melissa C Funaro, Qalab Abbas, John Adabie Appiah, Mohammod Jobayer Chisti, Walter Commerell, Suiyven Elvis Dzelamunyuy, Rudimar Martinez Fernandez, Anjelica L Gonzalez, Cintia Johnston, Evance Luckson Kaiwe, Manjinder Kaur, Hans-Joerg Lang, Eric D McCollum, José Marcos González Moraga, Jayashree Muralidharan, Kelsey Renning, Herng Lee Tan, Laura Alejandra Vélez Ruiz Gaitán, Sebastián González-Dambrauskas, Patrick T Wilson, Brenda M Morrow, J Lucian Davis","doi":"10.1016/S2214-109X(24)00453-4","DOIUrl":"10.1016/S2214-109X(24)00453-4","url":null,"abstract":"<p><strong>Background: </strong>Bubble continuous positive airway pressure (bCPAP) is a low-cost, non-invasive respiratory support therapy for children with respiratory distress, but its effectiveness is dependent on the context. We aimed to understand contextual factors influencing bCPAP implementation for children aged 1-59 months in low-income and middle-income countries (LMICs) and to develop a theory explaining how these factors influence implementation outcomes.</p><p><strong>Methods: </strong>In this realist review, we generated an initial programme theory comprising candidate context-mechanism-outcome configurations (CMOCs) via review of key references and team discussion. On July 25, 2023, we conducted a search for peer-reviewed and grey literature, without date restrictions, describing bCPAP use for paediatric respiratory distress in LMICs. We included references describing related contexts, mechanisms, or outcomes. We coded statements from the literature supporting each CMOC, iteratively revising and adding CMOCs using inductive and deductive logic. We assembled an international, interdisciplinary panel of 22 bCPAP stakeholders to refine CMOCs using iterative surveys, focus groups, and interviews until we reached thematic saturation. This realist review is registered with PROSPERO (CRD42023403584).</p><p><strong>Findings: </strong>Of 1640 peer-reviewed references and eight grey literature references retrieved, 38 peer-reviewed articles and two grey literature documents were deemed eligible for inclusion after removal of duplicates and screening. After four rounds of expert surveys and three focus groups, we identified 18 CMOCs. CMOCs were synthesised into a final programme theory operating at five levels to influence implementation feasibility, fidelity, and sustainability: (1) the bCPAP device, (2) local partnerships and infrastructure, (3) clinical and technical teams, (4) caregivers and the community, and (5) institutional practices.</p><p><strong>Interpretation: </strong>Using realist methods with a diverse, international stakeholder panel, we generated a theory that could explain how bCPAP therapy works in different contexts. This theory could be leveraged to enhance the rigour of future bCPAP implementation trials.</p><p><strong>Funding: </strong>Yale National Clinician Scholars Program, US National Center for Advancing Translational Science (TL1TR001864), and National Heart, Lung, and Blood Institute (T32HL155000).</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e232-e245"},"PeriodicalIF":19.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11779698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Menopause: a global health and wellbeing issue that needs urgent attention.","authors":"Gayathri Delanerolle, Peter Phiri, Sohier Elneil, Vikram Talaulikar, George U Eleje, Rabia Kareem, Ashish Shetty, Lucky Saraswath, Om Kurmi, Cristina Laguna Benetti-Pinto, Ifran Muhammad, Nirmala Rathnayake, Teck-Hock Toh, Ieera Madan Aggarwal, Jian Qing Shi, Julie Taylor, Kathleen Riach, Kristina Potocnik, Ian Litchfield, Helen Felicity Kemp, Paula Briggs","doi":"10.1016/S2214-109X(24)00528-X","DOIUrl":"10.1016/S2214-109X(24)00528-X","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e196-e198"},"PeriodicalIF":19.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873129","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":"Cancer plans should consider local needs.","authors":"Bettina Müller, Raul Murillo","doi":"10.1016/S2214-109X(24)00534-5","DOIUrl":"https://doi.org/10.1016/S2214-109X(24)00534-5","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 2","pages":"e181-e182"},"PeriodicalIF":19.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076019","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":"Prevalence, aetiology, and hospital outcomes of paediatric acute critical illness in resource-constrained settings (Global PARITY): a multicentre, international, point prevalence and prospective cohort study.","authors":"Teresa B Kortz, Adrian Holloway, Asya Agulnik, David He, Stephanie Gordon Rivera, Qalab Abbas, John Adabie Appiah, Anita V Arias, Jonah Attebery, Jhon Camacho-Cruz, Paula Caporal, Karla Emilia de Sa Rodrigues, Ericka Fink, Niranjan Kissoon, Jan Hau Lee, Eliana López-Barón, Srinivas Murthy, Fiona Muttalib, Katie Nielsen, Kenneth Remy, Firas Sakaan, Amelie von Saint Andre-von Arnim, Adriana Teixeira Rodrigues, William Blackwelder, Matthew O Wiens, Adnan Bhutta","doi":"10.1016/S2214-109X(24)00450-9","DOIUrl":"https://doi.org/10.1016/S2214-109X(24)00450-9","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Children in resource-constrained settings (RCS) have disproportionately high illness and mortality; however, the prevalence in RCS of paediatric acute critical illness (P-ACI; life-threatening conditions that require time-sensitive interventions) is unknown. Most P-ACI can be managed with basic critical care (stabilisation, fluid resuscitation, oxygen, and vital-organ support), but RCS hospitals often lack such essential services. This study estimated the prevalence and examined the aetiology of P-ACI among children at RCS hospitals to support critical care capacity building and inform resource allocation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a hybrid prospective cohort and multinational point prevalence study of acutely ill or injured children aged 28 days to 14 years who presented to RCS hospitals on four designated days between July 20, 2021, and July 12, 2022. We measured the proportion of participants with P-ACI, applying the definition for acute paediatric critical illness (DEFCRIT) framework for research in resource-variable settings, and followed up admitted patients for hospital outcomes. In participants with P-ACI, we report diagnoses associated with critical illness. We used descriptive statistics to summarise site and cohort data by country sociodemographic category (Socio-demographic Index; SDI) and multivariable logistic regression to assess whether country sociodemographic category was independently associated with P-ACI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;The study included 46 sites, 19 countries, and 7538 children, among whom 2651 (35·2%) were admitted to hospital and 68 died (all-cause mortality 0·9% [95% CI 0·7-1·1]). 985 (13·1% [95% CI 12·3-13·9]) participants had P-ACI. Among all sociodemographic categories, P-ACI prevalence was highest (28·0% [26·0-30·1]; 512 of 1828 participants) in low-SDI countries (p&lt;0·0001). Mortality among those with P-ACI was 6·3% (4·9-8·0; 62 deaths). The most common P-ACI diagnoses were pneumonia (152 [15·4%] of 985 participants), sepsis or septic shock (102 [10·4%]), and malaria (95 [9·6%]). In an adjusted model, country sociodemographic category was not significantly associated with P-ACI frequency. Among all 68 deaths in the study, 40 (59% [46-71]) occurred within 48 h of presentation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;P-ACI in RCS hospitals is common, associated with high mortality, disproportionately elevated in low-SDI countries, and associated with conditions that can be managed with basic critical care. This study underlines the need for investment in basic critical care services in RCS to address a major contributor to preventable mortality in hospitalised children.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Funding: &lt;/strong&gt;National Institutes of Health (USA); Medical Research Council (Singapore); Grand Challenges Canada; and University of Maryland, Baltimore (USA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Translations: &lt;/strong&gt;For the French, Portuguese and Spanish translations of the abstract see S","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 2","pages":"e212-e221"},"PeriodicalIF":19.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075668","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}