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Evaluating national infection prevention and control minimum requirements: evidence from global cross-sectional surveys, 2017-22. 评估国家感染预防和控制最低要求:2017-22 年全球横断面调查证据。
IF 34.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-01 DOI: 10.1016/s2214-109x(24)00277-8
Ermira Tartari,Sara Tomczyk,Anthony Twyman,Ana Paula Coutinho Rehse,Mohamed Gomaa,Maha Talaat,Aparna Singh Shah,Howard Sobel,Joao Paulo Toledo,Benedetta Allegranzi
BACKGROUNDWHO infection prevention and control (IPC) minimum requirements provide standards to reduce the risk of infection during health-care delivery. We aimed to investigate the global implementation of these requirements at national levels and the progress of doing so across 2021-22 compared with 2017-18 to identify future directions for interventions.METHODSNational IPC focal points were invited to complete an online survey measuring IPC minimum requirements from July 19, 2021, to Jan 31, 2022. The primary outcome was the proportion of countries meeting IPC minimum requirements. Country characteristics associated with this outcome were assessed with beta regression. Subset analyses were conducted to compare the 2021-22 indicators with a WHO IPC survey conducted in 2017-18 and to assess the correlation of the proportion of IPC minimum requirements met with the results of other WHO metrics.FINDINGS106 countries (ie, 13 low income, 27 lower-middle income, 33 upper-middle income, and 33 high income) participated in the survey (56% response rate). Four (4%) of 106 met all IPC minimum requirements. The highest scoring IPC core component was multimodal improvement strategies and the lowest was IPC education and training. The odds of meeting IPC minimum requirements was higher among high-income countries compared with low-income countries (adjusted odds ratio 2·7, 95% CI 1·3-5·8; p=0·020). Compared with the 2017-18 survey, there was a significant increase in the proportion of countries reporting an active national IPC programme (65% to 82%, p=0·037) and a dedicated budget (26% to 44%, p=0·037). Evaluation of the IPC minimum requirements compared with other survey instruments revealed a low positive correlation.INTERPRETATIONTo build resilient health systems capable of withstanding future health threats, urgently scaling up adherence to WHO IPC minimum requirements is essential.FUNDINGWHO.TRANSLATIONSFor the French and Spanish translations of the abstract see Supplementary Materials section.
背景世界卫生组织(WHO)感染预防与控制(IPC)最低要求为降低医疗服务过程中的感染风险提供了标准。我们旨在调查这些要求在国家层面的全球实施情况,以及与 2017-18 年相比,2021-22 年期间的实施进展,以确定未来的干预方向。方法邀请各国 IPC 联络点完成一项在线调查,以衡量 2021 年 7 月 19 日至 2022 年 1 月 31 日期间的 IPC 最低要求。主要结果是达到 IPC 最低要求的国家比例。通过贝塔回归评估了与这一结果相关的国家特征。进行了子集分析,将 2021-22 年的指标与 2017-18 年进行的世卫组织 IPC 调查进行比较,并评估达到 IPC 最低要求的国家比例与世卫组织其他指标结果的相关性。106 个国家中有 4 个(4%)达到了 IPC 的所有最低要求。得分最高的 IPC 核心内容是多模式改进策略,得分最低的是 IPC 教育和培训。与低收入国家相比,高收入国家达到 IPC 最低要求的几率更高(调整后的几率比 2-7,95% CI 1-3-5-8;P=0-020)。与 2017-18 年调查相比,报告有积极的国家 IPC 计划(65% 至 82%,p=0-037)和专项预算(26% 至 44%,p=0-037)的国家比例显著增加。与其他调查工具相比,对IPC最低要求的评估显示出较低的正相关性。FUNDINGWHO.TRANSLATIONS有关摘要的法文和西班牙文译文,请参见补充材料部分。
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引用次数: 0
Ebola disease outbreak caused by the Sudan virus in Uganda, 2022: a descriptive epidemiological study. 2022 年乌干达苏丹病毒引发的埃博拉疫情:描述性流行病学研究。
IF 19.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-01 Epub Date: 2024-08-30 DOI: 10.1016/S2214-109X(24)00260-2
Zainah Kabami, Alex R Ario, Julie R Harris, Mackline Ninsiima, Sherry R Ahirirwe, Jane R Aceng Ocero, Diana Atwine, Henry G Mwebesa, Daniel J Kyabayinze, Allan N Muruta, Atek Kagirita, Yonas Tegegn, Miriam Nanyunja, Saudah N Kizito, Daniel Kadobera, Benon Kwesiga, Samuel Gidudu, Richard Migisha, Issa Makumbi, Daniel Eurien, Peter J Elyanu, Alex Ndyabakira, Helen Nelly Naiga, Jane F Zalwango, Brian Agaba, Peter C Kawungezi, Marie G Zalwango, Patrick King, Brenda N Simbwa, Rebecca Akunzirwe, Mercy W Wanyana, Robert Zavuga, Thomas Kiggundu

Background: Uganda has had seven Ebola disease outbreaks, between 2000 and 2022. On Sept 20, 2022, the Ministry of Health declared a Sudan virus disease outbreak in Mubende District, Central Uganda. We describe the epidemiological characteristics and transmission dynamics.

Methods: For this descriptive study, cases were classified as suspected, probable, or confirmed using Ministry of Health case definitions. We investigated all reported cases to obtain data on case-patient demographics, exposures, and signs and symptoms, and identified transmission chains. We conducted a descriptive epidemiological study and also calculated basic reproduction number (Ro) estimates.

Findings: Between Aug 8 and Nov 27, 2022, 164 cases (142 confirmed, 22 probable) were identified from nine (6%) of 146 districts. The median age was 29 years (IQR 20-38), 95 (58%) of 164 patients were male, and 77 (47%) patients died. Symptom onsets ranged from Aug 8 to Nov 27, 2022. The case fatality rate was highest in children younger than 10 years (17 [74%] of 23 patients). Fever (135 [84%] of 160 patients), vomiting (93 [58%] patients), weakness (89 [56%] patients), and diarrhoea (81 [51%] patients) were the most common symptoms; bleeding was uncommon (21 [13%] patients). Before outbreak identification, most case-patients (26 [60%] of 43 patients) sought care at private health facilities. The median incubation was 6 days (IQR 5-8), and median time from onset to death was 10 days (7-23). Most early cases represented health-care-associated transmission (43 [26%] of 164 patients); most later cases represented household transmission (109 [66%]). Overall Ro was 1·25.

Interpretation: Despite delayed detection, the 2022 Sudan virus disease outbreak was rapidly controlled, possibly thanks to a low Ro. Children (aged <10 years) were at the highest risk of death, highlighting the need for targeted interventions to improve their outcomes during Ebola disease outbreaks. Initial care-seeking occurred at facilities outside the government system, showing a need to ensure that private and public facilities receive training to identify possible Ebola disease cases during an outbreak. Health-care-associated transmission in private health facilities drove the early outbreak, suggesting gaps in infection prevention and control.

Funding: None.

背景:2000 年至 2022 年间,乌干达曾七次爆发埃博拉疫情。2022 年 9 月 20 日,乌干达卫生部宣布乌干达中部穆本德地区爆发苏丹病毒病。我们描述了疫情特点和传播动态:在这项描述性研究中,根据卫生部的病例定义将病例分为疑似、可能或确诊病例。我们对所有报告病例进行了调查,以获得病例患者的人口统计学、接触、体征和症状等数据,并确定了传播链。我们开展了一项描述性流行病学研究,并计算了基本繁殖数(Ro)估计值:2022年8月8日至11月27日期间,146个地区中有9个地区(6%)发现了164例病例(142例确诊,22例可能)。中位年龄为 29 岁(IQR 20-38),164 名患者中有 95 名(58%)为男性,77 名(47%)患者死亡。症状出现时间为 2022 年 8 月 8 日至 11 月 27 日。10岁以下儿童的病死率最高(23名患者中有17人[74%]死亡)。发热(160 名患者中的 135 [84%] 人)、呕吐(93 [58%] 人)、虚弱(89 [56%] 人)和腹泻(81 [51%] 人)是最常见的症状;出血并不常见(21 [13%] 人)。在发现疫情之前,大多数病例患者(43 名患者中的 26 [60%])都在私立医疗机构就诊。中位潜伏期为 6 天(IQR 5-8),从发病到死亡的中位时间为 10 天(7-23)。大多数早期病例为医疗机构相关传播(164 名患者中的 43 例 [26%]);大多数后期病例为家庭传播(109 例 [66%])。总体Ro为1-25:尽管发现较晚,但 2022 年苏丹病毒病的疫情还是得到了迅速控制,这可能要归功于较低的 Ro 值。儿童(年满 15 岁):无:无。
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引用次数: 0
Delivering non-communicable disease services through primary health care in selected south Asian countries: are health systems prepared? 在选定的南亚国家通过初级保健提供非传染性疾病服务:卫生系统做好准备了吗?
IF 19.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-01 Epub Date: 2024-08-20 DOI: 10.1016/S2214-109X(24)00118-9
Syed Masud Ahmed, Anand Krishnan, Obaida Karim, Kashif Shafique, Nahitun Naher, Sanjida Ahmed Srishti, Aravind Raj, Sana Ahmed, Lal Rawal, Alayne Adams

In the south Asian region, delivering non-communicable disease (NCD) prevention and control services through existing primary health-care (PHC) facilities is urgently required yet currently challenging. As the first point of contact with the health-care system, PHC offers an ideal window for prevention and continuity of care over the life course, yet the implementation of PHC to address NCDs is insufficient. This review considers evidence from five south Asian countries to derive policy-relevant recommendations for designing integrated PHC systems that include NCD care. Findings reveal high political commitment but poor multisectoral engagement and health systems preparedness for tackling chronic diseases at the PHC level. There is a shortage of skilled human resources, requisite infrastructure, essential NCD medicines and technologies, and dedicated financing. Although innovations supporting integrated interventions exist, such as innovations focusing on community-centric approaches, scaling up remains problematic. To deliver NCD services sustainably, governments must aim for increased financing and a redesign of PHC service.

在南亚地区,迫切需要通过现有的初级卫生保健(PHC)设施提供非传染性疾病(NCD)预防和控制服务,但这一工作目前仍面临挑战。作为与医疗保健系统的第一个接触点,初级卫生保健为预防和生命过程中的连续性护理提供了一个理想的窗口,但初级卫生保健在应对非传染性疾病方面的实施还不够充分。本综述考虑了五个南亚国家的证据,为设计包括非传染性疾病护理在内的综合初级保健系统提出了与政策相关的建议。研究结果表明,在初级卫生保健层面应对慢性疾病的政治承诺很高,但多部门参与和卫生系统准备不足。缺乏熟练的人力资源、必要的基础设施、基本的非传染性疾病药物和技术以及专项资金。尽管存在支持综合干预的创新措施,例如以社区为中心的创新方法,但扩大规模仍然是个问题。为了可持续地提供非传染性疾病服务,政府必须以增加资金和重新设计初级保健服务为目标。
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引用次数: 0
Revolution in microbiological diagnostics needs LMIC solutions. 微生物诊断的革命需要低收入国家的解决方案。
IF 34.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-01 DOI: 10.1016/s2214-109x(24)00362-0
William Calero-Cáceres
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引用次数: 0
Addressing global micronutrient inadequacies: enhancing global data representation. 解决全球微量营养素不足问题:加强全球数据的代表性。
IF 19.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-01 Epub Date: 2024-08-29 DOI: 10.1016/S2214-109X(24)00338-3
Camille Lassale, Bamba Gaye
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引用次数: 0
Correction to Lancet Glob Health 2024; published online Aug 20. https://doi.org/10.1016/S2214-109X(24)00121-9. https://doi.org/10.1016/S2214-109X(24)00121-9.
IF 19.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-01 Epub Date: 2024-08-28 DOI: 10.1016/S2214-109X(24)00371-1
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引用次数: 0
Improving urban health through primary health care in south Asia. 通过南亚初级保健改善城市健康。
IF 19.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-01 Epub Date: 2024-08-20 DOI: 10.1016/S2214-109X(24)00121-9
Krishna D Rao, Mohan Bairwa, Akriti Mehta, Sana Hyat, Rushdia Ahmed, Lalini Rajapaksa, Alayne M Adams

South Asia is rapidly urbanising. The strains of rapid urbanisation have profound implications for the health and equity of urban populations. This Series paper examines primary health care (PHC) in south Asian cities. Health and its social determinants vary considerably across south Asian cities and substantial socioeconomic inequities are present. Although cities offer easy geographical access to PHC services, financial hardship associated with health care use and low quality of care are a concern, particularly for low-income residents. Providing better PHC in south Asia requires a multi-sectoral response, with effective and resourced urban local bodies; increased public financing for health care; and new service delivery models aimed at low-income urban communities that involve strengthening public sector services, strengthening government engagement with private providers where necessary, and engaging with low-income communities and the PHC providers that serve them.

南亚正在迅速城市化。快速城市化带来的压力对城市人口的健康和公平产生了深远的影响。本系列文件探讨了南亚城市的初级卫生保健(PHC)问题。南亚各城市的健康状况及其社会决定因素差异很大,而且存在严重的社会经济不平等现象。尽管城市在地理位置上提供了获得初级卫生保健服务的便利,但与医疗保健使用相关的经济困难和低质量的医疗保健是一个令人担忧的问题,特别是对低收入居民而言。要在南亚提供更好的初级保健服务,需要采取多部门应对措施,包括建立有效的、资源充足的城市地方机构;增加保健方面的公共资金;以及针对城市低收入社区的新服务提供模式,其中包括加强公共部门的服务,必要时加强政府与私营服务提供商的合作,以及与低收入社区和为其提供服务的初级保健服务提供商合作。
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引用次数: 0
Mpox outbreaks in Africa constitute a public health emergency of continental security. 非洲爆发的麻风腮疫情是事关非洲大陆安全的公共卫生紧急事件。
IF 19.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-01 Epub Date: 2024-08-20 DOI: 10.1016/S2214-109X(24)00363-2
Nicaise Ndembi, Morenike Oluwatoyin Folayan, Ngashi Ngongo, Francine Ntoumi, Dimie Ogoina, Maha El Rabbat, Jean-Marie Okwo-Bele, Jean Kaseya
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引用次数: 0
Respiratory syncytial virus infection among children younger than 2 years admitted to a paediatric intensive care unit with extended severe acute respiratory infection in ten Gavi-eligible countries: the RSV GOLD-ICU Network study. 十个符合 Gavi 资格的国家中因扩展性严重急性呼吸道感染而入住儿科重症监护病房的两岁以下儿童的呼吸道合胞病毒感染情况:RSV GOLD-ICU 网络研究。
IF 19.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-01 Epub Date: 2024-08-28 DOI: 10.1016/S2214-109X(24)00269-9

Background: Patient-level data on life-threatening respiratory syncytial virus (RSV) infection in children in low-income and lower-middle-income countries (LMICs) are scarce, and this scarcity might limit demand for RSV interventions in LMICs who rely on support from Gavi, the Vaccine Alliance. We aimed to describe the characteristics of RSV-positive children younger than 2 years who were admitted to paediatric intensive care units (PICUs) with extended severe acute respiratory infection (eSARI) in Gavi-eligible countries.

Methods: The RSV GOLD-ICU Network study is a 2-year prospective, multicountry, observational study of children younger than 2 years admitted to a PICU with eSARI. The study was conducted at 12 referral hospitals in Bolivia, Cameroon, The Gambia, Ghana, Haiti, Mozambique, Nepal, Nigeria, Sudan, and Tanzania. For comparison with a high-income country, patients were also included from two referral hospitals in the Netherlands. Children were eligible for inclusion if they were aged between 4 days and 2 years, admitted to a PICU, and met the WHO eSARI definition. RSV infection was confirmed within 72 h of PICU admission via a molecular point-of-care test at LMIC study sites and via a PCR test at the Dutch study sites. Clinical data were extracted from admission charts of patients; underlying conditions that were identified at admission were classified as comorbidities. Socioeconomic and demographic data were collected via a written, structured, parental questionnaire.

Findings: Between April 28, 2021, and Sept 30, 2023, we included 2118 children who were admitted to a PICU with eSARI in the ten participating countries. 614 (29·0%; range 23·0-38·2) of 2118 children tested positive for RSV and 608 were included in descriptive analyses as six medical files were lost at one study site and data could not be retrieved. Among all 608 children infected with RSV, 379 (62%) were male and 229 (38%) were female. Median age at testing was 3·0 months (IQR 1·3-7·7). 30 (5%) of 608 children died from RSV infection. RSV fatality occurred at seven of ten participating LMIC study sites and was highest in Tanzania (seven [27%] of 26 children). Median age at testing of children who died with RSV infection was 1·8 months (IQR 1·1-4·2).

Interpretation: To our knowledge, this is the first prospective, multicountry study reporting data from children admitted to a PICU with life-threatening RSV infection in Gavi-eligible countries. As there is no access to intensive care for most children in LMICs, RSV prevention is urgently needed.

Funding: Bill & Melinda Gates Foundation.

Translations: For the Arabic, Portuguese, Hausa and Nepali translations of the abstract see Supplementary Materials section.

背景:低收入和中低收入国家(LMICs)儿童感染危及生命的呼吸道合胞病毒(RSV)的患者水平数据很少,这种稀缺性可能会限制依赖疫苗联盟 Gavi 支持的中低收入国家对 RSV 干预措施的需求。我们旨在描述符合 Gavi 条件的国家中因严重急性呼吸道感染(eSARI)而入住儿科重症监护病房(PICU)的 2 岁以下 RSV 阳性儿童的特征:RSV GOLD-ICU 网络研究是一项为期 2 年的前瞻性多国观察研究,研究对象是因 eSARI 而入住 PICU 的 2 岁以下儿童。该研究在玻利维亚、喀麦隆、冈比亚、加纳、海地、莫桑比克、尼泊尔、尼日利亚、苏丹和坦桑尼亚的 12 家转诊医院进行。为了与高收入国家进行比较,还纳入了荷兰两家转诊医院的患者。年龄在 4 天至 2 岁之间、入住 PICU 并符合世界卫生组织 eSARI 定义的儿童均可纳入研究。在低收入和中等收入国家的研究地点,RSV 感染是在 PICU 入院后 72 小时内通过分子床旁检测确认的;在荷兰的研究地点,则是通过 PCR 检测确认的。从患者入院病历中提取临床数据;入院时确定的基础疾病被归类为合并症。社会经济和人口统计学数据通过书面、结构化的家长问卷收集:在 2021 年 4 月 28 日至 2023 年 9 月 30 日期间,我们纳入了十个参与国家中 2118 名因 eSARI 而入住 PICU 的儿童。2118 名儿童中有 614 名(29-0%;范围 23-0-38-2)RSV 检测呈阳性,其中 608 名儿童被纳入描述性分析,因为有一个研究地点丢失了六份医疗档案,无法检索数据。在所有 608 名感染 RSV 的儿童中,379 名(62%)为男性,229 名(38%)为女性。检测时的年龄中位数为 3-0 个月(IQR 1-3-7-7)。608 名儿童中有 30 人(5%)死于 RSV 感染。在 10 个低收入、中等收入国家的参与研究地点中,有 7 个出现了 RSV 死亡病例,其中坦桑尼亚的死亡病例最多(26 名儿童中有 7 名 [27%])。因感染 RSV 而死亡的儿童接受检测时的中位年龄为 1-8 个月(IQR 1-1-4-2):据我们所知,这是第一项前瞻性多国研究,报告了符合 Gavi 资格的国家中因感染危及生命的 RSV 而入住 PICU 的儿童的数据。由于大多数低收入国家的儿童无法获得重症监护,因此迫切需要预防 RSV:比尔及梅琳达-盖茨基金会:摘要的阿拉伯语、葡萄牙语、豪萨语和尼泊尔语译文见补充材料部分。
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引用次数: 0
Access to highly effective long-acting RSV-monoclonal antibodies for children in LMICs-reducing global inequity. 为低收入国家儿童提供高效长效 RSV 单克隆抗体--减少全球不公平现象。
IF 19.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-01 Epub Date: 2024-07-24 DOI: 10.1016/S2214-109X(24)00258-4
Heather J Zar, Manuele Piccolis, Jonne Terstappen, Natalie I Mazur, Lobna Gaayeb, Sébastien Morin, Louis Bont
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引用次数: 0
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Lancet Global Health
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