Lancet Global Health最新文献

{"title":"Progress in reducing socioeconomic inequalities in the use of modern contraceptives in 48 focus countries as part of the FP2030 initiative between 1990 and 2020: a population-based analysis.","authors":"Carolina Cardona, Jean Christophe Rusatira, Carolina Salmeron, Michelle Martinez-Baack, Jose G Rimon, Philip Anglewicz, Saifuddin Ahmed","doi":"10.1016/S2214-109X(24)00424-8","DOIUrl":"10.1016/S2214-109X(24)00424-8","url":null,"abstract":"<p><strong>Background: </strong>Despite increases in modern contraception use, socioeconomic inequalities in family planning persist. In this study, we aimed to measure progress in reducing socioeconomic inequalities in modern contraceptive prevalence rate (mCPR) and demand for family planning satisfied by modern methods (mDFPS) in 48 countries as part of the Family Planning 2030 (FP2030) initiative between 1990 and 2020 for which Demographic and Health Survey data were available.</p><p><strong>Methods: </strong>We analysed two rounds of Demographic and Health Survey data per country. Changes in concentration indices between two survey rounds were compared to measure reductions in overall socioeconomic-related inequalities in modern contraceptive use. Poisson regression models were used to measure the adjusted average annual rate of change across wealth quintiles.</p><p><strong>Findings: </strong>In this population-based analysis study, all countries reduced socioeconomic-related inequalities in modern contraceptive use among in-union women of reproductive age (15-49 years) during the observed 30-year period. On average, mCPR increased at an annual rate of 2·1% (95% CI 2·1-2·2), and the rate of increase for the poorest women was 3·1% (3·0-3·2), which outpaced the rate of increase for the richest women of 1·3% (1·3-1·4%). The pattern of progress was similar for mDFPS, but at a slower pace. Overall, levels of mCPR and mDFPS increased, and socioeconomic-related inequalities were reduced during this period.</p><p><strong>Interpretation: </strong>Substantial progress has been made in reducing socioeconomic-related inequalities in family planning across the 48 studied countries, which account for 86% of the population of the 82 FP2030 initiative countries. During the past three decades, poorer women have seen greater improvements in modern contraceptive use and demand satisfaction compared with richer women. As contraceptive prevalence rates are near their maximum, it is crucial to ensure marginalised and vulnerable groups are not left behind.</p><p><strong>Funding: </strong>Bill & Melinda Gates Foundation.</p><p><strong>Translations: </strong>For the French and Spanish translations of the abstract see Supplementary Materials section.</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 1","pages":"e38-e49"},"PeriodicalIF":19.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11659844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873276","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 2024 small island developing states report of the Lancet Countdown on health and climate change.","authors":"Georgiana M Gordon-Strachan, Stephanie Y Parker, Heather C Harewood, Pablo A Méndez-Lázaro, Salanieta T Saketa, Kimalie F Parchment, Maria Walawender, Abdullahi O Abdulkadri, Paul J Beggs, Daniel F Buss, Riley J Chodak, Shouro Dasgupta, Olga De Santis, Natalie G Guthrie-Dixon, Saria Hassan, Harry Kennard, Sandeep B Maharaj, Kwesi G Marshall, Shelly R McFarlane, Kimberley S McKenzie, Maziar Moradi-Lakeh, Madhuvanti Murphy, Michelle A Mycoo, Roannie Ng Shiu, Megan B O'Hare, Christopher A L Oura, Fereidoon Owfi, Ali Owfi, Karen A Polson, Mahnaz Rabbaniha, Elizabeth J Z Robinson, David C Smith, Meisam Tabatabaei, Lanea L Tuiasosopo, Marina Romanello","doi":"10.1016/S2214-109X(24)00421-2","DOIUrl":"10.1016/S2214-109X(24)00421-2","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e146-e166"},"PeriodicalIF":19.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819968","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":"Contraceptive equity: insights from the progress in 48 FP2030 countries.","authors":"Ndema Habib, Moazzam Ali","doi":"10.1016/S2214-109X(24)00502-3","DOIUrl":"10.1016/S2214-109X(24)00502-3","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 1","pages":"e2-e3"},"PeriodicalIF":19.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873174","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":"Resolving the CD4-testing crisis to help end AIDS-related deaths.","authors":"Omar Syarif, Rita Oladele, Tinne Gils, Radha Rajasingham, Jonathan Falconer, Pamela Achii, Edna Tembo, Donald Denis Tobaiwa, Kenneth Mwehonge, Charlotte Schutz, Nelesh P Govender, Graeme Meintjes, David B Meya, Angela Loyse","doi":"10.1016/S2214-109X(24)00444-3","DOIUrl":"10.1016/S2214-109X(24)00444-3","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e16-e18"},"PeriodicalIF":19.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570267","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":"Strategies for more equitable engagement for African researchers.","authors":"Bamba Gaye, Ngoné Gaye, Gurbinder Singh, Naoufel Madani, Roberta Lamptey, Jamal Eddine Kohen, Abdoulaye Samb, Léon Tshilolo, Pasquale Maffia, Ibrahima Socé Fall, Modou Jobe","doi":"10.1016/S2214-109X(24)00427-3","DOIUrl":"10.1016/S2214-109X(24)00427-3","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e14-e15"},"PeriodicalIF":19.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649390","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":"An innovative Community Mobilisation and Community Incentivisation for child health in rural Pakistan (CoMIC): a cluster-randomised, controlled trial.","authors":"Jai K Das, Rehana A Salam, Zahra Ali Padhani, Arjumand Rizvi, Mushtaq Mirani, Muhammad Khan Jamali, Imran Ahmed Chauhadry, Imtiaz Sheikh, Sana Khatoon, Khan Muhammad, Rasool Bux, Anjum Naqvi, Fariha Shaheen, Rafey Ali, Sajid Muhammad, Simon Cousens, Zulfiqar A Bhutta","doi":"10.1016/S2214-109X(24)00428-5","DOIUrl":"10.1016/S2214-109X(24)00428-5","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Infectious diseases remain the leading cause of death among children younger than 5 years due to disparities in access and acceptance of essential interventions. The Community Mobilisation and Community Incentivisation (CoMIC) trial was designed to evaluate a customised community mobilisation and incentivisation strategy for improving coverage of evidence-based interventions for child health in Pakistan.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;CoMIC was a three-arm cluster-randomised, controlled trial in rural areas of Pakistan. Clusters were formed by grouping villages based on geographical proximity, ethnic consistency, and ensuring a population between 1500 to 3000 per cluster. Clusters were randomly assigned (1:1:1) to either community mobilisation, community mobilisation and incentivisation, or the control arm. Community mobilisation included formation of village committees which conducted awareness activities, while clusters in the community mobilisation and incentivisation group were provided with a novel conditional, collective, community-based incentive (C3I) in addition to community mobilisation. C3I was conditioned on serial incremental targets for collective improvement in coverage at cluster level of three key indicators (primary outcomes): proportion of fully immunised children, use of oral rehydration solution, and sanitation index, assessed at 6 months, 15 months, and 24 months, and village committees decided on non-cash incentives for people in the villages. Data were analysed as intention-to-treat by an independent team masked to study groups. The trial is registered at ClinicalTrials.gov, NCT03594279, and is completed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Between Oct 1, 2018 and Oct 31, 2020, 21 638 children younger than 5 years from 24 846 households, with a total population of 139 005 in 48 clusters, were included in the study. 16 clusters comprising of 152 villages and 7361 children younger than 5 years were randomly assigned to the community mobilisation and incentivisation group; 16 clusters comprising of 166 villages and 7546 children younger than 5 years were randomly assigned to the community mobilisation group; and 16 clusters comprising of 139 villages and 6731 children younger than 5 years were randomly assigned to the control group. Endline analyses were conducted on 3812 children (1284 in the community mobilisation and incentivisation group, 1276 in the community mobilisation group, and 1252 in the control group). Multivariable analysis indicates improvements in all primary outcomes including a higher proportion of fully immunised children (risk ratio [RR] 1·3 [95% CI 1·0-1·5]), higher total sanitation index (mean difference 1·3 [95% CI 0·6-1·9]), and increased oral rehydration solution use (RR 1·5 [1·0-2·2]) in the community mobilisation and incentivisation group compared with the control group at 24 months. There was no evidence of difference between community mobilisation and control for any ","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 1","pages":"e121-e133"},"PeriodicalIF":19.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11659842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873155","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":"Global burden of tuberculous meningitis in children aged 0-14 years in 2019: a mathematical modelling study.","authors":"Karen du Preez, Helen E Jenkins, Leonardo Martinez, Silvia S Chiang, Sicelo S Dlamini, Mariia Dolynska, Andrii Aleksandrin, Julia Kobe, Stephen M Graham, Anneke C Hesseling, Jeffrey R Starke, James A Seddon, Peter J Dodd","doi":"10.1016/S2214-109X(24)00383-8","DOIUrl":"10.1016/S2214-109X(24)00383-8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Tuberculous meningitis is fatal if untreated and can lead to lifelong neurological sequelae. However, to our knowledge, there are no data on the number of children affected by this disease. We aimed to estimate the global disease burden and attributable mortality of childhood tuberculous meningitis by WHO regions, age groups, treatment status, and HIV status in 2019.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We developed a Bayesian mathematical model to estimate the number of children aged 0-14 years who developed tuberculous meningitis, died from tuberculous meningitis, and did not die from tuberculous meningitis but had neurological sequelae in 2019. We reviewed the literature and used meta-analyses to quantify key parameters used as model inputs: risk of tuberculous meningitis after Mycobacterium tuberculosis infection, tuberculous meningitis as a proportion of tuberculosis notification data (ie, routine surveillance data that countries report to WHO), and risk ratios for tuberculous-meningitis mortality by age group. We identified routine tuberculosis surveillance data from countries and literature that reported the proportion of notified childhood tuberculosis that was due to tuberculous meningitis. Country-level data were from Brazil; the USA; Ukraine; South Africa; and the European Centre for Disease Prevention and Control, which included 29 countries but was aggregated and considered as one site. We assumed tuberculosis notification was synonymous with detection and treatment, combined age-disaggregated risk ratios and published meta-analytic estimates of the case-fatality rate in children who received treatment to produce estimates of tuberculous-meningitis mortality by age group and HIV status, and assumed that untreated tuberculous meningitis was always fatal. We assumed similar age-disaggregated risk ratios for neurological sequelae among children who had treatment for tuberculous meningitis and lived as for children who died.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;An estimated 24 000 (95% credible interval 22 300-25 700) children younger than 15 years developed tuberculous meningitis in 2019. Of these children, 13 000 (12 100-13 900) were estimated to have been diagnosed and treated for tuberculous meningitis. Most untreated children were younger than 5 years. Among the 24 000 children with tuberculous meningitis, 16 100 (14 900-17 300) were estimated to have died in 2019, of whom 1101 (6·8%) had HIV. 13 380 (83·1%) of 16 100 deaths were estimated to be in children younger than 5 years and 11 000 (68·3%) were estimated to be in children who did not receive tuberculous-meningitis treatment. Of the 7900 (5800-10 000) children who did not die, 5550 (5110-5980) were estimated to have neurological sequelae.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;Our estimates of tuberculous meningitis in children younger than 15 years showed substantial mortality and morbidity. Improved diagnostics and strong health-care systems to facilit","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 1","pages":"e59-e68"},"PeriodicalIF":19.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873183","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":"Association of current Schistosoma mansoni, Schistosoma japonicum, and Schistosoma mekongi infection status and intensity with periportal fibrosis: a systematic review and meta-analysis.","authors":"Adanna Ewuzie, Lauren Wilburn, Dixa B Thakrar, Huike Cheng, Fabian Reitzug, Nia Roberts, Reem Malouf, Goylette F Chami","doi":"10.1016/S2214-109X(24)00425-X","DOIUrl":"10.1016/S2214-109X(24)00425-X","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Periportal fibrosis is a severe morbidity caused by both current and past exposure to intestinal schistosomes. We aimed to assess the association between current infection status and intensity of Schistosoma mansoni, Schistosoma japonicum, or Schistosoma mekongi with periportal fibrosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this systematic review and meta-analysis, we searched the Cochrane Central Register of Controlled Trials, Embase, Global Health, Global Index Medicus, and MEDLINE from database inception to June 18, 2024. We applied methodological filters to limit our search to randomised controlled trials or observational studies, including before-and-after study designs. Animal studies were excluded, and no date or language limits were applied. We excluded reviews, editorials, personal opinions, and case reports. Self-reported infection status was an ineligible exposure. Two reviewers independently screened abstracts and full-text reports for eligibility. A third reviewer was consulted in cases of disagreement. The outcome of periportal fibrosis was recorded as reported by study authors to investigate variation in liver fibrosis definitions. For the key exposure of current infection, data were extracted for Schistosoma species, diagnostics, and author-provided infection status and intensity definitions. A meta-analysis was conducted for current schistosome infection status and intensity against author-defined current periportal fibrosis. Pooled effect sizes were derived using inverse-variance weighted random effects. Subgroup analyses included study characteristics and quality. The modified National Institute of Health risk of bias tool was used for assessing study quality. The protocol adhered to PRISMA reporting standards and was prospectively registered on PROSPERO, CRD42022333919.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Our electronic search retrieved 2853 records, of which 1036 were duplicates. Nine records were identified in bibliographies of eligible full-text reports. We screened 1826 titles and abstracts to find 282 articles that met our inclusion criteria for full-text review. 41 studies were eligible for systematic review, 33 studies were eligible for infection status meta-analysis, and seven studies were eligible for infection intensity meta-analysis. Periportal fibrosis was heterogeneously defined with the Niamey ultrasound protocol most used. When findings were pooled, current schistosome infection status was associated with a higher likelihood of periportal fibrosis compared with no current infection (odds ratio [OR] 2·65, 95% CI 1·79-3·92; p&lt;0·0001). Heterogeneity was high (I&lt;sup&gt;2&lt;/sup&gt;=95·81%). In sub-Saharan Africa, before the widespread introduction of mass drug administration in 2003 there was a significant association between current infection status and periportal fibrosis (OR 5·38, 95% CI 2·03-14·25) but this association was no longer present after 2003 (1·19, 0·82-1·74). No association of curre","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 1","pages":"e69-e80"},"PeriodicalIF":19.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873172","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":"Effectiveness and acceptability of a 24-h interval versus a 48-h interval between mifepristone intake and misoprostol administration for in-hospital abortion at 9-20 gestational weeks: an international, open-label, randomised, controlled, non-inferiority trial.","authors":"Margit Endler, Unnop Jaisamrarn, Suneeta Mittal, Phutrakool Phanupong, Du Van Du, Toan Anh Ngo, Hans Vemer, A Metin Gülmezoglu, Kristina Gemzell-Danielsson","doi":"10.1016/S2214-109X(24)00416-9","DOIUrl":"10.1016/S2214-109X(24)00416-9","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Optimising management of second-trimester medical abortion is important, as complications increase with gestational age. We aimed to compare a 24-h interval with a 48-h interval between mifepristone intake and misoprostol administration in in-hospital, second-trimester medical abortion for effectiveness and acceptability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This open-label, randomised, controlled, non-inferiority trial was conducted at nine hospitals in India, Sweden, Thailand, and Viet Nam among adults undergoing medical abortion for a singleton viable pregnancy at a gestation of between 9 weeks and 20 weeks. Participants were randomly assigned (1:1) via central computer-generated sequence stratified by study site to receive 200 mg mifepristone orally and (after being admitted to hospital) 800 μg misoprostol vaginally either 24 h (the intervention) or 48 h (the control) later followed by 400 μg misoprostol sublingually every 3 h. If no abortion occurred after five doses, the 200 mg mifepristone was repeated, followed by the same misoprostol regimen the following day. The participants, researchers, and clinic staff were not masked to the allocation group. The primary outcome was complete fetal expulsion (herein defined as successful abortion) within 12 h of the initial misoprostol dose. The non-inferiority margin was set at 5%. Outcomes were compared in the modified intention-to-treat (mITT) population, from which randomly assigned participants who discontinued before receiving mifepristone or misoprostol were excluded. This trial is registered as an International Standard Randomised Controlled Trial, number ISRCTN49711891, and is completed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Between Feb 18, 2015, and Oct 15, 2016, we screened 724 individuals and 540 participants were enrolled in the study (271 in the 24-h interval group and 269 in the 48-h interval group). Nine participants were excluded from analysis because they did not return for either mifepristone intake or misoprostol administration. The mITT population therefore consisted of 531 participants, of whom 266 were allocated to the 24-h interval group and 265 to the 48-h interval group. By mITT, the succsessful abortion rate within 12 h was 89% (236 of 266 participants) in the 24-h interval group and 94% (248 of 265 participants) in the 48-h interval group (odds ratio 0·54, 95% CI 0·29-1·00). The risk difference was -4·86% (95% CI -0·05 to -9·67), which exceeded our non-inferiority margin of 5%. One participant in the 24-h interval group died following an otherwise uncomplicated abortion from what was assessed as being an amniotic fluid embolism unrelated to their participation in the trial. The most common adverse events in both groups were heavy bleeding, shivering, fever, and nausea.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;A 24-h interval between mifepristone intake and misoprostol administration has a lower rate of successful abortion within 12 h than a 48-h interva","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 1","pages":"e112-e120"},"PeriodicalIF":19.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873178","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":"Estimates of resource use in the public-sector health-care system and the effect of strengthening health-care services in Malawi during 2015-19: a modelling study (Thanzi La Onse).","authors":"Timothy B Hallett, Tara D Mangal, Asif U Tamuri, Nimalan Arinaminpathy, Valentina Cambiano, Martin Chalkley, Joseph H Collins, Jonathan Cooper, Matthew S Gillman, Mosè Giordano, Matthew M Graham, William Graham, Iwona Hawryluk, Eva Janoušková, Britta L Jewell, Ines Li Lin, Robert Manning Smith, Gerald Manthalu, Emmanuel Mnjowe, Sakshi Mohan, Margherita Molaro, Wingston Ng'ambi, Dominic Nkhoma, Stefan Piatek, Paul Revill, Alison Rodger, Dimitra Salmanidou, Bingling She, Mikaela Smit, Pakwanja D Twea, Tim Colbourn, Joseph Mfutso-Bengo, Andrew N Phillips","doi":"10.1016/S2214-109X(24)00413-3","DOIUrl":"10.1016/S2214-109X(24)00413-3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In all health-care systems, decisions need to be made regarding allocation of available resources. Evidence is needed for these decisions, especially in low-income countries. We aimed to estimate how health-care resources provided by the public sector were used in Malawi during 2015-19 and to estimate the effects of strengthening health-care services.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;For this modelling study, we used the Thanzi La Onse model, an individual-based simulation model. The scope of the model was health care provided by the public sector in Malawi during 2015-19. Health-care services were delivered during health-care system interaction (HSI) events, which we characterised as occurring at a particular facility level and requiring a particular number of appointments. We developed mechanistic models for the causes of death and disability that were estimated to account for approximately 81% of deaths and approximately 72% of disability-adjusted life-years (DALYs) in Malawi during 2015-19, according to the Global Burden of Disease (GBD) estimates; we computed DALYs incurred in the population as the sum of years of life lost and years lived with disability. The disease models could interact with one another and with the underlying properties of each person. Each person in the Thanzi La Onse model had specific properties (eg, sex, district of residence, wealth percentile, smoking status, and BMI, among others), for which we measured distribution and evolution over time using demographic and health survey data. We also estimated the effect of different types of health-care system improvement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;We estimated that the public-sector health-care system in Malawi averted 41·2 million DALYs (95% UI 38·6-43·8) during 2015-19, approximately half of the 84·3 million DALYs (81·5-86·9) that the population would otherwise have incurred. DALYs averted were heavily skewed to children aged 0-4 years due to services averting DALYs that would be caused by acute lower respiratory tract infection, HIV or AIDS, malaria, or neonatal disorders. DALYs averted among adults were mostly attributed to HIV or AIDS and tuberculosis. Under a scenario whereby each appointment took the time expected and health-care workers did not work for longer than contracted, the health-care system in Malawi during 2015-19 would have averted only 19·1 million DALYs (95% UI 17·1-22·4), suggesting that approximately 21·3 million DALYS (20·0-23·6) of total effect were derived through overwork of health-care workers. If people becoming ill immediately accessed care, all referrals were successfully completed, diagnostic accuracy of health-care workers was as good as possible, and consumables (ie, medicines) were always available, 28·2% (95% UI 25·7-30·9) more DALYS (ie, 12·2 million DALYs [95% UI 10·9-13·8]) could be averted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;The health-care system in Malawi provides substantial health gains wi","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e28-e37"},"PeriodicalIF":19.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644644","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}