In this Viewpoint, we argue that the project to decolonise implementation science is an important and much needed endeavour, but should move beyond a focus on equity to a more disruptive decolonial approach that interrogates the field's methodological and epistemological foundations. Methodological pluralism in implementation science-one that integrates diverse ways of knowing-is not only more just, but also more effective and scientifically robust. Achieving this requires uncomfortable confrontation with the colonial architecture of academic research and accepted ways of knowing.
{"title":"Decolonising implementation science: a call for methodological pluralism.","authors":"Sali Hafez,Agata Pacho,Ruth Ponsford,Meghna Ranganathan,Mitzy Gafos,Seyi Soremekun","doi":"10.1016/s2214-109x(25)00477-2","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00477-2","url":null,"abstract":"In this Viewpoint, we argue that the project to decolonise implementation science is an important and much needed endeavour, but should move beyond a focus on equity to a more disruptive decolonial approach that interrogates the field's methodological and epistemological foundations. Methodological pluralism in implementation science-one that integrates diverse ways of knowing-is not only more just, but also more effective and scientifically robust. Achieving this requires uncomfortable confrontation with the colonial architecture of academic research and accepted ways of knowing.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"25 1","pages":"e281-e285"},"PeriodicalIF":34.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/s2214-109x(25)00469-3
Christopher G Kemp,Lauren White,Emily E Haroz,Donald Warne
Implementation science is a diverse and evolving field that draws on multiple epistemologies and methods. However, the dominant foundations of implementation science remain settler colonial, biomedical, and positivist. In Indigenous and other marginalised settings, these foundations can result in poor epistemological, ethical, and practical fit. We argue that a paradigm shift that is grounded in Indigenous values, sovereignty, relationality, and epistemologies is needed. We propose seven guiding principles for a decolonising implementation science. Drawing from emerging scholarship and innovative Indigenous-led frameworks from the USA, Aotearoa New Zealand, and Australia, these principles centre sovereignty, strengths-based approaches, and relational accountability. These principles also offer a roadmap to redefine rigour, expand what counts as evidence, and ensure genuine community control over the research process. Although born from Indigenous experience, these principles provide a framework for transforming implementation science to be more just, equitable, and effective for marginalised communities globally.
{"title":"Towards a decolonising implementation science: principles from Indigenous leadership.","authors":"Christopher G Kemp,Lauren White,Emily E Haroz,Donald Warne","doi":"10.1016/s2214-109x(25)00469-3","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00469-3","url":null,"abstract":"Implementation science is a diverse and evolving field that draws on multiple epistemologies and methods. However, the dominant foundations of implementation science remain settler colonial, biomedical, and positivist. In Indigenous and other marginalised settings, these foundations can result in poor epistemological, ethical, and practical fit. We argue that a paradigm shift that is grounded in Indigenous values, sovereignty, relationality, and epistemologies is needed. We propose seven guiding principles for a decolonising implementation science. Drawing from emerging scholarship and innovative Indigenous-led frameworks from the USA, Aotearoa New Zealand, and Australia, these principles centre sovereignty, strengths-based approaches, and relational accountability. These principles also offer a roadmap to redefine rigour, expand what counts as evidence, and ensure genuine community control over the research process. Although born from Indigenous experience, these principles provide a framework for transforming implementation science to be more just, equitable, and effective for marginalised communities globally.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"29 1","pages":"e296-e301"},"PeriodicalIF":34.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/s2214-109x(25)00479-6
Gnanaraj Jesudian
{"title":"Safe scale-up of simulation-based training for minimally invasive surgery.","authors":"Gnanaraj Jesudian","doi":"10.1016/s2214-109x(25)00479-6","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00479-6","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"254 1","pages":"e174-e175"},"PeriodicalIF":34.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/s2214-109x(25)00444-9
Tara Pattilachan Menon,Aju Mathew,Puneeth Iyengar,Bishal Gyawali,C S Pramesh,Edward Christopher Dee
Member states of the South Asian Association for Regional Cooperation (SAARC), home to over 2 billion people, carry a disproportionate cancer burden shaped by stark heterogeneity in risk, access, and outcomes. Beyond large proportions of people living in poverty in the context of frail infrastructure, inequities are compounded by intersecting identities, including gender, caste, religion, language, geography, and sexual or gender minority status. Commonly, women face delayed diagnosis amid low human papillomavirus vaccination and screening; rural communities confront distance and cost; Dalit, indigenous, and refugee groups experience structural exclusion; and language discordance and cultural beliefs impede timely care. Financial toxicity is pervasive, pushing households into poverty despite emerging insurance schemes. Drawing on targeted literature from SAARC countries, we argue for an intersectionality-informed agenda: strengthen registries and national cancer control programmes with disaggregated data; expand equitable financing and workforce deployment; embed cultural competence and bias mitigation in clinical training; and prioritise research that models intersecting risks. Implementing context-appropriate strategies will be essential for achieving equitable cancer control across the region.
{"title":"Intersectionality of cancer disparities in south Asia.","authors":"Tara Pattilachan Menon,Aju Mathew,Puneeth Iyengar,Bishal Gyawali,C S Pramesh,Edward Christopher Dee","doi":"10.1016/s2214-109x(25)00444-9","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00444-9","url":null,"abstract":"Member states of the South Asian Association for Regional Cooperation (SAARC), home to over 2 billion people, carry a disproportionate cancer burden shaped by stark heterogeneity in risk, access, and outcomes. Beyond large proportions of people living in poverty in the context of frail infrastructure, inequities are compounded by intersecting identities, including gender, caste, religion, language, geography, and sexual or gender minority status. Commonly, women face delayed diagnosis amid low human papillomavirus vaccination and screening; rural communities confront distance and cost; Dalit, indigenous, and refugee groups experience structural exclusion; and language discordance and cultural beliefs impede timely care. Financial toxicity is pervasive, pushing households into poverty despite emerging insurance schemes. Drawing on targeted literature from SAARC countries, we argue for an intersectionality-informed agenda: strengthen registries and national cancer control programmes with disaggregated data; expand equitable financing and workforce deployment; embed cultural competence and bias mitigation in clinical training; and prioritise research that models intersecting risks. Implementing context-appropriate strategies will be essential for achieving equitable cancer control across the region.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"254 1","pages":"e272-e280"},"PeriodicalIF":34.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/s2214-109x(25)00449-8
,
BACKGROUNDWomen with anaemia have a higher risk of postpartum haemorrhage than those without anaemia. We examined the association between episiotomy and postpartum haemorrhage in women with moderate or severe anaemia.METHODSWe conducted a cohort analysis using data from the World Maternal Antifibrinolytic-2 (WOMAN-2) trial. Women with moderate or severe anaemia who were giving birth vaginally were recruited from 34 hospitals in Nigeria, Pakistan, Tanzania, and Zambia. On arrival at hospital, the participants' haemoglobin concentration was measured with a validated point-of-care haemoglobin test. Moderate anaemia was defined as a haemoglobin concentration of 70-99 g/L and severe anaemia as a haemoglobin concentration lower than 70 g/L. Episiotomy was defined as any perineal incision during delivery. Women were excluded from the WOMAN-2 trial if they were younger than 18 years and lacked consent from a guardian, had a known allergy to the trial intervention, had an indication or contraindication to the intervention, or were diagnosed with postpartum haemorrhage before the umbilical cord was clamped. The primary outcome was a clinical diagnosis of postpartum haemorrhage (estimated blood loss ≥500 mL or any blood loss causing haemodynamic instability), and the secondary outcome was calculated postpartum haemorrhage (estimated from peripartum change in haemoglobin concentration). We modelled the outcomes with multilevel logistic regression, adjusting for confounders with inverse probability of treatment weighting.FINDINGSBetween Aug 24, 2019, and Sept 19, 2023, 4355 (28·9%) of the 15 068 women recruited to the WOMAN-2 trial had an episiotomy. In primiparous women who had non-instrumental births, the incidence of episiotomy was 81·1% in Pakistan (2703 of 3335), 63·3% (307 of 485) in Nigeria, 28·5% (69 of 242) in Zambia, and 15·1% (111 of 735) in Tanzania. Clinically diagnosed postpartum haemorrhage occurred in 1034 (6·9%) of 15 066 participants, and calculated postpartum haemorrhage occurred in 1417 (9·5%) of 14 863. After adjustment for confounders, episiotomy was associated with clinically diagnosed postpartum haemorrhage (odds ratio 1·88, 95% CI 1·33-2·66) and calculated postpartum haemorrhage (1·63, 1·14-2·34).INTERPRETATIONAlthough WHO recommends against the routine use of episiotomy, many first-time mothers were given this procedure. Episiotomy might increase the risk of postpartum haemorrhage in women with moderate or severe anaemia. As anaemia is known to worsen the life-threatening complications of postpartum haemorrhage, the risks of routine episiotomy could be even greater in women with anaemia.FUNDINGWellcome and the Bill & Melinda Gates Foundation.TRANSLATIONSFor the Swahili, Urdu, Yoruba, Hausa and Igbo translations of the abstract see Supplementary Materials section.
{"title":"Episiotomy and postpartum haemorrhage in women with moderate or severe anaemia: a cohort analysis of data from the WOMAN-2 trial.","authors":" , ","doi":"10.1016/s2214-109x(25)00449-8","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00449-8","url":null,"abstract":"BACKGROUNDWomen with anaemia have a higher risk of postpartum haemorrhage than those without anaemia. We examined the association between episiotomy and postpartum haemorrhage in women with moderate or severe anaemia.METHODSWe conducted a cohort analysis using data from the World Maternal Antifibrinolytic-2 (WOMAN-2) trial. Women with moderate or severe anaemia who were giving birth vaginally were recruited from 34 hospitals in Nigeria, Pakistan, Tanzania, and Zambia. On arrival at hospital, the participants' haemoglobin concentration was measured with a validated point-of-care haemoglobin test. Moderate anaemia was defined as a haemoglobin concentration of 70-99 g/L and severe anaemia as a haemoglobin concentration lower than 70 g/L. Episiotomy was defined as any perineal incision during delivery. Women were excluded from the WOMAN-2 trial if they were younger than 18 years and lacked consent from a guardian, had a known allergy to the trial intervention, had an indication or contraindication to the intervention, or were diagnosed with postpartum haemorrhage before the umbilical cord was clamped. The primary outcome was a clinical diagnosis of postpartum haemorrhage (estimated blood loss ≥500 mL or any blood loss causing haemodynamic instability), and the secondary outcome was calculated postpartum haemorrhage (estimated from peripartum change in haemoglobin concentration). We modelled the outcomes with multilevel logistic regression, adjusting for confounders with inverse probability of treatment weighting.FINDINGSBetween Aug 24, 2019, and Sept 19, 2023, 4355 (28·9%) of the 15 068 women recruited to the WOMAN-2 trial had an episiotomy. In primiparous women who had non-instrumental births, the incidence of episiotomy was 81·1% in Pakistan (2703 of 3335), 63·3% (307 of 485) in Nigeria, 28·5% (69 of 242) in Zambia, and 15·1% (111 of 735) in Tanzania. Clinically diagnosed postpartum haemorrhage occurred in 1034 (6·9%) of 15 066 participants, and calculated postpartum haemorrhage occurred in 1417 (9·5%) of 14 863. After adjustment for confounders, episiotomy was associated with clinically diagnosed postpartum haemorrhage (odds ratio 1·88, 95% CI 1·33-2·66) and calculated postpartum haemorrhage (1·63, 1·14-2·34).INTERPRETATIONAlthough WHO recommends against the routine use of episiotomy, many first-time mothers were given this procedure. Episiotomy might increase the risk of postpartum haemorrhage in women with moderate or severe anaemia. As anaemia is known to worsen the life-threatening complications of postpartum haemorrhage, the risks of routine episiotomy could be even greater in women with anaemia.FUNDINGWellcome and the Bill & Melinda Gates Foundation.TRANSLATIONSFor the Swahili, Urdu, Yoruba, Hausa and Igbo translations of the abstract see Supplementary Materials section.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"41 1","pages":"e224-e232"},"PeriodicalIF":34.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/s2214-109x(25)00499-1
Francesco Di Gennaro,Luigi Pisani,Giacomo Guido,Annalisa Saracino
{"title":"Proximity as core to co-design in global health.","authors":"Francesco Di Gennaro,Luigi Pisani,Giacomo Guido,Annalisa Saracino","doi":"10.1016/s2214-109x(25)00499-1","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00499-1","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"264 1","pages":"e197"},"PeriodicalIF":34.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 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.
{"title":"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.","authors":"Pryanka Relan,Jamie Rylance,Yaseen M Arabi,Pauline Convocar,Matthieu Rolland,Janet V Diaz, ","doi":"10.1016/s2214-109x(25)00480-2","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00480-2","url":null,"abstract":"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.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"46 1","pages":"e233-e241"},"PeriodicalIF":34.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947456","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：