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Combined interventions for the testing and treatment of HIV and schistosomiasis among fishermen in Malawi: a three-arm, cluster-randomised trial. 马拉维渔民艾滋病毒和血吸虫病检测与治疗联合干预：三臂群随机试验。

IF 34.3 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Lancet Global Health

Pub Date : 2024-10-01 DOI: 10.1016/s2214-109x(24)00283-3

Augustine T Choko,Kathryn L Dovel,Sekeleghe Kayuni,Donaldson F Conserve,Anthony Buttterworth,Amaya L Bustinduy,J Russell Stothard,Wala Kamchedzera,Madalo Mukoka-Thindwa,James Jafali,Peter MacPherson,Katherine Fielding,Nicola Desmond,Elizabeth L Corbett

BACKGROUNDUndiagnosed HIV and schistosomiasis are highly prevalent among fishermen in the African Great Lakes region. We aimed to evaluate the efficacy of lakeside interventions integrating services for HIV and male genital schistosomiasis on the prevalence of schistosomiasis, uptake of antiretroviral therapy (ART) for HIV, and voluntary male medical circumcision (VMMC) among fishermen in Malawi.METHODSWe conducted a three-arm, cluster-randomised trial in 45 lakeshore fishing communities (clusters) in Mangochi, Malawi. Clusters were defined geographically by their home community as the place where fishermen leave their boats (ie, a landing site). Eligible participants were male fishermen (aged ≥18 years) who resided in a cluster. Clusters were randomly allocated (1:1:1) through computer-generated random numbers to either enhanced standard of care (SOC), which offered invitation with information leaflets to a beach clinic offering HIV testing and referral, and presumptive treatment for schistosomiasis with praziquantel; peer education (PE), in which a nominated fisherman was responsible for explaining the study leaflet to promote services to his boat crew; or peer distribution education (PDE), in which the peer educator explained the leaflet and distributed HIV self-test kits to his boat crew. The beach clinic team and fishermen were not masked to intervention allocation; however, investigators were masked until the final analysis. Coprimary composite outcomes were the proportion of participants who had at least one Schistosoma haematobium egg observed on light microscopy from 10 mL of urine filtrate and the proportion who had self-reported initiating ART or scheduling VMMC by day 28. Outcomes were analysed by intention to treat; multiple imputation for missing outcomes was done; random-effect binomial models adjusting for baseline imbalance and clustering were used to compute unadjusted and adjusted risk differences, risk ratios (RRs) and 95% CIs, and intracluster correlation coefficients for each outcome. This trial is registered with ISRCTN, ISRCTN14354324.FINDINGSBetween March 1, 2022, and Jan 29, 2023, 45 (65·2%) of 69 clusters assessed for eligibility were enrolled in the trial, with 15 clusters per arm. Of the 6036 fishermen screened at baseline, 5207 (86·3%) were eligible for participation: 1745 (87·6%) of 1991 in the enhanced SOC group, 1687 (81·9%) of 2061 in the PE group, and 1775 (89·5%) of 1984 in the PDE group. Compared with the prevalence of active schistosomiasis in the enhanced SOC group (292 [16·7%] of 1745), 241 (13·6%) of 1775 fishermen in the PDE group (adjusted RR 0·80 [95% CI 0·69-0·94]; p=0·0054) and 263 (15·6%) of 1687 fishermen in the PE group (0·92 [0·79-1·07]; p=0·28) had schistosomiasis at day 28. 230 (13·2%) in the enhanced SOC group, 281 (16·7%) in the PE group, and 215 (12·1%) in the PDE group initiated ART or were scheduled for VMMC. ART initiation or VMMC scheduling was not significantly increased with the PDE int

背景非洲大湖区的渔民中艾滋病和血吸虫病的诊断率很高。我们的目的是评估整合了艾滋病和男性生殖器血吸虫病服务的湖边干预措施对马拉维渔民中血吸虫病流行率、艾滋病抗逆转录病毒疗法（ART）接受率和自愿男性包皮环切术（VMMC）的影响。集群的地理定义是以渔民离开渔船的地方（即上岸地点）为母社区。符合条件的参与者为居住在集群中的男性渔民（年龄≥18 岁）。群组是通过电脑随机分配的（1:1：通过计算机生成的随机数字，各群组被随机分配（1:1:1）到以下两种方案中的一种：强化标准护理方案（SOC），即邀请渔民携带宣传单页到海滩诊所接受艾滋病毒检测和转诊，并使用吡喹酮对血吸虫病进行假定性治疗；同伴教育方案（PE），即由指定的渔民负责向其船员解释研究宣传单页以推广服务；或同伴分发教育方案（PDE），即由同伴教育者向其船员解释宣传单页并分发艾滋病毒自我检测包。海滩诊所团队和渔民在干预分配时不戴面具，但调查人员在最终分析前戴面具。主要综合结果是：从 10 毫升尿液滤液中用光学显微镜观察到至少一个血吸虫虫卵的参与者比例，以及在第 28 天之前自述开始接受抗逆转录病毒疗法或安排了 VMMC 的参与者比例。试验结果按意向治疗进行分析；对缺失结果进行多重估算；使用随机效应二叉模型对基线不平衡和聚类进行调整，以计算每种结果的未调整和调整后风险差异、风险比 (RR) 和 95% CI 以及聚类内相关系数。该试验已在 ISRCTN 注册，ISRCTN14354324.研究结果在 2022 年 3 月 1 日至 2023 年 1 月 29 日期间，经评估符合条件的 69 个群组中有 45 个（65%-2%）被纳入试验，每个臂有 15 个群组。在基线筛查的 6036 名渔民中，有 5207 人（86-3%）符合参与条件：在 1991 年的强化 SOC 组中，有 1745 人（87-6%）符合条件；在 2061 年的 PE 组中，有 1687 人（81-9%）符合条件；在 1984 年的 PDE 组中，有 1775 人（89-5%）符合条件。与强化 SOC 组的活动性血吸虫病流行率（1745 人中的 292 人 [16-7%]）相比，PDE 组 1775 名渔民中的 241 人（13-6%）（调整后 RR 0-80 [95% CI 0-69-0-94]；p=0-0054）和 PE 组 1687 名渔民中的 263 人（15-6%）（0-92 [0-79-1-07]；p=0-28）在第 28 天感染了血吸虫病。强化 SOC 组中有 230 人（13-2%）、PE 组中有 281 人（16-7%）和 PDE 组中有 215 人（12-1%）开始接受抗逆转录病毒疗法或安排了 VMMC。与增强型 SOC 组相比，PDE 干预未显著增加抗逆转录病毒疗法的启动或 VMMC 计划（0-88 [0-74-1-05]; p=0-15），而 PE 干预则略有增加（1-16 [0-99-1-37]; p=0-069）。本试验未报告严重不良事件。解释我们发现，使用同伴教育来提高抗逆转录病毒疗法和自愿监测母婴传播率的证据不足，但增加分发艾滋病毒自我检测包以促进对服务的高度参与并降低活动性血吸虫病流行率的证据确凿，这表明在马拉维各地难以到达的社区推广的潜力很大。

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引用次数: 0

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

Lancet Global 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

The potential distraction of a pan-regimen approach to tuberculosis. 对结核病采取泛治疗方法可能会分散注意力。

IF 19.9 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Lancet Global Health

Pub Date : 2024-10-01 Epub Date: 2024-08-16 DOI: 10.1016/S2214-109X(24)00328-0

Oxana Rucsineanu, Jennifer Furin

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

Lancet Global 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 (R_o) 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 R_o was 1·25.

Interpretation: Despite delayed detection, the 2022 Sudan virus disease outbreak was rapidly controlled, possibly thanks to a low R_o. 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。

{"title":"Ebola disease outbreak caused by the Sudan virus in Uganda, 2022: a descriptive epidemiological study.","authors":"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","doi":"10.1016/S2214-109X(24)00260-2","DOIUrl":"10.1016/S2214-109X(24)00260-2","url":null,"abstract":"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.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e1684-e1692"},"PeriodicalIF":19.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11413514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120898","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}

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

Lancet Global 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

Lancet Global Health

Pub Date : 2024-10-01 DOI: 10.1016/s2214-109x(24)00362-0

William Calero-Cáceres

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

Lancet Global Health

Pub Date : 2024-10-01 Epub Date: 2024-08-29 DOI: 10.1016/S2214-109X(24)00338-3

Camille Lassale, Bamba Gaye

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

Lancet Global Health

Pub Date : 2024-10-01 Epub Date: 2024-08-28 DOI: 10.1016/S2214-109X(24)00371-1

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

Lancet Global 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。

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

Lancet Global 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

引用次数: 0

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