The Lancet regional health. Southeast Asia最新文献

Background: In highly measles immunized countries, immunity gaps in adolescents and young adults are a key issue posing an obstacle to measles elimination. This study aims to identify the gaps by estimating the age-stratified probability of seropositivity, and to ascertain a suitable age for the administration of a third dose of a measles-containing vaccine (MCV3) to effectively fill these gaps.

Methods: We retrospectively obtained measles serological results from hospital setting among among individuals aged 13-39 years and developed a serocatalytic dynamic probability model, stratifying seropositivity due to vaccination or natural infection. We calibrated the model to age-stratified seropositivity data within a Bayesian setting using the Metropolis-Hastings algorithm. A scenario analysis to determine a suitable age for MCV3 administration was also performed.

Findings: The overall prevalence of measles seropositivity was 65.6% (95% confidence interval [CI]: 61.5-69.6). Posterior predictive curves for the age-stratified seroprevalence exhibited a decreasing trend from ages 13-20 years but an upward trend from 26 to 30 years. The age at which a given individual's serostatus reached a 50% probability of seronegativity was found to be approximately 18-20 years depending on the annual measles force of infection.

Interpretation: Our findings highlight a significant measles immunity gap in young adults aged 20-26 years, posing an increased risk of transmission. A MCV3 at the age of 18-20 years potentially closes the gap and aids measles elimination programmes.

Funding: This work was supported by Faculty of Tropical Medicine (MCTM, ICTM grant), Mahidol University (to T.N.) and APC fee was supported by Mahidol University (to T.N.). S.M. and W.P. were funded in whole, or in part, by the Wellcome Trust [Grant number 220211]. For the purpose of open access, the authors have applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.

Background: South Asians may be particularly susceptible to premature myocardial infarction (MI) owing both to conventional cardiovascular risk factors and practices distinctive to South Asia. Identifying modifiable risk factors for MI in these populations could inform prevention strategies. We have, therefore, studied conventional risk factors and other characteristics in relation to occurrence of first MI in Bangladesh.

Methods: In a case-control study involving 8133 first-onset MI cases and 8124 controls recruited in Bangladesh, we calculated odds ratios (ORs) for MI adjusted, for age, sex, smoking status, history of diabetes, history of hypertension, family history of MI, and LDL-cholesterol. We assessed the potential public health impact of risk factor modification using population attributable fractions (PAFs).

Findings: The median (IQR) age of first MI was 53 (45-60) years. Adjusted ORs (95% CIs) were 2.80 (2.57-3.05) for cigarette smoking, 2.17 (1.94-2.43) for family history of MI, 2.27 (2.07-2.48) for history of hypertension, 1.91 (1.72-2.13) for history of diabetes, and 1.53 (1.47-1.58) per 1-SD higher LDL-cholesterol. The highest PAFs (95% CIs) were with current cigarette smoking (49% [46%-52%]), higher LDL-cholesterol (31% [29%-33%]) and history of hypertension (15% [13%-16%]). As for regionally distinctive practices, ORs were 4.02 (3.13-5.17) with biri/hukkah smoking, 2.09 (1.52-2.87) with chewing tobacco, and 1.26 (1.05-1.51) with parental history of first-cousin marriage.

Interpretation: Our results confirm the relevance of several conventional risk factors to risk of first MI in Bangladesh, and identify associations with MI of practices distinctive to South Asia, including indigenous modes of tobacco consumption and parental first-cousin marriage. These findings suggest opportunities for cardiovascular disease prevention in Bangladesh that embrace both conventional and regionally distinctive risk factors.

Funding: The BRAVE Study Coordinating Centre is underpinned by grants from the British Heart Foundation, UK Medical Research Council and National Institute for Health Research Cambridge Biomedical Research Centre.

Background: Treatment delays are significantly associated with advanced stage, poor response to treatment, increased mortality risk, poor health outcomes, increased healthcare expenditures among cancer patients. However, factors associated with these delays have not yet been robustly evaluated. In order to bridge this gap, we determined the delayed time to treatment initiation (TTI) among cancer patients in India, ascertained its determinants, and assessed the trends of delayed TTI.

Methods: We analysed data collected from 6695 cancer patients seeking outpatient/daycare treatment, recruited at purposively selected seven healthcare facilities across six states of India. Data on socio-demographic and clinical characteristics including date of cancer diagnosis, date of treatment initiation, cancer site, stage and type of treatment were collected to determine the median TTI and ascertain its determinants among cancer patients in India. Time to treatment initiation was calculated as the duration (days) between diagnosis of cancer (histologically/clinically) and date of initiation of treatment. Multi-variable logistic regression was employed to analyse the relationship between the outcome variable (TTI) and each explanatory variable. A Cox Proportional Hazard (CPH) model was used to conduct time-to-event analysis, and to assess the impact of government-funded health insurance on timely cancer treatment initiation.

Findings: The median (IQR) overall TTI was 20 (7-39) days, with a mean of 53.7 days (SD, 192.9). The TTI was higher for those having head and neck cancer (median TTI: 29 days, IQR: 10.5-55.5) and those receiving radiotherapy as initial treatment (27.5 days, IQR: 10-49.5). Younger patients, those educated up to graduation level and males had significantly lower odds of delayed TTI. As compared to patients who were diagnosed between 1995 and 2017, those diagnosed after 2018 had a 36% (26-46%) higher odds of timely initiation of treatment within 30 days. Upon stratifying by enrolment under PMJAY, we found that while the access for timely treatment initiation increased by 33% for those who were not enrolled, vs. 90% among those enrolled under PM-JAY. Overall, this shows significant improvement in timely initiation of cancer treatment as a result of introduction of PM-JAY.

Interpretation: The study highlights the positive impact of government-funded health insurance schemes on the timely access to cancer treatment in India. Our study recommends expanding AB PM-JAY cancer packages to include cost-effective treatments, increasing population coverage under screening programs and promoting e-RUPI to reduce financial constraints associated with diagnostic services to address delayed treatment initiation due to unknown cancer stages.

Funding: Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India.

Neonatal care is essential for the well-being of newborns, particularly premature or critically ill patients. Despite advancements in medical technology and evidence-based practice, India faces significant challenges in neonatal nursing, including resource limitations, inconsistent training, and inadequate policy support. This paper examines the current state of neonatal nursing in India, highlighting disparities between urban and rural areas, and comparing them to global practices. It explores systemic issues affecting neonatal care, such as inadequate educational frameworks, a shortage of trained faculty, and insufficient clinical exposure. We outline a comprehensive approach to address these challenges, including the introduction of Neonatal Nurse Practitioner programs, enhancements in specialized training, promotion of evidence-based practices, and integration of technology. We also emphasize the need for stronger policy support and increased funding to improve the neonatal care infrastructure. By adopting these recommendations, India can make significant strides towards improving neonatal outcomes and aligning itself with global health targets.

Background: India, with the largest population and second-highest type 2 diabetes mellitus (T2DM) prevalence, presents a unique genetic landscape. This study explores the genetic profiling of T2DM, aiming to bridge gaps in existing research and provide insights for further explorations.

Methods: We conducted a systematic review and meta-analysis of literature published up to September 2024 using databases like PubMed, Web of Science, Scopus, and Google Scholar to identify SNPs associated with T2DM in case-control studies within the Indian population. Data extraction followed a rigorously designed checklist independently verified by two reviewers. The quality of the studies assessed by utilizing Newcastle Ottawa scale, and heterogeneity through Cochran's Q, τ², H² and I ² statistics. Fixed effect and random effect model was employed for meta-analysis based on heterogeneity, and publication bias was assessed by funnel plot analysis, Egger's and Begg's statistical test. In SNPs with adequate studies meta-regression was used to assess source of heterogeneity. Statistical analyses were performed using Stata 18.0 software.

Findings: Our search identified 1309 articles, with 67 included in the systematic review and 35 in the meta-analysis. These 67 case-control studies, involving 33,407 cases and 30,762 controls, analyzed 167 SNPs across 61 genes. Of these, 89 SNPs mapped to 46 genes showed significant associations with T2DM risk (P < 0.05), including 67 linked to increased risk and 16 with protective effects. Geographical analysis highlighted inter- and intra-regional variations. Meta-analysis of 25 SNPs revealed 12 SNPs with high T2DM risk compatibility. TCF7L2 gene exhibited a strong compatibility with an overall OR of 1.44 (95% CI 1.36-1.52) and S-value 112.41, while TCF7L2 variants rs7903146 and rs12255372, with OR 1.56 (95% CI 1.43-1.66) and S-value 89.036, OR of 1.36 (95% CI 1.17-1.35) with an S-value of 15.45 respectively.

Interpretation: Our study highlights the importance of considering the diverse ethnic groups of India for development of targeted and effective T2DM management strategies.

Funding: Department of Biotechnology (DBT) and Indian Council of Medical Research (ICMR), Government of India.

Background: India's caesarean delivery (CD) rate of 21.5% suggests adequate national access to CD but may mask significant disparities. We examined variation in CD rates across states (geography), wealth, and health care sector (public versus private). We also aimed to determine relative inequality in CD rates across wealth quintiles.

Methods: The current study was a cross-sectional analysis of CD rates from the National Family Health Survey-5 (2019-2021) disaggregated by asset-based household wealth quintiles for each state and by healthcare sector (public versus private). Data from 724,115 women aged 15-49 years across 28 states and eight union territories were analysed. Women who reported their most recent live birth within the past five years were included. Relative inequality was measured by comparing CD rates in the richest versus the poorest quintiles.

Findings: Disaggregating the national CD rate of 21.5% showed substantial variation in CD rate across states, ranging from 5.2% in Nagaland to 60.7% in Telangana and across wealth quintiles, ranging from 0% to 76.7% (Assam). CD facility rates were higher in private than public facilities across all wealth quintiles. Over two-thirds of states (69%) had at least twice the CD rate in the richest wealth quintile versus the poorest quintile. Relative inequality in CD rates between the richest and poorest was 5.3 nationally and was higher in public (4.0) versus private (1.4) facilities.

Interpretation: The national CD rate in India masks complex geographical, wealth, and sector-related inequalities in CD utilisation. Accounting for these variations is imperative when interpreting national-level rates to better assess the equity in the distribution of CD services.

Funding: None.