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One health intervention for the control and elimination of scrub typhus, anthrax, and brucellosis in Southeast Asia: a systematic review 东南亚控制和消除恙虫病、炭疽病和布鲁氏菌病的一种保健干预措施:系统性审查
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-10-24 DOI: 10.1016/j.lansea.2024.100503
The “One Health” (OH) approach, introduced in 2004, integrates human, animal, and environmental health to address emerging and re-emerging diseases. This study evaluates OH strategies used by southeast Asian countries for brucellosis, anthrax, and scrub typhus. We systematically searched Medline, EMBASE, ProQuest, and EBSCO-CINHL up to May 11, 2023, screened 711 articles, and included ten studies (five on brucellosis, four on anthrax, and two on scrub typhus). Key strategies identified included intersectoral collaboration, vaccination initiatives, and comprehensive surveillance systems for both humans and animals. Additional efforts were noted in improving health infrastructure and implementing preventive measures. The review underscores that although some progress has been made, a more integrated OH approach is crucial for effective prevention and management of zoonotic diseases in southeast Asia, highlighting the need for enhanced collaboration and coordinated efforts across sectors.
2004 年推出的 "统一健康"(OH)方法综合了人类、动物和环境健康,以应对新出现和再次出现的疾病。本研究评估了东南亚国家针对布鲁氏菌病、炭疽和恙虫病所采用的 "OH "策略。我们系统检索了 Medline、EMBASE、ProQuest 和 EBSCO-CINHL(截至 2023 年 5 月 11 日),筛选了 711 篇文章,并纳入了 10 项研究(5 项关于布鲁氏菌病,4 项关于炭疽,2 项关于恙虫病)。确定的主要战略包括跨部门合作、疫苗接种计划以及针对人类和动物的综合监控系统。还注意到在改善卫生基础设施和实施预防措施方面做出的其他努力。审查强调,尽管已经取得了一些进展,但要在东南亚有效预防和管理人畜共患病,就必须采取更加综合的 OH 方法,这也凸显了加强跨部门合作和协调努力的必要性。
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引用次数: 0
Point of care lactate for differentiating septic shock from hypovolemic shock in non-ICU settings: a prospective observational study 在非重症监护病房环境中,护理点乳酸可用于区分脓毒性休克和低血容量休克:一项前瞻性观察研究
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-10-21 DOI: 10.1016/j.lansea.2024.100500
<div><h3>Background</h3><div>Septic shock and hypovolemic shock are life-threatening illnesses that necessitate immediate recognition and intervention, as they can result in deadly consequences. While the underlying processes may vary, both entities can exhibit hypotension and organ dysfunction. No studies have been conducted on bedside testing to differentiate between these illnesses. Lactate measurement has been established as a viable option for early detection of septic shock. However, its role in diagnosing hypovolemic shock has yet to be evaluated. The aim of the study was to investigate alterations in lactate levels among diarrheal patients with septic shock and hypovolemic shock following the administration of first fluid resuscitation.</div></div><div><h3>Methods</h3><div>We conducted a prospective observational study in critically ill diarrheal adults aged ≥18 years in the emergency ward in Dhaka Hospital of icddr,b from 21st October 2021 to 31st May 2023 (total 19 months). The enrollment process was operational between 8:30 AM and 5:00 PM. Diarrheal adults with a diagnosis of sepsis with shock featured with poor peripheral perfusion (characterized by cold periphery and weak or absent pulse and capillary refill time >3 s) or hypotension (characterized by mean arterial pressure <65 mm-Hg) were enrolled as cases and consecutive diarrheal patients without any obvious features of sepsis with hypovolemic shock (due to severe dehydration) comprised the comparison group. POC lactate test was done at hours 0, 1st and 6th by StatStrip Lactate meters (Nova Biomedical, US) to all enrolled patients. For comparison of POC lactate levels, we used paired t-test for comparing the lactate samples drawn at hour 0, hour 1 and 6 with the septic shock and hypovolemic shock group. Odds ratio (OR) and their 95% confidence intervals (CIs) were used to demonstrate the strength of association. The study was registered at <span><span>Clinicaltrials.gov</span><svg><path></path></svg></span> (<span><span>NCT05108467</span><svg><path></path></svg></span>) and received institutional ethical approval (PR-21097).</div></div><div><h3>Findings</h3><div>Of 435 patients, 135 had septic shock and 141 had hypovolemic shock, rest 41 patient responded with fluid bolus. 25% (34/135) of the people in the septic shock group died whereas there is no mortality in the hypovolemic shock group. The number of patients visiting from outside Dhaka city had more septic shock than from inside were higher in comparison with (55% vs. 28%; p < 0.001). Statistically significant difference was observed between septic shock and hypovolemic shock group for a median POC lactate in 0, 1st and 6th hours with an OR of 1.07 (95% CI: 0.99, 1.17; p = 0.039); 1.48, (95% CI: 1.28, 1.70; p < 0.001) and 2.36 (95% CI: 1.85, 3.00; p < 0.001), respectively. The gradient of 1st to 2nd sample between septic shock and hypovolemic shock was found to be significantly different (OR: 0.74, 95% CI: 0.64
背景败血性休克和低血容量性休克是危及生命的疾病,需要立即识别和干预,因为它们可能导致致命后果。虽然其基本过程可能各不相同,但这两种疾病都会表现出低血压和器官功能障碍。目前还没有研究通过床旁检测来区分这两种疾病。乳酸测量已被确定为早期检测脓毒性休克的可行方法。然而,它在诊断低血容量性休克方面的作用还有待评估。本研究旨在调查脓毒性休克和低血容量性休克腹泻患者在接受首次液体复苏后乳酸水平的变化。报名时间为上午 8:30 至下午 5:00。诊断为脓毒症伴休克的成人腹泻患者以外周灌注不足(表现为外周发冷、脉搏微弱或消失、毛细血管再充盈时间为 3 秒)或低血压(表现为平均动脉压为 65 mm-Hg)为病例,无明显脓毒症特征的连续腹泻患者以低血容量休克(由于严重脱水)为对比组。所有入组患者均在第 0、1 和 6 小时使用 StatStrip 乳酸测量仪(Nova Biomedical,美国)进行了 POC 乳酸测试。为了比较 POC 乳酸水平,我们使用配对 t 检验法比较了脓毒性休克组和低血容量休克组在第 0 小时、第 1 小时和第 6 小时抽取的乳酸样本。用比值比(OR)及其 95% 置信区间(CI)来证明关联的强度。该研究已在 Clinicaltrials.gov 注册(NCT05108467),并获得了机构伦理批准(PR-21097)。脓毒性休克组中有 25% (34/135)的患者死亡,而低血容量性休克组则无死亡病例。达卡市外就诊的患者中,脓毒性休克患者人数高于达卡市内就诊的患者人数(55% vs. 28%; p <0.001)。脓毒性休克组和低血容量休克组在 0 小时、1 小时和 6 小时的 POC 乳酸中位数有明显统计学差异,OR 分别为 1.07(95% CI:0.99,1.17;p = 0.039)、1.48(95% CI:1.28,1.70;p <;0.001)和 2.36(95% CI:1.85,3.00;p <;0.001)。脓毒性休克和低血容量性休克之间的第 1 次样本到第 2 次样本的梯度有显著差异(OR:0.74,95% CI:0.64,0.85;p <;0.001)。通过提供快速、可靠和准确的结果,该测试可帮助临床医生快速诊断和治疗脓毒性休克等时间敏感性疾病。捐赠者未参与设计、实施、分析、数据解读或撰写手稿,也未决定是否发表。通讯作者可获得所有数据,并对稿件的最终批准和提交负责。
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引用次数: 0
Assessment of public health laboratory preparedness and response in WHO South-East Asia region during the COVID-19 pandemic: lessons learned and future directions 评估 COVID-19 大流行期间世卫组织东南亚地区公共卫生实验室的准备和应对情况:经验教训和未来方向
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-10-19 DOI: 10.1016/j.lansea.2024.100496
This Health Policy reviews the preparedness and response of public health laboratories in the WHO South-East Asia Region (SEAR) during the COVID-19 pandemic. Through a scoping review and in-depth interviews with key stakeholders, the study identifies successes, challenges, and lessons learned from available literature and the perspective of senior laboratory leaders. Key themes include human resources, health information systems, diagnostic capacity, public risk communication, biosafety, biosecurity, funding, and laboratory network coordination. The findings provide a comprehensive overview of the adaptive capacities of laboratories, the contextual factors influencing their response, and the implications for future pandemic preparedness. This study demonstrates the resilience and adaptability of diagnostic networks in the face of a pandemic but also emphasises the need for strategic resource allocation, highlighting the importance of flexible and scalable networks in managing public health crises. The success of these deployments highlights the necessity for continual investment and coordination of national, regional, and global resources in diagnostic infrastructure to improve preparedness for future public health crises.
本《卫生政策》回顾了世界卫生组织东南亚地区(SEAR)公共卫生实验室在 COVID-19 大流行期间的准备和响应情况。通过范围审查和对主要利益相关者的深入访谈,本研究从现有文献和实验室高级领导人的角度确定了成功、挑战和经验教训。关键主题包括人力资源、卫生信息系统、诊断能力、公共风险沟通、生物安全、生物安保、资金和实验室网络协调。研究结果全面概述了实验室的适应能力、影响其应对措施的背景因素以及对未来大流行病防备工作的影响。这项研究证明了诊断网络在面对大流行病时的应变能力和适应能力,同时也强调了战略性资源分配的必要性,突出了灵活、可扩展的网络在管理公共卫生危机中的重要性。这些部署的成功凸显了在诊断基础设施方面持续投资和协调国家、地区和全球资源的必要性,以改善对未来公共卫生危机的准备。
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引用次数: 0
Advancing evidence-based decision-making in Bhutan: development of a health technology assessment framework 推进不丹的循证决策:制定卫生技术评估框架
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-10-18 DOI: 10.1016/j.lansea.2024.100489
Bhutan is currently transforming its health system and has updated its Health Technology Assessment (HTA) framework. This revision is designed to prioritize health initiatives and ensure the sustainability of the health system. This updated framework has been developed through an iterative process involving a desk-based review and stakeholder consultations at the beginning and after the development of the draft framework. The framework outlines the stages of the HTA process and identifies the stakeholders with their roles and responsibilities. The framework has been contextualised to Bhutan's needs and has been endorsed by the high-level decision-making authority for the health sector. The experience highlights diverse challenges and solutions including international collaborations for the institutionalisation of HTA and the lessons learned from this process offer insights for HTA efforts in other settings.

Funding

UNDP-led Access and Delivery Partnership (ADP).
不丹目前正在改革其卫生系统,并已更新了其卫生技术评估(HTA)框架。此次修订旨在确定卫生举措的优先次序,确保卫生系统的可持续性。更新后的框架是通过迭代过程制定的,其中包括案头审查以及在制定框架草案之初和之后与利益相关者的磋商。该框架概述了 HTA 流程的各个阶段,并确定了利益相关者的作用和责任。该框架已根据不丹的需求进行了调整,并得到了卫生部门高层决策机构的认可。该经验强调了各种挑战和解决方案,包括为实现 HTA 制度化而开展的国际合作,从这一过程中吸取的经验教训为其他环境下的 HTA 工作提供了启示。
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引用次数: 0
The implications of waiving local clinical trials for drugs in India: a double-edged sword? 印度放弃当地药物临床试验的影响:一把双刃剑?
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-10-18 DOI: 10.1016/j.lansea.2024.100501
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引用次数: 0
Effectiveness of an expanded role for community health workers on malaria blood examination rates in malaria elimination settings in Myanmar: an open stepped-wedge, cluster-randomised controlled trial 在缅甸消除疟疾的环境中扩大社区卫生工作者的作用对疟疾血液检查率的影响:开放式阶梯式群组随机对照试验
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-10-17 DOI: 10.1016/j.lansea.2024.100499

Background

As Greater Mekong Subregion countries approach malaria elimination, the motivation and social role of community health workers (CHWs), and malaria blood examination rates, have declined in parallel with decreasing malaria burden. To address this issue, a health system model which expanded the role for CHWs was co-designed with communities and health stakeholders in the Mekong Subregion and field-tested in Myanmar.

Methods

An open stepped-wedge cluster-randomised (at the village-level) controlled trial (ClinicalTrials.gov NCT04695886) was conducted in 72 villages in Myanmar from Nov 1, 2021 to April 17, 2022 to evaluate the effectiveness and cost-effectiveness of the expanded CHW model. One-off and continuous implementation costs of the models were calculated.

Findings

A total of 2886 malaria rapid diagnostic tests (RDTs) (control period: 1365; intervention period: 1521) were undertaken across 72 villages during the 24-week study period. Compared to the existing CHW model, the introduction of an expanded role for CHWs resulted in a 23% relative increase in village weekly malaria blood examination rates by RDT, the primary outcome, (adjusted incidence rate ratio (AIRR) = 1.23, 95% CI = 1.01, 1.50, p = 0.036), adjusting for time and season. A 3.3-fold relative increase in village weekly referral rate of dengue, tuberculosis, diarrhoea, or RDT-negative fever cases after the introduction of the expanded CHW model (AIRR = 3.17, 95% CI = 1.23, 8.18, p = 0.017), was also observed. The total cost per CHW per five-year period was US$14,794 for the expanded CHW model and $5816 for the existing CHW model.

Interpretation

An expanded CHW model, co-designed with communities and health stakeholders, can increase malaria blood examination rates in malaria elimination settings and referral rates for other infectious diseases. Expanded CHW models will facilitate maintaining annual blood examination rates required for malaria elimination accreditation by the WHO.

Funding

An International Multilateral Donor (QSE-M-UNOPS-BI-20864-007-40).
背景随着大湄公河次区域国家即将消灭疟疾,社区保健员(CHWs)的积极性和社会作用以及疟疾血液检查率却随着疟疾负担的减轻而下降。为了解决这一问题,我们与湄公河次区域的社区和卫生利益相关者共同设计了一种扩大社区保健员作用的卫生系统模式,并在缅甸进行了实地测试。方法:2021 年 11 月 1 日至 2022 年 4 月 17 日,我们在缅甸的 72 个村庄开展了一项开放式阶梯式群组随机(村级)对照试验(ClinicalTrials.gov NCT04695886),以评估扩大社区保健员模式的有效性和成本效益。在为期 24 周的研究期间,72 个村庄共进行了 2886 次疟疾快速诊断检测(RDT)(对照期:1365 次;干预期:1521 次)。与现有的社区保健员模式相比,在引入社区保健员的更大作用后,村庄每周通过 RDT 进行疟疾血液检查的比率相对增加了 23%,这是主要结果(调整后发病率比 (AIRR) = 1.23,95% CI = 1.01,1.50,p = 0.036),并对时间和季节进行了调整。在引入扩大的 CHW 模式后,村庄每周的登革热、肺结核、腹泻或 RDT 阴性发烧病例转诊率也相对增加了 3.3 倍(AIRR = 3.17,95% CI = 1.23,8.18,p = 0.017)。与社区和卫生利益相关者共同设计的扩大的 CHW 模式可提高消除疟疾环境中的疟疾血液检查率和其他传染病的转诊率。扩大的社区保健工作者模式将有助于保持世卫组织消除疟疾认证所要求的年度血液检查率。
{"title":"Effectiveness of an expanded role for community health workers on malaria blood examination rates in malaria elimination settings in Myanmar: an open stepped-wedge, cluster-randomised controlled trial","authors":"","doi":"10.1016/j.lansea.2024.100499","DOIUrl":"10.1016/j.lansea.2024.100499","url":null,"abstract":"<div><h3>Background</h3><div>As Greater Mekong Subregion countries approach malaria elimination, the motivation and social role of community health workers (CHWs), and malaria blood examination rates, have declined in parallel with decreasing malaria burden. To address this issue, a health system model which expanded the role for CHWs was co-designed with communities and health stakeholders in the Mekong Subregion and field-tested in Myanmar.</div></div><div><h3>Methods</h3><div>An open stepped-wedge cluster-randomised (at the village-level) controlled trial (<span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> <span><span>NCT04695886</span><svg><path></path></svg></span>) was conducted in 72 villages in Myanmar from Nov 1, 2021 to April 17, 2022 to evaluate the effectiveness and cost-effectiveness of the expanded CHW model. One-off and continuous implementation costs of the models were calculated.</div></div><div><h3>Findings</h3><div>A total of 2886 malaria rapid diagnostic tests (RDTs) (control period: 1365; intervention period: 1521) were undertaken across 72 villages during the 24-week study period. Compared to the existing CHW model, the introduction of an expanded role for CHWs resulted in a 23% relative increase in village weekly malaria blood examination rates by RDT, the primary outcome, (adjusted incidence rate ratio (AIRR) = 1.23, 95% CI = 1.01, 1.50, p = 0.036), adjusting for time and season. A 3.3-fold relative increase in village weekly referral rate of dengue, tuberculosis, diarrhoea, or RDT-negative fever cases after the introduction of the expanded CHW model (AIRR = 3.17, 95% CI = 1.23, 8.18, p = 0.017), was also observed. The total cost per CHW per five-year period was US$14,794 for the expanded CHW model and $5816 for the existing CHW model.</div></div><div><h3>Interpretation</h3><div>An expanded CHW model, co-designed with communities and health stakeholders, can increase malaria blood examination rates in malaria elimination settings and referral rates for other infectious diseases. Expanded CHW models will facilitate maintaining annual blood examination rates required for malaria elimination accreditation by the WHO.</div></div><div><h3>Funding</h3><div>An <span>International Multilateral Donor</span> (<span><span>QSE-M-UNOPS-BI-20864-007-40</span></span>).</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":null,"pages":null},"PeriodicalIF":5.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142446312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Routine immunization against Streptococcus pneumoniae and Haemophilus influenzae type B and antibiotic consumption in India: a dynamic modeling analysis 印度肺炎链球菌和 B 型流感嗜血杆菌常规免疫接种与抗生素消耗:动态模型分析
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-10-16 DOI: 10.1016/j.lansea.2024.100498

Background

Childhood vaccinations can reduce disease burden and associated antibiotic use, in turn reducing the risk of antimicrobial resistance (AMR). We retrospectively estimated the population-level reductions in antibiotic use in India following the introduction of vaccines against Streptococcus pneumoniae and Haemophilius influenzae type B in the national immunization program for children in the mid-2010s and projected future gains to 2028 if vaccination coverage were to be increased.

Methods

Using IndiaSim, a dynamic agent-based microsimulation model (ABM) for India, we simulated the spread of Streptococcus pneumoniae and Haemophilius influenzae type B (Hib) among children to estimate reductions in antibiotic use under the scenarios of: (i) pneumococcal and Hib vaccine coverage levels equivalent to the national coverage of pentavalent diphtheria-pertussis-tetanus third dose (DPT3) compared to a baseline of no vaccination, and (ii) near-universal (90%) coverage of the vaccines compared to pre-COVID national DPT3-level coverage. Model parameters, including national DPT3 coverage rates, were based on data from the National Family Household Survey 2015–2016 and other published sources. We quantified reductions in antibiotic consumption nationally and by state and wealth quintiles.

Findings

We estimate that coverage of S. pneumoniae and Hib vaccines at the same level as DPT3 in India would translate to a 61.4% [95% UI: 43.8–69.5] reduction in attributable antibiotic use compared to a baseline of zero vaccination coverage. Increases in childhood vaccination coverage between 2004 and 2016 have likely reduced attributable antibiotic demand by as much as 93.4% among the poorest quintile. Increasing vaccination coverage by an additional 11 percentage points from 2016 levels results in mortality and antibiotic use across wealth quintiles becoming increasingly similar (p < 0.05), reducing in health inquities. We project that near-universal vaccine coverage would further reduce inequities in antibiotic demand and may eliminate of outbreak-associated antibiotic use from S. pneumoniae and Hib.

Interpretation

Though vaccination has a complex relationship with antibiotic use because both are modulated by socioeconomic factors, increasing vaccinations for S. pneumoniae and Hib may have a significant impact on reducing antibiotic use and improving health outcomes among the poorest individuals.

Funding

The Bill & Melinda Gates Foundation (grant numbers OPP1158136 and OPP1190803).
背景儿童接种疫苗可减少疾病负担和相关抗生素的使用,从而降低抗菌药耐药性 (AMR) 的风险。我们回顾性地估算了印度在 2010 年代中期将肺炎链球菌疫苗和 B 型流感嗜血杆菌疫苗纳入国家儿童免疫计划后抗生素使用量的减少情况,并预测了如果提高疫苗接种覆盖率,到 2028 年的未来收益。方法利用印度的动态代理微观模拟模型(ABM)IndiaSim,我们模拟了肺炎链球菌和乙型流感嗜血杆菌(Hib)在儿童中的传播情况,以估算在以下情况下抗生素使用量的减少情况:(i) 与未接种疫苗的基线相比,肺炎球菌和 Hib 疫苗的覆盖率相当于全国五价白喉-百日咳-破伤风三联疫苗(DPT3)的覆盖率;以及 (ii) 与 COVID 前全国 DPT3 疫苗的覆盖率相比,疫苗的覆盖率接近普及(90%)。模型参数(包括全国 DPT3 接种率)基于 2015-2016 年全国家庭住户调查的数据和其他已公布的来源。我们对全国以及各邦和财富五分位数的抗生素消耗量减少情况进行了量化。研究结果 我们估计,与疫苗接种覆盖率为零的基线相比,如果印度的肺炎链球菌疫苗和 Hib 疫苗的覆盖率与 DPT3 疫苗的覆盖率持平,那么可归因的抗生素使用量将减少 61.4% [95% UI:43.8-69.5]。2004 年至 2016 年间,儿童疫苗接种覆盖率的提高可能会使最贫困的五分之一人口的可归因抗生素需求减少 93.4%。将疫苗接种覆盖率在 2016 年的基础上再提高 11 个百分点,可使不同财富五分位数人群的死亡率和抗生素使用量变得越来越接近(p < 0.05),从而减少健康不公。我们预计,接近普及的疫苗接种率将进一步减少抗生素需求方面的不公平现象,并可能消除肺炎链球菌和 Hib 引起的疫情相关抗生素使用。尽管肺炎球菌和 Hib 疫苗接种与抗生素使用有着复杂的关系,因为两者都受社会经济因素的影响,但增加肺炎球菌和 Hib 疫苗接种可能会对减少抗生素使用和改善最贫困人口的健康状况产生重大影响。
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引用次数: 0
Estimating the impact of imported malaria on local transmission in a near elimination setting: a case study from Bhutan 在接近消灭疟疾的环境中估算输入性疟疾对当地传播的影响:不丹的案例研究
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-10-15 DOI: 10.1016/j.lansea.2024.100497

Background

Bhutan has achieved a substantial reduction in both malaria morbidity and mortality over the last two decades and is aiming for malaria elimination certification in 2025. However, a significant percentage of malaria cases in Bhutan are imported (acquired in another country). The aim of the study was to understand how importation drives local malaria transmission in Bhutan.

Methods

Information on geo-located individual-level laboratory-confirmed malaria cases between 2016 and 2020 was obtained from the Bhutan Vector-borne Disease Control Program. Records included the date of diagnosis and treatment, type of cases classified as indigenous or imported, and malaria species. Hawkes Processes were used to study the role of imported malaria in local transmission in Bhutan. We imposed 15 days delay for a mosquito to become infectious in the model.

Findings

There were 285 cases during the study period and 58.6% (159) were imported malaria. 71.1% (113) of these imported cases were Plasmodium vivax and 73.6% (117) were from India. The model suggested that a person remains infectious for 8 days for Plasmodium falciparum malaria but over 19 days for P. vivax. The background intensity from imported malaria cases was much greater for P. vivax cases (maximum 0.17) resulting in more importations than P. falciparum cases (maximum 0.06). However, model fitting suggested that local P. falciparum transmission was mainly driven by importations but additional factors such as relapse played a role for P. vivax.

Interpretation

Imported malaria cases are key drivers of transmission within Bhutan, with most cases since 2016 being P. vivax. Control programmes should be devised to target interventions towards the P. vivax strain and test those who are more likely to bring in imported malaria cases or acquire it from returning travellers.

Funding

None.
背景不丹在过去二十年里大幅降低了疟疾发病率和死亡率,并力争在 2025 年获得消灭疟疾认证。然而,不丹的疟疾病例中有很大一部分是输入性病例(从其他国家感染)。该研究旨在了解输入性疟疾是如何推动不丹当地疟疾传播的。研究方法从不丹病媒传播疾病控制项目中获取了 2016 年至 2020 年期间经实验室确诊的疟疾病例的地理位置信息。记录包括诊断和治疗日期、本地或输入病例类型以及疟疾种类。霍克斯过程用于研究输入性疟疾在不丹本地传播中的作用。我们在模型中设定了蚊子感染的 15 天延迟时间。研究结果在研究期间共有 285 例病例,58.6%(159 例)为输入性疟疾。在这些输入病例中,71.1%(113 例)为间日疟原虫,73.6%(117 例)来自印度。模型显示,恶性疟原虫疟疾的感染期为 8 天,而间日疟原虫疟疾的感染期超过 19 天。输入性疟疾病例的背景强度(最大值为 0.17)远高于恶性疟原虫病例(最大值为 0.06),从而导致输入性疟疾病例的增加。然而,模型拟合表明,当地恶性疟原虫传播主要由输入病例驱动,但复发等其他因素也对间日疟原虫传播起了作用。应制定控制计划,针对间日疟原虫菌株采取干预措施,并对那些更有可能带来输入性疟疾病例或从回国旅行者那里感染间日疟原虫的人进行检测。
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引用次数: 0
Deferoxamine, deferasirox, and deferiprone triple iron chelator combination therapy for transfusion-dependent β-thalassaemia with very high iron overload: a randomised clinical trial 去铁胺、去铁胺和去铁酮三联铁螯合剂联合疗法治疗输血依赖型β-地中海贫血伴极高铁超载:随机临床试验
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-10-15 DOI: 10.1016/j.lansea.2024.100495

Background

Many patients with β-thalassaemia die prematurely due to iron overload. In this study, we aim to evaluate the efficacy and safety of the triple combination of deferoxamine, deferasirox and deferiprone on iron chelation in patients with transfusion-dependent β-thalassaemia with very high iron overload.

Methods

This open-label, randomised, controlled clinical trial was conducted at Colombo North Teaching Hospital, Sri Lanka. Transfusion-dependent β-thalassaemia patients with ferritin >3500 ng/mL were randomised 2:1 into intervention (deferoxamine, deferasirox and deferiprone) and control (deferoxamine and deferasirox) arms. Reduction in serum ferritin after six months was the primary outcome measure. Reduction in liver iron content, improvement in cardiac T2∗, and adverse effects were secondary outcome measures.

Findings

Twenty-three patients (intervention-15, control-8) were recruited. 92% and 62% in the intervention and control arms showed a reduction in ferritin, respectively. The mean reduction of ferritin was significantly higher in intervention (−1094 ± 907 ng/mL) compared to control (+82 ± 1588 ng/mL) arm (p = 0.042). There was no statistically significant difference in the liver iron content in two arms. In the intervention arm, 67% improved cardiac T2∗ (mean change +6.72 ± 9.63 ms) compared to 20% in the control arm (mean change −3.00 ± 8.24 ms). Five patients discontinued deferiprone due to arthralgia, which resolved completely after stopping the drug.

Interpretation

Triple combination therapy with deferoxamine, deferasirox and deferiprone is more efficacious in reducing iron burden measured by serum ferritin and showed a positive trend in reducing myocardial iron content in patients with transfusion-dependent β-thalassaemia with very high iron overload. Deferiprone has the disturbing side effect of reversible but severe arthropathy.

Funding

None.
背景许多β-地中海贫血患者因铁负荷过重而过早死亡。在这项研究中,我们旨在评估去铁胺、地拉罗司和去铁酮三联疗法对铁超载极高的输血依赖型β-地中海贫血患者进行铁螯合治疗的有效性和安全性。铁蛋白为 3500 ng/mL 的输血依赖型β-地中海贫血患者按 2:1 随机分为干预组(去铁胺、去铁胺和去铁酮)和对照组(去铁胺和去铁胺)。6个月后血清铁蛋白的降低是衡量疗效的主要指标。研究结果招募了 23 名患者(干预组 15 人,对照组 8 人)。干预组和对照组分别有 92% 和 62% 的患者铁蛋白有所下降。与对照组(+82 ± 1588 ng/mL)相比,干预组铁蛋白的平均降幅(-1094 ± 907 ng/mL)明显更高(p = 0.042)。两组的肝脏铁含量在统计学上没有明显差异。干预组中,67%的患者心脏T2∗有所改善(平均变化+6.72 ± 9.63 ms),而对照组中只有20%的患者(平均变化-3.00 ± 8.24 ms)。5名患者因关节痛而停用去铁酮,停药后关节痛完全缓解。解释去铁胺、去铁胺和去铁酮三联疗法在减轻血清铁蛋白测定的铁负荷方面更有效,在减轻输血依赖型β地中海贫血患者的心肌铁含量方面显示出积极的趋势。去铁酮具有令人不安的副作用,即可逆但严重的关节病。
{"title":"Deferoxamine, deferasirox, and deferiprone triple iron chelator combination therapy for transfusion-dependent β-thalassaemia with very high iron overload: a randomised clinical trial","authors":"","doi":"10.1016/j.lansea.2024.100495","DOIUrl":"10.1016/j.lansea.2024.100495","url":null,"abstract":"<div><h3>Background</h3><div>Many patients with β-thalassaemia die prematurely due to iron overload. In this study, we aim to evaluate the efficacy and safety of the triple combination of deferoxamine, deferasirox and deferiprone on iron chelation in patients with transfusion-dependent β-thalassaemia with very high iron overload.</div></div><div><h3>Methods</h3><div>This open-label, randomised, controlled clinical trial was conducted at Colombo North Teaching Hospital, Sri Lanka. Transfusion-dependent β-thalassaemia patients with ferritin &gt;3500 ng/mL were randomised 2:1 into intervention (deferoxamine, deferasirox and deferiprone) and control (deferoxamine and deferasirox) arms. Reduction in serum ferritin after six months was the primary outcome measure. Reduction in liver iron content, improvement in cardiac T2∗, and adverse effects were secondary outcome measures.</div></div><div><h3>Findings</h3><div>Twenty-three patients (intervention-15, control-8) were recruited. 92% and 62% in the intervention and control arms showed a reduction in ferritin, respectively. The mean reduction of ferritin was significantly higher in intervention (−1094 ± 907 ng/mL) compared to control (+82 ± 1588 ng/mL) arm (p = 0.042). There was no statistically significant difference in the liver iron content in two arms. In the intervention arm, 67% improved cardiac T2∗ (mean change +6.72 ± 9.63 ms) compared to 20% in the control arm (mean change −3.00 ± 8.24 ms). Five patients discontinued deferiprone due to arthralgia, which resolved completely after stopping the drug.</div></div><div><h3>Interpretation</h3><div>Triple combination therapy with deferoxamine, deferasirox and deferiprone is more efficacious in reducing iron burden measured by serum ferritin and showed a positive trend in reducing myocardial iron content in patients with transfusion-dependent β-thalassaemia with very high iron overload. Deferiprone has the disturbing side effect of reversible but severe arthropathy.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":null,"pages":null},"PeriodicalIF":5.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142438414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Beyond the bench: LGBTQ+ health equity after India’s “no same-sex marriage” verdict 法官之外:印度 "禁止同性婚姻 "判决后的 LGBTQ+ 健康平等
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-10-08 DOI: 10.1016/j.lansea.2024.100494
LGBTQ+ people (e.g., lesbian, gay, bisexual, transgender, and queer or questioning people) experience systemic marginalisation and discrimination globally and throughout India. In October 2023, the Indian Supreme Court rejected the legal recognition of same-sex marriage, blocking marriage equality for LGBTQ+ people and contending that the right to marry neither qualifies as a fundamental right accorded by the Indian Constitution nor falls under the Supreme Court’s purview. Although the Supreme Court declared opposition to discrimination based on sexual orientation, its failure to recognise same-sex marriage legally is a substantial obstruction to full LGBTQ+ equality. We propose that the refusal of the Indian legal system to honour same-sex marriage while calling for an end to societal violence and discriminatory behaviour against the LGBTQ+ community is inherently flawed and counterintuitive. Informed by our team’s multidisciplinary orientation as healthcare professionals, researchers, and advocates, we delineate explicit challenges that LGBTQ+ people in India may encounter due to the Supreme Court’s recent ruling. We subsequently put forth a series of interprofessional and intersectoral recommendations to mitigate this decision’s immediate and long-term consequences, providing an actionable path toward LGBTQ+ inclusion, justice, and equity in India.
在全球和整个印度,LGBTQ+人群(如女同性恋、男同性恋、双性恋、变性人和同性恋或质疑者)都遭受着系统性的边缘化和歧视。2023 年 10 月,印度最高法院驳回了对同性婚姻的法律承认,阻止了 LGBTQ+ 人士的婚姻平等,并认为结婚权既不符合印度宪法赋予的基本权利,也不属于最高法院的职权范围。尽管最高法院宣布反对基于性取向的歧视,但它不承认同性婚姻的合法性是 LGBTQ+ 完全平等的实质性障碍。我们认为,印度法律体系在呼吁结束针对 LGBTQ+ 群体的社会暴力和歧视行为的同时,却拒绝承认同性婚姻,这种做法本身就存在缺陷,而且有悖常理。基于我们团队作为医疗保健专业人士、研究人员和倡导者的多学科定位,我们明确指出了印度的 LGBTQ+ 群体可能会因最高法院最近的裁决而面临的挑战。随后,我们提出了一系列跨专业和跨部门的建议,以减轻该裁决的直接和长期影响,为印度 LGBTQ+ 的包容、正义和公平提供了一条可行之路。
{"title":"Beyond the bench: LGBTQ+ health equity after India’s “no same-sex marriage” verdict","authors":"","doi":"10.1016/j.lansea.2024.100494","DOIUrl":"10.1016/j.lansea.2024.100494","url":null,"abstract":"<div><div>LGBTQ+ people (e.g., lesbian, gay, bisexual, transgender, and queer or questioning people) experience systemic marginalisation and discrimination globally and throughout India. In October 2023, the Indian Supreme Court rejected the legal recognition of same-sex marriage, blocking marriage equality for LGBTQ+ people and contending that the right to marry neither qualifies as a fundamental right accorded by the Indian Constitution nor falls under the Supreme Court’s purview. Although the Supreme Court declared opposition to discrimination based on sexual orientation, its failure to recognise same-sex marriage legally is a substantial obstruction to full LGBTQ+ equality. We propose that the refusal of the Indian legal system to honour same-sex marriage while calling for an end to societal violence and discriminatory behaviour against the LGBTQ+ community is inherently flawed and counterintuitive. Informed by our team’s multidisciplinary orientation as healthcare professionals, researchers, and advocates, we delineate explicit challenges that LGBTQ+ people in India may encounter due to the Supreme Court’s recent ruling. We subsequently put forth a series of interprofessional and intersectoral recommendations to mitigate this decision’s immediate and long-term consequences, providing an actionable path toward LGBTQ+ inclusion, justice, and equity in India.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":null,"pages":null},"PeriodicalIF":5.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142428165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
The Lancet regional health. Southeast Asia
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