Pub Date : 2025-04-07DOI: 10.1016/j.lansea.2025.100575
Edward Fottrell , Harry Costello , Naveed Ahmed , Carina King , Sanjit Kumer Shaha , Tasmin Nahar , Malini Pires , Andrew Copas , Hassan Haghparast-Bidgoli , Joanna Morrison , Abdul Kuddus , Kishwar Azad
<div><h3>Background</h3><div>Cognitive impairment has a major impact on health, quality of life and survival and its increasing burden presents a critical global health challenge. Empirical population-based studies of cognitive function and its association with demographic, socioeconomic, health and behavioural factors among older adults in low-resource setting are rare. This study describes the burden of cognitive impairment and associations with demographic, health and behavioural factors among older adults in rural Bangladesh.</div></div><div><h3>Methods</h3><div>We conducted a population-based cross-sectional study of a random sample of men and women aged 60 years and above in 96 rural villages in Bangladesh. Cognitive function was measured using the Bangla Adaptation of the Mini-mental State Examination (BAMSE), where higher score indicates higher function. Blood pressure, height and weight were measured using standard protocols and fasting glucose and 2-h oral glucose test were used to identify diabetes risk. Interviewer administered survey questionnaires assessed depressive symptoms, anxiety and self-reported health behaviours. Analyses were carried out separately for men and women and examined associations between sociodemographic, health and behaviour factors with BAMSE scores using robust Poisson regression.</div></div><div><h3>Findings</h3><div>Data were gathered from 403 (216 female, 187 male) eligible participants. More than 50% of the population had at least mild cognitive impairment and women had lower cognitive scores than men. Younger age, higher education, wealth, and literacy were significantly associated with higher BAMSE scores among women and men. Associations with marital status varied between men and women, with being married having a positive association with BAMSE among women, i.e. higher cognitive function (relative score ratio (95% CI) 1.08 (1.02, 1.15), p = 0.013), but no association among men (0.94 (0.87, 1.02), p = 0.13). No clear associations were observed with diabetes or hypertension, but overweight and obesity were associated with an increased BAMSE score among women (1.10 (1.02, 1.19), p = 0.011) but not men (1.01 (0.94, 1.10), p = 0.70). Moderate and severe depressive symptoms were associated with lower BAMSE scores among men (0.90 (0.82, 0.99), p = 0.037), but not women (0.94 (0.83, 1.06), p = 0.31). Physical activity was associated with a relative increase in BAMSE score (1.08 (1.01, 1.16), p = 0.020) among women, though no association was seen in men (1.01 (0.95, 1.07), p = 0.76). The consumption of betel was associated with lower BAMSE among women (0.94 (0.89, 1.00), p = 0.056), but there was no evidence of association among men (1.01 (0.96, 1.07), p = 0.61).</div></div><div><h3>Interpretation</h3><div>A large proportion of older adults in rural Bangladesh have impaired cognitive function and there are important gender differences in the distribution of cognitive scores and their association with demograph
{"title":"Cognitive function and associations with demographic, socioeconomic, health and behavioural factors among older adult men and women in rural Bangladesh: a population-based cross-sectional study","authors":"Edward Fottrell , Harry Costello , Naveed Ahmed , Carina King , Sanjit Kumer Shaha , Tasmin Nahar , Malini Pires , Andrew Copas , Hassan Haghparast-Bidgoli , Joanna Morrison , Abdul Kuddus , Kishwar Azad","doi":"10.1016/j.lansea.2025.100575","DOIUrl":"10.1016/j.lansea.2025.100575","url":null,"abstract":"<div><h3>Background</h3><div>Cognitive impairment has a major impact on health, quality of life and survival and its increasing burden presents a critical global health challenge. Empirical population-based studies of cognitive function and its association with demographic, socioeconomic, health and behavioural factors among older adults in low-resource setting are rare. This study describes the burden of cognitive impairment and associations with demographic, health and behavioural factors among older adults in rural Bangladesh.</div></div><div><h3>Methods</h3><div>We conducted a population-based cross-sectional study of a random sample of men and women aged 60 years and above in 96 rural villages in Bangladesh. Cognitive function was measured using the Bangla Adaptation of the Mini-mental State Examination (BAMSE), where higher score indicates higher function. Blood pressure, height and weight were measured using standard protocols and fasting glucose and 2-h oral glucose test were used to identify diabetes risk. Interviewer administered survey questionnaires assessed depressive symptoms, anxiety and self-reported health behaviours. Analyses were carried out separately for men and women and examined associations between sociodemographic, health and behaviour factors with BAMSE scores using robust Poisson regression.</div></div><div><h3>Findings</h3><div>Data were gathered from 403 (216 female, 187 male) eligible participants. More than 50% of the population had at least mild cognitive impairment and women had lower cognitive scores than men. Younger age, higher education, wealth, and literacy were significantly associated with higher BAMSE scores among women and men. Associations with marital status varied between men and women, with being married having a positive association with BAMSE among women, i.e. higher cognitive function (relative score ratio (95% CI) 1.08 (1.02, 1.15), p = 0.013), but no association among men (0.94 (0.87, 1.02), p = 0.13). No clear associations were observed with diabetes or hypertension, but overweight and obesity were associated with an increased BAMSE score among women (1.10 (1.02, 1.19), p = 0.011) but not men (1.01 (0.94, 1.10), p = 0.70). Moderate and severe depressive symptoms were associated with lower BAMSE scores among men (0.90 (0.82, 0.99), p = 0.037), but not women (0.94 (0.83, 1.06), p = 0.31). Physical activity was associated with a relative increase in BAMSE score (1.08 (1.01, 1.16), p = 0.020) among women, though no association was seen in men (1.01 (0.95, 1.07), p = 0.76). The consumption of betel was associated with lower BAMSE among women (0.94 (0.89, 1.00), p = 0.056), but there was no evidence of association among men (1.01 (0.96, 1.07), p = 0.61).</div></div><div><h3>Interpretation</h3><div>A large proportion of older adults in rural Bangladesh have impaired cognitive function and there are important gender differences in the distribution of cognitive scores and their association with demograph","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"36 ","pages":"Article 100575"},"PeriodicalIF":5.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143785557","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}
{"title":"Resurgence of syphilis among blood donors in a single institute in Eastern India: a looming threat to public health and transfusion services","authors":"Suvro Sankha Datta , Aniruddha Hazra , Najla Haneefa Basheela , Sanjay Bhattacharya , Soumyadip Chatterji","doi":"10.1016/j.lansea.2025.100572","DOIUrl":"10.1016/j.lansea.2025.100572","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"36 ","pages":"Article 100572"},"PeriodicalIF":5.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143739864","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}
Pub Date : 2025-03-29DOI: 10.1016/j.lansea.2025.100571
Pranav Shrestha , Hendrik Lohse , Christopher Bhatla , Heather McCartney , Alaa Alzaki , Navdeep Sandhu , Pardip Kumar Oli , Sanjeev Chaudhary , Ali Amid , Rodrigo Onell , Nicholas Au , Hayley Merkeley , Videsh Kapoor , Rajan Pande , Boris Stoeber
Background
Sickle cell disease (SCD) persists as a major global health problem, disproportionately affecting children in low- and middle-income countries (LMIC). Accurate and low-cost point-of-care techniques are urgently needed in LMIC to detect carrier or disease forms with haemoglobin S (HbS) and other variants like β-thalassemia.
Methods
An open-label, international, multicentre study was conducted at clinical sites in Nepal and Canada. Blood samples were collected from healthy volunteers (HbAA) and participants with known haemoglobinopathies (HbA/β-thalassemia, HbAS, HbS/β-thalassemia, HbSS). The performance of six low-cost tests (Conventional sickling test; HbS solubility test; HemoTypeSC; Sickle SCAN; Gazelle Hb variant test; Automated sickling test using automated microscopy and machine learning) was evaluated against HPLC (ClinicalTrials.gov Identifier: NCT05506358).
Findings
Between September 2022 and March 2023, we enrolled 138 participants (aged 2–74 years; 59% female, 41% male) at clinical sites in Nepal and Canada. Four low-cost tests (HemoTypeSC, Sickle SCAN, Gazelle, and automated sickling), which could identify phenotypes, detected severe SCD (HbSS, HbS/β-thalassemia) accurately (sensitivity >96%; specificity >99%). In contrast, for carrier forms, HemotypeSC and Sickle SCAN only detected HbAS (sensitivity >97%; specificity 100%) and not HbA/β-thalassemia (sensitivity 0%; specificity 100%), while Gazelle detected HbAS (sensitivity 100%, specificity 100%) and HbA/β-thalassemia (sensitivity 91%, specificity 99%), and automated sickling test detected both trait conditions (HbAS and HbA/β-thalassemia; sensitivity 85%, specificity 85%).
Interpretation
When HbS co-exists with β-thalassemia, Gazelle and automated sickling test accurately identify severe SCD and carrier forms. However, HemotypeSC and Sickle SCAN miss β-thalassemia trait, and need to be complemented with other low-cost tests.
{"title":"Evaluation of low-cost techniques to detect sickle cell disease and β-thalassemia: an open-label, international, multicentre study","authors":"Pranav Shrestha , Hendrik Lohse , Christopher Bhatla , Heather McCartney , Alaa Alzaki , Navdeep Sandhu , Pardip Kumar Oli , Sanjeev Chaudhary , Ali Amid , Rodrigo Onell , Nicholas Au , Hayley Merkeley , Videsh Kapoor , Rajan Pande , Boris Stoeber","doi":"10.1016/j.lansea.2025.100571","DOIUrl":"10.1016/j.lansea.2025.100571","url":null,"abstract":"<div><h3>Background</h3><div>Sickle cell disease (SCD) persists as a major global health problem, disproportionately affecting children in low- and middle-income countries (LMIC). Accurate and low-cost point-of-care techniques are urgently needed in LMIC to detect carrier or disease forms with haemoglobin S (HbS) and other variants like β-thalassemia.</div></div><div><h3>Methods</h3><div>An open-label, international, multicentre study was conducted at clinical sites in Nepal and Canada. Blood samples were collected from healthy volunteers (HbAA) and participants with known haemoglobinopathies (HbA/β-thalassemia, HbAS, HbS/β-thalassemia, HbSS). The performance of six low-cost tests (Conventional sickling test; HbS solubility test; HemoTypeSC; Sickle SCAN; Gazelle Hb variant test; Automated sickling test using automated microscopy and machine learning) was evaluated against HPLC (<span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> Identifier: <span><span>NCT05506358</span><svg><path></path></svg></span>).</div></div><div><h3>Findings</h3><div>Between September 2022 and March 2023, we enrolled 138 participants (aged 2–74 years; 59% female, 41% male) at clinical sites in Nepal and Canada. Four low-cost tests (HemoTypeSC, Sickle SCAN, Gazelle, and automated sickling), which could identify phenotypes, detected severe SCD (HbSS, HbS/β-thalassemia) accurately (sensitivity >96%; specificity >99%). In contrast, for carrier forms, HemotypeSC and Sickle SCAN only detected HbAS (sensitivity >97%; specificity 100%) and not HbA/β-thalassemia (sensitivity 0%; specificity 100%), while Gazelle detected HbAS (sensitivity 100%, specificity 100%) and HbA/β-thalassemia (sensitivity 91%, specificity 99%), and automated sickling test detected both trait conditions (HbAS and HbA/β-thalassemia; sensitivity 85%, specificity 85%).</div></div><div><h3>Interpretation</h3><div>When HbS co-exists with β-thalassemia, Gazelle and automated sickling test accurately identify severe SCD and carrier forms. However, HemotypeSC and Sickle SCAN miss β-thalassemia trait, and need to be complemented with other low-cost tests.</div></div><div><h3>Funding</h3><div><span>UBC</span> <span>PSI</span>, <span>Canada Research Chairs</span>, <span>UBC</span> HIFI Awards, <span>UBC</span> 4YF, Naiman Vickars Endowment fund.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"35 ","pages":"Article 100571"},"PeriodicalIF":5.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725360","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}
Cholangiocarcinoma (CCA) is a significant health concern in Thailand, as the age-standardized rates (ASR) and other trends fluctuate across different regions. However, comprehensive national estimates are lacking. This study examined the Thai ASR of CCA trends from 2012 to 2021 and projected the incidence rates to 2026.
Methods
This retrospective cohort analysis examined 6379 CCA cases from population-based cancer registries (PBCRs) in the northern, central, northeastern, and southern regions for the time period January 1, 2012, to December 31, 2021. The Joinpoint, age-period-cohort, and Nordpred models were used to assess CCA incidence trends and predictions.
Findings
CCA incidence trends in Thailand showed a decrease, with an average annual percentage change (AAPC) of −7.20% (95% CI: −11.04 to −3.19) for males, and −5.81% (95% CI: −10.81 to −0.54) for females. The projected incidence rate per 100,000 person-years for 2026 varied slightly according to the model: Joinpoint (males: 6.1, females: 3.4), age-period-cohort (males: 6.0, females: 3.3), and Nordpred (males: 5.5, females: 3.4). Regional analyses revealed decreasing trends in the northern and northeastern regions, with 2026 projections indicating further declines exceeding the 10-year trends. Owing to the small sample size, trends in the central and southern regions could not be determined.
Interpretation
Thailand's CCA rate has generally decreased but varies geographically; the northern and northeastern regions remain at high risk. To minimize CCA nationally, initiatives should be maintained, new risk factors explored, diagnostics improved, and regional variances addressed.
Funding
The Graduate School of Khon Kaen University.
{"title":"Updated cholangiocarcinoma incidence trends and projections in Thailand by region based on data from four population-based cancer registries","authors":"Oraya Sahat , Surichai Bilheem , Apiradee Lim , Siriporn Kamsa-ard , Apiporn Thinkhamrop Suwannatrai , Surin Uadrang , Atit Leklob , Wasan Chansaard , Nithima Sriket , Chalongpon Santong , Karnchana Daoprasert , Supot Kamsa-ard","doi":"10.1016/j.lansea.2025.100569","DOIUrl":"10.1016/j.lansea.2025.100569","url":null,"abstract":"<div><h3>Background</h3><div>Cholangiocarcinoma (CCA) is a significant health concern in Thailand, as the age-standardized rates (ASR) and other trends fluctuate across different regions. However, comprehensive national estimates are lacking. This study examined the Thai ASR of CCA trends from 2012 to 2021 and projected the incidence rates to 2026.</div></div><div><h3>Methods</h3><div>This retrospective cohort analysis examined 6379 CCA cases from population-based cancer registries (PBCRs) in the northern, central, northeastern, and southern regions for the time period January 1, 2012, to December 31, 2021. The Joinpoint, age-period-cohort, and Nordpred models were used to assess CCA incidence trends and predictions.</div></div><div><h3>Findings</h3><div>CCA incidence trends in Thailand showed a decrease, with an average annual percentage change (AAPC) of −7.20% (95% CI: −11.04 to −3.19) for males, and −5.81% (95% CI: −10.81 to −0.54) for females. The projected incidence rate per 100,000 person-years for 2026 varied slightly according to the model: Joinpoint (males: 6.1, females: 3.4), age-period-cohort (males: 6.0, females: 3.3), and Nordpred (males: 5.5, females: 3.4). Regional analyses revealed decreasing trends in the northern and northeastern regions, with 2026 projections indicating further declines exceeding the 10-year trends. Owing to the small sample size, trends in the central and southern regions could not be determined.</div></div><div><h3>Interpretation</h3><div>Thailand's CCA rate has generally decreased but varies geographically; the northern and northeastern regions remain at high risk. To minimize CCA nationally, initiatives should be maintained, new risk factors explored, diagnostics improved, and regional variances addressed.</div></div><div><h3>Funding</h3><div>The <span>Graduate School of Khon Kaen University</span>.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"35 ","pages":"Article 100569"},"PeriodicalIF":5.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725222","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}
Pub Date : 2025-03-29DOI: 10.1016/j.lansea.2025.100562
Sira Jam Munira , Shiva R. Naga , Irum Fatima Dehraj , Kate Doyle , Naito Kanon , Mohammad Tahir Yousafzai , Dipesh Tamrakar , Afshan Piyar Ali , Annaya Barman Jui , Alice S. Carter , Dipu Chandra Das , Surrendar Dawani , Khalid Iqbal , Seema Irfan , Mohammad Shahidul Islam , Muhammad Ashraf Memon , Tuba Khan , Shamsun Nahar , Md. Hafizur Rahman , Nasir Saleem Saddal , Senjuti Saha
Background
The Surveillance for Enteric Fever in Asia Project (SEAP) conducted blood culture surveillance for Salmonella enterica serotype Typhi (S. Typhi) and Paratyphi (S. Paratyphi) to provide an evidence base for prevention and control measures in Bangladesh, Nepal, and Pakistan.
Methods
From October 2020 to September 2022, we conducted prospective clinical surveillance and retrospective laboratory surveillance at health facilities in Dhaka, Bangladesh; Kathmandu and Kavrepalanchok, Nepal; and Karachi, Pakistan. Patients were eligible if they were outpatients with three or more days of fever in the last week. In Nepal and Pakistan, inpatients were eligible if they had suspected or confirmed enteric fever; in Bangladesh, only inpatients with confirmed enteric fever were enrolled. Patients with blood culture–confirmed enteric fever identified by hospital laboratories and laboratory network sites were also enrolled. Patients completed interviews and medical records were reviewed and abstracted. All enrolled patients had blood cultures performed. Antibiograms were performed to characterize drug sensitivity. We summarized the data descriptively.
Findings
A total of 17,593 patients were enrolled from 19 facilities. Of these, 8410 patients had culture-confirmed enteric fever. Case counts in all countries decreased in the early stages of the COVID-19 pandemic, but increased over time in Bangladesh and Pakistan. Case counts remained low throughout the study period in Nepal. In all countries, typhoid was more common than paratyphoid; the proportion of paratyphoid cases ranged from 8.4% in Pakistan to 16% in Nepal. Extensively drug-resistant typhoid was common in Pakistan (69%), but was not detected in Bangladesh or Nepal.
Interpretation
Cases of enteric fever decreased during the COVID-19 pandemic, though it is not clear how much of this decrease relates to true changes in transmission versus health-seeking behavior.
Funding
This project was funded by the Gates Foundation through INV-008335.
{"title":"Changes in enteric fever trends during the COVID-19 pandemic from the Surveillance for Enteric Fever in Asia Project: a cross-sectional study","authors":"Sira Jam Munira , Shiva R. Naga , Irum Fatima Dehraj , Kate Doyle , Naito Kanon , Mohammad Tahir Yousafzai , Dipesh Tamrakar , Afshan Piyar Ali , Annaya Barman Jui , Alice S. Carter , Dipu Chandra Das , Surrendar Dawani , Khalid Iqbal , Seema Irfan , Mohammad Shahidul Islam , Muhammad Ashraf Memon , Tuba Khan , Shamsun Nahar , Md. Hafizur Rahman , Nasir Saleem Saddal , Senjuti Saha","doi":"10.1016/j.lansea.2025.100562","DOIUrl":"10.1016/j.lansea.2025.100562","url":null,"abstract":"<div><h3>Background</h3><div>The Surveillance for Enteric Fever in Asia Project (SEAP) conducted blood culture surveillance for <em>Salmonella enterica</em> serotype Typhi (<em>S</em>. Typhi) and Paratyphi (<em>S</em>. Paratyphi) to provide an evidence base for prevention and control measures in Bangladesh, Nepal, and Pakistan.</div></div><div><h3>Methods</h3><div>From October 2020 to September 2022, we conducted prospective clinical surveillance and retrospective laboratory surveillance at health facilities in Dhaka, Bangladesh; Kathmandu and Kavrepalanchok, Nepal; and Karachi, Pakistan. Patients were eligible if they were outpatients with three or more days of fever in the last week. In Nepal and Pakistan, inpatients were eligible if they had suspected or confirmed enteric fever; in Bangladesh, only inpatients with confirmed enteric fever were enrolled. Patients with blood culture–confirmed enteric fever identified by hospital laboratories and laboratory network sites were also enrolled. Patients completed interviews and medical records were reviewed and abstracted. All enrolled patients had blood cultures performed. Antibiograms were performed to characterize drug sensitivity. We summarized the data descriptively.</div></div><div><h3>Findings</h3><div>A total of 17,593 patients were enrolled from 19 facilities. Of these, 8410 patients had culture-confirmed enteric fever. Case counts in all countries decreased in the early stages of the COVID-19 pandemic, but increased over time in Bangladesh and Pakistan. Case counts remained low throughout the study period in Nepal. In all countries, typhoid was more common than paratyphoid; the proportion of paratyphoid cases ranged from 8.4% in Pakistan to 16% in Nepal. Extensively drug-resistant typhoid was common in Pakistan (69%), but was not detected in Bangladesh or Nepal.</div></div><div><h3>Interpretation</h3><div>Cases of enteric fever decreased during the COVID-19 pandemic, though it is not clear how much of this decrease relates to true changes in transmission versus health-seeking behavior.</div></div><div><h3>Funding</h3><div>This project was funded by the <span>Gates Foundation</span> through INV-008335.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"35 ","pages":"Article 100562"},"PeriodicalIF":5.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725223","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}
Pub Date : 2025-03-28DOI: 10.1016/j.lansea.2025.100564
Sheikh Jamal Hossain , Tom Palmer , S.M. Mulk Uddin Tipu , Syeda Fardina Mehrin , Shamima Shiraji , Mohammed Imrul Hasan , Mohammad Saiful Alam Bhuiyan , Nur-E Salveen , Fahmida Tofail , Helen Baker-Henningham , Hassan Haghparast-Bidgoli , Jena D. Hamadani
Background
This study presents results of a cost and cost-effectiveness analysis of two parenting interventions (group-based and pairs) integrated into primary health care centers in rural Bangladesh.
Methods
A within-trial cost-effectiveness analysis was conducted for two trials of parenting interventions aiming to support child development through play and interactions. Eligible participants for both trials were underweight children aged 5–24 months. Participants in the control arms in both trials received standard health services. Intervention costs were estimated rom the provider perspective over the time horizon of each study (21 months for the group-based intervention; 24 months for the pair-based intervention). Incremental cost effectiveness ratios were estimated for all primary child development outcomes and presented in terms of cost per standard deviation improvements in the outcomes. A series of cost scenario analyses were conducted to assess the effect of changing cost assumptions on the cost and cost-effectiveness results. All results are presented in 2022 USD. The studies were registered with ClinicalTrials.gov (NCT02208531).
Findings
Total provider costs in the within-trial analysis were US$ 67,668 for the group-based intervention and US$ 117,028 for the pair intervention. Estimated cost per child covered by the interventions was US$ 156 for the group intervention and US$ 136 for the pair intervention, reflecting likely economies of scale in delivery of the pair intervention. An additional US$ 100 expenditure on the group intervention is estimated to lead to a 0.55 SD improvement in cognition, 0.44 SD in language development and 0.33 SD in motor development. For the pair intervention, the corresponding estimates are improvements of 0.95 SD, 0.81 SD, and 0.88 SD, respectively. Under potential scale up scenarios, the economic cost per child could reduce substantially to US$ 61 and US$ 77 for group and pair interventions, respectively.
Interpretation
The findings indicates that cost-efficiency and cost-effectiveness results for both interventions are comparable with the results from limited similar interventions in LMICs. However, implementation costs of the interventions will be substantially lower at scale due to lower monitoring costs, economies of scale, and full integration into the public health system.
Funding
This work was supported by Grand Challenges Canada. ICDDR,B and core unrestricted support form the Government of Bangladesh and the Government of Canada.
{"title":"Cost-effectiveness analysis of two integrated early childhood development programs into Bangladeshi primary health-care services","authors":"Sheikh Jamal Hossain , Tom Palmer , S.M. Mulk Uddin Tipu , Syeda Fardina Mehrin , Shamima Shiraji , Mohammed Imrul Hasan , Mohammad Saiful Alam Bhuiyan , Nur-E Salveen , Fahmida Tofail , Helen Baker-Henningham , Hassan Haghparast-Bidgoli , Jena D. Hamadani","doi":"10.1016/j.lansea.2025.100564","DOIUrl":"10.1016/j.lansea.2025.100564","url":null,"abstract":"<div><h3>Background</h3><div>This study presents results of a cost and cost-effectiveness analysis of two parenting interventions (group-based and pairs) integrated into primary health care centers in rural Bangladesh.</div></div><div><h3>Methods</h3><div>A within-trial cost-effectiveness analysis was conducted for two trials of parenting interventions aiming to support child development through play and interactions. Eligible participants for both trials were underweight children aged 5–24 months. Participants in the control arms in both trials received standard health services. Intervention costs were estimated rom the provider perspective over the time horizon of each study (21 months for the group-based intervention; 24 months for the pair-based intervention). Incremental cost effectiveness ratios were estimated for all primary child development outcomes and presented in terms of cost per standard deviation improvements in the outcomes. A series of cost scenario analyses were conducted to assess the effect of changing cost assumptions on the cost and cost-effectiveness results. All results are presented in 2022 USD. The studies were registered with <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> (<span><span>NCT02208531</span><svg><path></path></svg></span>).</div></div><div><h3>Findings</h3><div>Total provider costs in the within-trial analysis were US$ 67,668 for the group-based intervention and US$ 117,028 for the pair intervention. Estimated cost per child covered by the interventions was US$ 156 for the group intervention and US$ 136 for the pair intervention, reflecting likely economies of scale in delivery of the pair intervention. An additional US$ 100 expenditure on the group intervention is estimated to lead to a 0.55 SD improvement in cognition, 0.44 SD in language development and 0.33 SD in motor development. For the pair intervention, the corresponding estimates are improvements of 0.95 SD, 0.81 SD, and 0.88 SD, respectively. Under potential scale up scenarios, the economic cost per child could reduce substantially to US$ 61 and US$ 77 for group and pair interventions, respectively.</div></div><div><h3>Interpretation</h3><div>The findings indicates that cost-efficiency and cost-effectiveness results for both interventions are comparable with the results from limited similar interventions in LMICs. However, implementation costs of the interventions will be substantially lower at scale due to lower monitoring costs, economies of scale, and full integration into the public health system.</div></div><div><h3>Funding</h3><div>This work was supported by <span>Grand Challenges Canada</span>. <span>ICDDR,B</span> and core unrestricted support form the <span>Government of Bangladesh</span> and the <span>Government of Canada</span>.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"35 ","pages":"Article 100564"},"PeriodicalIF":5.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715001","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}
Pub Date : 2025-03-27DOI: 10.1016/j.lansea.2025.100568
Mariyam Sibghatullah, Komal Dayani, Mekaiel Zia, Taha Sabri
This Viewpoint provides a comprehensive review of the historical context, legal frameworks, and societal implications associated with the criminalisation of suicide in Pakistan, along with the process that was utilised for the decriminalisation of suicide. The context focuses on the importance of decriminalising suicide, presenting evidence and insights into how the criminalisation of suicide has impacted individuals, families, and the healthcare system. The process of decriminalising suicide in Pakistan focuses on the public awareness strategies, emphasising the key role that the stories of people with lived experience of mental illness played in shifting the societal attitudes and misconceptions related to suicide. Through discussions of the challenges faced in the process of repealing Section 325 of the Pakistan Penal Code (PPC), we emphasise the need for continued public awareness efforts to address the religious misconceptions related to suicide. With the implementation of the law still pending, we argue that decriminalising suicide aligns with the development of a National Suicide Prevention Strategy. The Viewpoint also presents recommendations for government representatives, public health professionals, policymakers, and other stakeholders to utilise our learnings to develop a robust suicide prevention strategy with a multisectoral approach, strengthening the medical system to respond to mental health emergencies.
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