Pub Date : 2025-07-01DOI: 10.1016/j.lansea.2025.100567
Syed Billal Hossain , Mohammad Kamruzzaman Khan , Mahfuza Mubarak
{"title":"Cancer-specific cut-offs of treatment initiation delay and assessment of their associated variables: a research concern","authors":"Syed Billal Hossain , Mohammad Kamruzzaman Khan , Mahfuza Mubarak","doi":"10.1016/j.lansea.2025.100567","DOIUrl":"10.1016/j.lansea.2025.100567","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"38 ","pages":"Article 100567"},"PeriodicalIF":5.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144588820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-28DOI: 10.1016/j.lansea.2025.100624
Sumedha Mitra , Manogna Sagiraju , Hitesh Pradhan , David Yao , Jayant M. Pinto , Jonas S. Sundarakumar , CBR-SANSCOG Study Team
Background
Household air pollution (HAP) from polluting cooking fuels, a rampant issue in rural India, is suspected to be a significant modifiable risk factor for cognitive impairment; however, evidence supported by neuroimaging in this population, is lacking.
Methods
Baseline cross-sectional data (n = 4145) of participants aged ≥45 years from the ongoing Centre for Brain Research-Srinivaspura Aging, Neuro Senescence, and COGnition (CBR-SANSCOG) study in a rural South Indian aging population, was utilised. HAP exposure was proxied via polluting cooking fuel or technology use (only clean vs. at least one polluting vs. only polluting cooking technology use). Global and domain-specific cognitive functioning was assessed using computerised culturally adapted test batteries. A subset (n = 994) underwent brain MRI (3T) to estimate regional brain volumes and white matter hyperintensities (WMHs) burden. Fully adjusted linear regression models were used to test the associations between HAP exposure, cognition, and brain MRI parameters.
Findings
Only polluting cooking technology users had significantly lower scores in global cognition (βstd. = −0.28 [−0.44, −0.11], padj [FDR corrected p-value] = 0.002), visuospatial ability (βstd. = −0.28 [−0.48, −0.08], padj. = 0.013), and executive functions (βstd. = −0.25 [−0.44, −0.07], padj. = 0.019), whereas at least one polluting cooking technology users had lower scores in global cognition only (βstd. = −0.10 [−0.15, −0.04], padj. <0.001), compared to the clean cooking technology users. Upon sex-stratification, only female polluting cooking technology users had lower global cognitive scores (βstd. = −0.11 [−0.20, −0.03], padj. = 0.018) and lower hippocampus volumes (βstd. = −0.18 [−0.35, −0.01], p = 0.030).
Interpretation
Polluting cooking technology users may be at a higher risk for cognitive impairment. Rural females, who tend to be more exposed than males, could have greater vulnerability to HAP's adverse effects on the brain. Policies promoting clean cooking fuel/technology adoption are imperative.
Funding
CBR-SANSCOG study is funded by the Centre for Brain Research, India.
{"title":"The cognitive toll of household air pollution: cross–sectional associations between polluting cooking fuel use, cognitive functions and brain MRI in a rural aging population from Karnataka, India","authors":"Sumedha Mitra , Manogna Sagiraju , Hitesh Pradhan , David Yao , Jayant M. Pinto , Jonas S. Sundarakumar , CBR-SANSCOG Study Team","doi":"10.1016/j.lansea.2025.100624","DOIUrl":"10.1016/j.lansea.2025.100624","url":null,"abstract":"<div><h3>Background</h3><div>Household air pollution (HAP) from polluting cooking fuels, a rampant issue in rural India, is suspected to be a significant modifiable risk factor for cognitive impairment; however, evidence supported by neuroimaging in this population, is lacking.</div></div><div><h3>Methods</h3><div>Baseline cross-sectional data (n = 4145) of participants aged ≥45 years from the ongoing Centre for Brain Research-Srinivaspura Aging, Neuro Senescence, and COGnition (CBR-SANSCOG) study in a rural South Indian aging population, was utilised. HAP exposure was proxied via polluting cooking fuel or technology use (only clean vs. at least one polluting vs. only polluting cooking technology use). Global and domain-specific cognitive functioning was assessed using computerised culturally adapted test batteries. A subset (n = 994) underwent brain MRI (3T) to estimate regional brain volumes and white matter hyperintensities (WMHs) burden. Fully adjusted linear regression models were used to test the associations between HAP exposure, cognition, and brain MRI parameters.</div></div><div><h3>Findings</h3><div>Only polluting cooking technology users had significantly lower scores in global cognition (β<sub>std.</sub> = −0.28 [−0.44, −0.11], p<sub>adj</sub> [FDR corrected p-value] = 0.002), visuospatial ability (β<sub>std.</sub> = −0.28 [−0.48, −0.08], p<sub>adj.</sub> = 0.013), and executive functions (β<sub>std.</sub> = −0.25 [−0.44, −0.07], p<sub>adj.</sub> = 0.019), whereas at least one polluting cooking technology users had lower scores in global cognition only (β<sub>std.</sub> = −0.10 [−0.15, −0.04], p<sub>adj.</sub> <0.001), compared to the clean cooking technology users. Upon sex-stratification, only female polluting cooking technology users had lower global cognitive scores (β<sub>std.</sub> = −0.11 [−0.20, −0.03], p<sub>adj.</sub> = 0.018) and lower hippocampus volumes (β<sub>std.</sub> = −0.18 [−0.35, −0.01], p = 0.030).</div></div><div><h3>Interpretation</h3><div>Polluting cooking technology users may be at a higher risk for cognitive impairment. Rural females, who tend to be more exposed than males, could have greater vulnerability to HAP's adverse effects on the brain. Policies promoting clean cooking fuel/technology adoption are imperative.</div></div><div><h3>Funding</h3><div>CBR-SANSCOG study is funded by the <span>Centre for Brain Research</span>, India.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"39 ","pages":"Article 100624"},"PeriodicalIF":5.0,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-26DOI: 10.1016/j.lansea.2025.100626
Tina Damodar , Maria Jose , Uddhava V. Kinhal , Bhagteshwar Singh , Surbhi Telang , Akhila Lekha , Srilatha Marate , Namratha Prabhu , Chitra Pattabiraman , Prathyusha Parthipulli Vasuki , A.V. Lalitha , Fulton Sebastian Dsouza , Sushma Veeranna Sajjan , Gangasamudra Veerappa Basavaraja , Mallesh Kariyappa , Benedict Daniel Michael , Reeta S. Mani , Tom Solomon , Vykuntaraju K. Gowda , Vasanthapuram Ravi , Ruwanthi Kolamunnage-Dona
Background
Scrub typhus and other doxycycline-treatable infections are significant contributors of acute encephalitis syndrome (AES) in India. Limited surveillance in South India has hindered their recognition and the inclusion of doxycycline in treatment protocols. We aimed to systematically investigate infectious aetiologies of AES in children from Karnataka, India, and develop clinical prediction models for diagnosing scrub typhus and guiding clinical decisions for doxycycline therapy.
Methods
This multicentre, prospective study enrolled children aged >28 days to 18 years with AES presenting to three tertiary care hospitals in Bengaluru, India. Primary outcomes were microbiological diagnosis of AES and clinical prediction models for diagnosing scrub typhus and identifying patients with doxycycline-treatable causes. Models were developed using multivariable logistic regression, internally validated, and simplified into point-scoring systems. Model performance was evaluated using c-statistics, calibration slopes, and calibration-in-the-large, adhering to TRIPOD guidelines.
Findings
Between February 2020 and February 2023, 714 children were screened, of whom 587 were included. Of these, 315 (54%) had a microbiological diagnosis. Scrub typhus accounted for 138/315 (44%), and doxycycline-treatable causes were diagnosed in 193/315 (61%) of these cases. Key predictors associated with both scrub typhus and doxycycline-treatable causes were age, illness duration, lymphadenopathy, oedema, hepatomegaly, lymphocyte count, platelet count, and serum albumin levels. Adjusted c-statistics were 0.83 (95% CI: 0.78–0.87) for the scrub typhus model and 0.75 (95% CI: 0.7–0.81) for the doxycycline model, with calibration slopes of 0.85 (0.82–0.88) and 0.83 (0.78–0.87), respectively. CITL values were −0.03 (−0.06–0) and 0.05 (0.02–0.09). Points-based scores predicted probabilities ranging from 5% to 99.8% (scrub typhus model) and 20%–99% (doxycycline-treatable model).
Interpretation
Scrub typhus was the most common microbiological diagnosis, and most patients had a doxycycline-treatable cause, underscoring the need to prioritise doxycycline in empirical treatment protocols in South India. The models demonstrated strong performance; however external validation is necessary for broader applicability.
Funding
DBT/Wellcome Trust India Alliance FellowshipIA/CPHE/18/1/503960.
{"title":"Development and internal validation of clinical prediction models for scrub typhus and doxycycline-treatable causes in paediatric acute encephalitis syndrome in Karnataka, India: a multicentre, prospective study","authors":"Tina Damodar , Maria Jose , Uddhava V. Kinhal , Bhagteshwar Singh , Surbhi Telang , Akhila Lekha , Srilatha Marate , Namratha Prabhu , Chitra Pattabiraman , Prathyusha Parthipulli Vasuki , A.V. Lalitha , Fulton Sebastian Dsouza , Sushma Veeranna Sajjan , Gangasamudra Veerappa Basavaraja , Mallesh Kariyappa , Benedict Daniel Michael , Reeta S. Mani , Tom Solomon , Vykuntaraju K. Gowda , Vasanthapuram Ravi , Ruwanthi Kolamunnage-Dona","doi":"10.1016/j.lansea.2025.100626","DOIUrl":"10.1016/j.lansea.2025.100626","url":null,"abstract":"<div><h3>Background</h3><div>Scrub typhus and other doxycycline-treatable infections are significant contributors of acute encephalitis syndrome (AES) in India. Limited surveillance in South India has hindered their recognition and the inclusion of doxycycline in treatment protocols. We aimed to systematically investigate infectious aetiologies of AES in children from Karnataka, India, and develop clinical prediction models for diagnosing scrub typhus and guiding clinical decisions for doxycycline therapy.</div></div><div><h3>Methods</h3><div>This multicentre, prospective study enrolled children aged >28 days to 18 years with AES presenting to three tertiary care hospitals in Bengaluru, India. Primary outcomes were microbiological diagnosis of AES and clinical prediction models for diagnosing scrub typhus and identifying patients with doxycycline-treatable causes. Models were developed using multivariable logistic regression, internally validated, and simplified into point-scoring systems. Model performance was evaluated using c-statistics, calibration slopes, and calibration-in-the-large, adhering to TRIPOD guidelines.</div></div><div><h3>Findings</h3><div>Between February 2020 and February 2023, 714 children were screened, of whom 587 were included. Of these, 315 (54%) had a microbiological diagnosis. Scrub typhus accounted for 138/315 (44%), and doxycycline-treatable causes were diagnosed in 193/315 (61%) of these cases. Key predictors associated with both scrub typhus and doxycycline-treatable causes were age, illness duration, lymphadenopathy, oedema, hepatomegaly, lymphocyte count, platelet count, and serum albumin levels. Adjusted c-statistics were 0.83 (95% CI: 0.78–0.87) for the scrub typhus model and 0.75 (95% CI: 0.7–0.81) for the doxycycline model, with calibration slopes of 0.85 (0.82–0.88) and 0.83 (0.78–0.87), respectively. CITL values were −0.03 (−0.06–0) and 0.05 (0.02–0.09). Points-based scores predicted probabilities ranging from 5% to 99.8% (scrub typhus model) and 20%–99% (doxycycline-treatable model).</div></div><div><h3>Interpretation</h3><div>Scrub typhus was the most common microbiological diagnosis, and most patients had a doxycycline-treatable cause, underscoring the need to prioritise doxycycline in empirical treatment protocols in South India. The models demonstrated strong performance; however external validation is necessary for broader applicability.</div></div><div><h3>Funding</h3><div><span>DBT</span>/<span>Wellcome Trust India Alliance Fellowship</span> <span><span>IA/CPHE/18/1/503960</span></span>.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"39 ","pages":"Article 100626"},"PeriodicalIF":5.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144480651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Infectious disease modelling (IDM) is a useful tool supporting evidence to inform policies on disease outbreaks. Understanding situation, existing capacities and needs will enable countries to prepare and use the evidence derived from IDM for future outbreaks. This report maps Thailan's IDM landscape, identifies key stakeholders, and provides recommendations to develop a supportive ecosystem. We found that there is a moderate capacity to conduct and use IDM in Thailand. Users of IDM are spread across ministries and government level, while IDM evidence suppliers operate in departments in a few universities. Key challenges concern availability and quality of data, human resource capacity, integration of initiatives and communication mechanisms between evidence users and providers, and sustainable funding for IDM activities. Investing in human and data infrastructure, including IDM ecosystem development, could enhance Thailand's capacity to synthesise and use evidence for future outbreak preparedness, while also contributing to regional efforts in health security and outbreak response.
Funding
This study was supported by a grant from the Rockefeller Foundation [2022 ARO 004] and the National Science, Research and Innovation Fund, Thailand Science Research and Innovation (TSRI).
传染病模型（IDM）是一种有用的工具，支持证据，为疾病暴发政策提供信息。了解情况、现有能力和需求将使各国能够准备和利用IDM得出的证据应对未来的疫情。本报告描绘了泰国的IDM格局，确定了主要利益攸关方，并提供了发展支持性生态系统的建议。我们发现，泰国开展和使用IDM的能力中等。IDM的使用者遍布各部委和政府一级，而IDM证据提供者则在少数大学的院系中运作。主要挑战涉及数据的可得性和质量、人力资源能力、倡议的整合以及证据使用者和提供者之间的沟通机制，以及IDM活动的可持续供资。投资于人力和数据基础设施，包括IDM生态系统发展，可以增强泰国综合和利用证据以应对未来疫情的能力，同时也有助于卫生安全和疫情应对方面的区域努力。本研究得到了洛克菲勒基金会[2022 ARO 004]和泰国国家科学、研究和创新基金（TSRI）的资助。
{"title":"Past, present, and future: a situational analysis of infectious disease modelling in Thailand","authors":"Manit Sittimart, Chayapat Rachatan, Panchanok Muenkaew, Saudamini Vishwanath Dabak","doi":"10.1016/j.lansea.2025.100618","DOIUrl":"10.1016/j.lansea.2025.100618","url":null,"abstract":"<div><div>Infectious disease modelling (IDM) is a useful tool supporting evidence to inform policies on disease outbreaks. Understanding situation, existing capacities and needs will enable countries to prepare and use the evidence derived from IDM for future outbreaks. This report maps Thailan's IDM landscape, identifies key stakeholders, and provides recommendations to develop a supportive ecosystem. We found that there is a moderate capacity to conduct and use IDM in Thailand. Users of IDM are spread across ministries and government level, while IDM evidence suppliers operate in departments in a few universities. Key challenges concern availability and quality of data, human resource capacity, integration of initiatives and communication mechanisms between evidence users and providers, and sustainable funding for IDM activities. Investing in human and data infrastructure, including IDM ecosystem development, could enhance Thailand's capacity to synthesise and use evidence for future outbreak preparedness, while also contributing to regional efforts in health security and outbreak response.</div></div><div><h3>Funding</h3><div>This study was supported by a grant from the <span>Rockefeller Foundation</span> [2022 ARO 004] and the <span>National Science, Research and Innovation Fund</span>, <span>Thailand Science Research and Innovation</span> (TSRI).</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"39 ","pages":"Article 100618"},"PeriodicalIF":5.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144490216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Background</h3><div>Throughout the COVID-19 pandemic, wastewater surveillance emerged as an important tool as an important tool by providing data that are more representative of the population than case reporting, which is often biased towards individuals with health-seeking behaviour or access to healthcare. With changing phases of the pandemic, decreased testing, and varying viral shedding rates, it is crucial to have a robust, sustainable, and flexible wastewater surveillance system that can serve as an independent signal of disease outbreaks. We aimed to identify ‘bellwether’ sewershed sites for sustainable disease surveillance in Bengaluru, India.</div></div><div><h3>Methods</h3><div>We conducted this longitudinal study from December 2021 to January 2024 at 26 centralised sewershed sites in Bengaluru city (∼11 million inhabitants). We quantified weekly SARS-CoV-2 RNA concentrations to track infection dynamics and identify ‘bellwether’ sewershed sites. This was achieved by integrating established metrics for wastewater analysis, calculating sample-to-sample percentage rate of change, and applying algorithms to differentiate signal from noise, thereby validating factors contributing to the precision and reliability of outbreak predictions.</div></div><div><h3>Findings</h3><div>Using 2873 wastewater samples, we applied a modified algorithm (COVID-SURGE algorithm) to identify ‘bellwether’ sewershed sites using longitudinal wastewater data on SARS-CoV-2 from 26 sewershed sites in Bengaluru. We utilised an Excel-based calculator (COVID-SURGE calculator) for user-entered wastewater data that differentiates signal from noise (underlying variability) based on the algorithm, with adjustments made to the input format of viral data and a specified limit of detection (LOD) value from the reverse transcriptase-quantitative PCR kit. We identified 11 ‘bellwether’ sites: four with large catchment sizes (KC Valley 1, KC Valley 2, Rajacanal, Doddabelee); four with medium sizes (Agaram, Nagasandra, KR Puram, Yelahanka); and three with small sizes (Chikkabegur, Chikkabanavara, Lalbagh). These were the best performers and can serve as a useful subset of sewage treatment plants for an early warning system at the city level.</div></div><div><h3>Interpretation</h3><div>Using wastewater metrics helps in selecting permanent sewershed sites and identifying sub-sites that can be scaled up during peak outbreak periods to detect disease hotspots, or scaled down during lean periods, especially when clinical data are unavailable. In a post-pandemic world, particularly in low-resource settings, focusing on the best-performing sewershed sites will ensure high-quality data that captures valid signals amid the noise from wastewater, conserves resources, and optimises public health actions beyond SARS-CoV-2.</div></div><div><h3>Funding</h3><div>This work has been supported by funding from the <span>Rockefeller Foundation</span> (grant <span><span>2021 HTH018</span></spa
{"title":"Identifying bellwether sewershed sites for sustainable disease surveillance in Bengaluru, India: a longitudinal study","authors":"Rebecca Fern Daniel , Subash K. Kannan , Namrta Daroch , Sutharsan Ganesan , Farhina Mozaffer , Vishwanath Srikantaiah , Lingadahalli Subrahmanya Shashidhara , Rakesh Mishra , Farah Ishtiaq","doi":"10.1016/j.lansea.2025.100619","DOIUrl":"10.1016/j.lansea.2025.100619","url":null,"abstract":"<div><h3>Background</h3><div>Throughout the COVID-19 pandemic, wastewater surveillance emerged as an important tool as an important tool by providing data that are more representative of the population than case reporting, which is often biased towards individuals with health-seeking behaviour or access to healthcare. With changing phases of the pandemic, decreased testing, and varying viral shedding rates, it is crucial to have a robust, sustainable, and flexible wastewater surveillance system that can serve as an independent signal of disease outbreaks. We aimed to identify ‘bellwether’ sewershed sites for sustainable disease surveillance in Bengaluru, India.</div></div><div><h3>Methods</h3><div>We conducted this longitudinal study from December 2021 to January 2024 at 26 centralised sewershed sites in Bengaluru city (∼11 million inhabitants). We quantified weekly SARS-CoV-2 RNA concentrations to track infection dynamics and identify ‘bellwether’ sewershed sites. This was achieved by integrating established metrics for wastewater analysis, calculating sample-to-sample percentage rate of change, and applying algorithms to differentiate signal from noise, thereby validating factors contributing to the precision and reliability of outbreak predictions.</div></div><div><h3>Findings</h3><div>Using 2873 wastewater samples, we applied a modified algorithm (COVID-SURGE algorithm) to identify ‘bellwether’ sewershed sites using longitudinal wastewater data on SARS-CoV-2 from 26 sewershed sites in Bengaluru. We utilised an Excel-based calculator (COVID-SURGE calculator) for user-entered wastewater data that differentiates signal from noise (underlying variability) based on the algorithm, with adjustments made to the input format of viral data and a specified limit of detection (LOD) value from the reverse transcriptase-quantitative PCR kit. We identified 11 ‘bellwether’ sites: four with large catchment sizes (KC Valley 1, KC Valley 2, Rajacanal, Doddabelee); four with medium sizes (Agaram, Nagasandra, KR Puram, Yelahanka); and three with small sizes (Chikkabegur, Chikkabanavara, Lalbagh). These were the best performers and can serve as a useful subset of sewage treatment plants for an early warning system at the city level.</div></div><div><h3>Interpretation</h3><div>Using wastewater metrics helps in selecting permanent sewershed sites and identifying sub-sites that can be scaled up during peak outbreak periods to detect disease hotspots, or scaled down during lean periods, especially when clinical data are unavailable. In a post-pandemic world, particularly in low-resource settings, focusing on the best-performing sewershed sites will ensure high-quality data that captures valid signals amid the noise from wastewater, conserves resources, and optimises public health actions beyond SARS-CoV-2.</div></div><div><h3>Funding</h3><div>This work has been supported by funding from the <span>Rockefeller Foundation</span> (grant <span><span>2021 HTH018</span></spa","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"39 ","pages":"Article 100619"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144298580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Our Viewpoint makes the case for the complete decriminalisation of abortion in Nepal (and beyond) as a key strategy to removing barriers to abortion care. The criminal framing of abortion—even if subject to exceptions—creates legal barriers to accessing abortion, which then compound socio-cultural and medical barriers. Nepal represents fertile ground for abortion law reform centred on complete decriminalisation due to its pioneering constitutional approach to sexual and reproductive health rights. However, even in Nepal's liberal context, the enduring partial criminalisation of abortion hinders abortion access, especially for historically marginalised groups and in remote areas. This Viewpoint recommends complete decriminalisation in Nepal and South and Southeast Asian countries facing similar socio-legal barriers to abortion access. Our position as legal experts echoes calls for the complete decriminalisation of abortion by national and international medical professional bodies, which we hope will inform regional strategies to improve access to safe abortions.
{"title":"The case for the complete decriminalisation of abortion care in Nepal and beyond","authors":"Sabrina Germain , Mara Malagodi , Roshani Regmi , Radhika Saxena , Shivani Shinde","doi":"10.1016/j.lansea.2025.100616","DOIUrl":"10.1016/j.lansea.2025.100616","url":null,"abstract":"<div><div>Our Viewpoint makes the case for the complete decriminalisation of abortion in Nepal (and beyond) as a key strategy to removing barriers to abortion care. The criminal framing of abortion—even if subject to exceptions—creates legal barriers to accessing abortion, which then compound socio-cultural and medical barriers. Nepal represents fertile ground for abortion law reform centred on complete decriminalisation due to its pioneering constitutional approach to sexual and reproductive health rights. However, even in Nepal's liberal context, the enduring partial criminalisation of abortion hinders abortion access, especially for historically marginalised groups and in remote areas. This Viewpoint recommends complete decriminalisation in Nepal and South and Southeast Asian countries facing similar socio-legal barriers to abortion access. Our position as legal experts echoes calls for the complete decriminalisation of abortion by national and international medical professional bodies, which we hope will inform regional strategies to improve access to safe abortions.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"38 ","pages":"Article 100616"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144297198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cancer incidence is increasing globally. Although Pakistan does not have a unified national cancer registry, several institutional and regional cancer registries can provide vital information for cancer planning. Following the Joanna Briggs Institute and PRISMA-ScR guidelines, we conducted a comprehensive search across multiple databases and grey literature. Data were extracted regarding registry characteristics, data collection methods, and study details, and findings were summarised narratively to highlight key attributes and data gaps. Of 3714 unique abstracts screened, 102 studies met inclusion criteria, including 92 reporting registry data and 10 describing registry characteristics without patient-level data. Seventeen cancer registries were identified, with varying scope and geographical coverage. Only 19 of Pakistan's 129 cities contribute data to at least one registry. Data collection methods ranged from paper-based forms to advanced software systems. The Karachi Cancer Registry was noted for its high research output. Funding sources were limited, and several registries faced operational challenges. This Review highlights Pakistan's fragmented cancer registry landscape. While important policy-level data can be obtained from existing registries, there is an urgent need for strategic efforts and stakeholder collaboration to establish a national cancer registry system. Such a system could enhance cancer surveillance, inform public health efforts, and serve as a model for similar initiatives in south and southeast Asia.
{"title":"Cancer registries in Pakistan: a scoping review","authors":"Sehar Salim Virani , Kaleem Sohail Ahmed , Megan Springer , Muzamil Hussain , Leslie Christensen , Farah Asif , Shahid Pervez , Zehra Fadoo , Asim Belgaumi , Syed Nabeel Zafar","doi":"10.1016/j.lansea.2025.100615","DOIUrl":"10.1016/j.lansea.2025.100615","url":null,"abstract":"<div><div>Cancer incidence is increasing globally. Although Pakistan does not have a unified national cancer registry, several institutional and regional cancer registries can provide vital information for cancer planning. Following the Joanna Briggs Institute and PRISMA-ScR guidelines, we conducted a comprehensive search across multiple databases and grey literature. Data were extracted regarding registry characteristics, data collection methods, and study details, and findings were summarised narratively to highlight key attributes and data gaps. Of 3714 unique abstracts screened, 102 studies met inclusion criteria, including 92 reporting registry data and 10 describing registry characteristics without patient-level data. Seventeen cancer registries were identified, with varying scope and geographical coverage. Only 19 of Pakistan's 129 cities contribute data to at least one registry. Data collection methods ranged from paper-based forms to advanced software systems. The Karachi Cancer Registry was noted for its high research output. Funding sources were limited, and several registries faced operational challenges. This Review highlights Pakistan's fragmented cancer registry landscape. While important policy-level data can be obtained from existing registries, there is an urgent need for strategic efforts and stakeholder collaboration to establish a national cancer registry system. Such a system could enhance cancer surveillance, inform public health efforts, and serve as a model for similar initiatives in south and southeast Asia.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"38 ","pages":"Article 100615"},"PeriodicalIF":5.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-13DOI: 10.1016/j.lansea.2025.100610
Jose Marco Antonio II , Stephanie Wang , Frederic Ivan L. Ting , Jeremiah R. Vallente , Edward Christopher Dee , Erin Jay G. Feliciano
Hemophilia is a rare, chronic bleeding disorder with high treatment costs that pose significant economic challenges, particularly in many countries of Southeast Asia (SEA), where disease burden is disproportionately high. In this commentary, we explore the drivers of financial toxicity (FT) in hemophilia care across SEA. We identify key contributors including inadequate health insurance coverage, reliance on unstable humanitarian aid, geographic disparities in care access, and cultural factors that place financial and emotional strain on families. Despite some policy efforts—such as universal health coverage and national cancer control plans—systemic gaps in financing, infrastructure, and provider distribution persist. We propose actionable steps using the social ecological model of health to reduce FT at the individual, interpersonal, community, and policy levels, including expanded insurance coverage, decentralized care, telehealth access, financial navigation services, and public education. Addressing the multifactorial nature of FT is essential to improving quality of life and equity in care for patients with hemophilia in SEA.
{"title":"Financial toxicity of hemophilia care in Southeast Asian countries","authors":"Jose Marco Antonio II , Stephanie Wang , Frederic Ivan L. Ting , Jeremiah R. Vallente , Edward Christopher Dee , Erin Jay G. Feliciano","doi":"10.1016/j.lansea.2025.100610","DOIUrl":"10.1016/j.lansea.2025.100610","url":null,"abstract":"<div><div>Hemophilia is a rare, chronic bleeding disorder with high treatment costs that pose significant economic challenges, particularly in many countries of Southeast Asia (SEA), where disease burden is disproportionately high. In this commentary, we explore the drivers of financial toxicity (FT) in hemophilia care across SEA. We identify key contributors including inadequate health insurance coverage, reliance on unstable humanitarian aid, geographic disparities in care access, and cultural factors that place financial and emotional strain on families. Despite some policy efforts—such as universal health coverage and national cancer control plans—systemic gaps in financing, infrastructure, and provider distribution persist. We propose actionable steps using the social ecological model of health to reduce FT at the individual, interpersonal, community, and policy levels, including expanded insurance coverage, decentralized care, telehealth access, financial navigation services, and public education. Addressing the multifactorial nature of FT is essential to improving quality of life and equity in care for patients with hemophilia in SEA.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"38 ","pages":"Article 100610"},"PeriodicalIF":5.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号