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}
Ensuring the uninterrupted availability of the anti-rabies vaccine (ARV) and rabies immunoglobulin (RIG) in health facilities is crucial to achieve the global target of zero dog-mediated human rabies deaths by 2030. This study aimed to estimate the availability of ARV and RIG across health facilities in India.
Methods
We conducted a nationwide health facility-based, cross-sectional study across 60 districts selected by multistage probability sampling from 15 Indian states. In each district, we selected nine health facilities. We interviewed staff involved in the rabies control program in each of the selected health facilities, and abstracted and physically validated information on the availability of ARV and RIG.
Findings
Of the 534 health facilities surveyed, 467 (87.5%) were public sector health facilities. ARV was available in 372 (79.7%, 95% CI: 75.7%–83.2%) public sector health facilities, ranging from 60.0% to 93.2% in different geographic regions. Availability of ARV was lowest in Urban Primary Healthcare Centres (UPHCs) (58.9%, 95% CI: 45.0%–71.9%). RIG was available in 95 (20.3%, 95% CI: 16.8%–24.3%) public sector health facilities, with the highest availability in southern states (27/88, 30.7%). The availability of RIG ranged from 1.8% (95% CI: 16.8%–24.3%) in UPHCs to 69.2% (95% CI: 48.2%–85.7%) in medical college hospitals.
Interpretation
Considerable geographic and facility-level variations exist in the availability of ARV and RIG across India. Bridging the gap in the availability of ARV and RIG should be prioritised to achieve the goal of zero-dog-mediated human rabies deaths by 2030.
{"title":"Availability of anti-rabies vaccine and rabies immunoglobulin in Indian health facilities: a nationwide cross-sectional health facility survey","authors":"Navaneeth S. Krishna , Jeromie Wesley Vivian Thangaraj , Shanmugasundaram Devika , Aruna Sasi , Suganya Egambaram , D Sudha Rani , Siraj Ahmed Khan , Anitha Delli , Ashok Kumar Srivastava , Ayush Mishra , Basavaraj Shrinivasa , Chandhini Pandiyan , Devendra Gour , Debjani Ram Purakayastha , Nirmal Verma , Parul Sharma , Ravinder Kumar Soni , Sabarinatha Ramasamy , Sreelakshmi Mohandas K , Subrata Baidya , Manoj V. Murhekar","doi":"10.1016/j.lansea.2025.100608","DOIUrl":"10.1016/j.lansea.2025.100608","url":null,"abstract":"<div><h3>Background</h3><div>Ensuring the uninterrupted availability of the anti-rabies vaccine (ARV) and rabies immunoglobulin (RIG) in health facilities is crucial to achieve the global target of zero dog-mediated human rabies deaths by 2030. This study aimed to estimate the availability of ARV and RIG across health facilities in India.</div></div><div><h3>Methods</h3><div>We conducted a nationwide health facility-based, cross-sectional study across 60 districts selected by multistage probability sampling from 15 Indian states. In each district, we selected nine health facilities. We interviewed staff involved in the rabies control program in each of the selected health facilities, and abstracted and physically validated information on the availability of ARV and RIG.</div></div><div><h3>Findings</h3><div>Of the 534 health facilities surveyed, 467 (87.5%) were public sector health facilities. ARV was available in 372 (79.7%, 95% CI: 75.7%–83.2%) public sector health facilities, ranging from 60.0% to 93.2% in different geographic regions. Availability of ARV was lowest in Urban Primary Healthcare Centres (UPHCs) (58.9%, 95% CI: 45.0%–71.9%). RIG was available in 95 (20.3%, 95% CI: 16.8%–24.3%) public sector health facilities, with the highest availability in southern states (27/88, 30.7%). The availability of RIG ranged from 1.8% (95% CI: 16.8%–24.3%) in UPHCs to 69.2% (95% CI: 48.2%–85.7%) in medical college hospitals.</div></div><div><h3>Interpretation</h3><div>Considerable geographic and facility-level variations exist in the availability of ARV and RIG across India. Bridging the gap in the availability of ARV and RIG should be prioritised to achieve the goal of zero-dog-mediated human rabies deaths by 2030.</div></div><div><h3>Funding</h3><div><span>Indian Council of Medical Research</span>.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"38 ","pages":"Article 100608"},"PeriodicalIF":5.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279522","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 : 2025-06-10DOI: 10.1016/j.lansea.2025.100617
Tawanchai Jirapramukpitak , Suttha Supanya
Background
While specialist-led early intervention services (EIS) have been shown to be effective for early-phase psychosis, the effectiveness of a non-specialist-led EIS is still unclear. The study aims to determine the effectiveness of a low-intensity case management (LICM) programme led by lay health workers for patients during early episodes of psychosis on six-month outcomes compared to usual care (UC) in Bangkok, Thailand.
Methods
This pragmatic randomised controlled trial (Lay-CARE) included patients aged ≥18 years with a history of a first or second episode of psychotic disorder residing in the Bangkok Metropolitan Region (Thammasat University hospital's catchment district). Participants were randomised to either LICM or UC group. LICM intervention consisted of family psychoeducation, facilitation of access to services, and home or telephone visits, whereas UC was the baseline of care participants were receiving. The intervention started in October 2020 and ended in May 2021. The 6-month endline assessment started in April 2021 and ended in May 2021. The primary outcome was social functioning measured by the Personal and Social Performance Scale Thai version. Secondary outcomes were symptom severity, service use and medication adherence. The treatment effect size was determined using the average treatment effect (ATE). Due to the nature of the intervention, blinding of participants and assessors was not possible. The trial was registered with the Thai Clinical Trial Registry (TCTR20210509001).
Findings
130 participants were randomised to LICM group and 125 to UC group. At the six-month endline, participants in LICM group demonstrated improved socially useful activities (ATE 0.06, 95% CI 0.00–0.13, p = 0.041), less aggressive or disturbing behaviour (ATE −0.17, 95% CI −0.27 to −0.06, p = 0.002), and better self-care (ATE 0.13 95% CI 0.05–0.22, p = 0.003) than participants in UC group. LICM intervention did not affect personal and social relationships, symptom severity, medication adherence, or service use.
Interpretation
In low-resource settings, LICM programme can improve areas of social functioning among patients with early episodes of psychosis over six months.
Funding
Health Systems Research Institute (HSRI), Thailand (Grant No. 60-087).
虽然专家主导的早期干预服务（EIS）已被证明对早期精神病有效，但非专家主导的EIS的有效性仍不清楚。该研究旨在确定由非专业卫生工作者领导的低强度病例管理（LICM）规划对泰国曼谷早期精神病发作患者六个月预后的有效性，并与常规护理（UC）进行比较。方法本实用随机对照试验（Lay-CARE）纳入年龄≥18岁、有首次或第二次精神障碍病史、居住在曼谷大都会区（法政大学医院集水区）的患者。参与者被随机分为LICM组或UC组。LICM干预包括家庭心理教育，便利获得服务，以及家庭或电话访问，而UC是参与者接受护理的基线。干预始于2020年10月，于2021年5月结束。为期6个月的期末评估于2021年4月开始，于2021年5月结束。主要结果是通过泰国版的个人和社会表现量表来衡量社会功能。次要结局是症状严重程度、服务使用和药物依从性。采用平均治疗效应（ATE）确定治疗效应大小。由于干预的性质，不可能对参与者和评估者进行盲法。该试验已在泰国临床试验注册中心注册（TCTR20210509001）。结果：130名参与者被随机分为LICM组，125名参与者被随机分为UC组。在六个月的终点线，与UC组相比，LICM组的参与者表现出更好的社会有用活动（ATE 0.06, 95% CI 0.00-0.13, p = 0.041），更少的攻击或干扰行为（ATE - 0.17, 95% CI 0.00 - 0.027至- 0.06,p = 0.002），更好的自我照顾（ATE 0.13 95% CI 0.05-0.22, p = 0.003）。LICM干预不影响个人和社会关系、症状严重程度、药物依从性或服务使用。在低资源环境下，LICM项目可以改善早期精神病患者超过6个月的社会功能。资助卫生系统研究所（HSRI），泰国（批准号60-087）。
{"title":"Lay health worker-delivered case management for early episodes of psychosis in Bangkok, Thailand (Lay-CARE): a single-centre, pragmatic, randomised controlled trial","authors":"Tawanchai Jirapramukpitak , Suttha Supanya","doi":"10.1016/j.lansea.2025.100617","DOIUrl":"10.1016/j.lansea.2025.100617","url":null,"abstract":"<div><h3>Background</h3><div>While specialist-led early intervention services (EIS) have been shown to be effective for early-phase psychosis, the effectiveness of a non-specialist-led EIS is still unclear. The study aims to determine the effectiveness of a low-intensity case management (LICM) programme led by lay health workers for patients during early episodes of psychosis on six-month outcomes compared to usual care (UC) in Bangkok, Thailand.</div></div><div><h3>Methods</h3><div>This pragmatic randomised controlled trial (Lay-CARE) included patients aged ≥18 years with a history of a first or second episode of psychotic disorder residing in the Bangkok Metropolitan Region (Thammasat University hospital's catchment district). Participants were randomised to either LICM or UC group. LICM intervention consisted of family psychoeducation, facilitation of access to services, and home or telephone visits, whereas UC was the baseline of care participants were receiving. The intervention started in October 2020 and ended in May 2021. The 6-month endline assessment started in April 2021 and ended in May 2021. The primary outcome was social functioning measured by the Personal and Social Performance Scale Thai version. Secondary outcomes were symptom severity, service use and medication adherence. The treatment effect size was determined using the average treatment effect (ATE). Due to the nature of the intervention, blinding of participants and assessors was not possible. The trial was registered with the Thai Clinical Trial Registry (TCTR20210509001).</div></div><div><h3>Findings</h3><div>130 participants were randomised to LICM group and 125 to UC group. At the six-month endline, participants in LICM group demonstrated improved socially useful activities (ATE 0.06, 95% CI 0.00–0.13, p = 0.041), less aggressive or disturbing behaviour (ATE −0.17, 95% CI −0.27 to −0.06, p = 0.002), and better self-care (ATE 0.13 95% CI 0.05–0.22, p = 0.003) than participants in UC group. LICM intervention did not affect personal and social relationships, symptom severity, medication adherence, or service use.</div></div><div><h3>Interpretation</h3><div>In low-resource settings, LICM programme can improve areas of social functioning among patients with early episodes of psychosis over six months.</div></div><div><h3>Funding</h3><div><span>Health Systems Research Institute</span> (HSRI), Thailand (Grant No. <span><span>60-087</span></span>).</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"38 ","pages":"Article 100617"},"PeriodicalIF":5.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144243099","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}
Indigenous tribal communities in the state of Odisha, eastern India, face persistent health disparities driven by socio-economic marginalisation, geographical isolation, and limited healthcare access. The Odisha Tribal Family Health Survey (OTFHS) aimed to comprehensively assess the health status, socio-demographic characteristics, and healthcare utilisation patterns of Odisha’s tribal populations.
Methods
A community-based survey was conducted between July 2022 and July 2023, covering 9711 households across 389 clusters in 14 tribal-dominated districts in Odisha. The study included 30,292 participants from 53 notified tribal groups. The study included participants of all age groups (from neonates to the elderly, aged 0 years and above), with 56% of the sample comprising females. Individuals belonging to one of the notified tribes who were permanent residents and provided written consent were included, while bedridden individuals and those with recognisable cognitive impairments were excluded. Data collection involved the use of structured tools at the household and individual levels, anthropometric measurements, point-of-care tests (including blood pressure, random blood glucose, and haemoglobin levels, as well as haemoglobinopathy screening), and laboratory analyses of blood serum samples (for liver function, kidney function, and lipid and iron profiles).
Findings
OTFHS revealed that 88.0% of children aged 12–23 months were fully vaccinated and over 40% of children younger than five years were stunted or underweight. Anaemia affected 71.3% of children aged 6–59 months, with prevalence remaining high among adolescents (76.1% of females, 56.9% of males) and adults (77.5% of women, 42.1% of men). 93.0% of women had bank accounts and 91.4% of births occurred in healthcare facilities. Gaps persisted in antenatal care (40.3% completed four or more visits) and hygienic menstrual practices (35.8% of women).
Interpretation
OTFHS offers crucial disaggregated data, guiding targeted health improvements and policy reforms essential for bridging health equity gaps. The specific focus on Indigenous populations and a broader look at the social determinants alongside health indicators reflect the multi-dimensional nature of healthcare interventions needed for vulnerable groups.
Funding
Scheduled Castes and Scheduled Tribes Research and Training Institute (SCSTRTI), Odisha, India.
{"title":"A comprehensive assessment of health indicators among tribal populations in Odisha, India (Odisha Tribal Family Health Survey): a community-based, cross-sectional study","authors":"Jaya Singh Kshatri , Kavitha AK , Tanveer Rehman , Haimanti Bhattacharya , Dinesh Bhuyan , Asit Mansingh , Uttam Kumar Sahoo , Moushumi Nayak , Swagatika Kanungo , Debdutta Bhattacharya , Sanghamitra Pati","doi":"10.1016/j.lansea.2025.100611","DOIUrl":"10.1016/j.lansea.2025.100611","url":null,"abstract":"<div><h3>Background</h3><div>Indigenous tribal communities in the state of Odisha, eastern India, face persistent health disparities driven by socio-economic marginalisation, geographical isolation, and limited healthcare access. The Odisha Tribal Family Health Survey (OTFHS) aimed to comprehensively assess the health status, socio-demographic characteristics, and healthcare utilisation patterns of Odisha’s tribal populations.</div></div><div><h3>Methods</h3><div>A community-based survey was conducted between July 2022 and July 2023, covering 9711 households across 389 clusters in 14 tribal-dominated districts in Odisha. The study included 30,292 participants from 53 notified tribal groups. The study included participants of all age groups (from neonates to the elderly, aged 0 years and above), with 56% of the sample comprising females. Individuals belonging to one of the notified tribes who were permanent residents and provided written consent were included, while bedridden individuals and those with recognisable cognitive impairments were excluded. Data collection involved the use of structured tools at the household and individual levels, anthropometric measurements, point-of-care tests (including blood pressure, random blood glucose, and haemoglobin levels, as well as haemoglobinopathy screening), and laboratory analyses of blood serum samples (for liver function, kidney function, and lipid and iron profiles).</div></div><div><h3>Findings</h3><div>OTFHS revealed that 88.0% of children aged 12–23 months were fully vaccinated and over 40% of children younger than five years were stunted or underweight. Anaemia affected 71.3% of children aged 6–59 months, with prevalence remaining high among adolescents (76.1% of females, 56.9% of males) and adults (77.5% of women, 42.1% of men). 93.0% of women had bank accounts and 91.4% of births occurred in healthcare facilities. Gaps persisted in antenatal care (40.3% completed four or more visits) and hygienic menstrual practices (35.8% of women).</div></div><div><h3>Interpretation</h3><div>OTFHS offers crucial disaggregated data, guiding targeted health improvements and policy reforms essential for bridging health equity gaps. The specific focus on Indigenous populations and a broader look at the social determinants alongside health indicators reflect the multi-dimensional nature of healthcare interventions needed for vulnerable groups.</div></div><div><h3>Funding</h3><div><span>Scheduled Castes and Scheduled Tribes Research and Training Institute</span> (SCSTRTI), Odisha, India.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"38 ","pages":"Article 100611"},"PeriodicalIF":5.0,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144231715","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}
We aimed to study the outcomes (remission, flare and adverse events) of biological disease-modifying anti-rheumatic drugs (bDMARD) in children with JIA from a low-middle-income country setting, and explore the factors associated with these outcomes.
Methods
The Pediatric Rheumatology Clinic bDMARD register (2009 to August 2024) was screened to enrol children with JIA and at least 3 months follow-up whilst on bDMARDs. Participant characteristics and clinical responses were collected in a pre-designed proforma to evaluate the primary objective i.e., studying outcomes among children with JIA on bDMARDs. The secondary objective was to study factors associated with time-to-remission (TTR) and flare-after-stopping-bDMARDs.
Findings
One-hundred-fifteen children (59.1% boys) with 168 patient-years of bDMARD use were enrolled for this single-centre study. Enthesitis-related arthritis was the commonest subtype of JIA (n = 44, 38.3%). The most commonly used bDMARD was adalimumab (n = 43, 37.3%). The median (IQR) delay to initiation of bDMARD from the perceived need was 2 (0–6) months, primarily due to financial impediments (n = 81, 70.4%). Fifteen (13%) children screened positive for tuberculosis infection. One hundred ten (95.6%) children achieved remission on bDMARD, after a median (IQR) of 7.5 (4–12) weeks. Macrophage activation syndrome at initiation was significantly associated (HR 3.6 (1.3–10.0), p = 0.03) with a longer time-to-remission. bDMARDs were stopped in n = 68/115 (59.1%) after a median (IQR) 15 (9.6–26.5) months, of whom n = 33/68 (48.5%) flared at 6 (3.5–12) months of follow-up. A longer time-to-remission (OR 1.12 (1.02–1.23), p = 0.01) was significantly associated with flare after stopping bDMARDs. Forty-two (36.5%) patients experienced adverse events. The most striking adverse events were serious infections requiring hospitalisation (n = 13, 11.3%) and tuberculosis (n = 4, 3.5%). All children who developed tuberculosis were on TNFi (Adalimumab).
Interpretation
Though children on bDMARDs showed comparable remission rates, we noted a higher frequency of serious infections and tuberculosis, compared to the experience described from high-income countries. These observations highlight the need for further surveillance of outcomes of bDMARD use among children with JIA in an LMIC setting.
Funding
There has been no financial support for this work.
{"title":"Outcomes of children with juvenile idiopathic arthritis receiving biological disease-modifying anti-rheumatic drugs: a retrospective single-centre experience from India","authors":"Pavneet Kaur , Farheen Kizhakkeveettil Saheer , Bala Siva Rama Krishna J , Banoth Sreeshanth , Ayisha Kavil Peedika , Bareddy Sai Thrisha Reddy , Ashish Datt Upadhyay , Rakesh Lodha , Sushil Kumar Kabra , Narendra Bagri","doi":"10.1016/j.lansea.2025.100612","DOIUrl":"10.1016/j.lansea.2025.100612","url":null,"abstract":"<div><h3>Background</h3><div>We aimed to study the outcomes (remission, flare and adverse events) of biological disease-modifying anti-rheumatic drugs (bDMARD) in children with JIA from a low-middle-income country setting, and explore the factors associated with these outcomes.</div></div><div><h3>Methods</h3><div>The Pediatric Rheumatology Clinic bDMARD register (2009 to August 2024) was screened to enrol children with JIA and at least 3 months follow-up whilst on bDMARDs. Participant characteristics and clinical responses were collected in a pre-designed proforma to evaluate the primary objective i.e., studying outcomes among children with JIA on bDMARDs. The secondary objective was to study factors associated with time-to-remission (TTR) and flare-after-stopping-bDMARDs.</div></div><div><h3>Findings</h3><div>One-hundred-fifteen children (59.1% boys) with 168 patient-years of bDMARD use were enrolled for this single-centre study. Enthesitis-related arthritis was the commonest subtype of JIA (n = 44, 38.3%). The most commonly used bDMARD was adalimumab (n = 43, 37.3%). The median (IQR) delay to initiation of bDMARD from the perceived need was 2 (0–6) months, primarily due to financial impediments (n = 81, 70.4%). Fifteen (13%) children screened positive for tuberculosis infection. One hundred ten (95.6%) children achieved remission on bDMARD, after a median (IQR) of 7.5 (4–12) weeks. Macrophage activation syndrome at initiation was significantly associated (HR 3.6 (1.3–10.0), p = 0.03) with a longer time-to-remission. bDMARDs were stopped in n = 68/115 (59.1%) after a median (IQR) 15 (9.6–26.5) months, of whom n = 33/68 (48.5%) flared at 6 (3.5–12) months of follow-up. A longer time-to-remission (OR 1.12 (1.02–1.23), p = 0.01) was significantly associated with flare after stopping bDMARDs. Forty-two (36.5%) patients experienced adverse events. The most striking adverse events were serious infections requiring hospitalisation (n = 13, 11.3%) and tuberculosis (n = 4, 3.5%). All children who developed tuberculosis were on TNFi (Adalimumab).</div></div><div><h3>Interpretation</h3><div>Though children on bDMARDs showed comparable remission rates, we noted a higher frequency of serious infections and tuberculosis, compared to the experience described from high-income countries. These observations highlight the need for further surveillance of outcomes of bDMARD use among children with JIA in an LMIC setting.</div></div><div><h3>Funding</h3><div>There has been no financial support for this work.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"38 ","pages":"Article 100612"},"PeriodicalIF":5.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144222301","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 : 2025-06-05DOI: 10.1016/j.lansea.2025.100613
Aungsumalee Pholpark , Hsu Myat Mon , Leonard Thomas Lim , Tsolmongerel Tsilaajav , Valeria de Oliveira Cruz , Piya Hanvoravongchai
Strengthening primary health care (PHC) is essential for achieving universal health coverage, with effective financing playing a critical role in its success. Despite the increasing emphasis on PHC investment, securing sustainable public financing remains a significant challenge in the countries of the South-East Asia (SEA) Region. This study provides an overview of PHC financing arrangements in Bangladesh, Indonesia, Maldives, and Nepal, highlighting key challenges in these four countries. Data sources included the document review (87 documents included across the four countries) and key informant interviews (21 in total). Findings highlight the diverse approaches to PHC financing across the four countries, bringing out common and country-specific challenges. Our findings suggest that while PHC has been receiving more attention in policy agendas, underlying PHC financing functions still face many challenges. Some constraints stem from the existing health financing models within these countries, indicating a need for targeted reforms.
{"title":"Challenging inadequate and fragmented primary health care financing: findings from Bangladesh, Indonesia, Maldives, and Nepal","authors":"Aungsumalee Pholpark , Hsu Myat Mon , Leonard Thomas Lim , Tsolmongerel Tsilaajav , Valeria de Oliveira Cruz , Piya Hanvoravongchai","doi":"10.1016/j.lansea.2025.100613","DOIUrl":"10.1016/j.lansea.2025.100613","url":null,"abstract":"<div><div>Strengthening primary health care (PHC) is essential for achieving universal health coverage, with effective financing playing a critical role in its success. Despite the increasing emphasis on PHC investment, securing sustainable public financing remains a significant challenge in the countries of the South-East Asia (SEA) Region. This study provides an overview of PHC financing arrangements in Bangladesh, Indonesia, Maldives, and Nepal, highlighting key challenges in these four countries. Data sources included the document review (87 documents included across the four countries) and key informant interviews (21 in total). Findings highlight the diverse approaches to PHC financing across the four countries, bringing out common and country-specific challenges. Our findings suggest that while PHC has been receiving more attention in policy agendas, underlying PHC financing functions still face many challenges. Some constraints stem from the existing health financing models within these countries, indicating a need for targeted reforms.</div></div><div><h3>Funding</h3><div><span>WHO South-East Asia Regional Office</span>.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"38 ","pages":"Article 100613"},"PeriodicalIF":5.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144222472","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