Pub Date : 2024-10-18DOI: 10.1016/j.lansea.2024.100489
Annapoorna Prakash , Pempa , Tshering Duba , K C Sarin , Saudamini Vishwanath Dabak , Ugyen Tashi
Bhutan is currently transforming its health system and has updated its Health Technology Assessment (HTA) framework. This revision is designed to prioritize health initiatives and ensure the sustainability of the health system. This updated framework has been developed through an iterative process involving a desk-based review and stakeholder consultations at the beginning and after the development of the draft framework. The framework outlines the stages of the HTA process and identifies the stakeholders with their roles and responsibilities. The framework has been contextualised to Bhutan's needs and has been endorsed by the high-level decision-making authority for the health sector. The experience highlights diverse challenges and solutions including international collaborations for the institutionalisation of HTA and the lessons learned from this process offer insights for HTA efforts in other settings.
{"title":"Advancing evidence-based decision-making in Bhutan: development of a health technology assessment framework","authors":"Annapoorna Prakash , Pempa , Tshering Duba , K C Sarin , Saudamini Vishwanath Dabak , Ugyen Tashi","doi":"10.1016/j.lansea.2024.100489","DOIUrl":"10.1016/j.lansea.2024.100489","url":null,"abstract":"<div><div>Bhutan is currently transforming its health system and has updated its Health Technology Assessment (HTA) framework. This revision is designed to prioritize health initiatives and ensure the sustainability of the health system. This updated framework has been developed through an iterative process involving a desk-based review and stakeholder consultations at the beginning and after the development of the draft framework. The framework outlines the stages of the HTA process and identifies the stakeholders with their roles and responsibilities. The framework has been contextualised to Bhutan's needs and has been endorsed by the high-level decision-making authority for the health sector. The experience highlights diverse challenges and solutions including international collaborations for the institutionalisation of HTA and the lessons learned from this process offer insights for HTA efforts in other settings.</div></div><div><h3>Funding</h3><div>UNDP-led Access and Delivery Partnership (ADP).</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"30 ","pages":"Article 100489"},"PeriodicalIF":5.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142444687","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 : 2024-10-18DOI: 10.1016/j.lansea.2024.100501
Rajmohan Seetharaman
{"title":"The implications of waiving local clinical trials for drugs in India: a double-edged sword?","authors":"Rajmohan Seetharaman","doi":"10.1016/j.lansea.2024.100501","DOIUrl":"10.1016/j.lansea.2024.100501","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"31 ","pages":"Article 100501"},"PeriodicalIF":5.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142446409","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 : 2024-10-17DOI: 10.1016/j.lansea.2024.100499
Win Han Oo , Win Htike , May Chan Oo , Pwint Phyu Phyu , Kyawt Mon Win , Nay Yi Yi Linn , Tun Min , Ei Phyu Htwe , Aung Khine Zaw , Kaung Myat Thu , Naw Hkawng Galau , Julia C. Cutts , Julie A. Simpson , Nick Scott , Katherine O’Flaherty , Paul A. Agius , Freya J.I. Fowkes
Background
As Greater Mekong Subregion countries approach malaria elimination, the motivation and social role of community health workers (CHWs), and malaria blood examination rates, have declined in parallel with decreasing malaria burden. To address this issue, a health system model which expanded the role for CHWs was co-designed with communities and health stakeholders in the Mekong Subregion and field-tested in Myanmar.
Methods
An open stepped-wedge cluster-randomised (at the village-level) controlled trial (ClinicalTrials.govNCT04695886) was conducted in 72 villages in Myanmar from Nov 1, 2021 to April 17, 2022 to evaluate the effectiveness and cost-effectiveness of the expanded CHW model. One-off and continuous implementation costs of the models were calculated.
Findings
A total of 2886 malaria rapid diagnostic tests (RDTs) (control period: 1365; intervention period: 1521) were undertaken across 72 villages during the 24-week study period. Compared to the existing CHW model, the introduction of an expanded role for CHWs resulted in a 23% relative increase in village weekly malaria blood examination rates by RDT, the primary outcome, (adjusted incidence rate ratio (AIRR) = 1.23, 95% CI = 1.01, 1.50, p = 0.036), adjusting for time and season. A 3.3-fold relative increase in village weekly referral rate of dengue, tuberculosis, diarrhoea, or RDT-negative fever cases after the introduction of the expanded CHW model (AIRR = 3.17, 95% CI = 1.23, 8.18, p = 0.017), was also observed. The total cost per CHW per five-year period was US$14,794 for the expanded CHW model and $5816 for the existing CHW model.
Interpretation
An expanded CHW model, co-designed with communities and health stakeholders, can increase malaria blood examination rates in malaria elimination settings and referral rates for other infectious diseases. Expanded CHW models will facilitate maintaining annual blood examination rates required for malaria elimination accreditation by the WHO.
Funding
An International Multilateral Donor (QSE-M-UNOPS-BI-20864-007-40).
{"title":"Effectiveness of an expanded role for community health workers on malaria blood examination rates in malaria elimination settings in Myanmar: an open stepped-wedge, cluster-randomised controlled trial","authors":"Win Han Oo , Win Htike , May Chan Oo , Pwint Phyu Phyu , Kyawt Mon Win , Nay Yi Yi Linn , Tun Min , Ei Phyu Htwe , Aung Khine Zaw , Kaung Myat Thu , Naw Hkawng Galau , Julia C. Cutts , Julie A. Simpson , Nick Scott , Katherine O’Flaherty , Paul A. Agius , Freya J.I. Fowkes","doi":"10.1016/j.lansea.2024.100499","DOIUrl":"10.1016/j.lansea.2024.100499","url":null,"abstract":"<div><h3>Background</h3><div>As Greater Mekong Subregion countries approach malaria elimination, the motivation and social role of community health workers (CHWs), and malaria blood examination rates, have declined in parallel with decreasing malaria burden. To address this issue, a health system model which expanded the role for CHWs was co-designed with communities and health stakeholders in the Mekong Subregion and field-tested in Myanmar.</div></div><div><h3>Methods</h3><div>An open stepped-wedge cluster-randomised (at the village-level) controlled trial (<span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> <span><span>NCT04695886</span><svg><path></path></svg></span>) was conducted in 72 villages in Myanmar from Nov 1, 2021 to April 17, 2022 to evaluate the effectiveness and cost-effectiveness of the expanded CHW model. One-off and continuous implementation costs of the models were calculated.</div></div><div><h3>Findings</h3><div>A total of 2886 malaria rapid diagnostic tests (RDTs) (control period: 1365; intervention period: 1521) were undertaken across 72 villages during the 24-week study period. Compared to the existing CHW model, the introduction of an expanded role for CHWs resulted in a 23% relative increase in village weekly malaria blood examination rates by RDT, the primary outcome, (adjusted incidence rate ratio (AIRR) = 1.23, 95% CI = 1.01, 1.50, p = 0.036), adjusting for time and season. A 3.3-fold relative increase in village weekly referral rate of dengue, tuberculosis, diarrhoea, or RDT-negative fever cases after the introduction of the expanded CHW model (AIRR = 3.17, 95% CI = 1.23, 8.18, p = 0.017), was also observed. The total cost per CHW per five-year period was US$14,794 for the expanded CHW model and $5816 for the existing CHW model.</div></div><div><h3>Interpretation</h3><div>An expanded CHW model, co-designed with communities and health stakeholders, can increase malaria blood examination rates in malaria elimination settings and referral rates for other infectious diseases. Expanded CHW models will facilitate maintaining annual blood examination rates required for malaria elimination accreditation by the WHO.</div></div><div><h3>Funding</h3><div>An <span>International Multilateral Donor</span> (<span><span>QSE-M-UNOPS-BI-20864-007-40</span></span>).</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"31 ","pages":"Article 100499"},"PeriodicalIF":5.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142446312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1016/j.lansea.2024.100498
Chirag K. Kumar , Alec C. Gleason , Giridara Gopal Parameswaran , Amit Summan , Eili Klein , Ramanan Laxminarayan , Arindam Nandi
Background
Childhood vaccinations can reduce disease burden and associated antibiotic use, in turn reducing the risk of antimicrobial resistance (AMR). We retrospectively estimated the population-level reductions in antibiotic use in India following the introduction of vaccines against Streptococcus pneumoniae and Haemophilius influenzae type B in the national immunization program for children in the mid-2010s and projected future gains to 2028 if vaccination coverage were to be increased.
Methods
Using IndiaSim, a dynamic agent-based microsimulation model (ABM) for India, we simulated the spread of Streptococcus pneumoniae and Haemophilius influenzae type B (Hib) among children to estimate reductions in antibiotic use under the scenarios of: (i) pneumococcal and Hib vaccine coverage levels equivalent to the national coverage of pentavalent diphtheria-pertussis-tetanus third dose (DPT3) compared to a baseline of no vaccination, and (ii) near-universal (90%) coverage of the vaccines compared to pre-COVID national DPT3-level coverage. Model parameters, including national DPT3 coverage rates, were based on data from the National Family Household Survey 2015–2016 and other published sources. We quantified reductions in antibiotic consumption nationally and by state and wealth quintiles.
Findings
We estimate that coverage of S. pneumoniae and Hib vaccines at the same level as DPT3 in India would translate to a 61.4% [95% UI: 43.8–69.5] reduction in attributable antibiotic use compared to a baseline of zero vaccination coverage. Increases in childhood vaccination coverage between 2004 and 2016 have likely reduced attributable antibiotic demand by as much as 93.4% among the poorest quintile. Increasing vaccination coverage by an additional 11 percentage points from 2016 levels results in mortality and antibiotic use across wealth quintiles becoming increasingly similar (p < 0.05), reducing in health inquities. We project that near-universal vaccine coverage would further reduce inequities in antibiotic demand and may eliminate of outbreak-associated antibiotic use from S. pneumoniae and Hib.
Interpretation
Though vaccination has a complex relationship with antibiotic use because both are modulated by socioeconomic factors, increasing vaccinations for S. pneumoniae and Hib may have a significant impact on reducing antibiotic use and improving health outcomes among the poorest individuals.
Funding
The Bill & Melinda Gates Foundation (grant numbers OPP1158136 and OPP1190803).
{"title":"Routine immunization against Streptococcus pneumoniae and Haemophilus influenzae type B and antibiotic consumption in India: a dynamic modeling analysis","authors":"Chirag K. Kumar , Alec C. Gleason , Giridara Gopal Parameswaran , Amit Summan , Eili Klein , Ramanan Laxminarayan , Arindam Nandi","doi":"10.1016/j.lansea.2024.100498","DOIUrl":"10.1016/j.lansea.2024.100498","url":null,"abstract":"<div><h3>Background</h3><div>Childhood vaccinations can reduce disease burden and associated antibiotic use, in turn reducing the risk of antimicrobial resistance (AMR). We retrospectively estimated the population-level reductions in antibiotic use in India following the introduction of vaccines against <em>Streptococcus pneumoniae</em> and <em>Haemophilius influenzae</em> type B in the national immunization program for children in the mid-2010s and projected future gains to 2028 if vaccination coverage were to be increased.</div></div><div><h3>Methods</h3><div>Using IndiaSim, a dynamic agent-based microsimulation model (ABM) for India, we simulated the spread of <em>Streptococcus pneumoniae</em> and <em>Haemophilius influenzae</em> type B (Hib) among children to estimate reductions in antibiotic use under the scenarios of: (i) pneumococcal and Hib vaccine coverage levels equivalent to the national coverage of pentavalent diphtheria-pertussis-tetanus third dose (DPT3) compared to a baseline of no vaccination, and (ii) near-universal (90%) coverage of the vaccines compared to pre-COVID national DPT3-level coverage. Model parameters, including national DPT3 coverage rates, were based on data from the National Family Household Survey 2015–2016 and other published sources. We quantified reductions in antibiotic consumption nationally and by state and wealth quintiles.</div></div><div><h3>Findings</h3><div>We estimate that coverage of <em>S. pneumoniae</em> and Hib vaccines at the same level as DPT3 in India would translate to a 61.4% [95% UI: 43.8–69.5] reduction in attributable antibiotic use compared to a baseline of zero vaccination coverage. Increases in childhood vaccination coverage between 2004 and 2016 have likely reduced attributable antibiotic demand by as much as 93.4% among the poorest quintile. Increasing vaccination coverage by an additional 11 percentage points from 2016 levels results in mortality and antibiotic use across wealth quintiles becoming increasingly similar (p < 0.05), reducing in health inquities. We project that near-universal vaccine coverage would further reduce inequities in antibiotic demand and may eliminate of outbreak-associated antibiotic use from <em>S. pneumoniae</em> and Hib.</div></div><div><h3>Interpretation</h3><div>Though vaccination has a complex relationship with antibiotic use because both are modulated by socioeconomic factors, increasing vaccinations for <em>S. pneumoniae</em> and Hib may have a significant impact on reducing antibiotic use and improving health outcomes among the poorest individuals.</div></div><div><h3>Funding</h3><div>The <span>Bill & Melinda Gates Foundation</span> (grant numbers <span><span>OPP1158136</span></span> and <span><span>OPP1190803</span></span>).</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"31 ","pages":"Article 100498"},"PeriodicalIF":5.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441182","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 : 2024-10-15DOI: 10.1016/j.lansea.2024.100497
Kinley Wangdi , H Juliette T. Unwin , Kinley Penjor , Tsheten Tsheten , Tobgyal , Archie Clements , Darren Gray , Manas Kotepui , Samir Bhatt , Peter Gething
Background
Bhutan has achieved a substantial reduction in both malaria morbidity and mortality over the last two decades and is aiming for malaria elimination certification in 2025. However, a significant percentage of malaria cases in Bhutan are imported (acquired in another country). The aim of the study was to understand how importation drives local malaria transmission in Bhutan.
Methods
Information on geo-located individual-level laboratory-confirmed malaria cases between 2016 and 2020 was obtained from the Bhutan Vector-borne Disease Control Program. Records included the date of diagnosis and treatment, type of cases classified as indigenous or imported, and malaria species. Hawkes Processes were used to study the role of imported malaria in local transmission in Bhutan. We imposed 15 days delay for a mosquito to become infectious in the model.
Findings
There were 285 cases during the study period and 58.6% (159) were imported malaria. 71.1% (113) of these imported cases were Plasmodium vivax and 73.6% (117) were from India. The model suggested that a person remains infectious for 8 days for Plasmodium falciparum malaria but over 19 days for P. vivax. The background intensity from imported malaria cases was much greater for P. vivax cases (maximum 0.17) resulting in more importations than P. falciparum cases (maximum 0.06). However, model fitting suggested that local P. falciparum transmission was mainly driven by importations but additional factors such as relapse played a role for P. vivax.
Interpretation
Imported malaria cases are key drivers of transmission within Bhutan, with most cases since 2016 being P. vivax. Control programmes should be devised to target interventions towards the P. vivax strain and test those who are more likely to bring in imported malaria cases or acquire it from returning travellers.
{"title":"Estimating the impact of imported malaria on local transmission in a near elimination setting: a case study from Bhutan","authors":"Kinley Wangdi , H Juliette T. Unwin , Kinley Penjor , Tsheten Tsheten , Tobgyal , Archie Clements , Darren Gray , Manas Kotepui , Samir Bhatt , Peter Gething","doi":"10.1016/j.lansea.2024.100497","DOIUrl":"10.1016/j.lansea.2024.100497","url":null,"abstract":"<div><h3>Background</h3><div>Bhutan has achieved a substantial reduction in both malaria morbidity and mortality over the last two decades and is aiming for malaria elimination certification in 2025. However, a significant percentage of malaria cases in Bhutan are imported (acquired in another country). The aim of the study was to understand how importation drives local malaria transmission in Bhutan.</div></div><div><h3>Methods</h3><div>Information on geo-located individual-level laboratory-confirmed malaria cases between 2016 and 2020 was obtained from the Bhutan Vector-borne Disease Control Program. Records included the date of diagnosis and treatment, type of cases classified as indigenous or imported, and malaria species. Hawkes Processes were used to study the role of imported malaria in local transmission in Bhutan. We imposed 15 days delay for a mosquito to become infectious in the model.</div></div><div><h3>Findings</h3><div>There were 285 cases during the study period and 58.6% (159) were imported malaria. 71.1% (113) of these imported cases were <em>Plasmodium vivax</em> and 73.6% (117) were from India. The model suggested that a person remains infectious for 8 days for <em>Plasmodium falciparum</em> malaria but over 19 days for <em>P. vivax.</em> The background intensity from imported malaria cases was much greater for <em>P. vivax</em> cases (maximum 0.17) resulting in more importations than <em>P. falciparum</em> cases (maximum 0.06). However, model fitting suggested that local <em>P. falciparum</em> transmission was mainly driven by importations but additional factors such as relapse played a role for <em>P. vivax</em>.</div></div><div><h3>Interpretation</h3><div>Imported malaria cases are key drivers of transmission within Bhutan, with most cases since 2016 being <em>P. vivax</em>. Control programmes should be devised to target interventions towards the <em>P. vivax</em> strain and test those who are more likely to bring in imported malaria cases or acquire it from returning travellers.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"31 ","pages":"Article 100497"},"PeriodicalIF":5.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142438154","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}
Many patients with β-thalassaemia die prematurely due to iron overload. In this study, we aim to evaluate the efficacy and safety of the triple combination of deferoxamine, deferasirox and deferiprone on iron chelation in patients with transfusion-dependent β-thalassaemia with very high iron overload.
Methods
This open-label, randomised, controlled clinical trial was conducted at Colombo North Teaching Hospital, Sri Lanka. Transfusion-dependent β-thalassaemia patients with ferritin >3500 ng/mL were randomised 2:1 into intervention (deferoxamine, deferasirox and deferiprone) and control (deferoxamine and deferasirox) arms. Reduction in serum ferritin after six months was the primary outcome measure. Reduction in liver iron content, improvement in cardiac T2∗, and adverse effects were secondary outcome measures.
Findings
Twenty-three patients (intervention-15, control-8) were recruited. 92% and 62% in the intervention and control arms showed a reduction in ferritin, respectively. The mean reduction of ferritin was significantly higher in intervention (−1094 ± 907 ng/mL) compared to control (+82 ± 1588 ng/mL) arm (p = 0.042). There was no statistically significant difference in the liver iron content in two arms. In the intervention arm, 67% improved cardiac T2∗ (mean change +6.72 ± 9.63 ms) compared to 20% in the control arm (mean change −3.00 ± 8.24 ms). Five patients discontinued deferiprone due to arthralgia, which resolved completely after stopping the drug.
Interpretation
Triple combination therapy with deferoxamine, deferasirox and deferiprone is more efficacious in reducing iron burden measured by serum ferritin and showed a positive trend in reducing myocardial iron content in patients with transfusion-dependent β-thalassaemia with very high iron overload. Deferiprone has the disturbing side effect of reversible but severe arthropathy.
{"title":"Deferoxamine, deferasirox, and deferiprone triple iron chelator combination therapy for transfusion-dependent β-thalassaemia with very high iron overload: a randomised clinical trial","authors":"Anuja Premawardhena , Sakuni Wanasinghe , Chamodi Perera , Muditha Nayana Wijethilaka , R.H.M.G. Rajakaruna , R.A.N.K.K. Samarasinghe , Senani Williams , Sachith Mettananda","doi":"10.1016/j.lansea.2024.100495","DOIUrl":"10.1016/j.lansea.2024.100495","url":null,"abstract":"<div><h3>Background</h3><div>Many patients with β-thalassaemia die prematurely due to iron overload. In this study, we aim to evaluate the efficacy and safety of the triple combination of deferoxamine, deferasirox and deferiprone on iron chelation in patients with transfusion-dependent β-thalassaemia with very high iron overload.</div></div><div><h3>Methods</h3><div>This open-label, randomised, controlled clinical trial was conducted at Colombo North Teaching Hospital, Sri Lanka. Transfusion-dependent β-thalassaemia patients with ferritin >3500 ng/mL were randomised 2:1 into intervention (deferoxamine, deferasirox and deferiprone) and control (deferoxamine and deferasirox) arms. Reduction in serum ferritin after six months was the primary outcome measure. Reduction in liver iron content, improvement in cardiac T2∗, and adverse effects were secondary outcome measures.</div></div><div><h3>Findings</h3><div>Twenty-three patients (intervention-15, control-8) were recruited. 92% and 62% in the intervention and control arms showed a reduction in ferritin, respectively. The mean reduction of ferritin was significantly higher in intervention (−1094 ± 907 ng/mL) compared to control (+82 ± 1588 ng/mL) arm (p = 0.042). There was no statistically significant difference in the liver iron content in two arms. In the intervention arm, 67% improved cardiac T2∗ (mean change +6.72 ± 9.63 ms) compared to 20% in the control arm (mean change −3.00 ± 8.24 ms). Five patients discontinued deferiprone due to arthralgia, which resolved completely after stopping the drug.</div></div><div><h3>Interpretation</h3><div>Triple combination therapy with deferoxamine, deferasirox and deferiprone is more efficacious in reducing iron burden measured by serum ferritin and showed a positive trend in reducing myocardial iron content in patients with transfusion-dependent β-thalassaemia with very high iron overload. Deferiprone has the disturbing side effect of reversible but severe arthropathy.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"30 ","pages":"Article 100495"},"PeriodicalIF":5.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142438414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-08DOI: 10.1016/j.lansea.2024.100494
Sofia Weiss Goitiandia , Akhilesh Agarwal , Smita C. Banerjee , Nirmala Bhoo-Pathy , Chandan Bose , Mahati Chittem , Roop Gursahani , L. Ramakrishnan , Smriti Rana , Naveen Salins , Malar Velli Segarmurthy , Aashiana Thiyam , William E. Rosa
LGBTQ+ people (e.g., lesbian, gay, bisexual, transgender, and queer or questioning people) experience systemic marginalisation and discrimination globally and throughout India. In October 2023, the Indian Supreme Court rejected the legal recognition of same-sex marriage, blocking marriage equality for LGBTQ+ people and contending that the right to marry neither qualifies as a fundamental right accorded by the Indian Constitution nor falls under the Supreme Court’s purview. Although the Supreme Court declared opposition to discrimination based on sexual orientation, its failure to recognise same-sex marriage legally is a substantial obstruction to full LGBTQ+ equality. We propose that the refusal of the Indian legal system to honour same-sex marriage while calling for an end to societal violence and discriminatory behaviour against the LGBTQ+ community is inherently flawed and counterintuitive. Informed by our team’s multidisciplinary orientation as healthcare professionals, researchers, and advocates, we delineate explicit challenges that LGBTQ+ people in India may encounter due to the Supreme Court’s recent ruling. We subsequently put forth a series of interprofessional and intersectoral recommendations to mitigate this decision’s immediate and long-term consequences, providing an actionable path toward LGBTQ+ inclusion, justice, and equity in India.
{"title":"Beyond the bench: LGBTQ+ health equity after India’s “no same-sex marriage” verdict","authors":"Sofia Weiss Goitiandia , Akhilesh Agarwal , Smita C. Banerjee , Nirmala Bhoo-Pathy , Chandan Bose , Mahati Chittem , Roop Gursahani , L. Ramakrishnan , Smriti Rana , Naveen Salins , Malar Velli Segarmurthy , Aashiana Thiyam , William E. Rosa","doi":"10.1016/j.lansea.2024.100494","DOIUrl":"10.1016/j.lansea.2024.100494","url":null,"abstract":"<div><div>LGBTQ+ people (e.g., lesbian, gay, bisexual, transgender, and queer or questioning people) experience systemic marginalisation and discrimination globally and throughout India. In October 2023, the Indian Supreme Court rejected the legal recognition of same-sex marriage, blocking marriage equality for LGBTQ+ people and contending that the right to marry neither qualifies as a fundamental right accorded by the Indian Constitution nor falls under the Supreme Court’s purview. Although the Supreme Court declared opposition to discrimination based on sexual orientation, its failure to recognise same-sex marriage legally is a substantial obstruction to full LGBTQ+ equality. We propose that the refusal of the Indian legal system to honour same-sex marriage while calling for an end to societal violence and discriminatory behaviour against the LGBTQ+ community is inherently flawed and counterintuitive. Informed by our team’s multidisciplinary orientation as healthcare professionals, researchers, and advocates, we delineate explicit challenges that LGBTQ+ people in India may encounter due to the Supreme Court’s recent ruling. We subsequently put forth a series of interprofessional and intersectoral recommendations to mitigate this decision’s immediate and long-term consequences, providing an actionable path toward LGBTQ+ inclusion, justice, and equity in India.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"30 ","pages":"Article 100494"},"PeriodicalIF":5.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142428165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-07DOI: 10.1016/j.lansea.2024.100486
Om Prakash Bera , U. Venkatesh , Gopal Krushna Pal , Siddhant Shastri , Sayantan Chakraborty , Ashoo Grover , Hari Shanker Joshi
Background
Uttar Pradesh, India's largest state, faces critical pollution levels, necessitating urgent action. The National Clean Air Programme (NCAP) targets a 40% reduction in particulate pollution by 2026. This study assesses the impact of NCAP on 15 non-attainment cities in Uttar Pradesh using the Prophet forecasting model.
Methods
Monthly data on AQI and concentrations from 2016 to 2023 were sourced from the Uttar Pradesh Pollution Control Board. Significant changes in mean AQI and levels from 2017 to 2023 were evaluated using the Friedman test. Prophet models forecast concentrations for 2025–26, with relative percentage changes calculated and model evaluation metrics assessed.
Findings
Most cities exhibited unhealthy air quality. Jhansi had the lowest AQI (72.73) in 2023, classified as ‘moderate’ by WHO standards. Gorakhpur consistently showed ‘poor’ AQI levels, peaking at 249.31 in 2019. Western Uttar Pradesh cities such as Ghaziabad, Noida, and Moradabad had significant pollution burdens. Predictions showed Bareilly with over a 70% reduction in levels, Raebareli 58%, Moradabad 55%, Ghaziabad 48%, Agra around 41%, and Varanasi 40%, meeting NCAP targets. However, Gorakhpur and Prayagraj predicted increases in levels by 50% and 32%, respectively. Moradabad's model showed the best performance with an of 0.81, MAE of 17.27 , and MAPE of 0.10.
Interpretation
Forecasting concentrations in Uttar Pradesh's non-attainment cities offers policymakers substantial evidence to enhance current efforts. While existing measures are in place, our findings suggest that intensified provisions may be necessary for cities predicted to fall short of meeting program targets. The Prophet model's forecasts can pinpoint these at-risk areas, allowing for targeted interventions and regional adjustments to strategies. This approach will help promote sustainable development customized to each city's specific needs.
{"title":"Assessing the impact of the National Clean Air Programme in Uttar Pradesh's non-attainment cities: a prophet model time series analysis","authors":"Om Prakash Bera , U. Venkatesh , Gopal Krushna Pal , Siddhant Shastri , Sayantan Chakraborty , Ashoo Grover , Hari Shanker Joshi","doi":"10.1016/j.lansea.2024.100486","DOIUrl":"10.1016/j.lansea.2024.100486","url":null,"abstract":"<div><h3>Background</h3><div>Uttar Pradesh, India's largest state, faces critical pollution levels, necessitating urgent action. The National Clean Air Programme (NCAP) targets a 40% reduction in particulate pollution by 2026. This study assesses the impact of NCAP on 15 non-attainment cities in Uttar Pradesh using the Prophet forecasting model.</div></div><div><h3>Methods</h3><div>Monthly data on AQI and <span><math><mrow><msub><mtext>PM</mtext><mn>10</mn></msub></mrow></math></span> concentrations from 2016 to 2023 were sourced from the Uttar Pradesh Pollution Control Board. Significant changes in mean AQI and <span><math><mrow><msub><mtext>PM</mtext><mn>10</mn></msub></mrow></math></span> levels from 2017 to 2023 were evaluated using the Friedman test. Prophet models forecast <span><math><mrow><msub><mtext>PM</mtext><mn>10</mn></msub></mrow></math></span> concentrations for 2025–26, with relative percentage changes calculated and model evaluation metrics assessed.</div></div><div><h3>Findings</h3><div>Most cities exhibited unhealthy air quality. Jhansi had the lowest AQI (72.73) in 2023, classified as ‘moderate’ by WHO standards. Gorakhpur consistently showed ‘poor’ AQI levels, peaking at 249.31 in 2019. Western Uttar Pradesh cities such as Ghaziabad, Noida, and Moradabad had significant pollution burdens. Predictions showed Bareilly with over a 70% reduction in <span><math><mrow><msub><mtext>PM</mtext><mn>10</mn></msub></mrow></math></span> levels, Raebareli 58%, Moradabad 55%, Ghaziabad 48%, Agra around 41%, and Varanasi 40%, meeting NCAP targets. However, Gorakhpur and Prayagraj predicted increases in <span><math><mrow><msub><mtext>PM</mtext><mn>10</mn></msub></mrow></math></span> levels by 50% and 32%, respectively. Moradabad's model showed the best performance with an <span><math><mrow><msup><mi>R</mi><mn>2</mn></msup></mrow></math></span> of 0.81, MAE of 17.27 <span><math><mrow><mi>μ</mi><mi>g</mi><mo>/</mo><msup><mi>m</mi><mn>3</mn></msup></mrow></math></span>, and MAPE of 0.10.</div></div><div><h3>Interpretation</h3><div>Forecasting <span><math><mrow><msub><mtext>PM</mtext><mn>10</mn></msub></mrow></math></span> concentrations in Uttar Pradesh's non-attainment cities offers policymakers substantial evidence to enhance current efforts. While existing measures are in place, our findings suggest that intensified provisions may be necessary for cities predicted to fall short of meeting program targets. The Prophet model's forecasts can pinpoint these at-risk areas, allowing for targeted interventions and regional adjustments to strategies. This approach will help promote sustainable development customized to each city's specific needs.</div></div><div><h3>Funding</h3><div>No funding was issued for this research.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"30 ","pages":"Article 100486"},"PeriodicalIF":5.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142428166","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 : 2024-10-01DOI: 10.1016/j.lansea.2024.100491
The Lancet Regional Health – Southeast Asia
{"title":"Tackling cardiometabolic disease in southeast Asia: local research to inform local practice","authors":"The Lancet Regional Health – Southeast Asia","doi":"10.1016/j.lansea.2024.100491","DOIUrl":"10.1016/j.lansea.2024.100491","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"29 ","pages":"Article 100491"},"PeriodicalIF":5.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142425133","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}
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