The Lancet regional health. Southeast Asia最新文献

{"title":"Integration of clinical data with scanned ECGs using deep learning methods for stroke risk prediction in Indian patients with atrial fibrillation: evidence from the KERALA-AF study","authors":"Qinkai Yu ,&nbsp;Jinbert L. Azariah ,&nbsp;Z. Sajan Ahmad ,&nbsp;Rajappan Anilkumar ,&nbsp;Peter Calvert ,&nbsp;Yang Chen ,&nbsp;Yalin Zheng ,&nbsp;Yanda Meng ,&nbsp;Bahuleyan Charantharayil Gopalan ,&nbsp;Gregory Y.H. Lip","doi":"10.1016/j.lansea.2025.100715","DOIUrl":"10.1016/j.lansea.2025.100715","url":null,"abstract":"<div><h3>Background</h3><div>Stroke risk stratification in patients with atrial fibrillation (AF) is challenging, particularly in under-represented South Asian populations. The use of a multimodal deep-learning artificial intelligence (AI) model, which integrates clinical data with widely available paper electrocardiogram (ECG) images, represents a novel predictive approach that has not previously been validated in this population.</div></div><div><h3>Methods</h3><div>This study used data from the prospective KERALA-AF registry, the largest prospective AF study in South Asia. We developed a multimodal deep-learning AI model to predict incident stroke within one year by combining tabular clinical data with scanned paper ECGs. We benchmarked its performance (AUC) against machine learning (ML) models using only clinical data and the CHA₂DS₂-VASc score.</div></div><div><h3>Findings</h3><div>Of 631 patients included (mean age 64.4, SD 12.9; 54.2% female), 25 (4.0%) experienced a stroke within one year. The multimodal deep learning AI model incorporating ECG data achieved the highest discrimination (AUC 0.816, 95% CI 0.704–0.914), substantially outperforming the CHA₂DS₂-VASc score (AUC 0.666) and all compared machine learning models trained on clinical data alone. Permutation analysis showed the scanned paper ECG images contributed 57.1% of the model's predictive signal, which boosted the model's performance significantly.</div></div><div><h3>Interpretation</h3><div>Integrating scanned paper ECGs with clinical data via deep learning methods significantly enhanced 1-year stroke clinical risk prediction in South Asian AF patients. This study demonstrates the value of using multimodal AI with readily available, non-digital data in improving clinical risk stratification beyond current approaches based on clinical risk factors alone.</div></div><div><h3>Funding</h3><div><span>Kerala Chapter of Cardiological Society of India</span>.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"44 ","pages":"Article 100715"},"PeriodicalIF":6.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977225","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}

{"title":"Is universal depression screening cost-effective across all Indian states? Addressing parameter uncertainty: author's reply","authors":"Neha Purohit,&nbsp;Shankar Prinja","doi":"10.1016/j.lansea.2026.100717","DOIUrl":"10.1016/j.lansea.2026.100717","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"44 ","pages":"Article 100717"},"PeriodicalIF":6.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977227","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}

{"title":"Burden of typhoid fever and antimicrobial resistance in India (2023): a modelling study","authors":"Vijayalaxmi V. Mogasale ,&nbsp;Jacob John ,&nbsp;Nikhil Sahai ,&nbsp;Arindam Ray ,&nbsp;Habib Hasan Farooqui ,&nbsp;Vittal Mogasale ,&nbsp;Bhim Gopal Dhoubhadel ,&nbsp;W. John Edmunds ,&nbsp;Andrew Clark ,&nbsp;Kaja Abbas","doi":"10.1016/j.lansea.2025.100714","DOIUrl":"10.1016/j.lansea.2025.100714","url":null,"abstract":"<div><h3>Background</h3><div>India is one of the countries with a high typhoid fever burden. In 2022, the National Technical Advisory Group on Immunisation recommended including the typhoid conjugate vaccine (TCV) in the Universal Immunisation Programme. In this study, we aimed to estimate the 2023 burden of typhoid fever and its antimicrobial resistance (AMR) to inform targeted vaccine introduction strategies.</div></div><div><h3>Methods</h3><div>We used a decision tree model to estimate typhoid cases, hospitalisations, complications, and deaths. Incidence and clinical parameters were derived from a multicentre Indian study, with state-wise AMR prevalence from a systematic review. Two co-primary and four alternative scenarios were presented to validate the robustness of the findings.</div></div><div><h3>Findings</h3><div>We estimated 4.9 million (95% UI: 4.4–5.6) typhoid cases and 7850 (4300–14,900) deaths in India in 2023. Of 730,000 (534,000–970,000) hospitalisations, 600,000 (435,000–799,000; 82%) were attributable to fluoroquinolone-resistant. Under primary scenario A, children &lt;5 years accounted for 321,000 (235,000–427,000; 44.0%) hospitalisations and 2600 (1300–4800; 34.0%) deaths. Under primary scenario B, 5–9 years of age accounted for 265,000 (135,000–278,000; 36.0%) hospitalisations and 2900 (1500–5300; 36.0%) deaths. Delhi, Maharashtra, and Karnataka together accounted for 29% of the national burden and had the highest rates of fluoroquinolone-resistant cases and deaths among the ten highest-burden states. Deaths linked to fluoroquinolone-resistance, multidrug resistance, third-generation cephalosporins, and azithromycin resistance were 4700 (1800–10,200), 122 (45–294), 183 (69–431), and 183 (68–432), respectively.</div></div><div><h3>Interpretation</h3><div>Fluoroquinolone-resistance drives a large share of typhoid-related hospitalisations and deaths, especially in children under five and in high-burden states of India. Targeted TCV introduction, with broader age coverage among children, would maximise impact.</div></div><div><h3>Funding</h3><div><span>WISE programme</span>; <span>Vaccine Impact Modelling Consortium</span>; <span>Japan Agency for Medical Research and Development</span>.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"44 ","pages":"Article 100714"},"PeriodicalIF":6.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939179","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}

{"title":"Identifying undiagnosed HIV infected individuals in a community-based door to door testing initiative in outbreak affected areas of Larkana and surrounding districts, Pakistan","authors":"Muhammad S. Jamil ,&nbsp;Muhammad S. Pasha ,&nbsp;Atif Ali ,&nbsp;Shahida Memon ,&nbsp;Altaf A. Soomro ,&nbsp;Zulfiqar Dharejo ,&nbsp;Alaama A. Sabry ,&nbsp;Yvan Hutin ,&nbsp;Joumana Hermez","doi":"10.1016/j.lansea.2025.100713","DOIUrl":"10.1016/j.lansea.2025.100713","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;In April 2019, an outbreak of HIV was reported in Larkana district of Sindh province, Pakistan. The outbreak primarily affected children and was associated with unsafe injections in healthcare settings. Testing services delivered from health care facilities continued to identify new HIV infections in Larkana and surrounding districts. We describe a community-based educate, test and treat initiative implemented in these areas to identify undiagnosed HIV infections in the community. We analyzed the data to describe HIV-positivity, linkage to care and HIV risk exposure among diagnosed persons.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;HIV rapid testing was offered door-to-door to people 18 months to 60 years of age who were not known to be HIV-positive. Testing was conducted in 12 union councils (UCs; lowest administrative unit) of Taluka/sub-district “Ratodero” (district Larkana), four UCs of Taluka “Garhi Yasin” (district Shikarpur) and seven UCs of Taluka “Garhi Khairo” (district Jacobabad). Those with two reactive rapid results in the community were referred for confirmation and linkage to care at the nearest HIV treatment centre. We calculated HIV positivity (number of people with two reactive rapid tests in the community among those tested) disaggregated by age, sex and location, and assessed the proportion linked to care among those HIV-positive and self-reported HIV risk exposure among those diagnosed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Between 6 and 21 September 2023, 43,883 individuals were tested in Ratodero, of whom 47% were females and 47% were aged &lt;15 years. Of those tested, 73 (0.17%) were HIV-positive (48 persons aged &lt;15 [0.24%] and 25 persons aged ≥15 [0.11%]) and 63 (86%) were linked to treatment. Forty eight persons (76%) reported exposure to reused needles or syringes. In surrounding areas, between 28 November to 12 December 2023, 24,352 individuals were tested, of whom 60% were females and 49% were aged &lt;15 years. Of those tested, 158 (0.65%) were HIV-positive (56 persons aged &lt;15 [0.47%] and 102 persons aged ≥15 [0.83%]) and 94 (59%) were linked to treatment. Forty seven persons (51%) reported reuse of needles or syringes and 15 (16%) transfusion of blood/blood products.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;More than five years since the nosocomial HIV outbreak in Ratodero, undiagnosed HIV infections persist in the community. The undiagnosed HIV infection is common among children in Ratodero, and among both adults and children in surrounding areas. Self-reported HIV risk exposures point to reuse of needles and syringes as the predominant mode of transmission. The situation warrants urgent need to address unsafe injection practices and safety in healthcare facilities.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Funding&lt;/h3&gt;&lt;div&gt;The educate, test and treat programme was funded through the &lt;span&gt;Global Fund&lt;/span&gt; COVID-19 Response Mechanism country grant. No specific funding was received for this programme","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"44 ","pages":"Article 100713"},"PeriodicalIF":6.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939180","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}

{"title":"Functional precision approach in patients with very high risk acute lymphoblastic leukaemia in India: a single-centre cohort study","authors":"Jasmeet Sidhu ,&nbsp;Arijit Chakraborty ,&nbsp;Parag Das ,&nbsp;Fabio D. Steffen ,&nbsp;Subhajit Kundu ,&nbsp;Sangramjit Basu ,&nbsp;Bhaswati Tarafdar ,&nbsp;Tanima Dey ,&nbsp;Abhirupa Kar ,&nbsp;Mousumi Biswas ,&nbsp;Ankita Das ,&nbsp;Naveen Sivadasan ,&nbsp;Pritha Dasgupta ,&nbsp;Niharendu Ghara ,&nbsp;Beat Bornhauser ,&nbsp;Jean-Pierre Bourquin ,&nbsp;Shekhar Krishnan ,&nbsp;Vaskar Saha","doi":"10.1016/j.lansea.2025.100710","DOIUrl":"10.1016/j.lansea.2025.100710","url":null,"abstract":"<div><h3>Background</h3><div>Persistence of measurable residual disease (MRD) and high-risk cytogenetics are established predictors of relapse in childhood acute lymphoblastic leukaemia (ALL).</div></div><div><h3>Methods</h3><div>Outcomes of children with ALL treated with the ICiCLe-ALL-2014 protocol at a single centre, between August 2013 and May 2023 were analysed. Co-culture <em>ex-vivo</em> drug response profiling (DRP) was performed on diagnostic or relapsed samples. Patients classified as very high risk (VHR) received DRP guided therapeutic modifications. Event free (EFS) and overall (OS) survival were compared across risk categories.</div></div><div><h3>Findings</h3><div>Among 715 patients, at a median 55 (50–58) months, the 3-year EFS for standard-risk, intermediate-risk, high-risk B, T-ALL and VHR were 71% (64%–78%), 67% (58%–75%), 77% (70%–82%), 81% (71%–88%), and 38% (24%–52%) respectively (p &lt; 0.0001). Persistent MRD at end of consolidation was associated with inferior EFS (40.3%, p ≤ 0.0001). Drug sensitivity scores from DRP performed on 112 samples identified panobinostat (median DSS 23.4), venetoclax (20.7), daunorubicin (17.9), selinexor (12.7) and bortezomib (12.1) as effective in VHR or relapsed ALL. From November 2020, 25 VHR patients received a modified treatment block incorporating venetoclax and bortezomib. At 1.5-year, landmark EFS was 81.8% (58%–93%) with the modified regimen vs 67.7% (49–81) with standard therapy (p = 0.0324). Venetoclax sensitivity correlated with MRD clearance (p = 0.0070).</div></div><div><h3>Interpretation</h3><div>DRP enabled identification of effective agents for integration into therapy of VHR paediatric ALL. The addition of venetoclax and bortezomib was well tolerated and associated with improved early survival outcomes. These findings support prospective evaluation of DRP-guided treatment regimens in VHR ALL.</div></div><div><h3>Funding</h3><div><span>DBT-Wellcome India Alliance</span>, <span>Tata Consultancy Services</span>.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"44 ","pages":"Article 100710"},"PeriodicalIF":6.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884023","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}

{"title":"Household SARS-CoV-2 transmission during Omicron wave in Chiang Mai, Thailand: a prospective observational study","authors":"Woottichai Khamduang ,&nbsp;Pitaya Suebtam ,&nbsp;Intira Jeannie Collins ,&nbsp;Patumrat Sripan ,&nbsp;Kittipan Chalom ,&nbsp;Sayamon Hongjaisee ,&nbsp;Nang Kham-Kjing ,&nbsp;Nantawan Wangsaeng ,&nbsp;Premmarin Inmonthian ,&nbsp;Aphirak Pinasu ,&nbsp;Napatsakorn Kohklang ,&nbsp;Mathis Arnal ,&nbsp;Moira Spyer ,&nbsp;Ilse Steffens-Westerhof ,&nbsp;Apinun Aramrattana ,&nbsp;Marc Lallemant ,&nbsp;Chaisiri Angkurawaranon ,&nbsp;Patricia Bruijning-Verhagen ,&nbsp;Nicole Ngo-Giang-Huong ,&nbsp;Thailand VERDI-RECOVER study team","doi":"10.1016/j.lansea.2025.100711","DOIUrl":"10.1016/j.lansea.2025.100711","url":null,"abstract":"<div><h3>Background</h3><div>SARS-CoV-2 transmission studies involving children in Thailand have been relatively limited to the early waves with the alpha and delta variants. Our study aims to address these gaps by examining household transmission in Chiang Mai, northern Thailand, during the Omicron wave in a post vaccination period.</div></div><div><h3>Methods</h3><div>This prospective observational study enrolled households comprising a confirmed COVID-19 index patient with at least one uninfected contact and a child (&lt;18 years of age who maybe an index or contact). Participant data, nasopharyngeal swabs, and blood samples were collected at entry and final visit. Participants recorded daily symptoms for 21 days and self-administered SARS-CoV-2 antigen tests every other day for 14 days. Incident infections were confirmed by RT-PCR. Secondary attack rates (SARs) were calculated and associated factors were analyzed using multivariable generalized estimating equations models. Phylogenetic analysis was used to confirm intra-household transmission.</div></div><div><h3>Findings</h3><div>From July 2022 to May 2024, 93 households (93 index cases, 197 contacts) were enrolled; 52% of index cases and 49% of contacts were &lt;18 years. Among contacts, despite 89% (175/197) having received the SARS-CoV-2 vaccine (of whom 75% &gt; 6 months prior), 44 became infected, yielding a household SAR of 33% (95% CI: 24–44). In phylogenetically-confirmed transmission, SAR was 25% (95% CI: 17–35). Index low viral load (aRR: 0.82, 95% CI: 0.74–0.92) and contacts baseline anti-NCP IgG positivity (aRR: 0.42, 95% CI: 0.22–0.83) were significantly associated with lower household transmission.</div></div><div><h3>Interpretation</h3><div>Despite widespread vaccination, household transmission of SARS-CoV-2 remained common. Prior immunity in contacts and lower viral load in index cases reduced risk. These findings underscore the central role of households in ongoing spread and highlight the value of booster vaccination and genomic surveillance to clarify transmission pathways and inform prevention policies.</div></div><div><h3>Funding</h3><div>The study was funded by the <span>European Health and Digital Executive Agency</span> (HADEA), <span>European Commission</span>, and by the <span>Institut de Recherche pour le Développement</span> (IRD), France.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"44 ","pages":"Article 100711"},"PeriodicalIF":6.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939050","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}

{"title":"Is universal depression screening cost-effective across all Indian states? Addressing parameter uncertainty","authors":"Ziyi Niu ,&nbsp;Wenyan Tang ,&nbsp;Jiafeng Zhang","doi":"10.1016/j.lansea.2025.100712","DOIUrl":"10.1016/j.lansea.2025.100712","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"44 ","pages":"Article 100712"},"PeriodicalIF":6.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977226","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}

{"title":"Zero leprosy is within reach: eliminating leprosy in low-endemic settings demands political will","authors":"Anil Fastenau","doi":"10.1016/j.lansea.2025.100703","DOIUrl":"10.1016/j.lansea.2025.100703","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"44 ","pages":"Article 100703"},"PeriodicalIF":6.2,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690498","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}

{"title":"Prevalence of hypoxemia among sick children, aged under-five years, seeking healthcare at primary health facilities in Uttar Pradesh, India: an observational-cohort study","authors":"Shally Awasthi ,&nbsp;Divas Kumar ,&nbsp;Anuj Kumar Pandey ,&nbsp;Girdhar Gopal Agarwal ,&nbsp;Anmol Jacob ,&nbsp;Kovid Sharma ,&nbsp;Monika Agarwal ,&nbsp;Hélène Langet ,&nbsp;Gaurav Kumar ,&nbsp;Gillian A. Levine ,&nbsp;Silvia Cicconi ,&nbsp;Michael Ruffo ,&nbsp;Mira Emmanuel-Fabula ,&nbsp;Fenella Beynon ,&nbsp;Fabian Schär ,&nbsp;Kaspar Wyss ,&nbsp;Valérie D'Acremont ,&nbsp;TIMCI Collaborator Group","doi":"10.1016/j.lansea.2025.100706","DOIUrl":"10.1016/j.lansea.2025.100706","url":null,"abstract":"<div><h3>Background</h3><div>Hypoxemia or low blood oxygen saturation (SpO₂) increases risk of mortality in children aged under-five years. Integrated Management of Neonatal and Childhood Illness guidelines in India recommend referral to higher centre at SpO₂ &lt;90%. The primary objective was to assess prevalence of hypoxemia among sick under-five, seeking healthcare at rural primary health facilities in Uttar Pradesh, India. Secondary objective assessed completion of referral (defined as reaching higher referral facilities) in hypoxemic children by day-7.</div></div><div><h3>Methods</h3><div>Secondary data analyses from pulse oximetry (POx) arm of a cluster randomized trial. Hypoxemia, defined as SpO₂ &lt;94%, was assessed on day-0 and completion of referral through telephonic follow-up on day-7 (+2 days). Severe hypoxemia was defined as SpO₂ &lt;90%. Registration number: CTRI/2022/03/041325.</div></div><div><h3>Findings</h3><div>From 20-June-2022 to 21-April-2023, 24,966 children were enrolled, among whom SpO₂ readings were available for 94·4% (n = 23,560) children. Prevalence of hypoxemia was 1·3% (308/23,560) and severe hypoxemia was 29·2% (90/308). Lost to follow-up among hypoxemic was 9·4% (29/308). Among hypoxemic 27·9% (86/308) and among severe hypoxemic 46·7% (42/90) children were referred. Referral completion among hypoxemic was 20·3% (16/79) and severe hypoxemic 23·8% (10/40). Mortality in hypoxemic children was 3·9% (11/279), vs 0·05% (11/20,292) in non-hypoxemic ones.</div></div><div><h3>Interpretation</h3><div>Prevalence of hypoxemia is low among sick children presenting to rural health facilities of northern India. Less than one-third of hypoxemic children (and less than half of severely hypoxemic) were referred to higher facility, and only one in five completed referrals. Therefore, identifying and addressing the factors associated with these findings, would strengthen the integration of POx in primary healthcare facilities.</div></div><div><h3>Funding</h3><div>This work is supported by Unitaid as part of the <span>Tools for Integrated Management of Childhood Illness</span> (TIMCI) project under grant number n°2019-35-TIMCI to PATH.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"43 ","pages":"Article 100706"},"PeriodicalIF":6.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790035","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}

{"title":"Adapting WHO drowning prevention strategies for children in Indonesia: barriers, enablers, and policy perspectives for LMICs","authors":"Muthia Cenderadewi ,&nbsp;Richard C. Franklin ,&nbsp;Prima B. Fathana ,&nbsp;Susan G. Devine","doi":"10.1016/j.lansea.2025.100697","DOIUrl":"10.1016/j.lansea.2025.100697","url":null,"abstract":"<div><div>Drowning is among the top five causes of child mortality in some parts of Indonesia yet remains neglected in national health policy. This study explored how World Health Organization (WHO)-recommended drowning prevention strategies can be adapted in Indonesia through seven focus group discussions with 62 parents of children under five and community leaders across coastal and inland villages in West Nusa Tenggara Province. Participants identified barriers including financial constraints, rural inaccessibility, and sociocultural norms, alongside enablers such as community support for swimming lessons, supervised childcare, and first-aid training. Findings highlight the need for affordable and culturally appropriate interventions. Policy priorities include integrating swimming lessons into school curricula, subsidising community-based swimming programs, establishing supervised childcare centres, expanding first-aid training for community members as bystanders, and strengthening cross-sector coordination.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"43 ","pages":"Article 100697"},"PeriodicalIF":6.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145694089","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}