Outcome of newly diagnosed, transplant eligible, multiple myeloma (MM) patients have improved significantly during the past two decades. A small proportion of patients are long term survivors beyond 10 years. We evaluated clinical and laboratory characteristics of these long term survivors.
Methods
Four hundred and thirty eight consecutive MM patients underwent autologous stem cell transplantation (ASCT) between 1995 and 2019. Patients median age was 52 years, (range, 20–73) and 291 (66.4%) were males. 35.3% had ISS stage III disease. 96 (21.9%) patients were long term survivors (LTS), defined as those alive 120 months or more.
Findings
Compared to others, LTS patients more frequently had ISS stage I (42% vs 28.5%, p < 0.001), serum albumin ≥3.5 g/dl (72% vs 57%, p < 0.005), platelet count ≥150,000/μL (88% vs 71%, p < 0.001), eGFR ≥40 ml/min (85.4% vs 75%, p < 0.01), and bone marrow plasma cells ≤40% (60% vs 49%, p < 0.03). Transplant within 12 months of diagnosis (73% vs 51.5%, p < 0.001) and in first remission (89.6% vs 71.3%, p < 0.001) were more common in LTS. Post-ASCT response was superior: CR (80% vs 65.5%, p < 0.004), CR + VGPR (94.8% vs 82.5%, p < 0.001). At median follow-up of 115 months, median overall survival was 264 months and progression-free survival 158 months.
Interpretation
This study identifies a distinct subgroup of MM patients with long-term survival, characterized by favourable baseline features, early and effective treatment, and deep post-transplant responses, with a median progression-free survival exceeding 13 years.
Funding
No funding was received for present study.
背景：在过去的二十年中，新诊断的、符合移植条件的多发性骨髓瘤（MM）患者的预后有了显著改善。一小部分患者是10年以上的长期幸存者。我们评估了这些长期幸存者的临床和实验室特征。方法1995 - 2019年，连续438例MM患者行自体干细胞移植（ASCT）。患者中位年龄52岁（20 ~ 73岁），男性291例（66.4%）。35.3%为ISS III期。96例（21.9%）患者为长期幸存者（LTS），定义为存活120个月或更长时间的患者。结果：与其他患者相比，LTS患者更多出现ISS I期（42% vs 28.5%, p < 0.001）、血清白蛋白≥3.5 g/dl （72% vs 57%, p < 0.005）、血小板计数≥150000 /μL （88% vs 71%, p < 0.001）、eGFR≥40ml /min （85.4% vs 75%, p < 0.01）、骨髓浆细胞≤40% （60% vs 49%, p < 0.03）。诊断后12个月内移植（73% vs 51.5%, p < 0.001）和首次缓解（89.6% vs 71.3%, p < 0.001）在LTS中更为常见。asct后的反应更好：CR (80% vs 65.5%, p < 0.004), CR + VGPR （94.8% vs 82.5%, p < 0.001）。中位随访115个月，中位总生存期为264个月，无进展生存期为158个月。本研究确定了一个长期生存的MM患者亚组，其特点是良好的基线特征，早期有效的治疗，移植后深度反应，中位无进展生存期超过13年。本研究未获资助。
{"title":"Characteristics of long term survivors of multiple myeloma after autologous stem cell transplantation: a retrospective analysis from a tertiary care centre in India","authors":"Lalit Kumar , Rajegowda Chethan , Prabhat Singh Malik , Raja Pramanik , Ranjit Sahoo , Ahitagni Biswas , Omdutt Sharma , Ritu Gupta , Atul Sharma , Saumya Ranjan Mallick , AIIMS Myeloma Group","doi":"10.1016/j.lansea.2025.100680","DOIUrl":"10.1016/j.lansea.2025.100680","url":null,"abstract":"<div><h3>Background</h3><div>Outcome of newly diagnosed, transplant eligible, multiple myeloma (MM) patients have improved significantly during the past two decades. A small proportion of patients are long term survivors beyond 10 years. We evaluated clinical and laboratory characteristics of these long term survivors.</div></div><div><h3>Methods</h3><div>Four hundred and thirty eight consecutive MM patients underwent autologous stem cell transplantation (ASCT) between 1995 and 2019. Patients median age was 52 years, (range, 20–73) and 291 (66.4%) were males. 35.3% had ISS stage III disease. 96 (21.9%) patients were long term survivors (LTS), defined as those alive 120 months or more.</div></div><div><h3>Findings</h3><div>Compared to others, LTS patients more frequently had ISS stage I (42% vs 28.5%, p < 0.001), serum albumin ≥3.5 g/dl (72% vs 57%, p < 0.005), platelet count ≥150,000/μL (88% vs 71%, p < 0.001), eGFR ≥40 ml/min (85.4% vs 75%, p < 0.01), and bone marrow plasma cells ≤40% (60% vs 49%, p < 0.03). Transplant within 12 months of diagnosis (73% vs 51.5%, p < 0.001) and in first remission (89.6% vs 71.3%, p < 0.001) were more common in LTS. Post-ASCT response was superior: CR (80% vs 65.5%, p < 0.004), CR + VGPR (94.8% vs 82.5%, p < 0.001). At median follow-up of 115 months, median overall survival was 264 months and progression-free survival 158 months.</div></div><div><h3>Interpretation</h3><div>This study identifies a distinct subgroup of MM patients with long-term survival, characterized by favourable baseline features, early and effective treatment, and deep post-transplant responses, with a median progression-free survival exceeding 13 years.</div></div><div><h3>Funding</h3><div>No funding was received for present study.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"42 ","pages":"Article 100680"},"PeriodicalIF":6.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145417969","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 : 2025-11-01DOI: 10.1016/j.lansea.2025.100689
Bayu Satria Wiratama , Vicka Oktaria , Khoriah Indrihutami , Muhammad Hardhantyo , Ahmad Watsiq Maula , Hanevi Djasri , Rizka Dinari , Muhammad Syairaji , Suwarti , Ariel Pradipta , Dwi Utomo Nusantara , Ardiana Kusumaningrum , Andrew , Marillyn Mariana Tamburian , Ilma Safira Baehaqi , Rebecca Merrill , Henry Surendra , Fetty Wijayanti , Benjamin A. Dahl , Raph L. Hamers
Background
SARS-CoV-2 ancestral-strain vaccines have effectively reduced SARS-CoV-2-related severe illness and death worldwide. However, waning immunity over time has warranted revaccination to boost immunity. Indonesia, like most low- and middle-income countries, has not provided regular vaccine boosters post-pandemic. This study assessed the longer-term durability of protection from ancestral-strain third- and fourth-dose boosters.
Methods
We conducted a test-negative case–control study among symptomatic adults seeking SARS-CoV-2 testing at 14 purposely selected test sites in the major cities of Yogyakarta and Jakarta (March 2023–May 2024). Test-positive individuals were cases and test-negative individuals were controls. SARS-CoV-2 variants were identified using whole genome sequencing. We used multivariable logistic regression to estimate absolute or incremental vaccine effectiveness (VE) against symptomatic infection and COVID-19-related hospitalisation or death, adjusted for main confounders.
Findings
Of 2439 participants (median age 35 years, 56.2% female), 388 were cases and 2051 controls. Vaccination with two primary doses, a third-dose or fourth-dose booster did not provide sustained protection against Omicron XBB/JN.1 symptomatic infection up to median 27, 20 or 13 months since administration, respectively. However, there was sustained incremental protection from the third-dose booster (administered median 20 month prior) against hospitalisation (VE 38.3% [95% CI 3.9–60.3]) and death (55.2% [17.7–75.6]) for older individuals (aged >50 years), and against death (55.2% [12.8–76.9]) for individuals with one or more comorbidities. There was also sustained incremental protection from the fourth-dose booster (administered median 13 months prior) against hospitalisation for older individuals (50.2% [10.3–72.3]) and individuals with one or more comorbidities (74.4% [49.2–87.1]).
Interpretation
Ancestral-strain vaccine boosters provided durable, moderate protection against severe or fatal outcomes from Omicron XBB/JN.1 infection for older and comorbid individuals. The findings highlight the benefits of improving access to revaccination for vulnerable groups in Indonesia.
{"title":"Durability of protection of ancestral-strain COVID-19 third- and fourth-dose vaccine boosters against Omicron XBB/XBB.1 and JN.1 symptomatic infection, hospitalisation and mortality in Indonesian adults (2023–2024): a test-negative case–control study","authors":"Bayu Satria Wiratama , Vicka Oktaria , Khoriah Indrihutami , Muhammad Hardhantyo , Ahmad Watsiq Maula , Hanevi Djasri , Rizka Dinari , Muhammad Syairaji , Suwarti , Ariel Pradipta , Dwi Utomo Nusantara , Ardiana Kusumaningrum , Andrew , Marillyn Mariana Tamburian , Ilma Safira Baehaqi , Rebecca Merrill , Henry Surendra , Fetty Wijayanti , Benjamin A. Dahl , Raph L. Hamers","doi":"10.1016/j.lansea.2025.100689","DOIUrl":"10.1016/j.lansea.2025.100689","url":null,"abstract":"<div><h3>Background</h3><div>SARS-CoV-2 ancestral-strain vaccines have effectively reduced SARS-CoV-2-related severe illness and death worldwide. However, waning immunity over time has warranted revaccination to boost immunity. Indonesia, like most low- and middle-income countries, has not provided regular vaccine boosters post-pandemic. This study assessed the longer-term durability of protection from ancestral-strain third- and fourth-dose boosters.</div></div><div><h3>Methods</h3><div>We conducted a test-negative case–control study among symptomatic adults seeking SARS-CoV-2 testing at 14 purposely selected test sites in the major cities of Yogyakarta and Jakarta (March 2023–May 2024). Test-positive individuals were cases and test-negative individuals were controls. SARS-CoV-2 variants were identified using whole genome sequencing. We used multivariable logistic regression to estimate absolute or incremental vaccine effectiveness (VE) against symptomatic infection and COVID-19-related hospitalisation or death, adjusted for main confounders.</div></div><div><h3>Findings</h3><div>Of 2439 participants (median age 35 years, 56.2% female), 388 were cases and 2051 controls. Vaccination with two primary doses, a third-dose or fourth-dose booster did not provide sustained protection against Omicron XBB/JN.1 symptomatic infection up to median 27, 20 or 13 months since administration, respectively. However, there was sustained incremental protection from the third-dose booster (administered median 20 month prior) against hospitalisation (VE 38.3% [95% CI 3.9–60.3]) and death (55.2% [17.7–75.6]) for older individuals (aged >50 years), and against death (55.2% [12.8–76.9]) for individuals with one or more comorbidities. There was also sustained incremental protection from the fourth-dose booster (administered median 13 months prior) against hospitalisation for older individuals (50.2% [10.3–72.3]) and individuals with one or more comorbidities (74.4% [49.2–87.1]).</div></div><div><h3>Interpretation</h3><div>Ancestral-strain vaccine boosters provided durable, moderate protection against severe or fatal outcomes from Omicron XBB/JN.1 infection for older and comorbid individuals. The findings highlight the benefits of improving access to revaccination for vulnerable groups in Indonesia.</div></div><div><h3>Funding</h3><div>US <span>Centers for Diseases Control and Prevention.</span></div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"42 ","pages":"Article 100689"},"PeriodicalIF":6.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466923","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}
Chronic kidney disease of unknown cause (CKDu) has been reported in “hotspots” around the world and linked to occupational heat stress, exposure to agrochemicals and environmental toxins. This was a systematic, statewide, population-based, observational study of agricultural workers in Tamil Nadu, to estimate the prevalence of chronic kidney disease (CKD) and CKDu.
Methods
The state of Tamil Nadu was divided into five agroclimatic zones and stratified multi-stage cluster sampling was performed to select a representative study population. All participants underwent clinical evaluation and laboratory testing (Phase 1). Repeat sampling was performed after 3 months for all individuals with an eGFR <60 mL/min per 1.73 m2 during initial sampling (Phase 2).
Findings
Among 3350 participants who were screened, the number of participants with eGFR ≤60 mL/min per 1.73 m2 at the end of Phase 1 and Phase 2 were 584 and 178, respectively. The overall prevalence of CKD was therefore 5.31% (95% CI 4.58–6.13), with the prevalence of CKDu being 2.66% (95% CI 2.14–3.26). The factors that were significantly associated with CKD were increased age, diabetes, hypertension, absence of formal education, anaemia, smokeless tobacco use, and weekly hours of outdoor work. Notably, 406 participants with an eGFR ≤60 mL/min per 1.73 m2 during Phase 1 had a normal eGFR when re-measured during Phase 2. These episodes of transient subclinical AKI could potentially contribute to CKD.
Interpretation
The prevalence of CKD among agricultural workers in Tamil Nadu is 5.31%, with about half of these due to CKDu. The effect of transient subclinical AKI on CKD progression needs further study.
Funding
Tamil Nadu Health System Reform Program, Department of Health and Family Welfare, Government of Tamil Nadu.
背景不明原因慢性肾脏病（CKDu）已在世界各地的“热点”报道，并与职业性热应激，暴露于农用化学品和环境毒素有关。这是一项系统的、全州范围的、基于人群的、对泰米尔纳德邦农业工人的观察性研究，旨在估计慢性肾脏疾病（CKD）和CKDu的患病率。方法将泰米尔纳德邦划分为5个农业气候带，采用分层多阶段整群抽样的方法，选取具有代表性的研究人群。所有参与者都进行了临床评估和实验室测试（第一阶段）。3个月后对所有初始采样时eGFR为60 mL/min / 1.73 m2的个体进行重复采样（第二阶段）。在筛选的3350名参与者中，在1期和2期结束时eGFR≤60 mL/min / 1.73 m2的参与者人数分别为584人和178人。因此，CKD的总患病率为5.31% (95% CI 4.58-6.13)， CKDu的患病率为2.66% （95% CI 2.14-3.26）。与CKD显著相关的因素是年龄增加、糖尿病、高血压、缺乏正规教育、贫血、无烟烟草使用和每周户外工作时间。值得注意的是，406名在第一阶段eGFR≤60 mL/min / 1.73 m2的参与者在第二阶段重新测量eGFR时正常。这些短暂的亚临床AKI发作可能会导致CKD。泰米尔纳德邦农业工人CKD患病率为5.31%，其中约一半由CKDu引起。短暂性亚临床AKI对CKD进展的影响有待进一步研究。资助泰米尔纳德邦政府卫生和家庭福利部泰米尔纳德邦卫生系统改革方案。
{"title":"CKDu-AGRI Study—a population-based cross-sectional study of chronic kidney disease and chronic kidney disease of unknown aetiology among agricultural workers in Tamil Nadu, India","authors":"Natarajan Gopalakrishnan , Subramaniam Sudharshini , Ramanathan Sakthirajan , Thanigachalam Dineshkumar , Tanuj Moses Lamech , Anavarathan Somasundaram , Seshadri Jayalakshmi , Uma Maheswari , Sivadoss Raju , Mookaiah Seenivasan , Venkatesh Arumugam , Nandakumar Nachimuthu , Janani Surya , Suliankatchi Abdulkader Rizwan , Vishwanathan Ramasubramaniam , Rajendran Kasirajan Manorajan , Ayyakkannu Indirani Nigazh , Sivaprakasam T. Selvavinayagam","doi":"10.1016/j.lansea.2025.100683","DOIUrl":"10.1016/j.lansea.2025.100683","url":null,"abstract":"<div><h3>Background</h3><div>Chronic kidney disease of unknown cause (CKDu) has been reported in “hotspots” around the world and linked to occupational heat stress, exposure to agrochemicals and environmental toxins. This was a systematic, statewide, population-based, observational study of agricultural workers in Tamil Nadu, to estimate the prevalence of chronic kidney disease (CKD) and CKDu.</div></div><div><h3>Methods</h3><div>The state of Tamil Nadu was divided into five agroclimatic zones and stratified multi-stage cluster sampling was performed to select a representative study population. All participants underwent clinical evaluation and laboratory testing (Phase 1). Repeat sampling was performed after 3 months for all individuals with an eGFR <60 mL/min per 1.73 m<sup>2</sup> during initial sampling (Phase 2).</div></div><div><h3>Findings</h3><div>Among 3350 participants who were screened, the number of participants with eGFR ≤60 mL/min per 1.73 m<sup>2</sup> at the end of Phase 1 and Phase 2 were 584 and 178, respectively. The overall prevalence of CKD was therefore 5.31% (95% CI 4.58–6.13), with the prevalence of CKDu being 2.66% (95% CI 2.14–3.26). The factors that were significantly associated with CKD were increased age, diabetes, hypertension, absence of formal education, anaemia, smokeless tobacco use, and weekly hours of outdoor work. Notably, 406 participants with an eGFR ≤60 mL/min per 1.73 m<sup>2</sup> during Phase 1 had a normal eGFR when re-measured during Phase 2. These episodes of transient subclinical AKI could potentially contribute to CKD.</div></div><div><h3>Interpretation</h3><div>The prevalence of CKD among agricultural workers in Tamil Nadu is 5.31%, with about half of these due to CKDu. The effect of transient subclinical AKI on CKD progression needs further study.</div></div><div><h3>Funding</h3><div><span>Tamil Nadu Health System Reform Program</span>, <span>Department of Health and Family Welfare</span>, <span>Government of Tamil Nadu</span>.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"42 ","pages":"Article 100683"},"PeriodicalIF":6.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145417966","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 : 2025-10-25DOI: 10.1016/j.lansea.2025.100685
Satyajit Kundu , Rajat Das Gupta
{"title":"A missing piece in Bangladesh's nutrition agenda: indigenous children and adolescents in the Chittagong Hill Tracts","authors":"Satyajit Kundu , Rajat Das Gupta","doi":"10.1016/j.lansea.2025.100685","DOIUrl":"10.1016/j.lansea.2025.100685","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"42 ","pages":"Article 100685"},"PeriodicalIF":6.2,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145364242","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 : 2025-10-10DOI: 10.1016/j.lansea.2025.100681
Sandersan Onie , Patrick Berlinquette , Stephanie Onie , Jessica Nilam , Jiemi Ardian , Anna Surti Ariani , Juneman Abraham , Daiane B. Machado , Mark Sinyor , Michelle Torok , Fiona Shand , Mark Larsen
Background
Suicide is a global public health issue, with over 75% of deaths occurring in low- and middle-income countries (LMICs), where access to mental health services is often limited. In Indonesia, where stigma is high and professional support scarce, there is a critical need for scalable, non-traditional approaches to reach individuals at risk. One such approach is using online search engine advertisements to engage individuals searching for suicide-related content and encourage help-seeking.
Methods
This study analysed data from an online Google Ads campaign conducted in Indonesia in March 2023, targeting individuals searching for suicide-related keywords. The campaign was co-designed with local experts and people with lived experience. We compared its engagement and cost-effectiveness to similar campaigns previously conducted in the USA and Australia. The primary outcome was total engagement rate (engagements/impressions), and the secondary outcome was effective cost per engagement (adjusted for purchasing power and inflation).
Findings
The Indonesian campaign achieved an engagement rate of 11.04%, which was 18 times higher than the US campaign (0.61%) and 15 times higher than the Australian campaign (0.72%). It also had an effective cost per engagement five times lower than those in the USA and Australia. All campaigns outperformed industry standards for health and medical advertising.
Interpretation
Search engine advertising is a rapid, cost-effective, and scalable tool to connect individuals in Indonesia with suicide prevention support. These findings underscore the importance of context-specific research in LMICs, where interventions may have greater impact than predicted from high-income country data.
Funding
The study was funded by the Australian Department of Foreign Affairs and Trade, Australian-Indonesian Institute (AII2020322), an NHMRC Investigator Grant (GNT2034904), Suicide Prevention Australia Innovation Grant, and the Lynch Family Foundation Research Fellowship in Global Health Equity.
{"title":"Search engine ads for suicide prevention: analysis of engagement from Indonesia relative to Australia, the USA, and the medical industry standards","authors":"Sandersan Onie , Patrick Berlinquette , Stephanie Onie , Jessica Nilam , Jiemi Ardian , Anna Surti Ariani , Juneman Abraham , Daiane B. Machado , Mark Sinyor , Michelle Torok , Fiona Shand , Mark Larsen","doi":"10.1016/j.lansea.2025.100681","DOIUrl":"10.1016/j.lansea.2025.100681","url":null,"abstract":"<div><h3>Background</h3><div>Suicide is a global public health issue, with over 75% of deaths occurring in low- and middle-income countries (LMICs), where access to mental health services is often limited. In Indonesia, where stigma is high and professional support scarce, there is a critical need for scalable, non-traditional approaches to reach individuals at risk. One such approach is using online search engine advertisements to engage individuals searching for suicide-related content and encourage help-seeking.</div></div><div><h3>Methods</h3><div>This study analysed data from an online Google Ads campaign conducted in Indonesia in March 2023, targeting individuals searching for suicide-related keywords. The campaign was co-designed with local experts and people with lived experience. We compared its engagement and cost-effectiveness to similar campaigns previously conducted in the USA and Australia. The primary outcome was total engagement rate (engagements/impressions), and the secondary outcome was effective cost per engagement (adjusted for purchasing power and inflation).</div></div><div><h3>Findings</h3><div>The Indonesian campaign achieved an engagement rate of 11.04%, which was 18 times higher than the US campaign (0.61%) and 15 times higher than the Australian campaign (0.72%). It also had an effective cost per engagement five times lower than those in the USA and Australia. All campaigns outperformed industry standards for health and medical advertising.</div></div><div><h3>Interpretation</h3><div>Search engine advertising is a rapid, cost-effective, and scalable tool to connect individuals in Indonesia with suicide prevention support. These findings underscore the importance of context-specific research in LMICs, where interventions may have greater impact than predicted from high-income country data.</div></div><div><h3>Funding</h3><div>The study was funded by the <span>Australian Department of Foreign Affairs and Trade</span>, <span>Australian-Indonesian Institute</span> (<span><span>AII2020322</span></span>), an <span>NHMRC Investigator Grant</span> (<span><span>GNT2034904</span></span>), <span>Suicide Prevention Australia Innovation Grant</span>, and the <span>Lynch Family Foundation Research Fellowship in Global Health Equity</span>.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"42 ","pages":"Article 100681"},"PeriodicalIF":6.2,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145270150","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}
Delivery at ‘term’ is considered low risk for mothers and neonates. Evidence suggests variable outcomes at different gestations, even within ‘term’. This study aims to compare pregnancy characteristics and neonatal outcomes of delivery at different gestations at ‘term’.
Methods
We analysed the data of the island-wide multicentre Sri Lanka Birth Weight Study, which recruited all live-born newborns in 13 hospitals over 2 months in 2023. Only data of singleton pregnancies and term neonates were included. Pregnancy complications and neonatal outcomes of each gestation were analysed by logistic regression.
Findings
8053 ‘term’ singleton deliveries (1805, 2367, 2087, 1762, and 32 at 37, 38, 39, 40 and 41 weeks) were included. A higher proportion of mothers delivering at 37 weeks had pregestational diabetes (AOR: 7.84, 95% CI: 4.24–14.37), chronic hypertension (AOR: 4.37, 95% CI: 2.01–9.49), pregnancy-induced hypertension (AOR: 2.65, 95% CI: 1.92–3.66) and gestational diabetes (AOR: 1.96, 95% CI: 1.57–2.44) compared to mothers delivering at 39 weeks. The elective caesarean section rate was highest at 37 weeks (783, 43.4%) compared to 38 weeks (737, 31.1%) or higher gestations. Delivery at 37 weeks was associated with inferior neonatal outcomes of 5-min APGAR <8 (AOR: 3.04, 95% CI: 1.36–6.76), requiring resuscitation (AOR: 1.74, 95% CI: 1.27–2.38) and admission to intensive care (AOR: 1.62, 95% CI: 1.09–2.41) compared to 38 weeks.
Interpretation
Neonates born at 38 weeks showed better outcomes than those born at 37 weeks. When elective delivery is necessary, postponing it from 37 weeks to at least 38 weeks would positively impact neonatal outcomes.
Funding
UNICEF, Sri Lanka, funded the Sri Lanka Birth Weight Study. No funding obtained for this manuscript.
{"title":"Pregnancy and neonatal outcomes of term deliveries of singleton pregnancies at different gestations in Sri Lanka: a multicentre prospective study","authors":"Sachith Mettananda , Himali Herath , Ranod Madushith , Tiran Dias , Rasika Herath , Sampatha Goonewardena , Dhammica Rowel , Abner Elkan Daniel , Susie Perera","doi":"10.1016/j.lansea.2025.100677","DOIUrl":"10.1016/j.lansea.2025.100677","url":null,"abstract":"<div><h3>Background</h3><div>Delivery at ‘term’ is considered low risk for mothers and neonates. Evidence suggests variable outcomes at different gestations, even within ‘term’. This study aims to compare pregnancy characteristics and neonatal outcomes of delivery at different gestations at ‘term’.</div></div><div><h3>Methods</h3><div>We analysed the data of the island-wide multicentre Sri Lanka Birth Weight Study, which recruited all live-born newborns in 13 hospitals over 2 months in 2023. Only data of singleton pregnancies and term neonates were included. Pregnancy complications and neonatal outcomes of each gestation were analysed by logistic regression.</div></div><div><h3>Findings</h3><div>8053 ‘term’ singleton deliveries (1805, 2367, 2087, 1762, and 32 at 37, 38, 39, 40 and 41 weeks) were included. A higher proportion of mothers delivering at 37 weeks had pregestational diabetes (AOR: 7.84, 95% CI: 4.24–14.37), chronic hypertension (AOR: 4.37, 95% CI: 2.01–9.49), pregnancy-induced hypertension (AOR: 2.65, 95% CI: 1.92–3.66) and gestational diabetes (AOR: 1.96, 95% CI: 1.57–2.44) compared to mothers delivering at 39 weeks. The elective caesarean section rate was highest at 37 weeks (783, 43.4%) compared to 38 weeks (737, 31.1%) or higher gestations. Delivery at 37 weeks was associated with inferior neonatal outcomes of 5-min APGAR <8 (AOR: 3.04, 95% CI: 1.36–6.76), requiring resuscitation (AOR: 1.74, 95% CI: 1.27–2.38) and admission to intensive care (AOR: 1.62, 95% CI: 1.09–2.41) compared to 38 weeks.</div></div><div><h3>Interpretation</h3><div>Neonates born at 38 weeks showed better outcomes than those born at 37 weeks. When elective delivery is necessary, postponing it from 37 weeks to at least 38 weeks would positively impact neonatal outcomes.</div></div><div><h3>Funding</h3><div><span>UNICEF</span>, Sri Lanka, funded the Sri Lanka Birth Weight Study. No funding obtained for this manuscript.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"42 ","pages":"Article 100677"},"PeriodicalIF":6.2,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145222996","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 : 2025-09-29DOI: 10.1016/j.lansea.2025.100676
Nisaa Wulan , Lekey Khandu , Debra Ten Brink , Gyambo Sithey , Tashi Dendup , Ye Yu Shwe , Anna Bowring , Nick Scott , Kelvin Burke , Rowan Martin-Hughes
Background
There are limited and conflicting data regarding HIV transmission and behavioural risk factors, particularly among groups with increased risk of exposure to HIV in Bhutan. This study aims to explore comprehensive pathways to HIV infections among key populations in Bhutan.
Methods
Demographic, epidemiological, and behavioural data were collated to inform an Optima HIV model for Bhutan. The model was calibrated for a period 1990 and 2021 to align with emerging national research into risk attribution of HIV infections and behavioural dynamics of key populations. This was supplemented by qualitative feedback from stakeholder consultations throughout January–June 2022, while maintaining the consistency of the country-accepted output from the 2022 Estimation and Projection Package (EPP-Spectrum model) across all years.
Findings
In 2021, sex work was directly associated with 54% of new HIV infections. In total, 86% of new HIV infections were estimated to be among key and vulnerable populations, their direct partners, and their children. HIV prevalence remained low, ranging from 0.7% to 3.1% among key populations. Due to the relatively short duration of risk activity (average of three years among female sex workers [FSW]), only an estimated 9.7% of undiagnosed people living with HIV could be reached through interventions focused on key populations.
Interpretation
Greater efforts in developing strategies that can prevent new HIV infections among individuals currently at risk—and identifying undiagnosed HIV infections among those with historic risk who are not currently accessing HIV services—could help achieve the elimination of HIV transmission in Bhutan.
Funding
This analysis was funded through The Sustainability of HIV Services for Key Populations in Southeast Asia (SKPA-1) project, funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria under agreement QMZ-H-AFAO, with Health Equity Matters as Principal Recipient. Save the Children is the sub-recipient of SKPA in Bhutan.
关于艾滋病毒传播和行为风险因素的数据有限且相互矛盾，特别是在不丹艾滋病毒暴露风险增加的群体中。本研究旨在探索不丹关键人群感染艾滋病毒的综合途径。方法对人口统计、流行病学和行为数据进行整理，为不丹的Optima HIV模型提供信息。该模型在1990年和2021年期间进行了校准，以配合新兴的国家对艾滋病毒感染风险归因和关键人群行为动态的研究。在2022年1月至6月期间，利益攸关方磋商的定性反馈作为补充，同时在所有年份保持国家接受的2022年估算和预测一揽子计划（EPP-Spectrum模型）产出的一致性。2021年，性工作与54%的新增艾滋病毒感染直接相关。总的来说，估计86%的艾滋病毒新感染发生在关键和脆弱人群、他们的直接伴侣及其子女中。艾滋病毒流行率仍然很低，在重点人群中为0.7%至3.1%。由于风险活动的持续时间相对较短（女性性工作者[FSW]的平均时间为三年），通过针对重点人群的干预措施，估计只有9.7%的未确诊的艾滋病毒感染者能够得到帮助。在制定战略方面作出更大努力，以防止目前处于危险中的个人感染新的艾滋病毒，并在那些目前没有获得艾滋病毒服务的历史风险人群中确定未诊断的艾滋病毒感染，这有助于消除不丹的艾滋病毒传播。这项分析是通过东南亚重点人群艾滋病毒服务可持续性项目（SKPA-1）资助的，该项目由全球防治艾滋病、结核病和疟疾基金根据qmz - h -粮农组织协议资助，卫生公平事项为主要接受方。救助儿童会是不丹SKPA的次级接受者。
{"title":"Establishing HIV transmission pathways in Bhutan: a modelling study","authors":"Nisaa Wulan , Lekey Khandu , Debra Ten Brink , Gyambo Sithey , Tashi Dendup , Ye Yu Shwe , Anna Bowring , Nick Scott , Kelvin Burke , Rowan Martin-Hughes","doi":"10.1016/j.lansea.2025.100676","DOIUrl":"10.1016/j.lansea.2025.100676","url":null,"abstract":"<div><h3>Background</h3><div>There are limited and conflicting data regarding HIV transmission and behavioural risk factors, particularly among groups with increased risk of exposure to HIV in Bhutan. This study aims to explore comprehensive pathways to HIV infections among key populations in Bhutan.</div></div><div><h3>Methods</h3><div>Demographic, epidemiological, and behavioural data were collated to inform an Optima HIV model for Bhutan. The model was calibrated for a period 1990 and 2021 to align with emerging national research into risk attribution of HIV infections and behavioural dynamics of key populations. This was supplemented by qualitative feedback from stakeholder consultations throughout January–June 2022, while maintaining the consistency of the country-accepted output from the 2022 Estimation and Projection Package (EPP-Spectrum model) across all years.</div></div><div><h3>Findings</h3><div>In 2021, sex work was directly associated with 54% of new HIV infections. In total, 86% of new HIV infections were estimated to be among key and vulnerable populations, their direct partners, and their children. HIV prevalence remained low, ranging from 0.7% to 3.1% among key populations. Due to the relatively short duration of risk activity (average of three years among female sex workers [FSW]), only an estimated 9.7% of undiagnosed people living with HIV could be reached through interventions focused on key populations.</div></div><div><h3>Interpretation</h3><div>Greater efforts in developing strategies that can prevent new HIV infections among individuals currently at risk—and identifying undiagnosed HIV infections among those with historic risk who are not currently accessing HIV services—could help achieve the elimination of HIV transmission in Bhutan.</div></div><div><h3>Funding</h3><div>This analysis was funded through The Sustainability of HIV Services for Key Populations in Southeast Asia (SKPA-1) project, funded by the <span>Global Fund to Fight AIDS</span>, <span>Tuberculosis and Malaria under agreement QMZ-H-AFAO</span>, with Health Equity Matters as Principal Recipient. Save the Children is the sub-recipient of SKPA in Bhutan.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"42 ","pages":"Article 100676"},"PeriodicalIF":6.2,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183447","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}
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