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}
Pub Date : 2025-09-25DOI: 10.1016/j.lansea.2025.100673
Fahmida Tasnim Richi , Safaet Alam
Bangladesh has achieved notable improvements in nutrition, including declines in undernourishment and stunting. There has been uneven progress, with high rates of stunting and wasting persisting in some areas, such as Sylhet. Food availability has improved, but diet diversity and quality remain low, resulting in chronic micronutrient deficiencies, particularly among women and children. At the same time, rates of overweight, obesity, and diet-related non-communicable diseases (NCDs) are rising, signaling a double burden of malnutrition. Combined with systemic vulnerabilities such as poverty, gender inequality, and climate change, this double burden runs the risk of undoing the progress already achieved. Bangladesh needs to reorient policies to focus on diet quality, increase consumption of micronutrients, and prevent obesity and noncommunicable diseases. The primary recommendations include expanding access to nutrition services, developing climate-resilient food systems, and strengthening nutrition-sensitive governance and policy. Other countries undergoing similar changes can learn valuable lessons from Bangladesh's experience, which underscores the need for an integrated, long-term strategy for nutrition and public health.
{"title":"From hidden hunger to double burden: Bangladesh's urgent need to prioritize diet quality","authors":"Fahmida Tasnim Richi , Safaet Alam","doi":"10.1016/j.lansea.2025.100673","DOIUrl":"10.1016/j.lansea.2025.100673","url":null,"abstract":"<div><div>Bangladesh has achieved notable improvements in nutrition, including declines in undernourishment and stunting. There has been uneven progress, with high rates of stunting and wasting persisting in some areas, such as Sylhet. Food availability has improved, but diet diversity and quality remain low, resulting in chronic micronutrient deficiencies, particularly among women and children. At the same time, rates of overweight, obesity, and diet-related non-communicable diseases (NCDs) are rising, signaling a double burden of malnutrition. Combined with systemic vulnerabilities such as poverty, gender inequality, and climate change, this double burden runs the risk of undoing the progress already achieved. Bangladesh needs to reorient policies to focus on diet quality, increase consumption of micronutrients, and prevent obesity and noncommunicable diseases. The primary recommendations include expanding access to nutrition services, developing climate-resilient food systems, and strengthening nutrition-sensitive governance and policy. Other countries undergoing similar changes can learn valuable lessons from Bangladesh's experience, which underscores the need for an integrated, long-term strategy for nutrition and public health.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"41 ","pages":"Article 100673"},"PeriodicalIF":6.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158317","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}
India accounts for one-fifth of the global hepatitis A virus (HAV) infections and half of HAV-related deaths. There is a lack of nationally representative population-based data on the endemicity of HAV to inform vaccination policy. We aimed to estimate the age-specific seroprevalence of HAV infection among individuals aged 6–30 years.
Methods
We used serum samples collected during the fourth national COVID-19 serosurvey conducted between 14 June and 6 July 2021 to estimate the seroprevalence of HAV infection. The survey was conducted in 70 randomly selected districts across 20 Indian states and one union territory. We tested the serum samples from individuals aged six to 30 years for IgG antibodies against HAV. We estimated the overall and state-specific seroprevalence, along with 95% CIs, for the age groups of 6–10, 11–15 and 16–30 years. We classified the HAV endemicity in India using WHO classification (high, intermediate, low and very low).
Findings
We tested 14,778 serum samples from individuals aged six to 30 years for IgG antibodies against HAV. Of these, 12,236 (90.0%, 95% CI 88.5–91.4) were found to be reactive. The seroprevalence increased with age, from 74.7% (71.1–77.9) among children aged 6–10 years to 85.2% (82.7–87.4) among those aged 11–15 years and 96.9% (96.3–97.5) among individuals aged 16–30 years. India was categorized as having intermediate endemicity for HAV infection as per the WHO classification. Of the 21 states or union territories included in the survey, 18 had intermediate endemicity.
Interpretation
Our study findings indicate an intermediate level of endemicity for HAV infection in India. While these findings support consideration of hepatitis-A vaccination, further evidence on disease burden and cost-effectiveness is needed to inform policy decisions.
Funding
Gates Foundation & Indian Council of Medical Research.
{"title":"Seroprevalence of IgG antibodies against hepatitis-A infection among individuals aged 6–30 years in India, 2021: a nationwide population-based cross-sectional study","authors":"Muthusamy Santhosh Kumar , Chethrapilly Purushothaman Girish Kumar , Velusamy Saravanakumar , Thiyagarajan Karunakaran , Jeromie Wesley Vivian Thangaraj , Sriram Selvaraju , Kiran Rade , Ramasamy Sabarinathan , Surendran Parvathi , Smita Asthana , Rakesh Balachandar , Sampada Dipak Bangar , Avi Kumar Bansal , Jyothi Bhat , Debjit Chakraborty , Vishal Chopra , Dasarathi Das , Kangjam Rekha Devi , Gaurav Raj Dwivedi , S Muhammad Salim Khan , Krishna Pandey","doi":"10.1016/j.lansea.2025.100669","DOIUrl":"10.1016/j.lansea.2025.100669","url":null,"abstract":"<div><h3>Background</h3><div>India accounts for one-fifth of the global hepatitis A virus (HAV) infections and half of HAV-related deaths. There is a lack of nationally representative population-based data on the endemicity of HAV to inform vaccination policy. We aimed to estimate the age-specific seroprevalence of HAV infection among individuals aged 6–30 years.</div></div><div><h3>Methods</h3><div>We used serum samples collected during the fourth national COVID-19 serosurvey conducted between 14 June and 6 July 2021 to estimate the seroprevalence of HAV infection. The survey was conducted in 70 randomly selected districts across 20 Indian states and one union territory. We tested the serum samples from individuals aged six to 30 years for IgG antibodies against HAV. We estimated the overall and state-specific seroprevalence, along with 95% CIs, for the age groups of 6–10, 11–15 and 16–30 years. We classified the HAV endemicity in India using WHO classification (high, intermediate, low and very low).</div></div><div><h3>Findings</h3><div>We tested 14,778 serum samples from individuals aged six to 30 years for IgG antibodies against HAV. Of these, 12,236 (90.0%, 95% CI 88.5–91.4) were found to be reactive. The seroprevalence increased with age, from 74.7% (71.1–77.9) among children aged 6–10 years to 85.2% (82.7–87.4) among those aged 11–15 years and 96.9% (96.3–97.5) among individuals aged 16–30 years. India was categorized as having intermediate endemicity for HAV infection as per the WHO classification. Of the 21 states or union territories included in the survey, 18 had intermediate endemicity.</div></div><div><h3>Interpretation</h3><div>Our study findings indicate an intermediate level of endemicity for HAV infection in India. While these findings support consideration of hepatitis-A vaccination, further evidence on disease burden and cost-effectiveness is needed to inform policy decisions.</div></div><div><h3>Funding</h3><div><span>Gates Foundation</span> & <span>Indian Council of Medical Research</span>.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"41 ","pages":"Article 100669"},"PeriodicalIF":6.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158332","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}
Nafithromycin, a novel macrolide belonging to the lactone ketolide subclass, exhibits excellent in vitro potency against pathogens causing community-acquired bacterial pneumonia (CABP), in conjunction with high and sustained pulmonary concentrations allowing for once-daily dosing. We aimed to compare efficacy and safety of nafithromycin with moxifloxacin for treatment of CABP.
Methods
This was a phase III, randomized, double-blind, non-inferiority study in adults with CABP (PORT risk class II, III, IV), conducted at 31 sites across India. Patients were randomized (1:1) via block randomisation using interactive voice/web response system to receive oral nafithromycin 800 mg q24h for 3 days or oral moxifloxacin 400 mg q24h for 7 days. The primary efficacy endpoint was the proportion of patients with early clinical response (ECR) at Day 4 in the modified-intent-to-treat population (MITT). Favourable ECR was defined as alive and ≥1 level improvement in ≥2 CABP symptoms compared to baseline and without worsening of other CABP symptoms. A non-inferiority margin of 12.5% was utilised. This trial is registered with Clinical Trial Registry—India (CTRI/2019/11/021964).
Findings
Between February 2021 and June 2023, 488 patients were enrolled with 244 randomized to each treatment. MITT population included 477 patients with 40% belonging to PORT risk class III/IV. Demography and baseline characteristics were comparable between groups. ECR was observed in 91.3% (220/241) of patients in nafithromycin group and 89.0% (210/236) of patients in moxifloxacin group of the MITT population [difference, 2.3%; 95% CI (−3.1, 7.8)] establishing statistical non-inferiority between treatments. Most common treatment-emergent adverse events reported (≥2% patients in any treatment group) were abdominal pain, diarrhoea, headache and nausea, which were all mild in severity.
Interpretation
A 3-day regimen of oral nafithromycin was non-inferior to a 7-day regimen of oral moxifloxacin for the treatment of CABP.
Funding
Co-funded by Wockhardt and BIRAC, Department of Biotechnology, Government of India.
{"title":"Efficacy and safety of a 3-day once-daily regimen of oral nafithromycin in comparison to oral moxifloxacin for the treatment of community-acquired bacterial pneumonia in adults: a phase III, randomized, double-blind controlled trial","authors":"Himanshu Pophale , Monica Gupta , Lily Llorens , Piotr Iwanowski , Ranjeet Gutte , Rajesh Chavan , Anasuya Patel , Harsha Agrawal , Snehal Palwe , Prashant Joshi , Hariharan Periasamy , Mahesh Patel , Balaji Veeraraghavan , Sachin Bhagwat","doi":"10.1016/j.lansea.2025.100666","DOIUrl":"10.1016/j.lansea.2025.100666","url":null,"abstract":"<div><h3>Background</h3><div>Nafithromycin, a novel macrolide belonging to the lactone ketolide subclass, exhibits excellent <em>in vitro</em> potency against pathogens causing community-acquired bacterial pneumonia (CABP), in conjunction with high and sustained pulmonary concentrations allowing for once-daily dosing. We aimed to compare efficacy and safety of nafithromycin with moxifloxacin for treatment of CABP.</div></div><div><h3>Methods</h3><div>This was a phase III, randomized, double-blind, non-inferiority study in adults with CABP (PORT risk class II, III, IV), conducted at 31 sites across India. Patients were randomized (1:1) via block randomisation using interactive voice/web response system to receive oral nafithromycin 800 mg q24h for 3 days or oral moxifloxacin 400 mg q24h for 7 days. The primary efficacy endpoint was the proportion of patients with early clinical response (ECR) at Day 4 in the modified-intent-to-treat population (MITT). Favourable ECR was defined as alive and ≥1 level improvement in ≥2 CABP symptoms compared to baseline and without worsening of other CABP symptoms. A non-inferiority margin of 12.5% was utilised. This trial is registered with Clinical Trial Registry—India (CTRI/2019/11/021964).</div></div><div><h3>Findings</h3><div>Between February 2021 and June 2023, 488 patients were enrolled with 244 randomized to each treatment. MITT population included 477 patients with 40% belonging to PORT risk class III/IV. Demography and baseline characteristics were comparable between groups. ECR was observed in 91.3% (220/241) of patients in nafithromycin group and 89.0% (210/236) of patients in moxifloxacin group of the MITT population [difference, 2.3%; 95% CI (−3.1, 7.8)] establishing statistical non-inferiority between treatments. Most common treatment-emergent adverse events reported (≥2% patients in any treatment group) were abdominal pain, diarrhoea, headache and nausea, which were all mild in severity.</div></div><div><h3>Interpretation</h3><div>A 3-day regimen of oral nafithromycin was non-inferior to a 7-day regimen of oral moxifloxacin for the treatment of CABP.</div></div><div><h3>Funding</h3><div>Co-funded by <span>Wockhardt</span> and <span>BIRAC</span>, <span>Department of Biotechnology</span>, <span>Government of India</span>.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"41 ","pages":"Article 100666"},"PeriodicalIF":6.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145121132","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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