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}
Newborn screening for sickle cell disease (NBS for SCD) is essential for timely detection and management. In 2019, a study encompassing early screening, follow-up, and comprehensive care for SCD babies was undertaken in seven SCD-prevalent tribal regions of India. The study also aimed to identify the barriers and facilitators affecting its implementation.
Methods
A qualitative exploratory descriptive approach was used to conduct in-depth interviews with purposively selected participants (n = 127) including parents of newborns with SCD. The data were compiled and analysed using NVivo14. Predominant themes were identified through frequency analysis and the number of references, and they were further classified using the Multilevel Ecological Model of Health (MEMH).
Findings
Twenty-five themes emerged, of which thirteen highlighted barriers, the predominant ones being stigma & local beliefs, lack of integration of NBS with the health system, accessibility challenges and difficulties with blood sample collection & testing. Seven themes addressed facilitators such as the inclusion of frontline health workers, skilled human resources and regular follow-ups. Five themes emerged for recommendations including integrating NBS for SCD into the health system, behaviour change communication and enhanced stakeholder collaboration.
Interpretation
The study identified barriers and facilitators across multiple levels, advocating the need for a holistic approach. The findings suggest that a comprehensive SCD management program must address socio-cultural dimensions and effectively integrate with the health system, providing valuable insights for shaping policies for NBS in SCD-prevalent areas.
Funding
The study was funded by the Indian Council of Medical Research.
背景新生儿镰状细胞病（NBS for SCD）筛查对于及时发现和管理至关重要。2019年，在印度七个流行SCD的部落地区进行了一项包括SCD婴儿早期筛查、随访和全面护理的研究。这项研究还旨在查明影响其执行的障碍和促进因素。方法采用定性探索性描述方法，对有目的选择的包括新生儿SCD父母在内的参与者（n = 127）进行深度访谈。使用NVivo14对数据进行编译和分析。通过频率分析和参考文献数量确定主要主题，并使用多层健康生态模型（MEMH）对其进行进一步分类。共出现了25个主题，其中13个突出了障碍，主要是耻辱和地方信仰、国家统计局与卫生系统缺乏整合、可获得性挑战和血液样本采集和检测方面的困难。七个主题涉及促进因素，如纳入一线卫生工作者、熟练人力资源和定期后续行动。建议提出了五个主题，包括将国家统计局纳入卫生系统、行为改变沟通和加强利益攸关方合作。该研究确定了跨多个层面的障碍和促进因素，主张需要一个整体的方法。研究结果表明，一个全面的SCD管理计划必须解决社会文化层面的问题，并有效地与卫生系统相结合，为制定SCD流行地区的NBS政策提供有价值的见解。这项研究是由印度医学研究委员会资助的。
{"title":"Barriers, facilitators and recommendations for the implementation of newborn sickle cell screening program in tribal communities: findings from a qualitative multicentric study in India","authors":"Nithin Rajamani , Apoorva Pandey , Suchitra Surve , Shrey Desai , Ragini Kulkarni , Ravi Gajbhiye , Rajasubramaniam Shanmugam , Kapilkumar Dave , Anna Salomi Kerketta , Suman Sundar Mohanty , Mahendra Thakor , Kalpita Gawit , Lakshmana Bharathi , M. Alwas , Anita Nadkarni , Prabhakar Kedar , Yogeshwar Kalkonde , Saritha Nair , Harpreet Kaur , Manisha Madkaikar","doi":"10.1016/j.lansea.2025.100664","DOIUrl":"10.1016/j.lansea.2025.100664","url":null,"abstract":"<div><h3>Background</h3><div>Newborn screening for sickle cell disease (NBS for SCD) is essential for timely detection and management. In 2019, a study encompassing early screening, follow-up, and comprehensive care for SCD babies was undertaken in seven SCD-prevalent tribal regions of India. The study also aimed to identify the barriers and facilitators affecting its implementation.</div></div><div><h3>Methods</h3><div>A qualitative exploratory descriptive approach was used to conduct in-depth interviews with purposively selected participants (n = 127) including parents of newborns with SCD. The data were compiled and analysed using NVivo14. Predominant themes were identified through frequency analysis and the number of references, and they were further classified using the Multilevel Ecological Model of Health (MEMH).</div></div><div><h3>Findings</h3><div>Twenty-five themes emerged, of which thirteen highlighted barriers, the predominant ones being stigma & local beliefs, lack of integration of NBS with the health system, accessibility challenges and difficulties with blood sample collection & testing. Seven themes addressed facilitators such as the inclusion of frontline health workers, skilled human resources and regular follow-ups. Five themes emerged for recommendations including integrating NBS for SCD into the health system, behaviour change communication and enhanced stakeholder collaboration.</div></div><div><h3>Interpretation</h3><div>The study identified barriers and facilitators across multiple levels, advocating the need for a holistic approach. The findings suggest that a comprehensive SCD management program must address socio-cultural dimensions and effectively integrate with the health system, providing valuable insights for shaping policies for NBS in SCD-prevalent areas.</div></div><div><h3>Funding</h3><div>The study was funded by the <span>Indian Council of Medical Research</span>.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"41 ","pages":"Article 100664"},"PeriodicalIF":6.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145121133","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}
<div><h3>Background</h3><div>The Department of Health Research, Ministry of Health and Family Welfare, India, established the Virus Research and Diagnostic Laboratory Network (VRDLN) in 2014 to strengthen viral diagnostic capabilities and provide a system for routine virological surveillance. In 2022, we also initiated the Model for Integrated Influenza Surveillance in Tamil Nadu (MIST) to enhance surveillance of virologic and clinical characteristics of severe acute respiratory infections (SARI) cases in selected sentinel tertiary care hospitals. This study investigates the epidemiology of Human Metapneumovirus (HMPV) in India by analysing data from these distinct but related surveillance systems.</div></div><div><h3>Methods</h3><div>We analysed VRDLN data from 2019 to 2024 to describe HMPV cases based on time, place, and personal characteristics. We presented a comparison of two periods—2019 to 2023 and 2024—to compare historical trends with the current scenario. We also examined detailed clinical and laboratory profiles of HMPV-positive SARI cases collected under the MIST project from 2022 to 2024 (a case series). Hospitals under the VRDLN conducted testing of any physician-referred patient, while MIST exclusively tested SARI patients who met a standardised case definition. While the VRDLN provided an overall picture of the testing and positivity trends, MIST provided details on laboratory parameters, and clinical course and outcomes of positive cases. All laboratories adhered to standardised quality-assured testing protocols and reported data to a centralized database.</div></div><div><h3>Findings</h3><div>Between 2019 and 2023, the VRDLN tested 20,625 patients for HMPV, of whom 1030 (3.2%) were positive. In 2024, 11,155 patients were tested, with 367 (3.3%) confirmed positive. Across both periods, age-stratified analysis indicated that the majority of tests were conducted among children. The highest positivity was observed in those aged 1–2 years, with 4.5% (128/2864) testing positive in 2019–2023 and 4.6% (70/1508) in 2024. Most HMPV-positive cases presented with Acute Respiratory Infection (ARI)/Influenza-like illness (ILI), accounting for 85.4% [566/17,090] of cases in 2019–2023 and 40.3% [148/1697] in 2024, as most testing was carried out among these patients. Fever and cough were the most common symptoms, reported in 70.3% of cases from 2019 to 2023 and 79.6% (292/8398) in 2024, and in 60.5% (401/12,059) and 60.8% (223/5977) of cases, respectively. Under the MIST project, we tested 3599 SARI patients between 2022 and 2023, identifying 28 (0.8%) HMPV-positive cases. Patients experienced a median illness duration of 11 days (interquartile range [IQR]: 7.5–14.5) and stayed in the hospital for a median of 7 days (IQR: 5–9.5). Eight cases required intensive care for a median of 3.5 days (IQR: 2.5–6), while 12 cases needed oxygen support for a median of three days (IQR: 3–5.5). Among the 28 cases, 25 (89.3) showed clinical improvement at disc
{"title":"Epidemiology of Human Metapneumovirus (HMPV) in India: a cross-sectional study","authors":"Rizwan Suliankatchi Abdulkader , Neetu Vijay , Varsha Potdar , Joshua Chadwick , Jitendra Narayan , Sabarinathan Ramasamy , Devika Shanmugasundaram , Selvavinayagam Thirumalaicheri Sivaprakasam , Manoj Murhekar , Nivedita Gupta","doi":"10.1016/j.lansea.2025.100667","DOIUrl":"10.1016/j.lansea.2025.100667","url":null,"abstract":"<div><h3>Background</h3><div>The Department of Health Research, Ministry of Health and Family Welfare, India, established the Virus Research and Diagnostic Laboratory Network (VRDLN) in 2014 to strengthen viral diagnostic capabilities and provide a system for routine virological surveillance. In 2022, we also initiated the Model for Integrated Influenza Surveillance in Tamil Nadu (MIST) to enhance surveillance of virologic and clinical characteristics of severe acute respiratory infections (SARI) cases in selected sentinel tertiary care hospitals. This study investigates the epidemiology of Human Metapneumovirus (HMPV) in India by analysing data from these distinct but related surveillance systems.</div></div><div><h3>Methods</h3><div>We analysed VRDLN data from 2019 to 2024 to describe HMPV cases based on time, place, and personal characteristics. We presented a comparison of two periods—2019 to 2023 and 2024—to compare historical trends with the current scenario. We also examined detailed clinical and laboratory profiles of HMPV-positive SARI cases collected under the MIST project from 2022 to 2024 (a case series). Hospitals under the VRDLN conducted testing of any physician-referred patient, while MIST exclusively tested SARI patients who met a standardised case definition. While the VRDLN provided an overall picture of the testing and positivity trends, MIST provided details on laboratory parameters, and clinical course and outcomes of positive cases. All laboratories adhered to standardised quality-assured testing protocols and reported data to a centralized database.</div></div><div><h3>Findings</h3><div>Between 2019 and 2023, the VRDLN tested 20,625 patients for HMPV, of whom 1030 (3.2%) were positive. In 2024, 11,155 patients were tested, with 367 (3.3%) confirmed positive. Across both periods, age-stratified analysis indicated that the majority of tests were conducted among children. The highest positivity was observed in those aged 1–2 years, with 4.5% (128/2864) testing positive in 2019–2023 and 4.6% (70/1508) in 2024. Most HMPV-positive cases presented with Acute Respiratory Infection (ARI)/Influenza-like illness (ILI), accounting for 85.4% [566/17,090] of cases in 2019–2023 and 40.3% [148/1697] in 2024, as most testing was carried out among these patients. Fever and cough were the most common symptoms, reported in 70.3% of cases from 2019 to 2023 and 79.6% (292/8398) in 2024, and in 60.5% (401/12,059) and 60.8% (223/5977) of cases, respectively. Under the MIST project, we tested 3599 SARI patients between 2022 and 2023, identifying 28 (0.8%) HMPV-positive cases. Patients experienced a median illness duration of 11 days (interquartile range [IQR]: 7.5–14.5) and stayed in the hospital for a median of 7 days (IQR: 5–9.5). Eight cases required intensive care for a median of 3.5 days (IQR: 2.5–6), while 12 cases needed oxygen support for a median of three days (IQR: 3–5.5). Among the 28 cases, 25 (89.3) showed clinical improvement at disc","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"41 ","pages":"Article 100667"},"PeriodicalIF":6.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145095502","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 : 2025-09-12DOI: 10.1016/j.lansea.2025.100670
Patumrat Sripan , Siti Norbayah Yusof , Donsuk Pongnikorn , Imjai Chitapanarux , Balqis Bahtiar , Nor Saleha Ibrahim Tamin , Karnchana Daoprasert , Narate Waisri , Young-Joo Won , RuRu Chun-Ju Chiang , Annalisa Trama , Hadrien Charvat , Kriengkrai Srithanaviboonchai , Tomohiro Matsuda
Background
In Southeast Asia (SEA), the understanding of most rare cancers is limited, which sometimes leads to delays in diagnosis, treatment, and care. This study aimed to estimate for the first time the incidence of rare cancers in SEA using population-based cancer registry (PBCR) data from the 2011–2015 period.
Methods
This study used data from the nationwide PBCR of Malaysia and two PBCRs in northern Thailand in Chiang Mai and Lampang Cancer registries. The age-standardized incidence rate (ASR) per 100,000 person-year of the rare cancers included in the RARECAREnet list was calculated. All analyses were performed using SEER∗Stat (version 8.3.5). Cancers defined as rare by RARECAREnet in Europe were also rare in Thailand and Malaysia.
Findings
The ASR of some rare cancers in Thailand and Malaysia were greater than that in Japan, Korea, and Taiwan, including some pediatric cancers (pancreatoblastoma and odontogenic malignant tumors) in Malaysia, eye and adnexal cancer, and epithelial tumors of the penis in Thailand. ASR of nasopharyngeal cancer was higher in Thailand and Malaysia than in Japan and Korea but lower compared to Taiwan.
Interpretation
Although most rare cancers were also rare in Thailand and Malaysia, some cancers were not considered rare. However, the incidence of some rare cancers in Thailand and Malaysia were higher than that in Japan, Korea, and Taiwan. To enhance understanding, diagnosis, treatment, and care of rare cancers, reliable epidemiological data needs to be generated under the RARECAREnet Asia project by working with countries in Asia with high-quality PBCRs.
Funding
This study was supported by a UICC Yamagiwa-Yoshida Memorial International Cancer Study Grant (Award/Grant Number: YY/2022-1477) and Government of Japan Ministry of Health Labour and Welfare Grant numbers: 23EA1033, and was partially supported by Chiang Mai University, Thailand.
{"title":"Incidence patterns of rare cancer in southeast Asian and western Pacific countries (RARECAREnet Asia project): a study using population-based cancer registry data, 2011–2015","authors":"Patumrat Sripan , Siti Norbayah Yusof , Donsuk Pongnikorn , Imjai Chitapanarux , Balqis Bahtiar , Nor Saleha Ibrahim Tamin , Karnchana Daoprasert , Narate Waisri , Young-Joo Won , RuRu Chun-Ju Chiang , Annalisa Trama , Hadrien Charvat , Kriengkrai Srithanaviboonchai , Tomohiro Matsuda","doi":"10.1016/j.lansea.2025.100670","DOIUrl":"10.1016/j.lansea.2025.100670","url":null,"abstract":"<div><h3>Background</h3><div>In Southeast Asia (SEA), the understanding of most rare cancers is limited, which sometimes leads to delays in diagnosis, treatment, and care. This study aimed to estimate for the first time the incidence of rare cancers in SEA using population-based cancer registry (PBCR) data from the 2011–2015 period.</div></div><div><h3>Methods</h3><div>This study used data from the nationwide PBCR of Malaysia and two PBCRs in northern Thailand in Chiang Mai and Lampang Cancer registries. The age-standardized incidence rate (ASR) per 100,000 person-year of the rare cancers included in the RARECAREnet list was calculated. All analyses were performed using SEER∗Stat (version 8.3.5). Cancers defined as rare by RARECAREnet in Europe were also rare in Thailand and Malaysia.</div></div><div><h3>Findings</h3><div>The ASR of some rare cancers in Thailand and Malaysia were greater than that in Japan, Korea, and Taiwan, including some pediatric cancers (pancreatoblastoma and odontogenic malignant tumors) in Malaysia, eye and adnexal cancer, and epithelial tumors of the penis in Thailand. ASR of nasopharyngeal cancer was higher in Thailand and Malaysia than in Japan and Korea but lower compared to Taiwan.</div></div><div><h3>Interpretation</h3><div>Although most rare cancers were also rare in Thailand and Malaysia, some cancers were not considered rare. However, the incidence of some rare cancers in Thailand and Malaysia were higher than that in Japan, Korea, and Taiwan. To enhance understanding, diagnosis, treatment, and care of rare cancers, reliable epidemiological data needs to be generated under the RARECAREnet Asia project by working with countries in Asia with high-quality PBCRs.</div></div><div><h3>Funding</h3><div>This study was supported by a <span>UICC Yamagiwa-Yoshida Memorial International Cancer</span> Study Grant (Award/Grant Number: <span><span>YY/2022-1477</span></span>) and <span>Government of Japan Ministry of Health Labour and Welfare</span> Grant numbers: <span><span>23EA1033</span></span>, and was partially supported by <span>Chiang Mai University</span>, Thailand.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"41 ","pages":"Article 100670"},"PeriodicalIF":6.2,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048878","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 : 2025-09-10DOI: 10.1016/j.lansea.2025.100663
Martha P. Montgomery , Prabda Praphasiri , Darunee Ditsungnoen , Pasakorn Akarasewi , Malinee Chittaganpitch , Pilaipan Puthavathana , Khanchit Limpakarnjanarat , Ponthip Wirachwong , Tawee Chotpitayasunondh , Narumol Sawanpanyalert , Chaninan Sonthichai , William W. Davis , Sonja J. Olsen , Supamit Chunsuttiwat
Prior to 2000, influenza burden in Thailand and other low- and middle-income countries was underappreciated, and influenza vaccination was uncommon. For the last two decades, Thailand Ministry of Public Health (MOPH) and U.S. Centers for Disease Control and Prevention have collaborated to understand influenza burden and the costs and benefits of influenza vaccination in Thailand. Built on a long-standing national disease notification system, Thailand MOPH established robust surveillance platforms for pneumonia and influenza, which provided insights into seasonality, disease incidence, and populations at risk for severe disease. In 2004, human cases of avian influenza brought attention to influenza's pandemic potential. Concern for an influenza pandemic combined with evidence of the cost effectiveness of influenza vaccination accelerated vaccine policy. Surveillance and vaccination policy were leveraged for and strengthened by the 2009 influenza H1N1 and COVID-19 pandemics. This personal view documents Thailand's experience in developing influenza surveillance and influenza vaccination policy.
{"title":"Influenza surveillance and vaccine policy in Thailand—a historical perspective","authors":"Martha P. Montgomery , Prabda Praphasiri , Darunee Ditsungnoen , Pasakorn Akarasewi , Malinee Chittaganpitch , Pilaipan Puthavathana , Khanchit Limpakarnjanarat , Ponthip Wirachwong , Tawee Chotpitayasunondh , Narumol Sawanpanyalert , Chaninan Sonthichai , William W. Davis , Sonja J. Olsen , Supamit Chunsuttiwat","doi":"10.1016/j.lansea.2025.100663","DOIUrl":"10.1016/j.lansea.2025.100663","url":null,"abstract":"<div><div>Prior to 2000, influenza burden in Thailand and other low- and middle-income countries was underappreciated, and influenza vaccination was uncommon. For the last two decades, Thailand Ministry of Public Health (MOPH) and U.S. Centers for Disease Control and Prevention have collaborated to understand influenza burden and the costs and benefits of influenza vaccination in Thailand. Built on a long-standing national disease notification system, Thailand MOPH established robust surveillance platforms for pneumonia and influenza, which provided insights into seasonality, disease incidence, and populations at risk for severe disease. In 2004, human cases of avian influenza brought attention to influenza's pandemic potential. Concern for an influenza pandemic combined with evidence of the cost effectiveness of influenza vaccination accelerated vaccine policy. Surveillance and vaccination policy were leveraged for and strengthened by the 2009 influenza H1N1 and COVID-19 pandemics. This personal view documents Thailand's experience in developing influenza surveillance and influenza vaccination policy.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"41 ","pages":"Article 100663"},"PeriodicalIF":6.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048877","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 : 2025-08-27DOI: 10.1016/j.lansea.2025.100656
Iltaf Hussain , Muhammad Fawad Rasool , Jamshid Ullah , Muhammad Nafees , Inzemam Khan , Muhtar Kadirhaz , Miaomiao Xu , Chengzhou Tang , Yi Dong , Wei Zhao , Jie Chang , Yu Fang
Background
Poverty is a potential contributor to antibiotic resistance; however, the previous studies have not adequately addressed the role of poverty in shaping antibiotic resistance through social inequalities. Considering this, the current study evaluated the role of multi-dimensional poverty in antibiotic resistance.
Methods
A mixed-method study was conducted in three provinces of Pakistan using multistage sampling to recruit physician-confirmed urinary tract infection (UTI) patients from public laboratories. Antibiotic resistance data were collected from susceptibility reports, while poverty was measured using the multi-dimensional poverty index (MPI). Water, sanitation and hygiene (WASH) practices were assessed through a self-developed, validated questionnaire. Survey-weighted logistic regression analysis examined the association between MPI and antibiotic resistance.
Findings
A total of 698 patients were recruited, with more than half being in some level of deprivation (total = 413, vulnerable: 117, deprived: 76, severely deprived: 220). Multidimensional poverty was independently associated with increased odds of multidrug resistance (MDR). The risk of MDR was significantly increase across the deprivation level in unadjusted analysis (vulnerable; OR: 1.94, 95% CI 1.11–3.39, deprived; OR: 2.05, 95% CI 1.06–3.98, and severely deprived: OR: 1.80, 95% CI 1.04–3.09). After adjusting for antibiotics misuse and poor WASH practices, the association persisted. In the fully adjusted model, the risk of MDR was further increased in the poorer-subgroups, (vulnerable; aORs: 3.03, 95% CI 1.33–6.73, deprived; aOR: 3.01, 95% CI 1.26–7.15, and severely deprived; aOR: 4.28 95% CI 1.74–10.49). The qualitative interviews (n = 34) from patients highlighted that financial barriers drove self-medication with leftover antibiotics and treatment non-adherence. Poor WASH infrastructure was described as a systemic contributor to infection spread. In addition, patients in the poorer subgroups were presented with delayed treatment seeking.
Interpretation
The risk of antibiotic resistance increases with the increasing levels of deprivation; however, we should not assume that higher deprivation directly drives antibiotic resistance. Instead, structural barriers such as limited healthcare access, poor WASH infrastructure, and financial constraints create an environment where self-medication, treatment non-adherence, and infection transmission occur across all poverty levels, not just because of individual choices. These findings emphasize the need for interventions that address healthcare inequities, improve WASH infrastructure, and regulate antibiotic access, combined with behavior-changing interventions.
Funding
This work was funded by the “Young Talent Support Plan” of the Health Science Center, Xi’an Jiao
贫困是抗生素耐药性的一个潜在因素；然而，以前的研究并没有充分解决贫困在通过社会不平等形成抗生素耐药性方面的作用。考虑到这一点，本研究评估了多维贫困在抗生素耐药性中的作用。方法采用混合方法，在巴基斯坦3个省采用多阶段抽样方法，从公共实验室招募医生确诊的尿路感染（UTI）患者。从药敏报告中收集抗生素耐药性数据，而使用多维贫困指数（MPI）衡量贫困。水、环境卫生和个人卫生（WASH）做法通过自行开发的有效问卷进行评估。调查加权logistic回归分析检验了MPI与抗生素耐药性之间的关系。研究结果共招募了698名患者，其中一半以上处于某种程度的剥夺状态（总数= 413，脆弱：117，剥夺：76，严重剥夺：220）。多维贫困与多药耐药（MDR）几率增加独立相关。在未调整的分析中，MDR的风险在剥夺水平上显著增加（脆弱；OR: 1.94, 95% CI 1.11-3.39；剥夺；OR: 2.05, 95% CI 1.06-3.98；严重剥夺：OR: 1.80, 95% CI 1.04-3.09）。在调整了抗生素滥用和不良的WASH做法后，这种关联仍然存在。在完全调整后的模型中，较贫困亚组的耐多药风险进一步增加（易感亚组，aOR: 3.03, 95% CI 1.33-6.73，贫困亚组；aOR: 3.01, 95% CI 1.26-7.15，严重贫困亚组；aOR: 4.28, 95% CI 1.74-10.49）。来自患者的定性访谈（n = 34）强调了经济障碍导致使用剩余抗生素和治疗依从性不强的自我用药。不良的讲卫生基础设施被认为是导致感染传播的一个系统性因素。此外，较贫穷亚组的患者出现了延迟寻求治疗的情况。抗生素耐药性的风险随着剥夺程度的增加而增加；然而，我们不应该假设更高的剥夺直接导致抗生素耐药性。相反，结构性障碍，如有限的医疗服务可及性、落后的讲卫生基础设施和财政限制，创造了一种环境，使自我药疗、不坚持治疗和感染传播发生在所有贫困水平，而不仅仅是由于个人的选择。这些发现强调需要采取干预措施，解决卫生保健不公平问题，改善讲卫生基础设施，规范抗生素获取，并结合改变行为的干预措施。本工作由西安交通大学医学部“青年人才支持计划”和国家自然科学基金（批准号：72274150）资助。
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