Bulletin of the World Health Organization最新文献

Priscilla Idele talks to Gary Humphreys about the drivers of falling fertility rates and the need for data-driven rights-based, youth-led responses.

Objective: To assess the impact of an integrated model of care in curing hepatitis C in people who use drugs in Thailand.

Methods: The C-Free Study enrolled people with current or prior drug use and their partners in a prospective cohort at community drop-in centres providing harm reduction services. Participants were screened for human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV) and sexually transmitted infections. Eligible participants with HCV infection received a 12-week course of sofosbuvir-velpatasvir. The main impact outcome was sustained virological response, measured 12 weeks after treatment completion.

Results: Between June 2019 and April 2023, we enrolled 2871 participants in 10 sites across Thailand: 1601 (55.8%) had HCV antibodies; 1275 (44.4%) had active HCV infection; 846 (29.5%) had HIV; and 221 (7.7%) had HBV. Of 1134 participants with active HCV who started treatment with sofosbuvir-velpatasvir, 939 (82.8%) achieved a sustained virological response. Among 987 participants completing treatment, 95.1% achieved a sustained virological response. In multivariable analysis, age > 40 years (adjusted odds ratio, aOR: 1.63; 95% confidence interval, CI: 1.04-2.54) and poor treatment adherence (aOR: 0.06; 95% CI: 0.02-0.20) were associated with sustained virological response. Of 34 serious adverse events during treatment, six led to treatment discontinuation including five non-treatment-related deaths.

Conclusion: Community-based HCV treatment of people who use drugs in Thailand, within harm reduction settings, is safe and effective. Integration of this strategy into national programmes could enhance HCV elimination in people who use drugs.

Objective: To assess the geriatric medicine content in national standard treatment guidelines and essential medicines lists across the 47 Member States of the World Health Organization (WHO) African Region.

Methods: Until 28 June 2025, we searched for national guidelines and lists in the Global Essential Medicines database and the WHO Repository of National Essential Medicines Lists. We examined each document for a geriatric medicine chapter and guidance on the management of frailty, falls, palliative care, osteoporosis, parkinsonism, incontinence, delirium, dementia and polypharmacy. We obtained country-level data from the World Bank and WHO. Using χ² -tests, we determined associations between country-level metrics and geriatric medicine content.

Findings: We obtained a standard treatment guideline or essential medicines list from all 47 countries. Six (13%) documents contained a geriatric medicine chapter (five in English, one in French). Guidance on parkinsonism was the most common (42 documents; 89%), while guidance on frailty was the least common (three documents; 6%). Guidance on dementia was associated with current and predicted percentage population aged 65 years or older (P-value: 0.05), while guidance on palliative care was associated with healthy life expectancy both at birth and at age 60 years (P-value: 0.02 and P-value: 0.02, respectively).

Conclusion: Countries in the African Region with a higher proportion of people older than 65 years were more likely to include geriatric medicine content in their standard treatment guidelines and essential medicines lists. There is considerable potential for expanding guidance on management of common geriatric conditions, such as frailty, incontinence and polypharmacy.

Faced with significant population decline, many governments have turned to pronatalist policies to boost birth rates, even though such approaches are frequently ineffective and potentially infringe on reproductive rights. This study demonstrates that a more effective and immediate policy alternative exists: reducing preventable and treatable mortality. Using United Nations data, we modelled population projections to 2050 in 28 countries and territories, comparing a baseline scenario against two benchmarks: an immediate increase to replacement-level fertility and the reduction of national mortality rates to match the rate of Japan. Our findings show that investing in health is a more effective way to reduce population decline than raising fertility, particularly for countries in eastern and south-eastern Europe. For countries in the World Health Organization European Region that are most affected by population decline, achieving Japanese mortality levels would almost halve population loss, greatly outperforming the reduced decline expected with a replacement fertility approach. We consider that reducing mortality should be a central pillar of a demographic strategy. This approach offers faster demographic returns, aligns with human rights and healthy ageing goals, and provides a stronger return on prior societal investments in education and health. We recommend that policy-makers therefore move towards strengthening health systems, disease prevention and public health interventions. At the same time, they should integrate these measures with broader institutional reforms for a more sustainable response to population change that protects human rights.