Bulletin of the World Health Organization最新文献

Objective: To determine factors associated with inpatient death among a cohort of children aged 6-59 months with severe acute malnutrition in north-western Nigeria.

Methods: Our observational study used routine programmatic data of all children aged 6-59 months admitted to two inpatient facilities in Katsina State with severe acute malnutrition in 2022. We assessed nutritional status at admission by weight-for-height z-score (WHZ), mid-upper-arm circumference (MUAC) and bilateral nutritional oedema using World Health Organization definitions. We used Cox-proportional hazard models to identify predictors of mortality, with and without adjustment for sex, age group, nutritional status at admission, major clinical complications and comorbidities.

Findings: Of 12 771 children included in the analysis, we observed an overall inpatient mortality of 8.4%. Compared with children admitted by the MUAC criterion alone, we noted that children admitted by the WHZ criterion alone had twice the risk of death; children admitted with kwashiorkor and low WHZ had more than four times the risk. Older children with marasmus had a higher risk of death than younger children (adjusted hazard ratio: 1.74; 95% confidence interval: 1.50-2.03). We did not observe any significant association between stunting and mortality. Our findings were not altered by any of the complications or comorbidities recorded.

Conclusion: Children with a low WHZ at admission have a higher risk of death than those with a low MUAC, and should be subject to special considerations when associated with oedema. MUAC alone is an insufficient criterion to identify all the children at risk of death from malnutrition.

Objective: To assess the quality and consistency of reported age patterns of female genital mutilation in self- and proxy-reported survey data.

Methods: We used 10 Demographic and Health Surveys (DHS) from 2005 to 2023 in Senegal. These surveys contained information on female genital mutilation status and age at experiencing this practice for women who reported data on themselves and daughters for whom data were reported by their mothers. We assessed data quality by completeness of information on age at female genital mutilation in a logistic regression analysis. We compared the occurrence of age heaping across DHS and individual survey characteristics such as education, age cohort and completeness of date of birth reporting. We estimated the median age at female genital mutilation of daughters and women to assess the consequences of differences in data quality for the interpretation of survey data on this practice.

Findings: Self-reported data were more prone to incomplete reporting of age at female genital mutilation and age heaping than proxy-reported data. These findings held true across individual survey characteristics and different DHS. The estimates for median age at female genital mutilation were susceptible to differences in data quality of age at female genital mutilation of daughters and women.

Conclusion: Self-reported data on age at female genital mutilation are of lower quality than proxy-reported data. These differences potentially distort trend estimates of age at female genital mutilation. Caution is needed when combining self- and proxy-reported survey data on female genital mutilation.

Objective: To gain insight into how governments regulate their health laboratory sector, by reviewing health laboratory licensing legislation across different health-care systems in a diverse range of 18 countries worldwide.

Method: We selected countries for a diverse range of health-care systems, geography, income level, licensing legislation and standards adhered to. We selected aspects of health laboratory licensing that were consistently present in different countries and suitable for meaningful comparison, focusing on legislative approaches, certification and accreditation models, regulation, quality assurance, and biosafety and biosecurity requirements.

Findings: Our analysis revealed that the licensing legislation for health laboratories typically encompasses two principal components: administrative procedural law and substantive law. We observed that the different ways in which countries regulate their health laboratories could be categorized within three distinct legislative approaches, namely: standalone licensing act, general licensing act and one based on a health insurance contract. Most countries used a two-step application process, comprising registration and licensing steps. License validity periods ranged over 1-5 years, with some countries opting for permanent licenses. Countries adopted diverse standards and requirements, with some mandating accreditation.

Conclusion: Our findings highlight the diverse legislative approaches to health laboratory licensing, reflecting varying national capacities and regulatory priorities. Integrating robust quality standards, especially those aligned with International Organization for Standardization standard no. 15189, is essential for strengthening laboratory oversight and public health response. Effective licensing frameworks not only enhance domestic laboratory systems but also contribute to global health security through alignment with international obligations.

Objective: To evaluate a combined hearing and eye screening model for newborns attending immunization clinics in Cameroon.

Methods: We analysed data from a screening project that took place between November 2021 and February 2024, which assessed both the hearing and eyes of newborns using otoacoustic emission and fundal reflex tests, respectively. We then evaluated sensitivity, specificity and predictive values of screening conducted by trained auxiliary staff versus specialists.

Findings: We screened 1807 newborns, of which 54% (976) were female. The median age at screening was 13 days. Eight percent of newborns (141/1807) did not pass the otoacoustic emission test; screeners scheduled these newborns for a second-line otoacoustic emission test within three months. Only 28% (39/141) returned for the repeat otoacoustic emission test. Of the returning babies, 33% (13/39) still did not pass, and screeners referred them for an auditory brainstem response threshold test. Screeners detected an absent fundal reflex in 2% (27) of babies. Compared to specialists, trained auxiliary staff showed 82% sensitivity and 99% specificity in hearing screening; predictive values were 90% (positive) and 99% (negative). For eye screening, sensitivity was 67% and specificity 99%, with predictive values of 86% (positive) and 98% (negative).

Conclusion: Combined screening performed by trained auxiliary staff in immunization clinics offers a promising approach to screening newborns' hearing and eyes, enabling broader population coverage with fewer resources. Combined screening conducted at immunization clinics includes both hospital- and community-born babies and is therefore suitable for countries with a high number of out-of-hospital births.

Although most countries have ethical oversight systems for health-related research involving human participants, mechanisms for assessing the quality of those systems are not regularly used, particularly in low-resource settings. To address this gap, the Regulatory System Strengthening, Regulation and Safety unit and Health Ethics and Governance unit of the World Health Organization (WHO) recently released a tool for benchmarking ethics oversight of health-related research involving human participants. The tool provides a simple, easy-to-measure set of indicators for assessing the quality of research ethics oversight systems without the need to invest a great deal of resources. The tool comprises 48 indicators divided across three areas: (i) the national context; (ii) research ethics committees; and (iii) institutions that conduct health-related research involving humans, such as academic medical centres. Indicators related to the national context are intended to be evaluated in a single assessment applicable to the country as a whole, whereas indicators related to research ethics committees and research institutions are evaluated on an entity-by-entity basis. Some countries may choose to assess a representative sample of research ethics committees and institutions; alternatively, national authorities might ask research ethics committees and institutions to undertake self-assessments and report the results. Research ethics committees or institutions could also use WHO's tool on their own as part of a process of quality improvement. WHO is working with global partners to disseminate the tool and support global implementation. Widespread use of the tool is expected to enhance policy coherence in ethics oversight and facilitate multinational research.

Objective: To test 50% indoor residual spraying coverage (percentage of households sprayed) for non-inferiority against the recommended 80% coverage for malaria control.

Methods: Indoor residual spraying was done in 2021 and 2022 on Bioko, Equatorial Guinea, in a control arm (80% coverage) and intervention arm (50% coverage) with 37 clusters each. We assessed malaria infection in a representative sample of the population during annual surveys using rapid diagnostic tests. We compared the change in the odds of Plasmodium falciparum infection between baseline and post-intervention using difference-in-differences analysis within a survey-weighted binomial generalized linear model. Given differences between the arms at baseline, we adjusted the model for indoor residual spraying coverage at baseline.

Findings: Relative to baseline, the odds of malaria infection post-intervention were 1.11 (95% confidence interval, CI: 0.81-1.52) in the 80% arm and 0.97 (95% CI: 0.72-1.29) in the 50% arm. In the adjusted model, the change in the odds of P. falciparum infection was no greater in the intervention arm than in the control arm (odds ratio: 0.89; 95% CI: 0.58-1.36), with the upper CI being lower than the non-inferiority margin of 1.43.

Conclusion: There was no evidence that 50% coverage was inferior in preventing malaria, which supports the use of this target in settings where this level makes indoor residual spraying feasible by increasing the cost-effectiveness and equity of the intervention.

Objective: To characterize childhood hepatitis B virus (HBV) epidemiology to inform elimination efforts in the Democratic Republic of the Congo, one of the most populous African countries.

Methods: Using the most recent (2013-2014) nationally representative Demographic and Health Survey, we analysed hepatitis B surface antigen (HBsAg) on dried blood spots and associated survey data from children aged 6-59 months. We estimated HBsAg-positivity prevalence nationally, regionally and by potential correlates of infection. We evaluated spatial variation in HBsAg-positivity prevalence overall, and by age, sex and vaccination status.

Findings: Using data representing 5773 children, we observed a national HBsAg-positivity prevalence of 1.3% (73/5773; 95% confidence interval, CI: 0.9 to 1.7), ranging from 0.0% in Kinshasa to 5.6% in Sud-Ubangi. Prevalence among boys (1.8%; 95% CI: 1.2 to 2.7) was double that among girls (0.7%; 95% CI: 0.4 to 1.3). Testing negative for tetanus antibodies, rural residence and poorer household were associated with higher HBsAg-positivity prevalence. We observed no difference in prevalence by age. Children had higher HBsAg-positivity odds if living with one or more HBsAg-positive adult household member (odds ratio, OR: 2.3; 95% CI: 0.7 to 7.8), particularly an HBsAg-positive mother (OR: 7.2; 95% CI: 1.6 to 32.3). Notably, nearly two thirds (36/51) of HBsAg-positive children had a HBsAg-negative mother.

Conclusion: Our investigation highlights the importance of subnational prevalence estimates in large countries such as the Democratic Republic of the Congo, and we have identified regions that may benefit from improved childhood vaccination delivery strategies and community HBV prevention efforts.