Bulletin of the World Health Organization最新文献

Objective: To determine time and cost differences between one- and two-step injectable artesunate formulations for treatment of severe malaria and compare their safety and treatment outcomes.

Methods: We conducted an open-label randomized clinical trial at hospitals in Kinshasa, Democratic Republic of the Congo and Korogwe, United Republic of Tanzania in patients aged 3 months to 16 years with severe malaria. We randomly allocated patients to a new one-step injectable artesunate formulation or the conventional two-step formulation. After discharge, patients were followed for 4 weeks. The main outcomes evaluated were time and cost of administering treatment, and clinical and pharmacodynamic effects.

Findings: Between 7 June 2022 and 11 August 2023, 200 patients were randomized (1:1) to either the one-step or two-step arm. Mean time to administer artesunate was 2 min 22 s (standard deviation, SD: 50 s) in the one-step arm and 3 min 41 s (SD: 95 s) in the two-step (P-value: < 0.0001). Mean cost of syringes and needles used per patient was 0.53 (SD: 0.13) United States dollars (US$) in the one-step arm versus US$ 0.84 (SD:  0.22) in the two-step (P-value: 0.0001). Parasite clearance half-lives were 2.1 h (SD: 0.9) in the one-step arm and 2.0 h (SD: 0.8) in the two-step (P -value: 0.173). Severe adverse events occurred in one patient in each arm (P -value: 1.000), while 242 and 229 ungraded adverse events occurred in the one- and two-step arms, respectively (P -value: 0.549).

Conclusion: In children with severe malaria, one-step injectable artesunate was quicker and cheaper to administer and had equivalent safety and efficacy compared with the conventional formulation.

Objective: To evaluate a family doctor-led, community-based intervention to reduce non-prescription antibiotic use.

Methods: We conducted a parallel-group, cluster-randomized controlled trial at 22 community health centres in Shenzhen, China, over an 8-month period in 2023. We randomly (1 : 1) assigned community health centres to provide a 4-week, family doctor-led, community-based online health intervention, or to provide routine care only. Eligible participants were adults aged 18 to 75 years who had resided in the community for more than 6 months. The primary outcome was the level of non-prescription antibiotic use (including self-medication with antibiotics and purchase of antibiotics without a prescription). Secondary outcomes were: levels of self-medication with antibiotics; purchase of antibiotics without a prescription; self-storage of antibiotics; and prescribed antibiotic use.

Findings: We enrolled 1550 participants, with 788 assigned to the intervention group and 762 to the control group. We observed a significant decrease in non-prescription antibiotic use in the intervention group compared to the control group (odds ratio, OR: 0.49; 95% confidence interval, CI: 0.31-0.77) at 6 months. There was a significant reduction in self-medication (OR: 0.33; 95% CI: 0.13-0.83) and purchase of antibiotics without a prescription (OR: 0.59; 95% CI: 0.37-0.94), but not in self-storage (OR: 0.80; 95% CI: 0.54-1.18) or prescribed antibiotic use (OR: 0.94; 95% CI: 0.48-1.87) at 6 months.

Conclusion: The family doctor-led, community-based intervention demonstrated promising effectiveness and feasibility. This study provides valuable insights for the design and implementation of such interventions aimed at promoting rational use of antibiotics.

Objective: To investigate the attainability of the 2030 universal health coverage (UHC) target of 80% using Ethiopia as a case study.

Methods: We examined trends in Ethiopia's universal health service coverage index and its subindices between 2000 and 2021 in Ethiopia. To assess long-term progress, we projected coverage to 2030 and 2040 using Bayesian models. Simulation models evaluated the effect of expanding health system inputs, including service capacity and funding, on UHC.

Findings: Ethiopia's universal health service coverage index increased steadily from 2000 to 2015 and slowed between 2015 and 2019 before progress stalled between 2019 and 2021. Projections indicate the country will achieve a UHC index of 64.7% by 2030, failing to meet the 80% target. Projected subindex values for 2030 were 68.4% for reproductive, maternal, neonatal and child health and 66.1% for infectious diseases but only 58.5% for noncommunicable diseases. Simulation modelling indicated that doubling health system inputs would only modestly increase UHC and that the 80% target is unlikely to be reached before 2040.

Conclusion: The trajectory of UHC in Ethiopia reflects both achievements and persistent gaps in health services. Modelling suggests that boosting health system inputs alone will be insufficient to reach the 80% coverage target by 2030. Structural reforms, better governance and greater system integration are required. The modelling framework used could help other countries assess progress and design context-specific, equitable pathways towards UHC.

National, regional and international pharmacopoeias set standards for the quality of medicines and provide instructions for testing to ensure those standards are met. Medicines, tests, standards and methods all vary among the more than 60 pharmacopoeias currently in use. These publications were developed mainly to regulate medicine manufacturing, where safety is essential and methods are generally complex. These methods require sophisticated equipment, specific materials and high levels of skill, and can generate large quantities of pharmaceutical waste. However, pharmacopoeias are also used to guide medicine quality testing for other purposes and in other settings. Notably, they are used in post-marketing surveillance and research on medicine quality in low- and middle-income countries where the prevalence of substandard and falsified medicines is thought to be highest. Regulators and other researchers in these settings may not have access to all the equipment, materials and skills needed to follow pharmacopoeias exactly. Therefore, they often develop work-arounds, which are rarely acknowledged or described when reporting results. Our experience using modified methods for testing amoxicillin tablets in Indonesia suggests that necessary work-arounds can significantly distort study outcomes, potentially leading to misguided policy responses. We argue that standard-setting bodies should recognize challenges to testing in research and surveillance contexts in resource-constrained settings where patient safety is not at immediate risk. These bodies should provide evidence-based guidance on low-cost, environmentally sustainable modifications to industry-standard testing methods for use in these contexts. The research community must inform this guidance, providing details of modifications and their outcomes, both successful and unsuccessful.

Objective: To explore and map how community engagement is conducted in the development or adaptation of health guidelines, norms and standards.

Methods: We conducted a methodological review by searching MEDLINE, Scopus and CINAHL databases for articles published from January 2007 to May 2025, excluding publications reporting the engagement of only one or two community members on the guideline development panel. We extracted and categorized data on guideline characteristics (type of guideline, issuing entity, health-care topic), community engagement methods, the stages of guideline development for which community members were engaged and any evidence of evaluation. We compared the study characteristics using descriptive statistics.

Findings: We reviewed 267 publications representing 258 unique studies, predominantly based in high-income countries. We observed that people affected by the health condition were most commonly engaged, and typically through surveys, workshops or as panel members. We noted that community engagement was most commonly used to identify community priorities and values, but less frequently for defining guideline scope or implementation. Although some studies described innovative approaches (for example, including lived-experience panels), these are rarely implemented globally. Only a small proportion of our reviewed studies included any evaluation of guideline development practices.

Conclusion: Our review highlights the importance and challenges of implementing community engagement in global health guideline development, which may involve adapting existing engagement methods to a global context, leveraging technology while encouraging diversity, and carefully balancing the costs and benefits of extensive engagement. Striving for inclusive guideline development processes can lead to effective and equitable health recommendations worldwide.