Bulletin of the World Health Organization最新文献

Objective: To provide observational statistics on reported violent incidents, deaths and injuries associated with polio immunization activities in the context of global polio eradication efforts.

Methods: We made a systematic search of registries dedicated to documenting violence against health workers, as well as online news reports related to targeted attacks against polio immunization activities.

Findings: We identified 362 violent incidents between 1998 and 2024 that reported 359 deaths, 358 non-fatal injuries and 179 kidnappings associated with polio immunization activities. Incidents included attacks on immunization facilities, workers, support staff (for example, security and transportation) and/or vaccine recipients, which also sometimes involved family members of vaccinees or uninvolved bystanders. The reported incidents occurred in 14 countries. The two countries still endemic for wild poliovirus transmission as of 2025 accounted for 85% (607/717) of the total deaths and injuries: Pakistan 69% (497/717) and Afghanistan 15% (110/717). Of the deaths and injuries reported, 47% (404/857) were vaccine delivery personnel, including individuals identified as volunteers, workers or staff and 28% (236/857) were security personnel. The total number of violent incidents peaked in 2014 (51 incidents, 64 deaths and 56 injuries), followed by 2024 (42 incidents, 40 deaths and 63 injuries), which are double the average of the preceding 5 years.

Conclusion: We found substantial human costs associated with the polio immunization activities conducted to achieve the goal of global polio eradication. Efforts are needed to find effective solutions to protect individuals on the frontline of polio immunization activities, particularly in places where the risks are highest.

Objective: To conduct a systematic review and meta-analysis of pregnancy-associated acute kidney injury in low- and middle-income countries.

Method: We searched the databases Cochrane Central Register of Controlled Trials, Embase, Google Scholar, OvidMedline, ProQuest and Scopus for articles published during 2013-2025 reporting the incidence, etiology and outcomes of the condition in low- and middle-income countries. We conducted a meta-analysis of the studies that used the diagnostic criteria of the Kidney Disease: Improving Global Outcomes organization. We conducted subgroup analyses and a meta-regression to explore sources of heterogeneity.

Findings: We reviewed 43 studies and included 40 in our meta-analysis, covering 424 081 pregnancies in 15 low- and middle-income countries. We observed a pooled incidence of 91 cases (95% confidence interval, CI: 63-133) per 10 000 pregnancies, highest in studies conducted in the World Health Organization African Region (254; 95% CI: 152-421). We estimated case fataliy of 10.8% (95% CI: 7.6-15.3) and neonatal death or stillbirth in 29.8% of cases (95% CI: 24.2-36.1). We observed that the condition was associated with 18.8-fold higher odds of maternal death (95% CI: 10.0-35.5) and 4.6-fold higher odds of adverse fetal outcomes (95% CI: 2.1-10.0). We identified pre-eclampsia (44.1%), haemorrhage (26.2%) and sepsis (16.5%) as the leading etiologies.

Conclusion: Pregnancy-associated acute kidney injury is a significant maternal health concern in low- and middle-income countries. By providing more resources to prevent the common etiologies and expand the availability of antenatal care, its deleterious effects on maternal and fetal outcomes can be reduced.

The World Health Organization recently redefined leprosy elimination as a phased process, with the first milestone being the interruption of transmission, achieved when no new child cases (defined as younger than 15 years) are reported for five consecutive years. In Pakistan, the well-functioning leprosy programme, with effective case management, context-specific active case-finding strategies and a robust data management system, has contributed to a decrease in new cases. Between 2001 and 2023, new adult cases dropped by 75% (from 878 cases to 220 cases annually) and child cases by 83% (from 93 to 16). To support the country's goal of no new child cases by 2030 and ultimately eliminate the disease, the nongovernmental organizations Marie Adelaide Leprosy Centre and Aid to Leprosy Patients, with support from the German Leprosy and Tuberculosis Relief Association, have developed a zero leprosy roadmap. As part of this roadmap, the leprosy elimination strategy emphasizes improving active case-finding and providing post-exposure prophylaxis for contacts of leprosy cases, who are at the highest risk. Other key activities include establishing a monitoring and evaluation system for leprosy elimination, upgrading the health information management system to DHIS2, and training general practitioners and dermatologists to improve their capacity for accurate diagnosis and referral. The strategy also emphasizes improved counselling for new cases and the active involvement of individuals affected by leprosy in policy discussions. The roadmap offers globally relevant, scalable strategies for leprosy elimination in low-endemic settings. Lessons from Pakistan's experience can inform and inspire similar efforts in other countries.

Objective: To assess the effectiveness of mental health and psychosocial support interventions for addressing post-traumatic stress symptoms in children and adolescents in humanitarian settings, with separate analyses of targeted and universal interventions.

Methods: We systematically searched MEDLINE, Web of Science, PTSDpubs and PsycInfo databases for relevant randomized controlled trials that involved individuals aged 18 years or younger in humanitarian settings and compared psychological interventions with passive controls. Random-effects meta-analyses were performed separately for interventions targeted to specific symptoms and for more general universal interventions. The review was registered on PROSPERO (CRD42023434878).

Findings: The meta-analysis included 16 trials of targeted interventions (n = 2356) and 11 of universal interventions (n = 3378) that met inclusion criteria. Children and adolescents who received targeted interventions reported significantly fewer post-traumatic stress symptoms after the intervention than controls. These positive effects were sustained at follow-up. Benefits were also observed for depressive symptoms. In addition, universal interventions were associated with significantly fewer post-traumatic stress symptoms. Moderator analyses showed that outcomes were not significantly influenced by country income level, the use of lay or professional therapists, or whether trauma was caused by human-made or natural disasters. However, considerable heterogeneity and a high risk of bias were noted across studies.

Conclusion: Both targeted and universal mental health and psychosocial support interventions were associated with fewer post-traumatic stress symptoms among children and adolescents in humanitarian settings compared with passive controls. As interventions delivered by non-specialists were also successful, task-sharing could be considered where resources are scarce.