Bulletin of the World Health Organization最新文献

Problem: In sub-Saharan Africa, hypertension prevalence is usually estimated from participant recall. We assessed the accuracy of self-reported hypertension in women of reproductive age.

Approach: In PRECISE (PREgnancy Care Integrating translational Science, Everywhere), an observational prospective cohort study, we recruited 1825 non-pregnant women of reproductive age, 610 in the Gambia, 609 in Kenya and 606 in Mozambique. We compared self-reported and measured hypertension (systolic blood pressure ≥ 140mmHg or diastolic blood pressure ≥ 90mmHg). We adjusted hypertension prevalence for age, body mass index, education, parity, and antihypertensive medicine and oral contraceptive use.

Local setting: PRECISE was conducted in both urban and rural hospitals or clinics.

Relevant changes: The women were generally in their late twenties and parous. Adjusted measured hypertension prevalence was higher in Mozambique (10.4%; 95% confidence interval, CI: 7.9-12.7) and the Gambia (9.3%; 95% CI: 6.6-12.6) than in Kenya (4.6%; 95% CI: 3.0-6.6). Self-reported hypertension prevalence was highest in the Gambia (12.9%; 95% CI: 10.2-15.9) versus Mozambique (4.2%; 95% CI: 2.8-5.7) or Kenya (6.7%; 95% CI: 5.0-8.6). Sensitivity of self-reported (versus measured) hypertension was less than 45% in all countries, with specificities more than 89%. Positive likelihood ratios were fair in the Gambia (3.70; 95% CI: 2.47-5.54), and good in Kenya (5.79; 95% CI: 3.36-9.98) and Mozambique (5.18; 95% CI: 2.56-10.46). All negative likelihood ratios were poor (≥ 0.20).

Lessons learnt: Self-reported hypertension is unsuitable for population hypertension estimates among women of reproductive age in these countries.

Objective: To understand why caesarean sections are performed for stillborn babies by investigating caesarean section rates and indications in sub-Saharan African countries and to examine whether fetal vital status at admission is associated with caesarean section.

Methods: The study involved registry data on 105 872 babies weighing 1000 g or more born to women aged 13 to 50 years at 16 hospitals in Benin, Malawi, Uganda and United Republic of Tanzania between 1 July 2021 and 30 June 2023. We assessed caesarean section rates and indications, and used multivariable logistic regression analyses to estimate associations between fetal heartbeat at admission and caesarean section, by birth outcome.

Findings: The caesarean section rate was 28.0% (29 640/105 872) overall, 40.9% (858/2098) for intrapartum stillbirths and 19.0% (322/1694) for antepartum stillbirths. Previous caesarean section was among the top three indications across birth outcomes. Information on fetal heartbeat at admission was unavailable for 24.7% (7312/29 640) of caesarean section births. Multivariable analysis showed that the odds of a caesarean section was significantly higher when fetal heartbeat was not reported compared with the detection of a heartbeat among both antepartum (adjusted odds ratio, aOR: 2.55; 95% confidence interval, CI: 1.53-4.26) and intrapartum (aOR: 2.08; 95% CI: 1.51-2.87) stillbirths.

Conclusion: Unknown fetal heartbeat at admission was associated with a higher odds of caesarean section, possibly due to attempts to provide optimum care given diagnostic uncertainty. Decision-making processes on the mode of birth need to be better understood and feasible fetal monitoring recommendations are required for low-resource settings.

Objective: To estimate the financial and economic costs and the cost-effectiveness of thermal ablation compared to cryotherapy and loop diathermy within a screen-and-treat approach to cervical cancer screening in Zambia.

Methods: We analysed costs within a randomized controlled trial in which women eligible for ablative treatment after cervical cancer screening were assigned to one of three treatment arms: thermal ablation, cryotherapy or loop diathermy. We used a microcosting approach to calculate programme, personnel, equipment and consumable costs for two groups: women treated without follow-up (screened-and-treated) and women who completed follow-up (follow-up-completed). We also estimated trial costs and projected costs if the screen-and-treat approach were to be integrated into routine cervical cancer services. To assess how cost-effective the treatments were, we used a decision tree model.

Findings: Out of the 3124 women who were screened-and-treated, 2386 (76.4%) completed follow-up. In the trial scenario, costs for thermal ablation were lower than cryotherapy and loop diathermy, both per screened-and-treated woman (39.6 United States dollars (US$) versus US$ 42.3 and US$ 50.6, respectively) and per follow-up-completed woman (US$ 55.1 versus US$ 57.9 and US$ 66.2, respectively). In the routine scenario, costs for thermal ablation were also lower than for other treatments (US$ 12.7 versus US$ 15.6 and US$ 34.9, respectively, for screen-and-treat) due to significantly lower personnel costs. Thermal ablation was cost-effective compared to cryotherapy and loop diathermy.

Conclusion: Our study suggests that thermal ablation is a cost-effective option for the screen-and-treat approach to cervical cancer screening compared with cryotherapy and loop diathermy.

Objective: To investigate the associations between national breast cancer screening programmes and breast cancer mortality globally.

Methods: We collected data on breast cancer screening programmes and breast cancer mortality from the World Health Organization's Global Health Observatory, the Global Burden of Diseases 2021 study and the Eurostat database. We assessed differences in breast cancer mortality between countries with regular and irregular screening programmes, adjusting for sociodemographic index. We calculated annual changes in breast cancer mortality from 2015 to 2021 and assessed differences in mortality changes between countries with regular and irregular screening programmes.

Findings: Between 2015 and 2021, 94 of 194 countries reported having national breast cancer screening programmes. In 2021, countries with regular breast cancer screening programmes had 3.74 fewer deaths (95% uncertainty interval, UI: 1.69-5.81) per 100 000 population than countries with irregular screening programmes. This difference was more pronounced in women aged 50-74 years: 10.13 fewer deaths (95% UI: 4.47-15.80) per 100 000. From 2015 to 2021, the age-standardized mortality rate decreased by 1.02% (95% UI: 0.71-1.36) annually in countries with regular breast cancer screening programmes, whereas countries with irregular programmes had an annual increase of 0.45% (95% UI: 0.23-0.69). Higher breast cancer screening coverage rates were associated with lower mortality in the European region.

Conclusion: Countries with breast cancer screening programmes had a significant reduction in breast cancer mortality. Reducing breast cancer mortality globally will require adopting national breast cancer screening programmes and increasing screening coverage, particularly among women aged 50-74 years.

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.