Bulletin of the World Health Organization最新文献

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.

Objective: To assess extreme weather early warning systems in large cities across the world.

Methods: Among cities with populations above 1 million reporting to the Carbon Disclosure Project Cities Adaptation Actions database from 2021 to 2023, we included those providing a description of at least one adaptation action for a climate hazard in at least one year. We identified cities reporting early warning systems using the United Nations Early Warnings for All framework, which includes four pillars: risk knowledge, hazard monitoring and forecasting, warning communication and preparedness. We also tracked public health engagement in these systems.

Findings: We identified 182 cities, of which 71 described full early warning systems across the four pillars. Cities in high- and upper middle-income countries described early warning systems nearly three times more often than those in low- and lower middle-income countries. Multihazard early warning systems  were reported by 35 (49%) cities, and many of these involved institutionalized cross-sectoral coordination and funded at least one activity from their own resources. Health was reported as a goal of early warning systems by 58 (82%) cities, although just 29 (41%) indicated a specific role for public health agencies.

Conclusion: These findings suggest that many large cities are not covered by these health-protective systems. We recommend development of a city-specific framework for early warning systems that identifies roles for health, and scaling up of these tools, particularly in cities in low- and lower middle-income countries, to ensure strengthened adaptive urban resilience against climate threats.

Objective: To estimate the outcome of programmes on human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS), tuberculosis and malaria in Malawi across multiple health domains.

Methods: We used an integrated epidemiological and health system model to estimate the impact of HIV/AIDS, tuberculosis and malaria programmes in Malawi from 2010 to 2019. We incorporated interacting disease dynamics, intervention effects and health system use in the model. We examined four scenarios, comparing actual programme delivery with hypothetical scenarios excluding the health programmes individually and collectively.

Findings: From 2010 to 2019, an estimated 1.08 million deaths and 74.89 million disability-adjusted life years were prevented by the HIV/AIDS, tuberculosis and malaria programmes. An additional 15 600 deaths from other causes were also prevented. Life expectancy increased by 13.0 years for males and 16.9 years for females. The programmes accounted for 18.5% (95% uncertainty interval, UI: 18.2 to 18.6) of all health system interactions, including 157.0 million screening and diagnostic tests and 23.2 million treatment appointments. Only 41.5 million additional health worker hours (17.1%; 95% UI: 15.9 to 17.4%) of total health worker time) were needed to achieve these gains. The HIV/AIDS, tuberculosis and malaria programmes required an additional 120.7 million outpatient appointments, which were offset by a net decrease in inpatient care (9.4 million bed-days) that would have been necessary in their absence.

Conclusion: HIV/AIDS, tuberculosis and malaria programmes have greatly increased life expectancy and provided direct and spill-over effects on health in Malawi. These investments reduced the burden on inpatient and emergency care, which requires more intensive health worker involvement.

Problem: Inefficient workflows, incomplete data and lack of interoperability can hinder the uptake of electronic records systems, challenges particularly relevant in cancer treatment with its complex longitudinal and multidisciplinary nature. Further, products developed in high-income countries are not designed for compatibility with the workflows of low- and middle-income countries, which face additional issues of cost.

Approach: We evaluated centres with different resources and geographical locations to develop the requirements of our product. We published an invitation to potential vendors, evaluated submitted product development bids and enlisted six vendors. Our subcommittees developed workflow modules and templates, ensured interoperability and developed key performance indicators.

Setting: The National Cancer Grid, a network of more than 360 cancer centres in India, assembled a team of experienced oncologists and digital health experts to develop electronic medical records products with specialized oncology capabilities.

Relevant changes: Our collaboration between clinical and technical experts led to the development of six new, high-quality and interoperable products, compliant with the varying needs and resources of hospitals. We supported more than 20 centres with procurement and adoption through partial funding and technical assistance.

Lessons learnt: In developing product requirements, we gained an understanding of the challenges faced by hospitals in implementing such systems; by inviting vendors to submit a product development bid, we ensured that the product development cost was borne by the vendor and not hospitals; and by monitoring user feedback, we can continue to address issues raised by health workers and encourage the adoption of electronic medical records.