Author Archives: Lancet Global Health

[Articles] Effect of non-monetary incentives on uptake of couples’ counselling and testing…

Small non-monetary incentives, which are potentially scalable, were associated with significantly increased CHTC and HIV case diagnosis. Incentives did not increase social harms beyond the few typically encountered with CHTC without incentives. The intervention could help achieve UNAIDS 90-90-90 targets.

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[Articles] The global burden of tuberculosis mortality in children: a mathematical modelling…

Tuberculosis is a top ten cause of death in children worldwide and a key omission from previous analyses of under-5 mortality. Almost all these deaths occur in children not on tuberculosis treatment, implying substantial scope to reduce this burden.

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[Corrections] Correction to Lancet Glob Health 2017; 5: e593–603

Habib MA, Soofi S, Cousens S, et al. Community engagement and integrated health and polio immunisation campaigns in conflict-affected areas of Pakistan: a cluster randomised controlled trial. Lancet Glob Health 2017; 5: e593–603—In this Article, included children were stated to be younger than 24 months of age in the summary and the legend of table 6, this has been corrected to 60 months. In the summary and figure 2, the number of households visited and surveyed, children assessed, and clusters in the trial profile has been corrected.

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[Correspondence] Gender myths in global health – Authors’ reply

We thank Sarah Hawkes and Kent Buse for their remarks on our Comment.1 They are correct in saying that men in post-transition countries bear a greater global burden of disease and live shorter lives than that of women. However, the reverse is true in the poorest of countries where, for example, maternal mortality remains very high.2 Moreover, although women live longer, they tend to have more debilitating chronic conditions, and self-reported health is worse in women worldwide.3,4

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[Correspondence] Bringing all together for research capacity building in LMICs

The Comment by David Beran and colleagues in the Lancet Global Health1 rightly points out the need to address inequity in research investment in low-income and middle-income countries (LMICs) through focus on capacity building of research institutions and preference of population needs over funders’ interests. Investment in research depends on whether countries recognise research as a means to achieve development. However, research in LMICs is challenged with poor investment by both government and funders; weak coordination between researchers and policy makers in evidence generation, evidence synthesis, and its use in decision making; inadequate funding to the researchers to execute their research ideas; and, very importantly, discouraging research environments to groom prospective researchers.

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[Correspondence] Community health systems: allowing community health workers to emerge from the…

We agree with the Editorial (May, 2017)1 that stated “community health workers are desperately needed globally” but “often still stand…at the fringes of the health system, undefined and unsupported and therefore unable to completely fulfil their potential”.1 As the 40th anniversary of the Alma Ata Declaration approaches,2 it is time to appropriately recognise the role and potential of community health systems. Further to the recent momentum highlighted,1 we would add the lessons learned from the West Africa Ebola outbreak about the importance of community health systems3 and the election of a WHO Director-General with direct experience in expanding Ethiopia’s community level workforce.

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[Correspondence] Lychee-associated encephalopathy in China and its reduction since 2000

We commend Aakash Shrivastava and colleagues (April, 2017)1 on their meticulous epidemiological and toxicological investigation, which attributed severe encephalopathy in Indian children to methyl cyclopropyl glycine from lychees (also spelled litchis).1

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[Correspondence] Routine fruit washing to prevent acute toxic encephalopathy – Authors’ reply

P A Desingu points out our investigation finding that routinely washing vegetables and fruits could be protective against acute toxic encephalopathy1 and suggests that this indicates that an exogenous toxin or agent in unwashed fruits or vegetables, rather than the naturally occurring toxins hypoglycin A and methylenecyclopropylglycine (MCPG) found in lychees, might be associated with the recurring epidemic toxic encephalopathy in Muzaffarpur. We considered this possibility, and tested extensively for evidence of exogenous agents, such as pesticides and herbicides, in the biological specimens of affected children as well as in fruits, vegetables, and grains collected from affected villages; these results were all consistently negative.

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[Correspondence] Routine fruit washing to prevent acute toxic encephalopathy

I read with great interest the Article by Aakash Shrivastava and colleagues (January, 2017)1 that reported the association of a 2014 outbreak of acute toxic encephalopathy in Muzaffarpur, India, with lychee (also spelled litchi) consumption using a case-control study. The study reported that lychee consumption 24 h before onset of symptoms was associated with acute toxic encephalopathy in 67 (65%) of 103 cases and 23 (23%) of 102 controls. The same case-control study reported that routinely washing vegetables and fruits was associated with acute toxic encephalopathy in 32 (32%) of 99 cases and 58 (70%) of 83 controls.

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[Correspondence] Lychee-associated acute hypoglycaemic encephalopathy outbreaks in Muzaffarpur,…

The article by Aakash Shrivastava and colleagues in The Lancet Global Health (April, 2017)1 is timely, and presents an important finding: validation of lychee-associated hypoglycaemic encephalopathy. First described in India,2–4 the disease is caused by lychee (also spelled litchi) consumption after a prolonged fast by undernourished children due to the presence of a hypoglycaemic agent, methylene cyclopropyl glycine (MCPG). The President of the Indian Academy of Pediatrics expressed scepticism when cases of encephalopathy were first linked with lychee consumption in 2014.

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[Comment] Joint external evaluation process: bringing multiple sectors together for global…

The International Health Regulations (2005; IHR) is a legally binding instrument with a purpose of “preventing, protecting against, controlling and providing a public health response to the international spread of diseases in ways that are commensurate with and restricted to public health risks.1 The IHR Review Committee on Second Extension recommended to transition from self-evaluations to approaches that combine self-evaluation, peer review, and voluntary external evaluation, thus the IHR Monitoring and Evaluation Framework was developed, with the Joint External Evaluation (JEE) being one of its components.

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[Comment] Improving the quality of WHO guidelines over the last decade: progress and challenges

WHO is a leading and respected source of normative guidance. With a particular focus on the needs of low-income and middle-income countries, the scope of WHO guidelines is vast, ranging from specific interventions aimed at controlling particular aspects of emerging health threats (eg, Infant feeding in areas of Zika virus transmission1) to broad public health guidance (eg, International travel and health2).

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[Comment] Cassava, konzo, and neurotoxicity

Cassava (Manihot esculenta) forms part of the staple diet for more than 600 million people across the world, particularly those that live in poverty and remote areas where food security is poor.1 The plant grows in poor soil and is relatively drought resistant; the tubers are rich in carbohydrates and the leaves contain some protein.

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[Comment] Tuberculosis in children: under-counted and under-treated

Tuberculosis is the number one infectious cause of death worldwide1 but remains underappreciated as a cause of morbidity and mortality in children. Because many children have difficulty expectorating sputum and because paediatric tuberculosis is usually pauci-bacillary and often extra-pulmonary, paediatric tuberculosis is especially difficult to diagnose with standard sputum-based assays. Predicted associations between paediatric and adult tuberculosis burden2,3 place paediatric incidence at 10% of total global tuberculosis incidence, but tuberculosis notification rates (already inadequate in adults) are lowest in children, with roughly 40% of incident cases in children younger than 15 years having been diagnosed and notified in 2015.

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