Author Archives: Lancet Global Health

[Health Policy] Innovative financing instruments for global health 2002–15: a systematic…

Development assistance for health (DAH), the value of which peaked in 2013 and fell in 2015, is unlikely to rise substantially in the near future, increasing reliance on domestic and innovative financing sources to sustain health programmes in low-income and middle-income countries. We examined innovative financing instruments (IFIs)—financing schemes that generate and mobilise funds—to estimate the quantum of financing mobilised from 2002 to 2015. We identified ten IFIs, which mobilised US$8·9 billion (2·3% of overall DAH) in 2002–15.

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[Articles] Cost-effectiveness of Xpert MTB/RIF for tuberculosis diagnosis in South Africa: a…

After analysing extensive primary data collection during roll-out, we found that Xpert introduction in South Africa was cost-neutral, but found no evidence that Xpert improved the cost-effectiveness of tuberculosis diagnosis. Our study highlights the importance of considering implementation constraints, when predicting and evaluating the cost-effectiveness of new tuberculosis diagnostics in South Africa.

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[Articles] Effect of community health clubs on child diarrhoea in western Rwanda:…

Community health clubs, in this setting in western Rwanda, had no effect on caregiver-reported diarrhoea among children younger than 5 years. Our results question the value of implementing this intervention at scale for the aim of achieving health gains.

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[Articles] Efficacy and safety of praziquantel in preschool-aged and school-aged children…

Praziquantel shows a flat dose-response and overall lower efficacy in PSAC compared with in SAC. In the absence of treatment alternatives, a single dose of praziquantel of 40 mg/kg, recommended by the WHO for S mansoni infections in SAC can be endorsed for PSAC in preventive chemotherapy programmes.

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[Corrections] Correction to Lancet Glob Health 2017; 5: e537–44

Mohammadi Y, Parsaeian M, Mehdipour P, et al. Measuring Iran’s success in achieving Millennium Development Goal 4: a systematic analysis of under-5 mortality at national and subnational levels from 1990 to 2015. Lancet Glob Health 2017: 5: e537–44—In this Article, the spelling of two author names have been corrected: Maziar Moradi-Lakeh and Saeide Aghamohamadi. Additionally, the correct affiliation for the author Hamidreza Jamshidi is the Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

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[Correspondence] The predicament of patients with suspected Ebola – Authors’ reply

We thank Thomas Mayrhofer and colleagues for offering their threshold model as an explanation for patients’ aversion to accessing Ebola facilities during the recent Ebola outbreak in west Africa. We agree that this threshold model provides a rational and more elegant explanation of patients’ avoidance of ill-equipped and poorly sanitised holding centres; however, such an explanation was not the goal of our Comment.1 Instead, we aimed to produce a reductio ad absurdum2 of rationalist approaches to understanding behaviour during the Ebola outbreak.

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[Correspondence] The predicament of patients with suspected Ebola

In their Comment in The Lancet Global Health, Eugene Richardson and colleagues1 criticised the tendency of many analyses of the Ebola epidemic (eg, a WHO report2) to ignore that it may be rational for a patient with a fever to avoid an Ebola treatment unit. They use the prisoner’s dilemma to explain such non-cooperative behaviour.

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[Correspondence] Renaming non-communicable diseases

The call by Luke Allen and Andrea Feigl (February, 2017)1 to reframe non-communicable diseases (NCDs) is welcome. The lack of focus on these increasingly important causes of morbidity, impairment, and mortality, with their commensurate increasing consumption of health and societal resources and reduced economic contribution, is inappropriate and damaging for all the reasons Allen and Feigl cogently argue. Few things that are described in the negative as what they are not obtain the understanding or action they deserve.

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[Comment] Preventing deaths from pesticide self-poisoning—learning from Sri Lanka’s success

WHO estimates that over 800 000 people die by suicide each year, with the majority of these deaths occurring in low-income and middle-income countries (LMICs).1 During the late 1990s and early 2000s an estimated 35% of suicides, or 300 000 deaths, were due to intentional pesticide self-poisoning.2 These numbers have since fallen,3 but WHO still considers pesticide self-poisoning to be one of the three most important means of global suicide.1

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[Articles] Comparison of sputum collection methods for tuberculosis diagnosis: a systematic…

Tuberculosis diagnoses were substantially increased by either pooled collection or by providing instruction on how to produce a sputum sample taken at any time of the day. Both interventions had a similar effect to that reported for the introduction of new, expensive laboratory tests, and therefore warrant further exploration in the drive to end the global tuberculosis epidemic.

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[Comment] Remembering the basics: interventions to improve sputum collection for tuberculosis…

WHO estimates that 30–50% of people with tuberculosis are untreated, in part because of underdiagnosis.1 Patients with undiagnosed (or diagnosed and untreated) tuberculosis are most likely to transmit infection, so strategies to reduce disease burden should focus on improving the pathway to care for patients. The past decade has seen welcome innovations in diagnostic technology, notably the Xpert MTB/RIF assay, which is significantly more sensitive than smear microscopy and provides rapid identification of rifampicin resistance.

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[Comment] Counting disability: emerging consensus on the Washington Group questionnaire

In November, 2016, at the fourth meeting of the Inter-agency and Expert Group on Sustainable Development Goal (SDG) Indicators in Geneva, a group of leading UN agencies, civil society actors, and independent experts issued a statement1 strongly supporting the Washington Group on Disability Statistics’ Short Set of Questions (WGSS)2 as the preferred method to use with the SDGs to number the world’s population of people with a disability. Further support quickly followed at the UN World Data Forum in Cape Town.

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[Comment] New INDEPTH strategy for the SDGs using robust population data

The INDEPTH Network comprises 49 health and demographic surveillance systems (HDSSs) that monitor the lives of nearly 4 million individuals in 20 low-income and middle-income countries (LMICs). The HDSSs generate and publish robust population-based data on topics such as fertility, migration, mortality, and socioeconomic conditions. These data are needed at local, national, and global levels for setting health and population priorities and testing progress against them. HDSSs are also platforms for clinical and health intervention trials.

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[Comment] Reframing non-communicable diseases as socially transmitted conditions

In a Comment (February, 2017),1 we argued that action on the conditions currently referred to as non-communicable diseases (NCDs) may be hampered by the inadequacy of their label. We received a remarkable amount of feedback on this suggestion, and in this Comment we synthesise the responses garnered from a Lancet Facebook poll, Correspondence letters,2–5 and a related GHD Online discussion. We also propose a new definition based on shared social drivers.

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