Abstract:
BACKGROUND:In South Africa, sputum smear microscopy has been replaced with Xpert MTB/RIF as the initial diagnostic test for tuberculosis. In a pragmatic parallel cluster-randomised trial, we evaluated the effect on patient and programme outcomes. METHODS:We randomly allocated 20 laboratories (clusters) in medium-burden districts of South Africa to either an Xpert (immediate Xpert) or microscopy (Xpert deferred) group (1:1), stratified by province. At two primary care clinics per laboratory, a systematic sample of adults giving sputum for tuberculosis investigation was assessed for eligibility. The primary outcome was mortality at 6 months from enrolment. Masking of participants' group allocation was not possible because of the pragmatic trial design. The trial is registered with the ISRCTN registry (ISRCTN68905568) and the South African Clinical Trial Register (DOH-27-1011-3849). FINDINGS:Between June and November, 2012, 4972 people were screened, and 4656 (93·6%) enrolled (median age 36 years; 2891 [62%] female; 2212 [62%] reported being HIV-positive). There was no difference between the Xpert and microscopy groups with respect to mortality at 6 months (91/2324 [3·9%] vs 116/2332 [5·0%], respectively; adjusted risk ratio [aRR] 1·10, 95% CI 0·75-1·62]). INTERPRETATION:Xpert did not reduce mortality at 6 months compared with sputum microscopy. Improving outcomes in drug-sensitive tuberculosis programmes might require not only better diagnostic tests but also better linkage to care. FUNDING:Bill & Melinda Gates Foundation.
journal_name
Lancet Glob Healthjournal_title
The Lancet. Global healthauthors
Churchyard GJ,Stevens WS,Mametja LD,McCarthy KM,Chihota V,Nicol MP,Erasmus LK,Ndjeka NO,Mvusi L,Vassall A,Sinanovic E,Cox HS,Dye C,Grant AD,Fielding KLdoi
10.1016/S2214-109X(15)00100-Xsubject
Has Abstractpub_date
2015-08-01 00:00:00pages
e450-e457issue
8issn
2214-109Xpii
S2214-109X(15)00100-Xjournal_volume
3pub_type
杂志文章,随机对照试验abstract:BACKGROUND:Low blood glucose concentrations are common in sick children who present to hospital in low-resource settings and are associated with increased mortality. The cutoff blood glucose concentration for the diagnosis and treatment of hypoglycaemia currently recommended by WHO (2·5 mmol/L) is not evidence-based. W...
journal_title:The Lancet. Global health
pub_type: 杂志文章,随机对照试验
doi:10.1016/S2214-109X(20)30388-0
更新日期:2020-12-01 00:00:00
abstract:BACKGROUND:Global efforts to increase births at health-care facilities might not reduce maternal or newborn mortality if quality of care is insufficient. However, little systematic evidence exists for the quality at health facilities caring for women and newborn babies in low-income countries. We analysed the quality o...
journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(16)30180-2
更新日期:2016-11-01 00:00:00
abstract:BACKGROUND:In accordance with the age parameters specified in Sustainable Development Goal target 3.4, current policy and monitoring of non-communicable disease (NCD) mortality trends focus on people aged 30-69 years. This approach excludes the majority of NCD deaths, which occur at older ages. We aimed to compare card...
journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(19)30069-5
更新日期:2019-05-01 00:00:00
abstract:BACKGROUND:The reduction by a third of premature non-communicable disease (NCD) mortality by 2030 is the ambitious target of Sustainable Development Goal (SDG) 3.4. However, the indicator is narrowly defined, including only four major NCDs (cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases) an...
journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(20)30035-8
更新日期:2020-04-01 00:00:00
abstract:BACKGROUND:Many countries are implementing health system reforms to achieve universal health coverage (UHC) by 2030. To understand the progress towards UHC in Bangladesh, we estimated trends in indicators of the health service and of financial risk protection. We also estimated the probability of Bangladesh's achieving...
journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(17)30413-8
更新日期:2018-01-01 00:00:00
abstract:BACKGROUND:In 2007, WHO launched a global initiative for the elimination of mother-to-child transmission of syphilis (congenital syphilis). An important aspect of the initiative is strengthening surveillance to monitor progress towards elimination. In 2008, using a health systems model with country data inputs, WHO est...
journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(16)30135-8
更新日期:2016-08-01 00:00:00
abstract::Intervention coverage-the proportion of the population with a health-care need who receive care-does not account for intervention quality and potentially overestimates health benefits of services provided to populations. Effective coverage introduces the dimension of quality of care to the measurement of intervention ...
journal_title:The Lancet. Global health
pub_type: 杂志文章,评审
doi:10.1016/S2214-109X(20)30104-2
更新日期:2020-05-01 00:00:00
abstract:BACKGROUND:Trials of intermittent preventive treatment (IPTp) of malaria in pregnant women that compared dihydroartemisinin-piperaquine with the standard of care, sulfadoxine-pyrimethamine, showed dihydroartemisinin-piperaquine was superior at preventing malaria infection, but not at improving birthweight. We aimed to ...
journal_title:The Lancet. Global health
pub_type: 杂志文章,随机对照试验
doi:10.1016/S2214-109X(20)30119-4
更新日期:2020-07-01 00:00:00
abstract:BACKGROUND:The age-specific association between blood pressure and vascular disease has been studied mostly in high-income countries, and before the widespread use of brain imaging for diagnosis of the main stroke types (ischaemic stroke and intracerebral haemorrhage). We aimed to investigate this relationship among ad...
journal_title:The Lancet. Global health
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更新日期:2018-06-01 00:00:00
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journal_title:The Lancet. Global health
pub_type: 杂志文章
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更新日期:2017-08-01 00:00:00
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journal_title:The Lancet. Global health
pub_type: 杂志文章
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更新日期:2019-07-01 00:00:00
abstract:BACKGROUND:In 2002-04, we did a randomised controlled trial in southern Nepal, and reported that children born to mothers taking multiple micronutrient supplements during pregnancy had a mean birthweight 77 g greater than children born to mothers taking iron and folic acid supplements. Children born to mothers in the s...
journal_title:The Lancet. Global health
pub_type: 杂志文章,随机对照试验
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更新日期:2014-11-01 00:00:00
abstract:BACKGROUND:Avahan is a large-scale, HIV preventive intervention, targeting high-risk populations in south India. We assessed the cost-effectiveness of Avahan to inform global and national funding institutions who are considering investing in worldwide HIV prevention in concentrated epidemics. METHODS:We estimated cost...
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更新日期:2014-09-01 00:00:00
abstract:BACKGROUND:Brazil ranks second worldwide in total number of COVID-19 cases and deaths. Understanding the possible socioeconomic and ethnic health inequities is particularly important given the diverse population and fragile political and economic situation. We aimed to characterise the COVID-19 pandemic in Brazil and a...
journal_title:The Lancet. Global health
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更新日期:2020-08-01 00:00:00
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journal_title:The Lancet. Global health
pub_type: 杂志文章,评审
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更新日期:2021-01-11 00:00:00
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journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(17)30033-5
更新日期:2017-03-01 00:00:00
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journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(14)70346-8
更新日期:2015-05-01 00:00:00
abstract:BACKGROUND:Scrub typhus (caused by Orientia tsutsugamushi), murine typhus (caused by Rickettsia typhi), and leptospirosis are common causes of febrile illness in Asia; meningitis and meningoencephalitis are severe complications. However, scarce data exist for the burden of these pathogens in patients with CNS disease i...
journal_title:The Lancet. Global health
pub_type: 杂志文章
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更新日期:2015-02-01 00:00:00
abstract:BACKGROUND:Chagas disease is currently prevalent in European countries hosting large communities from Latin America. Whether asymptomatic individuals at risk of Chagas disease living in Europe should be screened and treated accordingly is unclear. We performed an economic evaluation of systematic Chagas disease screeni...
journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(17)30073-6
更新日期:2017-04-01 00:00:00
abstract:BACKGROUND:The average age at which people start smoking has been decreasing in many countries, but insufficient evidence exists on the adult hazards of having started smoking in childhood and, especially, in early childhood. We aimed to investigate the association between smoking habits (focusing on the age when smoke...
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pub_type: 杂志文章
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更新日期:2016-09-01 00:00:00
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journal_title:The Lancet. Global health
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更新日期:2020-04-01 00:00:00
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journal_title:The Lancet. Global health
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更新日期:2015-01-01 00:00:00
abstract:BACKGROUND:No study of long-term protection following killed oral cholera vaccination has been done outside of the historically cholera-endemic areas of south Asia, or has examined protection after a single-dose vaccination regimen. To address this, we examined the duration of protection of the standard two-dose regime...
journal_title:The Lancet. Global health
pub_type: 杂志文章
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更新日期:2018-09-01 00:00:00
abstract:BACKGROUND:The risk of severe COVID-19 if an individual becomes infected is known to be higher in older individuals and those with underlying health conditions. Understanding the number of individuals at increased risk of severe COVID-19 and how this varies between countries should inform the design of possible strateg...
journal_title:The Lancet. Global health
pub_type: 杂志文章
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更新日期:2020-08-01 00:00:00
abstract:BACKGROUND:The burden of dengue virus (DENV) infection across geographical regions of India is poorly quantified. We estimated the age-specific seroprevalence, force of infection, and number of infections in India. METHODS:We did a community-based survey in 240 clusters (118 rural, 122 urban), selected from 60 distric...
journal_title:The Lancet. Global health
pub_type: 杂志文章
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更新日期:2019-08-01 00:00:00
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journal_title:The Lancet. Global health
pub_type: 杂志文章
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更新日期:2019-07-01 00:00:00
abstract:BACKGROUND:Attainment of universal health coverage is a global health priority. The Myanmar Government has committed to attainment of universal health coverage by 2030, but progress so far has not been assessed. We aimed to estimate national and subnational health service coverage and financial risk protection. METHOD...
journal_title:The Lancet. Global health
pub_type: 评论,杂志文章
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更新日期:2018-09-01 00:00:00
abstract:BACKGROUND:Knowledge of the relation between health-system factors and child mortality could help to inform health policy in low-income and middle-income countries. We aimed to quantify modifiable health-system factors and their relation with provincial-level heterogeneity in under-5, infant, and neonatal mortality ove...
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pub_type: 杂志文章
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更新日期:2014-08-01 00:00:00