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  • ABT-199 During our analysis we sought to

    2019-06-12

    During our analysis, we sought to uncover the source of the oft-cited so-called fact that the risk of maternal mortality of women aged 15–19 years is twice that of women aged 20–24 years (and that the risk for those younger than 15 years is five-times higher). We identified dozens of instances over the past 25 years in which these figures were cited, often without any reference. Although we cannot be sure, the original source seems to be a study done in the late 1960s in rural Bangladesh. This early study was based on surveillance data collected in Matlab Thana and showed that the maternal mortality rate for mothers aged 15–19 years was 7·4 per 1000 livebirths whereas for mothers aged 20–24 it was 3·8. For mothers younger than 15 years, the rate was 17·7. These ratios were subsequently cited in a 1989 WHO volume and then repeated many times in journal articles, reports, and policy documents without reference to the original data. A compilation of age-specific maternal mortality data from 40 countries during roughly the same ABT-199 as the Bangladesh study suggested a much more moderate excess risk for young mothers, but the findings were mostly ignored in the scientific literature. Until very recently, little research has re-examined these early findings on the basis of the more comprehensive data now available.
    Dinesh Mondal and colleagues (January, p e51) investigated the safety and efficacy of single-dose liposomal amphotericin B for treatment of visceral leishmaniasis (also known as kala azar) in Bangladesh. The successful administration of single-dose liposomal amphotericin B at a primary health centre is heartening. In a linked Comment, Prabhat Kumar Sinha and Sujit Bhattacharya discussed adverse events reported in the study. Concerns about potential risks of adverse drug reactions and resistance prompted WHO to initiate pharmacovigilance for miltefosine, another drug used to treat leishmaniasis, and develop an educational manual for patients and health workers. Pharmacovigilance and reporting of adverse drug reactions, especially at primary health centres, remain difficult. Efforts are needed for post-marketing surveillance of single-dose liposomal amphotericin B for cost, benefit, and safety in real life. Sinha and Bhattacharya also refer to the high cost of treatment with liposomal amphotericin B (Ambisome, Gilead, USA). An alternative low-cost formulation, developed in academic institutions in India with funding from the Indian Department of Biotechnology, has been tested for leishmaniasis and has been commercialised as Fungisome (Lifecare, India) by a scientist entrepreneur, and could be provided a much lower price than that of Ambisome. Post-marketing surveillance has been done with results similar to those of pre-marketing phase 1–3 studies. Clinical trials funded by the Indian Government of single doses of morula formulation are underway, and have shown promising initial results for safety and efficacy. We hope that this drug will further lower the cost of treatment, making therapy affordable to patients with the greatest need.
    We recently attended the 11th International Congress on AIDS in Asia and the Pacific () in Bangkok, Thailand. ICAAP is the largest forum on HIV/AIDS held in the Asia–Pacific region and globally one of the largest AIDS conferences. The conference has been organised for more than 20 years, and according to the organisers “it has played a key role in raising public awareness, building political commitment, strengthening advocacy networks, and disseminating knowledge on HIV/AIDS issues among key affected populations and other stakeholders in the region”.
    Lancet Glob Health In this Article (March, 2014), the Funding line in the Summary should have read “Wellcome Trust, SHARE.” In addition, the second sentence in the Acknowledgments section should have read “This study and the development of the intervention was funded by the Wellcome Trust and UK aid from the Department of International Development as part of the SHARE research programme. However, the views expressed do not necessarily reflect the Department\'s official policies.” This correction has been made as of Feb 27, 2014.