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Objective To demonstrate how the new internationally comparable instrument, the People's Voice Survey, can be used to contribute the perspective of the population in assessing health system performance in countries of all levels of income. Methods We surveyed representative samples of populations in 16 low-, middle- and high-income countries on health-care utilization, experience and confidence during 2022-2023. We summarized and visualized data corresponding to the key domains of the World Health Organization universal health coverage framework for health system performance assessment. We examined correlation with per capita health spending by calculating Pearson coefficients, and within-country income-based inequities using the slope index of inequality. Findings In the domain of care effectiveness, we found major gaps in health screenings and endorsement of public primary care. Only one in three respondents reported very good user experience during health visits, with lower proportions in low-income countries. Access to health care was rated highest of all domains; however, only half of the populations felt secure that they could access and afford high-quality care if they became ill. Populations rated the quality of private health systems higher than that of public health systems in most countries. Only half of respondents felt involved in decision-making (less in high-income countries). Within countries, we found statistically significant pro-rich inequalities across many indicators. Conclusion Populations can provide vital information about the real-world function of health systems, complementing other system performance metrics. Population-wide surveys such as the People's Voice Survey should become part of regular health system performance assessments. [phrase omitted] [phrase omitted] Objectif Montrer comment l'enquete People's Voice Survey, un nouvel instrument comparable au niveau international, peut etre utilise pour nourrir la perspective d'une evaluation des performances du systeme de sante par la population dans des pays de tous les niveaux de revenus. Methodes Nous avons interroge des echantillons representatifs d'habitants de 16 pays a revenu faible, intermediaire et eleve sur leur recours aux soins de sante, leur experience en la matiere et la confiance qu'ils y accordent sur la periode 2022-2023. Nous avons ensuite resume et visualise les donnees correspondant aux principaux domaines du cadre de l'Organisation mondiale de la Sante relatif a la couverture sanitaire universelle pour evaluer les systemes de sante. Enfin, nous avons examine la correlation avec les depenses individuelles en soins de sante en calculant les coefficients Pearson, ainsi que les disparites de revenus au sein de chaque pays a l'aide de l'indice de pente de l'inegalite. Resultats Dans le domaine de l'efficacite des soins, nous avons decele des lacunes considerables au niveau des examens medicaux et de l'approbation envers l'offre publique de soins de sante primaires. Seul un repondant sur trois a fait etat d'une excellente experience en tant que patient lors des visites sanitaires, le pourcentage etant moins eleve dans les pays a revenu faible. Tous domaines confondus, c'est l'acces aux soins de sante qui a recu la meilleure note; toutefois, a peine la moitie des personnes interrogees avaient la conviction de pouvoir beneficier de soins de qualite a prix abordable si elles venaient a tomber malades. La qualite des systemes de sante prives a ete jugee superieure a celle des systemes de sante publics dans la plupart des pays. Enfin, la moitie seulement des repondants se sent impliquee dans la prise de decisions (voire moins dans les pays a revenu eleve). Par ailleurs, nous avons trouve au sein de chaque pays des inegalites statistiquement significatives en faveur des categories les plus aisees et ce, pour de nombreux indicateurs. Conclusion Les populations peuvent fournir des informations vitales sur le fonctionnement reel des systemes de sante, ce qui permet de completer les autres mesures de performances. Les enquetes telles que People's Voice Survey, menees aupres de l'ensemble des habitants, devraient desormais etre integrees aux evaluations periodiques des performances des systemes de santes. [phrase omitted] Objetivo Demostrar como el nuevo instrumento de comparacion internacional, la People's Voice Survey, se puede utilizar para aportar la perspectiva de la poblacion al evaluar el desempeno del sistema sanitario en paises de todos los niveles de ingresos. Metodos Se encuestaron muestras representativas de poblaciones de 16 paises de ingresos bajos, medios y altos sobre la utilizacion de la atencion sanitaria, la experiencia y la confianza durante 2022 y 2023. Se resumieron y visualizaron los datos correspondientes a los ambitos clave del marco de cobertura sanitaria universal de la Organizacion Mundial de la Salud para la evaluacion del desempeno de los sistemas sanitarios. Se examino la correlacion con el gasto sanitario per capita calculando los coeficientes de Pearson y las desigualdades basadas en los ingresos dentro de los paises utilizando el indice de desigualdad de la pendiente. Resultados En el ambito de la eficacia de la atencion, se encontraron importantes deficiencias en los examenes de salud y en la aprobacion de la atencion primaria publica. Solo uno de cada tres encuestados declaro tener una experiencia de usuario muy buena durante las visitas sanitarias, con porcentajes mas bajos en los paises de ingresos bajos. El acceso a la atencion sanitaria fue el mejor valorado de todos los ambitos; sin embargo, solo la mitad de las poblaciones se sentian seguras de poder acceder y costearse una atencion de alta calidad en caso de enfermar. En la mayoria de los paises, la poblacion valoro mas la calidad de los sistemas sanitarios privados que la de los publicos. Solo la mitad de los encuestados se sentian implicados en la toma de decisiones (menos en los paises de ingresos altos). Dentro de los paises, se encontraron desigualdades estadisticamente significativas a favor de los mas ricos en muchos indicadores. Conclusion Las poblaciones pueden proporcionar informacion vital sobre el funcionamiento real de los sistemas sanitarios, como complemento de otras metricas de desempeno del sistema. Las encuestas poblacionales, como la People's Voice Survey, deberian formar parte de las evaluaciones periodicas del funcionamiento de los sistemas sanitarios., Introduction The notion that health systems should be people-centred seems unexceptional. Health systems are occupied with serving people, are funded by people and aim to improve people's health as their [...]

Background Antenatal care (ANC) is an essential platform to improve maternal and newborn health (MNH). While several articles have described the content of ANC in low- and middle-income countries (LMICs), few have investigated the quality of detection and management of pregnancy risk factors during ANC. It remains unclear whether women with pregnancy risk factors receive targeted management and additional ANC. Methods and findings This observational study uses baseline data from the MNH eCohort study conducted in 8 sites in Ethiopia, India, Kenya, and South Africa from April 2023 to January 2024. A total of 4,068 pregnant women seeking ANC for the first time in their pregnancy were surveyed. We built country-specific ANC completeness indices that measured provision of 16 to 22 recommended clinical actions in 5 domains: physical examinations, diagnostic tests, history taking and screening, counselling, and treatment and prevention. We investigated whether women with pregnancy risks tended to receive higher quality care and we assessed the quality of detection and management of 7 concurrent illnesses and pregnancy risk factors (anemia, undernutrition, obesity, chronic illnesses, depression, prior obstetric complications, and danger signs). ANC completeness ranged from 43% in Ethiopia, 66% in Kenya, 73% in India, and 76% in South Africa, with large gaps in history taking, screening, and counselling. Most women in Ethiopia, Kenya, and South Africa initiated ANC in second or third trimesters. We used country-specific multivariable mixed-effects linear regression models to investigate factors associated with ANC completeness. Models included individual demographics, health status, presence of risk factors, health facility characteristics, and fixed effects for the study site. We found that some facility characteristics (staffing, patient volume, structural readiness) were associated with variation in ANC completeness. In contrast, pregnancy risk factors were only associated with a 1.7 percentage points increase in ANC completeness (95% confidence interval 0.3, 3.0, p-value 0.014) in Kenya only. Poor self-reported health was associated with higher ANC completeness in India and South Africa and with lower ANC completeness in Ethiopia. Some concurrent illnesses and risk factors were overlooked during the ANC visit. Between 0% and 6% of undernourished women were prescribed food supplementation and only 1% to 3% of women with depression were referred to a mental health provider or prescribed antidepressants. Only 36% to 73% of women who had previously experienced an obstetric complication (a miscarriage, preterm birth, stillbirth, or newborn death) discussed their obstetric history with the provider during the first ANC visit. Although we aimed to validate self-reported information on health status and content of care with data from health cards, our findings may be affected by recall or other information biases. Conclusions In this study, we observed gaps in adherence to ANC standards, particularly for women in need of specialized management. Strategies to maximize the potential health benefits of ANC should target women at risk of poor pregnancy outcomes and improve early initiation of ANC in the first trimester., Author(s): Catherine Arsenault 1,*, Nompumelelo Gloria Mfeka-Nkabinde 2, Monica Chaudhry 3, Prashant Jarhyan 3, Tefera Taddele 4, Irene Mugenya 5, Shalom Sabwa 6, Katherine Wright 6, Beatrice Amboko 5, Laura [...]

PURPOSE: Subset analyses from phase III evaluation of epidermal growth factor receptor inhibition (EGFRi) suggest improved outcomes in patients with EGFR-amplified gastroesophageal adenocarcinoma (GEA), but large-scale analyses are lacking. This multi-institutional analysis sought to determine the role of EGFRi in the largest cohort of patients with EGFR-amplified GEA to date. PATIENTS AND METHODS: A total of 60 patients from 15 tertiary cancer centers in six countries met the inclusion criteria. These criteria required histologically confirmed GEA in the metastatic or unresectable setting with EGFR amplification identified by using a Clinical Laboratory Improvement Amendments-approved assay, and who received on- or off-protocol EGFRi. Testing could be by tissue next-generation sequencing, plasma circulating tumor DNA next-generation sequencing, and/or fluorescence in situ hybridization performed by a Clinical Laboratory Improvement Amendments approved laboratory. Treatment patterns and outcomes analysis was also performed using a deidentified clinicogenomic database (CGDB). RESULTS: Sixty patients with EGFR-amplified GEA received EGFRi, including 31 of 60 patients (52%) with concurrent chemotherapy. Across treatment lines, patients achieved a 43% objective response rate with a median progression-free survival of 4.6 months (95% CI, 3.5 to 6.4). Patients receiving EGFRi in first-, second-, and third-line therapy achieved a median overall survival of 20.6 months (95% CI, 13.5 to not reached [NR]), 9 months (95% CI, 7.9 to NR), and 8.4 months (7.6 to NR), respectively. This survival far exceeded the 11.2-month (95% CI, 8.7 to 14.2) median overall survival from first-line initiation of non-EGFRi therapy in patients with EGFR-amplified GEA in the CGDB. Despite this benefit, analysis of the CGDB (January 2011-December 2020) suggests that only 5% of patients with EGFR-amplified GEA received EGFRi. CONCLUSION: Patients with EGFR-amplified GEA derive significant benefit from EGFRi. Further prospective investigation of EGFRi in a well-selected patient population is ongoing in an upcoming trial of amivantamab in EGFR and/or MET amplified GEA.