Journal of Epidemiology and Global Health最新文献

Background: Non-pharmaceutical interventions (NPIs) against COVID-19 globally altered RSV seasonality, yet longitudinal evidence on age-specific severity changes remains scarce in China.

Methods: In this hospital-based surveillance study, 20,305 children hospitalized with acute lower respiratory infection (ALRI) were enrolled. RSV was detected via RT-PCR across three phases: pre-pandemic (2017-2019), NPIs implementation (2020-2022), and post-NPIs (2023-2024).

Results: RSV positivity varied significantly between phases (p < 0.001), peaking at 38.85% (742/1,910) in 2021. Seasonal peaks shifted from winter (pre-pandemic) to spring (post-NPIs). The disease burden shifted toward infants aged 7-12 months (38.92%, 845/2,171 vs. 20.55%, 200/973 pre-pandemic; p < 0.001). Notably, mechanical ventilation was required in 8.00% (4/50) and 5.71% (2/35) of severe pneumonia cases aged 13-36 months during Phases II and III, respectively, whereas no cases were recorded pre-pandemic (0/14; p > 0.05).

Conclusion: NPIs fundamentally reshaped RSV epidemiology, inducing seasonal shifts and redirecting disease burden toward older infants experiencing delayed primary infection due to "immune debt."

Background: This study aimed to characterize the incidence, seasonality, and co-infection patterns of respiratory syncytial virus (RSV), influenza A and B, and SARS-CoV-2 among hospitalized children aged 0-5 years in Hamedan Province, a semi-arid region in western Iran, from April 2023 to March 2024. Key research questions included assessing post-pandemic shifts in viral seasonality, evaluating the extent of RSV circulation, and determining the frequency of co-infections in a resource-limited pediatric setting where regional data remain scarce.

Methods: A total of 586 nasopharyngeal/oropharyngeal samples were collected from children aged 0-5 years hospitalized with acute respiratory symptoms (≥ 2 of: fever ≥ 38 °C, cough, dyspnea, oxygen saturation < 95%). Multiplex real-time PCR (sensitivity 95%, specificity 98%) was used to detect RSV, SARS-CoV-2, and influenza A (H1N1, H3N2) and B. Statistical analysis included chi-square and Fisher's exact tests, and generalized linear models (binomial distribution, logit link).

Results: Among 586 inpatients (mean age: 2.8 years; 62.5% male), 27.0% tested positive for influenza (60% influenza A [35% H1N1, 25% H3N2], 40% influenza B), 6.0% for RSV, and 6.3% for SARS-CoV-2. Influenza peaked in autumn (41.3%, p < 0.001), RSV in winter (18.2%, p < 0.001), and SARS-CoV-2 in spring (15.3%, p = 0.005). Co-infections were rare (0.9%).

Conclusions: Findings reveal altered post-pandemic seasonality, reduced RSV activity, and low co-infection rates, suggesting potential ecological and immunological shifts. These trends highlight the need for sustained virus-specific surveillance and recalibrated vaccination strategies-particularly influenza vaccination in autumn and RSV prophylaxis in winter-in resource-limited pediatric settings.

Background: Emerging evidence suggests that insulin resistance (IR) may influence coronary artery disease (CAD) progression. However, the relationship between dietary insulinemic potential and IR surrogate markers and CAD severity remains unclear.

Methods: This cross-sectional study utilized data from the Nutrition Heshmat Registry (NUTHER) in Guilan, Iran, including 930 patients at risk for CAD. CAD severity was assessed using the Gensini score based on angiographic findings. Dietary intake was evaluated using a validated 168-item food frequency questionnaire (FFQ), with energy-adjusted dietary insulin load, and dietary insulin index calculated accordingly. The triglyceride-glucose (TyG)-BMI index was derived as a surrogate marker of insulin resistance.

Results: Of the 930 patients analyzed, 565 were categorized as having less severe CAD (Gensini score < 60) and 365 as severe CAD (Gensini score ≥ 60). Multiple regression models adjusted for various confounding factors showed that participants in the highest quartile of the TyG-BMI index had a 1.98-fold higher odds of severe CAD (OR (95%CI) = 1.98 (1.31-2.99); P-for-trend = 0.001), while those in the highest quartile of energy-adjusted dietary insulin load, and dietary insulin index had 2.41-fold and 2.22-fold increased odds of severe CAD, respectively (Q4 ORs (95%CIs) = 2.41 (1.41-4.12) for e.a.IL, and 2.22 (1.29-3.82) for e.a.II; P-for-trend < 0.001).

Conclusion: Our significant findings suggest that higher TyG-BMI, dietary insulin load, and insulin index are likely associated with an increased odds of severe CAD. Monitoring and modifying dietary insulinemic potential and improving metabolic health may serve as practical strategies for reducing CAD severity in at-risk populations.

Background: Lung cancer is the leading cause of cancer deaths worldwide. Due to late detection, patients have low survival rates. We aimed to examine lung cancer epidemiology in the Kingdom of Saudi Arabia by computing standardised rates for the different regions of the country and across years.

Methods: We used the Saudi Cancer Registry data to conduct a retrospective study for all lung cancer cases diagnosed between 2015 and 2020. We identified cases using ICD-O-3 codes, with no exclusions by morphology. We followed the Surveillance, Epidemiology, and End Results guidelines for staging. We analysed demographic and tumour characteristics and used mid-year population estimates from the General Authority for Statistics for standardisation. We then calculated age-sex standardised incidence rates and standardised incidence ratios using indirect standardisation. We compared geographical trends in incidence across regions and years.

Results: Based on the total number of 3,861 lung cancer cases reported to the Saudi Cancer Registry between 2015 and 2020, we estimated the average six-year crude incidence rate of 2.1 per 100,000. We observed variability in incidence across different regions ranging from 0.59 per 100,000 in Jazan to 3.36 per 100,000 in the Eastern Province. Age-standardised rates show males with consistently higher rates than females throughout the study period. Sex-based differences were statistically significant (P < 0.05). We also found that males had a higher proportion of squamous cell and small cell carcinomas than females (18.71% vs. 08.99% and 10.22% vs. 05.13% respectively).

Conclusions: Our findings show a male predominance, regional disparities, and late-stage adenocarcinoma diagnoses. These patterns are consistent with known risk factors, including tobacco exposure, environmental risks, and delayed detection, and support the implementation of targeted prevention, earlier diagnosis, and regionally tailored interventions in the Kingdom of Saudi Arabia.

Background: The Gulf Cooperation Council region hosts large numbers of migrant workers, which has important implications for public health. Studies have documented varied disease risks among these populations. This paper examines risk factors for communicable diseases among migrant workers in this region. It darws on a social-ecological model to explore the interplay of individual, social, environmental, and structural factors. The paper also outlines policy areas where action may strengthen public health outcomes.

Methods: This study conducted a systematic review following PRISMA guidelines. We searched PubMed, Scopus, Embase, Web of Science, CINAHL, and Global Health. We identified 113 records through database searches, screened 72 unique records after duplicate removal, and assessed 24 at full-text for eligibility. Extracted data were managed using standardized Excel-based forms, cross-checked for accuracy, and synthesised narratively by grouping studies according to disease type and risk-factor domains following established guidance. We applied co-occurrence analysis of risk factors across studies. Data synthesis used a narrative approach to compare findings across heterogeneous study designs, focusing on recurring patterns in reported.

Results: Co-occurrence analysis using Pearson correlations, Jaccard coefficients, and phi coefficients (bootstrap 95% CIs) showed susbtantial convergent validity. Healthcare access and language barriers each appeared frequently alongside labour camps. Crowded conditions were often linked with low awareness. Migration from endemic countries showed little overlap with occupational exposure.

Conclusions: Communicable disease risks among migrant workers in the GCC arise from multiple, interacting factors. Healthcare access barriers and labour camp housing repeatedly emerged among the most prominent co-occurring risk factors. Communicable disease risks among migrant workers in the GCC largely reflect structural conditions, particularly housing, healthcare access, and legal and occupational vulnerabilities, highlighting the need for coordinated regional policies that strengthen surveillance, improve living conditions, and expand equitable access to care.

Purpose: While Zambia has an efficient program for early detection of cervical cancer, most cases are diagnosed at advanced stages. This study examined the time between suspecting cancers at screening clinics and histopathologic confirmation of cervical cancer in the Lusaka Province of Zambia.

Methods: This study included the records of 3,483 women with suspected cancerous lesions identified by visual inspection of the cervix (VIA) who were referred from Lusaka Province screening facilities from 2014 to 2022. The study linked screening records with corresponding histopathologic results of the lesions after examination at the University Teaching Hospital. Variables abstracted from the medical records included age, human immunodeficiency virus (HIV) status, district of residence and referral clinic, and dates of referral and confirmed diagnosis.

Results: False-positive VIA results constituted about 90% of all referrals. Women living with HIV (WLWH) had longer wait times between screening referrals and receipt of histopathologic results, most notably women coming from rural settings (median of 146 days) compared to urban settings (median of 69 days) (p < 0.05). Among women diagnosed with low-grade intraepithelial lesions, WLWH had a 63% higher risk of confirmed cancer diagnosis (CI: 1.16, 2.29) than women not living with HIV. For high-grade intraepithelial lesions, the adjusted HR showed WLWH having a 17% (CI: 0.89, 1.53) higher risk of confirmed cancer diagnosis compared to women not living with HIV.

Conclusion: The high rate of false-positives and long wait times call for expanded service infrastructure, particularly in rural settings, and continuing provider education/training to optimize screening sensitivity and shorten wait times in the Lusaka Province. Such measures may reduce the overload on the existing histopathology infrastructure and may provide lessons for other limited-resource countries facing similar cancer control and prevention challenges.

Background: Forced displacement has created widespread health disparities, with refugees experiencing disproportionate risks of chronic conditions like hypertension. In the United States, a limited understanding of how knowledge, attitudes, and practices (KAP) shape blood pressure (BP) outcomes continues to hinder equitable care. This study explores the relationship between KAP and BP control among Iraqi and Syrian refugees who resettled in the United States.

Methods: Iraqi and Syrian refugees (n = 95) with hypertension at a federally qualified health center in San Diego, California, participated in this study. They completed a survey in Arabic assessing KAP based on a scale validated in non-English speakers and were instructed to do home BP monitoring using digital cuffs for at least 3 days per week for 4 weeks. The outcome was BP control based on the American College of Cardiology (ACC) criteria, calculated from an average of home BP readings. Mixed-effect logistic regression was used to assess the relationship between each KAP quartile and BP control. KAP quartile was categorized into (poor, fair, good, excellent).

Results: Participants were 56% male, and the mean age was 58.8 (± 15.97) years. 86% were unemployed, 40% had at least a bachelor's degree, 63% had limited English proficiency, and only 3.6% had an annual income of ≥$35,000. Mean BP was 129/79 mmHg (SD systolic: 22.17 mmHg; SD diastolic: 11.15 mmHg). Scores were computed for each KAP sub-scale: knowledge (0-16), attitude (1-20), and practice (1-8). Knowledge 13.2 (± 2.37), attitude 14.6 (± 2.38), and practice 6.5 (± 1.17). Higher knowledge levels were associated with higher odds of BP control (OR 1.89, 95% CI 1.39-2.55). An inverse relationship was observed between attitudes and BP control: participants with "Fair" and "Good" scores had reduced odds of BP control (OR = 0.63, 95% CI: 0.52-0.77; and OR = 0.58, 95% CI: 0.45-0.75, respectively).

Conclusions: These findings highlight the urgent need for culturally grounded health education and systems-level strategies that address both informational and perceptual barriers to BP control. Advancing health equity for refugee populations demands interventions that go beyond awareness, integrating trust-building, accessibility, and empowerment into chronic disease management.

Background: Neonatal sepsis remains a major cause of preventable neonatal mortality globally, yet diagnosis remains difficult in low-resource settings due to the inaccessibility and the long turnaround time of blood culture. Clinical prediction models can support the early detection and management of sepsis.

Objective: To develop and internally validate a diagnostic prediction model for the diagnosis of neonatal sepsis in a low-resource setting, Ethiopia.

Methods: An institution-based cross-sectional study was conducted from January 2022 to December 2024. We collected data through medical record review among 607 newborns with suspected sepsis. Predictors were selected using the least absolute shrinkage and selection operator (LASSO) and then subjected to multivariable logistic regression. Model performance was assessed by discrimination and calibration. Ten-fold cross-validation was performed to assess the model's internal validity, and clinical utility was assessed by decision curve analysis. External validation was not performed. The R statistical software was used for data analysis.

Results: The proportion of sepsis was 36.1% (95% CI: 32.3, 39.9). The final model incorporated maternal anemia, fever, antibiotic use during pregnancy, temperature abnormality, presence of a focus of infection, invasive procedure before admission, leukocytosis, leukopenia, and thrombocytopenia. The model demonstrated an area under the receiver operating characteristic curve (AUROC) of 0.87(95% CI: 0.84, 0.90) and good calibration. The model achieved a sensitivity of 86.8%, specificity of 71.1%, negative predictive value of 90.5%, and a positive likelihood ratio of 3.0. The decision curve analysis showed a higher net benefit than the "treat-all" or "treat-none" strategies.

Conclusions: We developed a diagnostic prediction model for neonatal sepsis, demonstrating good discrimination, high sensitivity, and negative predictive value, with a modest positive likelihood ratio, reflecting its utility for ruling in or out sepsis. The model can be incorporated into routine neonatal care practices and quality improvement initiatives following external validation.

Background: Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide and a leading cause of cervical, anogenital, and oropharyngeal cancers. While global epidemiology is well-documented, data from Saudi Arabia remain fragmented. Updated evidence is essential to guide national prevention and vaccination strategies.

Methods: We systematically searched PubMed, Embase, Web of Science, MEDLINE, and Google Scholar for studies reporting HPV prevalence, genotypes, or risk factors in Saudi Arabia. Eligible studies included cross-sectional, cohort, and case-control designs assessing cervical, anal, oral, or penile HPV using validated molecular methods. Data on study characteristics, prevalence, genotypes, risk factors, and prognostic outcomes were extracted. Reporting followed PRISMA-ScR guidelines.

Results: HPV prevalence ranged from 4.7% to 31.6% in general populations and up to 52.9% in high-risk groups. The most common genotypes were HPV-16, HPV-18, and other high-risk (HR) types.

Conclusion: HPV represents a growing public health concern in Saudi Arabia, with HR genotypes predominating. Sociodemographic and behavioral factors influence infection patterns. Large-scale, population-based studies remain limited, highlighting the need for comprehensive surveillance, vaccination programs, and targeted awareness initiatives to reduce HPV-related disease burden.