Journal of Epidemiology and Global Health最新文献

Background: Malaria remains a major public health problem that continues to cause death in under-five children nearly every minute. The purpose of this systematic review and meta-analysis was to determine the pooled prevalence and predictors of asymptomatic malaria in children in Sub-Saharan Africa.

Methods: Relevant studies were retrieved from Web of Science, Cochrane Library, PubMed, Google Scholar, Gray Literature, Embase, and African Online Journal databases published between 2014 and 2024. Data quality was assessed by a tool developed by Hoy and colleagues and classified as low, moderate, or high risk of bias. We performed a random effects model and sub-group analysis by age group, region, and diagnostic methods. The protocol was registered in the PROSPERO (CRD42024584354).

Results: A total of 24 cross-sectional studies with 19,169 participants from 10 Sub-Saharan Africa countries were included in the analyses under the age of 15 years. The overall prevalence of asymptomatic malaria was 25% (95% CI: 20-30%) and showed no evidence of publication bias. Utilization of insecticide-treated nets was significantly associated with asymptomatic malaria. In addition, the overall prevalence of anemia in asymptomatic Plasmodium-infected children under the age of 15 was found to be 35% (95% CI: 24-46%). Subgroup analysis showed significant regional and diagnostic tool differences in asymptomatic Plasmodium infection.

Conclusion: The findings of this study revealed a high prevalence of asymptomatic plasmodium infection in children with significant regional variations. There was a significant association with anemia and the utilization of insecticide-treated nets.

Background: Hypertension is a major public health issue and a leading risk factor for cardiovascular disease (CVD). We assessed blood pressure (BP) control among adult hypertensive patients attending non-communicable disease (NCD) clinics in five Rwandan district hospitals.

Methods: We extracted data on hypertensive management from five Rwandan district hospitals from June 2016 to August 2021. BP control was defined as systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) < 90 mmHg measured within the last four months. We performed statistical analysis using chi-square tests and multivariate regression analyses with 95% confidence intervals (CI).

Results: Blood pressure control was achieved in 41.5% of hypertensive patients (n = 438/1,055). The majority were aged > 60 years (mean age 62; n = 663/1,055; 62.8%), and women, with approximately three-quarters of patients (n = 796/1,055; 75.5%) had a BMI between 18.5 and 24.9 Kg/m² and the majority (n = 843/1,055; 79.9%) resided in rural districts. More than half (n = 585/1,055; 55.5%) were taking two antihypertensive medications. Factors significantly associated with uncontrolled BP included BMI ≥ 30 kg/m² (p < 0.001), use of Angiotensin-converting enzyme (ACE) inhibitors (p = 0.01), use of four antihypertensive drugs (p = 0.013), and missing an NCD clinic appointment (p < 0.001).

Conclusions: BP control rates among hypertensive patients attending NCD clinics remain low. Strengthening patient counseling, encouraging physical activity, and improving medication adherence are critical. Building the capacity of healthcare staff at both hospital and health centre levels is vital to improving hypertension management in NCD clinics.

Background: Onchocerciasis, a neglected tropical disease (NTD) caused by Onchocerca volvulus, is hyperendemic in many parts of Africa, including South Sudan. Pregnant women may be a parasite reservoir as they are not included in routine ivermectin (IVM) treatments due to unassessed drug safety. In our study we determined the proportion of pregnant women infected with Onchocerca volvulus and assessed the knowledge and practices on IVM use during pregnancy.

Methodology/principal findings: A hospital-based cross-sectional study was conducted in 2023 at Maridi hospital in Maridi County, an onchocerciasis endemic area in South Sudan. All pregnant or one-week post-partum women willing to participate were interviewed, clinically examined, tested with the Ov16 Bioline rapid diagnostic test (RDT) and skin snipped for O. volvulus detection. A total of 317 women aged between 14 and 44 years participated in the study [median age: 23 years (IQR: 19-29)]. Of 290 women who were tested, 179 (61.7%) were Ov16 RDT positive (SD Bioline). Of the 162 women skin snipped, 51 (31.5%) were positive for O. volvulus microfilarial worm following microscopic examination. The microfilaridemia (skin parasite load) ranged between one microfilaria per skin snip (1mf/ss) and 300 mf/ss with a mean value of value of 12.4 (sd: ± 49.1) mf/ss. Most pregnant women (87.8% (274/312)) knew that it was not advised to take IVM during pregnancy. Out of 309 women, 54 (17.5%) had never taken IVM, and 6.4% (16/251) inadvertently took IVM during pregnancy. Of the 16 women who took IVM during pregnancy, 50% (8/16) knew that they were pregnant. Out of 248 women with children, 9 (3.6%) had children suffering from epilepsy; two of them had two children with epilepsy. No abnormalities were reported in the children of the women who took IVM.

Conclusions: Our study is the first to investigate the prevalence and level of O. volvulus infection among pregnant women in onchocerciasis-endemic areas in Africa. Our results showed a high infection rate of O. volvulus among pregnant women, which may pose a risk for adverse materno-foetal outcomes. Pregnant women in South Sudan are a reservoir for parasite transmission. A clinical trial evaluating the potential beneficial effect of treating O. volvulus infected pregnant women with IVM should be considered, as our preliminary results and the literature suggest that IVM intake might not affect the newborn.

Background: Lipids are known to be involved in carcinogenesis, but the associations between lipid profiles and different lung cancer histological classifications remain unknown.

Methods: Individuals who participated in national adult health surveillance from 2012 to 2018 were included. For patients who developed lung cancer during follow-up, a 1:2 control group of nonlung cancer participants was selected after matching. Multivariate conditional logistic regression was used to explore the associations between lipid profiles, different lung cancer histological classifications and epidermal growth factor receptor mutation statuses. Subgroup, sensitivity, and dose‒response analyses were also performed.

Results: A total of 4,704,853 participants (30,337 lung cancer participants and 4,674,516 nonlung cancer participants) were included. In both the main and sensitivity analyses, the associations remained constant between lower high-density lipoprotein (HDL) cholesterol levels and a higher risk of lung cancer (main analysis: odds ratio: 1.13 [1.08-1.18]) and squamous cell carcinoma (1.29 [1.16-1.43]). Hypertriglyceridemia was associated with a lower risk of adenocarcinoma (0.90 [0.84-0.96]) and a higher risk of small cell lung cancer (1.31 [1.11-1.55]). Hypercholesterolemia was associated with a lower risk of squamous cell carcinoma (0.84 [0.76-0.94]). In the subgroup analysis, lower HDL cholesterol levels were associated with greater risk across most subgroups. HDL cholesterol levels also demonstrated a dose‒response association with the development of lung cancer.

Conclusions: The distinct associations between specific lipid profiles and lung cancer subtypes suggest that lipid metabolism may play different mechanistic roles in lung cancer development.

Background: Rabies is a preventable yet deadly public health threat. Despite the availability of effective vaccines for both humans and animals, the persistence of rabies-related fatalities underscores the need for enhanced public education strategies. This study aimed to develop and validate a Rabies Health Education Module delivered via a Massive Open Online Course, targeting adult dog owners in Kelantan, Malaysia.

Methods: The development of RaHEM followed the ADDIE framework. A comprehensive analysis was conducted through literature reviews, cross-sectional surveys, and stakeholder interviews. The module's content was designed and developed based on the Modified Health Belief Model and Mayer's Cognitive Theory of Multimedia Learning. Validation was performed by a panel of six experts and ten dog owners through content and face validity indices, respectively.

Results: The module was organized into five core topics, each addressing specific aspects of rabies prevention. Content validity indices for all topics exceeded the acceptable threshold of 0.83, with an overall module CVI of 0.91 for relevance and 0.88 for clarity. Face validity indices also surpassed the 0.83 threshold, with overall module FVI scores of 1.00 for understandability and 0.99 for clarity.

Conclusion: The RaHEM MOOC was successfully developed and thoroughly validated, ensuring it met its intended objectives and was suitable for the target audience. This educational module offers a promising approach to enhancing rabies prevention through accessible and engaging online education, potentially contributing to reduced rabies transmission and fatalities. Further studies are recommended to evaluate the module's effectiveness in improving rabies knowledge and attitudes.

Background: During the COVID-19 outbreak in December 2022 in China, some laboratory workers in SARS-CoV-2 nucleic acid testing (NAT) laboratories remained uninfected.

Objectives: To evaluate if the incidence of SARS-CoV-2 infection was reduced in laboratory workers who performed SARS-CoV-2 NAT, and whether this reduction resulted from the healthy worker effect.

Methods: This retrospective cohort study included 423 laboratory workers from 14 SARS-CoV-2 NAT laboratories in Xiamen, China. The incidence of SARS-CoV-2 infection among laboratory workers was analysed based on whether and how long they were engaged in NAT. The healthy worker effect among the laboratory workers engaged in NAT was examined.

Results: The incidence of SARS-CoV-2 infection was lower in workers engaged in SARS-CoV-2 NAT, with a gradual reduction observed as the cumulative time of SARS-CoV-2 NAT increased. A healthy worker effect was observed and eliminated after matching and stratification based on gender, age, education level, and vaccination. Workers who had ever participated in SARS-CoV-2 NAT had a lower cumulative probability of SARS-CoV-2 infection and a longer duration from vaccination to SARS-CoV-2 infection, and this trend was found to be more prominent with a longer cumulative time to SARS-CoV-2 NAT.

Conclusions: A reduction in SARS-CoV-2 infections was observed among laboratory workers conducting SARS-CoV-2 NAT after controlling for the healthy worker effect. This finding has broader implications for understanding the role of natural immunity and its interaction with vaccine immunity in defending against SARS-CoV-2 infection.

The incidence of thyroid cancer has shown marked increases globally over recent decades. This study investigated how the incidence of papillary thyroid carcinoma (PTC) subtypes and World Health Organisation (WHO) endocrine tumour classification changes have affected overall thyroid cancer incidence recorded in Australia. Using incidence data from the Australian Institute of Health and Welfare cancer registry (spanning 1982 to 2019), this descriptive epidemiological study employed joinpoint regression analysis to assess temporal trends in thyroid carcinoma incidence, focusing on PTC. Results were then compared with WHO endocrine tumour classification changes over the same period. The results showed increasing trends for the classic PTC subtype over the entire 38-year period and for thyroid microcarcinomas post-2003, while a declining trend for the follicular variant of PTC was observed commencing in 2015. Examination of PTC incidence also revealed distinct changes in trends that align with the WHO classification of papillary microcarcinoma as a subtype in 2004 and the reclassification of some encapsulated follicular variant of PTCs to non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) in 2016/17. Even when taking these WHO classification changes into account, significant increases in PTC over the last three decades are observed. These findings underscore the shifts in classification driven by improving diagnostic clarity influencing thyroid carcinoma incidence patterns. However, thyroid carcinoma cases in Australia have dramatically increased over the last three decades independent of WHO classification changes, suggesting a genuine increase rather than simply being a direct consequence of improved reporting and diagnostics.

Sleep is influenced by various factors, including social, economic, genetic, and medical factors, and work and study schedules. Medical students are highly susceptible to sleep-related problems. In this study, we aimed to evaluate the sleep patterns and quality of medical students and determine their correlation with academic achievement. This cross-sectional study was conducted at the King Abdulaziz University between November 2022 and April 2023. The participants completed an online questionnaire distributed to all medical students via social media channels. The questionnaire included the Pittsburgh Sleep Quality Index to assess sleep quality and Epworth Sleepiness Scale to measure excessive daytime sleepiness (EDS). Academic performance was self-reported by students based on their grade point average. Of the 274 participants, 54.0% were males with a mean age of 22.81 years. Only 21.5% of students reported normal sleep quality during the previous month, with almost 78.5% reporting poor sleep quality and 40.9% experiencing EDS. Notably, no associations were observed between the sleep quality and sleep-wake patterns and academic performance of the students (p = 0.324 and 0.784, respectively). These findings highlight the substantial prevalence of poor sleep quality and EDS among Saudi medical students, consistent with global trends. Unexpectedly, no significant correlation was observed between sleep quality and student academic performance. These findings suggest that the demanding nature of medical education significantly impacts the sleep patterns and overall well-being of students.

Background: A substantial subset of individuals recovering from the Coronavirus disease 2019 (COVID-19) continues to experience persistent symptoms. Individuals with type 2 diabetes face increased morbidity and mortality following COVID-19 infection. This study aimed to identify risk factors for developing post-COVID-19 conditions among COVID-19 patients with diabetes compared to those without diabetes in the United Arab Emirates.

Methods: A retrospective study was conducted on a random sample of 400 patients with confirmed COVID-19 (n = 200/400 patients with diabetes versus n = 200 patients without diabetes). Participants were invited to a telephone interview to assess post-COVID-19 symptoms persisting for at least three months after their initial positive COVID-19 polymerase chain reaction (PCR) test. A total of 167 hospitalized patients participated, including 89 with pre-existing diabetes and 78 without diabetes.

Results: The prevalence of self-reported post-COVID-19 conditions among participants with diabetes was 34.9%, compared to 14.1% among those without diabetes. Patients with diabetes reported a significant decline in functional status post-COVID-19, with 34.8% experiencing impaired physical activity and 32.6% reporting pain and discomfort, compared to 15.4% and 11.5%, respectively, among participants without diabetes. Older age and female gender were associated with a higher prevalence of post-COVID-19 conditions in the diabetes group.

Conclusion: Patients with diabetes in this study self-reported a higher frequency and severity of post-COVID-19 conditions compared to those without diabetes. Risk factors predisposing to severe post-COVID-19 conditions included female gender, older age, and comorbidities. Self-reported depression was rare in both groups of this cohort.