Journal of Epidemiology and Global Health最新文献

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.

The 2023 Gaza conflict precipitated a collapse of essential health services, exposing the extreme fragility of chronic disease care in humanitarian crises. Non-communicable diseases (NCDs) account for more than 70% of deaths in Palestine, yet the management of hypertension, diabetes, cardiovascular disorders, and renal failure has been critically disrupted by the destruction of infrastructure, blockade of medical supplies, and mass displacement. This work synthesizes recent peer-reviewed literature, WHO and UN reports, and field assessments from 2023 to 2025 examining the continuity of NCD care in Gaza. Adherence to medical follow-up among NCD patients has declined from 96.7% before the war to 40.7% amid ongoing conflict, while more than 90% of primary healthcare facilities report shortages in insulin, antihypertensives, and dialysis supplies. Only 14 of 36 hospitals remain partially functional, leaving thousands without life-sustaining treatment. The findings reveal how conflict transforms chronic, manageable diseases into acute emergencies. Sustaining NCD care must therefore be recognized as a humanitarian and ethical imperative, requiring an immediate ceasefire and restoration of essential health system functions.

Background: Vaccinations are among the most effective interventions against infectious diseases such as measles, influenza, and COVID-19. Nevertheless, there are significant differences in vaccination readiness. The aim of this study was to validate the 7 C scale, which measures seven psychological factors comprising general vaccination readiness, in both German and Greek, and to investigate differences in vaccination behavior between a German and a Greek sample.

Methods: A cross-sectional study was conducted with a convenience sample of 576 study participants, of whom 319 responded to the online survey in German and 257 in Greek. Analyses included internal consistency, structural validity, construct validity through the known-groups method, item analysis, and floor and ceiling effects. The two samples differed significantly in terms of demographic data such as age, gender and education, as well as in religiosity and vaccination behavior.

Results: The German sample showed a higher vaccination rate for most vaccinations, except for vaccinations against hepatitis A, varicella, and meningococcal disease, wheras in the Greek sample, there were significantly more "I don't know" responses regarding vaccination status. The 7 C scale of vaccination readiness demonstrated acceptable to good psychometric properties in terms of both internal consistency and construct validity in both samples, although there were some weaknesses in the component that measures calculation^R in both the 21-item and 7-item versions. The 7-component structure was confirmed using a confirmatory factor analysis. The German and the Greek samples differ primarily in the components confidence, complacency^R, and conspiracy^R, with significantly higher values in the German sample. Binary logistic regression analysis demonstrated that the 7 C scale had the lowest predictive value for measles vaccination and the highest for COVID-19.

Conclusion: The German and Greek versions of the 7 C scale are invaluable research tools for investigating vaccination readiness. A comprehensive understanding of the underlying factors contributing to vaccine hesitancy is imperative for the development of culturally tailored educational initiatives. These initiatives must be designed to address prevalent misconceptions regarding vaccination, with the objective of enhancing vaccination rates, and promoting public health.

Background: Depression is a prevalent psychological complication among burn injury survivors. Affected patients face increased risks of prolonged hospitalization, additional surgical and reconstructive interventions, higher healthcare utilization, and suicidal ideation. This systematic review and meta-analysis quantified depression prevalence by severity and examined factors associated with post-burn depression.

Methods: We searched twelve databases from inception to 14 June 2023. We included clinical studies comparing the demographic, burn-related, or management-related factors between patients with depression and patients without depression among burn injury survivors.

Results: Of the pooled 2,957 patients from ten articles, 36.8% experienced depression. Among those with depression, 33.1% had mild, 34.0% had moderate, and 10.8% had severe depression. Meta-analysis indicated an overall depression prevalence of 60.7% (95% confidence interval [CI]: 44.5-74.8%). Patients with total body surface area > 30% had 2.48 times higher risk of depression. Age, gender, marital status, burn type, burn degree, and burn site did not significantly influence risk of depression among burn injury survivors.

Conclusion: Depression affects approximately two-fifths of burn survivors, with one-quarter experiencing moderate depression and one-tenth severe depression, especially in major burns. Systematic psychological assessment and standardized mental health interventions are warranted to optimize recovery and quality of life.

Background: Human Papillomavirus (HPV) remains the leading cause of cervical cancer in Ecuador, which suffers from systemic programmatic failures that undermine the global elimination strategy.

Crisis: Ecuador's HPV vaccination coverage (35.6% first dose; 17.3% complete) is the lowest in Latin America, starkly contrasting with the WHO's 90% target for cervical cancer elimination (Pan American Health Organization 2025). Structural inequities, a profound genotypic mismatch with the circulating quadrivalent vaccine (HPV 58/31/52 prevalence), and fragmented implementation perpetuate this public health crisis (Jose Ortiz Segarra et al. Infectious Disease Reports, 15(3):267-278 2023).

Key findings: Our analysis reveals that the nation's health-center-based model fails to reach vulnerable populations, a problem exacerbated by critical cold chain deficiencies in 30% of facilities. In contrast, regional successes, such as Peru's school-based programs (94% coverage) and Colombia's strategic adoption of the nonavalent vaccine, offer a clear roadmap for reform (Pan American Health Organization 2025, María Ines Sarmiento-Medina et al. PLOS ONE, 19(2):e0297579 2024).

Recommendations: We propose an evidence-based 5-point plan to overhaul Ecuador's strategy: a targeted nonavalent vaccine pilot, immediate adoption of a single-dose schedule, culturally adapted self-sampling programs, phased-in gender-neutral vaccination, and urgent investment in cold chain infrastructure.

Background: Leukemia presents a significant and evolving public health challenge in Saudi Arabia, yet long-term nationwide epidemiological trends are unavailable. This study aimed to characterize temporal, demographic, and regional patterns in leukemia incidence from 1997 to 2022.

Methods: We conducted a retrospective nationwide analysis using the Saudi Cancer Registry and Global Burden of Disease data. We calculated age-standardized incidence rates (ASR), age-specific incidence rates (AIR) per 100 000, and average/annual percentage changes (AAPC/APC) by age, sex, leukemia type, and administrative region.

Results: The overall ASR was 5.9, with an increase over time (AAPC = 2.28, 95% CI 1.68‒2.87), sharply accelerating after 2016 (APC = 9.47, 95% CI 6.21‒15.18). This trend was driven by a dual burden in pediatric (0-14 years; boys AAPC = 2.67, 95% CI 1.95‒3.40; girls AAPC = 2.38, 95% CI 1.41‒3.66), and 50+ adults (males AAPC = 1.7, 95% CI 0.55‒2.86; females AAPC = 3.0, 95% CI 1.76‒4.25), including a 147% AIR increase among males aged 75+. Myeloid leukemia (AAPC = 2.68, 95% CI 0.67‒3.66) became the most common type after 2019, overtaking lymphoid leukemia. Regionally, Riyadh had the highest overall burden (ASR = 6.7), while the Northern region exhibited the fastest growth (AAPC = 10.51, 95% CI 4.09‒16.89). Qassim was the sole exception (AAPC = - 4.54, 95% CI -6.43‒-2.63).

Conclusion: Leukemia incidence in Saudi Arabia is accelerating at a rate exceeding global trends, highlighting the need for targeted, regionally adapted surveillance. Further research into underlying demographic and regional drivers is essential to guide effective cancer control planning.

Background: Chronic non-bacterial osteomyelitis (CNO) is a chronic auto-inflammatory disorder affecting bones in children and adolescents. The study aimed to assess pediatric CNO patients' demographic, clinical, laboratory, imaging, and histopathology characteristics and treatment responses.

Methods: This is a descriptive and analytical multicenter study that reviewed 58 patients diagnosed with CNO between 2015 and 2021 across six centers in Saudi Arabia.

Results: The mean age at diagnosis was eight years, and 62% of the patients were females (n = 36). The most common clinical manifestation was bone pain (n = 51, 88%). Elevated erythrocyte sedimentation rate (> 15 mm/hr) was observed in 85% (n = 49) of patients, and positive C-reactive protein (> 8 mg/L) was observed in 41% (n = 24). Bone biopsy was performed in 56.9% (n = 33) of patients. The lower limbs (n = 37, 64%) were the most involved sites. Non-steroidal anti-inflammatory drugs (NSAIDs) were the most commonly used treatment modality, with 88% of patients (n = 51) receiving this treatment. Bisphosphonates and tumor necrosis factor inhibitors (Anti-TNF) were used in 55% (n = 32) of patients, while methotrexate and systemic steroids were used in 36% (n = 21). Clinical remission was achieved in 84% of CNO patients.

Conclusions: This study provides valuable insights into the phenotype of CNO in the pediatric population and shares the experience of multiple centers in treating this rare condition in Saudi patients.

Background: Hand, foot, and mouth disease (HFMD) is a prevalent contagious viral illness primarily affecting children under five years old globally, with potential for severe complications. It a common pediatric illness primarily caused by enteroviruses (EV), yet data on its epidemiology and viral diversity in Saudi Arabia remain scarce. This study addresses this knowledge gap by providing the first molecular prevalence data for HFMD in Saudi Arabia, aiming to determine the genomic serotypes of enterovirus (EV) infections in pediatric HFMD cases and investigate their association with disease outcome.

Methods: Thirty-four pediatric patients clinically diagnosed with HFMD in Jeddah between November 2023 and June 2024 were enrolled. Oral and throat swabs were analyzed using real-time RT-PCR using broad-spectrum EV detection and conventional RT-PCR targeting the 5'-noncoding regions, followed by Sanger sequencing and phylogenetic analysis for comprehensive serotype identification.

Results: Of the 34 cases, enteroviruses were detected in 82.35% (28/34) of cases. The majority of cases were male (64.7%) and under six years old (61.67%), with a median age of 4.88 ± 3.19 years. Clinical symptoms predominantly included typical rashes on the head, face, and limbs (96.67%), fever (73.53%), and skin itchiness (58.82%). Sequence analysis based on 5'-NCR identified five EV serotypes: CV-A6 (50%), CV-A16 (35.7%), CV-A10 (7.1%), EV-A71 (3.6%), and CV-A5 (3.6%). CV-A6 was the predominant serotype and detected across all age groups, with the highest subtype diversity in children ≤ 3 years. Phylogenetic analysis revealed that Saudi strains were closely related to global isolates, especially from Asia and Europe, suggesting multiple introductions and localized transmission.

Conclusion: This pilot study reveals substantial genetic diversity and co-circulation of multiple EV serotypes among HFMD cases in Jeddah. The predominance of CV-A6 aligns with recent global trends, underscoring the need for ongoing molecular surveillance and public health preparedness, including vaccine strategy development targeting emerging serotypes.