Journal of Epidemiology and Global Health最新文献

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.

Background: Vitamin D, an essential fat-soluble metabolite, plays a critical role in various physiological functions and human growth and development. This study investigates the factors influencing the knowledge, attitudes, and practices of the population regarding vitamin D supplementation.

Methods: A self-administered questionnaire was distributed via social media platforms (Facebook, Instagram, X, WhatsApp, LinkedIn) to collect responses from adult participants aged 18 + in Saudi Arabia, Jordan, Egypt, and Iraq from November 2023 to February 2024. Following Tabachnick and Fidell's guidelines, a minimum sample size of 200 was targeted for ten independent variables (Approval number: 2023-PHA-50).The reliability and internal consistency score via Cronbach's α (= 0.8) for the Likert scale in the practice section and (= 0.7) for the attitude section. Statistical analysis involved frequency, percentages, and simple/multiple-linear regression analysis to assess study predictors.

Results: A total of 1340 responses were obtained from four countries: Saudi Arabia (n = 412, 30.8%), Egypt (n = 400, 29.9%), Jordan (n = 310, 23.1%), and Iraq (n = 217, 16.2%). Median knowledge scores (± IQR) in Egypt, Jordan, and Iraq indicated a moderate level of understanding regarding vitamin D supplementation (11 ± 3, 11 ± 2, and 11 ± 3, respectively), whereas Saudi Arabia exhibited lower levels of knowledge (7 ± 2). Neutral attitudes toward vitamin D were observed across all countries, while Jordan and Iraq showed good median practice scores (17 ± 5, 16 ± 5), compared to moderate levels in Saudi Arabia and Egypt (13 ± 3, 15 ± 5), respectively. Multi-linear regression analysis indicated that in Saudi Arabia, younger respondents exhibited higher knowledge, attitudes, and practice scores, while individuals working in the non-health sector displayed higher attitudes and practice scores (p-value = 0.06, 0.009, < 0.001). Similarly, in Iraq and Jordan, those working in the non-health sector demonstrated higher knowledge scores (p-value < 0.001, < 0.001, respectively). Furthermore, males attained higher attitude scores in samples from Jordan, Egypt, and Iraq (p-value < 0.001, 0.003, < 0.001).

Conclusion: This study highlights varying levels of knowledge, attitudes, and practices regarding vitamin D supplementation across different demographic groups and countries. Addressing misconceptions and promoting awareness, particularly among younger individuals and those working outside the health sector, is crucial for optimizing vitamin D supplementation practices and enhancing public health outcomes.

Background: Uganda has experienced seven laboratory-confirmed Ebola virus disease (EBOD) outbreaks from 2000 to 2022, with reported case-fatality ratios (CFRs) varying widely. The influence of diagnostic and response delays on outbreak-level mortality has not been systematically assessed. We conducted a rapid systematic review and meta-analysis to quantify the effect of diagnostic and response delays on outbreak-level mortality.

Methods: We registered the review on OSF and adhered to PRISMA-2020 guidelines. We searched PubMed, Embase, Scopus, Web of Science, WHO Global Index Medicus, and grey literature through 30 April 2025. Eligible reports described laboratory-confirmed human EBOD in Uganda (2000-2022) and reported case counts, deaths, or quantitative timeliness metrics. Outbreak-level CFRs were meta-analyzed using random-effects models with Freeman-Tukey transformation (metafor package in R). Mixed-effects meta-regression assessed the association between continuous delay metrics and transformed CFR.

Results: Fifteen reports met inclusion criteria, spanning 741 confirmed cases and 358 deaths. The pooled CFR was 45.4% (95% CI: 26.2%-65.2%; I² = 87.8%) across seven outbreaks. By species, Sudan ebolavirus outbreaks (n = 5) had a CFR of 44.6% (95% CI: 33.7%-55.6%), Bundibugyo ebolavirus (n = 1) 24.8% (95% CI: 18.2%-32.1%), and Zaire ebolavirus (n = 1) 100% (95% CI: 61.2%-100.0%). In meta-regression, each additional day from first case report to specimen collection was associated with a significant increase in CFR (β = 0.142 on the transformed scale; p = 0.025; R² = 62%), translating to an approximate absolute increase of 3.8% points in CFR per day at a baseline risk of 45%. Conversely, longer delays from symptom onset in the index case to national outbreak declaration were linked to a slight decrease in CFR (β = - 0.00765; p = 0.047).

Conclusions: Uganda's EBOD outbreaks exhibit high and variable mortality, with diagnostic delays substantially amplifying case-fatality. Rapid specimen collection and prompt public health responses are critical to reducing EBOD mortality. Strengthening laboratory networks and accelerating declaration protocols should be central to future outbreak preparedness in Uganda and similar contexts.

Background: NOVA food group consumption has received significant attention recently for assessing the quality of dietary intake and has been linked to weight gain and obesity.

Aim: to examine the ultra-processed foods (UPFs) and different NOVA food groups among Jordanian adults in various body mass index (BMI) categories.

Methodology: A cross-sectional study was conducted among 537 Jordanian adults (aged 19-64) from February to April 2024. Anthropometric data were collected, and habitual dietary intake was assessed using a validated Arabic food frequency questionnaire (FFQ). Foods were classified according to the NOVA system into minimally or unprocessed foods (MUPF), processed culinary ingredients (PCI), processed foods (PF), and UPFs. The total energy from each group was analyzed using ESHA's Food Processor software.

Result: UPFs contributed approximately 52% of daily energy intake; however, total energy intake was not significantly different across BMI categories (p = 0.870). Obese individuals had a higher MUPF intake (% of total Kcal) (31.97% ± 10.63%) and a lower UPF intake (50.57% ± 12.17%) compared to normal-weight individuals (MUPF: 29.85% ± 9.78%; UPF: 53.52% ± 10.99%; p < 0.05). Excess-weight participants also showed a higher MUPF intake (32.32% ± 10.03 vs. 29.74% ± 9.64) and lower UPF intake (50.27% ± 11.32 vs. 53.65% ± 10.86) than those with normal weight (p < 0.01). No significant differences were found for PCI or PF intake.

Conclusion: Despite generally high UPF consumption, individuals with higher BMI consume more energy from MUPF and less from UPF, suggesting a potential shift toward healthier food choices as body weight increases. Therefore, interventions should also focus on energy balance and portion control in normal-weight people within MUPF, not just UPFs.

Background: Diarrhea remains a major cause of preventable mortality in Latin American and Caribbean (LAC) countries, particularly among children and vulnerable populations. However, there are no studies showing the changes that have occurred in recent years in developing countries. Our objective was to determine the evolution of diarrhea mortality rates in LAC countries between 2000 and 2019.

Methods: An ecological observational time series study was conducted using only countries with complete population-based data in the World Health Organization mortality database between 2000 and 2019 with diarrhea mortality. Analyses were performed using Joinpoint Regression software to calculate mortality trends and annual percentage change by sex and by country. A mortality rates analysis of the last 5 years of the study period was performed to assess the countries with the highest rates.

Results: Between 2000 and 2019, most Latin American and Caribbean countries experienced a significant decline in diarrhea-related mortality across all age groups and sexes. The largest reductions were observed in Ecuador, Costa Rica, and El Salvador. In children aged 0-14 years, thirteen countries showed significant decreases, notably Ecuador, Venezuela, and Colombia. Moreover, in the most recent five-year period (2015-2019), the highest age-standardized mortality rates (ASMRs) were observed in Guatemala (11.14 per 100,000 in males; 5.97 in females) and Guyana (5.82 in males; 4.30 in females), while the lowest ASMRs were recorded in Chile (0.29 in males; 0.28 in females) and Argentina (0.36 in males; 0.33 in females).

Conclusion: In the two decades from 2000 to 2019, diarrhea-related mortality rates declined in Latin American and Caribbean countries, largely due to public health interventions and policies.