Journal of Epidemiology and Global Health最新文献

Background: Gene-drive modified mosquitoes (GDMMs) offer a novel strategy for malaria control by genetically altering mosquito populations to reduce transmission. We assessed public awareness, attitudes, and factors influencing acceptance of GDMMs in Northern Uganda.

Methods: This mixed-methods study included both quantitative and qualitative components. In the quantitative survey, 301 participants were recruited through multistage stratified sampling. Data were collected using a structured questionnaire guided by the Health Belief Model (HBM) and Theory of Planned Behaviour (TPB). Attitudes were measured using a 5-point Likert scale and categorized into favourable or unfavourable. A favourable attitude was defined as a positive disposition towards GDMMs; a high subjective norm score reflected strong perceived social support. Poisson regression was used to identify factors independently associated with acceptance, reported as adjusted prevalence ratios (aPRs), 95% confidence intervals and p-values. For the qualitative component, we conducted 22 in-depth interviews, which were analysed thematically using Atlas ti. 9.

Results: Of 301 participants, 169 (56.1%) were male, with a median age of 35 years (interquartile range [IQR]: 29-42). Only 60 (19.9%) were aware of GDMMs, mainly through social media (48.3%). Acceptance was reported by 193 participants (64.1% [95% CI: 58.4-69.5]). Overall, 129 (42.9%) participants had a favourable attitude, 102 (33.9%) had a high subjective norm score, and 101 (33.6%) had a high perceived behavioural control score. Independent predictors of GDMM acceptance included favourable attitude (aPR: 1.25, 95% CI: 1.05-1.49, p = 0.013), high subjective norm score (aPR: 1.28, 95% CI: 1.08-1.51, p = 0.004), and high perceived behavioural control (aPR: 1.23 [95% CI: 1.05-1.46, p = 0.013). Qualitative findings revealed three themes: limited awareness, facilitators (e.g., perceived benefits, trust in authorities, safety assurances), and barriers (e.g., environmental and ethical concerns).

Conclusions: Despite low awareness, most participants supported GDMMs for malaria control. Acceptance was strongly influenced by attitudes, social norms, and behavioural control. Our findings underscore the relevance of HBM and TPB constructs particularly attitudes, social norms, and behavioural control in shaping public acceptance of emerging vector control technologies. Future implementation should integrate behavioural change models to address concerns, improve trust, and enhance adoption.

Objective: We aimed to investigate the effects of football derbies in Turkey on emergency department (ED) visits.

Methods: We retrospectively analyzed patients who visited the ED of a training and research hospital in Turkey between January 1 and December 31, 2024. We evaluated four football derby days and four normal weekend days for comparison. We defined three time periods: 6 h before match start, 2 h during the match, and 12 h after the match. We recorded patients' demographic and clinical information and classified ED visit diagnoses into 6 main categories.

Results: We included 8,353 ED visits (4,207 normal days; 4,146 derby days). We found a statistically significant difference in visit distribution between derby days and normal days according to diagnosis categories (p < 0.001). Despite a 1.45% decrease in total visits on derby days, we observed a disproportionate increase in trauma and other external cause diagnoses (a 4.5% increase), respiratory system diseases (an 8.4% increase), and cardiovascular diseases (a 1.8% increase). Being a derby day increased the probability of trauma diagnoses by 29.7% (p < 0.001). Increasing age reduced this probability by 0.6%, being female reduced it by 12%, and pre-match time period increased it by 33% (p < 0.05 for all). We observed a 6% increase in trauma-related visits among women on derby days (p = 0.010).

Conclusion: Football derby matches affect ED visit patterns, particularly trauma diagnoses, respiratory diseases, and cardiovascular diseases. The increase in trauma diagnoses relates to the presence or absence of derby, time period, gender, and age. Women's trauma-related visits increased on derby days. We recommend considering these findings in ED resource planning and public health policies.

Background: Mycobacterium tuberculosis lineages exhibit variability in geographic distribution, transmissibility, and disease phenotype. Ethiopia is one of the countries with the highest prevalence of tuberculosis. The aim of this study was to summarize the proportion of lineages and sublineages by drug resistance profile and TB type.

Methods: The results were reported in accordance with the PRISMA guidelines. The study protocol was registered with ID CRD42024498336. Studies reporting Mtb lineages and sublineages with drug resistance profiles published between March 2010 and June 2024 were included. I² was used to evaluate heterogeneity. A p-value less than 0.05 and an I² value greater than 75% indicated significant heterogeneity.

Results: A total of 5554 Mycobacterium tuberculosis strains were included from 32 studies. The percentage of East African Indian was 26.8% (95% CI: 22.6-30.6), and Euro-American was 64.1% (95% CI: 59.6-68.4) among all TB cases. In studies that included only multidrug- or rifampicin-resistant cases, the percentage of East African Indian was 33.78% (95% CI: 27.81-39.74), while Euro-American was 52.96% (95% CI: 41.32-64.61). Euro-American, followed by East African-Indian, was the predominant lineage across locations and TB types; however, East African-Indian was significantly higher in the Amhara region for both pulmonary TB and extra-pulmonary TB (EPTB) than in Addis Ababa. As defined by spoligotyping, T3ETH (28.22%), CAS1-Kili (18.13%), and T1 (11.54%) were the three most common sublineages among MDR/RR TB cases, while CAS1-Delhi (20.23%), T1 (16.71%), and T3ETH (13.50%) were the most common among susceptible cases.

Conclusion: The three most prevalent Mtb sublineages significantly contribute to the TB and drug resistance epidemic; such data are vital for prioritizing contact tracing. The variation in EAI percentage among EPTB cases across regions likely reflects the influence of genetic variation on the prevalence of EPTB. This suggests a need for genomic surveillance to inform the development of more targeted interventions.

Background: Despite global efforts to enhance maternal healthcare access, Somalia has reported one of the highest maternal mortality rates, at 621 deaths per 100,000 live births in 2020. This occurs amid conflict, humanitarian crises, and a fragile health infrastructure. Antenatal care is critical for reducing maternal deaths.

Methods: This cross-sectional study utilized data from the 2020 Somalia Demographic and Health Survey (SDHS), focusing on 3,375 women aged 14-45 years who had delivered live births in the five years preceding the survey. The primary outcome was antenatal care utilization, defined as the attendance of four or more antenatal care (ANC) visits (ANC4+). The independent variables captured maternal, household, and geographic characteristics, including residence type (urban, rural, nomadic), and regional disparities across Somalia's 16 administrative divisions. A weighted binary logistic regression analysis was performed to identify associated factors.

Results: Overall, only 7.0% of the women received the WHO-recommended minimum of four ANC visits, indicating an alarmingly low utilization rate. Significant disparities were identified, with nomadic women facing 90% lower odds and rural women facing 70% lower odds of adequate ANC than their urban counterparts. Regional variations were striking: Lower Jubba and Nugaal showed significantly higher ANC utilization, whereas Togdheer exhibited significantly lower utilization than the reference region (Awdal). Notably, the statistical significance of the wealth quintile and education diminished in the adjusted model, suggesting that their effects might be mediated by other factors, such as urban-rural disparities.

Conclusion: This study reveals that only 7 out of 100 pregnancies in Somalia receive the WHO-recommended minimum of four ANC visits, placing Somalia among the lowest-performing countries globally for antenatal care utilization. These findings underscore the urgent need for targeted interventions and equity-focused policies to close the maternal health service gaps, particularly in nomadic and rural populations.

Background: Seasonal influenza is a highly contagious acute respiratory infection that imposes a considerable global health burden. Although numerous investigations have examined the short-term effects of ambient temperature or humidity on influenza incidence, relatively few have addressed their combined effects. To bridge this gap, the present study sought to conduct a time-series analysis to examine the combined effects of temperature and relative humidity on influenza incidence in Japan, while accounting for potential confounders.

Methods: Weekly time-series data on influenza incidence and meteorological factors (i.e., mean temperature (°C), relative humidity (%), precipitation (mm), wind speed (m/s) and sunshine duration (hours)) were collected from all 47 prefectures in Japan from 2010 to 2019. A composite exposure metric, humidex, was calculated to capture the combined effects of temperature and relative humidity. We employed an extended two-stage time-series design. In the first stage, a time-stratified case-crossover design was implemented using conditional quasi-Poisson regression integrated with a distributed lag non-linear model to characterize the humidex-influenza associations at the prefectural level. In the second stage, a multivariate meta-analysis was conducted to derive pooled national estimates.

Results: A total of 14,526,346 influenza cases were analyzed. Overall, an inverted J-shaped association between short-term exposure to humidex and influenza incidence was observed. Decreases in humidex were associated with an increased risk of influenza, with the maximum relative risk (RR) reaching 10.75 (95% confidence interval [CI]: 8.35-3.82). The elevated risk corresponding to low humidex (5th percentile) became apparent at week 0, persisted until week 4, and peaked at approximately week 1 (RR = 3.31, 95% CI: 2.89-4.31). Furthermore, significant geographical heterogeneity in influenza incidence was detected across prefectures (Q = 343.4, p-value < 0.001; I² = 46.4%).

Conclusions: Our findings demonstrates that the combined effects of ambient temperature and relative humidity are significantly associated with an elevated risk of influenza in Japan. These findings underscore the urgent need for bespoke public health interventions tailored to mitigate adverse health outcomes in regions characterized by persistently low humidex values.

Background: The number of food delivery workers engaging in online food delivery (OFD) services has soared recently. While they are exposed to air pollutants from traffic exhaust frequently, their exposure to carbon monoxide (CO) is seldom assessed. This study aimed to assess the CO exposure of food delivery workers using exhaled air with consideration of smoking habits.

Methods: We recruited food delivery workers from OFD services and compared their CO concentrations in exhaled air with those of a reference group. In addition, we used a questionnaire to gather data on sociodemographic characteristics, health behaviors, health status, and work-related conditions.

Results: We enrolled 156 food delivery workers and a reference group of 49 members. The results showed that food delivery workers had a higher mean CO concentration in exhaled air (4.79 ppm vs. 1.51 ppm, p < 0.001) as well as a higher proportion of smokers (25.0% vs. 4.1%, p < 0.001). While food delivery workers with smoking habits had a much higher mean CO concentration in exhaled air than those without smoking habits (14.46 ppm vs. 1.57 ppm, p < 0.001), amongst non-smokers, the CO concentration was still higher in food delivery workers than in the reference group (1.57 ppm vs. 1.13 ppm, p = 0.002). Among smokers, smoking might contribute 89% of the CO in exhaled air.

Conclusions: Food delivery workers had higher CO concentrations in exhaled air than the reference group, indicating higher exposure levels. Smoking is an important contributing factor when using exhaled air for CO exposure assessment.

Background: Cambodia is experiencing a demographic shift likely to increase the burden of noncommunicable diseases (NCDs). Identifying patterns of risk factors among adults can contribute to efforts to effectively target and prevent these chronic diseases. This study aims to examine latent classes of population risk based on behavioral and metabolic risk factors for NCDs in Cambodia.

Methods: Data from 5275 respondents aged 18 and older from the 2023 Cambodian World Health Survey Plus were used for analysis. Latent class analysis identified distinct classes of individuals with similar behavioral and metabolic risk factors. Indicator variables included tobacco and alcohol use, fruit and vegetable diet, physical activity, body mass index, blood pressure, blood glucose, and total cholesterol and triglyceride levels. Multinomial logistic regression was employed to predict latent class membership based on sociodemographic characteristics.

Results: Three distinct latent classes were identified: "alcohol users with lower metabolic risk" (37.8%), "substance users with compounding unhealthy behaviors" (15.0%), and "alcohol users with higher metabolic risk" (47.2%). Men, older adults, and individuals with lower education were more likely to be substance users with compounding unhealthy behaviors and alcohol users with higher metabolic risks.

Conclusions: These findings highlight the need for targeted public health strategies to address the combined impact of multiple risk factors, particularly among men, older adults, and individuals with lower education levels.

Background: Effective response during global health emergencies hinges on the quality of guidelines provided by authoritative organisations like the World Health Organisation (WHO). This study assessed the quality of WHO emergency guidelines disseminated through the Disease Outbreak News (DONs) platform between 2023 and 2024 to identify strengths and weaknesses across established quality domains.

Methods: A total of 115 WHO guidelines issued within DONs were analysed using the AGREE II framework, which evaluates six domains: Scope and Purpose; Stakeholder Involvement; Rigour of Development; Clarity of Presentation; Applicability, and Editorial Independence. Descriptive statistics and one-way repeated measures ANOVA were conducted to determine significant differences among domain scores.

Results: The analysis revealed statistically significant differences across domains, F(2.40, 552.34) = 739.09, p < .001, ηp² = 0.866. The highest mean scores were recorded for Scope and Purpose (M = 6.46) and Clarity of Presentation (M = 6.27), indicating strengths in goal articulation and user accessibility. Conversely, Editorial Independence (M = 2.74) and Rigour of Development (M = 3.26) scored the lowest, pointing to persistent gaps in transparency and methodological robustness.

Conclusions: While WHO guidelines during emergencies perform well in clarity and scope, critical weaknesses remain in transparency, stakeholder engagement, and methodological rigour. These findings indicate the need for more balanced and inclusive guideline development processes to enhance trust and utility during public health emergencies.

Background: Stroke is a leading cause of death in the U.S., with mortality trends influenced by hyperlipidemia, a significant risk factor for atherosclerosis and cardiovascular disease that can lead to ischemic stroke. This analysis examines stroke-related mortality in hyperlipidemia among adults aged 25 and older from 1999 to 2023.

Methods: A retrospective analysis of CDC WONDER investigated trends in mortality from Stroke (ICD codes: I60-I69) among Hyperlipidemia patients (ICD codes: E78.0, E78.1, E78.3, E78.4, E78.5) aged 25 and older. Joinpoint regression analysis calculated age-adjusted mortality rates (AAMR) per 100,000 individuals, annual percentage changes (APC), Average Annual Percent Change (AAPC), and 95% confidence intervals.

Results: Between 1999 and 2023, stroke and hyperlipidemia caused 241,308 deaths, with AAMRs of 1.38 in 1999 and 7.46 in 2023, an AAPC of + 7.16 (95% CI: 6.66 to 8.52). Adult men had higher AAMRs than women, with increases for both sexes [AAPC: + 7.20 vs. + 7.10; p < 0.001]. Black individuals had the highest AAMRs, followed by Hispanics. AAMR rose for all races, notably for Blacks/African Americans (AAPC: + 8.63%) and adults aged 65 and above (AAPC: + 7.35%). Northeast regions have the highest AAMRs, with the Midwest showing the most significant rise (AAPC: + 7.86%). AAMRs varied by state, from 2.0 in Georgia to 9.43 in Vermont in 2023. Non-metropolitan areas had higher AAMRs (4.31) than metropolitan areas (3.54).

Conclusion: This analysis reveals significant demographic and racial disparities in Stroke mortality among U.S. adults with Hyperlipidemia, which highlights the urgent need for targeted, equity-focused interventions to address these disparities.

Respiratory Syncytial Virus (RSV) represents a predominant etiological agent of severe acute lower respiratory tract infections (ALRTIs) among infants and young children in The Gambia, contributing substantially to seasonal peaks in paediatric hospitalizations and mortality during the annual rainy season [1-3]. Despite recent global approvals of maternal RSV vaccines, their operational feasibility and sociocultural acceptability in resource-constrained settings remain inadequately characterized. This cross-sectional, mixed-methods study evaluated these parameters among 179 antenatal and lactating mothers attending Edward Francis Small Teaching Hospital (EFSTH) between June and August 2025, utilizing structured questionnaires complemented by qualitative insights from healthcare providers. Findings revealed critically deficient maternal awareness of RSV: merely 12.8% of participants acknowledged familiarity with the virus, and only 10.6% recognized its potential for life-threatening infant respiratory disease. Healthcare workers constituted the primary information source (82.6%). Paradoxically, willingness to accept maternal RSV vaccination was elevated (81.6% during pregnancy; 74.9% during lactation), predominantly motivated by trust in clinical recommendations. Primary barriers included safety apprehensions (88.8%), vaccine unavailability (41.9%), and limited awareness (79.3%). Multiparity significantly correlated with gestational vaccine acceptance (p = 0.004), while tertiary education predicted RSV awareness (p = 0.022). Hospital-based administration was preferred (88.3%). This study concludes that while maternal RSV vaccination is broadly acceptable in The Gambia, profound knowledge deficits and systemic impediments especially safety concerns and supply chain limitations compromise feasibility. Programmatic success necessitates integration into antenatal care (ANC) frameworks, provider-driven education initiatives, and fortified cold chain logistics. These evidence-based insights offer actionable guidance for policymakers developing context-specific maternal immunization strategies to mitigate infant RSV burden in analogous low-resource settings.