Journal of Epidemiology and Global Health最新文献

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.

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.