Journal of Epidemiology and Global Health最新文献

Background: The universal test and treat (UTT) program, is a strategy for eliminating HIV and, it involves screening all populations at risk for HIV infection, initiating early treatment for those diagnosed HIV positive, monitoring and maintaining treatment, and Retaining patients in care. Therefore, this meta-analysis evaluates the impact of the Test-and-Treat strategy on HIV-positive patients in Ethiopia, focusing on mortality rates and disease progression.

Methods: A systematic literature search was conducted using databases such as PubMed, Embase, African Journals Online (AJOL), Google Scholar, and Web of Science. Data were classified into two periods: 2005 to 2015 (before test and treat era) and 2016-2024 (after test and treat strategy). Eligible studies included cohort and cross-sectional designs providing distinct data for these timeframes, irrespective of publication year, to assess reductions in mortality and disease progression (WHO Stage III or IV). Study quality and bias were assessed using the Newcastle-Ottawa Scale (NOS), ensuring rigorous evaluation across selection, comparability, and outcome domains. A random-effects model was employed for the meta-analysis.

Results: The pooled mortality rate decreased significantly from 21% (95% CI: 14-29%) in the before test and treat period to 9% (95% CI: 6-12%) after the test and treat period, representing a 57.14% reduction. The proportion of patients in WHO Stage III declined from 47% (95% CI: 39-54%) to 21% (95% CI: 16-26%), a reduction of 55.32%. Similarly, the prevalence of WHO Stage IV decreased from 14% (95% CI: 12-16%) to 8% (95% CI: 5-10%), reflecting a 42.86% reduction.

Conclusion: The test and treat strategy in Ethiopia has substantial reductions in mortality and disease progression. These results underscore the effectiveness of early, universal treatment initiation in improving patient survival and reducing the burden of HIV-related complications.

Background: In Ethiopia's Sidama National Regional State, diarrhea remains the second most common cause of illness among children under five, despite a decrease in its mortality rate. However, limited research has been conducted in Ethiopia to identify the causes behind the continuing rise in the prevalence of diarrhea in children associated with exposure to domestic animals. Therefore, this study explores the relationship between domestic animal, environmental, and human behavioral factors and confirmed cases of diarrhea in children under five in the Sidama National Regional State of Ethiopia.

Methods: We conducted a matched-pairs case-control study involving 306 cases and 306 controls in the Sidama region from September 2022 to February 2023. Cases and controls were identified at healthcare facilities, and interviews and observations were completed at residential homes with children under five. We collected data using the KoboCollect application and analyzed it through conditional logistic regressions. The random forest (RF) method with the classification RF model was used to compare its findings with those of the multivariate conditional regression analysis. The statistical analyses were conducted using R v.4.3.2 software.

Results: The study indicated that having a caretaker who is a housewife [matched adjusted odds ratio (mAOR) = 3.09, 5% CI (1.09, 8.70)], a mean number of chickens ≥ 5 [mAOR = 5.18, 95% CI (2.70, 9.95)], the absence of soap at handwashing facilities [mAOR = 2.61, 95% CI (1.34, 5.10)], those who travel more than 30 min to fetch water [mAOR = 3.14, 95% CI (1.13, 8.78)], children who are in contact with animal feces [mAOR = 2.44, 95% CI (1.24, 4.82)], and households living with animals [mAOR = 3.28, 95% CI (1.71, 6.30)] showed significant associations with under-five diarrhea. The random forest analysis also identified the first five variables as the main risk factors for diarrhea occurrence among children under-five years of age.

Conclusions: Risk factors for diarrhea among children under-five include a high number of chickens, cohabitation with animals, prolonged water-fetching times, poor hand hygiene, and caretakers' occupational status. Animal feces management, improved water access, and hygiene education are critical to reducing under-five diarrheal diseases.

Background: The pediatric intensive care unit (PICU) plays a crucial role in managing critically ill children requiring advanced airway, respiratory, and hemodynamic support. Reducing the mortality rate is one of the primary objectives in every ICU. However, data regarding mortality and associated risk factors from low-resource countries remain insufficient. The aim of our study was to describe the mortality pattern, and to evaluate risk factors associated with mortality in the PICU at Mukalla Maternity and Childhood Hospital.

Methods: This retrospective study analyzed the admission records for children aged over 1 month to 15 years from the PICU over four years (1st January 2021 to 31st December 2024). The information retrieved included gender, age, place of residence, body weight, nutritional status, vaccination status, clinical presentations on admission, temperature, level of consciousness, presence of co-morbidities, the lag time between illness onset and hospital admission, date of admission, date of discharge, referring source, readmission frequency, diagnosis, need for mechanical ventilation, and condition at discharge (survived /deceased).

Results: Out of the 790 patients admitted to the PICU, 716 were included in the study. The three most common disease categories among admissions were respiratory diseases (29.5%), central nervous system diseases (27.1%), and gastrointestinal diseases (11%). The overall mortality rate was 38.1%. Among deceased patients, 57.9% were severely undernourished, 38.5% were unvaccinated, and 63.4% had associated co-morbidities. The most common causes of death were pneumonia (26%), meningoencephalitis (17.2%), and sepsis/septic shock (9.2%). Independent risk factors of PICU mortality included length of PICU stay [AOR 0.129, p < 0.001], need for mechanical ventilation [AOR 68.6, p < 0.001], cardiovascular diseases [AOR 3.1, p = 0.003], hypothermia [AOR 7.1, p = 0.014], convulsions [AOR 0.375, p = 0.001], disturbance of consciousness [AOR 2.1, p = 0.002], and hepatosplenomegaly [AOR 15.7, p = 0.024].

Conclusion: The mortality in our PICU is high and is associated with several independent factors. Recognizing these risk factors will facilitate the identification of critical cases, enable the prioritization of resources, and support the implementation of essential modifications.

This article examines the rise and fall of global health's so-called golden age, from the 1990s to the early 2020s, a period marked by multilateral cooperation, historic funding increases, and major institutional innovations. It highlights the factors that have led to the decline-including funding cuts, political shifts, and emerging global crises-and argues for a reimagined framework for global health going forward. Recommendations include diversifying funding, empowering regional coalitions, adapting new governance models, and defending the principle of health equity. Without such reforms, the next era risks deepening global disparities in health outcomes.

Background: Cutaneous Leishmaniasis (CL) is a tropical disease of public health concern, resulting from infection with Leishmania parasites and transmitted through the bite of infected female sandflies. Community awareness is an essential component of disease control and prevention. This study aimed to synthesize evidence on knowledge, attitudes, and practices about CL among the general population.

Methods: A comprehensive literature search was performed across multiple databases, including PubMed, Scopus, Web of Science, EMBASE, ScienceDirect, Google Scholar, Springer, and ProQuest for studies published in English up to January 2025. Search terms included both MeSH and free-text keywords related to KAP toward CL. The quality of included studies was assessed using the Newcastle-Ottawa Scale (NOS). Data were extracted, and a random-effects meta-analysis of proportions was applied for pooling of studies. Heterogeneity was explored through subgroup and sensitivity analyses. The certainty of the evidence was evaluated using the GRADE approach.

Results: Knowledge was assessed by 47 studies (n = 21,930), while attitude was assessed by 32 studies (n = 13,171), and practice was evaluated by 30 studies (n = 13,729) for CL. Overall, the general population had an estimated 54.5%(95% CI: 47.8 to 61.1) good knowledge of CL, with positive attitudes at 56.2% (95% CI: 48.5 to 63.8), and practically 49.5% (95% CI: 40.3-53.8). A substantial heterogeneity was observed between studies (I2 > 98% in all cases). The European region had the highest level of knowledge (75.3%), while the Southeast Asia region had a positive attitude (65.6%) and good practice in the Eastern Mediterranean region (45.9%). Meta-regression analyses indicated that the year of publication was significantly associated with heterogeneity in knowledge and attitude outcomes. In contrast, the WHO region was significantly associated with heterogeneity in practice outcomes (p < 0.05). According to the GRADE approach, the overall certainty of evidence was moderate for both knowledge and attitude outcomes, and high for practice outcomes.

Conclusion: The level of knowledge, attitude, and practice of the general population regarding CL is not at the desired level in many regions, especially in endemic countries. These results emphasize the need to design and implement educational interventions and targeted awareness programs to promote public KAP about CL, especially in areas with high prevalence and low practice.

Background: In Madagascar, a sentinel surveillance system was set up in 18 hospitals since 2014 and was managed by the Ministry of Public Health and the Institut Pasteur de Madagascar. In order to improve the access to appropriate health care in Madagascar, the main clinical diagnoses in hospitalized patients were analyzed.

Methods: At hospitalization of a patient, each unit involved in the sentinel surveillance recorded the clinical diagnosis through an e-health platform. Data from September 2014 to July 2018 were analyzed. Morbidity and annual incidence of diseases according to ICD-10 were reported.

Results: A total of 140,789 inpatients information was recorded. The median age was 28.2 years (IQR: 18.3; 45.3). 21.6% of the children < 15 years suffered from communicable diseases. The hospital morbidity was 4.01% for malaria, 0.84% for tuberculosis, 0.09% for HIV/AIDS and 0.05% for plague. The hospital morbidity of non-communicable diseases was higher compared to communicable diseases with 7.8%, 7.1% and 3.1% for "Diseases of the circulatory system", "Injury, poisoning and certain other consequences of external causes" and "Mental and behavioural disorders", respectively. "Pregnancy, childbirth and puerperium" represented 20.5% of the hospitalized patients.

Conclusions: The e-health platform enabled continuous and standardized data collection. Communicable diseases affect mainly children < 15 years. Non-communicable diseases are on the rise and need more attention by national health authorities. A number of hospitalizations could be prevented by a better health care management at the community-based health care level and by implementation of a Universal Health Coverage (UHC) in Madagascar.

Background: Pediatric dermatoses are common and impact the quality of life. This study aimed to estimate the prevalence and characteristics of pediatric dermatoses among 1^ry and 2^ry school students in Egypt.

Methods: A Cross-sectional study was conducted on 23,203 1^ry and 2^ry school students of both sexes in eight governorates in Egypt between January 2023 and May 2023. A clinical examination for skin diseases was done, and a self-administered, author-designed questionnaire was given to children to complete with the assistance of their parents.

Results: The average age of students was 12.00 ± 3.33 years. Prevalence of skin diseases was 37.9%. Positive family history of skin disease (aOR 3.482, 95% CI: 2.871-4.222, p < 0.001), sanitary water disposal (aOR 3.846, 95% CI: 3.001-4.930, p < 0.001), residence (aOR 1.760, 95% CI: 1.657-1.870, p < 0.001), father's occupation and education (aOR 1.494, 95% CI: 1.334-1.672, p < 0.001 and aOR 1.349, 95% CI: 1.251-1.454, p < 0.001, respectively), and crowding index (aOR 1.469, 95% CI: 1.372-1.573, p < 0.001) were independent risk factors for exhibiting skin diseases.

Conclusion: A high prevalence of pediatric dermatosis was established with associated sociodemographic risk factors, so healthcare and education programs and services should be directed toward children with continuous supervision and periodic examination.

Purpose: Measles is a highly contagious but vaccine-preventable infectious disease. According to health authorities such as the ECDC (20240, urgent action is required to address the increasing spread of measles and insufficient vaccination coverage across the EU. The main objective of the present research is a comparative analysis of measles outbreak risk in two neighbouring countries with intensive economic relations and similar socio-economic challenges-Bulgaria and Romania. This research aims to deliver results on measles outbreak risk assessment in Bulgaria's neighbouring countries to gain broader insight on the potential threats faced regionally and globally.

Methods: Data from a 50-year period was collected on immunization coverage and demographic dynamics in Bulgaria and Romania. The main objective of the paper is the calculation of an annual Risk Index defined as the ratio of all susceptible individuals to the total population. A mathematical model is applied to estimate the immunization coverage and demographic parameters on an annual basis. This allows us to calculate with satisfactory precision the accumulation of susceptible persons tracing at least 20 years back in the history, needed for the calculation of an annual Risk Index.

Results: The Risk Index curves for measles outbreak in Bulgaria and Romania are calculated for the period 2000 to 2023. The Risk Index curve for Bulgaria reveals a concerning increase after 2015, with particularly alarming values projected for 2017 and later. The results of the Risk Index for Romania after 2016 are also concerning. In 2023, the Risk Index for Bulgaria hits 7.55%, whereas in Romania it hits 8.1%.

Conclusion: Comparing the findings from the Risk Index to the real data from measles outbreaks for two neighbouring countries-with similar socio-demographic challenges-shows that the Risk Index is a good indicator for risk of measles outbreak. It can help the health authorities to forecast potential measles outbreaks - alongside vaccination coverage, demographic factors should also be considered when monitoring public health.

Background: On October 8, 2022, Kampala, the capital city of Uganda, recorded its first Sudan virus disease (SVD) case. We described strategies utilized by Kampala Capital City Authority (KCCA) during SVD outbreak response in Kampala City from October 2022 - January 2023.

Methods: We reviewed daily situation reports submitted by KCCA incident management team to document strategies implemented throughout the SVD response. During SVD After Action Review (AAR), we convened consensus meetings with the Directorate of Public Health and Environment, incident management team, rapid response teams, and representatives from implementing partners. The AAR served as a structured platform for reflection and consensus-building through semi-structured group discussions among stakeholders. Findings were thematically synthesized to identify effective strategies and operational challenges encountered during SVD response in Kampala City.

Results: KCCA established an incident management system to coordinate the SVD response. Daily coordination meetings were held with rapid response teams and implementing partners to address emerging challenges. A centralized call and dispatch center served as the coordination hub for rapid response teams, facilitating timely verification of alerts and response to suspected SVD cases. Case investigation teams established epidemiological linkages among confirmed SVD cases and identified contacts for daily follow up. Designated ambulances were utilized to transport high-risk patients to isolation units, while confirmed cases were referred to Entebbe Ebola Treatment Unit. Infection prevention and control teams provided essential decontamination services and distributed IEC materials to affected health facilities and communities. KCCA also leveraged innovative strategies such as drones to disseminate public health messages, distributed placards with SVD symptoms and preventive measures, and actively engaged business communities, media outlets, and local leaders to enhance public awareness and risk communication.

Conclusion: KCCA's response to the 2022 Sudan virus disease outbreak demonstrated effectiveness of leveraging existing coordination structures, adapting surveillance tools, and engaging communities in a complex city setting. The integration of emergency preparedness efforts and contextualized approaches such as mobile phone tracking, closed-circuit television (CCTV) footage, school-based interventions, and drone utilization contributed to timely containment. These strategies demonstrate valuable best practices for strengthening emergency preparedness and response capacities in high-risk urban settings.