SAGE Open Medicine最新文献

Background: Timely initiation of antenatal care is critical for reducing maternal and neonatal morbidity and mortality. Despite this, late initiation remains a significant public health challenge in rural Zimbabwe. This study aimed to assess the determinants of late antenatal care bookings among pregnant women in Mangwe District in 2025.

Methods: A facility-based cross-sectional study was conducted between August 2024 and June 2025 among 171 pregnant women selected through systematic random sampling from five clinics. Data on socio-demographics, accessibility, and maternal factors were collected using a structured questionnaire deployed on Kobo Collect. The outcome variable was the timing of the first antenatal care visit, categorized as "late" (>20 weeks gestation). Data was analyzed in STATA version 15, using chi-square tests and multiple logistic regression to identify factors associated with late booking.

Results: The prevalence of late antenatal care bookings was 50.9%. Significant determinants included lower educational attainment (p = 0.009), unemployment (p = 0.030), and a lack of knowledge about the importance of early antenatal care (p = 0.001). While not statistically significant in the final model, logistical barriers were highly prevalent, with 47.8% of late bookers reporting challenges in accessing care, primarily due to long distances and lack of transportation.

Conclusion: Five in 10 women had late antenatal care bookings in Mangwe District, which is predominantly driven by educational, economic, and knowledge-based barriers. To decrease late antenatal care bookings, interventions must prioritize targeted community health education, economic empowerment initiatives, and practical solutions to overcome transport and distance challenges.

Objective: This study compared the performance of different machine learning models in predicting in-hospital mortality in patients hospitalized for heart failure.

Methods: Demographic and clinical data of 229 patients were retrospectively reviewed for this study. The variables included age, sex, hypertension, diabetes, coronary artery disease, peripheral artery disease, chronic kidney failure, Charlson comorbidity index, and length of hospital stay. In-hospital mortality ("in-hospital death") was defined as the dependent variable. The machine learning methods used included logistic regression, random forest, gradient boosting, and multilayer perceptron models. The model performance was evaluated using the receiver operating characteristic area under the curve, precision-recall area under the curve, F1 score, and Brier score.

Results: In-hospital mortality was observed in 7 of the 229 patients included in the study (3.1%). The mean age and frequency of chronic kidney disease were higher among deceased patients, whereas the Charlson comorbidity index did not differ significantly between survivors and non-survivors. In model comparisons, the Gradient Boosting model showed the best overall performance (ROC-AUC: 0.87, PR-AUC: 0.76, F1: 0.73; Brier score: 0.12).

Conclusion: The Gradient Boosting model demonstrated the highest performance in predicting in-hospital mortality in patients with heart failure. Machine learning algorithms offer strong potential beyond traditional statistical approaches for the prognostic prediction of complex clinical scenarios such as heart failure.

Objective: To develop and validate a parsimonious and clinically applicable nomogram for predicting 28-day mortality in patients with bacterial pneumonia complicated by sepsis and acute kidney injury using data from the Medical Information Mart for Intensive Care-IV database.

Methods: A total of 470 eligible patients were enrolled and randomly assigned to a derivation cohort (n = 330) and a validation cohort (n = 140). Candidate predictors were screened using least absolute shrinkage and selection operator regression with the λ.1se criterion, followed by multivariable logistic regression to construct the final model. Model performance was assessed in both cohorts using discrimination (area under the receiver operating characteristic curve), calibration plots, calibration statistics, and decision curve analysis. A nomogram was developed based on the final predictors.

Results: Least absolute shrinkage and selection operator regression identified three independent predictors-age, Sequential Organ Failure Assessment score, and urine output-which were incorporated into the final nomogram. The model demonstrated good discrimination in the derivation cohort (area under the receiver operating characteristic curve = 0.802; 95% confidence interval: 0.750-0.853) and validation cohort (area under the receiver operating characteristic curve = 0.803; 95% confidence interval: 0.721-0.885). Calibration curves and corresponding intercept and slope values indicated satisfactory agreement between predicted and observed mortality risks in both cohorts. Decision curve analysis showed that the nomogram yielded higher net clinical benefit compared with Sequential Organ Failure Assessment alone across a wide range of threshold probabilities.

Conclusion: The nomogram integrating age, Sequential Organ Failure Assessment score, and urine output provides accurate and clinically meaningful prediction of 28-day mortality among patients with bacterial pneumonia complicated by sepsis and acute kidney injury. This tool may facilitate early risk stratification and guide individualized clinical decision-making in the intensive care unit setting.

Background: Dengue fever transmitted primarily by Aedes mosquitoes is a growing health concern in Sudan, particularly in Port Sudan. Given the resource strain imposed by the ongoing war, this study aimed to evaluate physicians' knowledge, attitudes, and practices (KAP) regarding dengue fever. Our central hypothesis was that sociodemographic factors, educational history, and specialized training would significantly influence KAP scores within this challenging conflict environment.

Methods: A cross-sectional study was conducted among physicians working at Osman Digna Hospital, Port Sudan Teaching Hospital, and Sea Corporation Hospital from July to September 2024. The calculated sample size was 150 physicians, distributed across the three hospitals using a stratified sampling technique. Data collection was conducted by using a validated and reliable questionnaire from the literature. The questionnaire was developed in Google Forms and distributed to physicians via social media and email. Data were analyzed using the Statistical Package for the Social Sciences software, IBM Corp. IBM SPSS Statistics for Windows, Version 23. Armonk, NY: IBM Corp.

Results: Of the 150 respondents, 53% were female with a mean age of 30.5 (±4.8) years. The median years of experience were 2 (interquartile range, 1-5) years. Only 37% had participated in dengue fever workshops. Despite this, 55% exhibited good knowledge, 94% had a positive attitude, and 77% demonstrated appropriate practices regarding dengue fever. Significant associations were observed between workplace and knowledge (p value = 0.044), workshop attendance and physician practices (p value = 0.05), and a highly significant association between knowledge and practices (p value = 0.010).

Conclusion: Most physicians in Port Sudan demonstrated positive attitudes and good practices for dengue prevention and control. While overall KAP was moderately good, persistent and significant knowledge gaps were identified, particularly regarding the identification of less common symptoms, criteria for severe dengue, and effective vector control measures. These gaps were especially pronounced among those who had not attended dengue fever workshops.

Background: Human papillomavirus (HPV) infection is among the most common sexually transmitted infections worldwide and a leading cause of cervical cancer, which claims the life of one woman every minute globally. HPV vaccination is a proven, effective strategy to prevent cervical cancer. Despite vaccine availability, few studies have assessed awareness and perceptions among female secondary school students, a key target group for early vaccination. Addressing this gap is essential for designing interventions to improve vaccine acceptance and coverage.

Objectives: This study aimed to assess knowledge and attitudes toward the HPV vaccine and identify associated factors among female secondary school students in Nifas Silk Lafto Sub-City, Addis Ababa, Ethiopia.

Methods: Institutional-based cross-sectional study was conducted from May 10 to 20, 2023, in Nifas Silk Lafto Sub-City. Stratified sampling was used to select study participants. A total of 635 students were selected using a simple random sampling technique. Data were collected using structured self-administered questionnaires. The data were entered into EpiData version 4.6 and analyzed with SPSS version 25. Descriptive statistics (such as frequency, percentage, and means) were used to summarize the data, while binary and multivariable logistic regression analyses were performed to identify factors associated with the outcome variables. Adjusted odds ratios with 95% confidence intervals (CI) and p-value <0.05 were used to determine statistical significance.

Results: A total of 616 students participated, with a response rate of 97%. Of the respondents, 55.5% had good knowledge and 58.6% had positive attitudes toward the HPV vaccine. Age between 18-20 years (AOR = 2.579, 95% CI = 1.446-4.598, p<0.001) and prior awareness of the HPV vaccine (AOR = 10.441, 95% CI = 6.530-16.694, p<0.001) were significantly associated with good knowledge. Factors significantly associated with a positive attitude included prior awareness of the HPV vaccine (AOR = 0.368, 95% CI = 0.239-0.567, p<0.001), receiving information from healthcare providers (AOR = 2.434, 95% CI = 1.055-5.615, p = 0.037), and knowledge about the HPV vaccine (AOR = 1.464, 95% CI = 1.000-2.144, p = 0.05).

Conclusions: Overall knowledge and attitudes toward the HPV vaccine were low compared to other studies. Age and prior awareness of the HPV vaccine were significantly associated with knowledge. Additionally, prior awareness, source of information and knowledge significantly influenced attitudes toward the HPV vaccine. Therefore, targeted health education programs are recommended to improve awareness and attitudes among female secondary school students.

Background: Suicide is a leading cause of death worldwide. However, data on adolescent suicidal ideation remains limited in rural Bangladesh.

Objective: This study identifies the prevalence and associated factors of suicidal ideation among adolescents in rural southern Bangladesh.

Method: A cross-sectional study was conducted among 500 school-going adolescents in a southern rural subdistrict in Bangladesh. Data were collected using the Suicidal Behaviors Questionnaire-Revised.

Result: The lifetime prevalence of suicidal ideation was 20.2% (n = 101; 95% CI: 16.9%-24.0%), and the prevalence in the past 12 months was 19.6% (n = 98; 95% CI: 16.3%-23.3%). The prevalence of suicidal attempts was 8.8% (n = 44, 95% CI: 6.6%-11.6%). Associated factors included being ever-married (Adjusted Odds Ratio (AOR): 6.9; 95% CI: 1.4-33.2; p = 0.016), excessive internet use (AOR: 4.3; 95% CI: 1.1-16.3; p = 0.033), lack of close friendships (AOR: 3.3; 95% CI: 1.2-8.8; p = 0.017), poor family relationships (AOR: 3.1; 95% CI: 1.3-7.2; p = 0.011), and moderate (AOR: 5.9; 95% CI: 2.2-15.9; p ⩽ 0.001), severe (AOR: 8.4; 95% CI: 2.2-34.4; p = 0.003), and extremely severe (AOR: 11.6; 95% CI: 2.6-52.4; p = 0.001) depressive symptoms.

Conclusion: These study findings can help design effective strategies to prevent suicide and enhance adolescent mental well-being.

Background: Maternal death is a foremost public health concern in underdeveloped countries, particularly in postwar Eastern Tigray, Ethiopia, where healthcare infrastructure is limited. Identifying obstetric risk factors is crucial to reducing unnecessary maternal mortality. Disparities in knowledge of obstetric danger signs are a critical barrier to reducing maternal mortality, particularly in fragile, post-conflict settings.

Objective: The main goal is to measure the knowledge disparity of pregnant women about obstetric danger signs and associated factors at postwar Eastern Tigray, Ethiopia, health facility centers using penalized and Bayesian logistic regression.

Methods: We conducted a health-facility-based cross-sectional study. Data were collected from 102 pregnant women, primarily from rural areas, using structured interviews. Predictors included socioeconomic factors (education, residence, and income), healthcare access (distance to a health facility), and obstetric history (parity). Knowledge of obstetric danger signs was the outcome, classified as "good" (⩾3 signs identified) or "poor." Associations were analyzed using penalized logistic regression and Bayesian logistic regression.

Results: Descriptive statistics revealed profound disparities in knowledge: prevalence was 92.3% in urban versus 12.7% in rural residents, 93.5% for the shortest versus 5.1% for the longest travel time, and 5.6% for the lowest versus 91.7% for higher education levels. Penalized regression identified urban residence as the strongest predictor (adjusted odds ratio = 27.4, p = 0.002). Bayesian analysis affirmed significant associations for education Level 2 (median odds ratio = 78.2, 95% credible interval: 9.7, 1042.4). The longest travel time was associated with a 97% reduction in the odds of knowledge (odds ratio = 0.03, 95% credible interval: 0.002, 0.34). Model comparison confirmed the superiority of penalized regression over the failed standard model.

Conclusion: Knowledge of obstetric danger signs is predominantly determined by structural access factors specifically urban residence and travel time to health facilities followed by educational attainment. These findings highlight the urgent need for targeted, equity-focused interventions that address geographical and infrastructural barriers to health information in postwar Eastern Tigray, Ethiopia.

Objectives: Antibiotics have diminished mortality rates associated with bacterial infections. However, their misuse worsens antimicrobial resistance. This study aimed to evaluate antibiotic prescribing patterns using World Health Organization/International Network for Rational Use of Drug prescribing indicators and its determinants at public hospitals in Eastern Tigrai, Ethiopia.

Methods: A multicenter cross-sectional study was done among encounters prescribed from 1 December 2023 to 30 November 2024 at Doctor Tsegay, Freweyni, and Fre-Semaetat Primary Hospitals. A total of 1800 encounters were selected using systematic random sampling. Data collected from 01 December 2024 to 31 January 2025 were analyzed using SPSS version 21. Binary logistic regression was done to identify determinants of antibiotic prescribing setting statistical significance at p < 0.05. A model fitness test was performed using the Hosmer-Lemeshow goodness-of-fit.

Results: Antibiotics were prescribed in 65.7% of encounters (1183/1800), totaling 1465 antibiotics. The mean prescribing indicators were 1.24 (Standard deviation 0.48) antibiotics per encounter, and 26.4% of encounters included an injection. Nearly all antibiotics were prescribed from the essential medicine list (99.6%) and by generic name (97.5%). Overall, 67.0% of antibiotics were classified under the "Access" group and 33.0% under the "Watch" group, with none from the "Reserve" group. Factors significantly associated with antibiotic prescribing included being under 18 years of age (adjusted odds ratio = 2.6; 95% confidence interval: 1.54-4.2), receiving ⩾3 drugs (adjusted odds ratio = 7.8; 95% confidence interval: 5.4-11.4), having ⩾2 diseases (adjusted odds ratio = 2.1; 95% confidence interval: 1.27-3.4), and presenting diseases of the genitourinary system (adjusted odds ratio = 9.4; 95% confidence interval: 3.9-22.8).

Conclusion: Antibiotic prescribing practices were not aligned with World Health Organization standards, indicating substantial overuse. Such patterns may contribute to the worsening of antimicrobial resistance. Strengthening adherence to World Health Organization and national treatment guidelines is essential to promote rational use of antibiotics in these hospitals.

Central obesity is one of the defining features of metabolic syndrome (MetS). MetS comprises a cluster of metabolic disturbances including insulin resistance (IR), hypertension, and altered glucose, lipid, and fatty acid metabolism. These alterations are characterized by reduced levels of high-density lipoprotein (HDL) commonly referred to as "good cholesterol" and increased levels of low-density lipoprotein (LDL) or "bad cholesterol". While HDL protects against cardiovascular disease (CVD), elevated LDL increases disease risk. Collectively, these metabolic abnormalities raise the risk of developing type-2 diabetes (T2D), metabolic dysfunction-associated steatohepatitis (MASH), and CVDs. The raising global incidence of MetS is largely attributed to sedentary lifestyles, westernization, and the consumption of energy-dense processed foods, making it a growing public health concern across the globe. In recent years microRNAs (miRNAs), which are small non-coding RNA molecules (18 to 25 nucleotides), have emerged as important regulators of post-transcriptional gene expression in metabolic and inflammatory pathways. Among these, miR-155 have received considerable attention for its role in immune activation, inflammatory signalling, cancer, and energy balance. MiR-155 modulates key genes involved in insulin signalling, glucose metabolism, and metabolic homeostasis, thereby contributing to overall metabolic control. Given these roles, circulating miR-155 has arisen as a promising non-invasive biomarker for metabolic abnormalities and a potential therapeutic target in MetS. This review highlights the multifaceted roles of miR-155 and summarizes accumulating evidence supporting its central involvement in the physiological and pathological mechanisms underlying MetS, with implications for early diagnosis and therapeutic development.

Background: Helicobacter pylori (H. pylori) infection remains highly prevalent in low- and middle-income countries and is a major cause of chronic gastritis and upper gastrointestinal morbidity. In endemic settings, infection was often influenced by environmental and hygienic exposures. Data examining these associations among symptomatic gastritis patients in Pakistan are limited.

Objective: To describe the prevalence of H. pylori positivity and examine its association with environmental, hygienic, and lifestyle characteristics among patients with clinically diagnosed gastritis in Northern Pakistan.

Methods: This multi-center cross-sectional study was conducted from January to December 2024 in 3 tertiary-care hospitals in Islamabad, Rawalpindi, and Wah Cantt. Patients aged ⩾16 years with clinically diagnosed gastritis were consecutively enrolled. H. pylori status was determined using invasive and non-invasive diagnostic modalities employed in routine clinical care. Sociodemographic, environmental and behavioural data were collected using a structured, pilot-tested questionnaire. Associations were assessed using chi-square or Fisher's exact tests.

Results: Among 250 participants, 225 (90.0%) were H. pylori positive. Infection status was not significantly associated with age, sex, education level or place of residence. In contrast, untreated drinking water, absence of household water treatment, poor hand hygiene, skipping or delaying meals and consumption of uncooked or undercooked food were significantly associated with H. pylori positivity (p ⩽ 0.001). There were substantial overlaps in gastrointestinal symptoms between infected and non-infected patients. In H. pylori-positive people, post-treatment eradication was noted in 65.6% and recurrence in 40.0%.

Conclusion: In this endemic area, the prevalence of H. pylori positivity became very high among individuals who surpassed the clinical diagnosis of gastritis. Infection status was strongly associated with environmental and hygienic factors in this symptomatic population. These results reflect associations and not causal determinants and emphasize the need of longitudinal studies.