Global Epidemiology最新文献

Barriers and facilitators to healthcare access for migrants in Morocco: A narrative review 摩洛哥移民获得医疗保健的障碍和促进因素：叙述性审查

Global Epidemiology

Pub Date : 2026-06-01 Epub Date: 2026-01-15 DOI: 10.1016/j.gloepi.2026.100249

Amaghdour Chaimaa , Farhan Houssein Ali , Belouali Radouane , Hassouni Kenza

Background

International migration has increased significantly in recent decades, creating major challenges for health systems, particularly in transit and destination countries such as Morocco. Migrants, often living in precarious socio-economic conditions, face multiple obstacles to healthcare access, which heightens their vulnerability. This narrative review aims to identify the main barriers and facilitators to healthcare access for migrants in Morocco, using Levesque's conceptual framework.

Methods

A literature search was conducted in PubMed, Web of Science, Scopus and Google Scholar, as well as in institutional sources (WHO, IOM, UNHCR, HCP). Relevant publications published between 2013 and 2025 in French or English were critically reviewed. The analysis was structured according to the five dimensions of Levesque's framework: accessibility, acceptability, availability, affordability and appropriateness.

Results

Twenty-two publications were included. Findings reveal that migrants in Morocco face economic, geographical, linguistic, sociocultural, administrative and structural barriers. Financial constraints, lack of health coverage, and regional disparities are among the most significant obstacles. However, several facilitators were also identified, including NGO initiatives, community-based support, and inclusive public policies.

Conclusion

Migrant access to healthcare in Morocco remains shaped by complex and multidimensional challenges. Despite notable progress, greater coordination, sustainability, and cultural sensitivity are required to ensure equitable and universal access to healthcare for all migrants, regardless of legal or economic status.

近几十年来，国际移徙显著增加，给卫生系统带来了重大挑战，特别是在摩洛哥等过境国和目的地国。移徙者往往生活在不稳定的社会经济条件下，在获得医疗保健方面面临多重障碍，这加剧了他们的脆弱性。本叙述性审查旨在利用Levesque的概念框架，确定摩洛哥移民获得医疗保健的主要障碍和促进因素。方法在PubMed、Web of Science、Scopus、b谷歌Scholar以及机构来源（WHO、IOM、UNHCR、HCP）进行文献检索。对2013年至2025年间以法文或英文出版的相关出版物进行了严格审查。根据Levesque框架的五个维度进行分析：可及性、可接受性、可获得性、可负担性和适当性。结果共纳入文献22篇。调查结果显示，摩洛哥的移民面临经济、地理、语言、社会文化、行政和结构障碍。财政限制、缺乏医疗保险和区域差异是最重要的障碍。然而，也确定了几个促进因素，包括非政府组织倡议、社区支持和包容性公共政策。结论：摩洛哥移民获得医疗保健的机会仍然受到复杂和多方面挑战的影响。尽管取得了显著进展，但需要加强协调、可持续性和文化敏感性，以确保所有移徙者，无论其法律或经济地位如何，都能公平和普遍地获得医疗保健。

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引用次数: 0

AlzStack: Forecasting early-onset Alzheimer's with an explainable AI system using multiple data balancing techniques AlzStack：使用多种数据平衡技术，通过可解释的人工智能系统预测早发性阿尔茨海默病

Global Epidemiology

Pub Date : 2026-06-01 Epub Date: 2025-12-07 DOI: 10.1016/j.gloepi.2025.100235

Venkata Aditi Modali , Manohar Pavanya , R. Vijaya Arjunan , D. Cenitta , Niranjana Sampathila , Radhika Kamath , Krishnaraj Chadaga

Alzheimer's disease (AD) is a degenerative neurological disease that progresses over time, making early detection crucial for effective intervention and better patient prognosis. Traditional diagnostic methods such as cognitive assessments, neuroimaging, and biomarker analysis can be time-consuming, costly, and inconsistent. We introduce AlzStack, a soft voting ensemble model to classify AD from a richly detailed dataset containing 2149 patients across demographic, medical, lifestyle, and cognitive variables. To resolve class imbalance, we implemented a pipeline 5-fold cross-validation, randomized search for hyper parameter tuning and advanced resampling methods such as SMOTE (Synthetic Minority Oversampling Technique), ADASYN, BorderlineSMOTE, and SVMSMOTE. Soft Vote Classifier surpassed both stacking ensembles and hard voting with an AUC value of 94.27 %, accuracy of 93.26 %, precision of 89.17 %, a recall of 92.11 %, and F1-score value of 90.61 %.A secondary experiment with only resampling methods applied to data to all base models served as a baseline for comparison confirming the superior performance of cross-validation AlzStack configuration. To improve interpretability, we utilized a wide range of Explainable Artificial Intelligence (XAI methods) and these approaches yielded global and local explanations about model behavior, emphasizing key features like MMSE scores, functional measures, and behavioral markers. Combining robust predictive performance with explainable decision-making makes AlzStack is a healthcare decision-support algorithm for the early detection of AD.

阿尔茨海默病（AD）是一种随时间进展的退行性神经系统疾病，因此早期发现对于有效干预和改善患者预后至关重要。传统的诊断方法，如认知评估、神经成像和生物标志物分析，可能耗时、昂贵且不一致。我们介绍了AlzStack，这是一个软投票集成模型，用于从包含2149名患者的数据集中对AD进行分类，包括人口统计、医疗、生活方式和认知变量。为了解决类不平衡问题，我们实现了管道5倍交叉验证，随机搜索超参数调整和高级重采样方法，如SMOTE（合成少数过采样技术），ADASYN， BorderlineSMOTE和SVMSMOTE。软投票分类器的AUC值为94.27%，准确率为93.26%，准确率为89.17%，召回率为92.11%，f1得分值为90.61%，超过了堆叠集成和硬投票。通过对所有基础模型的数据只采用重采样方法进行二次实验，作为比较基线，确认交叉验证AlzStack配置的优越性能。为了提高可解释性，我们使用了广泛的可解释人工智能（XAI方法），这些方法产生了关于模型行为的全局和局部解释，强调了MMSE分数、功能测量和行为标记等关键特征。将稳健的预测性能与可解释的决策相结合，使AlzStack成为一种用于早期发现AD的医疗保健决策支持算法。

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引用次数: 0

Systematic review of the tuberculosis burden in prisons: Regional patterns and gaps in Latin America and the Caribbean 监狱结核病负担的系统审查：拉丁美洲和加勒比的区域模式和差距

Global Epidemiology

Pub Date : 2026-06-01 Epub Date: 2026-01-07 DOI: 10.1016/j.gloepi.2026.100244

Ricardo Perea-Jacobo , Jose Luis Soto-Ledesma , Rafael Laniado-Laborín , Dora-Luz Flores , Rogelio Zapata-Garibay , J. Eduardo González-Fagoaga , Luis Alberto García-Sánchez , Javier Robles-Flores , Liliana Guadalupe Villa-Aviles , Raquel Muñiz-Salazar

Objective

To systematically review and synthesize the available literature on the prevalence and incidence of tuberculosis in incarcerated populations in Latin America and the Caribbean, identifying regional patterns, data gaps, and key challenges and providing recommendations for strengthening TB control strategies within prison settings.

Methods

A systematic review was conducted across databases and reports using the following search terms: “tuberculosis”, “prisons”, “prisoners”, “Latin America”, “Caribbean”, “inmates”, and “social readaptation center”. The review focused on prevalence rates, country-specific studies, total prison population studied by country, diagnostic methods used, and the frequency of TB reporting.

Results

A total of 45 studies met the inclusion criteria, with most conducted in Brazil (60%), Colombia (13%), and Paraguay (9%). TB prevalence and incidence in prisons were found to be up to ten times higher than in the general population, with substantial variation in study design, diagnostic tools, and reporting standards. Structural risk factors such as overcrowding, HIV coinfection, and limited access to molecular diagnostics were frequently reported. Notably, no studies were found from Caribbean countries, and only one study was identified in Mexico, revealing significant regional data gaps.

Conclusion

TB in Latin American prisons represents a serious but underreported public health crisis. The combination of elevated incidence, limited diagnostics, and fragmented surveillance highlights the urgent need for standardized, prison-specific TB control strategies and expanded research in underrepresented regions.

目的系统回顾和综合有关拉丁美洲和加勒比地区被监禁人群中结核病患病率和发病率的现有文献，确定区域模式、数据差距和主要挑战，并为加强监狱环境中的结核病控制策略提供建议。方法使用以下搜索词：“结核病”、“监狱”、“囚犯”、“拉丁美洲”、“加勒比”、“囚犯”和“社会再适应中心”，对数据库和报告进行系统回顾。审查的重点是流行率、国别研究、按国家研究的监狱总人数、使用的诊断方法以及结核病报告的频率。结果共有45项研究符合纳入标准，其中大多数在巴西（60%）、哥伦比亚（13%）和巴拉圭（9%）进行。研究发现，监狱中的结核病患病率和发病率比一般人群高出10倍，研究设计、诊断工具和报告标准存在很大差异。结构性风险因素，如过度拥挤、艾滋病毒合并感染和获得分子诊断的机会有限，经常被报道。值得注意的是，没有发现来自加勒比国家的研究，仅在墨西哥发现了一项研究，这表明存在重大的区域数据差距。结论拉美监狱中的结核病是一种严重但未被充分报道的公共卫生危机。发病率升高、诊断有限和监测分散等综合因素突出表明，迫切需要制定针对监狱的标准化结核病控制战略，并在代表性不足的地区扩大研究。

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引用次数: 0

Epidemiology of alcohol use and alcohol use disorders among the population of Buea, south west region, Cameroon: A survey study 喀麦隆西南地区Buea人口中酒精使用和酒精使用障碍的流行病学：一项调查研究

Global Epidemiology

Pub Date : 2026-06-01 Epub Date: 2025-12-03 DOI: 10.1016/j.gloepi.2025.100236

Nadège Emégam Kouémou, Ven-Laura Atem Yega, Franklin Mbeboh Savo, Ndzweng Linda Tamanji

Background

Alcohol consumption worldwide is associated with a range of health and societal problems. Epidemiology data are valuable tools for predicting the outcome of a given behaviour on the general population's health. This study aimed to evaluate the patterns of alcohol consumption among Buea inhabitants.

Material and methods

This cross-sectional study involves 422 participants (244 men and 178 women) aged 15 years and above who have been residents of the Buea municipality for more than a year. This study was conducted from March to May 2019 using a semi-structured questionnaire. The questionnaire included socio-demographic information and the 10 items of the Alcohol Use Disorder Identification Test (AUDIT).

Results

The results obtained showed that many of the alcohol misusers were men. 34.6 % of the participants indicated drinking above the recommended levels. 93.8 % of the respondents admitted to consuming alcohol in the company of others, mostly in bars. Beer was the leading alcoholic beverage consumed in Buea. Alcohol intake for pleasure and to relieve stress were among the leading causes of alcohol drinking in the study population. The vast majority of participants reported misbehavior after alcohol intake. The number of women with AUDIT C score greater than 5 was also significant. Aggressivity, memory loss, and falls after drinking were also recorded in the study population.

Conclusion

The alcohol consumption patterns in Buea are associated with many behavioral misconducts. Therefore, there is a need for community education to curve the incidence of neurological diseases and alcohol addiction behaviour in the Buea municipality.

世界范围内的酒精消费与一系列健康和社会问题有关。流行病学数据是预测特定行为对一般人群健康影响的宝贵工具。本研究旨在评估布埃亚居民的酒精消费模式。材料和方法这项横断面研究涉及422名参与者（244名男性和178名女性），年龄在15岁及以上，在布埃亚市居住超过一年。本研究于2019年3月至5月进行，采用半结构化问卷。问卷内容包括社会人口学信息和酒精使用障碍鉴定测试（AUDIT）的10项内容。结果结果表明，酗酒者以男性居多。34.6%的参与者表示饮酒量超过了建议水平。93.8%的受访者承认曾在他人陪同下饮酒，主要是在酒吧。啤酒是Buea消费的主要酒精饮料。在研究人群中，为娱乐和缓解压力而饮酒是饮酒的主要原因。绝大多数参与者报告了饮酒后的不良行为。审计C得分大于5的女性人数也很显著。在研究人群中，攻击性、记忆力减退和饮酒后跌倒也有记录。结论Buea地区的酒精消费模式与许多不良行为有关。因此，有必要进行社区教育，使布埃亚市的神经系统疾病和酒精成瘾行为的发病率曲线化。

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引用次数: 0

Interpretation of the IARC quantitative bias analysis of talc and ovarian cancer 国际癌症研究机构对滑石粉与卵巢癌定量偏倚分析的解释

Global Epidemiology

Pub Date : 2026-06-01 Epub Date: 2026-01-21 DOI: 10.1016/j.gloepi.2026.100251

Julie E. Goodman, Denali N. Boon

The International Agency for Research on Cancer (IARC) conducted a quantitative bias analysis (QBA) of talc use and ovarian cancer in Monograph 136. While the inclusion of a QBA was an important improvement compared to prior monographs, it was based on “best guesses” of sensitivity and specificity, rather than available data on talc recall. IARC incorporated some uncertainty in its analysis, but did not consider uncertainty around each sensitivity and specificity value. IARC concluded that a positive association between talc and ovarian cancer was credible but, even setting aside methodological issues, the QBA clearly showed that cohort study results were very similar before and after adjustment with various assumptions about sensitivity and specificity, and that case-control studies results were greatly attenuated. Thus, IARC's conclusions are inconsistent with the analyses presented in the Monograph, which clearly demonstrate that exposure misclassification could fully explain associations in case-control studies, and that epidemiology evidence does not support an association between talc and ovarian cancer. We propose that future IARC QBAs rely on empirical data rather than expert guesses (when possible), are fully transparent, consider all relevant information (including dose-response data), and use probabilistic and Bayesian analyses to address uncertainties.

国际癌症研究机构（IARC）在专论136中对滑石粉的使用和卵巢癌进行了定量偏倚分析（QBA）。虽然与之前的专著相比，QBA的加入是一个重要的改进，但它是基于敏感性和特异性的“最佳猜测”，而不是关于滑石粉召回的可用数据。IARC在其分析中纳入了一些不确定性，但没有考虑每个敏感性和特异性值的不确定性。IARC得出结论，滑石粉与卵巢癌之间的正相关是可信的，但即使抛开方法学问题，QBA也清楚地表明，在对敏感性和特异性进行各种假设的调整前后，队列研究结果非常相似，病例对照研究结果也大大减弱。因此，IARC的结论与专论中提出的分析不一致，后者清楚地表明，暴露错误分类可以完全解释病例对照研究中的关联，并且流行病学证据不支持滑石粉与卵巢癌之间的关联。我们建议未来的IARC qba依赖于经验数据而不是专家猜测（如果可能的话），完全透明，考虑所有相关信息（包括剂量-反应数据），并使用概率和贝叶斯分析来解决不确定性。

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引用次数: 0

Undetected circulation of monkeypox virus in Portugal: Evidence for a 50-day gap before first detection 葡萄牙未被发现的猴痘病毒传播：首次发现前50天间隔的证据

Global Epidemiology

Pub Date : 2026-06-01 Epub Date: 2025-12-15 DOI: 10.1016/j.gloepi.2025.100238

Rita Cordeiro , Fernando da Conceição Batista , Ana Pelerito , Isabel Lopes de Carvalho , Sílvia Lopo , Raquel Neves , Raquel Rocha , Paula Palminha , Maria José Borrego , Maria Sofia Núncio , João Paulo Gomes

As mpox continues to spread globally, proactive monitoring and preparedness are crucial to minimize impact and enhance response strategies. Using a mathematical model combining a negative binomial distribution with Richards' logistic curve, we reconstructed the hidden phase of mpox transmission in Portugal, offering insights into the timing and dynamics of the initial outbreak. The analysis of 950 PCR-positive and 986 negative cases suggested that symptom onset occurred between March 24 and April 2, 2022, with March 27 identified as the most probable date. This study delineates the likely period of silent circulation of MPXV in Portugal, providing a clearer understanding of early outbreak dynamics and surveillance performance. Possible imperfections in early diagnostic testing and limited awareness of mpox may have contributed to delayed recognition of the outbreak. By demonstrating how retrospective mathematical modelling can estimate undetected transmission periods, our findings highlight the value of such approaches in epidemic reconstruction and underscore the importance of strengthening early surveillance systems to detect undiagnosed transmission of mpox in non-endemic countries.

随着麻疹继续在全球蔓延，积极监测和防范对于尽量减少影响和加强应对战略至关重要。利用将负二项分布与Richards logistic曲线相结合的数学模型，我们重建了葡萄牙m痘传播的隐藏阶段，从而深入了解了最初爆发的时间和动态。对950例pcr阳性和986例阴性病例的分析表明，症状发生在2022年3月24日至4月2日之间，3月27日被确定为最有可能的发病日期。本研究描述了MPXV在葡萄牙静默传播的可能时期，为早期疫情动态和监测表现提供了更清晰的认识。早期诊断检测方面可能存在的缺陷和对痘的认识有限，可能导致对疫情的认识延迟。通过展示回顾性数学模型如何能够估计未被发现的传播期，我们的研究结果强调了这种方法在流行病重建中的价值，并强调了加强早期监测系统以在非流行国家发现未被诊断的m痘传播的重要性。

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引用次数: 0

Effect of completing eight or more antenatal care contacts on adverse pregnancy outcomes in a district hospital in Ghana: A propensity score–matched and doubly robust analysis 在加纳的一家地区医院，完成八次或更多的产前护理接触对不良妊娠结局的影响：倾向评分匹配和双重稳健分析

Global Epidemiology

Pub Date : 2026-06-01 Epub Date: 2026-02-20 DOI: 10.1016/j.gloepi.2026.100253

Frederick Osei Owusu , Emmanuel Konadu , Helena Addai-Manu , Julius Kwabena Karikari , Esther Serwah Agbedinu , Nuheila Ibrahim , Lydia Asenso , Mercy Addae , Joseph Osarfo , Bernice Enyonam Akpaloo , Mawuse Kanfra , Douglas Aninng Opoku

Introduction

Evidence from low- and middle-income countries (LMICs), especially using robust causal inference techniques to estimate the association between ≥8 antenatal care (ANC) contacts and adverse pregnancy outcomes, remains limited. This study examines the association between completing eight or more ANC contacts and adverse pregnancy outcomes, specifically low birth weight (LBW) and preterm birth (PTB).

Methods

A cross-sectional study was conducted using retrospective delivery data at Juaben Government Hospital, Ghana. LBW and PTB were compared between women who made ≥8 ANC contacts and those who did not. Propensity score matching (1:1), inverse probability of treatment weighting, and doubly robust estimates were employed to address confounding and estimate the association between completing ≥8 ANC contacts and LBW and PTB.

Results

At baseline, the sample included 2156 women, of whom over half (51.3%) had ≥8 ANC contacts before delivery. After matching, women in both groups had similar characteristics. After matching on covariates, women with ≥8 ANC contacts had approximately 31.0% (ATT: 0.69; 95%CI: 0.53–0.90) and 54.0% (ATT: 0.46; 95%CI: 0.37–0.57) lower risks of delivering a LBW infant and a PTB, respectively. Inverse probability of treatment weighting and doubly robust estimates yielded comparable estimates for both outcomes. In a secondary analysis of ≥4 ANC contacts, the magnitude of the association was weaker than that observed in the ≥8 ANC model.

Conclusion

This study demonstrated that completing ≥8 ANC contacts was consistently associated with lower odds of LBW and PTB among this cohort of pregnant women. This finding adds to the limited empirical evidence from LMICs on the implementation of the WHO eight-contact ANC model, suggesting that higher ANC contacts in a similar resource-constrained setting may be associated with improved maternal and infant outcomes.

来自低收入和中等收入国家（LMICs）的证据仍然有限，特别是使用可靠的因果推断技术来估计≥8次产前护理（ANC）接触与不良妊娠结局之间的关联。本研究探讨了完成八次或更多ANC接触与不良妊娠结局，特别是低出生体重（LBW）和早产（PTB）之间的关系。方法对加纳Juaben政府医院的分娩资料进行回顾性横断面研究。比较与ANC接触≥8次的妇女的LBW和PTB。采用倾向评分匹配（1:1）、治疗加权逆概率和双重稳健估计来解决混淆问题，并估计完成≥8次ANC接触与LBW和PTB之间的关系。结果基线时，样本包括2156名妇女，其中超过一半（51.3%）在分娩前接触过≥8次ANC。配对后，两组女性的特征相似。在对协变量进行匹配后，接触过≥8次ANC的妇女分娩LBW婴儿和PTB的风险分别降低约31.0% （ATT: 0.69; 95%CI: 0.53-0.90）和54.0% （ATT: 0.46; 95%CI: 0.37-0.57）。治疗权重的逆概率和双稳健估计对两种结果产生了可比较的估计。在第二次分析中，≥4次ANC接触的关联程度弱于≥8次ANC模型中观察到的关联程度。结论本研究表明，在该队列孕妇中，完成≥8次ANC接触与较低的LBW和PTB发生率一致相关。这一发现补充了来自中低收入国家关于实施世卫组织八人接触接触新生儿模式的有限经验证据，表明在类似的资源受限环境中，较高的新生儿接触接触可能与改善的孕产妇和婴儿结局有关。

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引用次数: 0

Machine learning-based identification of determinants of pulse pressure in pregnant women 基于机器学习的孕妇脉压决定因素识别

Global Epidemiology

Pub Date : 2026-06-01 Epub Date: 2026-01-07 DOI: 10.1016/j.gloepi.2026.100245

Merga Abdissa Aga

Background

Pulse pressure (PP) is an important marker of arterial stiffness and cardiovascular risk during pregnancy, yet its longitudinal determinants remain insufficiently characterized, particularly in low-resource settings.

Objective

To identify determinants of longitudinal pulse pressure among pregnant women using machine learning approaches and to compare their predictive performance with a conventional mixed-effects modeling framework.

Methods

We conducted a retrospective cohort study of 549 pregnant women attending public antenatal care services at Bishoftu General Hospital, Oromia region, Ethiopia, comprising 2760 repeated pulse pressure measurements. Pulse pressure was modeled as a continuous longitudinal outcome. Predictors included maternal sociodemographic characteristics, clinical measurements, obstetric history, and gestational age at each visit. A generalized linear mixed model, random forest regression, and XGBoost regression were applied. Participant-level data partitioning was used for model training and evaluation, and predictive performance was assessed using root mean squared error (RMSE) and mean absolute error (MAE).

Results

Tree-based machine learning models showed improved predictive performance compared with the mixed-effects model, indicating the presence of nonlinear and time-dependent relationships between predictors and pulse pressure trajectories. Maternal age, body weight, gestational age, and pulse pressure values from previous visits consistently contributed to pulse pressure prediction.

Conclusion

Machine learning methods applied to longitudinal antenatal data provide a flexible and effective framework for modeling pulse pressure dynamics during pregnancy. This approach enhances understanding of key clinical and temporal determinants and may support improved cardiovascular risk assessment in maternal health care settings.

脉压（PP）是妊娠期间动脉僵硬度和心血管风险的重要标志，但其纵向决定因素尚未充分表征，特别是在低资源环境中。目的利用机器学习方法确定孕妇纵向脉压的决定因素，并将其预测性能与传统的混合效应建模框架进行比较。方法对在埃塞俄比亚奥罗米亚地区Bishoftu总医院接受公共产前保健服务的549名孕妇进行回顾性队列研究，包括2760次重复脉压测量。脉压建模为连续的纵向结果。预测因素包括每次就诊时产妇的社会人口学特征、临床测量、产科史和胎龄。采用广义线性混合模型、随机森林回归和XGBoost回归。采用参与者水平的数据划分进行模型训练和评估，并使用均方根误差（RMSE）和平均绝对误差（MAE）评估预测性能。结果与混合效应模型相比，基于树的机器学习模型的预测性能有所提高，这表明预测因子与脉压轨迹之间存在非线性和时间依赖关系。产妇年龄、体重、胎龄和以往就诊的脉压值一致有助于脉压预测。结论将机器学习方法应用于产前纵向数据，为妊娠期脉压动态建模提供了一个灵活有效的框架。这种方法加强了对关键临床和时间决定因素的理解，并可能支持改善孕产妇保健环境中的心血管风险评估。

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引用次数: 0

Sleep quality and psychological distress among Bangladeshi medical students: Prevalence, predictors, and sex-institutional differences 孟加拉国医学生的睡眠质量和心理困扰：患病率、预测因素和性别制度差异

Global Epidemiology

Pub Date : 2026-06-01 Epub Date: 2026-01-06 DOI: 10.1016/j.gloepi.2026.100243

Abdul Muyeed , Ratul Rahman , Sumaiya Islam Suchi , Kawsar Ahmed , Tahmina Akter Tithi

Background

Poor sleep quality and psychological distress are common in medical students worldwide. Understanding the relationship between sleep quality and psychological distress is crucial for enhancing student well-being and academic achievement. This study aimed to assess the prevalence and influencing factors of poor sleep quality and psychological distress among Bangladeshi medical students, and to explore sex and institutional differences.

Methods

A cross-sectional study was conducted among 378 medical students using a structured questionnaire. Data were collected using the Depression, Anxiety, and Stress Scale (DASS-21) and the Pittsburgh Sleep Quality Index (PSQI). Statistical analyses including confirmatory factor analysis (CFA), independent samples t-tests, and a bivariate test of association were conducted.

Results

The prevalence rates of poor sleep quality (67.2 %), depression (55.8 %), anxiety (58.7 %), and stress (38.6 %) were significantly high among medical students in Bangladesh. The CFA test recommended a three-factor model for DASS-21 and a two-factor model for PSQI. A moderately positive association was found between sleep quality and depression, anxiety, and stress. Independent samples t-tests showed that male students reported lower PSQI and DASS-21 scores. Additionally, depression (AOR = 2.61, 95 % CI: 1.37–4.99) and stress (AOR = 2.77, 95 % CI: 1.25–6.14) were found as the most significant predictors of sleep quality.

Conclusions

Psychological distress, excessive time spent on social media, and online games negatively influence sleep quality, while being a male, smoking, and having career-building opportunities positively influence sleep quality. Interventions aimed at reducing stress and promoting healthy sleep practices are urgently needed within medical institutions.

睡眠质量差和心理困扰在全世界医科学生中很常见。了解睡眠质量和心理困扰之间的关系对于提高学生的幸福感和学业成绩至关重要。本研究旨在评估孟加拉医学生睡眠质量差和心理困扰的患病率及其影响因素，并探讨性别和制度差异。方法采用结构化问卷对378名医学生进行横断面调查。使用抑郁、焦虑和压力量表（DASS-21）和匹兹堡睡眠质量指数（PSQI）收集数据。统计分析包括验证性因子分析（CFA）、独立样本t检验和双变量关联检验。结果孟加拉国医学生睡眠质量差（67.2%）、抑郁（55.8%）、焦虑（58.7%）、压力（38.6%）的患病率较高。CFA测试推荐DASS-21采用三因素模型，PSQI采用双因素模型。睡眠质量与抑郁、焦虑和压力之间存在适度正相关。独立样本t检验显示，男生PSQI和DASS-21得分较低。此外，抑郁（AOR = 2.61, 95% CI: 1.37-4.99）和压力（AOR = 2.77, 95% CI: 1.25-6.14）被发现是睡眠质量最显著的预测因子。结论心理困扰、过度使用社交媒体和网络游戏对睡眠质量有负向影响，而男性、吸烟和有职业发展机会对睡眠质量有正向影响。医疗机构迫切需要旨在减轻压力和促进健康睡眠习惯的干预措施。

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引用次数: 0

Unveiling hidden heterogeneity and inequalities in the continuum of care for reproductive, maternal, and child health services in sub-Saharan Africa: A multilevel latent class analysis approach 揭示撒哈拉以南非洲生殖、孕产妇和儿童健康服务连续护理中隐藏的异质性和不平等：一种多层次潜在类别分析方法

Global Epidemiology

Pub Date : 2026-06-01 Epub Date: 2025-12-11 DOI: 10.1016/j.gloepi.2025.100237

Abebew Aklog Asmare , Awoke Seyoum Tegegne , Denekew Bitew Belay

Improving reproductive, maternal, newborn, and child health (RMNCH) services is vital for achieving the Sustainable Development Goals (SDGs) for maternal and child survival. This study utilized multilevel latent class analysis (MLCA) on Demographic and Health Surveys (DHS) data from 29 sub-Saharan African (sSA) countries to identify RMNCH service utilization patterns, examine covariate effects, and assess coverage inequalities. Secondary data from the most recent DHS conducted in 29 sSA countries from 2015 to 2024 were used. MLCA was performed on 12 RMNCH service indicators to account for the hierarchical structure of the data. Summary inequality indicators were used to assess differences in posterior class membership for lower-level classes across wealth quintiles, maternal education, maternal occupation, and place of residence. Women's RMNCH service utilization was divided into two categories: optimal and suboptimal users, and two higher-level categories: high and low coverage. Higher maternal education, household wealth, media access, and early antenatal care were related to a higher likelihood of being in the optimal utilizer class. In contrast, rural location and a longer distance to health services were associated with a lower likelihood. Inequality indices revealed significant differences among optimal utilizers, particularly in terms of mother education and household wealth. Targeted interventions are urgently required to promote RMNCH service utilization in sSA by addressing persistent socioeconomic disparities, particularly among women with no education, lower incomes, and low access to health care.

改善生殖、孕产妇、新生儿和儿童健康服务对于实现关于孕产妇和儿童生存的可持续发展目标至关重要。本研究利用来自29个撒哈拉以南非洲（sSA）国家的人口与健康调查（DHS）数据的多水平潜在类分析（MLCA）来确定RMNCH服务利用模式，检查协变量效应，并评估覆盖不平等。使用了2015年至2024年在29个sSA国家进行的最新DHS的次要数据。为了解释数据的层次结构，对12个RMNCH服务指标进行了MLCA。摘要不平等指标用于评估不同财富五分位数、母亲教育、母亲职业和居住地的下层阶级后验阶级成员的差异。将妇女RMNCH服务利用率分为最优用户和次优用户两类，以及高覆盖率和低覆盖率两个更高层次的类别。较高的母亲教育、家庭财富、媒体访问和早期产前保健与进入最佳利用阶层的可能性较高有关。相比之下，农村地区和较远的医疗服务与较低的可能性相关。不平等指数揭示了最佳利用者之间的显著差异，特别是在母亲教育和家庭财富方面。迫切需要有针对性的干预措施，通过解决持续存在的社会经济差距，特别是未受教育、收入较低和获得医疗保健机会较少的妇女之间的差距，促进社会保障区内妇幼保健服务的利用。

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引用次数: 0