Pub Date : 2025-11-08DOI: 10.1016/j.gloepi.2025.100230
Md. Siddikur Rahman, Md. Abu Bokkor Shiddik
Explainable artificial intelligence for predicting dengue outbreaks in Bangladesh using eco-climatic triggers,” presents an advance method on artificial intelligence (AI) in the integration of data science and epidemiology combining with machine learning (ML) techniques. We reflect here on XAI's vast implication in public health research. Its potential to inform climate sensitive diseases prediction in low level income settings. Dengue is one of the fastest growing public health challenge in densely populated and climate-sensitive regions like Bangladesh. We developed a novel framework on this study that combines predictive accuracy with interpretability and expandability against this fast growing health problem through XAI. It enables the actionable insights for early warning systems (EWS) and disease prevention.
{"title":"Reflections on explainable artificial intelligence for predicting dengue outbreaks in Bangladesh","authors":"Md. Siddikur Rahman, Md. Abu Bokkor Shiddik","doi":"10.1016/j.gloepi.2025.100230","DOIUrl":"10.1016/j.gloepi.2025.100230","url":null,"abstract":"<div><div>Explainable artificial intelligence for predicting dengue outbreaks in Bangladesh using eco-climatic triggers,” presents an advance method on artificial intelligence (AI) in the integration of data science and epidemiology combining with machine learning (ML) techniques. We reflect here on XAI's vast implication in public health research. Its potential to inform climate sensitive diseases prediction in low level income settings. Dengue is one of the fastest growing public health challenge in densely populated and climate-sensitive regions like Bangladesh. We developed a novel framework on this study that combines predictive accuracy with interpretability and expandability against this fast growing health problem through XAI. It enables the actionable insights for early warning systems (EWS) and disease prevention.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"10 ","pages":"Article 100230"},"PeriodicalIF":0.0,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-31DOI: 10.1016/j.gloepi.2025.100228
Gunnar Johansson , Jonas Reinold , Nelly L. Shapero , Tekla L. Rosell , Leif A. Jørgensen , Niklas Koenen , Christian Frøsig , Michael Falkenberg , Lene Holdrup , Kristian Juul
Objective
This real-life analysis quantifies the incidence rate of diagnosed hyponatraemia in patients treated with a desmopressin Orally Disintegrating Tablet 25–50 μg (ODT) versus patients treated for lower urinary tract symptoms (LUTS) across Sweden, Denmark, and Germany.
Material and methods
Claims data and register data from drug registries, hospital records, laboratories, and intensive care units were accessed from the three countries in this imposed Post-Authorisation Safety Study (PASS). The incidence rates of diagnosed hyponatraemia, mortality, major cardiovascular events (MACE), venous thromboembolism (VTE), and acute exacerbation of congestive heart failure (CHF) were calculated using Poisson regression. A sensitivity analysis and subgroup analyses of older adult patients and patients with contraindications were conducted. The clinicaltrial.gov number is NCT04740645.
Results
In total, 1,099,545 patients were included in Sweden, Denmark, and Germany. Of these 6745 (0.61 %) were ODT-treated patients, and 1,092,800 (99.39 %) were LUTS-treated patients. The incidence rate of diagnosed hyponatraemia, based on ICD-10 codes, was in the range of 9.04–24.15/1000 patient-years in the ODT cohort and 1.39–4.45/1000 patient-years in the LUTS cohort. Laboratory measured clinically significant hyponatraemia had incidence rates of 139.9 and 33.0/1000 patient-years in the ODT and LUTS cohorts, respectively. The incidence rates of mortality, MACE, and VTE were comparable between groups, with variations in subgroups of patients. Due to different baseline characteristics between the countries, a planned meta-analysis could not be performed.
Conclusion
Results from this real-life study does not indicate any added safety concerns related to use of ODT, since increased rate of hyponatraemia is already in the SmPC.
{"title":"Real-life safety assessment of orally disintegrating desmopressin tablet: Incidence of diagnosed hyponatraemia and other events across three European countries","authors":"Gunnar Johansson , Jonas Reinold , Nelly L. Shapero , Tekla L. Rosell , Leif A. Jørgensen , Niklas Koenen , Christian Frøsig , Michael Falkenberg , Lene Holdrup , Kristian Juul","doi":"10.1016/j.gloepi.2025.100228","DOIUrl":"10.1016/j.gloepi.2025.100228","url":null,"abstract":"<div><h3>Objective</h3><div>This real-life analysis quantifies the incidence rate of diagnosed hyponatraemia in patients treated with a desmopressin Orally Disintegrating Tablet 25–50 μg (ODT) versus patients treated for lower urinary tract symptoms (LUTS) across Sweden, Denmark, and Germany.</div></div><div><h3>Material and methods</h3><div>Claims data and register data from drug registries, hospital records, laboratories, and intensive care units were accessed from the three countries in this imposed Post-Authorisation Safety Study (PASS). The incidence rates of diagnosed hyponatraemia, mortality, major cardiovascular events (MACE), venous thromboembolism (VTE), and acute exacerbation of congestive heart failure (CHF) were calculated using Poisson regression. A sensitivity analysis and subgroup analyses of older adult patients and patients with contraindications were conducted. The <span><span>clinicaltrial.gov</span><svg><path></path></svg></span> number is <span><span>NCT04740645</span><svg><path></path></svg></span>.</div></div><div><h3>Results</h3><div>In total, 1,099,545 patients were included in Sweden, Denmark, and Germany. Of these 6745 (0.61 %) were ODT-treated patients, and 1,092,800 (99.39 %) were LUTS-treated patients. The incidence rate of diagnosed hyponatraemia, based on ICD-10 codes, was in the range of 9.04–24.15/1000 patient-years in the ODT cohort and 1.39–4.45/1000 patient-years in the LUTS cohort. Laboratory measured clinically significant hyponatraemia had incidence rates of 139.9 and 33.0/1000 patient-years in the ODT and LUTS cohorts, respectively. The incidence rates of mortality, MACE, and VTE were comparable between groups, with variations in subgroups of patients. Due to different baseline characteristics between the countries, a planned meta-analysis could not be performed.</div></div><div><h3>Conclusion</h3><div>Results from this real-life study does not indicate any added safety concerns related to use of ODT, since increased rate of hyponatraemia is already in the SmPC.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"10 ","pages":"Article 100228"},"PeriodicalIF":0.0,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-20DOI: 10.1016/j.gloepi.2025.100227
Hajar Golbabaei Pasandi , Ahmad Khosravi , Mohammad Hassan Emamian , Seyed Abbas Mousavi , Hassan Hashemi , Akbar Fotouhi
Background
Dichotomizing a continuous outcome, sleep quality score, is associated with loss of information, and bias. Here we compared the performance of dichotomizing sleep quality scores according to cut-point as outcome variable in multivariable logistic regression with using that as continuous outcome in an adjusted distributional method.
Methods
In this study, the data from the second phase of the Shahroud eye cohort study (ShECS) on 4710 adults were used. Sleep quality score using Pittsburg index was normalized using item response theory (IRT) method. Sleep quality score was used as a dichotomized variable in a logistic regression model and as a continuous variable in an adjusted distributional method.
Results
The overall prevalence of poor sleep quality was 44.9 % (95 %CI, 43.4–46.2). In the adjusted distributional model poor sleep quality was associated with female gender (OR = 2.08; 95 %CI: 1.9–2.2), old age (OR = 1.2; 95 %CI: 1.0–1.4), low economic status (OR = 1.3; 95 % CI: 1.1–1.4), Illiteracy (OR = 1.4; 95 %CI: 1.2–1.7), diabetes (OR = 1.1; 95 %CI: 1.0–1.2), hypertension (OR = 1.2; 95 %CI: 1.0–1.3) and tobacco smoking (OR = 1.2; 95 %CI: 1.1–1.4). There was no difference between the size and direction of the observed association between two competing models. The confidence interval of the ORs and the marginal differences in proportions of poor sleep quality for the diabetic and non-diabetic people using the distributional method was more precise (narrower confidence interval) than logistic regression.
Conclusion
Using the adjusted distributional method based on linear regression instead of dichotomizing the continuous outcome in logistic regression leads to narrower and more precise CIs for ORs but size and direction of associations between two models are identical. Comparison between two models showed that statistical performance of two models is equals. In addition to increasing age, women have higher odds of poor sleep quality than men. Some other modifiable predictors such as smoking, diabetes, and hypertension can be investigated to improve sleep quality.
{"title":"Factors related to sleep quality in the adult population of Shahroud; Comparison of adjusted distributional and multivariable logistic regression analysis","authors":"Hajar Golbabaei Pasandi , Ahmad Khosravi , Mohammad Hassan Emamian , Seyed Abbas Mousavi , Hassan Hashemi , Akbar Fotouhi","doi":"10.1016/j.gloepi.2025.100227","DOIUrl":"10.1016/j.gloepi.2025.100227","url":null,"abstract":"<div><h3>Background</h3><div>Dichotomizing a continuous outcome, sleep quality score, is associated with loss of information, and bias. Here we compared the performance of dichotomizing sleep quality scores according to cut-point as outcome variable in multivariable logistic regression with using that as continuous outcome in an adjusted distributional method.</div></div><div><h3>Methods</h3><div>In this study, the data from the second phase of the Shahroud eye cohort study (ShECS) on 4710 adults were used. Sleep quality score using Pittsburg index was normalized using item response theory (IRT) method. Sleep quality score was used as a dichotomized variable in a logistic regression model and as a continuous variable in an adjusted distributional method.</div></div><div><h3>Results</h3><div>The overall prevalence of poor sleep quality was 44.9 % (95 %CI, 43.4–46.2). In the adjusted distributional model poor sleep quality was associated with female gender (OR = 2.08; 95 %CI: 1.9–2.2), old age (OR = 1.2; 95 %CI: 1.0–1.4), low economic status (OR = 1.3; 95 % CI: 1.1–1.4), Illiteracy (OR = 1.4; 95 %CI: 1.2–1.7), diabetes (OR = 1.1; 95 %CI: 1.0–1.2), hypertension (OR = 1.2; 95 %CI: 1.0–1.3) and tobacco smoking (OR = 1.2; 95 %CI: 1.1–1.4). There was no difference between the size and direction of the observed association between two competing models. The confidence interval of the ORs and the marginal differences in proportions of poor sleep quality for the diabetic and non-diabetic people using the distributional method was more precise (narrower confidence interval) than logistic regression.</div></div><div><h3>Conclusion</h3><div>Using the adjusted distributional method based on linear regression instead of dichotomizing the continuous outcome in logistic regression leads to narrower and more precise CIs for ORs but size and direction of associations between two models are identical. Comparison between two models showed that statistical performance of two models is equals. In addition to increasing age, women have higher odds of poor sleep quality than men. Some other modifiable predictors such as smoking, diabetes, and hypertension can be investigated to improve sleep quality.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"10 ","pages":"Article 100227"},"PeriodicalIF":0.0,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145362178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-13DOI: 10.1016/j.gloepi.2025.100226
Kavitha A.K. , Jaya Singh Kshatri , Marjan van den Akker , Mohammad Akhtar Hussain , Haimanti Bhattacharya , Sanghamitra Pati
Purpose
Indigenous populations in India face a growing burden of multimorbidity, yet data on its prevalence and patterns remain scarce. This study estimated the prevalence, determinants, and co-occurrence of multimorbidity among Indigenous adults using data from the Odisha Tribal Family Health Survey (OTFHS).
Methods
The analysis included 19,430 adults (≥18 years) from 9711 households across 14 districts, representing 53 Indigenous groups, including 13 Particularly Vulnerable Tribal Groups (PVTGs). Multimorbidity—defined as having ≥2 chronic conditions—was assessed through self-reports and laboratory results. Prevalence estimates used descriptive statistics; associated factors were identified via ordinal logistic regression, and co-occurrence patterns of chronic conditions were visualized using a matrix-based plot that displays the frequency and overlap of conditions (UpSet plot).
Results
The weighted prevalence of multimorbidity was 21.7 % (95 % CI: 20.5 %, 22.9 %), increasing from 3.8 % in those aged 18–25 to 48.2 % in those 60 and older. Regression analysis showed that older age, male sex, and tobacco and alcohol use were significantly associated with higher odds of multimorbidity. Hypertension was the most prevalent condition, often co-occurring with kidney disease, liver disease, or back pain.
Conclusion
These findings highlight the urgent need for age- and sex-sensitive, integrated health interventions tailored to Indigenous communities.
{"title":"Epidemiology of multimorbidity among indigenous adults: Insights from a large-scale population survey of 53 different indigenous groups in East India","authors":"Kavitha A.K. , Jaya Singh Kshatri , Marjan van den Akker , Mohammad Akhtar Hussain , Haimanti Bhattacharya , Sanghamitra Pati","doi":"10.1016/j.gloepi.2025.100226","DOIUrl":"10.1016/j.gloepi.2025.100226","url":null,"abstract":"<div><h3>Purpose</h3><div>Indigenous populations in India face a growing burden of multimorbidity, yet data on its prevalence and patterns remain scarce. This study estimated the prevalence, determinants, and co-occurrence of multimorbidity among Indigenous adults using data from the Odisha Tribal Family Health Survey (OTFHS).</div></div><div><h3>Methods</h3><div>The analysis included 19,430 adults (≥18 years) from 9711 households across 14 districts, representing 53 Indigenous groups, including 13 Particularly Vulnerable Tribal Groups (PVTGs). Multimorbidity—defined as having ≥2 chronic conditions—was assessed through self-reports and laboratory results. Prevalence estimates used descriptive statistics; associated factors were identified via ordinal logistic regression, and co-occurrence patterns of chronic conditions were visualized using a matrix-based plot that displays the frequency and overlap of conditions (UpSet plot).</div></div><div><h3>Results</h3><div>The weighted prevalence of multimorbidity was 21.7 % (95 % CI: 20.5 %, 22.9 %), increasing from 3.8 % in those aged 18–25 to 48.2 % in those 60 and older. Regression analysis showed that older age, male sex, and tobacco and alcohol use were significantly associated with higher odds of multimorbidity. Hypertension was the most prevalent condition, often co-occurring with kidney disease, liver disease, or back pain.</div></div><div><h3>Conclusion</h3><div>These findings highlight the urgent need for age- and sex-sensitive, integrated health interventions tailored to Indigenous communities.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"10 ","pages":"Article 100226"},"PeriodicalIF":0.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145320220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-06DOI: 10.1016/j.gloepi.2025.100222
Bilesha Perera , Ravindra P. Rannan-Eliya , Nilmini Wijemunige , Sarath Samarage , H.M.M. Herath , Wasantha Jayawardene , Mohammad R. Torabi
Background
Reliable epidemiological evidence of alcohol use in Sri Lanka is limited. This study addressed this gap using nationally representative data.
Methods
Data from a 2018/2019 national study of non-institutionalized adults in Sri Lanka were used. Weighted data were analysed using descriptive and logistic regression techniques.
Results
Among 6473 adults (mean age 43.9 (SD = 16.7); 52.5 % women) surveyed, 53.1 % (95 %CI; 51.9 %, 54.3 %) of men and 2.0 % (95 % CI; 1.9 %, 2.1 %) of women were current (yearly) alcohol users. Per capita consumption of alcohol was 3.12 l for men and 0.028 l for women. Predictors of alcohol use in men included being aged 30–39 years, Sinhalese ethnicity, secondary education, currently married, and being in the middle wealth quintile and in women, being aged 30–39 years, Indian Tamil ethnicity, tertiary education, being a widow or separated, and being in the highest wealth quintile were the significant predictors of current alcohol use. Hazardous drinking (≥21 units per week) was observed only in men: 14.1 %. In men, smoking, elevated blood pressure and low self-rated health were related to higher likelihood of alcohol use. Alcohol use showed protective effects on type 2 diabetes and depression in men.
Conclusions
Prevalence, distribution and associated factors of alcohol use vary by demographic and health characteristics of Sri Lankan adults. Preventive strategies should be based on population risk stratification of alcohol use.
{"title":"Epidemiology of alcohol use in Sri Lanka: Findings of the SLHAS national survey","authors":"Bilesha Perera , Ravindra P. Rannan-Eliya , Nilmini Wijemunige , Sarath Samarage , H.M.M. Herath , Wasantha Jayawardene , Mohammad R. Torabi","doi":"10.1016/j.gloepi.2025.100222","DOIUrl":"10.1016/j.gloepi.2025.100222","url":null,"abstract":"<div><h3>Background</h3><div>Reliable epidemiological evidence of alcohol use in Sri Lanka is limited. This study addressed this gap using nationally representative data.</div></div><div><h3>Methods</h3><div>Data from a 2018/2019 national study of non-institutionalized adults in Sri Lanka were used. Weighted data were analysed using descriptive and logistic regression techniques.</div></div><div><h3>Results</h3><div>Among 6473 adults (mean age 43.9 (<em>SD</em> = 16.7); 52.5 % women) surveyed, 53.1 % (95 %CI; 51.9 %, 54.3 %) of men and 2.0 % (95 % CI; 1.9 %, 2.1 %) of women were current (yearly) alcohol users. Per capita consumption of alcohol was 3.12 l for men and 0.028 l for women. Predictors of alcohol use in men included being aged 30–39 years, Sinhalese ethnicity, secondary education, currently married, and being in the middle wealth quintile and in women, being aged 30–39 years, Indian Tamil ethnicity, tertiary education, being a widow or separated, and being in the highest wealth quintile were the significant predictors of current alcohol use. Hazardous drinking (≥21 units per week) was observed only in men: 14.1 %. In men, smoking, elevated blood pressure and low self-rated health were related to higher likelihood of alcohol use. Alcohol use showed protective effects on type 2 diabetes and depression in men.</div></div><div><h3>Conclusions</h3><div>Prevalence, distribution and associated factors of alcohol use vary by demographic and health characteristics of Sri Lankan adults. Preventive strategies should be based on population risk stratification of alcohol use.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"10 ","pages":"Article 100222"},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145320219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stroke is a significant clinical condition characterized by inadequate blood flow to the brain, resulting in cerebral function loss and potential death if not promptly treated. In developed countries, stroke incidence is decreasing due to efforts targeting risk factors like high blood pressure and smoking, though aging populations sustain high overall rates. Globally, stroke ranks among the top causes of death and disability, with Africa experiencing notably high stroke-related mortality rates. Understanding these trends and predictors is crucial for shaping effective healthcare strategies and interventions to reduce stroke mortality across the continent. Therefore, this umbrella review aimed to assess the pooled prevalence of stroke mortality and its associated predictors in Africa.
Method
This umbrella review systematically synthesized findings from systematic reviews and meta-analyses on stroke mortality rates in Africa, following established methodology. Various databases, including PubMed, Embase, Scopus, and others, were searched up to June 2024 for English-language studies reporting stroke mortality prevalence and determinants. Data were extracted using standardized methods in Excel, and study quality was assessed using the AMSTAR tool. Heterogeneity was measured using Higgin's I2 Statistics, and summary prevalence estimates were calculated with the Der Simonian-Laird random-effects model. Publication bias was assessed by visually inspecting funnel plots and conducting Egger's regression tests.
Result
In this umbrella review, data from nine systematic review and meta-analysis studies encompassed 341 primary studies with a total sample size of 170,501 stroke patients admitted to hospitals in Africa. The overall pooled prevalence of stroke mortality in Africa was 20.3 % (95 % CI: 17.3–23.2). Western Africa exhibited the highest prevalence at 27 % (95 % CI: 14.4–39.6), and hemorrhagic stroke patients had a notably higher mortality rate of 26.1 % (95 % CI: 24–28.3).
Conclusion
This study reveals significant variations in stroke mortality across Africa, with the highest prevalence reported in Western Africa and among hemorrhagic stroke patients. Factors associated with increased stroke mortality include severe neurological impairment (Glasgow Coma Scale <8), aspiration pneumonia, older age, vascular disease, female gender, lack of aspirin treatment, reduced renal function, and diabetes.
{"title":"Mortality rate of stroke and its determinants in Africa: An umbrella review of systematic review and meta-analysis","authors":"Addisu Getie , Mihretie Gedfew , Tegene Atamenta Kitaw , Gizachew Yilak , Melaku Bimerew","doi":"10.1016/j.gloepi.2025.100225","DOIUrl":"10.1016/j.gloepi.2025.100225","url":null,"abstract":"<div><h3>Introduction</h3><div>Stroke is a significant clinical condition characterized by inadequate blood flow to the brain, resulting in cerebral function loss and potential death if not promptly treated. In developed countries, stroke incidence is decreasing due to efforts targeting risk factors like high blood pressure and smoking, though aging populations sustain high overall rates. Globally, stroke ranks among the top causes of death and disability, with Africa experiencing notably high stroke-related mortality rates. Understanding these trends and predictors is crucial for shaping effective healthcare strategies and interventions to reduce stroke mortality across the continent. Therefore, this umbrella review aimed to assess the pooled prevalence of stroke mortality and its associated predictors in Africa.</div></div><div><h3>Method</h3><div>This umbrella review systematically synthesized findings from systematic reviews and meta-analyses on stroke mortality rates in Africa, following established methodology. Various databases, including PubMed, Embase, Scopus, and others, were searched up to June 2024 for English-language studies reporting stroke mortality prevalence and determinants. Data were extracted using standardized methods in Excel, and study quality was assessed using the AMSTAR tool. Heterogeneity was measured using Higgin's I<sup>2</sup> Statistics, and summary prevalence estimates were calculated with the Der Simonian-Laird random-effects model. Publication bias was assessed by visually inspecting funnel plots and conducting Egger's regression tests.</div></div><div><h3>Result</h3><div>In this umbrella review, data from nine systematic review and meta-analysis studies encompassed 341 primary studies with a total sample size of 170,501 stroke patients admitted to hospitals in Africa. The overall pooled prevalence of stroke mortality in Africa was 20.3 % (95 % CI: 17.3–23.2). Western Africa exhibited the highest prevalence at 27 % (95 % CI: 14.4–39.6), and hemorrhagic stroke patients had a notably higher mortality rate of 26.1 % (95 % CI: 24–28.3).</div></div><div><h3>Conclusion</h3><div>This study reveals significant variations in stroke mortality across Africa, with the highest prevalence reported in Western Africa and among hemorrhagic stroke patients. Factors associated with increased stroke mortality include severe neurological impairment (Glasgow Coma Scale <8), aspiration pneumonia, older age, vascular disease, female gender, lack of aspirin treatment, reduced renal function, and diabetes.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"10 ","pages":"Article 100225"},"PeriodicalIF":0.0,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-30DOI: 10.1016/j.gloepi.2025.100223
Syed Toukir Ahmed Noor , Sazid Siddique , Oishi Das , Samin Yeasar , Raisha Binte Islam
Background
Mental health conditions, particularly symptoms of anxiety and depression among women of reproductive age, constitute a substantial public health burden. However, comprehensive studies on these issues are scarce in Mozambique.
Objective
This study aims to investigate the prevalence and factors associated with depression and anxiety symptoms among Mozambican women of reproductive age using nationally representative data.
Methods and materials
We analyzed data from the 2022–23 Mozambique Demographic and Health Survey, including a sample of 13,183 women aged 15–49. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) scale. Multivariable logistic regression analysis was used to identify associated factors, and a concentration curve was employed to assess wealth-related inequality of mental health conditions.
Results
Depression symptoms were reported by 10 % (95 % CI: 9.5–10.7) of women, while 11 % (95 % CI: 10.5–11.7) reported anxiety symptoms. Older age, skilled professions, and pregnancy were associated with higher odds of depression and anxiety symptoms. Conversely, women from wealthier households who engaged in agricultural work and had greater household decision-making power showed lower odds. Geographically, women in Nampula province had significantly higher odds, whereas those in Gaza province had lower odds. Also, significant wealth-related inequality was observed, with lower socioeconomic groups having higher mental health conditions.
Conclusion
These findings highlight the urgent need for targeted interventions addressing socioeconomic and geographic disparities in mental health among Mozambican women. Efforts should focus on improving access to mental health services and integrating mental health care into broader public health strategies.
{"title":"Exploring mental health disparities in Mozambique: Depression and anxiety symptoms among reproductive-aged women using data from Mozambique Demographic and Health Survey 2022–23","authors":"Syed Toukir Ahmed Noor , Sazid Siddique , Oishi Das , Samin Yeasar , Raisha Binte Islam","doi":"10.1016/j.gloepi.2025.100223","DOIUrl":"10.1016/j.gloepi.2025.100223","url":null,"abstract":"<div><h3>Background</h3><div>Mental health conditions, particularly symptoms of anxiety and depression among women of reproductive age, constitute a substantial public health burden. However, comprehensive studies on these issues are scarce in Mozambique.</div></div><div><h3>Objective</h3><div>This study aims to investigate the prevalence and factors associated with depression and anxiety symptoms among Mozambican women of reproductive age using nationally representative data.</div></div><div><h3>Methods and materials</h3><div>We analyzed data from the 2022–23 Mozambique Demographic and Health Survey, including a sample of 13,183 women aged 15–49. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) scale. Multivariable logistic regression analysis was used to identify associated factors, and a concentration curve was employed to assess wealth-related inequality of mental health conditions.</div></div><div><h3>Results</h3><div>Depression symptoms were reported by 10 % (95 % CI: 9.5–10.7) of women, while 11 % (95 % CI: 10.5–11.7) reported anxiety symptoms. Older age, skilled professions, and pregnancy were associated with higher odds of depression and anxiety symptoms. Conversely, women from wealthier households who engaged in agricultural work and had greater household decision-making power showed lower odds. Geographically, women in Nampula province had significantly higher odds, whereas those in Gaza province had lower odds. Also, significant wealth-related inequality was observed, with lower socioeconomic groups having higher mental health conditions.</div></div><div><h3>Conclusion</h3><div>These findings highlight the urgent need for targeted interventions addressing socioeconomic and geographic disparities in mental health among Mozambican women. Efforts should focus on improving access to mental health services and integrating mental health care into broader public health strategies.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"10 ","pages":"Article 100223"},"PeriodicalIF":0.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145264456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although promising effort has been made so far, HIV remains a public health concern. Women in Ethiopia are disproportionately affected by HIV, accounting for a majority of new infections and HIV -related deaths. However, the geospatial distribution of HIV among women in Ethiopia is not well understood, making it challenging to develop geographically targeted measures. Besides, to accelerate the pathway of decreasing HIV prevalence and plan geographically specific interventions, understanding the geospatial distribution of HIV seropositivity among women plays a crucial role.
Methods
A spatial analysis was conducted among 14,778 weighted samples of women in the reproductive age group. Global Moran's I was computed to determine whether HIV seropositivity is randomly distributed, clustered, or dispersed. Getis-Ord Gi* spatial statistic was done to identify spatial clusters of cold and hot spot areas.
Results
HIV seropositivity among women in Ethiopia is distributed non-randomly (Global Moran's I = 0.16). The distribution of HIV ranges from 0.02 % to 6.16 %. A hotspot clustering of HIV seropositivity was identified in Addis Ababa, Harari, Dire Dawa, and Gambela region. Women residing in the primary cluster, encompassing Addis Ababa, Harari, and Dire Dawa, exhibited a substantially increased risk of HIV infection compared to the reverse group (LLR = 32.88, 95CI:26.33–39.36).
Conclusion
HIV seropositivity among women in Ethiopia is unevenly distributed, with clear spatial clustering. The highest concentration of cases was identified in Addis Ababa, Harari, Dire Dawa, and Gambela, with significantly elevated risk observed in the primary cluster regions. These findings underscore the importance of geographically targeted interventions to address the concentrated burden of HIV in high-risk regions.
{"title":"Mapping the spatial distribution and characteristics of HIV seropositivity among women in Ethiopia. A spatial analysis","authors":"Tegene Atamenta kitaw , Amanuel Tadesse Koyas , Bruktawite Afework Tekle , Ribka Nigatu Haile","doi":"10.1016/j.gloepi.2025.100224","DOIUrl":"10.1016/j.gloepi.2025.100224","url":null,"abstract":"<div><h3>Background</h3><div>Although promising effort has been made so far, HIV remains a public health concern. Women in Ethiopia are disproportionately affected by HIV, accounting for a majority of new infections and HIV -related deaths. However, the geospatial distribution of HIV among women in Ethiopia is not well understood, making it challenging to develop geographically targeted measures. Besides, to accelerate the pathway of decreasing HIV prevalence and plan geographically specific interventions, understanding the geospatial distribution of HIV seropositivity among women plays a crucial role.</div></div><div><h3>Methods</h3><div>A spatial analysis was conducted among 14,778 weighted samples of women in the reproductive age group. Global Moran's I was computed to determine whether HIV seropositivity is randomly distributed, clustered, or dispersed. Getis-Ord Gi* spatial statistic was done to identify spatial clusters of cold and hot spot areas.</div></div><div><h3>Results</h3><div>HIV seropositivity among women in Ethiopia is distributed non-randomly (Global Moran's <em>I</em> = 0.16). The distribution of HIV ranges from 0.02 % to 6.16 %. A hotspot clustering of HIV seropositivity was identified in Addis Ababa, Harari, Dire Dawa, and Gambela region. Women residing in the primary cluster, encompassing Addis Ababa, Harari, and Dire Dawa, exhibited a substantially increased risk of HIV infection compared to the reverse group (LLR = 32.88, 95CI:26.33–39.36).</div></div><div><h3>Conclusion</h3><div>HIV seropositivity among women in Ethiopia is unevenly distributed, with clear spatial clustering. The highest concentration of cases was identified in Addis Ababa, Harari, Dire Dawa, and Gambela, with significantly elevated risk observed in the primary cluster regions. These findings underscore the importance of geographically targeted interventions to address the concentrated burden of HIV in high-risk regions.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"10 ","pages":"Article 100224"},"PeriodicalIF":0.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite national efforts, maternal mortality remains a major public health challenge in Ethiopia. Identifying context-specific causes and delays in receiving appropriate and timely healthcare is essential to guide targeted interventions. This study analysed maternal mortality in Addis Ababa over a 5-year period to identify the causes and contributing factors.
Methods
A retrospective analysis was conducted using maternal death surveillance data collected from 2017 and 2021 in Addis Ababa. The data were extracted from health facility-based maternal death case-based reports and the verbal autopsy tool utilized for community-based maternal death investigations. The data are part of the national surveillance system owned by the Public Health Emergency Management Center of the Ethiopian Public Health Institute. Information included in the dataset included socio-demographic characteristics, the underlying causes of death, the timing of death, and type of delays in receiving healthcare.
Results
A total of 309 maternal deaths were recorded in Addis Ababa. The maternal mortality ratio was 74 maternal deaths per 100,000 live births. The majority of deaths (86.4 %) occurred after delivery. Direct obstetric causes were responsible for 94.2 % of deaths, with obstetric haemorrhage identified as the leading cause (41.1 %). Other direct causes included hypertensive disorders (23.0 %) and puerperal sepsis (12.6 %). An additional 5.8 % of deaths were resulting from indirect causes. Among the deaths resulting from direct obstetric causes, 62.2 % were due to delays in receiving appropriate and timely care after reaching health facilities. Common reasons for the delays in receiving care were delayed facility referrals (46.0 %), case management challenges (43.1 %), and lack of supplies and equipment (28.7 %). Furthermore, 37.5 % of deaths were resulting from delays in deciding to seek health care, primarily contributed by a failure to recognize the problem. About a quarter of deaths (24.7 %), were contributed by delays in reaching health facility, predominantly due to delayed arrival at referral receiving health facilities.
Conclusion
Although the maternal mortality ratio in Addis Ababa is lower than the national rate, it is still above the WHO target. Almost all maternal deaths were results of the direct obstetric causes. Delays in receiving appropriate and timely care remain the leading contributing factor to maternal deaths. Strengthening emergency referral systems, enhancing facility-based management capacity through health worker training, and increasing community awareness could address key gaps in reducing preventable maternal mortality. Enhanced surveillance can be used to monitor the impact of interventions over time.
{"title":"Maternal death surveillance in Addis Ababa, Ethiopia, 2017–2021: Causes and contributing factors","authors":"Sisay Tiroro Salato , Tolcha Kebebew , Zegaye Hailemariam Tessema , Habitamu Yimer , Sileshi Demelesh Sasie","doi":"10.1016/j.gloepi.2025.100219","DOIUrl":"10.1016/j.gloepi.2025.100219","url":null,"abstract":"<div><h3>Background</h3><div>Despite national efforts, maternal mortality remains a major public health challenge in Ethiopia. Identifying context-specific causes and delays in receiving appropriate and timely healthcare is essential to guide targeted interventions. This study analysed maternal mortality in Addis Ababa over a 5-year period to identify the causes and contributing factors.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted using maternal death surveillance data collected from 2017 and 2021 in Addis Ababa. The data were extracted from health facility-based maternal death case-based reports and the verbal autopsy tool utilized for community-based maternal death investigations. The data are part of the national surveillance system owned by the Public Health Emergency Management Center of the Ethiopian Public Health Institute. Information included in the dataset included socio-demographic characteristics, the underlying causes of death, the timing of death, and type of delays in receiving healthcare.</div></div><div><h3>Results</h3><div>A total of 309 maternal deaths were recorded in Addis Ababa. The maternal mortality ratio was 74 maternal deaths per 100,000 live births. The majority of deaths (86.4 %) occurred after delivery. Direct obstetric causes were responsible for 94.2 % of deaths, with obstetric haemorrhage identified as the leading cause (41.1 %). Other direct causes included hypertensive disorders (23.0 %) and puerperal sepsis (12.6 %). An additional 5.8 % of deaths were resulting from indirect causes. Among the deaths resulting from direct obstetric causes, 62.2 % were due to delays in receiving appropriate and timely care after reaching health facilities. Common reasons for the delays in receiving care were delayed facility referrals (46.0 %), case management challenges (43.1 %), and lack of supplies and equipment (28.7 %). Furthermore, 37.5 % of deaths were resulting from delays in deciding to seek health care, primarily contributed by a failure to recognize the problem. About a quarter of deaths (24.7 %), were contributed by delays in reaching health facility, predominantly due to delayed arrival at referral receiving health facilities.</div></div><div><h3>Conclusion</h3><div>Although the maternal mortality ratio in Addis Ababa is lower than the national rate, it is still above the WHO target. Almost all maternal deaths were results of the direct obstetric causes. Delays in receiving appropriate and timely care remain the leading contributing factor to maternal deaths. Strengthening emergency referral systems, enhancing facility-based management capacity through health worker training, and increasing community awareness could address key gaps in reducing preventable maternal mortality. Enhanced surveillance can be used to monitor the impact of interventions over time.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"10 ","pages":"Article 100219"},"PeriodicalIF":0.0,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145264872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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