Clinical Epidemiology and Global Health最新文献

{"title":"Connotation of serum levels of vitamin D3 and LL-37 with urinary tract infection in type 2 diabetic patients","authors":"Zahraa A. Hashim","doi":"10.1016/j.cegh.2026.102299","DOIUrl":"10.1016/j.cegh.2026.102299","url":null,"abstract":"<div><h3>Problem considered</h3><div>Type 2 diabetes mellitus (T2DM) is characterized by inappropriacy of innate immunity leading to higher rates of urinary tract infection (UTI), an important risk factor for urinary tract complications. 25-hydroxy vitamin D may donate, via the production of the antimicrobial peptide cathelicidin (LL-37), to epithelial host defense against colonization of uro-pathogens. This study aimed to assess serum levels of vitamin D₃ and LL-37 in T2DM patients with and without UTI and to measure the association of these two parameters with metabolic profile and microbial distribution pattern.</div></div><div><h3>Methods</h3><div>Patients' characteristics were documented and included patients’ age, sex, duration of being diagnosed with T2DM, concurrent treatments, other diseases, body mass index, and smoking status. Blood sample was collected from each enrolled patient for metabolic profiling, serum vitamin D_3, and LL-37 measurement. Urine sample was collected for urinalysis and patients were grouped accordingly into with-UTI (group A) and without-UTI (group B) groups.</div></div><div><h3>Results</h3><div>One hundred and twelve T2DM patients (aged 51.1 ± 5.8 years) were enrolled; 50 patients with UTI and 62 without. Serum levels of vitamin D₃ were found to be significantly lower in patients with UTI (17.9 ± 4.8 ng/mL) than in patients without UTI (25.2 ± 5.7 ng/mL) (p &lt; 0.01). In accordance, LL-37 levels were significantly reduced in group A members (27.5 ± 6.9 ng/mL) when compared to group B members (35.5 ± 8.6 ng/mL) (p-value &lt;0.01). <em>E. coli</em> was the most common isolated uro-pathogen (40 %) followed by <em>P. aeruginosa</em> and <em>S. aureus</em> (14 % each), <em>Enterobacter</em> (10 %), <em>Klebsiella</em> spp (8 %) and <em>Proteus</em> spp (4 %). No significant difference in serum LL-37 levels was encountered between the three types of microbial isolates (p-value &lt;0.05). A strong positive correlation was reported between LL-37 and vitamin D₃ levels in patients without UTI (<em>r</em>_<em>s</em>: 0.9855, p-value: &lt;0.01). A weak, though non-significant, correlation was observed between LL-37 and vitamin D₃ in patients with UTI (<em>r</em>_<em>s</em>: 0.25283, p-value: &gt;0.05).</div></div><div><h3>Conclusion</h3><div>Findings suggest that diminished serum levels of vitamin D₃ and LL-37 could have clinical implications and could act as a potential immunological indicator for the tendency to develop UTI in diabetic patients.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102299"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079333","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}

{"title":"Biologic treatment outcomes in rheumatoid arthritis: Biomarker response and cost-effectiveness analysis in an Albanian cohort","authors":"Dorela Hasankolli ,&nbsp;Mirela Miraci ,&nbsp;Silvi Bozo ,&nbsp;Teuta Backa ,&nbsp;Marsida Mulaj ,&nbsp;Entela Haloci ,&nbsp;Fatjola Ferrollari","doi":"10.1016/j.cegh.2026.102301","DOIUrl":"10.1016/j.cegh.2026.102301","url":null,"abstract":"<div><h3>Background</h3><div>Rheumatoid arthritis (RA) is a chronic autoimmune disease causing progressive joint damage, disability, and high healthcare costs. Biologic DMARDs have improved outcomes, but responses vary. Identifying predictive biomarkers and evaluating cost-effectiveness are essential, particularly in resource-limited settings like Albania.</div></div><div><h3>Methods</h3><div>A retrospective cohort study at Mother Teresa University Hospital Center, Tirana, included 162 RA patients treated with bDMARDs (2021–2024). All met ACR/EULAR criteria and had biomarker data at baseline and six months. ESR, CRP, fibrinogen, RF, and anti-CCP were analyzed using paired t-tests (p &lt; 0.05). Cost-effectiveness analysis compared direct drug costs with biomarker improvement across adalimumab and tocilizumab using ICERs.</div></div><div><h3>Results</h3><div>Tocilizumab (46.8 %), adalimumab (37.1 %), and etanercept (16.1 %) were the main bDMARDs used. ESR, CRP, and fibrinogen significantly decreased (p &lt; 0.01). Six-month direct costs were 1136.20 USD for adalimumab, 2233.40 USD for etanercept, and 4069.00 USD for tocilizumab. Adalimumab demonstrated the best cost-effectiveness, with the lowest cost per unit biomarker reduction (ESR 87.40 USD/mm/h; CRP 59.80 USD/mg/L; fibrinogen 1456.66 USD/g/L). Tocilizumab achieved the greatest biomarker reductions but had the highest price (156.60 USD/unit) and incremental costs, with ICERs of 2932.80 USD vs. adalimumab, below Albania's 3 × GDP threshold (∼21,000 USD) for ESR and CRP, but near/exceeding it for fibrinogen.</div></div><div><h3>Conclusions</h3><div>Among available biologics, adalimumab shows the most favorable cost-effectiveness, while tocilizumab may be justified in non-responders to TNF inhibitors. Etanercept was considered economically dominated and was not included in the incremental cost-effectiveness analysis. Biomarker-guided assessment supports cost-effective and evidence-based management of RA in Albania.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102301"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038881","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}

{"title":"Seroprevalence of Toxoplasma gondii and associated factors among pregnant women consulted in Buhodle Healthcare Centers, Somalia","authors":"Mohamed Osman ,&nbsp;Abdullahi Adan ,&nbsp;Abdulahi Abdiwali Mahamed ,&nbsp;Md Al-Mamun ,&nbsp;Marufa Alam","doi":"10.1016/j.cegh.2026.102293","DOIUrl":"10.1016/j.cegh.2026.102293","url":null,"abstract":"<div><h3>Problem considered</h3><div>Toxoplasma gondii infection is a globally prevalent parasitic disease with serious health consequences, especially for pregnant women due to the risk of congenital transmission. Despite its importance, limited data exist on its prevalence in Somalia. This study aimed to determine the seroprevalence of T. gondii infection and identify associated risk factors among pregnant women attending healthcare centers in Buhodle District, Somalia.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted from March to May 2024 among 384 randomly selected pregnant women. Serum samples were analyzed using competitive ELISA (cELISA) to detect T. gondii antibodies. Data were processed using EpiData and SPSS. Descriptive statistics summarized participant characteristics, while bivariate and multivariate logistic regression analyses identified associations between potential risk factors and seropositivity. A p-value &lt;0.05 and a 95 % confidence interval were considered statistically significant.</div></div><div><h3>Results</h3><div>The overall seroprevalence of T. gondii was 36.4 % (140/384). Among these, 28.1 % (108/140) were positive for anti-T. gondii IgG antibodies, indicating prior exposure, while 8.3 % (32/140) were positive for IgM, reflecting recent infection. Multivariable logistic regression revealed significant associations between T. gondii seropositivity and lower educational attainment, as well as frequent contact with soil (p &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>The high prevalence of T. gondii infection among pregnant women in Buhodle District indicates a substantial public health concern. Targeted community awareness programs, enhanced antenatal screening, and further epidemiological and molecular studies are essential to reduce maternal and fetal health risks.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102293"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038989","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}

{"title":"Reasons for medication non-adherence among diabetes mellitus patients in Kelantan: A cross-sectional study","authors":"Thamron Keowmani ,&nbsp;Erwan Ershad Ahmad Khan ,&nbsp;Siti Farhain Amir ,&nbsp;Suzita Mukhtar ,&nbsp;Raja Nurul Fatin Raja Kamaruzaman ,&nbsp;Kok Han Lim ,&nbsp;Mohd Azri Mohd Khatib ,&nbsp;Nurul Ezzati Arifin ,&nbsp;Siti Nur Sarah Saharudin","doi":"10.1016/j.cegh.2026.102297","DOIUrl":"10.1016/j.cegh.2026.102297","url":null,"abstract":"<div><h3>Objectives</h3><div>The main objective of this study was to investigate self-reported reasons for medication non-adherence among type 2 diabetes mellitus (T2DM) patients in Kelantan.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted among a representative sample of the Kelantanese population of T2DM patients who refilled their medications at government health clinics between April 15th and May 31st, 2025 (<em>n</em> = 458). Medication adherence was measured using the Simplified Medication Adherence Scale (SMAQ). Reasons for medication non-adherence were obtained via a structured interview. Associations between baseline characteristics and low adherence were estimated using the chi-squared test.</div></div><div><h3>Results</h3><div>The survey response rate was 83.2 % (472/566). Three percent (14/472) of respondents were excluded from the analysis due to missing data. The top five reasons for non-adherence were ‘I forgot’ 92.3 % (385/417), ‘I was late for/missed the medication refill appointment at the pharmacy counter’ 31.2 % (130/417), ‘Nobody reminds me to take the medications’ 24.7 % (103/417), ‘There are too many medications to take’ 22.1 % (92/417) and ‘I feel healthy’ 21.6 % (90/417). The prevalence of low adherence was 18.8 % (86/417). Distance from home to clinic &gt;5 km (<em>p</em> = 0.045) and the need for assistance in medication taking (<em>p</em> = 0.035) were significantly associated with low adherence.</div></div><div><h3>Conclusions</h3><div>Our study identified several key reasons for medication non-adherence among patients with T2DM in Kelantan, including forgetfulness, missed refill appointments, lack of reminders, polypharmacy, and the perception of being healthy. Distance to the clinic and reliance on others for medication administration were significantly associated with low adherence. These findings highlight the need for patient-centred interventions that address both behavioural and structural barriers to adherence.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102297"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980500","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}

{"title":"Prevalence and determinants of time to first intimate partner violence incidents among ever-married Ethiopian women","authors":"Ashefet Agete Mengste ,&nbsp;Denekew Bitew Belay ,&nbsp;Haile Mekonnen Fenta ,&nbsp;Ding-Geng Chen","doi":"10.1016/j.cegh.2026.102300","DOIUrl":"10.1016/j.cegh.2026.102300","url":null,"abstract":"<div><h3>Background</h3><div>Intimate partner violence (IPV), including physical, emotional, and sexual abuse disproportionately affects women globally, particularly in sub-Saharan Africa.</div></div><div><h3>Objective</h3><div>This study examined the timing and determinants of first experiences of IPV among ever-married Ethiopian women.</div></div><div><h3>Participants and setting</h3><div>The study analyzed nationally representative data from 4720 ever-married women who participated in the 2016 Ethiopian Demographic and Health Survey.</div></div><div><h3>Methods</h3><div>Cox proportional hazards and parametric accelerated failure time (AFT) models were used to identify factors influencing time to first IPV. Women who had not experienced IPV by the survey date or who reported IPV occurring before marriage were treated as right-censored. Multiple AFT distributions were compared, and the best-fitting models were selected.</div></div><div><h3>Results</h3><div>Approximately 30 % of women reported experiencing at least one form IPV, most commonly emotional (22.3 %). The log-normal AFT model best fit physical and sexual violence, while the Weibull AFT model fit emotional violence. Older women (35–49 years) experienced IPV later than younger women (time ratios [TR]: 2.09 physical, 2.82 sexual, 3.00 emotional). Husband's alcohol use, controlling behavior, family violence history, and fear of the husband were associated with earlier IPV occurrence (TR &lt; 1). More children delayed physical and emotional violence (TR &gt; 1), while older age at marriage predicted earlier emotional violence (TR = 0.7).</div></div><div><h3>Conclusions</h3><div>Age, regional differences, family background, and husbands' behaviors significantly influence the timing of IPV onset among Ethiopian women. Targeted prevention programs addressing harmful partner behaviors, alcohol use, and intergenerational violence are essential to delay or prevent IPV and safeguard women's wellbeing.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102300"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079332","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}

{"title":"Assessing the epidemiological and economic impact of dengue from 1990 to 2021 in Indonesia","authors":"Wahyu Pudji Nugraheni ,&nbsp;Syarifah Nuraini ,&nbsp;Triwibowo Ambar Garjito ,&nbsp;Indah Pawitaningtyas ,&nbsp;Sinta Dewi Lestyoningrum ,&nbsp;Linta Meyla Putri ,&nbsp;Afi Nursafingi ,&nbsp;Asep Kusnali ,&nbsp;Adistha Eka Noveyani ,&nbsp;P.W. Dhewantara","doi":"10.1016/j.cegh.2026.102303","DOIUrl":"10.1016/j.cegh.2026.102303","url":null,"abstract":"<div><h3>Problem considered</h3><div>Dengue fever remains a significant public health problem in Indonesia, one of the country's most severely affected in Southeast Asia. Despite ongoing control efforts, the disease continues to cause major health and economic impacts. This study aimed to evaluate the epidemiological and economic impact of dengue.</div></div><div><h3>Method</h3><div>An ecological time-trend analysis was performed using secondary data from the Global Burden of Disease (GBD) 2021 database, national health statistics, and provincial minimum wage data. Dengue incidence, mortality, and DALYs were mapped and quantified across 34 provinces, and economic losses were estimated using a human capital approach. Geospatial analyses visualized regional disparities.</div></div><div><h3>Results</h3><div>Indonesia's age-standardized dengue incidence peaked in 2015 (912.4 per 100,000 among males; 1076.7 among females). Females showed consistently higher incidence, while males experienced higher mortality; DALYs increased sharply between 2005 and 2017 before stabilizing. The highest DALYs and economic losses (&gt;IDR 6 trillion combined) were observed in West Java, East Java, and Central Java. Marked geographic disparities correlated with variations in population density, healthcare access, and vector control capacity.</div></div><div><h3>Conclusion</h3><div>Dengue imposes a heavy and sustained health and financial burden in Indonesia, with dense provinces most impacted. Interventions such as strengthened surveillance, region-specific vector control, improved urban sanitation, and expanded healthcare access are essential to limit further losses. Economic analysis highlights urgent needs for resource allocation and locally tailored responses to mitigate dengue's impact.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102303"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079251","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}

{"title":"Anthropometric, sociodemographic and metabolic factors associated with clinically expressed insulin resistance in individuals with type 2 diabetes","authors":"Rudminaitė Emilė,&nbsp;Čypaitė Gabrielė,&nbsp;Šimonienė Diana","doi":"10.1016/j.cegh.2026.102322","DOIUrl":"10.1016/j.cegh.2026.102322","url":null,"abstract":"<div><div>Clinically expressed insulin resistance (IR) in type 2 diabetes (T2D) patients usually leads to poor hyperglycaemia control and progression of complications.</div></div><div><h3>Aims</h3><div>to evaluate how selected sociodemographic, metabolic and anthropometric factors are linked to expressed IR among T2D patients and assess the clinical tools for IR evaluation.</div></div><div><h3>Methods</h3><div>A sample of 100 T2D patients aged 18 - 80 years old was divided based on their daily insulin requirement into case (&gt;1IU/kg/d) and control (&lt;1IU/kg/d) groups. The data was obtained by interviewing patients using original questionnaires, analysing their medical history, performing clinical examination and blood tests.</div></div><div><h3>Results</h3><div>The case group subjects were younger (p &lt; 0.001) and the duration of their diabetes was shorter (p &lt; 0.001). The patients with expressed IR more often had metabolic syndrome (p = 0.005) and dyslipidaemia (86.2% vs. 67.8%, p = 0.018), particularly hypertriglyceridemia. All patients with expressed insulin resistance (IR) exhibited elevated levels of visceral adipose tissue (VAT &gt;454 g), and the prevalence of visceral obesity was significantly higher in this group compared to the control group (100% vs. 72.7%, p = 0.032). High insulin requirement strongly correlated with HOMA-IR and eGDR in patients with T2D and could be used in determining IR.</div></div><div><h3>Conclusions</h3><div>Patients with T2D and expressed IR were younger and the duration of diabetes was shorter. The prevalence of metabolic syndrome and dyslipidemia—specifically hypertriglyceridemia—was higher among individuals with expressed IR. Although the percentage of total body fat was comparable between groups, the amount of visceral adipose tissue was significantly greater in patients with expressed IR.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102322"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147397806","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}

{"title":"Health literacy and coronavirus guideline adherence among families in Mexico","authors":"Steven Hoffman ,&nbsp;Kaitlin Ward ,&nbsp;Dorian Huang ,&nbsp;Kyleigh Hatch ,&nbsp;Dayna Kirby ,&nbsp;Julianne Croft ,&nbsp;David Wood ,&nbsp;Flavio F. Marsiglia","doi":"10.1016/j.cegh.2026.102294","DOIUrl":"10.1016/j.cegh.2026.102294","url":null,"abstract":"<div><h3>Problem considered</h3><div>The COVID-19 pandemic severely impacted Mexico, where misinformation and limited health literacy (HL) may have influenced public adherence to preventive guidelines. Prior studies have suggested that HL plays a critical role in shaping health behaviors, yet little is known about how HL affects Coronavirus Guideline Adherence (CGA) within family units, particularly among parents and youth in Mexico.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional study with 373 parent–youth pairs across all Mexican states. Participants completed online surveys measuring general HL using a validated 12-item scale and CGA through self-reported adherence to public health guidelines. We applied actor-partner interdependence modeling to assess how parents' and youths' HL influenced their own and each other's CGA. Analyses accounted for key demographic factors, including age, sex, residence type, and socioeconomic status.</div></div><div><h3>Results</h3><div>Higher HL was associated with greater personal adherence to COVID-19 guidelines for both parents and youth. Parents' HL predicted their own adherence and significantly influenced youth adherence, while youths’ HL predicted only their own adherence. Female participants reported higher adherence levels than males. No significant differences were observed by socioeconomic status or rural versus urban residence.</div></div><div><h3>Conclusion</h3><div>These findings suggest that improving HL can strengthen adherence to public health guidelines during health crises. Importantly, parental HL appears to influence not only parents’ own behaviors but also those of their children, highlighting the potential value of family-centered health promotion strategies. Culturally sensitive interventions that enhance HL may help communities, particularly in Mexico, better navigate future public health emergencies by boosting compliance with preventive measures.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102294"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146189608","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}

{"title":"Risk factors of overweight/obesity among children aged 48-59 Months in Wajo, South Sulawesi: A cross-sectional study","authors":"Andi Rispah Sulistianingsih ,&nbsp;Nurjazuli Nurjazuli ,&nbsp;Martha Irene Kartasurya ,&nbsp;Syamsulhuda Budi Musthofa","doi":"10.1016/j.cegh.2026.102324","DOIUrl":"10.1016/j.cegh.2026.102324","url":null,"abstract":"<div><h3>Problem considered</h3><div>Childhood obesity plays a crucial role in the emergence of chronic diseases and has become a global public health challenge. This study aims to identify the risk factors associated with overweight/obesity among children aged 48-59 months.</div></div><div><h3>Methods</h3><div>This study used a cross-sectional design involving 763 children in 9 districts. The districts were selected based on the highest number of students and demographic variation. Bivariate analysis was conducted to identify risk factors associated with overweight/obesity, followed by logistic regression to calculate adjusted odds ratios with 95% CI.</div></div><div><h3>Results</h3><div>The prevalence of overweight/obesity was 7.1%. Related factors include boys, high maternal education level, working mothers, high screen time, inadequate sleep duration, early initiation of breastfeeding, and the combined effect of delivery method and exclusively breastfed history. The final multiple regression indicated that children delivered vaginally and not exclusively breastfed had a 6.37 times (95% CI: 2.80-14.47) higher risk. Children born by cesarean section but exclusively breastfed had a 3.41 times (95% CI: 1.38-8.40) higher risk, while children born by cesarean section and not exclusively breastfed had a 5.01 times (95%CI: 2.04-12.31) higher risk of being overweight/obese. Boys had a higher risk (aOR = 2.96; 95% CI: 1.56-5.62). High maternal education level resulting in a 1.94 times (95%CI:1.08-3.50).</div></div><div><h3>Conclusions</h3><div>The combined effect of delivery method and non-exclusively breastfed was the strongest predictor for childhood overweight/obesity. Integrating postpartum breastfeeding support and visual-based educational tools into routine immunization visits can effectively mitigate obesity risks across all social groups.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102324"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147398242","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}

{"title":"Analysis of awareness, utilization patterns, and barriers in accessing E-pharmacies for family planning in Lagos state, Nigeria","authors":"Uchenna Okafor ,&nbsp;Chinedu Okoye ,&nbsp;Mohammed Alhaji ,&nbsp;David Atama ,&nbsp;Arinze Okafor ,&nbsp;Salamatu Abdulrahman ,&nbsp;Babatunde Oyelana ,&nbsp;Bolanle Fajemirokun ,&nbsp;Kenechukwu Eruchalu","doi":"10.1016/j.cegh.2026.102306","DOIUrl":"10.1016/j.cegh.2026.102306","url":null,"abstract":"<div><h3>Problem considered</h3><div>Family planning is fundamental to gender equity and improvements in maternal and child health outcome. Nigeria has a fertility rate of 5.4 and her modern Contraceptive Prevalence Rate (mCPR) remains low at 15% and 38% among married women and sexually active unmarried women respectively. Access to family planning commodities and services continues also to be wrought with significant challenges. Digital health innovations can go a long way to address some of these challenges towards accelerating achievement of universal health coverage milestones.</div></div><div><h3>Methods</h3><div>In-Depth Interviews (IDIs) with 18 women and quantitative surveys with 1082 women were conducted. Qualitative components explored experiences and perceptions related to FP methods and digital access to FP services and products. The quantitative component utilized R (version 4.0.5) to provide descriptive and inferential analysis of the data.</div></div><div><h3>Results</h3><div>Awareness and utilization of digital platforms for FP services was low generally with barriers to digital FP access identified to include privacy concerns, lack of trust in digital platforms, and cost issues. Quantitative findings indicate that while (87%) of respondents are aware of family planning, only (16%) of these are aware of e-pharmacies/telemedicine platforms as channels for family planning service delivery. Age, education and income were statistically significant for digital FP access and awareness (P &lt; 0.00, 0.00 &amp; 0.02 respectively).</div></div><div><h3>Conclusion</h3><div>The findings from this study are useful in informing programs aimed at improving digital health service awareness and utilization as well as optimization of scalable digital models linked to e-pharmacies towards increasing access to modern contraceptives.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102306"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190014","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}