Clinical Epidemiology and Global Health最新文献

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IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-01

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Assessing the hotspot analysis and spatial clustering for pulmonary tuberculosis from 2019 to 2023 in Mysuru district, India 2019 - 2023年印度迈苏尔地区肺结核热点分析及空间聚类分析

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-01 DOI: 10.1016/j.cegh.2025.102272

Suhail Azam Khan , M.C. Manjunatha , B.S. Jayaraj , S.K. Chaya , K.S. Lokesh , Mohammad Shiraz Ahmed , P.A. Mahesh

Background

Pulmonary Tuberculosis (PTB) remains a major cause of morbidity in India despite progress in TB elimination, accounting for roughly 25 % of global TB cases. Ongoing spatial and demographic disparities hinder further reduction. The study aims to assess PTB syndemic profiles, spatial distribution, and persistent hotspots in a high-burden Indian district from 2019 to 2023 using geospatial analytics to inform precision public health policies.

Methods

A retrospective cross-section analysis of 10,201 PTB cases in Mysuru district used ArcGIS and Google Earth Pro to examine point density by age, gender, HIV status, and diabetes. Spatial autocorrelation (Moran's I, Getis-Ord Gi∗) identified hotspot clusters, while chi-square tests evaluated demographics and comorbidity trends.

Results

Between 2019 and 2023, PTB cases declined by 7.7 % (from 2245 to 2029). Cases among individuals aged 0–18 and 19–44 fell by 22 % and 22.3 %, respectively. Both male and female cases dropped by about 9.5 %, while diabetes cases rose by 10 % and non-diabetes cases fell by 6.5 %. HIV-positive cases declined by 52.6 %. A Moran's Index of 0.381799, z-score of 31.45, and p-value <0.001 indicate strong, statistically significant spatial clustering.

Conclusion

Despite the overall decline in disease burden, persistent urban PTB clusters continue to affect the elderly and individuals with diabetes. While TB-HIV comorbidity has significantly decreased, the enduring Diabetes-TB overlap highlights the need for integrated, geospatially targeted interventions and continuous GIS-based surveillance to address high-risk clusters and advance TB elimination in urban areas.

背景：尽管在消除结核病方面取得了进展，但肺结核仍然是印度发病的主要原因，约占全球结核病病例的25%。目前的空间和人口差距阻碍了进一步减少。该研究旨在利用地理空间分析，评估2019年至2023年印度高负担地区肺结核的症状概况、空间分布和持续热点，为精确的公共卫生政策提供信息。方法采用ArcGIS和谷歌Earth Pro软件对Mysuru地区10201例PTB病例进行回顾性横断面分析，按年龄、性别、HIV感染状况和糖尿病进行点密度分析。空间自相关（Moran's I, Getis-Ord Gi *）确定了热点集群，而卡方检验评估了人口统计学和合并症趋势。结果2019 - 2023年，肺结核病例下降7.7%（从2245例下降到2029例）。0-18岁和19-44岁的病例分别下降了22%和22.3%。男性和女性病例均下降了约9.5%，而糖尿病病例上升了10%，非糖尿病病例下降了6.5%。艾滋病毒阳性病例下降了52.6%。Moran's Index为0.381799，z-score为31.45，p值<；0.001表明空间聚类性很强，具有统计学意义。结论尽管疾病负担总体下降，但持续存在的城市肺结核集群继续影响老年人和糖尿病患者。虽然结核病-艾滋病毒合并症已显著减少，但长期存在的糖尿病-结核病重叠突出表明，需要采取综合的、有地理空间针对性的干预措施和基于地理信息系统的持续监测，以解决高风险群集问题，并推动城市地区消除结核病。

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Intersecting cultural beliefs and structural barriers: Healthcare-Seeking for buruli ulcer in Imo State, Nigeria 交叉的文化信仰和结构性障碍：尼日利亚伊莫州布鲁里溃疡的求医情况

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-01 DOI: 10.1016/j.cegh.2025.102283

Chigozie Divine Onwuka , Evangeline Tochi Oparaocha

Problem

Buruli ulcer (BU), caused by Mycobacterium ulcerans, is a neglected tropical disease endemic to parts of Nigeria. Despite its public health impact, healthcare-seeking behavior in rural communities’ remains poorly understood, limiting targeted interventions.

Methods

A cross-sectional mixed-methods study was conducted in four endemic LGAs of Imo State. Quantitative data were collected from 300 respondents using structured questionnaires, while qualitative data were generated through 30 in-depth interviews with patients and caregivers, 12 interviews with traditional healers, 9 key informant interviews with health workers, and 7 focus group discussions. Quantitative analysis employed descriptive statistics and logistic regression, while qualitative transcripts were analyzed thematically using the Socio-Ecological Model

Results

Only 27.4 % of respondents sought biomedical care within two weeks of symptom onset, while 34.7 % consulted traditional healers first. Delayed hospital presentation was associated with low education (AOR = 2.14; 95 % CI: 1.4–3.8), belief in spiritual causation (AOR = 1.88; 95 % CI: 1.1–3.3), residing more than 5 km from the nearest health facility (AOR = 1.76; 95 % CI: 1.5–4.5), and lack of health insurance (AOR = 1.54; 95 % CI: 1.1–2.8). Qualitative data revealed spiritual interpretations, poverty, gender inequities, stigma, and mistrust of health facilities as barriers

Conclusion

Healthcare-seeking for BU in Imo State is constrained by the intersection of cultural beliefs and structural barriers. Interventions should combine culturally sensitive education, stigma reduction, financial protection, and decentralized service delivery to improve timely access to care.

问题由溃疡分枝杆菌引起的布鲁里溃疡是尼日利亚部分地区流行的一种被忽视的热带病。尽管它对公共卫生有影响，但对农村社区的求医行为仍然知之甚少，这限制了有针对性的干预措施。方法采用横截面混合方法对伊莫州4例地方性lga进行研究。使用结构化问卷从300名受访者中收集定量数据，同时通过对患者和护理人员的30次深度访谈、对传统治疗师的12次访谈、对卫生工作者的9次关键信息提供者访谈和7次焦点小组讨论产生定性数据。定量分析采用描述性统计和逻辑回归，定性记录采用社会生态模型进行主题分析。结果只有27.4%的受访者在症状出现两周内寻求生物医学治疗，而34.7%的受访者首先咨询传统治疗师。延迟就诊与受教育程度低（AOR = 2.14; 95% CI: 1.4-3.8）、信仰精神因果关系（AOR = 1.88; 95% CI: 1.1-3.3）、居住距离最近的医疗机构超过5公里（AOR = 1.76; 95% CI: 1.5-4.5）以及缺乏医疗保险（AOR = 1.54; 95% CI: 1.1-2.8）有关。定性数据显示精神解释、贫困、性别不平等、耻辱和对卫生设施的不信任是障碍。结论伊莫州布鲁里溃疡的求医受到文化信仰和结构性障碍的交叉制约。干预措施应结合文化敏感教育、减少污名、财务保护和分散服务提供，以改善及时获得护理的机会。

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IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-01

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IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-01

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IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-01

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IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-01

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IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-01

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IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-01

引用次数: 0

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-01

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