Pub Date : 2026-01-01Epub Date: 2025-11-28DOI: 10.1016/j.cegh.2025.102243
Parisa Shojaei
Problem considered
The goal of this study was testing the communication model of the social determinants effective on healthcare in women referred to the healthcare centers based on the WHO's approach: pathway analysis.
Methods
This analytical cross-sectional study was conducted on 700 women referred to a public healthcare center in northwest Tehran. Data were collected using Keyes's Social Well-Being Questionnaire (KSWBQ), which measures five dimensions of social health. Based on the conceptual framework of the World Health Organization's model of social determinants of health, path analysis was applied to investigate the structural relationships between socioeconomic variables and women's social health. Statistical analyses were performed using SPSS version 27 and LISREL 8.8.
Results
In the first model with the outcome variable being the Keyes social well-being score, the most meaningful direct positive effect in social acceptance (β = 0.22) and social solidarity (β = 0.15) is the age variable. In social participation (β = 0.79), social coherence (β = 0.79) and social prosperity (β = 0.83), income has the most direct effect. From the indirect effective factors, occupation was the most effective in all the social well-being dimensions except for social prosperity.
Conclusion
Effective determinants of women's social well-being should be considered by governments in order to further advance the health of women, families and finally the society.
{"title":"Examining the model of social determinants affecting the health of referring women to the center of health with the World Health Organization model approach: a path analysis","authors":"Parisa Shojaei","doi":"10.1016/j.cegh.2025.102243","DOIUrl":"10.1016/j.cegh.2025.102243","url":null,"abstract":"<div><h3>Problem considered</h3><div>The goal of this study was testing the communication model of the social determinants effective on healthcare in women referred to the healthcare centers based on the WHO's approach: pathway analysis.</div></div><div><h3>Methods</h3><div>This analytical cross-sectional study was conducted on 700 women referred to a public healthcare center in northwest Tehran. Data were collected using Keyes's Social Well-Being Questionnaire (KSWBQ), which measures five dimensions of social health. Based on the conceptual framework of the World Health Organization's model of social determinants of health, path analysis was applied to investigate the structural relationships between socioeconomic variables and women's social health. Statistical analyses were performed using SPSS version 27 and LISREL 8.8.</div></div><div><h3>Results</h3><div>In the first model with the outcome variable being the Keyes social well-being score, the most meaningful direct positive effect in social acceptance (β = 0.22) and social solidarity (β = 0.15) is the age variable. In social participation (β = 0.79), social coherence (β = 0.79) and social prosperity (β = 0.83), income has the most direct effect. From the indirect effective factors, occupation was the most effective in all the social well-being dimensions except for social prosperity.</div></div><div><h3>Conclusion</h3><div>Effective determinants of women's social well-being should be considered by governments in order to further advance the health of women, families and finally the society.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"37 ","pages":"Article 102243"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684887","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 : 2026-01-01Epub Date: 2025-11-28DOI: 10.1016/j.cegh.2025.102252
Afrina Mizawati , Nursyirwan Effendi , Delmi Sulastri , Rozi Sastra Purna
Problem considered
Anemia among women of reproductive age, particularly prospective brides, remains a significant public health concern in Indonesia. Despite national programs, preventive efforts are often fragmented and lack structured education, family engagement, and cross-sector collaboration. This study aimed to explore determinants of anemia prevention practices to inform the development of the Anemia-Free Integrated Network Approach (AFRINA).
Methods
This descriptive qualitative study employed in-depth interviews and focus group discussions with 71 informant (24 prospective brides and 47 supporting stakeholders), including midwives, health officials, and community leaders, purposively and snowball recruited to ensure diverse perspectives. Data collection was conducted between September and December 2024. Semi-structured interview guides explored knowledge, screening practices, supplementation adherence, and intersectoral collaboration. Data were analyzed using thematic analysis to identify barriers, enablers, and opportunities related to anemia prevention.
Results
The analysis revealed five major themes related to premarital anemia prevention: limited exposure to anemia information; superficial understanding of anemia risks; inconsistent and unenforced screening policies; poor adherence to iron supplementation; and weak coordination and shared responsibility across health, religious, and community sectors. These themes directly informed the development of the AFRINA Framework, which emphasizes structured education, early intervention, strengthened supplementation adherence, multisectoral collaboration, and coordinated referral pathways.
Conclusions
Anemia prevention among prospective brides requires a holistic approach that integrates digital health communication, family engagement, and cross-sector policy implementation. The findings from this qualitative phase serve as a foundation for developing a targeted intervention model tailored to local needs.
{"title":"“Developing an integrated model for anemia prevention in prospective brides: A qualitative exploration of multisectoral collaboration in bengkulu city of Indonesia”","authors":"Afrina Mizawati , Nursyirwan Effendi , Delmi Sulastri , Rozi Sastra Purna","doi":"10.1016/j.cegh.2025.102252","DOIUrl":"10.1016/j.cegh.2025.102252","url":null,"abstract":"<div><h3>Problem considered</h3><div>Anemia among women of reproductive age, particularly prospective brides, remains a significant public health concern in Indonesia. Despite national programs, preventive efforts are often fragmented and lack structured education, family engagement, and cross-sector collaboration. This study aimed to explore determinants of anemia prevention practices to inform the development of the Anemia-Free Integrated Network Approach (AFRINA).</div></div><div><h3>Methods</h3><div>This descriptive qualitative study employed in-depth interviews and focus group discussions with 71 informant (24 prospective brides and 47 supporting stakeholders), including midwives, health officials, and community leaders, purposively and snowball recruited to ensure diverse perspectives. Data collection was conducted between September and December 2024. Semi-structured interview guides explored knowledge, screening practices, supplementation adherence, and intersectoral collaboration. Data were analyzed using thematic analysis to identify barriers, enablers, and opportunities related to anemia prevention.</div></div><div><h3>Results</h3><div>The analysis revealed five major themes related to premarital anemia prevention: limited exposure to anemia information; superficial understanding of anemia risks; inconsistent and unenforced screening policies; poor adherence to iron supplementation; and weak coordination and shared responsibility across health, religious, and community sectors. These themes directly informed the development of the AFRINA Framework, which emphasizes structured education, early intervention, strengthened supplementation adherence, multisectoral collaboration, and coordinated referral pathways.</div></div><div><h3>Conclusions</h3><div>Anemia prevention among prospective brides requires a holistic approach that integrates digital health communication, family engagement, and cross-sector policy implementation. The findings from this qualitative phase serve as a foundation for developing a targeted intervention model tailored to local needs.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"37 ","pages":"Article 102252"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616720","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}
To estimate the prevalence, incidence and frequency of diarrhoeal episodes among children under five in India, identifying trends and associated factors based on studies published from 2011 to 2024.
Methods
A systematic review and Meta-analysis were conducted using the PRISMA guidelines in electronic databases (Web of Science, EMBASE, CINAHL, Scopus, Cochrane Library, PubMed, Google Scholar) between 2011 and 2024. Community-based studies were included focusing on children under five in India, defining diarrhea as three or more loose stools in 24 h, regardless of recall period. Diarrhoeal rates were logit-transformed to generate pooled estimates, and a random effects empirical Bayes model was used for the meta-analysis. Subgroup, sensitivity analysis and meta-regression was performed to assess the heterogeneity and Egger's test for publication bias.
Findings
A total of 64 community-based studies across 21 Indian states (53 cross-sectional and 11 longitudinal) were included in the review. The pooled acute diarrhea prevalence was 22.8 % (95 % CI: 19.5, 26.0 %) from 48 studies, with high heterogeneity (I2 = 99.13 %). Prevalence was highest in Central and North India (24.3 %), followed by East (22.5 %), West (18.8 %), and South (17.6 %). There was a year-to-year variation from 2011 to 2024, ranging from a low of 9.4 % in 2021 to a high of 51.9 % in 2009. The pooled incidence rate from four studies was 21.78 cases per 100 person-years (95 % CI: 12.31, 31.24), while five studies reported 1.73 episodes per person-year (95 % CI: 0.67, 2.79). Meta-regression suggested a marginally significant annual decline in diarrhea prevalence of 1.27 %.
Conclusion
This review provides a comprehensive analysis of the magnitude of acute diarrheal disease in Indian children under five over 13 years. Trend analysis showed a considerable variability across studies with prevalence rates ranging from 9 % to 51.9 %, with half of the studies reporting rates ranging from 17.3 % to 24.5 %. The incidence rate of 21.78 cases per person years highlights the significant burden of diarrheal disease. This study supports the development of evidence-based strategies to lessen the effects of diarrheal illnesses and improve child health outcomes in India by offering insightful information to researchers, policymakers, and medical professionals.
{"title":"Trend analysis of acute diarrhoeal disease patterns among Indian children under five (2011–2024): A systematic review and meta-analysis","authors":"Melissa Glenda Lewis, Diplina Barman, Rounik Talukdar, Suman Kanungo","doi":"10.1016/j.cegh.2025.102224","DOIUrl":"10.1016/j.cegh.2025.102224","url":null,"abstract":"<div><h3>Objectives</h3><div>To estimate the prevalence, incidence and frequency of diarrhoeal episodes among children under five in India, identifying trends and associated factors based on studies published from 2011 to 2024.</div></div><div><h3>Methods</h3><div>A systematic review and Meta-analysis were conducted using the PRISMA guidelines in electronic databases (Web of Science, EMBASE, CINAHL, Scopus, Cochrane Library, PubMed, Google Scholar) between 2011 and 2024. Community-based studies were included focusing on children under five in India, defining diarrhea as three or more loose stools in 24 h, regardless of recall period. Diarrhoeal rates were logit-transformed to generate pooled estimates, and a random effects empirical Bayes model was used for the meta-analysis. Subgroup, sensitivity analysis and meta-regression was performed to assess the heterogeneity and Egger's test for publication bias.</div></div><div><h3>Findings</h3><div>A total of 64 community-based studies across 21 Indian states (53 cross-sectional and 11 longitudinal) were included in the review. The pooled acute diarrhea prevalence was 22.8 % (95 % CI: 19.5, 26.0 %) from 48 studies, with high heterogeneity (I<sup>2</sup> = 99.13 %). Prevalence was highest in Central and North India (24.3 %), followed by East (22.5 %), West (18.8 %), and South (17.6 %). There was a year-to-year variation from 2011 to 2024, ranging from a low of 9.4 % in 2021 to a high of 51.9 % in 2009. The pooled incidence rate from four studies was 21.78 cases per 100 person-years (95 % CI: 12.31, 31.24), while five studies reported 1.73 episodes per person-year (95 % CI: 0.67, 2.79). Meta-regression suggested a marginally significant annual decline in diarrhea prevalence of 1.27 %.</div></div><div><h3>Conclusion</h3><div>This review provides a comprehensive analysis of the magnitude of acute diarrheal disease in Indian children under five over 13 years. Trend analysis showed a considerable variability across studies with prevalence rates ranging from 9 % to 51.9 %, with half of the studies reporting rates ranging from 17.3 % to 24.5 %. The incidence rate of 21.78 cases per person years highlights the significant burden of diarrheal disease. This study supports the development of evidence-based strategies to lessen the effects of diarrheal illnesses and improve child health outcomes in India by offering insightful information to researchers, policymakers, and medical professionals.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"37 ","pages":"Article 102224"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685524","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}
Inflammatory bowel disease (IBD) is a chronic immune-mediated condition of the gastrointestinal system. Anemia is one of the most prevalent extraintestinal manifestations of IBD. This study assessed the global prevalence of anemia in patients with IBD.
Methods
A systematic review and meta-analysis were conducted following PRISMA guidelines to estimate the prevalence of anemia in IBD across world from year 2015–2024. The literature search was conducted in PubMed, Web of Science, Scopus, and Embase. The inclusion and exclusion criteria were pre-defined. The data on prevalence of anemia were extracted and Random effect pooled prevalence with 95 % CI was estimated for overall IBD and separately for Crohn's disease and ulcerative colitis. The subgroup was also defined among types of anemia, age groups, country, study site and study designs.
Results
The Search identified 791 records and 47 publications with a sample population of 138577 unique IBD cases from 22 countries and 5 continents were included in the prevalence estimation. The prevalence of anemia among overall IBD populations was 36.9 % (95 % CI:31.1–42.9), the prevalence of iron deficiency anemia (IDA) was 32.2 % (95 % CI:25.6–39.1), and the prevalence anemia of chronic disease (ACD) was 8.1 % (95 % CI:5.8–10.7). The country wise analysis shows highest prevalence of anemia in Bulgaria, for IDA highest prevalence was in Poland and ACD was highest in India.
Conclusions
Anemia is a common and variable complication of IBD globally. Its prevalence differs significantly by anemia subtype and geographic region, highlighting a substantial and complex burden.
{"title":"Burden of anemia in inflammatory bowel disease: A systematic review and meta-analysis","authors":"Rupa Tharu , Savitesh Kushwaha , Rachana Srivastava , Vaneet Jearth , Nitin Kaushal , Anupam Kumar Singh , Shweta Khandelwal , Poonam Khanna","doi":"10.1016/j.cegh.2025.102262","DOIUrl":"10.1016/j.cegh.2025.102262","url":null,"abstract":"<div><h3>Problem considered</h3><div>Inflammatory bowel disease (IBD) is a chronic immune-mediated condition of the gastrointestinal system. Anemia is one of the most prevalent extraintestinal manifestations of IBD. This study assessed the global prevalence of anemia in patients with IBD.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis were conducted following PRISMA guidelines to estimate the prevalence of anemia in IBD across world from year 2015–2024. The literature search was conducted in PubMed, Web of Science, Scopus, and Embase. The inclusion and exclusion criteria were pre-defined. The data on prevalence of anemia were extracted and Random effect pooled prevalence with 95 % CI was estimated for overall IBD and separately for Crohn's disease and ulcerative colitis. The subgroup was also defined among types of anemia, age groups, country, study site and study designs.</div></div><div><h3>Results</h3><div>The Search identified 791 records and 47 publications with a sample population of 138577 unique IBD cases from 22 countries and 5 continents were included in the prevalence estimation. The prevalence of anemia among overall IBD populations was 36.9 % (95 % CI:31.1–42.9), the prevalence of iron deficiency anemia (IDA) was 32.2 % (95 % CI:25.6–39.1), and the prevalence anemia of chronic disease (ACD) was 8.1 % (95 % CI:5.8–10.7). The country wise analysis shows highest prevalence of anemia in Bulgaria, for IDA highest prevalence was in Poland and ACD was highest in India.</div></div><div><h3>Conclusions</h3><div>Anemia is a common and variable complication of IBD globally. Its prevalence differs significantly by anemia subtype and geographic region, highlighting a substantial and complex burden.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"37 ","pages":"Article 102262"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790473","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 : 2026-01-01Epub Date: 2025-12-04DOI: 10.1016/j.cegh.2025.102257
Samah Saleh , Ihab Abdel-Aziz Gebreel , Salah hassan AL Hanafy , Ahmed Tawfik Bayad , Sherry Medhat Ayad , Shaimaa Baher Abdel-aziz , Abdelhamid Mohamed El Shabrawy
Problem considered
Climate change-related perceptions and communication are important factors influencing people's support for climate change policies and individual behavior. The purpose of this Youth-Led PAR is to involve young people in framing the discussion about climate change, identifying knowledge, perception about CC and its effects.
Methods
This is an exploratory population-based study that was implemented in partnership with the Egyptian Ministry of Environment (MOE) and UINCEF/Egypt Country Office (ECO) during the period from June 2023 to December 2023. A qualitative investigative approach was chosen for this study's methodology including 90 focus group discussions and 180 in-depth interviews in 10 governorates including a purposive sample of 1082 respondents.
Results
The interview questions elicited responses related to five thematic areas: young people's awareness, attitudes and beliefs; lessons learned, mitigation strategies, barriers against contribution; Roles and responsibilities for the implementation strategies; Advocacy campaigns and raising awareness. The findings revealed that young people perceive climate change as a global warming phenomenon. The majority realized that the situation would be worse, children, adolescents and young people are the most affected due to spreading diseases, emerging new organisms, increasing in mental health problems.
Conclusions
Generate evidence and assessing youth's understanding related to climate change impact on health is a critical issue. The study results can provide the foundation to develop community-based awareness campaigns, draw attention to the causes, indicators, and broad hazards of CC, advocate for the urgent need to support strict governmental policies and the development of future environmental impact reducing strategies.
{"title":"A qualitative analysis of climate change-related perceptions among a sample of the Egyptian population: A youth participatory action research","authors":"Samah Saleh , Ihab Abdel-Aziz Gebreel , Salah hassan AL Hanafy , Ahmed Tawfik Bayad , Sherry Medhat Ayad , Shaimaa Baher Abdel-aziz , Abdelhamid Mohamed El Shabrawy","doi":"10.1016/j.cegh.2025.102257","DOIUrl":"10.1016/j.cegh.2025.102257","url":null,"abstract":"<div><h3>Problem considered</h3><div>Climate change-related perceptions and communication are important factors influencing people's support for climate change policies and individual behavior. The purpose of this Youth-Led PAR is to involve young people in framing the discussion about climate change, identifying knowledge, perception about CC and its effects.</div></div><div><h3>Methods</h3><div>This is an exploratory population-based study that was implemented in partnership with the Egyptian Ministry of Environment (MOE) and UINCEF/Egypt Country Office (ECO) during the period from June 2023 to December 2023. A qualitative investigative approach was chosen for this study's methodology including 90 focus group discussions and 180 in-depth interviews in 10 governorates including a purposive sample of 1082 respondents.</div></div><div><h3>Results</h3><div>The interview questions elicited responses related to five thematic areas: young people's awareness, attitudes and beliefs; lessons learned, mitigation strategies, barriers against contribution; Roles and responsibilities for the implementation strategies; Advocacy campaigns and raising awareness. The findings revealed that young people perceive climate change as a global warming phenomenon. The majority realized that the situation would be worse, children, adolescents and young people are the most affected due to spreading diseases, emerging new organisms, increasing in mental health problems.</div></div><div><h3>Conclusions</h3><div>Generate evidence and assessing youth's understanding related to climate change impact on health is a critical issue. The study results can provide the foundation to develop community-based awareness campaigns, draw attention to the causes, indicators, and broad hazards of CC, advocate for the urgent need to support strict governmental policies and the development of future environmental impact reducing strategies.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"37 ","pages":"Article 102257"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737221","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}
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.
{"title":"Intersecting cultural beliefs and structural barriers: Healthcare-Seeking for buruli ulcer in Imo State, Nigeria","authors":"Chigozie Divine Onwuka , Evangeline Tochi Oparaocha","doi":"10.1016/j.cegh.2025.102283","DOIUrl":"10.1016/j.cegh.2025.102283","url":null,"abstract":"<div><h3>Problem</h3><div>Buruli ulcer (BU), caused by <em>Mycobacterium ulcerans</em>, 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.</div></div><div><h3>Methods</h3><div>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</div></div><div><h3>Results</h3><div>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</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"37 ","pages":"Article 102283"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925035","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}
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。
{"title":"Assessing the hotspot analysis and spatial clustering for pulmonary tuberculosis from 2019 to 2023 in Mysuru district, India","authors":"Suhail Azam Khan , M.C. Manjunatha , B.S. Jayaraj , S.K. Chaya , K.S. Lokesh , Mohammad Shiraz Ahmed , P.A. Mahesh","doi":"10.1016/j.cegh.2025.102272","DOIUrl":"10.1016/j.cegh.2025.102272","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"37 ","pages":"Article 102272"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145883501","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 : 2026-01-01Epub Date: 2025-12-19DOI: 10.1016/j.cegh.2025.102268
Minh Ho , Tung Viet Le , Ly Thi-Ly Tran , Huong Thanh Nguyen
Problem considered
Antenatal depression can create social and economic pressures for families and communities. Pregnant women with antenatal depression may struggle to maintain employment, manage household responsibilities, and provide a stable environment for the fetus. Assessing the prevalence of antenatal depression and its influencing factors provides necessary information to develop support programs for pregnant women and their families.
Methods
A mixed-method study design was employed. Quantitative information assessed signs of depression using the Edinburgh Postnatal Depression scale among 312 pregnant women residing in Da Nang City. Qualitative information was gathered through in-depth interviews with 8 participants, including representatives of healthcare managers and staff, and focus group discussions with pregnant women exhibiting and not exhibiting signs of depression. Quantitative data were analysed using descriptive statistics and univariate logistic regression, while qualitative data were recorded, transcribed, and thematically analysed.
Results
The study found 28.2 % prevalence of antenatal depression. Qualitative analysis revealed positive influencing factors including: marital status (married/living with partner), planned pregnancy, support from husband's family, good relationship with husband, and having social support; Negative influencing factors included: advanced maternal age, low educational attainment, previous pregnancy complications, fetal abnormalities, having two or more children, poor relationship with mother-in-law, preference for male offspring within the family, experiencing mental and physical violence from the husband, and the support from service providers is inadequate.
Conclusions
Depression symptoms are prevalent among pregnant women, so it's important for healthcare professionals to understand the risk factors for depression in pregnant women.
{"title":"Depression and influencing factors among pregnant women living in central Viet Nam: A mixed-methods study","authors":"Minh Ho , Tung Viet Le , Ly Thi-Ly Tran , Huong Thanh Nguyen","doi":"10.1016/j.cegh.2025.102268","DOIUrl":"10.1016/j.cegh.2025.102268","url":null,"abstract":"<div><h3>Problem considered</h3><div>Antenatal depression can create social and economic pressures for families and communities. Pregnant women with antenatal depression may struggle to maintain employment, manage household responsibilities, and provide a stable environment for the fetus. Assessing the prevalence of antenatal depression and its influencing factors provides necessary information to develop support programs for pregnant women and their families.</div></div><div><h3>Methods</h3><div>A mixed-method study design was employed. Quantitative information assessed signs of depression using the Edinburgh Postnatal Depression scale among 312 pregnant women residing in Da Nang City. Qualitative information was gathered through in-depth interviews with 8 participants, including representatives of healthcare managers and staff, and focus group discussions with pregnant women exhibiting and not exhibiting signs of depression. Quantitative data were analysed using descriptive statistics and univariate logistic regression, while qualitative data were recorded, transcribed, and thematically analysed.</div></div><div><h3>Results</h3><div>The study found 28.2 % prevalence of antenatal depression. Qualitative analysis revealed positive influencing factors including: marital status (married/living with partner), planned pregnancy, support from husband's family, good relationship with husband, and having social support; Negative influencing factors included: advanced maternal age, low educational attainment, previous pregnancy complications, fetal abnormalities, having two or more children, poor relationship with mother-in-law, preference for male offspring within the family, experiencing mental and physical violence from the husband, and the support from service providers is inadequate.</div></div><div><h3>Conclusions</h3><div>Depression symptoms are prevalent among pregnant women, so it's important for healthcare professionals to understand the risk factors for depression in pregnant women.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"37 ","pages":"Article 102268"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790487","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}
Lymphatic filariasis (LF) remains a significant public health issue in Indonesia despite global progress and national elimination efforts. This study aimed to comprehensively assess the influence of socioeconomic characteristics, preventive behaviors, and housing environmental factors on the risk of LF among Indonesian adults.
Methods
This cross-sectional study used the 2023 Indonesia Health Survey to examine associations between socioeconomic factors, protective behaviors, housing characteristics, and lymphatic filariasis (LF) among 570,618 adults. Associations with LF were analyzed using multivariable logistic regression, with results reported as adjusted odds ratios (AORs) and 95 % confidence intervals.
Results
The prevalence of LF was 0.14 %. Socio-demographic characteristics (age, sex, education, wealth index, and residence) were not statistically associated with LF risk. However, regular use of mosquito repellents (sprays, coils, electric devices) was significantly associated with a 25 % reduction in LF risk (AOR 0.75, 95 % CI: 0.59–0.95). Living in houses with non-permanent roofing (AOR 1.49, 95 % CI: 0.97–2.28) and without ceilings (AOR 1.20, 95 % CI: 0.93–1.54) showed increased, though non-significant, odds of LF occurrence.
Conclusion
LF risk in Indonesia is not distinguished by socioeconomic status but is more strongly determined by consistent adoption of protective behaviors and housing quality. Universal access to mosquito repellents and targeted improvement in housing infrastructure should be prioritized as equitable and effective LF control strategies.
{"title":"Factors associated with lymphatic filariasis in Indonesia","authors":"Sinta Dewi Lestyoningrum , Adistha Eka Noveyani , Debri Rizki Faisal , Wahyu Pudji Nugraheni , Syarifah Nuraini , Indah Pawitaningtyas , Linta Meyla Putri","doi":"10.1016/j.cegh.2025.102277","DOIUrl":"10.1016/j.cegh.2025.102277","url":null,"abstract":"<div><h3>Problem considered</h3><div>Lymphatic filariasis (LF) remains a significant public health issue in Indonesia despite global progress and national elimination efforts. This study aimed to comprehensively assess the influence of socioeconomic characteristics, preventive behaviors, and housing environmental factors on the risk of LF among Indonesian adults.</div></div><div><h3>Methods</h3><div>This cross-sectional study used the 2023 Indonesia Health Survey to examine associations between socioeconomic factors, protective behaviors, housing characteristics, and lymphatic filariasis (LF) among 570,618 adults. Associations with LF were analyzed using multivariable logistic regression, with results reported as adjusted odds ratios (AORs) and 95 % confidence intervals.</div></div><div><h3>Results</h3><div>The prevalence of LF was 0.14 %. Socio-demographic characteristics (age, sex, education, wealth index, and residence) were not statistically associated with LF risk. However, regular use of mosquito repellents (sprays, coils, electric devices) was significantly associated with a 25 % reduction in LF risk (AOR 0.75, 95 % CI: 0.59–0.95). Living in houses with non-permanent roofing (AOR 1.49, 95 % CI: 0.97–2.28) and without ceilings (AOR 1.20, 95 % CI: 0.93–1.54) showed increased, though non-significant, odds of LF occurrence.</div></div><div><h3>Conclusion</h3><div>LF risk in Indonesia is not distinguished by socioeconomic status but is more strongly determined by consistent adoption of protective behaviors and housing quality. Universal access to mosquito repellents and targeted improvement in housing infrastructure should be prioritized as equitable and effective LF control strategies.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"37 ","pages":"Article 102277"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145883500","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 : 2026-01-01Epub Date: 2025-12-02DOI: 10.1016/j.cegh.2025.102248
Reham M. Alahmad
Problem considered
Human Papillomavirus (HPV) is a significant etiological factor in several cancers, including cervical and head and neck squamous cell carcinoma (HNSCC). While HPV-16 is the most commonly reported genotype globally, emerging evidence indicates regional variations in genotype distribution. In Saudi Arabia, data on HPV genotypes in these cancers remain limited. This study investigated the prevalence and genotype distribution of high-risk HPV (HR-HPV) in base of tongue squamous cell carcinoma (BOTSCC), cervical squamous cell carcinoma (CSCC), and tonsillar squamous cell carcinoma (TSCC), and to evaluate implications for HPV vaccine coverage.
Methods
A total of 97 patients (11 BOTSCC, 70 CSCC, and 16 TSCC) were tested for the presence and genotypes of HR-HPV using molecular methods. The distribution of HR-HPV genotypes, single and multiple infections, was assessed, and genotypes were compared to the coverage provided by the nine-valent HPV vaccine.
Results
In patients with base of tongue squamous cell carcinoma (BOTSCC), HPV DNA was detected in all cases, with HPV-35 being the most prevalent genotype (90 %), followed by HPV-16 (63 %) and HPV-45 (9 %). Notably, 81.8 % of BOTSCC patients exhibited multiple HPV infections, predominantly dual infections. Among cervical squamous cell carcinoma (CSCC) cases, HPV-35 was again the most frequently detected genotype (84 %), followed by HPV-16 (68 %) and HPV-18 (54 %), while HPV-33 was not observed. In tonsillar squamous cell carcinoma (TSCC), 81.3 % of patients tested positive for.
Conclusion
The predominance of HPV-35 over HPV-16 in CSCC and HNSCC highlights a unique regional pattern and a gap in current vaccine coverage. The detection of non-vaccine genotypes supports the need for regional surveillance and potential expansion of vaccine targets to improve protection against HPV-related cancers in Saudi Arabia.
{"title":"Comparative analysis of HPV prevalence and genotype distribution in patients with base of tongue, cervical, and tonsillar squamous cell carcinomas: Indications of a shift in HPV genotype patterns","authors":"Reham M. Alahmad","doi":"10.1016/j.cegh.2025.102248","DOIUrl":"10.1016/j.cegh.2025.102248","url":null,"abstract":"<div><h3>Problem considered</h3><div>Human Papillomavirus (HPV) is a significant etiological factor in several cancers, including cervical and head and neck squamous cell carcinoma (HNSCC). While HPV-16 is the most commonly reported genotype globally, emerging evidence indicates regional variations in genotype distribution. In Saudi Arabia, data on HPV genotypes in these cancers remain limited. This study investigated the prevalence and genotype distribution of high-risk HPV (HR-HPV) in base of tongue squamous cell carcinoma (BOTSCC), cervical squamous cell carcinoma (CSCC), and tonsillar squamous cell carcinoma (TSCC), and to evaluate implications for HPV vaccine coverage.</div></div><div><h3>Methods</h3><div>A total of 97 patients (11 BOTSCC, 70 CSCC, and 16 TSCC) were tested for the presence and genotypes of HR-HPV using molecular methods. The distribution of HR-HPV genotypes, single and multiple infections, was assessed, and genotypes were compared to the coverage provided by the nine-valent HPV vaccine.</div></div><div><h3>Results</h3><div>In patients with base of tongue squamous cell carcinoma (BOTSCC), HPV DNA was detected in all cases, with HPV-35 being the most prevalent genotype (90 %), followed by HPV-16 (63 %) and HPV-45 (9 %). Notably, 81.8 % of BOTSCC patients exhibited multiple HPV infections, predominantly dual infections. Among cervical squamous cell carcinoma (CSCC) cases, HPV-35 was again the most frequently detected genotype (84 %), followed by HPV-16 (68 %) and HPV-18 (54 %), while HPV-33 was not observed. In tonsillar squamous cell carcinoma (TSCC), 81.3 % of patients tested positive for.</div></div><div><h3>Conclusion</h3><div>The predominance of HPV-35 over HPV-16 in CSCC and HNSCC highlights a unique regional pattern and a gap in current vaccine coverage. The detection of non-vaccine genotypes supports the need for regional surveillance and potential expansion of vaccine targets to improve protection against HPV-related cancers in Saudi Arabia.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"37 ","pages":"Article 102248"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685518","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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