Clinical Epidemiology and Global Health最新文献_第9页

Unequal beginnings: Gender-specific determinants of early childhood development in Bangladesh 不平等的开端：孟加拉国儿童早期发展的性别决定因素

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-10-14 DOI: 10.1016/j.cegh.2025.102203

Md Shoebuj Zaman , Md Asadujjaman , Maliha Mahazabin , Sourav Kumar Barman , Benojir Ahammed , Sharlene Alauddin

Background

Early childhood development (ECD) is essential for lifelong health and well-being, however it remains underprioritized in developing countries like Bangladesh. This study explores how child, maternal, family, and sociodemographic factors affect ECD and measures the disparities of the factors among male and female children.

Methods

The Multiple Indicator Cluster Survey (MICS), 2019 data was utilized to assess the factors influencing the early child development index (ECDI) status. Binary logistic regression was employed to identify significant risk factors associated with ECDI.

Results

The overall prevalence of ECDI scores is 78.2 %, where female (81.6 %) children achieved a comparatively higher ECDI score than male (74.9 %) children. Female children (AOR = 1.38, 95 % CI:1.24–1.53) and those aged 48–59 months (AOR = 1.70, 95 % CI:1.52–1.90) had significantly higher odds of ECDI compared to male children and those aged 36–47 months. Positive associations were also observed for children whose mothers had higher education, attended early childhood education programs, belonged to wealthier households, and read three or more books at home. In contrast, undernutrition and exposure to physical violence experienced by mothers were significantly associated with lower odds of achieving adequate ECDI. Furthermore, the study found that the risk factors influencing ECDI differ between male and female children, indicating gender-specific influences on early childhood development.

Conclusions

This study found significant associations between child, maternal, and sociodemographic factors and ECDI, revealing gender disparities in Bangladesh. Targeted policies promoting maternal education, early learning access, child nutrition, and maternal well-being are essential to improve early childhood development nationwide.

儿童早期发展对终身健康和福祉至关重要，但在孟加拉国等发展中国家，儿童早期发展仍未得到重视。本研究探讨了儿童、母亲、家庭和社会人口因素如何影响幼儿发展，并测量了男女儿童中这些因素的差异。方法利用2019年多指标类集调查（MICS）数据，对影响儿童早期发育指数（ECDI）状况的因素进行评估。采用二元逻辑回归来确定与ECDI相关的重要危险因素。结果患儿ECDI评分的总体患病率为78.2%，其中女性患儿（81.6%）的ECDI评分高于男性患儿（74.9%）。女性患儿（AOR = 1.38, 95% CI:1.24 ~ 1.53）和48 ~ 59月龄患儿（AOR = 1.70, 95% CI:1.52 ~ 1.90）发生ECDI的几率明显高于男性患儿和36 ~ 47月龄患儿。如果母亲受过高等教育，参加过早期儿童教育项目，家庭富裕，在家阅读三本或更多的书，孩子也会有积极的联系。相比之下，营养不良和遭受身体暴力的母亲与获得足够ECDI的几率较低显著相关。此外，研究发现，影响ECDI的危险因素在男性和女性儿童之间存在差异，这表明性别对儿童早期发育的影响存在差异。本研究发现儿童、母亲和社会人口因素与ECDI之间存在显著关联，揭示了孟加拉国的性别差异。促进孕产妇教育、早期学习机会、儿童营养和孕产妇福祉的有针对性的政策对于改善全国儿童早期发展至关重要。

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引用次数: 0

Perceptions and challenges of Artificial Intelligence adoption in Nigerian public healthcare: Insights from consultant doctors across five tertiary hospitals 尼日利亚公共医疗保健采用人工智能的看法和挑战：来自五家三级医院顾问医生的见解

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-10-10 DOI: 10.1016/j.cegh.2025.102200

David B. Olawade , Aanuoluwapo Clement David-Olawade , Manisha Nitin Gore , Ojima Z. Wada

Problem considered

Artificial Intelligence (AI) adoption in Nigerian healthcare settings faces unique challenges due to limited infrastructure, regulatory gaps, and varied levels of familiarity among healthcare professionals. This study explores consultant doctors' perceptions of AI adoption in public healthcare across five tertiary hospitals in Southwestern Nigeria.

Method

The study was conducted across five purposively selected public tertiary hospitals across five states. Using purposive sampling, 15 consultant doctors from specialties, including radiology, internal medicine, and emergency medicine, participated in semi-structured interviews. Data was collected through interviews that explored knowledge, challenges, and opportunities surrounding AI in healthcare. Following Braun and Clarke's framework, thematic analysis was used to identify key themes.

Results

The study revealed a nascent but growing awareness of AI's applications in healthcare, with familiarity primarily concentrated in diagnostic imaging and predictive analytics. While consultants acknowledged AI's potential to enhance diagnostic speed and accuracy, they also expressed concerns regarding diminished human interaction, the risk of diagnostic inaccuracies, and the potential for over-reliance on AI systems. Ethical considerations surrounding data privacy and the need for robust regulatory oversight were prominent. Participants emphasized the necessity for stringent data protection protocols and well-defined guidelines governing AI implementation.

Conclusion

Consultant doctors view AI as a potentially transformative tool for Nigerian public healthcare but underscore the critical need for comprehensive training programs, robust regulatory frameworks, and substantial infrastructural improvements to ensure its responsible and effective integration. Additionally, AI models must be customized to address Nigeria-specific healthcare challenges.

人工智能（AI）在尼日利亚医疗保健机构的应用面临着独特的挑战，原因包括基础设施有限、监管空白以及医疗保健专业人员对AI的熟悉程度参差不齐。本研究探讨了顾问医生对尼日利亚西南部五家三级医院公共医疗保健采用人工智能的看法。方法本研究在五个州的五所公立三级医院进行。采用有目的抽样的方法，对来自放射科、内科和急诊医学等专业的15名会诊医生进行了半结构化访谈。通过访谈收集数据，探讨医疗保健领域人工智能的知识、挑战和机遇。遵循Braun和Clarke的框架，主题分析被用于识别关键主题。研究结果显示，人们对人工智能在医疗保健领域的应用有了初步但不断增长的认识，熟悉程度主要集中在诊断成像和预测分析方面。虽然顾问们承认人工智能在提高诊断速度和准确性方面的潜力，但他们也对人际互动减少、诊断不准确的风险以及过度依赖人工智能系统的可能性表示担忧。围绕数据隐私的道德考虑和强有力的监管监督的必要性是突出的。与会者强调必须制定严格的数据保护协议和明确的人工智能实施准则。咨询医生将人工智能视为尼日利亚公共医疗保健的潜在变革工具，但强调迫切需要全面的培训计划、健全的监管框架和实质性的基础设施改进，以确保其负责任和有效的整合。此外，必须定制人工智能模型，以应对尼日利亚特有的医疗保健挑战。

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引用次数: 0

Prevalence and risk factors of scrub typhus infection: Findings from a cross-sectional study in a rural setting in southern Tamil Nadu, India 恙虫病感染的流行和危险因素：来自印度泰米尔纳德邦南部农村环境的横断面研究结果

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-10-09 DOI: 10.1016/j.cegh.2025.102199

Sauvik Dasgupta , Petchimuthu Petchiammal , Raja Rajathi , Kasthuri Rengan Gopinath , Purushothaman Rajamani Asish , Venkatesan Sindhuja , Sivaprakasam T. Selvavinayagam , Girish Kumar Chethrapilly Purushothaman

Problem considered

Scrub typhus is a significant yet underdiagnosed cause of acute febrile illness in rural areas, where limited diagnostics and overlapping symptoms hinder timely detection. Existing evidence is largely hospital-based, with minimal data from community settings. This study aimed to estimate the prevalence and identify risk factors for scrub typhus using serological and molecular diagnostics in a rural population of southern Tamil Nadu.

Methods

A cross-sectional study was conducted between October 2022 and September 2024 at the Upgraded Primary Health Centre, Kallur, Tirunelveli. A total of 231 adults with fever ≥38 °C lasting more than five days were enrolled. Scrub typhus diagnosis was based on IgM ELISA (OD ≥ 1.50), Weil-Felix test (OXK titre ≥1:80), and quantitative real-time PCR (qRT-PCR) targeting the 47-kDa htrA gene. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) with 95 % confidence intervals (CI) to identify independent risk factors.

Results

Scrub typhus was confirmed in 24 of 231 patients (10.4 %). Of these, 8 were positive by both Weil-Felix and IgM ELISA, 10 by IgM ELISA alone, and 6 exclusively by qRT-PCR. Molecular testing identified 25 % of cases missed by serology. Significant risk factors included close animal contact (aOR: 2.48, 95 % CI: 1.01–6.09) and residence near bushy or scrub vegetation (aOR: 2.75, 95 % CI: 1.02–7.38).

Conclusion

Complementary testing with serological and qRT-PCR can improve early detection of scrub typhus. Public health interventions at the community level should focus on behavioural and environmental risk factors by strengthening health education and surveillance.

考虑到的问题：在农村地区，恙虫病是急性发热性疾病的一个重要病因，但诊断不足，症状重叠阻碍了及时发现。现有的证据主要是基于医院的，来自社区环境的数据很少。本研究旨在利用血清学和分子诊断方法估计泰米尔纳德邦南部农村人口中恙虫病的流行情况并确定危险因素。方法横断面研究于2022年10月至2024年9月在蒂鲁内veli Kallur升级初级卫生中心进行。共有231名持续发烧≥38°C超过5天的成年人被纳入研究。恙虫病诊断基于IgM ELISA （OD≥1.50）、Weil-Felix检测（OXK滴度≥1:80）和针对47kda htrA基因的实时荧光定量PCR （qRT-PCR）。采用多变量logistic回归计算校正优势比（aOR）， 95%置信区间（CI）确定独立危险因素。结果231例患者中有24例（10.4%）确诊为恙虫病。其中Weil-Felix ELISA和IgM ELISA均阳性8例，IgM ELISA单独阳性10例，qRT-PCR单独阳性6例。分子检测发现25%的血清学漏诊病例。显著危险因素包括与动物密切接触（aOR: 2.48, 95% CI: 1.01-6.09）和居住在灌木丛或灌丛植被附近（aOR: 2.75, 95% CI: 1.02-7.38）。结论血清学检测与qRT-PCR检测相结合可提高恙虫病的早期检出率。社区一级的公共卫生干预措施应通过加强卫生教育和监测，重点关注行为和环境风险因素。

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引用次数: 0

Regional disparities of TB-HIV coinfection among national health insurance members in Indonesia 印度尼西亚国家健康保险成员中结核病-艾滋病毒合并感染的地区差异

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-10-09 DOI: 10.1016/j.cegh.2025.102201

Paisal Paisal , Agung Dwi Laksono

Problem considered

TB-HIV coinfection remains a significant public health issue in Indonesia, with the National Health Insurance (NHI) playing a key role in its management. Although Indonesia is divided into seven major regions, available coinfection data are typically reported only at the national level or for selected provinces. This study aims to examine regional disparities in TB-HIV coinfection among NHI members.

Methods

A secondary analysis was conducted using 2023 Indonesian NHI data comprising 39,635 TB patients aged 25–49 years. The relationship between TB-HIV coinfection and geographic region was assessed, controlling for sex, age, marital status, and NHI membership class. Binary logistic regression was applied to estimate adjusted odds ratios (aOR) with 95 % confidence intervals.

Results

The national prevalence of TB-HIV coinfection was 4.6 %. Substantial disparities were identified across regions. Papua exhibited the highest risk, with patients 4.702 times more likely to have coinfection compared to Sumatra (95 % CI: 4.297–5.144), followed by Maluku at 1.824 times (95 % CI: 1.539–2.161). In contrast, Sulawesi showed the lowest risk at 0.713 times compared to Sumatra (95 % CI: 0.651–0.780). These results confirm significant regional variation in TB-HIV coinfection among NHI members.

Conclusions

This study shows that TB-HIV coinfection in Indonesia is disproportionately concentrated in regions with unique geographic and demographic characteristics, particularly Papua and Maluku. These findings emphasize the importance of utilizing subnational data to design geographically targeted interventions. Furthermore, this research can provide valuable insights for other countries with heterogeneous populations and diverse geographic conditions facing similar dual epidemics.

结核病-艾滋病毒合并感染在印度尼西亚仍然是一个重大的公共卫生问题，国民健康保险（NHI）在其管理中发挥着关键作用。虽然印度尼西亚分为七个主要区域，但现有的合并感染数据通常仅在国家一级或选定的省份报告。本研究的目的是检查结核病-艾滋病毒合并感染的地区差异在国民健康保险的成员。方法对2023年印尼国家健康保险数据进行二次分析，其中包括39,635例25-49岁的结核病患者。在控制性别、年龄、婚姻状况和NHI会员等级的情况下，评估TB-HIV合并感染与地理区域的关系。采用二元逻辑回归估计校正优势比（aOR），置信区间为95%。结果全国TB-HIV合并感染率为4.6%。各区域之间存在巨大差异。巴布亚岛的风险最高，患者合并感染的可能性是苏门答腊岛的4.702倍（95% CI: 4.297-5.144），其次是马鲁古岛的1.824倍（95% CI: 1.539-2.161）。相比之下，苏拉威西岛的风险最低，为苏门答腊岛的0.713倍（95% CI: 0.651-0.780）。这些结果证实了全国健康保险计划成员中结核-艾滋病毒合并感染的显著区域差异。本研究表明，印度尼西亚的结核病-艾滋病毒合并感染不成比例地集中在具有独特地理和人口特征的地区，特别是巴布亚和马鲁古。这些发现强调了利用次国家数据设计有地理针对性的干预措施的重要性。此外，这项研究可以为面临类似双重流行病的其他人口异质和地理条件不同的国家提供有价值的见解。

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引用次数: 0

Addressing the 2025 diphtheria surge in Somalia: A call for urgent policy action 应对2025年索马里白喉激增：呼吁采取紧急政策行动

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-10-09 DOI: 10.1016/j.cegh.2025.102196

Abdiwali Ahmed Hirey , Augustus Osborne , Mohamed Mustaf Ahmed , Abdirasak Sharif Ali

引用次数: 0

Intersecting illnesses and incomes: A mixed-methods inquiry into the cost of Hypertension and diabetes in rural households 交叉疾病与收入：农村家庭高血压和糖尿病费用的混合方法调查

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-10-08 DOI: 10.1016/j.cegh.2025.102197

Santhosh N. Poojary , Ankeeta Menona Jacob , Monisha Mary P , Nanjesh Kumar Siddappa , Sukanya Shetty , Neetha Kamath

Problem considered

Hypertension (HTN) and Type 2 Diabetes Mellitus (T2DM) impose a significant economic burden globally, entailing high direct and indirect medical and non-medical costs. Using a mixed-methods approach, this study aimed to estimate the medical and non-medical costs and the socio-economic consequences associated with managing co-existing HTN and T2DM in a rural community in Karnataka, India.

Methods

A mixed-methods study was conducted among 83 patients diagnosed with both HTN and T2DM in a rural area of Karnataka. Quantitative data on healthcare-related costs were collected using a structured questionnaire, while qualitative insights were gathered through two focus group discussions (FGDs) with patients. Data were analysed using SPSS v 29.0, and Qualitative analysis was conducted using the QDA Miner software tool 6.

Results

The median monthly direct medical cost was ₹570 (IQR: ₹364–₹986.5) for oral medications and ₹500 (IQR: ₹400–₹1200) for injectables and lab investigations. Hospitalisation imposed a substantial burden with a median cost of ₹20,000 (IQR: ₹12,500–₹45,000). Non-medical costs included stay (₹1500; IQR: ₹1000–₹2050), travel (₹300; IQR: ₹200–₹500), and food (₹250; IQR: ₹200–₹1000). Indirect costs from wage loss were significant, with a median daily income loss of ₹500 (IQR: ₹500–₹650) for patients and ₹600 (IQR: ₹500–₹650) for caregivers. Qualitative findings revealed recurring financial stress, disrupted education and savings, coping mechanisms (borrowing, missing medicines), and distress due to stock-outs at government facilities.

Conclusion

Managing HTN and T2DM imposes a substantial financial burden on rural households, exacerbated by limited access to affordable care and indirect income losses.

高血压（HTN）和2型糖尿病（T2DM）在全球范围内造成了重大的经济负担，导致了高昂的直接和间接医疗和非医疗费用。本研究采用混合方法，旨在估计印度卡纳塔克邦农村社区与管理HTN和T2DM共存相关的医疗和非医疗成本以及社会经济后果。方法对印度卡纳塔克邦农村地区确诊为HTN和T2DM的83例患者进行混合方法研究。使用结构化问卷收集了有关医疗保健相关费用的定量数据，同时通过与患者的两次焦点小组讨论（fgd）收集了定性见解。数据分析采用SPSS v 29.0，定性分析采用QDA Miner软件工具6。结果每月直接医疗费用中位数为口服药物570卢比（IQR：₹364 -₹986.5）和₹500卢比（IQR：₹400 -₹1200）注射和实验室调查。住院费用中位数为20,000卢比（IQR: 12,500卢比- 45,000卢比），负担沉重。非医疗费用包括住宿（₹1500;IQR：₹1000 -₹2050），旅行（₹300;IQR：₹200 -₹500），和食物（₹250;IQR：₹200 -₹1000）。工资损失的间接成本很大，患者的每日收入损失中位数为500卢比（IQR: 500卢比- 650卢比），护理人员的每日收入损失中位数为600卢比（IQR: 500卢比- 650卢比）。定性调查结果揭示了反复出现的财政压力、教育和储蓄中断、应对机制（借款、缺药）以及政府设施缺货造成的困境。结论：管理HTN和T2DM给农村家庭带来了沉重的经济负担，并因获得负担得起的医疗服务的机会有限和间接收入损失而加剧。

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引用次数: 0

Association of body mass index on long COVID: Predisposing factors, symptom severity, and functional status in a Spanish cohort of COVID-19 patients 体重指数与长COVID的关系：西班牙COVID-19患者队列中的易感因素、症状严重程度和功能状态

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-10-08 DOI: 10.1016/j.cegh.2025.102195

María Gabriela Torres-Romero , Nicolás Escrivá , Elena Barado , Laura Moreno-Galarraga , Alejandro Fernandez-Montero

Problem considered

Long COVID (LC) refers to a collection of symptoms that persist or emerge after an acute SARS-CoV-2 infection. It is a complex, multi-system condition that significantly affects quality of life. While obesity is a well-known risk factor for severe acute COVID-19, its role in the development and severity of LC remains underexplored. This study aimed to investigate the association between pre-infection Body Mass Index (BMI) and LC, as well as its impact on symptom type, their severity, and functional status.

Methods

This case-control study included 315 participants with prior confirmed SARS-CoV-2 infection. Participants were classified as LC cases or controls based on WHO criteria. Data was collected via an online self-reported survey. BMI prior to COVID-19 was categorized as underweight, normal weight, or overweight/obesity. Functional impairment was assessed using the Post-COVID Functional Status (PCFS) scale, models were used to examine associations, adjusting for potential confounders.

Results

Participants with overweight/obesity were associated with an increased developing LC (OR 2.85; 95 % CI 1.38–5.87) and experiencing moderate to severe functional limitations (OR 2.65; 95 % CI 1.32–5.31), compared to those with normal weight. Obesity was also associated with a higher likelihood of developing specific LC symptoms, including asthenia, dyspnea, headache, brain fog, anxiety, and myalgia. Underweight status showed less consistent associations.

Conclusion

Pre-infection obesity is an independent factor for the development LC and its functional consequences. Individuals with obesity may be considered a high-risk group and prioritized in public health strategies.

long COVID （LC）是指急性SARS-CoV-2感染后持续存在或出现的一系列症状。它是一种复杂的、多系统的疾病，显著影响生活质量。虽然肥胖是严重急性COVID-19的一个众所周知的危险因素，但其在LC的发展和严重程度中的作用仍未得到充分探讨。本研究旨在探讨感染前身体质量指数（BMI）与LC的关系，以及其对症状类型、严重程度和功能状态的影响。方法本病例对照研究纳入315例既往确诊为SARS-CoV-2感染的受试者。参与者根据世卫组织标准被分类为LC病例或对照。数据是通过在线自我报告调查收集的。在COVID-19之前，BMI被归类为体重不足、体重正常或超重/肥胖。使用新冠肺炎后功能状态（PCFS）量表评估功能损伤，使用模型检查相关性，调整潜在混杂因素。结果与体重正常的参与者相比，超重/肥胖的参与者与发展中的LC增加（OR 2.85; 95% CI 1.38-5.87）和中度至重度功能限制（OR 2.65; 95% CI 1.32-5.31）相关。肥胖还与出现特定LC症状的可能性较高相关，包括虚弱、呼吸困难、头痛、脑雾、焦虑和肌痛。体重过轻的状态显示出不太一致的关联。结论感染前肥胖是导致LC发生及其功能后果的独立因素。肥胖个体可被视为高危人群，应优先考虑公共卫生策略。

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引用次数: 0

The relationship between spirituality and resilience among families with mental illness in Indonesia 印尼精神疾病家庭的灵性与复原力的关系

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-10-08 DOI: 10.1016/j.cegh.2025.102192

Faizatur Rohmi , Arik Agung Setiawan

Background

Providing long-term home care for mental illness can be detrimental to the physical, mental, social, and spiritual health of the family and can impact family resilience.

Purpose

This study aims to identify the relationship between spirituality and resilience among families with mental illness.

Methods

This cross-sectional correlation study. Participants consisted of families of mentally illness patients registered with the Malang District Health Service. The inclusion criteria of the respondents, The sampling technique uses purposive sampling. Data were collected using demographic questionnaires, Spiritual Connection Questionnaire: SCQ-48, and Walsh Family Resilience Questionnaire. Pearson's correlation coefficient was applied for data analysis.

Results

A total of 125 families with mental illness participated in the study. Mean scores of spirituality, family resilience were 16.33 ± 4.5 and 39.89 ± 10.9. Pearson correlation showed a significant correlation between spirituality and resilience (r = 0.309, P = 0,001).

Conclusion

This study revealed that spirituality plays a role as a pillar in building resilience in families caring for people with mental illness, in addition this study revealed that spirituality can enhance healthy coping strategies, especially in uncertain situations when caring for patients.

为精神疾病患者提供长期的家庭护理可能对家庭的身体、心理、社会和精神健康有害，并可能影响家庭的恢复力。目的探讨精神疾病家庭成员的精神状态与心理弹性之间的关系。方法采用横断面相关性研究。参与者包括在玛琅区卫生局登记的精神病患者家属。调查对象的纳入标准，抽样技术采用目的性抽样。采用人口统计问卷、精神联系问卷（SCQ-48）和Walsh家庭弹性问卷收集数据。采用Pearson相关系数进行数据分析。结果共125个精神疾病家庭参与研究。精神、家庭弹性的平均得分分别为16.33±4.5分和39.89±10.9分。Pearson相关分析显示，精神状态与心理弹性之间存在显著相关（r = 0.309, P = 0.001）。结论本研究发现，在照顾精神疾病患者的家庭中，灵性在建立心理弹性中起着重要的作用，此外，本研究还发现，在照顾患者时，灵性可以增强健康的应对策略，特别是在不确定的情况下。

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引用次数: 0

Effectiveness and challenges of FAST implementation for tuberculosis case detection in Indonesian private hospital: A mixed-method study 印度尼西亚私立医院结核病病例检测FAST实施的有效性和挑战：一项混合方法研究

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-10-08 DOI: 10.1016/j.cegh.2025.102198

Merita Arini , Darsino Darsino , Ekorini Listiowati , Dono Widiatmoko

Objectives

Tuberculosis (TB) is a leading cause of infectious disease deaths globally, with Indonesia among the top three affected countries. This study evaluates the effectiveness, challenges, and enablers of implementing FAST (Find cases Actively, Separate safely, and Treat effectively) to control TB.

Methods

This study utilized an implementation research approach, employing a sequential explanatory design in a class B private teaching hospital in Central Java, Indonesia. The study included a retrospective data analysis of TB reports from January to December 2022, followed by qualitative exploration through observations, in-depth interviews, and focus group discussions with 12 healthcare workers (HCWs). Thematic analysis using a System Framework (structure-process-output) integrated with quantitative findings provided a comprehensive understanding.

Results

FAST implementation effectively improved TB case detection, with a strong association observed between its application and TB case finding rates (χ² = 108.052, df = 1, p < 0.001). Among 172,058 outpatient visits, 64,432 were screened via FAST, yielding 281 new TB cases (0.16 %). The FAST procedure demonstrated higher TB positivity with a Prevalence Ratio 2.59 (95 % CI: 2.15–3.13). Key enablers included leadership support, robust hospital policies, infrastructure and equipment readiness, adequate and skilled HCWs, and multisector collaboration. However, limited hospital information systems, lack of ongoing motivational sessions and training, multiple hospital entry points, and suboptimal community engagement hindered optimal implementation.

Conclusions

FAST effectively detects TB cases and shows potential for TB control in Indonesian private hospitals. A comprehensive and sustainable approach is crucial to ensure FAST implementation and follow-up of screening results through accurate diagnosis and timely treatment.

结核病（TB）是全球传染病死亡的主要原因，印度尼西亚是受影响最大的三个国家之一。本研究评估了实施FAST（积极发现病例、安全分离和有效治疗）以控制结核病的有效性、挑战和推动因素。方法本研究采用实施研究法，采用序贯解释设计，在印度尼西亚中爪哇省一家B类私立教学医院进行研究。该研究包括对2022年1月至12月的结核病报告进行回顾性数据分析，然后通过观察、深度访谈和与12名卫生保健工作者（HCWs）的焦点小组讨论进行定性探索。使用系统框架（结构-过程-输出）与定量结果相结合的专题分析提供了全面的理解。结果fast的实施有效提高了结核病病例检出率，其应用与结核病病例检出率之间存在很强的相关性（χ2 = 108.052, df = 1, p < 0.001）。在172,058次门诊就诊中，64,432例通过FAST筛查，产生281例新发结核病病例（0.16%）。FAST程序显示较高的结核阳性，患病率为2.59 （95% CI: 2.15-3.13）。关键促成因素包括领导支持、健全的医院政策、基础设施和设备准备、充足和熟练的卫生保健员以及多部门协作。然而，有限的医院信息系统，缺乏持续的激励会议和培训，多个医院切入点，以及次优的社区参与阻碍了最佳实施。结论fast能有效地检测出印尼私立医院的结核病病例，在结核病控制方面具有一定的潜力。通过准确诊断和及时治疗，确保快速实施和跟踪筛查结果，全面和可持续的方法至关重要。

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引用次数: 0

Exploring the decision-making process for trial of labour after caesarean: A qualitative study from a high-volume maternity care setting in Puducherry, South India 探索剖腹产后分娩试验的决策过程：一项定性研究，来自印度南部普杜切里的高容量产科护理设置

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-10-06 DOI: 10.1016/j.cegh.2025.102194

Bhabani Pegu , Jyothi Vasudevan , Latha Chaturvedula , Sonali Sarkar , N. Sreekumaran Nair , Anish Keepanasseril

Problem considered

Rising caesarean section rates, particularly repeat procedures, pose clinical and ethical concerns in low- and middle-income countries. Vaginal birth after caesarean (VBAC) presents a safe and viable choice for many women. However, decisions regarding trial of labour after caesarean (TOLAC) are influenced by more than just clinical criteria; personal experiences, social contexts, and the availability of information deeply shape them.it wa aimed to explore the perceptions, experiences, and decision-making processes of women considering TOLAC in a high-volume maternity care setting in Puducherry, South India.

Methods

A qualitative study was conducted using in-depth interviews with 17 postpartum women who had been evaluated for TOLAC. Thematic analysis was employed to identify the key domains that shape decision-making. Data were coded inductively and thematically framed through the lens of autonomy and informational agency.

Results

Five interconnected themes emerged: (1) Embodied Experience and Medical Memory; (2) Fear, Resolve, and Emotional Negotiation; (3) Cultural Scripts and Social Endorsements; (4) Provider Interactions and Health System Navigation; and (5) Digital and Peer-Based Information Seeking. Women navigated TOLAC decisions by reframing risk, interpreting medical advice, and balancing cultural and familial expectations. Their agency was influenced by social media, peer networks, and trust in healthcare institutions.

Conclusion

Women's decisions on VBAC reflect clinical considerations and emotional, cultural, and digital influences. Supporting person-centred maternity care in LMICs requires respectful dialogue, early counselling, and acknowledgement of women's evolving information environments and autonomy.

不断上升的剖腹产率，特别是重复手术，在低收入和中等收入国家引发了临床和伦理问题。剖宫产后阴道分娩（VBAC）为许多妇女提供了安全可行的选择。然而，有关剖腹产后试产（TOLAC）的决定不仅受到临床标准的影响；个人经历、社会背景和信息的可用性深深地塑造了他们。它的目的是探索的观念，经验和决策过程的妇女考虑TOLAC在普杜切里，印度南部的高容量产妇护理设置。方法采用深度访谈法对17例进行TOLAC评估的产后妇女进行定性研究。采用专题分析来确定影响决策的关键领域。通过自主性和信息代理的视角，对数据进行归纳编码和主题框架。结果出现了五个相互关联的主题：(1)具身体验与医学记忆；(2)恐惧、决心与情绪谈判；(3)文化剧本和社会背书；(4)提供者互动与卫生系统导航；(5)数字化和基于同伴的信息搜索。女性通过重新定义风险、解释医疗建议、平衡文化和家庭期望来引导TOLAC的决策。他们的代理受到社交媒体、同行网络和对医疗机构的信任的影响。结论女性对VBAC的决定反映了临床考虑以及情感、文化和数字的影响。在中低收入国家支持以人为本的产妇护理需要相互尊重的对话、早期咨询，并承认妇女不断变化的信息环境和自主权。

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