Journal of Global Health最新文献

Female genital schistosomiasis (FGS) is one of the most neglected tropical diseases in the world, affecting over 56 million women and girls in Africa alone. It is a sequala of Schistosoma haematobium infection and is characterised by lesions on the cervix and other reproductive structures. Schistosomiasis and FGS are prevalent in women living in, migrating from, or traveling to Schistosoma haematobium-endemic countries. FGS is associated with significant morbidity, including adverse pregnancy outcomes. Unfortunately, imported schistosomiasis and FGS often remain undiagnosed or are diagnosed only at late stages of disease progression, months to years after arrival in non-endemic settings. This is due to limited diagnostic and screening test availability for schistosomiasis and an absence of awareness and guidelines to diagnose imported FGS, especially among sexual and reproductive health providers. Fragmented care pathways between infectious disease, travel/tropical medicine, and reproductive health services further contribute to missed diagnoses, while structural and social inequities due to migration status and stigma lead to barriers in FGS diagnosis and management.

Background: In 2012, World Health Organization (WHO) recommended outpatient oral amoxicillin for children aged 2-59 months with chest indrawing pneumonia without general danger signs, based on randomised trials. We assessed mortality and case management for such children routinely managed at primary healthcare centres (PHCs) in Lagos, Nigeria.

Methods: This prospective observational cohort study (September 2021-September 2023) was conducted in Ikorodu Local Government Area (LGA), nested within the Integrated Sustainable childhood Pneumonia and Infectious disease Reduction in Nigeria (INSPIRING) Lagos study across 16 PHCs. PHC healthcare workers (HCWs) trained in Integrated Management of Childhood Illness (IMCI) provided routine care, while INSPIRING staff independently assessed eligibility using IMCI criteria. The primary outcome was the 14-day case fatality rate (CFR) among children with chest indrawing pneumonia without general danger signs; secondary outcomes included antibiotic use, treatment adherence, and referral practices.

Results: PHC HCW identified 24 chest indrawing cases, while INSPIRING staff diagnosed 247 cases, including 19 of the 24 identified by PHC HCWs. Among those followed up (n = 16), the CFR was 6.3% (n/N = 1/16; 95% confidence interval (CI) = 0.2-30.2) for PHC HCW identified cases; with the same death identified by INSPIRING staff (n/N = 1/197; CFR = 0.5%). The single event in each cohort, and high loss to follow-up, imply that these CFR estimates are statistically fragile and should be interpreted as indicative only. Only 4% (n/N = 1/24) of children received routine care aligned with IMCI protocols. Of those prescribed antibiotics, 50% (n/N = 4/8) completed the full course, and just 1 of the 6 of referred children was admitted to hospital.

Conclusions: PHC HCWs rarely diagnosed chest indrawing pneumonia, and one-third of the patients were lost to follow up leading to a smaller than expected sample and therefore an imprecise CFR. Improving HCW capacity to identify and manage pneumonia, alongside strengthening IMCI implementation, is critical to reducing preventable child deaths in this setting.

Background: The COVID-19 pandemic has disrupted early childhood environments globally, raising concerns about its potential impacts on neurodevelopment. Although early childhood is a critical developmental period, large-scale evidence from South Korea - where strict social distancing and unique caregiving structures were in place - remains limited. We aim to evaluate age- and domain-specific neurodevelopmental outcomes among children aged 0-5 years before and during the pandemic, focusing on differences by age and sex.

Methods: We analysed children aged 0-5 years using data from a national health screening programme and a pre-post comparison design with repeated cross-sectional data. We compared the pre-pandemic (July 2018-March 2020) and pandemic (April 2020-December 2021) periods. We categorised children into infants (9-12 months), toddlers (18-36 months), and preschoolers (42-71 months). We measured developmental outcomes using the Korean Developmental Screening Test across six domains: gross motor, fine motor, cognition, language, social skills, and self-help. We conducted multivariable logistic regression and difference-in-differences analyses.

Results: We analysed 6 253 076 assessments from 2 797 459 children. Peer-level developmental status declined significantly during the pandemic across all age groups, with the most pronounced decrease among toddlers (adjusted odds ratio (aOR) = 0.92; 95% confidence interval (CI) = 0.91-0.92), followed by infants and preschoolers. The language domain experienced the greatest decline (aOR = 0.87; 95% CI = 0.86-0.88), whereas the gross motor domain showed significant improvement (aOR = 1.13; 95% CI = 1.11-1.15). Boys were more adversely affected than girls, particularly in gross motor and social skill domains.

Conclusions: The COVID-19 pandemic led to significant developmental declines among young children, particularly in language and social domains and among toddlers. Boys were more adversely affected than girls, especially in language and socioemotional skills, highlighting sex-related vulnerabilities. Prioritising early screening and interventions targeting these key domains, alongside sex-sensitive strategies and caregiver support, will be essential to mitigate developmental disruptions during future pandemics.

Background: This study aimed to assess the burden of early-onset cancers in China and the trends in their associated risk factors based on the latest cancer statistics.

Methods: We integrated and analysed data on 34 cancers in China from the Global Burden of Disease 2021 study and the Global Cancer Observatory 2022 project. The primary outcomes included age-standardised incidence (ASIR), mortality (ASMR), and disability-adjusted life years rates (ASDR), and the average annual percent change.

Results: In 2022, an estimated 743 688 new cases and 159 167 cancer-related deaths caused by early-onset cancers in China, with an ASIR of 98.37 per 100 000, and an ASMR of 21.40 per 100 000. Thyroid cancer, breast cancer, and cervical cancer were the most common cancers among female, while thyroid cancer, liver and intrahepatic bile ducts cancer, and trachea, bronchus, and lung (TBL) cancer were the most common cancers among male. Breast cancer, cervical cancer, and TBL cancer had the highest mortality rates in female, while liver and intrahepatic bile ducts cancer, TBL cancer, and colorectal cancer had the highest rates in male. From 1990-2021, the largest increases in ASIR, ASMR, and ASDR were observed for early-onset neuroblastoma and other peripheral nervous cell tumours, multiple myeloma, and kidney cancer. Smoking and high body mass index remained the primary risk factors contributing to disability-adjusted life years for most early-onset cancers.

Conclusions: Developing targeted health prevention strategies for specific cancer types and promoting healthy lifestyles could help reduce the burden of early-onset cancers in China.

Earthquakes are the deadliest natural hazards. While stronger building codes are essential for reducing their health impacts, achieving full compliance is a costly, long-term effort, particularly for low- and middle-income countries. We highlight low-cost, high-impact interventions across three areas that can complement building code implementation and significantly reduce risks. First, strengthening health emergency governance to ensure that lines of command and accountability are clear when a disaster strikes. Governments need response plans that outline actions, roles, and responsibilities, and enable coordinated action through emergency operations centres and incident command systems. Second, enhancing risk communication and community engagement is critical. Communities are often the first responders to seismic events. Training them in first aid and search and rescue, involving them in preparedness planning, and co-developing communication approaches ensure more tailored and actionable responses. Finally, improving international coordination can enhance the predictability and effectiveness of external support by establishing aid agreements, harmonising border-entry procedures, and ensuring staff are trained to work with and coordinate international Emergency Medical Teams. Governments and the international community should increase investments to limit the health impact of earthquakes, including through the outlined low-cost interventions.

Background: Tuberculosis (TB) remains a major public health challenge in China. Although meteorological factors are known to influence its transmission, their nonlinear and lagged impacts across regions and seasons remain unclear. We quantified these effects using the most detailed national data set available and explored how climate information can enhance TB prediction and control.

Methods: We conducted a nationwide ecological time-series study by integrating weekly TB surveillance data (2005-19) with high-resolution meteorological and air pollution models. We assessed associations between TB incidence and meteorological factors using negative binomial regression and distributed lag nonlinear models to account for nonlinear and delayed effects.

Results: From 2005 to 2019, TB cases in China decreased from 1.23 million to 0.75 million (estimated annual percent change <0 across all regions), with the burden remaining highest in western and southern China. Higher weekly mean temperature (incidence rate ratio (IRR) = 1.33) and precipitation (IRR = 1.03) increased TB risk, while greater temperature differences (IRR = 0.96) and relative humidity (IRR = 0.92) had protective effects. Temperature effects peaked in summer (IRR = 1.80; P < 0.05). Lagged analyses showed that extreme high temperatures and high wind speeds initially suppressed, but subsequently elevated TB risk, while higher precipitation and humidity showed delayed risk effects.

Conclusions: By integrating fine-scale epidemiological and meteorological data, our study adds to our knowledge on TB epidemiology by more accurately characterising climate-disease interactions and enhancing the predictive capability of risk models. The findings provide empirical evidence to support the development of risk stratification tools and guide the implementation of proactive, phased intervention strategies aimed at mitigating the persistent TB burden in high-risk regions.

Background: Suboptimal sleep and diabetes are major contributors to mortality. However, whether sleep patterns differentially affect mortality across glycaemic statuses remains unclear. This study examined associations of sleep patterns (sleep duration and sleep disorders) with all-cause mortality among individuals with normoglycaemia, prediabetes, and diabetes.

Methods: Data were obtained from the Taiwan MJ cohort, including 534 238 participants enrolled between 1996 and 2022. Sleep duration ('less than 6 hours', '6-8 hours', 'more than 8 hours') and sleep disorders (yes/no) were assessed via standardised questionnaires. Glycaemic status was classified as normoglycaemia, prediabetes, or diabetes. Mortality data were obtained from the Taiwan Death Registry. Cox proportional hazards regression models were employed to evaluate the association between sleep patterns and the risk of all-cause mortality.

Results: The study included 363 863 participants with normoglycaemia, 144 602 with prediabetes, and 25 773 with diabetes. Over a median follow-up period of 19 years, 52 208 deaths were recorded. Compared with those who slept 6-8 hours, normoglycaemia individuals who slept less than 6 hours had a higher risk of all-cause mortality (hazard ratio (HR) = 1.05; 95% confidence interval (CI) = 1.02-1.08) and those who slept more than eight hours had a higher risk of all-cause mortality across all glycaemic groups: normoglycaemia (HR = 1.19; 95% CI = 1.15-1.24), prediabetes (HR = 1.24; 95% CI = 1.19-1.30), and diabetes (HR = 1.29; 95% CI = 1.22-1.36). Sleep disorders were also associated with increased mortality among individuals with prediabetes (HR = 1.04; 95% CI = 1.01-1.07) and diabetes (HR = 1.07; 95% CI = 1.02-1.11).

Conclusions: Long sleep durations and sleep disorders were associated with increased mortality, especially among individuals with impaired glucose regulation while short sleep duration was discovered to associate with increased risk of mortality in people with normoglycaemia. These findings highlight the potential role of sleep assessment in risk stratification, although the observational nature of the study limits causal inference.

Background: The Mediterranean lifestyle (MEDLIFE) is generally considered to have a positive effect on several health outcomes. However, little is known about its impact on age-related eye diseases. We aimed to assess the effect of MEDLIFE on the risk of three such diseases: cataract, glaucoma, and age-related macular degeneration (AMD).

Methods: We included 113 829 participants from the UK Biobank who were free of age-related eye diseases at baseline and followed them up prospectively for disease occurrence. Adherence to MEDLIFE was assessed using 25 items, categorised under three blocks: 'Mediterranean food consumption' (block 1), 'Mediterranean dietary habits' (block 2), and 'physical activity, rest, social habits' (block 3). We used a Cox proportional hazard model to examine the associations of the MEDLIFE index and each of its blocks with incident age-related eye diseases.

Results: During a median follow-up of 10.5 years, 9954 cases of cataract, 1956 cases of glaucoma, and 1736 cases of AMD were identified. We noted an inverse association between the MEDLIFE index and new-onset cataract (P-value for trend = 0.005). A one-point increment in the MEDLIFE score was associated with a 1.5% (95% confidence interval (CI) = 0.7-2.3) reduction in the risk of cataract, and with a 2.4% (95% CI = 0.5-4.3) reduction in AMD incidence. Analysis of MEDLIFE blocks indicated that block 2 (hazard ratio (HR) = 0.97; 95% CI = 0.95-0.99) and block 3 (HR = 0.97; 95% CI = 0.95-0.99) were associated with lower risk of cataract. Block 2 was further related to reduced risk of AMD (HR = 0.95; 95% CI = 0.91-0.99). Although we found no association between the MEDLIFE index and incident glaucoma, block 3 was associated with lower glaucoma risk (HR = 0.94; 95% CI = 0.90-0.98).

Conclusions: Higher adherence to MEDLIFE was associated with decreased incidence of cataract and AMD, while the 'physical activity, rest, and social interactions' block was related to a lower risk of glaucoma. Our findings suggest that MEDLIFE may serve as a potential behavioural intervention for preventing age-related eye diseases.

Background: Despite substantial progress in maternal and child health (MCH) in China, achieving equitable outcomes across urban and rural areas remains elusive. To this end, this study investigated long-term trends in urban-rural disparities in maternal and child mortality rates in China from 1991 to 2023 and projected future trajectories for the 2024-30 period.

Methods: We obtained data on national, urban, and rural maternal mortality ratios (MMRs), under-five mortality rates (U5MRs), infant mortality rates (IMRs), and neonatal mortality rates (NMRs) for the 1991-2023 period from the National Bureau of Statistics of China. We analysed and predicted mortality rates during this period by utilising rate differences (RDs), rate ratios (RRs), average growth rates, and estimated annual percentage changes, along with the autoregressive integrated moving average model.

Results: From 1991 to 2023, the national MMRs declined from 80 per 100 000 live births to 15.1 per 100 000 live births. Over the same period, U5MRs decreased from 61.0‰ to 6.2‰, IMRs declined from 50.2‰ to 4.5‰, and NMRs declined from 33.1‰ to 2.8‰. During this period, urban MMRs decreased from 46.3 per 100 000 live births to 12.5 per 100 000 live births. Correspondingly, urban U5MRs declined from 20.9‰ to 3.9‰, IMRs declined from 17.3‰ to 2.9‰, and NMRs declined from 12.5‰ to 1.7‰. In rural areas, MMRs declined from 100 per 100 000 live births to 17.0 per 100 000 live births, while U5MRs declined from 71.1‰ to 7.2‰, IMRs declined from 58.0‰ to 5.2‰, and NMRs declined from 37.9‰ to 3.2‰. The RDs and RRs of MMRs, U5MRs, IMRs, and NMRs exhibited overall downward trends, while the autoregressive integrated moving average model predicted continued declines in mortality rates across the country, including in urban and rural areas, from 2024 to 2030.

Conclusions: China has achieved substantial progress in MCH, with mortality rates and disparities falling in both urban and rural areas, yet urban-rural disparities persist. Future MCH services should shift from broad coverage to precision quality improvement. These experiences also offer valuable insights for low- and middle-income countries (LMICs) undergoing rapid urbanisation, highlighting the importance of coordinated development of urban and rural health systems to achieve equitable and accessible health outcomes.

Background: The relationships among clinical hypothyroidism (CH), subclinical hypothyroidism (SCH), and intrahepatic cholestasis in pregnancy (ICP) remain unclear. We aimed to determine the relationship between hypothyroidism and the risk for ICP.

Methods: We conducted this retrospective cohort study at a tertiary care hospital. We used logistic regression analysis to study the risk of ICP, and restricted cubic splines to clarify the quantitative relationship between thyrotropin (TSH) or free thyroxine (FT4) and ICP. We used the Kaplan-Meier method and Cox regression to evaluate the relationship between hypothyroidism and the onset of ICP. Lastly, we checked the Cox proportional hazards assumption using the Schoenfeld residual test.

Results: We included 42 615 pregnant women in the final study. The risk of ICP was higher in the CH group (adjusted odds ratio (aOR) = 3.03; 95% confidence interval (CI) = 2.00-4.58, P < 0.001) than in the euthyroidism group. Thyroid peroxidase antibody (TPOAb)(+) CH was also significantly associated with the risk of ICP (aOR = 3.30; 95% CI = 1.92-5.68, P < 0.001). However, SCH was not significantly associated with the risk of ICP. Consistent results were observed in the subgroup analysis of ICP based on onset time and severity. Furthermore, reduced FT4 and elevated TSH levels had a dose-response relationship with ICP. Additionally, ICP occurred earlier in the TPOAb(+) CH subgroup than in other groups (log-rank P < 0.001; hazard ratio = 3.50; 95% CI = 2.05-5.98, P < 0.001).

Conclusions: We found that CH was significantly associated with a greater risk of ICP. CH, especially TPOAb(+) CH, is associated with a greater risk of both early and severe ICP. Furthermore, the prevalence of ICP increases with increasing TSH and decreasing FT4.