Journal of Global Health最新文献

Background: Hypertension-diabetes comorbidity (HDC) substantially increases the risk of cardiovascular and microvascular complications, yet population-based evidence from tropical island settings in China remains limited. This study estimated the prevalence of HDC among adults in Hainan Province and examined associated factors across sociodemographic, metabolic, and lifestyle domains.

Methods: We analysed data from the Hainan Province '2 + 3' health service package epidemiological survey, a population-based cross-sectional study conducted across all 24 administrative divisions from 3 November to 31 December 2022 using a two-stage disproportionate cluster sampling design. After prespecified data quality control and cleaning, 32 857 adults were included. Survey weights were applied to produce population-representative estimates, and survey-weighted multivariable logistic regression was used to identify factors associated with HDC.

Results: The weighted prevalence of HDC was 7.0%, higher in men (8.0%) than women (6.0%), and increased sharply with age (1.6% in 18-39 years, 7.7% in 40-59 years, and 18.5% in ≥ 60 years). In the fully adjusted model, female sex was inversely associated with HDC (adjusted odds ratio (aOR) = 0.64; 95% confidence interval (CI) = 0.55-0.74), while older age (40-59 years: aOR = 5.42; 95% CI = 4.29-6.85), (≥ 60 years: aOR = 16.37; 95% CI = 13.38-20.04) and Li ethnicity (aOR = 1.60; 95% CI = 1.20-2.14) were associated with higher odds. Overweight (aOR = 1.83; 95% CI = 1.63-2.06), obesity (aOR = 2.68; 95% CI = 2.28-3.15), and dyslipidaemia (aOR = 1.74; 95% CI = 1.58-1.92) were independently associated with HDC, whereas underweight showed an inverse association (aOR = 0.67; 95% CI = 0.52-0.86). Among participants with self-reported diagnosed hypertension and diabetes, 66.8% reported taking any blood pressure control measure and 36.9% reported taking any blood glucose control measure, respectively.

Conclusions: In tropical China, HDC affects a substantial proportion of adults and is strongly associated with male sex, older age, excess adiposity, and dyslipidaemia. The low uptake of diabetes control measures among diagnosed individuals highlights the need to strengthen integrated screening, follow-up, and chronic disease management in this setting.

Background: The COVID-19 pandemic disrupted country health systems and necessitated urgent actions to offset its effects on service provision, especially for vulnerable populations such as mothers and children. We aimed to analyse the experiences of healthcare workers in Burkina Faso and Mozambique, and the perceived effects of COVID-19 on reproductive, maternal, newborn, and child health (RMNCH) service provision and utilisation.

Methods: We conducted key informant interviews with healthcare workers involved in direct patient care and managerial positions in two provinces in Burkina Faso (Kadiogo and Boulkiemdé) (n = 33) and three provinces in Mozambique (Maputo City, Maputo Province, and Nampula) (n = 66). We audio-recorded, transcribed, and coded the interviews using a deductive and inductive coding approach. We analysed perceptions of RMNCH service disruptions and compared the results between the two countries. We used an inductive analysis method.

Results: The health systems in Burkina Faso and Mozambique reacted quickly and in a similar way to contain the COVID-19 pandemic. However, the adoption of COVID-19 activities and the implementation of rotational staff schedules may have slowed down the provision of services. Some services, such as antenatal care and child nutritional services, were limited. In both countries, respondents reported that unforeseen patient costs, such as for face masks, shortages in child medications, and fear from patients of getting COVID-19 virus at health facilities appeared to have hindered service utilisation.

Conclusions: The COVID-19 pandemic did not appear to have ceased the availability of or cause substantial disruptions to RMNCH services at health facilities in either country, but our findings showed that key informants perceived the pandemic did influence the reorganisation of health services, and the provision and utilisation of RMNCH services.

Background: The high incidence and economic burden of coronary heart disease (CHD) represent a major public health challenge in Xinjiang, a region in northwest China. We aimed to assess the effects of a diagnosis-related group (DRG) policy on treatment costs and treatment efficiency in Bortala Mongol Autonomous Prefecture, Kashgar, and Kizilsu Kirghiz Autonomous Prefecture of Xinjiang, China.

Methods: We retrieved data on CHD inpatients from three prefectures in the Xinjiang medical insurance database. Then, we used interrupted time series analyses to evaluate the effect of the DRG policy on these inpatients. The analysis spanned the period from 1 January 2022 to 31 December 2024, with the policy intervention point for each prefecture defined by its respective DRG implementation date. We divided patients into pre-DRG and post-DRG groups based on the timing of the DRG policy's implementation. The outcome variables for treatment costs were total cost, drug cost, medical supplies cost, and out-of-pocket (OOP) payments; the outcome variable for treatment efficiency was length of stay (LOS).

Results: Compared to the pre-DRG period, the total cost, drug cost, OOP, and LOS for CHD inpatients in three prefectures all decreased, with a growth rate (GR)<0. In contrast, the medical supplies cost in the Bortala Mongol Autonomous Prefecture and the Kizilsu Kirghiz Autonomous Prefecture increased (GR>0). Following the implementation of the DRG in Xinjiang, CHD inpatients in the Bortala Mongol Autonomous Prefecture saw a significant downward trend in drug cost (β₃ = -26.898; 95% confidence interval (CI) = -45.303, -8.493; P = 0.004), and their LOS decreased significantly in both level (P = 0.001) and trend (P = 0.034). The total cost for CHD inpatients in Kashgar showed a significant downward trend, and drug cost decreased significantly in both level (P = 0.003) and trend (P < 0.001). However, we observed no statistically significant differences in the remaining indicators of the two regions, or for all changes for CHD inpatients in the Kizilsu Kirghiz Autonomous Prefecture (all P > 0.05).

Conclusions: The DRG policy in Xinjiang has successfully controlled certain treatment costs and improved treatment efficiency for inpatients with CHD in the Bortala Mongol Autonomous Prefecture and in Kashgar. However, the implementation of DRG in the Kizilsu Kirghiz Autonomous Prefecture has not yet shown significant results and thus warrants monitoring and research.

Background: Tuberculosis (TB) remains a major public health challenge in China and worldwide, with smoking being a key modifiable risk factor. Given China's large population and rising smoking rates, this paper aims to examine the link between smoking and TB incidence.

Methods: We systematically searched six databases from inception for studies reporting smoking exposure, TB outcomes, and smoker-non-smoker comparisons. Two reviewers independently screened records, extracted data, and assessed bias. We analysed smoking-TB associations using random-effects meta-analysis of odds ratios (ORs) and hazard ratios (HRs).

Results: We included 17 studies reporting ORs and 7 studies reporting HRs in the quantitative synthesis. The pooled OR for TB incidence among smokers compared with non-smokers was 1.77 (95% confidence interval (CI) = 1.29-2.43), indicating a statistically significant increase in risk of TB. For studies reporting hazard ratios, the pooled estimate was 2.39 (95% CI = 1.28-4.45), showing a significant association between smoking and increased TB incidence.

Conclusions: Both active and passive smoking significantly elevate the risk of TB and worsen its outcomes in China. Our result indicate that COVID-19 pandemic may have indirectly exacerbated smoking-related risks through disruptions to TB services, heightened psychosocial stress, and shifts in smoking behaviours, with potential implications for TB risk and outcomes. Thus, integrating smoking cessation strategies into TB programmes, focusing on heavy smokers in especially high-prevalence areas, and raising public awareness could enhance efforts to prevent and control TB worldwide.

Registration: PROSPERO: CRD420251070123.

Background: Epilepsy is a common neurological disorder characterised by spontaneous seizures without an identifiable cause, leading to high morbidity and a significant public health burden. Understanding trends in its incidence, prevalence, mortality, and disability-adjusted life years (DALYs) is essential for developing effective prevention and treatment strategies. We aim to describe global trends in epilepsy over the past 32 years and explore the impact of sociodemographic index (SDI) levels on disease burden using the Global Burden of Disease 2021 data.

Methods: We analysed the global burden of epilepsy (1990-2019) using age-standardised rates (ASRs) and their 95% uncertainty intervals (UI). We assessed temporal trends with estimated annual percentage change and joinpoint regression. We used decomposition analysis to quantify the effects of population growth, ageing, and epidemiological shifts. Using the Pearson correlation, we examined the relationship between SDI and DALY rates. Additionally, we evaluated global disparities using the slope index of inequality and the concentration index. We used multidimensional health inequality analysis to identify the population with the highest disease burden. Lastly, we used frontier analysis to identify DALY gaps across 204 countries, and the Bayesian age-period-cohort model to predict future burden.

Results: The global burden of epilepsy decreased from 1990 (ASR = 208.1; 95% UI = 163.2, 260.3) to 2021 (ASR = 177.8; 95% UI = 137.7, 225.9). However, there was a gradual increase in incidence from 1990 (ASR = 38.1; 95% UI = 27.9, 49.5) to 2021 (ASR = 42.8; 95% UI = 31.2, 53.7) and prevalence from 1990 (ASR = 287.5; 95% UI = 215.7, 363.0) to 2021 (ASR = 307.4; 95% UI = 234.7, 389.0). The ASR of DALYs was negatively correlated with SDI (R² = 0.619; P < 0.001). Furthermore, a multidimensional analysis of health inequalities identified specific groups with a high disease burden. Frontier analysis identified countries and regions that require targeted interventions to address the burden. We projected that the ASDR will continue to decline, with rates dropping to 159.56 (95% UI = 102.26, 216.86) for males and to 109.32 (95% UI = 70.47, 148.17) for females by 2050.

Conclusions: We provide valuable insights into global trends and the burden of epilepsy, emphasising the need for targeted prevention and healthcare strategies across socioeconomic levels.

Background: Depression and anxiety are common comorbidities among people living with HIV (PLHIV) and may be influenced by sleep quality; evidence from Benin remains limited. We assessed the prevalence of depression and anxiety among PLHIV on antiretroviral therapy (ART) and evaluated their association with sleep quality.

Methods: We conducted a hospital-based cross-sectional study at Benin's National Teaching Hospital from December 2023 to February 2024. Adults on ART ≥ 6 months were randomly sampled from the clinic registry. Validated tools were used: Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7, moderate-or-worse threshold ≥ 10; Pittsburgh Sleep Quality Index, poor sleep > 5. Multivariable logistic regression identified factors independently associated with depression and anxiety.

Results: Among 312 participants (68.3% female; mean age 44.3 ± 12.3 years), the prevalence of depression and anxiety was 20.8% (n/N = 65/312) and 12.8% (n/N = 40/312), respectively; poor sleep quality was common (57.1%, n/N = 178/312). Good sleep quality was independently protective for both depression with adjusted odds ratio (aOR) = 0.3, 95% confidence interval (CI) = 0.2-0.6 and anxiety (aOR = 0.4; 95% CI = 0.2-0.9). Age ≥ 44 years was associated with higher odds of anxiety (aOR = 2.1; 95% CI = 1.0-4.5), while other sociodemographic and clinical covariates were not independently associated.

Conclusions: Moderate-or-worse depressive and anxiety symptoms are frequent among PLHIV in this setting, and sleep quality shows a robust independent association with both outcomes. Integrating routine mental-health and sleep screening with clear referral pathways within ART services is warranted; longitudinal and interventional studies should test whether improving sleep reduces symptoms and enhances ART outcomes.

Background: Air pollution is an environmental stimulus that may predispose pregnant women to postpartum depression (PPD). However, the relationship between maternal exposure to air pollutants and PPD is still unclear. Understanding the magnitude of this effect is critical to developing public health policies that protect women's reproductive health.

Methods: We searched all studies published in PubMed, Embase, Scopus, and Web of Science up to December 2024. The research protocol has been registered in PROSPERO. Test for homogeneity based on Cochran's Q and I² statistics was calculated, and the restricted maximum likelihood random effect model was applied. We assessed the overall quality of pooled estimates, the influence of single studies on the meta-analytic estimates, sources of between-study heterogeneity, and publication bias.

Results: Of the 7881 unique publications identified, nine studies met the inclusion criteria for final review, involving 405 635 pregnant women. We comprehensively assessed the available data on air pollutants and PPD risk. Maternal exposure to particulate matter diameter ≤10 μm (PM₁₀) increases the risk of PPD (pooled odds ratio (OR) = 1.08; 95% CI = 1.02-1.14, the whole pregnancy; pooled OR = 1.09; 95% CI = 1.03-1.15, the second trimester). Additionally, PPD was significantly associated with an increase of carbon monoxide (CO), nitrate ion (NO₃^-), and ammonium ion (NH₄⁺).

Conclusions: Maternal exposure to PM₁₀, CO, NO₃^-, and NH₄⁺ during pregnancy is associated with PPD occurrence, especially in the second trimester. Interventions to improve air pollutants may mitigate the maternal risks of developing PPD. Our findings support public health interventions and environmental policy reforms to protect maternal mental health.

Registration: PROSPERO CRD42024626359.

Background: In previous studies in low- and middle-income countries (LMICs), group antenatal care (gANC) has been shown to increase health facility delivery and enhance the care experience for both women and providers. Here, we investigate whether those benefits lead to improvements in postnatal outcomes.

Methods: We examine three time points of data on participation in the gANC programme as an independent variable to predict postnatal mother and newborn health outcomes using multivariate analysis and propensity matching techniques. This approach aimed to isolate the causal effect of the number of gANC meetings attended on the probability of postnatal healthcare checks for the mother and infant, modern contraception utilisation, and breastfeeding. To achieve this, we used inverse-probability weighting in addition to adjusted multivariate logistic regression models.

Results: We observed high retention at final follow-up and high attendance overall, with higher attendance associated with a variety of background and sociodemographic variables. Participants' attrition (under 24%) was well within power analysis assumptions. We found evidence of a strong positive relationship between greater gANC session attendance and mothers' postnatal health checks, breastfeeding initiation, and modern contraception utilisation. Adjustment for a set of sociodemographic and prior pregnancy- and delivery-related variables via inverse probability weighting suggested that a positive effect on these outcomes generally persists, especially at the highest levels of gANC session attendance.

Conclusions: The gANC programme at scale in Nigeria produced high levels of participation and resulted in positive postnatal outcomes among women who attended most of the meetings.

Background: China's sustained fertility decline has intensified population contraction and ageing. Following the rollout of the three-child policy, clarifying fertility intentions among the childbearing-age population and their determinants is crucial for effective policy design and fertility promotion.

Methods: We conducted a systematic search of PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang, China Science and Technology Journal Database, and Chinese Biomedical Literature Database. We included in the analysis studies published from 31 May 2021 to 10 May 2025 that examined third-child fertility intention (TCFI) and its determinants among the childbearing-age population in China. We used the Joanna Briggs Institute Critical Appraisal Checklist for cross-sectional studies to assess the quality of studies. Further, we estimated pooled prevalence with random-effects models.

Results: A total of 37 studies were included in the analysis (n = 113 009 participants). The pooled prevalence of TCFI and willingness to have another child (WHAC) were 7.6% and 12.7%. Factors associated with higher TCFI included age >35 years, male sex, education at or below high school level, monthly personal income >CNY 2000, ethnic minority status, having at least one non-only-child spouse, and having no pension insurance. For WHAC, remarriage and good self-assessed health were significant determinants.

Conclusions: Both TCFI and WHAC remain low in China's childbearing-age population. Enhancing childcare subsidies, strengthening medical security, and addressing core economic constraints such as housing and education may help raise fertility intentions.

Registration: PROSPERO: CRD420251036086.

Background: Globally, widowhood affects 258 million females, with India contributing 56 million individuals and 78% of spousal losses being women. Increased life expectancy and reduced mortality inequalities imply a rise in widowhood. Despite profound personal and societal consequences, granular demographic and temporal insights into widowhood in India are limited. This study provides estimates of widowhood prevalence and headcount disaggregated by age and gender at the sub-national level.

Methods: The complete case records of ever-married persons from five rounds of the National Family Health Survey (NFHS), between 1993 to 2021 were analysed. We estimate widowhood prevalence and headcount by age and gender across states and union territories. Integrated Public Use Microdata Series Population Weight (IPUMS POPWT) methodology was utilised to estimate the headcount. Additionally, Standardized Absolute Change (SAC) was estimated to quantify the change in percentage point of widowhood prevalence.

Results: Widowhood prevalence has remained relatively stable; however, the headcount has increased from 40 819 749 to 77 079 889 between 1993 to 2021 in India. At the state-level, the prevalence of widowhood has declined and converged, while its headcount has increased and diverged. Female widowhood prevalence has consistently remained higher, but a faster decline among females, primarily driven by an increased age at marriage. For instance, among females aged 65 years or above, prevalence of widowhood exceeds 50%. This shifts widowhood towards older ages for females, suggesting feminisation and rectangularisation of widowhood in India. A pronounced North-South divide persisted, influenced by differing sociocultural norms.

Conclusions: Widowhood prevalence is increasingly concentrated among older females across states in India. Given the multiple vulnerabilities faced by widows, it is imperative to gain insight from areas where widows survive for extended period after their spouse's death as well as areas, where widows have shorter lifespan such as the northern regions to meaningfully address their specific vulnerabilities.