Frontiers in epidemiology最新文献

Background: Lower respiratory infections are the leading cause of paediatric morbidity and mortality. This study documents the incidence and etiology of influenza-like illness (ILI) among young children in rural eastern India.

Methods: We conducted a surveillance of ILI in children visiting paediatric clinics of two hospitals in District West Midnapore, West Bengal from April 1, 2022 to March 31, 2023. Nasopharyngeal swabs were collected from children 0-2 years of age with ILI and tested for influenza, respiratory syncytial virus (RSV), and SARS-CoV-2; a representative set for the respiratory panel.

Results: Of 9,923 outpatient children 0-14 years of age screened, 1,001 had ILI, of which 439 (44%) were in 0-2-year-olds. The ILI incidence was 439/4,310 [10.2% (95% CI: 9.29-11.1)] in the 0-2-year-olds, 288/2,473 [11.6% (10.4-12.9)] in >2-5-year-olds, and, 274/3,140 [8.7% (7.7-9.7)] in >5-14-year-olds. Of 390 enrolled children (median age: 12 months), viruses were identified in 23.3%, occurring singly (15%) or with other viruses (1.3%). RSV was the most common virus (12.6%), followed by influenza (6.6%) and SARS-CoV-2 (0.77%). Influenza subtypes included IA/H3 (50%), IA/H1N1pdm2009 (34.6%) and IB (15.4%). IA/H1N1pdm09 predominated during the 2022 monsoon, RSV during 2022 autumn and A/H3 and B during 2023 winters. Cough and difficulty breathing were associated with RSV. The major bacteria detected were Streptococcus pneumoniae (55.5%), Haemophilus influenzae (29%) and Moraxella catarrhalis (3.7%). Other viruses were parainfluenza virus 3 (4.4%), bocavirus (3.7%) and adenovirus (3%). Viral-bacterial co-detections were frequent (20%). Seventeen children required hospitalization, with difficulty breathing increasing hospitalization risk (OR = 4.47, 95% CI: 1.67-12). Children with RSV had increased odds of hospitalization (OR = 3.11, 95% CI: 1-9.26).

Conclusions: The majority of ILI was observed in children aged 0-2 years, with RSV and influenza as major viral causes associated with ILI. RSV increased the risk of hospitalization. These findings contribute to building the evidence base for maternal RSV immunization policy in India.

Background: Access to emergency care (EC) services is crucial for severe anaemia outcome. Limited information exists on the association between travel times to EC services and the presentation and severity of anaemia upon hospital admission. Here, we investigate the association between travel time and presentation of severe anaemia (compared to mild/moderate anaemia) at admission in western Kenya.

Methods: Data from January 2020 to July 2023 from Busia County Referral Hospital were assembled for paediatric admissions aged 1-59 months residing in Busia County. Travel time from a patient's village to the hospital was calculated using a least cost path algorithm. Anaemia severity was categorised as mild (Hb ≥ 7-<10 g dl^-1), moderate (Hb ≥ 5-<7 g dl^-1) and severe (Hb < 5 g dl^-1). We fitted a geostatistical model accounting for covariates to estimate the association between travel times to EC services and severe anaemia presentation.

Results: Severe anaemia admissions had the highest median travel time of 36 min (IQR: 25,54) (p-value: <0.001). Compared to children living within a 30 min travel time to the hospital, the adjusted odds ratio (AOR) of severe anaemia presentation relative to mild/moderate anaemia was 2.44 (95% CI: 1.63-3.55) for those residing within 30-59 min. For travel times of 60-89 min, the AOR was 3.55 (95% CI: 1.86-6.10) and for ≥90 min, the AOR was 3.41 (95% CI: 1.49-7.67).

Conclusion: Travel time is significantly associated with the severity of paediatric anaemia presentations at hospitals. Addressing disparities in travel times such as strategic bolstering of lower-level facilities to offer EC services, is crucial for implementing new interventions and optimizing existing hospital-linked interventions to enhance healthcare delivery.

We present Regional Psychologically Valid Agents (R-PVAs) as a modeling approach to predicting transmission-reducing behaviors and epidemiology. The approach builds upon computational cognitive theory and formalizes aspects of theories of individual-level behavior change. We present R-PVA models of social distancing and mask wearing in response to dynamics in the physical and information environments in the 50 U.S. states. The models achieve strong goodness-of-fits for predicting day-to-day mask-wearing (R ² = 0.93) and social distancing (R ² = 0.62) for the first three waves of COVID-19, prior to the rollout of vaccines.

Background: Multiple myeloma (MM) is a malignant hematologic disorder characterized by the abnormal clonal proliferation of bone marrow plasma cells and excessive production of immunoglobulins, often leading to severe organ damage. Due to its high incidence, recurrence, and death rates, MM poses a significant burden on individuals and global healthcare systems. This study leverages the latest data from the Global Burden of Disease Study 2021 (GBD 2021) to analyze the epidemiological trends of MM and propose effective preventive strategies.

Methods: Using data from GBD 2021, we analyzed the age-standardized incidence rate (ASIR), death rate (ASDR), and disability-adjusted life years (DALYs) of MM, evaluating temporal trends through estimated annual percentage change (EAPC). Pearson correlation analysis was employed to explore the relationship between age-standardized rates (ASRs) and the Sociodemographic Index (SDI). Additionally, frontier analysis was conducted. Finally, Bayesian age-period-cohort models were utilized to predict the trends of MM ASRs through 2040.

Results: In 2021, the global number of new MM cases was 148,755 (95% UI: 131,780.4-162,049.2), with 116,359.6 deaths (95% UI: 103,078.6-128,470.6) and 2,595,595 DALYs (95% UI: 2,270,483.6-2,889,968.2). Age-standardized rates increased with age. Between 1990 and 2021, the global burden of MM exhibited a consistent upward trend across all populations, with males and older adults bearing the highest burden. The analysis demonstrated a positive correlation between ASRs and the SDI. Frontier analysis indicated regions with medium-to-high SDI have the greatest potential for reducing ASRs. Among all risk factors, high body mass index (BMI) was identified as the most significant contributor to MM. Projections suggest that by 2040, the global burden of MM may experience a decline.

Conclusion: Driven by population aging and advancements in diagnostic capabilities, the global burden of multiple myeloma continues to rise. Targeted prevention and treatment strategies, particularly for elderly and high-risk populations, are essential to alleviate the disease burden and improve patient outcomes.

Introduction: Illicit alcohol, existing outside legal frameworks, lacks safety standards and may contain harmful substances. In Africa, the illicit alcohol market is pervasive, contributing to significant public health challenges. The state in Zambia may not be so different where abuse of alcohol was associated to unintended injuries, suicidal ideation and physical fights that in some cases lead to death. This mirrors these challenges; according to the Zambia Stepwise Survey for Non-Communicable Diseases (NCDs) Risk Factors (2017), 21.7% of adults consume alcohol, with urban areas experiencing higher rates of illicit production.

Aim: The study aimed to assess the public health risk implications associated with the production and retail of illicit alcohol based on the hygiene and sanitation of these premises. A quantitative approach was employed in Livingstone, Lusaka, and Ndola.

Methods: We employed a quantitative approach was conducted in Livingstone, Lusaka, and Ndola. A hygiene and sanitation observation tool obtained from the Lusaka City Council was adapted and utilized to evaluate the conditions of these premises.

Results: The study found that Livingstone exhibited the highest rate of unavailability of water supply at illicit alcohol production sites, with 18% lacking access to water, while Lusaka had 13% without water supply of the zones selected, all sites in Ndola had water supply.

Conclusion: Given the growing trend of consuming illicit alcohol in such unsanitary environments, urgent interventions are warranted. The study recommends the implementation of enforcement of regulations, including regular inspections and enhanced enforcement mechanisms, to ensure hygienic and sanitary production practices.

Background: Neighborhood disorder has been found to be associated with worse mental health outcomes, such as depression. This study examined the association between perceived neighborhood disorder on depressive symptoms in a nationally representative sample of Jamaican adults, and whether any association was mediated by perception of neighbourhood crime and safety problems or collective efficacy (CE).

Methods: Secondary analysis was conducted on the Jamaica Health and Lifestyle Survey (JHLS III). The JHLS III, a cross-sectional nationally representative survey, was administered to 2,807 individuals aged 15 years and older in Jamaica and completed in 2017. Regression analyses were performed to identify associations between perceived neighborhood disorder and depressive symptoms and mediation analyses to examine the roles of perceived neighborhood crime and safety problems and CE in the pathway between perceived neighbourhood disorder and depressive symptomatology.

Results: The odds of depressive symptomatology were 1.55 (95% CI = 1.14, 2.10) times as high among respondents living in neighborhoods perceived as having high disorder compared to those with low disorder. Partial mediation by perceived neighborhood crime and safety problems and low CE in the disorder-depressive symptomatology relation was observed. Twelve percent and 7% of the association between neighbourhood disorder and depressive symptoms were explained through perceived neighborhood crime and safety problems and low CE, respectively. In serial mediation analysis the association between perceived neighborhood disorder and depressive symptoms was mediated by perception of neighborhood crime and safety problems which, in turn, was mediated by reported CE.

Discussion: The pathway between neighborhood disorder and depressive symptoms may be reduced by intervening on reducing neighborhood crime and safety problems and/or improving CE in Jamaican neighborhoods.

Introduction: This systematic review and meta-analysis investigate the relationship between PM_2.5 exposure and increased influenza risk (e.g., increased hospital admissions, confirmed influenza cases), synthesizing previous findings related to pollutant effects and exposure durations.

Methods: We searched PubMed, Web of Science, and Scopus for relevant studies up to 1 January 2010, following Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines for selection and analysis.

Results: Our review included 16 studies and found that a 10 μg/m³ increase in daily PM_2.5 levels was associated with an increase of 1.5% rise in influenza risk (95% CI: 0.08%, 2.2%), with significant variations across different temperatures and lag times post-exposure. The analysis revealed heightened risks, with the most significant increases observed under extreme temperature conditions. Specifically, colder conditions were associated with a 14.2% increase in risk (RR = 14.2%, 95% CI: 3.5%, 24.9%), while warmer conditions showed the highest increase, with a 29.4% rise in risk (RR = 29.4%, 95% CI: 7.8%, 50.9%). Additionally, adults aged 18-64 were notably affected (RR = 4%, 95% CI: 2.9%, 5.1%).

Discussion: These results highlight PM_2.5's potential to impair immune responses, increasing flu susceptibility. Despite clear evidence of PM_2.5's impact on flu risk, gaps remain concerning exposure timing and climate effects. Future research should broaden to diverse regions and populations to deepen understanding and inform public health strategies.

Background: Intervention strategies such as health campaigns, pre-screening, health education, and health talks exist. Still, they are only active if there are outbreaks of the specific infectious disease not mainly NCDs. Therefore, there is a need to develop intervention strategies to improve the prevention and control of behavioral risk factors for NCDs by determining social, economic, and health system factors. Hence, the study aimed to determine the prevalence and determinants of behavioral risk factors contributing to NCDs in Bushbuckridge, South Africa.

Methods: This cross-sectional descriptive study involved 2,400 respondents selected from healthcare facilities. The participants were selected using simple random sampling. Data was analyzed using SPSS version 29. A comparison of proportions was performed using the chi-square test. The association between sociodemographic and lifestyle factors with predictors of behavioral risk factors for NCD was analyzed using binary regression analysis, and the statistical significance was set at a p-value of <0.05.

Results: The mean age of the study was 46.27 ± 13.38. The prevalence of Smoking was 51.3% (1,211). The prevalence of alcohol consumption within the past year was 19.3% (463), while inadequate fruit and vegetable intake was 76.2%. Physical inactivity was 97.2%. Additionally, hypertension and diabetes were 51% and 50.1% respectively. Participants (≥35 years) were likely to have low fruit and vegetable intake (aOR = 1.3; 95% CI: 0.99-1.62). Widows were 30% less likely to smoke (aOR = 0.72; 95% CI: 0.57-0.92), yet they were 1.4 times more likely to consume alcohol (aOR = 1.4; 95% CI: 0.99-1.84). Unemployed participants were found to have a higher likelihood of consuming alcohol (aOR = 1.3; 95% CI: 1.02-1.54).

Conclusion: The prevalence of behavioral risk factors for NCDs was found to be high among rural populations residing in Bushbuckridge, underscoring the need for sustained and comprehensive interventions. In rural areas like Bushbuckridge, the combination of poverty, unemployment, limited healthcare access, and evolving social dynamics creates a challenging environment that fosters unhealthy behaviors and increases the risk of NCDs. To effectively reduce the burden of these diseases in such communities, public health strategies must focus on socio-economic and cultural determinants, rather than just demographic factors.

Background: Urinary tract infections (UTIs) remain one of the most common diseases worldwide that occur both in the community and in healthcare settings. Thus, this study aimed to compare the burden of nosocomial and community-acquired bacterial UTIs among patients attending Hiwot Fana Comprehensive Specialized University Hospital, Eastern Ethiopia.

Method: A hospital-based cross-sectional study was conducted using a convenient sampling technique from January 2024 to April 2024. Descriptive statistics were employed, and bivariate and multivariable logistic regression analyses were used to identify associated factors at p < 0.05 with a 95% confidence interval (CI) considered statistically significant.

Results: The rate of hospital-acquired UTIs was 42% (95% CI: 35-50), while the rate of community-acquired UTIs was 28% (95% CI: 22-36). The predominant bacterial isolates were Escherichia coli (37%), Staphylococcus aureus (7.8%), and Klebsiella pneumoniae (7.8%). The overall multidrug resistance rate was 91 (77.8%). Lack of formal education [adjusted odds ratio (AOR), 0.02; 95% CI: 0.001-0.6], surgery during admission (AOR, 0.02; 95% CI: 0.002-0.3), delay in voiding urine (AOR, 0.01; 95% CI: 0.005-0.1), previous UTIs (AOR, 0.04; 95% CI: 0.004-0.4), and previous admission (AOR, 0.07; 95% CI: 0.01-0.5) were the main factors significantly associated with bacterial UTIs.

Conclusions: A significantly higher prevalence of hospital-acquired bacterial UTIs was observed compared to community-acquired bacterial UTIs. The commonest isolates were E.coli, S. aureus, and K. pneumoniae. The drug resistance rate was very high. Modifiable individual-level factors were the major significant factors of UTIs. Thus, health workers and other stakeholders should tackle UTIs by increasing community awareness, promoting personal hygiene, and improving healthcare service quality.

Background: Cholera is a highly contagious bacterial disease that causes severe watery diarrhea. It spreads mainly through contaminated food or water containing Vibrio cholerae O139 and remains a major global public health threat. We investigated an outbreak to identify its cause, source, and risk factors and to develop control measures.

Method: A suspected case was classified as the occurrence of acute watery diarrhea in a Dollo Ado District resident aged 2 or older between February 2, 2023 and March 15, 2023. A confirmed case was a suspected case with Vibrio cholerae detected in the patient's stool sample. An investigation of the outbreak was conducted; cases were described and the environment, where contamination may take place assessed and an unmatched case-control study conducted in Suftu Kebele, which served as the epi center of the outbreak. Logistic regression was used to identify risk factors for cholera infection.

Results: A total of 92 cases were identified, including 66 males and 26 females, with four deaths (4.3% fatality rate). Males had a higher attack rate (2.4 per 1,000 people) than females (1.6 per 1,000 people). Suftu village was the hardest-hit area (attack rate: 41 per 1,000 people). The outbreak began after a person suspected of having cholera returned from mandera, kenya, on February 2, 2023. Five days later, cases emerged in suftu village. Many residents practiced open defecation and used the dawa river for bathing, washing clothes, and drinking. Using untreated river water significantly increased the risk of infection (AOR = 20, 95% CI: 5.2-73).

Conclusion: The outbreak likely started at a funeral of a suspected cholera case, spreading through contaminated river water. It was contained within a week by restricting river water use and preventing further contamination.