BMC Public Health最新文献

Background: Diabetes mellitus is a major public health concern in low- and middle-income countries, particularly in fragile health systems such as Afghanistan. Limited community-based evidence exists on the burden and correlates of diabetes among rural populations. This study aimed to estimate the prevalence of diabetes and identify its associated risk factors among adults living in rural areas of Herat province, Afghanistan, using the WHO Stepwise approach to noncommunicable disease (NCD) risk factor surveillance.

Methods: A community-based cross-sectional survey was conducted from January to December 2024 among adults aged ≥ 18 years residing in rural areas of Herat province. A multistage cluster sampling technique was applied following the WHO STEPS methodology. Data were collected on sociodemographic characteristics, behavioral and metabolic risk factors using standardized questionnaires, physical measurements, and fasting blood samples. Diabetes was defined as fasting plasma glucose ≥ 126 mg/dL or self-reported use of antidiabetic medication. Both bivariable and multivariable logistic regression analyses were performed to determine factors associated with diabetes, with adjusted odds ratios (AOR) and 95% confidence intervals (CI) reported.

Results: A total of 609 participants were included in the analysis (mean age: 40.6 ± 15.8 years; 51.9% were female). The overall prevalence of diabetes was 7.6% (95% CI, 5.6-9.9). In the multivariable analysis, age 45-54 years (AOR = 3.99; 95% CI: 1.31-12.16) and hypertension (AOR = 2.37; 95% CI: 1.29-4.36) were independently associated with diabetes. Education and central obesity were significant in bivariable analysis but lost significance after adjustment.

Conclusions: The prevalence of diabetes among adults in rural Herat province is considerable, highlighting an urgent need for community-level screening and preventive interventions prioritizing older adults and individuals with hypertension. Strengthening primary health care and integrating NCD surveillance in rural Afghanistan are essential to reduce the growing burden of diabetes.

Background: Syndromic surveillance systems leverage non-diagnostic data sources to enable the early detection of infectious gastroenteritis outbreaks. However, their use in high-income countries (HICs) remains underexplored. This scoping review explores published literature on syndromic surveillance for gastroenteritis outbreaks in HICs, focusing on the types of data used, their effectiveness, and reported outcomes.

Methods: A systematic search was conducted in PubMed, Embase, Scopus, and CINAHL for studies published from 2000 onwards. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Data extraction was conducted using a structured form adapted from the Joanna Briggs Institute (JBI) guidelines and the Centers for Disease Control and Prevention (CDC) framework for evaluating surveillance systems was used to systematically guide the extraction. Studies using diagnostic data or in-person healthcare visit data (e.g., GP or ED presentations) were excluded, in line with the syndromic surveillance purpose of early detection in HICs.

Results: Ten studies met the inclusion criteria. The most common data sources were over-the-counter (OTC) medication sales (n = 5) and telehealth consultations (n = 4), followed by web-based queries (n = 2) and school absenteeism reports (n = 1). OTC and telehealth data provided timely, sensitive, and representative outbreak signals. However, challenges (e.g., seasonal stockpiling, demographic variability) affected OTC sales, while shifts in health-seeking behaviour influenced telehealth data reliability. Web-based queries showed early warning potential but were limited by geographic and demographic biases. School absenteeism data were useful for child-focused settings but had reporting limitations. Most studies assessed timeliness and sensitivity, with limited evaluations of other key attributes such as representativeness, acceptability, and stability. No studies explicitly considered health-seeking behaviour as a rationale for data selection.

Conclusions: This scoping review underscores the potential of syndromic surveillance for detecting gastroenteritis outbreaks in high-income countries. While most data sources could provide a signal for early outbreak detection, the findings highlight the need for more comprehensive evaluations, improved data representativeness, and the integration of health-seeking behaviour considerations in syndromic surveillance system design. These areas should be the focus of future research to enhance the effectiveness of syndromic surveillance for gastroenteritis in high-income countries.