High Prevalence Regions Research Articles

The behaviour of TB patients in East Lombok through a health belief model approach

BackgroundTuberculosis (TB) is a global health problem, including in Indonesia, with East Lombok as a high prevalence region. Although control programmes have been implemented, TB cases remain high. Patient behaviours that are less supportive of treatment, such as non-compliance and social stigma, pose a challenge to TB control efforts in this area. This study aims to explore the behaviour of people with tuberculosis (TB) in East Lombok using the Health Belief Model (HBM) approach.Participants and procedureThe method applied was a cross-sectional design, involving 112 respondents with TB who were registered at the Puskesmas. Data were collected through interviews using a questionnaire measuring components of HBM, including perceived vulnerability, severity, benefits, barriers, cues to action, and self-efficacy.ResultsThe analysis showed that perceived vulnerability (p = 0.022), perceived benefits (p = 0.006), perceived barriers (p = 0.045), cues to action (p = 0.004), and self-efficacy (p = 0.009) had a significant influence on the health behaviour of TB patients. Patients with high perceived vulnerability were 1.617 times more likely to adhere to treatment, while those with high perceived barriers were 31.6% less likely to adhere. Social support from family and health professionals also played an important role in improving adherence.ConclusionsFrom this study emphasise the need for interventions designed to increase positive perceptions and reduce perceived barriers, as well as consider the local social and cultural context to improve TB treatment adherence in East Lombok.

Importance of community awareness of the Nipah virus

Background: The Nipah virus (NiV), a zoonotic pathogen, poses a significant public health risk in high-prevalence regions like Bangladesh. The virus, transmitted primarily through fruit bats, can cause severe illnesses ranging from respiratory infections to fatal encephalitis. Given its high fatality rate and recurrent outbreaks, enhancing community awareness is crucial for effective prevention and control. This paper highlights the importance of community awareness in mitigating the spread of the Nipah virus and emphasizes the role of education in promoting preventive measures and early detection. Methods: The study reviews existing literature and case studies on community education initiatives, focusing on awareness campaigns in affected regions. The analysis covers strategies for disseminating information, addressing cultural barriers, and engaging local stakeholders to improve public health responses. Results: Community education efforts have shown promising outcomes, including early detection of symptoms, reduced transmission rates, and improved adoption of preventive practices such as avoiding raw date palm sap. Awareness programs involving local leaders and healthcare workers have been particularly effective in increasing knowledge and reducing stigma associated with the disease. Conclusion: Raising community awareness is a critical component of Nipah virus prevention strategies. Ongoing educational initiatives, integrated with broader health programs, can enhance public understanding and prepare communities to respond effectively to outbreaks. Investment in awareness campaigns is essential for building resilience against Nipah virus and other emerging infectious diseases.

Implementation of an Opt-out and Rapid Point-Of-Care Syphilis Testing Program for Pregnant Patients Presenting to the Emergency Department.

Adult and congenital syphilis rates are rising in the US. The aim of this pre- and post-implementation study was to determine whether implementation of an opt-out laboratory-based and rapid syphilis point-of-care testing program in the emergency department (ED) improves the detection and treatment of syphilis during pregnancy in a high-prevalence region. This pre-and post-implementation study was conducted at the University of Texas Health Science Center, Houston, TX. During the pre-implementation phase (11/01/2023 - 02/29/2024), pregnant patients presenting to the ED underwent lab-based syphilis testing using the reverse algorithm only when clinically indicated. In the post-implementation phase (03/01/2024 - 06/25/2024), pregnant patients without prenatal care or with no documented syphilis result underwent opt-out syphilis testing using the Syphilis Health Check (SHC) point-of-care test and the lab-based reverse syphilis testing algorithm. Patients with positive syphilis test results were treated by providers. All results were confirmed with the lab-based test and patient follow up was scheduled. During the pre-implementation period, 302 pregnant patients presented to the ED, and only 6 (2%) underwent syphilis lab-based testing, none of which yielded positive results. In the post-implementation period, 322 pregnant patients presented to the ED and 202 (62.7%) were approached. Of these, 114 (56.4%) were tested using either the SHC or lab-based reverse algorithm (p < 0.001). Four patients tested positive for syphilis, indicating a prevalence of 3.5%. An opt-out and rapid syphilis testing program for pregnant individuals visiting the ED increased syphilis screening from 2% to 56.4%, and detected syphilis that might have otherwise been missed.

Characterization and Implications of the Regionally Prevalent ST8333 Strains of Salmonella enterica Serotype 4,[5],12:i: - China, 2017-2023.

Salmonella enterica is a significant foodborne pathogen responsible for millions of infections and thousands of deaths worldwide each year. The increasing prevalence of the ST34 Salmonella enterica serotype 4,5,12:i:-(S. 4,[5],12:i:-) poses a substantial public health threat in China. At the end of 2023, the TraNet early-warning module, utilizing whole-genome sequencing data, identified a newly regionally prevalent sequence type of S. 4,[5],12:i:-, designated ST8333, primarily found in Sichuan Province. Analysis revealed high rates of antimicrobial resistance genes, particularly to aminoglycosides and β-lactams. Plasmid comparisons suggest that ST8333 isolates acquired multidrug-resistance plasmids of swine origin during their distribution in Sichuan Province. The emergence of ST8333, likely associated with pork consumption, underscores the importance of food safety measures. The high prevalence of multidrug resistance poses challenges for treatment and highlights the need for vigilant surveillance and control measures. Strengthening efforts in regions like Sichuan, identified as a reservoir for multidrug-resistant ST8333 strains, is crucial to prevent further transmission and potential nationwide dissemination. Surveillance and control measures are imperative to curb the spread of multidrug-resistant ST8333 isolates, particularly in high-prevalence regions.

Expression of anti-HBe in HBeAg and HIVp24 seropositive patients and its relation to antibodies against HIV-specific proteins in Warri, Nigeria

BackgroundCo-infection with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) poses significant clinical challenges, particularly in high-prevalence regions. The presence of anti-HBe antibodies can offer insights into immune responses and disease progression in co-infected patients.ObjectivesThis study aims to investigate the prevalence and clinical significance of anti-HBe antibodies in HBV and HIV co-infected patients in Warri, Nigeria, while analyzing their relationship with HIV-specific antibody profiles.MethodsA cross-sectional study involving 200 HBeAg and HIVp24 seropositive patients was conducted. Blood samples were analyzed for anti-HBe using ELISA, alongside assessments for HBeAg and HIVp24. HIV-specific antibodies were detected using Western blot. Data were analyzed using chi-square tests and logistic regression models (IBM SPSS 23.0).ResultsThe study enrolled 200 patients with dual seropositivity for HBeAg and HIVp24. Among these, 150 patients had confirmed HBeAg positivity, of whom 68 (45%) tested positive for anti-HBe. This presence was significantly associated with HIVp24 positivity (p = 0.04). Anti-HBe levels positively correlated with HIV-specific antibodies, with higher mean anti-HBe expression in patients with antibodies to gp120 (1.8 ± 0.4 AU/mL) and gp41 (1.7 ± 0.3 AU/mL). The odds ratio for anti-HBe presence with HIV-specific antibodies was 2.3 (95% CI: 1.5–3.5, p = 0.008).ConclusionThe findings indicate a prevalent presence of anti-HBe antibodies among HBeAg-positive HIV co-infected patients, highlighting significant correlations with HIV-specific antibodies. This underscores the complex immune interactions between HBV and HIV, emphasizing the need for integrated management strategies and the potential role of anti-HBe as a marker for disease progression.

Spatial-Temporal Distribution of 12-Year Periodontal Disease Prevalence in a Large Population Using Geographical Information Systems: A Longitudinal Study.

Periodontal diseases, commonly linked to dental biofilm and affecting adults, were studied using Geographic Information Systems (GIS) and Kernel Analyses with epidemiological data. This paper presents a hybrid method for use in epidemiological studies by evaluating the spatiotemporal distribution of disease prevalence. This study analy ed 47,757 patients from the Department of Periodontology out of 662,351 visitors to University Faculty of Dentistry (2012 to July 2023). The central districts of Kayseri in Turkey were selected as the study areas. Periodontitis prevalence was assessed through radiographic evidence and clinical examination. Point-based location data, including gender, age, and disease type, matched household data, creating building-based spatial data. Kernel Density (KD) and Average Nearest Neighbor (ANN) analyses examined patient concentration and disease types in specific regions. Accordingly, standard deviation ellipses were prepared by year to assess the spatial changes in the regions where patients resided. The study found higher periodontitis prevalence in males, increasing with age, while gingivitis decreased. After 2017, periodontitis prevalence notably declined. Location-based data exhibited clustering in patient distribution. KD maps showed similar patient distributions over the years, with more applications from areas closer to the Faculty of Dentistry. The spatial distribution of the patients applying has remained consistent over the last 5 years. Through GIS, KD maps reveal the spatial-temporal distribution of periodontitis patients. This aids in identifying high-prevalence regions and guiding strategic healthcare facility placement. Implementing preventive programs in high-demand areas, particularly in family health centers (local health facilities), can reduce community-wide periodontal disease prevalence.

Advances in Diagnostic Modalities for Helicobacter pylori Infection.

Helicobacter pylori (H. pylori) infection is a widespread global health issue with a varying prevalence influenced by geography, socioeconomic status, and demographics. In the U.S., the prevalence is lower, though certain groups, such as older adults and immigrants from high-prevalence regions, show higher rates. The decrease in infection rates in developed countries is due to improved sanitation, antibiotics, and healthcare, whereas developing countries continue to experience high rates due to poor living conditions. H. pylori infection can be asymptomatic or cause symptoms like dyspepsia, abdominal pain, bloating, nausea, and loss of appetite. Pathophysiologically, H. pylori contribute to conditions such as gastritis, peptic ulcers, and gastric cancer through mechanisms including urease production and the release of virulence factors, leading to chronic inflammation and an increased cancer risk. Diagnostic methods for H. pylori have progressed significantly. Non-invasive techniques, such as serological assays, stool antigen tests, and urea breath tests, are practical and sensitive. Invasive methods, including endoscopic biopsy and molecular diagnostics, are more definitive but resource intensive. Recent advancements in diagnostic technology, including matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), biosensor technology, and next-generation sequencing (NGS), promise improved speed, accuracy, and accessibility. These innovations are expected to enhance the detection and management of H. pylori, potentially reducing the global disease burden. This review aims to discuss these diagnostic modalities with a focus on further advances under investigation.

Risk factors of pulmonary tuberculosis in Indonesia: A case-control study in a high disease prevalence region.

Tuberculosis (TB) remains one of the most widespread infectious diseases in the world, with high mortality and morbidity rates, contributing to a significant disease burden, particularly in developing countries. The aim of this study was to determine the risk factors of TB among the population aged 17 years (late adolescent) and above in one of the high TB prevalence countries, Indonesia. A case-control study was conducted in Banda Aceh, Indonesia, involving newly diagnosed pulmonary TB patients who visited one of the eleven community health centers in Banda Aceh. The controls were individuals matched by age and sex who lived near the cases and had no TB infection. A total of 16 risk factors were assessed. Hierarchical multivariable logistic regression models were used to examine the association between the risk factors and the occurrence of TB. A total of 196 cases and 196 controls were included in the study. Multivariable logistic regression analysis identified 11 independent predictors for the occurrence of TB after controlling possible confounders. Patients who lived in houses with insufficient light exposure were 77 times more likely to develop TB compared to those living in houses with sufficient light exposure (adjusted odds ratio (AOR): 77.69; 95%CI: 27.09, 222.79). The study also showed that people who had close contact with TB patients (AOR: 25.39; 95%CI: 2.10, 306.52), had poor knowledge of TB (AOR: 24.2; 95%CI: 6.89, 85.17), had comorbidities (AOR: 4.49; 95%CI: 1.35, 14.89), insufficient food utilization (AOR: 3.41; 95%CI: 1.51, 7.71), negative preventive behavior (AOR: 3.39; 95%CI: 1.49, 7.72), low education level (AOR: 3.08; 95%CI: 1.26, 7.55), and insufficient housing humidity (AOR: 2.89; 95%CI: 1.18, 7.12) were associated with increased the odds of having TB. Being employed, having income above minimum wage, and having good nutritional intake were protective factors for developing TB. In conclusion, the determinants of TB among people aged 17 years and older are a clear indication of the need for TB prevention programs targeting not only individual risk factors but also environmental risk factors, particularly providing adequate housing conditions. This study provided useful information that might help to develop and adopt effective policies for TB control in Indonesia.

Farm management practices and host species richness associated with higher likelihood of tuberculosis positive farms in Western Spain

Despite enormous efforts, complete animal tuberculosis (TB) eradication has only been achieved in few regions. Epidemiological analyses are key to identify TB risk factors and set up targeted biosecurity measures. Here, we conducted an in-depth characterization of 84 extensive beef cattle farms from a high TB prevalence region in Western Spain, and assessed how farm management and wildlife presence on farms contribute to cattle TB risk. Twenty-six out of 84 variables were associated with cattle farm TB positivity. Farm management variables associated with TB positivity included older cattle, larger herd size, highly fragmented farm structure and greater connectivity between farms. TB-positive farms provided supplemental feed over a higher number of months, used calf feeders, and had higher number of waterholes. Detecting Eurasian wild boar (Sus scrofa), red fox (Vulpes vulpes), European badger (Meles meles), roe deer (Capreolus capreolus), or Egyptian mongoose (Herpestes ichneumon) on cattle farms was also associated with farm TB positivity. The best ordinal regression model indicated that in farms with a large herd size (> 167 animals) the odds of being positive or recurrently positive (versus negative) was 7.34 (95% CI = 2.43–23.51) times higher that of farms with small herd size. Further, for every additional host species detected in the farm premises, the odds of being TB-positive increased 56%. We conclude that both cattle management and wildlife need to be targeted for successful TB control in grazing-based farming systems.

Allelic frequency of pathogenic α1-antitrypsin variants in the Japanese population: Results from a survey of open Japanese genetic variation databases

α1-antitrypsin deficiency (AATD) is a hereditary disorder with a global prevalence that differs across regions. AATD is highly prevalent in Europe and North America but rarely found in Asian countries, including Japan, possibly because of the founder effect of the pathogenic SERPINA1 variants PI*Z and PI*S. However, AATD remains underdiagnosed even in high-prevalence and low-prevalence regions, possibly because of lack of awareness. In this study, we surveyed open Japanese genetic variation databases to estimate AATD prevalence in Japan. We identified allelic frequencies (AFs) of 5 among the 14 major pathogenic SERPINA1 variants from three datasets, collectively derived from 63,119 Japanese participants. The mean AF was determined to be 8.56 × 10−4 (95% confidence interval [CI]: 6.43 × 10−4 to 1.12 × 10−3). Given that this represents the entire Japanese population, one AATD patient was speculated to be born per 1.37 × 106 births (95% CI: 7.97 × 105 to 2.42 × 106) in Japan. Our results support the prevailing notion that AATD is extremely rare in Japan.

Pediatric keratoconus in a tertiary eye hospital in Eastern province, Saudi Arabia: Patient characteristics and management outcomes.

This study investigates pediatric keratoconus in a tertiary eye hospital in Eastern Province, Saudi Arabia, aiming to understand the presenting features and treatment outcomes in this high-prevalence region. The research addresses pediatric keratoconus clinical profile and management strategies. A retrospective cohort study was conducted from 2022 to 2023, reviewing medical records of pediatric keratoconus patients. Demographic data, clinical characteristics, risk factors, presenting symptoms, and treatment outcomes were recorded. Severity staging was performed based on Amsler-Krumeich's classification. The study included 218 eyes from 109 pediatric keratoconus patients, with 65% of male and 35% of female patients. Decreased vision was the most common symptom (92%), and risk factors included a family history of keratoconus (9%) and vernal keratoconjunctivitis (6%). Stage 1 was the most frequent in both age groups (<14 years and ≥ 14 years). Treatment strategies included corneal collagen cross-linking (CXL), hard contact lenses, corneal rings, deep anterior lamellar keratoplasty (DLK), and penetrating keratoplasty. Significant improvements were observed in visual acuity, refractive errors, and tomographic parameters following these interventions. This study provides valuable insights into pediatric keratoconus in Saudi Arabia, emphasizing the importance of early diagnosis and interventions for better outcomes. Larger, multicenter prospective studies are essential for a comprehensive understanding of pediatric keratoconus and its optimal management. The findings contribute to the knowledge base and guide future research to improve patient quality of life.

Adaptive and maladaptive pathways of COVID-19 worry on well-being: Across-national study.

In a preregistered study, we examined whether worries about COVID-19 are simultaneously linked with enhanced well-being through social interaction and with reduced well-being through depression symptoms. In August 2020, census-matched participants from high- and low-prevalence regions in the United States and Italy (N = 857) completed assessments of COVID-19 worry, social interaction, depression symptoms, and well-being. Worries about COVID-19 predicted both more social interaction and more depression (ps < 0.001). In multiple mediational analyses, an adaptive pathway of COVID-19 worry through social interaction was associated with higher well-being, whereas a maladaptive pathway through depression symptoms was associated with lower well-being. Further, a comparison of high and low COVID-19 prevalence regions replicated the mediational findings for social interaction, providing evidence against reverse causation and common method variance. Findings suggest that normative worries about acute stressors may both benefit and undermine well-being, depending on their impact on social behavior or depression symptoms.

Handheld echocardiography for the screening and diagnosis of rheumatic heart disease: a systematic review to inform WHO guidelines

Early detection and diagnosis of acute rheumatic fever and rheumatic heart disease are key to preventing progression, and echocardiography has an important diagnostic role. Standard echocardiography might not be feasible in high-prevalence regions due to its high cost, complexity, and time requirement. Handheld echocardiography might be an easy-to-use, low-cost alternative, but its performance in screening for and diagnosing acute rheumatic fever and rheumatic heart disease needs further investigation. In this systematic review and meta-analysis, we searched Embase, MEDLINE, LILACS, and Conference Proceedings Citation Index-Science up to Feb 9, 2024, for studies on the screening and diagnosis of acute rheumatic fever and rheumatic heart disease using handheld echocardiography (index test) or standard echocardiography or auscultation (reference tests) in high-prevalence areas. We included all studies with useable data in which the diagnostic performance of the index test was assessed against a reference test. Data on test accuracy in diagnosing rheumatic heart disease, acute rheumatic fever, or carditis with acute rheumatic fever (primary outcomes) were extracted from published articles or calculated, with authors contacted as necessary. Quality of evidence was appraised using GRADE and QUADAS-2 criteria. We summarised diagnostic accuracy statistics (including sensitivity and specificity) and estimated 95% CIs using a bivariate random-effects model (or univariate random-effects models for analyses including three or fewer studies). Area under the curve (AUC) was calculated from summary receiver operating characteristic curves. Heterogeneity was assessed by visual inspection of plots. This study was registered with PROSPERO (CRD42022344081). Out of 4868 records we identified 11 studies, and two additional reports, comprising 15 578 unique participants. Pooled data showed that handheld echocardiography had high sensitivity (0·87 [95% CI 0·76-0·93]), specificity (0·98 [0·71-1·00]), and overall high accuracy (AUC 0·94 [0·84-1·00]) for diagnosing rheumatic heart disease when compared with standard echocardiography (two studies; moderate certainty of evidence), with better performance for diagnosing definite compared with borderline rheumatic heart disease. High sensitivity (0·79 [0·73-0·84]), specificity (0·85 [0·80-0·89]), and overall accuracy (AUC 0·90 [0·85-0·94]) for screening rheumatic heart disease was observed when pooling data of handheld echocardiography versus standard echocardiography (seven studies; high certainty of evidence). Most studies had a low risk of bias overall. Some heterogeneity was observed for sensitivity and specificity across studies, possibly driven by differences in the prevalence and severity of rheumatic heart disease, and level of training or expertise of non-expert operators. Handheld echocardiography has a high accuracy and diagnostic performance when compared with standard echocardiography for diagnosing and screening of rheumatic heart disease in high-prevalence areas. World Health Organization. For the Chinese, French, Italian, Persian, Portuguese, Spanish and Urdu translations of the abstract see Supplementary Materials section.

Quality and safety actions in primary care practices in COVID-19 pandemic: the PRICOV-19 study in Spain

BackgroundPrimary Health Care (PHC) has been key element in detection, monitoring and treatment of COVID-19 cases in Spain. We describe how PHC practices (PCPs) organized healthcare to guarantee quality and safety and, if there were differences among the 17 Spanish regions according to the COVID-19 prevalence.MethodsCross-sectional study through the PRICOV-19 European Online Survey in PCPs in Spain. The questionnaire included structure and process items per PCP. Data collection was due from January to May 2021. A descriptive and comparative analysis and a logistic regression model were performed to identify differences among regions by COVID-19 prevalence (low < 5% or high ≥5%).ResultsTwo hundred sixty-six PCPs answered. 83.8% of PCPs were in high prevalence regions. Over 70% PCPs were multi-professional teams. PCPs attended mainly elderly (60.9%) and chronic patients (53.0%). Regarding structure indicators, no differences by prevalence detected. In 77.1% of PCPs administrative staff were more involved in providing recommendations. Only 53% of PCPs had a phone protocol although 73% of administrative staff participated in phone triage. High prevalence regions offered remote assessment (20.4% vs 2.3%, p 0.004) and online platforms to download administrative documents more frequently than low prevalence (30% vs 4.7%, p < 0.001).More backup staff members were hired by health authorities in high prevalence regions, especially nurses (63.9% vs 37.8%, p < 0.001. OR:4.20 (1.01-8.71)). 63.5% of PCPs provided proactive care for chronic patients. 41.0% of PCPs recognized that patients with serious conditions did not know to get an appointment.Urgent conditions suffered delayed care in 79.1% of PCPs in low prevalence compared to 65.9% in high prevalence regions (p 0.240). A 68% of PCPs agreed on having inadequate support from the government to provide proper functioning. 61% of high prevalence PCPs and 69.5% of low ones (p: 0.036) perceived as positive the role of governmental guidelines for management of COVID-19.ConclusionsSpanish PCPs shared a basic standardized PCPs’ structure and common clinical procedures due to the centralization of public health authority in the pandemic. Therefore, no relevant differences in safety and quality of care between regions with high and low prevalence were detected. Nurses and administrative staff were hired efficiently in response to the pandemic. Delay in care happened in patients with serious conditions and little follow-up for mental health and intimate partner violence affected patients was identified. Nevertheless, proactive care was offered for chronic patients in most of the PCPs.

Prevalence trends of anemia impairment in adolescents and young adults with HIV/AIDS

BackgroundAnemia is a common complication of HIV/AIDS, particularly in adolescents and young adults across various countries and regions. However, little is known about the changing prevalence trends of anemia impairment in this population over time.MethodsData on anemia in adolescents and young adults with HIV/AIDS from 1990 to 2019 were collected from the Global Burden of Disease. Prevalence was calculated by gender, region, and country for individuals aged 10–24, and trends were measured using estimating annual percentage changes (EAPC).ResultsGlobally, the prevalence of adolescents and young adults with HIV/AIDS increased from 103.95 per 100,000 population in 1990 to 203.78 in 2019. However, anemia impairment has decreased over the past three decades, with a global percentage decreasing from 70.6% in 1990 to 34.7% in 2019, mainly presenting as mild to moderate anemia and significantly higher in females than males. The largest decreases were observed in Central Sub-Saharan Africa, North America, and Eastern Sub-Saharan Africa, with EAPCs of -2.8, -2.34, and -2.17, respectively. Tajikistan (78.76%) and Madagascar (74.65%) had the highest anemia impairment percentage in 2019, while China (16.61%) and Iceland (13.73%) had the lowest. Anemia impairment was closely related to sociodemographic index (SDI) levels, with a high proportion of impairment in low SDI regions but a stable decreasing trend (EAPC = -0.37).ConclusionContinued anemia monitoring and management are crucial for patients with HIV, especially in high-prevalence regions and among females. Public health policies and interventions can improve the quality of life and reduce morbidity and mortality.

Persistent Global Burden of Stunting Among Children

Introduction: Childhood stunting is a critical indicator of chronic undernutrition, reflecting global challenges in poverty, food security, and health care, with variability highlighting the multifaceted nature of nutritional well-being. Objective: This study aims to provide a comprehensive overview of the global prevalence and trends of childhood stunting, elucidating the interplay of factors influencing its dynamics. Methods: A systematic review and analysis of epidemiological studies, meta-analyses, and health reports were conducted to compile a detailed table on the worldwide prevalence and trends of childhood stunting. Results: The collected data reveal a significant global burden of stunting, with notable disparities across regions, socioeconomic statuses, and age groups. Findings show a persistent high prevalence in regions like northwest Ethiopia and varied trends, with some areas achieving reductions in stunting rates due to effective interventions, while others witness stagnation or increases. Key associations were identified between stunting and factors such as low birth weight, socioeconomic status, and maternal health. The synthesis of recent studies indicates a critical ongoing public health challenge, particularly in Asia and Africa, where a significant proportion of children under five remain stunted. Discussion: The study underscores the complex interplay of demographic, socioeconomic, and environmental factors influencing stunting, highlighting the essential role of targeted and multifaceted public health interventions in mitigating this pervasive issue. Conclusion: Addressing childhood stunting necessitates a global commitment to integrated, evidence-based strategies focusing on the nutritional, health, and socio-economic determinants to ensure the well-being and growth of children worldwide.

Uncovering Risks Associated with Smoking Types and Intensities in Esophageal Cancer within High-Prevalence Regions in Africa: A Comprehensive Meta-analysis.

Tobacco is usually cited among the well-known risk factors of esophageal cancer; nevertheless, the extent of the contribution of the type of smoking and its intensity to the disease has not been comprehensively elucidated in Africa. We searched MEDLINE/PubMed, Excerpta Medica Database, Web of Science, Scopus, Cochrane Library, and African Journals Online studies published before September 2023. The quality of the studies was assessed using the Newcastle-Ottawa scale, and the funnel plot was used for assessing potential publication bias. Meta-analyses were conducted to estimate summary effects using random-effects models. This study included 22,319 participants from 27 studies. The results strongly indicate a significant association between tobacco use and a higher risk of esophageal cancer. The risk of esophageal cancer is notably higher among pipe smokers [OR = 4.68; 95% confidence interval (CI), 3.38-6.48], followed by hand-rolled cigarette smokers (OR = 3.79; 95% CI, 2.68-5.35), in comparison with those who smoked commercially manufactured cigarettes (OR = 2.46; 95% CI, 1.69-3.60). Our findings also showed that the risk of esophageal cancer is highest in people smoking >183 packs per year (OR = 5.47; 95% CI, 3.93-7.62), followed by those smoking 93 to 183 packs per year (OR = 3.90; 95% CI, 3.13-4.86), in comparison with those smoking ≤92 packs per year (OR = 2.90; 95% CI, 2.19-3.84). Our findings strongly show that among the different types of tobacco use in Africa, pipe and hand-roller smokers face a higher risk of esophageal cancer.

Clinical, phenotypic, and genotypic characteristics of ESBL-producing Salmonella enterica bloodstream infections from Qatar

BackgroundResistant Salmonella infections are a major global public health challenge particularly for multidrug-resistant (MDR) isolates manifesting as bloodstream infections (BSIs). ObjectivesTo evaluate clinical, phenotypic, and genotypic characteristics of extended-spectrum beta-lactamase (ESBL) producing Salmonella enterica BSIs from Qatar. MethodsPhenotypic ESBL Salmonella enterica from adult patients presenting with positive BSIs were collected between January 2019 to May 2020. Microbiological identification and characterization were performed using standard methods while genetic characteristics were examined through whole genome sequencing studies. ResultsOf 151 episodes of Salmonella enterica BSI, 15 (10%) phenotypic ESBL isolates were collected. Recent travel was recorded in most cases (80%) with recent exposure to antimicrobials (27%). High-level resistance to quinolines, aminoglycosides, and cephalosporins was recorded (80-100%) while meropenem, tigecycline and colistin demonstrated universal susceptibility. Genomic evaluation demonstrated dominance of serotype Salmonella Typhi sequence type 1 (93%) while antimicrobial resistance genes revealed dominance of aminoglycoside resistance (100%), qnrS1 quinolones resistance (80%), blaCTX-M-15 ESBLs (86.7%), and paucity of AmpC resistance genes (6.7%). ConclusionsInvasive MDR Salmonella enterica is mainly imported, connected to patients from high prevalent regions with recent travel and antimicrobial use caused by specific resistant clones. In suspected cases of multidrug resistance, carbapenem therapy is recommended.

Behavioral and cognitive factors influencing tick-borne disease risk in northeast China: Implications for prevention and control strategies

The growth in ecotourism and nature-based recreational activities in China has resulted in an increased frequency of visits to green spaces, thereby elevating exposure to ticks and the subsequent risk of tick-borne diseases. This study comprehensively investigate individual behavioral and cognitive factors associated with the risk of contracting tick-borne diseases to facilitate the development of effective prevention and control strategies, supporting public health initiatives in high-prevalence regions. We conducted an extensive questionnaire survey among 3000 residents from three northeastern provinces in China (Heilongjiang, Jilin, and Liaoning), where tick-borne diseases exhibit relatively high prevalence. The survey focused on gathering information regarding participants' tick bite history, perception of tick-borne disease risks, and outdoor activity patterns. Using structural equations analysis, we explored the pathways and strengths of the associations between these factors. Our findings revealed an average self-reported tick bite rate of 14% among the participants. Notably, tick-borne encephalitis exhibited the highest self-reported prevalence of infection (4%) among tick-borne diseases, while both Lyme disease and Severe fever with thrombocytopenia syndrome had a prevalence of 2%. The average rate of tick bites among respondents' pets was 14%, with bites predominantly located on the ears, back, and abdomen. The strongest correlation was observed between tick bite rate and subsequent infections, emphasizing its role as the primary contributing factors to infectious status. Moreover, our results indicated that the causal structure of tick-borne disease infections varied across different cities, underscoring the significance of considering the ecological environment and regional knowledge on ticks. This study provides valuable insights into the current landscape of tick-borne disease infections in northeast China and identifies potential behavioral and cognitive factors, an aspect that has not been previously investigated. Our findings enable predictions on the future impact of knowledge dissemination efforts and improved urban facilities on mitigating tick bites and reducing tick-borne disease infections.

The impact of urolithiasis on urology services in a high-prevalence region: A multicenter study

The impact of urolithiasis on urology services in a high-prevalence region: A multicenter study