Population-based Cross-sectional Survey Research Articles

What’s happening in the kitchen? The influence of nutritional knowledge, attitudes and, practices (KAP), and kitchen characteristics on women’s dietary quality in Ethiopia

BackgroundLow dietary quality significantly contributes to public health risks in low-income countries. This situation is particularly concerning for vulnerable groups, such as women and children, who are at increased risk of malnutrition due to inadequate access to proper nutrition. This study aimed to assess the influence of nutrition-related knowledge, attitudes, and practices, and kitchen characteristics on women’s dietary quality in Ethiopia.MethodA population-based cross-sectional survey was conducted from August to September 2022 in five regions and two city administrations in Ethiopia. A multistage stratified cluster sampling method was employed. From ninety-nine enumeration areas, twenty eligible households were selected. A total of 1,980 women aged 15–49 years were included in this survey. The data were collected using a structured questionnaire about socio-demographic characteristics, food frequency, 24-hour dietary recall, and nutrition-related knowledge, attitudes, and practices. The determinants of dietary quality were identified using Poisson, logistic, and ordinary least square regression analyses. Variables with a p-value less than 0.05 were considered to indicate statistical significance.ResultsThe results showed that the average dietary diversity score for women was 3.4 ± 0.85. Only 21.5% of the participants achieved the minimum dietary diversity for women (MDD-W), and the mean adequacy ratio for nutrients was 61.6%. The participants’ average nutrition-related knowledge, attitudes, and practices scores were 63%, 39%, and 23%, respectively. The regression analysis showed knowledge and attitude positively associated with dietary diversity and the mean nutrient adequacy ratio (P < 0.01). Cooking time and propensity to prepare new food were also positively associated with dietary diversity and with minimum dietary diversity (P < 0.01).ConclusionOur study showed that good nutrition-related knowledge and a positive attitude toward nutrition positively and significantly influence dietary quality, along with cooking time and the propensity to prepare new foods.

Inverse relationship of oxidative balance score with hyperuricemia among Chinese adults: a population-based cross-sectional study

BackgroundThe oxidative balance score (OBS) is a composite metric highlights pro-oxidants and antioxidants balance, representing the overall burden of oxidative stress. This study aims to examine the association between OBS and hyperuricemia in a Chinese population.MethodsThis study was based on population-based cross-sectional survey data of Fujian province from August 2020 to April 2021. OBS was determined based on 10 food and lifestyle OBS components. The association between OBS and hyperuricemia was investigated using logistic regression analysis. Subgroup analyses identified sensitive populations. Restricted cubic spline (RCS) was performed to examine the potential dose-response relationship.ResultsA total of 9464 participants were included in the final analysis. An inverse association between OBS and hyperuricemia was observed and remained after adjusting for potential confounders. Each additional unit of OBS was associated with a 4% and 7% reduction in the risk of hyperuricemia in men [OR: 0.96(0.94,0.99)] and women [OR: 0.93(0.90,0.96)], respectively. Participants in the highest quartile had a 22% and 37% lower risk of hypertension compared with the lowest quartile of OBS in men [0.78(0.62,0.97)] and women [OR: 0.63(0.49,0.79)], respectively. There were significant interactions between OBS and gender, hypertension, and dyslipidemia on hyperuricemia (Pinteraction < 0.05), except for age, education, and diabetes (Pinteraction > 0.05). A linear dose-response relationship between OBS and the risk of hyperuricemia (Pnonlinear = 0.7854) was observed.ConclusionsAn inverse association as well as dose-response relationship between OBS and hyperuricemia were observed. Increasing antioxidant levels through lifestyle modification may be an effective way to prevent hyperuricemia, especially in women. Large prospective cohort studies and randomized controlled trials are required to verify the effect of OBS on hyperuricemia and elucidate its causal mechanism.

Knowledge and Use of Menthol-Mimicking Cigarettes Among Adults in the US

Cigarette companies have been introducing synthetic cooling agent menthol-mimicking cigarettes into the US marketplace as menthol cigarette bans are implemented. These cigarettes may reduce the public health benefits of menthol cigarette bans. To examine the epidemiology of the use of synthetic cooling agent menthol-mimicking cigarettes among adults in the US. This population-based cross-sectional survey study of adults in the US (≥21 years) with oversampling of Asian, American Indian or Alaska Native, Black or African American, and Hispanic or Latino peoples was conducted from March to May 2024. Participants were recruited from an online panel using a sample-matching approach to achieve national representation. Data were weighted to be nationally representative. Descriptive statistics were used to summarize the population characteristics. Weighted prevalence of awareness of, ever use (among those aware), current use (among ever used), susceptibility (among noncurrent use), and likely to switch to synthetic cooling agent menthol-mimicking cigarettes were estimated overall and by covariate. Sequential weighted logistic regression models were used to estimate the associations between covariates and synthetic cooling agent menthol-mimicking-related outcomes (awareness, ever use, current use, susceptibility). Statistical analysis was performed from July to September 2024. Demographics, state menthol cigarette ban, cigarette smoking, and disclosure of synthetic cooling agent. Awareness of, susceptibility to, ever and currently using synthetic cooling agent menthol-mimicking cigarettes and intention to switch to these cigarettes if a nationwide menthol cigarette ban were enacted. The study population included 3200 US adults (47.4% men; 0.8% American Indian or Alaska Native, 5.9% Asian, 12.0% Black or African American, 16.0% Hispanic or Latino, 63.6% White, and 1.9% other race; 34.8% with a college degree; and 36.7% with annual household income of ≥$75 000). Overall, 29.1% (95% CI, 27.0%-31.1%) of US adults were aware of synthetic cooling agent menthol-mimicking cigarettes, 36.9% (95% CI, 33.1%-40.8%) of those aware ever used these cigarettes, 24.7% (95% CI, 20.1%-29.3%) of those who ever used reported currently using these cigarettes, and 37.5% (95% CI, 33.4%-41.6%) of those not currently using were susceptible to using them. Black or African American (vs White), men (vs women), adults aged 60 years or younger (vs adults aged ≥61 years), adults who used menthol and nonmenthol cigarettes (vs adults who did not smoke cigarettes), and those who lived in states with a menthol cigarette ban (vs those who lived in states with no ban) had higher odds of awareness, ever use, current use, and/or susceptibility to these cigarettes. Considering a national menthol cigarette ban, 50.8% (95% CI, 42.8%-58.7%) of adults who smoked menthol cigarettes and were aware of menthol-mimicking cigarettes with a synthetic cooling agent reported likely to switch to these cigarettes. Ever using these cigarettes was associated with the likelihood of switching (adjusted odds ratio, 2.61 [95% CI, 1.20-5.68]). In this survey study of US adults, a substantial proportion were aware of and had already experimented with synthetic cooling agent menthol-mimicking cigarettes. These products may serve as a substitute for menthol cigarettes and reduce the public health benefits of a menthol cigarette ban in promoting smoking cessation.

Exploring public support for novel tobacco and alcohol control policies in Great Britain 2021-2023: A population-based cross-sectional survey.

This study assessed support for novel tobacco compared with alcohol control policies among adults in Great Britain in 2021-2023. Objectives were to assess 1) overall level of support for tobacco compared to alcohol control policies; 2) level of support for tobacco compared to alcohol control policies among people who smoke tobacco or who consume alcohol at increasing and higher risk levels, or who do both; 3) level of support for tobacco compared to alcohol control policies among different sociodemographic groups? Data were collected in September/October 2021-2023 in a monthly population-based survey on smoking and drinking behaviour of adults across Great Britain (N=6311), weighted to match the overall population. Outcome measure was level of support for each seven tobacco and alcohol control policies. More people were in support of tobacco than alcohol control policies (e.g., 57% vs. 51% for tax-related policies). This trend was apparent across all sociodemographic subgroups. With one exception, the policies included in this study were supported by more than half of the participants. The exception was decreasing the visibility of alcohol products in shops, which received 41% of support. People who engaged in the behaviour targeted by policies (tobacco more so than alcohol use) were generally less supportive. Overall, public support for tobacco and alcohol control policies is high in Great Britain. With one exception, the policies were supported by over half of participants, suggesting that the public is in favour of government regulations to reduce smoking and drinking prevalence in Great Britain.

Ocular Injuries and Intimate Partner Violence: A Review of the Literature.

Intimate partner violence (IPV) is a leading cause of death and disability across the world. We sought to investigate the prevalence and clinical presentation of ocular injuries in IPV. Literature review revealed 16 published studies that evaluated ocular injuries in IPV, of which the study types included 9 retrospective studies, 2 prospective, 1 review, 1 invited commentary, 2 case reports, and 1 population-based cross-sectional survey. These studies suggest that 45% of IPV incidents involve ocular injury. Various injury types have been described including traumatic cataract, dislocated lens, retinal detachment, intraocular hemorrhage, orbital and zygomaticomaxillary complex fractures, optic nerve avulsion, and open globe injuries. Implementation of IPV screening programs in various clinical settings, including an emergency department evaluating ocular trauma, suggests a positive association with identification of IPV and improving access to resources. Within IPV, ocular injuries are a prevalent and important cause of vision loss. Various injuries have been reported affecting nearly every anatomical region of the eye. Routine screening for IPV among patients that present with ocular injuries and evaluating for visual complaints among patients experiencing IPV are both important. Future work focused on prospective studies and evaluation of screening techniques may be impactful.

Effect of a youth-led early childhood care and education programme on children's development and learning in rural Sindh, Pakistan (LEAPS): a stepped-wedge cluster-randomised implementation trial.

In low-income and middle-income countries, an estimated 181·9 million (74·6%) preschool-aged children do not receive adequate nurturing care in health, nutrition, protection, learning, and responsive care, thus jeopardising their healthy development across the life course. Working alongside the health sector, multisectoral actions including social protection and education are necessary to achieve child health and development outcomes. Innovations are needed to expand access to high-quality early childhood care and education (ECCE) for young children and opportunities for youth development. Youth Leaders for Early Childhood Assuring Children are Prepared for School (LEAPS) is a two-generation programme that trains female youth aged 18-24 years to deliver ECCE. We evaluated the effectiveness of LEAPS to improve children's school readiness when delivered at scale in rural Pakistan. We implemented a stepped-wedge cluster-randomised trial with three steps from Dec 3, 2018, to June 30, 2021. 99 villages (clusters) in four districts in rural Sindh, Pakistan, were randomly assigned (1:1:1) to introduce LEAPS across three steps. Eligible clusters were those that had a feeder primary school run by the National Commission for Human Development, a department of the Ministry of Federal Education and Professional Training; were safe; had space for a LEAPS preschool; could identify a female youth to deliver the ECCE service; and had not previously participated in the pilot study. Government partners trained female youth, aged 18-24 years, to provide community-based ECCE, enrolling up to 20 children, aged 3·5-5·0 years, per class. Population-based cross-sectional surveys were conducted at baseline and after each step for children who were eligible if they resided in the cluster, were aged 4·5-5·5 years at the time of the survey, and without any severe clinical health conditions or disability. The primary outcome was children's school readiness using the International Development and Early Learning Assessment (IDELA) composite score comprising emergent numeracy, emergent literacy, socio-emotional development, and motor skills. An intention-to-treat analysis was conducted, using linear mixed models accounting for clustering and the stepped-wedge design. The trial is registered with ClinicalTrials.gov (NCT03764436). LEAPS was implemented in 91 of 99 villages. In eight clusters, a LEAPS preschool could not be set up. For the intervention programme, the average enrolment of children in a LEAPS preschool was 19 (SD 3, range 12-20). A total of 3858 children (n=3852 with complete IDELA data) were assessed across the four survey rounds conducted between Jan 1, 2019, and March 31, 2021. LEAPS increased school readiness (standardised mean difference: 0·30 [95% CI 0·20-0·40]; p<0·0001) as compared with the control condition. LEAPS offers a scalable solution to expand access to high-quality ECCE and promote children's school readiness while providing employment for female youth in rural Pakistan and settings with similarly low ECCE participation. Dubai Cares; and Saving Brains, Grand Challenges Canada. For the Urdu translation of the abstract see Supplementary Materials section.

Exposure to physical, sexual and emotional violence and health-related factors among the adult population in the Faroe Islands.

The Faroe Islands is a small homogenous archipelago located in the North Atlantic Ocean with no prior study of violence among adults. In an adult population-based sample, we studied physical, sexual and emotional violence and health and socio-economic determinants. A population-based cross-sectional survey conducted between November 2020 and February 2021 was based on a newly initiated questionnaire that included 1068 randomly selected individuals aged 18-75. A total of 34.8% reported exposure to physical violence, 21.8% to sexual violence and 22.3% to emotional violence. A total of 12.6% of the women and 7.6% of the men reported exposure to all three types of violence. The consequences of childhood violence had a more significant effect on the subjects compared to adult-life violence. Additionally, individuals exposed to violence had significantly lower odds of achieving any educational attainment. Compared to men and after adjustments, women had 50% lower odds of exposure to physical (odds ratio=0.5, p<0.001) and more than three times the odds of exposure to sexual violence (odds ratio=3.1, p<0.001). The odds of emotional violence were sex independent, both unadjusted and adjusted. Moreover, exposure to violence showed a life-long negative impact.

Changes in child restraint practices in Shenzhen, China three years after the enactment of local legislation: two population-based cross-sectional surveys.

The enactment of child restraint systems (CRSs) legislation is highly effective in increasing CRS practices. However, evidence from low- and middle-income countries is still lacking. This study aimed to assess the changes in CRS practices in Shenzhen, China following the implementation of CRS legislation. Data from two cross-sectional surveys conducted in community health service centres and kindergartens 1 year before and 3 years after the enactment of mandatory CRS legislation in 2015 were used to assess the changes in CRS practices in Shenzhen, China. Temporal changes in CRS practices were investigated, and logistic regression models were performed to examine the differences in CRS practices 3 years after the legislation compared with the period before the legislation. The proportion of CRS possession and use increased from 27.8% (1047/3768, 95% CI: 26.4% to 29.3%) to 72.6% (4900/6748, 95% CI: 71.5% to 73.7%) and from 22.9% (864/3768, 95% CI: 21.6% to 24.3%) to 56.3% (3800/6748, 95% CI: 55.1% to 57.5%), respectively, with a decrease of appropriate CRS use from 75.9% (656/864, 95% CI: 72.9% to 78.7%) to 69.7% (2649/3800, 95% CI: 68.2% to 71.2%) after the implementation of CRS legislation. The findings indicate a significant improvement in CRS possession and use in Shenzhen, 3 years after the enactment of mandatory CRS legislation. Further efforts to update the local legislation to provide specific guidelines for appropriate CRS use and implement targeted multifaceted interventions are needed to increase optimal CRS practices for better child passenger safety in Shenzhen.

Service Delivery Redesign for Noncommunicable Disease Management: Assessment of Needs and Solutions Through a Co-Creation Process in Argentina.

In Argentina, the implementation of a national strategy to reduce the prevalence of noncommunicable diseases (NCDs) has been hampered by challenges at the provincial level. We aimed to design a new model of care for NCDs at the primary care level by conducting a multimodal system assessment and co-design of potential solutions in the province of Mendoza. We carried out a mixed-methods study with 7 components: evaluation of patterns of care, patient focus groups, cross-sectional standardized population-based phone survey, an electronic cohort follow-up of patients with type 2 diabetes, in-depth interviews with stakeholders, a knowledge test for health care providers on chronic condition management, and a Delphi consensus to provide recommendations from stakeholders. Focus group and in-depth interviews revealed access to primary health care for NCDs was associated with problems with long waiting times and time-consuming procedures for referral to laboratory tests, hospital care, and provision of medication. Mental health care services were particularly limited. Survey respondents (N=1,190) were predominantly covered through public (41%) or social security sectors (54%); 41% fell in the lowest income group. Contact with the health system was high (5.7 annual visits), but 19.7% reported unmet health care needs. Public sector providers perceived they provided high-quality care despite insufficient material and human resources. Within the social security sector, the main challenge was insufficient staff, particularly affecting mental health care. Health care providers showed a higher percentage of correct answers to depression-related questions, but worse results were seen in hypertension and diabetes care. Actions supported by evidence and expert agreement were identified for implementation to guide future system changes. Our research highlights the potential for Argentina's primary care system to initiate transformative, system-level changes aimed at improving health outcomes. We propose an innovative methodological assessment and co-design for improving primary care.

People living with chronic pain in Canada face difficult decisions and decisional conflict concerning their care: data from the national DECIDE-PAIN survey

BackgroundShared decision-making is an imperative in chronic pain care. However, we know little about the decision-making process, especially in primary care where most chronic pain care is provided. We sought to understand decisional needs of people living with chronic pain in Canada.MethodsWe conducted a population-based cross-sectional online survey of random samples of adults living in Canada with chronic noncancer pain and registered with the Leger Marketing panel. We followed the International Association for Study of Pain definition of chronic pain (i.e., persistent or recurrent pain lasting longer than three months). We used a stratified proportional random sampling based on the population and chronic pain prevalence of each province to achieve representativeness. Based on the Ottawa Decision Support Framework, we collected data on difficult decisions (i.e., decision with more than one option and no clear best option) related to their chronic pain condition, the level of decisional conflict associated with the most difficult decisions (i.e., Decisional Conflict Scale), the assumed and preferred role during the decision-making process (i.e., Control Preferences Scale), and respondents’ characteristics. We used descriptive quantitative analyses of survey responses.ResultsOf the 31,545 invited panellists, 2,666 met the eligibility criteria, and 1,649 respondents from the 10 Canadian provinces completed the survey. Respondents had diverse socio-demographic profiles. Mean age was 51.8 years (SD = 16.3). Half were men (51.4%), most lived in urban areas (87.8%), mean pain duration was 8.5 years (SD = 9.6), and respondents reported an average number of painful body regions of 2.3 (SD = 1.5). We observed that 96.7% of respondents faced at least one difficult decision across their care pathways. These difficult decisions were related to numerous issues from the medical consultation, diagnosis, treatment, and daily life. Almost half of respondents made their most difficult decision with a primary care physician. One third of respondents experienced a high level of clinically significant decisional conflict (Decisional Conflict Scale score ≥ 37.5). Two-thirds of respondents self-reported having a collaborative role during their decision while three-quarters wanted this role.ConclusionsPeople living with chronic pain in Canada have unmet decisional needs and need support to make optimal decisions to manage their chronic pain. Our findings will guide future development of interventions to implement shared decision-making, especially to support primary care where discussions about difficult decisions often occur.

The effects of long-term exposure to PM2.5 on health-related quality of life in adolescents: an empirical study from China

Health-related quality of life (HRQoL) is a health indicator that indicates the individual’s overall perception of physical, psychological, and social well-being. Air pollution potentially affects the individual’s HRQoL. However, the evidence about the effects of air pollution on HRQoL, particularly in adolescents, remains limited. This study explored the effects of air pollution exposure on adolescents’ HRQoL. Data were collected from a population-based cross-sectional survey conducted in Shandong Province of China. The Tobit regression model (Tobit-CF) combined with the control function (CF) based on instrumental variables was used as the main regression model, and causal mediation analysis was conducted to explore the mechanism with the time spent on outdoor activity (OA) as the mediator. The final analysis included a total of 266,138 adolescents with an average age of 13 years. This study found that long-term exposure to air pollution would impair the adolescent’s HRQoL, with the decrease in outdoor activities potentially serving as a mediator. Compared to males and older adolescents, females, and younger adolescents are more susceptible to experiencing HRQoL impairment induced by air pollution exposure. The empirical strategy used in this study also provides the reference and insight for future environmental health research to infer causality using cross-sectional data.

Association between Grit and Insomnia: A Population-based Study

BackgroundThis study aimed to investigate the association of the grit scale, a personality trait characterized by perseverance and passion, with both the presence and the severity of insomnia in the Korean adult population. MethodsA nationwide population-based cross-sectional survey was conducted through face-to-face interviews using structured questionnaires between September and December 2018 in Korea. Grit was assessed by using the 8-item Short Grit Scale. Participants were categorized into insomnia and non-insomnia groups based on a threshold of 10 on the Insomnia Severity Index (ISI). The association between girt and insomnia was analyzed using multiple linear regression and multivariable logistic regression, controlling for sociodemographic factors, lifestyles, and comorbidities. ResultsA total of 2,453 participants (49.9% male; aged 19 to 92 years) were enrolled in the study. Individual grit scores ranged from 1.75 to 5.00 points (mean [SD], 3.27 [0.42]), and insomnia was present in 16.5 % of the population. The insomnia group exhibited lower grit score compared to the non-insomnia group (3.11 [0.40] vs. 3.30 [0.42], p<0.001, Cohen’s d = 0.46). Grit was negatively associated with ISI scores (β = -0.15, 95% CI = -0.19, -0.11, p<0.001) and with having insomnia (OR 0.40, 95% CI = 0.30, 0.55, p<0.001), after controlling for covariates. ConclusionsIndividuals with higher grit were less likely to have insomnia. Clinicians should consider personality traits, such as grit, in the evaluation and the management of insomnia.

Population-Based Survey of Urinary Incontinence, Overactive Bladder, and Other Lower Urinary Tract Symptoms in Five Developing Countries: Results of the BEBIC Study.

This study aimed to assess the prevalence of urinary incontinence (UI) and lower urinary tract symptoms (LUTS) in five selected low and middle-income countries to provide appropriate evidence for other related studies. In this multinational population-based cross-sectional survey between August 2019 and April 2021, validated questionnaires were used to assess LUTS in adults over 18 years from Iran, Egypt, Bangladesh, Brazil, and Cameroon. A total of 1477 participants from five countries completed the questionnaires. The mean age of participants was 43.5 ± 15.7 years. 37.1% reported at least one episode of UI per week. UUI prevalence in different countries analysis showed that the commonest prevalence was reported in Cameron (40.0%; n = 30), while the lowest was 15.0% (n = 31) in Brazil. Stress UI was common in Iran (38.7%; n = 338), and Bangladesh had the lowest rate (7.8%; n = 16). Urinary urgency was the common LUTS among participants (59.9%, n = 818 out of 1477 participants). Nocturia was the other prevalent symptom among cases (50.6%; 748 out of 1477 cases), and this symptom had a higher rate in elderly populations. Men reported voiding and postmicturition symptoms more frequently than women. Storage symptoms except for nocturia, including frequency, urgency, and UI were common in women while voiding symptoms, including straining, and intermittency were reported more frequently in men than women. A high prevalence of urinary symptoms was reported in low to middle-income countries.

Acceptability of physiotherapists as primary care practitioners for the care of people with musculoskeletal disorders: a French population-based cross-sectional survey

ObjectivesIn France, early access to physiotherapy for people with musculoskeletal disorders (MSKDs) depends on prescription and referral by the family physician in the physician-led model of care. The readiness of French people for direct access to physiotherapy is not known. This survey aims to identify the perceptions of French adults regarding physiotherapists' competence to diagnose and manage MSKDs if they were primary care practitioners, confidence in their ability to provide quality care, and satisfaction with the last episode of care for those concerned; and to identify factors associated with these three variables. DesignFrench population-based cross-sectional survey. ParticipantsA representative sample of the French adult population was surveyed between June 2020 and September 2021. Outcome measuresCollected variables included previous physiotherapy experience, perception of competence to diagnose and manage MSKDs as primary care practitioners, confidence about quality of care, and self-referral preferences. Multivariate logistic regression analyses were performed to identify the factors associated with these three variables. ResultsA total of 1000 participants completed the survey; 854 (85%) believed that physiotherapists would be competent primary care practitioners, and 920 (92%) were confident about the quality of care. Most had previously consulted a physiotherapist (n = 823, 82%); of these, 762 (91%) were satisfied with care received. ConclusionThis large sample of French adults considered physiotherapists as competent to diagnose and treat some MSKDs as primary care practitioners, and that they provided quality care. Further studies should investigate the scope of care, safety, and efficacy of a direct access physiotherapy model. Contribution of Paper•Physiotherapists were considered competent as primary care practitioners.•Participants were satisfied with previous physiotherapy received.•Our results support the implementation of direct access physiotherapy in France.

High immunity and low mortality after Omicron and mass event in Cameroon despite low vaccination.

Little is known about the evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunity in African communities. We evaluated changes in anti-SARS-CoV-2 antibodies, mortality and vaccination status in Cameroon between August 2021 and September 2022 to begin describing the evolution of the pandemic in Africa. The study was conducted across Cameroon's 10 regional capitals, between 2021 and 2022 as the country hosted a mass gathering. We conducted a cross-sectional population-based survey in 2022, including SARS-CoV-2 seroprevalence testing and retrospective mortality estimation using two-stage cluster sampling. We estimated and compared seroprevalence and crude mortality rates (CMR) to a survey conducted in 2021 using the same methodology. We performed serologic testing on 8400 individuals and collected mortality data from 22 314 individuals. Approximately 5% in each survey reported SARS-CoV-2-vaccination. Rapid diagnostic test-based seroprevalence increased from 11.2% (95% confidence interval [CI]: 10-12.5) to 59.8% (95% CI: 58.3-61.2) between 2021 and 2022, despite no increase in the proportion vaccinated. The CMR decreased from 0.17 to 0.06 deaths per 10 000 persons per day between 2021 and 2022. In 2022, no deaths were reportedly attributable to COVID-19 as compared to 17 deaths in 2021. Over a 12-month period encompassing two waves of omicron variant SARS-CoV-2 and a mass gathering, SARS-CoV-2 seropositivity in Cameroon approached 60%, and deaths declined despite low vaccination coverage. This study challenges the assumption that high immunisation coverage is the sole determinant of epidemic control in the African context and encourages policymakers to increasingly rely on local research when designing response strategies for more effective outbreak management.

Population-based cross-sectional survey of cervical cancer screening prevalence and socio-demographic correlates in Bangladeshi women.

Cervical cancer, albeit preventable, is the second-most deadly gynecological cancer in developing nations. Little is known about cervical cancer among Bangladeshi women. This study aims to estimate the prevalence of cervical cancer screening and demographic correlates to identify potential variabilities in screening rates among different demographic groups and regions. This study used secondary data from the WHO STEPS 2018 Survey. We used Bayesian regression to perform the bivariate analyses between the outcome and each explanatory factor, as it generates more acceptable results and improves parameter estimates. The top-ranked socio-demographic factors were identified using a two-step cluster analysis. This method determines the relevance of predictor variables and automatically establishes the number of clusters. The prevalence of Bangladeshi women who had ever been screened for cervical cancer was 6.2%. In the adjusted model, women with the following socio-demographic factors had a higher likelihood of developing cervical cancer: being 18-29 years old (AOR = 3.3, 95% CI: 0.24, 15.27) or 45-59 years old (AOR = 2.8, 95% CI: 1.22, 6.0), currently married (AOR = 2.3, 95% CI: 1.36, 3.70), and employed (AOR = 2.4, 95% CI: 1.40, 4.06). Women in the Barisal division were found to have higher odds of being screened for cervical cancer (AOR = 21, 95% CI: 0.66, 121.97). Cluster analysis found residence status predisposes women to cervical cancer screening. There is a significant potential for substantial reductions in the burden of cervical cancer in Bangladesh by strengthening the application of cervical cancer screening. Future studies should examine how socioeconomic status, culture, and healthcare access affect cervical cancer screening trends for different divisions in Bangladesh. An independent national cancer registry is urgently needed to evaluate screening trends and outcomes.

Functional difficulty among children in Malaysia – findings from the National Health and Morbidity Survey (NHMS) 2019

IntroductionData on child functioning and disability are important for public policy development which aimed at reducing child disability prevalence and strengthening the provision of appropriate and timely health care services. This study reports the prevalence of functional difficulty in Malaysian children aged 2–17 years and its associated sociodemographic factors and epilepsy.MethodsData on children aged 2–17 years (n = 4576) were generated from the National Health and Morbidity Survey (NHMS) 2019, a population-based cross-sectional survey. Functional difficulty in children was assessed using the United Nations Children’s Fund (UNICEF)/Washington Group on Disability Statistics (WG) Child Functioning Module (CFM). The questionnaires were administered to the parents or guardians of the children via face-to-face interviews. Functional difficulty, defined as having difficulty in at least one domain, was examined for its prevalence and associations with sociodemographic variables and the epilepsy variable in children using descriptive analysis and multiple logistic regression.ResultsThe overall prevalence of functional difficulty among children aged 2–17 years was 4.7%. Multiple logistic regression analysis revealed that older children, children from households whose heads of household had a lower education level and children who have epilepsy were significantly more likely to experience functional difficulty (p < 0.05). Children of Chinese ethnicity were less likely to experience functional difficulty compared to children of Malay ethnicity.ConclusionsThis study provides baseline findings on the prevalence of functional difficulty among children in Malaysia using nationally representative data. Although the prevalence was relatively low, the information is important for the planning of strategies to improve the development and well-being of children in Malaysia and for achieving the Sustainable Development Goals (SDGs).

HIV Outcomes Among Women Living With HIV Who Experienced Early Sexual Violence Across Four Sub-Saharan African Countries.

Early experiences of sexual violence may influence HIV care and treatment outcomes among women living with HIV (WLHIV). We examined whether self-report by WLHIV of being forced into their first sexual experience was associated with awareness of HIV-positive status, being on antiretroviral therapy (ART) and being virologically suppressed. We conducted a secondary analysis using nationally representative, cross-sectional Population-based HIV Impact Assessment surveys from Lesotho, Malawi, Zambia, and Zimbabwe conducted from 2015 through 2017. Adjusted logistic regression models with survey weights and Taylor series linearization were used to measure the association between forced first sex and 3 HIV outcomes: (1) knowledge of HIV status among all WLHIV, (2) being on ART among WLHIV with known status, and (3) virological suppression among WLHIV on ART. Among WLHIV, 13.9% reported forced first sex. Odds of knowledge of HIV status were not different for WLHIV with forced first sex compared with those without (adjusted odds ratio [aOR], 1.17; 95% CI: 0.95 to 1.45). Women living with HIV with forced first sex had significantly lower odds of being on ART (aOR 0.74, 95% CI: 0.57 to 0.96) but did not have lower odds of virological suppression (aOR 1.06, 95% CI: 0.80 to 1.42) compared with WLHIV without forced first sex. While high proportions of WLHIV were on ART, report of nonconsensual first sex was associated with a lower likelihood of being on ART which may suggest that early life trauma could influence long-term health outcomes.

Motivators and Barriers of Seasonal Influenza Vaccine Uptake among Adults, Riyadh, Saudi Arabia

Background: Understanding the specific barriers for uptaking seasonal influenza vaccine, faced by different demographic groups, can lead to targeted communication strategies that resonate with the community’s values and beliefs.Objectives: To estimateof the rate of uptaking seasonal influenza vaccine in the last season and vaccine acceptance rate in the current season as well as defining motivators for uptaking as well as barriers for not uptaking the vaccine aamong adult general population.Subjects and methods: A cross-sectional population-based online survey was conducted among adult population of all natinalities, aged over 18 years and currently living in Riyadh city, Saudi Arabia. An electronic Arabic/English questionnaire was utilized for collecting data. It included four main sections: Socio-demographic, habitual and medical characteristics of the participants, awareness about the importance of seasonal influenza vaccine and source of information about that, attitude towards seasonal influenza vaccine, motivators and barriers of uptaking seasonal influenza vaccine.Results: A total of 361 participantss were included in the study. The age of almost a third of them (36%) ranged between 25 and 34 years whereas that of 9.7% was 65 years and above. Males represented 54.8% of the participants. Overall, 49% of the participants expressed neutral attitude towards seasonal influenza vaccine whereas 34.1% and 16.9% expressed either positive or negative attitude, resspectively. The commonly reported motivator to uptake the seasonal influenza vaccine was to prevent illness and reduce influenza complications (78.7%), followed by protection during Umrah and Hajj (37.1%), social responsibility and collective immunity (33.5%) and positive past experience with the vaccine (27.7%) while the most frequenmtly reported barriers of not to uptake the vaccine was fear of side effects (75.9%), followed by misinformation or myths (41%), prior negative experience with the vaccine (29.4%), perceived natural immunity (27.1%) and lack of knowledge or awareness (25.2%).Conclusion: Majority of adult population in Riyadh expressed either neutral or positive attitude towards seasonal influenza vaccine. The commonly reported motivator to uptake the seasonal influenza vaccine was prevention of illness and reduction of influenza complications while the most frequently reported barrier was fear of side effects.

Factors associated with the development, severity, and resolution of post COVID-19 condition in adults living in Canada, January 2020 to August 2022.

We aimed to characterize the burden of post COVID-19 condition (PCC) among adults in Canada and identify factors associated with its occurrence, severity, and resolution. We used self-report data from a population-based cross-sectional probability survey of adults in Canada conducted between April and August 2022. Incidence and prevalence of PCC were estimated using confirmed infections, as well as confirmed and suspected combined. Multivariable modeling using confirmed cases identified associated factors. As of August 2022, 17.2% (95% CI 15.7, 18.8) of adults with confirmed infections and 16.7% (95% CI 15.5, 18.0) of adults with confirmed or suspected infections experienced PCC, translating to 3.3% (95% CI 3.0, 3.6) and 4.4% (95% CI 4.1, 4.8) of all adults, respectively. Age less than 65years (aORs of 1.75 to 2.14), more pre-existing comorbidities (aORs of 1.75 to 3.57), and a more severe initial infection (aORs of 3.52 to 9.69) were all associated with higher odds of PCC, while male sex at birth (aOR = 0.54, 95% CI 0.41, 0.70), identifying as Black (aOR = 0.23, 95% CI 0.11, 0.51), and being infected after 2020 (aORs of 0.24 to 0.55) were associated with lower odds. Those residing in a rural area (aOR = 2.31, 95% CI 1.35, 3.93), or reporting a disability (aOR = 2.87, 95% CI 1.14, 7.25), pre-existing chronic lung condition (aOR = 5.47, 95% CI 1.85, 16.12) or back problem (aOR = 2.34, 95% CI 1.26, 4.36), or PCC headache (aOR = 2.47, 95% CI 1.60, 3.83) or weakness (aOR = 2.27, 95% CI 1.41, 3.68) had higher odds of greater limitations in daily activities, while males had lower odds (aOR = 0.54, 95% CI 0.34, 0.85). Two or more pre-existing chronic conditions (aHRs from 0.33 to 0.38), or PCC symptoms relating to the heart (aHR = 0.25, 95% CI 0.07, 0.90), brain fog (aHR = 0.44, 95% CI 0.23, 0.86), or stress/anxiety (aHR = 0.48, 95% CI 0.24, 0.96) were associated with a decreased rate of symptom resolution. Over the first two and a halfyears of the pandemic, a substantial proportion of infected adults in Canada reported PCC. Females and people with comorbidities were disproportionately impacted.