National Population-based Survey Research Articles

Incidence of First-ever Stroke, Stroke Events, and Early Case Fatality Rate in China: Results from a National Population-based Survey.

In recent years, stroke has become the leading cause of death in the Chinese population，and the burden of stroke is huge. The aim of this study is to describe the epidemiological characteristics of population-based stroke incidence and case fatality rates in China, which are nationally representative. In 2013, a nationally representative household survey was conducted at 155 survey sites in 31 provinces. All stroke cases occurring within 1 year before the start of the survey period, including first-ever and recurrent strokes, were considered event cases. According to computed tomography, magnetic resonance imaging, and autopsy results, stroke was classified as ischemic, hemorrhagic, subarachnoid hemorrhagic, or difficult-to-classify stroke. The 7- and 30-day case fatality rates after stroke onset were investigated. A total of 595,711 people were surveyed, with 2164 diagnosed stroke events and 1645 first-ever strokes. The age-standardized incidence of first-ever stroke and stroke event incidence in the Chinese population were 229.5 and 300.61 per 100,000 person-years, respectively. The world population age-standardized incidence of first-ever stroke and stroke events by the World Health Organization were 188.5 and 246.3 per 100,000 person-years, respectively. Among the 31 provinces, the top five incidence rates of first-ever stroke were recorded in Shannxi, Heilongjiang, Ningxia, Henan, and Tianjin (518.0, 400.8, 389.5, 366.6, and 344.0 per 100,000 person-years, respectively). The top five incidence rates of stroke events were documented in Heilongjiang, Shannxi, Henan, Tianjin, and Ningxia (672.7, 603.1, 580.2, 469.0, and 456.2 per 100,000 person-years, respectively). The 7- and 30-day case fatality rates were 14.3% and 17.8% for patients with first-ever stroke, respectively. Significant differences in the 30-day mortality rate of different stroke subtypes were recorded: 8.3% (95% CI, 8.2-8.5) for ischemic stroke, 44.4% (95% CI, 42.2-46.5) for cerebral hemorrhage, and 3.1% (95% CI, 3.0-3.3) for subarachnoid hemorrhage (P < 0.0001). Compared with the area of residence, the 30-day mortality rate of first-ever stroke in rural areas was 19.8% (95% CI, 19.3-20.3), which was higher than that in urban areas (14.9% [95% CI, 14.5-15.3]) (P = 0.011). In China, the incidences of first-ever stroke and stroke events are increasing, whereas the early case fatality rate is declining, which will inevitably lead to a higher stroke prevalence and a greater stroke burden. Therefore, the primary and secondary prevention strategies should be strengthened to reduce the incidence and burden of stroke.

How does mHealth benefit older Chinese adults' quality of life? Examining the roles of eHealth literacy, health motivation, and patient activation.

China is experiencing a rapid increase in its aging population, leading to the emergence of significant challenges to improve the quality of life (QoL) of older adults. The study aims to explore the potential benefits of using mobile health technology in improving the QoL for older Chinese adults. This study utilized a subsample of adults aged 60 and above from a cross-sectional, population-based national survey conducted among Chinese adults (N = 852). A moderated mediation analysis was conducted to investigate the impact of mHealth use on older Chinese adults' QoL, focusing on the mediating roles of eHealth literacy and patient activation and the moderating effect of motivation for health promotion and prevention. The results indicate that mHealth use directly enhances the QoL of older Chinese adults (β = .061, p < .001), and this effect is mediated by eHealth literacy and patient activation (β = .057, Boots 95% CI [.044, .072]). Furthermore, motivation for health promotion and prevention moderates the relationship between eHealth literacy and patient activation (β = .133, p < .001). These results demonstrate the positive impact of mHealth use on the QoL of older Chinese adults and reveal the underlying mechanisms involving mental and physical factors. These findings underscore the significance of increased attention to promoting mHealth use among older Chinese adults and provide a new way to enhance eHealth literacy and patient activation by encouraging the adoption of mHealth products.

Early employment after childbirth: a cross-sectional analysis using data from a national maternity survey in England.

Participation in paid work after childbirth may have important health and socioeconomic impacts on women and their families. We investigated women's employment patterns at six months postpartum and the factors that influence them. Using data from a 2018 population-based national maternity survey in England, employment status at six months postpartum was assessed. Logistic regression was used to explore sociodemographic and pregnancy- and birth-related factors associated with being in paid work by six months postpartum. Descriptive analysis was used to explore employment characteristics and motivations of women in paid work. Of the 4313 participants included, 7.7% were in paid work by six months postpartum. Factors associated with being in paid work were age≥35years [(adjusted odd ratios (aOR):1.37, 95% confidence interval (CI):1.02-1.84], not living with a partner (aOR:0.50, 95%CI:0.28-0.90), and pre-term birth (aOR:0.38, 95%CI:0.20-0.69). The most frequently reported motivation was financial need (76%), followed by wanting to work (41%). Financial need was associated with younger age, living in a more socioeconomically disadvantaged area, not living with a partner, and lower education level. Postpartum employment patterns and motivations for working vary according to sociodemographic characteristics. These findings have important implications for parental leave and childcare policies, which should be equitable across different groups.

Socioeconomic Variation in Tobacco Smoking Among the Adult Population in Ireland.

Differences in smoking prevalence across socioeconomic groups are a major driver of health inequalities. Although smoking prevalence continues to decline across most developed countries, socioeconomic inequalities in smoking still persist. While Ireland is among a small number of countries with a tobacco-endgame goal set to achieve a smoking prevalence of 5% by 2025, the challenge this presents by socioeconomic status is uncharted. We analyzed how differences in smoking status across various socioeconomic groups have changed over time in the adult population in Ireland. We used cross-sectional smoking data from the national population-based Healthy Ireland Survey for 2015-2022 (n = 52494). Educational attainment and area-based deprivation were used as socioeconomic indicators. Socioeconomic differences and changes in inequality over time were identified using the relative index of inequality (RII). Multinomial logistic regression was used to analyze the association between socioeconomic status and daily smoking, occasional smoking, former smoking, and never smoking with adjustment for sex, age, and survey year. We observed the highest daily smoking rates among the least educated (OR = 11.62; 95% CI = 9.91, 13.63) and individuals living in the most deprived areas (OR = 4.23; 95% CI = 3.55, 5.04). Additionally, we identified significant relative smoking inequalities over the observation period continued to increase, among the least educated (RII = 2.86, 95%CI = 2.63, 3.09) and individuals living in the most deprived areas (RII = 2.64, 95% CI = 2.36, 2.93). Despite generally reducing smoking prevalence, socioeconomic inequalities continue to widen among the smoking population in Ireland. As the tobacco endgame deadline of 2025 is fast approaching, this study highlights the urgent need to consider potential effects across the lowest socioeconomic status groups when implementing equity-oriented tobacco control policies.

Early employment after childbirth: A cross-sectional analysis using data from the National Maternity Survey in England

BackgroundEarly participation in paid work after childbirth may have long-lasting health and socioeconomic impacts for women and their families, yet there has been little research on women's early postpartum employment behaviours in England since the 2000s. We investigated women's employment patterns within six months of childbirth and the factors that influence them. MethodsUsing data from a population-based national maternity survey in England in 2018, employment status at six months postpartum was assessed. Descriptive analysis was used to explore employment characteristics of women in paid work. Logistic regression was used to explore sociodemographic, pregnancy- and birth-related factors associated with postpartum employment status. FindingsOf the 4313 participants included, 7·7% were in paid work within six months of childbirth. The most frequently reported motivation for being in paid work was needing the money (76%), followed by wanting to work (41%). The median time for (re)entering paid work was 17 weeks (IQR 13–26 weeks) and the median weekly hours worked was 24 (IQR 12–36 hours). The childcare option most frequently reported was the baby's grandparent(s) (47·8%), followed by spouses/partners (44·5%). Maternal age ≥35 years (compared to 30–34 years) was positively associated with being in paid work within six months of childbirth (aOR: 1·37, 95% CI 1·02–1·84), while not living with a partner (aOR 0·50, 95% CI 0·28–0·90), and having a pre-term birth (aOR 0·38, 95% CI 0·20–0·69) were negatively associated with being in paid work within six months. InterpretationThe low prevalence of women in paid employment within six months of childbirth aligns with recent downward trends. Factors associated with early postpartum employment show mixed patterns, however, which may reflect variation in financial pressures and opportunities. Our findings may assist policymakers when evaluating current and future family-based policies such as amendments to state-funded childcare and paid parental leave allowance. FundingThis research is funded by the National Institute for Health Research (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Maternal and Neonatal Health and Care, PR-PRU-1217-21202. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. GF is funded by a Clinical Research Fellowship awarded by the Nuffield Department of Population Health, University of Oxford.

Prevalence and Risk Factors of HIV Drug Resistance in Zimbabwe: Evidence from Zimbabwe Population-Based HIV Impact Assessment (ZIMPHIA) 2020 Survey.

(1) Background: HIV drug resistance (HIVDR) poses a significant challenge to the effectiveness of antiretroviral therapy and the overall management of HIVand AIDS. Understanding the predictors of HIVDR is critical for developing strategies to mitigate its impact. The objectives of this study were to identify the predictors of HIVDR among Zimbabwe Population-Based HIV Impact Assessment (ZIMPHIA 2020) study participants, a national population-based survey. (2) Methods: Data from people living with HIV who participated in the ZIMPHIA 2020 were used to determine the predictors of HIVDR. (3) Results: The prevalence of HIVDR was 44.9%. Acquired HIVDR was present in 76.1% of people with a virological failure and transmitted resistance is 22.6% in naïve individuals. Factors associated with HIVDR in adjusted analysis were the number of lifetime sexual partners (aOR = 1.03, 95% CI: 1.01-1.06, p = 0.017), each additional year since the first HIV positive result (aOR = 1.17, 95% CI: 1.09-1.25, p < 0.01), each additional year on ART (aOR = 1.14, 95% CI: 1.06-1.23, p = 0.001), initiating ART before 2014 (aOR = 3.08, 95% CI: 1.72-5.49, p = 0.020), ever had switched antiretrovirals (aOR = 2.47, 95% CI: 1.15-5.29, p = 0.020) or had ever had a viral load test (aOR = 2.54, 95% CI: 1.54-4.17, p < 0.001) and a CD4 count < 350 (aOR = 2.04, 95% CI: 1.48-2.83, p < 0.01), while age ≥ 50 (aOR = 0.56, 95% CI: 0.32-0.98, 32 p = 0.04), condom use at last encounter (OR: 0.49, 95%CI: 0.33-0.73, p < 0.001), and not being on ART (aOR = 0.09, 95% CI: 0.06-0.13, p < 0.01) were associated with reduced odds of HIVDR. Conclusions: HIVDR was high among the participants. There is a need to address HIVDR and enhance the mechanisms already in place. This study introduces more information that would help in developing targeted interventions to prevent HIVDR and improve patient outcomes.

Prevalence of adults with fatigue in Germany: results of the ‘German Health Update 2023’ study

Abstract Background Fatigue is a non-specific symptom complex associated with exhaustion, lack of motivation and concentration. It has high public health relevance due to impairments in quality of life and work ability and increased risk of accidents. Fatigue has increasingly gained attention as one of the most common post-acute consequences of SARS-CoV-2 infection. Fatigue is also common among non-infected people and there is a lack of population-based background data. Therefore, we investigated the prevalence and factors associated with fatigue in a population-based epidemiological study in Germany. Methods The analyses are part of the national population-based cross-sectional telephone survey ‘German Health Update’ (GEDA 2023) in adults (3/2023-2/2024). Fatigue was surveyed using the Fatigue Assessment Scale (FAS) and dichotomized into yes (at least mild/moderate) versus no fatigue. The FAS is an instrument for mild-to-moderate fatigue, which must be distinguished from chronic fatigue syndrome (CFS). Weighted analyses of the data from 9,766 adults were carried out descriptively and in multivariable Poisson models, considering sociodemographic and health-related determinants. Results The prevalence of fatigue in Germany was estimated to be 29.7% (95% CI 28.1-31.2) and was highest in 18- to 29-year-olds at 39.6% (35.0-44.4). The prevalence decreased up to 65- to 79- year-olds (20.6% (18.2-23.3)) and was again higher in people aged 80 and over (33.2% (28.9-37.7)). Women had a higher risk of fatigue than men (aRR 1.19 (1.08-1.32)). Lower education (aRR 1.29 (1.13-1.49)) and medium education (aRR 1.13 (1.01-1.27)) were associated with increased risk of fatigue. There were significant associations between fatigue and chronic illness, depressive symptoms and long COVID. Conclusions Fatigue is a common symptom among adults in Germany. Female gender, young and very old adulthood as well as lower education are associated with higher risk of fatigue. Key messages • The correlations between fatigue and socio-demographic variables as well as parameters of physical and mental health provide important indications of groups particularly affected by fatigue. • The fatigue survey in GEDA 2023 is one of the few current European studies that describe the frequency of fatigue in the general population and analyzes health and sociodemographic determinants.

Assessment of intention to use modern contraceptives among women of reproductive age in Benin: evidence from a national population-based survey

BackgroundWomen’s intentions to use any contraceptive method are critical for better understanding their future needs and making them more likely to act on that intention. This study assessed the factors associated with the intention to use modern contraceptives among women of reproductive age in Benin.MethodsThis was a cross-sectional study that used the 2017–2018 Benin Demographic and Health Survey (BDHS). The study analyzed a weighted sample of 13, 582 women of reproductive age who were non-users of contraceptives. The intention to use contraceptives was the outcome variable. Multivariate logistic regression analysis was conducted to determine the factors associated with the intention to use contraceptives among women of reproductive age. The results were estimated using an adjusted odds ratios (aOR) with a 95% confidence interval (CI) and statistical significance set at p < 0.05. ResultsApproximately 35.0% of the women had the intention to use modern contraception. We found that women aged between 30 and 34 (aOR = 0.70, 95%CI: 0.57, 0.86), 35–39 (aOR = 0.52, 95%CI: 0.42, 0.66), 40–44(aOR = 0.30, 95%CI: 0.22, 0.39) and 45–49 (aOR = 0.10, 95%CI: 0.07, 0.14), Muslim women (aOR = 0.68, 95%CI: 0.53, 0.85) and those who perceived the distance to a health facility not to be a big problem (aOR = 0.75, 95%CI: 0.67, 0.84) were less likely to have the intention to use modern contraceptives compared with their counterparts. On the other hand, women who attained primary (aOR = 1.21, 95%CI: 1.07, 1.36), secondary (aOR = 1.39, 95%CI: 1.21, 1.59), and higher education (aOR = 1.60, 95%CI: 1.13, 2.26), women who were employed (aOR = 1.39, 95%CI: 1.23, 1.57), women with no religion (aOR = 1.32, 95%CI: 1.04, 1.69), women whose partners were working (aOR = 1.69, 95%CI: 1.16, 2.44), women who heard about family planning in the media (aOR = 1.51, 95%CI: 1.16, 2.44), and women in the poorer (aOR = 1.31, 95%CI: 1.10, 1.54), middle (aOR = 1.42, 95%CI: 1.20, 1.67]), richer (aOR = 1.23, 95%CI: 1.03, 1.47), and richest households (aOR = 1.42, 95%CI: 1.15, 1.75) were more likely to have the intention to use contraceptives than their counterparts.ConclusionThe study provides valuable insights into the intention to use contraceptives among women of reproductive age in Benin. The findings indicate that the proportion of women who have intention to use contraceptives remains low. The findings of this study could inform the development of targeted interventions and policies to increase access to and uptake of contraceptives in Benin, with the ultimate aim of improving the reproductive health and well-being of women and their families.

Dietary diversity among women with depressive and generalized anxiety symptoms in Nepal

This study sought to determine whether there was any correlation between the dietary diversity score and symptoms of major depressive disorder (MDD) and generalized anxiety disorder (GAD) in Nepali women who were of reproductive age. In a national cross-sectional population-based survey of women (15–49 years) (N = 7442) in Nepal, MDD was assessed with the PHQ-9 and GAD with the GAD-7, and dietary diversity with a 24 h food consumption recall of 10 food groups. Multinominal and logistic regression were used to estimate predictors of MDD and GAD symptoms. The prevalence of mild and moderate-to-severe MDD symptoms was 15.7% and 5.4%, respectively, and the prevalence of mild and moderate-to-severe GAD symptoms was 20.8% and 7.5%, respectively. The overall dietary diversity mean score was 4.66 (SD = 1.67). In the final multivariable model, adjusted for relevant confounders, dietary diversity was inversely associated with moderate-to-severe MDD symptoms (Adjusted Incidence Risk Ratios-AIRR: 0.90, 95% CI 0.84–0.97), and with moderate-to-severe GAD symptoms (AIRR: 0.86, 95% CI 0.80–0.92). Furthermore, in the fully adjusted regression model, pulses (Adjusted Odds Ratio-AOR: 0.77, 95% CI 0.60–0.98) and Vitamin A rich fruits and vegetables (AOR: 0.69, 95% CI 0.51–0.94) were inversely associated with MDD symptoms. In addition, Vitamin A rich fruits and vegetables (AOR: 0.57, 95% CI 0.43–0.75), dairy (AOR: 0.80, 95% CI 0.67–0.97), and pulses (AOR: 0.69, 95% CI 0.56–0.85) were inversely associated with GAD symptoms. Dietary diversity was inversely associated MDD and GAD symptoms.

Sociodemographic Factors, Health-Risk Behaviors, and Chronic Conditions Are Associated with a High Prevalence of Depressive Symptoms: Findings from the Indonesian Family Life Survey-5

Depression is a significant public health challenge. However, limited research exists regarding the risk of sociodemographic factors, health-risk behavior, and chronic conditions in relation to the development of depression in Indonesia. This study assesses the prevalence of depressive symptoms in adolescents and adults, and identifies its potential associations with sociodemographic factors, health-risk behaviors, and chronic conditions. A national cross-sectional population-based survey was performed, using the Indonesian Family Life Survey (IFLS-5), to assess depressive symptoms in respondents aged 15 years and older. Depression was evaluated using the Center for Epidemiologic Studies-Depression (CES-D) scale, and potential associations with sociodemographic factors, health-risk behaviors, and chronic conditions were examined using logistic regression analysis. The study revealed a high prevalence of depressive symptoms, with the highest incidence observed in the age group of 25–34 years. Factors such as unmarried status, younger age, good physical activity, and having chronic conditions showed associations with depression. These findings have implications for developing public mental health strategies to reduce the prevalence of depression in Indonesia.

Barriers Experienced by Community-Dwelling Older Adults Navigating Formal Care: Evidence From an Australian Population-Based National Survey.

This study aims to identify the relationship between psychosocial factors and unmet needs among community-dwelling older adults who have received or who expect to receive formal home-based aged care services. A subsample of the national Survey of Disability, Ageing and Carers was used to examine the prevalence of having any unmet needs among older adults navigating care. We also examined associations between older adults' psychosocial factors and their unmet needs using logistic regression. Regression analyses highlighted that perceived social isolation (OR = 1.62, 95% CI: 1.30-2.01), high/very high psychological distress (OR = 2.11, 95% CI: 1.52-2.93), and occasional assistance from informal support (OR = 1.92, 95% CI: 1.22-3.05) were associated with increased odds of having unmet needs, after adjusting for other covariates. Our study suggests that older adults facing psychosocial difficulties or lacking informal support are more likely to encounter barriers in accessing formal care. Future policy should address the psychosocial needs and support networks of older adults.

Examining determinants of stunting in Urban and Rural Indonesian: a multilevel analysis using the population-based Indonesian family life survey (IFLS).

In Indonesia, chronic malnutrition leading to stunted growth in children represents a significant issue within the public health domain. The prevalence of stunting varies between urban and rural areas, reflecting disparities in access to nutrition, healthcare, and other socioeconomic factors. Understanding these disparities is crucial for developing targeted interventions to address the issue. The study used data from the fifth wave of the Indonesian Family Life Survey (IFLS), which is a national cross-sectional population-based survey conducted across approximately 13 provinces in Indonesia in 2014-2015. Multivariate and Multilevel logistic regression models were utilized in the analysis to determine the factors associated with the prevalence of stunting in Indonesian children. The multivariate logistic regression analysis indicated that among children aged 24-59 months in Indonesia, stunting was associated with the age of the child, birth weight, maternal nutritional status, and residence. Subsequently, the multilevel logistic regression analysis revealed that in rural areas, the age of the child and birth weight exhibited significant associations with stunting. Conversely, in urban areas, stunted children were influenced by 7 factors, including the child's age (months), age of weaning, birth weight (kg), mother and father's age, place of birth, and maternal nutritional status. Variations in childhood stunting between urban and rural regions in Indonesia were observed, indicating a differential prevalence. The study's findings suggests the importance of age-appropriate nutritional support, healthcare interventions, and growth monitoring. Focused interventions are vital, potentially encompassing initiatives such as improving access to maternal and child healthcare services, promoting adequate nutrition during pregnancy and infancy, and facilitate greater parental engagement in childcare responsibilities.

Twelve-month prevalence, persistence, severity, and treatment of mood and anxiety disorders in Qatar's national mental health study.

To estimate 12-month prevalence, persistence, severity, and treatment of mental disorders and socio-demographic correlates in Qatar. We conducted the first national population-based telephone survey of Arab adults between 2019 and 2022 using the Composite International Diagnostic Interview and estimated 12-month DSM-5 mood and anxiety disorders and their persistence (the proportion of lifetime cases who continue to meet 12-month criteria). The 12-month prevalence of any disorder was 21.1% (10.4% mild, 38.7% moderate, and 50.9% severe) and was associated with: younger age, female, previously married, and with persistence of any disorder. Persistence was 74.7% (64.0% mood and 75.6% anxiety) and was significantly associated with secondary education or lower. Minimally adequate treatment received among those with any 12-month mental disorder was 10.6% (74.6% in healthcare and 64.6% non-healthcare sectors). Severity and the number of disorders significantly associated with each other and with treatment received (χ2=7.24, p=0.027) including adequate treatment within the mental health specialty sector (χ2=21.42, p<0.001). Multimorbidity and sociodemographics were associated with 12-month mental disorder. Treatment adequacy in Qatar are comparable to high-income countries. Low treatment contact indicate need for population-wide mental health literacy programes in addition to more accessible and effective mental health services.

Associations between heat waves and chronic kidney disease in China: The modifying role of land cover

The increasing frequency of heat waves under the global urbanization and climate change background poses elevating risks of chronic kidney disease (CKD). Nevertheless, there has been no evidence on associations between long-term exposures to heat waves and CKD as well as the modifying effects of land cover patterns. Based on a national representative population-based survey on CKD covering 47,086 adults and high spatial resolution datasets on temperature and land cover data, we found that annual days of exposure to heat waves were associated with increased odds of CKD prevalence. For one day/year increases in HW_975_4d (above 97.5 % of annual maximum temperature and lasting for at least 4 consecutive days), the odds ratio (OR) of CKD was 1.14 (95 %CI: 1.12, 1.15). Meanwhile, stronger associations were observed in regions with lower urbanicity [rural: 1.14 (95 %CI: 1.12, 1.16) vs urban: 1.07 (95 %CI: 1.03, 1.11), Pinteraction < 0.001], lower water body coverage [lower: 1.14 (95 %CI: 1.12, 1.16) vs higher: 1.02 (95 %CI: 0.98, 1.05), Pinteraction < 0.001], and lower impervious area coverage [lower: 1.16 (95 %CI: 1.14, 1.18) vs higher: 1.06 (95 %CI: 1.03, 1.10), Pinteraction = 0.008]. In addition, this study found disparities in modifying effects of water bodies and impervious areas in rural and urban settings. In rural regions, the associations between heat waves and CKD prevalence showed a consistent decreasing trend with increases in both proportions of water bodies and impervious areas (Pinteraction < 0.05). Nevertheless, in urban regions, we observed significant effect modification by water bodies, but not by impervious areas. Our study indicates the need for targeted land planning as part of adapting to the kidney impacts of heat waves, with a focus on urbanization in rural regions, as well as water body construction and utilization in both rural and urban regions.

Towards elimination of chronic viral hepatitis in French Polynesia: results from a national population-based survey

In French Polynesia, hepatitis B virus (HBV) infection appears as a major risk factor for hepatocellular carcinoma (HCC), which detection rate in the Austral archipelago is among the highest in the world. Through a nationally representative cross-sectional survey of the adult population, this study aimed at assessing the prevalence of HBV, but also hepatitis C virus (HCV), and hepatitis delta virus (HDV). A total of 1942 blood samples from participants aged 18-69 years were tested for anti-HBc, anti-HBs, HBsAg, anti-HCV IgG, and HDV RNA. Complete genome sequencing of detected HBV strains was performed. Among participants, 315/1834, 582/1834, 33/1834, 0/1857, and 0/33 tested positive for anti-HBc, anti-HBs, HBsAg, anti-HCV IgG, and HDV RNA, respectively. The population prevalence of HBsAg was estimated at 1.0% (95% CI: 0.6-1.7). All HBsAg carriers were born in French Polynesia before vaccination at birth became mandatory. In multivariate analyses, identified factors associated with HBsAg carriage included: the archipelago of residence (p<0.0001), age (p<0.0001), and education level (p=0.0077). HBV genotypes B, C, and F were detected. French Polynesia has a low endemicity level of HBV and its population may be considered at low risk for HCV and HDV infection. However, prevalence of HBsAg was found concerning in Austral (3.8%; 95% CI: 1.9-7.5) and Marquesas (6.5%; 95% CI: 3.8-11) archipelagoes. In the Austral archipelago, the presence of genotype C may account for the elevated rate of HCC. Our findings warrant more efforts to improve access to detection, prevention and care to people born before the systematic vaccination policy application, and residing in higher-risk areas, to achieve HBV elimination in French Polynesia. Research Delegation of French Polynesia.

Prevalence and Correlates of Depressive and Generalised Anxiety Symptoms Among Female Adolescents in Nepal: Results of a Cross-sectional National Population-Based Survey in 2022

AbstractThe aim of this study was to assess the prevalence and associated factors of major depressive disorder symptoms (MDDs) and generalized anxiety disorder symptoms (GADs) among female adolescents in Nepal. In a national cross-sectional population-based survey of female adolescents (N = 1379; 15–19 years) in Nepal, MDDs was assessed with the PHQ-9 and GADs with the GAD-7. Logistic and Poisson regression were used to estimate predictors of MDDs and GADs. The prevalence of MDDs was 7.8% (4.5% with a cut-off of ≥ 10 scores), and the prevalence of GADs was 13.4% (5.6% with a cut-off of ≥ 10 scores). In multivariable models, older age (17–19 years), higher education, greater wealth status, poor self-rated health status, genital sore or ulcer, currently pregnant, pregnancy loss, alcohol use, and early sexual debut were positively associated with MDDs and/or MDD scores. Older age, greater wealth status, living in the Terai region, poor self-rated health status, current alcohol use, pregnancy loss, big problem with getting permission for medical help were positively associated with GADs and/or GAD scores. About one in ten female adolescents report MDDs or GADs, and several associated factors were identified which can be targeted in mental health interventions in this population.

National cross-sectional cluster survey of tuberculosis prevalence in Timor-Leste: a study protocol

IntroductionTimor-Leste has one of the world’s highest estimated tuberculosis (TB) incidences, yet the data which informs this estimate is limited and the true burden of TB disease is not known....

Depression and generalized anxiety and associated factors among adult women and men in Nepal: Results of a national cross-sectional survey in 2022

ABSTRACT The aim of this study was to assess the prevalence and correlates of major depressive disorder (MDD) and generalized anxiety disorder (GAD) among adults in a national population-based survey in Nepal in 2022. MDD was assessed with the PHQ-9 and GAD with the GAD-7. Among women, the prevalence of mild and moderate or severe MDD was 16.2% and 5.9%, respectively, and the prevalence of mild and moderate or severe GAD was 20.6% and 8.2%, respectively. Among men, the prevalence of mild and moderate or severe MDD was 9.4% and 1.8%, respectively, and the prevalence of mild and moderate or severe GAD was 14.0% and 2.4%, respectively. Among women, in the multivariable model, poor self-rated health status, genital discharge, barriers to access health care, having two or more control issues with their husband or partner, experiencing one, or two or more forms of emotional violence, and exposure to two or three types of intimate partner violence were positively associated with MDD. Being widowed, divorced or separated, poor self-rated health status, genital discharge, barriers to access health care, having two or more control issues with their husband or partner, experiencing two or more forms of emotional violence, and exposure to two or three types of intimate partner violence were positively associated with GAD. Among men, poor self-rated health status, current tobacco use, genital sore or ulcer, sons and/or daughters had died, younger age and never internet use were positively associated with MDD, and being widowed, divorced or separated, poor self-rated health status, younger age and sons and/or daughters had died were positively associated with GAD. Low rates and several associated factors of MDD and GAD were found in Nepal.

Prevalence and Levels of Anti-SARS-CoV-2 Antibodies in the Eswatini Population and Subsequent Severity of the Fourth COVID-19 Epidemic Wave

Background: Seroepidemiology studies are useful for quantifying the magnitude of past infections and estimating the extent of population-based immunity to inform risk mitigation strategies for the future. We report on the only national population-based survey of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) immunoglobulin G (IgG) seroprevalence in Eswatini. Methods: The survey was undertaken from 31 August to 30 September 2021, following three earlier waves of coronavirus disease (COVID-19), and preceded the onset of the fourth wave, which was dominated by the Omicron variant of concern. We also report on epidemiological trends of recorded COVID-19 cases and hospitalizations before and after the fourth COVID-19 wave through to March 2022. We evaluated the immunoglobulin G (IgG) seropositivity based on either anti-nucleocapsid (N) or anti-spike (S) antigens. Results: Of 4564 individuals, 58.5% were female, 36.0% were aged 18–50 years, and 863 (18.9%) of adults who were older than 18 years had received at least a single dose of COVID-19 vaccine. Overall, 2769 (60.7%) were seropositive with heterogeneity across sub-regions (53.7%; 95% CI:49.2–58.1 to 68.6%; 95% CI:64.5–72.4), with the highest rates occurring in sub-regions of the Manzini region. Seropositivity was higher in vaccinated individuals (84.5%; 95% CI: 81.9–86.7) compared to unvaccinated individuals (55.1%; 95% CI:53.5–56.7). Amongst unvaccinated individuals, seropositivity was highest in 18–50-year-olds (59.5%;95% CI: 56.9–62.1). Seropositivity was associated with female gender, previous positive SARS-CoV-2 NAAT status and being vaccinated, non-smoking, and being formally employed. We estimated as of 15 September 2021 that there had been 639,475 SARS-CoV-2 infections (95% CI; 620,824–658,003) in Eswatini, which was 25.5-fold greater than the 25,048 COVID-19 cases that had been recorded by then. The national case fatality rate (CFR) based on recorded cases was 4.8%, being 25-fold greater than the infection fatality rate (0.19; 95% CI: 0.18–0.19) based on recorded deaths and extrapolating the force of infection from seroprevalence. Nationally and across all four regions, we report the decoupling of COVID-19 cases from hospitalisations and deaths, observed as early as during the third wave, which was dominated by the Delta variant compared with earlier waves. Conclusions: We identified that 60.7% of people in Eswatini had been infected by SARS-CoV-2 at least once and before the onset of the Omicron wave in mid-November 2021. Despite a modest uptake of COVID-19 vaccines, the evolution of population immunity from infection has likely contributed to the decoupling of infection and severe COVID-19 in Eswatini.

Sight impairment registration in Trinidad: trend in causes and population coverage in comparison to the National Eye Survey of Trinidad and Tobago

BackgroundLittle was known about the population coverage and causes of sight impairment (SI) registration within the Caribbean, or the extent to which register studies offer insights into population eye health.MethodsWe compared causes of SI registration in the Trinidad and Tobago Blind Welfare Association (TTBWA) register with findings from the 2014 National Eye Survey of Trinidad and Tobago (NESTT), and estimated registration coverage. Cross-sectional validation studies of registered clients included interviews, visual function and cause ascertainment in July 2013, and interviews and visual function in July 2016.ResultsThe TTBWA register included 863 people (all ages, 48.1%(n = 415) male) registered between 1951 and 2015. The NESTT identified 1.1%(75/7158) people aged ≥5years eligible for partial or severe SI registration, of whom 49.3%(n = 37) were male. Registration coverage was approximately 7% of the eligible population of Trinidad. Nevertheless, there was close agreement in the causes of SI comparing the register and population-representative survey. Glaucoma was the leading cause in both the register (26.1%,n = 225) and population-based survey (26.1%, 18/69 adults), followed by cataract and diabetic retinopathy. In the validation studies combined, 62.6%(93/151) clients had severe SI, 28.5%(43/151) had partial SI and 9.9%(15/151) did not meet SI eligibility criteria. SI was potentially avoidable in at least 58%(n = 36/62) adults and 50%(n = 7/14) children.ConclusionWe report very low register coverage of the SI population, but close agreement in causes of SI to a contemporaneous national population-based eye survey, half of which resulted from preventable or treatable eye disease.