Introduction Since the implementation of Iran’s Family Medicine Program (FMP) in 2005, numerous studies have evaluated its outcomes. However, Evidence on family physician performance and Family Physician Program performance remains fragmented. This review synthesized available evidence and identified key strengths and gaps.Theory The review was guided by primary health care performance frameworks developed by the World Health Organization (WHO) and the World Organization of Family Doctors (WONCA).Method A scoping review was conducted using the Arksey and O’Malley framework and PRISMA-ScR guidelines. International and national databases were searched for studies published between 2005 and 2025. Eligible studies were screened independently by two reviewers, and data were synthesized through thematic analysis.Results: Of 1,861 records identified, 37 studies met the inclusion criteria. Family physicians demonstrated satisfactory performance in hypertension and diabetes management, maternal and child health services, and doctor-patient communication. Prescribing practices improved in several settings. However, deficiencies persisted in osteoporosis and mental health care, antibiotic stewardship, referral documentation and feedback, and community engagement.Discussion The Iranian FMP performs relatively well in clinical care but face challenges in population health functions and system coordination. Strengthening training, referral systems, community participation, and standardized assessment frameworks may improve program effectiveness and support quality improvement.
Introduction: Interstitial lung disease and pulmonary sarcoidosis are increasingly recognised worldwide, yet population-level epidemiological data from Saudi Arabia remain scarce. Theory: This analysis is framed within the Global Burden of Disease (GBD) framework, in which these conditions form a predefined combined cause category within a mutually exclusive cause hierarchy. GBD outputs are modelled estimates, so temporal change may reflect diagnostic capacity, coding practices and data availability as well as underlying disease occurrence. Method: Data were extracted from GBD 2023 for Saudi Arabia (location ID 152, cause ID 516). Age-standardised rates per 100,000 population with 95% uncertainty intervals were analysed by sex and age group using Joinpoint regression, age–period–cohort analysis, and ARIMA forecasting. Results: Between 1990 and 2023, prevalence increased from 50.33 to 79.90 per 100,000 in males and from 76.52 to 115.28 in females. Incidence increased from 5.86 to 8.64 and from 7.28 to 10.81, and mortality from 3.43 to 5.43 and from 3.05 to 7.88. Average annual percent changes were +1.41% in males and +1.25% in females for prevalence, +1.18% and +1.20% for incidence, and +1.40% and +2.92% for mortality. Discussion: GBD-modelled estimates suggest an increase in the estimated burden, with higher female prevalence and incidence estimates, a female-to-male mortality ratio that increased over time, and a strong age-related pattern. Findings should be interpreted cautiously, as temporal change may reflect diagnostic capacity, coding practices, healthcare access, data availability and modelling assumptions. Improved national disease monitoring, registry development and primary epidemiological studies are needed.
Introduction Hearing loss affects more than 430 million people worldwide and is expected to rise to over 700 million by 2050. There is a well-established association between hearing loss and chronic kidney disease (CKD), as both systems share similar physiological and anatomical characteristics. This study aimed to determine the prevalence and type of hearing loss in individuals with CKD undergoing haemodialysis and to evaluate its impact on their quality of life (QoL).Methods This quantitative cross-sectional study compared 33 CKD participants receiving haemodialysis with 33 age- and sex-matched controls with normal kidney function. Data collection included case history, QoL questionnaires, otoscopy, tympanometry, pure tone audiometry, and Distortion Product Otoacoustic Emissions. Statistical analyses consisted of Mann-Whitney tests, correlations, Friedman tests, and regression analysis.Results Hearing loss was significantly more prevalent in the CKD group (75.8%) compared to the control group (3.0%), with high-frequency loss being most common. Age and CKD status were significant predictors of hearing loss (p < 0.01). Strong positive correlations were found between dialysis duration and hearing thresholds, as well as between hearing loss severity and reduced QoL (p < 0.001).Conclusions The findings highlight the importance of routine audiological monitoring for individuals with CKD, particularly those undergoing long-term haemodialysis.
Introduction Population-based interventions delivered through preschools, schools, and public dental services are often intended to support equitable access to oral health and preventive care. However, how such interventions are organized and experienced across Swedish regions remains insufficiently described. The aim of this study was to explore how coordinators responsible for regional oral health promotion describe population-based work for children and adolescents, including organization, implementation, and perceived opportunities and challenges.Method A qualitative design with an inductive approach was employed. Semi-structured, open-ended interviews were conducted with 17 coordinators responsible for health promotion interventions in the Public Dental Service across Sweden. Data were examined using reflexive thematic analysis.Results Participants described balancing universal approaches with targeted interventions to address differing needs among children and adolescents. Oral health promotion was shaped through collaboration and negotiation between regional priorities and local partners, including schools, preschools, child health services, and community organizations. Participants described the importance of adapting interventions to local contexts and how preventive activities were organized and evaluated across regional contexts. Sustaining preventive and oral health promotion activities was perceived as challenging because limited resources, competing priorities, and population mobility, while supportive leadership, organizational clarity, political commitment, and opportunities for early intervention were perceived as important conditions.Conclusions Population-based oral health work involves universal and targeted preventive approaches, with implementation shaped by regional mandates, organizational conditions, and intersectoral collaboration. These conditions are perceived as important for sustaining preventive work, while further research is needed to assess implementation, population coverage, effectiveness, and equity outcomes.
Background Treating diarrheal illnesses in children under five presents unique challenges due to a combination of regional and national factors. This study aims to tackle these issues by examining whether a culturally adapted information booklet can improve maternal knowledge, attitudes, and practices (KAP) regarding diarrheal disease outcomes.Methods A quasi-experimental one-group pre-test–post-test design was conducted among 65 mothers attending an under-five clinic in Jordan between 15 June and 20 August 2025. The sample size was initially estimated using G*Power version 3.1 for a two-tailed paired-samples t-test, assuming α = 0.05, 80% power, and an expected effect size of Cohen’s d = 0.71. Data were collected using a KAP questionnaire before and after exposure to the culturally adapted Arabic information booklet. Descriptive statistics and paired-samples t-tests were used for data analysis, with statistical significance set at p < 0.05.Results The mean age of participating mothers was 30.9 ± 5.1 years. Knowledge scores increased from 4.85 ± 1.23 at baseline to 8.49 ± 1.45 at follow-up. Similarly, attitude scores increased from 29.60 ± 3.16 at baseline to 45.80 ± 3.21 at follow-up, while practice scores increased from 9.03 ± 2.87 to 16.87 ± 1.81, respectively. All three domains of improvement achieved a highly statistically significant difference of p < 0.001.Conclusion The current study indicates for the efficacy of a culturally adapted information booklet intervention on enhancing maternal knowledge, attitudes and practice regarding diarrheal disease prevention and management.
World Health Organization has supported the broad conception of disability and developed a standardized tool/scale which could be used to estimate burden of disability/activity limitations in society. However, to the best of our knowledge, empirical evidence on disability burden among young adults has been largely limited to western contexts only. The current study aimed to estimate functional disability burden among young university students in Ghana. A total of 1200 undergraduate students completed the World Health Organization Disability Assessment Schedule 2.0 which comprises 36 items and divided into six domains: cognitive domain, getting around, self-care, getting along with people, life activities and participation in society. While 60.7% of the participants were females (n = 728), 39.3% were males (n = 477). The ages of the participants ranged from 18 years to 31 years. The data were analysed using means, frequency counts, t-test and analysis of variances. The result showed mild to moderate functional disability burden among young university students. Moreover, moderate to profound incidence of disability burden were found in life activities, getting around and self-care. Differences were noted between participants on age, gender and engagement in regular exercise. The study concludes with a recommendation for promoting disability screening as part of effort towards lessening disability burden among young university students in Ghana.
Introduction Population aging poses health challenges for older adults in China. Social participation may promote healthy aging, but its mechanisms remain unclear, and health is often treated as unidimensional. This study aims to examine the association between social participation and multidimensional health among Chinese older adults, and to test the mediating role of digital use.Theory Based on the social cognition theory, this study will explore the relationship between social participation and the multi-dimensional health of the elderly, and will consider the use of digital technology as a bridge connecting social participation and multi-dimensional health.Methods Using cross-sectional data from 9,652 older adults from the 2020 China Longitudinal Aging Social Survey (CLASS), we employed multiple linear regression and mediation analyses. Objective physical health was measured by 21 ADL/IADL items, subjective physical health by self-rated health, and mental health by depressive symptoms. All statistical analyses were performed using STATA 18.0.Results (a) Social participation substantially promoted older adults’ objective physical health (β = 0.017, p < 0.01), subjective physical health (β = 0.011, p < 0.01), and negatively predicted depressive symptoms (β= −0.024, p < 0.01). (b) Digital use is a key mediating mechanism linking social participation to geriatric health status.Discussion Social participation improves older adults’ health through digital use, with effects differing across health dimensions. Policies should promote digital inclusion and tailor interventions to specific health goals. This approach will improve older adults’ quality of life and feelings for happiness.
Introduction The ‘One Big Beautiful Bill’ is framed by its proponents as the largest middle-class tax cut in U.S. history and a catalyst for economic growth. Yet, beneath the marketing of ‘jobs, tax cuts, and American prosperity’, the legislation conceals sweeping rollbacks of Medicaid, food assistance, education, reproductive care, and expanded immigration enforcement, alongside tax windfalls for venture capital and immigration enforcement.Theory Drawing on David Harvey’s concept of accumulation by dispossession, we argue that the bill advances upward redistribution under the guise of tax relief, at the expense of public health.Method We synthesize statutory provisions with congressional budget projections, policy organizations’ analyses, and peer-reviewed research on comparable policies to assess plausible impacts on economic security and population health.Results The bill threatens to unravel decades of incremental gains in health equity by shifting resources away from public goods and toward private markets. The resulting toll, in preventable deaths, untreated illnesses, food insecurity, and exacerbating wealth inequality, could be staggering.Discussion We contend that public health scholars must actively resist these harms, by championing a more just distribution of shared resources and treating such legislation as a threat to population health, subject to the same rigorous scrutiny as any grave epidemiologic exposure.
Introduction Birth Preparedness and Complication Readiness (BPCR) is a key safe motherhood intervention aimed at reducing maternal and neonatal mortality through timely decision-making, delivery planning, and rapid response to obstetric emergencies. This narrative review synthesizes evidence on BPCR implementation in Tanzania, examines underlying barriers, and proposes strategies to strengthen BPCR.Methods A structured narrative review was conducted using PubMed, Scopus, and Google Scholar, supplemented by grey literature from national and international sources. Searches used MeSH and free-text terms related to BPCR, maternal health, and the Three Delays Model. Studies (2016–2026) addressing BPCR in Tanzania were included. From 162 records, 14 publications were thematically synthesized.Results BPCR implementation in Tanzania shows marked regional and contextual disparities, with generally low preparedness, particularly in rural areas. Barriers were grouped into four domains: socio-cultural and gender-related factors, economic constraints, health system limitations, and knowledge and awareness gaps. These barriers interact across the Three Delays Framework, leading to delayed decision-making, delayed access to care, and suboptimal facility-based management. Key determinants of BPCR uptake included antenatal care attendance, male partner involvement, education level, and health system readiness, which collectively shape preparedness outcomes across settings.Conclusion BPCR in Tanzania is constrained by interconnected individual, socio-cultural, economic, and health system barriers. Strengthening implementation requires integrated, equity-focused interventions that improve antenatal care quality, promote male and community engagement, enhance financial protection mechanisms, and strengthen health system capacity. These strategies are essential for reducing preventable maternal deaths and achieving Sustainable Development Goal 3.1
Background Although psychological well-being (PWB), sense of coherence (SoC), and resilience have been widely studied, longitudinal evidence regarding their reciprocal relationships among medical students remains limited. This study examined the bidirectional longitudinal relationships among these psychological resources using a two-wave cross-lagged panel design.Methods A two-wave longitudinal study was conducted among medical students from seven medical colleges in Islamabad, Pakistan. A total of 722 students participated at baseline (August–September 2022) and 465 at the six-month follow-up (March–April 2023), with 401 participants successfully matched across both waves. Cross-lagged panel modeling (CLPM) was used to examine reciprocal longitudinal relationships while controlling for age, gender, and socioeconomic status.Results Significant autoregressive effects were observed for PWB, SoC, and resilience across the two measurement occasions. Significant reciprocal cross-lagged associations were identified between PWB and both SoC and resilience. Higher baseline SoC and resilience predicted subsequent PWB, whereas higher baseline PWB predicted subsequent levels of SoC and resilience. In contrast, the reciprocal associations between SoC and resilience were weaker and not consistently significant.Conclusion The findings suggest that psychological well-being, sense of coherence, and resilience function as dynamically interconnected psychological resources among medical students. Strengthening psychological well-being alongside resilience and sense of coherence may therefore represent an important strategy for supporting student mental health in demanding educational environments. Further longitudinal studies with additional measurement waves are warranted to confirm these developmental relationships.
Introduction China’s multi-layer health insurance system provides financial protection through basic insurance (Urban Employee Basic Medical Insurance [UEBMI] and Urban-Rural Resident Basic Medical Insurance [URRBMI]), catastrophic supplemental coverage, and medical assistance. URRBMI enrollees face higher inadequate-protection rates than UEBMI enrollees, but evidence relies on survey and mean-based statistics that obscure distributional variation.Theory We measured financial protection using the out-of-pocket (OOP) ratio, since administrative claims lack household income data needed for traditional catastrophic health expenditure measures. We hypothesised that shared reimbursement ceilings produce ‘tail convergence’, narrowing protection gaps among highest-cost patients, undetectable by mean-based analyses.Method We analysed 31,416 non-communicable disease (NCD) inpatient episodes from a tertiary hospital in Southwest China (2023–2025), covering circulatory, respiratory, neoplastic, and endocrine disorders. Inadequate protection was defined as OOP ratio >40%. We used patient-clustered logistic and quantile regression.Results Overall, 25.6% of admissions experienced inadequate protection (URRBMI 27.0% vs. UEBMI 14.8%; adjusted OR 2.47, 95% CI 2.24–2.72; 2.60 with cost and length of stay additionally adjusted). Quantile regression revealed tail convergence: the insurance gap was 12.3 percentage points at the median but converged to zero at the 90th percentile, as both schemes reached the reimbursement ceiling. Medical assistance beneficiaries had the lowest median OOP ratio (21.2%).Discussion In this single-centre cohort of hospitalised NCD patients in southwest China, tail convergence likely reflects exhaustion of basic-scheme reimbursement ceilings, not the province’s catastrophic-insurance ceiling. Enhanced benefit design and progressive cost-sharing may address this exposure. Medical assistance is effective but under-reaching; findings require multi-site confirmation.
Objective To evaluate the global burden of acute myeloid leukemia (AML) attributable to high body mass index (BMI), smoking, benzene exposure, and formaldehyde exposure from 1990 to 2021.Methods A repeated cross-sectional analysis was performed using Global Burden of Disease 2021 data from 204 countries and territories. Age-standardized mortality rates (ASMRs), age-standardized disability-adjusted life year rates (ASDRs) for AML, and estimated annual percentage changes (EAPCs) were calculated.Results Global AML ASMR declined from 1.693 (95% UI, 1.356–2.077) to 1.566 (95% UI, 1.366–1.797) per 100,000. The AML burden attributable to high BMI increased by 19.6% (EAPC: 0.609), whereas smoking-related burden decreased by 26.2% (EAPC: −0.929). Men had a higher burden than women. Benzene/formaldehyde exposure was the leading attributable risk among those aged 15–19 years. High BMI predominated among adults aged ≥20 years, whereas smoking surpassed high BMI in men aged ≥50 years. High sociodemographic index (SDI) regions had the highest absolute burden, whereas High-middle SDI regions showed the fastest increase in high BMI-related burden (+76.6%).Conclusions The global modifiable AML risk pattern is shifting from tobacco-centered to a broader profile involving weight management and occupational exposure. These findings should be interpreted as comparative risk assessment estimates and policy-prioritization signals, rather than individual-level causal attributions.
Speech–language pathology (SLP) remains one of the most feminized health and education professions. Existing discussions commonly frame men’s low participation as a recruitment problem: gendered occupational images, limited awareness, and anticipated stigma may discourage men from considering SLP. This Rapid Communication argues that such a framing captures only the boundary of the profession. Men may encounter barriers when entering feminized work and still benefit from assumptions that associate masculinity with authority, expertise, and leadership once they are inside it. Bringing together research on occupational coding, professional identity, gendered organizations, and the glass escalator, we distinguish numerical underrepresentation from structural disadvantage. We describe this relationship as an entry–advancement asymmetry and use it to reconsider the familiar analogy between men in feminized occupations and women in male-dominated ones. The distinction also changes the policy question. Recruitment may widen occupational choice, but headcount diversity alone does not redistribute recognition, authority, pay, or advancement and may reproduce existing gender hierarchies. A reflection from wartime Ukraine situates the argument in a health system where rehabilitation needs are acute. An equality-oriented response must address both access to SLP and the gendered organization and valuation of communication and care work.
Introduction Under climate change, non-optimal temperature is a key environmental risk for noncommunicable diseases (NCDs), but global evidence comparing disease-specific burdens across climate zones and development levels remains limited. We assessed attributable NCD burden during 1990–2021.Theory We used a conceptual framework linking temperature exposure with NCD burden, integrating low and high temperature exposure, socio-demographic index (SDI), climate-zone stratification and age-period-cohort (APC) modelling to explain regional heterogeneity.Method Using Global Burden of Disease 2021 data, we calculated age-standardised death rates and age-standardised disability-adjusted life-year (DALY) rates for NCDs attributable to low, high and non-optimal temperature. We examined associations with mean annual temperature, SDI and climate zones, and used APC models to estimate age, period and cohort effects.Results Mortality and DALY burdens were higher in cold regions, whereas diabetes and kidney disease burdens were greater and worsening in hot regions. During 1992–2021, low-middle SDI regions improved most slowly, with net drift values of −0.137% for NCD mortality and −0.127% for DALY rates. High-temperature-related cardiovascular burdens increased in all regions (net drift >0%). After age 50, between-SDI disparities in NCD mortality widened. In low-middle SDI regions, low-temperature-related diabetes and kidney disease risks increased after 2002–2006.Discussion The burden of NCDs attributable to non-optimal temperature showed spatial inequality. Climate adaptation should prioritise low-middle SDI regions, older adults, worsening diabetes and kidney disease burdens in hotter regions, and heat-related cardiovascular risks, while strengthening early warning systems, climate-resilient infrastructure, integrated chronic disease management, and mechanistic and intervention research.
Background Grayanotoxin-containing wild honey causes cholinomimetic activity through voltage-gated sodium channel activation and increases the excitability of cardiac and neuronal membranes, leading to cardiovascular and neuronal toxicity. Prior studies describe general-population cases, but interactions with co-morbidities are unexplored.Methods A retrospective case series (2019–2024) of 10 patients with confirmed ingestion and preexisting co-morbidities (diabetes mellitus, hypertension, dyslipidemia, and ischemic heart disease) presenting to Manipal Teaching Hospital, Nepal. Hospital medical records and telephone-based questionnaire were used to collect demographics, ingestion history, symptoms, vital signs, investigation results, management, and outcomes.Findings Mean age was 56.4 years with co-morbidity in all. Predominant cardiovascular and neurological symptoms with dizziness (90%), vomiting (30%), and seizures (30%). Major cardiovascular features were bradycardia (80%) and hypotension (60%); T-wave inversions (V5–V6) exclusively in all IHD patients (2/2 seizure with normal cardiac biomarker). All diabetics (2/2)presented in hyperglycemic state (>200 mg/dL) and developed acute renal impairment (creatinine 1.5–1.6 mg/dL) during hospital stay; non-diabetics (3/8) presented in hypoglycemic state (<70 mg/dL). Supportive care yielded full recovery without mortality (median stay 2.7 days) or sequelae.Conclusion Grayanotoxin amplifies the severity of co-morbid conditions with distinct patterns: diabetes leading to hyperglycemia and renal impairment; T wave changes with seizure in ischemic heart disease, prompting enhanced and intensive monitoring requirements in patients with co-morbid condition.
Background As governments become more concerned about the costs of supporting an ageing population, some have adopted policy levers to incentivise mature labour force participation. Since 1 July 2023 Australia has increased the age at which government-provided pensions can be accessed from 65 to 67. Currently, some people work beyond 67 even though they can afford to retire, while others leave the workforce well before 67, often because of failing health, thus contributing to a loss of workplace expertise.Theory Here, we examine what features encourage workers to remain in employment, despite two disincentives; sufficient retirement savings, and poor health. In the context of the Australian knowledge economy, we consider theories about a micro-policy lever; workplace culture and practices to retain older workers in the workforce. We propose that support for older workers’ specific health and social needs are part of this micro-policy lever.Method We conducted in-depth interviews with 12 older white-collar workers with existing health problems to examine their complex deliberations about whether to remain working or not.Findings We found that feeling valued and receiving managerial support to accommodate older workers’ health requirements are key reasons for remaining at work.Discussion If workplaces aspire to retain their workforce well into their sixties, they need to demonstrate that they value older workers and flexibly accommodate their health conditions.
Background: Racial trauma, a growing public health concern, captures the cumulative distress caused by racism, discrimination, and systemic inequalities. While much of the existing research has been United States (US)-centric, this study explores racial trauma within a United Kingdom (UK) context.Theory Grounded in a developmental psychology and cumulative stress frameworks, the study examines racial trauma among young adults (ages 18–30) in the UK and its relationship with depression, anxiety, and PTSD, whilst considering intersectional demographic and socio-cultural factors.Method: In a cross-sectional online survey, 156 participants completed validated measures of racial adversity, racial trauma, depression, anxiety and PTSD.Results Racial adversity was strongly associated with racial trauma (lifetime β = .618; recent β = .621). After adjusting for gender, immigration generation and regional diversity, racial trauma stayed significant only for PTSD. Those in more diverse regions reported lower trauma and distress, though regional effects were small.Discussion: This study highlights the urgency of addressing racial adversity through systemic and policy-level interventions, particularly in less diverse areas. By situating racial trauma within a UK context, the research contributes to a growing body of literature that examines the public health impacts of racism.
Introduction Menopause is often framed as a negative biomedical transition. This overlooks experiences that are shaped by social, cultural, and economic contexts.Method This online qualitative study used a social constructionist approach to examine how n = 362 Australian cisgender women, aged 45–64 years, made sense of menopause within the overlapping pressures of midlife. Data were analysed using reflexive thematic analysis.Results Four themes were constructed: (1) Menopause as a period of disruption and destabilisation; (2) Exhaustion and the demands of productivity; (3) Ease, acceptance, and positive midlife experiences; and (4) Freedom, resilience, and emergent strengths. Menopause was socially situated and interpreted in relation to expectations of productivity and competence across work, caregiving, and social roles. For some, menopause disrupted routines and signalled reduced capacity within contexts that prioritised productivity. For others, experiences were more manageable than expected and provided a time for reflection and renegotiation.Discussion Menopause is a socially and relationally mediated experience, where symptoms cannot be separated from the socio-cultural and institutional contexts through which women’s ageing is mediated and understood. The findings highlight the need to move beyond biomedical framings and recognise the overlapping influence of social and economic expectations on women in midlife.
In South Africa (SA), rising obesity rates are increasingly linked to high intake of sugar-sweetened beverages (SSBs), posing a serious public health challenge. To address this, SA implemented the Health Promotion Levy (HPL) in 2018, Africa’s first sugar tax, aiming to raise the cost of SSBs and reduce their consumption. Evidence indicates that the HPL reduced consumer SSB purchases and encouraged SSB manufacturers to reformulate their SSBs. However, challenges remain, including consumer substitution with untaxed sugary products, limited awareness of the HPL, and industry resistance. This review examines the design, impact, and limitations of the HPL, highlighting the need for complementary strategies and ongoing monitoring of the HPL to ensure long-term public health impact.
Background: The Kingdom of Saudi Arabia (KSA) continues to face significant challenges in tuberculosis (TB) control owing to population mobility, mass gatherings, and the large expatriate workforce. Conventional epidemiological methods have limited ability to resolve transmission chains and characterize the evolution of drug-resistant Mycobacterium tuberculosis (MTB). Methods: A narrative review of molecular and genomic studies published between 2004 and 2024 was conducted to compile evidence on MTB population structure, transmission dynamics, and drug resistance in KSA. Results: Early genotyping studies demonstrated substantial genetic diversity, reflecting frequent strain importation associated with migration, whereas whole-genome sequencing (WGS) studies revealed considerable ongoing local transmission alongside multiple importation events. Lineages 3 (Central Asian [CAS]) and 4 (Euro-American) were the predominant MTB lineages, while lineages 1 and 2 were more commonly identified among expatriate populations. WGS studies detected transmission clusters in community, healthcare, and congregate settings and identified genetic determinants of multidrug-resistant TB, including compensatory mutations that may enhance the transmission and persistence of resistant strains. Conclusions: Current molecular and genomic evidence indicates that TB epidemiology in KSA is shaped by both imported infections and sustained local transmission, although their relative contributions vary across epidemiological settings. Expanded implementation of WGS-based surveillance integrated with epidemiological investigations will strengthen TB control by improving outbreak detection, monitoring transmission, and informing strategies to combat drug-resistant TB.
