To improve women’s reproductive health and reproductive rights, appropriate interventions are needed to support family planning (FP) use during the postpartum period. Evidence on Arabic-language digital health interventions remains limited. This study aimed to assess the effect of enhanced counseling, alone and combined with an mHealth application, on modern FP method use among postpartum married women in Jordan. A three-arm, parallel-group controlled trial with systematic individual allocation was conducted in six primary healthcare centers. Within each center, consecutively enrolled eligible women were assigned using a prespecified repeating 1:3:3 sequence to standard care, enhanced FP counseling, or enhanced counseling plus an Arabic-language mHealth application. Enhanced counseling was delivered by midwives who completed a five-day training workshop; the mHealth intervention provided FP information and 40 push notifications over the intervention period. At four months after baseline, 79.6
Most evidence linking phenotypic traits to breast cancer risk derives from Western populations, leaving a critical gap for the Middle East and North Africa region, where breast cancer presents at younger ages and where demographic, metabolic, and lifestyle profiles differ substantially. To address this, we conducted an exploratory phenome-wide association analysis within the Qatar Biobank, systematically screening 93 demographic, anthropometric, biochemical, lifestyle, and medical history variables among 96 women with physician-confirmed breast cancer and 471 healthy controls. A three-stage filtering pipeline: i) Benjamini–Hochberg-corrected significance, ii) Cliff”s Delta effect sizes, and iii) crude odds ratios, reduced 42 initial associations to 18 candidates, which were then evaluated using age-adjusted logistic regression with confounding quantified by percentage change in log-transformed odds ratios. Age was the dominant correlate of breast cancer status (OR = 1.10 per year, 95
Digital alcohol marketing has evolved rapidly with the growth of social media. Modern digital environments are driven by user-generated content UGC relating to peer-to-peer sharing, liking, and commenting on alcohol brands, which blurs the line between commercial promotion and authentic social interaction. This systematic review synthesises recent research on the association between digital alcohol marketing and alcohol-related outcomes, while examining the dual roles of UGC and health warnings as empirical countermeasures. Following PRISMA guidelines, eight electronic databases (PubMed, Web of Science, Scopus, JSTOR, PsycINFO, Medline, Taylor Francis Online, ScienceDirect) were systematically searched for quantitative studies published between 2017 and late 2024. Studies were included if they investigated exposure to, and/or engagement with, alcohol marketing in digital contexts, as were studies which examined the role of user-generated messaging and health warnings in alcohol ads. Eligible outcomes were alcohol-related beliefs, attitudes, intentions, and behaviours. Eighteen quantitative studies met inclusion criteria (10 cross-sectional, 7 experimental, 1 longitudinal). Positive associations with alcohol-related outcomes were reported across all 14 studies (77.8
Reliable estimation of sensitive public health outcomes, such as underreported COVID-19 cases and vaccine hesitancy, is frequently hindered by social stigma and nonresponse bias, particularly in culturally sensitive contexts like Pakistan. Traditional surveys often underestimate prevalence, limiting the effectiveness of public health interventions. Multi-stage stratified paired response frameworks (MSPRFs) incorporating two and three-stage randomization with dual scrambling mechanisms under stratified simple random sampling were applied. A cross-sectional survey of 1,200 participants (600 urban, 600 rural) from Faisalabad, Lahore, Multan, and Rawalpindi (June-August 2021) was conducted using anonymous questionnaires to collect data on outbreak cases and vaccine hesitancy. The MSPRFs demonstrated substantially enhanced estimation efficiency (PRE 290–399
Urban outbreaks of Ebola present heightened risks of rapid amplification and cross-regional spread. On 30 January 2025, the Uganda Ministry of Health declared an Ebola Sudan virus disease (SVD) outbreak first identified in a fatal case at a national referral hospital in Kampala, one of East Africa’s most densely populated and highly connected urban centres. The source of the index infection, presumed to be a zoonotic spillover event, was not established. Despite high transmission risk and major disruptions in global health financing, the outbreak was rapidly contained. We analysed the response to identify innovations and system adaptations that enabled control and to derive lessons for future preparedness in resource-constrained settings. We conducted a retrospective implementation analysis using a structured review of national and district response plans, situation reports, laboratory and surveillance summaries, early and after-action review reports, policies, and standard operating procedures generated during the 2025 SVD response. Data were analysed using a framework-based thematic analysis organised around the World Health Organization (WHO) Strategic Preparedness and Response Plan (SPRP) response pillars, to identify innovations and intensified adaptations of existing approaches. The outbreak was limited to 14 cases (12 confirmed, 2 probable) across seven districts, with two deaths among confirmed cases (confirmed-case fatality rate 16.7
Outdoor and indoor air pollution often co-occur and may exert combined health effects, but their combined effect on incident stroke risk remains poorly understood. This study aimed to investigate the associations of ambient particulate matter (PM2.5) exposure and solid fuel use with incident stroke among Chinese middle-aged and elderly adults. This prospective cohort study used data from the China Health and Retirement Longitudinal Study. One-year pre-baseline county-level PM2.5 exposure was assigned using the China High Air Pollutants dataset, and household solid fuel use was assessed at baseline according to participants’ primary cooking and heating fuels. Cox proportional hazards models adjusted for prespecified covariates were used to estimate the independent and joint associations of PM2.5 exposure and solid fuel use with incident stroke. The overall trend across combined exposure categories was evaluated using ordinal exposure scores. Of 13,917 adults with a mean age of 58.90 years, 1,060 developed incident stroke during follow-up. Solid fuel users had a higher risk of incident stroke than nonusers [hazard ratio (HR) = 1.38, 95
To examine the evolving epidemiological characteristics of pediatric drug poisoning in Wenzhou, China from 2017 to 2024, focusing on temporal trends, age/sex-specific risks, and changes in poisoning intent and toxin types, and to generate evidence-based guidance for targeted prevention and treatment strategies at regional pediatric medical centers. Clinical data were retrospectively collected from 1,531 pediatric patients admitted to the emergency observation rooms of Wenzhou Medical University Second Affiliated Hospital and Yuying Children’s Hospital between January 2017 and December 2024. Analyses included demographic characteristics, toxin types, exposure intent, temporal distribution, and clinical outcomes, with a focus on trends by age, sex, and toxin category. Of the 1,531 patients, 689 (45.0
To examine the long-term, phase-specific effects of national tuberculosis program transitions on key TB indicators in India using interrupted time-series analysis, informing future TB policy and program design. Thirteen key tuberculosis indicators were analysed using data from the India TB Report and World Health Organisation estimates. Interrupted time-series analysis with linear generalised estimating equations was used to quantify level and trend changes associated with successive national tuberculosis program phases Revised National Tuberculosis Control Programme Phase-I(2000–2005), Revised National Tuberculosis Control Programme Phase-II (2006–2011) Combined as a RNTCP (2000–2011), Revised National Tuberculosis Control Programme National Strategic Plan Phase-I (2012–2016), Revised National Tuberculosis Control Programme National Strategic Plan Phase-II (2017–2019) and the National Tuberculosis Elimination Programme (2020–2023) reflecting the programme renaming effective 1 January 2020 and the availability of data at the time the analysis was finalised, over the study period 2000–2023. Across tuberculosis indicators, observed outcomes diverged substantially from model-derived counterfactual trajectories, with heterogeneity by programme phase. TB incidence per lakh population showed no immediate deviation during RNTCP, followed by a cumulative reduction of 52
Mpox has re-emerged as a public health concern, highlighting the need to strengthen frontline preparedness. Primary healthcare workers require adequate knowledge to recognise symptoms, understand transmission, differentiate mpox from other conditions, and follow appropriate management protocols. They must also be prepared to implement appropriate infection prevention and control measures. This study aimed to assess knowledge and readiness regarding mpox management among primary healthcare workers in Malaysia and identify associated factors. A newly developed questionnaire underwent content and face validation, followed by psychometric evaluation using two-parameter logistic item response theory for the knowledge domain and exploratory factor analysis and confirmatory factor analysis for the readiness domain. The questionnaire was then administered in a cross-sectional study among 333 primary healthcare workers in Malaysia. The total knowledge and readiness scores were converted to percentage scores. Descriptive statistics and linear regression analyses were conducted. Mean percentage scores were 78.0
Atrial fibrillation (AF) is a common arrhythmia and the major cause of morbidity and mortality in cardiovascular disease. Although the pathogenesis of AF is unclear, insulin resistance and inflammation have been recognized to be strongly associated with AF. This study aimed to investigate the association between triglyceride-glucose (TyG) index, neutrophil to high-density lipoprotein cholesterol ratio (NHR) and AF. A total of 1468 subjects from a single center were used in the retrospective study, and logistic regression analysis was used to determine the association between the TyG index, NHR and AF. The receiver operating characteristic (ROC) curve was used to assess the predictive ability of these independent associated with AF. AF patients exhibited higher levels of TyG index and NHR than non-AF patients. The TyG index (OR = 2.79, 95
Brucellosis is a neglected zoonotic infection with persistent transmission in many endemic regions despite long-standing control efforts. Limitations in diagnosis, fragmented surveillance systems, and inconsistent implementation of control measures continue to hinder effective disease management. The objective is to critically examine current gaps in the diagnosis, global and regional epidemiology, and control of brucellosis within a One Health framework. A structured narrative review was conducted using PubMed, Scopus, and Web of Science. Peer-reviewed articles, reviews, and relevant reports published in English were screened using predefined keywords related to brucellosis, diagnosis, epidemiology, treatment, and control. Studies were selected based on relevance to human and animal disease, diagnostic approaches, and public health implications. Data were synthesized qualitatively with emphasis on diagnostic limitations, surveillance gaps, and intersectoral challenges. Evidence indicates that brucellosis remains underdiagnosed and underreported globally, particularly in low- and middle-income countries. Serological assays, although widely used, are limited by cross-reactivity and variable performance, while culture and molecular methods face constraints related to biosafety, cost, and accessibility. Marked regional heterogeneity reflects differences in veterinary infrastructure, food safety practices, and surveillance capacity. Inadequate integration between human and animal health sectors continues to undermine control efforts. Persistent gaps in diagnostics, surveillance, and coordinated control strategies contribute to ongoing transmission of brucellosis. Strengthening One Health approaches, improving access to standardized diagnostic tools, and enhancing surveillance systems are essential for reducing the global burden of disease.
Therapeutic inertia is a major barrier to optimal glycemic control in type 2 diabetes (T2DM), yet its impact in low-resource settings is not well-documented. This retrospective cohort study investigated the effect of therapeutic inertia on treatment outcomes in patients with T2DM receiving care at a tertiary hospital in southern Ethiopia. A retrospective cohort study was conducted among 159 adult ambulatory T2DM patients between June 2020 and 2023. Data were collected from medical records. The primary outcome was poor treatment outcome, defined as fasting blood glucose > 130 mg/dL or development of a new diabetes-related complication. Exposure was defined as failure to intensify treatment within three months of uncontrolled glycemia. Cox proportional hazard models were used to assess the association between therapeutic inertia and poor treatment outcomes. The medical records of 159 T2DM patients were reviewed. Poor treatment outcomes were common in the therapeutic inertia group (68.6
Carbapenem-resistant Enterobacterales (CRE) represent a growing public health challenge worldwide, particularly in healthcare settings where the options for treatment are limited, and the mortality rate is high. Data on the epidemiology, molecular characteristics, and clinical outcomes of CRE infections in southern Saudi Arabia are limited. A retrospective cohort study was performed at a tertiary care hospital from 2021 to 2024, including adult patients with culture-confirmed CRE infections. Information on demographics, comorbidities, infection characteristics, antimicrobial therapy, molecular resistance mechanisms, and clinical outcomes was collected. Multivariable logistic regression analysis was performed to identify antibiotic-related predictors of poor outcomes, defined as a combination of 30-day mortality and treatment failure. A total of 230 patients with infections caused by CRE were included in the study, with a mean age of 71.8 years; 96.1
Diarrhoeal diseases remain a major cause of under-five mortality in South Asia despite global health progress. This study quantifies the economic losses due to premature under-five deaths from diarrhoeal diseases, analyzing trends, aetiologies, and risk factors across five South Asian countries between 2010 and 2023. Using data from the datasets published by the Institute for Health Metrics and Evaluation (IHME) and World Bank indicators, the study applied the human capital approach to estimate the present value of lost future labour income associated with diarrhoeal deaths among children under five. Losses were estimated in both purchasing power parity (PPP)-adjusted and nominal U.S. dollars to reflect real productivity losses and fiscal implications, respectively. While age-standardized mortality and DALY rates declined significantly across South Asia (EAPC − 5.2 for both), the economic burden of premature mortality due to childhood diarrhoeal diseases remained substantial. India accounted for the largest absolute loss in future labour income, estimated at USD 5,581 million PPP, followed by Pakistan (USD 1,571 million PPP) and Bangladesh (USD 360 million PPP). When expressed relative to national GDP using nominal estimates, Pakistan experienced the highest proportional economic loss, equivalent to approximately 0.055
Abstract Background The Covid-19 pandemic highlighted a critical lesson for global health systems: effective preparedness depends on timely access to reliable and interconnected health data. Across many countries, fragmented information systems limited the rapid exchange and use of data needed for outbreak detection, response, and decision-making. In Uganda, the recurrent emergence of infectious disease outbreaks, including Ebola, Marburg virus disease, and cholera, has reinforced the importance of resilient and interoperable health information systems. Although substantial progress has been made in strengthening disease surveillance and response mechanisms, persistent challenges continue to affect the country’s capacity to generate and utilize high-quality data during public health emergencies. Methods This study combined a review of published and grey literature with qualitative inquiry to explore existing challenges in Uganda’s health data ecosystem. Six key informants with expertise in health information systems, disease surveillance, and outbreak response participated in in-depth interviews to provide insights into current gaps and potential solutions. Results The findings revealed several interconnected challenges, including fragmented and poorly integrated information systems, limited access to critical digital infrastructures, incomplete digitalization of data collection processes, and weaknesses in data quality and accessibility. These challenges often result in delays in data sharing and evidence-based decision-making during outbreaks. Participants noted that many of these barriers are well recognized and can be addressed through targeted and relatively modest investments. Key recommendations included accelerating the integration of existing health information platforms, expanding end-to-end digital data collection, increasing investments in health information systems, and strengthening coordination among government agencies and development partners. Conclusions Strengthening Uganda’s preparedness for future epidemics requires sustained commitment to interoperable health information systems and high-quality data management. Building on the strong foundations already established through collaboration with partners such as World Health Organization and Africa Centres for Disease Control and Prevention, targeted investments and enhanced governance mechanisms could address the most pressing system gaps. Advancing these efforts will improve the availability and use of quality health data, enabling more effective surveillance, faster outbreak response, and greater resilience against future public health threats.
Congenital anomalies (CA), ICD-10 Q00–Q99 codes, are major causes of infant morbidity and mortality, but national assessments remain limited in countries without integrated birth defect surveillance. This study characterized hospital burden, mortality, and epidemiological patterns of CA among infants in Ecuador. A retrospective descriptive analysis of national administrative records was conducted using data from the INEC. Hospital discharge records covered 2012–2024, while mortality records and live birth statistics were incorporated according to availability. Analyses were restricted to infants under 1 year of age. Descriptive statistics, graphical assessment of temporal patterns, non-parametric comparison between periods, and correlation analyses were applied. Overall, 43,134 hospital discharge events associated with CA were recorded, with a mean annual count of 3,318. Separately, in the code-level analysis of the 50 most frequent ICD-10 diagnostic codes, cardiovascular, musculoskeletal, and genitourinary categories accounted for the largest aggregated counts. Hospital discharges decreased significantly during the pandemic/post-pandemic period compared with 2012–2019 (-21.8
Background Obesity is a growing global health challenge, with central adiposity posing particularly high cardiometabolic risk. In low- and middle-income countries (LMICs) like India, the coexistence of undernutrition and obesity reflects a double burden of malnutrition. However, limited research has examined how socioeconomic inequalities in high-risk adiposity vary across age cohorts using combined anthropometric measures. Aim To assess age-cohort patterns of socioeconomic inequalities in high-risk adiposity defined using a composite of body mass index (BMI) and waist-to-hip ratio (WHR) in a nationally representative Indian population. Methods We analysed data from Wave-1 (2017–2018) of the Longitudinal Ageing Study in India (LASI), including 65,150 adults with complete anthropometric and socioeconomic data. High-risk body composition (BWC) was defined as overweight BMI with high-risk WHR, or obese BMI with any WHR. Descriptive, regression, and inequality measures (CI and Erreygers CI with decomposition) were used to examine disparities by socioeconomic status across age cohorts. Results The 18–44 cohort had the highest prevalence of overweight (28.4%) and obesity (10.9%), while WHR increased sharply with age (p < 0.001). Nearly all overweight (93%) and obese (91.6%) individuals were WHR high-risk. High-risk BWC was more common among women, urban residents, and individuals with higher education and wealth (p < 0.001). Inequality analysis showed a pro-rich concentration in all cohorts, peaking at ages 45–59 (ECI: 0.214), with education as the largest contributor (24–30%). Conclusion High-risk adiposity in India is patterned by age and SES. WHR captures substantial central obesity risk, highlighting the need for equity-focused, life-course obesity prevention strategies.
Sports-related ocular trauma is a significant cause of unilateral visual impairment and blindness, yet large-scale epidemiological studies on hospitalized cases are lacking. The aim of this study is to analyze the epidemiological characteristics, injury mechanisms, and visual outcomes of sports-related ocular trauma in China, and provide evidence for developing prevention strategies. A multicenter cross-sectional study was conducted based on data from hospitalized patients with sports-related ocular trauma from 99 medical institutions registered in the “China Ocular Trauma Registry System” (COTS) between 2021 and 2024. Demographic characteristics, sports types, ocular injuries, and visual acuity were analyzed using descriptive statistics. Sports-related injuries constituted 3.60
Armed conflicts substantially disrupt health systems and undermine routine childhood immunization, increasing the risk of vaccine-preventable disease outbreaks. While declines in vaccination coverage in conflict settings are well documented, less is known about the multi-level determinants associated with childhood vaccination outcomes in African countries affected by armed conflict. This scoping review maps and synthesizes existing empirical evidence on factors associated with childhood vaccination in these settings. A scoping review was conducted in accordance with PRISMA-ScR guidelines. Systematic searches were performed in PubMed, Embase, and Scopus, with supplementary searches in Google Scholar. Peer-reviewed observational studies and systematic reviews published from January 2015 onwards were included if they examined determinants associated with childhood vaccination outcomes in African countries affected by armed conflict. Findings were synthesized narratively and grouped into thematic determinant domains encompassing caregiver characteristics, socioeconomic factors, geographic barriers, conflict-related determinants, and health-system constraints. Twenty-eight studies met the inclusion criteria. Evidence was geographically concentrated in a limited number of countries, particularly Ethiopia, Somalia/Somaliland, the Democratic Republic of Congo, and Nigeria. Maternal/caregiver education and empowerment, geographic access barriers/remoteness, and household/community poverty and wealth were the most frequently reported determinant categories. Across settings, maternal education, antenatal care attendance, and facility-based delivery were consistently associated with higher vaccination uptake. Conversely, poverty, rural residence, insecurity, displacement, and disruption of routine services were recurrent barriers to complete and timely immunization. Health-system constraints such as stock-outs, limited outreach services, and shortages of trained personnel further compounded inequities in vaccination access. Childhood vaccination in conflict-affected African countries is shaped by a complex interplay of socioeconomic vulnerability, caregiver characteristics, conflict dynamics, and health-system disruption. Armed conflict appears to amplify pre-existing inequities in access to routine immunization services. The current evidence base remains geographically uneven, highlighting important gaps in several conflict-affected settings. Strengthening context-specific research is essential to inform resilient, effective, and equitable immunization strategies in conflict-affected settings.
