Cocody-Bingerville, southeastern Côte d'Ivoire, a traditional focus of yellow fever (YF), has faced outbreaks of dengue (DEN) that caused 4,371 cases and 29 deaths from 2023-2024. However, local Aedes vector studies and arboviral outbreak responses have mostly focused on urban neighborhoods including intra-urban villages, but no prior research has been done in peripheral villages. We compared Aedes aegypti indices, container productivity, and DEN and YF epidemic risks between peri-urban and intra-urban villages during the outbreaks. From August 2023 to July 2024, we sampled Aedes eggs, larvae and pupae among three peri-urban and three intra-urban villages. Sampling was done in domestic and peridomestic ecozones of 100 households in each village per survey, and uniformly across four climatic seasons: short dry, short rainy, long dry, and long rainy seasons. We compared Ae. aegypti container productivity, Stegomyia indices (house index: HI, container index: CI, and Breteau index: BI) and pupal indices (pupae per house index: PHI, pupae per container index: PCI, and pupae per person index: PPI) across villages, ecozones and seasons. Aedes aegypti widely dominated Aedes fauna in both peri-urban (98.1%) and intra-urban (99.8%) villages. The most productive containers were small containers (31.1%), tires (30.5%) and medium containers (20.1%) in the peri-urban villages, and tires (64.6%) and small containers (18.7%) in the intra-urban villages that yielded over 80% of all the pupae collected in each village type. These key containers produced substantially more pupae in the domestic ecozones (70.9%) in the peri-urban villages, but equitably between the domestic (48.8%) and peridomestic (51.2%) ecozones in the intra-urban villages. In all villages, key containers provided over 80% of pupae sampled during short dry and long rainy seasons. CI, HI and BI were comparable between the peri-urban (29.9%, 35.9% and 41.4) and intra-urban (36.7%, 48.0% and 56.2) villages. However, PCI (3.38 vs. 1.26 pupae/container), PHI (5.18 vs. 1.75 pupae/house) and PPI (1.25 vs. 0.54 pupae/person) values were, respectively, 2.7, 3.0 and 2.3-fold higher in the intra-urban compared to peri-urban villages. Lower pupal indices in the intra-urban villages were compensated by five additional Aedes vector species. All indices were correlated to rainfall in all villages, with correlation coefficients varying from 0.16 to 0.84. In Cocody-Bingerville, all sampled peri-urban and intra-urban villages hosted high densities of Ae. aegypti immatures and habitats (tires, small or medium containers). Stegomyia indices remained consistently high, exceeding WHO DEN and YF epidemic thresholds in all villages, potentially contributing to ongoing DEN outbreaks. Aedes vector surveillance and outbreak responses should be extended to peri-urban villages, as they are likely contributors to arbovirus persistence and reintroduction. This is the first study to directly compare Aedes indices across peri-urban and intra-urban settings during an arboviral outbreak and offers a baseline for strategically reducing human exposure. Community-led interventions (larval source reduction, larviciding, public awareness) targeting identified larval habitats could help control arboviral outbreaks.
The most well- recognized method of feeding a baby is breastfeeding. Out of all the preventive measures, breastfeeding and supplemental feeding have the most impact on child mortality for infants and young children. Babies are shielded against acute infections by the mother's antibodies found in breast milk, and it boosts a baby's immune system, their reaction to immunizations and cognitive benefits. This was aimed to compare and identify the factors associated with exclusive breastfeeding practice among the rural and urban lactating mothers of the District. Exclusive breast feeding practice of this rural area was in line with the urban which was 68.1% (95% CI, 62.1-73) and 64% (95% CI, 53.5-74.4) respectively. This might be due to the similar primary health care policy intervention system both in the rural and urban areas of the Region. Besides of this, both the rural and urban mothers of the district were more benefited from the Ethiopia primary health care packages. A comparative cross-sectional study was conducted. A total of 346 lactating mothers were enrolled for the study. 5 rural and 1 urban Kebeles were randomly selected. From these the simple random sampling technique was used. The interviewer administered structured questionnaire was employed. Epi-Data Manager Version 4.6 was used to enter, encode, and clean the data for consistency and completeness. The data was analyzed using SPSS version of 22. Bivariable and multivariable logistic regression analysis were performed. A total of 346 lactating mothers were selected in both rural (258) and urban (88) areas of the district. The response rate was 248 (96.12%) in rural and 86 (97.72%) in urban. The prevalence of exclusive breastfeeding practice in the rural and urban areas was 68.1% (95% CI, 62.1-73) and 64% (95% CI, 53.5-74.4), respectively. According to the multivariable logistic regression analysis, in the rural mothers' educational status [AOR = 2.46, 95% CI (1.3-4.6)], parity [AOR = 2.56, 95% CI (1.4-4.7)], and antenatal care visit [AOR = 2.35, 95% CI (1.0-5.4)] were associated factors. In the urban area, education on exclusive breastfeeding practice during antenatal care visits [AOR = 3.46, CI (1.2-10)], mode of delivery [AOR = 3.7, CI (1.2-11.5)] and education on exclusive breast feeding practice during postnatal care visit [AOR = 2.9, CI (1.0-8.1)] were associated factors. Based on the mean score, exclusive breastfeeding practice in the rural and urban areas was slightly above the mean. This result doesn't show a significant difference both in the rural and urban areas. But this was lower than the notional and global recommendation level. It was substantially correlated with maternal educational status, parity, and prenatal care visits in the rural areas and with health education during prenatal care visits, method of birth, and postnatal care visits in the urban areas. We recommend that health care policy makers and health care providers strengthen the delivery of health education about exclusive breastfeeding practice during ANC visits and PNC visits, and they should advocate institutional delivery. Secondly, mothers should attend ANC and PNC and conduct institutional delivery so as to get information about exclusive breastfeeding practice.
Chronic obstructive pulmonary disease (COPD) is a leading cause of global morbidity and mortality. Emerging evidence suggests disparities in COPD outcomes between rural and urban populations, but no prior review has synthesised these differences globally. Five databases (Medline, Embase, Emcare, CINAHL and Cochrane Central) were searched in May 2025. Eligible peer-reviewed studies directly compared rural and urban populations in at least one of four measures of COPD burden: prevalence, symptom burden, exacerbations or mortality. Study quality was assessed and narrative synthesis was conducted due to heterogeneity in outcome measures. Of 1339 screened studies, 32 met inclusion criteria, spanning 13 countries. COPD prevalence was higher rurally in 83% (15/18) of studies, with 11/15 demonstrating statistical significance. This pattern was consistent across geographical distributions. Total exacerbation rates were higher rurally in 60% (3/5) of studies, although hospitalisations varied significantly. 50% (6/12) of studies reported higher hospitalisation rates in urban areas and 5/12 studies reporting higher rates in rural areas. 86% (6/7) of studies demonstrated higher mortality rurally and symptom burden was higher amongst rural residents in 67% (4/6) of studies; however, the majority of these were conducted in the USA. This review highlights consistent rural-urban inequalities in COPD prevalence and outcomes, reflecting the impact of healthcare inequities, socioeconomic deprivation and environmental exposures on COPD burden in rural areas. Targeted interventions promoting equitable healthcare access, health education, transition to cleaner fuels and rural access to smoking cessation and pulmonary rehabilitation services are essential to mitigate these disparities and improve outcomes in rural populations.
There are substantial inequalities in alcohol-related mortality related to individual-level education, income, and employment status, but less is known about the association between alcohol-related mortality and the geographic characteristics of an area. This systematic review aims to explore whether area-level features, including area-level measures of socioeconomic status, are associated with alcohol-attributable mortality. We systematically searched Medline (Ovid), CINAHL, EMBASE, PsycINFO, Web of Science, Emerald Insight, and Epistemonikos databases (2004 - 2024), supplemented with searches of grey literature, for primary quantitative studies conducted in high-income countries. Eligible studies examined associations between alcohol-attributable morality and one or more geographic characteristic. Studies were quality appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies, the Critical Appraisal Skills Programme for cohort studies, and the National Heart, Lung and Blood Institute checklist was adapted for assessing ecological studies. The findings were synthesised narratively. CRD42024499928. The searches identified 73 eligible studies covering mortality from a range of alcohol-attributable conditions, including chronic alcohol-specific conditions (e.g. alcohol-related liver disease) and alcohol-related incidents (e.g. road traffic collisions, suicides). Study quality was found to be good in most cases. Urban-rural location was the most common exposure and alcohol-specific mortality was the most common outcome measured in the included studies. Of the 34 studies examining area-level socioeconomic deprivation, all studies found a positive association between deprived areas and alcohol-attributable mortality. Of the 49 studies that examined urban-rural location, 26 (53.1%) found a positive association between rural location and alcohol-attributable mortality. Fourteen studies (28.6%) found urban location significant. Rural locations were particularly associated with alcohol-related road traffic collisions and suicides. Greater area-level deprivation and rurality are associated with higher rates of alcohol-related mortality.
There are no Indian studies estimating Cognitive Reserve (CR) across rural and urban aging populations. We estimated CR from two ongoing aging studies in rural (CBR-SANSCOG, n = 4459) and urban (CBR-TLSA, n = 663) southern India. We used years of education (YOE), job skill level (JSL), social network diversity (SND) and multilingualism (ML) as factors and assigned weights based on their capability to predict cognitive performance (assessed using a culturally adapted cognitive test battery). We evaluated several candidate machine learning models and chose the linear regression based on its fit. In the rural cohort, YOE, ML, and SND contributed significantly (Rural CR = 0.085×YOE + 0.184×ML + 0.030×SND), whereas YOE, ML and JSL were significant contributors for the urban cohort (Urban CR = 0.064×YOE + 0.184×ML + 0.197×JSL). The contribution of CR factors differs across rural and urban Indian populations. Targeted interventions to enhance population-specific CR factors could reduce dementia risk.
In response to the dual challenges of global climate change and China's "dual carbon" goals, the digital economy has become increasingly vital in enhancing urban energy-related carbon emission efficiency. However, traditional studies have not fully considered its interregional network linkages and the resulting spatial spillover effects. To address this gap, this study employs panel data from 271 prefecture-level cities in China between 2011 and 2022 to construct a spatial correlation network of the digital economy. By integrating a modified gravity model, social network analysis, and spatial econometric techniques, we systematically examine the mechanisms, spatial heterogeneity, and spillover effects of this network on urban energy carbon emission efficiency. The findings reveal four main insights: (1) The spatial correlation network of China's urban digital economy demonstrates a complex and multi-threaded structure, with core cities such as Shanghai, Beijing, and Shenzhen dominating digital resource flows. Although overall carbon emission efficiency has improved, disparities across cities have widened. (2) An increase in network centrality significantly enhances energy carbon emission efficiency, with more pronounced positive externalities in the eastern region and in megacities. (3) Network centrality exerts significant spatial spillover effects on efficiency, exhibiting a boundary effect: the spillover coefficient peaks at 170 km and decays with greater distance. (4) Urban innovation capacity serves as a key transmission channel in improving efficiency, whereas industrial upgrading currently imposes certain constraints, as the expansion of energy-intensive industries may inhibit short-term efficiency gains. These results provide practical implications for fostering spatially coordinated carbon reduction and improving urban energy carbon emission efficiency in China.
In this article, we examine two urban railway projects in Hanoi, Vietnam: Line 2A, operational since 2021, and Line 3, currently partly operational and partly under construction. Despite high hopes for these 'sustainable' transportation projects, little scholarly attention has focused on the inequities and negative impacts associated with their construction and operations. Specifically, the displacements and insecurities faced by Hanoi residents living or working along these lines have been largely overlooked. Drawing on conceptual debates from the recent infrastructure turn, we examine how Hanoi's first two urban railway lines have disrupted the lives and livelihoods of local residents. Our findings are based upon in-depth qualitative fieldwork conducted in 2019, 2022, and 2024, including interviews, a photovoice project along Line 2A, and an ethnographic case study of an alley partly destroyed by Line 3's construction. We find that the land acquisition and construction processes have inflicted infrastructural violence on numerous nearby residents and workers, creating categories of 'lucky', 'unlucky', and 'least lucky' residents. We investigate how some residents are adapting by establishing new livelihoods beneath or alongside the lines, carving out opportunities in otherwise underutilised spaces. We argue that these individuals are engaging in careful urban spatial politics to navigate the impacts of these projects while avoiding conflict with urban officials focused on 'modernisation' discourses. 在本文中，我们研究了越南河内的两个城市铁路项目：自 2021 年起投入运营的 2A 号线，以及目前已部分投入运营，正在建设中的 3 号线。尽管人们对这些“可持续的”交通项目寄予厚望，但学术界很少关注与其建设和运营相关的不公平和负面影响。具体来说，在这些线路沿线生活或工作的河内居民所面临的流离失所和不安全感，在很大程度上被忽视了。基于近年来围绕“基础设施转向” 展开的概念论争，我们考察了河内首批建设的两条城市铁路线路如何对当地居民的日常生活与生计造成了干扰。我们的研究结果基于 2019 年、2022 年和 2024 年进行的深入定性实地考察，包括访谈、2A 号线沿线的影像发声项目，以及对一处因 3 号线建设而部分被损毁的小巷开展的民族志案例研究。我们发现，土地征用和建设过程使众多附近的居民和工人遭受了基础设施暴力，造成了“幸运”、“不幸”和“最不幸运”的居民类别。我们研究了一些居民如何通过在线路下方或沿线开拓新生计来适应变化，并在原本未充分利用的空间中创造机会。我们认为，这些人正在采取审慎的城市空间政治，以应对这些项目的影响，同时避免与秉持“现代化”话语的城市官员发生冲突。.
As residents' demand for leisure consumption spaces continues to grow, the development of these spaces influences their perception of urban environments and life satisfaction. To examine how different urban leisure consumption spaces affect life satisfaction, we analyze service quality and life satisfaction using Dianping and Weibo Sign-in data through deep learning methods like Feature Tokenizer Transformer, then evaluate the relative importance of service quality's impact. Results show that high service quality significantly enhances life satisfaction, while the quantity of spaces has negligible effect. Among different space types, Catering exerts the strongest influence on life satisfaction, followed by Entertainment, Personal care, Retail, and Sports, with regional and functional variations in these effects. This systematic study using multi-source big data and deep learning enriches media geography and spatial behavior theories while providing references for optimizing urban functional layout and public service policies.
The frailty index is a composite indicator of older adults' health status. This study examines temporal trends in frailty among China's older population and seeks to disentangle the respective roles of aging, cohort replacement, and period-specific environments. Using longitudinal data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and drawing on the accelerated longitudinal design framework, we decompose changes in frailty along the age-period-cohort (APC) dimensions. We estimate the marginal contributions of age, survey period, and birth cohort to frailty patterns among older Chinese adults and, on this basis, generate projections of future frailty trends. First, the frailty index increases strictly monotonically with age. The cohort effect exhibits an overall declining trend, such that later-born cohorts show lower frailty at the same age and in the same period. The period effect shifts upward over the sample window, suggesting that the influence of macro-level environments and institutional change on frailty is not a simple unidirectional health gain. Second, frailty displays pronounced gender and urban-rural disparities: rural men have the lowest overall levels, whereas urban women rise more rapidly at advanced ages and remain the most frail. Moreover, the urban-rural gap among women widens faster than that among men, and within-city gender disparities also intensify more rapidly than within rural areas; advanced old age emerges as a critical interval in which urban-rural and gender inequalities interact and amplify. Third, frailty among China's future older population is projected to worsen continuously, albeit at different rates across groups. The largest increase is expected among urban older women, followed by rural older women, while frailty among rural older men is projected to surpass that of urban older men after 2035. Across years, the upward shift is generally larger for rural groups than for urban groups and is more pronounced at advanced ages, implying that the future burden of frailty may be increasingly concentrated among rural older adults. These findings highlight the importance of an APC-informed and ALD-based perspective for interpreting frailty dynamics and for producing structurally grounded projections. The projected widening of rural disadvantage at advanced ages underscores the need for forward-looking public health and long-term care planning with attention to urban-rural and gender inequalities.
Prescribing processes for the elderly are complex and challenging due to advanced age-related physiologic changes, co-morbidities, and co-medications which increase the chances of medication errors. There are, however, limited studies on the magnitude and profiles of medication errors among elderly populations in low-resource settings such as Tanzania. To determine the prevalence and profiles of medication errors among elderly in-patients at Mwananyamala Regional Referral Hospital (MRRH) in Dar-es-Salaam in Tanzania. Medical data were analyzed of patients aged 65 years and above who were admitted to MRRH between March 2019 and February 2020 for any type of illness. Medication errors were systematically assessed using STOPP/START criteria. Of 298 patients' records analyzed, the majority were females (n=151, 50.7%). Each patient had at least 2 diseases with an average of 5 types of medicines per patient. Twenty-eight patients (9.40%) had at least one error while the majority (n=270, 90.60%) had no medication errors. Medication omission accounted for the majority of errors present (86, 28.86%). Medication errors were prevalent among elderly patients admitted at MRRH, with diverse profiles related to the errors. Further studies are warranted to devise and adopt strategies to mitigate medication errors in this population.
Cyclospora cayetanensis is an important foodborne parasite worldwide, with fresh produce and contaminated irrigation water as major transmission vehicles. In South Asia, environmental surveillance data remain limited. We investigated the occurrence of C. cayetanensis DNA in fresh produce and irrigation water across peri-urban areas of Khyber Pakhtunkhwa, Pakistan, and assessed environmental and farm-level factors associated with contamination. A cross-sectional study was conducted in Peshawar and Kohat districts from April to September 2025. A total of 420 samples were collected, including 300 fresh produce samples (six commonly consumed vegetables and herbs) and 120 irrigation water samples from canal, tube-well, and mixed sources. Samples were processed using concentration techniques, and detection was performed by nested PCR targeting the 18 S rRNA gene. Structured field questionnaires were used to capture farm-level practices, and logistic regression was applied to identify risk factors. We detected C. cayetanensis DNA in 6.0% of produce (18/300) and 12.5% of irrigation water (15/120; p = 0.028). Canal water (20.0%) was more frequently contaminated than tube-well water (5.0%; OR 4.75; 95% CI: 1.01-22.3). Leafy vegetables and herbs had higher contamination than smooth-surfaced produce (8.0% vs. 2.0%; p = 0.009). In multivariable analysis, canal irrigation (aOR 3.41), proximity to drainage channels ≤ 50 m (aOR 3.98), and use of untreated rinsing water (aOR 2.91) remained independently associated with contamination (all p < 0.05). This study provides among the first molecular evidence of C. cayetanensis contamination at the produce-water interface in peri-urban Khyber Pakhtunkhwa, Pakistan, identifying surface irrigation and poor water management as key risk factors. However, because PCR detects DNA rather than viable organisms, these findings indicate environmental contamination and potential exposure pathways rather than direct infection risk. Sequencing confirmation is needed to exclude cross-amplification of related coccidia.
While the drug-related risks and harms associated with being unhoused have been previously identified, little is known about the drug-related impacts of displacement from housing. This qualitative and community-based participatory research study explores drug use patterns and risks among people living with HIV (PLHIV) displaced from housing in the West End and the Downtown Eastside neighbourhoods of Vancouver, British Columbia. Between May 2023 and June 2024, semi-structured interviews (n = 29) and participant observations (n = 6) were conducted with PLHIV who use drugs displaced within the last six months from housing in the West End and/or the Downtown Eastside. Data were analyzed thematically and interpreted by drawing on the intersectional risk environment framework. Two illustrative cases that exemplified broader themes across the data were selected to better contextualize participants' experiences of displacement and drug use. Participants positioned drug use as critical to managing their health and survival needs, which were amplified by displacement. Coupled with increased drug use, participants experienced reduced access to safer environments for drug use and changes to their risk environment in ways that exacerbated their post-displacement overdose risk. Cases rendered visible how this was particularly true for participants experiencing intersecting oppressions based on race, ethnicity, gender, sexual orientation, and class. This study advances our understanding of displacement and its impacts on drug use patterns and risks across and within diverse communities of PLHIV. Our findings underscore the urgent need for housing and urban policies to complement harm reduction efforts. We call for participatory planning approaches that foster genuine collaboration between policymakers and marginalized communities to co-create housing and urban policies that are responsive to the needs of those most affected.
Indigenous peoples experience significant health inequities compared to non-Indigenous peoples. The reasons for this are multi-faceted. Access to healthcare for marginalised Indigenous peoples is made more difficult by living rurally; urban counterparts have improved healthcare access and health outcomes. This review aimed to further understand the healthcare experiences of rural Indigenous peoples residing in New Zealand (Aotearoa), Australia, Canada or the United States of America (USA). Participants were required to self-identify as Indigenous consumers of healthcare aged 18 years or older, with personal or family experiences of receiving healthcare. Contextually, rural healthcare service access in any healthcare setting was chosen. The countries chosen for inclusion were New Zealand, Australia, Canada, and the USA. Exclusion criteria included studies with non-Indigenous participants with healthcare experiences that were unable to be isolated and extracted, as well as studies involving both rural and urban healthcare experiences where the urban experiences were unable to be isolated and removed. The electronic databases Scopus (Elsevier), CINAHL Complete (EBSCOhost) and Medline (OVID) were searched. Articles were screened by one author (TC) to identify primary research studies that reported patient lived experiences and included Indigenous participants who live rurally. Searches were completed in June 2024 and limited to full text, English language and date limited to 2004-2024. Articles were then analysed via thematic analysis. Seven articles were analysed. The articles were located in Aotearoa, Australia, and Canada. No suitable studies from the USA were identified or included. Five themes were identified as having impacted the healthcare experiences of Indigenous peoples: distance to care; quality of care and racism; support from and impact on, whānau (family); health professional communication and knowledge sharing; and Indigenous solutions and holistic care. Ensuring that patient-centred care also involves wider family members has been shown to be beneficial, as has the engagement of Indigenous health professionals and health workers in providing culturally inclusive healthcare. Health professionals should consider language and communication techniques when engaging with people seeking healthcare and not make assumptions, for example around health knowledge.
Early HIV diagnosis allows timely interventions to control HIV transmission. We have determined the proportion of recent infections among people living with HIV (PLHIV) enrolling to care in Ethiopia and identified factors associated with recent infection. Participants (aged ≥ 15 years) newly enrolled in HIV care were recruited from urban clinics in central Ethiopia (2022-2024). We used a recent infection testing algorithm, combining limiting antigen avidity serology and viral load quantification, to determine HIV infection recency. Factors associated with recent infection were investigated using logistic regression analysis, including sex-stratified analyses. Among 622 participants (median age 35 years; 364 [58.5%] women), 42 (6.8%) had recent infection. Recent infection was more common among PLHIV aged 15-24 years compared to those > 24 years (adjusted odds ratio [aOR], 4.3; 95% confidence interval [CI], 2.1-8.6), and in PLHIV belonging to key and priority populations (aOR, 2.2; 95% CI, 1.1-4.2). In sex-stratified analyses, age 15-24 years remained significantly associated with recent infection in both men (unadjusted odds ratio, 6.4; 95% CI, 1.5-26.5) and women (aOR, 2.7; 95% CI,1.2-6.1), whereas belonging to key and priority populations was significantly associated with recent infection only among women (aOR, 2.4; 95% CI, 1.1-5.2). A low proportion of PLHIV newly enrolled in care had recently acquired HIV infection. Recent infection was more common among persons aged 15-24 years and women belonging to key and priority populations. Further scale-up of HIV testing services are needed to improve detection of recent infection, which could help in prevention of new infections.
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Sanitation workers face chronic occupational exposure to ambient air pollution and traffic-related particulate matter; however, the prevalence of high-risk lung nodules in this vulnerable population remains unclear. Furthermore, the potential association between physical health-related quality of life (HRQoL) and nodule risk, along with its sex-specific patterns, has not been adequately investigated. This cross-sectional study included 1,018 outdoor sanitation workers in Hohhot, Inner Mongolia Autonomous Region, China. All participants underwent low-dose computed tomography (LDCT) screening and completed the SF-8 Health Survey. Lung nodules were assessed by two independent radiologists in a blinded manner. High-risk lung nodules (Lung-RADS Category 4) were confirmed by at least two senior specialists. Multivariate logistic regression and interaction analyses were employed to evaluate the association between Physical Component Summary (PCS) scores and high-risk lung nodules, adjusting for age, sex, smoking status, and socioeconomic factors. A total of 16 participants (1.57%) were identified with high-risk lung nodules, of whom 9 (56.3%) were never-smoking females. The fully adjusted model included 994 participants. Multivariable logistic regression revealed an inverse association between PCS and high-risk lung nodules. Treated as a continuous variable, PCS showed a marginal inverse association after adjusting for sex, age, smoking, education, and residence (OR = 0.92, 95% CI: 0.84-1.00, P = 0.0505). When dichotomized at a cutoff of 50, a significantly decreased risk was observed in the PCS ≥ 50 group vs. the PCS < 50 group, which persisted after full adjustment (OR = 0.29, 95% CI: 0.10-0.83, P = 0.0211). Generalized additive models indicated a significant, nearly linear relationship (P = 0.027). Furthermore, subgroup analyses showed this protective effect was accentuated in females (OR = 0.87, 95% CI: 0.79-0.96, P = 0.0065) and highly educated individuals (OR = 0.81, 95% CI: 0.70-0.94, P = 0.0042), both yielding significant interactions (P for interaction = 0.0407 and 0.0319, respectively). Interactions for age, income, smoking, BMI, and residence were non-significant. A higher PCS is inversely associated with high-risk lung nodules, demonstrating a generally approximate linear relationship. This inverse association is more pronounced in females and individuals with higher educational levels, suggesting potential effect modification by sex and education.
The double burden of malnutrition (DBM), defined as the coexistence of undernutrition and overnutrition within the same household, is an increasing public health concern in South and Southeast Asia, yet evidence on its household-level determinants remains fragmented. This systematic review and meta-analysis aimed to synthesize evidence on factors associated with household-level DBM in South and Southeast Asia. PubMed, Scopus, and Web of Science were searched for observational studies published between January 2000 and September 2025. Two reviewers (AT & MAS) independently screened studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale adapted for cross-sectional studies. Random-effects meta-analyses were conducted for factors reported in ≥5 studies, and pooled odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. Thirty studies were included, of which 26 were eligible for meta-analysis. Urban residence (OR = 1.38, 95% CI: 1.20, 1.59), higher household wealth (OR = 1.55, 95% CI: 1.31, 1.83), older maternal age (OR = 2.22, 95% CI: 1.97, 2.50), maternal short stature (OR = 1.90, 95% CI: 1.69, 2.13), older child age (OR = 1.79, 95% CI: 1.44, 2.23), and cesarean delivery (OR = 1.76, 95% CI: 1.20, 2.57) were associated with higher likelihood of DBM. Higher maternal education and breastfeeding were found to be protective factors. Effective interventions should adopt integrated, life-course approaches that simultaneously address undernutrition and overnutrition across critical stages, particularly during adolescence, pregnancy, and early childhood. Policies should prioritize maternal education, breastfeeding promotion, and adolescent nutrition to break intergenerational cycles of malnutrition.This study was registered at PROSPERO as CRD420251155844.
BackgroundPuerperal sepsis remains a preventable contributor to maternal illness. Pregnancy-related sepsis is responsible for ∼10% to 15% of maternal deaths. Despite this burden, no comprehensive review has examined self-care practices related to its prevention. Therefore, this review sought to evaluate self-care behaviors aimed at preventing puerperal sepsis and to explore associated factors among postnatal women in Africa.Data Sources and MethodsWe conducted a systematic review and metaanalysis of 17 eligible studies on the prevalence of self-care practices for puerperal sepsis prevention and their associations among postnatal mothers. Searched PubMed, Web of Science, Wiley Online Library, ScienceDirect, African Journals Online, and Google Scholar from December 10, 2023 to January 15, 2024. A Joanna Briggs Institute adapted tool was used to assess the quality of the studies. Forest plot, Cochran's Q test, subgroup analysis, sensitivity analysis, and metaregression model were used to test heterogeneity between included studies. Funnel plots and Egger's test were used to examine publication bias.ResultsA total of 17 studies that meet the inclusion criteria were included. The pooled prevalence of self-care for puerperal sepsis prevention practices among postpartum women was 36.09% (95% CI: 26.35, 45.82). Among postpartum women, urban dwellers (AOR: 3.23, 95% CI: 1.86, 5.63), those who were above tertiary education status (AOR: 2.81, 95% CI: 1.11, 4.67), those who had a good level of knowledge (AOR: 2.45, 95% CI: 1.11, 4.67), and those who had ≥4 ANC contacts (AOR: 3.75, 95% CI: 2.23, 6.31) were identified as associated factors.ConclusionsOnly 36.09% of postpartum women practiced self-care practices to prevent puerperal sepsis at home. It would be better to design a new healthcare system during maternal healthcare to scale up mothers' self-care puerperal sepsis prevention practices to reduce maternal morbidity and mortality caused by puerperal sepsis. In addition, all healthcare providers recognize the need to foster new thinking and to apply greater action to address identified factors of poor self-care and puerperal sepsis prevention practices.PROSPERO RegistrationCRD420251042794. Self-care practices for puerperal sepsis prevention and associated factors among postnatal women in Africa: A systematic review and meta-analysisPuerperal sepsis remains a preventable contributor to maternal illness. Pregnancy-related sepsis is responsible for ∼10% to 15% of maternal deaths. Although some primary studies have been conducted on self-care prevention practices and related factors, the findings have been inconsistent, making it difficult to generalize their results across Africa. Therefore, this systematic review aimed to evaluate the overall self-care prevention practices and their associated factors among postpartum mothers. I hope our findings will help to identify relevant gaps and contribute to improving self-care practices to prevent complications of puerperal sepsis and encourage early self-reporting about the condition. In addition, all healthcare providers recognize the need to foster new thinking and to apply greater action to address identified factors of poor self-care and puerperal sepsis prevention practices.
To estimate the age-stratified, hepatitis A virus (HAV) seroprevalence in eight Indian states. A cross-sectional seroprevalence survey was conducted in 120 rural and 105 urban population clusters across eight Indian states between 12 December 2022 and 28 November 2023. In each cluster, ten participants were randomly selected from each of the age groups: (i) 2 to 4 years; (ii) 5 to 9 years; (iii) 10 to 14 years; (iv) 15 to 30 years; and (v) > 30 years. Serum samples were tested for anti-HAV antibodies. Overall, the HAV seroprevalence in the five age groups was 33.2% (95% confidence interval, CI: 30.4-36.2), 51.9% (95% CI: 49.0-54.8), 69.2% (95% CI: 66.6-71.8), 89.7% (95% CI: 88.6-90.8) and 97.4% (95% CI: 96.9-97.8), respectively. The female-to-male ratio was 1.52 : 1 and the HAV seroprevalence was 73.0% (4940/6768) in females versus 63.2% (2821/4453) in males. Overall, HAV endemicity was found to be high-intermediate in study groups in Gujarat, Jammu, Karnataka, Punjab and Rajasthan, high in Bihar, intermediate in Assam and low-intermediate in rural Manipur. As the overall seroprevalence for all children younger than 15 years was 51.9%, substantially more than 40% were at risk of HAV infection. Although HAV endemicity varied widely across urban and rural study populations in the eight Indian states, it was generally high-intermediate, providing evidence that HAV endemicity in India has declined in recent years. The study's findings could help Indian policy-makers decide on HAV vaccination for children. Estimer la séroprévalence du virus de l’hépatite A (VHA) par tranche d’âge dans huit États indiens. Une enquête transversale de séroprévalence a été menée parmi 120 groupes de population rurale et 105 groupes de population urbaine dans huit États indiens du 12 décembre 2022 au 28 novembre 2023. Au sein de chaque groupe, dix participants ont été sélectionnés au hasard dans chacune des tranches d’âge suivantes: (i) 2 à 4 ans; (ii) 5 à 9 ans; (iii) 10 à 14 ans; (iv) 15 à 30 ans; et (v) > 30 ans. Des échantillons de sérum ont été testés pour détecter la présence d’anticorps anti-VHA. Dans l’ensemble, la séroprévalence du VHA dans les cinq groupes d’âge était de 33,2% (IC (intervalle de confiance) à 95%: 30,4–36,2), 51,9% (IC à 95%: 49,0–54,8), 69,2% (IC à 95%: 66,6–71,8), 89,7% (IC à 95%: 88,6–90,8) et 97,4% (IC à 95%: 96,9–97,8), respectivement. Le rapport femmes/hommes était de 1,52:1 et la séroprévalence du VHA était de 73,0% (4940/6768) chez les femmes contre 63,2% (2821/4453) chez les hommes. Dans l’ensemble, l’endémicité du VHA s’est avérée élevée à moyenne dans les groupes étudiés au Gujarat, au Jammu-et-Cachemire, au Karnataka, au Pendjab et au Rajasthan, élevée au Bihar, moyenne en Assam et faible à moyenne dans les zones rurales du Manipur. La séroprévalence globale chez tous les enfants de moins de 15 ans étant de 51,9%, plus de 40% d’entre eux étaient exposés à un risque d’infection par le VHA. Bien que l’endémicité du VHA variait considérablement entre les populations urbaines et rurales étudiées dans les huit États indiens, elle était généralement élevée à moyenne, ce qui prouve que l’endémicité du VHA en Inde a diminué ces dernières années. Les résultats de l’étude pourraient aider les décideurs politiques indiens à prendre des décisions concernant la vaccination des enfants contre le VHA. Estimar la seroprevalencia del virus de la hepatitis A (VHA) estratificada por edad en ocho estados de la India. Se realizó una encuesta transversal de seroprevalencia en 120 conglomerados de población rurales y 105 urbanos en ocho estados de la India entre el 12 de diciembre de 2022 y el 28 de noviembre de 2023. En cada conglomerado, se seleccionaron aleatoriamente diez participantes de cada uno de los siguientes grupos de edad: (i) 2 a 4 años; (ii) 5 a 9 años; (iii) 10 a 14 años; (iv) 15 a 30 años; y (v) >30 años. Las muestras de suero se analizaron para detectar anticuerpos anti-VHA. En general, la seroprevalencia de VHA en los cinco grupos de edad fue del 33,2% (intervalo de confianza del 95% [IC]: 30,4-36,2), 51,9% (IC del 95%: 49,0-54,8), 69,2% (IC del 95%: 66,6-71,8), 89,7% (IC del 95%: 88,6-90,8) y 97,4% (IC del 95%: 96,9-97,8), respectivamente. La razón mujer:hombre fue de 1,52:1 y la seroprevalencia de VHA fue del 73,0% (4940/6768) en mujeres frente al 63,2% (2821/4453) en hombres. En general, se observó que la endemicidad del VHA fue intermedia-alta en los grupos de estudio de Gujarat, Jammu, Karnataka, Punjab y Rajastán, alta en Bihar, intermedia en Assam e intermedia-baja en zonas rurales de Manipur. Dado que la seroprevalencia global en todos los niños menores de 15 años fue del 51,9%, una proporción sustancialmente superior al 40% estaba en riesgo de infección por VHA. Aunque la endemicidad del VHA varió ampliamente entre las poblaciones urbanas y rurales estudiadas en los ocho estados de la India, en general fue intermedia-alta, lo que aporta evidencia de que la endemicidad del VHA en la India ha disminuido en los últimos años. Los resultados del estudio podrían ayudar a los responsables de la formulación de políticas en la India a decidir sobre la vacunación frente al VHA en la población infantil. تقدير معدل الانتشار المصلي لفيروس التهاب الكبد أ (HAV) حسب الفئة العمرية في ثماني ولايات هندية. تم إجراء دراسة استقصائية مقطعية لمعدل الانتشار المصلي في 120 مجموعة سكانية ريفية، و 105 مجموعة سكانية حضرية في ثماني ولايات هندية، بين 12 ديسمبر/كانون أول 2022، و28 نوفمبر/تشرين ثاني 2023. في كل مجموعة، تم اختيار عشرة مشاركين عشوائياً من كل فئة عمرية: (1) 2 إلى 4 سنوات؛ و(2) 5 إلى 9 سنوات؛ و(3) 10 إلى 14 سنة؛ و(4) 15 إلى 30 سنة؛ و(5) أكثر من 30 سنة. تم اختبار عينات المصل للكشف عن الأجسام المضادة لفيروس التهاب الكبد أ. بشكل عام، بلغ معدل الانتشار المصلي لفيروس التهاب الكبد أ في المجموعات العمرية الخمس %33.2 (بفاصل ثقة مقداره %95: 30.4 إلى 36.2)، و%51.9 (بفاصل ثقة مقداره %95: 49.0 إلى 54.8)، و%69.2 (بفاصل ثقة مقداره %95: 66.6 إلى 71.8)، و%89.7 (بفاصل ثقة مقداره %95: 88.6 إلى 90.8)، و%97.4 (بفاصل ثقة مقداره %95: 96.9 إلى 97.8)، على الترتيب. كانت نسبة الإناث إلى الذكور 1.52: 1 وبلغت نسبة الانتشار المصلي لفيروس التهاب الكبد أ %73.0 (4940/6768) لدى الإناث في مقابل %63.2 (2821/4453) لدى الذكور. بشكل عام، تم اكتشاف أن استشراء فيروس التهاب الكبد أ كان متوسطًا إلى مرتفعًا في مجموعات الدراسة في غوجارات وجامو وكارناتاكا والبنجاب وراجستان، ومرتفعًا في بيهار، ومتوسطًا في آسام، ومنخفضًا إلى متوسطًا في المناطق الريفية في مانيبور. ونظرًا لأن معدل الانتشار الإجمالي لجميع الأطفال دون سن 15 عامًا كان %51.9، فإن أكثر من %40 كانوا معرضين لخطر الإصابة بفيروس التهاب الكبد أ. على الرغم من أن انتشار فيروس التهاب الكبد أ تباين بشكل كبير بين التجمعات السكانية الحضرية والريفية في الولايات الهندية الثماني، إلا أنه كان مرتفعًا إلى متوسط بشكل عام، مما يوفر دليلًا على أن انتشار فيروس التهاب الكبد أ في الهند في السنوات الأخيرة. قد تساعد نتائج الدراسة واضعي السياسات الهنود في اتخاذ قرار بشأن تطعيم الأطفال ضد فيروس التهاب الكبد أ. 旨在按年龄分层评估印度八个邦的甲型肝炎病毒 (HAV) 血清阳性反应率。. 于 2022 年 12 月 12 日至 2023 年 11 月 28 日期间在印度八个邦共选取 120 个农村人口群和 105 个城市人口群开展了一项血清阳性反应率横断面研究。从每个人口群的以下各个年龄组中分别随机挑选了十名参与者：(i) 2 至 4 岁；(ii) 5 至 9 岁；(iii) 10 至 14 岁；(iv) 15 至 30 岁；以及 (v) 30 岁以上。然后对这些参与者的血清样本进行了抗 HAV 抗体检测。. 总体而言，五个年龄组的 HAV 血清阳性反应率分别为 33.2%【95% 置信区间 (CI)：30.4-36.2】；51.9%（95% CI：49.0-54.8）；69.2%（95% CI：66.6-71.8）；89.7%（95% CI：88.6-90.8）；以及 97.4%（95% CI：96.9-97.8）。女性与男性之比为 1.52:1，其中女性的 HAV 血清阳性反应率为 73.0% (4,940/6,768)，男性则为 63.2% (2,821/4,453)。通过检测各研究组以确定 HAV 地方性流行水平，我们发现，总体而言，古吉拉特邦、查谟、卡纳塔克邦、旁遮普邦和拉贾斯坦邦属于中高流行区；比哈尔邦属于高流行区；阿萨姆邦属于中等流行区，而曼尼普尔邦农村地区则属于中低流行区。由于所有 15 岁以下孩子的整体血清阳性反应率为 51.9%，所以存在 HAV 感染风险的孩子所占比例远超 40%。. 虽然印度八个邦城市和农村研究人群的 HAV 地方性流行水平差异很大，但是总体属于中高水平，这表明近年来印度的 HAV 地方性流行水平有所下降。该研究的结果有利于帮助印度的政策制定者决定该如何为孩子们安排 HAV 疫苗接种。. Оценить серопревалентность вируса гепатита А (ВГА) со стратификацией по возрасту для восьми штатов Индии. Перекрестное сероэпидемиологическое исследование было проведено в 120 сельских и 105 городских кластерах населения в восьми штатах Индии в период с 12 декабря 2022 года по 28 ноября 2023 года. В каждом кластере были случайным образом отобраны по десять участников из каждой возрастной группы: (i) от 2 до 4 лет; (ii) от 5 до 9 лет; (iii) от 10 до 14 лет; (iv) от 15 до 30 лет; (v) > 30 лет. Образцы их сыворотки были протестированы на наличие антител к ВГА. В целом серопревалентность ВГА в пяти возрастных группах составила 33,2% (95%-й доверительный интервал, ДИ: 30,4–36,2), 51,9% (95%-й ДИ: 49,0–54,8), 69,2% (95%-й ДИ: 66,6–71,8), 89,7% (95%-й ДИ: 88,6–90,8) и 97,4% (95%-й ДИ: 96,9–97,8) соответственно. Соотношение женщин и мужчин составляло 1,52:1, и серопревалентность ВГА у женщин составила 73,0% (4940/6768) в сравнении с 63,2% (2821/4453) у мужчин. В целом эндемичность по ВГА была оценена как средне-высокая в исследуемых группах в Гуджарате, Джамму, Карнатаке, Пенджабе и Раджастане, высокая в Бихаре, средняя в Ассаме и средне-низкая в сельских районах Манипура. Так как общая серопревалентность для всех детей младше 15 лет составила 51,9%, значительно больше 40% из них имели риск развития инфекции, вызванной вирусом гепатита А. Хотя эндемичность ВГА значительно варьировалась между городской и сельской популяцией в восьми штатах Индии, в целом ее можно охарактеризовать как средне-высокую, что свидетельствует о снижении эндемичности вируса гепатита А в Индии за последние годы. Результаты исследования могут помочь индийским политикам в принятии решения о вакцинировании детей от ВГА.
Hepatitis C (HCV) is an important cause of global morbidity and mortality and can progress to cirrhosis and hepatocellular carcinoma. Vertical transmission occurs in around 5%‒6% of cases, increasing in pregnant women with a high viral load or co-infection with HIV. Although universal screening is recommended by international guidelines, its implementation in Brazil is uneven. This study estimated the seroprevalence of anti-HCV antibodies among pregnant women attending public maternity hospitals in Paraná and compared the results with national data. This was an observational, descriptive, and cross-sectional population-based study to assess seroprevalence. The study included 1202 pregnant women aged between 16 and 49, treated in 14 public maternity hospitals in Paraná, in different regions of the state. Anti-HCV screening was carried out by ELISA, and reactive cases were confirmed by viral load (PCR). Sociodemographic and obstetric data and risk factors were obtained from questionnaires and medical records. Nine participants tested positive for anti-HCV antibodies, corresponding to a seroprevalence of 0.75% (95% CI 0.34%‒1.40%). This seroprevalence falls within the range reported in previous Brazilian cross-sectional studies of pregnant women (0.06%-2.66%). No active infection was identified, as all reactive samples were HCV RNA-negative. More than half were unaware of their previous infection. No significant associations with traditional risk factors were observed. The low anti-HCV seroprevalence and the absence of detectable viremia indicate a minimal risk of vertical transmission in the cohort studied. These findings are consistent with low endemicity settings and support the role of prenatal screening in identifying previously undiagnosed infection and enabling linkage to postpartum care. The studies reviewed showed substantial heterogeneity in prevalence estimates, reflecting differences in population characteristics, sample sizes, study periods, and methodologies. The under-representation of rural areas and the exclusion of illiterate women may have led to an underestimation of seroprevalence and should be considered when interpreting the results. Therefore, the findings are primarily generalizable to literate pregnant women attending public maternity hospitals in urban and peri‑urban áreas.