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Chronic kidney disease (CKD) is an important but under-recognized cause of morbidity in young people living in low- and middle-income countries (LMICs), where epidemiological data in this age group are limited and fragmented. LMICs, as defined by the World Bank, have a gross national income per capita between United States dollar 1136 and United States dollar 13845 (2024). To summarize the prevalence of CKD among individuals aged ≤ 25 years in LMICs and to explore sources of between-study variability. We performed a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. PubMed, EMBASE, Cochrane Library, and Google Scholar were searched for original studies reporting CKD prevalence in LMIC populations aged 0-25 years. Study-level proportions were pooled using a random intercept logistic regression model (generalized linear mixed model) with logit transformation. Heterogeneity was quantified using τ 2, I 2, and Q statistics. Prespecified subgroup analyses stratified studies by world region and study setting (community-based, hospital/clinic-based, CKD/end-stage renal disease registries, and specific disease cohorts). Random-effects meta-regression examined the contribution of region and setting to heterogeneity. Sensitivity analyses excluding registry and high-risk cohorts were undertaken to approximate prevalence in more general populations. Nineteen studies from 17 countries (339940 participants; 96674 CKD cases) were included. The overall pooled prevalence was 11.7% (95% confidence interval: 5.5%-23.3%), with a prediction interval spanning 0.3%-84% and extreme heterogeneity (τ 2 = 3.41; I 2 = 99.9%). Subgroup analyses showed a clear gradient by setting, from lowest prevalence in community-based samples to highest in registries and disease-specific cohorts. Meta-regression indicated that setting explained 36.8% and region 28.2% of between-study variance, while both combined explained 61.4%. In sensitivity analyses restricted to more general populations, pooled prevalence was in the 4%-5% range (random-effects 95% confidence interval: 2%-9%), although heterogeneity remained high. CKD in young people in LMICs is common and highly variable, largely reflecting differences in study setting and geography, and warrants targeted early detection and surveillance strategies.

HPV-positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) patients have improved survival compared to HPV-negative OPSCC (HPV-) patients (5-year survival rates of &#x223c;80% versus &#x223c;40%). The predictive value of p16 immunohistochemistry (IHC) for HPV+ OPSCC, the most widely used clinical test for HPV status, varies by HPV+ OPSCC prevalence in geographically different populations, but variation within a region is not well described. We analyzed p16 IHC and survival in two geographically and demographically diverse OPSCC cohorts of African American (AA, n = 177, Louisiana Tumor Registry) and non-Hispanic white (NHW, n = 392, University of Michigan) patients. HPV+ prevalence was 29.3% in AA versus 86.8% in NHW. p16+ OPSCC was associated with significantly better survival in NHW than in AA patients (HR=4.65, 95% CI: 2.88-7.51, Cox p < 0.0001), adjusting for covariates. AA p16- had worse survival than NHW p16- (log-rank p < 0.001). p16 was less predictive of HPV RNA status for AA than NHW patients (positive predictive value = 65.4% vs. 94.9%, p < 0.05). Among HPV RNA+ patients (79 NHW,17 AA), AA had worse survival than NHW (log-rank p < 0.001). Survival disparities exist after accounting for heterogeneous HPV+ tumor rates. The PPV of p16 for HPV RNA-defined OPSCC is substantially lower in AA vs NHW patients. Guidelines for HPV testing in OPSCC should be attentive to factors beyond geography.

In recent years, several biologics targeting Type 2 inflammation have been developed for treating chronic rhinosinusitis with nasal polyps (CRSwNP). These have been studied in registrational randomized controlled trials (RCTs), which vary in their patient populations, trial design, endpoints, geography, timing, or data-handling processes. While (in)direct treatment comparisons and meta-analyses have been carried out to compare efficacy results from RCTs, often these fail to properly account for these between-study differences. Here, we summarize the key between-study differences that can influence trial outcomes and highlight the resulting challenges faced when comparing outcomes from different Phase III RCTs of biologics in CRSwNP.

The impact of climate change on health is well recognised, yet its influence on postoperative complications remains underexplored. This systematic review examines how climatic factors-particularly temperature, humidity and seasonal variations-affect surgical outcomes. Systematic review with narrative synthesis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. A comprehensive search of PubMed, Web of Science and the Cochrane Library from June 2015 to June 2025 was conducted. An additional supplementary PubMed search was performed to identify further relevant studies. Included were studies published in English or German that examined associations between climatic factors, including temperature, humidity, precipitation or seasonality and postoperative outcomes in surgical patients. Studies without a surgical or climatic focus, animal studies, reviews and commentaries were excluded. Two reviewers independently screened studies and extracted data using predefined criteria. Risk of bias was assessed using the Newcastle-Ottawa Scale. Due to methodological heterogeneity, findings were synthesised narratively. Fifteen studies were included. High ambient temperatures were frequently associated with increased risks of surgical site infections (SSIs). Some large studies reported that even a one-degree rise significantly elevated infection rates. Humidity was also linked to higher infection rates, with evidence suggesting an independent effect in some cases. Seasonal changes influenced complication rates across regions and surgical disciplines, with infection and pneumonia peaks in summer or winter months. A few studies reported increased risks during heavy rainfall or institutional transitions such as the 'July effect'. Overall, elevated temperature and humidity appear to be associated with increased postoperative risks, especially SSIs. Seasonal patterns may further influence outcomes depending on geography and procedure type. While the available evidence supports a link between climate and surgical complications, methodological differences and limited adjustment for confounders highlight the need for more rigorous studies.

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease with the global epidemiological profile remaining incompletely understood. While previous systematic reviews existed, an updated comprehensive synthesis is needed to delineate the disease burden. We searched PubMed, Embase, Scopus, Web of Science and Cochrane databases from inception to 18 February 2025, for studies reporting the incidence, prevalence or mortality of ALS in the general population. Pooled estimates with 95% CIs were calculated, and subgroup analyses were performed. Of 29&#x2009;110 articles initially screened, 142 were included. Global pooled incidence was 1.65 per 100&#x2009;000 person-years (95% CI 1.43 to 1.91), prevalence was 5.05 per 100&#x2009;000 population (95%&#x2009;CI 4.26 to 5.99) and mortality was 1.26 per 100&#x2009;000 person-years (95%&#x2009;CI 0.94 to 1.69). Both incidence rate ratio (IRR=0.74) and prevalence rate ratio (PRR=0.69) indicated significantly lower disease burden in females than in males. The burden of disease exhibited a marked age-dependent pattern, peaking at ages 70-79. Temporal trend analyses revealed a consistent increase in prevalence from 1963 to 1999&#x2009;onwards, while incidence peaked in 2014-2017. Geographically, incidence and prevalence were highest in Europe, North America and Oceania and lowest in Asia and South America. The disease burden was significantly higher in high-income countries compared with both upper-middle-income and lower-middle-income countries. This systematic review provides updated global ALS burden estimates, showing variations by sex, age, time and geography and underscoring the complex interplay of genetic, environmental and socioeconomic factors, with implications for health planning, resource allocation and etiological research.

IgE-mediated food allergy prevention guidelines are now established in many countries, but their implementation in routine clinical practice globally remains unclear. An anonymous online survey was distributed to healthcare professionals (HCPs) through the World Allergy Organization network between December 2024 and April 2025, collecting data on food allergy prevention recommendations in daily clinical practice. The analysis included 731 healthcare professionals from 80 countries worldwide: Asia (36.7%), Europe (27.1%), North America (15.9%), and Rest of the World (20.0%; Russia, South America, Africa, Oceania). Unsupervised clustering revealed two distinct practice patterns-one favoring early allergen introduction and one favoring later introduction-with timing varying by allergen type. For peanuts, clusters diverged between early (median 6&#x2009;months of age) and late (median 18&#x2009;months of age) introduction recommendations for high-risk infants. Allergen introduction timing was independently driven by region and specialty: North American HCPs recommend peanut introduction 6.7&#x2009;months earlier than those in Asia (5.48 &#xb1; $$ \pm $$ 3.32 vs. 12.18 &#xb1; $$ \pm $$ 7.27&#x2009;months; p&#x2009;<&#x2009;0.001), and pediatric allergists globally advocate for introduction 2.37&#x2009;months earlier than non-allergists (8.72 &#xb1; $$ \pm $$ 5.85 vs. 11.09 &#xb1; $$ \pm $$ 7.14&#x2009;months, p&#x2009;=&#x2009;0.024). This disparity is more pronounced in high-risk infants than in normal-risk infants. The variability in allergen introduction practices, driven by geography and medical specialty, highlights a persistent gap in prevention guidelines adoption. This divergence likely reflects both suboptimal implementation of existing recommendations and regional differences in food allergy epidemiology. These findings underscore the need for population-tailored allergen introduction strategies across diverse healthcare settings.

Given the inconsistent definitions of nature, we used a bottom-up protype approach (total N = 824) to solicit features of the natural environment (Study 1) and centrality ratings of those features (Study 2). Study 3 tested the prototype structure via ratings of scenarios composed of highly prototypical (vs. less prototypical) features. Over 100 features were generated, and features like wildlife, trees, and ecosystems were rated as most central, with features associated with people much less so. Results of Study 3 supported the protype structure with high (vs. low) prototypical scenarios rated higher in naturalness. We also explored individual differences in subjective nature connectedness; highly connected people generated more features and rated features as more prototypical. The nature protype provides a resource for researchers and practitioners to design or assess stimuli/spaces that fit people's views of nature, and we discuss the useful scope of this prototype (e.g., across geography and identities).

The "golden hour" concept remains debated in low- and middle-income countries with fragmented systems. This study evaluated the synergistic association of prehospital delay and injury severity on outcomes, specifically analyzing referral system inefficiencies. A retrospective study of 339 trauma patients was conducted in Guayaquil, Ecuador. Multivariable Poisson regression models with robust variance and restricted cubic splines were developed specifically for the n= 274 cohort (&#x2264;240 min) to identify independent predictors of complications and mortality, focusing on the time &#xd7; New Injury Severity Score interaction. Urban distance analysis (n = 84) was performed to isolate geographic from systemic factors. Penetrating injuries predominated (80%, out of 273 penetrating cases, firearms n = 218). Prehospital delay independently predicted complications (P = 0.042), with a risk ratio of 1.55 (95% confidence interval: 1.01-2.38). A lethal synergistic interaction was identified between time and severity (P = 0.003); while delays were tolerated in moderate trauma, mortality escalated exponentially for critical patients (New Injury Severity Score 55) after the first hour. Kaplan-Meier analysis confirmed a survival disadvantage after the "golden hour" (P = 0.024). Crucially, for urban transfers, transport distance did not differ significantly between early and delayed groups (P = 0.226), indicating that systemic referral inefficiencies (door-in-door-out delays), rather than geography, drive prehospital exhaustion. Prehospital delay and injury severity exhibit a lethal synergistic interaction. The "golden hour" is frequently exhausted by referral chain inefficiencies regardless of physical proximity. Transitioning to a direct primary transport model ("scoop and run") is associated with mitigated physiological debt and potentially improves survival in critical penetrating trauma.

In December 2025, the Advisory Committee on Immunization Practices recommended individual-based decision-making-termed shared clinical decision-making (SCDM) on CDC schedules-for hepatitis B (HepB) birth-dose vaccination in infants of mothers documented as HBsAg-negative at delivery. We evaluated projected economic, health, and distributional consequences for the 2026&#x2009;US birth cohort. A hybrid decision tree-Markov cohort model took the societal perspective over a lifetime horizon for 3.6 million 2026&#x2009;US births, under three coverage-decline scenarios (10-, 20-, and 30-percentage-point). Costs (2026&#x2009;US dollars) and outcomes were discounted 3% annually. Outcomes included costs, infections, deaths, quality-adjusted life years (QALYs), and equity impacts by insurance, race/ethnicity, hospital type, and geography. Probabilistic sensitivity analysis used 10,000 iterations; reporting followed CHEERS 2022. Under the base-case 20-percentage-point decline, SCDM was projected to produce approximately 44 additional acute infections, 8 additional chronic HBV cases, 2 additional HBV-related deaths (incomplete-linkage scenario), and 56 discounted QALYs lost per cohort. Assuming incremental counseling time for all policy-sensitive births, SCDM generated approximately $301 million in net societal cost-driven principally by provider counseling opportunity cost, not disease treatment-and was dominated by universal vaccination. With counseling time assigned zero cost, SCDM remained less effective but less costly, implying approximately $0.7 million per QALY to retain universal vaccination. Modeled burdens concentrated among Medicaid/CHIP and safety-net populations. This early assessment used scenario-based coverage-decline, counseling-time, mortality, and completion assumptions as post-policy data were unavailable; results are projections, not observations. Moving from universal birth-dose vaccination to SCDM was projected to reduce timely vaccination and increase preventable infections across all scenarios. The societal-cost conclusion hinged on whether SCDM imposed counseling-time burden at scale, whereas the unfavorable health-effect direction was robust. Postimplementation evidence on coverage, counseling, completion, and linkage to care is needed before treating SCDM as low-cost or low-risk. In the United States, newborn babies are usually given the first dose of the hepatitis B vaccine in the hospital, within a day of birth. This &#x201c;birth dose&#x201d; protects infants from a virus that can cause serious, lifelong liver disease.In December 2025, a US vaccine advisory committee changed this recommendation for babies whose mothers had tested negative for hepatitisB. Instead of recommending the birth dose for every newborn, it suggested that parents and their doctor decide case by case. This study used a computer model to estimate what that change could mean for the roughly 3.6 million babies born in the United States in 2026.The model projected that if fewer newborns receive the dose on time, there would be more hepatitis B infections, more long-term (chronic) infections, and a small number of additional deaths over these children&#x2019;s lifetimes. The change was also estimated to cost society about $301 million&#x2014;mainly because of the extra time doctors and nurses would spend discussing the decision with families, not because of treating illness. Even when that counseling time was assumed to cost nothing, the policy still led to more infections and worse health.The projected harms fell most heavily on babies from lower-income families and under-resourced hospitals, which could widen existing health gaps.Because the policy is new, these results are projections based on assumptions, not real-world measurements. Tracking what actually happens, including vaccination rates and infections, is needed before treating this change as low-cost or low-risk.

Urban venues serve as arenas for social mixing, yet less is known about how public transit infrastructure shapes the geography of mixing at specific locations. This study examines how transit catchment diversity-the socioeconomic heterogeneity of populations reachable by public transit-associates with visitor diversity at points of interest (POIs) in nine Swedish and three US cities. Using mobile phone GPS traces and aggregated foot traffic data from 2024, we compute visitor diversity indices based on visitors' home-neighborhood birth-background composition and employ spatial regression models and geographically weighted regression (GWR). Transit catchment diversity positively predicts visitor diversity across nearly all cities, but this association is robust only in the largest metropolitan areas; in smaller cities, the coefficient attenuates to insignificance once geographic catchment composition, centrality, and venue density are controlled. Spatial spillovers in visitor diversity follow general geographic proximity rather than shared transit-stop connectivity, suggesting that the association operates through catchment population composition rather than station-level linkages. Transit-diversity hotspots occur not in already-diverse venues, but in lower-diversity POIs with lower commercial density, greater distance from transit in US cities, and greater centrality in Sweden. These patterns are consistent with transit-accessible population composition being associated with visitor diversity, particularly where alternative pathways to diverse co-presence are limited.

The Eastern Spotted Dove (Spilopelia chinensis) is a widespread human-commensal bird, frequently involved in wildlife law enforcement cases. Following such cases, confiscated individuals are often released back into the wild, yet the potential genetic impacts of these releases remain unclear due to limited understanding of the species' population genetic structure in China. This study aimed to assess the genetic diversity and population structure of Eastern Spotted Doves in Jiangsu Province to provide a scientific basis for the management of confiscated individuals. This study analyzed the genetic diversity and structure of 139 individuals from 13 sampling sites across five avian geographical regions in Jiangsu Province, China, using mitochondrial cytochrome b (Cytb) and Displacement loop (D-loop) sequences, and explored the impact of urbanization on genetic differentiation. A total of 49 haplotypes were detected. The samples exhibited high haplotype diversity (H d &#x2009;=&#x2009;0.896) but low nucleotide diversity (pi&#x2009;=&#x2009;0.00216). The maximum likelihood phylogenetic tree showed that no geographical clustering, and the haplotype network displayed a star-shaped topology with core haplotypes shared across all regions. AMOVA revealed that genetic differentiation among groups was negligible and non-significant, regardless of grouping by geography or urbanization level. Pairwise F st values were close to zero and non-significant, while gene flow estimates (N m ) exceeded 28 in all comparisons. These findings indicate that the Eastern Spotted Doves in Jiangsu Province lack significant population genetic structure, with strong gene flow maintained across regions. The species' high adaptability to urban environments and dispersal capacity likely sustain genetic connectivity. From a mitochondrial genetic perspective, the in&#xa0;situ or proximate release of confiscated individuals within Jiangsu Province poses minimal genetic contamination risk. However, validation using nuclear markers, such as microsatellites or single nucleotide polymorphisms, is recommended.

The management of advanced low rectal cancer is shaped by an ongoing tension between two surgical philosophies regarding lateral pelvic lymph node (LPLN) disease. Eastern and Western guidelines diverge on whether systematic lateral lymph node dissection (LLND) should accompany total mesorectal excision (TME), reflecting different views of the locoregional behavior of LPLN involvement and different thresholds for accepting the urinary and sexual morbidity that accompanies full sidewall clearance. In this editorial, we argue that intraoperative interrogation of each individual case offers a way to refine, rather than resolve by regional consensus, this geography-driven dichotomy, and that indocyanine green (ICG) near-infrared fluorescence provides a principled means of individualizing the extent of lateral dissection. Peritumoral submucosal injection of ICG enables real-time visualization of lymphatic drainage and intraoperative identification of lateral pelvic sentinel lymph nodes (LPSLNs), which can be biopsied and submitted for frozen section. It is important to distinguish between the two applications of this signal. As an intraoperative visualization adjunct, ICG improves lateral node retrieval, and the supporting comparative evidence is relatively consistent. As a sentinel-based decision tool for safely omitting lateral dissection when the sentinel node is negative, the concept is promising but rests on a smaller and less mature evidence base; it remains investigational and requires validation in larger prospective studies with long-term oncologic and functional outcomes before it can guide the omission of lateral dissection in practice. We outline the operative protocol used in our department, extended from sentinel node mapping for gynecological malignancies, and place it in the context of contemporary systematic, propensity-matched, and prospective sentinel biopsy series. In our view, fluorescence-assisted selective LLND may serve as a pragmatic bridge between existing paradigms, preserving the oncologic intent of Japanese-style lateral clearance while aligning with Western priorities of minimizing unnecessary morbidity through tailored, image-guided surgery.

Literature on pediatric uveitis frequently describes the disease as noninfectious, bilateral, and anterior with a female sex predilection. This characterization misrepresents epidemiology studies from many parts of the world. This systematic review and Bayesian meta-analysis combines demographic and clinical data representing 43 studies from 26 countries over the last 10 years to create a global picture of the epidemiology of pediatric uveitis. We performed additional Bayesian meta-regression analyses to explore how geography, economy, and climate may have played a role in inter-study variability. While there was a greater proportion of females in studies from high-income countries, there was a male sex predilection in lower-middle-income countries. We found that climate had a greater bearing on proportion of infectious etiologies than economic or regional designation, and that these factors played varying roles with regards to specific infectious and noninfectious etiologies. Income alone proved to be a significant moderator of vision at presentation, with high-income countries having the highest proportion of patients with good vision and the lowest proportion of patients with poor vision. Our study helps to better characterize the complex global picture of pediatric uveitis.

The oral cavity harbors a complex and abundant viral community, collectively known as the oral virome, which is predominantly composed of bacteriophages. The oral phageome is highly heterogeneous across human populations and correlated with factors such as geography, ethnicity, lifestyle, and urbanization. This phageome is crucial for maintaining oral microbial homeostasis and is strongly associated with various oral diseases. Emerging studies greatly highlight the therapeutic promise of bacteriophages, which can not only be used to treat infectious diseases but to modulate the microbiota. However, their specific functions and applications within the oral cavity remain poorly explored. Here, we review relevant literature on the oral phageome, and the intricate interactions among phages, bacteria, and the human host underlying health and diseases. We shed light on emerging avenues of phage-based therapies and examined the underlying obstacles. Our review suggests that future efforts should prioritize mechanistic studies and therapeutic development to harness this enigmatic component of the human oral microbiome.

Chronic obstructive pulmonary disease (COPD) remains a leading cause of premature mortality and disability worldwide. National averages in the United States often obscure heterogeneity across sex, geography, rurality, and age. We examined U.S. COPD mortality trends from 1999 to 2024 and contextualized findings using Global Burden of Disease (GBD) 2023 data. We conducted a serial cross-sectional ecological study using Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) mortality data and investigator-generated GBD 2023 visual outputs. Age-adjusted mortality rates (AAMRs, per 100,000 population, standardized to the year 2000&#x202f;U.S. standard population) were assessed by sex, age group, race and ethnicity, census region, state, and urbanization. Joinpoint regression (National Cancer Institute Joinpoint software, v5.2.0) was used to estimate annual percent changes (APCs), average annual percent changes (AAPCs), and 95% confidence intervals (CIs). GBD 2023 figures contextualized global prevalence, socio-demographic development and COPD disability-adjusted life-years (DALYs), and regional risk-factor contributions. From 1999 to 2024, COPD deaths rose from 99,550 to 132,115 (+32.71%), while the AAMR declined from 56.38 to 45.26 per 100,000 (AAPC, -0.88; 95% CI, -1.15 to -0.61). Men showed greater improvement (74.09 to 47.97; AAPC, -1.59) than women (46.03 to 43.17; AAPC, -0.31), whose rates rose until 2016 before declining. Urban-rural disparities widened: metropolitan areas improved (54.91 to 47.16; AAPC, -0.61), whereas nonmetropolitan areas worsened (62.73 to 72.41; AAPC, +0.77). In 2024, state-level AAMRs ranged from 18.51 to 85.39 per 100,000. Age gradients were steep, from 0.08 among adults aged 25-34&#x202f;years to 523.69 per 100,000 among those aged &#x2265;85&#x202f;years. GBD 2023 data confirmed a non-linear pattern across socio-demographic development, with burden driven by smoking, ambient particulate pollution, occupational exposures, and household air pollution. U.S. COPD mortality has improved nationally, yet progress remains uneven. Population ageing, slower decline among women, and persistent rural and geographic inequalities sustain the burden. Public health strategies should prioritize women-centered case finding, rural access to smoking cessation and pulmonary rehabilitation, and place-based exposure reduction.

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Assimilation of coccygeal vertebrae with the sacrum can be an obstetrical impediment in humans. This study evaluates homeotic transformation of the thoracic-lumbar (T-L) and lumbar-sacral (L-S) boundaries and position of the diaphragmatic vertebra (DV) as proximate determinants of this assimilation. Sample is 311 females and 791 males, ages 20-49&#x2009;years, who died in the United States from the 19th to 21st centuries. Results show 33% of females and 42% of males have fusion of coccygeal vertebrae with the sacrum. In both sexes, cranial transformation of the T-L and L-S boundaries is associated with assimilation of coccygeal vertebrae with the sacrum, whereas caudal transformation of these boundaries is associated with inhibition of this assimilation. Males, but not females, also show assimilation of coccygeal vertebrae with the sacrum with cranial transformation of DV, and inhibition of this assimilation with caudal transformation of DV. Females have higher prevalence of caudal transformation of the T-L and L-S boundaries than males (15% and 7%, respectively), and males have higher prevalence of cranial transformation of these boundaries than females (22% and 11%, respectively). Assimilation of coccygeal vertebrae with the sacrum contracts posterior space of the pelvic outlet. Dual contraction of posterior and anterior spaces of the outlet can be obstetrically perilous. High prevalence of assimilation of coccygeal vertebrae with the sacrum contributes to selection for sexual dimorphism of the pubic arch and angulation of the sacrum, with females larger than males.

In many low- and middle-income countries, uneven service coverage across urban-rural gradients and tenure regimes produces highly heterogeneous household waste disposal behaviors, with important implications for public health, air quality, and environmental integrity. Using Eswatini's 2017 National Population and Housing Census-the first national census in the country to include household waste disposal variables and the first opportunity for a georeferenced, countrywide, household-level assessment-we analyzed 2326 enumeration areas (EAs) and 6 disposal modalities: regular collection, irregular collection, public pit dumping, backyard pits, open burning, and undesignated dumping. We applied spatially explicit multivariate clustering to identify distinct disposal profiles and then evaluated geographic patterning using spatial autocorrelation and hotspot mapping. Five clusters were distinguished, revealing a pronounced urban-rural divide and strong tenure effects. Urban and company-town settings exhibited the highest reliance on regular collection (mean &#x2248;52%) yet retained substantial open burning (&#x2248;43%), indicating persistent behavioral and/or service-quality gaps even where collection exists. Rural EAs, particularly on customary Eswatini Nation Land (both rural development areas (RDA) and non-RDA), were characterized by dominant backyard pit use (&#x2248;81%) alongside elevated public pit dumping (&#x2248;61%) and undesignated dumping (&#x2248;24%). Spatial statistics further showed concentrated rural hotspots of informal disposal practices, with notable clustering in parts of Lubombo and Shiselweni. These results support targeted, cluster-specific practical and policy interventions that combine rural service expansion, demand-side behavior change to reduce open burning, and governance arrangements that explicitly engage traditional authorities in planning, siting, and compliance.