Journal of Epidemiology and Global Health最新文献

{"title":"Long COVID-19 and Coexistence of Fatigue and Depression: A Cross-sectional Study from Saudi Arabia.","authors":"Abdulrahman Alharbi, Faisal Almogbel, Unaib Rabbani, Ziad A Memish","doi":"10.1007/s44197-024-00312-7","DOIUrl":"10.1007/s44197-024-00312-7","url":null,"abstract":"<p><strong>Background and objectives: </strong>Coronavirus disease 2019 (COVID-19) is associated with various manifestations even after infection resolution. This study aimed to assess the prevalence of post-COVID-19 fatigue and its predictors.</p><p><strong>Methods: </strong>We conducted a nationwide cross-sectional study among Polymerase Chain Reaction test confirmed COVID-19 cases in Saudi Arabia from July 2021 to February 2022. We collected data through telephonic interviews covering socio-demographics, comorbidities, body mass index, smoking, illness severity, and COVID-19 vaccination status. We assessed fatigue using Fatigue Severity Scale while depression was assessed using Patient Health Questionnaire-2. Logistic regression was employed to analyze the relationship between post-COVID-19 fatigue and depression.</p><p><strong>Results: </strong>The analysis included 361 participants with a mean age of 37 ± 10.5 years, among whom 43% were female. Approximately 10% had comorbidities, and 21% were current smokers. Nearly two-thirds (68%) of the participants reported mild illness. The prevalence of perceived fatigue was 22.7%, while fatigue measured by the Fatigue Severity Scale was 14.4%. The multivariable logistic regression model revealed that COVID-19 severity and depression were significant predictors of post-COVID-19 fatigue; adjusted odds ratio 1.87 (95% CI: 1.10 to 3.18) and 14.3 (95% CI: 4.55 to 45.0), respectively.</p><p><strong>Conclusion: </strong>Our findings suggest a higher prevalence of perceived fatigue compared to that measured by the Fatigue Severity Scale, underscoring the importance of using a valid assessment tool for fatigue among COVID-19 patients to ensure proper management. The significant association between post-COVID-19 fatigue and depression highlights the need for psychological assessment of COVID-19 patients to enhance their post-infection quality of life.</p>","PeriodicalId":15796,"journal":{"name":"Journal of Epidemiology and Global Health","volume":" ","pages":"1602-1608"},"PeriodicalIF":3.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11652431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing Detection of Legionnaires' Disease in a Large Italian Hospital in the Period 2016-2023.","authors":"Marilena La Sorda, Flavio De Maio, Maria Scaturro, Barbara Fiori, Giulia Santarelli, Jessica Iera, Fabiola Mancini, Brunella Posteraro, Maria Luisa Ricci, Maurizio Sanguinetti","doi":"10.1007/s44197-024-00276-8","DOIUrl":"10.1007/s44197-024-00276-8","url":null,"abstract":"<p><p>The pandemic marked the beginning of an era of dynamic and rapid changes in the diagnosis of respiratory infections. Herein we describe Legionnaires' disease trend in the years 2016-2023 in a large Italian hospital showing how improvements in diagnostic algorithms impact on its detection.</p>","PeriodicalId":15796,"journal":{"name":"Journal of Epidemiology and Global Health","volume":" ","pages":"1358-1362"},"PeriodicalIF":3.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11442907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Regional Distribution of Beta-Hemoglobin Variants in Saudi Arabia: Insights from the National Premarital Screening Program\".","authors":"Mansour Aljabry, Suha Sulimani, Ghazi Alotaibi, Hassan Aljabri, Shaker Alomary, Omar Aljabri, Maha Sallam, Abdulrahman Alsultan","doi":"10.1007/s44197-024-00281-x","DOIUrl":"10.1007/s44197-024-00281-x","url":null,"abstract":"<p><strong>Background: </strong>Hemoglobinopathies are among the most prevalent inherited disorders globally, with carrier prevalence varying significantly across regions. In Saudi Arabia, high rates of consanguineous marriages amplify the risk of these disorders.</p><p><strong>Aim: </strong>This study aims to assess the burden of hemoglobinopathies by evaluating the prevalence and regional distribution of beta-hemoglobin variants, including rare variants, among couples participating in the national premarital screening program.</p><p><strong>Methods: </strong>Data were collected from the premarital genetic screening program and entered into the SEHA platform, covering the 13 administrative regions of Saudi Arabia. Blood samples underwent various screening tests for infectious and genetic diseases. Hemoglobin electrophoresis samples were analyzed using capillary electrophoresis, High-Performance Liquid Chromatography (HPLC), or a combination of both methods.</p><p><strong>Results: </strong>From 2011 to 2018, 1,871,184 individuals were included in the study, with 49.8% male and 50.2% female. The average age was 30.2 years. Hemoglobin S (HbS) was identified in 88,431 individuals (4.7% of the tested population and 78.5% of abnormal screening results), primarily as a sickle cell trait. β-thalassemia was the second most common disorder, identified in 22,420 individuals (1.2% of the population and 19.9% of hemoglobin disorders). HbC and HbD were each detected in 0.04% of cases, while HbO-Arab was identified in 0.007% and HbG in 0.006%. Hemoglobin E and hemoglobin Lepore were found to be extremely rare.</p><p><strong>Conclusion: </strong>The study demonstrates regional variation in the prevalence of hemoglobin genetic variants in Saudi Arabia. To effectively mitigate this risk, it is imperative to strengthen public education and awareness, particularly focusing on genetic screening and counseling.</p>","PeriodicalId":15796,"journal":{"name":"Journal of Epidemiology and Global Health","volume":" ","pages":"1242-1248"},"PeriodicalIF":3.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11442792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Changes in Social Isolation and Loneliness with Incident Cardiovascular Events and Mortality.","authors":"Yilin Chen, Huachen Xue, Yu Nie, Yujing Zhou, Sizhi Ai, Yaping Liu, Jihui Zhang, Yannis Yan Liang","doi":"10.1007/s44197-024-00243-3","DOIUrl":"10.1007/s44197-024-00243-3","url":null,"abstract":"<p><strong>Background: </strong>It remains unknown how the patterns of change of social isolation and loneliness are associated with the onset of cardiovascular disease (CVD) and mortality. We aimed to investigate the longitudinal association of changes in social isolation and loneliness with incident CVD, all-cause mortality, CVD mortality and subsequent cardiac function.</p><p><strong>Methods: </strong>This prospective cohort study included 18,258 participants aged 38-73 years who participated in visit 0 (2006-2010) and visit 1 (2012-2013) using UK Biobank (mean age 57.1, standard deviation [SD] 7.4; 48.7% males). Social isolation or loneliness was categorized into four patterns: never, transient, incident, and persistent. Incident CVD, all-cause and CVD mortality were ascertained through linkage data. Cardiac function was assessed by cardiovascular magnetic resonance imaging in a subsample (N = 5188; visit 2, since 2014).</p><p><strong>Results: </strong>Over a median follow-up of 8.3 (interquartile range [IQR] 8.1-8.6) years, compared with never social isolation, persistent social isolation was associated with the higher risk of incident CVD (hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.03-1.33), all-cause (1.42, 1.12-1.81) and CVD (1.53, 1.05-2.23) mortality. Likewise, persistent loneliness was strongly associated with the greater risk of incident CVD (1.13, 1.00-1.27), all-cause (1.28, 1.02-1.61) and CVD mortality (1.52, 1.06-2.18).</p><p><strong>Conclusions: </strong>Persistent social isolation and loneliness posed a substantially higher risk for incident CVD, all-cause and CVD mortality, and cardiac dysfunction than other patterns. Persistent social isolation and loneliness, along with an increasing cumulative score, are associated with lower cardiac function.</p>","PeriodicalId":15796,"journal":{"name":"Journal of Epidemiology and Global Health","volume":" ","pages":"962-973"},"PeriodicalIF":3.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11442883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141154952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Human Toxoplasmosis in Spain Throughout the Three Last Decades (1993-2023): A Systematic Review and Meta-analysis.","authors":"Mariola Miguel-Vicedo, Paula Cabello, M Carmen Ortega-Navas, David González-Barrio, Isabel Fuentes","doi":"10.1007/s44197-024-00258-w","DOIUrl":"10.1007/s44197-024-00258-w","url":null,"abstract":"<p><p>Humans are infected by Toxoplasma gondii worldwide and its consequences may seriously affect an immune deprived population such as HIV and transplanted patients or pregnant women and foetuses. A deep knowledge of toxoplasmosis seroprevalence in Spain is needed in order to better shape health policies and educational programs. We present the results of the first systematic review and meta-analysis on the human prevalence for this disease in Spain. Databases (PubMed, Web of Science, SCOPUS and Teseo) were searched for relevant studies that were published between January 1993 and December 2023 and all population-based cross-sectional and longitudinal studies reporting the human seroprevalence in Spain were revised. Within the population analysed, our targeted groups were immunocompetent population, pregnant women and immunocompromised patients. Among 572 studies and 35 doctoral theses retrieved, 15 studies and three doctoral theses were included in the meta-analysis. A random effects model was used for the meta-analyses due to the high heterogeneity found between studies (I²: 99.97), since it is a statistically conservative model, in addition to allowing better external validity. The global pooled seroprevalence was 32.3% (95% CI 28.7-36.2%). Most of the studies carried out were in pregnant women and the meta-analysis reported that the pooled seroprevalence of toxoplasmosis in pregnant women in Spain was 24.4% (24,737/85,703, 95% CI 21.2-28.0%), based on the random effects model. It is recommended to continue monitoring the seroprevalence status of T. gondii in order to obtain essential guidelines for the prevention and control of the infection in the population.</p>","PeriodicalId":15796,"journal":{"name":"Journal of Epidemiology and Global Health","volume":" ","pages":"621-637"},"PeriodicalIF":3.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141306107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-specific Multimorbidity Patterns and Burden on All-Cause Mortality and Public Direct Medical Expenditure: A Retrospective Cohort Study.","authors":"Sabrina Nan Hong, Francisco Tsz Tsun Lai, Boyuan Wang, Edmond Pui Hang Choi, Ian Chi Kei Wong, Cindy Lo Kuen Lam, Eric Yuk Fai Wan","doi":"10.1007/s44197-024-00256-y","DOIUrl":"10.1007/s44197-024-00256-y","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate age-specific multimorbidity patterns and morbidity burden on mortality and healthcare expenditure across age groups.</p><p><strong>Patients and methods: </strong>Retrospective observational study between January 1, 2009 to December 31, 2017 using electronic health records in Hong Kong: Individuals were stratified by age (< 50, 50-64, 65-79, ≥ 80), and sub-classified by number of morbidities (0, 1, 2, 3, ≥ 4) out of 21 common chronic conditions. Clustering analyses were conducted to identify specific patterns of multimorbidity. Association between the number as well as combinations of morbidities and all-cause mortality and public expenditure was examined.</p><p><strong>Results: </strong>4,562,832 individuals with a median follow-up of 7 years were included. Mental disorders were the top morbidities among young individuals, while cardiovascular diseases were prevalent in the elderly. An increased number of morbidities was associated with a greater relative risk for mortality and medical expenditure, and this relationship was stronger among younger patients. Compared to individuals in the same age group without morbidity, the hazard ratios (HR; 95% CI) of all-cause mortality in patients aged < 50 and ≥ 80 with two comorbidities 3.81 (3.60-4.03) and 1.38 (1.36-1.40), respectively, which increased to 14.22 (9.87-20.47) and 2.20 (2.13-2.26), respectively, as the number of morbidities increased to ≥ 4. The stroke-hypertension cluster was shown to be associated with the highest HR of mortality 2.48 (2.43-2.53) among all identified clusters arising from the clustering analysis.</p><p><strong>Conclusion: </strong>Given the stronger association between multimorbidity and all-cause mortality and greater opportunity costs in younger populations, prevention and management of early-onset multimorbidity are warranted. (248 words).</p>","PeriodicalId":15796,"journal":{"name":"Journal of Epidemiology and Global Health","volume":" ","pages":"1077-1088"},"PeriodicalIF":3.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141310825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triglyceride-Glucose Index as Predictor for Hypertension, CHD and STROKE Risk among Non-Diabetic Patients: A NHANES Cross-Sectional Study 2001-2020.","authors":"Bisher Sawaf, Sarya Swed, Hidar Alibrahim, Haidara Bohsas, Tirth Dave, Mohamad Nour Nasif, Wael Hafez, Fatema Ali Asgar Tashrifwala, Yazan Khair Eldien Jabban, Safwan Al-Rassas, Heba Haj Saleh, Abdul Rehman Zia Zaidi, Baraa Alghalyini, Shaymaa Abdelmaboud Mohamed, Waleed Farouk Mohamed, Amr Farwati, Mohammed Najdat Seijari, Naim Battikh, Basma Elnagar, Seema Iqbal, Karla Robles-Velasco, Ivan Cherrez-Ojeda","doi":"10.1007/s44197-024-00269-7","DOIUrl":"10.1007/s44197-024-00269-7","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease (CVD) is a leading cause of global mortality. Early intervention and prevention of CVD depend on accurately predicting the risk of CVD. This study aimed to investigate the association between the TyG index and the risk of coronary heart disease (CHD), congestive heart failure (CHF), heart attack (HA), stroke, and hypertension (HTN) among patients without diabetes in the United States.</p><p><strong>Methods: </strong>In this retrospective, cross-sectional study, we used data from the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2020. We conducted several regression analysis models and calculated the sensitivity and specificity of (TyG) index for predicting the onset of CHD, CHF, HA, stroke, and HTN.</p><p><strong>Results: </strong>A total of 10,937 individuals without diabetes participated in our study. Individuals with a TyG index greater than 8.96 displayed significant increasing in various parameters, including BMI, systolic/diastolic blood pressure, total cholesterol, LDL, and Apo-B levels (p < 0.001). Almost all regression models ensured that a higher TyGI value was associated with higher odds of having CHD, CHF, HA, stroke, and HTN, which patients with a TyGI value higher than 8.96 have odds ratios of 2.24-5.58 for CHD, 1.68-4.42 for stroke, 2.45-3.77 for HA and 1.75-3.93 for HTN comparing than patients with a TyGI value lower than 8.11 (p-value < 0.05).We evaluated the predictive value of the TyG index for each endpoint, obtaining the following area under the curve (AUC) values: 54.75% for CHF (95% CI: 0.542-0.614), 52.32% for stroke (95% CI: 0.529-0.584), 55.67% for HA (95% CI: 0.595-0.646), 55.59% for HTN (95% CI: 0.574-0.597), and 50.31% for CHD (95% CI: 0.592-0.646).</p><p><strong>Conclusion: </strong>The TyG index showed a strong correlation with cardiovascular risk factors in individuals without diabetes, however it was a poor predictor of almost studied cardiovascular diseases.</p>","PeriodicalId":15796,"journal":{"name":"Journal of Epidemiology and Global Health","volume":" ","pages":"1152-1166"},"PeriodicalIF":3.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11442902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141492237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smoking Cessation and Utilization of Cessation Assistance in 13 low- and middle-income countries - changes between Two Survey Rounds of Global Adult Tobacco Surveys, 2009-2021.","authors":"Chandrashekhar T Sreeramareddy, Lai Pei Kuan","doi":"10.1007/s44197-024-00283-9","DOIUrl":"10.1007/s44197-024-00283-9","url":null,"abstract":"<p><strong>Introduction: </strong>Monitoring changes in cessation behaviors and cessation assistance is critical for policymaking.</p><p><strong>Methods: </strong>We analyzed two rounds (2009-2014 and 2015-2021) of Global Adult Tobacco Surveys in 13 countries. We estimated the quit ratio, quit attempt, and utilization of cessation assistance. The availability of cessation services was obtained from World Health Organization reports. We calculated absolute and relative changes in quit ratio, quit attempt, and cessation assistance. We assessed socio-economic determinants of cessation behaviors by binary logistic regression analyses on pooled data.</p><p><strong>Results: </strong>In all countries during both rounds smoking prevalence was 7.6-33.8%, the quit ratio was 0.15-0.54%, and the quit attempt was 17.7-52.8%. Quit ratio improved in Indonesia by 100% but declined in Turkey by 56%. Quit attempts increased in Indonesia (31.9%), Mexico (16.9%) and China (15.9%) but decreased in Turkey (140.4%), Vietnam (43.1%), and Romania (62.4%). In both rounds, using at least one method was 12.5-99.8% while the WHO-recommended method was 4.1-88.4%. In both rounds \"try to quit without any assistance\" and \"other methods\" were the most frequently reported cessation assistance. Nicotine replacement therapy (0.2-25.3%) was frequently used as recommended cessation assistance. Nicotine replacement therapy was available in most countries but not quitline and support services.</p><p><strong>Conclusion: </strong>Limited progress was made in smoking cessation behaviors and cessation assistance in most countries. Health education to improve demand for smoking cessation and availability of evidence-based, low-cost smoking cessation assistance including quit-smoking may improve quit ratios in the population.</p>","PeriodicalId":15796,"journal":{"name":"Journal of Epidemiology and Global Health","volume":" ","pages":"1257-1267"},"PeriodicalIF":3.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11442961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141916871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of High Covid-19 Vaccination Rate in an Aging Population: Estimating Averted Hospitalizations and Deaths in the Basque Country, Spain Using Counterfactual Modeling.","authors":"Carlo Delfin S Estadilla, Javier Mar, Oliver Ibarrondo, Nico Stollenwerk, Maíra Aguiar","doi":"10.1007/s44197-024-00286-6","DOIUrl":"10.1007/s44197-024-00286-6","url":null,"abstract":"<p><p>COVID-19 vaccines have demonstrated significant efficacy in reducing severe symptoms and fatalities, although their effectiveness in preventing transmission varies depending on the population's age profile and the dominant variant. This study evaluates the impact of the COVID-19 vaccination campaign in the Basque Country region of Spain, which has the fourth highest proportion of elderly individuals worldwide. Using epidemiological data on hospitalizations, ICU admissions, fatalities, and vaccination coverage, we calibrated four versions of an ordinary differential equations model with varying assumptions on the age structure and transmission function. Counterfactual no-vaccine scenarios were simulated by setting the vaccination rate to zero while all other parameters were held constant. The initial vaccination rollout is estimated to have prevented 46,000 to 75,000 hospitalizations, 6,000 to 11,000 ICU admissions, and 15,000 to 24,000 deaths, reducing these outcomes by 73-86%. The most significant impact occurred during the third quarter of 2021, coinciding with the Delta variant's dominance and a vaccination rate exceeding 60%. Sensitivity analysis revealed that vaccination coverage had a more substantial effect on averted outcomes than vaccine efficacy. Overall, the vaccination campaign in the Basque Country significantly reduced severe COVID-19 outcomes, aligning with global estimates and demonstrating robustness across different modeling approaches.</p>","PeriodicalId":15796,"journal":{"name":"Journal of Epidemiology and Global Health","volume":" ","pages":"1289-1299"},"PeriodicalIF":3.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11442822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved Child Feces Management Mediates Reductions in Childhood Diarrhea from an On-Site Sanitation Intervention: Causal Mediation Analysis of a Cluster-Randomized Trial in Rural Bangladesh.","authors":"Jesse D Contreras, Mahfuza Islam, Andrew Mertens, Amy J Pickering, Benjamin F Arnold, Jade Benjamin-Chung, Alan E Hubbard, Mahbubur Rahman, Leanne Unicomb, Stephen P Luby, John M Colford, Ayse Ercumen","doi":"10.1007/s44197-024-00210-y","DOIUrl":"10.1007/s44197-024-00210-y","url":null,"abstract":"<p><strong>Background: </strong>The WASH benefits Bangladesh trial multi-component sanitation intervention reduced diarrheal disease among children < 5 years. Intervention components included latrine upgrades, child feces management tools, and behavioral promotion. It remains unclear which components most impacted diarrhea.</p><p><strong>Methods: </strong>We conducted mediation analysis within a subset of households (n = 720) from the sanitation and control arms. Potential mediators were categorized into indicators of latrine quality, latrine use practices, and feces management practices. We estimated average causal mediation effects (ACME) as prevalence differences (PD), defined as the intervention's effect on diarrhea through its effect on the mediator.</p><p><strong>Results: </strong>The intervention improved all indicators compared to controls. We found significant mediation through multiple latrine use and feces management practice indicators. The strongest mediators during monsoon seasons were reduced open defecation among children aged < 3 and 3-8 years, and increased disposal of child feces into latrines. The strongest mediators during dry seasons were access to a flush/pour-flush latrine, reduced open defecation among children aged 3-8 years, and increased disposal of child feces into latrines. Individual mediation effects were small (PD = 0.5-2 percentage points) compared to the overall intervention effect but collectively describe significant mediation pathways.</p><p><strong>Discussion: </strong>The effect of the WASH Benefits Bangladesh sanitation intervention on diarrheal disease was mediated through improved child feces management and reduced child open defecation. Although the intervention significantly improved latrine quality, relatively high latrine quality at baseline may have limited benefits from additional improvements. Targeting safe child feces management may increase the health benefits of rural sanitation interventions.</p>","PeriodicalId":15796,"journal":{"name":"Journal of Epidemiology and Global Health","volume":" ","pages":"765-778"},"PeriodicalIF":3.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140175012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}