Journal of Epidemiology and Global Health最新文献

{"title":"Unveiling the Future of Infective Endocarditis Diagnosis: The Transformative Role of Metagenomic Next-Generation Sequencing in Culture-Negative Cases.","authors":"Shafiu A Umar Shinge, Binbin Zhang, Baixin Zheng, Yongjia Qiang, Hussein M Ali, Youmbi T Vanessa Melchiade, Lu Zhang, Minnan Gao, Guibin Feng, Kuan Zeng, Yanqi Yang","doi":"10.1007/s44197-025-00455-1","DOIUrl":"https://doi.org/10.1007/s44197-025-00455-1","url":null,"abstract":"<p><p>Culture-negative infective endocarditis (CNE) remains a significant diagnostic challenge in cardiology and infectious disease, often leading to delayed or empirical treatment. Metagenomic next-generation sequencing (mNGS) has emerged as a complementary diagnostic tool capable of identifying fastidious, unexpected, or novel pathogens without prior assumptions. This narrative review synthesizes evidence from 152 studies (2015-2024), evaluating mNGS within existing diagnostic frameworks for culture-negative IE. Compared to conventional diagnostics (blood cultures, PCR, 16 S rRNA sequencing), mNGS demonstrates enhanced detection capabilities for polymicrobial infections and rare pathogens, though methodological heterogeneity across studies precludes definitive performance comparisons. Performance varies substantially based on sample type, sequencing platform, and bioinformatic pipelines. Real-world applications reveal persistent challenges, including cost barriers, interpretive complexities in low-biomass samples, and contamination risks. Integration with host-response biomarkers and AI-driven interpretation platforms shows promise for advancing clinical utility. For mNGS to be effectively integrated into routine CNE care, standardization, regulatory clarity, and equitable implementation will be essential.</p>","PeriodicalId":15796,"journal":{"name":"Journal of Epidemiology and Global Health","volume":"15 1","pages":"108"},"PeriodicalIF":3.1,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12373624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956649","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":"Utilizing an mHealth Platform and Community Health Workers to Enhance Epilepsy Screening and Treatment in a Rural Setting in Mali: A Closed Cohort Study.","authors":"Housseini Dolo, Mohamed Kamaforo, Fatoumata Dite Nènè Konipo, Oumar Sangho, Mariam Daou, Boubacar Camara, Abdoulaye Konate, Mohamed Sininta, Moussa Sangare, Drissa M Toure, Hannah C Fritz, Peter J Winch, Hamadoun Sangho, Yaya Ibrahim Coulibaly, Youssoufa M Maiga, Seydou Doumbia","doi":"10.1007/s44197-025-00454-2","DOIUrl":"10.1007/s44197-025-00454-2","url":null,"abstract":"<p><strong>Background: </strong>In Mali, the screening, diagnosis, and treatment of epilepsy face significant challenges due to a shortage of qualified health workers in rural areas, limited access to health services, and cultural barriers. This study assessed how mHealth platforms can support task shifting to community health workers (Relais) to screen and treat epilepsy at the community level.</p><p><strong>Methods: </strong>We conducted a cohort study involving persons with epilepsy (PWE) and Relais in 17 villages in the Nonkon health area of the Kolokani Health District, approximately 105 km northwest of Bamako, the capital city of Mali. Relais collected data using mobile phones equipped with an \"Epi-Collect\" application specifically designed for epilepsy management, enabling Relais to record patient information digitally. All collected data was securely stored in \"telesante.ml,\" a telemedicine platform utilized by healthcare professionals.</p><p><strong>Results: </strong>Out of 64 patients suspected of having epilepsy by the Relais and indexed on the platform, 61 patients were confirmed by the neurologist through remote evaluation, resulting in a confirmation rate of 95%. After an 18-month follow-up, the patient retention rate was 86.89% (53 out of 61). At baseline, 98.36% (60 out of the 61) experienced at least one seizure per month. However, after six months of treatment, 89.28% (50 out of 56 at month six) PWE had no seizures in the last month (p < 0.0001).</p><p><strong>Conclusion: </strong>This study demonstrates the insightful effectiveness of leveraging an mHealth platform to empower community Relais to manage epilepsy in rural Mali. The Relais demonstrated a high capacity for screening, with neurologists confirming most suspected cases they identified. This innovative approach resulted in excellent patient outcomes, including a high retention rate over the follow-up period and statistically significant reduction in seizures. While challenges such as mobile network coverage and varying literacy levels among Relais were encountered, the findings strongly support this mHealth strategy as a viable solution to bridge the healthcare gap, significantly improving access to and management of epilepsy for remote and hard-to-reach populations.</p>","PeriodicalId":15796,"journal":{"name":"Journal of Epidemiology and Global Health","volume":"15 1","pages":"109"},"PeriodicalIF":3.1,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12373575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956595","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":"Tolerance of Inactivated SARS-CoV-2 Vaccine for People Living with HIV: A Real-World Evidence Analysis from a Retrospective Cohort Study.","authors":"Qian He, Tao Zhou, Ying Feng, Yuefei Li, Zhen Ni, Ning Zhang, Jing Chen, Mingjian Ni, Shi Zhao, Kai Wang","doi":"10.1007/s44197-025-00452-4","DOIUrl":"10.1007/s44197-025-00452-4","url":null,"abstract":"<p><strong>Background: </strong>The tolerance of inactivated SARS-CoV-2 vaccines in people living with HIV (PLWH) remains unclear. We aimed to evaluate the tolerance of inactivated SARS-CoV-2 vaccines in PLWH.</p><p><strong>Methods: </strong>This retrospective cohort study recruited 3327 PLWH for questionnaires and laboratory testing. Subjects were screened to ensure they were receiving antiretroviral therapy for PLWH without SARS-CoV-2 infection. Poisson regression analyses were conducted to assess the association between vaccination and HIV viral rebound, estimating absolute risk difference and relative risk (RR).</p><p><strong>Results: </strong>A total of 724 PLWH without SARS-CoV-2 infection participated in this study. No significant increase in HIV viral rebound risk was observed after vaccination in the 1/2-dose, 3-dose, and 4-dose groups compared to the 0-dose group. The RRs for the 1/2-dose, 3-dose, and 4-dose groups were 1.22 (95% confidence interval [CI]: 0.55, 2.72), 0.90 (95% CI: 0.48, 1.69), and 1.01 (95% CI: 0.35, 2.89), respectively. Similar results were observed across subgroups. Post-vaccination adverse reactions were minimal, occurring in 2.16% of cases, mostly fatigue and muscle soreness.</p><p><strong>Conclusion: </strong>Our study suggests that inactivated SARS-CoV-2 vaccines do not adversely affect the risk of HIV viral rebound and were well-tolerated in PLWH.</p>","PeriodicalId":15796,"journal":{"name":"Journal of Epidemiology and Global Health","volume":"15 1","pages":"106"},"PeriodicalIF":3.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12354443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855392","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":"Estimated Incidence of Hospitalisations and Deaths Attributable to Respiratory Syncytial Virus Infections in Adults in Norway between 2010 and 2019: A Time-Series Modelling Study.","authors":"Maribel Casas, Caihua Liang, Tor Molden, Robin Bruyndonckx, Mikel Esnaola, Somsuvro Basu, Worku Biyadgie Ewnetu, Pimnara Peerawaranun, Solomon Molalign Moges, Bradford D Gessner, Aleksandra Polkowska-Kramek, Elizabeth Begier","doi":"10.1007/s44197-025-00448-0","DOIUrl":"10.1007/s44197-025-00448-0","url":null,"abstract":"<p><strong>Background: </strong>Respiratory syncytial virus (RSV) can lead to serious respiratory illnesses in both children and adults, particularly affecting older individuals and those with chronic health issues. Due to its symptoms resembling other respiratory viruses and irregular RSV standard-of-care testing, RSV cases in adults frequently remain unreported.</p><p><strong>Methods: </strong>We retrospectively estimated the incidence of hospitalisations and deaths attributable to RSV in adults in Norway using a time-series model-based approach. Data were obtained from the Norwegian Patient Registry and Norwegian Cause of Death Registry to estimate RSV-attributable hospitalisations and deaths, respectively, among adults from 2010 to 2019. A quasi-Poisson time-series regression model was applied to estimate RSV annual (age- and risk-stratifications) hospitalisation incidence rates (IRs) and mortality rates (per 100,000 person-years).</p><p><strong>Results: </strong>Annual RSV-attributable hospitalisation IRs for adults aged ≥ 65 years with risk factors were 289-517 for cardiorespiratory, 243-434 for cardiovascular, and 178-318 per 100,000 person-years for respiratory hospitalisations. RSV-attributable hospitalisations represented 1-3% of total cardiorespiratory hospitalisations. Adults aged 18-44 years with risk factors had similar rates as those aged ≥ 65 years without risk factors. RSV-attributable mortality rates for adults aged ≥ 65 years were 19-35 for cardiorespiratory, 11-19 for respiratory, and 10-18 per 100,000 person-years for cardiovascular deaths. RSV-attributable deaths accounted for 1-5% of total cardiorespiratory deaths.</p><p><strong>Conclusions: </strong>RSV significantly contributes to hospitalisations and deaths in adults in Norway, particularly among older adults and younger adults with underlying diseases. The introduction of RSV vaccines can have a substantial public health impact in reducing the burden of RSV-attributable cardiovascular and respiratory events.</p>","PeriodicalId":15796,"journal":{"name":"Journal of Epidemiology and Global Health","volume":"15 1","pages":"107"},"PeriodicalIF":3.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12354426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855391","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":"Immunization Coverage and Barriers among Hajj and Umrah Pilgrims: Insights into Vaccine Uptake and Compliance.","authors":"Adeeb A Bulkhi, Hani M Almoallim, Majed S Obaid, Nahla H Hariri, Hamsah S Alqashqri, Ismail A Alghamdi, Amar Mohammad A Alkhotani, Muhammad Irfanullah Siddiqui, Heba M Adly, Mohammed A Garout, Elbagir A Elfaki, Saleh A K Saleh, Noura Mohammed Bakhsh, Raghda Sami Hassan H Alhazmi, Aous S Alhazmi, Jaffar A Al-Tawfiq, Fahad A Alamri, Anas A Khan","doi":"10.1007/s44197-025-00447-1","DOIUrl":"10.1007/s44197-025-00447-1","url":null,"abstract":"","PeriodicalId":15796,"journal":{"name":"Journal of Epidemiology and Global Health","volume":"15 1","pages":"104"},"PeriodicalIF":3.1,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144794695","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":"Indications for Pediatric Enucleations of Non-Retinoblastoma Globes in Saudi Arabia with Clinical and Radiological Correlation To Final Histopathological Diagnosis.","authors":"Azza My Maktabi, Hala A Helmi, Yaser M Benthabet, Seham Aljohar, Hind Manaa Alkatan","doi":"10.1007/s44197-025-00449-z","DOIUrl":"10.1007/s44197-025-00449-z","url":null,"abstract":"","PeriodicalId":15796,"journal":{"name":"Journal of Epidemiology and Global Health","volume":"15 1","pages":"105"},"PeriodicalIF":3.1,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144794696","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":"Epidemiological Characteristics of MERS-CoV Human Cases, 2012- 2025.","authors":"Mazin Barry","doi":"10.1007/s44197-025-00446-2","DOIUrl":"10.1007/s44197-025-00446-2","url":null,"abstract":"<p><strong>Aim: </strong>To describe the epidemiological characteristics of Middle East respiratory syndrome coronavirus (MERS-CoV) human cases since the first reported case in 2012.</p><p><strong>Methods: </strong>This is a retrospective descriptive epidemiological analysis of all laboratory-confirmed MERS-CoV human cases reported to the World Health Organization (WHO) from 2012 to May 2025. Cumulative cases globally, along with their demographics, comorbidities, epidemiological exposure, symptoms, hospital admissions, and mortality, were included. Descriptive analysis was used for the data.</p><p><strong>Results: </strong>Between March 2012 and May 2025, a total of 2,626 laboratory-confirmed MERS-CoV human cases were reported to the WHO, with 947 (36.1%) resulting in deaths. The majority of cases occurred in the Kingdom of Saudi Arabia (KSA), with 2,217 (84.4%) human cases and 866 (39.1%) deaths. Twenty-six other countries reported human cases, with the highest number occurring in South Korea, which reported 186 cases (7.1%). The highest number of cases occurred in 2014, with 662 (29.9%) cases, followed by 2015, with 453 (20.4%) cases. Almost half of the cases in KSA (44.7%) were secondary infections, and most (83%) required hospital admission, with 39.7% requiring admission to intensive care unit. The most common comorbidities were diabetes mellitus, chronic heart disease, and chronic renal failure. Between 2020 and the end of May 2025, 113 new human cases of MERS-CoV infection (4.3%) were reported, with the majority occurring in KSA. In 2025 alone, 10 new cases were reported, with two deaths. Secondary transmission occurred in 60% of these cases. Seven of the 10 cases were reported in April 2025 alone.</p><p><strong>Conclusion: </strong>Between 2012 and May 2025, the majority of MERS-CoV infections occurred in the Kingdom of Saudi Arabia and had a high mortality, reaching 40%. Although most cases were reported between 2014 and 2015, new human cases are still ongoing and are increasing in 2025. Continued epidemiological investigation and surveillance are needed.</p>","PeriodicalId":15796,"journal":{"name":"Journal of Epidemiology and Global Health","volume":"15 1","pages":"103"},"PeriodicalIF":3.1,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12328865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144794694","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":"Towards Rabies Elimination in Pakistan: Barriers, Facilitators, and the Role of One Health.","authors":"Anum Shaikh, Shifa Salman Habib, Ali Faisal Saleem, Naseem Salahuddin","doi":"10.1007/s44197-025-00441-7","DOIUrl":"10.1007/s44197-025-00441-7","url":null,"abstract":"<p><strong>Background: </strong>Rabies is a neglected zoonotic disease with an estimated 59,000 deaths annually, disproportionately affecting low- and middle-income countries. Pakistan remains a high-burden setting due to weak surveillance, poor intersectoral coordination, and limited public awareness. Therefore, this study aimed to examine the barriers and facilitators to rabies control in Pakistan through the One Health approach, integrating perspectives from both community members and institutional stakeholders.</p><p><strong>Methods: </strong>This mixed-methods study design was conducted in Karachi, where 385 household respondents completed a structured Knowledge, Attitudes, and Practices (KAP) survey, and 10 stakeholders (out of 14 approached) were interviewed across human, animal, and environmental sectors. The survey tool was adapted from previously validated instruments and pilot-tested. Thematic analysis was conducted using a deductive framework based on One Health principles. The quantitative data were analyzed descriptively using IBM SPSS Statistics 21, whereas the qualitative data were analyzed using Atlas.ti.</p><p><strong>Results: </strong>The average knowledge score was 5.54 out of 13 (42.6%), indicating substantial knowledge gaps among community members. Key barriers identified included limited vaccine availability, inadequate surveillance systems, fragmented dog population control, and weak multisectoral collaboration. Enabling factors included stakeholder willingness, local Trap-Neuter-Vaccinate-Release (TNVR) initiatives, and existing collaborative frameworks. Stakeholder awareness of the One Health approach was present but lacked institutional translation.</p><p><strong>Conclusion: </strong>A coordinated, One Health-based strategy for rabies elimination is urgently needed in Pakistan that addresses both systemic and community-level gaps through sustained advocacy, stronger intersectoral coordination, expansion of TNVR initiatives, and establishment of centralized surveillance for bite incidents and post-exposure management.</p>","PeriodicalId":15796,"journal":{"name":"Journal of Epidemiology and Global Health","volume":"15 1","pages":"102"},"PeriodicalIF":3.1,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12328853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789305","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":"Advanced Stage Disease Progression and Mortality Rate Before and After the Implementation of the Universal Test and Treat Strategy (UTT) for HIV Patients in Ethiopia: A Systematic Review and Meta-Analysis.","authors":"Sisay Moges, Bereket Aberham Lajore, Betelhem Asmerom Debesay, Degefa Tadele Belato","doi":"10.1007/s44197-025-00422-w","DOIUrl":"10.1007/s44197-025-00422-w","url":null,"abstract":"<p><strong>Background: </strong>The universal test and treat (UTT) program, is a strategy for eliminating HIV and, it involves screening all populations at risk for HIV infection, initiating early treatment for those diagnosed HIV positive, monitoring and maintaining treatment, and Retaining patients in care. Therefore, this meta-analysis evaluates the impact of the Test-and-Treat strategy on HIV-positive patients in Ethiopia, focusing on mortality rates and disease progression.</p><p><strong>Methods: </strong>A systematic literature search was conducted using databases such as PubMed, Embase, African Journals Online (AJOL), Google Scholar, and Web of Science. Data were classified into two periods: 2005 to 2015 (before test and treat era) and 2016-2024 (after test and treat strategy). Eligible studies included cohort and cross-sectional designs providing distinct data for these timeframes, irrespective of publication year, to assess reductions in mortality and disease progression (WHO Stage III or IV). Study quality and bias were assessed using the Newcastle-Ottawa Scale (NOS), ensuring rigorous evaluation across selection, comparability, and outcome domains. A random-effects model was employed for the meta-analysis.</p><p><strong>Results: </strong>The pooled mortality rate decreased significantly from 21% (95% CI: 14-29%) in the before test and treat period to 9% (95% CI: 6-12%) after the test and treat period, representing a 57.14% reduction. The proportion of patients in WHO Stage III declined from 47% (95% CI: 39-54%) to 21% (95% CI: 16-26%), a reduction of 55.32%. Similarly, the prevalence of WHO Stage IV decreased from 14% (95% CI: 12-16%) to 8% (95% CI: 5-10%), reflecting a 42.86% reduction.</p><p><strong>Conclusion: </strong>The test and treat strategy in Ethiopia has substantial reductions in mortality and disease progression. These results underscore the effectiveness of early, universal treatment initiation in improving patient survival and reducing the burden of HIV-related complications.</p>","PeriodicalId":15796,"journal":{"name":"Journal of Epidemiology and Global Health","volume":"15 1","pages":"101"},"PeriodicalIF":3.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12316661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760282","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":"Relationship Between Domestic Animals, Environmental and Behavioral Factors, and Under-Five Diarrhea in Sidama Region, Ethiopia: A Matched Case-Control Study.","authors":"Gorfu Geremew, Argaw Ambelu, Dessalegn Dadi, Alemayehu Haddis","doi":"10.1007/s44197-025-00421-x","DOIUrl":"10.1007/s44197-025-00421-x","url":null,"abstract":"<p><strong>Background: </strong>In Ethiopia's Sidama National Regional State, diarrhea remains the second most common cause of illness among children under five, despite a decrease in its mortality rate. However, limited research has been conducted in Ethiopia to identify the causes behind the continuing rise in the prevalence of diarrhea in children associated with exposure to domestic animals. Therefore, this study explores the relationship between domestic animal, environmental, and human behavioral factors and confirmed cases of diarrhea in children under five in the Sidama National Regional State of Ethiopia.</p><p><strong>Methods: </strong>We conducted a matched-pairs case-control study involving 306 cases and 306 controls in the Sidama region from September 2022 to February 2023. Cases and controls were identified at healthcare facilities, and interviews and observations were completed at residential homes with children under five. We collected data using the KoboCollect application and analyzed it through conditional logistic regressions. The random forest (RF) method with the classification RF model was used to compare its findings with those of the multivariate conditional regression analysis. The statistical analyses were conducted using R v.4.3.2 software.</p><p><strong>Results: </strong>The study indicated that having a caretaker who is a housewife [matched adjusted odds ratio (mAOR) = 3.09, 5% CI (1.09, 8.70)], a mean number of chickens ≥ 5 [mAOR = 5.18, 95% CI (2.70, 9.95)], the absence of soap at handwashing facilities [mAOR = 2.61, 95% CI (1.34, 5.10)], those who travel more than 30 min to fetch water [mAOR = 3.14, 95% CI (1.13, 8.78)], children who are in contact with animal feces [mAOR = 2.44, 95% CI (1.24, 4.82)], and households living with animals [mAOR = 3.28, 95% CI (1.71, 6.30)] showed significant associations with under-five diarrhea. The random forest analysis also identified the first five variables as the main risk factors for diarrhea occurrence among children under-five years of age.</p><p><strong>Conclusions: </strong>Risk factors for diarrhea among children under-five include a high number of chickens, cohabitation with animals, prolonged water-fetching times, poor hand hygiene, and caretakers' occupational status. Animal feces management, improved water access, and hygiene education are critical to reducing under-five diarrheal diseases.</p>","PeriodicalId":15796,"journal":{"name":"Journal of Epidemiology and Global Health","volume":"15 1","pages":"100"},"PeriodicalIF":3.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12314134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753450","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}