Global Epidemiology最新文献

{"title":"Identification of population multimorbidity patterns in 3.9 million patients from Bogota in 2018","authors":"Carolina Saavedra-Moreno ,&nbsp;Rafael Hurtado ,&nbsp;Nubia Velasco ,&nbsp;Andrea Ramírez","doi":"10.1016/j.gloepi.2024.100171","DOIUrl":"10.1016/j.gloepi.2024.100171","url":null,"abstract":"<div><h3>Background</h3><div>Multimorbidity has emerged as a challenge for health systems due to its association with adverse clinical outcomes. Given the limited information available on multimorbidity, particularly in low- and middle-income countries, this study characterizes multimorbidity patterns in the population of Bogotá, Colombia in 2018.</div></div><div><h3>Methods</h3><div>In a cross-sectional study, we analyzed 16 million medical consultation records from Bogotá reported in the National Service Delivery Records in 2018. Using network analysis, we quantified the prevalence of multimorbidity in the population and identified the most common associations between diagnoses, with data stratified by age, sex, and socioeconomic status.</div></div><div><h3>Results</h3><div>The study found that the prevalence of multimorbidity in the population was 44.2 %, increased with age, and was higher in women and in people affiliated to the contributory health scheme. Allergies and vasomotor rhinitis with asthma were common in young people. In women aged 19–39 years, obesity with hypothyroidism was common, while men in the same age group had obesity with dyslipidemia. In people aged 60 years and older, essential hypertension with dyslipidemia was the most common. In addition, some associations between diagnoses showed a higher association in people affiliated to the subsidized health scheme, with notable associations with trauma, especially in men.</div></div><div><h3>Conclusion</h3><div>Overall, the results provide valuable insights into multimorbidity in the population and highlight inequalities based on sociodemographic factors. Future research should investigate whether the lower prevalence of multimorbidity in vulnerable groups is related to biases in data collection or to underlying inequalities in healthcare access.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100171"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vitamin D deficiency in Ukraine: A multicentre cross-sectional study","authors":"Sofiia Shatylo ,&nbsp;Volodymyr Bogomaz ,&nbsp;Oleksii Babych","doi":"10.1016/j.gloepi.2024.100170","DOIUrl":"10.1016/j.gloepi.2024.100170","url":null,"abstract":"<div><h3>Background</h3><div>Available epidemiological data on vitamin D status in the Ukrainian population are limited.</div></div><div><h3>Objective</h3><div>The aim of this study is to investigate the prevalence of vitamin D deficiency in Ukraine.</div></div><div><h3>Methods</h3><div>This multicentre cross-sectional study included a total of 11,462 participants: 1530 children with a median age 10 years, (IQR 6–14) and 56.21 % of them were female; 9932 adults with a median age of 36 years (IQR 26–48) and 78.72 % of them were female. Serum 25-hydroxyvitamin D (25(OH)D) levels were measured once by chemiluminescent immunoassay (UniCel DxI 800 Access Immunoassay System, Beckman Coulter Inc., USA) in the period of January–December 2021 in Kyiv and Kyiv Oblast. The cut-offs were: vitamin D deficiency, &lt;50 nmol/L; moderate deficiency, 25–&lt;50 nmol/L; severe deficiency, &lt;25 nmol/L; vitamin D insufficiency, 50–&lt;75 nmol/L; vitamin D sufficiency, 75–&lt;250 nmol/L; optimal concentration, 75–&lt;125 nmol/L; increased levels, 125–&lt;250 nmol/L; and toxicity, ≥250 nmol/L.</div></div><div><h3>Results</h3><div>The median 25(OH)D level was 65.4 nmol/L (IQR 49.5–85.6) among all participants, severe vitamin D deficiency was recorded in 2.9 % of participants (95 % CI: 2.6–3.2), moderate deficiency in 23 % (95 % CI: 22–24), and vitamin D insufficiency in 37 % (95 % CI: 36–38).</div><div>Prevalence of vitamin D deficiency in group 1–17 years was 23.5 % (95 % CI: 21–26). We did not find vitamin D deficiency in children aged 1–2 years; however toxic levels were recorded in 4.2 % of the children in this age group (95 % CI: 1.4–9.6). Among the adults (≥18 years old), prevalence of vitamin D deficiency was 26 % (95 % CI: 25–27).</div></div><div><h3>Conclusion</h3><div>Vitamin D deficiency and insufficiency are common in Ukraine.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100170"},"PeriodicalIF":0.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142434056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modelling the factors associated with quality of life in women with osteoporosis: A cross-sectional study","authors":"Rahmatollah Moradzadeh ,&nbsp;Maryam Zamanian ,&nbsp;Maliheh Taheri","doi":"10.1016/j.gloepi.2024.100169","DOIUrl":"10.1016/j.gloepi.2024.100169","url":null,"abstract":"<div><h3>Background</h3><div>Considering the important factors contributing to different health-related quality of life (HRQoL) subscales is essential for implementing preventive measures to increase the HRQoL among women with osteoporosis. We here evaluated the variables related to the mental and physical HRQoL in a sample of Iranian osteoporotic women.</div></div><div><h3>Methods</h3><div>In this cross-sectional study, the participants included 111 women with osteoporosis in 2013. Physical and mental of HRQoL were measured by the ECOS-16 questionnaire. Other variables included BMD t-score (Osteoporosis was diagnosed based on bone mineral density (BMD) with BMD t-score &lt; −2.5), age, body mass index, educational level, marital status, duration of the disease, history of bone fracture in the past year, the number of pregnancies, and weekly walking hours. Final regression coefficients were obtained based on the total effects of estimations (decompositions of effects into direct, indirect and total effects) by structural equation model (SEM) analysis.</div></div><div><h3>Results</h3><div>The mean scores of physical and mental domains of HRQoL were 54(21) and 54(25), respectively. The mean of BMD t-score was −3.2 (0.9). Based on the regression coefficients obtained in the SEM model, weekly walking hours(2.2), number of pregnancies (−1.2), and history of bone fracture in past year(−2.9) were the more important determinants of physical aspect of HRQoL than other included variables of this study. Furthermore, age over than 60 (−9.1), history of bone fracture in past year(−4.8), weekly walking hours(2.3), marital status(−5), and education level (3.9)influenced the mental aspect of HRQoL.</div></div><div><h3>Conclusions</h3><div>Social and life style factors tend to impact on physical and mental domains of HRQoL, a measure that is influenced by multiple factors among postmenopausal women. In this respect, these obtained factors should be considered for health planning to improve the physical and mental domains of HRQoL among postmenopausal women.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100169"},"PeriodicalIF":0.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142539255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing AI/ML approaches and classical regression for predictive modeling using large population health databases: Applications to COVID-19 case prediction","authors":"Lise M. Bjerre ,&nbsp;Cayden Peixoto ,&nbsp;Rawan Alkurd ,&nbsp;Robert Talarico ,&nbsp;Rami Abielmona","doi":"10.1016/j.gloepi.2024.100168","DOIUrl":"10.1016/j.gloepi.2024.100168","url":null,"abstract":"<div><h3>Background</h3><div>Research comparing artificial intelligence and machine learning (AI/ML) methods with classical statistical methods applied to large population health databases is limited.</div></div><div><h3>Objectives</h3><div>This retrospective cohort study aimed to compare the predictive performance of AI/ML algorithms against conventional multivariate logistic regression models using linked health administrative data.</div></div><div><h3>Methods</h3><div>Using Ontario's population health databases, we created a cohort of residents of the city of Ottawa, Ontario, who underwent a PCR test for COVID-19 between March 10, 2020, and May 13, 2021. Using demographic, socio-economic and health data (including COVID-19 PCR test results and available, symptom data), we developed predictive models for the purpose of COVID-19 case identification using the following approaches: classical multivariate logistic regression (LR); deep neural network (DNN); random forest (RF); and gradient boosting trees (GBT). Model performance comparisons were made using the area under the curve (AUC) swarm plot for 10-fold cross-validation.</div></div><div><h3>Results</h3><div>The cohort consisted of <em>n</em> = 351,248 Ottawa residents tested for COVID-19 during the study period. Among whom, a total of <em>n</em> = 883,879 unique COVID-19 tests were performed (2.6 % positive test results). Inclusion of COVID-19 symptoms data in the analysis improved model performance and variable predictive value across all tested models (<em>p</em> &lt; 0.0001), with the 10-fold cross-validation AUC increasing to near or over 0.7 in all models when symptoms data were included. In various pairwise comparisons, the GBT method had the highest predictive ability (AUC = 0.796 ± 0.017), significantly outperforming multivariate logistic regression and the other AI/ML approaches.</div></div><div><h3>Conclusions</h3><div>Conventional multivariate regression-based models are better than some and worse than other machine learning algorithms to provide good predictive accuracy in a moderate dataset with a reasonable number of features. However, whenever possible, the AI/ML GBT approach should be considered.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100168"},"PeriodicalIF":0.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142424363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating effects of aging and disease progression in current and former smokers using longitudinal models","authors":"Matthew Strand ,&nbsp;Surya Bhatt ,&nbsp;Matthew Moll ,&nbsp;David Baraghoshi","doi":"10.1016/j.gloepi.2024.100165","DOIUrl":"10.1016/j.gloepi.2024.100165","url":null,"abstract":"<div><h3>Objectives</h3><div>To separate estimates of mean change in a health outcome into components of aging and disease progression for different severity groups of chronic obstructive pulmonary disease (COPD).</div></div><div><h3>Study design and methods</h3><div>A longitudinal model can be used to estimate mean change in a health outcome over time. Methods to separate this change into portions due to aging and disease progression are discussed, including conditions that allow for accurate estimation. Linear mixed models were used to estimate these changes for <em>forced expiratory volume in 1</em> <em>s</em> (FEV₁) for various COPD severity and smoking groups using a large cohort (COPDGene) followed for over 10 years.</div></div><div><h3>Results</h3><div>Based on an analysis of 4967 subjects, age-related loss in FEV₁ was found to be about 1 % per year, consistent with published work. Excess average losses (those beyond natural aging) were significant for all severity groups (except nonsmokers), including those with smoking history but normal lung function. Subjects in higher severity groups tended to have less loss in FEV₁, but more relative loss, compared to baseline averages. Losses in FEV₁ that included both aging and disease progression ranged from 1 to 3 % over severity groups, with current smokers generally exhibiting greater mean losses in FEV₁ than former smokers.</div></div><div><h3>Discussion</h3><div>Effects of disease progression separate from aging can be estimated in observational studies, although care should be taken in order to make sure assumptions involving this separation are reasonable for a given study. This article demonstrates methods to estimate such effects using temporal changes in lung function for subjects in the COPDGene study.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100165"},"PeriodicalIF":0.0,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the integration of epidemiological data into human health risk assessment: What risk assessors told us they want","authors":"Carl V. Phillips ,&nbsp;Igor Burstyn ,&nbsp;David J. Miller ,&nbsp;Ali K. Hamade ,&nbsp;Raghavendhran Avanasi ,&nbsp;Denali Boon ,&nbsp;Saumitra V. Rege ,&nbsp;Sandrine E. Déglin","doi":"10.1016/j.gloepi.2024.100167","DOIUrl":"10.1016/j.gloepi.2024.100167","url":null,"abstract":"<div><div>One of the practical contributions of epidemiology studies is to inform risk assessment and management to protect public health. However, there is a perception among some that environmental and occupational epidemiology is falling short of satisfying the needs of risk assessors. The specific reasons for this are not clearly understood. To help identify the points of dissatisfaction and possible areas for mutual learning, we conducted a survey of risk assessors, seeking their opinions of epidemiology research. We present a few quantitative measures and a thematic analysis of responses to open-ended questions. Survey results suggest that some risk assessors (with some adamant exceptions) believe that epidemiology has great potential to contribute to risk assessment but can be deficient in many ways. For example, respondents identified the lack of full disclosure of methods, deficiencies in exposure assessment, the absence of comprehensive uncertainty analyses, and the failure to investigate or explore thresholds of effects as some of the common shortcomings. These could be straightforward to address. Respondents also brought up a wide collection of more complicated and subtle concerns that could lead to further improvement of useful results. We identify areas where mutually-educating interdisciplinary dialogue seems particularly promising. Epidemiology research is expensive, and risk management decisions even more so; therefore, it is desirable for the risk assessment and epidemiologic communities to work toward making epidemiologic research more useful for informing decisions.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100167"},"PeriodicalIF":0.0,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142424362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The mockery that confounds better treatment of confounding in epidemiology: The change in estimate fallacy","authors":"Igor Burstyn","doi":"10.1016/j.gloepi.2024.100166","DOIUrl":"10.1016/j.gloepi.2024.100166","url":null,"abstract":"<div><div>Confounding is one of the most infamous bugbears of epidemiology, used by some to dismiss the field's utility outright. The subject has received considerable attention from epidemiologists and the field boasts a remarkable arsenal for addressing the issue. However, it appears that there are still misconceptions about how to identify variables that cause confounding (a lack of exchangeability) in epidemiologic practice. In this commentary, I examine whether analysis of the properties of change-in-estimate method for identification of confounding, exemplified by two highly cited papers, has been appropriately cited in published reports and whether it was utilized to improve epidemiologic practice. I conclude that the myth that a change-in-estimate criterion of 10 % is legitimate for identifying confounding persists in epidemiological practice, despite having been discredited by several independent research groups decades ago. Speculations on possible solutions to this problem are offered, but my work's main contribution is identification of a problem of how methodological advances in epidemiology may be misapplied. There currently do not exist any universal criteria for identification of confounding! “Citation without representation” or biased presentation of conclusions of methodological research may be pervasive.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100166"},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142424326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tailored guidance to apply the Estimand framework to Trials within Cohorts (TwiCs) studies","authors":"R. Gal ,&nbsp;R. Kessels ,&nbsp;K. Luijken ,&nbsp;L.A. Daamen ,&nbsp;D.R. Mink van der Molen ,&nbsp;S.A.M. Gernaat ,&nbsp;A.M. May ,&nbsp;H.M. Verkooijen ,&nbsp;P.M. van de Ven","doi":"10.1016/j.gloepi.2024.100163","DOIUrl":"10.1016/j.gloepi.2024.100163","url":null,"abstract":"<div><div><strong>Objective</strong>: The estimand framework offers a structured approach to define the treatment effect to be estimated in a clinical study. Defining the estimand upfront helps formulating the research question and informs study design, data collection and statistical analysis methods. Since the Trials within Cohorts (TwiCs) design has unique characteristics, the objective of this study is to describe considerations and provide guidance for formulating estimands for TwiCs studies.</div><div><strong>Methods</strong>: The key attributes of an estimand are the target population, treatments that are compared, the endpoint, intercurrent events and their handling, and the population-level summary measure. The estimand framework was applied retrospectively to two TwiCs studies: the SPONGE and UMBRELLA Fit trial. The aim is to demonstrate how the estimand framework can be implemented in TwiCs studies, thereby focusing on considerations relevant for defining the estimand. Three estimands were defined for both studies. For the SPONGE trial, estimators were derived.</div><div><strong>Results</strong>: Intercurrent events considered to occur exclusively or more frequently in TwiCs studies compared to conventional randomized trials included intervention refusal after randomization, misalignment of timing of routine cohort measurements and the intervention period, and participants in the control arm initiating treatments similar to the studied intervention. Considerations for handling refusal after randomization related to decisions on whether the target population should include all eligible participants or the subpopulation that would accept (or undergo) the intervention when offered. Considerations for handling treatment initiation in the control arm and misalignments of timing related to decisions on whether such events should be considered part of treatment policy or whether interest is in a hypothetical scenario where such events do not occur.</div><div><strong>Conclusion</strong>: The TwiCs study design has unique features that pose specific considerations when formulating an estimand. The examples in this study can provide guidance in the definition of estimands in future TwiCs studies.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100163"},"PeriodicalIF":0.0,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A note on handling conditional missing values","authors":"Mohammad Ali Mansournia ,&nbsp;Maryam Nazemipour ,&nbsp;Mahyar Etminan","doi":"10.1016/j.gloepi.2024.100164","DOIUrl":"10.1016/j.gloepi.2024.100164","url":null,"abstract":"<div><div>In medical research, some variables are conditionally defined on some levels of another variable, leading to conditional missing data. Imputation of this type of structural missing data is needed given inefficiency of listwise deletion inherent in regression modeling. Using some examples, we illustrate handling of conditional missing values using simple imputation procedures in etiologic and prediction research.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100164"},"PeriodicalIF":0.0,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142319449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the timeliness of birth registration in Fiji through a financial incentive","authors":"Christine Linhart ,&nbsp;Neel Singh ,&nbsp;Meli Nadakuca ,&nbsp;Varanisese Saumaka ,&nbsp;Carlie Congdon ,&nbsp;Sharita Serrao ,&nbsp;Richard Taylor ,&nbsp;Stephen Morrell","doi":"10.1016/j.gloepi.2024.100162","DOIUrl":"10.1016/j.gloepi.2024.100162","url":null,"abstract":"<div><h3>Background</h3><p>Fiji is a Pacific Island nation with the predominant ethnic groups indigenous Fijians (iTaukei) (62 %) and Fijians of Indian descent (31 %). This study reports on the effect of a Parental Assistance Payment Program (PAPP) tied to on-time birth registration, available in Fiji from August 2018 to July 2020.</p></div><div><h3>Methods</h3><p>Unit record birth registration data (<em>n</em> = 117,829) for children born during 2016–22 were used to calculate mean birth-to-registration intervals and the likelihood of on-time birth registration (within 365 days) before the PAPP (January 2016–July 2018) compared to during the PAPP (August 2018–July 2020), by population disaggregations (sex, ethnicity, age, marital status).</p></div><div><h3>Results</h3><p>During the PAPP, mean birth-to-registration intervals declined sharply by 81 %, from 665 days (95 %CI: 658–671) to 124 days (121–127). The largest declines were among i-Taukei children (803 to 139 days, 83 %) compared to non-iTaukei (283 to 76 days, 73 %); mothers aged 10–19 years (880 to 134 days, 85 %) compared to ≥20 years (653 to 123 days, 81 %); and single mothers (983 to 145 days, 85 %) compared to married mothers (570 to 115 days, 80 %). On-time birth registration increased from 57 % to 93 %, and the adjusted hazard ratio showed children born during the PAPP were 2.3 times more likely (95 %CI: 2.2–2.4) to have their birth registered on-time compared to children born before the PAPP. When the PAPP was discontinued in August 2020, the birth-to-registration interval increased sharply in all population groups.</p></div><div><h3>Conclusions</h3><p>During the two-year period the PAPP was available, it was highly effective at improving the timeliness of birth registration, particularly among iTaukei children, young mothers, and single mothers. After the PAPP was discontinued, the timeliness of birth registration deteriorated sharply. Longer post-PAPP follow-up time (≠5 years) is required to determine whether the timeliness of birth registration has deteriorated to levels similar to those during the pre-PAPP period.</p></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100162"},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590113324000282/pdfft?md5=1171905bb3ebcdc81969c7a95b876f4b&pid=1-s2.0-S2590113324000282-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142229625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}