Clinical Epidemiology and Global Health最新文献

{"title":"The hidden burden of undiagnosed diabetic kidney disease in primary care: Lessons from a rural Indian health system","authors":"K.K. Ashwin Raj,&nbsp;Mubarack Sani,&nbsp;Anaan Basha,&nbsp;Hiba Shaji,&nbsp;Krishnaraj Rajeev,&nbsp;K.P. Aiswarya","doi":"10.1016/j.cegh.2026.102377","DOIUrl":"10.1016/j.cegh.2026.102377","url":null,"abstract":"<div><h3>Background</h3><div>Diabetic kidney disease (DKD) is a major contributor to chronic kidney disease and related morbidity among individuals with type 2 diabetes mellitus. Early detection can delay disease progression; however, DKD often remains undiagnosed in primary-care settings, particularly in rural health systems. Evidence on the magnitude of undiagnosed DKD within routine diabetes care in India remains limited.</div></div><div><h3>Methods</h3><div>A community-based cross-sectional analytical study was conducted from May to June 2024 among adults with type 2 diabetes mellitus attending primary-care services in a rural area of Kerala, India. Sociodemographic, clinical, and laboratory data were collected using structured interviews and medical record review. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease equation. Undiagnosed DKD was defined as chronic kidney disease (eGFR &lt;60 mL/min/1.73 m²) in individuals without a prior documented diagnosis. Descriptive analyses, group comparisons, and logistic regression were performed.</div></div><div><h3>Findings</h3><div>Among 110 participants, 22.7% (95% CI: 15.0–30.5%) were identified with previously undiagnosed DKD, with all cases first detected at stage 3 or beyond. Individuals with undiagnosed DKD showed a significantly higher prevalence of elevated serum creatinine, anaemia, hyperkalaemia, and poor glycaemic control. Documentation of urine albumin testing and prior eGFR calculation was significantly lower among affected participants. In multivariable analysis, older age, hypertension, longer duration of diabetes, and higher serum creatinine levels were independently associated with undiagnosed DKD. The multivariable logistic regression model demonstrated good discriminatory performance, with an area under the receiver operating characteristic curve (AUC) of 0.89 (95% CI: 0.82–0.95).</div></div><div><h3>Interpretation</h3><div>A substantial hidden burden of undiagnosed diabetic kidney disease exists within routine primary-care diabetes services, with detection occurring predominantly at advanced stages. These findings indicate missed opportunities for early diagnosis despite regular health-system contact and highlight the need to strengthen systematic renal assessment within existing primary-care programmes.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"39 ","pages":"Article 102377"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147850747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autism spectrum disorders with comorbidities – A detailed profiling of risk factors and temperamental characteristics - Insights from a tertiary care center","authors":"Ushasti Sinha ,&nbsp;Sujay Shenoy ,&nbsp;Amrtavarshini Radhakrishna,&nbsp;Rajeshkrishna Panambur Bhandary","doi":"10.1016/j.cegh.2026.102364","DOIUrl":"10.1016/j.cegh.2026.102364","url":null,"abstract":"<div><h3>Background</h3><div>The prevalence of autism spectrum disorders (ASD) is rising worldwide. Psychiatric/physical comorbidities are common in ASD and untreated comorbidities worsen functioning. Understanding the risk factors and temperamental characteristics in ASD with comorbidities helps to inform preventive and early intervention efforts.</div></div><div><h3>Methods</h3><div>Data was collected from medical case records of children with ASD, aged 17 years and below, evaluated under the Department of Psychiatry, between January 2014 and December 2024. 120 clinical records with an ASD diagnosis were screened, out of which 46 were included for the study. The records were systematically scrutinized for risk factors, temperamental characteristics, symptoms of ASD and comorbidities according to ICD-11.</div></div><div><h3>Results</h3><div>74% of the children were aged 5 years or below. 48% had medical comorbidities, and 84.8% had psychiatric comorbidities. 43% and 32% had a family history of medical and psychiatric comorbidities, respectively. Among pre- and perinatal risk factors, 30% (14) had at least a single risk factor, and 52% (24) had more than one risk factor. Children with comorbidities had a higher median number of risk factors (2 vs 1). 48% of children had a difficult temperament, and all of them had comorbidities with ASD. Among these, the dimensions of temperament were heterogeneous.</div></div><div><h3>Conclusion</h3><div>Our study highlights the importance of detailed risk factor profiling and temperamental characteristics of ASD with comorbidities for preventive, promotion, and early intervention for ASD.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"39 ","pages":"Article 102364"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147850748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in cataract and glaucoma surgery in the Brazilian unified health system: a retrospective study from 2009 to 2024","authors":"Carolina Engelbrecht,&nbsp;Marina Martins Siqueira,&nbsp;Gabriely Rangel Pereira,&nbsp;Lucas Hernandes Correa,&nbsp;Nelson Wolosker,&nbsp;Marcelo Passos Teivelis","doi":"10.1016/j.cegh.2026.102372","DOIUrl":"10.1016/j.cegh.2026.102372","url":null,"abstract":"<div><h3>Background</h3><div>In 2020, cataracts were the leading cause of blindness worldwide, while glaucoma ranked second and remained the primary cause of irreversible blindness. This study analyzes data from Brazil's public health system (Sistema Único de Saúde - SUS) regarding cataracts and glaucoma, focusing on procedure volume, regional disparities, mortality, and ophthalmologist workforce.</div></div><div><h3>Methods</h3><div>De-identified data are publicly available through the Hospital Information System (HIS) and the Outpatient Information System (OIS). Additionally, data on ophthalmologists in the public health system were obtained from the National Registry of Health Establishments.</div></div><div><h3>Results</h3><div>The total number of cataract procedures increased from 364,600 in 2009 to 1.48 million in 2024, while glaucoma procedures rose from 18,500 to 45,200. Women over 50 predominated in cataract procedures, and they accounted for 60% of glaucoma procedures across all ages. There were 41 deaths related to cataract procedures and only one related to glaucoma. The number of ophthalmologists in SUS increased to an average of 6.2 per 100,000 inhabitants over the period.</div></div><div><h3>Conclusions</h3><div>From 2009 to 2024, at least 11.8 million cataract and glaucoma procedures were performed. The Southeast and Northeast regions led in cataract procedures, while the Southeast and North excelled in glaucoma. Women comprised the majority of surgeries, and the mortality rate was very low, with ophthalmologists concentrated primarily in major centers, especially in the Southeast.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"39 ","pages":"Article 102372"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147798451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Nirsevimab for Respiratory Syncytial Virus (RSV) prevention in India: current status and way forward","authors":"Nonita Dudeja ,&nbsp;Sankalp Dudeja ,&nbsp;Archisman Mohapatra ,&nbsp;Pratima Anand","doi":"10.1016/j.cegh.2026.102371","DOIUrl":"10.1016/j.cegh.2026.102371","url":null,"abstract":"<div><div>Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infections, hospitalisation and deaths among infants and young children globally. The burden is disproportionately high in lower and middle income countries, including India. Nirsevimab, a long acting monoclonal antibody, administered as a single dose, has demonstrated high effectiveness in preventing severe RSV disease and RSV-related hospitalisation in many high income countries. It is aligned with World Health Organization recommendations and has recently received marketing approval from the Central Drugs Standard Control Organization (CDSCO), India. However, its uptake in clinical practice in India is limited. Key barriers include the absence of national clinical or programmatic guidelines, limited national RSV surveillance data, high product cost, and operational and equity challenges within the health system. This narrative review summarises the epidemiological burden of RSV in India, including mortality, age and gestation-specific risk, and regional variation in seasonality. We discuss the strengths (S), weaknesses (W), opportunities (O) and challenges (C) related to introduction of Nirsevimab in India. We also discuss the current regulatory and policy landscape for Nirsevimab introduction on a large scale. We describe the strategic steps that can be taken going forward. Critical next steps include strengthening RSV surveillance, generating India-specific real world evidence and cost-effectiveness data, engaging policymakers and professional bodies, and exploring strategies to improve affordability and access. Strategic adoption of Nirsevimab into the health system of India has the potential to substantially reduce RSV-related morbidity and mortality among infants in India.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"39 ","pages":"Article 102371"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147798452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strengthening policies to support exclusive breastfeeding among informal working mothers in Indonesia","authors":"Ratih Wirapuspita Wisnuwardani ,&nbsp;Agung Dwi Laksono","doi":"10.1016/j.cegh.2026.102373","DOIUrl":"10.1016/j.cegh.2026.102373","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to assess the prevalence of exclusive breastfeeding and identity socio-demographic and health service factors associated with the practice among mothers working in the informal sector in Indonesia.</div></div><div><h3>Methods</h3><div>A secondary analysis was conducted using data from the 2022 Indonesian National Nutritional Status Survey, including 8915 children aged 0-23 months. Exclusive breastfeeding was defined as the outcome variable. Maternal characteristics and health service utilization were examined as predictors using binary logistic regression to estimate adjusted odds ratios with 95% confidence intervals.</div></div><div><h3>Results</h3><div>The prevalence of exclusive breastfeeding was 40.3%. Mothers residing in rural areas had higher odds of exclusive breastfeeding than those in urban areas (AOR 1.463; 95% CI 1.439-1.488). Mothers aged 25-44 years and those who married were more likely to practice exclusive breastfeeding. Lower educational attainment was associated with higher odds, whereas lower household wealth was associated with reduced likelihood. Utilization of maternal health services, including antenatal care (AOR 1.308; 95% CI 1.277-1.340), early inititation of breastfeeding (AOR 1.731; 95% CI 1.705-1.757), and institutional delivery (AOR 1.117; 95% CI 1.092-1.142), was positively associated with exclusive breastfeeding.</div></div><div><h3>Conclusion</h3><div>Exclusive breastfeeding among mothers working in the informal sector remains suboptimal in Indonesia. Strengthening access to maternal health services and addressing socioeconomic disparities, particularly in urban and low-income populations, are essential to improve breastfeeding outcomes.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"39 ","pages":"Article 102373"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147798450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of NutriSmart: A mobile application for nutrition education in South Indian preschool children","authors":"Faseela Mohammed Rasheed ,&nbsp;Pratheesh P. Gopinath ,&nbsp;Beela G.K","doi":"10.1016/j.cegh.2026.102319","DOIUrl":"10.1016/j.cegh.2026.102319","url":null,"abstract":"<div><h3>Problem considered</h3><div>Early childhood nutrition education tools lack cultural relevance for South Indian populations, with no existing applications specifically designed for preschool children aged 3-6 years. Poor dietary patterns established during this critical period persist into adulthood, contributing to long-term health complications.</div></div><div><h3>Methods</h3><div>A user-centered design approach was employed involving stakeholder consultation (n = 15 across focus groups and individual interviews), development of a 1023-item South Indian food database using ICMR-IFCT 2017, and psychometric validation with 35 parents of preschool children over one month in Thiruvananthapuram district, Kerala. Content validity (expert review), face validity, internal consistency reliability (Cronbach's α), and test-retest reliability were assessed across four domains: usability, content quality, perceived effectiveness, and trust.</div></div><div><h3>Results</h3><div>Content validity was confirmed by expert panel (I-CVI: 0.80-1.00, S-CVI/Ave: 0.92). NutriSmart demonstrated high internal consistency (α = 0.82-0.89) and excellent test-retest reliability (ICC = 0.85-0.91) across all domains. The application achieved a user-centered design score of 9/11, comparable to established paediatric nutrition applications. User feedback during testing led to iterative improvements including enhanced food selection interface and expanded allergen profiles (8 to 14 items).</div></div><div><h3>Conclusion</h3><div>NutriSmart is a psychometrically validated, culturally relevant digital nutrition education tool for South Indian preschool children, demonstrating strong preliminary validity, reliability, and user acceptance for promoting healthy eating behaviors in early childhood.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102319"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147397810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge, attitudes, and practices regarding dietary salt intake and its relationship with blood pressure in Vietnamese adults","authors":"Hai Thanh Nguyen ,&nbsp;Kien Trung Dong ,&nbsp;Diem Thi Hong Nguyen ,&nbsp;Hong Thi Nguyen ,&nbsp;Khoa Xuan Tang ,&nbsp;Anh Hai Cao ,&nbsp;Linh Thuy Nguyen ,&nbsp;Tuyet Thi Hong Nguyen ,&nbsp;Duc Minh Cap","doi":"10.1016/j.cegh.2026.102323","DOIUrl":"10.1016/j.cegh.2026.102323","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to assess knowledge, attitudes, and practices (KAP) related to dietary salt intake and to investigate the association between KAP and blood pressure among adults in Vietnam.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted involving 2100 participants selected through a multistage random sampling method. Data were collected through face-to-face interviews using a structured questionnaire and anthropometric measurements. Multivariable logistic regression models were employed to identify factors associated with KAP, while multivariable linear regression models were used to examine the relationship between KAP levels and blood pressure.</div></div><div><h3>Results</h3><div>Among the 2100 participants, 24.9% demonstrated good knowledge, 32.3% exhibited positive attitudes, and 6.5% reported good practices regarding dietary salt intake. Only 11.1% of participants had good overall KAP. Participants with good knowledge had systolic blood pressure that was 1.80 mmHg lower than those with poor knowledge (95% CI: −3.15 to −0.45; p = 0.009). Similarly, participants with good practices had diastolic blood pressure that was 1.83 mmHg lower than those with poor practices (95% CI: −3.40 to −0.26; p = 0.023). Furthermore, participants with good overall KAP had lower systolic (−2.78 mmHg; 95% CI: −4.00 to −1.57; p &lt; 0.001) and diastolic blood pressure (−2.27 mmHg; 95% CI: −4.07 to −0.47; p = 0.013) compared with those with poor overall KAP.</div></div><div><h3>Conclusions</h3><div>This study underscores the importance of improving knowledge and practices regarding dietary salt intake to enhance blood pressure control. Public health interventions promoting awareness and healthy behaviors may play a critical role in reducing hypertension.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102323"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147398240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and outcome of children with acute viral hepatitis using complementary and alternative medications (CAM) presenting to a tertiary care center of North India: A prospective observational study","authors":"Prerna Priyadarshini ,&nbsp;Sudhir Verma ,&nbsp;Manisha Verma ,&nbsp;Sanjeev Kumar Verma","doi":"10.1016/j.cegh.2026.102304","DOIUrl":"10.1016/j.cegh.2026.102304","url":null,"abstract":"<div><h3>Objective</h3><div>The use of complementary and alternative medicine (CAM) is a widespread practice worldwide for treating a variety of health conditions. The impact of CAM related drug induced liver injury (DILI) in pediatric population is not known. Therefore, this study is planned to examine the prevalence of use of CAMs in children with acute viral hepatitis (AVH) and to describe the outcome of CAM related liver injury (second hit) in children with hepatitis A and E related AVH.</div></div><div><h3>Methods</h3><div>This prospective observational study included children aged 1 to 18 years with AVH who presented to a tertiary care center in North India between April 2024 and September 2024. Clinical and laboratory details were noted on a predesigned format, including detailed history of use of CAM. Groups of children with AVH with and without use of CAMs were compared.</div></div><div><h3>Result</h3><div>During the study period 78 patients with AVH presented to the Department of Paediatrics of which 60 were enrolled. Thirty-seven (62%) had history of CAM use in past. On univariate analysis, pruritus (p = 0.021), ascites (p &lt; 0.001), hepatic encephalopathy (p = 0.021), and pediatric acute liver failure (PALF) (p = 0.001) were significantly more common among children with acute viral hepatitis who used complementary and alternative medicine (CAM). Variables found to be significant on univariate analysis were subjected to multivariate analysis. PALF (adjusted OR: 9.141; 95% CI: 1.526–54.764; p = 0.015) was independently associated with CAM use among children with AVH. The mortality rate among children with AVH who used CAM was 5.4% in this study.</div></div><div><h3>Conclusion</h3><div>The present study clearly highlights the high prevalence of CAM use in the pediatric population with AVH. Pruritus<strong>,</strong> ascites and PALF complicate, natural AVH course with CAM use.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102304"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147398241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cow's milk protein-induced FPIES: Clinical outcomes in severe cases","authors":"Príscila da Silva Pereira Vasconcelos,&nbsp;Tassiana dos Anjos,&nbsp;Juliana Bellote,&nbsp;Elizete Aparecida Lomazi,&nbsp;Maria Ângela Bellomo-Brandão","doi":"10.1016/j.cegh.2025.102235","DOIUrl":"10.1016/j.cegh.2025.102235","url":null,"abstract":"<div><h3>Problem considered</h3><div>Food Protein-Induced Enterocolitis Syndrome (FPIES) is a rare and poorly understood condition that primarily affects infants and young children. This study aimed to evaluate the clinical characteristics and outcomes of patients diagnosed with severe cow's milk protein-induced FPIES.</div></div><div><h3>Methods</h3><div>A case series was conducted involving pediatric patients who underwent oral food challenges OFCs for FPIES exclusively triggered by cow's milk protein, followed at the pediatric gastroenterology outpatient clinic of a quaternary hospital between January 16, 2018, and June 20, 2024.</div></div><div><h3>Results</h3><div>A total of six patients were included, and 24 OFCs were assessed. The median age at symptom onset was 44 days (range: 3–99 days). Before the first OFC, the median duration of the elimination diet was 11.2 months (Q1: 8.7 – Q3: 27 months; IQR: 18.3 months); for patients requiring additional OFCs, the median duration was 35.17 months (Q1: 27.27 – Q3: 72.2 months, IQR: 44.93). All patients required admission to the intensive care unit. Two patients were formula-fed, three received mixed feeding, and one received whole cow's milk. Three patients had a family history of atopy, and one had a personal history of atopy. One patient had Down syndrome (DS), one was otherwise healthy, one had a genetic disorder (3p deletion/16q duplication), and three patients had cytomegalovirus infection. All patients developed tolerance to cow's milk protein, with a median time of 33 months (range: 17–103 months).</div></div><div><h3>Conclusions</h3><div>While the overall prognosis of FPIES was favorable, managing cases with severe initial symptoms necessitating ICU admission is complex and frequently involves multiple OFC before achieving tolerance.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102235"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival analysis of syphilis infection in pregnant women of Papuan and non-Papuan ethnicities in Jayapura City and Regency, Papua, Indonesia","authors":"Mona Safitri Fatiah ,&nbsp;Yane Tambing ,&nbsp;Sarni Rante Allo Bela ,&nbsp;Titi Iswanti Afelya ,&nbsp;Genoveva C.C. Mollet ,&nbsp;Wilma Florensia ,&nbsp;Apriyana Irjayanti ,&nbsp;Maxsi Irmanto ,&nbsp;Ilmidin","doi":"10.1016/j.cegh.2025.102278","DOIUrl":"10.1016/j.cegh.2025.102278","url":null,"abstract":"<div><h3>Problem considered</h3><div>In Papua, Indonesia, syphilis in pregnancy persists as a public health concern, yet the role of ethnicity and culture in infection risk is poorly understood.</div></div><div><h3>Methods</h3><div>We conducted a prospective cohort study with an embedded mixed-methods design among 977 pregnant women attending their first Antenatal Care (ANC) visits across 15 health centers in Jayapura City and Regency (July 2025–August 2025).</div></div><div><h3>Results</h3><div>the overall cumulative incidence of syphilis during pregnancy was 11.7 %, differing significantly by ethnicity—13.8 % among Papuan women and 8.7 % among non-Papuan women (log-rank p = 0.03). Papuan women exhibited a higher syphilis risk compared to non-Papuans (AHR = 1.43; 95 % CI: 0.98–2.08), associated with cultural taboos against premarital pregnancy. Additional risk factors included unmarried status (AHR = 1.78; 95 % CI: 1.34–2.36), hepatitis B coinfection (AHR = 2.33; 95 % CI: 1.31–4.16), inconsistent condom use, and uncircumcised partners. Kaplan–Meier curves showed a steep decline in syphilis-free probability during the second and third trimesters. Qualitative insights underscored the influence of stigma, gendered sexual decision-making, and reliance on ANC for diagnosis and treatment.</div></div><div><h3>Conclusion</h3><div>Maternal syphilis in Jayapura is influenced by intertwined biological, behavioral, and socio-cultural factors. Targeted, culturally sensitive interventions, enhanced ANC utilization, integrated STI/Hepatitis services, and promotion of safe sexual practices are essential to reduce incidence and support elimination efforts.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102278"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}