Clinical Epidemiology and Global Health最新文献

{"title":"Time-to-event analysis of factors influencing mortality among pediatric patients receiving drug-susceptible tuberculosis treatment","authors":"Shalini Kumari,&nbsp;Subhajit Das,&nbsp;Alok Kumar,&nbsp;Jai Krishna Mishra,&nbsp;Brajesh Kumar Rai,&nbsp;Mukesh Kumar","doi":"10.1016/j.cegh.2026.102458","DOIUrl":"10.1016/j.cegh.2026.102458","url":null,"abstract":"<div><h3>Background:</h3><div>Tuberculosis (TB) remains a global public health challenge affecting all age groups. Children and adolescents are most vulnerable group that contribute to the overall TB burden. This study examined the epidemiological characteristics and factors associated with mortality among pediatric patients received Drug Suceptible (DS) TB treatment.</div></div><div><h3>Methods:</h3><div>This retrospective study analyzed data from 2300 pediatric TB patients registered for treatment in the Nikshay portal at the Department of TB and Respiratory Diseases, Sir Sunder Lal Hospital, Banaras Hindu University, Varanasi, India, between January 2017 and December 2023. Survival patterns were evaluated using the Kaplan–Meier estimates, Cox regression, and accelerated failure time (AFT) models with Weibull, log–logistic, and log-normal distributions. Model performance was assessed using Cox–Snell residual plots, log-likelihood, AIC, and BIC values.</div></div><div><h3>Results:</h3><div>Out of the 2300 pediatric TB patients included, 92 (4.0%) died during treatment. The log-normal AFT model provided the best fit and showed that Age (<span><math><mrow><mi>β</mi><mo>=</mo><mn>0.228</mn></mrow></math></span>, <span><math><mrow><mi>p</mi><mo>&lt;</mo><mn>0.001</mn></mrow></math></span>) and Site of disease (pulmonary TB) (<span><math><mrow><mi>β</mi><mo>=</mo><mn>1.375</mn></mrow></math></span>, <span><math><mrow><mi>p</mi><mo>&lt;</mo><mn>0.001</mn></mrow></math></span>) were associated with longer survival time. Whereas, microbiologically confirmed TB patients (<span><math><mrow><mi>β</mi><mo>=</mo><mo>−</mo><mn>2.255</mn></mrow></math></span>, <span><math><mrow><mi>p</mi><mo>&lt;</mo><mn>0.001</mn></mrow></math></span>) were associated with accelerated time to death. Kaplan–Meier analysis also showed higher mortality in children aged 1–6 years, patients with microbiologically confirmed TB, those with extrapulmonary disease, and patients whose follow-up was not done.</div></div><div><h3>Conclusions:</h3><div>Pediatric patients with these predictors represent high-risk groups requiring closer monitoring and targeted clinical management. Early identification and timely treatment of severe TB cases may improve survival outcomes and support progress toward TB elimination goals.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"41 ","pages":"Article 102458"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148935289","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":"Indoor air quality and work-related symptoms among healthcare workers in a Malaysian specialist hospital: A mixed-methods cross-sectional study","authors":"Purnima devi Suppiah,&nbsp;Stephenie Ann Albart,&nbsp;Nor Aslina Abd Jalil","doi":"10.1016/j.cegh.2026.102465","DOIUrl":"10.1016/j.cegh.2026.102465","url":null,"abstract":"<div><h3>Background/Objectives</h3><div>Indoor air quality (IAQ) in healthcare settings significantly influences the health, comfort, and productivity of healthcare workers (HCWs). Malaysia's tropical climate poses significant occupational health risks in hospital environments where inadequate ventilation, high humidity and pollutant accumulation intensify exposure hazards for healthcare workers. This study aimed to assess IAQ-related conditions across different hospital work areas (open and enclosed) and to describe environmental discomfort and self-reported health-related symptoms among healthcare workers in a major specialist hospital in northern Malaysia.</div></div><div><h3>Methods</h3><div>A mixed-methods design was employed, comprising a systematic walkthrough inspection guided by the Industry Code of Practice on Indoor Air Quality (ICOP-IAQ, 2010) and a cross-sectional survey using a validated Questionnaire for Building Occupants. Data from 265 HCWs were analysed using descriptive and inferential statistics (Chi-square test) to explore differences in environmental discomfort and reported symptoms across workstation types.</div></div><div><h3>Results</h3><div>Walkthrough inspection revealed visible fungal growth, dust accumulation, and poor ventilation across several clinical, support and administrative areas. The most commonly reported environmental discomforts were temperature variability (78.1%), dust (71.7%), and low temperature (68.3%), while the most frequently reported symptoms were fatigue (78.1%), headache (73.6%), and cough (69.1%). Open-concept workstations were significantly associated with high temperature, stuffy air, dry air, and unpleasant odours. <strong>Conclusions</strong>: The findings indicate notable IAQ-related concerns across hospital work areas, accompanied by widespread environmental discomfort and a high prevalence of self-reported SBS-like symptoms among healthcare workers.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"41 ","pages":"Article 102465"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148952016","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":"Evaluating chemotherapy-related cognitive impairment and its association with quality of life among cancer patients","authors":"Sneha Satheesh,&nbsp;Kadhieja Fasiha,&nbsp;Keerthan Ravi Chathukutty,&nbsp;Chaitrashree Gururaj,&nbsp;Vijith Shetty,&nbsp;Shraddha Shetty","doi":"10.1016/j.cegh.2026.102462","DOIUrl":"10.1016/j.cegh.2026.102462","url":null,"abstract":"<div><h3>Problem considered</h3><div>Cancer-related cognitive impairment or CRCI is an adverse effect of chemotherapy that reduces executive function, processing speed and memory of cancer patients. Various factors that are associated with CRCI in turn leads to a significant reduction in the quality of life of cancer patients. This study aims to identify the proportion of cancer patients having CRCI and reduced QoL, and assess the respective factors related to the decline of the same.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted in a period of 6 months among 138 cancer patients undergoing chemotherapy. Necessary data pertaining to sociodemographic and clinical aspects were collected, and questionnaires Functional Assessment of Cancer Therapy – Cognitive Function and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 were administered to assess the cognitive function and QoL, respectively. The data was entered and analysed using SPSS Software version 29. Pearson correlation and Linear regression were used to evaluate the data.</div></div><div><h3>Results</h3><div>A weak positive correlation (Pearson's r = 0.236, p = 0.005) was observed between cognitive function anf quality of life. On univariate analysis, age, comorbidities, alcohol and tobacco use, pre-medications and chemotherapy agents were associated with cognitive function and QoL. After adjustment for covariates, age, comorbidities, and tobacco/areca nut use remained significantly associated with cognitive impairment, whereas none of the assessed factors remained significantly associated with QoL.</div></div><div><h3>Conclusion</h3><div>Age, comorbidities, and tobacco/areca nut use were independently associated with cognitive impairment among patients receiving chemotherapy, and cognitive function was positively correlated with quality of life; no factors showed an independent association with QoL after adjustment. These findings support individualized screening and management strategies for chemotherapy-related cognitive impairment (CRCI).</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"41 ","pages":"Article 102462"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148935288","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":"Diagnostic performance of red cell parameters and discrimination indices for beta thalassemia trait identification, with a focus on the borderline HbA2 range: a population-based study from Delhi-NCR, India","authors":"Oishi Choudhury,&nbsp;Naorem Kiranmala Devi,&nbsp;Ravi Ranjan,&nbsp;Roumi Deb,&nbsp;Jatinder Singh Arora,&nbsp;Benrithung Murry,&nbsp;Ram Prasad Mitra,&nbsp;Kallur Nava Saraswathy","doi":"10.1016/j.cegh.2026.102461","DOIUrl":"10.1016/j.cegh.2026.102461","url":null,"abstract":"<div><h3>Background</h3><div>Beta thalassemia trait (BTT) screening is challenged by a diverse mutation spectrum and by individuals with borderline HbA2 values who may carry pathogenic variants despite near-normal screening results. This study aimed to characterise the genotypic spectrum of BTT carriers in a heterogeneous Indian population, compare hematological parameters across β⁰, β⁺, and rare HBB variant groups, and assess the diagnostic performance of red cell parameters and discrimination indices for carrier identification, with particular focus on the borderline HbA2 range.</div></div><div><h3>Methods</h3><div>Within a population-based cohort of 4886 young adults (Delhi NCR), 209 individuals (115 with HbA2 4–9%; 94 with borderline HbA2 3.2–3.9%) underwent molecular analysis by ARMS-PCR and Sanger sequencing.</div></div><div><h3>Results</h3><div>The β⁰ mutations (31.7%) showed the most pronounced thalassemic profile, and MCV, MCH, and HbA2 differed significantly across β⁰, β⁺, and rare HBB variant groups (p ≤ 0.002). In the full cohort, MCV was the strongest single discriminator (AUC 0.88), followed by HbA2 (0.86) and MCH (0.84); the Shine and Lal index performed best among the indices (AUC 0.88). Within the borderline subgroup, MCH and MCV retained the greatest discriminatory value (AUC 0.84 and 0.83), with high specificity (92.2% and 87.8%) at cut-offs of 20.8 pg and 73.9 fL, respectively.</div></div><div><h3>Conclusion</h3><div>MCV, MCH, and HbA2 are potentially the most informative first-tier measures for flagging BTT carriers, though molecular confirmation remains essential. In the borderline HbA2 range, MCH and MCV best prioritise individuals for molecular confirmation. Future studies should evaluate better screening criteria for this under-studied group to reliably identify carriers.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"41 ","pages":"Article 102461"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148951931","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":"Predicting contraceptive need and identifying associated patterns among postpartum women in Sub-Saharan Africa: A machine learning and association rule mining study","authors":"Eliyas Addisu Taye,&nbsp;Abel Temeche Kassaw,&nbsp;Dawit Yibabie Tegegne,&nbsp;Gabrela Yimer Hailie,&nbsp;Birhan Wassie Tessfay,&nbsp;Eden Yitbarek Woubet","doi":"10.1016/j.cegh.2026.102464","DOIUrl":"10.1016/j.cegh.2026.102464","url":null,"abstract":"<div><h3>Background</h3><div>Unmet need for postpartum contraceptive (PPC) remains a major public health challenge in Sub-Saharan Africa (SSA). Traditional regression models often fail to capture complex, non-linear interactions among predictors. This study developed an explainable machine learning framework combined with association rule mining to predict postpartum unmet need and extract policy-relevant multi-factor risk profiles.</div></div><div><h3>Methods</h3><div>We analyzed pooled Demographic and Health Survey (DHS) data from 66,454 postpartum women across 27 SSA countries (2016–2024). Logistic Regression, Random Forest, and XGBoost models were optimized using stratified five-fold cross-validation. SMOTE was applied strictly to training data to resolve class imbalance. Model performance was evaluated on an independent 20% test set using accuracy, precision, recall, F1-score, and AUC-ROC. SHapley Additive exPlanations (SHAP) prioritized key features for Apriori-based association rule mining (thresholds: Support <span><math><mrow><mo>≥</mo><mn>15</mn><mo>%</mo></mrow></math></span>, Confidence <span><math><mrow><mo>≥</mo><mn>45</mn><mo>%</mo></mrow></math></span>, Lift <span><math><mrow><mo>&gt;</mo><mn>1.0</mn></mrow></math></span>).</div></div><div><h3>Results</h3><div>In SSA, the overall prevalence of unmet need for PPC was 24.0%. Random Forest achieved the highest predictive performance (AUC-ROC: 0.84, 95% CI: 0.83–0.85; Accuracy: 86.0%; Recall: 85.0%; F1-score: 83.0%). SHAP analysis identified marital status (married), higher parity, maternal age (15-19), higher education attainment, and healthcare-access barriers as key predictors of unmet need. Association rule mining revealed multi-variable risk patterns; notably, being married combined with financial barriers to healthcare yielded a support of 18.02%, confidence of 48.34%, and a lift of 1.37 (a 37% increased risk above baseline).</div></div><div><h3>Conclusions</h3><div>Postpartum unmet need is associated with intersecting structural, economic, and systemic access barriers. Combining machine learning, SHAP, and association rule mining provides robust predictive power alongside interpretable, actionable insights to guide targeted reproductive health policy in low-resource settings.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"41 ","pages":"Article 102464"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148951932","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":"Seasonal variation in early preterm birth across Robson groups: A five-year cohort study","authors":"Merve Kırlangıç,&nbsp;Mehmet Mete Kırlangıç,&nbsp;Bahadır Alper Sargın,&nbsp;Lokman Tekin Ertekin","doi":"10.1016/j.cegh.2026.102472","DOIUrl":"10.1016/j.cegh.2026.102472","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the association between seasonal patterns in births according to the Robson classification and early preterm birth rates.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, 13,889 births at a tertiary referral hospital between September 2019 and September 2024 were analyzed. Robson groups were assigned based on obstetric characteristics. Early preterm birth (&lt;32 weeks) was identified using recorded gestational age. Seasonal distribution was defined by date of birth. Associations were assessed using chi-square tests and multivariable logistic regression adjusted for Robson group, season, and maternal age.</div></div><div><h3>Results</h3><div>Among 13,889 births, 1472 (10.6%) were preterm (&lt;37 weeks), including 120 early preterm births (&lt;32 weeks; 0.86% of all births). Early preterm birth risk differed significantly across Robson groups (p &lt; 0.001). In multivariable analysis, Robson Group 8 (OR 10.36, 95% CI 4.33–24.78), Group 9 (OR 11.60, 95% CI 3.32–40.51), and Group 10 (OR 5.51, 95% CI 2.52–12.04) were independently associated with increased early preterm birth risk compared with Group 1. Although descriptive seasonal differences were observed, season was not an independent predictor after adjustment.</div></div><div><h3>Conclusion</h3><div>Early preterm birth risk varies substantially across specific Robson groups. While seasonal differences were observed descriptively, seasonality did not independently predict early preterm birth. These findings support interpreting season as a contextual modifier rather than a direct causal determinant and underscore the need for multicenter studies incorporating trimester-specific exposure assessment.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"41 ","pages":"Article 102472"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148935280","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":"Is the cerebroplacental ratio predictive of adverse neonatal outcomes in fetal growth restriction?","authors":"Fatemeh Mirzaei,&nbsp;Saeedeh Pourrostami,&nbsp;Sara Najibi,&nbsp;Leila Allahqoli,&nbsp;Hamid Salehiniya,&nbsp;Ghazal Mansouri,&nbsp;Ibrahim Alkatout","doi":"10.1016/j.cegh.2026.102459","DOIUrl":"10.1016/j.cegh.2026.102459","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to evaluate the prognostic accuracy of the cerebroplacental ratio (CPR) for predicting adverse neonatal outcomes in pregnancies complicated by fetal growth restriction (FGR).</div></div><div><h3>Methods</h3><div>A prospective cohort study was conducted in …., from March 2021 to March 2023, including 114 women with estimated fetal weight &lt;10th percentile between 28 and 38 weeks of gestation. The primary objective was to assess the prognostic accuracy of CPR for adverse neonatal outcomes. The secondary objective was to identify clinical and neonatal predictors of adverse outcomes. CPR was calculated as the ratio of the middle cerebral artery pulsatility index to the umbilical artery pulsatility index, with abnormal values defined as ≤1.1. Participants were categorized into normal and abnormal CPR groups. Adverse neonatal outcomes included umbilical artery pH &lt; 7.1, 5-min Apgar score &lt;7, neonatal hypoglycemia (&lt;45 mg/dL), and NICU admission &gt;10 days. ROC curve analysis assessed prognostic accuracy, while logistic regression identified significant predictors. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CPR were calculated.</div></div><div><h3>Results</h3><div>A total of 98 patients were included in the analysis (49 per group). Neonates in the normal CPR group had significantly higher mean birth weight compared to the abnormal CPR group (2372.5 ± 649 g vs. 1802.5 ± 579 g, p &lt; 0.001). ROC analysis indicated an area under the curve (AUC) of 0.71 (95% CI: 0.56–0.75, p = 0.011) for CPR in predicting adverse neonatal outcomes. Using a cutoff value of 1.087, CPR demonstrated 78% sensitivity, 73% specificity, 77% positive predictive value, and 68% negative predictive value. Logistic regression showed that higher birth weight was protective against adverse outcomes, with each 100-g decrease associated with a 2% higher odds of an adverse neonatal event (adjusted OR 1.02; 95% CI 1.01–1.03; p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>CPR is a valuable, non-invasive tool for predicting adverse neonatal outcomes in FGR pregnancies. Lower CPR values were associated with poorer neonatal condition and increased NICU admissions. These findings support the use of CPR for risk assessment and clinical decision-making in high-risk pregnancies.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"41 ","pages":"Article 102459"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148935281","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":"Corrigendum to “Effectiveness and challenges of FAST implementation for tuberculosis case detection in Indonesian private hospital: A mixed-method study” [Clin Epidemiol Glob Health 36 (2025) 102198]","authors":"Merita Arini,&nbsp;Darsino Darsino,&nbsp;Ekorini Listiowati,&nbsp;Dono Widiatmoko","doi":"10.1016/j.cegh.2026.102455","DOIUrl":"10.1016/j.cegh.2026.102455","url":null,"abstract":"","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"41 ","pages":"Article 102455"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149050802","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":"Cross-region generalizability of early childhood development prediction models across South Asia: Evidence from harmonized MICS surveys","authors":"Md Monir Hossain,&nbsp;Ishrat Jahan,&nbsp;Amrin Binte Ahmed,&nbsp;Morsheda Akter Sanu,&nbsp;Rumana Rois","doi":"10.1016/j.cegh.2026.102407","DOIUrl":"10.1016/j.cegh.2026.102407","url":null,"abstract":"<div><h3>Background</h3><div>Early childhood development (ECD) is crucial for lifelong health and productivity, yet many children in low- and middle-income countries face developmental risks. It remains unclear how well ECD prediction models perform across diverse populations.</div></div><div><h3>Methods</h3><div>Using harmonized MICS-6 data from 42,291 children aged 36–59 months across Bangladesh, Nepal, Sindh, Balochistan, and Khyber Pakhtunkhwa, we assessed ECD status using the Early Childhood Development Index (ECDI). Ten machine learning algorithms were compared using Monte Carlo cross-validation, hyperparameter tuning, and SHAP-based interpretation. Cross-region predictive generalizability was evaluated through internal, cross-region external, and leave-one-region-out (LORO) validation.</div></div><div><h3>Results</h3><div>The proportion of children developmentally on track ranged from 21.0% (Bangladesh) to 36.3% (Nepal). Literacy–numeracy (66.7–89.5%) and socio-emotional development (58.6–88.7%) were relatively high, but the learning domain remained consistently low (5.4–16.1%). Internal validation yielded moderate performance (AUC: 0.568–0.770), with gradient boosting models performing best. Tuned models achieved AUCs from 0.643 (Bangladesh) to 0.771 (Balochistan). External validation showed reduced and variable performance (AUC: 0.610–0.758), with no model generalizing consistently across regions. Home stimulation and access to learning materials emerged as the strongest predictors across all settings.</div></div><div><h3>Conclusion</h3><div>ECD prediction models perform reasonably well within similar populations but show limited cross-context generalizability. The consistent importance of home learning environments highlights low-cost opportunities for intervention, while performance variability underscores the need for locally adapted predictive approaches in resource-constrained settings.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"40 ","pages":"Article 102407"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148523380","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":"Risk factors for congenital heart disease among Jordanian children: A case-control study","authors":"Hamzeh Al-Momani,&nbsp;Abdulrahman S. Abdelfattah,&nbsp;Aiman Al Sharei,&nbsp;Saiel Saleh,&nbsp;Sara N. Suwan,&nbsp;Bashar M. Al Zoubi,&nbsp;Hazim K. Abu Safiyah,&nbsp;Khadeeja Al Nadi,&nbsp;Reem Hamad,&nbsp;Mohamadrasoul Alrashaideh,&nbsp;Hazim Alkousheh","doi":"10.1016/j.cegh.2026.102412","DOIUrl":"10.1016/j.cegh.2026.102412","url":null,"abstract":"<div><h3>Problem considered</h3><div>Congenital heart disease (CHD) is the most common congenital birth defect worldwide. Evidence on maternal and perinatal risk factors in Jordan remains limited. This study aimed to identify factors associated with CHD among Jordanian children.</div></div><div><h3>Methods</h3><div>An unmatched case–control study was conducted in two tertiary hospitals between January 2022 and July 2023. Children with echocardiography-confirmed CHD (n = 219) were compared with controls without CHD (n = 178). Data were collected through structured face-to-face parental interviews covering maternal, obstetric, lifestyle, and child-related factors. Logistic regression analysis was used to assess associations.</div></div><div><h3>Results</h3><div>Family history of CHD (OR = 1.84, <em>P</em> = 0.028), antenatal maternal disease (OR = 1.90, <em>P</em> = 0.024) were significantly associated with CHD. Lower birth weight was more common among children with CHD (OR = 0.59, P = 0.01). Higher maternal education and multivitamin use were more common among controls. The most common lesions were atrial septal defect (38.8%) and ventricular septal defect (20.1%). Heart murmur was the most common presenting sign (55.3%). No significant associations were observed for some lifestyle-related exposures assessed in the study.</div></div><div><h3>Conclusion</h3><div>This is the first echocardiography-based study to evaluate factors associated with CHD among Jordanian children, and highlighted the importance of preconception counselling, smoking cessation, and improved antenatal screening. Family history of CHD, antenatal maternal disease, and lower birth weight showed significant associations with CHD. Larger multicentre prospective studies are needed to confirm these findings and better understand potentially modifiable risk factors.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"40 ","pages":"Article 102412"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148523378","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}