International Journal of Health Geographics最新文献

{"title":"Assessing the accuracy of routing engines in replicating children's walking routes to school: a comparative study of google, mapbox, and OSRM.","authors":"Hyesop Shin, Jonathan R Olsen, Paul Mccrorie, Fiona Caryl, Melody Smith, Rich Mitchell","doi":"10.1186/s12942-026-00473-7","DOIUrl":"10.1186/s12942-026-00473-7","url":null,"abstract":"<p><strong>Background: </strong>Active school travel (AST) can significantly increase children's physical activity. AST research often utilises global positioning system (GPS) devices to objectively track the routes children take to school. However, GPS-based studies are costly and often subject to recruitment bias which limits population representativeness. Routing engines, such as Google Maps, designed to help people navigate might be low-cost alternatives to the use of GPS if the engines were able to accurately model the routes children took in AST. To date, no studies have systematically evaluated whether routing engines can serve as a viable alternative for modelling children's walking routes to school. We assessed whether widely available routing engines can approximate children's walked routes, providing an internationally transferable, low-cost alternative.</p><p><strong>Methods: </strong>We compared three routing engines: Google, Mapbox, and Open Source Routing Machine (OSRM), in replicating the GPS measured walking trajectories of 233 school children (age 10-11) across urban and rural Scotland. The percentage of overlap (overlap accuracy, OA), between routing engine predictions and actual GPS tracks was assessed.</p><p><strong>Results: </strong>Mean OA was 67.6% for OSRM, 66.8% for Mapbox, and 62.6% for Google, indicating that approximately two-thirds of each predicted route overlapped with the GPS-measured track. These values were substantially higher than a shortest-path baseline computed on the Ordnance Survey (OS) road network (45.0%). No significant differences in OA were found by sex, deprivation, or urban/rural setting. However, route distance was negatively associated with OA (r = - 0.16 to - 0.23, p < 0.05). At an individual level, one-third of participants showed consistent results across all engines, whilst 49.4% had one discordant engine and 17.2% had mutually inconsistent engines.</p><p><strong>Conclusions: </strong>Contemporary routing engines reproduce roughly two-thirds of children's walked routes to school, without systematic differences by common sociodemographic or contextual factors. Overall, contemporary routing engines can complement GPS in children's mobility research and practice, offering an empirical reference point for future AST studies.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":48739,"journal":{"name":"International Journal of Health Geographics","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13397760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the role of international flight networks in disease spread: spatial epidemic prevention zones and hierarchical disease control policies.","authors":"Shan-Yin Yang, Wei Chien Benny Chin, Tzai-Hung Wen, Pei-Fen Kuo, Chun-Hsiang Chan","doi":"10.1186/s12942-026-00471-9","DOIUrl":"10.1186/s12942-026-00471-9","url":null,"abstract":"<p><p>This study analyzed the January 2020 international flight network, i.e., during the early global spread of COVID-19, to examine how global air connectivity shaped the timing of first imported cases and to derive policy-relevant spatial risk groupings. Infomap was used to delineate spatial epidemic prevention zones (SEPZs), and network indicators, including PageRank, betweenness centrality, the clustering coefficient, and hyperlink-induced topic search (HITS), were used to characterize the international passenger arrival probability, transfer-related connectivity, connection density, and spatial potential transmission. Passenger arrival probability and connection density were associated with a shorter time to arrival (T2A) of the first imported COVID-19 case, whereas a greater geographical distance was associated with a longer T2A. In contrast, macroscale socioeconomic indicators showed limited explanatory power in the early disease transmission. Building on the SEPZs and spatial transmission potential, we propose a hierarchical disease control framework as a decision-support tool for early-stage cross-border risk assessment and scenario planning.</p>","PeriodicalId":48739,"journal":{"name":"International Journal of Health Geographics","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13397806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping urban Aedes aegypti breeding containers: landscape-driven analysis in Bangkok, Thailand.","authors":"Eric Daudé, Alexandre Cebeillac, Kanchana Nakhapakorn, Richard E Paul","doi":"10.1186/s12942-026-00469-3","DOIUrl":"10.1186/s12942-026-00469-3","url":null,"abstract":"<p><p>Urban dengue risk emerges from spatially heterogeneous interactions between mosquito vectors, the environment, and human activities. In Bangkok, Aedes aegypti breeding containers are predominantly artificial recipies whose distribution is shaped by the morphological structure of urban environments, including built-up density, compactness, interstitial open spaces, and vegetation configuration, as well as by everyday practices such as storage, waste accumulation, gardening, and maintenance. We tested whether a landscape-based typology of Bangkok defines functionally similar mosquito breedings containers by conducting standardized field surveys of outdoor potential breeding containers (PBC) across 36 urban zones (May 2023-December 2024). Among the 4,921 geolocated individual PBCs, small containers (< 1 L) dominated the container pool and accounted for most between-zone variability. PBC density showed a non-linear association with the built-up density and urban compactness gradient, with higher densities at both extremes of this Axis 1. We characterized container spatial aggregation using cluster metrics and classified zones into four aggregation profiles using PAM clustering. A multivariate model combining built intensity and PCA-based descriptors (|Axis 1| and Axis 3) explained a substantial fraction of the variability in PBC cluster coverage, enabling metropolitan-scale mapping of structurally favorable environments. Overall, urban morphology provides a meaningful baseline for identifying functional mosquito breeding containers, but local socio-environmental factors remain critical for explaining breeding-site aggregation.</p>","PeriodicalId":48739,"journal":{"name":"International Journal of Health Geographics","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13397698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of univariate and multivariate spatial scan statistics in detecting geographic clusters of croup cases in Alberta.","authors":"Sara Khademioureh, Brian H Rowe, Rhonda J Rosychuk","doi":"10.1186/s12942-026-00468-4","DOIUrl":"10.1186/s12942-026-00468-4","url":null,"abstract":"<p><strong>Background: </strong>Croup is a common pediatric respiratory illness primarily affecting infants and toddlers. While understanding the geographic distribution and spatial clustering of croup healthcare encounters is crucial for public health planning and resource allocation, this area remains understudied. This study aimed to identify geographic clusters of croup healthcare encounters and areas of higher healthcare demand in Alberta, Canada, and compare univariate and multivariate spatial scan statistics using emergency department (ED) visits and physician claims data.</p><p><strong>Methods: </strong>We analyzed administrative health data for children aged ≤2 years in 70 sub-regional health authorities (sRHAs) in Alberta from 2017/18 to 2022/23. Data were aggregated by sRHA and year. Kulldorff's spatial scan statistics were used to identify croup clusters adjusted for sex distribution for each year separately. Analyses were conducted on each data source separately (univariate) and for both data sources simultaneously (multivariate).</p><p><strong>Results: </strong>During the study period, there were 32,740 ED visits and 49,389 physician claims for croup, with males accounting for 63.5% and 62.2% of the encounters, respectively. Overall, 59.8% of patients with physician claims and 82.8% of ED patients (n=21,688) accessed both healthcare settings during the study period. Significant spatial clustering was consistently identified, with 1-4 clusters annually in univariate, and 2-5 clusters in multivariate analyses. Certain northern areas appeared most consistently in all years and methods. The COVID-19 pandemic year (2020/21) showed unique patterns with the highest relative risks. ED visits data demonstrated wider geographic coverage with consistent major metropolitan area involvement, while physician claims data showed frequent clustering in different metropolitan areas. Multivariate and univariate analyses showed overlapping but distinct findings, with multivariate analysis identifying two clusters where only physician claims data showed significantly higher case numbers than expected.</p><p><strong>Conclusions: </strong>Significant geographic clustering of croup healthcare encounters exists in Alberta, with northern regions most consistently identified as areas of higher healthcare utilization. Both univariate and multivariate spatial scan statistics detected significant clusters, with multivariate analysis providing additional insights by simultaneously analyzing ED visits and physician claims data. The distinct clustering patterns between data sources indicate different healthcare utilization behaviours and demonstrate the value of multivariate approaches for comprehensive spatial epidemiological analysis.</p>","PeriodicalId":48739,"journal":{"name":"International Journal of Health Geographics","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13348534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147876232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spatial equity in the allocation of lifesaving resources: a cross-sectional spatial evaluation of automated external defibrillators in four first-tier Chinese cities.","authors":"Aiping Gou, Lei Wang, Jiangbo Wang, Chunyan Gou, Jing Li","doi":"10.1186/s12942-026-00470-w","DOIUrl":"10.1186/s12942-026-00470-w","url":null,"abstract":"<p><strong>Background: </strong>The timeliness of treatment for out-of-hospital cardiac arrest (OHCA) is critical for patient survival. Automated External Defibrillators (AEDs) are a proven effective intervention, yet China's rapidly developing Public Access Defibrillation (PAD) program may be accompanied by significant spatial inequities in AED distribution.</p><p><strong>Methods: </strong>This study developed a comprehensive multi-dimensional evaluation model to assess the spatial equity of AED allocation in four first-tier Chinese cities: Beijing, Shanghai, Guangzhou, and Shenzhen. The model integrated four dimensions: resource allocation (supply-demand ratio), spatial coverage (service coverage index), opportunity accessibility (accessibility index via an enhanced Gaussian two-step floating catchment area method), and spatial distribution (Gini coefficient). These dimensions were aggregated into a Comprehensive Equity Index (CEI) using the Entropy Weight Method (EWM). Leveraging high-resolution gridded population data and precise AED locations, our analysis captures fine-scale spatial variations often obscured in aggregate statistics. Furthermore, to uncover the spatially heterogeneous drivers of equity, we employed an integrated Principal Component Analysis and Geographically Weighted Regression (PCA-GWR) framework to analyze socioeconomic and urban environmental factors.</p><p><strong>Results: </strong>The results indicate that: (1) Overall comprehensive equity was low across all cities (mean CEI < 0.3). Shenzhen exhibited the highest equity (mean CEI: 0.252), followed by Beijing (0.207), with Shanghai and Guangzhou lagging. (2) A significant \"core-periphery\" disparity was observed in all cities, with core districts showing markedly higher equity than suburban districts, a gap particularly pronounced in Beijing and Shanghai. (3) The PCA-GWR analysis revealed pronounced spatial heterogeneity in the associations between external factors and AED equity. Degree of urbanization showed a generally positive association, which was consistently weaker in urban cores. Public service facility provision exhibited inconsistent (often negative) associations, while the wealth-population density trade-off demonstrated marked city-specific variation.</p><p><strong>Conclusions: </strong>This study provides a systematic, multidimensional assessment of AED allocation equity in major Chinese cities. By employing a spatially nuanced PCA-GWR framework, it reveals that equity is shaped by complex, location-specific interactions of urban development, service provision, and socioeconomic structure. The findings underscore the necessity for spatially differentiated policy interventions within China's PAD program to achieve more equitable and efficient deployment of these lifesaving resources.</p>","PeriodicalId":48739,"journal":{"name":"International Journal of Health Geographics","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13267634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Spatial modeling of the population dynamics of Anopheles mosquitoes in Madagascar.","authors":"Hobiniaina Anthonio Rakotoarison, Thiery Nirina Nepomichene, Hélène Guis, Romain Girod, Solofoarisoa Rakotoniaina, Fanjasoa Rakotomanana, Annelise Tran","doi":"10.1186/s12942-025-00443-5","DOIUrl":"10.1186/s12942-025-00443-5","url":null,"abstract":"","PeriodicalId":48739,"journal":{"name":"International Journal of Health Geographics","volume":"25 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13130576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastric cancer susceptibility mapping using GIS and machine learning in East Azerbaijan province, Iran.","authors":"Tayebeh Ahmadi, Ayub Mohammadi, Zeinab Mohammadzadeh, Elham Maserat, Shahnaz Naghashi","doi":"10.1186/s12942-026-00459-5","DOIUrl":"10.1186/s12942-026-00459-5","url":null,"abstract":"<p><p>Despite technological advancements, Gastric Cancer (GC) remains one of the most lethal malignancies worldwide. This study aimed to map spatial risk susceptibility for GC in East Azerbaijan province, located in northwest Iran, which ranks second nationally in GC incidence. In the first step, the residential addresses of 2,884 patients diagnosed with GC between 2015 and 2019 were geocoded using Google Earth, converting them into geographic coordinates for spatial analysis. The dataset was subsequently divided into two subsets: 80% of the cases were allocated for model training and 20% for validation. A set of environmental variables including elevation, rainfall, iron, volcanoes, copper, coal, Pb-Zn, arsenic, and mercury along with two models of Logistic Regression (LR) and Logistic Model Tree (LMT) was used to map areas susceptible to GC. The performance of the models was evaluated using Area Under the Curve (AUC) and Root Mean Square Error (RMSE) methods. The findings revealed that central regions of the study area are the hotspots for occurrence of the disease. Both LR and LMT models pinpointed nine counties as high-risk and susceptible areas for GC, while five counties were categorized as low-risk areas. In addition, evaluation of RMSE and AUC metrics showed that the LR model outperformed the LMT model across the study area. More results revealed that spatial clustering of GC cases in areas with higher rainfall and closer proximity to heavy metal deposits, supporting the hypothesis that environmental exposure contributes to disease risk. This study is useful for environmental health researchers, and regional public‑health authorities to locate high‑risk areas, prioritize screening, and allocate diagnostic and treatment resources efficiently.</p>","PeriodicalId":48739,"journal":{"name":"International Journal of Health Geographics","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13480028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spatial eco-climatic gradients drive adaptive 2La chromosomal inversion polymorphism in Anopheles coluzzii, a major malaria vector in Nigeria.","authors":"Adedapo O Adeogun, Oluwakemi Adetunji, Ayodele S Babalola, Romoke T Izekor, Tolulope A Oyeniyi, Oluwaseun Adesoye, Jasini Wahedi, Lateef O Busari, George Aniekeme, Seun Ajayi, Joseph Chabi, Samson T Awolola","doi":"10.1186/s12942-026-00465-7","DOIUrl":"10.1186/s12942-026-00465-7","url":null,"abstract":"<p><strong>Background: </strong>Chromosomal inversions are important genetic mechanisms that facilitate local adaptation, ecological flexibility, and behavioural variation in mosquito populations. In Anopheles coluzzii, a dominant malaria vector in West Africa, the 2La inversion has been associated with desiccation tolerance, thermal resistance, and insecticide resistance. Despite Nigeria's ecological diversity and substantial malaria burden, the spatial distribution and clinal dynamics of 2La inversion polymorphism in An. coluzzii remain poorly characterized. This study investigated the distribution of 2La inversion karyotypes across major Nigerian ecozones and examined their association with climatic gradients.</p><p><strong>Methods: </strong>Larvae of Anopheles mosquitoes were sampled across 12 states representing Nigeria's southern, central, and northern ecological zones. Species identification was conducted morphologically and confirmed with PCR diagnostics. The 2La inversion was determined using established molecular assays, and allele frequencies were analyzed with respect to ecozone and climatic gradients. Spatial distribution maps and statistical analyses, including correlation and clinal trend assessment, were done in R version 4.4.</p><p><strong>Results: </strong>A clear geographic structuring of 2La inversion polymorphism was observed in An. coluzzii populations. The 2La/2La homokaryotype was strongly predominant in the northern Sahelian and Sudan savanna ecozones, reflecting adaptation to hot and arid conditions. In contrast, the standard 2La+/2La+ arrangement was predominant in humid southern forest and mangrove regions. The heterokaryotype (2La/2La+) occurred at intermediate frequencies within the central transitional belt, where ecological gradients overlap. Karyotype frequencies exhibited a pronounced latitudinal cline, with heterozygosity peaking in central Nigeria. The spatial patterns indicate that climatic pressures, particularly aridity and humidity, might be a major determinant of inversion distribution in An. coluzzii from Nigeria.</p><p><strong>Conclusion: </strong>This study provides the first detailed nationwide characterization of 2La inversion polymorphism in An. coluzzii across Nigeria's ecological zones. The strong alignment between inversion frequency and eco-climatic gradients highlights the role of chromosomal rearrangements in promoting vector survival and ecological fitness. These adaptive patterns have significant implications for malaria control, as inversion-mediated adaptability may influence resting behaviour, insecticide response, and vector persistence under climate change. Integrating chromosomal inversion surveillance into entomological monitoring frameworks will be essential for designing ecologically tailored vector control strategies in Nigeria.</p>","PeriodicalId":48739,"journal":{"name":"International Journal of Health Geographics","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13220388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147628960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using genomic epidemiology and geographic activity spaces to investigate tuberculosis outbreaks in Botswana.","authors":"Chelsea R Baker, Ivan Barilar, Leonardo S de Araujo, Daniel M Parker, Kimberly Fornace, Patrick K Moonan, John E Oeltmann, James L Tobias, Volodymyr M Minin, Chawangwa Modongo, Nicola M Zetola, Stefan Niemann, Sanghyuk S Shin","doi":"10.1186/s12942-026-00467-5","DOIUrl":"10.1186/s12942-026-00467-5","url":null,"abstract":"<p><p>OBJECTIVES: Our objective was to identify potential ‘hotspots’ of tuberculosis (TB) transmission by integrating pathogen genomic and geospatial data, including activity spaces where transmission may occur (e.g. community locations such as work, school, or social venues) in addition to residential locations. METHODS: We analyzed geographic data collected during 2012–2016 for the Kopanyo Study, a population-based study of TB transmission in Botswana. We included participants with results from whole genome sequencing conducted on archived samples from the original study. We used a spatial log-Gaussian Cox process model to detect core areas of activity spaces belonging to individuals in TB outbreaks (genotypic groups with ≤ 5 single-nucleotide polymorphisms), which we compared to ungrouped participants (those not in a genotypic group of any size). RESULTS: We analyzed data for 636 participants, including 70 participants belonging to six outbreak groups with a combined total of 293 locations, and 566 ungrouped participants with a combined total of 2289 locations. Core areas (‘hotspots’) for each outbreak group were geographically distinct, and we found evidence of localized transmission in four of six outbreaks. Hotspots had different geographic characteristics when analyzing activity spaces compared to residential locations alone. CONCLUSIONS: The incorporation of activity spaces in geospatial modeling of genomic data may improve the characterization of potential transmission hotspots. </p>","PeriodicalId":48739,"journal":{"name":"International Journal of Health Geographics","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13173891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147617074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geospatial and multilevel analysis of lifetime HIV testing uptake among high-risk adults in Mozambique: evidence from the 2022-2023 DHS.","authors":"Thomas Kidanemariam Yewodiaw, Helen Lamesgin Endalew, Mihret Getnet, Amare Belete Getahun, Tiget Ayelgn Mengstie, Engidaw Fentahun Enyew, Mequanent Dessie Bitewa, Hiwot Tezera Endale, Tseganesh Asefa","doi":"10.1186/s12942-026-00462-w","DOIUrl":"10.1186/s12942-026-00462-w","url":null,"abstract":"<p><strong>Background: </strong>HIV testing is a critical entry point for prevention and treatment, yet disparities in uptake persist among high-risk populations in Mozambique. This study investigates the prevalence, spatial distribution, and determinants of lifetime HIV testing among high-risk adults aged 15-49 using 2022-2023 DHS data.</p><p><strong>Methods: </strong>A cross-sectional analysis of 15,393 high-risk adults was conducted. Descriptive statistics, spatial analyses (Moran's I, hotspot analysis, Kriging interpolation, SaTScan), and multilevel logistic regression models were applied to identify individual- and community-level factors associated with HIV testing uptake. We estimated the weighted prevalence of lifetime HIV testing uptake. Adjusted odds ratios (AORs) with 95% confidence intervals were reported to measure the association between explanatory variables and HIV testing uptake, while statistical significance was determined using p-values < 0.05.</p><p><strong>Results: </strong>Overall, 63.7% of high-risk adults had ever tested for HIV. Testing uptake was higher among females (66%) than males (57%), and among urban (76%) versus rural residents (56%). The highest testing rate was in the 25-34 age group (78%) and lowest among adolescents 15-19 years (31%). Wealth, education, marital status, employment, media exposure, and HIV knowledge positively influenced testing. Significant regional disparities were observed, with southern provinces (Maputo City 87.7%) showing higher uptake than northern and central provinces (Zambezia 44.9%). Spatial analysis confirmed strong clustering (Moran's I = 0.78, p < 0.001), identifying low-testing hotspots in northern and central rural areas. Multilevel modeling showed individual and community factors explained 62.9% of between-cluster variance, with females (AOR = 2.39), higher education (AOR = 6.44), marriage (AOR = 4), and urban residence (AOR = 1.58) significantly increasing odds of testing.</p><p><strong>Conclusion: </strong>HIV testing uptake in Mozambique remains uneven across socio-demographic and geographic groups. Targeted and equity-focused interventions are needed to expand testing among adolescents, men, rural populations, and residents of northern and central provinces. Strengthening community-based testing services, improving health education, and addressing geographic barriers will be essential for accelerating progress toward national HIV control targets.</p>","PeriodicalId":48739,"journal":{"name":"International Journal of Health Geographics","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147522401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}