PLOS global public health最新文献

{"title":"Evolution of the nutritional status and factors associated with undernutrition in children under five of age between 2014 and 2017 in 24 health districts of Burkina Faso.","authors":"T Bernadette Picbougoum, M A Serge Somda, Isidore T Traoré, Julia Lohmann, Manuela De Allegri, Hervé Hien, Nicolas Méda, Annie Robert","doi":"10.1371/journal.pgph.0004645","DOIUrl":"https://doi.org/10.1371/journal.pgph.0004645","url":null,"abstract":"<p><p>The prevalences of undernutrition in children under five years of age appeared to decrease over the last decade in Burkina Faso. However, the country is now facing new health and security challenges that could threaten this progress. Therefore, it is essential to monitor the evolution of the situation within this specific context. We aimed to assess trends in undernutrition among children under 5 years of age, as well as the factors associated with it, between 2014 and 2017 in Burkina Faso. A study based on secondary analysis of the data from 2013 and 2017 surveys, conducted in 24 districts across six health regions, was carried out. We worked with the household databases to select two sub-samples: 9,259 children from 2014 and 12,119 children from 2017. We assessed anthropometric indicators using World Health Organization standards, analyzed their proportions between 2017 and 2014, and according to the health regions and children's age groups. We examined the association of stunting and underweight with children, mothers, and households' characteristics in 2017 and for two selected health regions, using logistic regression. From 2014 to 2017, the proportion of severe stunting and severe underweight decreased respectively from 24.8% to 7.9% (p < 0.001) and from 19.6% to 8.8% (p < 0.001) certainly due to nutrition and health initiatives. As in 2014, stunting was associated with sex, living in poorest household with AdjOR = 1.31 (95%CI: 1.14 -1.50), or in household having three and more children under five years with AdjOR = 1.28 (95%CI: 1.12 -1.47). This study demonstrated a period of significant progress in undernutrition in children. But it identified the persistence of associated factors contributing to the high prevalence of undernutrition in Burkina Faso, where insecurity has become a prevailing issue. Further studies are needed to assess the sustainability of encouraging progress in children's nutritional status.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0004645"},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236178","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":"Length of hospital stay and its associated factors among women who gave birth by cesarean section in general hospitals of Sidama region, Ethiopia.","authors":"Amelo Bolka, Zerihun Weldekidan","doi":"10.1371/journal.pgph.0004582","DOIUrl":"https://doi.org/10.1371/journal.pgph.0004582","url":null,"abstract":"<p><p>Despite rising cesarean section (CS) rates in Ethiopia, evidence on determinants of postoperative length of hospital stay (LoS) remains scarce, particularly for rural general hospitals handling most deliveries. This study was aimed at assessing the length of hospital stay and its associated factors among women who undergo cesarean section in general hospitals of the Sidama region. An institution-based cross-sectional study was conducted among 505 post-CS mothers from 1 January to 20 February 2024. A multistage sampling method was followed to select the study respondents. Data was collected using a structured and pretested, interviewer-administered questionnaire. Data was collected using the Kobo Toolbox system and exported to Stata version 14.0 for management and analysis. Factors associated with the length of hospital stay were determined using a Poisson regression model. The factors associated with the outcome variable were identified using the adjusted risk ratio (ARR). Statistical significance was set at a p-value of less than 0.05. The median LoS post-CS was 4 days (interquartile range: 3-4). Significant predictors of prolonged LoS included maternal age (ARR = 1.014, 95% CI: 1.004-1.024), neonatal intensive care unit (NICU) admission (ARR = 1.31, 95% CI: 1.16-1.46), surgical site infection (ARR = 2.39, 95% CI: 1.88-3.04), and low postoperative hemoglobin (ARR = 0.94, 95% CI: 0.92-0.97). The median hospital stay after cesarean delivery in general hospitals of Sidama region was 4 days. Prolonged stays were associated with maternal age, NICU admission, surgical site infection, and low post-op hemoglobin. Targeting high-risk mothers with enhanced monitoring and wound care-alongside NICU-maternity service integration and safety-conscious discharge protocols-is recommended to accelerate recovery.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0004582"},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236179","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":"Magnitude of ectopic pregnancy, management methods, and its associated factors among pregnant women attending Ambo University Referral Hospital in Oromia Regional State, Ethiopia: A seven years retrospective institutional based cross-sectional study.","authors":"Nigussie Tesfaye Gizaw, Mekbeb Afework K/Mariam, Motuma Gutu Fayera","doi":"10.1371/journal.pgph.0004611","DOIUrl":"https://doi.org/10.1371/journal.pgph.0004611","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Ectopic pregnancy is the implantation of a blastocyst outside of the endometrial lining of the uterus. Ectopic pregnancy can take several forms, including ovarian, abdominal, and tubal. The most prevalent place for ectopic pregnancy is the fallopian tube, which accounts for over 97.7% of all ectopic gestations. The ampulla accounts for around 80% of tubal pregnancy, followed by the isthmus (12%), fimbria (5%). Ectopic pregnancy is diagnosed with the classic triad of amenorrhea, abdominal pain, vaginal bleeding, and a positive pregnancy test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to assess the magnitude of ectopic pregnancy, its management outcome, and associated factors among pregnant women attending Ambo University Referral Hospital in the Oromia Region, Ethiopia, in 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A seven-year retrospective cross-sectional study, from February 2018 to April 2024, was conducted at the Ambo University Referral Hospital, which is located in Ambo town, Ethiopia. Data concerning all pregnant mothers who were admitted and managed for ectopic pregnancy were extracted from the medical records of patients and the operation book by a trained data collector through Kobo Toolbox electronic data collection software. The collected data was checked first for its completeness, and it was exported into SPSS version 26 software for data analysis. Then Descriptive statistics were employed for summarizing the data, and bivariate and multivariate logistic regression analyses were used to identify the independent effect of the predictor variable on the outcome variable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;From February 2018 to April 2024, there were 17,687 total pregnancies, 6,249 gynecologic admissions, and 182 cases of ectopic pregnancies at Ambo University Referral Hospital. A total of 173 patients with ectopic pregnancy were included in the data analysis. The magnitude of ectopic pregnancy was 0.98% among the total pregnancies and accounted for 2.77% of all gynecological admissions during the study period. Most of the patients, 81 (46.8%), were in the 25-29 years age group, with a mean age of 27.16 ± SD 4.77 years. Mothers who had a previous history of abortion, a history of pelvic inflammatory disease, a history of ectopic pregnancy, or a history of tubal surgery had a statistically significant association with ectopic pregnancy. The majority of the patients were married, 98 (56.6%), and urban residents, 121 (69.9%). The majority of ectopic pregnancies occurred on the right side of the fallopian tube 144 (83.24%). Among the majority of ectopic pregnancies, 159 (61.3%) were tubal ampullary ectopic pregnancies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion and recommendation: &lt;/strong&gt;The major risk factors identified in this study were previous abortion, pelvic inflammatory disease, a previous history of ectopic pregnancy, and previous tubal surgery. The magnitude of the ectopic pregnancy in this study was 0.98%, which ","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0004611"},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236180","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":"Patient and health system delays in the diagnosis and treatment of tuberculosis in Gandaki, Nepal.","authors":"Bikram Singh Dhami, Damaru Prasad Paneru, Sagar Parajuli, K C Aarati, Dhirendra Nath","doi":"10.1371/journal.pgph.0004676","DOIUrl":"https://doi.org/10.1371/journal.pgph.0004676","url":null,"abstract":"<p><p>Delays in accessing healthcare worsen disease outcomes, increasing Tuberculosis (TB) transmission rates and mortality. Prolonged delays may contribute to drug-resistant TB strains in some cases, this study assessed delays in diagnosis and treatment among TB patients in Gandaki, Nepal. A cross-sectional study was conducted among a randomly selected sample of 194 TB patients enrolled in Direct Observed Treatment Short-course (DOTS) therapy. The data were collected through face-to-face interviews using a semi-structured interview schedule, which was developed through literature review and adaptation of the World Health Organization's multi-country study. Multivariate logistic regression was employed to identify factors associated with delays in diagnosis and treatment, considering a p value < 0.05 to indicate statistical significance. The median patient and health system delays were 35 (7-120) and 9 (2-98) days, respectively. Furthermore, 55.7% and 58.2% of patients experienced patient and health system delays, respectively. In the multivariable logistic regression analysis, factors associated with unacceptable patient delay included non enrollment in government health insurance programmes (AOR: 3.19; 95% CI: 1.29-7.98), seeking care from non-National Tuberculosis Program (non-NTP) providers (AOR: 3.19; 95% CI: 1.460-6.97), poor knowledge of TB (AOR: 3.74; 95% CI: 1.67-8.37), and high levels of perceived stigma (AOR: 3.15; 95% CI: 1.42-6.94). Furthermore, undergoing an initial diagnostic test other than GeneXpert (AOR: 3.25; 95% CI: 1.19-8.87) and visiting healthcare facilities multiple times before being diagnosed with TB (AOR: 5.62; 95% CI: 2.26-13.96) were significantly associated with unacceptable health system delay. Patient and health system delays were prevalent among TB patients. Reducing these delays is crucial for improving TB control. Therefore, urgent action is needed to implement education campaigns to improve TB literacy. Additionally, engaging private and informal healthcare providers and enhancing their capacity to deliver timely and effective TB care could potentially mitigate delays in diagnosis and treatment.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0004676"},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236181","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":"Adolescent boys' sociocultural beliefs and attitudes toward menstruation in selected high schools in Ghana: Mediation and moderation effect of knowledge.","authors":"Israel Wuresah, Priscilla Klutse, Sarah Odi Mantey, Isaiah Agorinya, Julie Hennegan, Sitsofe Gbogbo","doi":"10.1371/journal.pgph.0004354","DOIUrl":"https://doi.org/10.1371/journal.pgph.0004354","url":null,"abstract":"<p><p>Adolescent boys can reinforce negative societal attitudes towards menstruation and make it difficult for adolescent girls to achieve optimal menstrual health and hygiene (MHH) which defeats Sustainable Development Goals 3, 5.1, 5.2 and 5.6. This study investigated how knowledge mediates/moderates the association between sociocultural beliefs (SB) and attitudes of adolescent boys regarding menstruation in senior high schools in Ghana. A cross-sectional study was conducted in five mix-sex public senior high schools (SHS) in Volta region, Ghana. Probability proportional to size was used to distribute 431 study subjects among the schools, and surveys were conducted using structured questionnaires. Structural equation modeling (SEM) and generalized least square (GLS) modeling were conducted. The mean age of the sample was 17.3 (±1.0). Majority (60.6%) were between 15-17 years old, and Christians (95.4%). Half of them had low knowledge; 38% had moderate, and 11% had high knowledge. Meanwhile, negative SB (55.2%) outweighed positive SB, which reflected in their attitudes towards menstruation with 52.7% exhibiting poor attitudes. The SEM revealed that knowledge had a significant negative effect on SB and attitudes, with coefficients of -0.06 (SE = 0.01, p < 0.001), and -0.28 (SE = 0.06, p < 0.001) respectively. The GLS model indicated that knowledge also moderates the relationship between SB and attitudes. Male students in Ghana have a tendency to stigmatize menstruation among their female counterparts because they have inadequate knowledge about it and this may affect the achievement of optimal MHH by their female colleagues. It is evident that effective menstrual education reduces negative attitudes.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0004354"},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236177","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":"AI-driven solutions to improve safety and health: Application of the REDECA framework for agricultural tractor drivers.","authors":"Negin Ashrafi, Sahar Yousefi, Guy Roger Aby, Salah F Issa, Houshang Darabi, Kamiar Alaei, Greg Placencia, Maryam Pishgar","doi":"10.1371/journal.pgph.0003543","DOIUrl":"https://doi.org/10.1371/journal.pgph.0003543","url":null,"abstract":"<p><strong>Introduction: </strong>Despite tremendous efforts, including research, teaching, and extension, toward improving the safety of agricultural tractor drivers, the number of incidents related to agricultural tractor drivers has not declined. This evidence points out an urgent need to explore artificial intelligence (AI) solutions to improve the safety of tractor drivers.</p><p><strong>Methods: </strong>This paper uses 171 Fatality Assessment and Control Evaluation (FACE) reports related to tractor drivers and a new framework called Risk Evolution, Detection, Evaluation, and Control of Accidents (REDECA) to identify existing AI solutions, such as machine learning models for predictive maintenance, sensor-based monitoring, computer vision, and automated safety interventions, and specific areas where AI solutions are missed and can be developed to reduce incidents and recovery time. Fatality reports of tractor drivers were categorized into six main categories, including run over, pinned by/ Crushed and entanglement, fall, fire, roll over, and overturn. Each category was then subcategorized based on similarities of incident causes in the reports.</p><p><strong>Results: </strong>The application of the REDECA framework, which categorizes risk states into R1 (safe), R2 (hazard exposure), and R3 (incident), revealed potential AI solutions that could improve the safety of tractor drivers. In all categories, the REDECA framework lacks AI solutions for three elements, including the probability of reducing recovery time in R3, detecting changes between R2 and R3, and intervention to send workers to R2. Most of the categories were missing AI solutions for interventions to prevent entry to the R3 element of the REDECA. In addition, the fall, roll over, and overturn categories lacked AI intervention that minimized damage and recovery in R3.</p><p><strong>Conclusions: </strong>The outcome of this study shows an urgent need to develop AI solutions to improve tractor driver safety.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0003543"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227860","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":"Building models, building capacity: A review of participatory machine learning for HIV prevention.","authors":"Mark Sendak, Meg Young, Jee Young Kim, Alifia Hasan, Clare Kelsey, Catherine O'Neal, Tonya Jagneaux, Wayne Wilbright, John Couk, Stephen Lim, Tamachia Davenport, Shirley Lolis, Jennifer Thomas, Shannon Widman, Suresh Balu, Meredith Clement, Lance Okeke","doi":"10.1371/journal.pgph.0003862","DOIUrl":"https://doi.org/10.1371/journal.pgph.0003862","url":null,"abstract":"<p><p>A growing number of researchers and practitioners are embracing a \"participatory turn\" in machine learning (ML) to improve model development, prevent harm, and provide communities more influence over systems that impact them. In this paper, we explore the intersection of participatory practices in healthcare and the emerging focus on responsible AI with a focus on human immunodeficiency virus (HIV) care. We review the historical context of participation in HIV treatment and prevention, emphasizing how patient activism has shaped practices in this field. We then review participatory ML in HIV prevention and present a brief case study of a project designed to identify candidates for pre-exposure prophylaxis (PrEP) in Louisiana. The review highlights the essential steps in conducting participatory ML. Finally, we draw lessons for future participatory ML projects, underscoring the importance of long-term collaboration, responsiveness to partner feedback, and the crucial role of capacity-building for individuals and organizations. Effective participation requires substantial resources and investment, which supports overall project goals beyond mere improvements in model performance. We also draw lessons for advancing the participatory ML field, including (1) the impact of funding mandates on fostering effective engagement; (2) the need to scale participatory processes rather than just technologies; and (3) the need for genuine participation to allow flexibility in project plans, timelines, and shifts in institutional power dynamics.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0003862"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227862","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":"School and home-based educational intervention in urban Kenya: Sustained improvements in knowledge, attitudes, and practices for Aedes aegypti control.","authors":"Prathik Kalva, Jenna Forsyth, Francis Mutuku, Gladys Agola, Mwashee Lutt, Angelle Desiree LaBeaud","doi":"10.1371/journal.pgph.0004567","DOIUrl":"https://doi.org/10.1371/journal.pgph.0004567","url":null,"abstract":"<p><p>Aedes aegypti mosquitoes are the primary vectors for important arboviral health threats including chikungunya (CHIKV) and dengue (DENV) viruses, primarily breeding in domestic plastic containers. Previous studies have highlighted a severe lack of knowledge about non-malarial mosquito-borne diseases in Kenya, so we proposed a household and school-based educational intervention in urban coastal Kenya to determine whether it could bring about long-term improvements in knowledge, attitudes, and practices related to the source reduction of arboviral disease vectors. In this cluster-randomized controlled trial, 249 households from 5 villages were placed in the intervention arm and 243 households from 5 other similar villages were placed in the control arm. From each household, one fourth grade child was enrolled. Data on the child participants' knowledge, attitudes, and practices (KAP) were collected at baseline and 3- and 12-months post-intervention, along with counts of immature mosquitoes in containers in the participants' households. At 3 months, the intervention group showed significantly greater improvement in attitude scores compared to the control group (p = 0.01), with no significant differences in knowledge or practices. However, by 12 months, the intervention group demonstrated significant improvements in knowledge (1.51 vs. 0.35, p < 0.001), attitude (0.268 vs. -0.263, p < 0.001), and practice (0.118 vs. -0.235, p < 0.001) scores compared to the control group. Additionally, the house index (houses with at least one productive container) increased in both the intervention (13.9% to 25.6%) and control (9.4% to 28.4%) households, signifying that although the intervention improved knowledge and some practices, a more targeted approach is needed to address challenges in vector control. This study demonstrates that long-term advances in knowledge, attitudes, and practices regarding arboviral diseases can be achieved through household and school-based educational interventions.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0004567"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227884","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":"Thinking through abrupt closure in humanitarian assistance: Key ethical considerations in seemingly impossible conditions.","authors":"Lisa Eckenwiler, Isabel Munoz-Beaulieu, Revka Perez, Mayfourth Luneta, Shelley Rose Hyppolite, Lisa Schwartz, Matthew Hunt","doi":"10.1371/journal.pgph.0004656","DOIUrl":"https://doi.org/10.1371/journal.pgph.0004656","url":null,"abstract":"","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0004656"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227886","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":"Predicting mobile health clinic utilization for COVID-19 vaccination in South Carolina: A statistical framework for strategic resource allocation.","authors":"Fatih Gezer, Kerry A Howard, Kevin J Bennett, Alain H Litwin, Kerry K Sease, Lior Rennert","doi":"10.1371/journal.pgph.0003837","DOIUrl":"https://doi.org/10.1371/journal.pgph.0003837","url":null,"abstract":"<p><p>Mobile health clinics (MHCs) are effective tools for providing health services to disadvantaged populations, especially during health emergencies. However, patient utilization of MHC services varies substantially. Strategies to increase utilization are needed to maximize the effectiveness of MHC services by serving more patients in need. The purpose of this study is to develop a statistical framework to identify and prioritize high-risk communities for delivery of MHCs during health emergencies. Prisma Health MHCs delivered COVID-19 vaccines to communities throughout South Carolina between February 20, 2021, and February 17, 2022. In this retrospective study, we used generalized linear mixed effects models and ordinal logistic regression models to identify factors associated with, and predictive of, MHC utilization for COVID-19 vaccination by census tract. The MHCs conducted 260 visits to 149 sites and 107 census tracts. The site-level analysis showed that visits to schools (RR = 2.17, 95% CI = 1.47-3.21), weekend visits (RR = 1.38, 95% CI = 1.03-1.83), and visits when the resources were limited (term 1: 7.11, 95% CI = 4.43-11.43) and (term 2: 2.40, 95% CI = 1.76-3.26) were associated with greater MHC utilization for COVID-19 vaccination. MHC placement near existing vaccination centers (RR = 0.79, 95% CI = 0.68-0.93) and hospitals (RR = 0.83, 95% CI = 0.71-0.96) decreased utilization. Predictive models identified 1,227 (94.7%) census tracts with more than 250 individuals per MHC visit when vaccine resources were limited. Predictions showed satisfactory accuracy (72.6%). The census tracts with potential of high MHC demand had higher adolescent, 30-44 years old, and non-White populations; lower Primary Care Practitioners per 1,000 residents; fewer hospitals; and higher cumulative COVID-19 emergency department visits and deaths (compared to census tracts with low MHC demand). After the vaccines became widely available, the demand at MHCs declined. These study findings can improve MHC allocation by identifying and prioritizing medically underserved communities for strategic delivery of these limited resources, especially during health emergencies.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0003837"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227882","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}