PLOS global public health最新文献

{"title":"Multi-scale wastewater surveillance at a Bangkok tertiary care hospital: A potential sentinel site for real-time COVID-19 surveillance at hospital and national levels.","authors":"Quinton Hayre, Supaporn Wacharapluesadee, Piyapha Hirunpatrawong, Ananporn Supataragul, Opass Putcharoen, Leilani Paitoonpong","doi":"10.1371/journal.pgph.0004256","DOIUrl":"https://doi.org/10.1371/journal.pgph.0004256","url":null,"abstract":"<p><p>Wastewater-based epidemiology is a valuable tool for population-level pathogen surveillance, complementing clinical methods. While most sampling focuses on municipal wastewater treatment plants, emerging evidence suggests wastewater collected from hospital settings can lead to targeted clinical interventions. To investigate wastewater pathogen surveillance in hospital settings further, we tracked the presence and concentration of SARS-CoV-2 RNA in wastewater across multi-scale sample sites within a large, public tertiary care hospital in Bangkok, Thailand. From July 2022 to May 2023, weekly wastewater samples (n=392) were collected from various sample sites including clinical and non-clinical facilities, as well as the hospital's wastewater treatment plant. Influent wastewater at the hospital's wastewater treatment center yielded the most consistent SARS-CoV-2 RNA detection across all sample sites, with detection in all 26 samples. Despite varied building usage patterns, significant moderate negative correlations were found in 90% (9/10) of sample sites between wastewater RT-PCR cycle threshold values and clinical case data from hospital and national reports. Targeting specific buildings yielded distinct data trends, indicating their potential to offer complementary insights into viral shedding and transmission among clinical and non-clinical sub-populations within a hospital campus. Our findings suggest that hospital wastewater-based epidemiology reflects broader community disease trends, which may be especially useful in regions with limited municipal wastewater treatment coverage. Large tertiary care hospitals could serve as effective and cost-efficient sentinel surveillance sites for future pathogen monitoring, guiding public health actions.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 4","pages":"e0004256"},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812565","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":"Protecting global health partnerships in the era of destructive nationalism.","authors":"Maya Adam, Desiree LaBeaud, Nokwanele Mbewu, Jennifer Gates, Randall Waechter, Mercy J Borbor-Cordova, Lydiah Kibe, Sonia Alvarez, Annie Dori, Anil S Bilimale, Meggie Mwoka, Jessica Deffler, Michele Spring, Avriel R Diaz, Rachael Farquhar, Willy Dunbar, Comfort R Phiri, Valerie A Luzadis, Nicole Redvers, Cristina Alonso, Rosemary Rochford, Rachel Lowe, Kareem Coomansingh, Moses Laman, Rebeca Sultana, Sadie Ryan, Amaya L Bustinduy, Anita S Hargrave-Bouagnon, Shazia N Ruybal-Pesántez, Zebedee Kerry, Trevor Kelebi, Samuel McEwen, Leanne Robinson, Maritza Salazar Campo, Till Bärnighausen","doi":"10.1371/journal.pgph.0004428","DOIUrl":"https://doi.org/10.1371/journal.pgph.0004428","url":null,"abstract":"","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 4","pages":"e0004428"},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812915","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":"Zethembe: a co-developed couples intervention for young heterosexual couples in informal settlements in South Africa.","authors":"Andrew Gibbs, Zama Khoza, Sivuyile Khaula, Smanga Mkhwanazi, Jenevieve Mannell, Laura Washington","doi":"10.1371/journal.pgph.0004332","DOIUrl":"https://doi.org/10.1371/journal.pgph.0004332","url":null,"abstract":"<p><p>Effective interventions to address violence against women and girls in urban informal settlements are limited. To address this gap, we undertook an intervention co-development process, bringing together four young women (aged 18-25 years) living in an urban informal settlement, academics and NGO partners. Following the 6 Steps in Quality Intervention Development (6SQuID) approach we collaboratively worked through the steps using participatory methods, supporting the young women to think critically and interrogate their lived reality, identify the causes of violence in their lives, and where they felt change was possible. We co-created Zethembe Couples Care, and 'pre-tested' this with 17 participants (some were couples). Finally, the academics and practitioners revised the intervention and theory of change. The co-development process led to a series of learnings: the process of building trust and supporting young women to reflect and understand their lived realities took a long time (12 of 15 months), limiting intervention development time. The process also enabled young women to push back against received academic/practitioner wisdom, leading to a couples intervention focused on addressing communication and problem solving, where they felt change was possible, but potentially they could not adequately consider addressing structural drivers of violence. The Zethembe Couples Care intervention now requires piloting at a larger scale to develop it further and formally evaluate it.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 4","pages":"e0004332"},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812930","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":"Outcomes of pregnancy-related acute kidney injury: A retrospective study in the obstetric critical care unit at Kenyatta National Hospital 2020 to 2023.","authors":"Wanjiku Ng'ethe, Anne Pulei, Diana Ondieki, James Amenge, Rose Kosgei, Joshua Kayima, Alfred Osoti","doi":"10.1371/journal.pgph.0004396","DOIUrl":"https://doi.org/10.1371/journal.pgph.0004396","url":null,"abstract":"<p><p>Pregnancy-related acute kidney injury (PrAKI) is defined as a rapid decline in kidney function in the pregnancy or puerperal period that can result in life-threatening organ dysfunction. This study aimed to investigate socio-demographic features of critically ill women with pregnancy-related acute kidney injury as well as their maternal and foetal outcomes. Retrospective analysis of data in patients with pregnancy-related kidney injury in the obstetric critical care unit at a public tertiary referral centre in Kenya between February 2020-2023. Of the 266 patient files reviewed, pregnancy-related acute kidney was found in 203 patients. The main predisposing factors for acute kidney injury were hypertensive disorders in pregnancy (64.1%), obstetric haemorrhage (38.4%) and sepsis (36.5%). According to KDIGO (Kidney Disease Improving Global Outcomes) criteria, 44 patients presented in stage 1 (21.7%), 58 in stage 2 and 101 in stage 3 (49.8%). Patients with KDIGO stage 3 had a higher risk of high SOFA (Sequential Organ Failure Assessment) score (p =< 0.001), longer ICU stay (p = 0.008) and longer duration on ventilation (p = 0.010). Seventy-six patients underwent dialysis (37.4%). Recovery of renal function was complete in 91 patients (44.8%), partial in 41 (20.2%) with dependence on dialysis seen in 23 (23.6%). Forty-eight patients died (23.6%). Risks associated with mortality were mechanical ventilation (p = 0.001) and inotropic support (p =< 0.001) with statistically significant higher mean SOFA scores in those who died versus those who survived (12.6 ± 3.8 p =< 0.001 vs 8.6 ± 3.2). The incidence of PrAKI is still underestimated in the Kenyan setting with the majority of the patients presenting with advanced renal injury. These patients are at higher risk of adverse maternal morbidity and mortality in the critical care setting.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 4","pages":"e0004396"},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812876","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":"Bridging the gap: Enhancing HIV care pathways for young key populations in Chad.","authors":"Esias Bedingar, Sabrina Ebengho, Ferdinan Paningar, Ngarossorang Bedingar, Eric Mbaidoum, Naortangar Ngaradoum, Aisha K Yousafzai","doi":"10.1371/journal.pgph.0003790","DOIUrl":"https://doi.org/10.1371/journal.pgph.0003790","url":null,"abstract":"<p><p>Young key populations-sex workers and men who have sex with men (MSM)-face significant barriers to accessing HIV care in Chad due to stigma, discrimination, and socio-economic challenges. Although legal protections exist, gaps in enforcement continue to undermine care efforts. This study explored care pathways for young key populations in Chad to identify their specific challenges and propose targeted strategies to strengthen the HIV care continuum. Conducted in April 2025 in N'Djamena Chad, the qualitative study involved ten in-depth interviews with sex workers and MSM, aged 15-24 years, recruited through snowball sampling. Framework analysis revealed key themes across the HIV care continuum, specifically in testing, linkage to care, and retention in antiretroviral therapy (ART). Three major themes and 13 sub-themes emerged: (1) HIV testing and diagnosis, (2) linkage to care and ART initiation, and (3) retention in care and adherence to ART. Stigma-both externalized and internalized-was a significant barrier at every stage. Fear of disclosure, discrimination in healthcare settings, and financial constraints further hindered care engagement. Conversely, community-based awareness programs in faith-based institutions, and peer support networks were crucial in facilitating access to services. Addressing these challenges requires a comprehensive, multi-level approach that includes stigma-reduction training for healthcare workers, enforcement of anti-discrimination laws, targeted financial aid mechanisms, and integrated psychosocial counseling. Strengthening community-based interventions and peer-led outreach can further enhance engagement and retention, thereby improving health outcomes and reducing new infections among young key populations in Chad while aligning with global HIV targets.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 4","pages":"e0003790"},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813220","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":"Driving under viral impairment: Linking acute SARS-CoV-2 infections to elevated car crash risks.","authors":"Baran Erdik","doi":"10.1371/journal.pgph.0004420","DOIUrl":"https://doi.org/10.1371/journal.pgph.0004420","url":null,"abstract":"<p><p>This study explores the linkage between acute SARS-CoV-2 and car crashes across U.S. states, correlating with COVID-19 mitigation strategies, vaccination rates, and Long COVID prevalence. This investigation analyzed aggregate COVID-19 and car crash data spanning 2020-2023, with data collection occurring between March and May 2024. Analysis was done via a Poisson regression model, adjusted for population. Key variables included vaccination status, month-specific effects relating to initial pandemic shutdowns, and Long COVID rates. Results demonstrated a significant association between acute COVID-19 infections and an increase in car crashes, independent of Long COVID status to the tune of an OR of 1.25 [1.23-1.26]. This association was observed despite varying mitigation efforts and vaccination rates across states. The study found no protective effect of vaccination against car crashes, challenging prior assumptions about the benefits of vaccination. Notably, the risk associated with COVID-19 was found to be analogous to driving impairments seen with alcohol consumption at legal limits. Findings suggest significant implications for public health policies, especially in assessing the readiness of individuals recovering from COVID-19 to engage in high-risk activities such as pilots or nuclear plant employees. Further research is necessary to establish causation and explore the exact effects of COVID-19 within the CNS affecting cognition and behavior.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 4","pages":"e0004420"},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813237","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":"The determinants of female genital mutilation among daughters in Nigeria.","authors":"Charles Echezona Nzelu, Uche Maureen Nzelu, Amara Rita Ugwunze, Ngozi Azodoh","doi":"10.1371/journal.pgph.0004413","DOIUrl":"10.1371/journal.pgph.0004413","url":null,"abstract":"<p><p>Female Genital Mutilation/Circumcision (FGM/C) refers to the complete or incomplete removal of the female external genital or other injuries for non-medical or cultural reasons. It is a culturally harmful practice without health benefits with long-term complications to women's psychological, physical, and sexual health and well-being that violates the victims' rights because it is done without their consent. Despite International efforts to eradicate this harmful practice, it persists, therefore, this study examined the sociodemographic factors of mothers of reproductive age that affected the likelihood of their daughters undergoing female genital mutilation or circumcision. The 2021 Multiple Indicator Cluster Survey (MICS) female genital mutilation response weighted data of women of reproductive age 15-49 years was used for this study. Bivariate and multivariable logistic regression analyses were done to predict the determinants of female genital mutilation among daughters, and those with a p-value of ≤.05 were considered statistically significant determinants. Results showed a statistically significant difference between educational level, ethnicity of household head, household wealth index, geopolitical zone, ever circumcised, and daughter circumcised at Alpha =.05 in the multivariable regression analysis. Place of Residence and Marital Status were not statistically significant in the multivariable regression analysis at Alpha =.05. Considering that Nigeria has a population of over 200 million people, a figure of 14.2% of daughters circumcised is high and, therefore, requires concerted interventions by all stakeholders to address this harmful practice.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 4","pages":"e0004413"},"PeriodicalIF":0.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804855","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":"Barriers and facilitators to oral pre-exposure prophylaxis uptake among adolescents girls and young women at elevated risk of HIV acquisition in Lilongwe, Malawi: A qualitative study.","authors":"Simon C Nicholas, Maureen Matewere, Agatha Bula, Mercy Tsidya, Mina C Hosseinipour, Mitch Matoga, Alinane Linda Nyondo Mipando","doi":"10.1371/journal.pgph.0004006","DOIUrl":"10.1371/journal.pgph.0004006","url":null,"abstract":"<p><p>Among the estimated 12,500 new HIV infections in Malawi among people aged 15-24 each year, 70 percent occur in Adolescent Girls and Young Women (AGYW). The Ministry of Health (MoH) in Malawi rolled out an oral Pre-Exposure Prophylaxis (PrEP) prevention program targeting populations at elevated risk of HIV acquisition, including AGYW, in 2021. Since PrEP roll-out, there has been limited research exploring the factors that influence uptake of PrEP among AGYW. This study explored the barriers and facilitators to the uptake of PrEP among AGYW at elevated risk of HIV acquisition. it was an exploratory qualitative study conducted at Kawale Health Center in Lilongwe, Malawi, in February 2023, which employed a phenomenological design. Data were collected using semi-structured in-depth interviews and vignettes from purposively sampled 20 AGYW and 10 health care workers (HCWs) based on their PrEP status (on PrEP versus not on PrEP) and involvement in PrEP provision, respectively. The data were digitally recorded, managed using NVivo software and analysed using a thematic approach guided by the Consolidated Framework for Implementation Research (CFIR). AGYW identified perceived HIV risk and vulnerability and PrEP knowledge as facilitators. HCWs identified AGYW perceived HIV risk, HCW altitudes, and availability of youth friendly service center and resources as facilitators to PrEP uptake. Barriers identified by AGYW included PrEP side effects, limited PrEP information, lack of privacy, stigma, and lack of transportation. HCWs identified limited resources and burden of work as barriers. In conclusion, PrEP's full potential as an HIV prevention tool for AGYW requires a holistic approach that considers their particular requirements, removes systemic hurdles, and guarantees access to high-quality services. In addition, there is a need to create demand to increase the uptake of PrEP.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 4","pages":"e0004006"},"PeriodicalIF":0.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Accuracy of the Uganda National Tuberculosis and Leprosy Program diagnostic algorithm and the World Health Organisation treatment decision algorithms for childhood tuberculosis: A retrospective analysis.","authors":"Peter J Kitonsa, Bernard Kikaire, Peter Wambi, Annet Nalutaaya, Jascent Nakafeero, Gertrude Nanyonga, Emma Kiconco, Deus Atwiine, Robert Castro, Ernest A Oumo, Hellen T Aanyu, Mary N Mudiope, Ezekiel Mupere, Moorine P Sekadde, Swomitra Mohanty, Adithya Cattamanchi, Eric Wobudeya, Devan Jaganath","doi":"10.1371/journal.pgph.0004026","DOIUrl":"10.1371/journal.pgph.0004026","url":null,"abstract":"<p><p>Diagnosing childhood pulmonary tuberculosis (TB) is a challenge. This led the Uganda National Tuberculosis and Leprosy Program (NTLP) to develop a clinical treatment decision algorithm (TDA) for children. However, there is limited data on its accuracy, and how it compares to new World Health Organization (WHO) TB TDAs for children. This study aimed to evaluate and compare the accuracy of the 2017 Uganda NTLP diagnostic algorithm with the 2022 WHO TDAs for TB among children. We analyzed four years of clinical data from children <15 years old in Kampala, Uganda. Children were classified as per National Institutes of Health (NIH) consensus definitions (Confirmed, Unconfirmed or Unlikely TB). We applied the 2017 Uganda NTLP and 2022 WHO algorithms (A with chest x-ray [CXR], B without CXR) to make a decision to treat for TB or not, and calculated the sensitivity, specificity and predictive values in reference to Confirmed vs. Unlikely TB, as well as a microbiological and composite reference standard. Of the 699 children included in this analysis, 64% (451/699) were under 5 years, 53% (373/669) were male, 12% (85/699) were Xpert Ultra positive, 11% (74/669) were HIV positive and 6% had severe acute malnutrition (SAM). The Uganda NTLP algorithm had a sensitivity of 97.9% (95% CI: 96.4-99.4) and specificity of 25.9% (95% CI: 21.2-30.7). If CXR was considered unavailable, sensitivity was 97.9% (95% CI: 96.4-99.4) and specificity 28.1% (95% CI: 23.2-33.0). In comparison, WHO TDAs had similar sensitivity to the Uganda NTLP, but algorithm A was more specific (32.2%, 95% CI: 26.9-37.5) and algorithm B was less specific (15.4%, 95% CI: 11.3-19.5). The WHO TDAs had better specificity than the NTLP algorithm with CXR, and worse specificity without CXR. Further optimization of the algorithms is needed to improve specificity and reduce over-treatment of TB in children.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 4","pages":"e0004026"},"PeriodicalIF":0.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804930","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":"Household economic burden of managing people living with HIV and comorbidities of hypertension and diabetes in La Nkwantanang-Madina Municipality, Ghana.","authors":"Richmond Owusu, Esther Esi Degbor, Desmond Dzidzornu Otoo, Ruby A M Annan","doi":"10.1371/journal.pgph.0004371","DOIUrl":"10.1371/journal.pgph.0004371","url":null,"abstract":"<p><p>Managing HIV alongside chronic conditions such as hypertension and diabetes present significant economic challenges for households, especially in low-and middle-income countries. These chronic diseases not only reduce the quality of life of people living with HIV (PLHIV) but also further increase their economic burden. This study seeks to examine the economic burden of managing PLHIV with hypertension and diabetes comorbidities. The cross-sectional cost-of-illness study used quantitative data gathered from 56 PLHIV with hypertension and/or diabetes receiving ART at two Polyclinics and the Pentecost Hospital in the La Nkwantanang-Madina Municipality. A structured questionnaire was used to collect data on patients' socio-demographic characteristics, direct, indirect, and intangible costs between September to December 2023. Data was analyzed and presented descriptively.The total economic cost of PLHIV managing comorbidities was GHS11,892.11 (USD 1,022.54) with a direct cost of GHS10,739.00 (US$ 923.39) accounting for 90.3% and indirect cost of GHS 1,153.14 (US$ 99.15) accounting for 9.7% over 6 months. Direct medical costs constituted 83.1% of total costs with the cost of medicines being the largest cost component. There was a significant difference between the total costs across the comorbidities (X2=8.58, p = 0.0137). Approximately 45.24% of the average annual income per person was spent on managing comorbidities in PLHIV. About 89% of participants reported a low intangible cost burden. This study reveals the significant economic burden on households managing HIV with hypertension and diabetes comorbidities. Direct costs driven by medication expenses constituted the majority of the burden, while productivity losses compounded indirect costs. Despite widespread health insurance coverage, substantial out-of-pocket payments are made in the management of these comorbidities. The findings emphasize the need for integrated healthcare strategies to address both communicable and non-communicable diseases, especially in low-income settings, and policies to reduce financial barriers. Studies should explore long-term burden and strategies to alleviate the economic impact on vulnerable populations.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 4","pages":"e0004371"},"PeriodicalIF":0.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805084","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}