PLOS global public health最新文献

{"title":"Factors associated with the unmet need for spacing and limiting family planning: Evidence from a national survey.","authors":"Muhammad Khairul Alam, Rumana Rois","doi":"10.1371/journal.pgph.0007412","DOIUrl":"10.1371/journal.pgph.0007412","url":null,"abstract":"<p><p>Traditional binary frameworks tend to combine the various aspects of unmet family planning needs into one general category. This study evaluates unmet family planning needs by first using conventional multinomial logistic regression to determine baseline demographic risk profiles. It then applies machine learning methods such as Random Forest and XGBoost to see if they can provide further insights into non-linear patterns and complex interactions between features that standard regression might miss. Using data from the Bangladesh Demographic and Health Survey (BDHS 2022), we built a multivariable multinomial logistic regression model. Additionally, we applied sophisticated ensemble classifiers such as Random Forest and XGBoost, paired with a synthetic hybrid resampling technique (SMOTE) to address severe class imbalance. Feature selection was conducted using the Boruta algorithm, and we used Shapley Additive Explanations (SHAP) to visualize complex global patterns and interaction effects. Bivariate analysis showed significant associations between unmet needs and maternal age, parity, wealth, residence, and decision-making power (p < 0.05). Multivariable logistic regression confirmed that having more children (4 or more) greatly increased the likelihood of unmet needs for spacing (aOR = 20.60) and limiting (aOR = 2.24). Wealth was notably protective against unmet needs for limiting, especially for the richest quintile (aOR = 0.48). Although SHAP analysis offered exploratory insights into complex, non-linear interactions between residence and factors such as parity and education, the predictive accuracy of tree-based models (Random Forest, XGBoost) was only moderate, with macro-averaged AUCs comparable to those of traditional regression. Therefore, population-level conclusions are most reliably drawn from the MLR model. The limitations of cross-sectional survey data as a diagnostic tool show that spacing needs are often fluid, transient, and shaped by relationships. Addressing the unmet need gap involves moving away from broad media campaigns toward localized counseling, ensuring stable rural spacing supplies, and involving husbands and mothers-in-law to turn reproductive healthcare into a shared household conversation.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007412"},"PeriodicalIF":2.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149158","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":"Heterogeneity in Mycobacterium tuberculosis immunoreactivity in young children in Blantyre, Malawi: A community-based survey.","authors":"Hannah M Rickman, Mphatso D Phiri, Hannah Mbale, Helena R A Feasey, Marriott Nliwasa, George Chagaluka, James A Seddon, Henry C Mwandumba, Katherine C Horton, Marc Y R Henrion, Tisungane Mwenyenkulu, Kuzani N Mbendera, Emily S Nightingale, Elizabeth L Corbett, Peter MacPherson","doi":"10.1371/journal.pgph.0007269","DOIUrl":"10.1371/journal.pgph.0007269","url":null,"abstract":"<p><p>As tuberculosis (TB) incidence declines, transmission becomes increasingly concentrated in vulnerable populations and neighbourhoods. There is an urgent need for affordable surveillance strategies to monitor trends, identify high-risk groups and target interventions. TB disease prevalence surveys are no longer cost-effective in monitoring epidemiological trends as countries target TB elimination, while passive surveillance methodologies such as case-notification rates (CNRs) are biased by healthcare access disparities. Mycobacterium tuberculosis (Mtb) immunoreactivity surveys indirectly measure transmission and therefore undiagnosed infectious TB, and may provide valuable information to TB programmes globally. We conducted a pragmatic hybrid clinic- and household-based cross-sectional interferon-gamma release assay (IGRA) survey in healthy children aged 1-4 years in 33 high-burden neighbourhoods Blantyre, Malawi. Participants were recruited using novel convenience sampling in health facilities, alongside random household sampling guided by satellite imagery, and tested for Mtb immunoreactivity using QFT-Plus IGRA. We constructed hierarchical Bayesian logistic regression models for IGRA positivity, with neighbourhood-level random effects. Of 1,545 participants, 102 (6.6%) had a positive IGRA: an annual risk of Mtb infection (ARTI) of 2.7% (95% CrI 2.2-3.2%). Immunoreactivity was higher in the poorest third of households (8.7% vs 4.9%; adjusted odds ratio: 1.88, 95% CrI 1.08-3.01) compared to the richest, but was not associated with HIV exposure, malnutrition or reported household TB exposure. There was substantial between-neighbourhood heterogeneity (ARTI range 1.1-4.1%). There was no association between neighbourhood-level TB case notifications and ARTI. Measuring Mtb immunoreactivity in young children, using innovative recruitment strategies, revealed a high burden of immunoreactivity suggestive of recent TB transmission. Children in the poorest households were at highest risk, highlighting the importance of social and economic inequity in driving the TB epidemic. Case notification rates may not reflect the areas with the highest transmission, and Mtb immunoreactivity surveillance may support identification of high-risk populations, monitoring of trends and targeting of public health interventions.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007269"},"PeriodicalIF":2.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149797","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":"Beyond aspiration: An expenditure-based evaluation of progress towards the Abuja Declaration target and implications for domestic health financing in Africa.","authors":"Alex Olateju Adjagba, Jacob Novignon, Justice Nonvignon, Richmond Owusu, Ephrem Lemango, Helga Fogstad, Ngashi Ngongo, Jean Kaseya, George Laryea-Adjei","doi":"10.1371/journal.pgph.0007423","DOIUrl":"10.1371/journal.pgph.0007423","url":null,"abstract":"<p><p>In 2001, African Union (AU) member states committed to allocating 15% of their annual budget to health under the Abuja Declaration (AD). However, after more than two decades, health allocations across many countries still fall short of the target. This study uses an expenditure-based proxy for the AD to examine the likelihood and timing of attainment of the benchmark under historical fiscal trajectories.We compiled a 2002-2023 panel for 54 African countries using WHO and World Bank data. We distinguished observed, first and sustained attainment. Kaplan-Meier and Weibull models characterised time to first attainment, country-specific linear trends projected benchmark-crossing years through 2063, system GMM assessed expenditure-share persistence, and country and year fixed-effects models examined associations with primary health care (PHC) and immunisation expenditure per capita.In 2023, South Africa was the only one of 54 countries at or above the expenditure-based 15% benchmark. Five countries had attained it at least once during 2002-2023, and three sustained it for at least three consecutive years. Under the primary trend specification, which included the 51 countries with complete series, 42 (82.4%) were off track to attain the benchmark by 2063. Among the 48 countries without previous attainment, the median adjusted conditional probability of first attainment during 2023-2063 was 7.9% (IQR 4.6%-13.3%). The primary system-GMM lag coefficient was 0.821 (95% CI 0.635 to 1.006), indicating strong expenditure-share persistence. Higher government health prioritisation was associated with higher domestic government PHC expenditure per capita, while the association with total immunisation expenditure per capita was not statistically significant.Attainment of the expenditure-based Abuja benchmark remains uncommon and is unlikely to become widespread by 2063 if historical trends continue. While the 15% target remains politically useful as an accountability signal, efforts should target improving public health expenditure per capita, fiscal capacity, budget execution, financial protection and service coverage.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007423"},"PeriodicalIF":2.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148620","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":"Implementing computer‑aided detection for TB active case finding: A qualitative study of feasibility and acceptability in Tondo, Manila.","authors":"Emelie Yonally Phillips, Ma Danica Katrina P Galvan, Juno Min, Cathy Hewison, Carmina Duyala, John Carlo Palmado, Sheryl N Peral, Olivier Camelique, Mary Ruth C Roxas, Marve D Duka, Gina F Pardilla, Maria Julieta C Recidoro, Richard H Castro, Farah Hossain, Helena Huerga, Valentina Carnimeo","doi":"10.1371/journal.pgph.0007429","DOIUrl":"10.1371/journal.pgph.0007429","url":null,"abstract":"<p><p>Tuberculosis (TB) remains the leading cause of death from a single infectious agent, with over 1.23 million deaths globally in 2024. Despite available treatment and prevention strategies, timely and accurate detection remains challenging, particularly in high-burden settings such as the Philippines, which accounted for 6.8% of the global burden of TB in 2024. Computer-aided detection (CAD) software integrated with digital chest X-ray offers enhanced screening capacity, but its success depends on feasibility and acceptability within local health systems. This qualitative study explored perceptions and experiences of CAD integration during a Médecins Sans Frontières community-based TB active case finding campaign (ACF) in Tondo, Manila. In-depth interviews, focus group discussions, and direct observations were conducted with MSF staff, health center physicians, TB program personnel, ACF participants, and community leaders between January and April 2023. Thematic analysis identified four main themes: (1) Operational functionality and efficiency: Staff reported CAD increased screening capacity, supported clinical decision-making, and streamlined workloads; ACF participants reported a convenient process. (2) Human resources and role adaptation: Staff perceived role redistribution as initially challenging, highlighting the need for adequate capacity building and technical support; (3) Technical feasibility and system design: project managers and staff emphasized understanding CAD's capabilities and limitations to plan infrastructure, set thresholds, and compensate for inherent limitations. (4) Community acceptability and ethical considerations: community participants expressed mixed views on the reliability of novel \"high-tech\" tools and stressed the importance of aligning with local healthcare needs. This study demonstrates that implementing CAD in TB ACF is both feasible and acceptable when supported by careful planning and adaptation to local contexts. Sustainable implementation hinges on technical support and the meaningful involvement of healthcare workers and communities, whose insights help ensure ethical and effective digital health innovation. The experience in Tondo offers lessons on deploying CAD in high-burden, resource-constrained settings.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007429"},"PeriodicalIF":2.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13649030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139626","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":"A closing window: Canada needs to deliver on promises on health equity and principled pragmatism.","authors":"Shashika Bandara, Muriel Mac Seing, Charity Oga-Omenka, Michelle Amri, Zahid A Butt, Amelia Dinh, Karina Dubois-Nguyen, Marie Dorey, Joelle Ducharme, Saad El-Din Hassan, Janet Hatcher-Roberts, Justus Holben, Tina Lines, Nihad Mahmalat, Margaret Mutumba-Nakalembe, Hannah Neufeld, Nitika Pant Pai, Sanskruti Patel, Claudia Ximena Robayo-Gonzalez, Bukola Salami, Lauren Smith, Sarah Stecko, Eric Tchouaket Nguemeleu, Kathryn E Tiedje, Bilkis Vissandjée","doi":"10.1371/journal.pgph.0007441","DOIUrl":"10.1371/journal.pgph.0007441","url":null,"abstract":"","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007441"},"PeriodicalIF":2.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13649282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139399","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":"Multidrug resistance in bacteria causing community-acquired urinary tract infections among adult outpatients attending primary healthcare facilities in Mwanza, Tanzania.","authors":"Eunice G Emmanuel, Ashura Khamis, Elikana Michael, Dorina Muhizi, James Thomas, Bernard Okamo, Farida I Mkassy, Eveline T Konje, Vitus Silago, Martha F Mushi, Stephen E Mshana","doi":"10.1371/journal.pgph.0005638","DOIUrl":"10.1371/journal.pgph.0005638","url":null,"abstract":"<p><p>Urinary tract infections (UTIs) are a common indication for antibiotic use among adult outpatients in low- and middle-income countries, yet data on community-acquired UTIs (CA-UTIs) and antimicrobial resistance at primary healthcare facilities remain limited. A facility-based cross-sectional study was conducted from May to August 2024 at Igoma and Buzuruga Health Centres in Mwanza, Tanzania. Symptomatic adults without hospitalization within the preceding 30 days or urinary catheterization were enrolled. Clinical and demographic data were collected, and midstream urine specimens were cultured, followed by antimicrobial susceptibility testing using the disc diffusion method. Of 1,005 participants, the median age was 32 years [IQR: 23-49], 727 (72.3%) were female, and 64.3% reported to have been diagnosed with UTI within the previous six months. The median symptom duration before presentation was 8 days [IQR: 5-15]. Culture-confirmed UTI was detected in 221 participants (22.0%; 95% CI: 19.5-24.7), with Escherichia coli (32.9%) and Staphylococcus aureus (24.7%) being the most frequently isolated pathogens. Only 35.7% of culture-confirmed cases are presented with classic urinary symptoms of dysuria, frequency, or urgency. E. coli showed high resistance to ampicillin (93.4%), ciprofloxacin (62.3%), trimethoprim-sulfamethoxazole (60.7%), amoxicillin-clavulanic acid (57.4%), and tetracycline (55.7%); 82.8% were multidrug-resistant and 20.3% exhibited extended-spectrum beta-lactamase phenotypes. Among S. aureus isolates, 64.6% were cefoxitin-resistant, indicating methicillin resistance. CA-UTIs therefore constitutes a substantial burden among adult primary-care outpatients, accompanied by high antimicrobial resistance and frequent atypical clinical presentations. Improved access to UTI diagnostics, strengthened antimicrobial stewardship, and locally informed treatment guidelines are needed, particularly given the high resistance to commonly used empirical antibiotics.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0005638"},"PeriodicalIF":2.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13649018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139631","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":"Impact of cervical cancer-related stigma on screening uptake in Dakar and Kedougou, Senegal: A context-specific stigma index.","authors":"Fatou Bintou Seck, Saria Awadalla, Fatoumata Binetou Diongue, Ibrahima Ndiaye, Omar Gassama, Ndeye Mbombe Dieng, Adja Maguette Diaw, Hilaire Sarr, Victoria Winslow, Ndèye Marème Sougou, Sarah Abboud, Assane Sall, Alexis Claire Klima, Aida Fall, Aida Barro, Blessings Chisunkha, Ahmadou Babana El Alaoui, Aliath Salami, Jon Andrew Dykens, Caryn Elizabeth Peterson, Adama Faye","doi":"10.1371/journal.pgph.0006187","DOIUrl":"10.1371/journal.pgph.0006187","url":null,"abstract":"<p><p>Cervical cancer is a major public health problem, but it can be prevented through screening and treatment of precancerous lesions. The aim of this study was to assess the association between cervical cancer-related stigma and prior cervical cancer screening uptake among women in the Dakar and Kédougou regions of Senegal. A quantitative descriptive and analytical cross-sectional study was carried out in the Dakar and Kédougou regions. The study population consisted of women aged 25-69. Sampling was based on a two-stage cluster sampling methodology. Past participation in screening was self-reported, and an index of stigma was developed to quantify the level of cervical cancer related stigma in the study population. The items used to develop this index covered several domains that have been shown to be powerful predictors of stigma. Data were analyzed with R 4.5.0 software. Logistic regression was performed (5% alpha). A total of 287 women had data on their screening status, with only 15.7% reporting having undergone one or more screenings in the past. The mean age of participants was 36.23, and the majority (68.6%) were married and living in monogamous households. After adjustment for age, marital status and education level, higher stigma scores were associated with lower odds of screening (OR=0.58, 95% CI 0.38-0.83, p = 0.006). Cervical cancer stigma was significantly associated with lower odds of screening uptake. A better understanding of this barrier will enable us to better adapt strategies to combat this disease. Setting up a navigation program for this screening could help improve access to this service by removing the stigma barrier and any other major obstacle to screening. Our stigma index provides a comprehensive assessment of stigma and represents a novel tool that can be adapted for future research, including the evaluation of stigma reduction following implementation of our patient navigation intervention.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0006187"},"PeriodicalIF":2.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13648984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139598","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":"Digital health education needs for women with urinary incontinence in Kigali Rwanda, a phenomenological qualitative study.","authors":"Alexandre Dukundane, Rachel Murekatete, Jimmy Opiyo, Laura Keyser, Jessica McKinney, Rashidah Nambaziira, Robert Ojiambo","doi":"10.1371/journal.pgph.0006703","DOIUrl":"10.1371/journal.pgph.0006703","url":null,"abstract":"<p><p>Urinary incontinence (UI), an involuntary loss of urine, is a widespread pelvic floor disorder affecting 20-50% of women worldwide, with a 21% prevalence in Sub-Saharan Africa. Contributing factors include genetics, childbirth, and chronic conditions, leading to significant physical, social, and emotional challenges such as fear of leakage and isolation. Despite its impact, many affected women lack awareness of UI and available treatments, which include medication, surgery, and pelvic floor muscle training (PFMT). Knowledge gaps and misconceptions persist, hindering timely diagnosis and management. In response to these challenges, healthcare systems in Africa are adopting digital technologies (DTs), including WhatsApp and social media, to facilitate patient education and professional collaboration. Studies indicate that digital platforms can support women in managing UI, particularly through PFMT. However, little is known about women's digital health education needs, barriers, and platform preferences. This study explored these aspects among women with UI in Kigali through a phenomenological qualitative approach across four hospitals: Masaka, Rwanda Military, Kibagabaga, and King Faisal. Using purposive sampling, 20 women aged 20-70 were selected. Data analysis was conducted through thematic analysis using deductive and inductive coding. The findings revealed four key themes. First, there are significant knowledge gaps about UI, necessitating multimodal education to address misinformation and misconceptions. Second, participants regularly use digital devices and the internet, recognizing their benefits and affordability for accessing health information. Third, barriers to digital health education included distrust in the accuracy of online information and financial constraints in maintaining digital devices and internet services. Lastly, participants expressed a strong interest in multimodal digital health education platforms to receive UI-related information. Many women misunderstood UI, often confusing it with aging or other conditions, leading to delayed diagnosis, emotional distress, social withdrawal, financial strain, and reduced quality of life. Although digitally literate, they rarely sought digital health information on UI due to knowledge gaps, financial limitations, and skepticism about online sources. The study underscores the urgent need for accessible and trustworthy digital health education to bridge knowledge gaps, provide support, and enhance UI management among affected women.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0006703"},"PeriodicalIF":2.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13648990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139581","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":"Sex-specific hemostatic responses and alterations of Platelet Distribution Width (PDW) and D-dimer in mild COVID-19, Malaria, and co-infection in a tropical setting: A case-control study in Port Harcourt, Nigeria.","authors":"Erens Spiff Ekprikpo, Stella Urekweru Ken-Ezihuo, Zaccheaus Awortu Jeremiah","doi":"10.1371/journal.pgph.0007465","DOIUrl":"10.1371/journal.pgph.0007465","url":null,"abstract":"<p><p>In malaria-endemic tropical regions, overlapping coagulopathy in COVID-19 and malaria poses management challenges with potential sex differences. This STROBE-compliant case-control study evaluated sex-specific variations in platelet indices and assessed alterations of platelet distribution width (PDW) and D-dimer in mild cases. We studied 220 participants, 55 per group: healthy controls, malaria-positive, COVID-19-positive, and COVID-19 plus malaria co-infected, aged 20-65 years, balanced by sex (22 females and 33 males per group), conducted in Port Harcourt, Nigeria between November 2021 and March 2022. Platelet indices were measured using Sysmex XP-300 and D-dimer and fibrinogen by sandwich-ELISA. Data were analyzed using SAS 9.4 and JMP 14.3. PDW was significantly elevated in all infected groups versus controls: malaria 15.19 ± 1.47 fL, COVID-19 15.17 ± 1.51 fL, co-infection 15.58 ± 1.45 fL versus control 13.27 ± 1.20 fL; F = 25.850, p < 0.001. D-dimer was highest in co-infected group 552.80 ± 402.46 ng/mL; F = 2.816, p = 0.040. Two-way ANOVA showed no significant group×sex interaction for platelet indices but significant interactions for fibrinogen F = 18.42, p < 0.001 and D-dimer F = 3.14, p = 0.026. Sex-stratified analysis showed PDW higher in females in malaria p = 0.012 and co-infection p = 0.033, and D-dimer higher in males only in malaria p = 0.021. No significant correlations were observed between platelet indices and fibrinolytic markers. PDW was consistently elevated across mild infections and sex significantly modified fibrinolytic markers, indicating PDW and D-dimer are accessible indicators of hemostatic alterations in resource-limited tropical settings.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007465"},"PeriodicalIF":2.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13648994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139558","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":"National burden of disabilities in Bangladesh and its socio-demographic correlates: A 2021 cross-sectional analysis.","authors":"Mizanur Rahman, Md Shohel Rana, Gulam Khandaker, Md Mostafizur Rahman, Md Nuruzzaman Khan","doi":"10.1371/journal.pgph.0007463","DOIUrl":"10.1371/journal.pgph.0007463","url":null,"abstract":"<p><p>Disability remains an important public health and social challenge, particularly in low- and middle-income countries (LMICs), including Bangladesh. However, nationally representative evidence on its burden, distribution, and associated factors remains limited. This study estimated the national prevalence and patterns of disability in Bangladesh and examined their sociodemographic correlates. This cross-sectional study analysed data from 155,025 participants in the 2021 National Survey on Persons with Disabilities (NSPD). Disability status (yes or no) was the primary outcome. Explanatory variables were measured at the individual, household, and community levels. Multilevel mixed-effects logistic regression models, stratified by age group (0-17 years [children] and 18-95 years [adults]), were used to examine factors associated with disability. The prevalence of disability was 2.79% (95% CI 2.69-2.91). Physical disability (42.44%) and visual impairment (14.11%) were the most commonly reported types, and 11.60% of persons with disabilities reported multiple disabilities. Overall, disability was more prevalent among males, although sex-specific patterns differed by age. Among children, girls had 31% higher adjusted odds of disability than boys (adjusted odds ratio [aOR] 1.31, 95% CI 1.13-1.52), whereas no significant sex was observed among adults (aOR 1.06, 95% CI 0.95-1.19). In both age groups, the odds of disability increased with years of schooling and household wealth. Among adults, housewives, students, and blue-collar workers had higher odds of disability than agriculture workers. Higher community-level literacy was associated with higher odds of disability among adults, whereas the association was reversed among children. The findings support strengthening community-based disability identification and referral in Bangladesh through existing primary health-care services, particularly in underserved populations and areas. Coordination between the Ministry of Health and Family Welfare and the Department of Social Services could improve access to existing social protection, rehabilitation, and assistive-device services.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007463"},"PeriodicalIF":2.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13648970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139563","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}