PLOS global public health最新文献

{"title":"Barriers to viral suppression in children aged 9 years or younger on dolutegravir-based antiretroviral therapy in Malawi, a mixed-methods study.","authors":"Khumbo Phiri, Christine Hagstrom, Eric Lungu, Kelvin Balakasi, John Songo, Amos Makwaya, Deanna Smith, Anteneh Worku, Risa Hoffman, Sam Phiri, Kathryn Dovel, Joep J van Oosterhout","doi":"10.1371/journal.pgph.0004510","DOIUrl":"10.1371/journal.pgph.0004510","url":null,"abstract":"<p><p>After the transition to pediatric dolutegravir-based regimens, viral load (VL) suppression among children with HIV (CWH) in Malawi has remained suboptimal. This mixed-methods study assessed factors associated with high VL among young CWH on dolutegravir-based antiretroviral therapy (ART) and explored adherence barriers from primary-caregiver and healthcare worker perspectives. Between April-July 2023, we performed an unmatched case-control study at 49 Malawian health facilities. We included CWH aged ≤9 years, on dolutegravir-based ART, with a routine VL test-result that was high (≥1,000 copies/mL) for cases, or suppressed (<200 copies/mL) for controls. Using mixed-effect modified Poisson regression, we determined factors associated with high VL, adjusting for sex, site and district. To assess adherence barriers, we conducted in-depth interviews (IDIs) with randomly selected caregivers of CWH with high VL and with healthcare workers providing pediatric HIV care. Data were analyzed using a hybrid thematic approach that combined deductive and inductive coding strategies. We enrolled 538 CWH: 222 cases, with high VL and 316 controls, with suppressed VL. Duration on ART > 4 years (aRR = 0.86, 95% CI: 0.77-0.95) and ≥2 interruption in treatment episodes (≥28 days late for clinic appointment) in the 12 months before VL sample collection (aRR = 1.47, 95% CI: 1.28-1.68) were significantly associated with high VL. Through 54 IDIs (30-caregivers, 24-healthcare workers), five key adherence challenges were identified and affected the children ≤5 years the most: resistance to daily medication, difficulties taking multiple pills, food insecurity, fear of unintentional disclosure, and inability to attend clinic appointments consistently. This study highlights that behavioral, socio-economic and psychosocial factors influences ART adherence among CWH. Duration on ART and recent interruptions in treatment were associated with high VL, stressing the need for targeted interventions that will require health-system and client-level approaches to improve VL suppression among CWH in Malawi and similar settings.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 5","pages":"e0004510"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12124501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188606","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":"Death of backcountry winter-sports practitioners in avalanches - A systematic review and meta-analysis of proportion of causes of avalanche death.","authors":"Guang Rong, Lauri Ahonen, Gerit Pfuhl, Benjamin Ultan Cowley","doi":"10.1371/journal.pgph.0004551","DOIUrl":"10.1371/journal.pgph.0004551","url":null,"abstract":"<p><p>This study estimates the proportions of the three major causes of avalanche death globally, and reviews potential factors influencing the proportions of causes of avalanche-related deaths (PCAD). By searching databases and consulting experts, we retrieved studies and registries in multiple languages, which examined PCAD. As a result, we retrieved 1,415 reports and included 37 for the study (22 for meta-analysis). We performed a meta-analysis to estimate pooled proportions. Between-study heterogeneity was assessed jointly by [Formula: see text] and 95% prediction interval of pooled estimates. PCAD by trauma and asphyxia are 29% (95%CI 21-39%) and 82% (95%CI 72-88%), after the year of 2000. PCAD by hypothermia is 2% (95%CI 1-4%), estimated with studies having sufficient sample size. Time periods (before or after 2000), data representativeness (national subgroup), forensic procedures, and sample size explained between-study variation for proportions to a considerable extent. Factors influencing PCAD, that were either available or not available for quantitative synthesis, were summarized in a narrative systematic review (37 studies). In conclusion, we re-affirm asphyxia as the predominant cause of avalanche death, followed by trauma, and then hypothermia. Patterns of PCAD by trauma and asphyxia varied more after the year of 2000. A sample size > 75 is needed to estimate the proportion of hypothermia. PCAD discrepancies are lower in the data representing fatalities from a country than from regions. Without proper forensic diagnosis procedure, PCAD by trauma can be over-estimated. Under-reporting of forensic diagnostic criteria is an important bottleneck to the reliability of evidence in the field. Evidence on the role of other influencing factors to PCAD such as fatalities' expertise and usage of mitigation gear is anecdotal and warrants further research. The results of meta-analysis build upon synthesizing and summarizing studies with moderate to high risk of bias and should be interpreted with caution.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 5","pages":"e0004551"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12124587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188607","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":"Neurodevelopmental delay and associated factors among preterm infants aged 6 to 24 months adjusted gestation age in two urban hospitals in Uganda.","authors":"Joyce Nalwoga, Victoria Nakibuuka, Leonard Manirakiza, Tracy Tushabe Namata, Robert Sebunya","doi":"10.1371/journal.pgph.0004361","DOIUrl":"10.1371/journal.pgph.0004361","url":null,"abstract":"<p><p>Neurodevelopmental delay has been reported among preterm infants who survive beyond the neonatal period. However, there is paucity of data regarding neurodevelopmental outcomes in preterm infants in Africa, including Uganda. This study aimed to determine the prevalence and factors associated with neurodevelopment delay (NDD) in preterm infants aged 6-24 months of adjusted gestation age. A cross-sectional study was conducted among 206 preterm infants, aged between 6 and 24 months of adjusted gestation age in the preterm follow up clinics at St. Francis Hospital Nsambya and Mulago Specialized Women and Neonatal Hospital in Kampala-Uganda from 25th January 2021-25th January 2022. The prevalence of NDD was 13.6% (28/206), with social delay comprising 12.1% (25/206), fine motor delay 11.7% (24/206), language delay 10.7% (22/206) and gross motor delay 7.8% (16/206). Significant factors associated with NDD included microcephaly [aPR = 6.2, CI: 2.6-33.5, P < 0.001], severe acute malnutrition (SAM) [aPR = 4.6, CI: 1.87-12.56, P = 0.021], incomplete immunization [aPR = 2.8, CI: 1.23-4.76, P = 0.013], neonatal sepsis [aPR = 3.8, CI: 1.1-9.3, P = 0.026], neonatal hypoglycemia [aPR = 6.2, CI: 1.8-16.4, P = 0.002], lack of caretaker social support [aPR = 8.3, CI: 2.43-37.9, P = 0.002] and large family size (≥5 children) [aPR = 6.8, CI: 2.24-22.7, P = 0.002]. NDD affects 13.6% of preterm infants, with the social and fine motor delays being most prevalent. Modifiable factors like malnutrition, lack of caretaker social support and incomplete immunization should be screened and addressed to reduce NDD among preterm infants in Uganda.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 5","pages":"e0004361"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181378","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":"Exploring gender stereotypes and norms among peri-urban very young adolescents in Zimbabwe using participatory and qualitative approaches.","authors":"Owen Nyamwanza, Tariro S Bikwayi, Tariro Chinozvina, Leviticus Makoni, Farai Muronzi, Maxwell Changombe, Angela Obasi, Talent Makoni, Sinokuthemba Xaba, Owen Mugurungi, James R Hargreaves, Frances M Cowan, Webster Mavhu","doi":"10.1371/journal.pgph.0003845","DOIUrl":"10.1371/journal.pgph.0003845","url":null,"abstract":"<p><p>Gender stereotypes and norms shape very young adolescents' (VYAs, 10-14 years old) behaviours, including in relation to sexual and reproductive health (SRH). This formative study sought to determine and prioritise the stereotypes and norms to be targeted as part of work to co-develop a gender-transformative intervention for VYAs in Zimbabwe to promote positive masculinities and SRH. In 2023, we collected data from VYAs, using participatory workshops encompassing various activities. We also held focus group discussions with older adolescents and parents/guardians, and individual interviews with community influencers. We used interpretive thematic analysis to generate themes across data. We later presented research findings to diverse stakeholders to explore how the findings might influence the design of our gender-transformative intervention. Gender stereotypes emerged in relation to sexual behaviour and SRH norms. Both boys and girls seemed to condone boys' multiple, concurrent relationships. Boys were deemed to be unable to control their sexual urges. Menstrual stigma, myths and misconceptions were pervasive. Stereotypes were also evident in beliefs and norms around resource and task allocation. For example, both boys and girls concurred that given limited resources, educating a boy child should be prioritised even when a girl sibling is performing better academically. Stereotypes relating to labour distribution were also evident. Daily activity charts suggested longer working hours for girls. Differential attitudes towards drug and substance use among boys and girls were driven by underlying masculine norms. Of note, adolescents disapproved of some of these norms, pointing to an opportunity to shift them. Stakeholders highlighted the need for our planned intervention to focus on the wider community, in addition to VYAs themselves. The formative research enabled us to identify key gender stereotypes and norms, information which is critical for informing the planned gender-transformative intervention. Although deeply seated, these stereotypes are not insurmountable, particularly among VYAs.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 5","pages":"e0003845"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183370","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":"HIV prevalence, risk factors, prevention methods, and interventions among taxi drivers and commercial motorcyclists in sub-Saharan Africa: A scoping review.","authors":"John Baptist Asiimwe, Benjamin Betunga, Lilian Birungi, Joy Kabasindi Kamanyire, Moses Wankiiri, Lilian Nuwabaine, Joseph Kawuki, Edward Kumakech","doi":"10.1371/journal.pgph.0004239","DOIUrl":"10.1371/journal.pgph.0004239","url":null,"abstract":"<p><p>Transport workers, particularly taxi drivers and commercial motorcyclists, comprise a population at high risk for HIV and account for nearly one-third of new HIV infections in sub-Saharan Africa (SSA). Transport workers bridge HIV infections from high-risk populations to the general population. This scoping review aimed to map the available evidence around HIV prevalence, risk factors, prevention methods, and interventions among taxi drivers and commercial motorcyclists in SSA. This scoping review used the Arksey and O'Malley framework. Published articles were retrieved from MEDLINE, CINAHL, African Index Medicus, Web of Science, Scopus, EMBASE, HINARI, and Google Scholar from January 2000 to August 2024. Two authors screened the titles and abstracts of retrieved studies and examined the references of relevant articles for additional literature. Three authors independently extracted data from the included studies using a standard data extraction form. Data were analyzed using descriptive statistics and content analysis techniques. This review included 24 out of 126 studies. The HIV prevalence was 2.02%-9.9% among commercial motorcyclists and reached 33.4% in samples comprising both motorcyclists and taxi drivers. The high HIV infection rate in SSA when compared with the global adult general population was associated with numerous behavioral (e.g., multiple sex partners), psychosocial (e.g., stigma), and sociodemographic (e.g., age) risk factors. However, there was suboptimal use of HIV prevention methods such as safe male circumcision (20.7%-64.9%) and condoms (26%-45.7%) and few interventional studies (n = 2). Despite HIV testing being an entry point for chronic care, we found no study reporting the HIV cascade for commercial motorcyclists or taxi drivers with HIV. To inform better HIV policies and programs in SSA this review recommends additional observational and interventional research on HIV incidence, predictors, new models of HIV testing, antiretroviral-based HIV prevention methods, and the role of peer-to-peer support models in reducing HIV infection.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 5","pages":"e0004239"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182882","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":"Dietary diversity insufficiently explains differences in prevalence of anaemia in pregnancy across regions in Nigeria: A secondary analysis of Demographic and Health Survey 2018.","authors":"Ochuwa Adiketu Babah, Diana Sagastume, Opeyemi Rebecca Akinajo, Giulia Scarpa, Claudia Hanson, Elin C Larsson, Bosede Bukola Afolabi, Lenka Beňová","doi":"10.1371/journal.pgph.0004540","DOIUrl":"10.1371/journal.pgph.0004540","url":null,"abstract":"<p><p>The prevalence of anaemia in pregnancy differs across regions worldwide. Previous studies have reported associations between diet and anaemia. Dietary intake may be affected by regional factors like culture, food production and availability. However, in Nigeria, the association between dietary diversity and region in the context of anaemia prevalence among pregnant women is unclear. This study compared the prevalence of anaemia in pregnancy across regions in Nigeria and determined the association between dietary diversity and anaemia across the regions. It was across-sectional study of 1,525 pregnant women aged 15-49 screened for anaemia in Nigeria's Demographic and Health Survey 2018. The primary outcome was anaemia (haemoglobin concentration < 11g/dl, irrespective of trimester). The explanatory variable was minimum dietary diversity for women (MDD-W) defined as the consumption of at least five out of ten food groups on the day preceding the interview, stratified by region. Logistic regression analyses were used to determine the association between dietary diversity and anaemia in pregnancy by region. The prevalence of anaemia in pregnancy was 61.1% and it ranged from 55.2% in South-West to 71.1% in South-East region, p = 0.038. Less than half of pregnant women met the MDD-W requirement (45.8%). There was a significant crude association between MDD-W and anaemia, OR: 0.78 (95%CI: 0.60 - 0.99), which was lost when confounders were included, aOR: 0.85 (95%CI: 0.66-1.10). Compared to North-West region, anaemia in pregnancy was significantly higher in North Central region aOR:1.90 (1.14-3.16). The model with an interaction term between MDD-W and region was not a better fit for the data (LRtest p < 0.001) in multivariable model. In conclusion, the prevalence of anaemia in pregnancy is high in Nigeria and varies across regions, not only due to dietary diversity. Region is not an effect modifier of the association between MDD-W and anaemia.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 5","pages":"e0004540"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183462","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":"Healthcare workers' perspective about barriers and facilitators to pediatric HIV status disclosure in eastern Uganda using capability opportunity and motivation of behavior change model.","authors":"Joseph Kirabira, Godfrey Zari Rukundo, Brian C Zanoni, Celestino Obua, Edith Wakida, Christine Etoko Atala, Naume Etoko Akello, Keng-Yen Huang, Scholastic Ashaba","doi":"10.1371/journal.pgph.0004662","DOIUrl":"10.1371/journal.pgph.0004662","url":null,"abstract":"<p><p>HIV status disclosure by caregivers to children and adolescents living with HIV (CALH) remains a public health concern in countries with a high burden of HIV despite guidelines for healthcare workers (HCWs) to facilitate the process. This study explored barriers and facilitators to HIV disclosure at two referral hospitals in eastern Uganda focusing on the utilization of existing guidelines. In-depth qualitative interviews were conducted among all HCWs involved in the management of CALH at three pediatric HIV clinics. Research assistants collected data using a semi-structured interview guide designed based on the Capability, Opportunity, and Motivation of Behavior change (COM-B) Model. The audio-recorded interviews were transcribed verbatim, analyzed thematically, and categorized based on the COM-B and social-ecological models using the inductive content approach. Sixteen in-depth interviews were conducted among HCWs, including both males and females in equal numbers. The barriers to disclosure involved all five levels of the social-ecological model, while facilitators were at only three levels (individual, interpersonal, and institutional levels). Regarding the capability of HCWs to support disclosure, limited training affected their psychological (knowledge) and physical ability (skills), while awareness of responsibilities enhanced psychological ability. For opportunity, an unstable home environment, limited access to guidelines, and HIV-related stigma were barriers in physical and social environments, while peer support, teamwork, and orphanhood status were facilitators in the social environment. Limited health funding and lack of preparatory procedures affected reflective motivation, while delayed disclosure affected automatic motivation. Conversely, emotional reward and monitoring, checklists, and supervision enhanced the automatic motivation of HCWs toward disclosure. The findings highlighted several potentially modifiable factors that need to be addressed or reinforced to improve HIV disclosure and utilization of existing guidelines. These findings are key in informing stakeholders regarding the development of implementation strategies for improving pediatric HIV disclosure and utilization of existing guidelines in Uganda.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 5","pages":"e0004662"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182565","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":"Incidence of cerebrovascular disease in Peru from 2015 to 2023.","authors":"Diego Maximiliano Guevara Rodríguez, Juan Diego Pichihua Grandez, Fabrizio Valdivia Dianderas, José Del Carmen Sara","doi":"10.1371/journal.pgph.0004559","DOIUrl":"10.1371/journal.pgph.0004559","url":null,"abstract":"<p><p>Cerebrovascular disease (stroke) is one of the leading causes of mortality and disability worldwide, particularly in low- and middle-income countries. This study aims to estimate the incidence of stroke in Peru between 2015 and 2023 using national hospital discharge data provided by the National Health Superintendency. We conducted a mixed ecological study using records of stroke cases reported across various healthcare systems, including the Ministry of Health, Social Security, and private entities. Hospitalizations were categorized according to ICD-10 codes (I60-I64) and stratified by age, sex, and region. Incidence rates were calculated using population projections from the National Institute of Statistics and Informatics. A total of 89,776 hospital discharges for stroke were analyzed, yielding an incidence rate of 3.11 per 10,000 persons over the study period, with a predominance in men and individuals over 60 years of age. Cerebral infarction was the most common diagnosis, particularly among those over 40 years old. Incidence varied significantly across regions, with Lima and Callao consistently exceeding the national average. The results highlight disparities in healthcare access and the need for targeted public health interventions. Our findings provide a 9-year overview of stroke in Peru, offering evidence to estimate hospital bed demand and prioritize preventive and management strategies-particularly in regions with higher vulnerability.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 5","pages":"e0004559"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180330","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":"TB and diabetes in Eswatini: Addressing suboptimal treatment outcomes through integrated services.","authors":"Yael Hirsch-Moverman, Dana Bezuidenhout, Sakthi Senthilvelan, Lobsang Palmo, Debrah Vambe, Ntombifuthi Ginindza, Nonhlanhla Dlamini, Andrea A Howard, Joanne E Mantell","doi":"10.1371/journal.pgph.0004607","DOIUrl":"10.1371/journal.pgph.0004607","url":null,"abstract":"<p><p>Tuberculosis (TB) remains a significant public health challenge in Eswatini, a country with the highest global HIV prevalence. Diabetes mellitus (DM) is increasingly common among people newly diagnosed with TB, contributing to suboptimal TB treatment outcomes, including relapse and death. The DETECT study employed a multi-method approach to assess the prevalence and DM impact on TB treatment outcomes among adults with TB in 10 Ministry of Health facilities in Eswatini, and explore barriers and facilitators to integrating TB/DM services. DM screening was conducted using laboratory-based glycated hemoglobin (A1c) testing, with DM defined as A1c ≥ 6.5% and preDM as A1c 5.7-6.4%. We conducted logistic regression to assess DM's impact on TB treatment outcomes and 40 in-depth interviews with key stakeholders involved with TB services to explore barriers and facilitators to TB/DM service integration. Among the 373 adults diagnosed with TB and tested for DM, 13.4% had DM, 41.8% had preDM, and 44.8% had a normal A1c. The odds of poor TB treatment outcomes were 3.53 times higher (95%CI: 1.72-7.32) among those with DM compared to those without DM, after adjusting for age, HIV status, and new versus previously treated TB, highlighting the need for early DM diagnosis and treatment. Patient education and support, adequate screening resources, and community engagement were identified as facilitators of TB/DM service integration. Barriers included health system financial constraints, a perceived lack of need for exercise, insufficiently trained TB healthcare providers, inadequate supplies, societal stigma, limited patient autonomy in decision-making, and the unaffordability of healthy diets. The study found a high prevalence of DM/preDM among adults with TB in Eswatini, with DM significantly increasing the odds of poor TB treatment outcomes, irrespective of HIV status. The findings underscore the urgent need for enhanced tools and strategies to support healthcare providers in integrating TB and DM services effectively.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 5","pages":"e0004607"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183527","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":"Housing during the asylum process and its association with healthcare utilization for common mental disorders among refugees in Sweden: A nationwide cohort study.","authors":"Charlotta van Eggermont Arwidson, Jessica Holmgren, Kristina Gottberg, Petter Tinghög","doi":"10.1371/journal.pgph.0003987","DOIUrl":"10.1371/journal.pgph.0003987","url":null,"abstract":"<p><p>Refugees and asylum seekers face an increased risk of poor mental health, and evidence shows that housing in the post-migration context plays a crucial role in shaping their mental well-being. Research also suggests that institutional accommodations during the asylum process might be more detrimental to their mental health compared to private accommodations. We aimed to prospectively estimate the associations between housing type during the asylum process (institutional or self-organized accommodations) and healthcare utilization for common mental disorders (CMDs) after being granted a residence permit as a refugee in Sweden. This register-based cohort study includes all asylum seekers aged 18-60 who were granted residence permits in Sweden between 2010 and 2012, totaling 20,396 individuals, of whom 11,694 resided in self-organized housing (EBO) and 8,702 in accommodation centers (ABO). Using a generalized estimating equation (GEE), we estimated the associations between housing type (ABO or EBO) and prescriptions for antidepressants or anxiolytic medication, as well as specialized in- and outpatient visits with a diagnosis of CMDs, over a five-year follow-up period after being granted a residence permit. The adjusted odds ratio (controlled for sociodemographic factors) showed that those who had lived in ABO, compared with EBO, had a greater risk of any antidepressant or anxiolytic prescriptions (OR = 1.32, [1.21-1.44]) as well as any specialized in- or outpatient visits with a CMD diagnosis (OR = 1.41 [1.27-1.52]). Our results demonstrate that former asylum seekers who have lived in institutional housing use more mental healthcare services than those who have lived in self-organized housing, even when potential sociodemographic confounders and mediators are adjusted for. These associations persisted for up to five years after they had received a residence permit, highlighting that when asylum seekers live in institutional housing it is especially important to discuss how health can be promoted during the asylum-seeking period.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 5","pages":"e0003987"},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12118870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175921","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}