BMC Public Health [JOURNAL]
Sun
200 papers
The association between heat waves and pregnancy outcome among women undergoing assisted reproductive technology in Sichuan, China.
Ma T, Hu Y, Tang D … +5 more , Lin Y, Liu H, Long Y, Zuoqiu S, Tang T
BMC Public Health · 2026 Jul · PMID 42402568 · Full text
BACKGROUND: With the increasing frequency and intensity of extreme weather events due to climate change, heat waves have emerged as a significant public health threat. To date, the potential effect of extreme heat wave e...
BACKGROUND: With the increasing frequency and intensity of extreme weather events due to climate change, heat waves have emerged as a significant public health threat. To date, the potential effect of extreme heat wave events, particularly when combined with air pollution, remains poorly understood for pregnancy outcomes among women undergoing assisted reproductive technology (ART). METHODS: A retrospective study included 15,198 women receiving ART and 7519 fresh embryo transfer cycles between 2020 to 2022 at the Reproductive Center of West China Second University Hospital in Chengdu, China. Heat wave, a climate change indicator for extreme temperature events, was calculated based on daily temperature during the period of 85 days prior to oocyte retrieval. All environmental exposure variables, including weather and pollution, were matched geospatially to day 0 to day 85 before oocyte retrieval. Generalized linear model (GLMM) were used to assess the association between environmental exposures and ART outcomes, with secondary analysis using interaction terms between heat waves and individual pollutants. RESULTS: Exposure to one heat wave event was positively correlated with the likelihood of becoming pregnant (+ 34.9% in univariate model and + 34.5% in multivariate model for heat wave events + 1 time) and this association was more pronounced in women under 35 years of age (+ 53.7% heat wave events + 1 time), while no statistical correlation was observed between exposure to two heat wave events and ART outcomes. Additionally, CO exhibited a significant negative association with biochemical pregnancy for women under 35 years old (-66.2% for CO + 1 mg/m), and SO exhibited a significant negative association on biochemical pregnancy rate for women older than 35 years old (-6.5% for SO + 1 μg/m). Results from the interaction model indicated that concurrent exposure to O and two heat wave events was statistical associated with clinical pregnancy (OR = 3.77). CONCLUSIONS: Findings from this study suggest that heat waves could be an important climatic indicator that reflects the impact of extreme weather on pregnancy outcomes among women receiving ART treatment. The synergy between exposure to extreme temperatures and air pollution could be further analyzed to provide deeper insight into the environmental impact on reproductive health.
Multinational cohort study of health perception mismatch trajectories and risks of cognitive decline, depression, and mortality.
Hu X, Wu Z, Zhang X … +7 more , Wang Y, Xie K, Fan Y, Zhang D, Feng D, Bai Y, Zhang Q
BMC Public Health · 2026 Jul · PMID 42402575 · Full text
BACKGROUND: Health perception mismatch is common in older adults, yet its longitudinal patterns and prognostic value remain unclear. This study aimed to identify distinct mismatch trajectories and their associations with...
BACKGROUND: Health perception mismatch is common in older adults, yet its longitudinal patterns and prognostic value remain unclear. This study aimed to identify distinct mismatch trajectories and their associations with depression, cognitive decline, and mortality. METHODS: Data from three longitudinal ageing cohorts-the China Health and Retirement Longitudinal Study (CHARLS), English Longitudinal Study of Ageing (ELSA), and Health and Retirement Study (HRS)-were used to identify health perception mismatch trajectories and evaluate their associations with depression, cognitive impairment, and mortality. Baseline SRH-ADL/IADL interplay was examined within these longitudinal cohorts, while the National Health and Nutrition Examination Survey (NHANES) was retained as an independent external cross-sectional comparison. Associations were evaluated using multivariable regression, structural equation modeling, inverse probability of treatment weighting, causal forests, random-effects meta-analysis, and counterfactual prediction. FINDINGS: Baseline analyses in CHARLS, ELSA, and HRS showed heterogeneous and generally modest SRH-ADL/IADL additive interaction estimates, while NHANES provided an independent external cross-sectional comparison. Three stable perception mismatch trajectories, Mildly pessimistic, Mildly optimistic, and Highly optimistic, were consistently identified across CHARLS, ELSA, and HRS. Despite reporting better SRH, individuals in the Highly optimistic group had poorer baseline health and higher subsequent risks of depression, cognitive decline, and mortality. Counterfactual prediction analyses indicated 13-18% differences in mortality and depression risk between hypothetical trajectory contrasts, with the largest differences observed between the mildly pessimistic and highly optimistic classes, suggesting that discordantly favorable SRH may mark elevated risk. INTERPRETATION: Health perception mismatch trajectories may help identify older adults at elevated health risk. Discordantly optimistic perceptions may mark underlying vulnerability, suggesting that combining subjective and objective assessments could complement existing approaches to risk stratification. However, these observational findings do not establish that modifying health perceptions or trajectory membership would alter subsequent outcomes.
Driving NCD screening at scale: outcomes of a digital, CHW-led hypertension surveillance program in rural Rwanda.
Ntaganda E, El-Khatib Z, Gafirita J … +12 more , Mukamurigo J, Uwinkindi F, Masai J, Manirakiza M, Dukundane A, Tuyishime A, Njunguru J, Okemwa S, Niyonsenga SP, Uwayezu J, Ombiro O, Kalisa R
BMC Public Health · 2026 Jul · PMID 42401860 · Full text
BACKGROUND: Hypertension is the leading risk factor for cardiovascular diseases, with the greatest burden in low- and middle-income countries where access to care and infrastructure for prevention and management is limit...
BACKGROUND: Hypertension is the leading risk factor for cardiovascular diseases, with the greatest burden in low- and middle-income countries where access to care and infrastructure for prevention and management is limited. In Rwanda, community health workers (CHWs) have long played a critical role in improving access to health services. In 2023, the Turambe ('Live Longer') program integrated digitally enabled hypertension screening into Rwanda's community health program across three districts, equipping CHWs with blood pressure monitors and mobile devices loaded with the mUzima mobile application. This study aimed to assess the CHW-led screening process, evaluate the screening cascade from CHW identification to diagnosis confirmation, and determine the factors associated with hypertension diagnosis. METHODS: Data was extracted and socio-demographic and clinical characteristics were analyzed using frequencies and percentages. Chi-square tests assessed associations between diagnosis and patient characteristics, and logistic regression identified factors associated with hypertension diagnosis following referral. RESULTS: The program supported the screening of 499,475 community members representing 55.9% of the population aged 15 years and above. The majority of those screened were female (54.5%) and most were aged 35-44 years (29.6%). Of those screened, 63,291 (12.7%) individuals were found to have elevated blood pressure and were referred to health facilities. Among these referrals, 4,537 (7.2%) completed the referral by visiting a health facility and 2,873 (63.3%) of them were confirmed to have hypertension; 2,218 (48.9%) were newly diagnosed and 655 (14.4%) with a prior diagnosis. Among those who completed referral to health facilities, the proportion of those confirmed to have hypertension increased with age, reaching 71.0% among individuals aged above 65 years. Multivariable analysis showed that increasing age was strongly associated with a hypertension diagnosis, with those aged ≥ 65 years having 3.91 times higher odds (aOR: 3.91; 95% CI: 2.06-7.43) compared to those aged 25-34 years. Male sex was associated with 15% reduced odds (aOR: 0.85; 95% CI: 0.75-0.98) compared to females. CONCLUSION: This digital community-based hypertension screening program achieved substantial population coverage and a relatively high diagnostic yield among those who completed referral, demonstrating the potential of leveraging CHW networks and mobile technology for large-scale NCD detection and monitoring. However, low referral-to-care linkage limits inference on CHW diagnostic accuracy at the population level. Strengthened referral systems and further research into barriers to linkage are needed to translate community screening into timely diagnosis and management.
Correct knowledge of tuberculosis as a determinant of risk perception among patients with type 2 diabetes mellitus in rural Karnataka.
Jacob AM, P MM, Shetty AK
BMC Public Health · 2026 Jul · PMID 42401848 · Full text
BACKGROUND: The prevalence of type 2 diabetes mellitus (T2DM) varies significantly among Tuberculosis (TB) patients from 25.3 to 44% in India. Correct knowledge regarding TB symptoms is a determinant for health-seeking b...
BACKGROUND: The prevalence of type 2 diabetes mellitus (T2DM) varies significantly among Tuberculosis (TB) patients from 25.3 to 44% in India. Correct knowledge regarding TB symptoms is a determinant for health-seeking behaviour among T2DM patients. However, there is limited literature regarding TB knowledge and risk perception among patients with T2DM in rural communities of coastal Karnataka, India. OBJECTIVES: To determine the association of correct knowledge regarding TB among patients with T2DM and their TB risk perception in a rural community in coastal Karnataka. METHODOLOGY: A cross-sectional study was conducted over 18 months in the rural villages under the rural health training centre of a tertiary care private medical college at Dakshina Kannada District, Karnataka, involving 202 T2DM patients. Data were collected via pretested semi-structured questionnaires administered through interviews. Descriptive statistics and chi-square tests were used to analyse demographic variables, TB knowledge and TB risk perception. RESULTS: Among the 202 participants, 116 (57.4%) demonstrated overall correct knowledge regarding TB. Participants with high risk perception showed significantly better recognition of specific TB knowledge components, including airborne transmission (p = 0.013), key symptoms such as cough (p = 0.029), fever (p = 0.049), and weight loss (p = 0.019), as well as awareness of asymptomatic disease (p = 0.003) and extrapulmonary involvement (p = 0.046). They were also more likely to correctly reject misconceptions related to TB transmission.However, overall correct TB knowledge was not significantly associated with perceived risk (χ² = 0.008, p = 0.927). High risk perception was significantly associated with being single/widowed (p = 0.003), higher education (p < 0.001), higher socio-economic status (p < 0.001), skilled occupation (p < 0.001), and a family history of DM (p = 0.008). Age, sex, and duration of DM were not significantly associated with risk perception. CONCLUSION: Although more than half of the participants demonstrated correct TB knowledge, this did not translate into higher perceived risk, highlighting a critical knowledge-perception gap among patients with T2DM. While specific and clinically relevant knowledge components were associated with higher risk perception, general awareness alone was insufficient to evoke a sense of personal vulnerability. Educational strategies should therefore move beyond general information dissemination and focus on personalised risk communication that explicitly links DM with increased susceptibility to TB. Such interventions should emphasise the possibility of asymptomatic disease and promote timely screening and care-seeking behaviour.
Urban-rural dichotomy of emergency medical service demand: spatiotemporal patterns and heterogeneous driving mechanisms.
Wu C, Yu Q, Li Y … +3 more , Huang S, Li C, Luo L
BMC Public Health · 2026 Jul · PMID 42399937 · Full text
BACKGROUND: Persistent urban-rural disparities in emergency medical service (EMS) demand constitute a core challenge to global public health equity. Existing research focuses predominantly on static comparisons of demand...
BACKGROUND: Persistent urban-rural disparities in emergency medical service (EMS) demand constitute a core challenge to global public health equity. Existing research focuses predominantly on static comparisons of demand scale, with limited systematic analysis of spatiotemporal dynamics, shock responsiveness, and heterogeneous driving mechanisms across urban and rural EMS systems. Conventional one-size-fits-all regression models further widen the gap between academic findings and on-the-ground EMS operations. METHODS: Taking Ningbo, China as the case, we defined urban and rural units in full alignment with official EMS response zoning. Using 189,506 validated dispatch records from October 2022 to September 2025 (spanning the exogenous shock of China's COVID-19 policy adjustment), we applied a sequential framework integrating global negative binomial regression (GNBR) and geographically weighted regression (GWR) to compare spatiotemporal patterns and identify system-specific demand drivers. RESULTS: Urban EMS demand showed strong positive spatial autocorrelation (Global Moran's I = 0.47, p < 0.01) with contiguous high-demand clusters, and exhibited marked volatility across monthly, diurnal, and weekly scales alongside high sensitivity to policy shocks. Rural EMS demand displayed weak spatial autocorrelation (Global Moran's I = 0.25, p < 0.01) with scattered small-scale agglomeration, and maintained stable temporal patterns decoupled from external disruptions. Driving mechanisms differed structurally: urban demand was driven primarily by population aging and built environment intensity with significant spatial nonstationarity, while rural demand was shaped by traffic accessibility, localized service hubs, and terrain conditions. Based on these findings, we formalize two distinct EMS demand patterns: spatiotemporal coupling in urban areas and spatiotemporal independence in rural areas. CONCLUSIONS: This study advances theoretical understanding of urban-rural EMS demand heterogeneity beyond superficial scale comparisons. The practice-aligned sequential modeling framework provides a scalable analytical approach for heterogeneous health service research, and delivers evidence for targeted EMS planning, optimized resource allocation, and improved healthcare equity.
Association between household food insecurity and quality of life: a longitudinal study in Northeast Brazil, 2014-2019.
de Oliveira-Silva RT, de Araújo Palmeira P, de Toledo Vianna RP … +2 more , Garcia LRS, Sousa KG
BMC Public Health · 2026 Jul · PMID 42399910 · Full text
INTRODUCTION: There are still some gaps in the knowledge about food insecurity (FI) as a determinant of quality of life (QoL); for example, it is not known whether there is a dose‒response relationship, whether these ass...
INTRODUCTION: There are still some gaps in the knowledge about food insecurity (FI) as a determinant of quality of life (QoL); for example, it is not known whether there is a dose‒response relationship, whether these associations occur longitudinally, and how they behave in a population where the target audience is not composed of people affected by health problems. METHODS: This work prospectively analyzed the association between QoL and FI in individuals living in a socioeconomically disadvantaged Brazilian municipality between 2014 and 2019. This was a longitudinal prospective cohort study involving 225 individuals from families residing in a municipality with high social vulnerability in the northeast semiarid region of Brazil. The present study considered QoL as the dependent variable and food insecurity (FI) as the main independent variable. Multivariate analyses were conducted using mixed-effects regression, separately for each QoL domain. RESULTS: Baseline results showed mean QoL domain scores of 70.62 for Social Relationships, 69.42 for Physical Health, 64.77 for the Psychological domain, and 57.55 for the Environmental domain. Among these, only the Physical Health domain exhibited a statistically significant change at follow-up, with a mean reduction of 2.9 points. Multivariate analysis demonstrated an inverse association between FI and QoL scores in the Psychological and Environmental domains. Under conditions of moderate FI, scores declined by 4.728 points in the Psychological domain (p = 0.041) and 7.610 points in the Environmental domain (p = 0.000) over time. At the severe FI level, these reductions were more pronounced, reaching 9.465 points (p = 0.003) and 10.138 points (p = 0.000), respectively. CONCLUSION: The results presented in this cohort support the hypothesis that the phenomenon of FI was associated with poorer QoL outcomes over time.
Self-medication before and during the COVID-19 pandemic in Türkiye: evidence from national health surveys.
Demi̇rci̇ Ş
BMC Public Health · 2026 Jul · PMID 42399909 · Full text
BACKGROUND: Sociodemographic characteristics, health status, and access to health care are important determinants of health behaviors and may shift during periods of health system disruption such as the COVID-19 pandemic...
BACKGROUND: Sociodemographic characteristics, health status, and access to health care are important determinants of health behaviors and may shift during periods of health system disruption such as the COVID-19 pandemic. This study aimed to examine whether these determinants were associated with self-medication and whether the prevalence of self-medication changed in Türkiye before and during the COVID-19 pandemic. METHODS: This study used data from the Türkiye Health Survey conducted in 2019 (n = 16,253) and 2022 (n = 21,444), which was designed to provide national-level estimates for Türkiye. Descriptive analyses and chi-square tests were used to compare the prevalence of self-medication across survey periods. Multivariable modified Poisson regression models with robust variance were estimated separately for the pre-COVID-19 and during-COVID-19 periods to identify factors associated with self-medication and to estimate adjusted prevalence ratios (aPRs) with 95% confidence intervals. To assess whether associations differed between the two periods, pooled modified Poisson regression models were constructed including an indicator for survey period and interaction terms between the COVID-19 period and selected determinants. The statistical significance of interaction effects was evaluated using global Wald chi-squared tests. RESULTS: The prevalence of self-medication increased significantly from the pre-COVID-19 period (34.9%) to the during-COVID-19 period (38.8%) (p < 0.001). In pooled analyses, self-medication remained more prevalent during the COVID-19 period (aPR = 1.11, 95% CI: 1.08-1.14). Across both survey periods, higher prevalence of self-medication was observed among women, individuals with higher educational attainment, those reporting moderate or severe bodily pain, individuals with long-standing illness, tobacco or alcohol users, and those experiencing unmet health care needs due to waiting lists. Global interaction tests indicated that the associations of educational attainment, age group, and health insurance coverage with self-medication differed significantly between the pre- and during-COVID-19 periods, whereas the associations with gender, long-standing illness, and self-perceived health remained stable. CONCLUSIONS: Self-medication prevalence was higher during the COVID-19-period survey in Türkiye, and the associations between self-medication and several sociodemographic and health-related determinants differed between survey periods. These findings suggest that changes in health care access and perceived health needs occurring during public health crises may be associated with differences in self-medication patterns, highlighting the importance of monitoring self-medication behaviors and supporting vulnerable population groups.
Bridging systems for health equity: a scoping review of municipal-public health partnerships.
Mahani A, Revelli M, Zahid S … +13 more , Ali S, Tymczak A, Safaripour R, Bradley C, Muhajarine N, Fafard P, Shahab S, Diener T, McIntosh T, Cassola A, Husack K, Ihlebæk C, Neudorf C
BMC Public Health · 2026 Jul · PMID 42399907 · Full text
BACKGROUND: Municipalities influence population health outcomes both directly (e.g., fluoridation, road safety, and tobacco control) and indirectly through broader social, cultural, and environmental determinants of heal...
BACKGROUND: Municipalities influence population health outcomes both directly (e.g., fluoridation, road safety, and tobacco control) and indirectly through broader social, cultural, and environmental determinants of health such as housing, transportation, income, and social services. While intersectoral partnerships with public health systems are promoted as a policy tool for addressing complex health inequities, evidence on their models, effectiveness, and outcomes remains limited. METHODS: This scoping review aimed to map the literature on municipal-public health partnerships, with a focus on partnership models, reported outcomes, and the barriers and facilitators shaping their success. From 1,392 records, 105 studies were included. RESULTS: Two broad partnership models emerged: (1) ad-hoc, project-based collaborations, and (2) institutionalized collaborations, including intergovernmental relations, Health in All Policies, and strategic planning arrangements. Barriers included inadequate funding (48 studies), cultural and relational mismatches (33), system fragmentation and data-sharing challenges (32), and additional sub-themes under governance or leadership gaps. Facilitators included community engagement (34), capacity building (33), and sub-themes related to strong leadership or policy champions. Most studies (65%) focused solely on the implementation process of partnerships, while only nine studies (8%) examined health outcomes, reporting associations with improvements in areas such as smoking cessation and transportation equity. Municipal-public health partnerships are diverse yet under-evaluated, with the literature still dominated by process-focused studies and limited outcome or impact assessments. CONCLUSION: Recent evaluation guidance calls for broader outcome, impact, economic, and mixed-methods approaches, not only causal designs, so partnerships can be meaningfully assessed for their contributions to health equity and population health outcomes.
Perceptions of the use of smartwatches for the early detection of cardiac arrhythmias in Saudi Arabia: a cross-sectional study.
AlKhalaf RA, AlKhudair AM, AlMousa WH … +4 more , AlHadab FS, Alshareet FY, AlSultan NH, Elsheikh E
BMC Public Health · 2026 Jul · PMID 42399898 · Full text
BACKGROUND: Smartwatches and other wearable technologies have become increasingly popular for health monitoring, offering potential benefits in the early detection of cardiac arrhythmias such as atrial fibrillation (AF)....
BACKGROUND: Smartwatches and other wearable technologies have become increasingly popular for health monitoring, offering potential benefits in the early detection of cardiac arrhythmias such as atrial fibrillation (AF). Despite their expanding use, limited data exist regarding public perceptions and usage patterns of these devices in Saudi Arabia. Understanding these perceptions is essential to inform strategies for digital health integration and preventive cardiovascular care. OBJECTIVE: This study aimed to evaluate public perceptions, usage patterns, and factors influencing acceptance of smartwatches for early detection of cardiac arrhythmias among adults in Saudi Arabia. METHODS: A cross-sectional study was conducted between May and October 2023 across five major regions of Saudi Arabia. A total of 459 adults aged ≥ 22 years participated through structured face-to-face interviews using a validated questionnaire adapted from prior studies. Descriptive statistics summarized demographic characteristics and usage trends, while Poisson regression analysis identified determinants of positive perceptions toward wearable technologies. RESULTS: Nearly half of the respondents (46.4%) reported using wearable devices for health monitoring, with smartwatches being the most preferred (42.0%). Among smartwatch users, (35.2%) had received notifications of cardiac arrhythmia through their devices. Most participants (76.5%) expressed willingness to use smartwatches for arrhythmia detection, and (48.1%) strongly agreed that wearable technologies could contribute to the early diagnosis and monitoring of arrhythmia. Younger adults (22-51 years) demonstrated significantly more positive perceptions compared to those > 51 years (p < 0.05). Previous experience with wearables was also a significant predictor of favorable perception (p = 0.015). Educational level showed a positive but non-significant trend (p = 0.061), while gender and cardiovascular history were not associated with perception. CONCLUSION: The Saudi public shows a high level of awareness and positive perception toward using smartwatches for early cardiac arrhythmia detection. Younger age and prior experience with wearables were the strongest predictors of acceptance, underscoring the importance of digital literacy and user familiarity. Integrating smartwatches into preventive cardiology and public health initiatives-supported by education and clinical validation-may enhance early arrhythmia detection and promote proactive heart health management in Saudi Arabia.
Maternal metabolic determinants of accelerated infant weight gain in early life: assessing the combined effects of gestational diabetes and pre-pregnancy overweight.
Zhang B, Zhang D, Wu Q … +1 more , Xu R
BMC Public Health · 2026 Jul · PMID 42399897 · Full text
Pre-pregnancy overweight and gestational diabetes mellitus (GDM) increase the risk of accelerated fetal growth, but the effect of their individual or combined exposure on infant growth trajectory remains unclear. Clarify...
Pre-pregnancy overweight and gestational diabetes mellitus (GDM) increase the risk of accelerated fetal growth, but the effect of their individual or combined exposure on infant growth trajectory remains unclear. Clarifying whether these exposures will lead to sustained or time-limited growth patterns is essential for developing tailored, time-sensitive early childhood monitoring strategies.Methods We analyzed a population-based cohort of 16,712 mother-infant pairs from Jiangsu Province (2024) using longitudinal data. Infant weight was measured at birth, 1, 3, and 6 months. Linear mixed effects models were employed to examine the independent and joint associations of pre-pregnancy overweight and GDM with infant weight-for-age z-scores (WAZ), examining how the associations changed with infant age.Results Pre-pregnancy overweight showed a strong, positive association with higher infant WAZ (β = 0.160, 95% CI: 0.130 to 0.191), with no statistically significant change over time (overweight × age interaction: β = 0.005, 95% CI: 0.000 to 0.009; P = 0.060). In contrast, GDM alone had a statistically significant but relatively small initial effect (β = 0.065, 95% CI: 0.031 to 0.100), which significantly attenuated from birth to 6 months (GDM × age interaction: β = -0.008, 95% CI: -0.013 to -0.002; P = 0.006). The combined exposure yielded the highest initial β coefficient (β = 0.217, 95% CI: 0.175 to 0.259) and the most rapid attenuation (combined × age interaction: β = -0.017, 95% CI: -0.023 to -0.010; P < 0.001). At 6 months of age, the adjusted mean WAZ remained highest in the combined exposure group. The combined effect was approximately additive in magnitude (β_combined ≈ β_OW + β_GDM), and additive interaction metrics (RERI = 0.001, 95% CI: -0.112 to 0.114; AP = 0.005, 95% CI: -0.582 to 0.592; S = 1.01, 95% CI: 0.88 to 1.15) indicated no statistical additive interaction, with confidence intervals including the null values.Conclusions Different growth patterns were found in this study: pre-pregnancy overweight showed no statistically significant attenuation over the study period, while GDM's influence was time‑limited. The combined exposure presents peak early risk that moderates over time. Clinically, infants exposed to both maternal pre-pregnancy overweight and GDM (the combined exposure group) should receive the most intensive growth monitoring during the first six months of life. These findings highlight the necessity of developing targeted monitoring protocols and implement risk stratification and personalized interventions based on maternal metabolic profiles.
Economic development and under-five mortality: a global longitudinal analysis of lagged effects and between-country inequalities.
Li D, An W, Liu B … +9 more , Qing Z, Yin Z, Lu Y, Xu Y, Yin D, Li S, Cheng K, Yuan C, Dai Q
BMC Public Health · 2026 Jul · PMID 42399891 · Full text
BACKGROUND: Understanding the relationship between under-five mortality rate (U5MR) and economic development is essential for promoting global child health and advancing health equity. This study analyzed the spatiotempo...
BACKGROUND: Understanding the relationship between under-five mortality rate (U5MR) and economic development is essential for promoting global child health and advancing health equity. This study analyzed the spatiotemporal patterns of U5MR and its associations with macroeconomic indicators from 2000 to 2023. METHODS: Panel data from 158 countries were used to analyze to characterize the spatial distribution of U5MR in 2023 and regional trends in the average annual percent change (AAPC) of U5MR from 2000 to 2023. Spearman correlation analysis, lagged analysis, and panel Granger causality tests were conducted to evaluate the associations and directionality between the U5MR and gross domestic product (GDP), GDP per capita (GDPpc), GDP growth rate, and inflation. RESULTS: In 2023, U5MR remained markedly higher in sub-Saharan Africa than in other regions. From 2000 to 2023, U5MR declined more rapidly in Africa and parts of Asia, whereas declines were slower in Europe and North America. Regional correlation indicated that the AAPC of U5MR was significantly negatively associated with the AAPCs of GDP and GDPpc in Asia (r = -0.505; r = -0.605) and Europe (r = -0.368; r = -0.619), and with the AAPCs of GDP in Africa (r = -0.374). No significant associations were observed in the North America, South America or Oceania. Lagged analyses showed that GDP and GDPpc maintained consistently negative associations with U5MR across all lag periods. In contrast, the significance of the associations of GDP growth rate and inflation with U5MR varied across lag periods. Granger causality tests confirmed a bidirectional relationship between GDPpc and U5MR at the optimal lag order of 4. However, the causal effect from GDPpc to U5MR is not robust to lag order selection. U5MR exerts a unidirectional Granger causal effect on inflation. CONCLUSIONS: This study demonstrates that macroeconomic factors shape U5MR with significant regional disparities and heterogeneous lagged effects. Regional authorities should adopt differentiated strategies: prioritizing economic development in Asia, Europe, and Africa, while implementing health-focused improvement programs in North America, South America, and Oceania. Governments should maintain stable long-term economic and income growth, and increase sustained public investment in child health services and nutrition programs to lower U5MR. Given that lower U5MR drives economic growth, sustaining its decline is a long-term economic priority. TRIAL REGISTRATION: Clinical trial number: not applicable.
Occupational exposure to air pollution and respiratory health among urban street vendors in South India.
Muruganantham P, T S V, Ubaithullah AB … +5 more , Jayaraman N, Sethuraman S, Arasu V, Ravichandran H, Janakiraman B
BMC Public Health · 2026 Jul · PMID 42399879 · Full text
BACKGROUND: Street vending is a non-formal, vital domestic workforce in most developing nations. The street vendors operate in an unregulated environment and are frequently exposed to hazardous environmental pollutants,...
BACKGROUND: Street vending is a non-formal, vital domestic workforce in most developing nations. The street vendors operate in an unregulated environment and are frequently exposed to hazardous environmental pollutants, which is linked to chronic respiratory health problems. However, there is underreporting of this public health problem in literature, creating a blind spot in global health. OBJECTIVE: To assess the association between air quality, occupational exposure characteristics, and pulmonary function among street vendors in an urban community. METHODS: A cross-sectional study was conducted among 298 street vendors in Chennai city, India. Pulmonary function was assessed using peak expiratory flow rate (PEFR) and breath-holding time (BHT). Respiratory symptoms were evaluated using the Modified Borg Dyspnea Scale. Air quality was measured using the Air Quality Index (AQI). Linear regression analysis identified independent variables associated with PEFR. RESULTS: The mean age of participants was 38.5 ± 11.08 years, with 65.4% female. Mean PEFR was 376.1 ± 71.39 L/min, and BHT was 33.32 ± 9.07 s. High prevalence of respiratory symptoms was observed: coughing at work (58.7%) and morning phlegm (44%). Variables negatively associated with the PEFR included years working as a vendor (β=-3.34, p < 0.001), daily outdoor exposure hours (β=-6.48, p < 0.001), annual AQI (β=-1.80, p = 0.002), weight (β=-1.19, p < 0.001), and dyspnea at rest. BHT showed a strong positive association with PEFR (β = 3.03, p < 0.001). Only 2.3% of vendors reported using masks during work. CONCLUSION: Street vendors demonstrate measurable respiratory compromise associated with cumulative occupational exposure to air pollution. Long-term exposure metrics (annual AQI, years of work) were stronger indicators than short-term measures, emphasizing the chronic nature of occupational health risk. Findings underscore the need for targeted respiratory screening, awareness programs, and feasible protective interventions for this vulnerable informal workforce.
The association between healthy eating attitudes and sustainable dietary behaviors among university students: a cross-sectional study.
Berberoğlu HT, Çiftci F, Özkul Erdoğan E … +1 more , Akdoğan Y
BMC Public Health · 2026 Jul · PMID 42399876 · Full text
BACKGROUND: Unsustainable dietary patterns contribute substantially to climate change, biodiversity loss, and the growing global burden of non-communicable diseases. University years represent a critical transitional per...
BACKGROUND: Unsustainable dietary patterns contribute substantially to climate change, biodiversity loss, and the growing global burden of non-communicable diseases. University years represent a critical transitional period during which lifelong eating behaviors are shaped. Understanding whether positive attitudes toward healthy eating are associated with sustainable dietary behaviors may inform integrated public health strategies targeting both health and environmental outcomes. This study examined the relationship between healthy eating attitudes and sustainable nutrition behaviors among Turkish university students and explored associated demographic factors. METHODS: A cross-sectional study was conducted between December 2023 and October 2024 among 610 university students aged 18-26 years. Data were collected using structured self-report questionnaires. Healthy eating attitudes were assessed using the Attitude Scale for Healthy Nutrition (ASHN), and sustainable dietary behaviors were measured using the Behaviors Scale Towards Sustainable Nutrition (BSSN). Non-parametric tests, Spearman correlation analysis, confirmatory factor analysis, and structural equation modelling (SEM) were performed. RESULTS: Participants demonstrated generally high levels of healthy eating attitudes. A weak but statistically significant positive correlation was observed between overall healthy eating attitudes and sustainable dietary behaviors (r = 0.182, p < 0.001). SEM indicated that healthy eating attitudes were positively associated with sustainable nutrition behaviors (β = 0.542, p < 0.001). Non-smokers and female students exhibited significantly higher sustainable nutrition behavior scores compared to smokers and male students (p < 0.05). CONCLUSIONS: Healthy eating attitudes were positively associated with sustainable dietary behaviors among university students. Although the strength of the association was modest, the findings suggest that health-oriented attitudes may support environmentally responsible dietary practices. Public health interventions that integrate sustainability principles into university-based nutrition education and campus food policies may represent a promising strategy to advance both human and environmental health. Longitudinal studies are needed to clarify causal pathways.
Beyond biomedical control: governance, social protection, and system gaps in tuberculosis control in Kazakhstan - a qualitative study of decision-makers.
Aitambayeva N, Aringazina A, Nazarova L … +6 more , Narymbayeva N, Svetlanova S, Mamutova A, Amandikova N, Popova T, Kairatova G
BMC Public Health · 2026 Jul · PMID 42399870 · Full text
BACKGROUND: Tuberculosis (TB) remains a major public health challenge globally and in Kazakhstan, despite progress in reducing incidence. Increasing evidence highlights the role of social and structural determinants in s...
BACKGROUND: Tuberculosis (TB) remains a major public health challenge globally and in Kazakhstan, despite progress in reducing incidence. Increasing evidence highlights the role of social and structural determinants in shaping TB risk, disease progression, and treatment outcomes. However, limited research has explored how decision-makers conceptualize these factors and identify system-level gaps in TB control. This study aimed to examine regional decision-makers' perspectives on TB burden, social protection, health system capacity, and governance in Kazakhstan. METHODS: A qualitative study was conducted using in-depth, semi-structured interviews with 12 decision-makers from six regions of Kazakhstan, including representatives of regional health authorities and local governance structures. Participants were purposively sampled to ensure diversity in institutional roles and geographic context. Interviews were conducted between August and December 2020, audio-recorded, transcribed verbatim, and analyzed using inductive codebook thematic analysis supported by ATLAS.ti software. The study followed COREQ guidelines. RESULTS: Six major themes were identified. Participants consistently framed TB as a condition closely linked to structural inequality rather than solely a biomedical issue. Risk was perceived as concentrated among socially and geographically vulnerable populations, particularly in rural areas with limited access to care. A key finding was the identification of a "biomedical-social gap," whereby strong diagnostic and treatment capacity was perceived as insufficiently connected to social protection, outreach, and governance mechanisms. Participants attributed this gap to fragmented social assistance, uneven support for transport, food, and income-related needs, workforce and infrastructure constraints, inequities in rural access, and insufficient institutionalization of NGO involvement. Sustaining political commitment and non-stigmatizing public awareness was also identified as important for long-term TB control. CONCLUSIONS: Regional decision-makers perceived TB control in Kazakhstan as constrained by fragmented linkages between biomedical services, social protection, NGO outreach, rural access support, and intersectoral governance mechanisms. Strengthening patient-centered social support and coordination across clinical, social, and civil society sectors may help reduce perceived fragmentation and support more equitable TB control.
Epidemiology of Neisseria gonorrhoeae in Jordan: prevalence, incidence, and clearance from a national laboratory dataset, 2014-2025.
Abu-Dayyeh I, Al Tibi A, Ghunaim M … +4 more , Hasan T, Abdelnour A, Abu-Raddad LJ, Chemaitelly H
BMC Public Health · 2026 Jul · PMID 42399865 · Full text
BACKGROUND: Gonorrhea is a global public health priority due to substantial morbidity, sustained transmission, and increasing antimicrobial resistance; however, its epidemiology in Jordan and other settings with limited...
BACKGROUND: Gonorrhea is a global public health priority due to substantial morbidity, sustained transmission, and increasing antimicrobial resistance; however, its epidemiology in Jordan and other settings with limited surveillance and research, such as in the Middle East and North Africa, remains inadequately characterized. METHODS: Data from 8,779 individuals aged ≥ 15 years tested for current Neisseria gonorrhoeae (NG) infection at Biolab Diagnostic Laboratories in Jordan between 2014 and 2025 were analyzed. A cross-sectional design was used to estimate prevalence, assess temporal trends, and identify factors associated with infection among all 8,779 individuals. Retrospective cohort designs were used to assess incidence among 784 individuals and, exploratorily, clearance among 5 individuals with repeat testing. RESULTS: NG prevalence, defined as ever having a NAAT-positive test, was 0.4% (95% CI: 0.2-0.5%) overall and 0.1% (95% CI: 0.0-0.2%) among individuals tested for visa-related requirements. Corresponding point prevalence, based on one randomly selected test per individual, was 0.3% (95% CI: 0.2-0.5%) and 0.1% (95% CI: 0.0-0.2%), respectively. NG positivity was substantially higher in clinically motivated testing compared with visa-related testing and among individuals with more frequent testing. No consistent patterns were observed by age, sex, or governorate, and there was no evidence of a temporal decline. In the retrospective cohort, three incident infections were identified over 1,167 person-years of follow-up, yielding a cumulative incidence of 0.49% (95% CI: 0.16-1.53%) after two years of follow-up and an incidence rate of 2.57 per 1,000 person-years (95% CI: 0.83-7.97). In exploratory analysis, nearly all individuals with follow-up after a positive test had a subsequent negative result within 10 days. CONCLUSIONS: Observed NG prevalence and incidence rate in Jordan were low. However, high positivity in clinically motivated testing contexts and the absence of a temporal decline indicate ongoing transmission that requires control. Strengthening surveillance, expanding targeted testing and treatment among higher-risk populations, and integrating NG antimicrobial resistance monitoring are needed to inform prevention and control efforts.
Formative research on a post-discharge monitoring program using SQ-LNS to reduce acute malnutrition relapse risk in Mali : a qualitative study.
Heymsfield G, Kangas ST, Cichon B … +7 more , Coulibaly IN, Diarra NH, Diassana K, Haidara A, Ouologuem B, Diarra S, Kodish S
BMC Public Health · 2026 Jul · PMID 42399850 · Full text
INTRODUCTION: Up to 75% of children treated for severe acute malnutrition (SAM) relapse within six months of recovery, yet evidence on post-discharge interventions remains limited. We conducted a formative assessment to...
INTRODUCTION: Up to 75% of children treated for severe acute malnutrition (SAM) relapse within six months of recovery, yet evidence on post-discharge interventions remains limited. We conducted a formative assessment to understand how small-quantity lipid-based nutrient supplements (SQ-LNS) could be integrated in post-discharge care to prevent relapse. OBJECTIVE: This study aimed to inform whether and how a program integrating SQ-LNS into post-discharge monitoring could be implemented in Mali. Specifically, we aimed to: 1) identify barriers and enablers to post-discharge monitoring, 2) develop one or more post-discharge models based on recommendations, 3) understand the feasibility of these model(s), 4) describe acceptability of the model(s) and product, and 5) propose a final model to be piloted at larger scale. METHODS: This formative study comprised two iterative phases conducted between September 2024 and May 2025. In exploratory Phase One, we conducted semi-structured interviews with 12 caregivers of children with SAM and eight treatment providers, in triangulation with 13 focus groups among caregivers, health care workers (HCW's), and supervisors. Themes included current practices, anticipated challenges, and service delivery preferences. Findings informed a confirmatory Phase Two involving four direct observations of three delivery models implemented at four sites and 13 interviews with similar participants. Textual data were coded and thematically analyzed using Dedoose software. RESULTS: Although national guidelines recommend routine post-discharge monitoring for SAM children, it was rarely practiced due to limited awareness among HCW's. Both caregivers and HCW's supported the idea of post-SAM monitoring, preferring on-site over home visits for feasibility. Caregivers valued growth monitoring, interacting with HCW's, and nutritional supplementation. While unfamiliar with SQ-LNS, caregivers viewed it positively based on their experience with therapeutic foods. Three delivery models were tested: (1) weekly visits for one month transitioning to fortnightly thereafter, (2) fortnightly visits and program days, and (3) fortnightly visits for caregivers and weekly program days at the health site. Model three proved most feasible for caregivers and providers. CONCLUSION: This formative research informed a program design that aligns with caregiver preferences and health system capacity, requiring minimal external support. Fortnightly post-discharge monitoring paired with SQ-LNS supplementation at treatment sites is recommended.
Behavioral and psychosocial factors associated with coadministration of COVID-19 and influenza vaccines among the elderly.
Seo S, Jo S, Kim H … +7 more , Lee S, Jeong HS, Lee JW, Kim AR, Kang MJ, You M, Kim DH
BMC Public Health · 2026 Jul · PMID 42399847 · Full text
BACKGROUND: Health authorities recommend adults aged 65 years and older receive COVID-19 and influenza vaccines at the same visit to improve vaccine uptake in this high-risk group. However, it remains unclear how widely...
BACKGROUND: Health authorities recommend adults aged 65 years and older receive COVID-19 and influenza vaccines at the same visit to improve vaccine uptake in this high-risk group. However, it remains unclear how widely older adults have accepted this recommendation in practice. METHODS: Using data from the Korea Seroprevalence Study of Monitoring of SARS-CoV-2 Antibody Retention and Transmission, we examined coadministration uptake and factors associated with its acceptance among 2,860 community-dwelling Korean adults aged 65 years or older who received the 2023-2024 influenza vaccine. Verified vaccination and infection records from the Korea Disease Control and Prevention Agency were linked with survey responses on psychological antecedents of COVID-19 vaccination. Vaccination behavior was categorized as coadministration, separate visit vaccination, or influenza-only vaccination. RESULTS: Overall, 15.0% received both vaccines at the same visit, while 43.3% received them on separate days. Prior receipt of both vaccines was the strongest predictor of coadministration (OR, 2.59; 95% CI, 1.70-3.95). Higher confidence in COVID-19 vaccination (OR, 1.30; 1.12-1.50) and lower complacency (OR, 0.81; 0.73-0.91) were associated with coadministration uptake. CONCLUSIONS: These findings highlight the need for targeted efforts to build trust and communicate the safety and convenience of coadministration to improve uptake among older adults.
Provider perspectives on barriers to medico-legal service provision for sexual violence survivors in Kenya: a qualitative interview study.
Rockowitz S, Sidhar E, Kanja W … +1 more , Flowe HD
BMC Public Health · 2026 Jul · PMID 42399843 · Full text
BACKGROUND: Medico-legal services are essential for supporting survivors of sexual violence and facilitating access to justice. Unfortunately, their provision remains a challenge in many low-resource settings. In Kenya,...
BACKGROUND: Medico-legal services are essential for supporting survivors of sexual violence and facilitating access to justice. Unfortunately, their provision remains a challenge in many low-resource settings. In Kenya, high prevalence of sexual violence contrasts sharply with low rates of case progression and conviction, yet much of the existing evidence is drawn from intervention studies or specific health facilities, limiting understanding of routine medical practice for the general population. This study aimed to explore the perspectives of medico-legal professionals on barriers to delivering effective medico-legal services to sexual violence survivors in both urban and rural Kenya. METHODS: A qualitative descriptive study was conducted using either semi-structured or small group interviews with 21 medico-legal professionals, including clinicians, lawyers, and police officers. Participants were recruited through professional networks and a non-governmental organisation, known as the Wangu Kanja Foundation (WKF). Interviews were conducted in English either online or in person, audio-recorded, transcribed verbatim, and analysed using the Framework Method with an inductive thematic approach. RESULTS: Five key themes emerged: professional journey, operating outside of the norm, case details and procedure, limiting factors, and personal reflections. Participants reported inadequate formal training in sexual violence response, reliance on informal or NGO-led training, and significant shortages of forensic and psychosocial resources. Service provision was constrained by weak inter-sectoral collaboration, investigation and prosecution delays within the justice system, and public misconceptions about evidence preservation. Provider bias, including victim-blaming attitudes, and substantial emotional burden among professionals were also evident. CONCLUSIONS: Medico-legal professionals in Kenya face multiple interrelated barriers, including inadequate training, limited resources, and systemic constraints that hinder effective handling for sexual violence survivors and contribute to case attrition. Integrating sexual violence training into formal professional education, strengthening multisectoral collaboration, and improving resource allocation may enhance survivor-centred handling and improve medico-legal outcomes.
Association between residential physical environmental exposures and multidimensional successful ageing in the UK biobank.
Zhou J, He L, Wei H … +6 more , Zhao H, Yang Z, Chen H, Afzal S, Liu C, Luo B
BMC Public Health · 2026 Jul · PMID 42399841 · Full text
BACKGROUND: Successful ageing is a global priority, yet the impact of the physical environment on this multidimensional process is not fully understood. Previous research has predominantly focused on isolated exposures o...
BACKGROUND: Successful ageing is a global priority, yet the impact of the physical environment on this multidimensional process is not fully understood. Previous research has predominantly focused on isolated exposures or specific diseases, overlooking the complex physical "exposome." We aimed to evaluate the associations between a comprehensive array of environmental exposures and a holistic Successful Ageing Index (SAI). METHODS: In this cross-sectional study of 28,090 UK Biobank participants aged ≥ 60 years, we constructed a continuous SAI integrating 11 indicators across cognitive, physical, psychosocial, and disease domains. Fourteen residential environmental exposures-including air pollutants, noise, and natural environments-were assessed. We used multivariable linear regression, restricted cubic splines, and mediation analyses to evaluate independent associations, non-linearity, and biological pathways. RESULTS: In crude models, most air pollutants were negatively associated, and natural environments positively associated, with the SAI. However, after extensive adjustment for sociodemographic and lifestyle factors, associations with natural environments were largely attenuated. Conversely, PM (β = -0.15; 95% CI: -0.27, -0.04; P = 0.010, per 1-SD increase), No (β = -0.14; 95% CI: -0.26, -0.02; P = 0.022, per 1-SD increase) and NO (β = -0.16; 95% CI: -0.28, -0.05; P = 0.005, per 1-SD increase) remained significantly and independently associated with a lower SAI. These adverse effects were most pronounced in the physical and psychosocial domains and were stronger among males and individuals with lower socioeconomic status. Non-linear dose-response relationships were observed for NO and greenspace. Mediation analysis identified chronic inflammation and metabolic dysfunction as significant biological pathways linking air pollution to reduced successful ageing. CONCLUSION: Higher baseline residential traffic-related air pollution indicators were associated with lower multidimensional SAI in this cross-sectional analysis, after adjustment for sociodemographic and lifestyle factors. These findings suggest that reducing traffic-related air pollution may be relevant to population healthy ageing, although longitudinal studies are needed to determine whether such interventions can extend healthy lifespan or reduce late-life morbidity.
Assessment of hepatitis B and tetanus toxoid vaccination coverage and associated factors among healthcare workers at Kabul University of Medical Sciences affiliated hospitals in Afghanistan.
Golzareh P, Shahim S, Usmani N … +3 more , Mann EM, Sabawoon A, Yousofzai MS
BMC Public Health · 2026 Jul · PMID 42399840 · Full text
OBJECTIVE: Hepatitis B and tetanus remain significant public health challenges in Afghanistan, a developing country where vaccination coverage is suboptimal. Healthcare workers are particularly at risk due to their expos...
OBJECTIVE: Hepatitis B and tetanus remain significant public health challenges in Afghanistan, a developing country where vaccination coverage is suboptimal. Healthcare workers are particularly at risk due to their exposure to infected blood and bodily fluids, and they play a vital role as health role models; however, their vaccination rates for hepatitis B and tetanus are often inadequate, risking both their health and potential transmission to patients. This study aimed to assess the vaccination coverage and associated factors among health personnel in teaching hospitals affiliated with Kabul University of Medical Sciences, providing insights to inform strategies for improving immunization practices and occupational safety. METHODS: A cross-sectional study was conducted at three teaching hospitals affiliated with Kabul University of Medical Sciences. The study sample included medical personnel (physicians, nurses, midwives, laboratory technicians, and other clinical staff) actively engaged in patient care with direct exposure to blood or bodily secretions. Demographic and vaccination information were gathered from them using questionnaires. Descriptive statistics and logistic regression were performed using Stata version 18.0. RESULTS: A total of 284 professional staff members from the three teaching hospitals of Kabul University of Medical Sciences participated in this study from 20 December 2024 to 20 March 2025. The majority were male (52.8%), with ages ranging from 19 to 62 years. Hepatitis B vaccination coverage was 57.8% (full) and 67.3% (partial or full); tetanus toxoid vaccination coverage was 45.5% (full) and 49.3% (partial or full). Factors associated with hepatitis B vaccination included profession and work experience. Tetanus vaccination was strongly associated with gender and profession, with a trend toward higher odds among those with higher income. The most commonly cited reason for non-vaccination was lack of access (48.4%), including geographical barriers, unavailability of vaccines at health facilities, and cost. CONCLUSION: Hepatitis B and tetanus vaccination coverage among healthcare workers in Kabul was suboptimal but comparable to that reported in other developing countries, with distinct factors driving uptake for each vaccine. Despite near-universal positive attitudes toward vaccination, the primary barrier was lack of access, highlighting systemic gaps in occupational health services. Institutional vaccination programs with free, on-site access are needed to protect healthcare workers and their patients. Further studies with larger samples across diverse settings are needed to confirm these findings.
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