2026-04-01
Syeda Saima Alam, Plabon Sarkar, M A Rifat, Sumaiya Jahan, Rokibul Islam, Israt Jahan, Sanjib Saha
Background: Utilization of the maternal continuum of care (CoC)—comprising adequate antenatal care (ANC), skilled birth attendance, and postnatal care (PNC)—is critical for improving maternal and child health outcomes. However, dropout from the CoC remains substantial in Bangladesh, with women discontinuing services at different stages of pregnancy, delivery, and postpartum care. Objective: This study aimed to quantify maternal dropout at each stage of the CoC and identify socioeconomic and demographic factors associated with discontinuity, comparing two nationally representative survey rounds. Methods: Data were drawn from the Bangladesh Demographic and Health Surveys (BDHS) 2017‐2018 and 2022. Women aged 15 to 49 years with a live birth in the preceding 2 to 3 years were included. Completion of full CoC was defined as receiving at least 4 ANC visits, delivering with a skilled birth attendant, and obtaining at least 1 PNC contact within 48 hours of delivery. Predisposing (age, education, parity, religion, and division), enabling (wealth index, media exposure, health care access, and residence), and need factors (terminated pregnancy and desired pregnancy status) were identified using the Andersen Behavioral Model. Survey-weighted multivariable logistic regression models were fitted for each CoC component and overall CoC completion, with interaction terms to assess whether associations differed between survey rounds. Results: Among 8424 mothers, 27.9% (n=2350) failed to complete all components of the maternal CoC. Dropout was highest at the ANC stage (n=4962, 55.7%), followed by PNC (n=3976, 47.2%) and skilled birth attendant–assisted delivery (n=3378, 40.1%). Between survey rounds, overall CoC dropout decreased significantly from 31.9% (BDHS 2017‐2018) to 22.4% (BDHS 2022), reflecting modest improvements in service continuity. Factors significantly associated with higher odds of CoC dropout included lower maternal education (adjusted odds ratio [AOR] 2.70, 95% CI 1.94‐3.77; <.001), higher parity (AOR 2.73, 95% CI 2.12‐3.50; <.001), lower wealth quintiles (AOR 4.04, 95% CI 3.02‐5.41; <.001), and rural residence (AOR 1.40, 95% CI 1.18‐1.67; <.001). Protective factors included older maternal age at delivery (AOR 0.56, 95% CI 0.42‐0.74; <.001) and history of ever-terminated pregnancy (AOR 0.74, 95% CI 0.63‐0.86; <.001). Significant temporal interactions (all <.05) indicated that the strength of associations for education, parity, religion, wealth, media exposure, health care access barriers, residence, and pregnancy desire differed between survey rounds, reflecting changing determinants of CoC engagement amid policy reforms and pandemic disruptions. Conclusions: Maternal, socioeconomic, and geographic factors are strongly associated with discontinuity along the maternal health care continuum in Bangladesh. Statistically significant temporal variations underscore the impact of evolving health policies and system disruptions on maternal service utilization patterns. Targeted, area-specific interventions addressing these determinants across all CoC components are essential to improve maternal health care retention and achieve better maternal and child health outcomes.
2026-04-01
Siyuan Wang, Zhiwei Xu, Gian Luca Di Tanna, Yawen Jiang, Mingsheng Chen, Laura Downey, Stephen Jan, Lei Si
Background: Air pollution continues to impose a substantial health and economic burden in China. Despite recent improvements, national annual average PM2.5 (fine particulate matter) concentrations remain substantially above the levels deemed safe by the World Health Organization (WHO), underscoring the need for more stringent air quality control. Objective: This study aims to quantify the projected health and economic benefits of reducing PM2.5 concentrations in China under the Healthy China 2030 plan. Methods: Using the 2020 ground-level PM2.5 data as a baseline, we projected cause-specific mortality and morbidity outcomes for 337 prefecture-level cities in China from 2020 to 2030 under four policy scenarios: (1) Healthy China 2030 (10% reduction by 2025; 25 µg/m³ by 2030) and the WHO targets of (2) 15 µg/m³, (3) 10 µg/m³, and (4) 5 µg/m³ by 2030. Mortality for noncommunicable diseases, lower respiratory infections, stroke, ischemic heart disease, lung cancer, and chronic obstructive pulmonary disease was estimated using the Global Exposure Mortality Model. Hospitalizations were modeled using log-linear models based on national evidence. Results: In 2020, PM2.5 concentrations across the 337 cities ranged from 7 to 63 µg/m³, with a national annual mean of 32.6 µg/m³. Higher concentration levels were observed in eastern China, particularly in the eastern and southeastern regions. Overall, our analysis accounted for nearly 70% of the total population of China in 2020. Our analysis shows that maintaining PM2.5 at 2020 levels was projected to result in 9.04 million (95% CI 7.70‐10.67 million) attributable deaths, compared with 8.63 million (95% CI 7.42‐10.30 million) under the policy scenario, corresponding to 0.41 million premature deaths averted under the 14th Five-Year Clean Air Plan. Over 2021‐2030, PM2.5-attributable deaths declined from 17.76 million (95% CI 14.21‐20.95 million) under baseline conditions to 15.96 million (95% CI 12.85‐19.15 million) under the policy scenario. Achieving WHO targets would further reduce attributable deaths to 13.99 million (95% CI 11.25‐15.25 million) at 15 µg/m³, 12.86 million (95% CI 10.85‐14.85 million) at 10 µg/m³, and 11.49 million (95% CI 8.96‐13.45 million) at 5 µg/m³. The annual average hospitalizations declined by 21,422 cardiovascular and 26,545 respiratory admissions under the policy scenario, increasing to 41,690 and 51,681 at 15 µg/m³, 51,884 and 64,333 at 10 µg/m³, and 62,146 and 77,073 at 5 µg/m³, respectively. Subsequently, total economic gains reached US $123.7 billion under the policy scenario and increased to US $185.7 billion, US $240.7 billion, and US $306.5 billion under the 15, 10, and 5 µg/m³ scenarios, respectively. Conclusions: Our findings suggest that while the Healthy China 2030 Plan offered substantial health gains, achieving stricter WHO air quality targets could yield 2-3 times greater benefits. These findings will support the future development of stricter evidence-based national air quality standards.
2026-03-31
Michael Nunns, Samantha Febrey, Kieran Becker, Morgan Weiland, Jill Buckland, Rebecca Abbott, Rebecca Whear, Alison Bethel, Liz Shaw, Kate Boddy, Serena Carville, Tamsyn Harris, Jo Thompson Coon, G J Melendez-Torres
Background: Contact tracing (CT), the process of identifying and managing contacts of infected cases, is one public health and social measure that may reduce the spread of infectious diseases. While previous systematic reviews of CT exist, a comprehensive review of both the effectiveness and potential unintended consequences has not been undertaken to our knowledge. Understanding effective CT strategies could help governments and health authorities prepare effectively for emergency epidemic or pandemic situations. Objective: This study aims to systematically review the evidence on the effectiveness of CT across infectious diseases with epidemic or pandemic potential. Effectiveness is measured in terms of impacts on disease transmission, health care use, mortality, or unintended consequences. Methods: We searched 6 bibliographic databases (MEDLINE, Embase, Global Health, CINAHL Ultimate, Cochrane, and Scopus) between November 29 and December 3, 2024, with supplementary citation searching. We sought human studies comparing CT with interventions with no CT or other forms of CT, delivered in the community, in prespecified diseases of epidemic or pandemic potential. We included studies with any measure of disease transmission, related health care use, or unintended consequences of CT and prioritized studies with concurrent comparators. Screening, data extraction, and critical appraisal were performed in duplicate. Due to substantial heterogeneity, a narrative synthesis was performed. This review was informed by meetings with a patient and public involvement and engagement group. Results: After deduplication, a total of 12,816 titles and abstracts were screened, with 198 records assessed for eligibility at full text. Five additional studies were found through supplementary searching. Finally, 88 reports (of 86 studies) were included, of which 57 reports (of 55 studies) were prioritized. Two main routes of transmission were represented: respiratory (tuberculosis [TB], 15 studies; COVID-19, 5 studies) and blood-borne or sexually transmitted infections (STIs; 35 studies, of which 13 were in HIV, and 22 were bacterial or parasitic infections). No evidence was found on vector-borne, direct contact, or food- or water-borne routes of transmission. Evidence was highly heterogeneous, and more than half of the studies had notable methodological limitations. While there was no difference between CT and comparator interventions for most outcomes, there was some evidence of reductions in disease prevalence in TB and for provider-initiated CT to be superior to patient-led approaches in STIs. Only 2 studies reported measures of unintended consequences. Conclusions: We found inconsistent evidence for the effectiveness of CT, focused primarily on TB and on contrasts between provider-initiated CT and patient-led referral in STIs and HIV. High heterogeneity in study design precluded clear assertions regarding optimal strategies for CT, including with respect to relevant subgroups. Future work should consider generalizability of CT mechanisms across contexts, including by route of transmission and from the Global South, and a more thorough account of unintended consequences. Trial Registration:
2026-03-27
Woo-Ri Lee, Sungyoun Chun, Youyoung An, Hyun Seung Choi
Background: With rapid population aging, both traumatic injuries and hearing disability have become increasingly prevalent among older adults. Hearing disability may increase vulnerability to injury through impaired balance, reduced environmental awareness, and functional limitations; however, longitudinal evidence examining the association between hearing disability and injury risk remains limited. Objective: This study aimed to examine the association between hearing disability and the risk of injury among older adults using a quasi-experimental design with propensity score matching (PSM). Methods: This population-based cohort study included individuals aged 60 years and older with hearing disabilities and a matched control group without disabilities using data from the National Health Insurance Service–Senior cohort from 2008 to 2019. Injury admission, defined using codes S00 to S99, was the primary outcome. A quasi-experimental design was applied using PSM at a 1:3 ratio to balance baseline characteristics between the hearing-disabled and nondisabled groups. Cox proportional hazard regression models adjusted for all covariates were used to estimate hazard ratios. Sensitivity analyses were conducted according to disability severity and injury site. Results: The total number of participants was 43,944, with 10,986 (25%) in the hearing-disabled group and 32,958 (75%) in the nondisabled group, thus confirming a 1:3 matching ratio. The PSM results showed that the standardized mean difference values for all covariates were below the absolute value of 0.1, thus indicating that PSM was successfully performed. The incidence of injury admissions was higher in the hearing-disabled group (1567/10,986, 14.3% of patients) than in the nondisabled group (3966/32,958, 12%), and this difference was statistically significant (<.001). During the follow-up period, older adults with hearing disability had a significantly higher risk of injury admission compared with those without hearing disability (hazard ratio=1.21, 95% CI 1.14‐1.28; <.001). The association was stronger among individuals with more severe hearing disability and varied by injury site. Conclusions: Hearing disability in older adults is independently associated with increased injury admission risk, with greater severity conferring a higher risk and variation by injury site. Interventions such as hearing aid provision, targeted traffic safety measures, and enhanced community and family support are warranted to mitigate this burden.
2026-03-26
Saad Alshahrani, Ashraf A El-Metwally, Awad Alshahrani, Badr F Al-Khateeb, Aljohrah Ibrahim Aldubikhi, Khadijah Angawi, Amani Alharthy, Lubna Alnaim, Amal Mousa Zaidan, Raed Aldahash
Background: Renal disease represents a significant and growing public health concern globally and within Saudi Arabia. Despite the increasing burden of noncommunicable diseases, population-based data on the prevalence and determinants of renal disease in Saudi Arabia remain limited. Understanding epidemiology, including prevalence and associated risk factors of renal disease in the context of Saudi Arabia, is essential for designing preventive and early detection strategies. Objective: This study aims to estimate the prevalence of renal disease and to identify sociodemographic, behavioral, and clinically associated factors among adults attending primary health care centers (PHCs) in Riyadh, Saudi Arabia. Methods: A cross-sectional, community-based study was conducted between March 2023 and July 2023 across 48 PHCs within Riyadh, using a consecutive sampling strategy. Adults aged 18 years and older were recruited and completed a validated, interviewer-administered electronic questionnaire assessing sociodemographic characteristics, lifestyle behaviors, and medical history, including comorbid conditions and health care access. Multivariable logistic regression was used to determine factors associated with self-reported renal disease, with results expressed as adjusted odds ratios (AORs) and 95% CIs, ensuring model adequacy and precision. Results: A total of 14,239 participants were surveyed (n=7519, 52.8% female; mean age 41.6, SD 13.2 y). The prevalence of self-reported renal disease (including chronic kidney disease and kidney stones) was 3.5% (n=504). Individuals aged younger than 50 years had higher odds of renal disease (AOR 1.22, 95% CI 1.02‐1.47). Female individuals were more likely to report renal disease than males (AOR 1.51, 95% CI 1.24‐1.84). Participants with health insurance had increased odds (AOR1.74; 95% CI 1.44‐2.11). Smoking was strongly associated with renal disease (AOR 3.07, 95% CI 2.38‐3.96). Other important associated factors included comorbidities such as diabetes (AOR 1.51, 95% CI 1.12‐2.04), hypertension (AOR 2.27, 95% CI 1.67‐3.08), obesity (AOR 12.75, 95% CI 9.97‐16.30), hypercholesterolemia (AOR 1.93, 95% CI 1.43‐2.60), and heart disease (AOR 6.84, 95% CI 5.14‐9.10). Conclusions: This large, community-based cross-sectional study identifies a significant burden of renal disease among adults in Riyadh and highlights several modifiable risk factors that could be targeted in preventive health programs. The findings emphasize the importance of integrating renal health screening within PHCs and strengthening public health strategies addressing obesity, hypertension, and smoking. While the study relied on self-reported data without biomarker or clinical confirmation, potentially underestimating true prevalence and introducing misclassification bias, it provides a crucial population-level baseline that can guide resource allocation and inform the development of nationwide surveillance systems for early detection of renal disease.