Nevin Manimala

Arch Public Health. 2026 Mar 4. doi: 10.1186/s13690-026-01863-w. Online ahead of print.

ABSTRACT

BACKGROUND: The Democratic Republic of Congo (DRC) is recognized as the global epicenter of human Mpox. While vaccination is crucial for outbreak prevention, especially as the disease transitions from zoonotic spillover to sustained human-to-human transmission, comprehensive assessments of vaccination coverage trends across the country are notably absent from the literature. This systematic review and meta-analysis address this gap by providing the first pooled estimate of Mpox vaccine uptake and acceptance in the DRC over a 54-year period (1970-2024). Our study captures critical transitions, including the post-smallpox eradication era and recent global outbreaks, to identify temporal trends, geographic disparities in this high-risk setting.

METHODS: We conducted this review following PRISMA guidelines, systematically searching PubMed, Scopus, ScienceDirect, Web of Sciences, CINAHL, and Embase. Grey literature was also searched to ensure comprehensiveness. Using random-effects models, we calculated pooled estimates for vaccine uptake and acceptance rates, with prespecified subgroup analyses examining variations by: (1) period, (2) geographic region, and (3) type of participants. We quantified heterogeneity using I² statistics and conducted meta-regression to identify predictors of vaccination coverage heterogeneity. A p-value ˂ 0.05 was considered statistically significant.

RESULTS: Our analysis revealed a pooled Mpox vaccine uptake of 20.01% (95% CI: 7.45-43.75) with high heterogeneity (I² = 99.4%, p < 0.001), indicating substantial variability across studies. Vaccine acceptance was higher at 54.17% (95% CI: 20.82-84.16) with high heterogeneity (I² = 97.6%, p < 0.001). Temporal analysis showed a significant decline from 32.30% (95% CI: 14.62-57.75) coverage during 1970-2000 to 1.36% (95% CI: 0.29-6.11) in 2020-2024. Geographic disparities existed, with the Northwest regions achieving 47.11% (95% CI: 13.46-83.61) coverage compared to 5.47% (95% CI: 0.56-37.32) in Eastern conflict-affected zones. Meta-regression identified no significant predictors of coverage heterogeneity.

CONCLUSION: Despite moderate acceptance rates, actual Mpox vaccination uptake in the DRC remains low, with worsening coverage in recent years and substantial regional inequities. These findings underscore the urgent need for context-specific interventions to bridge the intention-action gap in this high-risk setting.

PMID:41782060 | DOI:10.1186/s13690-026-01863-w

Eur J Med Res. 2026 Mar 4. doi: 10.1186/s40001-026-04126-0. Online ahead of print.

ABSTRACT

BACKGROUND: The association of the triglyceride-glucose index, a validated marker of insulin resistance, with specific dietary patterns is unclear.

METHODS: This cross-sectional analysis of NHANES 1999-2018 included 19,016 adults. Logistic regression, restricted cubic splines, and interaction analyses were used to evaluate associations between macronutrient intake and the triglyceride-glucose index. This analysis was designed a priori to evaluate whether a low-carbohydrate, high-fat macronutrient distribution (captured by PEC, PEF, and carbohydrate-to-fat energy ratio) is associated with the TyG index.

RESULTS: Higher quartiles of percentage energy from carbohydrates and carbohydrate-to-fat energy ratio were associated with higher odds of an elevated TyG index, whereas higher quartiles of percentage energy from fat were associated with lower odds. Restricted cubic splines showed a positive linear association for carbohydrate energy and an inverse linear association for fat energy with TyG. Interaction analyses supported that a low-carbohydrate, high-fat pattern correlated with lower fasting triglyceride levels, and mediation analysis indicated that fasting triglycerides explained ~ 49% of the association between carbohydrate-to-fat energy ratio and TyG.

CONCLUSIONS: A low-carbohydrate, high-fat diet was significantly associated with a lower triglyceride-glucose index; this association was primarily mediated by reductions in fasting triglyceride levels.

PMID:41782055 | DOI:10.1186/s40001-026-04126-0

J Cannabis Res. 2026 Mar 5. doi: 10.1186/s42238-026-00412-0. Online ahead of print.

NO ABSTRACT

PMID:41782037 | DOI:10.1186/s42238-026-00412-0

Malar J. 2026 Mar 4. doi: 10.1186/s12936-026-05847-7. Online ahead of print.

ABSTRACT

BACKGROUND: After substantial progress in malaria control, Ethiopia’s Amhara Region experienced a marked resurgence since 2018. The relative contributions of climate variability, environmental context, intervention coverage, and unmeasured factors to this resurgence remain inadequately quantified. This study used a Bayesian spatiotemporal framework to estimate factor associations with malaria incidence, decompose spatial versus temporal climate effects, and identify persistent hotspots.

METHODS: We conducted an ecological district-level panel analysis of 13,944 district-month observations from 166 districts (January 2018-December 2024). Monthly confirmed malaria counts (total, Plasmodium falciparum, P. vivax) were modelled using Bayesian hierarchical negative binomial regression with BYM2 spatial and AR(1) temporal random effects, fitted with integrated nested Laplace approximation. Covariates included lagged rainfall, temperature, NDVI, elevation, and programmatic indicators (ITN ownership, IRS protection, and larval source management [LSM] intensity). Climate covariates were decomposed into between-district (spatial) means and within-district (temporal) deviations. Sensitivity analyses included alternative IRS protection windows and district fixed-effects models.

RESULTS: A total of 5,746,571 confirmed cases were reported (64.3% P. falciparum, 35.7% P. vivax). Mean monthly incidence increased 5.5-fold from 1.19 per 1,000 (2018) to 6.53 per 1,000 (2024), while regional mean maximum temperature showed a small declining trend over the period. In fully adjusted models, higher lagged maximum temperature and rainfall were associated with higher incidence, and elevation was protective. IRS protection, higher ITN ownership, and higher LSM intensity were each associated with lower incidence; effect directions were consistent in within-district sensitivity analyses, although residual confounding and measurement error cannot be excluded. Climate-incidence associations were predominantly spatial (between-district) rather than temporal (within-district), suggesting that geographic ecological suitability explains much of the spatial patterning, rather than temporal warming trends explaining the resurgence. Districts with persistently elevated residual spatial risk (exceedance probability of residual RR > 1.25) clustered in low-elevation western border areas.

CONCLUSIONS: Malaria resurgence in Amhara (2018-2024) occurred alongside strong spatial climatic and elevational gradients and was not consistent with a temporal warming-driven explanation at the regional scale. Remaining unexplained spatiotemporal variation highlights the likely importance of unmeasured drivers (e.g., conflict-related service disruption, vector/insecticide resistance dynamics, and population mobility). Climate-informed, spatially targeted intervention packages prioritizing districts with persistently high residual risk are warranted.

PMID:41782025 | DOI:10.1186/s12936-026-05847-7

Mov Ecol. 2026 Mar 4. doi: 10.1186/s40462-026-00642-0. Online ahead of print.

ABSTRACT

Extreme weather events, such as tropical storms, can pose profound disruption to nearshore marine environments. Although coastal ecosystems are particularly vulnerable to storm impacts, research describing the response of marine taxa to extreme weather remains limited, especially for highly mobile marine predators. In this study, we use acoustic telemetry to investigate the behavioral responses of juvenile white sharks (Carcharodon carcharias) at a Southern California nursery aggregation site to Tropical Storm Hilary in 2023. To aid in these efforts, we developed a novel occupancy modeling approach to statistically account and correct for temporal variations in acoustic receiver performance during disruptive storm conditions. Using detection data from synchronization transmitters, we first estimated the effects of key environmental factors on transmitter detection efficiency, with ambient noise, receiver tilt, and the density of animal transmitters present inside the receiver array emerging as particularly influential predictors. We then leveraged these estimated effects to inform a Bayesian state space model designed to investigate nursery occupancy dynamics, including environmental drivers of nursery emigration. Our results provide evidence of partial nursery evacuation, with over half of tagged sharks temporarily leaving monitored nearshore habitats in response to peak storm conditions. However, most emigrations were short-lived, with all but one shark returning to the aggregation site within three weeks of the storm. Evacuations from nursery habitats were best predicted by falling sea surface temperatures, although increased wave height, declining barometric pressure, and drops in salinity may have served as important secondary flight cues. Our efforts provide a rare opportunity to document the storm response behaviors of a recovering top predator, while also presenting tangible analytical solutions to commonly encountered technical challenges in the field of acoustic telemetry.

PMID:41782015 | DOI:10.1186/s40462-026-00642-0

Malar J. 2026 Mar 4. doi: 10.1186/s12936-025-05752-5. Online ahead of print.

ABSTRACT

BACKGROUND: Maternal malaria and its sequelae, including maternal mortality and neonatal infection, represent a growing public health crisis in Sub-Saharan Africa, often exacerbated by underlying socioeconomic factors. The study seeks to assess the associations between maternal socioeconomic indicators, maternal malaria, and neonatal peripheral parasitaemia in a Nigerian hospital.

METHODS: A cross-sectional analysis of 85 mother-infant pairs was conducted at a hospital in Osogbo, Osun state, Nigeria. Well-structured questionnaires were used to collect maternal demographics, socioeconomic indicators, and preventive practices. Mother, cord blood, and neonatal peripheral blood samples were collected for parasitemia through microscopy. Descriptive statistics, Fisher exact and chi-square tests were used for categorical variables, and univariate logistic regression for continuous predictors.

RESULTS: The prevalence of neonatal peripheral parasitemia was 8.2% (7/85). Maternal parasitemia strongly predicted neonatal infection. All positive neonates were born to mothers with positive microscopy (7/19), whereas no neonates from parasitemia negative mothers were infected (p < 0.001). No statistically significant associations were found between neonatal parasitemia and maternal education (p = 0.912), occupation (p = 0.183), insecticide treated net use (p = 0.413), or intermittent preventive therapy uptake (p = 1.000).

CONCLUSIONS: The present study revealed maternal parasitemia as a primary risk factor for neonatal malaria. While socioeconomic factors showed no significant association in this small cohort, these preliminary findings highlighted the need for larger studies with refined socioeconomic measures to fully elucidate these relationships. This highlights the critical need for strengthening antenatal malaria screening, ensuring timely treatment of maternal infection, and enhancing community-based malaria education to reduce vertical transmission in high-burden regions like Osun State, Nigeria.

PMID:41781969 | DOI:10.1186/s12936-025-05752-5

Malar J. 2026 Mar 4. doi: 10.1186/s12936-026-05839-7. Online ahead of print.

ABSTRACT

BACKGROUND: Malaria is a major public health problem in Ethiopia, and long-lasting insecticide-treated nets (LLINs) are one of the primary preventive strategies used to control it. Gondar Zuria District, Central Gondar Zone’s highest malaria-reporting district, reached 100% LLIN coverage in 2023. However, malaria cases remain high, suggesting gaps in LLIN utilization. Therefore, this study aimed to assess LLIN usage and determinants in Gondar Zuria District.

METHODS: Community-based mixed-methods study was conducted from February 1 to 28, 2025 among 700 participants selected through multistage sampling. Quantitative data was collected via interviewer-administered questionnaires and entered into EpiData version 4.6.0.2 and exported to SPSS version 25 for analysis. A binary logistic regression model was fitted, and statistical significance was determined using 95% confidence intervals (CI) and a p-value ≤ 0.05. Qualitative data were collected through purposively sampled interviews (n = 7) and key informant interviews (n = 3) and analyzed thematically.

RESULTS: The prevalence of ITN utilization was 55.6% (95% CI: 51.9%-59.3%) and was significantly associated with perceived severity (AOR = 1.74; 95% CI: 1.27-2.39), LLINs-to-family size ratio (AOR = 2.09; 95% CI: 1.51-2.91), and occupation specifically, being a government employee (AOR = 3.45; 95% CI: 1.57-7.58). The mixed methods design therefore provided a more comprehensive understanding by revealing behavioral and contextual factors that were not captured through quantitative data alone. Qualitative findings complemented the quantitative results by explaining why LLIN utilization remained low, highlighting misconceptions about net safety, doubts about effectiveness, discomfort due to heat, and structural barriers such as lack of space for hanging nets.

CONCLUSION: LLIN utilization in Gondar Zuria District fell below the national target (100%). Misconceptions and misinformation contribute to irregular use and reduced trust. Beyond distribution and health education, community-based behavior changes strategies such as household follow-ups by health workers and integrating LLIN promotion into local forums alongside routine net condition monitoring are essential to improve consistent use and advance malaria elimination efforts.

PMID:41781949 | DOI:10.1186/s12936-026-05839-7

BMC Med Educ. 2026 Mar 4. doi: 10.1186/s12909-026-08915-3. Online ahead of print.

ABSTRACT

BACKGROUND: Emergency medicine residents perform invasive procedures under time pressure, clinical uncertainty, and medico-legal risk, which can generate substantial anxiety among residents themselves. In this study, anxiety refers specifically to the practitioners’ own emotional and cognitive responses while performing invasive procedures, rather than to patient-related anxiety. Although fear of malpractice and general anxiety have been studied, their relationship with procedure-specific anxiety and perceived clinical competence has not been examined in an integrated manner among emergency medicine residents.

METHODS: This two-phase cross-sectional study included 168 emergency medicine residents from emergency departments across Türkiye. An online survey assessed procedure-related anxiety, perceived procedural difficulty, procedural self-efficacy, fear of malpractice, and trait anxiety across nine invasive procedures. Descriptive statistics were calculated, gender differences were examined using independent samples t-tests, and associations among variables were analyzed using Pearson correlation coefficients.

RESULTS: Higher perceived procedural difficulty was strongly associated with higher procedure-related anxiety, while higher self-efficacy was strongly associated with lower anxiety. Greater training duration was linked to lower perceived difficulty and anxiety and to higher self-efficacy. Trait anxiety showed moderate positive associations with perceived difficulty and procedure-related anxiety and a negative association with self-efficacy. Fear of malpractice was only weakly associated with procedure-related anxiety and was unrelated to training duration or self-efficacy. Female residents reported higher general and procedure-specific anxiety than male residents. Lack of experience and fear of complications were the most frequently reported sources of anxiety, and supervision by more experienced physicians was the most commonly used and valued coping strategy.

CONCLUSIONS: Procedure-related anxiety among emergency medicine residents is closely related to perceived difficulty, self-efficacy, and clinical experience, whereas fear of malpractice appears to be a relatively stable background concern. These findings suggest that procedural anxiety is a modifiable educational outcome that can be addressed through structured supervision, simulation-based training, and supportive learning environments.

TRIAL REGISTRATION: Not applicable. This study is an observational cross-sectional survey and was not registered.

PMID:41781925 | DOI:10.1186/s12909-026-08915-3

BMC Gastroenterol. 2026 Mar 4. doi: 10.1186/s12876-026-04714-8. Online ahead of print.

ABSTRACT

BACKGROUND: Biliary tract cancers (BTCs) in East Asia have traditionally been linked to inflammation-related etiologies. However, metabolic risk factors are increasingly contributing to BTC development. Temporal trends in BTC epidemiology remain underexplored in the Korean population. This study aimed to review 13-year trends in BTCs, focusing on metabolic and inflammatory comorbidities, in a southeastern Korean cancer center historically characterized by a high incidence of inflammation-related BTCs.

METHODS: This retrospective observational study analyzed 2,001 patients diagnosed with BTC at a southeastern Korean cancer center between 2009 and 2021. Data on general demographics (age, sex, smoking, alcohol), metabolic factors (hypertension, body mass index (BMI) ≥ 25 kg/m², diabetes mellitus, hyperlipidemia), and inflammatory conditions (viral hepatitis, liver cirrhosis, bile duct stone, liver fluke infection) were collected from electronic medical records. Annual trends in clinical and demographic variables were evaluated using the Cochran-Armitage trend test.

RESULTS: The cohort comprised 680 patients with gallbladder cancers and 586 patients with intrahepatic, 367 patients with perihilar, and 368 patients with distal cholangiocarcinomas. Gallbladder cancer was more common in females, whereas intrahepatic and distal cholangiocarcinomas were more prevalent in males. Over 13 years, the prevalence of hypertension and BMI ≥ 25 kg/m² significantly increased (both p < 0.001). The prevalence of diabetes mellitus remained stable at approximately 26%. Although the proportion of patients with inflammatory factors increased from 38.9% to 49.7%, this trend was not statistically significant (p = 0.646).

CONCLUSIONS: These findings indicate an ongoing epidemiological transition in BTC risk profiles in Korea, with metabolic factors, such as hypertension and obesity, playing an increasingly prominent role.

PMID:41781899 | DOI:10.1186/s12876-026-04714-8

BMC Infect Dis. 2026 Mar 4. doi: 10.1186/s12879-026-13000-7. Online ahead of print.

NO ABSTRACT

PMID:41781891 | DOI:10.1186/s12879-026-13000-7