A multilevel analysis of the determinants of HIV testing among men in Sub-Saharan Africa: Evidence from Demographic and Health Surveys across 10 African countries.

Sub-Saharan Africa, the epicenter of the HIV epidemic, has seen significant reductions in new infections over the last decade. Although most new infections have been reported among women, particularly adolescent girls, men are still disadvantaged in accessing HIV testing, care, and treatment services. Globally, men have relatively poorer HIV testing, care, and treatment indices when compared with women. Gender norms and the associated concept of masculinity, strength, and stereotypes have been highlighted as hindering men's acceptance of HIV counseling and testing. Therefore, men's suboptimal uptake of HIV testing services will continue limiting efforts to achieve HIV epidemic control. Thus, this study aimed to identify individual, neighborhood, and country-level determinants of sub-optimal HIV testing among men in Sub-Saharan African countries. We analyzed demographic and health datasets from surveys conducted between 2016 and 2020 in Sub-Saharan African Countries. We conducted multivariable multilevel regression analysis on 52,641 men aged 15-49 years resident in 4,587 clusters across 10 countries. The primary outcome variable was ever tested for HIV. HIV testing services uptake among men in these ten Sub-Saharan African countries was 35.1%, with a high of 65.5% in Rwanda to a low of 10.2% in Guinea. HIV testing services uptake was more likely in men with increasing age, some form of formal education, in employment, ever married, and residents in relatively wealthier households. We also found that men who possessed health insurance, had some form of weekly media exposure, and had accessed the internet were more likely to have ever received an HIV test. Unlike those noted to be less likely to have ever received an HIV test if they had discriminatory attitudes towards HIV, comprehensive HIV knowledge, recent sexual activity, and risky sexual behavior were positive predictors of HIV testing services uptake among men. Furthermore, men in communities with high rurality and illiteracy were less likely to receive an HIV test. Individual and community-level factors influence the uptake of HIV testing among Sub-Saharan African men. There was evidence of geographical clustering in HIV testing uptake among men at the community level, with about two-thirds of the variability attributable to community-level factors. Therefore, HIV testing programs will need to design interventions that ensure equal access to HIV testing services informed by neighborhood socioeconomic conditions, peculiarities, and contexts.

Non-alcoholic fatty liver disease and coexisting depression, anxiety and/or stress in adults: a systematic review and meta-analysis.

Background: Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver disease, affecting 25-30% of the general population globally. The condition is even more prevalent in individuals with obesity and is frequently linked to the metabolic syndrome. Given the known associations between the metabolic syndrome and common mental health issues, it is likely that such a relationship also exists between NAFLD and mental health problems. However, studies in this field remain limited. Accordingly, the aim of this systematic review and meta-analysis was to explore the prevalence of one or more common mental health conditions (i.e., depression, anxiety, and/or stress) in adults with NAFLD. Methods: PubMed, EBSCOhost, ProQuest, Ovid, Web of Science, and Scopus were searched in order to identify studies reporting the prevalence of depression, anxiety, and/or stress among adults with NAFLD. A random-effects model was utilized to calculate the pooled prevalence and confidence intervals for depression, anxiety and stress. Results: In total, 31 studies were eligible for inclusion, involving 2,126,593 adults with NAFLD. Meta-analyses yielded a pooled prevalence of 26.3% (95% CI: 19.2 to 34) for depression, 37.2% (95% CI: 21.6 to 54.3%) for anxiety, and 51.4% (95% CI: 5.5 to 95.8%) for stress among adults with NAFLD. Conclusion: The present findings suggest a high prevalence of mental health morbidity among adults with NAFLD. Given the related public health impact, this finding should prompt further research to investigate such associations and elucidate potential associations between NAFLD and mental health morbidity, exploring potential shared underlying pathophysiologic mechanisms. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42021288934.

Factors associated with cardiovascular disease: A comparative study of the UK Asian diaspora and residents of India.

INTRODUCTION: The aim of this paper is to investigate what factors are associated to cardiovascular disease and what differences exists between Asians living in the UK (from the English Longitudinal Study of Ageing) and the Asians living in India (from the Longitudinal Ageing Study in India). METHODS: Logistic regression was used to investigate how demographic and physical performance factors were associated with cardiovascular disease using data from Wave 6 of the English Longitudinal Study of Ageing and Wave 1 of the Longitudinal Study of Ageing in India, with the main variable of interest being country of residence, Asians in England or Asians in India. RESULTS: A total of 83,997 participants were included in the analyses. In the primary analysis, 73,396 participants from LASI were compared to 171 Asians in ELSA. After adjusting for age, blood pressure, resting heart rate, sex, waist circumference, gait, handgrip strength and standing balance, there was a statistically significant difference for the outcome of CVD between Whites ELSA (reference) and the participants of LASI (odds ratio = 0.77; 95% confidence interval = 0.60 to 0.99). There were no significant differences in CVD between the LASI participants, Asian ELSA, and the Non-White but not Asian ELSA groups. DISCUSSION: No difference was found between Asians that live in India compared to ethnic minorities living in England, including Asians, after adjusting for confounders, but was found between Whites in ELSA compared to LASI participants. A key limitation was the massive disparity in sample sizes between the ELSA subgroups and LASI. Further work is required where comparable sample sizes and longitudinal analyses allow trends to be identified and to investigate the factors associated with the difference in CVD between two similar ethnicities living in distinct locations. CONCLUSION: After adjusting for risk factors, there was no difference in CVD between localised Asians and the ethnic minorities in the UK, but there was a difference between the majority ethnicities in the respective countries.

COVID-19 vaccination implementation in 52 African countries: trajectory and implications for future pandemic preparedness.

INTRODUCTION: To end the COVID-19 pandemic, the WHO set a goal in 2021 to fully vaccinate 70% of the global population by mid-2022. We projected the COVID-19 vaccination trajectory in 52 African countries and compared the projected to the 'actual' or 'observed' coverage as of December 2022. We also estimated the required vaccination speed needed to have attained the WHO 70% coverage target by December 2022. METHODS: We obtained publicly available, country-reported daily COVID-19 vaccination data, covering the initial 9 months following the deployment of vaccines. We used a deterministic compartmental Susceptible-Exposed-Infectious-Recovered-type model and fit the model to the number of COVID-19 cases and vaccination coverage in each African country using a Markov chain Monte Carlo approach within a Bayesian framework. FINDINGS: Only nine of the 52 African countries (Tunisia, Cabo Verde, Lesotho, Mozambique, Rwanda, Seychelles, Morocco, Botswana and Mauritius) were on track to achieve full COVID-19 vaccination coverage rates ranging from 72% to 97% by the end of December 2022, based on their progress after 9 months of vaccine deployment. Of the 52 countries, 26 (50%) achieved 'actual' or 'observed' vaccination coverage rates within ±10 percentage points of their projected vaccination coverage. Among the countries projected to achieve <30% by December 2022, nine of them (Chad, Niger, Nigeria, South Sudan, Tanzania, Somalia, Zambia, Sierra Leone and Côte d'Ivoire) achieved a higher observed coverage than the projected coverage, ranging from 12.3 percentage points in South Sudan to 35.7 percentage points above the projected coverage in Tanzania. Among the 52 countries, 83% (43 out of 52) needed to at least double their vaccination trajectory after 9 months of deployment to reach the 70% target by December 2022. CONCLUSION: Our findings can guide countries in planning strategies for future global health emergencies and learning from each other, especially those that exceeded expectations and made significant progress towards the WHO's 2022 COVID-19 vaccination target despite projected poor coverage rates.

The potential impact of policies and structural interventions in reducing cardiovascular disease and mortality: a systematic review of simulation-based studies.

Background: The aim of the study was to investigate the potential effect of different structural interventions for preventing cardiovascular disease. Methods: Medline and EMBASE were searched for peer-reviewed simulation-based studies of structural interventions for prevention of cardiovascular disease. We performed a systematic narrative synthesis. Results: A total of 54 studies met the inclusion criteria. Diet, nutrition, tobacco and alcohol control and other programmes are among the policy simulation models explored. Food tax and subsidies, healthy food and lifestyles policies, palm oil tax, processed meat tax, reduction in ultra-processed foods, supplementary nutrition assistance programmes, stricter food policy and subsidised community-supported agriculture were among the diet and nutrition initiatives. Initiatives to reduce tobacco and alcohol use included a smoking ban, a national tobacco control initiative and a tax on alcohol. Others included the NHS Health Check, WHO 25 × 25 and air quality management policy. Future work and limitations: There is significant heterogeneity in simulation models, making comparisons of output data impossible. While policy interventions typically include a variety of strategies, none of the models considered possible interrelationships between multiple policies or potential interactions. Research that investigates dose-response interactions between numerous modifications as well as longer-term clinical outcomes can help us better understand the potential impact of policy-level interventions. Conclusions: The reviewed studies underscore the potential of structural interventions in addressing cardiovascular diseases. Notably, interventions in areas such as diet, tobacco, and alcohol control demonstrate a prospective decrease in cardiovascular incidents. However, to realize the full potential of such interventions, there is a pressing need for models that consider the interplay and cumulative impacts of multiple policies. Rigorous research into holistic and interconnected interventions will pave the way for more effective policy strategies in the future. Study registration: The study is registered as PROSPERO CRD42019154836. Funding: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 17/148/05.

This study aimed to explore the potential effects of various policy changes on the prevention of heart disease. By searching two large medical databases, we identified studies that employed computer models to estimate the impact of these policies on heart disease rates. In total, 54 studies matched our criteria. These studies considered a diverse range of policy interventions. Some delved into food and nutrition, investigating aspects like unhealthy food taxes, healthy food subsidies, stricter food regulations, and nutritional assistance programs. Others examined the impact of policies targeting tobacco and alcohol, encompassing smoking bans, nationwide tobacco control measures, and alcohol taxation. Further policies assessed included routine health checkups, global health goals, and measures to enhance air quality. One significant challenge lies in the varied approaches and models each study employed, making direct comparisons difficult. Furthermore, there's a gap in understanding how these policies might influence one another, as the studies did not consider potential interactions between them. While these policies show promise in the computer models, more comprehensive research is needed to fully appreciate their combined and long-term effects on heart health in real-world scenarios. As of now, we recognize the potential of these interventions, but further studies will determine their true impact on reducing heart disease rates.

Risk factors for newly-developed cardiovascular disease and quality of life during the COVID - 19 pandemic: an analysis of the English longitudinal study of ageing.

INTRODUCTION: The COVID-19 pandemic had a wide range of effects on the English population, including on health and quality of life due to the subsequent lockdown restrictions set. AIMS: To investigate longitudinal changes in developing cardiovascular disease (CVD) and how that affects quality of life from pre-pandemic and during two lockdowns in England, in adults aged 50 years and above, and what factors are associated with this. METHODS: Wave 9 of the core English Longitudinal Study of Ageing (ELSA) and Waves 1 and 2 of the ELSA COVID-19 sub-study were used to investigate the factors associated with developing CVD between timepoints, and what factors alongside CVD are associated with quality of life. RESULTS: Higher age and depression were associated with newly-developed CVD from pre-COVID to both COVID sub-study waves. Additionally, body mass index (BMI) increased odds of CVD and physical activity decreased odds. Non-White ethnicity, depression, females, and developing CVD were lower associated with quality of life. Decreased age and increased physical activity were associated with higher quality of life. DISCUSSION: Ethnicity was not associated with newly-developed CVD but was associated with quality of life. Other factors of importance include age, depression, gender, and physical activity. Findings are informative for future risk stratification and treatment strategies, especially while the COVID-19 pandemic is ongoing.

Determinants of partial and adequate maternal health services utilization in Nigeria: analysis of cross-sectional survey.

BACKGROUND: Access to health services during pregnancy, childbirth and the period after birth provides a substantial opportunity to limit cases of maternal mortality. In sub-Saharan Africa, the proportions of women who utilize health services remain below 70%. This study examined the factors associated with partial and adequate maternal health services utilization in Nigeria. METHODS: This paper used data from 2018 Nigeria Demographic and Health Survey (DHS) comprising 21,792 women aged 15-49 years who had given births within five years of the survey. The study focused on antenatal care attendance, place of birth and postnatal care using a combined model. Multinomial logistic regression was applied in the analysis. RESULTS: About 74% of the women attended antenatal care, 41% gave birth in health facilities and 21% attended postnatal care. While 68% of the women partially utilized health services, 11% adequately utilized the services. The odds of partially and adequately utilizing health services increased for ever married women, women with secondary or higher education, from richest households, living in urban area, having no problem either getting permission to visit health facility or reaching health facility. CONCLUSIONS: This study has revealed the factors associated with partial and adequate utilization of maternal health services in Nigeria. Such factors include education, household wealth, marital status, employment status, residence, region, media exposure, getting permission to use health service, unwillingness to visit health facility without being accompanied and distance to health facility. Efforts aimed at improving maternal health services utilization should place emphasis on these factors.

HIV research output in African Countries between 1986-2020.

HIV literature has grown exponentially since it was named the virus that causes acquired immunodeficiency syndrome (AIDS). Bibliometric analysis is a practical approach for quantitatively and qualitatively assessing scientific research. This work aims to describe HIV research output in Africa by country from 1986 until 2020. We conducted a search of the PubMed database in June 2021 for a 35-year period spanning 1986 to 2020. We comparatively weighed for countries' populations, gross domestic product (GDP), and the number of persons living with HIV (PLHIV) by calculating the ratio of the number of publications from each country. We used Poisson regression models to explore the trends in countries' HIV research output over the study period. The Pearson correlation analysis assessed the association between research output, population size, GDP, and the number of PLHIV.A total of 83,527 articles from African countries on HIV indexed in PubMed were included for analysis. Republic of South Africa, Uganda, Kenya, and Nigeria account for 54% of the total indexed publications with 33.2% (26,907); 8.4% (7,045); 7.3% (6,118); and 5.1% (4,254), respectively. Africa's proportion of the world's total HIV publications increased from 5.1% in 1986 to 31.3% in 2020. There was a strong positive and statistically significant correlation between the total indexed HIV publications and countries' GDP (r = 0.59, P<0.01), population (r = 0.58, P<0.01), and the estimated number of PLHIV (r = 0.72, P<0.01). The study found that Africa's contribution to global HIV research output increased over the 35 years, but it remains relatively low compared to the continent's burden of HIV infections. Our findings also revealed major differences in research output across sub-regions in Africa, with the Republic of South Africa having the highest output. The factors associated with HIV research output were economic strength, disease epidemiology, and population size.

Transcutaneous bilirubinometry versus total serum bilirubin measurement for newborns.

BACKGROUND: Jaundice is a very common condition in newborns, affecting up to 60% of term newborns and 80% of preterm newborns in the first week of life. Jaundice is caused by increased bilirubin in the blood from the breakdown of red blood cells. The gold standard for measuring bilirubin levels is obtaining a blood sample and processing it in a laboratory. However, noninvasive transcutaneous bilirubin (TcB) measurement devices are widely available and used in many settings to estimate total serum bilirubin (TSB) levels. OBJECTIVES: To determine the diagnostic accuracy of transcutaneous bilirubin measurement for detecting hyperbilirubinaemia in newborns. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL and trial registries up to 18 August 2022. We also checked the reference lists of all included studies and relevant systematic reviews for other potentially eligible studies. SELECTION CRITERIA: We included cross-sectional and prospective cohort studies that evaluated the accuracy of any TcB device compared to TSB measurement in term or preterm newborn infants (0 to 28 days postnatal age). All included studies provided sufficient data and information to create a 2 × 2 table for the calculation of measures of diagnostic accuracy, including sensitivities and specificities. We excluded studies that only reported correlation coefficients. DATA COLLECTION AND ANALYSIS: Two review authors independently applied the eligibility criteria to all citations from the search and extracted data from the included studies using a standard data extraction form. We summarised the available results narratively and, where possible, we combined study data in a meta-analysis. MAIN RESULTS: We included 23 studies, involving 5058 participants. All studies had low risk of bias as measured by the QUADAS 2 tool. The studies were conducted in different countries and settings, included newborns of different gestational and postnatal ages, compared various TcB devices (including the JM 101, JM 102, JM 103, BiliChek, Bilitest and JH20-1C) and used different cutoff values for a positive result. In most studies, the TcB measurement was taken from the forehead, sternum, or both. The sensitivity of various TcB cutoff values to detect significant hyperbilirubinaemia ranged from 74% to 100%, and specificity ranged from 18% to 89%. AUTHORS' CONCLUSIONS: The high sensitivity of TcB to detect hyperbilirubinaemia suggests that TcB devices are reliable screening tests for ruling out hyperbilirubinaemia in newborn infants. Positive test results would require confirmation through serum bilirubin measurement.

Food Insecurity and Associated Factors among Households in Maputo City.

Food insecurity (FI) is a global concern and is one of the main causes of malnutrition in low- and middle-income countries. In Mozambique, the burden of FI and how various factors contribute to FI is not well known. This study aimed to investigate the prevalence of FI and its associated factors in southern Mozambique. Data from 1842 household heads in Maputo City were analyzed in a cross-sectional design. Food insecurity was measured using a modified version of the US Department of Agriculture Household Food Security scale, and its association with socio-demographic factors was assessed through multiple regressions. Altogether, 79% of the households were food insecure; of these, 16.6% had mild FI, 28.1% moderate and 34.4% severe FI. The study revealed that low-income households, those with less educated heads, and those engaged in informal work were significantly more prone to FI. Likewise, dietary diversity and the number of meals were also significant predictors of FI. These findings suggest the need for decent work and job creation, which calls for joint efforts from government, the private sector, and international institutions. Furthermore, these key drivers should be considered in the development of public health policies and programs designed to alleviate household FI and malnutrition in Mozambique.

Socioeconomic Macro-Level Determinants of Hypertension: Ecological Analysis of 138 Low- and Middle-Income Countries.

AIM: To assess the relative importance of major socioeconomic determinants of population health on the burden of hypertension in Low-and-Middle-Income Countries (LMICs). METHODS: Country-level data from 138 countries based on World Development Indicators 2020 were used for correlation and linear regression analyses of eight socioeconomic predictors of hypertension: current health expenditure, domestic general government health expenditure per capita, GDP per capita, adult literacy rate, unemployment rate, urban population, multidimensional poverty index, and total population. RESULTS: The median prevalence of age-standardised hypertension was 25.8% across the 138 countries, ranging from 13.7% in Peru to 33.4% in Niger. For every 10% increase in the unemployment rate, the prevalence of hypertension increased by 2.70%. For every 10% increase in the percentage of people living in urban areas, hypertension was reduced by 0.63%. CONCLUSIONS: The findings revealed that countries with high GDP, more investment in health and an improved multidimensional poverty index have a lower prevalence of hypertension.

Impact of quality of life in developing cardiovascular disease later in life: Graphical chain model of the English Longitudinal Study of Ageing (ELSA).

INTRODUCTION: The aim of this paper is to demonstrate how graphical chain models can be used to model how cardiovascular disease affected quality of life in later life over the course of 17 years of data. METHODS: Waves 1-9 of the English Longitudinal Study of Ageing was used to investigate how quality of life changed over each wave using the CASP-19 questionnaire, and whether having experienced a cardiovascular event had an effect on quality of life. RESULTS: A total of 12,099 participants were included in the study. Participants had a mean age of 64.2 years, the majority of which were over 50 years old. Older people are more likely to have cardiac events. A one-unit rise in CES-D 8-item score was related with a 14% increased risk of CVD at Wave 1. Those with an O-level, A-level, or degree (or equivalent) had lower CVD risks than those with no education. Women had half the CVD risk of men. Living alone reduced the risk of a CVD-event by 15%. Moderate and vigorous exercise lowered cardiac event risk compared to no exercise. Current or ex-smokers have a 30% higher risk of CVD than non-smokers. Cardiovascular event was significantly associated with quality of life at waves 1 and 2 only. DISCUSSION: Events related to cardiovascular disease only affected quality of life in later life up to 4 years. Factors such as age, depression, perceived position on social ladder, and high levels of physical activity affected quality of life throughout the majority of waves.

A Scientometric Analysis of Africa's Health Science Journals Indexed in International and Regional Databases: A Comparative Analysis.

Objectives: This study aimed to compare the geographic coverage, citation impact, subject trends and authorship collaboration pattern of African health science journals indexed in international and regional databases. Methods: Data was collected from Ulrichs web serials directory, Web of Science (WoS), Scopus, PubMed, Google scholar, African Index Medicus (AIM) and African Journals Online (AJOL) between February 2023 and May 2023. Data was analysed using summary descriptive statistics such as percentages and interquartile ranges, and through network visualisation. Results: More than 40 African countries had no any health science journal indexed in WoS, whereas 20 African countries did not have any health science journal indexed in AJOL and AIM. The Journal of Advanced research was the top performing journal on almost all journal metric lists such as Google scholar's H5-Index, SNIP, Journal Impact Factor, and Citescore, except Journal Citation indicator. Conclusion: The coverage of African health science journals by international citation databases is still limited which result in low scientific impact of many African health science journals. Authorship collaboration is related to historical ties among countries.

Determining optimal strategies for primary prevention of cardiovascular disease: systematic review of cost-effectiveness analyses in the United Kingdom.

BACKGROUND: Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. The aim of the study was to guide researchers and commissioners of cardiovascular disease preventative services towards possible cost-effective interventions by reviewing published economic analyses of interventions for the primary prevention of cardiovascular disease, conducted for or within the UK NHS. METHODS: In January 2021, electronic searches of MEDLINE and Embase were carried out to find economic evaluations of cardiovascular disease preventative services. We included fully published economic evaluations (including economic models) conducted alongside randomised controlled trials of any form of intervention that was aimed at the primary prevention of cardiovascular disease, including, but not limited to, drugs, diet, physical activity and public health. Full systematic review methods were used with predetermined inclusion/exclusion criteria, data extraction and formal quality appraisal [using the Consolidated Health Economic Evaluation Reporting Standards checklist and the framework for the quality assessment of decision analytic modelling by Philips et al. (Philips Z, Ginnelly L, Sculpher M, Claxton K, Golder S, Riemsma R, et al. Review of guidelines for good practice in decision-analytic modelling in health technology assessment. Health Technol Assess 2004;8(36)]. RESULTS: Of 4351 non-duplicate citations, eight articles met the review's inclusion criteria. The eight articles focused on health promotion (n = 3), lipid-lowering medicine (n = 4) and blood pressure-lowering medication (n = 1). The majority of the populations in each study had at least one risk factor for cardiovascular disease or were at high risk of cardiovascular disease. For the primary prevention of cardiovascular disease, all strategies were cost-effective at a threshold of £25,000 per quality-adjusted life-year, except increasing motivational interviewing in addition to other behaviour change strategies. Where the cost per quality-adjusted life-year gained was reported, interventions varied from dominant (i.e. less expensive and more effective than the comparator intervention) to £55,000 per quality-adjusted life-year gained. FUTURE WORK AND LIMITATIONS: We found few health economic analyses of interventions for primary cardiovascular disease prevention conducted within the last decade. Future economic assessments should be undertaken and presented in accordance with best practices so that future reviews may make clear recommendations to improve health policy. CONCLUSIONS: It is difficult to establish direct comparisons or draw firm conclusions because of the uncertainty and heterogeneity among studies. However, interventions conducted for or within the UK NHS were likely to be cost-effective in people at increased risk of cardiovascular disease when compared with usual care or no intervention. FUNDING: This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in Health Technology Assessment. See the NIHR Journals Library website for further project information.

Increasing comprehensiveness and reducing workload in a systematic review of complex interventions using automated machine learning.

BACKGROUND: As part of our ongoing systematic review of complex interventions for the primary prevention of cardiovascular diseases, we have developed and evaluated automated machine-learning classifiers for title and abstract screening. The aim was to develop a high-performing algorithm comparable to human screening. METHODS: We followed a three-phase process to develop and test an automated machine learning-based classifier for screening potential studies on interventions for primary prevention of cardiovascular disease. We labelled a total of 16,611 articles during the first phase of the project. In the second phase, we used the labelled articles to develop a machine learning-based classifier. After that, we examined the performance of the classifiers in correctly labelling the papers. We evaluated the performance of the five deep-learning models [i.e. parallel convolutional neural network ( CNN ), stacked CNN , parallel-stacked CNN , recurrent neural network ( RNN ) and CNN-RNN]. The models were evaluated using recall, precision and work saved over sampling at no less than 95% recall. RESULTS: We labelled a total of 16,611 articles, of which 676 (4.0%) were tagged as 'relevant' and 15,935 (96%) were tagged as 'irrelevant'. The recall ranged from 51.9% to 96.6%. The precision ranged from 64.6% to 99.1%. The work saved over sampling ranged from 8.9% to as high as 92.1%. The best-performing model was parallel CNN , yielding a 96.4% recall, as well as 99.1% precision, and a potential workload reduction of 89.9%. FUTURE WORK AND LIMITATIONS: We used words from the title and the abstract only. More work needs to be done to look into possible changes in performance, such as adding features such as full document text. The approach might also not be able to be used for other complex systematic reviews on different topics. CONCLUSION: Our study shows that machine learning has the potential to significantly aid the labour-intensive screening of abstracts in systematic reviews of complex interventions. Future research should concentrate on enhancing the classifier system and determining how it can be integrated into the systematic review workflow. FUNDING: This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in Health Technology Assessment. See the NIHR Journals Library website for further project information.

Association between gender-based violence and hypertension among women in the Kyrgyzstan Republic.

BACKGROUND: Gender-based violence (GBV) is a significant global public health problem and the most prominent human rights violation severely impacting women's health and wellbeing. Therefore, the aim of this study is to evaluate the association between gender-based violence and hypertension in Kyrgyzstan Republic. METHODS: This study was conducted using population-based data of women from the 2018 Kyrgyzstan Demographic and Health Survey. The odds ratio was calculated to measure the association between GBV and hypertension, and p-values < 0.005 was considered statistically significant. RESULT: We included data of 4793 participants, and 621 (13%) of them had hypertension. Participants exposed to GBV were 24% more likely to have hypertension than unexposed participants (OR = 1.24, 95% CI: 1.03-1.48). Of all women with hypertension, 206 (33.0%) were exposed to GBV. Participants with secondary education or higher exposed to GBV were 24% more likely to be hypertensive than GBV unexposed women with the same education levels OR = 1.24, 95% CI: 1.04-1.49). Unemployed participants exposed to GBV were 45% more likely to develop hypertension than their unexposed counterparts (OR = 1.45, 95%CI: 1.15-1.81). Rural residents exposed to GBV were also 29% more likely to have hypertension than those unexposed to GBV (OR = 1.29, 95% CI: 1.04-1.59). The odds of hypertension among those exposed to GBV increase with age. CONCLUSION: The study revealed that GBV is a significant factor of having hypertension among Kyrgyz women.

Individual and contextual factors associated with childhood malnutrition: a multilevel analysis of the double burden of childhood malnutrition in 27 countries.

BACKGROUND: Malnutrition is a key global health challenge and a major contributor to childhood morbidity and mortality. In recent times, the contrasting coexistence of undernutrition including micronutrient deficiencies and overweight/obesity called double burden of malnutrition has been noted at individual, household or population level and/or at different times in life. The objective of this study was to examine individual, neighborhood and country level factors that are associated with the double burden of childhood malnutrition. METHODS: We conducted multivariable multilevel logistic regression analyses on the most recent demographic and health datasets from surveys conducted between 2015 and 2020 in low- and middle-income countries. We analyzed data of 138,782 children (level 1) living in 13,788 communities (level 2) from 27 countries (level 3). RESULTS: The results of our analysis show variation in childhood malnutrition across the 27 countries from as low as 6.5% in Burundi to as high as 29.5% in Timor Leste. After adjusting for all level factors, we found that those who were wasted/overweight tended to have had an episode of diarrhea or fever in the last two weeks preceding the survey, were part of a multiple birth, were being breastfed at the time of the survey and born to mothers with more than one under 5-child resident in neighborhoods with high illiteracy and unemployment rates. The intra-neighbourhood and intra-country correlation coefficients were estimated using the intercept component variance; 44.3% and 21.0% of variance in odds of double burden of childhood malnutrition are consequent upon neighborhood and country level factors respectively. CONCLUSIONS: Evidence of geographical clustering in childhood malnutrition at community and country levels was found in our study with variability due to neighborhood level factors twice that of country level factors. Therefore, strategies in tackling the double burden of malnutrition must consider these shared drivers, contextual barriers and geographical clustering effects.

Vulnerability in maternal, new-born, and child health in low- and middle-income countries: Findings from a scoping review.

OBJECTIVES: To identify and synthesise prevailing definitions and indices of vulnerability in maternal, new-born and child health (MNCH) research and health programs in low- and middle-income countries. DESIGN AND SETTING: Scoping review using Arksey and O'Malley's framework and a Delphi survey for consensus building. PARTICIPANTS: Mothers, new-borns, and children living in low- and middle-income countries were selected as participants. OUTCOMES: Vulnerability as defined by the authors was deduced from the studies. RESULTS: A total of 61 studies were included in this scoping review. Of this, 22 were publications on vulnerability in the context of maternal health and 40 were on new-born and child health. Definitions used in included studies can be broadly categorised into three domains: biological, socioeconomic, and environmental. Eleven studies defined vulnerability in the context of maternal health, five reported on the scales used to measure vulnerability in maternal health and only one study used a validated scale. Of the 40 included studies on vulnerability in child health, 19 defined vulnerability in the context of new-born and/or child health, 15 reported on the scales used to measure vulnerability in child health and nine reported on childhood vulnerability indices. As it was difficult to synthesise the definitions, their keywords were extracted to generate new candidate definitions for vulnerability in MNCH. CONCLUSION: Included studies paid greater attention to new-born/ child vulnerability than maternal vulnerability, with authors defining the terms differently. A definition which helps in improving the description of vulnerability in MNCH across various programs and researchers was arrived at. This will further help in streamlining research and interventions which can influence the design of high impact MNCH programs. SCOPING REVIEW REGISTRATION: The protocol for this review was registered in the open science framework at the registered address (https://osf.io/jt6nr).

Ethnic differences between South Asians and White Caucasians in cardiovascular disease-related mortality in developed countries: a systematic literature review.

BACKGROUND: Cardiovascular disease is the leading cause of death worldwide, with significantly worse mortality-related outcomes in ethnic minorities in developed countries. A systematic literature review and meta-analysis of observational studies was conducted to investigate cardiovascular disease-related mortality inequalities between South Asian and White Caucasian ethnic groups. METHODS: Published studies on mortality between South Asians and Whites in developed countries were retrieved from MEDLINE, PubMed, Embase, Web of Science, and grey literature sources (inception-April 2021) and critically appraised using the Quality in Prognosis Studies tool. Bayesian random-effects meta-analyses were performed for both primary and secondary outcomes. Heterogeneity was determined using the I2 statistic. RESULTS: Of the 9879 studies screened originally, 41 were deemed eligible. A further 3 studies were included via the later search. Of these, 15 reported cardiovascular disease-related mortality, 23 reported all-cause mortality, and 6 reported both. The meta-analysis results showed that South Asians had a significantly increased risk of cardiovascular disease mortality compared to Whites (risk ratio = 1.32; 95% credible interval = 1.14 to 1.54) and a decreased risk of all-cause mortality (risk ratio = 0.95; 95% credible interval = 0.83 to 1.12). DISCUSSION: South Asians had statistically significantly higher odds of cardiovascular disease-related mortality compared to Whites, but not for all-cause mortality. Risk of bias was a serious concern mainly due to a lack of confounders being reported. SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD42021240865.

Health research publications by South African authors from 1996 to 2015: a bibliometric analysis.

Introduction: research publications have a vital role in the scientific process, providing a strategic connection between the generation of new knowledge and its conversion into policy, practice, and positive health outcomes. There was a substantial increase in research funding in South Africa from the dawn of multi-party democracy in the mid-1990s to 2015. However, it is not known whether there was a corresponding increase in research publications from the country. Therefore, the objective of this bibliometric study was to assess trends and factors associated with health research publications from South Africa between 1996 and 2015. Methods: in July 2016, we searched Scopus for health science articles published between 01 January 1996 and 31 December 2015 with at least one author affiliated to an institution based in South Africa. We sought annual data on national-level indicators from Statistics South Africa and World Bank data. We used Poisson regression to examine trends in publication outputs and negative binomial regression to explore national-level factors associated with a change in the number of publications over time. Results: we identified 51,133 publications, with a mean of 2,557 publications per year. Four universities (University of Cape Town, University of the Witwatersrand, Stellenbosch University, and the University of Pretoria) contributed more than half of the publications. The top destination journals were the South African Medical Journal (14.57% of the articles), PLoS ONE (5.77%), South African Family Practice (4.68%), Journal of the South African Veterinary Association (2.48%), and The Lancet (2.37%). The annual number of publications increased five-fold from 1133 in 1996, with an upsurge after 2003, to 5820 in 2015. The average annual percentage growth in the number of publications rose from 3.31% in 1996-2000 to 13.63% in 2011-2015. Year of publication (incidence rate ratio 1.16, 95% confidence interval 1.14 to 1.18) and annual private expenditure on health (incidence rate ratio 1.08, 95% confidence interval 1.05 to 1.10) were independent predictors of publication output. Conclusion: the number of health research publications from South Africa grew substantially between 1996 and 2015, with wide variation in output among universities. Private expenditure on health may be a proxy of health research funding, which probably explains its association with publication output in this study.