Estimating typhoid incidence from community-based serosurveys: a multicohort study.

BACKGROUND: The incidence of enteric fever, an invasive bacterial infection caused by typhoidal Salmonellae (Salmonella enterica serovars Typhi and Paratyphi), is largely unknown in regions without blood culture surveillance. The aim of this study was to evaluate whether new diagnostic serological markers for typhoidal Salmonella can reliably estimate population-level incidence. METHODS: We collected longitudinal blood samples from patients with blood culture-confirmed enteric fever enrolled from surveillance studies in Bangladesh, Nepal, Pakistan, and Ghana between 2016 and 2021 and conducted cross-sectional serosurveys in the catchment areas of each surveillance site. We used ELISAs to measure quantitative IgA and IgG antibody responses to hemolysin E and S Typhi lipopolysaccharide. We used Bayesian hierarchical models to fit two-phase power-function decay models to the longitudinal antibody responses among enteric fever cases and used the joint distributions of the peak antibody titres and decay rate to estimate population-level incidence rates from cross-sectional serosurveys. FINDINGS: The longitudinal antibody kinetics for all antigen-isotypes were similar across countries and did not vary by clinical severity. The seroincidence of typhoidal Salmonella infection among children younger than 5 years ranged between 58·5 per 100 person-years (95% CI 42·1-81·4) in Dhaka, Bangladesh, to 6·6 per 100 person-years (4·3-9·9) in Kavrepalanchok, Nepal, and followed the same rank order as clinical incidence estimates. INTERPRETATION: The approach described here has the potential to expand the geographical scope of typhoidal Salmonella surveillance and generate incidence estimates that are comparable across geographical regions and time. FUNDING: Bill & Melinda Gates Foundation. TRANSLATIONS: For the Nepali, Bengali and Urdu translations of the abstract see Supplementary Materials section.

Health awareness, lifestyle and dietary behavior of university students in the northeast part of Bangladesh.

INTRODUCTION: University students generally face a variety of challenges. During this period of life, they practice some unhealthy eating patterns and lifestyles. Therefore, we aimed to assess the health awareness status of university students from the northeast part of Bangladesh and to evaluate its associated factors. METHODS: We conducted a cross-sectional study using a stratified random sampling among public and private university students from the northeast region of Bangladesh and interviewed 1143 students. We used a self-reported questionnaire, including questions related to awareness status, lifestyle practice, dietary habit and socio-demographic factors. To assess students' health awareness status and its association with their lifestyle practices and socio-demographic factors, we used logistic regression models. RESULTS: The majority (61%) of the students were not aware of better health status and their dietary habits were not adequate. Smokers [odds ratio (OR): 0.66; 95% confidence interval (CI): 0.44, 0.99] were less likely to be aware of better health status. The participants who thought that they were leading a healthy lifestyle were less likely (OR: 0.71; CI: 0.56, 0.92) to be aware. Moreover, frequency of participating in sports and the psychological factors related to eating behaviors were significantly (p < 0.05) associated with health awareness status. CONCLUSION: Our study findings may help to create a foundation for possible interventional programs on health awareness and nutritional education to improve the health awareness status and dietary behavior of university students. To prevent students from poor eating habits while feeling happy, effective programs (e.g. seminars, projects and media campaigns) should be held, which may include enhancing healthy and recommended amounts of food consumption.