Epidemiology Commons^™

Surveillance And Comparative Genomics Of Bacteria From Hospital And Human Reservoirs, Emily E. Benedict

WUSM Theses and Dissertations – All Programs

Bacteria are diverse and adaptable and, consequently, present in a wide variety of environments. They are capable of growing under intense pressures, including those brought on by the human immune system and disinfection strategies. To survive these pressures, bacteria develop resistances. Antimicrobial resistance, which occurs when a microbe is no longer responsive to the antibiotic intended to control it, is one such adaptation that presents an especially serious threat, as it limits treatment options for infections caused by antimicrobial resistant microbes. Similarly, the ability of bacteria to survive in environments subjected to heavy disinfection efforts, such as intensive care units …

Knowledge, Attitudes, And Practices (Kap) Of Parents Regarding The Prevention And Control Of Childhood Iron Deficiency Anemia In Egypt: A Cross-Sectional Study, Omnia Soliman

Theses and Dissertations

Childhood Iron Deficiency Anemia (IDA) remains a major public health challenge in Egypt, where its persistently high and rising prevalence carries substantial consequences for child growth, cognitive development, immunity, and long-term health outcomes. Globally, approximately 40% of children aged 6–59 months are affected by anemia (World Health Organization, 2025), and Egypt mirrors this burden, with national data showing a worsening trend in recent years. In Egypt, national strategies have traditionally focused on biomedical interventions such as iron supplementation and food fortification, while less attention has been directed toward behavioral and household-level determinants, particularly parental knowledge, attitudes, and practices (KAP) related …

Weathering The Divide: Social Determinants, Neighborhood Context, And Systemic Lupus Erythematosus Among African American Women, Vanessa Cl Morman

Electronic Theses and Dissertations

Background: Systemic lupus erythematosus (SLE) disproportionately affects African American women and contributes to racial health disparities in the United States. Although genetic susceptibility influences disease risk, growing evidence suggests that social determinants of health (SDOH), including neighborhood conditions, structural racism, and socioeconomic disadvantage, contribute to disease development and progression. Epigenetic mechanisms may provide a biological pathway linking adverse social conditions to chronic disease disparities. This dissertation examined the influence of SDOH on SLE disparities through evidence synthesis and empirical investigation to inform public health practice and policy.

Methods: This integrated learning experience consisted of three complementary manuscripts. Aim 1 was …

Women’S Empowerment And Child Stunting In Peru: A Nationally Representative Analysis, Marisella Chumán-Sánchez, Brando Ortiz-Saavedra, Leonardo J. Uribe-Cavero, Anita P. Llamo-Vilcherrez, Joshua W. Moxey, Carlos J. Toro-Huamanchumo

Research outputs 2022 to 2026

Background: Child stunting remains a persistent public health challenge in Peru. Although women’s empowerment has been linked to improved child health, evidence on its domain-specific relationship with stunting remains limited. The objective of this study was to assess the association between women’s empowerment, across attitudes towards violence, social independence, and decision-making, and child stunting in Peru.

Methods: We conducted an analytical cross-sectional study using nationally representative data from the 2021 Demographic and Family Health Survey (ENDES), including 16,650 mother-child pairs. Analyses of women’s empowerment were conducted in a sub-sample with complete SWPER data (n = 12,696). Stunting was defined as …

Progression Of Non-Radiographic To Radiographic Axial Spondyloarthritis: A Risk Model Based On A Chinese Cohort Study, Rui Ying Deng, Xiaojia Xu, Jian Hua Peng, Feng Cai Shen, Yao Gong, Dan Min Wang, Hong Jin Liang, Shu Xin Huang, Zhao Peng Chen, Wen Long Wu, Ze Xin Zheng, Ling Lin, Zhi Duo Hou

Research outputs 2022 to 2026

Objectives: To evaluate the progression from non-radiographic axial spondyloarthritis (nr-axSpA) to radiographic axial spondyloarthritis (r-axSpA) in a Chinese cohort, identify associated risk factors in both clinical and imaging arms, and enable risk stratification based on these factors. Methods: Overall, 572 patients with nr-axSpA were enrolled with a median follow-up of 5 years. Cox proportional hazard regression analyses were conducted to identify potential risk factors associated with the progression from nr-axSpA to r-axSpA in both clinical and imaging arms. A risk-scoring system was then developed by assigning each independent predictor a weight based on its regression coefficient. Patients were subsequently categorized …

Paternal Age And Offspring Bone Health And Body Composition At 20 Years: Findings From The Raine Study, Mia A. Percival, Kun Zhu, John P. Walsh, Marc Sim, Kara B. Anderson, Julie A. Pasco, Natalie K. Hyde

Research outputs 2022 to 2026

Aims: There is growing evidence supporting paternal contributions to child health. Previous findings from the Vitamin D In Pregnancy study suggest that advanced paternal age is associated with a range of poorer bone measures for offspring at age 11 years. Whether these associations are evident when peak bone mass is attained remains unknown. This study aimed to investigate associations between paternal age and offspring bone health and body composition at age 20 years.

Methods: Data from the Raine study, a multigenerational cohort, were used. Among 1183 offspring with total body DXA data (Norland XR-36 densitometer) at the 20-year follow up, …

Clinical, Geographic, And Administrative Factors Associated With Onset-To-Groin Puncture Time In Mechanical Thrombectomy, Affan Priyambodo Permana, Yoga Arif Syah Hidayat, Khairunnisa Farina Ilato, Nur Afianti Hasanah, Asri Chasanah Adisasmita

Kesmas

Acute ischemic stroke requires timely reperfusion, yet treatment delays remain a challenge in urban referral systems. This retrospective cohort study evaluated factors associated with onset-to-groin puncture time among 204 patients with acute ischemic stroke who underwent mechanical thrombectomy at a national brain center hospital in Jakarta, Indonesia. Clinical, geographic, administrative, and time-related variables were analyzed using non-parametric tests and multivariable linear regression. The median onset-to-groin puncture time was 455 minutes, with an interquartile range of 236.8 minutes. Hospital referral was independently associated with longer delays, with an adjusted delay of approximately 111 minutes compared with non-referred patients. Private insurance payment …

Trust As Public Health Infrastructure: Advancing Health Care Safety Through Risk Communication And Community Engagement, Karanvir Bhinder, Sahibpreet Bhinder

HCA Healthcare Journal of Medicine

Background

Preparedness frameworks traditionally emphasize surveillance, laboratory capacity, clinical care and logistics. However, recent public health emergencies have demonstrated that even technically sound interventions may fail when trust is weak, communication is fragmented or misinformation undermines public confidence. Risk communication and community engagement (RCCE) is therefore increasingly recognized as an important component of effective outbreak response.

Perspective

Evidence from COVID-19, Ebola and other public health emergencies demonstrates that trust, communication and community engagement influence adherence to public health guidance, vaccine acceptance, healthcare utilization and the implementation of evidence-based interventions. Despite this, RCCE is frequently operationalized as a support function rather …

Juvenile Delinquency In Alaska, 2019 And 2023, Gabriel Garcia

AJiC Fact Sheets

This fact sheet examines juvenile delinquency in Alaska, documenting changes in substance use and weapon-carrying among high school students and identifying associated risk and protective factors using weighted data from the 2019 and 2023 Alaska Youth Risk Behavior Survey (YRBS).

Youth Experience Of Violence In Alaska, 2019 And 2023, Gabriel Garcia

AJiC Fact Sheets

This fact sheet examines youth experiences of dating violence and sexual violence in Alaska, identifying patterns and factors associated with victimization among high school students. Using weighted data from the 2019 and 2023 Alaska Youth Risk Behavior Survey (YRBS), it compares the prevalence of physical dating violence, sexual dating violence, sexual violence by anyone, and forced sexual intercourse.

Language-Associated Services, Misinformation, And Covid-19 Vaccine Hesitancy Among Refugee And Immigrant Populations In Pennsylvania, Samuel Elenwo

Walden Dissertations and Doctoral Studies

Limited research has examined misinformation, cultural beliefs, and language accessibility together in relation to COVID-19 vaccine hesitancy among refugee and immigrant adults. Guided by the socioecological model, this quantitative, cross-sectional study analyzed electronic questionnaires from N = 120 consenting Pennsylvania residents aged 18 or older who identified as immigrants, refugees, asylees, or humanitarian parolees and used social media for COVID-19 health information. Pearson correlations and separate multiple linear regression models examined associations with continuous vaccine hesitancy scores, adjusting for age, gender, education, U.S. residency, and weekly social media use. Greater misinformation exposure (B = 0.394, p < .001) and higher cultural-belief scores (B = 0.211, p < .01) were associated with greater hesitancy. Better language accessibility was associated with lower hesitancy (B = −0.365, p < .001). The demographic and social media model explained 21.9% of the variation in hesitancy scores (R² = .219) and was statistically significant, F(15, 104) = 1.94, p < .05, although most variation remained unexplained. Greater weekly social media use was associated with greater hesitancy (B = 0.024, p < .05). Compared with high school/GED education, less than high school education was associated with lower hesitancy (B = −0.672, p < .01); WhatsApp use was associated with lower hesitancy than Facebook use (B = −0.345, p < .05). These findings point to the need for credible, culturally responsive vaccine communication in preferred languages and across relevant online channels. The associations identify communication priorities but do not establish causal effects.

Ecological Associations Between Homelessness Burden, Behavioral Health Factors, And Hiv-Related Outcomes Across New Jersey Counties, 2018–2023, Christopher E. Nwadinma

Walden Dissertations and Doctoral Studies

HIV disparities may reflect interconnected housing instability, behavioral health conditions, and healthcare access barriers, yet their relationships with HIV-related outcomes remain understudied across New Jersey counties. This quantitative ecological study examined associations between county-level homelessness burden and HIV prevalence, Stage 3 (AIDS) at diagnosis, and the PrEP-to-Need Ratio (PNR) during 2018–2023, with frequent mental distress and binge drinking as potential moderators. The social determinants of health framework guided the study. County-level data from New Jersey Point-in-Time reports, CDC AtlasPlus, NJSHAD, AIDSVu, CDC PLACES, the American Community Survey, and U.S. Census Bureau population estimates were analyzed using generalized estimating equations (GEE). …

Network Analysis Of Chronic Disease Diagnosis Co-Documentation In Insurance Claims Among Older Arkansans, Mohsen Bazargan, Mohammadreza Rezaei, Ehsan Yaghmaei, Meredith Adkins, Panteha Rezaiean, Koustav Ganguly, James Abbas, Cyril Rakovski

Mathematics, Physics, and Computer Science Faculty Articles and Research

Background

Multimorbidity among older adults presents growing clinical and economic challenges, particularly in medically underserved states such as Arkansas. However, it remains unclear whether chronic conditions documented in routine healthcare encounters exhibit structured patterns of diagnosis co-documentation or primarily reflect incidental co-documentation. Understanding these patterns may inform future studies of multimorbidity and healthcare utilization.

Objective

To characterize statewide, sex-stratified patterns of claim-level diagnosis co-documentation among Arkansas adults aged ≥ 65 years using administrative claims data.

Methods

We analyzed 2024 IQVIA administrative claims for Arkansas residents aged ≥ 65 years (1408,707 claims from 35,253 unique patients). Analyses were conducted at the …

Pooled Proportion And Associated Factors Of Postoperative Pain During The Recovery Time Among Adult Surgical Patients In An Ethiopian Setting With Limited Resources: A Systematic Review And Meta-Analysis, Sintayehu Samuel Lorato, Mitiku Desalegn, Kelemu Abebe Gelaw, Yohannes Godie Ashebir, Olyad Kuma Getahun, Gebeyehu Lakew, Mathewos Mekonnen Gemmechu, Tiruye Menshaw Tiruneh, Yibeltal Assefa Atalay, Amlaku Nigusie Yirsaw, Eyob Ketema Bogale, Natnael Atnafu Gebeyehu, Tewodros Shitemaw Tekoye, Genanew Kassie Getahun, Kedir Seid, Abel Tibebu Goshu

Research outputs 2022 to 2026

No abstract provided.

Prevalence Of Vitiligo In East Africa: Systematic Review And Meta-Analysis, Kedir Seid, Chala Getaneh Jaleta, Sintayehu Samuel Lorato, Mitiku Desalegn, Dawit Tesfaye Rundasa, Yohannes Godie Ashebir, Olyad Kuma Getahun, Gebeyehu Lakew, Mathewos Mekonnen Gemmechu, Mulualem Endeshaw Zeleke, Yibeltal Assefa Atalay, Amlaku Nigusie Yirsaw, Eyob Ketema Bogale, Abiy Hailu Tikuneh, Abas Ali Hassen, Eyasu Alem Lake, Tadesse Nigussie, Bushra Bibi, Fikiru Yigezu Y. Jaleta, Abebe Gedefaw Belete, Genanew Kassie Getahun

Research outputs 2022 to 2026

Background: Vitiligo is a chronic skin disorder characterized by the loss of melanocytes, resulting in depigmented macules and patches. No accurate estimate has been made of the prevalence of vitiligo in East Africa.

Objectives: To determine the prevalence of vitiligo in East Africa via a systematic review and meta-analysis of the literature.

Methods: A systematic review and meta-analysis were performed in accordance with the PRISMA guidelines. Eleven articles were retrieved from PubMed/MEDLINE, Embase, Scopus, Google Scholar, Science Direct, Web of Science and African Journals Online. Microsoft Excel was used to extract the data, which were then exported to STATA 17 …

Burden And Prioritization Of Airborne Diseases In Bogor City, 2024: A Situational Analysis, Tuti Alawiyah, Helda Helda, Menikha Maulida

Jurnal Epidemiologi Kesehatan Indonesia

Indonesia, particularly urban agglomeration areas such as Bogor, continues to face major challenges related to air quality, resulting in an increased risk of airborne disease transmission. This study aimed to assess the burden of airborne diseases and determine health problem priorities in Bogor City using surveillance data from 2022 to October 2024. A descriptive epidemiological study was conducted in Bogor City using surveillance data from 2022 to 2024. Health problem prioritization was performed using the Pan American Health Organization (PAHO)-adapted Hanlon method through structured questionnaires administered to an expert panel consisting of health office officials and heads of primary healthcare …

Covid-19 Vaccination Coverage And Associated Factors In Conflict-Affected Provinces Of The Democratic Republic Of The Congo: A Cross-Sectional Study, Anthony E. Mwakapugi

Jurnal Epidemiologi Kesehatan Indonesia

Background: This study analysed the coverage and determinant factors for COVID-19 vaccination in Ituri, North Kivu, and South Kivu provinces in the Democratic Republic of the Congo (D.R.C). These are war-affected provinces that have experienced prolonged armed conflict, potentially limiting vaccine access.

Methods: A cross-sectional analysis of 9,795 people aged at least 15 years old and older fromyears from the 2023–2024 D.R.C Demographic and Health III Survey was conducted. Weighted descriptive statistics, design-adjusted chi-square tests, and multivariable logistic regression identified determinants of vaccination uptake.

Results: Overall vaccination coverage was 14.1% (95% CI: 11.3% - 17.4%)16.6% (95% CI= 14.2–19.3), with marked …

Descriptive Epidemiology Of Tuberculosis Case With Diabetes Mellitus Identified Through Screening Activities In Indonesia, 2024, Chrisshanti Putri Pasaribu

Jurnal Epidemiologi Kesehatan Indonesia

Tuberculosis (TB) remains a major public health problem, particularly among individuals with diabetes mellitus (DM), who are at an increased risk of developing TB disease. Screening activities conducted through health facility-based screening and active case finding (ACF) provide opportunities to identify TB cases with DM comorbidity. This study aimed to describe the epidemiological characteristics of TB-DM cases identified through screening activities in Indonesia in 2024. This descriptive study used routine secondary program data obtained from the Tuberculosis Information System (SITB). The source population consisted of 615,357 individuals screened for TB in 2024, among whom 14,727 TB cases were identified. Of …

Situational Analysis Of Maternal And Child Health Problems In Dki Jakarta Province In 2024, Jennifer Irene Amorita Hadiono, Helda Helda, Tri Yunis Miko Wahyono, Inggariwati Inggariwati

Jurnal Epidemiologi Kesehatan Indonesia

Maternal and child health (MCH) is a critical indicator of national health development aligned with SDGs targets. DKI Jakarta, as a densely populated capital city, faces unique challenges in providing equitable MCH services. This study aims to analyze the situational status of MCH problems in DKI Jakarta Province in 2024 and to determine health priorities using the PAHO-adopted Hanlon method. A descriptive study using quantitative and qualitative approaches was conducted at the DKI Jakarta Provincial Health Office from October 2024 to January 2025. Primary data were collected through structured interviews, while secondary data were sourced from reports of the Nutrition …

Factors Associated With Hiv Infection Among People Who Inject Drugs In Jakarta, Igo Cahya Negara, Mondastri Korib Sudaryo, Helwiah Umniyati

Jurnal Epidemiologi Kesehatan Indonesia

HIV infection among people who inject drugs (PWID) remains a substantial public health burden, with Jakarta consistently reporting among the highest PWID-associated HIV prevalence in Indonesia. This study aimed to identify factors associated with HIV infection among PWID in Jakarta, utilizing secondary data from the 2023 Integrated Biological and Behavioral Survey (IBBS 2023). A cross-sectional study design was employed using secondary data from 261 PWID recruited in Jakarta. Bivariate associations were examined using Chi-square tests, and multivariate analysis was performed using modified Cox regression with a constant time parameter to estimate adjusted prevalence ratios (aPR) with 95% confidence intervals. The …