Vasuki Rajaguru

Background: Non-communicable diseases (NCDs) are a major global public health challenge, particularly in low- and middle-income countries such as Nepal. Despite the growing burden of hypertension, diabetes, and hypercholesterolemia, limited evidence exists on age-stratified patterns of NCDs and associated risk factors, especially among younger populations. This study investigated age-stratified prevalence of hypertension, diabetes and hypercholesterolemia and risk factors in Nepal to inform age-specific preventions and policy interventions. Methods: We analyzed nationally representative data from the 2019 STEPS Survey, including 3,219 participants aged 15–69 years. Descriptive statistics and chi-square tests describe participant characteristics. Multivariable logistic regression assessed associations between risk factors and NCDs, while univariate logistic regression, Wilcoxon scores, and pairwise multiple comparisons examined age-group differences in prevalence of NCDs and risk factors. Results: The mean participant age was 35.3 ± 12.8 years, with 56% female. Among adults aged ≥60 years, 50% used tobacco and 31.5% consumed alcohol. Alcohol consumption was also notably prevalent among individuals aged 15–29 years, affecting 30.7% of this age group. Physical inactivity was identified in 18.9% of the overall study population. The highest rates of overweight (30.2%) and stress (80.1%) were among adults aged 30–44, with obesity (9.0%) peaking at 45–59 years. Men (OR 2.04, 95% CI 1.62–2.55) and those aged 60 years or older (OR 4.92, 95% CI 3.35–7.22) had higher odds of hypertension. Diabetes (OR 6.34, 95% CI 3.58–11.23) and hypercholesterolemia (OR 2.66, 95% CI 1.77–3.98) were most prevalent in the 45–59 age group. Conclusions: The prevalence of NCDs and risk factors increases with age, yet substantial burdens exist among younger adults. Age-specific targeted policies should promote healthy behaviors and routine screening in youth, emphasize metabolic risk management and early detection in middle age, and ensure sustained treatment access and continuity of care for older adults.

Tuberculosis (TB) remains a major global health challenge requiring prolonged treatment that is often complicated by adverse drug reactions (ADRs), stigma, and poor treatment adherence. Although digital health interventions show promise in supporting TB care, patients’ needs, expectations, and design requirements for conversational agents remain poorly understood. This study identified challenges experienced by healthcare professionals and patients with TB and explored opportunities for designing a user-centered conversational agent for TB care. A mixed-methods approach was adopted, comprising surveys of 107 healthcare professionals and 31 patients with TB, followed by in-depth interviews with 10 patients. The survey assessed treatment challenges, adherence barriers, and digital health needs. The interview data explored participants’ treatment experiences and expectations for conversational agent–based support. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using inductive thematic analysis. Healthcare professionals reported ADR (25.1%), multidrug-resistant TB (17.1%), drug interaction management (15.6%), and low treatment adherence (15.6%) as key challenges. Patients’ needs focused on ADR consultation (35%), TB information (21.7%), and diagnostics (20%). The majority wanted to use mHealth (62.1%), with specific interests in side effect guidance (20.4%), self-diagnosis (13%), and treatment information (12.5%). The interviews revealed patients’ multifaceted needs related to TB treatment, including consistent communication with healthcare providers, effective ADR management, accurate and accessible TB information, social and psychological support during treatment, usable and accessible digital health solutions, and affordable services. These findings identified key design opportunities, including TB awareness, timely and personalized information, treatment adherence support, transparent treatment progress, psychosocial support, accessible digital services, and affordability. Healthcare professionals and patients reported unmet needs that conversational agents could potentially address. These findings provide user-centered guidance for developing conversational agents and contribute to evidence on digital health interventions for TB treatment support.

Background: Cancer imposes substantial clinical and financial burdens worldwide. Although Korea operates a universal National Health Insurance system, concerns remain regarding healthcare utilization and out‐of‐pocket (OOP) costs among cancer patients. This study compared healthcare utilization and OOP expenditure between adults with and without cancer in Korea and quantified adjusted differences associated with cancer. Methods: Data were obtained from the 2023 Korea Health Panel Survey and included adults aged ≥ 19 years. Healthcare utilization outcomes included outpatient visits, hospitalizations, emergency visits, total health encounters. OOP expenditures included inpatient, outpatient, emergency, pharmacy, and total annual healthcare expenditure. Survey‐weighted Poisson or negative binomial regression models and generalized linear models with gamma distribution and log link were used to estimate adjusted differences in healthcare utilization and OOP expenditures associated with cancer status after controlling for sociodemographic, socioeconomic, behavioral, insurance‐related, and clinical covariates. Results: Among 10,911 participants, 626 (5.7%) reported a history of cancer and 10,285 (94.3%) had no history of cancer. Mean annual healthcare utilization was significantly higher among participants with cancer than those without cancer including hospitalization (0.78 vs. 0.19), outpatient visits (32.93 vs. 18.59), emergency visits (0.20 vs. 0.11), and total utilization (33.91 vs. 18.89) Cancer was independently associated with an adjusted difference of 8.93 total visits, 0.49 hospitalizations, 8.36 outpatient visits, and 0.08 emergency visits annually (all p < 0.001). OOP expenditure was substantially higher among cancer patients ($1,828 vs. $676; p < 0.001), with significant adjusted differences in total OOP expenditure ($917), inpatient ($639), outpatient ($224), and pharmacy ($53). Lung ($2453), cervical ($1341), colorectal ($1113), and other cancers ($1201) showed the highest expenditure. Conclusion: Cancer is associated with markedly greater healthcare utilization and significant OOP expenditure burden despite Korea's National Health Insurance (NHI) coverage. Strengthening financial protection, expanding coverage for high‐cost care, reinforcing OOP caps, and supporting vulnerable households are essential. Future longitudinal studies incorporating cancer stages, treatment pathways, and indirect costs are warranted.

Background: Dementia imposes a growing public health burden in Korea, with substantial implications for families living with affected members. Although prior Korean studies have suggested an association between dementia‐related household context and depressive symptoms, population‐based evidence on co‐residence with a family member with dementia remains limited. This study examined the association between co‐residence with a family member with dementia and depressive symptoms among Korean adults aged 50 years and older. Methods: We conducted a cross‐sectional analysis using data from the 2024 Korea Community Health Survey. Among 231,728 respondents, 120,029 adults aged ≥ 50 years living in non‐single‐person households were included. The exposure was co‐residence with a family member reported to have dementia, rather than a direct measure of caregiving status, intensity, or duration. Depressive symptoms were assessed using the Patient Health Questionnaire‐9 (PHQ‐9), with a score ≥ 10 indicating clinically significant depressive symptoms. Survey‐weighted multiple logistic regression was used to estimate odds ratios and 95% confidence intervals. Results: Overall, 15.8% of individuals reported depressive symptoms. Living with a family member with dementia was highly associated with depressive symptoms (OR = 1.35; 95% CI: 1.29–1.42; p < 0.0001). Among men, significant lower associations showed with good health status (OR = 0.14; 95% CI: 0.13–0.16). Among women, similar patterns were observed, with high income (OR = 0.71; 95% CI: 0.63–0.80) and good health (OR = 0.14; 95% CI: 0.13–0.16) being strongly protective against depression. Conclusions: Co‐residence with a family member with dementia was associated with higher odds of depressive symptoms among Korean adults aged 50 years and older. These findings suggest the need to consider mental health screening and support strategies for families living with dementia, while acknowledging the cross‐sectional and self‐reported nature of the data.

Aims: Dietary supplement use has increased among adolescents, but its association with metabolic health remains unclear. This study examined the relationship between dietary supplement use, diet quality, obesity, and metabolic risk among Korean adolescents. Methods: This cross-sectional study used nationally representative KNHANES 2022–2024 data. A total of 1550 adolescents aged 10–18 years were included. Dietary supplement use during the previous year was assessed by questionnaire. Diet quality was evaluated using diet quality score based on selected dietary guideline-related components. Survey-weighted logistic and linear regression analyses were conducted after adjustment for demographic and dietary covariates. An exploratory indirect association analysis was performed to examine whether diet quality was statistically associated with the relationship between supplement use and metabolic risk clustering. Results: Overall, 43.1% of adolescents reported dietary supplement use. Supplement users had significantly better diet quality scores than non-users (β = 0.30, p < 0.001). Dietary supplement use was significantly associated with BMI (p = 0.011) and waist circumference (p = 0.010), but not with metabolic risk clustering (OR = 0.91, 95% CI: 0.67–1.24), fasting glucose, triglycerides, or HDL-cholesterol levels. Obesity was strongly associated with metabolic risk clustering regardless of supplement use. Compared with non-obese non-users, obese non-users (OR = 5.31, 95% CI: 3.22–8.78) and obese supplement users (OR = 3.68, 95% CI: 2.07–6.53) had significantly higher odds of metabolic risk clustering. Exploratory indirect association analysis showed that diet quality did not significantly mediate the association between dietary supplement use. Conclusions: Dietary supplement use was associated with better diet quality and favorable anthropometric indicators, but not with metabolic risk clustering or biochemical metabolic markers. These findings suggest that supplement use may reflect broader health-related behaviors rather than direct metabolic protection among Korean adolescents.

Metrological variations strongly influence malaria transmission by affecting mosquito breeding and survival. Côte d'Ivoire, located within a tropical climate zone, is particularly vulnerable to metrological variations that can alter disease patterns. This study aimed to assess the relationship between meteorological variations of temperature, precipitation, relative humidity and malaria incidence in Côte d'Ivoire from 2021 to 2023. This was a retrospective ecological time‐series study that used data from the National Malaria Control Program (NMCP) and meteorological data from SODEXAM. Monthly data was analyzed by ecological zones and age groups. Pearson's correlation and multiple linear regression models were used to examine associations between metrological variation factors and malaria incidence. Malaria incidence peaked during the rainy season (May–August) across all regions, with children under five representing 39% of total cases. Precipitation and relative humidity were positively and significantly correlated with malaria incidence ( r = 0.583–0.698, p < 0.05), while temperature showed a significant negative correlation ( r = −0.539 to −0.600, p < 0.05). Interaction analysis revealed that the effect of precipitation and humidity was strongest in the northern zone, where malaria transmission risk increased significantly ( β = 22.51, p = 0.01). Malaria transmission in Côte d'Ivoire is strongly associated with metrological variability, particularly rainfall and humidity. Elevated precipitation and humidity increase malaria morbidity, whereas high temperatures above 28°C suppress transmission. Integrating meteorological surveillance into malaria early warning systems can improve prediction and control strategies, especially among vulnerable populations such as children under five.

Purpose Tuberculosis (TB) remains a major public health challenge in low- and middle-income countries, including Nepal. Understanding the factors associated with TB treatment outcomes is essential for improving disease control and patient management. Methods A retrospective study was conducted using TB program data from Lalitpur District, Nepal. De-identified patient records were extracted from the Health Information Management System and the national e-TB register. Sociodemographic, behavioral, and clinical variables were analyzed. Descriptive statistics summarized patient characteristics, while Pearson’s chi-square test assessed associations between variables and treatment outcomes. Multivariable logistic regression was used to identify predictors of treatment success. Results A total of 2,779 TB patients were included in the study. The overall treatment success rate was high, with most patients completing treatment successfully. Age, gender, and HIV status were significantly associated with treatment outcomes. Patients older than 60 years had higher odds of unsuccessful treatment compared with younger patients. Female patients showed higher odds of treatment success than males. HIV-positive patients had significantly poorer treatment outcomes compared with HIV-negative individuals. Other factors, including ethnicity, residence, smoking status, TB type, registration type, treatment category, DOTS delivery approach, and GeneXpert results, were not significantly associated with treatment success. Conclusion Age, gender, and HIV status were key predictors of TB treatment outcomes in Lalitpur District. Strengthening integrated TB–HIV care, improving follow-up among older patients, and enhancing treatment adherence among male patients may help improve treatment success rates. These findings provide evidence to support targeted TB control strategies and contribute to achieving the World Health Organization’s End TB Strategy goals.

Background: Strengthening health leadership and management capacity in low- and middle-income countries (LMICs) is critical for building resilient health systems. The Dr. Lee Jong-wook Fellowship Program (LJWFP), implemented by the Korea Foundation for International Healthcare, was designed to equip public health administrators with competencies in policy implementation and system strengthening. However, long-term behavioural impacts of such programs are rarely evaluated beyond satisfaction and knowledge gains. This study assessed the long-term impact of the 2022 LJWFP cohort on competency achievement, satisfaction and workplace application using the Kirkpatrick evaluation framework. Methods: This mixed methods study analysed data from 13 fellows who participated in the 2022 LJWFP. Quantitative data were collected through pre- and post-training assessments, participant surveys and supervisor and peer evaluations. Qualitative evidence was obtained through follow-up assessments and structured field visits. Descriptive statistics summarized key outcomes and Pearson’s correlation analysis examined associations among competency achievement, training satisfaction and workplace application over a 2-y follow-up period. Results: The program demonstrated high training satisfaction, with substantial gains in knowledge and competency. The correlation between competency achievement and satisfaction was moderate and statistically significant (r=0.488, p<0.05), whereas the relationship between competency and field application was moderate but not statistically significant (r=0.445, p<0.05). A strong, statistically significant correlation was observed between satisfaction and field application (r=0.776, p<0.001), suggesting that participants who were more satisfied with the training were more likely to apply their learning in practice. Conclusions: The program effectively enhanced leadership skills and supported post-training applications. Future iterations should integrate mentorship and follow-up mechanisms, expand digital learning tools and measure system-level impact longitudinally. These findings highlight the value of context-tailored fellowships in advancing public health leadership and governance in LMICs.

Aims: Low-carbohydrate diets (LCDs) are associated with metabolic benefits, but their long-term effects remain uncertain, particularly in Asian populations with traditionally high carbohydrate intake. This study examined LCD patterns and their association with metabolic syndrome (MetS) in Korean adults using nationally representative data from the 2022–2023 Korea National Health and Nutrition Examination Survey (KNHANES). Methods: Among 9617 adults aged ≥20 years with complete dietary and health data, LCD score was calculated from the percentage of energy derived from carbohydrates (reverse-scored), fats, and proteins, and participants were categorized into high-carbohydrate, moderate-carbohydrate, and low-carbohydrate groups. MetS was defined using an Adult Treatment Panel III and Korean criteria. Survey-weighted logistic regression was applied to assess associations between LCD score and MetS across sequentially adjusted models. Results: MetS prevalence differed significantly across LCD decile groups (LCD1: 9.6%, LCD2: 5.8%, LCD3: 9.7%; p < 0.001). In a minimally adjusted model, LCD decile 3 was associated with higher odds of MetS (OR, 1.14; 95% CI: 1.02–1.27). However, this association was attenuated and became non-significant after further adjustment for key metabolic risk factors. Obesity, blood pressure, fasting glucose, triglycerides, and high-density lipoprotein cholesterol were all strongly associated with MetS (all p < 0.001), and income-related disparities were evident, with lower-income groups showing higher carbohydrate and lower fat and protein intakes. Conclusions: These findings suggest that LCD patterns are not independently associated with MetS once underlying metabolic factors are considered. Public health strategies in Korea would be emphasized by improving nutrient quality, promoting balanced macronutrient intake, and reducing socioeconomic inequalities in diet to mitigate metabolic risk among adults.

Background: Readmission following acute myocardial infarction (AMI) poses significant challenges to health systems and patient outcomes. The LACE index, a composite of Length of stay, Acuity of admission, Comorbidities, and Emergency department visits, is widely used for readmission prediction. However, its performance in large‐scale, real‐world Korean cohorts remains understudied. Objective: This study aimed to validate the predictive performance of the LACE index for 30‐day readmissions in AMI patients using a nationally representative Korean cohort. Methods: This retrospective cohort study analyzed data from the Korean National Health Insurance Service Sample (NHISS) database from 2011 to 2020. A total of 609,640 adult patients hospitalized for AMI were included. The LACE index was calculated for each patient, and 30‐day readmissions were identified. Logistic regression was used to estimate odds ratios (ORs) for readmission. Model discrimination was assessed using ROC curve analysis and C‐statistics. Subgroup and survival analyses were performed by age, LACE score, and comorbidity burden. Results: Among 609,640 AMI patients, 205 (0.034%) experienced 30‐day readmission. Patients with a LACE score of ≥ 10 had significantly higher odds of readmission (OR = 2.65; 95% CI: 1.68–4.19, p < 0.001) compared to those with scores 0–4. Middle‐aged adults (35–64 years) also showed elevated readmission risk (OR = 3.42; 95% CI: 1.74–6.73, p < 0.001), while older adults (≥ 65 years) did not have significantly different risk. The LACE index showed moderate discriminatory performance (C‐statistics = 0.71). Kaplan–Meier survival curves demonstrated significantly lower 30‐day survival among patients with LACE ≥ 10. Conclusions: Study findings suggest the LACE index is a useful tool for predicting 30‐day readmissions among AMI patients in Korea. Its simplicity and moderate accuracy support its application in clinical and policy‐level risk stratification strategies. Future prospective studies should refine prediction models by incorporating additional clinical variables.