Search Results (2,657)

Background: Climate change is increasingly recognised not only as an environmental emergency but also as a structural determinant of health and health-system performance. Its clinical consequences will not be distributed evenly: high-income countries face rising heat mortality, infrastructure fragility, ageing-related vulnerability, and the need to decarbonise technologically intensive care; middle- and low-income countries face heterogeneous but often more compressed combinations of heat, infectious disease, food insecurity, water stress, displacement, conflict-related fragility, and limited fiscal capacity. Objective: This structured narrative review proposes a comparative framework for understanding how climate change will transform health care across high-, middle-, and low-income settings and identifies adaptation priorities that are resilient, equitable, and low-carbon. Methods: We synthesised major climate-health assessments, peer-reviewed epidemiological studies, modelling papers, systematic and scoping reviews, and health-system decarbonisation literature identified through targeted searches and reference chaining. Five climate-health pathways, specified a priori from established direct, indirect, and socially mediated pathway frameworks, were used to organise the review. Findings: Climate change will reshape health care through five interacting pathways: direct thermal injury and extreme-weather mortality; altered infectious disease ecology; food, water, and nutritional insecurity; mental, maternal-child, and occupational impacts; and damage to the infrastructure, workforce, supply chains, finances, and emissions profile of health systems. In high-income countries, climate stress exposes the limits of hospital-centred, carbon-intensive, just-in-time care. In middle-income countries, expanding coverage and technology coexist with uneven insurance, large informal workforces, and rapidly growing emissions. In low-income and fragile settings, the same hazards interact with undernutrition, weak surveillance, under-resourced primary care, and constrained finance to produce larger marginal health losses. Conclusions: The central contribution is the concept of the climate-health divide: the unequal conversion of shared climate hazards into clinical demand, service disruption, financial stress, and emissions-intensive responses. Climate resilience and healthcare decarbonisation should therefore be designed together rather than treated as separate agendas. Full article

Robotic systems for pediatric rehabilitation must provide precise mechanical assistance while ensuring clinically appropriate risk control for vulnerable populations. In low- and middle-income countries (LMICs), academic medical robotics projects frequently fail to progress beyond intermediate Technology Readiness Levels (TRLs 3–5) due to limited translational planning. This study proposes and evaluates an integrated governance framework for academic pediatric rehabilitation robotics in LMIC settings, applied through the development of the AMCOR robotic orthosis for pediatric arthrogryposis multiplex congenita (AMC). The framework combines multiple national and international medical devices development standards and a dual regulatory pathway separating academic development from future translational stages. The framework is structured around four principles—auditability, TRL-proportional documentation, binding decision criteria, and regulatory separation—and is operationalized through a six-gate process. Across the first two gates (G0–G1), 38 traced requirements and 12 failure modes were documented. Five internal audits confirmed operational implementation of the quality management structure. The framework application also shaped core engineering decisions. The low amplitude and poor signal-to-noise ratio of sEMG signals observed in pediatric AMC patients rendered the original single-layer control strategy inadequate, prompting a framework-governed redesign toward a three-layer adaptive architecture based on signal quality thresholds and fallback safety logic. These findings demonstrate that a prospective, multi-standard governance model can improve early-stage academic medical robotics in resource-constrained settings. Generalizability beyond the single-center, two-gate application reported here requires further validation; however, the framework provides a replicable foundation for adoption in comparable LMIC contexts. Full article

Persistent high-risk human papillomavirus (HPV) infection drives cervical cancer, a leading cause of cancer-related mortality among women in low- and middle-income countries; its clinical course is shaped by the cervicovaginal microbiome, in which Lactobacillus-dominated communities are associated with enhanced viral clearance. Despite this, vaginal probiotic interventions often demonstrate limited colonization efficiency, and autochthonous strain libraries from Central Asia remain absent. We applied a tiered functional screening workflow to a collection of 235 vaginal lactic acid bacterial isolates recovered from 400 women undergoing routine gynecological examination in Astana, Kazakhstan. The workflow sequentially filtered isolates on (i) antimicrobial activity against seven urogenital indicator pathogens using the deferred antagonism assay, (ii) surface adhesion by the Brilis erythrocyte assay, and (iii) biofilm-forming capacity by crystal violet retention and laser-capture-microdissection (LCM) microscopy. Species-level identification of the selected candidate was performed by whole-genome shotgun sequencing followed by Kraken2 taxonomic classification. From 235 isolates, three rounds of phenotypic filtering identified four broad-spectrum antimicrobial candidates (127-3, 127-4, 107-2, 107-4) with non-overlapping inhibitory profiles against seven urogenital indicator strains. Adhesion phenotyping segregated candidates into low- and moderate-adhesion groups, with none reaching the high-adhesion threshold. Among all four candidates, only strain 127-4 produced a reproducible biofilm-associated signal (crystal violet retention OD490 = 0.09 ± 0.07 at 24 h; 0.08 ± 0.03 at 48 h), consistent with early surface attachment under static conditions. Whole-genome shotgun sequencing assigned 97.81% of classified reads to Lactiplantibacillus plantarum, supporting preliminary identification of the selected isolate as L. plantarum strain 127-4. Composite ranking confirmed 127-4 as the only isolate combining broad antimicrobial activity (5/7 indicators), moderate adhesion (specific adhesion index, SPA = 2.95), and a detectable biofilm-associated phenotype. We report the first systematic functional screening of autochthonous cervicovaginal lactic acid bacteria from a Central Asian population and identify L. plantarum 127-4 as a probiotic candidate with an integrated trait profile rarely identified through single-criterion screening approaches. Beyond candidate identification, this work establishes a transferable workflow for assembling functionally annotated vaginal Lactobacillus collections from underrepresented populations, providing a foundation for future population-specific probiotic interventions targeting cervicovaginal health. Full article

Objective: The objective of this study is to analyze trends in global research on vitamin D deficiency and mental health outcomes among women using bibliometric methods, focusing on publication output, citation patterns, collaboration structures, thematic research clusters, and key gaps in the existing literature. Methods: A structured bibliometric search of the Scopus database identified 1124 English-language, peer-reviewed articles published between 2000 and 2024 on vitamin D deficiency and mental health in women. Data were analyzed using VOSviewer-Version 1.6.20 to visualize publication trends, citation impact, co-authorship networks, and thematic clusters. Basic statistics were used to explain the publication patterns, while the analysis of networks revealed new research themes and connections across different areas of study. Results: Research output increased steadily, reaching a peak in 2024. Annweiler, C. was the most prolific author. Leading institutions included the University of Western Ontario, Harvard T.H. Chan School of Public Health, and Monash University based on citation impact. The United States contributed the most publications, followed by the United Kingdom and China. Thematic analysis showed strong links between vitamin D deficiency and depression, anxiety, neurodegenerative disorders, and metabolic conditions. Conclusions: This bibliometric analysis highlights the growing academic interest in vitamin D deficiency and its association with mental health outcomes among women. The findings reflect patterns in research activity, collaboration, and thematic focus rather than evidence of clinical effectiveness or causal relationships. While significant progress has been made, gaps remain in gender-specific research, life stage analysis, and representation from low- and middle-income countries. Full article

Background: Inappropriate antibiotic use contributes significantly to antibiotic resistance (ABR), particularly in low- and middle-income countries. Understanding community-level knowledge, attitudes, and practices is essential for designing effective interventions. This study assessed Knowledge, Attitudes and Practices (KAP) related to antibiotic use, with consideration of awareness of antibiotic resistance, in Montserrado County, Liberia. Methods: A community-based cross-sectional survey was conducted among 1160 adults in Montserrado County, Liberia, using a structured questionnaire to assess knowledge, attitudes, and practices (KAP) related to antibiotic use and antibiotic resistance. Composite KAP scores were calculated from Likert-scale items and subsequently categorized into ordered levels (poor, moderate, and good) based on percentile thresholds. Ordinal logistic regression was used to examine associations between sociodemographic characteristics and KAP outcomes. Results are presented as crude and adjusted odds ratios (COR, AOR) with 95% confidence intervals (CI), and statistical significance was set at p < 0.05. Results: Participants demonstrated moderate knowledge, with correct identification of antibiotic use for bacterial infections (skin infections: 78.8%; ear infections: 76.8%), but widespread misconceptions were observed, including use for colds and flu (73.6%) and diarrhea (80.7%). Attitudes were mixed, with many recognizing inappropriate use, yet expectation-driven demand remained common (62.7% dissatisfied when antibiotics were not prescribed; 80.9% willing to suggest antibiotics to clinicians). Practices were inconsistent, with both appropriate and inappropriate behaviors reported. While 46.2% of participants always completed antibiotic courses, inappropriate practices were frequent, including antibiotic use for common symptoms (38.6%), preventive use (37.2%), and self-medication without prescription (20.1% always). In multivariable analysis, older age was associated with higher knowledge (AOR = 3.82, 95% CI: 1.26–11.1), while lower education predicted poorer knowledge and practices (e.g., AOR = 0.25, 95% CI: 0.07–1.00). Urban residence was associated with poorer practices (AOR = 0.42, 95% CI: 0.29–0.61). Conclusions: While overall knowledge of antibiotic use in Montserrado County is moderate, critical misconceptions remain, and appropriate practices are inconsistent. Weak relationships between knowledge, attitudes, and practices highlight the limitations of knowledge-based interventions alone. Efforts to improve antibiotic use should address structural drivers, including access to antibiotics, healthcare-seeking behavior, and regulatory enforcement, through targeted and context-specific strategies. Full article

Background: Food insecurity remains a major public health challenge in many low- and middle-income countries, where environmental and socioeconomic conditions influence household access to adequate, safe, and nutritious food. Objectives: This study aimed to evaluate the associations between environmental and socioeconomic factors and household food security in Riobamba, Ecuador. Methods: A cross-sectional survey was conducted among 382 households using the Latin American and Caribbean Food Security Scale (ELCSA), complemented by structured and Likert-scale questions addressing agricultural production practices, food handling, waste management, and food choice and dietary diversity. Household food security status was classified according to the standard ELCSA scoring procedure and subsequently grouped into categories representing adequate or inadequate household food access and consumption. Binary Logit and Probit models were estimated to identify factors associated with household food security. Results: The Probit model showed slightly better predictive performance (classification accuracy = 73.56%; Pseudo R² = 0.2729; LR χ² = 143.94; p < 0.01). Household income was the strongest predictor of food security status (Logit coefficient = 1.1977; p < 0.01). Among the environmental variables, agricultural production practices (β = 0.8649; p < 0.01), food handling practices (β = 0.3714; p < 0.05), and food choice and dietary diversity (β = 0.6479; p < 0.01) were positively associated with adequate household food access and consumption, whereas waste management practices were not significantly associated. Household size and gender were also significantly associated with food security outcomes. Conclusions: These findings indicate that household food security in urban Ecuadorian settings is associated with both environmental and socioeconomic conditions. Policies promoting sustainable agricultural practices, safe food handling, dietary diversity, and socioeconomic well-being may contribute to strengthening household food security and nutrition. Full article

Background: Resource-constrained programs perform epilepsy surgery under limited access to advanced imaging and neuromodulation. We describe presurgical evaluation findings, early seizure outcomes, and safety from a mixed adult-pediatric cohort. Methods: Retrospective single-center series of 22 consecutive patients meeting surgical candidacy. We captured demographics, epilepsy classification/etiology, presurgical investigations (long-term Video-EEG, MRI, selective FDG-PET), procedure type, histopathology when available, and postoperative seizure outcome (ILAE). Complications were recorded using the ILAE adverse-event taxonomy. Results: Mean age at surgery was 21.2 ± 11.2 years; 15 (68%) were male. Epilepsy was focal in 15 (68%); structural etiologies predominated in 15 (68%). MRI was concordant with the presumed epileptogenic zone in 13 (59%). FDG-PET was obtained in 10 (45.5%) and was concordant in 7 (70%). Long-term Video-EEG (≥2 habitual seizures) was completed in 21. Mean delay to surgery was 10 years (IQR [8–15]); presurgical work-up averaged 10 months (IQR [6–15]). Procedures were resective 14 (64%), disconnective 6 (27%), and neuromodulatory 2 (9%). Histopathology was available in 16 cases, most commonly showing hippocampal sclerosis (n = 5) and focal cortical dysplasia (n = 5). At 14 months median follow-up (range 12–34), ILAE outcomes were: I 41% (9), II 14% (3), III 23% (5), IV 23% (5). Outcomes significantly differed by procedure: curative-intent (resection/disconnection) achieved ILAE I 60% (9) versus ILAE III/IV 7 after palliative-intent (corpus callosotomy/neuromodulation). No deaths or permanent deficits occurred; one corpus callosotomy case developed transient aseptic meningitis. Conclusions: In a resource-limited program, structured presurgical evaluation and careful selection yield resection/disconnection outcomes comparable to high-resource benchmarks, while corpus callosotomy/neuromodulation remain largely palliative. Practical, reproducible pathways may help shorten delays and improve access in similar settings. Full article

Human intestinal nematode infections (HINIs) remain a public health concern despite reduced prevalence following mass drug administration (MDA) in low- and middle-income countries. Children continue to bear a substantial burden of infection, and caregiver knowledge and practices may influence their risk of acquiring infection. Sustaining control during the transition of prevention programmes to surveillance-based strategies requires an understanding of behavioural determinants of transmission. Therefore, we assessed caregiver knowledge, attitudes, and practices (KAP) and their associations with sociodemographic characteristics and child infection status. A community-based cross-sectional study was conducted among 945 caregivers of primary school children in Anuradhapura, a low-prevalence setting where school-based MDA ceased in 2019, to assess caregiver KAP and child HINI status. An interviewer-administered questionnaire assessed KAP, sociodemographic, water, sanitation, hygiene (WASH), and behavioural factors. Participants were predominantly mothers (89.5%). Good knowledge was observed in 61.7%, positive attitudes in 95.6% and good practices in 99.2%. Knowledge gaps persisted regarding transmission and complications. Higher caregiver knowledge (OR = 0.52; 95% CI: 0.36–0.72) and regular deworming (OR = 0.58, 95% CI: 0.40–0.83) were associated with lower odds of infection, whereas attitudes and practices were not independently associated. Caregiver knowledge remains a key determinant of infection risk. Gaps in knowledge, misconceptions, and practices may sustain transmission even in low-prevalence settings. Strengthening health education, school-based hygiene promotion, and community engagement remains essential to reinforce preventive behaviours and support long-term control as countries transition from routine MDA to elimination-oriented strategies. Full article

Background: Non-operative management (NOM) is the standard of care for haemodynamically stable patients with blunt splenic injury; however, failure of NOM remains clinically significant, particularly in settings where adjunctive interventions such as splenic artery embolisation are not routinely utilised. This study aimed to evaluate NOM outcomes and identify predictors of failure at a South African Level I trauma centre. Methods: A retrospective cohort study of adult patients with blunt splenic injury over a 5-year period (2020–2025) was conducted. Patients were stratified according to their initial management strategy into operative and non-operative groups. Categorical variables were compared using Fisher’s exact test, and continuous variables using the Mann–Whitney U test. Multivariable logistic regression analysis was performed to identify independent predictors of NOM failure. Results: A total of 136 patients were included. Twelve patients (8.8%) underwent immediate operative management, while 124 (91.2%) were initially managed non-operatively. NOM was successful in 112 patients (90.3%), with 12 patients (9.7%) requiring delayed operative intervention. Overall mortality was 4.4% (6/136), with all deaths attributable to associated injuries rather than isolated splenic trauma. Increased admission heart rate was independently associated with NOM failure (OR 1.04 per beat increase; 95% CI 1.01–1.08; p = 0.009). Higher Injury Severity Scores and severe traumatic brain injury were more frequent in patients with NOM failure but were not independently predictive. Splenic artery embolisation was not utilised in this cohort. Conclusions: Non-operative management is safe and effective for blunt splenic injury, with high rates of splenic preservation. Admission tachycardia predicts NOM failure and may guide early clinical decision-making. These findings support the use of NOM in low- and middle-income settings where interventional radiology is not routinely available. Full article

Hepatitis B virus (HBV) infection remains a major public-health challenge in Peru, particularly in historically hyperendemic Amazonian and Andean regions; however, the structure, evolution, and equity of national HBV research have not been systematically evaluated. We conducted a PRISMA-informed bibliometric analysis of all peer-reviewed and theses on HBV in Peru published between 1988 and 2023 using Scopus, Google Scholar, and the Peruvian National Repository (RENATI). Bibliometric indicators, collaboration networks, thematic structure, and temporal thematic evolution were analyzed in R using bibliometrix- and network-based approaches. The final corpus comprised 232 documents, with a marked increase in production after 2005 and a publication peak in 2018. Scientific output was strongly concentrated in Lima-based institutions, while several departments historically associated with HBV endemicity exhibited minimal or absent research production. Nearly half of the corpus corresponded to undergraduate and postgraduate theses. Thematic analyses revealed persistent predominance of epidemiology, seroprevalence, and vaccination-related research, whereas molecular virology, therapeutics, and translational research remained peripheral or poorly represented. International collaboration was markedly limited. Overall, Peruvian HBV research has expanded quantitatively but remains geographically centralized and shows only limited correspondence with the contemporary geographic distribution of HBV incidence, while also remaining only partially aligned with the contemporary global HBV research frontier. These findings provide an evidence-based framework to guide research-priority setting, territorial equity policies, and strategic investment in infectious disease research capacity in Peru. Moreover, the weak association observed between scientific production and departmental HBV incidence suggests that factors beyond contemporary epidemiological burden contribute to the current distribution of research activity in Peru, highlighting a critical but often overlooked dimension of health inequity in low- and middle-income countries (LMIC) research systems. Full article

Palliative care evolved through recognition of subjectively experienced suffering, yet its availability depends on how societies recognize, prioritize and act. This paper presents a narrative, conceptually oriented synthesis of interdisciplinary literature from social science, bioethics and global health policy to examine how concepts of consciousness and suffering shape the governance and distribution of palliative care within health systems, particularly between high-income and low- and middle-income countries. These disparities are mediated by resources, as well as regulatory regimes, financing structures, workforce authority, and political prioritization. Relieving suffering is a health system responsibility that requires policy coherence, proportionate regulation and accountability in addressing global inequities. Full article

This study examines the relationship between domestic savings and fixed capital formation in African economies, focusing on the moderating role of institutional quality. Using panel data for 45 African countries over the period 1996–2024, we estimate a fixed-effects model with Driscoll–Kraay standard errors to account for cross-sectional dependence and heteroskedasticity. The findings confirm a positive and significant relationship between domestic savings and investment, consistent with traditional growth theory. More importantly, the results reveal that institutional quality significantly enhances the effectiveness of savings in promoting fixed capital formation, with stronger governance frameworks improving the allocation of resources and limiting diversion into unproductive uses. Disaggregated results further show that the moderating effect varies across institutional dimensions and is more pronounced in middle-income countries, while remaining weak or insignificant in low-income economies. These findings highlight the conditional nature of the savings–investment nexus and underscore the importance of institutional development in translating domestic resources into productive investment in Africa. Full article

Background/Objectives: The nutrition transition in low- and middle-income countries has produced a double burden of malnutrition (coexistence of excess weight, undernutrition, and micronutrient deficiencies), with scarce evidence in schoolchildren from vulnerable peri-urban areas of Paraguay. The objective was to characterize, in a multidimensional way, the nutritional status of children and adolescents from Limpio and to explore its associations with anemia and clinical, dietary, and environmental variables, in particular, reported intestinal parasitosis. Methods: Cross-sectional observational study in 90 participants aged 6 to 16 years recruited by convenience at six community settings. Anthropometry, body composition, capillary hemoglobin, dietary patterns, and environment were assessed. Weight status was classified using the WHO 2007 references (z-scores), anemia was described using WHO thresholds, and central obesity was assessed using a waist-to-height ratio > 0.5. Non-parametric tests, Fisher’s exact test, Spearman correlations, and multivariable logistic regression were used. Results: Overweight or obesity affected 39.3% (obesity, 16.7%) and central obesity 22.4%, with no cases of thinness, coexisting with anemia (27.0%), stunting (8.2%), and reported intestinal parasitosis (24.1%). Anemia was more frequent in children with reported intestinal parasitosis (45% versus 20%; adjusted OR 5.44; 95% CI 1.44–20.51). Height-for-age was inversely associated with the number of siblings (ρ = −0.25). Conclusions: This population showed a double burden of malnutrition. The association between reported, non-laboratory-confirmed intestinal parasitosis and capillary-hemoglobin-defined anemia was exploratory and non-causal, given the cross-sectional design. Together with the high burden of anemia, these findings raise the hypothesis of a possible triple burden of malnutrition, which would require confirmation through stool parasitological testing and biomarkers of iron status, inflammation, and other micronutrients. These findings are compatible with integrated community strategies addressing dietary quality, sanitation, and access to safe water; decisions on deworming and micronutrient supplementation should be guided by local parasitological surveillance and biomarker-based assessment rather than by these data alone. Because the study used a convenience sample from a single peri-urban community during one fieldwork period, the findings should not be generalized beyond similar vulnerable settings without further confirmation. Full article

Background: Sepsis is a leading cause of pediatric mortality worldwide, disproportionately affecting children in low- and middle-income countries (LMICs). However, timely recognition of potential sepsis and access to healthcare resources needed to diagnose pediatric sepsis according to international guidelines are challenging in LMICs. This exploratory study aimed to develop machine learning (ML) models to detect pediatric sepsis and septic shock using a simplified set of clinical data contextualized for practical use in resource-limited settings. Methods: This was a secondary analysis of an observational study of 100 children with potential sepsis admitted to a non-profit referral hospital in Dhaka, Bangladesh. The outcomes were sepsis as defined by a Phoenix Sepsis Score (PSS) ≥ 2 and septic shock (sepsis plus PSS cardiovascular sub-score ≥ 1). Models were trained using either clinical + laboratory variables or clinical-only variables. A single 24 h worst-value assessment window was derived per patient; stratified 5-fold cross-validation was used to maintain class proportions across the training and test folds. Model performance was assessed using area under the precision–recall curve (AUPRC) and area under the receiver operating characteristic curve (AUROC) with 95% confidence intervals (CIs) derived from a 2000-resample patient-level bootstrap of out-of-fold classifications. Logistic regression coefficients were used to assess feature contributions. Results: For sepsis classification, the non-laboratory model achieved an AUPRC of 0.942 (95% CI: 0.884–0.979) and an AUROC of 0.945 (95% CI: 0.890–0.983), with comparable performance from the clinical + laboratory model (AUPRC 0.941, 95% CI: 0.880–0.981; AUROC 0.945, 95% CI: 0.881–0.986). For septic shock, AUROCs of 0.870 (95% CI: 0.761–0.952) and 0.878 (95% CI: 0.758–0.967) were observed. However, these estimates should be interpreted cautiously, given the low prevalence (23%) and absence of external validation. SpO₂:FiO₂ ratio, GCS, and systolic blood pressure were consistently strong predictors across models. Conclusions: ML models using pragmatic clinical variables demonstrate preliminary diagnostic performance, with the non-laboratory model showing discrimination comparable to models incorporating laboratory data. Logistic regression demonstrated the most stable performance and may represent an early proof of concept for assistive diagnostic support. However, these models are not clinically usable without external validation. These findings are hypothesis-generating; external validation in larger, independent cohorts is essential before any clinical use, particularly for septic shock. Full article

Background: The United Nations International Multiple Micronutrient Antenatal Preparation of a multiple micronutrient supplement (UNIMMAP MMS or MMS) is replacing iron and folic acid supplementation (IFAS) in antenatal care (ANC) in low- and middle-income countries (LMICs). An investigation into determining how to secure a sustainable supply of MMS began in response to the Indonesian Ministry of Health (MOH)’s decision to introduce MMS into its national health services. Objective: We aimed to identify and test sustainable strategies for securing MMS supplies. Methods: A three-phase implementation science framework was applied to (1) foster an enabling environment for securing MMS supplies, (2) undertake implementation research (IR) to compare sourcing strategy options, and (3) plan and execute actions to scale MMS supply availability and distribution. The MOH assumed ownership of the initiative and guided policy, procurement, and program decisions. Results: (1) Landscaping resulted in recommendations that triggered supply-related policies, an accommodating regulatory framework, integration of MMS into key government support systems (i.e., budget, finance, procurement, and distribution), and identification of supply strategy options. (2) IR resulted in the selection of a local manufacturing and sourcing strategy for acquiring a sustainable supply of high-quality MMS product while retaining an option to import a limited supply of MMS during scaling. (3) A multi-year plan was developed to scale MMSs within ANC services. Conclusions: Applying implementation science provided an evidence-based framework with which to identify, establish, and test a sustainable strategy for securing MMS supplies and yielded insights useful for other countries introducing MMS into their national health systems. Full article