Search Results (3,357)

Background: A significant body of research has identified ongoing unmet needs among cancer survivors. However, there is limited information about the survivorship experiences of patients in low- and middle-income countries. This study examined the experiences of colorectal cancer (CRC) survivors in Thailand to understand their post-treatment needs and priorities. Methods: A qualitative descriptive study using semi-structured interviews was conducted with 24 colorectal cancer survivors purposively recruited from a large university hospital in Bangkok, Thailand. The interviews lasted 60–90 min, were audio-recorded, and transcribed verbatim. The data were analyzed using hybrid content analysis, guided by the five domains of the Survivors Unmet Needs Survey (SUNS): information, emotional health, financial concerns, access and continuity of care, and relationships. Results: Participants had a mean age of 57 (SD = 10.9) years. Most were male (58.3%) and diagnosed at a late stage (62.5%). All participants had undergone surgical treatment, and the average time since treatment completion was approximately 3.85 (SD = 2.8) years. Participants most often reported unmet needs in the information and emotional health domains. They also described inadequate physical infrastructure (e.g., overcrowded clinic spaces) and minimal involvement of multidisciplinary providers. Despite these challenges, survivors expressed strong trust in physicians and a preference for physician-led care. Telehealth was viewed as a potential solution to reduce access barriers and improve continuity of care. Conclusions: Guided by the SUNS framework, this study identified significant unmet needs among colorectal cancer survivors in Thailand, particularly in health information, psychological support, and care system infrastructure. Strengthening health information delivery, establishing dedicated survivorship clinics, and exploring scalable care models supported by telehealth could help bridge these gaps and promote more equitable survivorship care in low-resource settings. Full article

Vector-borne diseases (VBDs) continue to pose a persistent global health challenge, disproportionately impacting low- and middle-income countries where surveillance and healthcare infrastructure are constrained. Within these countries, residents of remote island communities are particularly vulnerable to emerging VBD threats; however, they remain critically understudied. We conducted a community-based cross-sectional survey of 300 residents from Shahpori Island, Bangladesh, and Gaya Island, Malaysia, to assess knowledge, attitudes, and practices (KAP) related to VBDs. Using a structured questionnaire and mixed-effects Poisson regression modeling, we identified socio-demographic predictors of VBD-related knowledge and compared KAP outcomes across the two islands. Significant disparities were observed between the two settings: the Gaya Island residents demonstrated a higher level of awareness regarding VBDs and preventive practices compared to the Shahpori residents. Education was a strong predictor of VBD knowledge, with individuals possessing secondary education or above exhibiting significantly better knowledge (β = 0.2024, p = 0.0003). Marital status was also a significant factor, with unmarried respondents showing lower levels of knowledge (β = –0.1657, p = 0.0372). Age was positively correlated with VBD knowledge (β = 0.0051, p = 0.0119), indicating a gradual increase with age, while income, gender, occupation, and household size were not significantly associated. Despite basic awareness of VBD symptoms and transmission, detailed understanding of mosquito ecology, disease symptoms, and breeding prevention strategies was remarkably poor, especially among the Shahpori residents. Our findings highlight critical gaps in VBD-related knowledge and prevention behaviors shaped by socio-economic and educational disparities. Community-focused public health strategies including educational campaigns, establishment of health infrastructure, access to trained healthcare providers, and integrated vector control interventions are urgently needed to enhance resilience against emerging VBD threats such as drug-resistant malaria in remote island populations. Full article

Background/Objectives: Generalized anxiety disorder (GAD) is one of the most commonly diagnosed anxiety disorders in primary care. The global lifetime prevalence of GAD is estimated at 3.7%, ranging from 1.6% in low-income countries to 5.0% in high-income countries, underscoring its widespread impact. Given the frequent co-occurrence of GAD with obesity, this association has important clinical implications, particularly for screening, prevention, and treatment strategies. The aim of this review is to identify potential biological mechanisms linking obesity and GAD, summarize the current state of knowledge in this area, and highlight existing research gaps, as well as directions for future research. Methods: This narrative review is based on the literature published between 2015 and 2025 concerning the co-occurrence of GAD and obesity, with a focus on potential shared mechanisms including HPA axis dysregulation, chronic inflammation, oxidative stress, insulin resistance, gut–brain axis and microbiota dysbiosis, sleep disturbance, and maladaptive eating behaviors. Results/Conclusions: A growing body of evidence suggests an important, albeit still ambiguously defined, relationship between obesity and GAD. GAD and obesity may reinforce each other, leading to a mutually reinforcing relationship. Despite growing interest, high-quality prospective and interventional studies focusing specifically on GAD are lacking. A potentially effective therapeutic approach should be integrated and multidisciplinary, combining psychological, pharmacological, and lifestyle interventions. It may also be beneficial for clinicians to consider routine assessment of anxiety in patients with obesity and, conversely, to monitor metabolic risk in individuals with GAD. Such an approach, targeting both mental and metabolic domains, holds promise for improving outcomes. Full article

Cervical cancer remains a significant public health challenge, disproportionately affecting women in low- and middle-income countries (LMICs). Persistent infection with high-risk types of human papillomavirus (HPV), particularly HPV16 and HPV18, is the central cause of cervical carcinogenesis, driven by the viral oncoproteins E6 and E7, which disrupt the host tumor suppressors p53 and retinoblastoma protein (pRb). Advances in molecular understanding have catalyzed effective primary and secondary prevention strategies. Prophylactic HPV vaccination, especially the nonavalent formulation, has demonstrated high efficacy in reducing HPV infections and cervical precancer. Concurrently, HPV deoxyribonucleic acid (DNA) testing, self-sampling, and screen-and-treat protocols are transforming screening paradigms, particularly in resource-limited settings. However, global disparities in vaccine access, screening coverage, and health infrastructure persist, impeding progress toward the World Health Organization’s (WHO) 90–70–90 elimination targets. By synthesizing recent advances in virology, prevention strategies, and implementation innovations, such as therapeutic vaccines, artificial-intelligence (AI)-driven diagnostics, and mobile health solutions, this review sheds light on their potential to narrow these equity gaps. Full article

Global climate change demands a rapid transition to renewable energy for sustainable development and carbon neutrality. However, existing frameworks often overlook the dynamics of renewable energy use across production, consumption, final production, and income perspectives of the economy, thereby limiting understanding of global energy transitions. This study addresses this gap using a multi regional input-output (MRIO) model to analyze renewable energy use globally from 2000 to 2021 through multiple perspectives. Our findings reveal significant disparities in renewable energy use across countries. The United States is the largest renewable energy user by four perspectives in 2021, while per capita renewable energy use reveals pronounced disparities, with heavily populated countries like China and India having notably low use levels. Furthermore, resource-exporting countries, as primary suppliers for global renewable energy, promote renewable energy use, making a substantial contribution to the energy transition. Sectoral analysis highlights the significance of electricity, gas, and water industries in renewable energy use. This study provides a comprehensive framework for analyzing renewable energy use, offering valuable insights to policymakers to accelerate equitable and sustainable energy transitions. Full article

Anemia has been a growing concern for the pediatric population in sub-Saharan Africa. Emerging risk factors for anemia under five years of age in low-income countries are multifaceted, including infectious diseases, nutritional deficiencies, hidden hunger, and various economic determinants, and its health burdens include childhood stunting and reduced cognitive function diminished school performance in children. However, the influence of climatic factors, particularly ambient temperatures, on pediatric anemia remains understudied. In this population-based study, we assess the region-specific associations between pediatric anemia and ambient temperatures in 43 countries in Africa from 2000 to 2019. Using generalized linear regression models (upon adjusting for covariates), we found that the risk of temperatures on pediatric anemia varies across four African regions, whereby the Central and Southern African regions have a positive association between pediatric anemia and ambient temperatures, and Western and Eastern regions are negatively affected. The study aims to provide evidence to stakeholders to curtail the onset of pediatric anemia in high-risk African regions to set up key interventions based on the sustainability goals set by the World Health Organization. Full article

Background: Geographic information systems (GIS) are a promising tool for mapping vaccination coverage and identifying missed communities, yet their use in low- and middle-income countries (LMICs) remains limited. In settings without standardized addresses such as schools or outreach sites, innovative methods are needed to collect and analyse spatial data. Schools offer a unique platform for identifying under-vaccinated children missed by routine or campaign efforts. Methods: During a pilot school vaccination screening program in Zambia, GIS reference maps of health facility catchment areas were developed from hand-drawn sketch maps, catchment area shapefiles, and coordinates of prominent landmarks. These maps were iteratively refined with input from local health staff. In caregiver interviews, data collectors used the maps to identify the child’s zone of residence within the health facility catchment area. Vaccination status was extracted from paper registries used during screening. Geographic heat maps were generated in ArcGIS to visualize under-vaccination by zone. Results: Of 535 children screened across 25 zones, 29% were under-vaccinated. Under-vaccination varied by zone, with clusters of missed children identified, for example, 50% of children in Kabushi Zone 6 were under-vaccinated, compared with much lower rates elsewhere. Conclusions: Pairing school-based vaccination checks with GIS mapping offers a scalable approach to identifying missed communities in LMICs. This method enables spatial analysis without household visits, supporting targeted immunization planning where traditional data systems fall short. However, because the study was limited to children enrolled in five purposively selected schools, out-of-school children and those in other schools were not represented. This selection bias may underestimate the true extent of under-vaccination, and future evaluations should incorporate broader and more representative populations. Full article

Comprehensive healthcare seeks to uphold the right to health by providing patient-centred care in both personal and work environments. However, the unequal distribution of healthcare services significantly restricts access in remote or underserved areas—a challenge that is particularly critical in mental health care within low-income countries. On average, there is only one psychiatrist for every 200,000 people, which severely limits early diagnosis and continuous monitoring in patients’ daily environments. In response to these challenges, this research explores the feasibility of implementing an information system that integrates cloud computing with an intelligent Facial Expression Recognition (FER) module to enable psychologists to remotely and periodically monitor patients’ emotional states. This approach enhances comprehensive clinical assessments, supporting early detection, ongoing management, and personalised treatment in mental health care. This applied research follows a descriptive and developmental approach, aiming to design, implement, and evaluate an intelligent cloud-based solution that enables remote monitoring of patients’ emotional states through Facial Expression Recognition (FER). The methodology integrates principles of user-centred design, software engineering best practices, and machine learning model development, ensuring a robust and scalable solution aligned with clinical and technological requirements. The development process followed the Software Development Life Cycle (SDLC) and included functional, performance, and integration testing. To assess overall system quality, we defined an evaluation framework based on ISO/IEC 25010 quality characteristics: functional suitability, performance efficiency, usability, and security. The intelligent FER model achieved strong validation results, with a loss of 0.1378 and an accuracy of 96%, as confirmed by the confusion matrix and associated performance metrics. Full article

Background: Antimicrobial resistance (AMR) is a growing global health threat, with children in low- and middle-income countries bearing a disproportionate burden. Data on resistance patterns and diagnostic practices in pediatric populations remain limited. This study evaluated diagnostic utilization and AMR among children hospitalized with bacterial infections at a national referral hospital in Kenya. Methods: We conducted a retrospective cohort study of pediatric inpatients (0–12 years) admitted with bacterial infections between 2017 and 2021. Patient records were identified using ICD-10 codes and reviewed for diagnostic testing and antimicrobial susceptibility. Descriptive statistics were conducted to show infection counts, diagnostic testing, and resistance outcomes. Results: Among 1608 patients, 1009/1608 (63%) were infants under one year. Culture was conducted in 640/1608 (40%) and antimicrobial sensitivity testing in 111/640 (17%) patients. Gastroenteritis (46%) was the most common infection and blood the most frequently collected specimen (31%). Of 1039 cultured specimens, 896/1039 (86%) showed no growth. The most commonly isolated organisms were Klebsiella pneumoniae 19/128 (15%), Staphylococcus epidermidis (13%, 17/128), and Enterococcus faecium (13%, 16/128). Notably, K. pneumoniae showed 100% resistance to third-generation cephalosporins, suggestive of ESBL production. Among the tested samples, 92/128 (72%) had MDROs, and 26/92 (28%) were extensively drug-resistant (XDR). Among the patients tested, 84/111 (76%) had MDROs, of which 25/84 (30%) were XDR. Children under 5 years had higher odds (OR = 5.84, 95% CI: 1.17-38.21) of having MDRO infections, as well as those with multiple admissions (OR = 3.77, 95% CI: 1.06–20.34). Further, increasing age was inversely associated with MDRO presence. The odds of MDRO infection decreased by 24% for every year increase in age (aOR = 0.76; 95% CI: 0.60–0.93; p = 0.006). Conclusions: The findings highlight the limited diagnostic use and a high burden of MDROs and XDR infections in hospitalized children. Strengthening diagnostic capacity and pediatric antimicrobial stewardship is urgently needed in such settings. Full article

Introduction: Newborn mortality is unacceptably high, especially in low- and middle-income countries. The Safer Births Bundle of Care (SBBC) was implemented in Tanzania, including training of healthcare workers on neonatal resuscitation by means of frequent in situ simulation training using improved training tools. We aimed to assess the acceptability of this training model among healthcare providers in selected health facilities under SBBC intervention. Methods: A cross-sectional study was conducted among healthcare workers in labor wards and obstetric theaters in selected facilities one year after the introduction of the SBBC model. The theoretical framework for assessment of the acceptability of healthcare interventions was used to assess the acceptability of the training model and accompanying tools. The chi-square test was used to assess the association between acceptability in specific constructs and average individual practice per month, while a modified Poisson regression analysis was used to assess factors associated with acceptability in specific framework constructs. Results: A total of 227 healthcare workers were enrolled in the study. Overall, 223 (98.2%) accepted the intervention. However, 207 (91.2%) reported that the intervention increased their work burden, while 39 (17.2%) reported that it interfered with other equally important activities. The level of health facility was independently associated with the reporting that engaging in simulation practice interfered with other equally important activities. Conclusions: In situ, low-dose, high-frequency facility-based simulation training for neonatal resuscitation was highly acceptable among healthcare providers. However, the perceived increased work burden of this intervention and interference with other equally important activities were identified as potential threats to successful implementation. Full article

Background and Objective: Stunting remains a critical public health concern affecting child growth and development, particularly among children under two years of age in low- and middle-income countries, including Rwanda. This study investigates spatiotemporal trends in stunting prevalence from 2020 to 2024 at the sector level using national surveillance data. Methods: To capture regional disparities and temporal trends, we used hierarchical Bayesian spatiotemporal models, which accounted for spatial structure, temporal correlations, and interactions, to estimate stunting prevalence across districts and sectors over time. Results: Between 2020 and 2024, the national prevalence of stunting among children under two years decreased from 33.1% to 21.7%, representing a 34.4% change. Three districts, Kamonyi, Nyarugenge, and Ngoma, achieved reductions of >70%, whereas Rubavu, Nyabihu, and Nyaruguru saw minimal change (14–15%). By 2024, several sectors in Kicukiro, Nyanza, Nyarugenge, and Kirehe had reduced levels of stunting below the national target of 19%. Conclusions: Despite considerable gains, significant geographical differences persist in the stunting prevalence of children under two, underscoring the need for targeted, decentralized interventions to mitigate and eliminate this in lagging areas. Full article

Background/Objectives: Extended-Spectrum Beta-Lactamase-producing Escherichia coli (ESBL-E. coli) are widely circulating in livestock of low- and middle-income countries. However, the drivers of their circulation remain largely unknown. Small-scale farms in Peru exhibit an unusually high prevalence of fecal carriage of ESBL-E. coli in their livestock. The objective of this study was to compare the prevalence of ESBL-E. coli fecal carriage in dairy cows, pigs, and poultry in the Lima and Ica regions of Peru and to identify the drivers associated with the observed prevalence at the farm level. Methods: We compared the prevalence of fecal carriage of ESBL-E. coli isolated from dairy cattle (N = 244 animals; 25 farms), pigs (N = 261; 25), and laying hens (N = 255; 10). We also administrated questionnaires to 59 farmers regarding their socioeconomic status, husbandry practices, animal diseases, and antibiotic use. Results: All but one of the 60 farms sampled had at least one animal carrying ESBL-E. coli. A statistically higher prevalence of ESBL-E. coli was estimated in dairy cows (75%) and pigs (61%) from Lima compared to laying hens from Ica (34%). Our statistical analyses (Poisson generalized linear models) using two variable selection approaches revealed that the prevalence of ESBL-E. coli was lower in farms raising laying hens, when farmers oversaw both animal husbandry and healthcare, and in farms with a lower number of gastrointestinal outbreaks in the last semester. Socio-economic features of farmers and self-reporting antibiotic use varied across farms (i.e., highest antibiotic use over the last semester was reported among pig farmers (96%), followed by laying hen (70%) and dairy cattle farmers (50%)), but these factors were not associated with the prevalence of ESBL-E. coli. Conclusions: Despite a relatively low number of farms sampled, our findings suggest that the widespread circulation of ESBL-E. coli among livestock in Peru could be mainly associated with unknown species-specific drivers, independently of the socioeconomic status of farmers and antibiotic use. Therefore, our study calls for future research to identify the specific drivers promoting the high prevalence of ESBL-E. coli among cattle and pigs in Peru. Full article

Multi-energy systems (MES), or energy hubs, offer a technologically viable solution for maintaining resilient energy infrastructure in the face of increasingly frequent disasters, which disproportionately affect low-income and disadvantaged communities; however, their adoption for these purposes remains poorly understood. Following PRISMA 2020, this paper systematically reviews the MES literature from both resiliency and equity perspectives to identify synergies, disparities, and gaps in the context of climate change and long-term decarbonization goals. From 2420 records identified from Scopus (1997–2023), we included 211 original MES research publications for detailed review, with studies excluded based on their scale, scope, or technology. Risk of bias was minimized through dual-stage screening and statistical analysis across 18 physical system and research approach categories. The results found that papers including equity are statically more likely to involve fully renewable energy systems, while middle income countries tend to adopt renewable systems with biofuels more than high income countries. Sector coupling with two energy types improved the resiliency index the most (73% difference between baseline and proposed MES), suggesting two-type systems are optimal. Statistically significant differences in modeling formulations also emerged, such as equity-focused MES studies adopting deterministic design models, while resilience-focused studies favored stochastic control formulations and load-shedding objectives. While preliminary studies indicate low operational costs and high resilience can synergistically be achieved, further MES case studies are needed with low-income communities and extreme climates. Broadly, this review novelly applies structured statistical analysis for the MES domain, revealing key trends in technology adoption, modeling approaches, and equity-resilience integration. Full article

Food insecurity remains a persistent global challenge, despite significant advancements in agricultural production and technology. The main objective of this study is to identify and quantitatively assess some of the structural determinants influencing country-level food insecurity and provide an empirical background for policy-making aimed at achieving the Sustainable Development Goal of Zero Hunger (SDG 2). This study employs a beta regression model in order to study moderate or severe food insecurity across 153 countries, using a cross-sectional dataset that integrates economic, agricultural, political, and demographic independent variables. The analysis identifies low household per capita final consumption expenditure (β = −9 × 10⁻⁵, p < 0.001), high income inequality expressed as a high GINI coefficient (β = 0.047, p < 0.001), high long-term inflation (β = 0.0176, p = 0.003), and low economic globalization (β = −0.021, p = 0.001) as the most significant predictors of food insecurity. Agricultural variables such as land area (β = −1 × 10⁻⁵, p = 0.02) and productivity per hectare (β = −9 × 10⁻⁵, p = 0.09) showed limited but statistically significant inverse effects (lowering food insecurity), while factors like unemployment, political stability, and conflict were not significant in the model. The findings suggest that increased economic capacity, inequality reduction, inflation control, and global trade integration are critical pathways for reducing food insecurity. Future research could employ beta regression in time-series and panel analyses or spatial models like geographically weighted regression to capture geographic differences in food insecurity determinants. Full article

Background/Objectives: Equitable access to childhood vaccines remains a challenge in many low- and middle-income countries. This study assessed coverage of WHO-recommended childhood vaccines in Cambodia and the Philippines, focusing on urban–rural and wealth disparities, and examined maternal demographic and socioeconomic factors influencing vaccination coverage. Methods: Cross-sectional data from Demographic and Health Surveys from Cambodia (2000–2021/22) and the Philippines (2003–2022) were used. Descriptive analyses were performed to elucidate vaccination coverage trends (BCG, hepatitis B birth dose, DTP, OPV, PCV, and measles). Urban–rural and wealth-related disparities were assessed by calculating absolute differences and Slope Index of Inequality. Logistic regression was used to analyze the impact of maternal demographics and socioeconomic status on vaccination coverage. Results: Cambodia showed significant increases in BCG, DTP, and OPV coverage over the past two decades, whereas those coverage in the Philippines declined slightly since 2017. In 2022, 75.2% of Filipino children received the BCG and hepatitis B (birth dose) vaccines, and around two-thirds completed DTP, OPV, and PCV vaccinations on schedule, lower than the rates in Cambodia. Only half of the children completed measles vaccination in both countries. Urban–rural disparities declined over time in both countries, but wealth inequalities persisted and widened in the Philippines between 2017 and 2022. Women with higher education attainment, from a wealthy household and having fewer children, was associated with increased likelihood of completing childhood vaccinations in both countries. Conclusions: Persistent socioeconomic disparities in childhood vaccination in low- and middle-income countries highlight the need for targeted pro-poor and community-based strategies to ensure equitable access. Full article