Resource-limited Areas Research Articles

Impact of Hydraulic Retention Time on The Quality of Treated Effluents in A Horizontal Subsurface Flow Wetland

Objective: This study aims to analyze the impact of hydraulic retention time (HRT) on the quality of treated effluents in a horizontal subsurface flow wetland. The research focuses on optimizing HRT to meet the standards established by Dominican Environmental Norms for wastewater discharges into surface waters, sanitary sewers, and coastal waters. Theoretical Framework: The study is grounded in principles of artificial wetland design and operation, emphasizing sustainable treatment systems for wastewater. Concepts such as biological contaminant removal, oxygenation through vegetation, and sedimentation processes are central to understanding the mechanisms driving contaminant reduction. Method: The horizontal subsurface flow wetland used in this study was colonized by Typha domingensis and monitored across seven HRTs (3, 5, 7, 9, 11, 13, and 15 days). Effluent quality was evaluated for parameters including coliforms, biochemical and chemical oxygen demand (BOD5 and COD), nitrogen, phosphorus, turbidity, and suspended solids. Results and Discussion: The findings showed that while most parameters reached normative levels at 3 days of HRT, total and fecal coliforms required 9 days to comply with limits. This indicates that with an additional disinfection system, a 3-day HRT could suffice, optimizing the system’s efficiency while maintaining compliance. The discussion highlights the relationship between HRT and contaminant removal, with recommendations for system adjustments based on influent characteristics. Research Implications: The study provides practical insights for the design and operation of artificial wetlands in resource-limited areas, promoting sustainable water treatment solutions. The results can inform policy and improve the efficiency of wastewater treatment practices in tropical and subtropical regions. Originality/Value: This research contributes novel data from the Dominican Republic, showcasing the application of horizontal subsurface flow wetlands in achieving environmental compliance. It highlights the potential for tailored HRTs to optimize artificial wetlands, balancing operational costs and treatment efficiency.

A POCT assay based on commercial HCG strip for miRNA21 detection by integrating with RCA-HCR cascade amplification and CRISPR/Cas12a.

Apoint-of-care testing (POCT) assay based on commercial HCG strip was proposed for miRNA21 detection by integrating RCA-HCR cascaded isothermal amplification with CRISPR/Cas12a. Three modules were integrated in the proposed platform: target amplification module composed of rolling circle amplification (RCA) cascaded with hybridization chain reaction (HCR), signal transduction module composed of CRISPR/Cas12a combined with HCG-agarose gel beads probes, and signal readout module composed of commercial HCG strips. The proposed RCA-HCR-CRISPR/Cas12a-HCG strip assay for miRNA21 detection had high sensitivity, and the limit of detection was as low as 37 fM. The proposed assay showed excellent specificity for miRNA21, as other miRNAs did not caused interference for detection. The recoveries of miRNA21 were ranged from 89.0 to 118.0%. The intra-batch and inter-batch coefficient of variation (CV) were 10.1-13.4% and 11.9-14.5%, respectively, which indicated ahigh accuracy and precision, and the serum matrix did not cause any interference. With the advantages of low-cost, high sensitivity, visualization, and easy popularization, the proposed assay is expected to provide a powerful tool for early diagnosis of tumor disease miRNA, especially in resource-limited areas.

Progress in research of incidence of co-infection of HIV and Mycobacterium tuberculosis and influencing factors

The co-infection of HIV and Mycobacterium tuberculosis (MTB) poses a severe challenge for the prevention and control of infectious disease, resulting in poor clinical outcomes of the patients and risk for wide spread. As steady progress in global health, the co-infection of HIV/MTB has been basically controlled, and the new cases are generally declining. However, its incidence remained high in resource-limited areas. The incidence of the co-infection of HIV/MTB is associated with the interaction among individual, social, health service, and natural factors. Comprehensive measures are needed to reduce this disease burden. This paper summarized the epidemiological characteristics of the co-infection of HIV/MTB and influencing factors both at home and abroad to provide evidence for the identifications of high-risk populations and areas and development of targeted prevention measures for the purpose of reduce the incidence of co-infection of HIV/MTB.

Development of a portable multi-step microfluidic device for point-of-care nucleic acid diagnostics

BackgroundThe COVID-19 pandemic has significantly affected global health, economies, and societies, and highlighted the urgent need for rapid, sensitive, affordable, and portable diagnostic devices for respiratory diseases, especially in areas with limited resources. In recent years, there has been rapid development in integrated equipments using microfluidic chips and biochemical detection technologies. However, these devices are expensive and complex to operate, showing limited feasibility for in point of care tests (PoCTs). This study aims to develop a cost-effective, portable, and practical microfluidic nucleic acid PoCT device for rapid virus diagnosis. ResultsHere, we developed a device based on freeze-dried reverse transcription loop-mediated isothermal amplification (RT-LAMP) reagents for rapid nucleic acid diagnostics. Homebrew RT-LAMP reagents were optimized to eliminate non-specific amplification. The multi-step device combines nucleic acid extraction, RT-LAMP and fluorescence detection in an integrated microfluidic chip, enabling sample-in, result-out diagnosis. This device showed satisfactory sensitivity in detecting SARS-CoV-2 and Trichomonas vaginalis RNA samples, with a limit of detection (LOD) of 400 copies/μL and 80 copies/μL respectively in 45 minutes. The LOD of cultured Trichomonas vaginalis samples were 0.32 cells/μL in 50 minutes. Additionally, the freeze-dried homebrew RT-LAMP can be stored at 4 °C for up to 30 days while still maintaining high sensitivity and detection capabilities. The cost of diagnosis was reduced to as low as 0.45 $ per reaction. Significance and NoveltyOverall, by integrating freeze-dried homebrew RT-LAMP and microfluidic chip, the device achieves ready-to-use, laboratory-free, quick, resource-independent and cost-effective nucleic acid detection, and provides a feasible alternative to complex equipments. The device shows potentials for point-of-care testing of SARS-CoV-2 and other respiratory diseases in remote or resource-limited areas with proper implementation.

CRISPR/Cas13a combined with reverse transcription and RPA for NoV GII.4 monitoring in water environments.

Water bodies contaminated with the norovirus (NoV) are important vectors for its transmission. Therefore, enhanced monitoring of NoV in aqueous environments plays an active role in preventing diseases. Here, we reverse transcribed viral RNA into cDNA, and then used the constructed RPA-CRISPR/Cas13a-based platform for sensitive and quantitative monitoring of NoV GII.4 in aqueous environments. The use of glycerol as a phase separator and the direct release of nucleic acids from the virus by NaOH significantly enhanced the stability of the assay and reduced its economic cost. This assay is sensitive, specific, and stable. Based on the qualitative detection method, we established a relatively accurate quantitative detection method using the plasmid as a standard. Four water samples, totaling 64 samples, were analyzed using this method and compared with the qPCR method. The results of the two methods showed 100% concordance with no significant difference in viral load. The entire process of our established method-from viral nucleic acid extraction to the output of the results-was completed in 30min, much less than the time required for qPCR method. This suggests that the assay can be used as an alternative to qPCR for monitoring the change of NoV GII.4 concentration in water bodies, and shows high potential for application in the immediate detection of viruses in aqueous environments and resource-limited areas.

Using primary and routinely collected data to determine prevalence and patterns of multimorbidity in rural China: a representative cross-sectional study of 6474 Chinese adults.

In China, rising chronic diseases has coincided with the increasing burden of multimorbidity, particularly for vulnerable populations. Limited primary data are available to understand the prevalence and patterns of multimorbidity, especially in resource-limited rural areas. This study aims to conduct robust evaluations of the prevalence and patterns of multimorbidity among rural adults in China, and to compare the differences in prevalence and patterns when using primary data alone versus in combination with routinely collected data. This cross-sectional study was conducted in three provinces in China, with two counties per province and 40 villages per county, resulted in a total of 240 villages. Participants were randomly selected and stratified by sex and age in each village. Multimorbidity, defined as the coexistence of two or more diseases in same individual, was assessed through data collection involving primary data (face-to-face questionnaire, physical examination and fasting blood sample collection) and routinely collected data (health insurance claims, hospital electronic records and infectious disease surveillance system). Multimorbidity prevalence and patterns were compared based on 1) primary data alone and 2) primary data complemented by routinely collected data. A total of 6474 individuals participated in this study (50.9% women, mean age 57.1). Combining routinely collected data with the primary data increased the prevalence of all single disease conditions. Multimorbidity prevalence rose from 35.7% with primary data alone to 44.4% with the addition of routinely collected data. The top three dyad multimorbidity patterns (hypertension with heart disease, stroke, or chronic digestive diseases) remained consistent between the two ascertainment methods, while triad pattern rankings had a substantial shift. According to blood pressure measurements, over 40% of participants had elevated blood pressure and may have undiagnosed hypertension. Over 20% may have undiagnosed mental health disorders base on the questionnaires, and nearly 10% with undiagnosed chronic kidney disease as indicated by blood testing. The utilisation of primary data combined with routinely collected data provided a robust estimation of multimorbidity burden in three rural regions in China. Yet, the prevalence may still have been underestimated due to inaccuracies in self-reported data and underdiagnosis of diseases. Future research should incorporate routinely collected data for more robust epidemiological evidence of multimorbidity. Harbin Medical University Leading Talent Grant (31021220002) and National Natural Science Foundation of China (72074065 and 72474063).

Developing an early detection model for skin diseases using a hybrid deep neural network to enhance health independence in coastal communities

The object of study is a solution for early skin disease diagnosis by integrating hybrid deep neural networks – EfficientNetB7 for Classification and YOLOv8 for detection. The system is designed to classify five skin conditions: Melanoma, Basal Cell Carcinoma (BCC), melanoma is a type of skin cancer that originates from melanocytes, the cells that produce skin pigment, Melanocytic Nevi (NV) Melanocytic nevus is a mole or dark spot on the skin formed due to the accumulation of melanocytes, Benign Keratosis-like Lesions (BKL) is a term for a group of skin changes that resemble keratosis but are non-cancerous, and Seborrheic Keratoses and other benign tumors to enhance the health diagnostics. The problem to be solved in this study revolves around improving early and accurate skin disease diagnosis, particularly in resource-limited or underserved areas and the lack of Accessible Diagnostic Tools and Low Efficiency of Current Diagnostic Methods. The study highlights EfficientNetB7's classification accuracy at 94 % and YOLOv8's means average precision (mAP) of 0.812 for detection. This hybrid system processes skin images efficiently, providing classification and detection outcomes with consistent performance in multiple tests. The results demonstrate that the EfficientNetB7 model achieved an accuracy of 94 % on test data, while YOLOv8 delivered a detection performance with a mean average precision (mAP) of 0.812. The web-based system efficiently processed skin images and provided classification and detection outcomes. Furthermore, integrating EfficientNetB7 and YOLOv8 allowed the skin disease detection system to classify five different diseases and assess malignancy risk. The systems are portable and can be used with minimal setup, making them practical for real-world diagnostic use. The Scope and Practical applications are designed for accessibility in resource-limited settings. The website-based skin disease detection tool provides a user-friendly platform accessible to the public and healthcare providers, especially in underserved areas. Each application's high accuracy and ease of use make them viable aids in early diagnosis, potentially improving healthcare access

Efficient Photolysis of Multidrug-Resistant Polymicrobial Biofilms.

Chronic wounds are prone to infections with multidrug-resistant bacteria, forming polymicrobial biofilms that limit treatment options and increase the risk of severe complications. Current cleansing options are insufficient to disrupt and remove tenacious biofilms; antibiotic treatments, on the other hand, often fall short against these biofilm-embedded bacteria. This study explores an non-antibiotic approach that extends beyond conventional porphyrin-based phototherapy by using blue light (BL) in conjunction with ferric ions (Fe(III)) to disrupt and eradicate biofilms. The dual not only degraded biofilm extracellular polymeric substances (EPS) in mono-species and polymicrobial biofilms by specifically targeting carboxyl-containing polysaccharides within the matrix but also exhibited broad-spectrum antimicrobial activity by affecting key components of the outer membrane and cell wall. Bacteria, such as K. pneumoniae, with compromised EPS after photolysis, demonstrated increased susceptibility to macrophage phagocytosis. Disruption of the polymicrobial biofilm structure also enhanced the bacterial susceptibility to bactericidal drugs. Treating wounds infected by mixed-species biofilm in diabetic mice demonstrated a substantial reduction in bacterial colonization and improved tissue repair. The BL-Fe(III) modality offers a safe, efficient alternative for managing chronic wound infections, making it ideal for repeated, non-invasive use at home, especially in resource-limited areas.

A multi-phase structured cascade model for mass training of community healthcare workers in performing clinical breast exams in remote regions.

Clinical breast exam (CBE) by outreach healthcare workers (HCW) may help downstage breast cancer in resource-limited areas where mammography may not be feasible. We evaluated the effectiveness of a pilot cascade-model training programme for HCWs in remote areas of Pakistan. The training programme comprised three phases. In phase one, fellowship-trained breast surgeons at a metropolitan academic centre trained six HCWs to perform CBEs. In phase two, these six HCWs (master trainers) trained 15 additional HCWs, implementing cascade training. In phase three, the consultant breast surgeon conducted a re-evaluation and refresher course for all 21 HCWs at least one year after the original training session. We assessed CBE ability and skills through pre- and post-changes through self-reported confidence and direct observation of procedural skills. Significant improvements in learners' self-reported confidence and CBE skills were observed in both phases one and two. The median scores in the learners' post-training self-reported confidence and CBE skills (inspection, palpation, and lymph node examination) improved by 20% and 46.2%, respectively, indicating excellent learning outcomes of the cascade training sessions. Phase three showed sustained high scores in self-reported confidence and CBE skills more than one year later. Mass training of outreach HCWs in remote regions in performing CBE may be possible with a structured multiphase cascade-training model and may be an important step in downstaging symptomatic breast cancer in low-resource settings.

Case management strategy enhances virological response in people living with human immunodeficiency virus in a resource-limited region in Southwest China: a real-world prospective observational study

This study assessed the effectiveness of case management compared to that of standard care in improving treatment outcomes for first-time antiretroviral therapy (ART) patients in Liangshan Prefecture, China. First-time ART patients (total n = 828) were divided into the Standard Care Group (SCG, n = 419) and Case Management Group (CMG, n = 409). At week 48, the CMG showed higher retention rates (97.7% vs. 93.6%), better adherence, and more complete virological responses (84.2% vs. 64.0%) compared to the SCG. These findings suggest that case management improves adherence and virological suppression in resource-limited areas, though further research is needed to confirm its broader applicability.

Laboratory validation of a simplified DNA extraction protocol followed by a portable qPCR detection of M. tuberculosis DNA suitable for point of care settings.

Tuberculosis, caused by Mycobacterium tuberculosis, is a treatable and curable disease, and yet remains one of the leading causes of death worldwide. Diagnosis is essential to reducing the number of cases and starting treatment, but costly tests and equipments that require complex infrastructure hamper their widespread use as a tool to contain the disease in vulnerable populations as well countries lacking resources. Therefore, it becomes necessary to develop new technological approaches to molecular methods as well as screening tests that can be rapidly conducted among people presenting to a health facility to differentiate those who should have further diagnostic evaluation for TB from those who should undergo further investigation for non-TB diagnoses. The present study aimed to evaluate two experimental DNA extraction methods from clinical samples (FTA card versus sonication) followed by analysis in a portable qPCR instrument (the Q3-plus). The FTA card-based protocol showed 100% sensitivity and specificity, while the sonication protocol showed 80% sensitivity and 89% specificity when compared to the traditional gold standard culture. The portable protocol, comprised by the FTA card method and the portable instrument Q3-Plus, showed sensitivity and specificity of 92% and 61%, respectively, when compared to culture, and 75% and 81%, respectively, when compared to the standard TB case classification. The ROC curve showed an AUC of 0.78 (p<0.001) for the portable protocol and 0.93 (p<0.001) for the GeneXpert Ultra. The limit of detection (LOD) for Mycobacterium tuberculosis (H37Rv strain) detection in spiked samples obtained using the portable protocol (FTA card and Q3-Plus) was 19.3 CFU/mL. As an added benefit, using the FTA card facilitates sample handling, transport, and storage. It is concluded that the use of the FTA card protocol and the Q3-Plus yields similar sensitivity and specificity as the gold standard diagnostic tests and case classification. We suggest that the platform is suitable to use as a point of care tool, assisting in the screening of tuberculosis in hard-to-reach or resource-limited areas.

Health insurance in rural Tanzania promotes self-care for among patients with non-communicable diseases via their disease management behaviours.

The rise of hypertension (HTN) and diabetes mellitus (DM) in Tanzania underscores the importance of self-care practices (SCP) for disease management. Despite the proven effectiveness of SCP, financial barriers in resource-limited rural areas hinder continuous care. Health insurance (HI) emerges as a critical solution to alleviate financial constraints and support SCP. This study examined an association between HI and SCP by generalised linear and ordinal logistic regressions, adjusted for sociodemographic factors. Mediation analysis highlighted the role of disease management behaviours (hospital visits and medication adherence) in the association. Data were collected through individual interviews with 909 patients. Better SCP for HTN and DM were associated with the National Health Insurance Fund (HTN: coefficient=0.571; DM: coefficient=0.567, p<0.001) and the improved Community Health Fund (iCHF) or CHF (HTN: coefficient=0.330; DM: coefficient=0.472, p<0.05), after adjustment for sociodemographic variables. Mediation analysis showed that disease management behaviours partially or fully mediated the relationship between HI and SCP. Enrolment in HI by patients in rural Tanzania exhibited better disease management behaviours and SCP. Efforts should focus on leveraging the HI schemes to expand their coverage in rural areas, which could benefit patients with non-communicable diseases.

China’s elderly mutual aid model: an active ageing perspective

Purpose China’s rural elderly care system faces significant challenges in addressing the needs of an ageing population, particularly in resource-limited areas. This study aims to critically examine the rural mutual aid elderly care model in China through the lens of active ageing principles. It explores how this model tackles elder care challenges in rural areas by emphasising health, participation and security, aiming to assess its effectiveness in reducing care costs while fostering self-reliance and mutual assistance. Design/methodology/approach A qualitative research methodology was used, focusing on document analysis to explore the rural mutual aid elderly care model within an active ageing framework. The study reviewed policy documents, academic literature and organisational records, using thematic analysis to understand the historical context, policy evolution and institutional support for this model. Findings The research identifies a significant shift from traditional passive care models to those grounded in active ageing principles. The rural mutual aid model, centring on health, participation and security, enables elderly individuals to engage in self-help and mutual assistance, thereby enhancing autonomy and reducing dependency. Key success factors include strong community networks and culturally resonant support systems. However, challenges such as resource limitations and regional disparities suggest areas for further improvement. Research limitations/implications The reliance on document analysis may not fully capture the experiences of elderly participants or account for regional variations in the model’s implementation. Future research could incorporate mixed methods, including interviews or case studies, for a more nuanced understanding of elderly care in rural China. The findings emphasise the need for scalable and adaptable policies to enhance the model’s effectiveness and support culturally appropriate care strategies. Practical implications The research presents significant implications for policymakers and practitioners regarding the rural mutual aid elderly care model. It emphasises the need for scalable policies that address resource limitations and enhance community engagement to improve care effectiveness. Key implications include promoting financial and social sustainability by fostering self-reliance among older adults, prioritising active ageing initiatives to enhance quality of life and community cohesion and adopting localised strategies that consider regional disparities. Moreover, these findings offer a blueprint for other countries facing similar ageing challenges, advocating for a culturally sensitive and community-driven approach to elderly care across East Asia. Social implications The study’s findings significantly impact how ageing is perceived and managed in rural Chinese communities. The shift from traditional, passive elderly care models to those grounded in active ageing principles reflects a societal transformation in valuing and supporting older adults. By promoting health, participation and security, the rural mutual aid elderly care model creates inclusive environments where the elderly actively contribute to their well-being and that of others. This approach challenges perceptions of ageing as a decline, fostering autonomy and meaningful engagement, ultimately reducing social isolation and enhancing cohesion through strengthened intergenerational relationships and shared responsibilities. Originality/value This study contributes to the literature by focusing on the rural mutual aid elderly care model in China through active ageing principles, addressing a notable gap in the non-Western application of these concepts. The findings offer valuable recommendations for policymakers and practitioners, emphasising community-driven approaches to ageing challenges in rural areas.

Rapid and multiple visual detection of Fasciola hepatica in feces via recombinase polymerase amplification integrated with CRISPR/Cas12a technology

Fasciola hepatica is a foodborne zoonotic parasite causing significant economic losses and impacting human and livestock health in resource-limited regions. We developed a rapid, reliable, and sensitive detection method combining recombinase polymerase amplification (RPA) with CRISPR/Cas12a, allowing visualization with the naked eye or a fluorescence reader. Multiple visual methods were used to analyze the assay results. Fluorescence signals were collected using a fluorescence reader or observed under UV or blue light. Lateral flow strips (LFS) were used for visual detection. Among seven primer pairs and three CRISPR RNA (crRNA) screened, F1/R1 and crRNA3 were optimal. The Cas12a reaction buffer was optimized with 50 mM Tris-HCl and 80 mM NaCl, with an RPA reaction time of 20 min. The assay showed high specificity and excellent sensitivity for F. hepatica, detecting 0.122 copies/μL with fluorescence and 8.6 copies/μL with LFS. Testing of 143 sheep and 43 human fecal samples showed 98.39 % consistency with qPCR and nested PCR, with prevalence rates of 52.45 % and 18.6 % in sheep and humans, respectively. Our assay offers substantial potential for point-of-care testing in resource-limited areas, addressing the need for rapid and accurate diagnosis of F. hepatica.

Application of a new type of double-lumen endotracheal tube in preterm infants with respiratory distress syndrome: study protocol for a non-inferiority randomised controlled trial (NISA)

BackgroundNon-invasive ventilation combined with pulmonary surfactant (PS) therapy is recognised as a method for treating neonatal respiratory distress syndrome (NRDS). Among the administration, methods of PS, INtubation–SURfactant–Extubation (InSurE) and less...

Blood Group Detection Using Fingerprint Images

Blood group detection is a crusial aspect of medical diagnostics, widely used in blood transfusions, organ transplants, and prenatal care. Traditional blood typing methods require blood samples and reagents, which can be invasive, timeconsuming, and costly. This research proposes a novel, non-invasive approach to identify blood group using fingerprint analysis. By using Cutting-edge techniques for image processing , we analyse unique fingerprint patterns and identify specific features linked to blood types. Our methodology incorporates image enhancement, Extracting data attributes and employing learning algorithms to classify blood groups accurately. We are planning to optimize and check the performance of the model on a robust dataset, achieving promising correctness and performance in blood group prediction. This technique holds promise to redefine blood typing processes, providing a rapid, cost-effective, and accessible solution for various medical applications, particularly in remote or resource-limited areas. Further improvements in accuracy through larger datasets and advanced algorithms could establish fingerprint-based blood group detection as a viable alternative to conventional methods.

Health workers’ knowledge and practices toward vaccine cold chain management and its associated factors in a resource-limited setting of Sheger, Oromia, Ethiopia: a multicenter cross-sectional study

BackgroundCold chain management is a continuous and cohesive process of preserving vaccines to ensure their availability and potency. However, the quality control of vaccines has been neglected in resource-limited areas such as Ethiopia. Adequate levels of health workers’ knowledge and practices in vaccine cold chain management are important to maintain the potency of vaccines and achieve the intended vaccine end goal.ObjectiveTo assess the level of knowledge and practices of health workers toward vaccine cold chain management and associated factors in resource-limited settings in Ethiopia.MethodsAn institution-based cross-sectional survey was conducted from May to June 2023 in eight sub-cities of Sheger City, Oromia Region, Ethiopia. 255 health workers were selected via simple random sampling from 17 health centers and 17 health posts. Data were collected through a self-administered questionnaire and entered in to EPI DATA version 3.1 and exported to SPSS version 26.0 software for analysis. Binary and multiple logistic regression analyses were carried out to identify factors associated with the knowledge and practices of health workers toward vaccine cold chain management. A variable with a p value < 0.25 was considered a candidate for further regression analysis, whereas a variable with a 95% CI and a p value < 0.05 was considered statistically significant.ResultA total of 255 respondents participated, for a 100% response rate. The overall magnitude of good knowledge and practice of vaccine cold chain management was 58% (95% CI: 52.2%--64.3%) and 52.2% (95% CI: 46.3-58.4%), respectively. Receiving pre-service training (AOR = 8.2; 95% CI: (2.93–22.99), availability of SOP/guidelines (AOR = 6.55; 95% CI: (2.0–21.36) and receiving supportive supervision (AOR = 4.2; 95% CI: (1.67–10.59)) were significantly associated with good knowledge of cold chain management. The availability of SOP/guidelines (AOR = 2.13; 95% CI: (1.22–3.7)) and the knowledge of health workers (AOR = 2.32; 95% CI: (1.11–4.8) were significantly associated with good cold chain management practices.ConclusionThere are gaps in knowledge and practice concerning cold chain management. There is an urgent need to improve the knowledge and practice of health workers in cold chain management in the newly organized but resource-limited administrative structure (Sheger) in Ethiopia.

Utility of Anthropometric Indexes for Detecting Metabolic Syndrome in Resource-Limited Regions of Northwestern China: Cross-Sectional Study.

Anthropometric indexes offer a practical approach to identifying metabolic syndrome (MetS) and its components. However, there is a scarcity of research on anthropometric indexes tailored to predict MetS in populations from resource-limited regions. This study aimed to examine the association between 8 easy-to-collect anthropometric indexes and MetS, and determine the most appropriate indexes to identify the presence of MetS for adults in resource-limited areas. A total of 10,520 participants aged 18-85 years from Ningxia Hui Autonomous Region, China, were included in this cross-sectional study. Participants were recruited through a stratified sampling approach from January 1, 2020, to December 31, 2021. MetS was defined using the International Diabetes Federation (IDF) criteria. Eight anthropometric indexes were examined, including BMI, waist-to-height ratio (WHtR), weight-adjusted waist index (WWI), conicity index, a body shape index (ABSI), lipid accumulation products (LAP), visceral obesity index (VAI), and the triglyceride-glucose (TyG) index. Logistic regression analysis and restricted cubic splines (RCSs) were applied to identify the association between the anthropometric indexes. The receiver operating characteristic curve and the area under the curve (AUC) were analyzed to identify and compare the discriminative power of anthropometric indexes in identifying MetS. The Youden index was used to determine a range of optimal diagnostic thresholds. Logistic regression analysis was applied to identify the association between the anthropometric indexes. A total of 3324 (31.60%) participants were diagnosed with MetS. After adjusting for age, ethnicity, current residence, education level, habitual alcohol consumption, and tobacco use, all the 8 indexes were positively correlated with the risks of MetS (P<.05). LAP presented the highest adjusted odds ratios (adjOR 35.69, 95% CI 34.59-36.80), followed by WHtR (adjOR 29.27, 95% CI 28.00-30.55), conicity index (adjOR 11.58, 95% CI 10.95-12.22), TyG index (adjOR 5.53, 95% CI 5.07-6.04), BMI (adjOR 3.88, 95% CI 3.71-4.05), WWI (adjOR 3.23, 95% CI 3.02-3.46), VAI (adjOR 2.11, 95% CI 2.02-2.20), and ABSI (adjOR 1.71, 95% CI 1.62-1.80). Significantly nonlinear associations between the 8 indexes and the risk of MetS (all Pnonlinear<.001) were observed in the RCSs. WHtR was the strongest predictor of MetS for males (AUC 0.91, 95% CI 0.90-0.92; optimal cutoff 0.53). LAP were the strongest predictor of MetS for females (AUC 0.89, 95% CI 0.89-0.90; optimal cutoff 28.67). Statistical differences were present between WHtR and all other 7 anthropometric indexes among males and overall (all P<.05). In females, the AUC values between LAP and BMI, WWI, ABSI, conicity index, VAI, and TyG index were significantly different (P<.001). No statistical difference was observed between LAP and WHtR among females. According to 8 anthropometric and lipid-related indices, it is suggested that WHtR and LAP are the most appropriate indexes for identifying the presence of MetS in resource-limited areas.

Malaria Cell Image Classification Using Compact Deep Learning Architectures on Jetson TX2

Malaria is a significant global health issue, especially in tropical regions. Accurate and rapid diagnosis is critical for effective treatment and reducing mortality rates. Traditional diagnostic methods, like blood smear microscopy, are time-intensive and prone to error. This study introduces a deep learning approach for classifying malaria-infected cells in blood smear images using convolutional neural networks (CNNs); Six CNN models were designed and trained using a large labeled dataset of malaria cell images, both infected and uninfected, and were implemented on the Jetson TX2 board to evaluate them. The model was optimized for feature extraction and classification accuracy, achieving 97.72% accuracy, and evaluated using precision, recall, and F1-score metrics and execution time. Results indicate deep learning significantly improves diagnostic time efficiency on embedded systems. This scalable, automated solution is particularly useful in resource-limited areas without access to expert microscopic analysis. Future work will focus on clinical validation.

The many faces of pediatric hydatid disease: a pictorial review.

Hydatid disease, caused by the larval stages of Echinococcus species, poses a significant public health challenge, especially in resource-limited cattle-producing areas of South America. The number of cases in children under the age of 15 is nearly 16% of the total cases in South America according to the latest report of the Pan American Health Organization (PAHO). The presentation of the disease depends on the anatomic location and correlates with the parasitic life stage. The liver is the most commonly affected organ in children, followed by the lungs, kidney, bone, and brain. The classification of hydatid cysts varies based on the parasite's stage, from purely cystic lesions to solid masses. The radiological approach varies by cyst location. Clinically, hydatid disease symptoms are nonspecific and organ-dependent, with imaging playing a crucial role in diagnosis. Complications include cyst rupture and superinfection, with potential severe consequences. This pictorial essay aims to illustrate the manifestations of hydatid cysts in an endemic population and highlight atypical signs for radiologists evaluating pediatric cysts in endemic regions.