Middle-income Countries Research Articles

Glycemic control and associated factors in patients with type 2 diabetes in Southwest Ethiopia: a prospective observational study

BackgroundDiabetes, a known syndrome marked by hyperglycemia and glucose intolerance, is increasing at an alarming rate worldwide. Over half a billion people worldwide have DM, and most live in low- and middle-income countries. Poor glycemic control is a public health concern in type 2 diabetes mellitus. Glycemic control and identifying factors associated with poor glycemic control can help healthcare providers design programs that improve glycemic control and the quality of services provided to patients.ObjectivesThis study was designed to assess the level of glycemic control and associated factors in patients with type 2 diabetes in Jimma Medical Center, Southwest Ethiopia.MethodsThis institution-based prospective observational study was conducted among 420 patients with type 2 diabetes at Jimma Medical Center’s diabetic clinics. A pretested structured interviewer-administered questionnaire was used to collect data, and a checklist was used to assess patient documents. The data were analyzed using SPSS version 26. The variables linked to poor glycemic control were investigated using binary logistic regression. Variables with p values less than 0.05 were considered statistically significant.ResultsSix-month follow-ups were conducted among 420 patients with type 2 diabetes, among whom 220 (52.38%) were women. The median age of the participants was 54(IQR = 40–60 years old). The proportion of respondents with uncontrolled fasting blood glucose was 58.1%. Sex (AOR = 2.576, 95% CI [2.80-11.479], P = 0.001), age(≥ 60) (AOR = 2.024, 95% CI [1.794–4.646], P = 0.002), diabetes duration > 10 years (AOR = 3.036, 95% CI [2.616–8.306], P = 0.003), type 2 diabetes mellitus on insulin + oral antidiabetic (OADs) (AOR = 2.08, 95% CI [298-3.918], P = 0.004), obesity (AOR = 2.18, 95% CI [(1.218–4.218)], P = 0.003), diabetic complications (AOR = 3.193, 95% CI [2.324–6.05], p = 0.002) and poor self-care practices (AOR = 3.034, 95% CI [5.821–7.02], P = 0.005) were found to be significantly associated with poor glycemic control.ConclusionAt the Jimma Medical Center, the prevalence of poor glycemic control was high. Based on these findings, teaching and counseling provided by healthcare providers should focus on improving diabetes self-care activities, weight reduction, and diabetic complications to achieve good glycemic control.Clinical trial numberNot applicable.

Cohort profile of a prospective cohort study among middle-aged community-dwellers in rural Vietnam: The Khánh Hòa cardiovascular study.

Disease burden associated with cardiovascular diseases (CVDs) in low- and middle-income countries has been on an increasing trend in the past decades. Despite the worldwide genetic, cultural, and environmental variations in determinants of CVDs, few studies have attempted the identification of risk factors of CVDs in low- and middle-income countries. This article aims to introduce the Khánh Hòa Cardiovascular Study, a prospective cohort study among middle-aged community dwellers in rural Khánh Hòa, Vietnam. A total of 3000 individuals, aged 40-60 years at baseline, participated in the baseline survey conducted from June 2019 to June 2020 and will be followed up for the subsequent 10 years. The baseline survey collected information on sociodemographic variables, disease history, lifestyle, social environment, and mental health via questionnaires, physical examinations, and biochemical measurements. Information on the incidence of severe health outcomes (i.e., mortality, CVDs, and cancer) has been and will be collected using a study-specific disease registry. Results showed that the prevalences of excess body weight (body mass index ≥25 kg/m2), hypertension, diabetes mellitus, and dyslipidemia were 25.9%, 39.6%, 10.2%, and 45.1%, respectively. Furthermore, by March 2023, 21 participants had died, including 5 CVD deaths and 12 cancer deaths. Moreover, we recorded 22 and 31 cases of nonfatal CVDs and cancer, respectively. These results suggest that many rural residents in Vietnam have high cardiometabolic risk, and underscore the importance of advancing research to identify risk factors and prevent the onset of serious health events.

Culturally Embedded Strategies for Lung Cancer Awareness in Hard-to-reach Communities in the Eastern Cape: Insights from Field Observations

Lung cancer is the leading cause of cancer death worldwide. The lack of knowledge and awareness about the signs and symptoms of lung cancer often results in late diagnosis in low- and middle-income countries (LMICs). Traditional beliefs, cultural practices, and social norms may influence health-seeking behaviours and contribute to misconceptions about lung cancer. This piece intimates the readers how culturally embedded communication strategies could promote lung cancer awareness in hard-to-reach communities in the Eastern Cape. We found that cultural barriers and challenges in raising awareness about lung cancer exist, highlighting the need for culturally appropriate communication approaches, emphasizing the importance of cultural sensitivity and community engagement. This engagement has implications for future interventions, providing valuable insights into best practices for addressing lung cancer awareness in similar contexts.

Antimicrobial resistance profile of Escherichia coli in drinking water from one health perspective in low and middle income countries

IntroductionAntimicrobial resistance is a major global public health concern, especially in low-resource settings. In low- and middle-income countries, the existing evidence about antimicrobial resistance in drinking water is inconsistence and not comprehensive. Therefore, this study aimed to estimate the pooled prevalence of antimicrobial resistance profiles of Escherichia coli from drinking water in low- and middle-income countries.MethodsThis study was conducted using comprehensive literature searches using various databases such as PubMed, Scientific Direct, HINARI, and Google Scholar. Data extraction was performed using Microsoft Excel and exported to STATA 14/SE software for analysis. We used the Joanna Briggs Institute’s quality appraisal tool to ensure the quality of the included studies. A random effects model was employed to estimate the pooled prevalence. Publication bias was evaluated using funnel plots and Egger’s regression test. Subgroup and sensitivity analysis were also conducted in this study.ResultsThe study found that the pooled prevalence of Escherichia coli isolates in drinking water was 37.94% (95% CI: 26.73–49.13). The prevalence of multidrug resistance was 43.65% (95% CI: 31.15–56.15). Regarding specific antimicrobials, the pooled resistance levels of Escherichia coli were 54.65% (95% CI: 41.35–67.96) against contrimoxazole, followed by 48.64% (95% CI: −3.6–101) against amoxicillin and 48% (95% CI: −18.1–114.2) against cefuroxime.ConclusionThe findings indicated a significant prevalence of antimicrobial resistance of Escherichia coli isolated from drinking water and its multidrug resistance. To address this issue, it recommends focusing on improving basic hygiene and sanitation practices and enhancing water and wastewater treatment systems.Systematic review registrationIdentifier CRD42024533592.

Microbial Etiology of Surgical Site Infections, Bacterial Isolates and their Antibiotic Susceptibility Patterns at Trauma University Hospital in Tirana, Albania

Hospital acquired infections in general and specifically surgical site infections increase significantly the morbidity and mortality of post-surgery patients. They are considered the most frequent postoperative complication worldwide, and a major public health burden especially in low income countries. The preventability and the high treatment costs of these complications, sets the focus towards identification of the most frequent etiological factors, in order to decrease the incidence of the phenomenon in different levels. This is a retrospective study carried out from January 1 to December 31, 2023. We analysed the microbiology and antibiotic susceptibility reports of specimens accepted and examined at the laboratory department of the Trauma University Hospital, Tirana. We reported standard operating procedure on direct microscopic examination with gram staining, and the susceptibility patterns reported by millimetre scaling the zone of inhibition of the examined antibiotics disks. We reported 40% negativity rate on the examined specimens. The most frequently isolated microorganisms within the positive results were Acinetobacter Baumannii (25.4%), Staphylococcus Aureus (13.5%), and Enterococcus faecalis (10.32%). The combination of cephalosporins together with aminoglycosides was found to be the most effective antibiotic prophylaxis formulation. Continuous surveillance of bacterial profiles through variable rich, statistically significant additional studies become crucial. The results will help toward better hospital acquired infection prevention and control. Received: 21 August 2024 / Accepted: 10 November 2024 / Published: 3 December 2024

Global Trends and Hotspots in the Research of the Effects of PM2.5 on Asthma: A Bibliometric and Visualized Analysis.

Fine particulate matter (PM2.5) has been identified as a significant environmental and public health challenge, particularly due to its association with respiratory diseases like asthma. With the global rise in urbanization and industrialization, PM2.5-related asthma research has grown substantially over the past two decades. This study aims to provide a comprehensive bibliometric analysis to map global research trends, highlight key contributors, and identify emerging hotspots in the relationship between PM2.5 and asthma. We performed a bibliometric analysis using the Web of Science Core Collection database, covering research from January 2004 to September 2024. The selected studies were analyzed using CiteSpace and VOSviewer to assess publication trends, global collaborations, and research hotspots through visualized networks and co-occurrence analyses. A total of 2035 publications were identified, demonstrating a steady increase in research output over the past two decades. The United States and China emerged as dominant contributors, frequently collaborating with countries like Canada, Australia, and South Korea. Key research areas focused on air quality, particulate matter exposure, and asthma exacerbation, with an increasing emphasis on indoor air pollution and long-term exposure risks. Institutional collaborations were led by prominent universities such as the University of California System and Harvard University. Additionally, research on vulnerable populations, particularly children, and the impact of early-life exposure to PM2.5 has gained attention in recent years. The global research landscape on PM2.5 and asthma has expanded significantly, with growing attention to interdisciplinary approaches that combine environmental science and public health. Future studies should focus on the global burden of air pollution, particularly in low- and middle-income countries, and address the long-term health impacts of PM2.5 exposure, especially in vulnerable populations.

Epidemiology of Fatal Poisonings from Organophosphorus Compounds in Rangpur District, Bangladesh

Background: Organophosphorus compound (OPC) poisoning represents a significant public health issue in low- and middle-income countries. Globally, the WHO estimates three million annual cases of pesticide poisoning, resulting in 220,000 deaths, predominantly in international settings. In Bangladesh, OPCs are frequently used for suicide in rural areas due to their affordability, toxicity, and accessibility. Objective: This study aimed to determine the prevalence, incidence by age and sex, and marital status of victims in cases of fatal organophosphorus poisoning in Rangpur District. Methods: This retrospective study analyzed all medicolegal autopsies conducted between October 2005 and January 2007 at the mortuary of Rangpur Medical College based on the history and preliminary findings of the deceased. Results: Of the 282 medicolegal autopsies performed during the study period, 60 (21%) resulted from organophosphorus poisoning. Females accounted for the majority of victims (31, 52%) compared to males (29, 48%). The highest prevalence of organophosphorus poisoning occurred in the Mithapukur area (17, 28%), with the age group 21-30 years showing the highest incidence (38%). Acute poisoning was more prevalent among married individuals (80%) compared to unmarried individuals (20%). Conclusion: Organophosphorus poisoning remains a significant healthcare challenge in Bangladesh. Enhanced awareness, restricted availability, and preventive measures are crucial for reducing mortality and morbidity associated with OPC poisoning.

Utilization of basic diabetes mellitus services among adult patients with diabetes mellitus at Mbarara Regional Referral Hospital diabetes clinic, Uganda: a cross-sectional study

BackgroundUtilization of diabetic care services remains a challenge among adult patients in low- and middle-income countries. Optimal utilization of diabetic care services could reduce morbidity and mortality and delay the development of long-term complications. This study assessed the utilization of basic diabetic care services and associated factors among diabetes mellitus patients at Mbarara Regional Referral Hospital in Western Uganda.MethodsWe enrolled 208 patients with either type 1 or 2 diabetes mellitus in a cross-sectional study between June and August 2022 at Mbarara Regional Referral Hospital, Uganda. Consecutive sampling was used to select patients with diabetes mellitus who attended the diabetes clinic based on their scheduled date of appointment. Optimal utilization of basic diabetic services was defined as receiving at least three of the four core services: health education, assessment of vital signs (blood sugar, blood pressure, and body mass index), assessment of diabetic complications, and diabetic drug refills. Modified Poisson regression analysis was used to assess the determinants of utilization of basic diabetic services in STATA version 14.0.ResultsThree-quarters of the study participants were female patients (75.0%), and the median (inter-quartile range, IQR) age was 52 (43, 56). Moreover, 62.0% [95% confidence interval (CI): 55.3–68.7] self-reported to have utilized basic diabetic care services. In the adjusted analysis, waiting longer than 120 min to receive any service [adjusted prevalence ratio (aPR) 0.46, 95% CI 0.27–0.80), being 45–54 years old (aPR 1.48, 95% CI:1.11–1.98), and being 55–60 years old (aPR, 1.38, 95% CI: 1.02 1.86)] were significantly associated with the utilization of basic diabetic care services.ConclusionUtilization of basic diabetic care services among adult patients remains sub-optimal. Age and waiting time were significantly associated with the utilization of diabetic care services. Interventions should be directed toward shortening the waiting time in service delivery at diabetes clinics.

Cholera in Zambia: Explanatory Factors and Mid-term Impact of the Sustainable Development Goals

Cholera, a highly contagious disease caused by Vibrio cholerae, poses a severe public health threat, especially in low- and middle-income countries with limited access to clean water and adequate sanitation. Symptoms such as acute watery diarrhoea, vomiting, and muscle cramps can lead to rapid dehydration, and without timely treatment, cholera can be fatal. Globally, cholera incidence has increased significantly, with World Health Organisation data showing a rise from 223,370 cases in 2021 to 472,697 in 2022, with the number of affected countries growing from 35 to 47. In Zambia, cholera outbreaks are recurrent, particularly during the rainy season, with 30 outbreaks recorded between 1977 and 2018. Fishing camps in rural areas and densely populated peri-urban areas, particularly in the Copperbelt and Lusaka provinces, report the highest incidences, attributed to inadequate waste management and poor drainage. This study investigates the factors influencing cholera dynamics in Zambia, focusing on climate variability, population density, and water and sanitation infrastructure. This study employs a mixed-methods approach, analysing historical cholera records, climate data, and socioeconomic factors since 1977. The article seeks to identify correlations between environmental and socioeconomic variables and cholera incidence, to guide effective public health strategies. The findings aim to support Zambia’s efforts to eliminate cholera within its borders by 2025, aligned with the Multisectoral Cholera Elimination Plan and Vision 2030.

The Brief Observation of Symptoms of Autism: Validation study in a Latin American sample.

Autism spectrum disorder is a complex condition associated with significant impairments in social communication and behavioral functioning. Diagnosis is dependent on clinician expertise, gathering of developmental history, and observation of specific behaviors. The suggested protocols include tools rendered invalid during the pandemic, which created significant barriers for diagnostic assessments. Furthermore, there are additional barriers in low-income countries in access to screening tools and standardized diagnostic tests for autism spectrum disorders that were only exacerbated during COVID-19. The Brief Observation of Symptoms of Autism instrument was developed to improve access to diagnostic assessment via telehealth during this time. The current study sought to validate the use of the Brief Observation of Symptoms of Autism within two Latin American countries. A sample of 313 children and adults from Argentina and Chile were examined. Results showed valid sensitivity and specificity scores with good fit across modules using two factors (i.e. Social Affect and Restricted, Repetitive Behaviors). Preliminary results of the current study demonstrated that the Brief Observation of Symptoms of Autism is a valid instrument for Latin American population and shows promise to be used beyond the pandemic to ease the diagnostic process. This is a collaborative work with BRINCAR Parent Association, who defined the need in our country to run the validation of Brief Observation of Symptoms of Autism and gave us support as the stakeholders at Lancet Commission.

Bioconversion of Food Wastes and By-products to Value-added Products: A Comprehensive Review

Food processing industries are considered to be rapidly expanding sectors due to the increase in the need for food to prevent hunger and the need for nourishing food to support the development of a healthy country. Nowadays, around one-third of the fresh crop is squandered during the food processing chain and is dumped in landfills and the ocean. According to an FAO report, 805 million people worldwide suffer from hunger, yet in 2020, the globe threw away 126 million tons of food waste. High amounts of waste and by products are produced during the manufacturing and processing of food in developing nations, which has a detrimental effect on the environment and is very expensive. It is crucial to turn these food wastes and byproducts into value-added goods for social, environmental, and economic reasons. The 3Rs—Reduce, Reuse, and Recycle—should be adhered to in order to address the problem of food waste in the food sector. Nonetheless, there is a good chance that these biomaterials will be used to create food additives, reducing poverty and malnutrition in the underdeveloped nations where they are generated. Beneficial substances including proteins, fats, carbohydrates, micronutrients, bioactive substances, and dietary fibers can be found in abundance in many of these biomaterials. First, this overview provides brief information on the production of different types of wastes from different processing sectors. Second, the several strategies for managing food waste sustainably as well as the difficulties in implementing these strategies are covered in length here. This review, is an assortment of information pertaining to the recovery of several value-added byproducts, such as biofuel generation, dietary fibers, phytochemicals, bio-preservatives, colorants, and bioactive compounds.

The role of private sponsorship on refugee resettlement outcomes: a mixed methods study of Syrians in a mid-sized city with a linguistic minority

ABSTRACT Given the growing number of refugees worldwide and the disproportionate burden borne by low- and middle-income host countries, the United Nations High Commissioner for Refugees has been seeking to expand pathways for refugees by relocating them to higher-income countries; as such, it put forward Canada’s program of private refugee sponsorship as a model to follow. Despite praise for Canada’s program, many countries hesitate to adopt it due to limited evidence on the integration outcomes of private refugee sponsorship. We address this knowledge gap by examining the case of Syrians resettled in a mid-sized city in Quebec, the only French-speaking province in Canada, using a mixed methods approach. We document the sponsorship experiences of Syrian refuges, and we estimate the effect of private vs. government sponsorship on their resettlement outcomes while controlling for pre-arrival characteristics. We find that private sponsorship offered refugees more diverse, intensive, enduring, and valued support compared to government sponsorship. Consistently with these results, our estimates show that private sponsorship could be an effective strategy for resettling refugees in medium-sized cities with respect to employment, housing, social networking, and a sense of belonging to the city, with the potential exception of acquiring the domestic language.

Addressing the 2050 demand for terrestrial animal source food

The high emissions intensity of terrestrial animal source food (TASF) and projected increasing demand in low- and middle-income countries (LMIC) have spurred interest in the development of animal-free alternatives and manufactured food items that aim to substitute for meat, milk, and eggs with the promise of reduced environmental impact of producing food. The developing world is the source of 75% of global emissions from ruminants and will house 86% of the world’s human population by 2050. The adoption of cost-effective, genetic, feed and nutrition practices, and improving livestock health in LMIC are seen as the most promising interventions to reduce emissions resulting from projected increased TASF demand though 2050. Genetic improvement is a particularly attractive approach to productivity enhancements, as such improvements are permanent and cumulative. Alternative proteins may play a role in addressing demand for affordable sources of nutrient-dense foods, however, price will be a major factor influencing adoption given 3.1 billion people globally (42%) were currently unable to afford a healthy diet in 2021. Additionally, there is currently a mismatch between the location of alternative protein companies, and both projected increased TASF demand and emissions. To date, the vast majority (>81%) of these companies are based in high-income countries. The sustainability implications of replacing TASF with alternative proteins at scale needs to consider not only environmental metrics but also the wider economic and social sustainability impacts, given the essential role that livestock play in the livelihoods and food security of approximately 1.3 billion people.

Assessing food consumed away from home in low-and middle-income countries by developing specific modules for household surveys: Experimental evidence from Vietnam and Burkina Faso.

In a world rapidly transitioning, food consumption away from home is rising, therefore representing an increasing share of individual's diet. Food consumed away from home negatively impacts diet, nutritional status and consequently has detrimental effects on health. In some contexts, where individual level dietary intake surveys are not regularly conducted, this behavior is not well documented leading to a gap of knowledge. The aim of the present study was to develop and validate in Burkina Faso and Vietnam specific modules that could be added to Household Consumption and Expenditure Surveys that are usually regularly conducted worldwide, in order to document the economic and nutritional importance of food consumption away from home. In each country, two survey modules, one long (100 food items) and one short (30 food items) were developed, to measure individual-level food consumption away from home over the last 7 days. The modules were relatively validated in comparison with data from three non-consecutive 24-hour dietary recalls conducted over the same 7-days period. The validation was conducted in different settings (urban, peri-urban and rural) in Burkina Faso (n = 924) and Vietnam (n = 918). In both countries, a good concordance between the 24-hour dietary recalls and the modules in their ability to identify a person as having consumed food away from home (>77%) was found. However, in both countries, both modules underestimate the mean energy intake coming from foods consumed away from home (from 122 to 408 kcal) while they overestimate the budget allocated to it (from -0.07 to -0.29 USD/day). None of developed food away from home modules were considered as valid. There is a need for the international community to continue to work on developing and validating tools capable to estimate nutritional intakes related to food consumption away from home and that could be added to regular national household-level surveys.

Perception of Child Bearing Women about Congenital Birth Disorders in Anambra State

Background: Congenital birth disorders causes a huge challenge and burden in low and middle income countries. It equally constitute a public health threat which deserve holistic attention in Anambra State. They can be due to advanced maternal age, maternal infection of child bearing women or multifactorial causes. Aim: The study determined the perception of child bearing women about risk factors, effects, management and prevention of congenital birth disorders in Anambra State. Materials and Methods: A descriptive cross -sectional survey design was adopted for the study, sample size was 436 and a multi stage sampling technique was used. The instrument for data collection was a self-structured questionnaire and data obtained were analysed using Microsoft excel, Chi-square for hypothesis testing and IBM statistical package for social sciences (SPSS) version 29. Results: it was revealed that most child bearing women have positive perception about the risk factors of congenital birth disorders (72.79%), effect on the affected child and family (71.50%), management by a specialist (100%), effective measures necessary to prevent congenital birth disorders (73.73) Conclusion: Congenital birth disorders is one of the public health concerns in Anambra State which may result in stigmatization, depression, marital strain, financial strain, parental exploitation, mental retardation, permanent disability and death. The major risk factors of congenital birth disorders are advanced maternal age, unhealthy life styles, occupation, smoking, alcohol, illiteracy and parity. Therefore, efforts should be made to raise awareness of the occurrence and risk factors of congenital birth disorders in developing countries.

The Burden of Gastric Cancer in Northern Central America.

Gastric cancer is the fourth leading cause of cancer-related death worldwide, with nearly one million new cases diagnosed in 2020. There is marked variation in gastric cancer incidence globally, with highest incidence rates reported in the United Nations regions of Eastern Asia, Eastern Europe, and Latin America. Although the United States is considered a low-incidence country, gastric cancer presents an important cancer disparity, with higher incidence in minoritized populations, including immigrants from high-incidence regions. The Northern Central America nations are low- and middle-income countries with a high gastric cancer incidence and large US immigrant populations. These countries lack comprehensive cancer registries, but recent GLOBOCAN-imputed gastric cancer estimates are in the range of 8 to 12/100,000 age-standardized incidence rates. Three epidemiologic studies carried out in El Salvador, Nicaragua, and Honduras demonstrate a higher than predicted burden of gastric cancer with low 5-year survival (<10%). The gastric cancer burden is projected to increase in the absence of changes to national and regional cancer control plans. Twelve evidence-based recommendations to reduce gastric cancer mortality in the Americas have recently been proposed, ranging from the "test-and-treat" Helicobacter pylori eradication strategy to endoscopic screening and surveillance programs. Translating these recommendations into a practical plan for this resource-limited setting could address the disproportionate gastric cancer burden. See related article by Peña-Galo et al., p. 1564 See related article by Ruiz de Campos et al., p. 1571 See related article by Dominguez et al., p. 1578.

Prevalence of metabolic syndrome in children and adolescents with obesity: a systematic review and meta-analysis.

This study investigated the prevalence trends of metabolic syndrome (MetS) in children and adolescents with obesity by systematically analyzing global data. Additionally, it aimed to compare regional disparities and criteria used to identify at-risk subpopulations among this demographic group. We searched three major databases, i.e., PubMed-Medline, Scopus, and Web of Science, from inception to August 31, 2023, yielding 2432 articles. We included original research papers reporting MetS prevalence among children and adolescents with obesity, irrespective of their regions and MetS diagnostic criteria used. We aggregated prevalence estimates using random-effects models to obtain the overall prevalence and conducted subgroup analyses for MetS criteria and study regions. We included 57 studies, amounting to 27,923 participants. The overall prevalence of MetS in participants with obesity varied greatly across studies, ranging from 2.1% to 74.4%, with an average prevalence of 29.4%. This high prevalence of MetS was further supported by a meta-analysis comprising 57 studies that further strengthened the observation of a high prevalence of MetS, revealing an overall prevalence of 26% (95% CI: 0.22-0.30; I2 = 98%). Children and adolescents with obesity face a heightened risk of developing MetS. There is a pressing need for heightened attention to this issue, particularly in low- and middle-income countries such as those in sub-Saharan Africa.

Implementing a healthcare-associated bloodstream infection surveillance network in India: a mixed-methods study on the best practices, challenges and opportunities, 2022

BackgroundHealthcare-associated bloodstream infections (BSI) threaten patient safety and are the third most common healthcare-associated infection (HAI) in low- and middle-income countries. An intensive-care-unit (ICU) based HAI surveillance network recording BSIs was started in India in 2017. We evaluated this surveillance network’s ability to detect BSI to identify best practices, challenges, and opportunities in its implementation.MethodsWe conducted a mixed-methods descriptive study from January to May 2022 using the CDC guidelines for evaluation. We focused on hospitals reporting BSI surveillance data to the HAI network from May 2017 to December 2021, and collected data through interviews, surveys, record reviews, and site visits. We integrated quantitative and qualitative results and present mixed methods interpretation.ResultsThe HAI surveillance network included 39 hospitals across 22 states of India. We conducted 13 interviews, four site visits, and one focus-group discussion and collected 50 survey responses. Respondents included network coordinators, surveillance staff, data entry operators, and ICU physicians. Among surveyed staff, 83% rated the case definitions simple to use. Case definitions were correctly applied in 280/284 (98%) case reports. Among 21 site records reviewed, 24% reported using paper-based forms for laboratory reporting. Interviewees reported challenges, including funding, limited human resources, lack of digitalization, variable blood culture practices, and inconsistent information sharing.ConclusionImplementing a standardized HAI surveillance network reporting BSIs in India has been successful, and the case definitions developed were simple. Allocating personnel, digitalizing medical records, improving culturing practices, establishing feedback mechanisms, and funding commitment are crucial for its sustainability.

Dietary diversity and development among early childhood children in rural China

BackgroundEarly childhood is a critical period for cognitive development, heavily influenced by nutrition. Despite significant economic advancements, malnutrition and micronutrient deficiencies persist in many low- and middle-income countries, including China, where dietary diversity remains suboptimal. Existing research predominantly relies on correlational data, underscoring the need for more rigorous empirical evidence. This study aims to fill that gap by providing stronger empirical evidence on the relationship between dietary diversity and developmental outcomes in rural Chinese children.MethodsWe conducted a longitudinal cohort study of 1,207 children aged 6–23 months, drawn from 100 villages across 22 counties in rural China, with three follow-up rounds extending until the children reached 51–83 months of age. Cognitive and non-cognitive development, as well as key health indicators, were evaluated. Cognitive development was measured using the Bayley Scales of Infant and Toddler Development and the Wechsler Preschool and Primary Scale of Intelligence Fourth Edition. Non-cognitive development was assessed via the Ages and Stages Questionnaire: Social-Emotional and the Strengths and Difficulties Questionnaire. Health indicators included anemia, frequency of illness in the past 2 weeks, and four key anthropometric measures (height-for-age z-scores, weight-for-age z-scores, weight-for-height z-scores, and body mass index-for-age z-scores). Multiple linear regression models were applied to analyze the relationship between dietary diversity scores (DDS) and developmental outcomes, incorporating child fixed effects and adjustments for time-variant confounders. We accounted for the hierarchical structure of the data by clustering standard errors at the village level, which also reflects the township level.ResultsThe regression analysis identified significant positive associations between DDS and cognitive (p &amp;lt; 0.01), as well as reduced illness incidence (p &amp;lt; 0.001) in children aged 6–54 months. Additionally, DDS demonstrated a strong positive effect on non-cognitive development (p &amp;lt; 0.001) in children 2 years and older. The associations between DDS, non-cognitive development (p &amp;lt; 0.01), and illnesses reduction (p &amp;lt; 0.001) remained robust under two-way fixed effects models.ImplicationsTo promote sustainable improvements in child development and health, policymakers should prioritize nutrition-focused interventions in rural areas. Community-based programs offering caregivers training and nutritional support, integrated within healthcare and social services infrastructures, are vital for ensuring families have the necessary resources enhance child wellbeing and long-term developmental outcomes.

Deep caries detection using deep learning: from dataset acquisition to detection.

The study aims to address the global burden of dental caries, a highly prevalent disease affecting billions of individuals, including both children and adults. Recognizing the significant health challenges posed by untreated dental caries, particularly in low- and middle-income countries, our goal is to improve early-stage detection. Though effective, traditional diagnostic methods, such as bitewing radiography, have limitations in detecting early lesions. By leveraging Artificial Intelligence (AI), we aim to enhance the accuracy and efficiency of caries detection, offering a transformative approach to dental diagnostics. This study proposes a novel deep learning-based approach for dental caries detection using the latest models, i.e., YOLOv7, YOLOv8, and YOLOv9. Trained on a dataset of over 3,200 images, the models address the shortcomings of existing detection methods and provide an automated solution to improve diagnostic accuracy. The YOLOv7 model achieved a mean Average Precision (mAP) at 0.5 Intersection over Union (IoU) of 0.721, while YOLOv9 attained a mAP@50 IoU of 0.832. Notably, YOLOv8 outperformed both, with a mAP@0.5 of 0.982. This demonstrates robust detection capabilities across multiple categories, including caries," "Deep Caries," and "Exclusion." This high level of accuracy and efficiency highlights the potential of integrating AI-driven systems into clinical workflows, improving diagnostic capabilities, reducing healthcare costs, and contributing to better patient outcomes, especially in resource-constrained environments. Integrating these latest YOLO advanced AI models into dental diagnostics could transform the landscape of caries detection. Enhancing early-stage diagnosis accuracy can lead to more precise and cost-effective treatment strategies, with significant implications for improving patient outcomes, particularly in low-resource settings where traditional diagnostic capabilities are often limited.