Low-income Settings Research Articles (Page 1)

A scoping review and taxonomy of epidemiological-macroeconomic models for livestock diseases.

Adolescent girls and young women (AGYW) are the epicenter of the global HIV epidemic. The FANMI trial is an unblinded randomized-controlled trial which evaluated the effectiveness of a community-based model of cohort HIV care vs. standard clinic-based care among AGYW living with HIV in Haiti. Participants ages 16-24 years were randomized 1:1 to FANMI vs. standard care. In the FANMI intervention, cohorts of 5-10 participants attended monthly sessions in a community center for integrated HIV clinical care, group counseling, and social activities led by the same provider. The primary outcome was 12-month retention, defined as any visit 9-15 months from study enrollment. Secondary outcomes included viral suppression (< 1000 copies/ml), risk behaviors, and acceptability. 120 AGYW with HIV enrolled (60 per arm) between May 2018 and January 2021. 73% (44/60) in FANMI vs. 68% (41/60) in standard care achieved 12-month retention (RR = 1.07; 95% CI 0.85-1.35). Excluding participants who never returned after enrollment, 83% (38/46) in FANMI vs. 71% (41/58) in standard care (RR = 1.17; 95% CI 0.95-1.45) achieved 12-month retention. 47% (28/60) in FANMI and 43% (26/60) in standard care achieved 12-month viral suppression (p = 0.45). FANMI participants reported high acceptability, decreased stigma, and increased social support. There was no significant difference in 12-month retention between arms. The FANMI intervention was more effective for participants who self-presented to the clinic for HIV testing compared to those tested in a community-based setting. FANMI was highly acceptable to participants and offers promise as a complementary program for AGYW with HIV in low-income settings.

Human settlement environment and childhood diarrhea in low- and middle-income countries.

What matters most? Understanding patient preferences in breast cancer treatment: A systematic review of discrete choice experiments.

Background Health worker motivation affects service quality, retention, and the performance of primary health systems, especially in low-income settings. In Ethiopia, Health Extension Workers (HEWs) form the backbone of the rural health system, yet limited empirical evidence exists on the factors influencing their motivation across diverse regional contexts. Methods A survey was conducted with 314 HEWs from six Woreda (Districts) and one town administration in the Oromia Region of Ethiopia, between July 1 and August 14, 2024. Motivation was operationally defined as the capacity of HEWs to initiate, direct, and maintain goal-oriented working behaviors. Descriptive statistics and logistic regression analyses were performed to identify significant associations between key socio-demographic and institutional factors with motivation, with results expressed as adjusted odds ratios (AOR). Results Overall level of motivation among the HEWs was 74.8%. Both intrinsic (socio-demographic) and extrinsic (institutional) factors were significantly associated with motivation. Being married was strongly associated with motivation compared to being single (AOR = 222.93; CI:95%; p &amp;lt; 0.05), as it was having &amp;gt;15 years of service (AOR = 5.79; CI:95%; p &amp;lt; 0.05) compared to &amp;gt;1 year of service. Institutional factors: satisfaction with performance related incentives (AOR = 2.46; CI: 95%; p &amp;lt; 0.05), knowledge and skill sharing with co-workers (AOR: 3.52; CI:95%; p &amp;lt; 0.05) and decision-making autonomy (AOR = 3.114; CI:95%; p &amp;lt; 0.05) were strong predictors of higher motivation. In contrast, inadequate implementation of the career development system (AOR = 0.510; CL:95%; p &amp;lt; 0.05), routine supervision and feedback (AOR = 0.503; CI: 95%; p &amp;lt; 0.05), and access to on-the-job or off-the-job training (AOR: 0.44; CI:95%; p &amp;lt; 0.05) were linked with lower motivation. Conclusion We found a relatively high motivation among HEWs in East Hararge compared to other regions in Ethiopia and Africa. Both intrinsic and extrinsic motivators identified play a key role in shaping the motivation levels of HEWs. To enhance worker motivation and productivity in the primary health care system, policymakers and health sector authorities need to implement targeted and evidence-based strategies, including structured career development pathways, performance-based incentives, strong collegial knowledge and skill sharing schemes, and decision-making autonomy.

The ambiguous clinical presentation of leptospirosis poses challenges for accurately assessing the global burden of this emerging disease. As a result, leptospirosis has not been recognized for inclusion in the WHO's neglected tropical diseases list. This underscores the urgent need for a diagnostic biomarker for early detection of illness and well-defined estimation of disease burden in urban and low-income settings. The recently discovered PF07598 gene family encoding virulence-modifying proteins (VMPs), including full-length LA3490, its truncated N-terminal ricin-binding lectin (RBL) domain, and a natural variant encoding only the C-terminal domain (LA0591), was evaluated for its potential to detect anti-VMP-specific IgG antibodies in early infection. The study was conducted on a well-characterized sample of febrile patients from Sri Lanka, with leptospirosis confirmation by microscopic agglutination test (MAT) and Quantitative PCR. The sample included 113 confirmed cases, 45 probable cases, 75 febrile patients, and 41 healthy subjects. Among confirmed cases, mean ELISA optical density (OD) values for LA0591, LA3490, and RBLs were 1.045 (standard error [SE]: 0.063), 0.835 (SE: 0.032), and 0.536 (SE: 0.019), respectively, compared with 0.261 (SE: 0.043), 0.697 (SE: 0.026), and 0.303 (SE: 0.019) in healthy subjects. Anti-VMP antibodies were detectable as early as day 2. In seroconversion cases, ELISA OD for LA0591 in acute MAT-negative samples was 1.347, comparable with high MAT titers. ROC analysis showed AUCs of 0.947 for LA0591 and 0.930 for LA3490, confirming their reliability as diagnostic markers. LA0591 demonstrated superior sensitivity, specificity, and early diagnostic capability, establishing it as a valuable tool for leptospirosis detection.

Common Mental Disorders (CMDs), such as depression and anxiety are highly prevalent, particularly among young people globally. In Zimbabwe, contributing factors like poverty, unemployment, and the COVID-19 pandemic have exacerbated these challenges. Despite the pressing need for mental health support among young people, there remains a significant knowledge gap on barriers and enablers to help-seeking for CMDs among this demographic. This study addressed this gap by applying the Consolidated Framework for Implementation Research (CFIR) as an analytical framework to explore the unique factors influencing mental health help-seeking among young people in Zimbabwe.MethodsWe utilised a qualitative research design and conducted 32 semi-structured interviews with young people (15–24 years) across high schools and the Friendship Bench (FB) in Harare between 20 December 2022 and 30 September 2023. Interviews were audiotaped and transcribed verbatim and then coded using an inductive approach to capture patterns grounded in participants’ experiences. Thematic analysis was utilised to develop relevant codes and identify relevant themes.ResultsNine themes were generated including six themes related to barriers (factors that hinder help-seeking for CMDs) and three themes related to enablers (factors that facilitate help-seeking for CMDs). Barriers identified include perceived stigma, privacy and confidentiality issues, unavailability of services, lack of awareness, financial challenges and lack of incentives. Enablers identified include raising awareness, implementing school based initiatives and enhancing accessibility and affordability of mental health services.ConclusionThis study revealed significant barriers and enablers to help-seeking for CMDs among young people in Zimbabwe. Addressing these multifaceted barriers and leveraging the identified enablers is key to creating supportive systems that encourage young people in low-resource settings to seek and engage with mental health services, ultimately improving their mental wellbeing and overall quality of life.

BackgroundAnemia remains a critical public health issue, especially in low-resource settings like Uganda, with severe consequences especially in HIV-positive children. Limited research has been conducted in low-income settings especially about anaemia in HIV-Positive children. This study aimed to determine the prevalence and factors associated with anemia among HIV positive children at Kayunga Regional Referral Hospital. In addition to assess iron deficiency anemia using Mentzer index.MethodsThis was a hospital based cross-sectional study conducted at KRRH. 384 HIV-positive children aged 6 months to 12 years attended the KRRH ART clinic between November 2024 to January 2025 were enrolled.Data was collected using structured questionnaires,information regarding their sociodemographic, medical and laboratory was obtained asking care giver or reviewing the medical record. Anthropometric measurements were done and interpreted compared to the WHO z-scores and obtained blood sample for CBC and analyzed.Anemia was defined based on age-specific hemoglobin thresholds: < 11.0 g/dL for children aged 6–59 months, < 11.5 g/dL for those aged 5–11 years, and <12.0 g/dL for children aged 12–14 years. Iron deficiency anemia was diagnosed with MI > 13. Logistic regression in STATA was done to determine the factors that were significantly associated with anaemia.ResultsMajority of the children (63.5%) were over 5 years of age and 52.9% were male and 57.3% had anemia with 95% confidence interval of 52.3–62.2%. The predominant severity category of anemia was moderate (48.6%). Multivariable analysis showed that caretakers who stopped in primary, having more than four siblings, being in current HIV stages 2 or 3, any history of hospital admission in the preceding six months, and being severely stunted, wasted, or experiencing concurrent stunting and wasting were independently associated with anemia among children infected with HIV (P-value < 0.05 for all). Iron deficiency anemia accounted for 54.1% of all children with anemia.

Anemia remains a critical public health issue, especially in low-resource settings like Uganda, with severe consequences especially in HIV-positive children. Limited research has been conducted in low-income settings especially about anaemia in HIV-Positive children. This study aimed to determine the prevalence and factors associated with anemia among HIV positive children at Kayunga Regional Referral Hospital. In addition to assess iron deficiency anemia using Mentzer index. This was a hospital based cross-sectional study conducted at KRRH. 384 HIV-positive children aged 6 months to 12 years attended the KRRH ART clinic between November 2024 to January 2025 were enrolled.Data was collected using structured questionnaires,information regarding their sociodemographic, medical and laboratory was obtained asking care giver or reviewing the medical record. Anthropometric measurements were done and interpreted compared to the WHO z-scores and obtained blood sample for CBC and analyzed. Anemia was defined based on age-specific hemoglobin thresholds: < 11.0 g/dL for children aged 6-59 months, < 11.5 g/dL for those aged 5-11 years, and <12.0 g/dL for children aged 12-14 years. Iron deficiency anemia was diagnosed with MI > 13. Logistic regression in STATA was done to determine the factors that were significantly associated with anaemia. Majority of the children (63.5%) were over 5 years of age and 52.9% were male and 57.3% had anemia with 95% confidence interval of 52.3-62.2%. The predominant severity category of anemia was moderate (48.6%). Multivariable analysis showed that caretakers who stopped in primary, having more than four siblings, being in current HIV stages 2 or 3, any history of hospital admission in the preceding six months, and being severely stunted, wasted, or experiencing concurrent stunting and wasting were independently associated with anemia among children infected with HIV (P-value < 0.05 for all). Iron deficiency anemia accounted for 54.1% of all children with anemia.

Background: Post-orthopedic surgery recovery extends beyond physical healing, encompassing psychological well-being and social reintegration. In low-income communities, limited access to individualized rehabilitation services often hampers comprehensive recovery. Group-based physiotherapy has emerged as a promising model that combines physical rehabilitation with peer support and social engagement, potentially addressing both functional and psychosocial recovery dimensions. Objective: To assess the impact of structured group physiotherapy on physical recovery and social reintegration among post-orthopedic surgery patients in low-income communities of South Punjab. Methods: A randomized controlled trial was conducted among 120 post-surgical orthopedic patients, equally divided into group-based physiotherapy and standard individual physiotherapy arms. Over a 12-week period, both groups participated in thrice-weekly supervised sessions. Functional recovery was evaluated using the Functional Independence Measure (FIM) and the Lower Extremity Functional Scale (LEFS), while social reintegration was assessed using the Reintegration to Normal Living Index (RNLI). Data were analyzed using independent sample t-tests and repeated measures ANOVA for normally distributed data. Results: Participants receiving group-based physiotherapy demonstrated significantly higher improvements in FIM (mean increase: 18.6 ± 4.3 vs. 13.2 ± 3.8; p &lt; 0.001) and LEFS scores (mean increase: 21.4 ± 5.1 vs. 15.7 ± 4.9; p = 0.002) compared with the control group. The RNLI scores revealed enhanced social participation and self-reported confidence in the group therapy cohort (mean difference: 6.8 ± 2.4; p &lt; 0.001). Additionally, participants in the group-based program reported greater satisfaction and motivation toward recovery. Conclusion: Group-based physiotherapy significantly improved both physical recovery and social reintegration outcomes in post-orthopedic surgery patients within low-income settings. The integration of social interaction within rehabilitation frameworks can enhance recovery efficiency and overall well-being.

To describe a novel surgical technique for managing posteriorly dislocated crystalline lens in low-income settings, which involves levitation of the lens with a 25-gauge needle and subsequent lens expression through a scleral tunnel. A superior self-sealing scleral tunnel of 8 mm length is created without entering the anterior chamber. A complete 23-gauge 3-port pars plana vitrectomy is performed. After vitrectomy completion, the scleral tunnel is opened. A 25-gauge bent needle is introduced in the vitreous cavity and used to elevate the crystalline lens above the iris plane, which is prolapsed into the anterior chamber. After viscoelastic injection, the lens is expressed en bloc through the scleral tunnel with a vectis. Peripheral retinal indented examination is performed. If indicated, a secondary intraocular lens (anterior chamber, iris-claw or scleral-fixated) is implanted. This technique achieves complete removal of a dropped crystalline lens without the need of a phaco-fragmatome or perfluorocarbon liquid. The levitation of the lens with a 25-gauge needle minimizes intraocular manipulations, and the self-sealing scleral tunnel eliminates the need for sutures. This technique is a practical and reproducible approach for managing posteriorly dislocated crystalline lenses in resource-limited settings. It offers a cost-effective solution suitable for widespread adoption in similar environments.

Drowning burdens in low- and middle-income contexts are underestimated, as current data collection systems gather inadequate data. We conducted one of the largest community-based surveys to date capturing fatal drowning data across age, gender and rurality, focusing on the state of West Bengal, India. A resource-efficient community knowledge approach was used to conduct an observational community-based survey where meetings were held with community residents and key informants to identify drowning deaths in the population. Identified deaths were verified at the victim's household through a structured survey, inquiring on the circumstances around the drowning death. A fatal drowning rate of 9.17/100 000 was found across the state. Drownings were highest in children 1-4 years old (60.02/100 000), followed by 5-9 years (19.20/100 000). Males faced higher rates across all ages (11.82/100 000) compared with females (6.33/100 000). Rural areas faced significantly higher drowning rates than urban areas (12.52/100 000 and 1.19/100 000, respectively). About half of the events occurred in waterbodies near the victim's home. Most events occurred between 10:00 a.m. and 2:00 p.m. and were over-represented during the monsoon months of June to August. A minority of cases were administered appropriate resuscitation techniques or taken to formal healthcare providers, and only 16.1% of events were issued death certificates. The results illustrated how routine data collection systems in low-income settings grossly underestimate drowning events, emphasising the importance of community-based surveys in capturing true drowning burdens in India and low- and middle-income country contexts more broadly.

Multiple sclerosis (MS) is a chronic neurodegenerative disease with significant temporal and regional heterogeneity. While earlier studies described the burden before 2019, recent shifts influenced by socioeconomic development, healthcare access, and environmental exposures remain unclear. Using the Global Burden of Disease database, we analyzed recent MS trends, assessed interactions of gender, age, and sociodemographic index (SDI), and projected future dynamics. Based on the Global Burden of Disease database from 1990 to 2021, this study collected epidemiological data of 2795 patients with MS from 204 countries and regions, covering core indicators such as incidence, prevalence, mortality, and disability-adjusted life years (DALYs). Data underwent standardized processing and WHO age-standardization. Long-term trends were analyzed with Joinpoint regression; regional variation by SDI and Moran I; gender and age distributions with chi-square; and inequalities by concentration indices and Lorenz curves. A Bayesian hierarchical model with Markov chain Monte Carlo was applied to forecast trends to 2050. From 1990 to 2021, global MS cases rose markedly (incidence +49.9%, prevalence +87.9%), but age-standardized incidence and prevalence remained stable (−3.5% and −0.4%), indicating population growth as the main driver. High-SDI regions showed rising incidence (Western Europe +27.8%, Latin America +31.6%), while low-SDI regions had sharp increases in case numbers but limited standardized rate changes. Mortality and DALYs decreased globally (−12.8% and −11.0%) but rose in resource-limited areas (mortality +110.9% in Central Latin America, DALYs +315% in West Africa). Women consistently bore a higher burden, with gender gaps most evident in low-income regions (315% higher mortality in West African women). MS prevalence strongly correlated with SDI (r = 0.6975, P < .001). Projections suggest gradual incidence growth with declining mortality and DALYs by 2050. Inequality analysis showed persistent deviations from equilibrium. Despite improved survival, high-SDI regions face the challenge of managing aging patients, while low-SDI regions suffer from high mortality and limited resources. The disproportionate burden in women, especially in low-income settings, underscores the need for tailored, equity-focused strategies.

Rehabilitation after stroke often falls short of providing optimal benefits to patients due to challenges related to restricted access, financial burden, and lack of adherence. Video-based intervention may help to overcome these barriers. To develop and test the feasibility of video-based telerehabilitation (TR) exercises for facilitating upper extremity motor function among stroke survivors. The study was conducted in two phases: video development and feasibility testing. The research team developed the video. Feasibility was assessed using a single-group pre-test-post-test design, focusing on adherence, acceptability, satisfaction, and motor function. A total of 30 stroke survivors were purposively recruited. Each participant received a 3-minute-42-second video-based TR program to be performed three times weekly over four weeks. Adherence and acceptability were monitored through participant-maintained diaries. Satisfaction and motor function were measured using the Client Satisfaction Questionnaire-8 (CSQ-8) and the Wolf Motor Function Test (WMFT), respectively. Twenty-nine participants (15 males) completed the study. The participants showed a strong commitment to the intervention with a 97% adherence rate. They accepted and reported the intervention as satisfactory. A remarkable score of satisfaction corroborates this based on the CSQ-8 (Mean [SD] = 28.6 [4.90]). A significant improvement in the WMFT was observed (p < 0.001) with a large effect size (d = 1.14) post-intervention. The mean difference was 8.8, with a 95% confidence interval ranging from 4.75 to 12.9. The video-based TR is feasible and can be deployed as a supplementary intervention. Future evaluation of the intervention is warranted to establish its effectiveness.

Children born to women living with HIV (WLWH) suffer increased morbidity and, in low-income settings, have two to three times the mortality of infants born to women without HIV. The basis for this increase remains elusive. In low-income settings, breastfeeding is recommended because health benefits outweigh the risk of transmission, especially when maternal antiretroviral therapy is provided. We profile the milk metabolome of 326 women with and without HIV sampled longitudinally for 18 months postpartum using global metabolomics. We identify perturbations in several metabolites, including tryptophan, dimethylarginine, and a recently discovered antiviral ribonucleotide, that are robustly associated with maternal HIV infection. Quantitative tryptophan and kynurenine levels in both milk and plasma reveal that these perturbations reflect systemic depletion of tryptophan and alterations in tryptophan catabolism in WLWH. Finally, we validate these signatures of maternal HIV infection in an independent cohort of healthier WLWH. Taken together, our findings demonstrate that milk tryptophan content and availability decrease among WLWH, which may indicate perturbations in milk tryptophan catabolism. The link between this perturbation and the increased morbidity and mortality of children born to WLWH merits further investigation.

Low- and middle-income countries (LMICs) face a high burden of trauma-related deaths, yet lack prospective, standardized data to guide care. In Pakistan, in-hospital trauma management and outcomes remain poorly documented. The aim of this study was to examine injury epidemiology, post-emergency department care, and hospital outcomes using a pilot digital trauma registry in Pakistan. This study was conducted from December 2021 to February 2023 at two leading tertiary care hospitals in Karachi, Pakistan. We included all admitted adult trauma patients (≥ 18 years). We prospectively collected data on demographics, injury details, inter-hospital case management, in-hospital care, and discharge outcomes. A total of 3,087 patients were enrolled, mostly male (79.82%), with 24.33% under 25 years old and 42.38% of Muhajir ethnicity. Road traffic injuries (RTIs) (56.43%), primarily amongst riders of two-wheelers (56.74%), were the leading cause, of whom only 8.66% wore helmets. Most arrived by ambulance (77.12%), and one third (33.66%) were transferred from another hospital. Extremity (55.17%) and head/neck injuries (41.72%) were most common. Severe injuries (ISS > 15) were seen in 30.26%, while 90.86% had a GCS > 12. X-rays (92.81%), CT scans (56.04%), and ultrasounds (16.55%) were common investigations. Surgery was performed in 50.28% of cases. The in-hospital mortality rate was 15.10%, and the median length of stay (LOS) was five days. Our findings show high in-hospital trauma mortality, often among patients transferred from other facilities, emphasizing the role of timely care. This study highlights the potential of trauma registries to inform preventive policies and clinical care, particularly in low-income settings.

Background: Hypertension remains a leading cause of cardiovascular morbidity and mortality, disproportionately affecting low- and middle-income countries (LMICs), where healthcare access and awareness are limited. Excessive sodium intake, often from discretionary salt used in cooking, contributes significantly to this burden. Salt substitutes, typically formulated by partially replacing sodium chloride with potassium chloride or other minerals, offer a cost-effective dietary intervention to lower blood pressure (BP) and reduce cardiovascular risk, particularly in resource-constrained settings. Objective: This review examines the efficacy of low-sodium salt substitutes (LSSS) in reducing blood pressure (BP) and its effects on cardiovascular (CV) outcomes, safety concerns, and challenges to their implementation in LMICs. Methods: We conducted a comprehensive narrative review of studies published between 1994 and 2024 using PubMed, Embase, and Scopus databases. Eligible studies included randomized controlled trials, systematic reviews, observational studies, and implementation research that evaluated the effects of LSSS on BP, CV outcomes, safety, and feasibility in LMIC contexts. Thematic synthesis was used to summarize the findings. Key Findings: Salt substitutes consistently lowered systolic and diastolic BP across diverse populations, with mean reductions ranging from 3 to 5 mmHg. Trials have also demonstrated reductions in stroke incidence, CV events, and all-cause mortality. However, the benefits were mostly derived from studies conducted in China and other upper-middle-income settings. Safety concerns (particularly hyperkalemia in individuals with chronic kidney disease or RAAS inhibitors) warrant targeted risk screening and public education. Implementation barriers in LMICs include cost, limited availability, poor awareness, and a lack of regulatory oversight. Conclusions: Salt substitutes present a promising, scalable strategy to reduce BP and CV disease burden in LMICs. However, their adoption must be context-specific, culturally sensitive, and supported by government subsidies, regulatory frameworks, and educational campaigns. Future trials should evaluate the long-term safety and cost-effectiveness in underrepresented LMIC populations to guide equitable public health interventions.

While the need for reconstructive microsurgical procedures has increased across the developing world, several constraints in low- and middle-income settings prevent its consistent performance. Our study aimed to understand the impact of microsurgery training on local capacity in a low-income setting, and to understand limitations that may affect long-term build-up of microsurgical capacity.Cross-sectional study evaluating survey responses of trainees and surgeons who participated in a Flap Transfer and Microsurgery course held in Ibadan, Nigeria. The survey consisted of a pre- and postcourse questionnaire, and a 2-year posttraining survey. The questionnaire sought to assess training impact on microsurgical capacity and limitations at each participants institution. Fourteen surgeons completed all questionnaires and were included in the study.Thirteen (92.3%) participants had encountered at least one defect requiring microvascular surgery within 2 years of the training, and 9 (69.2%) reported having performed at least one surgery. Most surgeons indicated having performed less procedures than needed across all defect anatomical site/etiology. The most common limitation reported by participants consisted of man-power shortage (78.6%), followed by expense of each procedure, difficulty procuring materials, and trainers with limited experience.There is a significant need for microsurgical reconstruction in sub-Saharan Africa, with varied local challenges preventing consistent delivery of microsurgical care. The analysis complements previous literature on microsurgical care in developing countries and highlights significant constraints preventing widespread adoption and the role of local training opportunities that help in building long-term local capacity.

Background: Type 2 diabetes mellitus (T2DM) remains a significant global health challenge, disproportionately affecting individuals in low-income settings. Dietary interventions play a critical role in its management, with glycaemic index (GI) emerging as a key factor influencing glycaemic control. Objective: This systematic review evaluates the effectiveness of low glycaemic index (LGI) diets compared to high glycaemic index (HGI) diets in managing T2DM among adults. Methods: A comprehensive search was conducted across Cochrane Library, EMBASE, PubMed, and CINAHL databases for randomised controlled trials (RCTs) published between January 2004 and September 2016. No language restrictions were applied. Data extraction followed PRISMA guidelines, and analysis was performed using Review Manager 5.3. Risk of bias and study quality were assessed across all included trials. Results: Six RCTs involving 604 adults met the inclusion criteria. Meta-analysis revealed that LGI diets led to a modest but statistically significant reduction in glycated haemoglobin (HbA1c) compared to HGI diets (mean difference: -0.11%; 95% CI: -0.22 to -0.01; p = 0.04), based on a fixed-effect model. Conclusion: Incorporating LGI dietary strategies into the nutritional management of adults with T2DM yields a small yet clinically meaningful improvement in glycaemic control. These findings support the integration of GI-based dietary planning into broader diabetes care frameworks.

ABSTRACTHarlequin Ichthyosis (HI) is an extremely rare, autosomal recessive, and highly fatal condition in neonates. It is especially difficult to control in the low‐ and middle‐income countries (LMICs) due to the low rate of prenatal screening, cultural reluctance, and lack of access to neonatal intensive care. We present a 37‐week neonate born to a diabetic mother from a consanguineous marriage with a background of HI‐related neonatal mortality. The child had classical manifestations of HI in the form of hyperkeratotic armor‐like plates, eclabium, ectropion, and limb contractures. Oral acitretin was started at 1.1 mg/kg/day along with intensive supportive care but the neonate had become septic and succumbed on day nine despite multi‐antibiotic therapy, intravenous fluid resuscitation, and oral retinoid therapy. There was mild dermatological improvement with retinoid therapy but systemic improvement was not observed. Antenatal diagnosis was not made because of poor prenatal care and religious reluctance. On record, the present case is the first reported one for our region showing a likely association between maternal diabetes and high HI severity because epigenetic studies suggest that hyperglycemia may alter fetal gene expression, particularly in pathways related to cell adhesion and barrier function. The case highlights the intersection of maternal comorbidities, consanguinity, and healthcare system gaps in aggravating HI outcomes in LMICs. It necessitates emergent interventions such as subsidized prenatal screening, genetic counseling outreach, particularly concerning maternal diabetes, additional research, consanguineous marriage counseling, and neonatal infection control to enhance prognosis and prevent recurrence.