Low-resource Countries Research Articles

Efficacy of Intermittent Peritoneal Dialysis in Pre Renal and Renal Acute Kidney Injury in Children

Background: Acute kidney injury (AKI) is a major health problem in children worldwide. Intermittent Peritoneal Dialysis (IPD) has been reported as the preferred modality for the management of AKI in low-resource setting countries like Bangladesh. Its efficacy in different varieties of AKI is less emphasized. This study aims to assess the efficacy of IPD in pre renal and renal causes of AKI in children. Methods: This prospective, interventional study was conducted at Department of Paediatric Nephrology, Bangladesh Shishu Hospital and Institute from January 2020 to December 2021. Total 56 children aged between 1 month to 12 years of either sex, diagnosed as AKI stage 2 or 3 due to pre renal and renal causes who required IPD were included. All patients got IPD for 72 hours. Clinical and laboratory parameters were measured daily and compared between pre renal and renal group on day 3 to assess efficacy. Results: In the pre renal group, 65.4% of patients were infants while in the renal group, 51.9% were aged 1-5 years. After 3 days of IPD, oedema improved in both groups but in renal group, more patients were still oedematous (p<0.001). Serum creatinine, blood urea levels and urea reduction ratio improved significantly in both groups with greater changes in pre renal group (p<0.001). In the renal group, 29.63% patients required hemodialysis and 7.4% required further IPD, whereas all pre renal patients improved with a single course of IPD without hemodialysis. Conclusion: Intermittent Peritoneal Dialysis is more effective in the treatment of pre renal AKI in children.

PAP Smear in Pregnant Women: A Hospital Based Study

Introduction: Pregnancy provides an important opportunity to screen the cervix for neoplastic and infectious diseases and to spread awareness. A Papanicolaou(Pap) smear is simple, cost effective and safe during pregnancy. In low resource countries, this may be the only opportunity when woman visits a health care centre. Objective of this study is to use Pap smear as a cervical cancer screening test in pregnant women and to determine the prevalence of abnormal Pap smear among pregnant women attending the antenatal outpatient department. Methods: A prospective study conducted in the department of Obstetrics and Gynaecology of Shree Birendra Hospital for a period of 12 months from September 2020 to August 2021. Inclusion criteria was pregnant women in the first trimester. Exclusion criteria were pregnancy greater than 12 weeks, symptoms of vaginal infection, history of sexual intercourse or vaginal medication or bleeding in the last 48 hours or normal Pap smear in last 3 years. Ayre’s spatula was used to conduct smear test in this study. All the smears were immediately fixatived in 95% ethanol and sent to the department of pathology. The cytological result were reported on the Bethesteda classification system 2014. Results: Out of 300 pregnant women enrolled in the study, the Pap smear report revealed that 28.3% of the study subjects had inflammatory smear 65.7% of the subjects showed negative for intraepithelial lesion or malignancy and only 0.3% of subjects had Atypical Squamous Cells of Undetermined Significance (ASCUS). No satisfactory sample was reported in 5.7% of the subjects. Conclusions: The antenatal period should be utilized as an opportunity to screen women for cancer cervix. Pap smear during pregnancy not only gives the opportunity to screen but also helps to create awareness.

Addressing Neurological Inequities in Developing Countries: Challenges and Strategic Solutions

Abstract Neurological disorders pose one of the most urgent healthcare challenges globally, with a particularly severe impact on low-resource settings. Effective responses to this crisis require timely, intersectoral strategies, and coordinated actions to drive substantial positive changes. Political determinants of health play a crucial role in advancing initiatives in surveillance, prevention, acute care, and rehabilitation for neurological conditions. An essential life-course approach to brain health focuses on early intervention and sustained care throughout an individual’s lifespan. Building a comprehensive system of care, underpinned by robust policies and financial investments, is critical for progress in low-resource countries. In addition, urgent reforms in education are needed to cultivate a skilled neurological workforce that is equipped to meet the demands of these regions. Intersectoral strategies, including telemedicine, mobile health, organized systems of care, helicopter ambulance services, and widespread public awareness campaigns, are vital components for creating an equitable and responsive neurological healthcare framework.

Surgical Practice in Resource-Limited Settings: Perspectives of Medical Students and Early Career Doctors: A Narrative Review.

Surgical practices in low-resource countries often fail to meet established standards. Both doctors and medical students have limited exposure to surgical cases, which hinders training and the development of surgical specialization. This study highlights the current state of surgical practice from a trainee's perspective, explores existing gaps in training and capacity building, and recommends practical solutions. We conducted a literature search on PubMed, Google Scholar, and other scientific databases using search terms such as "surgical practice," "doctors' perspectives in surgical practice," "surgery in low- and middle-income countries," and "solutions to surgical inadequacy." We included studies published from 2015 to 2024, with exceptions for a few highly relevant studies published prior to 2015. We outline the limitations identified in the literature concerning surgical training and healthcare in low- and middle-income countries. Many centers lack adequate infrastructure, human resources, and training. These challenges negatively affect the skills and quality of surgical care. However, some centers demonstrate that surgical practice is feasible through collaboration with institutions established in higher-income contexts. Telesurgery, task shifting and sharing, high-impact, low-cost surgeries, and collaborations with more developed health systems could effectively bridge the gap in surgical availability in LMICs.

Conducting Clinical Research in Low Research Resource Countries: Lessons Learned From the International Registry of Men With Advanced Prostate Cancer Study in Nigeria.

There is limited cancer clinical research in sub-Saharan African countries despite the significant burden of cancers. The primary objective of this strengths, weaknesses, opportunities, and threats (SWOT) analysis was to understand and document factors affecting the successful implementation of prostate cancer (CaP) clinical research in Nigeria. The research team used a qualitative design involving International Registry of Men with Advanced Prostate Cancer (IRONMAN) study team members as participants from four regional sites in Nigeria. One-hour listening sessions were conducted via Zoom at each site, focusing on SWOT related to the IRONMAN study. All sessions were recorded, transcribed, and analyzed. Themes were inductively coded and then synthesized across all four sites. The study teams identified several strengths and weaknesses in conducting the IRONMAN study at their respective sites. Key strengths included access to robust patient population for recruitment and the availability of essential resources, such as lab space, clinical knowledge, and adequate staffing. Weaknesses centered on the social determinants of health that hinder patient participation, such as transportation challenges, distance to clinics, limited access to care, and insufficient biorepository space for sample storage. A prominent opportunity identified was the potential for Nigerian institutions to engage in more clinical research, particularly multisite global trials. Threats included difficulties in retaining research staff and political instability. This study highlights the promising research opportunities in Nigeria. The lessons learned from the IRONMAN study provide valuable insights into the feasibility of conducting CaP clinical research and trials tailored to the needs of Black men in sub-Saharan Africa. These findings offer a roadmap for future research efforts, with the potential to expand clinical trials and improve health outcomes across the region.

Design, methodology, and early findings of an autism registry program: ABBILAR project.

The autism spectrum disorder (ASD) registry program presents a unique opportunity to facilitate advanced research in various aspects of ASD, particularly in low-resource countries like Iran. Given the international significance of autism research, registry programs play a critical role in data sharing. ASD registry programs have been effectively established in high-income countries over a few decades; however, there are limited examples from low- and middle-income countries. This study presents a firsthand description of the design and primary findings of a 9-year established ASD registry program from the northwest of Iran. It elucidates the program's feasibility for other low-income settings, providing valuable insights for researchers and policymakers.

Barriers and facilitators in the acquisition of diabetes knowledge among tertiary-care nurses in central and southern Malawi: an exploratory-descriptive qualitative study

BackgroundNumerous studies report low diabetes knowledge among nurses in sub-Saharan Africa. However, little is known about the factors that hinder and promote their acquisition of knowledge on diabetes mellitus. Understanding these factors is a pivotal step towards ensuring that nurses are knowledgeable and competent in the provision of care and education for patients with diabetes mellitus.MethodsThe study employed an exploratory-descriptive qualitative (EDQ) approach. Participants were identified from two tertiary hospitals. Twenty-six participants were purposively selected from these facilities. Data were collected through focus group discussions and analysis was done using Braun and Clarke’s approach to thematic analysis.ResultsThe following themes relating to barriers and facilitators in the nurses’ acquisition of diabetes knowledge emerged from the study: (a) individual hindrances; (b) organizational drawbacks; (c) personal ways of knowing; (d) organizational factors enhancing knowledge; and (e) suggestions for improving the nurses’ knowledge.ConclusionsThe study brings to light various challenges and opportunities in the acquisition of diabetes knowledge among tertiary-care nurses in Malawi. Given our study results, we believe that cost-effective measures can be utilised to address the barriers to the acquisition of diabetes knowledge among nurses. This is a crucial step towards ensuring that nurses are knowledgeable and competent in the provision of care for patients with diabetes in low-resource countries.

Examining patient choice and provider competition under the National Health Insurance Fund outpatient cover in Kenya: does it enhance access and quality of care?

BackgroundWhile patient choice and provider competition are predicted to influence provider behaviour for enhancing access and quality of care, evidence on provider perceptions and response to patient choice and provider competition is largely missing in low-resource settings such as Kenya. We examined provider and purchaser perceptions about whether patient choice and provider competition influenced provider behaviour and enhanced access and quality of outpatient care in Kenya.MethodsWe conducted a qualitative study to explore this across two purposefully selected counties. We conducted 15 in-depth interviews (IDIs) with health facility managers and National Health Insurance Fund (NHIF) staff across the two counties. We examined these across five areas summarised as either local market conditions or patient feedback following the Vengberg framework.ResultsNHIF members’ choice of outpatient facilities compelled private and faith-based providers to compete for members while public providers did not view choice as a way of spurring competition. Besides, all providers did not receive any information regarding the exit of NHIF members from their facilities. Providers felt that that information would be crucial for their planning, especially in enhancing service accessibility and quality of care. Most providers ensured the availability of drugs, provided a wider range of services and leveraged on marketing to attract and retain NHIF members. Finally, providers highlighted their redesign of service delivery to meet NHIF members’ needs whilst enhancing the quality-of-care aspects such as waiting time and having qualified health workers.ConclusionThere is a need for NHIF to share NHIF members’ exit information with providers to support their service delivery arrangements in response to NHIF members’ needs. Besides, this study contributes evidence on patient choice and provider competition and their influence on access and quality of care from a low-resource setting country which is crucial as NHIF transitioned to the Social Health Authority.

Neurological Recovery Following Surgical Intervention in Patients with Traumatic Spinal Cord Injury at the University Teaching Hospital in Zambia

Introduction Traumatic spinal cord injuries cause long-term disability and functional impairment. Timely and proper surgical treatment improves neurological recovery and functional outcomes. However, in low-resource setting countries, surgical intervention is usually delayed raising concerns about the recovery of patients. Hence, this study investigated the neurological improvement of patients undergoing surgery for traumatic spinal cord injuries at the University Teaching Hospital in Lusaka, Zambia. Methods This was a retrospective study that included all eligible patients with traumatic spinal cord injury managed surgically at the University Teaching Hospital between 2018 and 2022. The study assessed neurological improvement by comparing the American Spinal Injury Association’s neurological grading before surgery to that at discharge. Data was analysed using Stata 17, and the level of significance was set at 5%. Results Out of the 96 patients in the study, 45.8% showed neurological improvement of at least one grade after surgery. Patients with thoracic injuries showed lower improvement rates (25.0%) than those with cervical (55.0%) or lumbar injuries (65.0%), while those with incomplete injuries showed higher improvement rates (78.7%) (p <0.05). Thoracic injuries were associated with reduced neurological improvement (AOR 0.21; 95% CI: 0.04 – 0.95, p = 0.043), while incomplete injuries were associated with higher neurological improvement (AOR 18.58; 95% CI: 6.11 – 56.51, p < 0.001). Conclusion Neurological improvement was poor for thoracic injuries and complete injuries, highlighting the necessity for further investigation into the specific structural features and mechanisms of injury that contribute to poor neurological improvement in thoracic injuries and the identification of effective recovery approaches for these patients.

Trends and Outcomes of Laparoscopic Surgery in Low‐Resource Settings: Lessons From Two African Healthcare Systems–A Narrative Review

ABSTRACTIntroductionLaparoscopic surgery (LS) has been a promising development in surgical practice globally ever since its introduction. LS has exhibited many an advantage, including bettering patient outcomes, lowering the risk of postoperative infection, and displaying economical affluence. However, its implementation in the African continent still faces various challenges. In this review, we investigated the status of laparoscopic surgery integration in Africa.ObjectivesIn this review, we aimed to investigate the challenges posed by the implementation of LS in low resource countries as well as critically evaluating initiatives and their impact within said domiciles. We also provide recommendations that may assist in LS prosperity in these settings by focusing efforts on improving training and financial incentives.MethodsA comprehensive literature review was conducted to garner up‐to‐date evidence concerning the fate of LS adoption in low‐ to middle‐income countries. This comprised the analysis of different case studies from countries including Nigeria and Botswana, and investigated relevant recommendations and policies provided by other African countries.ResultsVarious challenges face the implementation of LS in countries with low resources comprising poor infrastructure, scarce training programs, and expert training personnel alongside financial boundaries. The adoption of LS in Africa has proved its benefits in improving patient outcomes and reducing hospital admissions. From a perspective of policy, it is crucial to sustain strong ties amongst institutions, stressing the importance of dynamic collaboration and locally tailored policies.ConclusionIt has been demonstrated that LS implementations in African nations lower infection rates and expedite recovery. A strong collaboration between governments, stakeholders, and healthcare providers is fundamental for successful integration of LS. Such extension in low‐resource environments may be achieved by providing proper training programs, funding infrastructure and equipment, and fostering effective financial initiatives.

Patología importada en urgencias

Introduction: the increase in migratory movements and travel to low-resource countries in recent years has led to an increase in the incidence of infectious diseases that are uncommon in Spain. The objective of the study was to describe the characteristics of patients with imported disease in the emergency room. Methods: a retrospective study was conducted between 2012-2019. The study included children under 16 years of age with a history of international travel in the past 3 months managed in the emergency department of the Hospital de Torrejón. We collected demographic and clinical data. Diagnoses were grouped into three categories: tropical infection (typically imported from tropical areas), communicable infections (including infections with global distribution and a greater prevalence in tropical areas, such as tuberculosis) and common infections. Results: the sample included 100 children were included. The median age was 3 years, and 53% were female. Eighty-seven percent had visited sub-Saharan Africa. The reason for the trip was to visit friends and relatives in 43% of cases, immigration in 45% and tourism in 9%. Four percent received prophylaxis against malaria. Twenty-four received a diagnosis of malaria, without a history of fever in 6. Other tropical infections included dengue, chikungunya and liver abscess. Five children received diagnoses of communicable infections (HIV, tuberculosis, meningitis, hepatitis A, giardiasis), and 67 children of common infections. Conclusions: malaria was the second most frequent diagnosis in children with fever following travel to an endemic area, after common infections. In our study, the initial presentation of life-threatening imported diseases were indistinguishable from those banal infections.

Midwife-Led Versus Obstetrician-Led Perinatal Care for Low-Risk Pregnancy: A Systematic Review and Meta-Analysis of 1.4 Million Pregnancies.

Background: The optimum model of perinatal care for low-risk pregnancies has been a topic of debate. Obstetrician-led care tends to perform unnecessary interventions, whereas the quality of midwife-led care has been subject to debate. This review aimed to assess whether midwife-led care reduces childbirth intervention and whether this comes at the expense of maternal and neonatal wellbeing. Methods: PubMed, Scopus, Cochrane Library, and Web of Science were systematically searched for relevant studies. Studies were checked for eligibility by screening the titles, abstracts, and full texts. We performed meta-analyses using the inverse variance method using RevMan software version 5.3. We pooled data using the risk ratio and mean difference with the 95% confidence interval. Results: This review included 44 studies with 1,397,320 women enrolled. Midwife-led care carried a lower risk of unplanned cesarean and instrumental vaginal deliveries, augmentation of labor, epidural/spinal analgesia, episiotomy, and active management of labor third stage. Women who received midwife-led care had shorter hospital stays and lower risks of infection, manual removal of the placenta, blood transfusion, and intensive care unit (ICU) admission. Furthermore, neonates delivered under midwife-led care had lower risks of acidosis, asphyxia, transfer to specialist care, and ICU admission. Postpartum hemorrhage, perineal tears, APGAR score < 7, and other outcomes were comparable between the two models of management. Conclusions: Midwife-led care reduced childbirth interventions with favorable maternal and neonatal outcomes in most cases. We recommend assigning low-risk pregnancies to midwife-led perinatal care in health systems with infrastructure allowing for smooth transfer when complications arise. Further research is needed to reflect the situation in low-resource countries.

Scaling cervical cancer screening in Mozambique: analysis of loop electrosurgical excision procedure (LEEP) specimens

ObjectivesAs cervical cancer screening programs are implemented and expanded, an increasing number of women require loop electrosurgical excision procedure (LEEP) for treatment of pre-invasive cervical disease. Our objective was to...

Asymptomatic bacteriuria screening for developing countries using a modified water quality test kit.

Between 2% and 15% of pregnant women unknowingly experience asymptomatic bacteriuria (ASB), defined as ≥105 CFU per milliliter of urine in the absence of symptoms. ASB increases the risk of adverse pregnancy outcomes including pyelonephritis, preterm labor, and low-birth weight infants. While pregnant women in the United States are routinely screened for ASB, those in developing countries with limited resources and funding lack an accurate mechanism for ASB screening. Aquagenx water quality test kits detect Escherichia coli, the most common causative agent of ASB, and total coliform bacteria in drinking water via colorimetric and fluorescent indicators. We found that the Aquagenx system is compatible with human urine and then proceeded to develop an ASB screening protocol using disposable inoculating loops. Our protocol diagnosed artificial ASB- samples (104 CFU/mL E. coli) with a false positive (FP) rate of 33% (n = 18) and ASB+ (105 CFU/mL E. coli) with a false negative (FN) rate of 5.6% (n = 18). Clinical sample testing with our protocol revealed a FP rate of 0% in ASB- samples (n = 28) and a FN rate of 0% in ASB+ samples caused by coliforms (n = 13). Aquagenx did not detect ASB in nine clinical samples with non-coliform etiological agents due to the limitations of the technology. However, with very high accuracy for detection of E. coli and other causative agents that collectively account for 90.1% of ASB cases, these kits could be used as a diagnostic ASB screening tool in developing countries in which there is currently no alternative to urine culture.IMPORTANCEAsymptomatic bacteriuria (ASB) affects 2%-15% of pregnant women and can result in adverse maternal and fetal outcomes if left undetected and untreated. In the United States and other developed nations, pregnant women are regularly screened for ASB via urine culture. However, in low-resource countries where bacterial culture is not available, dipstick testing is used. Although accurate in cases of symptomatic bacteriuria, dipstick detection is ineffective for detecting ASB. Here, we made use of an existing water quality field test for ASB urine screening, which would be readily deployable in low-resource settings. We optimized a dilution protocol for sampling patient urine within the detection limits of the Aquagenx kit technology. Overall, we were able to detect ASB samples with Gram-negative pathogens that collectively account for 90% of all ASB cases. Utilization of this repurposed technology for proactive medical screening may help prevent adverse pregnancy and birth outcomes due to ASB.

Obstetric Outcome and its Relationship with Mode of Delivery in Preterm Labour- A Study of 86 Patients in Combined Military Hospital, Dhaka

Background: Caesarean section in preterm pregnancy may add further pressure to the already existing poorly developed facilities for intensive perinatal care in low resource countries. The objective of the study was to determine the feto-maternal outcome and its relationship with mode of delivery in preterm labour. Methods: This was a descriptive type of cross-sectional study conducted at Department of Obstetrics and Gynecology, Combined Military Hospital (CMH), Dhaka, during March to August 20l8. The study population was total eighty-six patients having 28 to 36 weeks of gestation who were admitted in the above department and were in labour. Data were edited and analyzed by using computer-based software, statistical package for social sciences (SPSS) version 20.0. Results: Majority of the patients belonged to 26-30 years age group and were from low socioeconomic family (71.4 to 72.7) % and had below average nutritional status (88.1 to 93.2) %. The mean gestational age was 31 weeks and 35 weeks. Nulliparous (77.3 to 85.7) % and patients taking irregular antenatal check-up (69.0 to 72.8) % were predominant. About (59.1 to 66.7) % patients had vaginal delivery and (33.3 to 40.9) % patients had undergone caesarean section. Maternal morbidity was more in caesarean section (37.5%) than vaginal delivery (33.3%). Live birth babies were found 100% in caesarean section and 94.4% in vaginal delivery and among them 95.7% were from group I and 97.6% were from group ll. Perinatal mortality was higher in vaginal delivery than caesarean section (7.40% vs 2.7%) and also higher in group I than group ll (8.3% vs 2.3%). But late perinatal complications were more in caesarean section (47.2%) than vaginal delivery (45.1%) baby, and majority (60%) of them were from group l. Conclusion: Preterm pregnancy when leads to an early delivery, brings a grave consequence for both the mother and foetus. After birth, the premature newborn is at risk for complications related to incomplete development of its organ system. Caesarean section delivery in preterm labour improves foetal outcome to some extent, but not significantly, and leads the mother to more maternal morbidity. Perinatal mortality and morbidity is also inversely related to the gestational age at the time of delivery, in preterm labour - more the gestational age, less the perinatal mortality and morbidity. Bangladesh Armed Forces Med J Vol 57 No (1) June 2024, pp 43-49

Factors Associated with Intra Hospital Neonatal Mortality: A Case Study of the Neonatology Department at the Regional Hospital Center of Agadir (Morocco)

Background: Neonatal mortality (NNM) has significantly decreased in developed countries. However, it remains a major public health issue and a particular challenge in developing countries, with Morocco being no exception, as its NNM rate remains high. Objectives: This study aims to identify factors associated with NNM within the Neonatology Department at the Regional Hospital Center of Agadir. Methods: An analytical cross-sectional study design was chosen. To determine factors associated with early NNM, we employed binary logistic regression in both univariate and multivariate analyses, including all statistically significant variables in the multivariate model. Results: Three hundred and eight deceased neonates were included. The intra-hospital NNM rate was 17.4%, 95% CI (13.2 - 21.7), during the period from 2018 to 2021. A predominance of early NNM (81.8%). 52.3% were females. 47.7% of the deceased had low birth weight. 65.9% of the cases had an Apgar score &lt; 7. 44.2% were resuscitated. The factors that were statistically associated with the risk of early NNM were as follows: Admission age ≤ 1 day (aOR: 17.87; 95% CI: 5.78 - 55.29), neonatal admission age 2 - 7 days (aOR: 6.64; 95% CI: 1.68 - 26.30). Intra-hospital referral (aOR: 4.49; 95% CI: 1.59 - 12.65); emergency consultations (aOR: 4.25; 95% CI: 1.28 - 14.01). Conclusions: Neonatal mortality remains a major public health challenge in Morocco. Different risk factors associated with NNM have been identified. Addressing these factors could reduce neonatal deaths in low-resource countries. For this reason, we need to intensify our efforts to develop reliable and precise approaches.

Economic Burden of Community-Acquired Antibiotic-Resistant Urinary Tract Infections: Systematic Review and Meta-Analysis.

Antibiotic resistance (ABR) poses a major burden to global health and economic systems. ABR in community-acquired urinary tract infections (CA-UTIs) has become increasingly prevalent. Accurate estimates of ABR's clinical and economic burden are needed to support medical resource prioritization and cost-effectiveness evaluations of urinary tract infection (UTI) interventions. This study aims to systematically synthesize the evidence on the economic costs associated with ABR in CA-UTIs, using published studies comparing the costs of antibiotic-susceptible and antibiotic-resistant cases. We searched the PubMed, Ovid MEDLINE and Embase, Cochrane Review Library, and Scopus databases. Studies published in English from January 1, 2008, to January 31, 2023, reporting the economic costs of ABR in CA-UTI of any microbe were included. Independent screening of titles/abstracts and full texts was performed based on prespecified criteria. A quality assessment was performed using the Integrated Quality Criteria for Review of Multiple Study Designs (ICROMS) tool. Data in UTI diagnosis criteria, patient characteristics, perspectives, resource costs, and patient and health economic outcomes, including mortality, hospital length of stay (LOS), and costs, were extracted and analyzed. Monetary costs were converted into 2023 US dollars. This review included 15 studies with a total of 57,251 CA-UTI cases. All studies were from high- or upper-middle-income countries. A total of 14 (93%) studies took a health system perspective, 13 (87%) focused on hospitalized patients, and 14 (93%) reported UTI pathogens. Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa are the most prevalent organisms. A total of 12 (80%) studies reported mortality, of which, 7 reported increased mortality in the ABR group. Random effects meta-analyses estimated an odds ratio of 1.50 (95% CI 1.29-1.74) in the ABR CA-UTI cases. All 13 hospital-based studies reported LOS, of which, 11 reported significantly higher LOS in the ABR group. The meta-analysis of the reported median LOS estimated a pooled excess LOS ranging from 1.50 days (95% CI 0.71-4.00) to 2.00 days (95% CI 0.85-3.15). The meta-analysis of the reported mean LOS estimated a pooled excess LOS of 2.45 days (95% CI 0.51-4.39). A total of 8 (53%) studies reported costs in monetary terms-none discounted the costs. All 8 studies reported higher medical costs spent treating patients with ABR CA-UTI in hospitals. The highest excess cost was observed in UTIs caused by carbapenem-resistant Enterobacterales. No meta-analysis was performed for monetary costs due to heterogeneity. ABR was attributed to increased mortality, hospital LOS, and economic costs among patients with CA-UTI. The findings of this review highlighted the scarcity of research in this area, particularly in patient morbidity and chronic sequelae and costs incurred in community health care. Future research calls for a cost-of-illness analysis of infections, standardizing therapy-pathogen combination comparators, medical resources, productivity loss, intangible costs to be captured, and data from community sectors and low-resource settings and countries.

Dentification of artemether-lumefantrine combination drugs using mid-infrared spectroscopy and chemometric tools

The high circulation of substandard and/or falsified medicines is a major public health problem worldwide, particularly in low-resource countries. This work was carried out with the aim of combating this scourge using mid-infrared spectroscopy. The study focused on combination therapies based on artemether-lumefantrine and involved the construction and validation of a model for rapid detection of falsifications of artemether-lumefantrine. Other antimalarial drugs were also used to assess the specificity of the models constructed. A total of 46 samples were analyzed, all collected in Benin, from pharmacies in Departmental Hospital Centres and private pharmacies. The spectra recorded in the range from 4000 to 650 cm-1 were preprocessed then a principal component analysis was applied to break down and visualize the data, and to highlight groupings or trends. This enabled to observe the differences and similarities between the spectra of artemether/lumefantrine, and to assess the differentiating factors from other antimalarial molecules. Also, a data-driven soft independent modelling of class analogy (DD-SIMCA) model was built to evaluate its ability to authenticate artemether-lumefantrine samples. The other antimalarial drugs were used to test model specificity. Built DD-SIMCA model allowed a clear identification of artemether-lumefantrine (sensitivity 100%) and a good discrimination of other antimalarials (specificity 98%). Keywords: Quality control, construction, validation, DD-SIMCA.

A-251 Simplification of Molecular Diagnostics for Sexually Transmitted Infection Point-of-Care Testing

Abstract Background HPV-caused cancers contribute to a large disease burden, accounting for 5% of all cancers. It is estimated that over 700,000 people develop HPV-related cancers each year with the majority being cervical cancer. The burden of this disease is disproportionately carried by low-income countries with the highest rates of HPV cervical infections primarily found in sub-Saharan Africa, Latin America, Eastern Europe, and South-East Asia. Many regions in low-resource countries lack adequate access to sensitive point-of-care screening tools, preventing timely diagnosis and treatment. Current low-cost methods, such as Pap smears and visual inspection using acetic acid suffer from low sensitivity, specificity, and reproducibility which limit their effectiveness as a screening modality. Many countries use nucleic acid amplification tests (NAATs) to identify key HPV infections which may progress towards cervical cancer. However, the expenditure for NAAT-capable equipment and reagents are cost-prohibitive for rural and underserved communities. To reduce screening barriers, we developed an isothermal HPV molecular test that can detect all 14 cancer-causing HPV strains using a novel amplification methodology combined with G-quadruplex DNAzyme colorimetric detection. Methods We developed a novel isothermal amplification technique that is related to loop-mediated isothermal amplification (LAMP) but uses modified looped primers to enable exponential amplification at 60°C for 1 hour. The modified primers only require two binding sites compared to 4-6 in LAMP. To detect the amplified products, we used G-quadruplex peroxidase-like DNAzyme probes which reduce ABTS to produce a visually interpreted result. Analytical validation evaluated the method’s limit of detection, specificity, and accuracy. As proof of concept in a relevant matrix, clinical cervical brushings collected ThinPrep Pap media were tested with the new method and compared to an FDA-approved reference qPCR test. Results Repeated experiments demonstrate that the lowest detectable HPV DNA concentration was approximately 1000 genomic copies/µL with no amplification with other pathogens. As proof of concept, the comparison to the reference standard demonstrated high accuracy. Conclusions The application of our assay is intended as a near-patient screening tool with further evaluation by a clinician for confirmation. With an accurate and rapid screening tool, we envision low-resource regions across the world will have the tools to rapidly detect and treat cervical cancers in their early stages.

Stab Wounds of the Abdomen: Epidemiological, Clinical, Therapeutic and Evolutionary Aspects in the General Surgery Department of the N'zérékoré Regional Hospital (Guinea)

Aim: To determine the place of abdominal wounds among abdominal traumas and to describe their clinical, therapeutic and evolutionary aspects. Patients and Methods: This was a retrospective descriptive study based on analysis of the records of patients seen for abdominal stab wounds in the general surgery department of the N'Zérékoré regional hospital during the period from January 2011 to December 31, 2020. Epidemiological, clinical, therapeutic and evolutionary parameters were studied. Results: Out of a total of 745 cases of abdominal trauma, we found 89 cases of abdominal stab wounds, a frequency of 12.49%. The average age was 36, with a clear male predominance (78%). Pupils/students were the most represented (32.58%), and criminal assault was the most common circumstance (70.79%). Operative treatment was the most common (74%), and the small intestine was the organ most affected (34.84%); the after-effects were simple in 89.39% of patients, and we recorded 4 deaths (6.06%). Conclusion: Stab wounds of the abdomen are a real public health problem in Africa, especially in low-resource countries such as ours. Surgery is still indicated for severe injuries or complications.