Low And Medium Income Countries Research Articles

How do structured pedagogy programmes affect reading instruction in African early grade classrooms?

‘Structured pedagogy programmes’ (SPP) have recently become a dominant approach in interventions across low and medium-income countries (LMICs) to address the so-called ‘reading crisis’. SPPs entail a range of interventions including reading materials, lesson plans and teacher support aimed at changing instructional practice. This paper considers the impact of SPPs on pedagogy. As part of evaluations of the Literacy Achievement and Retention Activity (LARA) and the Read Liberia programmes, observations of 188 early grade reading lessons in Uganda and Liberia were conducted between 2017 and 2022. These included programme (treatment) classrooms and comparator (control) lessons. Both programmes aimed to improve the reading abilities of early grade learners through the training and coaching of teachers and the provision of materials, including daily scripted teacher guides. The article considers the intended curriculum of the two programmes and analyses the differences between treatment classrooms implementing the programmes, and control classrooms. The paper argues that while the ‘what’ of the SPPs (the textual base and curriculum content) is clearly defined and impacts pedagogy to some extent, the ‘how’, or interactive aspects of the pedagogy are diffuse in programme intensions and show little impact on instructional practice. The distinction between the what and the how of pedagogy highlights the need for a more developed theory of pedagogy underlying SPPs. Further, the analysis draws attention to the sociocultural aspect of pedagogy in shaping instruction, arguing for experimentation in contextually-sensitive pedagogies that work more with the grain of teachers’ local, existing practices.

Sensitivity study of a locally developed six electrode focused impedance method.

The Focused Impedance Method (FIM) is a new technique of electrical bioimpedance measurements in the human body. The idea originated in Bangladesh and provides an opportunity for localized measurement of bioimpedance down to reasonable depths from the body surface using skin surface electrodes. This has potential applications for physiological studies of targeted organs in the body and in detecting or diagnosing diseases and disorders. FIM is based on the age-old Tetra-Polar Impedance Measurement (TPIM) but provides a few significant improvements. Technology must be developed indigenously to obtain long-term benefits, particularly in Low and Medium Income countries (LMIC). This paper presents an experimental sensitivity study of the six-electrode version of the Focused Impedance method (FIM-6) with the circuit and phantom indigenously designed in Nepal. The work involved sensitivity studies of both FIM-6 and TPIM with the necessary circuit blocks developed through experimental validation. The sensitivity studies were performed on a simple 2D phantom with different electrode arrangements for FIM-6 and linear TPIM. A cylindrical object was placed at different positions for this study. The FIM-6 gave a high sensitivity in the central part, which remained almost constant within a small region that may be termed as the focused region. On the other hand, TPIM results fell off sharply away from the central point, making it unsuitable for practical measurements on target organs. Besides, there were areas with large negative sensitivities in TPIM, which were much smaller in FIM. The results obtained through this work clearly show the improvement offered by FIM over TPIM.

Quantitative health risk assessment of microbial hazards from water sources for community and self-supply drinking water systems

In low and medium income countries (LMIC) drinking water sources (wells and boreholes) often contain a high number of pathogenic microorganisms, that can pose significant human and environmental health risks. In this study, a quantitative microbial risk assessment approach based on existing literature was conducted to evaluate and compare the quantitative health risks associated with different age groups using various drinking water supply systems. Results showed that both community-supply and self-supply modes exhibit similar levels of risk. However, the self-supply water source consistently showed higher risks compared to the community-supply one. Borehole water was found to be a more suitable option than well water, consistently showing between 5 and 8 lower health risks for E. coli and fecal coliform levels, respectively. The sensitivity analysis further showed the importance of prioritizing the reduction of E. coli concentration in well water and fecal coliform concentration in borehole water. This study offers a fresh perception on quantifying the impact of exposure concentration and age groups, shedding light on how they affect environmental health risks. These findings provide valuable insights for stakeholders involved in the management and protection of water sources.

Is localization better than globalization for sustainability? Evidence from the nutraceuticals industry for managing malnutrition in India

The socioeconomic consequences of the worldwide burden of malnutrition are substantial, with long-term consequences for individuals, their families, and their countries. Despite being one of the world's greatest producers of various agricultural products, India has regularly performed poorly in the Global Hunger Index. The World Food Programme provides funds to deliver a nutraceutical product (Plumpy Nut) to malnourished children in Low- and Medium-Income Countries (LMIC). The cost of obtaining these items from the international market is high, and worldwide logistics contribute to pollution. Despite these efforts, there has been insufficient food to feed nearly 40% of malnourished children in India, owing to budget constraints. This research provides a linear programming model and the Augmented ε-Constraint Method for developing a sustainable nutraceutical network. The model examines whether localizing the availability of nutraceutical items, in comparison to global sourcing, might be a viable option for improved managing malnutrition in LMIC's. The findings illustrate that localization can lead to a significant reduction in both cost (50%) and greenhouse gas emissions (90%). In addition, localization leads to feeding increased number of malnourished children in the budget constraint environment. Localization can also lead to a reduction in lead time related to due import-related logistical delays. The study offers insights into various policy interventions for stakeholders such as the government, producers, malnourished children (consumers), and others, to reduce malnutrition, while contributing towards United Nations Sustainable Development Goals of Zero Hunger and Responsible Consumption-Production by 2030. We use a case study from India to validate the model.

NO2 Concentration Estimation at Urban Ground Level by Integrating Sentinel 5P Data and ERA5 Using Machine Learning: The Milan (Italy) Case Study

The measurement of atmospheric NO2 pollution concentrations has become a critical topic due to its impact on human health. Ground sensors are the most popular method for measuring atmospheric pollution, but they can be expensive to purchase, install, and maintain. In contrast, satellite technology offers global coverage but typically provides concentration estimates at the tropospheric level, not at the ground level where most human activities take place. This work presents a model that can be used to estimate NO2 ground-level concentrations in metropolitan areas using Sentinel-5P satellite images and ERA5 meteorological data. The primary goal is to offer a cost-effective solution for Low- and Medium-Income Countries (LMICs) to assess air quality, thereby addressing the air quality measurement constraints. To validate the model’s accuracy, study points were selected in alignment with the Regional Agency for the Environment Protection (ARPA) NO2 sensor network in the Metropolitan City of Milan. The results showed that the RMSE of the model estimations was significantly lower than the standard deviation of the real measurements. This work fills the gaps in the literature by providing an accurate estimation model of NO2 in the Metropolitan City of Milan using both satellite data and ERA5 meteorological data. This work presents as an alternative to ground sensors by enabling more regions to assess their air quality effectively.

The Drivers of Evidence-based Practice at Inception: Implications for Low- and Medium-income Countries

Low- and medium-income countries (LMICs) desire the multiple benefits of evidence-based practice (EBP) but have achieved minimal success so far. Moreover, frameworks for implementing EBP fail to acknowledge the external socio-political factors as core component of uptake and sustaining EBP in health care settings. Consequently, this paper will examine the influence of drivers of EBP and the implications for sustaining EBP diffusion into LMICs. Theoretically, EBP proposes that clinical treatment decisions be based on the most current verifiable evidence. Associated with improved quality of care, EBP is the universal standard of clinical interventions. Yet, since introducing EBP to LMICs, the integration process has been slow compared to the rapid development witnessed in the UK, US and Canada over the past 30 years. EBP proponents linked the resistance with institutional barriers in the LMICs. However, this paper argues that the external socio-political context is a proven barrier-breaking force but presently underestimated in LMICs. Central to this review, the socio-political dynamics in the UK, US and Canada were discussed to mirror the powerful influence that propelled EBP at its successful inception. The implication is that breaking the institutional barriers against sustainable EBP implementation in the LMICs requires synergy of influential forces outside the hospital settings. Unfortunately, most implementation studies from LMICs are limited to institutional barriers. Finally, hospital settings in LMICs face unique problems integrating EBP with daily care and to overcome the barriers, closer attention must be paid to the influence of the surrounding factors; political, technological, managerial and globalization forces.

The Ethics of Reviewing AI Studies by Research Ethics Committees (Recs) in Low and Medium Income Countries (LMICs)

The Ethics of Reviewing AI Studies by Research Ethics Committees (Recs) in Low and Medium Income Countries (LMICs)

Abdominal Trauma Imaging in a Nigerian Tertiary Hospital-Our Experience with 87 Adult Patients.

Abdominal trauma is a major cause of morbidity and mortality in low- and medium-income countries (LMICs). Abdominal trauma imaging is important in determining the location and severity of organ injury, the need for surgery, and the identification of complications. The choice of imaging in abdominal trauma in LMICs is influenced by peculiar problems, which include the availability of imaging modality, expertise, and cost. There are few reports on options of trauma imaging in LMICs, and this study aimed to identify and characterise the type of imaging done for patients presenting with abdominal trauma at the University of Ilorin Teaching Hospital. This was a retrospective observational study of patients with abdominal trauma who presented at the University of Ilorin Teaching Hospital from 2013 to 2019. Records were identified, and data were extracted and analysed. A total of 87 patients were included in the study. There were 73 males and 14 females. The abdominal ultrasound was the commonest modality done in 36 (41%) patients, whereas abdominal computed tomography was done in five (6%) patients. Eleven patients (13%) had no imaging done, and 10 of these patients proceeded to having surgery. In patients with intraoperative finding of perforated viscus, the sensitivity of radiography was 85% and specificity was 100%, whereas that of the ultrasound was 86.7% and 50% for sensitivity and specificity, respectively. The ultrasound scan was the commonest imaging done for patients who presented with features of haemorrhage (P = 0.04), odds ratio (OR) = 1.29 (95% confidence interval [CI] = 1.08-1.6), and patients with severe injury, P = 0.03, OR = 2.07 (95% CI = 1.06-4.06). Gender (P = 0.64), shock at presentation (P = 0.19), and mechanism of injury (P = 0.11) did not influence the choice of imaging. Abdominal trauma imaging in this setting was majorly via ultrasound and abdominal radiographs. Factors suggested to influence the pattern of abdominal trauma imaging in LMICs include the availability of specific imaging modality, cost, lack of standardisation and definite abdominal trauma protocols.

Extracorporeal blood purification in patients with liver failure: Considerations for the low-and-middle income countries of Latin America.

Severe liver failure is common in Low-and-Medium Income Countries (LMIC) and is associated with a high morbidity, mortality and represents an important burden to the healthcare system. In its most severe state, liver failure is a medical emergency, that requires supportive care until either the liver recovers or a liver transplant is performed. Frequently the patient requires intensive support until their liver recovers or they receive a liver transplant. Extracorporeal blood purification techniques can be employed as a strategy for bridging to transplantation or recovery. The most common type of extracorporeal support provided to these patients is kidney replacement therapy (KRT), as acute kidney injury is very common in these patients and KRT devices more readily available. However, because most of the substances that the liver clears are lipophilic and albumin-bound, they are not cleared effectively by KRT. Hence, there has been much effort in developing devices that more closely resemble the clearance function of the liver. This article provides a review of various non-biologic extracorporeal liver support devices that can be used to support these patients, and our perspective keeping in mind the needs and unique challenges present in the LMIC of Latin America.

Risky sexual behaviours among Ugandan university students: A pilot study exploring the role of adverse childhood experiences, substance use history, and family environment.

University students are known to have risky sexual behaviours (RSBs). The severity of the RSB is influenced by many factors, including the family environment, exposure to adverse childhood events (ACEs), and the use of addictive substances. However, there is limited information about the influence of ACEs and the family environment of these students in low-and medium-income countries (LMICs). Therefore, a pilot study was conducted among university students from a LMIC, Uganda. The present study comprised a cross-sectional online survey among Ugandan students at a public university (N = 316; 75% male; 52.2% aged between 18-22 years). The survey included questions relating to socio-demographic information, family environmental information, the Sexual Risk Survey (SRS), and the Adverse Childhood Experiences-International Questionnaire (ACE-IQ). Over half (53.8%) reported having had sexual intercourse. Males reported over two times higher mean total SRS score compared to females (χ2 = 4.06, p = 0.044). Approximately one-sixth of the sample had drunk alcohol or used illicit psychoactive substances in the past six months (16.1%). Among four regression analysis models, sociodemographic variables predicted the highest variance (13%), followed by family environment variables (10%), and both psychoactive substance use history (past six months) and ACEs individually explained approximately 5% variance in total SRS score, with the final model predicting 33% of the variance in RSB. The present study demonstrated a gender disparity with males involved in more RSB than females, as has been reported in most previous RSB studies. Family environment, sociodemographic factors, substance use, and ACEs all appear to contribute to RSB among university students. These findings will benefit other researchers exploring factors associated with RSB among university students and will help develop interventions to reduce RSB to protect students from unwanted pregnancies, sexually transmitted diseases, and HIV/AIDS.

Antihypertensive medicine use differs between Ghana and Nigeria

BackgroundNon-communicable diseases are a growing burden in many African countries; cardiovascular disease is the main disease. Antihypertensive medicines (AHM) are a common treatment option but we know little about community use in most low- and medium-income countries (LMIC). We aimed to describe the use of antihypertensive medicines (AHM) in Ghana and Nigeria using a novel data source.MethodsWe used data from mPharma—a health and pharmaceutical company which distributes pharmaceuticals to hospital and retail pharmacies. We extracted data using the anatomical therapeutic chemical (ATC) classification codes and calculated use in defined daily doses and explored patterns by class, medicines, dose, and originator or generic product.ResultsAHM use differed between Ghana and Nigeria. The most used classes in Ghana were angiotensin receptor blockers (ARB) followed by calcium channel blockers (CCB) and angiotensin-converting-enzyme inhibitors (ACEi). The five most used products were 16 mg candesartan, 30 mg nifedipine, 10 mg lisinopril, 5 mg amlodipine and 50 mg losartan. In Nigeria ARB, CCB and diuretics were widely used; the top five products were 50 mg losartan, 10 mg lisinopril, 30 mg nifedipine, 40 mg furosemide, and 5 mg amlodipine. More originator products were used in Ghana than Nigeria.ConclusionThe differences between Ghana and Nigeria may result from a combination of medical, contextual and policy evidence and reflect factors related to clinical guidance (e.g. standard treatment guidelines), accessibility to prescribers and the role of community pharmacies, and structure of the health system and universal health coverage including funding for medicines. We show the feasibility of using novel data sources to gain insights on medicines use in the community.

Health System Resilience and Community Participation amidst the Covid 19 Pandemic: A Case Study of SONJO (Sambatan Jogja) in the Special Region of Yogyakarta, Indonesia

There is a growing concern over how the Covid-19 pandemic might affect low- and medium- income countries (LMOCs) worse compared to high-income countries. The main contributor to this aggravation is the health system is not strong enough to sustain the shock the system caused by the pandemic. Therefore, strengthening the health system resilience in LMOCs is imperative to lessen the gap between countries. The health system resilience constitutes a set of capabilities to maintain shocks, adapt to the shock and transform into actions to keep the essential functions of the health system. The essential factor contributing to the resilience of a health system is the recognition of the complexity and dynamic power relationship underlying the system, including opening access for community participation. This study aims to describe how SONJO, a community-based organization in the Special Region of Yogyakarta (SRY), Indonesia, has played a crucial role in strengthening the health system resilience in the province during the Covid-19 pandemic 2021. As the nature of the research, this study conducts a qualitative approach to collect and analyze the data. The study shows that SONJO can develop adaptive mechanisms to cope with the outbreak through the collective action of diverse actors in the health system translated from shared knowledge, coordination, and values. SONJO acts as a social broker that bridges a wide range of actors in the health system of SRY through a digital platform.

Identifying degrees of deprivation from space using deep learning and morphological spatial analysis of deprived urban areas

Many cities in low- and medium-income countries (LMICs) are facing rapid unplanned growth of built-up areas, while detailed information on these deprived urban areas (DUAs) is lacking. There exist visible differences in housing conditions and urban spaces, and these differences are linked to urban deprivation. However, the appropriate geospatial information for unravelling urban deprivation is typically not available for DUAs in LMICs, constituting an urgent knowledge gap. The objective of this study is to apply deep learning techniques and morphological analysis to identify degrees of deprivation in DUAs. To this end, we first generate a reference dataset of building footprints using a participatory community-based crowd-sourcing approach. Secondly, we adapt a deep learning model based on the U-Net architecture for the semantic segmentation of satellite imagery (WorldView 3) to generate building footprints. Lastly, we compute multi-level morphological features from building footprints for identifying the deprivation variation within DUAs. Our results show that deep learning techniques perform satisfactorily for predicting building footprints in DUAs, yielding an accuracy of F1 score = 0.84 and Jaccard Index = 0.73. The resulting building footprints (predicted buildings) are useful for the computation of morphology metrics at the grid cell level, as, in high-density areas, buildings cannot be detected individually but in clumps. Morphological features capture physical differences of deprivation within DUAs. Four indicators are used to define the morphology in DUAs, i.e., two related to building form (building size and inner irregularity) and two covering the form of open spaces (proximity and directionality). The degree of deprivation can be evaluated from the analysis of morphological features extracted from the predicted buildings, resulting in three categories: high, medium, and low deprivation. The outcome of this study contributes to the advancement of methods for producing up-to-date and disaggregated morphological spatial data on urban DUAs (often referred to as ‘slums’) which are essential for understanding the physical dimensions of deprivation, and hence planning targeted interventions accordingly.

A five-year prospective study of the Aetiology, Pattern of Presentation, and Management of patients with burns in Ekiti State University Teaching Hospital

Background: Burns constitute a significant public health problem worldwide, with most reported mortalities occurring in low and medium-income countries (LMICs). Therefore, this study aimed to generate epidemiological data on the aetiologies, patterns of presentations, and outcomes of burn injuries in Ado Ekiti, the capital of Ekiti State. Methodology: This was a five-year prospective study of all patients with burns managed at Ekiti State University Teaching Hospital. The required information was entered into a hospital-based burn data collection form from admission to discharge. The data generated were exported to IBM SPSS version 23 for analysis. Results: A total of 160 patients were included in this study. The median age was 10.5 years (IQR 2 – 33). Half of the patients were aged <10 years old. About 66.9% of the injuries occurred indoors, with the kitchen being the most common injury site (49.4%). Scald was the most common aetiology, and most injuries occurred in the morning. While 71.9% had first aid at the injury site, the first aid agents used were potentially harmful in most cases. The injuries were predominantly partial-thickness with a mean TBSA burn of 14% and a median ABSI of 4 (IQR 3 – 5). The lower limbs were the most frequently affected body regions, with an overall mortality rate of 5%. Conclusion: Scalds are the most common aetiology of burns in Ado Ekiti, with most injuries occurring in the kitchen. The populace needs to be adequately educated on the suitable materials to provide first aid to burn victims

Hidradenitis suppurativa: racial and socioeconomic considerations in management.

Studies on hidradenitis suppurativa (HS) have found an increased prevalence of HS in skin of color and lower socioeconomic status patients, although the reasons for these differences are unclear. Demographic and therapeutic studies of HS originate primarily from developed Western countries, and data from low- and medium-income countries (LMIC) remain comparatively limited. In this review paper, we discuss differences in clinical presentation and comorbidities between racial and socioeconomic subpopulations and describe the genetic, biomedical, psychosocial, and ecological factors that may explain the associations between HS and skin of color and socioeconomic status. We highlight biomedical treatment considerations for LMIC including cost effective and less complex treatment strategies. We touch on population-based strategies to address the social determinants of health in HS management and discuss additional challenges arising from the COVID-19 pandemic.

Sex inequality in under-five deaths and associated factors in low and middle-income countries: a Fairlie decomposition analysis

BackgroundThere exist sex disparities in the burden of Under-five deaths (U5D) with a higher prevalence among male children. Factors explaining this inequality remain unexplored in Low-and Medium-Income Countries (LMIC). This study quantified the contributions of the individual- and neighborhood-level factors to sex inequalities in U5D in LMIC.MethodsDemographic and Health Survey datasets (2010-2018) of 856,987 under-five children nested in 66,495 neighborhoods across 59 LMIC were analyzed. The outcome variable was U5D. The main group variable was the sex of the child while individual-level and neighborhood-level factors were the explanatory variables. Fairlie decomposition analysis was used to quantify the contributions of explanatory factors to the male-female inequalities in U5D at p<0.05.ResultsOverall weighted prevalence of U5D was 51/1000 children, 55 among males and 48 among females (p<0.001). Higher prevalence of U5D was recorded among male children in all countries except Liberia, Kyrgyz Republic, Bangladesh, Nepal, Armenia, Turkey and Papua New Guinea. Pro-female inequality was however not significant in any country. Of the 59 countries, 25 had statistically significant pro-male inequality. Different factors contributed to the sex inequality in U5D in different countries including birth order, birth weight, birth interval and multiple births.ConclusionsThere were sex inequalities in the U5D in LMIC with prominent pro-male-inequality in many countries. Interventions targeted towards the improvement of the health system that will, in turn, prevent preterm delivery and improve management of prematurity and early childhood infection (which are selective threats to the male child survival) are urgently required to address this inequality.

Association between traumatic brain injury (TBI) patterns and mortality: a retrospective case-control study.

Background: Low and medium income countries (LMICs) such as Kenya experience nearly three times more cases of traumatic brain injury (TBI) compared to high income countries (HICs). This is primarily exacerbated by weak health systems especially at the pre-hospital care level. Generating local empirical evidence on TBI patterns and its influence on patient mortality outcomes is fundamental in informing the design of trauma-specific emergency medical service (EMS) interventions at the pre-hospital care level. This study determines the influence of TBI patterns and mortality. Methods: This was a case-control study with a sample of 316 TBI patients. Data was abstracted from medical records for the period of January 2017 to March 2019 in three tertiary trauma care facilities in Kenya. Logistic regression was used to assess influence of trauma patterns on TBI mortality, controlling for patient characteristics and other potential confounders. Results: The majority of patients were aged below 40 years (73%) and were male (85%). Road traffic injuries (RTIs) comprised 58% of all forms of trauma. Blunt trauma comprised 71% of the injuries. Trauma mechanism was the only trauma pattern significantly associated with TBI mortality. The risk of dying for patients sustaining RTIs was 2.83 times more likely compared to non-RTI patients [odds ratio (OR) 2.83, 95% confidence interval (CI) 1.62-4.93, p=0.001]. The type of transfer to hospital was also significantly associated with mortality outcome, with a public hospital having a two times higher risk of death compared to a private hospital [OR 2.18 95%CI 1.21-3.94, p<0.009]. Conclusion: Trauma mechanism (RTI vs non-RTI) and type of tertiary facility patients are transferred to (public vs private) are key factors influencing TBI mortality burden. Strengthening local EMS trauma response systems targeting RTIs augmented by adequately resourced and equipped public facilities to provide quality lifesaving interventions can reduce the burden of TBIs.

Association between traumatic brain injury (TBI) patterns and mortality: a retrospective case-control study

Background: Low and medium income countries (LMICs) such as Kenya experience nearly three times more cases of traumatic brain injury (TBI) compared to high income countries (HICs). This is primarily exacerbated by weak health systems especially at the pre-hospital care level. Generating local empirical evidence on TBI patterns and its influence on patient mortality outcomes is fundamental in informing the design of trauma-specific emergency medical service (EMS) interventions at the pre-hospital care level. This study determines the influence of TBI patterns and mortality. Methods: This was a case-control study with a sample of 316 TBI patients. Data was abstracted from medical records for the period of January 2017 to March 2019 in three tertiary trauma care facilities in Kenya. Logistic regression was used to assess influence of trauma patterns on TBI mortality, controlling for patient characteristics and other potential confounders. Results: The majority of patients were aged below 40 years (73%) and were male (85%). Road traffic injuries (RTIs) comprised 58% of all forms of trauma. Blunt trauma comprised 71% of the injuries. Trauma mechanism was the only trauma pattern significantly associated with TBI mortality. The risk of dying for patients sustaining RTIs was 2.83 times more likely compared to non-RTI patients [odds ratio (OR) 2.83, 95% confidence interval (CI) 1.62-4.93, p=0.001]. The type of transfer to hospital was also significantly associated with mortality outcome, with a public hospital having a two times higher risk of death compared to a private hospital [OR 2.18 95%CI 1.21-3.94, p<0.009]. Conclusion: Trauma mechanism (RTI vs non-RTI) and type of tertiary facility patients are transferred to (public vs private) are key factors influencing TBI mortality burden. Strengthening local EMS trauma response systems targeting RTIs augmented by adequately resourced and equipped public facilities to provide quality lifesaving interventions can reduce the burden of TBIs.

Instrumentation for Six Electrode Focused Impedance Method (FIM-6) for the study of localized regions in a volume conductor

Focused Impedance Method (FIM) is a new and simple technique of electrical bio-impedance that provides an opportunity for localized measurement down to reasonable depths of the body surface using skin surface electrodes. Conceived by one of the authors (KSR) and developed in Bangladesh by a group led by him, FIM has potential applications in physiological study and in the detection or diagnosis of diseases and disorders. Being a simple technique, it is particularly suitable for low and medium income countries (LMIC). To obtain long term benefit from any technology it is necessary that the technology is understood and developed indigenously, particularly under the limitation of a resource limited country. Indigenous development also allows for further improvisation, innovation, and application in future. This paper presents the indigenous design and development of the electronic instrumentation necessary for the implementation of six electrode version of Focused Impedance Method (FIM-6) in Nepal. The work involved basic characterization of the necessary circuit blocks developed through experimental validation. In particular, the design of isolating ferrite transformers required for the instrumentation posed a challenge which was solved limiting the range of the instrumentation to range variations encountered in practice on the human body, for which initial experiments were carried out on a live human subject. This led to a simplified design. The values obtained using the developed circuitry appears to give reasonable accuracy and would be useful for further implementation of the instrumentation using PCBs. However, further work can also be taken to improve the design of the current source used and of the transformers. Thus this work satisfies the initial requirement of attempting indigenous development of the FIM technique in an LMIC like Nepal.&#x0D; Bangladesh Journal of Medical Physics Vol.14 No.1 2021 P 1-15

3D printing: can it make surgery more accessible?

The advancement of 3-Dimensional (3D) printing technology has made the design and production of items increasingly ubiquitous amongst the public. This technology is increasingly being used widely in various medical fields. With its increasing cost efficiency and accessibility, it is the author's perspective that 3D technology can improve accessibility to surgical procedures in low- and medium-income countries (LMIC) by providing proceduralists with the basic equipment required to perform routine operations.