Search Results (684)

Health equity and financial inclusion (FI) are at the core of the Sustainable Development Goals, yet their intersection remains critically under-studied. This bibliometric study maps this emergent and fragmented field by analyzing 24,140 publications from Scopus, PubMed, Web of Science, and Lens.org over five decades. Employing co-citation and co-word analysis via VOSviewer, chart research trends, governance frameworks, and policy linkages were systematically presented. The analysis reveals that less than 0.3% of the identified literature explicitly bridges financial inclusion with health outcomes, and direct investigations into health equity are virtually absent. Despite recent growth, fundamental gaps persist, including a lack of empirical studies on digital financial tools in low- and middle-income countries (LMIC) health contexts and insufficient focus on disadvantaged populations. As the first comprehensive empirical mapping of this nexus, this study underscores the urgency for scholarly and policy action to strategically leverage financial instruments for equitable healthcare access. The findings provide a foundational map and a structured agenda to consolidate this nascent field. Full article

Background: Maternal health behaviors during pregnancy are crucial for maternal and fetal outcomes. While global research has explored that demographic, clinical, and psychosocial determinants significantly influence these behaviors, evidence from low- and middle-income countries (LMICs), including Albania, remains limited. This study aims to evaluate psychosocial perceptions and health behaviors related to lifestyle among pregnant women in a local Albanian community in order to identify which are higher risk subgroups that need targeted and tailored antenatal care interventions. Methods: This multicenter cross-sectional study included 200 pregnant women attending antenatal clinics from May to August 2024 in Vlora city, Albania. Participants were selected using consecutive sampling based on inclusion criteria. Data were collected through a validated questionnaire composed of five sections: demographic/obstetric data; maternal health behaviors; dietary diversity; physical activity, perceived stress; and social support. Clinical and anthropometric measurements were assessed by trained health professionals during antenatal visits. SPSS version 23.0 and binary logistic regression with p-value ≤ 0.05 statistically significant were used for data analysis. Results: Mean age was 28.3 ± 6.4 years, 71% employed and 83.5% urban residents. Key unhealthy behaviors included tobacco use (25.5%), alcohol consumption (10.5%), exposure to toxins (15%), and low dietary diversity (32%). We found significant correlations between low dietary diversity and rural residence (Adj OR = 2.48), hypertension (Adj OR = 6.88), and overweight/obesity (Adj OR = 2.33). Tobacco use was associated with unemployment and alcohol use with unemployment and hypertension variables. Low/moderate social support and high perceived stress were significantly related with multiple unhealthy behaviors, such as low dietary diversity, inadequate physical activity and antenatal care. Conclusions: Unhealthy nutritional behaviors, tobacco and alcohol use and low physical activity are more prevalent risk factors among pregnant women in Vlora city. Priority should be given to vulnerable groups, including rural residents, pregnant women with low social support, high perceived stress and those with hypertension and obesity. Interventions that integrate psychosocial support and health education into antenatal care services are urgently needed to enhance pregnancy outcomes in Albanian communities. Full article

Cervical cancer (CC) remains a leading cause of cancer-related mortality, particularly in low- and middle-income countries (LMICs), despite advancements in HPV vaccination and screening. Radiotherapy (RT) plays a critical role in managing CC, but conventional fractionated radiotherapy (CFRT) is limited by long treatment durations, which reduce patient adherence, increase the risk of treatment interruptions, and impair healthcare access in LMICs. Moderately hypofractionated radiotherapy (MHRT) may offer a promising alternative, delivering higher doses per fraction with fewer total fractions, thus shortening treatment duration and alleviating the burden on both patients and healthcare systems. Early clinical data suggest that MHRT achieve acceptable short- to medium-term tumor control with manageable toxicity. However, the small sample sizes and limited follow-up in published studies preclude definitive conclusions about long-term efficacy and safety. This review synthesizes the existing clinical evidence to outline the potential benefits and inherent limitations of MHRT in CC management and highlight the need for future large-scale, long-term randomized controlled trials with rigorous quality assurance protocols. These findings also have implications for the potential implementation of MHRT in LMICs. Full article

Type 2 diabetes mellitus (T2DM) is a growing public health challenge worldwide, disproportionately affecting populations in low- and middle-income countries (LMICs). Poor glycemic control contributes significantly to the global burden of non-communicable diseases (NCDs), increasing morbidity, mortality, and healthcare costs. Understanding behavioral and lifestyle determinants is critical for designing effective public health strategies, particularly in resource-limited settings such as Lesotho. A cross-sectional population-based study was conducted among 184 adults with T2DM attending the out-patient department of Maluti Adventist Hospital, Lesotho. Data was collected using a structured questionnaire and analyzed descriptively with SPSS 26 Variables assessed included sociodemographic, dietary practices, physical activity, behavioral risk factors and self-care knowledge. Participants were predominantly aged 45–69 years (65.2%), with an equal sex distribution. Hypertension was the most prevalent comorbidity (65.2%). Risk factor exposure was widespread, 100% consumed fewer than five daily servings of fruits/vegetables, 95.1% reported insufficient physical activity, and 88.0% had elevated blood pressure. Overall, 86.4% had three or more NCD risk factors. Knowledge levels were intermediate, with 33.2% scoring poor, 52.7% moderate, and only 14.1% good. Glycemic control was suboptimal, with 40.8% uncontrolled. This study highlights the urgent public health need to address lifestyle and behavioral determinants of poor glycemic control in Lesotho. Tailored interventions focusing on dietary education, physical activity promotion, and routine monitoring are essential to reduce NCD risks and improve outcomes. The findings have broader implications for achieving Sustainable Development Goal 3.4 on reducing premature NCD mortality in LMICs. Strengthening culturally sensitive health promotion, community-based interventions, and integrated chronic disease care models could significantly advance diabetes prevention and control in low-resource settings. Full article

Background: Chest radiography is the most widely used diagnostic imaging modality globally, yet its interpretation is hindered by a critical shortage of radiologists, especially in low- and middle-income countries (LMICs). The interpretation is both time-consuming and error-prone in high-volume settings. Artificial Intelligence (AI) systems trained on public data may lack generalizability to multi-view, real-world, local images. Deep learning tools have the potential to augment radiologists by providing real-time decision support by overcoming these. Objective: We evaluated the diagnostic accuracy of a deep learning-based convolutional neural network (CNN) trained on multi-view, hybrid (public and local datasets) for detecting thoracic abnormalities in chest radiographs of adults presenting to a tertiary hospital, operating in offline mode. Methodology: A CNN was pretrained on public datasets (Vin Big, NIH) and fine-tuned on a local dataset from a Nepalese tertiary hospital, comprising frontal (PA/AP) and lateral views from emergency, ICU, and outpatient settings. The dataset was annotated by three radiologists for 14 pathologies. Data augmentation simulated poor-quality images and artifacts. Performance was evaluated on a held-out test set (N = 522) against radiologists’ consensus, measuring AUC, sensitivity, specificity, mean average precision (mAP), and reporting time. Deployment feasibility was tested via PACS integration and standalone offline mode. Results: The CNN achieved an overall AUC of 0.86 across 14 abnormalities, with 68% sensitivity, 99% specificity, and 0.93 mAP. Colored bounding boxes improved clarity when multiple pathologies co-occurred (e.g., cardiomegaly with effusion). The system performed effectively on PA, AP, and lateral views, including poor-quality ER/ICU images. Deployment testing confirmed seamless PACS integration and offline functionality. Conclusions: The CNN trained on adult CXRs performed reliably in detecting key thoracic findings across varied clinical settings. Its robustness to image quality, integration of multiple views and visualization capabilities suggest it could serve as a useful aid for triage and diagnosis. Full article

Poor diet is the leading preventable risk factor for death worldwide, associated with over 10 million premature deaths and USD 8 trillion related costs every year. Artificial intelligence or AI is rapidly emerging as the most historically disruptive, innovatively dynamic, rapidly scaled, cost-efficient, and economically productive technology (which is increasingly providing transformative countermeasures to these negative health trends, especially in low- and middle-income countries (LMICs) and underserved communities which bear the greatest burden from them). Yet widespread confusion persists among healthcare systems and policymakers on how to best identify, integrate, and evolve the safe, trusted, effective, affordable, and equitable AI solutions that are right for their communities, especially in public health nutrition. We therefore provide here the first known global, comprehensive, and actionable narrative review of the state of the art of AI-accelerated nutrition assessment and healthy eating for healthcare systems, generated by the first automated end-to-end empirical index for responsible health AI readiness and maturity: the Responsible Health AI readiness and Maturity Index (RHAMI). The index is built and the analysis and review conducted by a multi-national team spanning the Global North and South, consisting of front-line clinicians, ethicists, engineers, executives, administrators, public health practitioners, and policymakers. RHAMI analysis identified the top-performing healthcare systems and their nutrition AI, along with leading use cases including multimodal edge AI nutrition assessments as ambient intelligence, the strategic scaling of practical embedded precision nutrition platforms, and sovereign swarm agentic AI social networks for sustainable healthy diets. This index-based review is meant to facilitate standardized, continuous, automated, and real-time multi-disciplinary and multi-dimensional strategic planning, implementation, and optimization of AI capabilities and functionalities worldwide, aligned with healthcare systems’ strategic objectives, practical constraints, and local cultural values. The ultimate strategic objectives of the RHAMI’s application for AI-accelerated public health nutrition are to improve population health, financial efficiency, and societal equity through the global cooperation of the public and private sectors stretching across the Global North and South. Full article

Background: Hypertension is a leading modifiable risk factor for cardiovascular diseases globally, disproportionately affecting low- and middle-income countries (LMICs), including South Africa. Primordial prevention targeting normotensive individuals plays a key role in reducing lifetime risk. Aim: To assess knowledge, attitudes and practices (KAP) and social determinants of health related to primordial hypertension prevention among normotensive adults in OR Tambo District, Eastern Cape province. Methods: A community-based cross-sectional study was conducted among 245 randomly selected normotensive adults. A validated questionnaire captured socio-demographic characteristics and KAP levels. Data analysis included descriptive statistics, Cronbach’s alpha, and chi-square tests (p < 0.05). Results: Participants demonstrated moderate knowledge (53.9%), highly positive attitudes (86.1%), and fair preventive practices (59.6%), highlighting a clear knowledge–practice gap. Higher knowledge was significantly associated with female gender (p < 0.001), older age (p < 0.001), and family history of hypertension (p = 0.001). Positive attitudes correlated with older age (p = 0.018) and higher education (p = 0.008). Knowledge level significantly predicted both positive attitudes (p < 0.001) and preventive practices (p = 0.009). Conclusions: Despite moderate knowledge and positive attitudes, a clear knowledge–practice gap was evident, possibly influenced by social and structural constraints. Strengthening primordial hypertension prevention in rural South Africa requires integrated strategies combining context-specific health education with interventions addressing structural barriers to enable sustainable behaviour change. Full article

Background: Inadequate nutrition, poor health care, and limited stimulation constrain early childhood development and cognitive potential. Micronutrient deficiencies during pregnancy and early life are prevalent in low- and middle-income countries (LMICs) and may impair cognitive outcomes. Maternal multiple-micronutrient (MMN) and point-of-use micronutrient powder (MNP) supplements improve birth outcomes and iron status, but their long-term cognitive impact remains unclear. This systematic review assessed the long-term impact of maternal MMN and early-childhood MNP supplementation on cognitive development among children aged 4–14 years in LMICs. Method: Following PRISMA guidelines (PROSPERO CRD42023459846), (cluster) randomized controlled trials were identified from six databases and gray literature (October 2023; updated July 2025). Records were managed in EndNote and screened in Covidence, and data were synthesized using Review Manager. Eligible studies examined MMN or MNP interventions during pregnancy, lactation, or early childhood, reporting cognitive, motor, or socio-emotional outcomes in children aged 4–14. Results: Ten studies met the inclusion criteria: six on maternal supplementation, three on early childhood interventions, and one combining both. Most were conducted in Asia, with one in Tanzania and one in Peru. Although most findings were not statistically significant, two large UNIMMAP-based trials indicated modest long-term improvements in procedural memory and intelligence, while one early childhood point-of-use MNP trial suggested enhanced pre-academic skills. Conclusions: Maternal MMN supplementation may modestly enhance specific domains of cognitive development, whereas evidence on the long-term effects of MMN and point-of-use MNPs on cognitive development remain limited, highlighting the necessity for further research. Full article

Antibiotics play a crucial role in the treatment of many complicated problems in clinical medicine, but antimicrobial resistance (AMR) has emerged as a serious concern threatening to undermine its effectiveness. Precision medicine (PM) which tailors treatment to individual and genetic and lifestyle factors, may offer a novel approach to combat AMR. Yet, little is known about how healthcare providers in Pakistan understand and integrate the concept of precision medicine within their knowledge, attitudes, and practices (KAP) towards AMR. This study aims to investigate the knowledge, attitude, and practices of healthcare professionals towards AMR and to explore their perception about precision medicine as a strategy to reduce AMR. A mixed method approach was employed for the study. The knowledge, attitude, and practices (KAP) of healthcare professionals (N = 326) were assessed through a validated questionnaire. SPSS version 26 (Statistical Package for the Social Sciences) was employed for descriptive and bivariate analyses to determine KAP score and its association with demographics. Qualitative data were gathered through a focus group discussion and thematic analysis was performed to explore the perception about PM. Results showed that healthcare professionals demonstrate poor knowledge (55.5%), relatively positive attitudes (54.6%), and that nearly half had unfavorable practices (48.3%). Significant associations (p < 0.05) were found between KAP scores and factors such as location, healthcare setting, educational level, professional designation, and prior infectious disease training. During focus group discussion (FGD), HCPs emphasized the cautious use of PM, particularly in the management of resistant infections. However, limitations in resources, poor governance, poverty, and access to data and testing facilities were highlighted as barriers in the implementation of PM into practice. This study highlights critical gaps in knowledge and practices towards AMR among HCPs. While PM is viewed as a potential tool against AMR, systemic support, resource allocation, and targeted awareness programs are essential to integrate PM into clinical practice. Full article

Background/Objectives: Reconstructive urology is critically underrepresented in global surgery initiatives, despite its essential role in managing congenital and acquired urogenital conditions. In response, a multinational Global Surgery Collaborative was launched in 2022 by a faculty from the University of Toronto, aiming to enhance reconstructive urology capacity in the Philippines, among other low- to low-middle-income countries through longitudinal mentorship and skills transfer. This report presents early experience from 2022 to 2024. Methods: This collaboration delivered annual in-person surgical missions from 2022 to 2024 at two major Philippine healthcare institutions. Training focused on pediatric and adult reconstructive urologic procedures. Local mentees participated in structured preoperative planning, intraoperative teaching, and postoperative debriefing. We conducted a prospective service evaluation comprising a prospective registry of consecutive cases and paired pre/post trainee surveys. Data were collected on patient demographics and surgical metrics. Primary clinical endpoints included operative time, length of stay, and complications (Clavien–Dindo), with standardized follow-up windows. Mentee educational outcomes were assessed through pre- and post-training trainee-reported (Likert) measures, evaluating comfort and technical understanding. Statistical analysis used the Wilcoxon signed-rank test to assess changes. Results: Over three years, 33 surgical cases were performed with 45 surgical resident mentees (Post-graduate year (PGY)4–PGY6) engaged. The median patient age was 23 (inter-quartile range [IQR] 12.5–41.5) years, with 33.3% pediatric and 84.8% of cases classified as major. The complication rate was 15.1%, with only one major event (3%). Across 45 mentees, comfort increased from a median 4.0 (IQR 2.5–5.0) to 7.0 (5.5–8.0) and technique understanding from 5.0 (4.0–6.5) to 9.0 (8.0–10.0), with large Wilcoxon effects (r = 0.877 and r = 0.875; both p < 0.001). Year-by-year analyses showed the same pattern with large effects. Conclusions: In this early three-year experience (33 cases, 84.8% major), this multi-institutional collaboration longitudinal mentorship model was feasible and safe, and was associated with significant trainee-reported improvements in comfort and technical understanding. This demonstrates a replicable model for global surgery in reconstructive urology, successfully enhancing surgical skills and fostering sustainable capacity in low- and middle-income countries (LMIC) settings. Full article

Background/Objectives: Despite global efforts, COVID-19 revealed severe spatial vaccine inequities, disproportionately affecting low- and middle-income countries (LMICs). Scholars across disciplines proposed numerous—and often competing—terms and theories to explain these disparities. In this review and within the context of the COVID-19 pandemic, we assess the usage, definition, and appropriateness of these terms and their linked theories or frameworks. Methods: We conducted a scoping review aiming to clarify key definitions, concepts, and frameworks of eight prominent terms used in the literature regarding COVID-19 global and/or regional vaccine inequities (i.e., vaccine nationalism, vaccine apartheid, vaccine colonialism, vaccine imperialism, vaccine racism, vaccine diplomacy, vaccine solidarity, and vaccine internationalism). The methodology followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines for Scoping Reviews and included papers from January 2020 to the end of October 2024. Results: We included 79 papers in our study. The majority (71%) were published in 2021–2022, with less than one-quarter authored by scholars from LMICs. Vaccine imperialism was consistently defined but rarely used, while vaccine nationalism and vaccine apartheid appeared more frequently with varied meanings. Yet, in most cases, all of these concepts identified economic interests of vaccine-producing countries as the root cause of the observed vaccine inequities. Vaccine diplomacy showed similar ambiguity, viewed by some as worsening inequities and by others as potentially mitigating them. The terms vaccine racism, vaccine colonialism, and vaccine solidarity were not explicitly identified but appear to be embedded within the definitions of other prominent terms detected. Conclusions: Across the preselected terms examined, we found numerous—and often conflicting—definitions, revealing the fragmented and competing understandings of the major drivers fueling global vaccine inequities. This lack of coherence inhibits evidence synthesis or shared theoretical progress but, most importantly, might undermine current and future efforts to address these inequities. Full article

Docosahexaenoic acid (DHA) is a long-chain omega-3 fatty acid essential for neurodevelopment, immune regulation, and key physiological functions during early life. In low- and middle-income countries (LMICs), limited access to DHA-rich foods contributes to disparities in intake and health outcomes. This narrative review describes the current evidence on dietary patterns of DHA intake and supplementation from pregnancy through childhood in LMICs and highlights the implications of these patterns for child health. The review is based on a systematic search conducted in PubMed using Medical Subject Heading (MeSH) terms related to DHA, dietary patterns, health outcomes, and LMICs. Studies published between 2014 and 2025 were screened using Covidence software. Eligible studies included observational, interventional, and review designs that reported DHA through dietary intake, supplementation, or measurement in biological samples during pregnancy, lactation, infancy, or childhood. Data extraction followed the PICOS (Population, Intervention, Comparison, Outcome, Study Design) framework. A total of 76 studies were included. Across LMICs, DHA intake was consistently insufficient among pregnant and lactating women, infants, and children. Reported dietary sources were generally low in DHA content. Intake or supplementation was associated with neurodevelopment, immune response, pregnancy outcomes, and cardiometabolic health, although findings were sometimes mixed or modified by gene–environment interactions. Results varied by study design, contextual factors, income level, and geographic access. Large gaps remain in nationally representative intake data. Despite its physiological relevance, DHA intake remains inadequate in LMICs during early life. This review underscores the importance of improving DHA intake in vulnerable populations and identifies evidence gaps to guide future research and inform context-specific nutrition strategies. Full article

An improved understanding of the sanitation enabling environment and status of market development (“sanitation economy”) is crucial not only for advancing national and global sanitation goals, but also for attracting the financing necessary to drive meaningful progress in low- and middle-income countries (LMICs). This need is particularly pressing as the sanitation sector faces a significant funding gap that must be bridged to meet the growing demands for sanitation services, infrastructure, and innovation. This paper reviews frameworks that assess the sanitation economy in LMICs with the aim of informing the development of more impactful future frameworks and the wider application of existing frameworks. Frameworks were identified through internet search and interviews with representatives of international sanitation sector organisations and universities. Thirty-nine frameworks were identified that have been or are currently being used in sanitation. Frameworks are diverse in the structure they adopt, their focus areas, the number of indicators, the number of countries covered, the frequency with which they have been applied, their reliance on primary versus secondary data sources, and their uptake and impact. Overall, use of the frameworks has been piecemeal and sporadic in LMICs. Only few frameworks have been picked up and applied by another organisation, although the results of some frameworks are widely used and cited. To ensure future efforts to measure and monitor the sanitation economy are evidence-based and make the best use of limited resources, frameworks currently in use should be independently evaluated and there should be greater collaboration and adoption of common frameworks. Full article

Tuberculosis (TB) remains a public health threat in low- and middle-income countries (LMICs) of the World Health Organization (WHO) Eastern Mediterranean Region (EMR), driven by a combination of social determinants including undernutrition, fragile health systems, conflict-related disruptions, human mobility and displacement, sub-optimal programmatic implementation, and insufficient domestic investment. These programmatic and governance constraints operate within a broader geopolitical context marked by conflict, sanctions, protracted crises, and large-scale displacement, which further limit countries’ ability to deliver uninterrupted TB services. In 2023, the region’s TB incidence was estimated at 116 per 100,000 population, with Pakistan alone accounting for about 73% of the regional burden. Despite a multitude of efforts, progress in reducing the TB burden in the EMR remains slow, with high case detection and treatment coverage gaps, low uptake of TB preventive treatment (TPT), underutilization of WHO-recommended rapid diagnostics, and only 25% of drug-resistant TB (DR-TB) cases initiated on treatment. Vulnerable populations, including internally displaced persons, migrants, refugees, prisoners, and returnees, continue to face major access barriers, and cross-border TB collaboration remains limited. This commentary reasons that the slow pace of TB burden reduction in the region is not only a biomedical or resource issue but also a reflection of structural and governance shortcomings. It proposes a ten-point strategic vision focused on building a sustainable ecosystem, enhancing primary healthcare systems, adopting people-centered and rights-based approaches, leveraging artificial intelligence, and gradually reducing dependency on external donors where feasible. However, in highly fragile settings such as Yemen or Somalia, domestic financing remains limited, and sustained external support will continue to be indispensable. The commentary calls for stronger national leadership, inclusive stakeholder engagement, and increased domestic financing to deliver integrated and resilient TB services. Ending TB in the EMR is within reach, but it requires boldly committed, coordinated, and country-led action. Full article

Background/Objectives: Social capital is a multifaceted concept that comprises structural and cognitive portions, and from the perspective of caregivers, it enables access to assistance and participation, improving well-being in resource-constrained settings. In low- and middle-income countries (LMICs) like Bangladesh, mothers are often the sole carers of children with cerebral palsy (CP), which may affect their social capital and livelihood; however, evidence in this regard is limited. This study assessed the effectiveness of integrated microfinance and community-based rehabilitation (IMCBR) on caregivers’ social capital in rural Bangladesh. Methods: This study was part of a randomized controlled trial (RCT) conducted in Shahjadpur, Sirajganj, with three study arms. Children aged ≤5 years with CP and their primary caregivers were enrolled. Twenty-four clusters (10–14 child–caregiver pairs per cluster) were randomly assigned to Arm-A: IMCBR, Arm-B: community-based rehabilitation (CBR) only, and Arm-C: standard care. Data were collected at the baseline, midline (6 months), and endline (12 months) using a structured questionnaire. Social capital was measured using the Short Adapted Social Capital Assessment Tool (SASCAT), which assesses structural and cognitive dimensions; higher scores indicated greater social capital. The SASCAT was culturally adapted and validated for use in Bangladesh. Descriptive, bivariate, and multivariate analyses were performed. Results: There were 251 dyads enrolled into the trial. At baseline, Arm-A had the lowest social capital scores but showed the greatest improvement by endline (60.0%), followed by Arm-B (54.1%) and Arm-C (6.0%). Structural social capital increased significantly in Arm-A compared with Arm-C (mean difference 2.88; 95% CI: 2.45–3.31; p < 0.001) and in Arm-B compared with Arm-C (mean difference 2.46; 95% CI: 2.04–2.87; p < 0.001). Cognitive social capital increased the most in Arm-B (10.7%), though group differences were not significant (p > 0.05). In Arm-A, improvements in social capital were inversely associated with the child’s Gross Motor Function Classification System (GMFCS) level (β = −0.69; 95% CI: −1.28 to −0.10; p < 0.05). Conclusions: IMCBR significantly improved caregivers’ social capital, particularly its structural components, in rural Bangladesh. Full article