Performance Evaluation of the Commonly-Used Portable Cholesterol Sensors for Telehealth Services in the Unreached Communities.

Portable medical sensors play an important role in healthcare services, especially in rural communities. Many telehealth systems use these devices for providing patients' vital information from a distance to remote doctors. Erroneous data will not only mislead the remote doctor for correct diagnosis but it will cause health threats to these unreached community people. Therefore, it is very important to identify good sensors with an acceptable level of accuracy but within the affordable price of the available sensors in the market. This study aims to identify quality portable cholesterol sensors with high accuracy with the reference of the Japanese clinical pathology laboratory as a gold standard. We have considered cholesterol sensors that measure total cholesterol for this study that are commonly used in the developing countries of Asia. We found that out of four, three of them were very much erroneous and cannot be recommended even for primary healthcare.

Sleep quality and temperament in association with autism spectrum disorder among infants in Japan.

BACKGROUND: Sleep problems and irritable temperaments are common among infants with autism spectrum disorder (ASD). The prospective association between such sleep problems and irritable temperaments and ASDs needs to be determined for elucidating the mechanism and exploring the future intervention study. Thus, in this study, we investigated whether sleep quality and temperament in 1-month-old infants are associated with the onset of ASD in 3-year-old children. We also assessed its sex-stratified associations. METHODS: We conducted a longitudinal study using data from 69,751 mothers and infants from a large-cohort study, the Japan Environment and Children's Study. We examined the prospective association between infant sleep quality and temperament at 1 month of age and ASD diagnosis by 3 years of age. RESULTS: Here we show infants with longer daytime sleep have a higher risk of later ASD than those with shorter daytime sleep (risk ratio [RR]: 1.33, 95% confidence interval [CI]: 1.01-1.75). Infants who experienced intense crying have a higher risk of ASD than those who did not (RR: 1.31, 95% CI: 1.00-1.72). There is a difference in sex in the association between a bad mood and later ASD. In particular, female infants experiencing bad moods have a higher risk of ASD than others (RR: 3.59, 95% CI: 1.91-6.75). CONCLUSIONS: The study findings provide important information for future intervention to reduce the risk of future ASD.

Sleep problems and irritable temperaments are common among infants with autism. This study looked at the sleep and temperament of nearly 70,000 1-month-old infants in Japan and whether they were subsequently diagnosed with autism spectrum disorder during the first three years of life. Children who had slept for longer during the day and were more prone to frequent, prolonged, or intense crying were more likely to have been diagnosed with Autism Spectrum Disorder by age 3. The findings of this study might be useful for those monitoring the development of autism spectrum disorder or developing support for those with autism spectrum disorders.

Impact of oral intervention on the oral and overall health of children living with HIV in Cambodia: a randomized controlled trial.

BACKGROUND: Maintaining oral health is essential for improving overall health of children living with HIV. Therefore, we evaluated the effectiveness of an oral health intervention for improving their oral and overall health. In addition, we examined their longitudinal association between changes in oral and overall health. METHODS: We conducted a 2-year randomized controlled trial involving children living with HIV in Cambodia. Children aged 3-15 years and their caregivers were randomly allocated either to the intervention (group A) or control (group B) arm. A second control arm (group C) included children without HIV. The group A children received oral health education sessions and practiced home-based daily care. RESULTS: In the baseline survey, 482 children participated (group A: n = 160, group B: n = 168, group C: n = 154), and 350 completed the endline survey. An interaction effect in teeth brushing duration was observed in children in group A relative to group B (AOR = 2.69, 95% CI: 1.37-5.31) and group C (AOR = 3.78, 95% CI: 1.70-8.40). Longitudinal associations were observed between changes in oral hygiene and overall health, as presented by alterations in dental caries in permanent teeth with viral load detection (adjusted odds ratio = 3.58, 95% CI: 1.10 - 11.73), in salivary flow quantity with the overall quality of life (ß = 0.07, 95% CI: < 0.01 - 0.13), as well as in dental caries, salivary pH, debris index with body mass index for age among group A children. CONCLUSIONS: Oral health intervention may improve oral care behaviors and potentially enhance overall health among children living with HIV in antiretroviral therapy in a resource-constrained setting. TRIAL REGISTRATION: ISRCTN 15177479.

Telehealth Care for Mothers and Infants to Improve the Continuum of Care: Protocol for a Quasi-Experimental Study.

BACKGROUND: Ensuring an appropriate continuum of care in maternal, newborn, and child health, as well as providing nutrition care, is challenging in remote areas. To make care accessible for mothers and infants, we developed a telehealth care system called Portable Health Clinic for Maternal, Newborn, and Child Health. OBJECTIVE: Our study will examine the telehealth care system's effectiveness in improving women's and infants' care uptake and detecting their health problems. METHODS: A quasi-experimental study will be conducted in rural Bangladesh. Villages will be allocated to the intervention and control areas. Pregnant women (≥16 gestational weeks) will participate together with their infants and will be followed up 1 year after delivery or birth. The intervention will include regular health checkups via the Portable Health Clinic telehealth care system, which is equipped with a series of sensors and an information system that can triage participants' health levels based on the results of their checkups. Women and infants will receive care 4 times during the antenatal period, thrice during the postnatal period, and twice during the motherhood and childhood periods. The outcomes will be participants' health checkup coverage, gestational and neonatal complication rates, complementary feeding rates, and health-seeking behaviors. We will use a multilevel logistic regression and a generalized estimating equation to evaluate the intervention's effectiveness. RESULTS: Recruitment began in June 2020. As of June 2022, we have consented 295 mothers in the study. Data collection is expected to conclude in June 2024. CONCLUSIONS: Our new trial will show the effectiveness and extent of using a telehealth care system to ensure an appropriate continuum of care in maternal, newborn, and child health (from the antenatal period to the motherhood and childhood periods) and improve women's and infants' health status. TRIAL REGISTRATION: ISRCTN Registry ISRCTN44966621; https://www.isrctn.com/ISRCTN44966621. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/41586.

Association of sleep quality with temperament among one-month-old infants in The Japan Environment and Children's Study.

This study aimed to examine the association between infant sleep quality and temperament in one-month-old infants using a large cohort study data. We used data from the Japan Environment and Children's Study, a cohort study which follows around 100,000 women from pregnancy until their children's development. The mothers were asked about their infants' sleep and temperament using a structured questionnaire. Frequent crying (adjusted odds ratio [AOR]: 1.05, 95% confidence interval [CI]: 1.00-1.10) and intense crying (AOR: 1.19, 95% CI: 1.13-1.25) were positively associated with longer sleep periods during the day than at night. Female infants with longer daytime sleep periods than that at nighttime were more likely to cry frequently (AOR: 1.11, 95% CI: 1.04-1.20). Parous women with infants who had frequent night awakening believed their infants cried more intensely (AOR: 1.17, 95% CI: 1.03-1.31). The study demonstrated a specific association between sleep quality and temperament in one-month-old infants. Based on the results of this study, further sleep intervention studies are required to improve infant temperament.

Portable Health Clinic System for Maternal and Child Health Care in COVID-19 Pandemic Situation.

Rural women in developing countries do not have any option but to visit the distant city to see the obstetricians and gynecologists in case of any maternal and child health issues. However, it becomes more difficult to travel during the COVID-19 pandemic situation. Thus, the telehealth service using the Portable Health Clinic can be very effective for maternal and child health care services. Since the PHC system provides home delivery services through the local health workers, the rural women can avail regular continuum of care services. This study found a 300% increase in participation in the continuum of care. This is not because they receive the service at home but also because they can receive consultancy from urban specialist doctors without travel during the pandemic situation.

Portable health clinic COVID-19 system for remote patient follow-up ensuring clinical safety.

Background: A developing country like Bangladesh suffers very much from the sudden appearance of the COVID-19 pandemic due to the shortage of medical facilities for testing and follow-up treatment. The Portable Health Clinic (PHC) system has developed the COVID-19 module with a triage system for the detection of COVID-19 suspects and the follow-up of the home quarantined COVID-19 patients to reduce the workload of the limited medical facilities. Methods: The PHC COVID-19 system maintains a questionnaire-based triage function using the experience of the Japanese practice of diseases management for early detection of suspected COVID-19 patients who may need a confirmation test. Then only the highly suspected patients go for testing preventing the unnecessary crowd from the confirmation PCR test centers and hospitals. Like the basic PHC system, it also has the features for patients' treatment and follow-up for the home quarantined COVID-19 positive and suspect patients using a telemedicine system. This COVID-19 system service box contains 4 self-checking medical sensors, namely, (1) thermometer, (2) pulse oximeter, (3) blood pressure machine, and (4) glucometer for patient's health monitoring including a tablet PC installed with COVID-19 system application for communication between patient and doctor for tele-consultancy. Results: This study conducted a COVID-19 triage among 300 villagers and identified 220 green, 45 light-yellow, 2 yellow, 30 orange, and 3 red patients. Besides the 3 red patients, the call center doctors also referred another 13 patients out of the 30 orange patients to health facilities for PCR tests as suspect COVID-19 positive, and to go under their follow-up. Out of these (3 + 13 =) 16 patients, only 4 went for PCR test and 3 of them had been tested positive. The remaining orange, yellow and light-yellow patients were advised home quarantine under the follow-up of the PHC health workers and got cured in 1-2 weeks. Conclusions: This system can contribute to the community healthcare system by ensuring quality service to the suspected and 80% or more tested COVID-19 positive patients who are usually in the moderate or mild state and do not need to be hospitalized. The PHC COVID-19 system provides services maintaining social distance for preventing infection and ensuring clinical safety for both the patients and the health workers.

Standardization of Personal Health Records in the Portable Health Clinic System.

A personal health record (PHR) is not only a collection of personal health data but also a personal healthcare and disease management tool for individual patients. Recently, PHRs have been considered indispensable tools for patient engagement in the area of noncommunicable diseases (NCDs) and have gained a special importance. Unfortunately, similar to several other developing countries, Bangladesh remains far behind in establishing a standard PHR system for the country despite the fact that the growth of NCDs is extremely high and accounts for approximately 70% of the total diseases experienced in the country. The Portable Health Clinic system, which has a PHR feature, was established in Bangladesh in 2010. This PHR system requires standardization for each country. The objective of this research is to standardize this PHR system with reference to the PHR system proposed by the Japanese Clinical Societies, which is a pioneer of work in this field in Asia.

Women's health status before and during the COVID-19 pandemic in rural Bangladesh: A prospective longitudinal study.

The coronavirus disease (COVID-19) pandemic has widely spread worldwide since 2020. Several countries have imposed lockdown or stay-at-home policies to prevent the infection. Bangladesh experienced a lockdown from March 2020 to May 2020, and internal travel was restricted. Such long and strict confinement may impact women's health. Herein, we aimed to assess the impact of the COVID-19 pandemic on women's health by comparing their health status before and during the pandemic. We conducted a prospective longitudinal study in two zones in the Chhaygaon union, rural district Shariatpur, Bangladesh. The study population comprised non-pregnant women aged 15-49 years. We visited the household of all eligible women and invited them for health checkups. The survey staff examined their health status at the checkup camps and conducted questionnaire interviews. In total, 121 non-pregnant women received health checkups both from June 2019 to July 2019 and in October 2020, before and during the COVID-19 pandemic, respectively. Compared with those during the 2019 health checkup, the medians of body mass index, systolic blood pressure, and diastolic blood pressure were significantly higher (22.7 kg/m2 to 23.6 kg/m2; 110.0 mmHg to 111.0 mmHg; and 73.0 mmHg to 75.0 mmHg, respectively, p<0.05) during the 2020 health checkup. In contrast, urine glucose levels were significantly lower (10.1% to 3.4%, p = 0.021). The lack of physical activity and other inconvenience accumulation caused by the prolonged confinement might have affected their health status. This necessitates local health workers to promote physical activity to prevent health deterioration during the pandemic.

Maternal and Child Healthcare Service by Portable Health Clinic System Using a Triage Protocol.

The number of deaths of a mother and child caused by maternal and child healthcare (MCH) issues has been greatly decreased recently, but still, the number is extremely high especially in developing countries. Although the governments have been given a priority in this issue, the lack of financial and human resources brings a limit. Thus, the use of low-cost but appropriate technology is required. Portable Health Clinic (PHC), a telemedicine system developed for providing primary healthcare, is such a technology. This study aimed to address this MCH issue with the aid of a low-cost PHC service involving a continuum-of-care protocol to the rural communities of Bangladesh. Moreover, this study introduces a triage protocol to distinguish high-risk patients from the early stage of the continuum of care who need special care and refer to specialized physicians to prevent unwanted deaths.

Evaluation of a package of continuum of care interventions for improved maternal, newborn, and child health outcomes and service coverage in Ghana: A cluster-randomized trial.

BACKGROUND: In low- and middle-income countries (LMICs), the continuum of care (CoC) for maternal, newborn, and child health (MNCH) is not always complete. This study aimed to evaluate the effectiveness of an integrated package of CoC interventions on the CoC completion, morbidity, and mortality outcomes of woman-child pairs in Ghana. METHODS AND FINDINGS: This cluster-randomized controlled trial (ISRCTN: 90618993) was conducted at 3 Health and Demographic Surveillance System (HDSS) sites in Ghana. The primary outcome was CoC completion by a woman-child pair, defined as receiving antenatal care (ANC) 4 times or more, delivery assistance from a skilled birth attendant (SBA), and postnatal care (PNC) 3 times or more. Other outcomes were the morbidity and mortality of women and children. Women received a package of interventions and routine services at health facilities (October 2014 to December 2015). The package comprised providing a CoC card for women, CoC orientation for health workers, and offering women with 24-hour stay at a health facility or a home visit within 48 hours after delivery. In the control arm, women received routine services only. Eligibility criteria were as follows: women who gave birth or had a stillbirth from September 1, 2012 to September 30, 2014 (before the trial period), from October 1, 2014 to December 31, 2015 (during the trial period), or from January 1, 2016 to December 31, 2016 (after the trial period). Health service and morbidity outcomes were assessed before and during the trial periods through face-to-face interviews. Mortality was assessed using demographic surveillance data for the 3 periods above. Mixed-effects logistic regression models were used to evaluate the effectiveness as difference in differences (DiD). For health service and morbidity outcomes, 2,970 woman-child pairs were assessed: 1,480 from the baseline survey and 1,490 from the follow-up survey. Additionally, 33,819 cases were assessed for perinatal mortality, 33,322 for neonatal mortality, and 39,205 for maternal mortality. The intervention arm had higher proportions of completed CoC (410/870 [47.1%]) than the control arm (246/620 [39.7%]; adjusted odds ratio [AOR] for DiD = 1.77; 95% confidence interval [CI]: 1.08 to 2.92; p = 0.024). Maternal complications that required hospitalization during pregnancy were lower in the intervention (95/870 [10.9%]) than in the control arm (83/620 [13.4%]) (AOR for DiD = 0.49; 95% CI: 0.29 to 0.83; p = 0.008). Maternal mortality was 8/6,163 live births (intervention arm) and 4/4,068 live births during the trial period (AOR for DiD = 1.60; 95% CI: 0.40 to 6.34; p = 0.507) and 1/4,626 (intervention arm) and 9/3,937 (control arm) after the trial period (AOR for DiD = 0.11; 95% CI: 0.11 to 1.00; p = 0.050). Perinatal and neonatal mortality was not significantly reduced. As this study was conducted in a real-world setting, possible limitations included differences in the type and scale of health facilities and the size of subdistricts, contamination for intervention effectiveness due to the geographic proximity of the arms, and insufficient number of cases for the mortality assessment. CONCLUSIONS: This study found that an integrated package of CoC interventions increased CoC completion and decreased maternal complications requiring hospitalization during pregnancy and maternal mortality after the trial period. It did not find evidence of reduced perinatal and neonatal mortality. TRIAL REGISTRATION: The study protocol was registered in the International Standard Randomised Controlled Trial Number Registry (90618993).

Portable health clinic for sustainable care of mothers and newborns in rural Bangladesh.

BACKGROUND AND OBJECTIVE: Regular health checkups are important for mothers and newborns to detect health problems at an early stage; however, this is often difficult in resource-limited settings. Therefore, the portable health clinic (PHC) for maternal and child health (MCH), a telemedicine health checkup system, was introduced as an intervention study in a rural area in Bangladesh. The aim of this research project was to report findings that we had observed at a mid-point of the intervention period. METHODS: This was an intervention study conducted in Shariatpur, Bangladesh. The study population included pregnant/parturient women aged 15-49 years and their newborns. With the help of the newly created PHC for MCH, health workers, with a set of sensor devices in an attaché case, visited mothers and newborns at home to examine their health status. Their health status was triaged into four categories using a data management application, and in cases of affected or emergent health status, they were placed on remote video consultation with a doctor. RESULTS: In total, 94 women were included in the PHC for MCH intervention. The rate of participants who received antenatal care at least four times or postnatal care at least once increased (from 29% to 51%, and from 27% to 78%, respectively) compared with before introducing PHC for MCH. Using the PHC for MCH, we detected health problems in pregnant/parturient women; a relatively high percentage had anemia (45-54%) and/or abnormal pulse rate (20-40%). Moreover, after introducing the PHC for MCH, more than 40% of women who received multiple antenatal care or postnatal care checkups improved their health status. CONCLUSIONS: The PHC for MCH could be an effective system to improve the health of mothers and newborns by increasing the availability of care. In the future, this system is expected to be used as a primary resource for maternity healthcare, not only in rural areas but also in other social environments.

EMBRACE intervention to improve the continuum of care in maternal and newborn health in Ghana: The RE-AIM framework-based evaluation.

BACKGROUND: Improving maternal and newborn health remains one of the most critical public health challenges, particularly in low- and lower-middle-income countries. To overcome this challenge, interventions to improve the continuum of care based on real-world settings need to be provided. The Ghana Ensure Mothers and Babies Regular Access to Care (EMBRACE) Implementation Research Team conducted a unique intervention program involving over 21 000 women to improve the continuum of care, thereby demonstrating an intervention program's effectiveness in a real-world setting. This study evaluates the implementation process of the EMBRACE intervention program based on the RE-AIM framework. METHODS: A cluster-randomized controlled trial was conducted in 32 sub-district-based clusters in Ghana. Interventions comprised of four components, and to evaluate the implementation process, we conducted baseline and endline questionnaire surveys for women who gave birth and lived in the study site. The key informant interviews of health workers and intervention monitoring were conducted at the health facilities in the intervention area. The data were analyzed using 34 components of the RE-AIM framework and classified under five general criteria (Reach, Effectiveness, Adoption, Implementation, and Maintenance). RESULTS: In total, 1480 and 1490 women participated in the baseline and endline questionnaire survey, respectively. In the intervention area, 83.8% of women participated (reach). The completion rate of the continuum of care increased from 7.5% to 47.1%. Newborns who had danger signs immediately after birth decreased after the intervention (relative risk = 0.82, 95% confidence interval = 0.68-0.99) (effectiveness). In the intervention area, 94% of all health facilities participated. Mothers willing to use their continuum of care cards in future pregnancies reached 87% (adoption). Supervision and manual use resolved the logistical and human resource challenges identified initially (implementation). The government included the continuum of care measures in their routine program and developed a new Maternal and Child Health Record Book, which was successfully disseminated nationwide (maintenance). CONCLUSIONS: Following the RE-AIM framework evaluation, the EMBRACE intervention program was considered effective and as having great potential for scaling across in real-world settings, especially where the continuum of care needs to be improved. TRIAL REGISTRATION: ISRCTN 90618993.

Oral health among HIV-positive and HIV-negative children in Phnom Penh, Cambodia: a cross-sectional study.

Background: HIV-positive children are at high risk for oral mucosal disorders. Additionally, their low immune status is associated with dental caries. However, little is known about how their dental caries and related risk factors, such as salivary flow, salivary pH level and oral health-related quality of life, differ from those of HIV-negative children. The study aimed to assess (1) dental caries and related risk factors in HIV-positive compared with HIV-negative children and (2) the association between these factors and HIV seropositive status in Phnom Penh, Cambodia. Methods: This was a cross-sectional study conducted as a baseline survey of a randomised controlled trial. The study setting was the National Pediatric Hospital's catchment area. The study population comprised 328 HIV-positive and 154 HIV-negative children aged 3-15 years and their caregivers. We collected clinical oral health data, questionnaire data to assess oral health-related quality of life and growth data. Results: The mean number of decayed, missing or filled permanent teeth (DMFT) and deciduous teeth (dmft) among HIV-positive children was 4.0 (SD 3.6) and 7.0 (SD 4.9), respectively. Among HIV-negative children, the respective values were 3.3 (SD 3.7) and 7.1 (SD 4.6). Living with HIV was positively associated with DMFT (adjusted OR 1.85, 95% CI 1.14 to 3.01) and salivary flow (ß=0.72, 95% CI 0.44 to 1.00) and negatively associated with salivary pH (ß=-0.13, 95% CI -0.24 to -0.02). However, HIV-positive status was not significantly associated with dmft or oral health-related quality of life. Conclusions: HIV-positive children had poorer oral health status regarding DMFT and salivary pH level. Specific strategies and further efforts are required to align their oral health status with that of HIV-negative children.

Dental caries in association with viral load in children living with HIV in Phnom Penh, Cambodia: a cross-sectional study.

BACKGROUND: Oral health status is associated with the overall health among people living with human immunodeficiency virus (HIV) infection. However, it is unclear whether dental caries is associated with the viral load in this population. Particularly, dental caries among children living with HIV needs better understanding as this can affect their overall health and future well-being. This study assessed the association between dental caries and viral load among children living with HIV in Phnom Penh, Cambodia. METHODS: This cross-sectional study, conducted at the National Pediatric Hospital as a baseline survey of a randomized controlled trial, included 328, 3-15-year-old children living with HIV and their primary caregivers. Calibrated and trained examiners conducted oral examinations for dental caries (DMFT/dmft index) in the children and retrieved the latest HIV viral load data from the hospital's patient information system. On the dental examination day, the children and their caregivers were invited to answer a questionnaire-based interview. Multiple logistic regression analysis was conducted to assess the association between dental caries and viral load. The cut-off point for undetectable viral load was set at < 40 copies/mL. RESULTS: Data from 328 children were included in the analysis; 68.3% had an undetectable viral load. The mean DMFT/dmft was 7.7 (standard deviation = 5.0). Adjusted regression analysis showed that dental caries in permanent or deciduous teeth was positively associated with detectable viral load (adjusted odds ratio [AOR]: 1.07, 95% confidence interval [CI]: 1.01-1.14). Conversely, antiretroviral therapy of ≥ 1 year and self-reported better adherence to antiretroviral drugs were negatively associated with detectable viral load. Among children with detectable viral load, dental caries in permanent or deciduous teeth was positively associated with non-suppression of viral load (> 1000 copies/mL) (AOR: 1.12, CI: 1.03-1.23). CONCLUSIONS: Dental caries was associated with viral load status detection among children living with HIV. This finding suggests that dental caries may affect their immune status. The oral health of children living with HIV should be strengthened, and further research is needed to clarify the causal relationship between viral load and oral health status.

Nurse-Led Mobile Phone Voice Call Reminder and On-Time Antiretroviral Pills Pick-Up in Nepal: A Randomized Controlled Trial.

This study investigates the efficacy of a nurse-led mobile phone voice call reminder intervention in improving on-time antiretroviral (ARV) pills collection in Nepal. Between October and December 2017, 468 HIV-positive individuals were recruited randomly and assigned to either nurse-led mobile phone voice call reminder (intervention) group or voice call with health promotion message (control) group, 234 were allocated to each group. We assessed on-time pills pick-up at baseline and six-month follow-up and analyzed it by intention-to-treat method. In the intervention group, participants improved their on-time ARV pills pick-up from 60% (141/234) at baseline to 71% (151/234) at the six-month follow-up. After adjusting for covariates, those in the intervention group were significantly more likely to pick-up their pills on-time than those in the control group (intervention × time; adjusted odds ratio 2.02, 95% CI 1.15-3.55). Nurse-led mobile phone voice call reminder is efficacious to improve on-time ARV collection.

Nutritional status and dietary diversity of school-age children living with HIV: a cross-sectional study in Phnom Penh, Cambodia.

BACKGROUND: HIV/AIDS continues to be a major public health concern for children. Each day, worldwide, approximately 440 children became newly infected with HIV, and 270 children died from AIDS-related causes in 2018. Poor nutrition has been associated with accelerated disease progression, and sufficient dietary diversity is considered a key to improve children's nutritional status. Therefore, this study aims to 1) examine nutritional status of school-age children living with HIV in Phnom Penh, Cambodia, and 2) identify factors associated with their nutritional status, especially taking their dietary diversity into consideration. METHODS: This cross-sectional study was conducted in May 2018 within the catchment area of the National Pediatric Hospital, Cambodia. Data from 298 children and their caregivers were included in the analyses. Using semi-structured questionnaires, face-to-face interviews were conducted to collect data regarding sociodemographic characteristics, quality of life, and dietary diversity. To assess children's nutritional status, body weight and height were measured. Viral load and duration of antiretroviral therapy (ART) were collected from clinical records. Multiple logistic regression analyses were performed to identify factors associated with stunting and wasting. RESULTS: Of 298 children, nearly half (46.6%) were stunted, and 13.1% were wasted. The mean number of food groups consumed by the children in the past 24 h was 4.6 out of 7 groups. Factors associated with children's stunting were age (adjusted odds ratio [AOR] 2.166, 95% confidence interval [CI]: 1.151, 4.077), household wealth (AOR 0.543, 95%CI: 0.299, 0.986), duration of receiving ART (AOR 0.510, 95%CI: 0.267, 0.974), and having disease symptoms during the past 1 year (AOR 1.871, 95%CI: 1.005, 3.480). The only factor associated with wasting was being male (AOR 5.304, 95%CI: 2.210, 12.728). CONCLUSIONS: Prevalence of stunting was more than double that of non-infected school-age children living in urban areas in Cambodia. This highlights the importance of conducting nutritional intervention programs, especially tailored for children living with HIV in the country. Although dietary diversity was not significantly associated with children's nutritional status in this study, the findings will contribute to implementing future nutritional interventions more efficiently by indicating children who are most in need of such interventions in Cambodia.

Redesigning Portable Health Clinic Platform as a Remote Healthcare System to Tackle COVID-19 Pandemic Situation in Unreached Communities.

Medical staff carry an inordinate risk of infection from patients, and many doctors, nurses, and other healthcare workers are affected by COVID-19 worldwide. The unreached communities with noncommunicable diseases (NCDs) such as chronic cardiovascular, respiratory, endocrine, digestive, or renal diseases became more vulnerable during this pandemic situation. In both cases, Remote Healthcare Systems (RHS) may help minimize the risk of SARS-CoV-2 transmission. This study used the WHO guidelines and Design Science Research (DSR) framework to redesign the Portable Health Clinic (PHC), an RHS, for the containment of the spread of COVID-19 as well as proposed corona logic (C-Logic) for the main symptoms of COVID-19. Using the distributed service platform of PHC, a trained healthcare worker with appropriate testing kits can screen high-risk individuals and can help optimize triage to medical services. PHC with its new triage algorithm (C-Logic) classifies the patients according to whether the patient needs to move to a clinic for a PCR test. Through modified PHC service, we can help people to boost their knowledge, attitude (feelings/beliefs), and self-efficacy to execute preventing measures. Our initial examination of the suitability of the PHC and its associated technologies as a key contributor to public health responses is designed to "flatten the curve", particularly among unreached high-risk NCD populations in developing countries. Theoretically, this study contributes to design science research by introducing a modified healthcare providing model.

Personal Health Record (PHR) System in Portable Health Clinic.

Personal Health Record (PHR) is not just the collection of personal health data but also a personal healthcare and disease management tool for the individual patient as well as a communication tool with the medical staff. Moreover, recently PHR has been considered an indispensable tool for patient engagement in the area of non-communicable diseases (NCDs) and has gained importance. Like many other developing countries, the growth of NCDs is very high in Bangladesh. Portable Health Clinic (PHC) system has been developed there with a focus on NCDs and PHR is there from the beginning. This study for the standardization of PHR system of PHC with the reference of the PHR proposed by Japanese Clinical Societies could be a reference work for the national PHR system development in the country.