Assessment of water, sanitation, and hygiene services in district health care facilities in rural area of Mekong Delta, Vietnam.

Access to sufficient water, sanitation, and hygiene (WASH) services is a crucial requirement for patients during therapy and general well-being in the hospital. However, in low- and middle-income countries, these services are often inadequate, resulting in increased morbidity and mortality of patients. This study aimed at assessing the current situation of WASH services in six District Health Care Facilities (DHCFs) in rural areas of the Mekong Delta provinces, Vietnam. The results showed that these services were available with inappropriate quality, which did not compromise the stakeholders' needs. The revealed WASH infrastructures have raised concerns about the prolonged hospital stays for patients and push nosocomial infections to a high level. The safety of the water supply was doubted as the high E. coli (> 60%) and total coliform incidence (86%) was observed with very low residual chlorine concentration (< 0.1 mg/L) in water quality assessment. Moreover, water supply contained a high concentration of iron (up to 15.55 mg/L) in groundwater in one DHCF. Technical assessment tool analysis proved that the improper management and lack of knowledge by human resources were the primary roots of the observed status WASH services. Improvement of the perceptions of WASH should be done for the hospital staff with collaboration and support from the government to prevent incidents in the future.

Development of a target product profile for new glucose self-monitoring technologies for use in low- and middle-income countries.

AIMS: Most glucose self-monitoring devices have been developed with high-income countries in mind. We developed a target product profile (TPP) for new glucose self-monitoring technologies for users in low- and middle-income countries (LMICs). METHODS: A draft TPP including 39 characteristics was developed by an expert group including diabetes specialists, device specialists, and people with diabetes, incorporating findings from qualitative research in LMICs. Each characteristic had minimal and optimal requirements for two use cases, frequent and sporadic use. Characteristics requiring refinement were identified via online survey. Characteristics with agreement level <90% for any requirement were reviewed by the expert group and amended as appropriate. RESULTS: One characteristic (shelf life) had agreement <75% (both requirements for both use cases). Characteristics with agreement ≥75% and <90% for the frequent use case included infrastructure level, measurement cycle, duration of use before replacement, interchangeability, and calibration (both requirements), and activity log and price per month to end payer (minimal requirement). Intended use (both requirements), accuracy, and price per month to end payer (optimal requirement) had agreement ≥75% and <90% for the sporadic use case. CONCLUSIONS: This TPP will inform developers on requirements for glucose self-monitoring technologies for LMICs, and support decision-makers in evaluating existing devices.

The status of refrigeration solutions for last mile vaccine delivery in low-income settings.

Recommendations for storage of most vaccines imply a continuous exposure to a temperature range between 0 °C and 10 °C, from the production to the administration to beneficiaries. According to the World Health Organization, more than 50% of vaccines are wasted around the world. Discontinuities of the cold chain in low-income settings where electricity is scarce contributes to this wastage. Recently, several advances have been made in cooling technologies to store and transport vaccines. This paper presents an overview of refrigeration technologies based on scientific publications, industry white papers and other grey literature. With a focus on vaccine transport, we briefly describe each refrigeration method, its best performing available devices as well as the outstanding research challenges in order to further improve its performance.

Ending Neonatal Deaths From Hypothermia in Sub-Saharan Africa: Call for Essential Technologies Tailored to the Context.

Neonatal death represents a major burden in Sub-Saharan Africa (SSA), where the main conditions triggering mortality, such as prematurity, labor complications, infections, and respiratory distress syndrome, are frequently worsened by hypothermia, which dramatically scales up the risk of death. In SSA, the lack of awareness on the procedures to prevent hypothermia and the shortage of essential infant devices to treat it are hampering the reduction of neonatal deaths associated to hypothermia. Here, we offer a snapshot on the current available medical solutions to prevent and treat hypothermia in SSA, with a focus on Kenya. We aim to provide a picture that underlines the essential need for infant incubators in SSA. Specifically, given the inappropriateness of the incubators currently on the market, we point out the need for reinterpretation of research in the field, calling for technology-based solutions tailored to the SSA context, the need, and the end-user.

Study protocol for a two-site clinical trial to validate a smartphone-based artificial intelligence classifier identifying cervical precancer and cancer in HPV-positive women in Cameroon.

INTRODUCTION: Cervical cancer remains a major public health challenge in low- and middle-income countries (LMICs) due to financial and logistical issues. WHO recommendation for cervical cancer screening in LMICs includes HPV testing as primary screening followed by visual inspection with acetic acid (VIA) and treatment. However, VIA is a subjective procedure dependent on the healthcare provider's experience. Its accuracy can be improved by computer-aided detection techniques. Our aim is to assess the performance of a smartphone-based Automated VIA Classifier (AVC) relying on Artificial Intelligence to discriminate precancerous and cancerous lesions from normal cervical tissue. METHODS: The AVC study will be nested in an ongoing cervical cancer screening program called "3T-study" (for Test, Triage and Treat), including HPV self-sampling followed by VIA triage and treatment if needed. After application of acetic acid on the cervix, precancerous and cancerous cells whiten more rapidly than non-cancerous ones and their whiteness persists stronger overtime. The AVC relies on this key feature to determine whether the cervix is suspect for precancer or cancer. In order to train and validate the AVC, 6000 women aged 30 to 49 years meeting the inclusion criteria will be recruited on a voluntary basis, with an estimated 100 CIN2+, calculated using a confidence level of 95% and an estimated sensitivity of 90% +/-7% precision on either side. Diagnostic test performance of AVC test and two current standard tests (VIA and cytology) used routinely for triage will be evaluated and compared. Histopathological examination will serve as reference standard. Participants' and providers' acceptability of the technology will also be assessed. The study protocol was registered under ClinicalTrials.gov (number NCT04859530). EXPECTED RESULTS: The study will determine whether AVC test can be an effective method for cervical cancer screening in LMICs.

A microfluidic approach for high efficiency extraction of low molecular weight RNA.

The lack of sample pre-treatment concepts that are easily automatable, miniaturized and highly efficient for both small volumes and low target concentrations, is one of the key issues that block the road towards effective miniaturized diagnostic instruments. This paper presents a novel, highly efficient and simple method for low-molecular weight RNA extraction using electricity only. Cells are lysed by thermo-electric lysis and RNA is purified using a gel-electrophoretic purification step. The combination of the two steps in one integrated cartridge reduces the time frame between the two steps, thus protecting RNA from enzymatic degradation. A disposable chip solution is proposed using a novel dry film resist laminate technology that allows cheap, large-scale fabrication. The chip contains crucial microfluidic innovations that allow for a simple user interface, reproducible functioning and precise quantification. Phaseguides are invented that allow controlled spatial injection of gel, injection of sample and recovery of extracted RNA. A precise sample volume can be defined by integrating electrophoretic actuation electrodes in the microfluidic chamber. Electrolytic gas bubbles that are the result of constant-current actuation are driven out from the chip by the novel introduction of capillary bubble-expulsion techniques. The extraction approach and the functionality of the chip are demonstrated for Escherichia coli and Streptococcus thermophilus bacteria. Linear extraction behavior is obtained for transfer-messenger RNA down to one colony-forming unit per microlitre, or five colony-forming units per chip. The latter is an increase in extraction efficiency of a factor of 1000 with respect to the commercial extraction kit Ambion Ribopure. The chip shows particularly good performance for extraction of low-molecular weight RNA, thereby eliminating the need for large ribosomal RNA and DNA removal. RNA can be extracted in less than 11 min, being a speed-up of more than a factor of 20 with respect to commercial extraction kits. The presented solution may find broad acceptance and application in drug discovery and clinical diagnostics.

A synthetic membrane protein in tethered lipid bilayers for immunosensing in whole blood.

Tethered lipid bilayers, containing a transmembrane synthetic ligand-gated ion channel (SLIC), have been formed on gold surfaces. The SLIC was designed as a highly selective receptor and reporter protein to detect antibodies in whole blood, which are of importance in malaria diagnosis. The specific binding of the antibody to the sensor surface was monitored on-line with label-free surface-sensitive techniques either optically by surface plasmon resonance in whole blood or electrically by measuring the channel activity of SLIC in blood serum. We demonstrate the feasibility of a highly sensitive and easily applicable whole blood biosensor on the basis of simple commercially available components. The sensor might find applications in the field of infectious diseases such as point-of-care diagnostics of malaria, high content quality control of blood samples of donors, or monitoring the efficacy of vaccination.