Facilitators and barriers to in vitro diagnostics implementation in resource-limited settings: A scoping review.

BACKGROUND: The World Health Organization (WHO) developed the model list of essential in vitro diagnostics (EDL) to guide countries to develop and update point-of-care (POC) per their disease priorities. The EDL includes POC diagnostic tests for use in health facilities without laboratories; however, their implementation might face several challenges in low- and middle-income countries (LMICs). AIM: To identify facilitators and barriers to POC testing service implementations in the primary health care facilities in the LMICs. SETTING: Low- and middle-income countries. METHODS: This scoping review was guided by Arksey and O'Malley's methodological framework. A comprehensive keyword search for literature was conducted in Google Scholar, EBSCOhost, PubMed, Web of Science and ScienceDirect using the Boolean terms ('AND' and 'OR'), as well as Medical Subject Headings. The study considered published articles in the English language from 2016 to 2021 and was limited to qualitative, quantitative and mixed-method studies. Two reviewers independently screened the articles at the abstract and full-text screening phases guided by the eligibility criteria. Data were analysed qualitatively and quantitatively. RESULTS: Of the 57 studies identified through literature searches, 16 met this study's eligibility criteria. Of the 16 studies, 7 reported on both facilitators and barriers; and the remainder reported on only barriers to POC test implementation such as inadequate funding, insufficient human resource, stigmatisation, et cetera. CONCLUSION: The study demonstrated a wide research gap in facilitators and barriers, especially in the general POC diagnostic test for use in health facilities without laboratories in the LMICs. Extensive research in POC testing service is recommended to improve service delivery.Contribution: This study's findings contribute to a few works of literature on existing evidence of POC testing.

Assessment of Wound-Healing Properties of Medicinal Plants: The Case of Phyllanthus muellerianus.

Phyllanthus muellerianus (Family Euphorbiaceae) is a shrub, which is widely distributed in West Africa and employed traditionally as a wound-healing agent especially in Ghana. The aim of the study was to determine the in vivo wound-healing activity of aqueous aerial part extract of P. muellerianus (PLE) and its major isolate, geraniin. Excision and incision wound models were used to determine the wound-healing activity. Wounds were treated with PLE (0.25, 0.5, and 1% w/w) and geraniin (0.1, 0.2, and 0.4% w/w) aqueous creams. PLE and geraniin significantly (p < 0.001) increased wound contraction rate and hydroxyproline production compared to untreated wounds. Histological studies of wound tissues showed high levels of fibroblasts and increased collagen content and cross-linking in PLE and geraniin-treated wound tissues. Immuno-histochemical investigations revealed high levels of TGF-ß1 in PLE and geraniin-treated wound tissues compared to the untreated wound tissues. Tensile strength of incised wounds was significantly (p < 0.05) high in PLE and geraniin-treated wounds. PLE (0.1-100 µg/mL) significantly (p < 0.001) reduce LDH release from HaCaT-keratinocytes compared to the untreated cells. PLE and geraniin possess wound healing and cytoprotective effect.

Antiallergic effect of an aqueous leaf extract of Pistia stratiotes in murine model of ovalbumin-induced allergic conjunctivitis.

AIM: The aim was to investigate the antiallergic effect of an aqueous leaf extract of Pistia stratiotes (ALPS) in a murine model of ovalbumin (OVA)-induced allergic conjunctivitis (AC). MATERIALS AND METHODS: Prior to topical challenge (instillation of 1.5 mg OVA in 10 µL phosphate buffered saline into their conjunctival sacs) to induce AC, groups of sensitized Imprinting Control Region mice (injected IP, on day 1 and 7, with 0.2 ml solution of 100 µg OVA and 0.01 mg aluminum hydroxide in phosphate buffered saline), were treated with 5 mg/kg cetirizine, 10, 50 or 100 mg/kg of ALPS, or 2 ml/kg normal saline per os. Conjunctival redness, lid edema, tearing and lid scratching (clinical symptoms of AC) were scored. Serum OVA specific immunoglobulins were determined using ELISA. Histopathological assessment of the conjunctival mucosal tissue was conducted. The extract was screened for secondary plant metabolites. RESULTS: Pretreatment with the extract significantly (P ≤ 0.05-0.01) and dose-dependently reduced the scores for clinical symptoms, which were marked in vehicle-pretreated mice. Pretreatment also lowered (P ≤ 0.01-0.001) serum OVA specific immunoglobulins. Mast cell infiltration and degranulation in conjunctival stroma (measured by an inflammatory score) in histopathological studies was also significantly low (P ≤ 0.05-0.01) on pretreatment. CONCLUSION: The ALPS exhibited interesting antiallergic activity and hence could be useful in managing AC.