Challenge of diagnosing acute infections in poor resource settings in Africa

Frequent disease outbreaks and acute infections occur in rural and low-income urban areas of Africa, with many health systems unprepared to diagnose and control diseases that are recurrent, endemic or have extended their geographic zone. In this review, we focus on acute infections that can be characterized by sudden onset, rapid progression, severe symptoms and poor prognosis. Consequently, these infections require early diagnosis and intervention. While effective vaccines have been developed against some of these diseases, lack of compliance and accessibility, and the need for repeated or multiple vaccinations mean large populations can remain vulnerable to infection. It follows that there is a need for enhancement of national surveillance and diagnostic capacity to avert morbidity and mortality from acute infections. We discuss the limitations of traditional diagnostic methods and explore the relative merits and applicability of protein-, carbohydrate- and nucleic acid-based rapid diagnostic tests that have been trialled for some infectious diseases. We also discuss the utility and limitations of antibody-based serological diagnostics and explore how systems biology approaches can better inform diagnosis. Lastly, given the complexity and high cost associated with after-service support of emerging technologies, we propose that, for resource-limited settings in Africa, multiplex point-of-care diagnostic tools be tailor-made to detect both recurrent acute infections and endemic infections.

Download Full-text

Loop-Mediated Isothermal Amplification (LAMP): A Rapid, Sensitive, Specific, and Cost-Effective Point-of-Care Test for Coronaviruses in the Context of COVID-19 Pandemic

Biology ◽

10.3390/biology9080182 ◽

2020 ◽

Vol 9 (8) ◽

pp. 182 ◽

Cited By ~ 13

Author(s):

Robin Augustine ◽

Anwarul Hasan ◽

Suvarthi Das ◽

Rashid Ahmed ◽

Yasuyoshi Mori ◽

...

Keyword(s):

Low Income ◽

Point Of Care ◽

Cost Effective ◽

Isothermal Amplification ◽

Diagnostic Methods ◽

Diagnostic Tools ◽

Paper Strip ◽

Ongoing Research ◽

Loop Mediated Isothermal Amplification ◽

Point Of Care Test

The rampant spread of COVID-19 and the worldwide prevalence of infected cases demand a rapid, simple, and cost-effective Point of Care Test (PoCT) for the accurate diagnosis of this pandemic. The most common molecular tests approved by regulatory bodies across the world for COVID-19 diagnosis are based on Polymerase Chain Reaction (PCR). While PCR-based tests are highly sensitive, specific, and remarkably reliable, they have many limitations ranging from the requirement of sophisticated laboratories, need of skilled personnel, use of complex protocol, long wait times for results, and an overall high cost per test. These limitations have inspired researchers to search for alternative diagnostic methods that are fast, economical, and executable in low-resource laboratory settings. The discovery of Loop-mediated isothermal Amplification (LAMP) has provided a reliable substitute platform for the accurate detection of low copy number nucleic acids in the diagnosis of several viral diseases, including epidemics like Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). At present, a cocktail of LAMP assay reagents along with reverse transcriptase enzyme (Reverse Transcription LAMP, RT-LAMP) can be a robust solution for the rapid and cost-effective diagnosis for COVID-19, particularly in developing, and low-income countries. In summary, the development of RT-LAMP based diagnostic tools in a paper/strip format or the integration of this method into a microfluidic platform such as a Lab-on-a-chip may revolutionize the concept of PoCT for COVID-19 diagnosis. This review discusses the principle, technology and past research underpinning the success for using this method for diagnosing MERS and SARS, in addition to ongoing research, and the prominent prospect of RT-LAMP in the context of COVID-19 diagnosis.

Download Full-text

Sensor-as-a-Service: Convergence of Sensor Analytic Point Solutions (SNAPS) and Pay-A-Penny-Per-Use (PAPPU) Paradigm as a Catalyst for Democratization of Healthcare in Underserved Communities

Diagnostics ◽

10.3390/diagnostics10010022 ◽

2020 ◽

Vol 10 (1) ◽

pp. 22 ◽

Cited By ~ 3

Author(s):

Victoria Morgan ◽

Lisseth Casso-Hartmann ◽

David Bahamon-Pinzon ◽

Kelli McCourt ◽

Robert G. Hjort ◽

...

Keyword(s):

Low Income ◽

Economically Disadvantaged ◽

Technology Development ◽

Point Of Care ◽

Diagnostic Tools ◽

Marginalized Communities ◽

Community Environment ◽

Service Convergence ◽

The Social

In this manuscript, we discuss relevant socioeconomic factors for developing and implementing sensor analytic point solutions (SNAPS) as point-of-care tools to serve impoverished communities. The distinct economic, environmental, cultural, and ethical paradigms that affect economically disadvantaged users add complexity to the process of technology development and deployment beyond the science and engineering issues. We begin by contextualizing the environmental burden of disease in select low-income regions around the world, including environmental hazards at work, home, and the broader community environment, where SNAPS may be helpful in the prevention and mitigation of human exposure to harmful biological vectors and chemical agents. We offer examples of SNAPS designed for economically disadvantaged users, specifically for supporting decision-making in cases of tuberculosis (TB) infection and mercury exposure. We follow-up by discussing the economic challenges that are involved in the phased implementation of diagnostic tools in low-income markets and describe a micropayment-based systems-as-a-service approach (pay-a-penny-per-use—PAPPU), which may be catalytic for the adoption of low-end, low-margin, low-research, and the development SNAPS. Finally, we provide some insights into the social and ethical considerations for the assimilation of SNAPS to improve health outcomes in marginalized communities.

Download Full-text

Towards better diagnostic tools for liver injury in low-income and middle-income countries

BMJ Global Health ◽

10.1136/bmjgh-2019-001704 ◽

2019 ◽

Vol 4 (4) ◽

pp. e001704 ◽

Cited By ~ 1

Author(s):

Saundria Moed ◽

Muhammad H Zaman

Keyword(s):

Chronic Hepatitis ◽

Liver Injury ◽

Low Income ◽

Liver Diseases ◽

Diagnostic Methods ◽

Low Income Countries ◽

Diagnostic Tools ◽

Middle Income ◽

Public Health Burden ◽

Middle Income Countries

Liver disease is a significant public health burden in both high-income and low-income countries, accounting for over 2 million annual, global deaths. Despite the significant mortality burden, liver diseases are historically a neglected problem due to a lack of accurate incidence and prevalence statistics, as well as national and international programmes targeting these diseases. A large portion of deaths due to liver diseases can be treated (eg, chronic hepatitis B), cured (eg, chronic hepatitis C) or prevented (eg, acute liver failure due to medications) if prompt diagnosis is made, but currently diagnostic methods fall short. Therefore, there is a critical need to fund the development of prompt, effective diagnostics for liver function, specifically in low-income and middle-income countries where the landscape for this testing is sparse. Here, we review and compare available and currently emerging diagnostic methods for liver injury in low-income and middle-income settings, while highlighting the opportunities and challenges that exist in the field.

Download Full-text

Identification of Mycoses in Developing Countries

Journal of Fungi ◽

10.3390/jof5040090 ◽

2019 ◽

Vol 5 (4) ◽

pp. 90 ◽

Cited By ~ 15

Author(s):

Amir Arastehfar ◽

Brian L. Wickes ◽

Macit Ilkit ◽

David H. Pincus ◽

Farnaz Daneshnia ◽

...

Keyword(s):

Developing Countries ◽

Real Time ◽

Real Time Pcr ◽

Fungal Infections ◽

Point Of Care ◽

Fungal Species ◽

Lateral Flow ◽

Lateral Flow Assay ◽

Diagnostic Methods ◽

Diagnostic Tools

Extensive advances in technology offer a vast variety of diagnostic methods that save time and costs, but identification of fungal species causing human infections remains challenging in developing countries. Since the echinocandins, antifungals widely used to treat invasive mycoses, are still unavailable in developing countries where a considerable number of problematic fungal species are present, rapid and reliable identification is of paramount importance. Unaffordability, large footprints, lack of skilled personnel, and high costs associated with maintenance and infrastructure are the main factors precluding the establishment of high-precision technologies that can replace inexpensive yet time-consuming and inaccurate phenotypic methods. In addition, point-of-care lateral flow assay tests are available for the diagnosis of Aspergillus and Cryptococcus and are highly relevant for developing countries. An Aspergillus galactomannan lateral flow assay is also now available. Real-time PCR remains difficult to standardize and is not widespread in countries with limited resources. Isothermal and conventional PCR-based amplification assays may be alternative solutions. The combination of real-time PCR and serological assays can significantly increase diagnostic efficiency. However, this approach is too expensive for medical institutions in developing countries. Further advances in next-generation sequencing and other innovative technologies such as clustered regularly interspaced short palindromic repeats (CRISPR)-based diagnostic tools may lead to efficient, alternate methods that can be used in point-of-care assays, which may supplement or replace some of the current technologies and improve the diagnostics of fungal infections in developing countries.

Download Full-text

Nanotechnology-Based Strategies for Effective and Rapid Detection of SARS-CoV-2

Materials ◽

10.3390/ma14247851 ◽

2021 ◽

Vol 14 (24) ◽

pp. 7851

Author(s):

Koena L. Moabelo ◽

Darius R. Martin ◽

Adewale O. Fadaka ◽

Nicole R. S. Sibuyi ◽

Mervin Meyer ◽

...

Keyword(s):

Point Of Care ◽

Health Care Systems ◽

Diagnostic Methods ◽

Diagnostic Tools ◽

Diagnostic Systems ◽

Rt Pcr ◽

Care Systems ◽

Detection And Diagnosis ◽

High Level ◽

The Cost

The coronavirus disease 2019 (COVID-19) pandemic has gained worldwide attention and has prompted the development of innovative diagnostics, therapeutics, and vaccines to mitigate the pandemic. Diagnostic methods based on reverse transcriptase-polymerase chain reaction (RT-PCR) technology are the gold standard in the fight against COVID-19. However, this test might not be easily accessible in low-resource settings for the early detection and diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The lack of access to well-equipped clinical laboratories, requirement for the high level of technical competence, and the cost of the RT-PCR test are the major limitations. Moreover, RT-PCR is unsuitable for application at the point-of-care testing (PoCT) as it is time-consuming and lab-based. Due to emerging mutations of the virus and the burden it has placed on the health care systems, there is a growing urgency to develop sensitive, selective, and rapid diagnostic devices for COVID-19. Nanotechnology has emerged as a versatile technology in the production of reliable diagnostic tools for various diseases and offers new opportunities for the development of COVID-19 diagnostic systems. This review summarizes some of the nano-enabled diagnostic systems that were explored for the detection of SARS-CoV-2. It highlights how the unique physicochemical properties of nanoparticles were exploited in the development of novel colorimetric assays and biosensors for COVID-19 at the PoCT. The potential to improve the efficiency of the current assays, as well as the challenges associated with the development of these innovative diagnostic tools, are also discussed.

Download Full-text

Diagnosis of Chlamydia trachomatis genital infections in the era of genomic medicine

Brazilian Journal of Microbiology ◽

10.1007/s42770-021-00533-z ◽

2021 ◽

Author(s):

Seema Shetty ◽

Christina Kouskouti ◽

Uwe Schoen ◽

Nikolaos Evangelatos ◽

Shashidhar Vishwanath ◽

...

Keyword(s):

Low Income ◽

Patient Management ◽

Genomic Medicine ◽

Diagnostic Methods ◽

Diagnostic Tools ◽

Genital Infections ◽

Omics Technologies ◽

Public Health Burden ◽

Advantages And Disadvantages ◽

The Impact

Abstract Purpose Chlamydial genital infections constitute significant sexually transmitted infections worldwide. The often asymptomatic status of C. trachomatis (CT) infections leads to an increased burden on human reproductive health, especially in middle- and low-income settings. Early detection and management of these infections could play a decisive role in controlling this public health burden. The objective of this review is to provide an insight into the evolution of diagnostic methods for CT infections through the development of new molecular technologies, emphasizing on -omics’ technologies and their significance as diagnostic tools both for effective patient management and control of disease transmission. Methods Narrative review of the diagnostic methodologies of CT infections and the impact of the introduction of -omics’ technologies on their diagnosis by review of the literature. Results Various methodologies are discussed with respect to working principles, required specifications, advantages, and disadvantages. Implementing the most accurate methods in diagnosis is highlighted as the cornerstone in managing CT infections. Conclusion Diagnostics based on -omics’ technologies are considered to be the most pertinent modalities in CT testing when compared to other available methods. There is a need to modify these effective and accurate diagnostic tools in order to render them more available and feasible in all settings, especially aiming on turning them to rapid point-of-care tests for effective patient management and disease control.

Download Full-text

Analytical and Clinical Assessment of a Portable, Isothermal Recombinase Polymerase Amplification (RPA) Assay for the Molecular Diagnosis of Urogenital Schistosomiasis

Molecules ◽

10.3390/molecules25184175 ◽

2020 ◽

Vol 25 (18) ◽

pp. 4175

Author(s):

John Archer ◽

Rebecca Barksby ◽

Tom Pennance ◽

Penelope Rostron ◽

Faki Bakar ◽

...

Keyword(s):

Diagnostic Tool ◽

Clinical Performance ◽

Point Of Care ◽

Pathogen Transmission ◽

Diagnostic Methods ◽

Recombinase Polymerase Amplification ◽

Diagnostic Tools ◽

Urogenital Schistosomiasis ◽

Predictive Values ◽

Highly Sensitive

Accurate diagnosis of urogenital schistosomiasis is crucial for disease surveillance and control. Routine diagnostic methods, however, lack sensitivity when assessing patients with low levels of infection still able to maintain pathogen transmission. Therefore, there is a need for highly sensitive diagnostic tools that can be used at the point-of-care in endemic areas. Recombinase polymerase amplification (RPA) is a rapid and sensitive diagnostic tool that has been used to diagnose several pathogens at the point-of-care. Here, the analytical performance of a previously developed RPA assay (RT-ShDra1-RPA) targeting the Schistosoma haematobium Dra1 genomic region was assessed using commercially synthesised S. haematobium Dra1 copies and laboratory-prepared samples spiked with S. haematobium eggs. Clinical performance was also assessed by comparing diagnostic outcomes with that of a reference diagnostic standard, urine-egg microscopy. The RT-ShDra1-RPA was able to detect 1 × 101 copies of commercially synthesised Dra1 DNA as well as one S. haematobium egg within laboratory-spiked ddH2O samples. When compared with urine-egg microscopy, the overall sensitivity and specificity of the RT-ShDra1-RPA assay was 93.7% (±88.7–96.9) and 100% (±69.1–100), respectively. Positive and negative predictive values were 100% (±97.5–100) and 50% (±27.2–72.8), respectively. The RT-ShDra1-RPA therefore shows promise as a rapid and highly sensitive diagnostic tool able to diagnose urogenital schistosomiasis at the point-of-care.

Download Full-text

Primary Diagnostic Tools for SARS-CoV-2 Infection (COVID-19): Mini Review Based on Current Challenges in Molecular Techniques and Point of Care Testing for Screening

International Journal of Pathogen Research ◽

10.9734/ijpr/2020/v5i430149 ◽

2021 ◽

pp. 94-104

Author(s):

K. Kokilavani ◽

Bindu Salim

Keyword(s):

Point Of Care ◽

Developed Countries ◽

Molecular Techniques ◽

Diagnostic Methods ◽

Diagnostic Tools ◽

Attractive Alternative ◽

Screening Methods ◽

Rapid Diagnostics ◽

Point Of Care Testing ◽

The Developed Countries

Pandemic outbreaks are always a challenge for the health care management to control the mortality rate when the preventive measures are not established. The challenge is being faced worldwide with the outbreak of COVID-19 including the developed countries. The only solution is to control the spread by conducting massive screening and isolating affected ones from the healthy ones, which needs the development of screening methods that can reach the maximum population. The next step is to come up with vaccines. The research concentration worldwide is focussed on developing rapid diagnostics and screening at an affordable cost. Multiple studies suggest that Reverse Transcription- Polymerase Chain Reaction (RT-PCR), protein testing and Computed Tomography (CT) should be the principal diagnostic methods for routine testing/ screening in patients with COVID-19. But three factors are still indistinct in those diagnostic methods such as rapidity, sensitivity, and specificity. Thus, alternative approaches that provide higher efficiency and rapid are highly appreciated for the super spread infectious disease detection. Presently, microfluidics-based test kits alternatively called as lab-on-a-chip or Point- Of -Care Testing (POCT) have been widely used in cancer and viral detection. The ability of POCT tests to provide short time results, suitable in low resource clinics or even at home should be an attractive alternative. So, the miniaturized tools suitable for COVID-19 detection will replace the current expensive methods. Despite the limitations, the approved tests are still providing good results for this high risk pandemic. Many articles in the recent past highlighted the POCT method is not less than any other screening methods and by reviewing a wide research background, the importance of developing POCTs for screening such pandemic is presented here.

Download Full-text

Determinant factors of urban housing preferences among low-income people in Greater Jakarta

International Journal of Housing Markets and Analysis ◽

10.1108/ijhma-05-2021-0056 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Djoni Hartono ◽

Tony Irawan ◽

Khoirunurrofik Khoirunurrofik ◽

Ramadani Partama ◽

Nurul Wajah Mujahid ◽

...

Keyword(s):

Developing Countries ◽

Housing Policy ◽

Low Income ◽

Urban Areas ◽

Choice Model ◽

Urban Housing ◽

Content Type ◽

Large Populations ◽

Using Data ◽

Surrounding Areas

Purpose High numbers of housing backlogs as well as inadequate housing for low-income are one of the Indonesian government’s major concerns, especially in urban areas where the price of house is high. This study aims to identify low-income communities’ preferences on house ownership status, renting or buying and house provider, public or private, in Jakarta and surrounding areas. Design/methodology/approach This study adapts Longley multistage choice model in the Indonesian context to analyze people’s preferences in choosing a place to live in urban areas. This study analyzes two choices of models which are aspects of homeownership (buying or renting) and aspects of residential types (private or public). Findings Using data collected through a survey of 1,000 households in greater Jakarta (Jakarta, Bogor, Depok, Tangerang, and Bekasi), this study found that households which have fixed employment status, an older age, a larger number of family members, higher level of education and literacy in housing policy, accessible house location and more affordable to own house have a higher probability to choose to own a house. In addition, education level, age, and family size are major determinants of a household’s decision to occupy a public house rather than a private house. The findings provide basic input to government development programs in designing housing policy for low-income people. Originality/value There are only a few studies related to house-ownership preferences in low-income people, especially in developing countries, including Indonesia. This study contributes to the housing studies literature by strengthening empirical evidence from developing countries that have large populations and mostly live in urban areas.

Download Full-text

Loop-Mediated Isothermal Amplification in Schistosomiasis

Journal of Clinical Medicine ◽

10.3390/jcm10030511 ◽

2021 ◽

Vol 10 (3) ◽

pp. 511

Author(s):

Juan García-Bernalt Diego ◽

Pedro Fernández-Soto ◽

Begoña Febrer-Sendra ◽

Beatriz Crego-Vicente ◽

Antonio Muro

Keyword(s):

Point Of Care ◽

Therapy Monitoring ◽

Isothermal Amplification ◽

Diagnostic Methods ◽

Diagnostic Tools ◽

Intermediate Hosts ◽

Early 21St Century ◽

Loop Mediated Isothermal Amplification ◽

Advantages And Disadvantages ◽

Point Of Care Test

Human schistosomiasis is one of the most important parasitic diseases, causing around 250 million cases (mostly in Africa) and 280,000–500,000 deaths every year. Due to the limited resources and the far-removed nature of many endemic areas, the implementation of new, sensitive and specific diagnostic tools has had little success. This is particularly true for PCR-based molecular methods that require expensive equipment and trained personnel to be executed. Loop-mediated isothermal amplification (LAMP) along with other isothermal techniques appeared in the early 21st century as an alternative to those methods, overcoming some of the aforementioned limitations and achieving a more inexpensive diagnostic. However, to this date, neither LAMP nor any other isothermal technique have signified a meaningful change in the way schistosomiasis diagnosis is routinely performed. Here, we present the recent developments in LAMP-based schistosomiasis diagnosis. We expose the main advantages and disadvantages of LAMP technology over PCR and other classical diagnostic methods focusing in various research approaches on intermediate hosts, animal models and patients. We also examine its potential clinical application in post-therapy monitoring, as well as its usefulness as a point-of-care test.

Download Full-text