Borneo Journal of Medical Sciences (BJMS)

Camera Trap Survey of Two Pheasant Species in the Crocker Range Biosphere Reserve

2026-07-09T17:40:06+08:00

Both the crested partridge (Rollulus rouloul) and great argus (Argusianus argus) are at high risk of extinction due to habitat loss and illegal hunting. While these relatively large pheasant species could be monitored using camera traps, such studies have been infrequent in the inland forests of Sabah. To help fill this gap, a camera trap survey was conducted at the Inobong Substation of the Crocker Range Biosphere Reserve to document their local activity patterns. Ten sampling points were established, with each spaced at least 200.0 m apart and 5.0 m away from local hiking trails and vehicle roads, with one camera trap deployed at each point. Over 675 camera trap nights, the great argus predominantly passed through the points, while the crested partridge mainly engaged in foraging behaviour. Both species were detected either individually or in groups of varying sizes and sex compositions, with the crested partridge exhibiting a larger average group size compared to the great argus. Although their overall diurnal activity patterns were highly similar, the crested partridge showed peak activity during different daylight hours compared to the great argus. This highlights a subtle form of temporal niche partitioning, likely due to interspecific competition for movement space, shelter, and food at the sampling points. Ultimately, the present results support the feasibility of employing camera traps for long-term monitoring of these two pheasant species in the inland forests of Sabah, although further assessment is required to address the limitations of this preliminary research.

Gender disparities, hyperglycemia and their association with atherogenic biomarkers

2026-07-09T21:37:50+08:00

Atherogenic index (AI) and coronary risk index (CRI) are potential biomarkers reflecting atherosclerosis which is a main aetiology of ischemic heart disease. Dyslipidemia is an important risk factor for atherosclerosis causing endothelial injury which is the initiation of athrogenesis. Cardiovascular disese (CVD) risk is significant associated with high AI in which coronary artery events were documented. Predictive values of AIP for CVD risk is more pronounced in the presence of any components of metabolic syndrome such as hyperglycemia and in male gender when compared to females. This study associate the atherogenic index (AI) and coronary risk index (CRI) between status of genders and the hyperglycemia.. It was a laboratory based study and a hundred volunteer adult subjects participated after giving informed consent. General proforma was used to collect subjects’ demographic data. Blood samples (5.0 mL) was collected in plain tubes from the subjects after overnight fast. Serum was isolated into dry plain plastic screw-capped containers and stored frozen-20°C prior to analyses. Serum total cholesterol (TC), triglycerides (Tg), high-density lipoprotein-cholesterol (HDL-C) and low-density lipoprotein-cholesterol (LDL-C) and fasting glucose concentrations were determined by chemical analyser. Atherogenic index is calculated as log (TG/HDL–C) and the Coronary risk index calculated as CRI=TC/HDL-C. There were 52 (51.5%) males and 48 (48.5%) females in this study. For the AI, there were statistically significant mean differences between genders (p-value < 0.001) and diabetes status (p-value = 0.039). As for CRI, only gender (p-value < 0.001) showed a statistically significant mean difference. Hence, we conclude that there is a significant mean difference between males and females for both AI and CRI. As for the other health status, only the status of diabetes mellitus was found to have a significant mean difference for AI. In conclusion, this study demonstrates that both AI and CRI differ significantly by gender, with males showing higher values, while diabetes status was independently associated with AI. These findings emphasize the relevance of gender- and diabetes-specific consideration in evaluating coronary artery disease risk.

Mitochondrial gene marker identification for a targeted hornbill eDNA assay

2026-07-09T21:52:56+08:00

The effectiveness of traditional hornbill monitoring through visual and acoustic surveys is often hampered by their cryptic behavior and habitat preference in dense rainforests. The challenges in hornbill detection have led to insufficient population data, posing a significant challenge to hornbill conservation efforts. Environmental DNA (eDNA) offers a complementary approach that enables non-invasive detection of species from trace genetic material shed into the surrounding environments. Targeted eDNA assay using real-time PCR (qPCR) allows the detection and quantification of low amount of target DNA in complex environmental samples. The design of primers defines the region of target DNA to be amplified from the complex DNA sequences present in environmental samples. Gene marker selection is critical to ensure assay specificity by identifying regions that are conserved enough within target species but variable enough between target and non-target species, used for design of primers. This study identifies the mitochondrial gene markers for the development of a targeted eDNA assay, using Anthracoceros albirostris as a proof-of-concept study. We compiled mitochondrial DNA (mtDNA) sequences of target and non-target, closely related species from the GenBank nucleotide database. Due to the lack of hornbills’ sequence data, we performed Sanger sequencing to generate mtDNA sequences targeting cytochrome c oxidase subunit 1 (COI), NADH dehydrogenase subunit 2 (ND2), and displacement loop (d-loop) genes using feather samples from four hornbill individuals. Analysis of sequence alignment revealed a high level of sequence similarity (>90%) among the three mtDNA genes. Despite the high similarity, specific regions within ND2 genes exhibited a sufficient level of sequence variation. This study presents the preliminary development of targeted hornbill eDNA assay, utilizing ND2 as gene marker for primer design. It serves as a foundational step towards the broader application of molecular tools to protect the iconic hornbills in Borneo.

Sustainable Aluminium Ion Removal Using Agro-Waste-Derived Activated Carbon for River Preservation: From Lab-Scale Towards Upscaling Study

2026-07-09T23:25:02+08:00

High heavy metal content in river water has been a threat to the ecosystem due to bioaccumulation and biomagnification. The Miri River was deemed unsuitable for recreational use with body contact. It requires conventional treatment if used for water supply, primarily due to its high aluminium (Al) content. This is due to the anthropogenic influences of the industrial areas upstream of the river. The Al could flow into the river due to surface runoff or wastewater discharge. This study synthesised an effective adsorbent from recycled agro-waste, specifically coconut shells (CS), obtained from local areas, for Al removal. The CS was continuously produced in association with a large amount of coconut production. The current study aims to address the local water pollution issue with locally available sources to maximise environmental benefits. Under optimal conditions, the adsorbent is able to remove up to 99.84% of Al from synthetic water on a laboratory scale, reducing the concentration from 58.81 mg/L to 0.10 mg/L. A larger-scale application was examined by implementing a floating prototype with an adsorbent pack placed on it, where a residual Al content of approximately 0.06 mg/L was obtained. Moreover, the thermodynamic study validated that the Al adsorption is not limited by temperature. The efficiency remains above 99.84% with a temperature range from 25oC to 60oC . The current study demonstrates the technical feasibility of Al removal on a larger-scale application by an adsorbent derived from recycled waste. These findings determined that the local agro-waste CS is an efficient adsorbent source for heavy metals remediation, particularly for the Miri River. A future study is required to focus on the installation of the system at other contaminated rivers.

The efficacy of long pools as fire breaks to protect peat swamp forest ecosystems: A case study in Binsuluk Forest Reserve, Sabah, Malaysia

2026-07-11T14:36:35+08:00

Peat swamp forests are vital carbon sinks but face increasing threats from persistent underground smoldering fires that release massive greenhouse gas emissions. Safeguarding these ecosystems requires effective containment of such threats. One implemented fire management method is the construction of long pools, ranging from 10 m to 20 m wide with strategic crossover points. This study evaluates the effectiveness of long pools as fire breaks by comparing fire distribution and intensity patterns before and after construction, alongside operational perspectives. The methodology combines qualitative interviews with senior Initial Attack Crew (IAC) officers regarding long pool efficacy, and a spatio-temporal analysis using MODIS Active Fire data to compare fire incidents in 2016 (pre-construction) and 2024 (post-construction). Results show a significant reduction in fire frequency, dropping from 91 occurrences in 2016 to 27 in 2024 with p<0.001. However, the intensity of fires breaching the boundary remained statistically unchanged with p=0.90. This indicates the long pools success is primarily as a preventative shield, providing water sources and access. The findings offer valuable insights into effective fire management and peat swamp forest conservation efforts

A Review on The Current Burden of Catastrophic Health Expenditure from Major Illnesses in Malaysia

2026-07-11T14:48:08+08:00

Several illnesses continue to generate disproportionate financial burdens for Malaysian households despite a subsidised health system. This review synthesised 12 studies published between 2020 and 2025 that reported catastrophic health expenditure (CHE) associated with chronic and infectious diseases. National surveys showed low CHE prevalence (2–3%), yet disease-specific studies reported much higher rates: 15% - 87% in cancer patients, 24% in kidney transplant recipients, 38%-80% in malaria (depending on CHE threshold), and 2% in adult asthma patients. Key drivers included low income, treatment intensity (chemotherapy, radiotherapy, transplant), absence of financial aid or Guarantee Letters, and sociodemographic vulnerabilities such as small or female-headed households, rural residence, and minority ethnicity. Non-medical and indirect costs, particularly transport and productivity loss, contributed substantially but were often under-measured. These findings highlight persistent gaps in financial protection, underscoring the need to expand coverage for non-medical costs, address inequities, and systematically integrate productivity loss into CHE monitoring to advance universal health coverage and safeguard household financial stability in Malaysia.

Advancing Rural Healthcare in Asia: A Scoping Review on the Application and Implementation of Artificial Intelligence

2026-07-11T15:08:15+08:00

Background: Artificial Intelligence (AI) has become a transformative tool in healthcare, with applications ranging from diagnostics to resource management. Despite its potential to revolutionize rural healthcare by improving access, quality, and efficiency, significant challenges remain in its implementation in these underserved areas. This scoping review aims to explore the applications, benefits, and challenges of AI in rural healthcare settings within the Asia region and to identify research gaps for future study. Methods: The review followed Arksey and O’Malley’s five-stage framework and adhered to the PRISMA-ScR. Relevant studies were identified through database searches (Science Direct, Scopus, ProQuest) focusing on application or implementation of AI in rural healthcare settings in Asian countries. Articles published between 2020 and 2024 were included, with a systematic selection process ensuring relevance and quality. Results: A total of fourteen studies conducted in Asia were included. The studies primarily examined AI application such as remote patient monitoring, diagnostic support, telehealth enhancements, and disease surveillance. Overall, AI demonstrated potential in improving healthcare access, diagnostic capabilities, and patient outcomes. However, challenges including data limitations, ethical concerns, infrastructure constraints, high costs, and inadequate workforce training were identified as barriers to successful implementation. Discussion: AI offers significant opportunities to address healthcare disparities in rural areas, but its potential is hindered by persistent challenges. The findings highlight the need for robust digital infrastructure, ethical frameworks, cost-effective solutions, and capacity-building initiatives. Collaborative efforts among stakeholders are crucial to overcoming these barriers and ensuring equitable healthcare delivery. Conclusion: AI holds significant promise for strengthening rural healthcare systems in Asia. Addressing infrastructural, ethical, and capacity-related barriers through context-specific and collaborative approaches is essential to support equitable and sustainable AI implementation in rural healthcare settings.

Association Between Maternal Smoking During Pregnancy and Risk of Autism Spectrum Disorder in Offspring: A Systematic Review

2026-07-11T15:20:24+08:00

Autism Spectrum Disorder (ASD) is a developmental condition that affects how individuals communicate, interact socially, and behave. One of the factor that is gaining attention is maternal smoking during pregnancy. Nicotine and other substances in tobacco smoke can cross the placenta and may interfere with fetal brain development. Despite these concerns, research findings on whether smoking during pregnancy increases the risk of ASD have been mixed. This review examines current evidence on the relationship between maternal smoking during pregnancy and the risk of ASD in offspring. It aims to assess the consistency and strength of reported associations, identify key confounding variables and evaluate the methodological quality of included studies. A structured search was carried out using PRISMA guidelines to identify observational studies published between January 1st 2013 and April 30th 2025. The review focused on studies with cohort, case-control, or cross-sectional designs. Study quality were assessed using tools from the Joanna Briggs Institute (JBI). From an initial pool of 6,915 records, 11 studies met the inclusion criteria. Most were conducted in high-income settings, with sample sizes ranging from fewer than 200 to over two million participants. Five studies reported statistically significant links between maternal smoking and ASD or its subtypes, though the observed effects were small. The remaining six studies, including the only one that used serum cotinine to verify smoking status, did not find a significant association. Differences in results appeared to relate to how smoking exposure and ASD were defined and measured, as well as differences between study populations. There is no clear or consistent evidence that maternal smoking during pregnancy is an independent risk factor for ASD. While some research points to a possible connection, results vary and are often limited by how smoking and ASD were assessed. Further research using more objective exposure data, larger and more diverse populations, and detailed subgroup analyses is needed to clarify whether any meaningful association exists.

Benefits Of Targeted Healthcare Subsidies: A Scoping Review

2026-07-12T01:39:19+08:00

Targeted healthcare subsidies can enhance the utilisation of under-utilised services, particularly among populations with limited access to healthcare. The inconsistency in data and lack of comprehensive synthesis present a significant challenge for policymakers and healthcare providers contemplating implementing or modifying healthcare voucher schemes. This study aims to determine the benefits of implementing specific healthcare subsidies. This study used a methodological framework developed by Arksey and O’Malley and refined by the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). The search strategy resulted in 534 citations from PubMed and Scopus. Out of the total, 187 instances were found to be duplications, while 347 were identified as unique study references. Furthermore, we found and analysed 43 pertinent references and full texts. Consequently, 30 studies were excluded, leaving 12 that satisfied the inclusion criteria for the review—targeted healthcare subsidies benefit by promoting the use of healthcare services, addressing vulnerable groups, encouraging private and public care, providing continuous care, relieving financial burdens, reducing carers’ stress, and decreasing waiting time for subsidised homes for the elderly. Tailored subsidy distribution addresses healthcare needs, improves accessibility, and reduces disparities in the system. By directing financial assistance towards identified areas of concern, policymakers can optimise resource allocation and enhance the overall efficiency of healthcare interventions.

Computer Vision Syndrome in University Students: A Narrative Review of Prevalence, Pathophysiology, and Management Strategies

2026-07-12T17:43:18+08:00

Background: Computer Vision Syndrome (CVS), or Digital Eye Strain, involves vision-related problems from prolonged uses of digital screens. The severity of its symptoms, which include ocular fatigue, headaches, blurred vision, dry eyes, and neck and shoulder pain, often correlates with screen time duration. Objectives: This narrative review examines the prevalence, consequences, and mitigation strategies for CVS among university students, a population particularly vulnerable due to their extensive reliance on digital devices for academic and leisure activities. Methods: search was conducted using databases such as PubMed, Scopus, and Google Scholar. The search focused on peer-reviewed articles published in English using keywords like “Computer Vision Syndrome,” “Digital Eye Strain,” “university students,” and “prevalence.” Results: The literature indicates a high prevalence of CVS among students, which rates often exceeding 70%. Key contributing factors include prolonged screen duration, improper workstation ergonomics, inadequate lighting, and uncorrected vision problems. Effective interventions include ergonomic adjustments, adherence to regular visual breaks like the 20-20-20 rule, proper eye care, and the use of computer glasses. Conclusion: CVS is a significantly and highly prevalent occupational health issue among university students that can negatively impact academic performance and quality of life. This review serves as an essential tool for educators and healthcare practitioners by consolidating evidence on effective prevention and management. Future research prioritizes longitudinal studies to tract CVS progression, intervention-based trials to compare management strategies, and deeper investigations into the psychological impacts of chronic CVS symptoms.

Climate Change and Food Security in Rural Asia: A Systematic Review of Governance Systems and Livelihood Adaptations

2026-07-12T01:51:06+08:00

Climate change has emerged as a major threat to food security, particularly in rural regions of Asia where communities rely heavily on agriculture for their livelihoods. Variability in temperature, shifts in precipitation patterns, and increased frequency of extreme weather events disrupt agricultural productivity and food accessibility, intensifying vulnerabilities among rural populations. This study aims to systematically assess the direct and indirect effects of climate change on rural food security in Asia and to explore adaptation strategies implemented by rural communities. A systematic review was conducted following PRISMA guidelines, and searches were performed in ProQuest, Semantic Scholar, and PubMed. Eligibility criteria included qualitative or mixed-methods studies involving rural Asian populations and addressing food security outcomes. Five studies met the inclusion criteria. The review found that climate change directly threatens crop yield stability, livestock productivity, and food availability, while indirect effects include economic shocks, migration pressures, and heightened gender disparities. Identified adaptation strategies included climate-resilient agricultural practices, community-based governance mechanisms, cooperative systems, and local livelihood diversification. Strengthening governance systems, promoting climate-smart agriculture, and ensuring inclusive adaptation, particularly for women and marginalized farmers are crucial for building rural resilience and securing sustainable food systems.

Drivers and Consequences of International Forced Migration: A Narrative Review

2026-07-12T17:51:48+08:00

International forced migration remains one of the most pressing global challenges, affecting millions of refugees and asylum seekers compelled to flee their homelands due to conflict, persecution, unmet basic needs, or environmental stressors. The humanitarian and policy implications are profound, as host countries must balance limited resources with the responsibility to provide protection and integration opportunities. This narrative review synthesises recent evidence on the drivers and consequences of international forced migration and identifies measures that support adaptation and assimilation. In May 2024, PubMed and Scopus were searched for peer‑reviewed studies published between 2019 and 2024, complemented by Google Search to capture reports, guidelines, and policy documents from reputable international organisations. A Population, Exposure, Outcome (PEO) framework guided the search and synthesis, enabling integration of diverse study designs and contexts. The review identified five primary drivers: political instability and conflict, economic collapse, environmental disasters and climate change, social and cultural breakdown, and human rights abuses. Consequences for migrants include economic hardship, weakened social belonging, health challenges, and threats to human security, while host countries experience both strain and benefit. Adaptation measures, such as simplifying asylum processes, providing humanitarian support, enhancing sociocultural skills, and expanding educational and employment opportunities, were highlighted as essential. The findings underscore the need for governments, NGOs, and international agencies to strengthen asylum systems, embed migrant-inclusive policies, and address under-researched areas, such as climate-related displacement and long-term health outcomes. Future research should adopt mixed‑method and longitudinal designs to provide comprehensive evidence for policy and practice.

Factors Associated with Childhood Vaccine Hesitancy or Refusal in Malaysia: A Systematic Review

2026-07-12T17:59:38+08:00

Vaccine hesitancy and refusal have emerged as a significant public health concern worldwide. In Malaysia, despite the long establishment of the National Immunization Programme (NIP) since the early 1950s, childhood vaccine refusal cases are showing an upgoing trend. This has led to resurgence of vaccine-preventable diseases like measles and diphtheria in recent years. This systematic review aims to synthesize existing evidence on the prevalence and factors associated with childhood vaccine hesitancy or refusal in Malaysia. A comprehensive literature search was conducted across electronic databases including Scopus, ScienceDirect, and PubMed. The review followed PRISMA 2020 guidelines. Eligibility criteria included English-language articles published between 2015 and 2025, focusing on parental hesitancy or refusal on childhood vaccination in Malaysia. The quality of included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool. The review included six high-quality studies done in Malaysia. Prevalence of childhood vaccine hesitancy in the studies ranged from 6.8% - 11.6%. Key risk factors identified included sociodemographic characteristics (parental employment status, education level, religion and parity), concern about vaccine safety, knowledge and awareness about vaccines, cultural and religious belief, mistrust in healthcare system / modern medicine, external influence and risk perception. In order to sustain high immunisation coverage in the country, implementation of culturally sensitive, evidence-based strategies that strengthen public trust, enhance provider communication and counter misinformation is essential.

Frontal Sinus Anatomy for Human Identification in Forensic Anthropology: A Review

2026-07-12T18:07:43+08:00

The frontal sinus has become a valuable tool in forensic anthropology, offering a unique and resilient marker for human identification. Located within the frontal bone, these paired cavities possess distinct morphological characteristics that remain stable throughout life. Its intracranial location contributes to the preservation of the frontal sinus, making it particularly useful in cases where other skeletal structures are compromised. Despite its documented forensic utility, research on the frontal sinus remains concentrated on specific populations. Since forensic anthropology is inherently population-specific, this variation highlights the importance of developing reference data tailored to underrepresented populations. This review synthesizes current knowledge on the anatomical basis, forensic significance, and applications of the frontal sinus, while emphasizing future directions and the potential of emerging technologies in advancing its role in human identification.

Health System Financing Effect on The Outcome of Diabetes Management in Low-Middle Income Countries: A Systematic Review

2026-07-12T18:21:35+08:00

Background: Diabetes continues to rise sharply in low- and middle-income countries (LMICs), where fragmented health system financing contributes to poor clinical outcomes and heightened financial vulnerability. Updated global estimates indicate that 537 million adults were living with diabetes in 2021, with 81% residing in LMICs, and the number is projected to reach 643 million by 2030 (International Diabetes Federation, 2021). Understanding how financing models influence diabetes management outcomes is critical to advancing universal health coverage (UHC). Objective: To systematically review the effect of health system financing mechanisms on diabetes management outcomes including awareness, treatment, adherence, and glycemic control in LMICs. Methods: This systematic review followed PRISMA 2020 guidelines. Searches were conducted in PubMed, Scopus and SpringerLink for studies published from 2011–2021. Eligible studies included adult populations in LMICs, examined financing models and reported diabetes management outcomes. Two independent reviewers performed screening, extraction, and quality appraisal using the Joanna Briggs Institute checklist. Results: From 1,463 records screened, 10 studies met the inclusion criteria. Most studies reported high OOP spending as a major barrier to diabetes care, contributing to catastrophic health expenditure, poor treatment adherence, and delayed diagnosis. In contrast, insurance-based and subsidized financing models were associated with better medication affordability, improved follow-up, and higher treatment uptake, though service-level constraints such as limited primary care capacity continued to impede optimal outcomes. Themes identified included (i) financial access and affordability, (ii) care continuity and treatment adherence, and (iii) system readiness and primary care availability.Conclusion: Health system financing strongly shapes diabetes management outcomes in LMICs. Heavy reliance on OOP payments undermines adherence, early diagnosis, and continuity of care, whereas pooled financing mechanisms improve access and reduce financial hardship. Sustainable, equitable financing reforms aligned with strengthened primary care systems are essential for improving diabetes outcomes in LMICs.

Medical Imaging in Rural Sabah: Current Barriers and Emerging Solutions

2026-07-12T19:00:21+08:00

Access to medical imaging remains limited in rural Sabah, Malaysia, due to geographical barriers, inadequate infrastructure, and a shortage of skilled radiology personnel. These constraints hinder early disease detection and timely medical intervention, perpetuating health disparities between urban and rural populations. This review examines the importance of medical imaging in rural healthcare, outlines current challenges, and explores innovative approaches to improve service accessibility. Emerging solutions include the use of mobile imaging units, task-shifting to optimize available human resources, and public–private partnerships (PPPs) to leverage shared infrastructure and expertise. Furthermore, teleradiology and artificial intelligence (AI) offer transformative potential in enhancing diagnostic accuracy, workforce training, and efficiency. Drawing lessons from successful models in Malaysia, Uganda, Saudi Arabia, and China, this paper highlights the need for a sustainable, multi-sectoral approach integrating policy support, technology adoption, and local capacity building. Such efforts are essential to ensure equitable and high-quality diagnostic services for Sabah’s rural and underserved communities.

Navigating the Challenges of Hospital Digitalization in Southeast Asia: A Systematic Review

2026-07-12T19:10:53+08:00

The rapid advancement of digital technologies has transformed healthcare globally, offering opportunities to improve the efficiency, quality, and accessibility of health services. In hospital settings, digitalization involves the adoption of tools such as electronic health records (EHRs), telemedicine, artificial intelligence (AI), Internet of Things (IoT), and healthcare management software. These technologies have the potential to optimize workflows, enhance patient care, reduce operational costs, and support data-driven decision-making. However, the transition from traditional operations to digital systems poses significant challenges, particularly in regions like Southeast Asia, where healthcare infrastructure and policies vary widely between countries. This systematic review aims to explore the challenges of hospital digitalization, particularly in Southeast Asia, focusing on barriers that hinder the adoption, implementation, and integration of digital technologies in hospital settings. As healthcare systems transition towards digitalization, identifying and addressing challenges becomes critical to optimizing hospital operation, improved patient outcomes, and sustainable healthcare delivery. This review seeks to provide a comprehensive understanding of the factors impeding digital transformation, including technological, infrastructural, financial, and human resource limitations. The findings will contribute to identifying strategies and policy recommendations to facilitate the smooth transition to digital healthcare. This study followed PRISMA guidelines to ensure systematic and transparent reporting. Articles were retrieved from ProQuest, Semantic Scholar, and PubMed databases, focusing on peer-reviewed literature published in English between 2019 and 2024. Six articles which met the inclusion criteria were analysed, and the findings were categorised to identify common themes. Five themes identified related to the challenges include: (1) System and data organization, (2) Patients as beneficiaries, (3) Human resources, (4) Exposure to digital tools, and (5) Facility environment. Understanding the specific barriers to digitalization is crucial for developing targeted interventions and strategies and helping policymakers, healthcare administrators, and managers to develop practical solutions for sustainable digital transformation in healthcare.

The Associated Risk Factors for Perinatal Depression Among Teenage Mothers – A Narrative Review

2026-07-12T19:38:40+08:00

Introduction: This narrative review focuses on the risk factors of depression in perinatal teenage mothers, a significant global health concern with implications for mother and child’s health. Perinatal depression is a common mental health disorder that affects a significant proportion of teenage mothers worldwide. Depending on the area and population under study, research has revealed that the prevalence of perinatal depression in adolescent women can vary from 33.2% to 74.3%. Given these concerns, this narrative review aims to examine the risk factors contributing to PND in perinatal teenage mothers, synthesizing evidence from global studies to inform targeted interventions. Methodology: This narrative review examined studies published in English from 2014 to 2024, sourced from Google Scholar, ScienceDirect, Scopus, PubMed, and ResearchGate. A structured search strategy was applied using Boolean operators (AND/OR) and Medical Subject Headings (MeSH) terms to identify studies on risk factors of perinatal depression among adolescent mothers. Studies were screened based on title, abstract, and full text, with inclusion criteria focusing on those addressing specific risk factors for perinatal depression in teenage mothers. The SANRA scale was used to assess study quality, ensuring methodological rigor. Key findings were thematically categorized and synthesized to identify common patterns and gaps in existing literature. Results: This review identifies key factors contributing to perinatal depression among teenage mothers, including socio-demographic, economic, cultural, and trauma-related factors. Low education, single status, and financial hardship were linked to higher depression risk due to limited resources and healthcare access. Stigma, social isolation, and cultural expectations further exacerbated mental health challenges. Additionally, trauma and polyvictimization, such as childhood abuse and partner violence, significantly increased depression risk. These findings highlight the need for holistic interventions addressing social, economic, and psychological determinants. Conclusions: Perinatal depression is a significant concern among adolescent mothers, influenced by multiple social, economic, and psychological risk factors. This review underscores the need for targeted interventions, early screening, and effective mental health support to mitigate its impact. Addressing these gaps through research and policy development is crucial to improving maternal and child health outcomes.

Urban-Rural Disparities in Food Insecurity and Nutritional Health: A Narrative Review

2026-07-12T19:48:16+08:00

Food insecurity affects an estimated 2.33 billion people, with a stark disparity between rural and urban populations. This review synthesizes the distinct drivers and health outcomes of this divide, a comparison made more urgent by recent climate and economic shocks. Rural food insecurity is primarily driven by climate vulnerability and agricultural dependency, often leading to undernutrition. Conversely, urban insecurity stems from market dependency and income instability, promoting a reliance on ultra-processed foods that contributes to rising obesity. This urban-rural dichotomy creates a global triple burden of malnutrition. Addressing this requires moving beyond siloed policies toward an integrated financial and systemic approach. Mobilizing investment to strengthen food supply chains and build resilience is essential for achieving equitable access to nutritious food.

α-Mangostin in Diabetic Wound Healing: Roles of Growth Factors and Endothelial Dysfunction

2026-07-12T19:56:28+08:00

Diabetic foot ulcers (DFUs) represent one of the most debilitating complications of diabetes mellitus, largely driven by impaired wound healing processes, endothelial dysfunction, and dysregulated growth factor activity. Normal wound repair is orchestrated by a coordinated sequence of cellular and molecular events involving macrophages, fibroblasts, and endothelial cells, with growth factors such as PDGF, VEGF, TGF-β, bFGF, and CTGF playing central roles. In diabetic conditions, however, hyperglycemia-induced oxidative stress, reduced nitric oxide availability, and chronic inflammation disrupt these pathways, leading to delayed angiogenesis and poor tissue regeneration. Natural products have emerged as promising alternatives for chronic wound management, owing to their antioxidant, anti-inflammatory, and pro-angiogenic properties. Among these, α-mangostin, the predominant xanthone in the mangosteen (Garcinia mangostana) pericarp, has demonstrated potent anti-inflammatory and proliferative effects in vitro, accelerating fibroblast migration and suppressing cytokines such as IL-6 and IL-8. While most studies to date have focused on normal wound models, evidence suggests that α-mangostin may also modulate endothelial function and growth factor signaling under diabetic conditions. This review synthesizes current knowledge on growth factor regulation, endothelial dysfunction, and the therapeutic potential of α-mangostin in diabetic wound healing. Understanding these mechanisms may provide a foundation for developing cost-effective, locally sourced, natural product-based therapies to reduce the clinical and economic burden of DFUs.