Innovative strategies for the surveillance, prevention, and management of pediatric infections applied to low-income settings

ABSTRACT

Introduction

Infectious diseases still cause a significant burden of morbidity and mortality among children in low- and middle-income countries (LMICs). There are ample opportunities for innovation in surveillance, prevention, and management, with the ultimate goal of improving survival.

Areas covered

This review discusses the current status in the use and development of innovative strategies for pediatric infectious diseases in LMICs by focusing on surveillance, diagnosis, prevention, and management. Topics covered are: Minimally Invasive Tissue Sampling as a technique to accurately ascertain the cause of death; Genetic Surveillance to trace the pathogen genomic diversity and emergence of resistance; Artificial Intelligence as a multidisciplinary tool; Portable noninvasive imaging methods; and Prognostic Biomarkers to triage and risk stratify pediatric patients.

Expert opinion

To overcome the specific hurdles in child health for LMICs, some innovative strategies appear at the forefront of research. If the development of these next-generation tools remains focused on accessibility, sustainability and capacity building, reshaping epidemiological surveillance, diagnosis, and treatment in LMICs, can become a reality and result in a significant public health impact. Their integration with existing healthcare infrastructures may revolutionize disease detection and surveillance, and improve child health and survival.

KEYWORDS:

• MITS
• bedside technology
• biomarkers
• child mortality
• infectious diseases
• artificial intelligence, low-income countries
• pediatrics
• ultrasonography

Article highlights

• The traditional research approaches in pediatric infectious diseases often face substantial barriers in low- and middle-income countries, such as scarce funding, limited infrastructure, lack of technical expertise, or logistical difficulties. This review discusses the current use and status of development of innovative strategies to overcome these hurdles.

• Minimally invasive tissue sampling, also known as minimally invasive autopsy, is a postmortem technique to accurately ascertain the cause of death in children using fine needles to obtain samples from key organs, amenable to high-quality diagnostic techniques.

• Genetic surveillance involves developing international collaborative networks to trace pathogen genomic diversity and emergence of resistance in diseases such as malaria, tuberculosis, HIV, or COVID-19.

• Artificial intelligence is a multidisciplinary tool for imaging processing, epidemiological modeling, or language processing systems.

• Portable noninvasive imaging devices are attractive and accessible methods for screening and diagnosing malaria, tuberculosis, pneumonia, or meningitis.

• Host-response prognostic biomarkers related to endothelial and immune activation can be measured in point-of-care devices to triage and risk-stratify sick patients, and identify children at risk of dying.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

DT receives the support of a fellowship from “La Caixa” Foundation (ID 100010434). The fellowship code is “LCF/BQ/DR21/11880018”. ISGlobal acknowledges support from the grant CEX2018-000806-S funded by MCIN/AEI/10.13039/501100011033, and support from the Generalitat de Catalunya through the CERCA Program.