Abstract: Preliminary evidence suggests air pollution, particularly fine particulate matter 2.5 (PM2.5), poses a significant threat to maternal health and women of reproductive age. While emerging evidence suggests a link between air pollution and maternal anemia, the specific effect of PM2.5 exposure on hemoglobin levels among reproductive-aged women (15-49 years) remains insufficiently studied. Maternal hemoglobin decline is a known risk factor for adverse pregnancy outcomes with potentially long-term consequences. Understanding the impact of PM2.5 exposure is crucial in regions like Sub-Saharan Africa, where both anemia rates and air pollution levels are significantly elevated. This population-based study investigates the association between ambient PM2.5 concentrations and maternal hemoglobin levels across 43 Sub-Saharan African countries from 2000-2019. Using generalized linear regression models adjusted statistically significant negative association between PM2.5 exposure and hemoglobin levels were observed in Central Africa, while no significant associations were found in Eastern, Western, or Southern Africa. These results suggest that PM2.5 may be an environmental determinant of maternal anemia, with effects that vary by geography. Further research is needed in understudied regions to validate and expand on these findings.

Abstract: Objective. To evaluate the prevalence, risk factors, aetiology, and management of traumatic dental injuries (TDIs) among children aged 1–18 years attending the De-partment of Pediatric Dentistry, Damascus University, Syria, during 2023–2024, and to illustrate representative clinical cases with documented outcomes. Methods. This ret-rospective cross-sectional study reviewed 2,716 patient records (2023–2024) and identi-fied 301 children with TDIs. Demographic, clinical, and behavioural variables were ex-tracted and analysed using χ², t tests, ANOVA, and binary logistic regression (IBM SPSS v26). Results. The overall TDI prevalence was 11.08%. Males were over twice as likely as females to experience TDIs (OR = 2.30; 95% CI = 1.76–3.01; p < 0.001). Older age acted as a protective factor (OR = 0.56; 95% CI = 0.43–0.74; p < 0.001). Falls were the most common cause (63.7%), and injuries most often occurred at home (48.9%). The maxillary central incisors were most frequently affected (68.5% of cases). Children with special healthcare needs had significantly more traumatised teeth (mean = 2.61 ± 1.13) than healthy chil-dren (1.66 ± 0.92; p < 0.001). Nearly half of the patients (45.3%) presented > one month after injury, and asymptomatic apical periodontitis and reversible pulpitis were the most frequent diagnoses. Representative case presentations demonstrated multidisci-plinary management using restorative, endodontic, and orthodontic approaches with favourable follow-up outcomes. Conclusions. TDIs affected about one in nine children in this Syrian cohort. Male gender, younger age, and previous trauma were key risk factors. The predominance of delayed presentation underscores the need for community education, early referral systems, and targeted preventive programs within school and home environments.

Abstract: Breast ultrasound image segmentation and classification are the two crucial steps for early diagnosis of cancer. In this work we developed a breast cancer segmentation and multiclass classification artificial intelligence tools based on pretrained models. The proposed workflow includes both the development of a segmentation model architecture and second the development of a series of classification models to classify the ultrasound greyscale images into normal, benign or malignant. The training and testing of the pretrained models were performed using the Breast Ultrasound Images (BUSI dataset). For the image segmentation task, the models were trained on the images while using masks as target variable. In the multiclass classification, each image was provided with accurate label “benign”, “normal” or “malignant” and used to train a multiclass classifier. Optuna was used for hyperparameter optimization and for the testing of various pretrained models to determine the best encoder (ResNet18, EfficientNet-B0 & MobileNetV2)-decoder (U-Net, U-Net++, DeepLabV3) image segmentation architecture. For multiclass classification, five different pretrained models (ResNet18, DenseNet121, InceptionV3, MobielNetV3, GoogleNet) were optimized and tested for their ability to classify breast cancer images. The developed Image segmentation models performed well in terms of delineating the lesion in the breast ultrasound images. DeepLabV3 outperformed other segmentation architectures with consistent performance across train, validation and test images with Dice Coefficients of 0.87, 0.80 and 0.83 respectively. ResNet18:DeepLabV3 achieved an Intersection over Union score of 0.78 during training. ResNet18: U-net++ achieved best Dice coefficient (0.83) and IoU (0.71) and AUC score of 0.91 on the test (unseen) dataset when compared to other models. For classification of breast cancer images, ResNet18 achieved an F1 score of 0.95 and an accuracy of 0.90 on the train dataset, while InceptionV3 outperformed other models on the test dataset with an F1 score of 0.75 and accuracy of 0.83. We demonstrate a comprehensive approach to automate the image segmentation and multiclass classification of breast cancer ultrasound images into benign, malignant or normal using transfer learning models on an imbalanced ultrasound image dataset.

Abstract: Anemia is a major public health concern in South Asia, a region where febrile illnesses and nutritional deficiencies are prevalent. While the environment is a key contributor to maternal anemia, there is limited availability of research on the association between ambient temperature and maternal anemia. This longitudinal population-based study with multiple covariates, utilizing population-level data, examines the relationship between climate change and maternal anemia over the period of 2010 to 2022. Using a negative binomial regression model adjusted for covariates, we modeled the region-specific (n = 8 nations) relationships between annual anemia prevalence in women of reproductive age (15-49 years old) and annual maximum temperatures. After adjustment, the statistical analysis revealed distinct regional differences, with an overall statistically significant but weak association between maternal anemia and maximum temperature. These findings underscore ambient temperature as a determinant of anemia risk in women of reproductive age in South Asia. Further research with larger datasets is needed to clarify causal mechanisms and strengthen evidence for developing climate-specific strategies to address the temperature-related anemia risk. Climate-centered approaches would reduce the large-scale impact of climate-related diseases and improve overall reproductive health.

Abstract: Background: caring for a child with Autism Spectrum Disorder (ASD) entails consid-erable emotional, social, and economic demands for families, who frequently experi-ence high levels of stress. Such parental stress can affect caregivers’ mental health and family dynamics, making its early detection and management essential. Objective: to analyse the level of parental stress among parents of children with ASD affiliated with the Ánsares Association (Huelva, Spain), taking into account relevant sociodemo-graphic variables. Methods: a quantitative, descriptive, cross-sectional study was conducted with 57 relatives of children with ASD (75.4% women, 22.8% men). The Parenting Stress Index – Short Form (PSI-SF) and a sociodemographic questionnaire collecting information on age, marital status, educational level, occupation, number of children, religious beliefs, and external caregiving support were used. Descriptive and bivariate analyses were performed using correlation and mean comparison tests. Re-sults: a total of 13.7% of participants showed clinically significant stress levels and 9.8% presented high levels. No statistically significant associations were found with sociodemographic variables, although trends toward greater stress were observed among women and parents without external support. Conclusion: these findings are consistent with previous literature and highlight the importance of providing psy-choeducational and emotional support programmes for families. They also emphasise the role of nursing in the early detection of distress and the comprehensive support of caregivers, thereby contributing to improved family quality of life.

Abstract: Background: Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system that causes progressive disability and psychosocial burden. Understanding how MS affects patients’ quality of life (QoL) is essential for developing patient-centered rehabilitation and psychosocial support interventions. Methods: A cross-sectional study was conducted among adults diagnosed with MS residing in Western Greece. Data were collected using the Multiple Sclerosis Quality of Life-54 (MSQOL-54) questionnaire. Demographic and clinical variables (age, gender, disease duration, and functional status) were analyzed using descriptive and inferential statistics. Pearson correlation and multiple regression analyses were performed to identify factors associated with QoL domains. Additionally, a systematic literature review following PRISMA guidelines was integrated to contextualize findings within the broader evidence base on MS-related QoL. Results: The study included 128 participants (72% female, mean age 39.8 ± 9.4 years). Overall QoL scores indicated moderate impairment (mean composite physical score = 53.6; mental health = 57.4). Fatigue, pain, and depressive symptoms were strongly correlated with lower QoL (p < 0.001). Longer disease duration and higher disability (EDSS ≥ 4) predicted poorer physical functioning. Conversely, higher perceived social and family support predicted better psychological adaptation and higher mental health scores (β = 0.42, p < 0.01). The PRISMA review synthesized 45 studies, confirming disability, fatigue, and depression as universal risk factors, while social support and resilience-building interventions emerged as protective elements. Conclusion: MS substantially impacts both physical and psychosocial dimensions of life. The findings emphasize the importance of integrated care models that combine medical treatment with psychosocial and rehabilitation programs focusing on resilience, coping, and social support. Early interventions may mitigate QoL deterioration and promote holistic well-being. Regional disparities in Western Greece highlight the need for tailored, accessible services.

Abstract: The Nepal Pharmacy Council (NPC) Act, 2057 BS (2000 AD), established the statutory body responsible for regulating pharmacy education, professional standards, and ethical practice in Nepal. Since its inception, pharmacy education has expanded significantly, from the initial PCL programs in 1972 to widespread Diploma, B. Pharm, M. Pharm, Pharm D, and Ph.D. programs across public and private institutions. Similarly, Nepal’s pharmaceutical industry and hospital pharmacy services have grown, yet challenges remain, including workforce shortages, uneven professional distribution, limited clinical integration, and underdeveloped regulatory enforcement. This study critically analyzes the NPC Act using a qualitative, document-based approach, employing SWOT analysis and international comparisons with legal frameworks from countries including the USA, UK, Australia, India, Japan, South Korea, and EU nations. Key findings indicate that while the Act provides foundational regulation, it lacks provisions for modern pharmacy roles, continuing professional development (CPD), research promotion, digitalization, and integration of pharmacists into public health and clinical services. Suggested amendments include revising the Council’s functions, enhancing merit-based governance, instituting mandatory CPD, clarifying roles of pharmacists and assistants, strengthening inspection and accreditation, and aligning with global standards. Implementing these reforms would modernize pharmacy regulation in Nepal, ensure high-quality education, strengthen healthcare integration, and enhance public safety.

Abstract: Background: Approximately one quarter of community-dwelling older adults experience at least one fall each year. Falls can result in soft tissue injuries, fractures, or even death. Given this high prevalence, it is essential to identify fall-related risk factors, develop predictive models, and prescribe effective exercise-based interventions to prevent falls. Objective: To analyze risk factors, predictors, and therapeutic interventions for falls in older adults. Methods: A literature search was conducted in SCIELO, PUBMED, and PEDro databases between October 15–20, 2025. Inclusion criteria comprised peer-reviewed, open-access studies in English published from 2020 onward. Findings were categorized into three domains: (1) fall risk factors, (2) predictive models, and (3) exercise-based interventions. Twenty studies met the inclusion criteria. Results: Falls among older adults arise from multifactorial interactions involving physical, clinical, cognitive, and social factors such as impaired mobility, comorbidities, polypharmacy, and cognitive decline. Lower-limb strength and functional performance are key determinants of fall risk. Current predictive models show limited accuracy, with fall history as the strongest predictor. Exercise-based interventions, particularly multicomponent and home-based programs, improve balance, strength, and mobility but show variable effects on fall rates. The absence of standardized parameters for exercise prescription limits the development of evidence-based guidelines. Conclusion: Falls in older adults are multifactorial events influenced by physical and cognitive decline. Predictive models remain imprecise, and although exercise interventions improve functional outcomes, their impact on reducing falls is inconsistent. Standardized exercise protocols are needed to optimize fall prevention strategies.

Abstract: Objective: To analyze the correlation between clinical and subjective oral health indicators and quality of life in pediatric patients with Complex Chronic Conditions (CCC). Methods: A cross-sectional study was conducted with 63 pediatric patients with CCC. Data collection in a hospital setting involved oral clinical examinations using the Simplified Oral Hygiene Index, caries experience (DMFT/dmft), gingival bleeding, and Dental Aesthetic Index. Oral health-related quality of life (OHRQoL) was measured using the Parental-Caregivers Perceptions Questionnaire (P-CPQ), completed by caregivers. Correlations between indicators and quality of life scores were analyzed using Spearman's correlation coefficient (ρ), with a significance level of p < 0.05. Results: Poor oral hygiene was observed in 34.9% of participants (mean OHI = 2.03) and a dmft index of 1.67. Gingival bleeding was present in more than 30% of sites in 47.6% of children, and severe or very severe malocclusion was observed in 47.6%. Overall oral health-related quality of life (OHRQoL) had a mean score of 26.38, with the functional limitation domain being the most affected. There were no correlations between objective clinical indicators and quality of life domains. However, the subjective perception of "difficulty biting or chewing" showed a strong and significant correlation with the functional limitation domain (ρ = 0.823; p < 0.001) and with overall quality of life (ρ = 0.812; p < 0.001). Conclusion: Functional perception (chewing difficulty) proved to be a more sensitive indicator of the impact on OHRQoL in children with chronic heart disease (CHD) than traditional clinical indices. These findings underscore the importance of incorporating subjective and functional assessments into oral health care strategies for this vulnerable population.

Abstract: Background: Financial stress can lead to emotional and psychosocial distress among informal caregivers of older adults and can have a profound impact on their overall wellbeing. While social support may buffer financial stress, the role of gender in moderating these relationships is less understood. This study examined whether gender moderates the associations between psychosocial distress, social support, and financial well-being among informal caregivers of older adults. Methods: A cross-sectional survey was conducted with a sample of N=589 caregivers; after listwise deletion, N=533 with complete data were analyzed. Financial well-being was measured using the Consumer Financial Protection Bureau (CFPB) Financial Well-Being Scale, psychosocial distress with a five-item distress scale, and social support with the OSSS-3. Gender, sociodemographic characteristics, and caregiving status were also collected. Independent t-tests, ANOVA, Pearson correlations, and multivariable linear regressions with interaction terms were used to assess the relationships among the study variables. Results: Male caregivers reported significantly higher financial well-being than females (52.66 vs. 50.12, p = 0.036). Stronger social support was associated with greater financial well-being (mean difference = 11.80, p < 0.001). Psychosocial distress was negatively correlated with financial well-being (r = –0.49, p < 0.001). Regression analyses revealed significant gender moderation: distress reduced financial well-being more sharply for males, while strong social support benefited females more substantially than males. Older age, higher income, and better self-rated health were also positively associated with financial well-being. Conclusion: Findings highlight gender-specific patterns in how psychosocial distress and social support influence financial well-being among caregivers. Intervention should be tailored to gender specific needs while addressing stress reduction and social support enhancement to improve financial well-being of informal caregivers of older adults.

Abstract:

Background: Lipedema is a chronic condition whose public awareness and detection is constantly growing, yet without strongly validated therapeutic opportunities. Objectives: Given the need to direct lipedema patients toward appropriate management approaches and the demand for new studies and methods, this invetigation aimed to assess the effects of a combined treatment consisting of extracorporeal shock wave therapy (ESWT), manual lymphatic drainage (MLD), intermittent pneumatic compression (IPC), and lifestyle recommendations compared to a 5-week control period prior to treatment in patients with lipedema. Methods: Retrospective evaluation of patients undergoing a 5-week control period with lifestyle recommendations followed by a 5-week treatment period (10 sessions) with a standardized protocol including ESWT, MLD and IPC. Circumference measurements at three designated points on the lower extremities were recorded at the start and end of the control period, and before and after treatment. Results: Data from 55 female patients (age: 46.9 ± 11.9 years, body mass index [BMI]: 29.54 ± 7.33 kg/m²) who completed both the control and treatment periods were included. Analysis of measurement changes over time showed significant improvements in 3 of 6 measured points during the control period, with no significant changes at other levels. In contrast, significant improvements were observed at all levels after treatment (p < 0.01). Conclusion: The combined use of ESWT, MLD, IPC, and lifestyle recommendations was found to be an effective method for managing lipedema treatment. Further studies on the relative impact of each and everyone of these 3 therapeutic components are encouraged.

Abstract:

Systemic lupus erythematosus (SLE) is a complex autoimmune disorder marked by autoantibody production and immune complex (IC) formation, leading to widespread inflammation and tissue damage. Neutrophil extracellular traps (NETs) — web-like structures of DNA, histones, and antimicrobial proteins — support innate immunity but drive SLE pathogenesis when dysregulated. This review examines SLE-specific NET mechanisms, their crosstalk with oxidative stress, and their therapeutic potential as antioxidants. SLE patients exhibit excessive NET formation, driven by proinflammatory low-density granulocytes (LDG) and ICs, and impaired NET clearance (reduced DNase1/DNase1L3 activity or anti-nuclease autoantibodies), leading to circulating NET accumulation. These NETs act as autoantigen reservoirs, forming pathogenic NET–ICs that amplify autoimmunity. Oxidative stress (via NADPH oxidase) and various mitochondrial reactive oxygen species (ROS) promote NETosis; antioxidants (both enzymatic and non-enzymatic) can inhibit NET formation by scavenging ROS or blocking NADPH oxidase. Preclinical studies show that curcumin, resveratrol, and mitochondrial-targeted MitoQ reduce NETs and lupus nephritis; clinical trials confirm that curcumin and N-acetylcysteine (NAC) lower SLE activity and proteinuria, supporting their potential as safe adjuvant therapies. However, high-dose vitamin E may exacerbate autoimmunity. Future research should clarify NET mechanisms in SLE and optimize antioxidant therapies (e.g., bioavailability, safe dosage and long-term safety).

Abstract: Avian influenza viruses (AIVs), including H5N1 and H7N9, from the Orthomyxoviridae family present substantial public health concerns. Unlike H7N9’s limited host range, H5N1 infects birds, various mammals, and humans. Recent concerns include widespread H5N1 infection of U.S. dairy cattle across 17 states affecting over 1000 herds with 41 human infections. Key observations include cow-to-cow transmission, viral presence in milk, and transmission to humans, mainly through occupational exposure. Evidence of mam-mal-to-mammal transmission has been documented in European and Canadian foxes and South American marine mammals. Standard pasteurization effectively inactivates the virus in milk. The continuing mammalian adaptations, particularly mutations like PB2-E627K, suggest potential for further evolution in new hosts, emphasizing the need for enhanced surveillance to mitigate pandemic risks.

Abstract:

Klebsiella pneumoniae is a prominent pathogen implicated in a wide range of infections, including pneumonia, urinary tract infections, and septicemia. Its ability to acquire and disseminate antibiotic resistance, coupled with the rising prevalence of hypervirulent strains, represents a significant public health threat. Understanding the molecular basis of drug resistance can guide the design and development of effective treatment strategies. Antimicrobial resistance (AMR) in these bacteria is a complicated process and cannot be attributed to only a single resistance mechanism. K. pneumoniae develops resistance to antibiotics through a variety of mechanisms, ranging from single molecular mechanisms to complex interactions, where molecular synergy exacerbates resistance. This review summarizes the current understanding of the molecular mechanisms that contribute to the drug resistance and virulence of this pathogen. Key antibiotic resistance mechanisms include drug inactivation via B-lactamases and carbapenemases, membrane remodeling, efflux pump systems, such as AcrAB-TolC and OqxAB, and biofilm formation facilitated by quorum sensing. Additionally, the role of ribosomal changes in resistance was highlighted. This review also examines the mechanisms of virulence, emphasizing fimbriae, iron acquisition systems, and immune evasion strategies. Understanding these mechanisms of drug resistance and virulence is crucial for remodeling existing antibiotics and developing new therapeutic strategies.

Abstract: This study investigates the impact of engagement with online health platforms (OHPs), perceived treatment effectiveness, and country of residence on patient attitudes toward atrial fibrillation (AF) treatments, mediated by threat perception and behavioral evaluation within an adapted Health Belief Model (HBM). A cross-sectional survey conducted in June 2024 included 589 members of two professionally curated OHPs: the AFIP Foundation (Netherlands) and StopAfib.org (United States). Data were analyzed using Structural Equation Modeling (SEM) to examine both direct and indirect relationships among engagement behaviors, perceived treatment effectiveness, country of residence, and patient attitudes toward AF treatments (PAAT). Results indicate that higher engagement (i.e., frequency of OHP visits and time spent on the OHP) positively predicts more favorable PAAT, whereas the number of content types consumed showed no significant mediating effect via threat perception or behavioral evaluation. By increasing awareness of AF and reinforcing the perceived effectiveness of treatments, OHPs can serve as effective tools for patient education and support. From a managerial perspective, these findings provide actionable insights for platform operators and healthcare stakeholders on which engagement factors most effectively enhance patient attitudes toward treatment options.

Abstract: Childhood obesity is a growing global public health challenge, defined primarily by body mass index (BMI) and driven by a combination of reduced physical activity, unhealthy diets, and environmental factors. Overweight in early young age may continue into the adult stage and is associated with physical, psychological challenges, and lower school performances. Beyond increasing the risk of chronic physical conditions, obesity in children is strongly associated with mental health issues such as depression, anxiety, and low self-esteem, often exacerbated by social stigma and body dissatisfaction. Mental health conditions are also an important factor in children with obesity. This review summarizes the development of childhood obesity due to consumption of junk food regularly, lack of outdoor physical activities, and increased screen time, playing video games, inaccessibility of healthy foods, and environment. In addition, this review summarized how overweight children suffer from various mental health conditions such as anxiety, peer pressure, depression, low school performances, and stress creating a cycle that affects both physical and emotional well-being. Effective prevention and management require integrated strategies, including promoting physical exercise, improving nutrition, supporting mental health, and implementing comprehensive community and policy interventions.

Abstract: This paper presents a comparative analysis of food security in tropical nations, using the framework established in the authors' 1981 study, "Considerations on the Food Situation in Tropical Countries and Future Perspectives." The original work introduced a prescient model defining agricultural productivity efficiency by the critical balance between Primary Energy (E1) direct climatic factors - and Secondary Energy (E2) - man-made inputs like irrigation and fertilizers. The 1981 diagnosis concluded that chronic underproduction was rooted in the socioeconomic barrier posed by the high cost of E2 inputs. Forty-five years later, the analysis reveals a bifurcated and discouraging legacy. While global quantitative metrics show dramatic reductions in chronic hunger and infant mortality, these gains are counterbalanced by profound systemic regression. The core structural constraints identified in 1981- land degradation, genetic uniformity, and technological inaccessibility - have intensified, morphing into global threats exacerbated by climate change. Crucially, the E1 constraint has become critically unstable, with rising temperatures nullifying E2 technological gains (AI, precision agriculture). Furthermore, the cost barrier of E2 has been magnified by geopolitical volatility, rendering essential inputs unaffordable and reaffirming the original prediction that structural solutions were necessary over simple resource injection. The ultimate failure is hypothesized to be systemic: a foundational misalignment where trillions of dollars in development aid prioritized short-term yield over long-term ecosystem health and governance reform, breaking the "total commitment" mandate set in 1974. To reverse this trajectory, future policies must shift focus from mere production increases to the algorithmic construction of resilience, mandating investments in rural infrastructure and equitable E2 access. The authors, whose warnings went unheeded in 1981, conclude by questioning whether this contemporary, data-driven diagnosis will finally compel the necessary systemic change, even as past experience tempers optimism.

Abstract: Background: Energy drink consumption among adolescents has surged globally, raising serious public health concerns due to associated risks such as insomnia, hypertension, increased heart rate and anxiety. Despite this, adolescents often remain unaware of the dangers posed by energy drink ingredients like caffeine and sugar. In Pakistan, where health education on such topics is limited, this study aimed to assess adolescents’ knowledge about the adverse health effects of energy drink consumption.Methods: A cross-sectional survey was conducted with 50 adolescents aged 15–18 years in Karachi, selected via purposive sampling from public venues (e.g., malls, parks). Participants completed a 12-item Likert-scale questionnaire assessing their knowledge on energy drink ingredients, effects, and usage. Scores were categorized into low (12–24), moderate (25–36), and high (37–60) awareness. Statistical analyses included descriptive statistics, t-tests, and Chi-square tests using SPSS (v25).Results: The mean awareness score was 25 (SD = 4.78). A majority (72%) fell into the low-awareness category. No statistically significant differences in awareness were found by gender (p = .33) or age group (p = .25), suggesting a uniformly low level of knowledge across the sample. While older adolescents (17–18) showed slightly higher awareness, the difference was not substantial.Conclusion: Findings reveal widespread knowledge deficits among adolescents regarding energy drink risks, irrespective of age or gender. This highlights the need for targeted, age-appropriate health education through schools and digital media to improve awareness and mitigate potential harm.

Abstract: Background/objectives: Dietary diversity, a key indicator of diet quality and nutritional status, remains poorly documented in Kinshasa’s urban and rural area for children under five years of age. This study aimed to identify factors associated with dietary diversity among children aged 24–59 months. Methods: A community based cross-sectional survey was conducted in December 2024 among 348 children aged 24–59 months, selected through a three stages random sampling. Dietary diversity was assessed using Dietary Diversity Score (DDS), defined as consumption of at least five of the eight food groups in the previous 24 hours. Multivariate regression logistic analyses were performed to identify determinants of adequate dietary diversity. Results: Among the 348 children, 63.5% achieved adequate dietary diversity. Higher odds ratio were observed among children age 48-59 months (aOR = 1.87; 95% CI: 1.02–3.43), from Christian households (aOR = 2.50; 95% CI: 1.02–6.10), of high socioeconomic status (aOR = 1.88; 95% CI: 1.003–3.51), and living in rural areas (AOR = 1.65; 95% CI: 1.02–2.66). Conclusion: Improving dietary diversity requires integrated strategies combining early child-feeding interventions, socioeconomic support, and promotion of local food production, particularly in low-income urban and rural settings.

Abstract: This report describes the development and deployment of the Public Health Quality Tool, an online resource designed to help mobile health clinics (MHCs) assess and improve the quality of their public health services. MHCs provide essential clinical and public health services to underserved populations but have historically lacked tools to assess and improve the quality of their work. To address this gap, the Public Health Quality Tool (PHQTool) was developed as an online, evidence-based, self-assessment resource for MHCs, hosted on the Mobile Health Map (MHMap) platform. Drawing from national public health frameworks and Honore et al.’s nine quality aims, the PHQTool focuses on six aims most relevant to mobile care: Equitable, Health Promoting, Proactive, Transparent, Effective, and Efficient. Development included expert consultation, pilot testing, and iterative refinement informed by user feedback. The tool allows clinics to evaluate practices, identify improvement goals, and track progress over time. Since implementation, 82 MHCs representing diverse organizational types have used the PHQTool, reporting high usability and identifying common improvement areas such as outreach, efficiency, and equity-driven service delivery. The PHQTool facilitates systematic quality assessment within the mobile clinic sector and supports consistent documentation of public health efforts. By providing a standardized, accessible framework for evaluation, it contributes to broader efforts to strengthen evidence-based quality improvement and promote accountability in MHCs.