External quality assessment is the process of evaluating the performance of a laboratory and the competence of professionals. Participation in EQA and standardizing the quality of laboratory services are a mandatory requirements for accreditation. This review is aimed at identifying and discussing challenges that hinder the effective implementation of an EQA program in countries with resource limited setting. To obtain abundant information, articles were identified by searching the literature publishedin English using the National Library of Medicine, PubMed, Science Direct and AMC digital library databases. The articles identified in the references were manually searched and included. After the article was identified, it was imported to Endnote version 8.1 and exported to Microsoft Word for citation. Based on this review, the major identified challenges that hinder the implementation of an EQA program include the high cost of control materials, malfunction and lack of maintenance for equipment failure and breakdown, a knowledge gap among laboratory professionals, noncommutability of control samples, and difficulty in assigning target values. In addition, failing to participate in EQA and failing to take corrective action are the major challenges identified. As a result, applying to an EQA program in resource-limited counties was highly challenging. To attain high performance in the laboratory and to provide quality laboratory service for patient care, the EQA supplier and the user laboratory must pay attention to these issues and take appropriate corrective actions for ongoing quality improvement and accreditation.

Background: Children in refugee camps, due to their living conditions, are the most vulnerable groups to suffer from anemia. Nutritional deficiencies, especially iron deficiency is the most common causes of anemia. However, there is limited information on the prevalence and associated factors of anemia in Ethiopia. Hence, this study aimed to assess the prevalence and associated factors of anemia among internally displaced children at Debark refugee camp, Northwest Ethiopia.Methods: A cross-sectional study was conducted on 354 internally displaced children, at Debark refugee camp from March to May 2022. A systematic sampling technique was employed. The socio demographic characteristics were collected by using structured questionnaire via face-to-face interview with the caregivers. The hemoglobin level was determined using HemoCue301+. Form anemic children, venous blood sample was collected for iron profile analysis. Parasitological and anthropometric measurements were also done. The data were entered using Epi-data version 4.6.0.6 and exported to STATA version 14 for analysis. Bi-variable and multivariable binary logistic regression analysis were done. Both crude odds ratio and adjusted odds ratio with the corresponding 95% confidence interval were calculated to measure the strength of association. P-Value < 0.05 was considered as statistically significant association.Results: From the total of 354 children included in this study, more than half (54.8%) of them were male. The median age of children was 7 years with interquartile range of (4–10) years. The total prevalence of anemia in this study was 33.62% (95% CI:28.7, 38.7). Moderate type anemia was predominant in this study. From anemic children 30 (25.2%) had iron deficiency anemia. In this study, low dietary diversity (AOR = 4.9; 95% CI: 2.0, 11.7), duration in the camp more than six months (AOR = 4.2; 95% CI:1.9, 9.4), presence of diarrhea (AOR = 2.7; 95% CI:1.3, 5.7), fever (AOR = 3.4; 95% CI:1.6, 7.1), and wasting (AOR = 3.6; 95% CI:1.3, 10.3) were significantly associated with the prevalence of anemia.Conclusion: Anemia was moderate public health problem in the current study. Focused policies and strategies towards to internally displaced children should be designed to reduce anemia, by preventing the significant risk factors associated with anemia.

Background: Thyroid neoplasms include a range of lesions, most of which are benign, though some may progress to or present as malignant. Diagnostic tools like FNAB, ultrasound, and hormone analysis are commonly used, though they have limitations. Recently, peripheral blood markers have been explored for their potential in differentiating thyroid lesions, despite controversy evidence. This review evaluates the diagnostic utility of NLR and PLR in thyroid lesions. Methods: We systematically searched all relevant articles on PubMed, Science Direct, Cochrane Library, and gray literature, including Google Scholar, for studies on the diagnostic utility of platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) in thyroid lesions. Two researchers independently screened articles, and study quality was assessed using the QUADAS 2 tool. A random-effects model calculated pooled sensitivity and specificity, while the area under the HSROC curve summarized diagnostic accuracy. Heterogeneity was evaluated with Higgins’ I² statistic, and publication bias was assessed using the MIDAS command. Subgroup analyses by sample size, gender distribution, cutoff values, and carcinoma types explored sources of heterogeneity. Results: A total of 12 studies were included in the final meta-analysis, with 9 focusing on NLR and 6 on PLR. Most of these studies were retrospective in design. The pooled sensitivity and specificity of NLR were 75% (95% CI: 65–82%) and 62% (95% CI: 42–75%), respectively. For PLR, the overall sensitivity and specificity were 70% (95% CI: 61–78%) and 57% (95% CI: 46–66%), respectively. The diagnostic accuracy, based on the area under the HSROC curve (AUC), was 0.75 (95% CI: 0.71–0.79) for NLR and 0.69 (95% CI: 0.65–0.73) for PLR. These results indicate that NLR has better diagnostic accuracy than PLR in distinguishing between benign and malignant thyroid lesions. Conclusion: While the NLR demonstrates better diagnostic utility than the PLR in distinguishing between benign and malignant thyroid lesions, its standalone diagnostic accuracy remains moderate. Therefore, we recommend using these markers as complementary tools alongside other standard diagnostic modalities until further studies provide more definitive evidence. Thyroid neoplasm is a type of cancer which arises from the thyroid parenchymal cell and affects the thyroid gland. The disease encompasses a variety of lesion, including benign adenomas to malignant carcinomas [1]. The majority of thyroid glands are noncancerous and are mostly benign. In some contexts, thyroid adenomas may transform into carcinomas as the nonfunctional adenomas possess oncogene mutations [2]. Overall, 5% of thyroid nodules are malignant. Notably, approximately 20% of follicular adenomas have the potential to progress into follicular carcinomas [3]. The common thyroid malignancies include, papillary, follicular, medullary and anaplastic types, which varies based on the aggressiveness of the cancer, which are highly variable clinical features; some may be indolent and slow progressing while others may be highly aggressive tumors with a high mortality rate [4,5]. Globally, thyroid cancer cases are increasing over time. Approximately 18.3 million thyroid cases were reported with a high prevalence rate in China and United States [6]. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used and performed for this systematic review and meta-analysis. This review was registered on PROSPERO with registration number of CRD42024559798.

Background: Anemia due to living condition disproportionally affects the global refugee children. Nutritional deficiency particularly iron deficiency is the primary causes of anemia. Hence, we conducted a systemic review and meta-analysis on the prevalence of anemia among refugee children. Methods: We searched systematically all relevant studies on the prevalence of anemia among refugee children including under the age of 18 years, which were conducted between 2009 and 2023 in English from PubMed, Embase, Scopus, Cochran library and other gray literatures such as google scholar. Two researchers independently screened articles based on their title and The Joana Brigg’s Institute (JBI) checklist was used to assess the quality of studies. Random effect model was utilized to calculate the pooled estimate of anemia. Higgins I² statistics and Egger’s test were analyzed to check heterogeneity and publication bias, respectively. Subgroup analysis by continent, age group of the children and year of study was employed to identify the source of heterogeneity. Result: A total of 14 studies were included in the final meta-analysis. Most of the studies were from Asian countries followed by African countries. The pooled prevalence of anemia among global refugee children was 36.54 with (95% CI: 23.79, 49.28). There was moderate level of heterogeneity between the studies (I² = 68.91, P<0.001). The highest pooled prevalence of anemia in refugee children was reported in African, it was 56.1%, whereas the lowest pooled prevalence of anemia was in N. America, it was 12.66%. The prevalence of anemia was highest (53.88) in studies done among under-five refugee children. Conclusion: The global prevalence of anemia among refugee children is found to be moderate public health problem. Anemia prevalence is more common in African refugee children. Intervention and prevention for should be focused especially for refugees found in low- and middle-income countries.

Background Stroke is a leading cause of death and disability globally. Caregivers of stroke survivors play a crucial role in the recovery process, yet they often experience high levels of depression. Understanding the global prevalence of depression among these caregivers and identifying associated factors is essential for developing effective support strategies. This study sought to assess the global pooled prevalence of depression and identify its associated factors among caregivers of stroke survivors. Method We conducted a comprehensive literature search across multiple databases, including Scopus, PsycINFO, EMBASE, Google Scholar, Psychiatry Online, and PubMed/MEDLINE, to identify relevant articles. Articles published from January 2004 up to January 10, 2024, that reported on the prevalence of depression among caregivers of stroke survivors were included. The data were extracted via Microsoft Excel, and statistical analyses were performed using Stata version 14. Publication bias was assessed using funnel plots and Egger’s test. The heterogeneity of the studies was assessed using Cochran’s Q and I² statistics. Sensitivity and subgroup analyses were employed to identify potential causes of heterogeneity. Results A total of 27 articles involving 3799 caregivers were included in the analysis. The pooled prevalence of depression among caregivers of stroke survivors was found to be 43.87% (95% confidence interval [CI] 35.99–51.74). Subgroup analyses revealed significant variations according to geographical regions, assessment tools used, study design, and caregiver types. Factors associated with higher levels of depression included long duration of caregiving and being a caregiver of a male stroke patient. Conclusion The findings of this systematic review and meta-analysis highlight a significant prevalence of depression among caregivers of stroke survivors globally. Factors associated with depression included a long duration of caregiving and being a caregiver of a male stroke patient. This study highlights the need for targeted interventions to support caregivers and address their mental health needs, thereby improving their well-being and the quality of care they provide.