Innovations and challenges in global health: a multidisciplinary perspective

¹Young Researchers and Elite Club, Sardasht Branch, Islamic Azad University, Sardasht, Iran, ² Department of Physical Education, Ur. C., Islamic Azad University, Urmia, Iran

^&Corresponding author
Osman Alipour, Young Researchers and Elite Club, Sardasht Branch, Islamic Azad University, Sardasht, Iran

Editorial    

Healthcare systems in low- and middle-income countries (LMICs) are experiencing rapid epidemiological, technological, and organisational transitions. Alongside the continuing burden of reproductive health inequities and chronic diseases, LMICs are simultaneously adopting minimally invasive surgery, digital imaging technologies, rehabilitation robotics, and patient-centred healthcare approaches. These transformations require multidisciplinary collaboration integrating clinical medicine, surgery, epidemiology, rehabilitation science, biomedical engineering, public health, and healthcare systems research.

This special issue features five original articles from Vietnam, Lesotho, and Malaysia, covering laparoscopic gastric cancer surgery, inpatient urology morbidity, three-dimensional breast augmentation, determinants of pregnancy termination, and robot-assisted gait training for stroke recovery. The studies highlighted in this supplement collectively demonstrate the evolving complexity of global health challenges within LMIC settings. Although the included papers span different specialities and populations, they converge around several major themes: technological innovation, healthcare system strengthening, patient-centred outcomes, social determinants of health, and multidisciplinary integration.

The reproductive health study from Lesotho highlights ongoing challenges related to pregnancy termination and reproductive healthcare accessibility among married women in Sub-Saharan Africa [1]. The Vietnamese studies demonstrate parallel transitions occurring within LMIC healthcare systems, including minimally invasive oncologic surgery, digital imaging-assisted reconstructive procedures, and the growing burden of chronic urologic disease requiring prolonged inpatient care [2-4]. In addition, the narrative review on robot-assisted gait training (RAGT) reflects the increasing integration of rehabilitation technology and biomedical engineering into post-stroke functional recovery strategies in Asia [5].

Additional studies published in this supplement address pediatric infectious diseases, haematology, oncology, critical care medicine, ophthalmology, otorhinolaryngology, oral health, diagnostic imaging, and translational biomedical research. Together, these contributions underscore the multidisciplinary nature of contemporary global health research in LMICs. This editorial discusses several overarching themes emerging from the featured studies, emphasising how healthcare innovation and healthcare system challenges increasingly intersect within resource-constrained environments.

Technological Innovation and Precision Healthcare in LMICs

One of the most important themes emerging from this supplement is the expanding integration of advanced technologies into healthcare delivery in LMIC settings. Historically, many sophisticated medical technologies were concentrated in high-income healthcare systems because of financial and infrastructural limitations. However, the studies included here demonstrate increasing technological adaptation across surgical care, imaging, and rehabilitation medicine.

The study by Nghia et al. (2026) illustrates the application of three-dimensional simulation systems in reconstructive and aesthetic surgery. Using the CRISALIX platform, investigators quantitatively evaluated changes in breast morphology before and after subpectoral augmentation. The study demonstrated significant postoperative increases in breast volume and projection, while also revealing that actual tissue responses differed from nominal implant dimensions. These findings support the growing role of digital imaging and computational simulation in individualised surgical planning and outcome prediction [3].

Similarly, the gastric cancer study by Dang et al. (2026) demonstrated the successful implementation of advanced minimally invasive surgery in a Vietnamese regional hospital. Totally laparoscopic distal gastrectomy with Billroth II reconstruction achieved 3-year overall survival and disease-free survival rates above 78%, while preserving a favourable postoperative quality of life. The study reflects increasing surgical sophistication within LMIC healthcare systems and the feasibility of advanced laparoscopic oncology outside highly specialised international centres [2].

The narrative review by Wan Ahmad et al. (2026) further expands this technological perspective into rehabilitation medicine. Across 21 reviewed studies involving 1,168 stroke survivors, robot-assisted gait training demonstrated improvements in gait speed, balance, endurance, and functional independence, particularly with exoskeleton-based systems. These findings highlight the growing role of rehabilitation robotics and biomedical engineering in addressing long-term disability after stroke, one of the leading causes of functional impairment globally [5]. Together, these studies demonstrate that technological innovation in LMICs is no longer restricted to diagnostic imaging or isolated tertiary centres. Increasingly, digital simulation, minimally invasive surgery, and rehabilitation robotics are being incorporated into broader clinical care pathways.

Healthcare System Burden and Resource Constraints

Another major theme concerns the increasing burden placed on LMIC healthcare systems by chronic disease management, repeated hospitalisation, and long-term care demands. As epidemiological transitions continue, healthcare systems must simultaneously manage acute illness, chronic non-communicable diseases, rehabilitation needs, and specialised surgical care.

The urology inpatient study by Nguyen et al. (2026) provides important insight into this challenge. Across 10,337 hospitalisation episodes, urolithiasis accounted for 48.0% of admissions, followed by urinary tract infections (25.9%) and prostate diseases (12.3%). The study also demonstrated that 28.6% of patients experienced multiple hospital admissions and that prolonged hospitalisation occurred in 79.3% of cases, with a mean length of stay of 8.5 days [4].

Importantly, prolonged hospitalisation was associated not only with disease-related factors such as comorbidity burden and older age but also with systemic factors, including self-pay status and referral pathways. These findings illustrate how healthcare utilisation in LMICs is shaped by both clinical and structural determinants.

The rehabilitation robotics review also indirectly reflects broader health system challenges. Although robot-assisted gait training demonstrated functional benefit, the authors emphasised the need for larger comparative studies and long-term evaluation of different robotic systems [5]. In LMIC settings, widespread implementation of rehabilitation robotics may face barriers related to cost, infrastructure, technical expertise, and maintenance requirements.

Similarly, advanced laparoscopic surgery requires sustained institutional investment in surgical training, perioperative systems, and postoperative follow-up infrastructure [2]. As LMIC healthcare systems adopt increasingly sophisticated technologies, ensuring sustainability and equitable access becomes critically important. Collectively, these studies demonstrate that healthcare innovation must occur alongside broader healthcare system strengthening strategies aimed at improving efficiency, continuity of care, affordability, and equitable resource allocation.

Patient-Centered Outcomes and Functional Recovery

A third important theme emerging from this supplement is the growing emphasis on patient-centred outcomes, functional recovery, and quality of life. Historically, healthcare research in many LMICs focused primarily on mortality reduction and disease control because of high burdens of acute illness and limited healthcare resources. However, modern healthcare increasingly recognises that functional independence, quality of life, and patient satisfaction are equally important indicators of healthcare effectiveness.

The gastric cancer study by Dang et al. (2026) clearly illustrates this transition. In addition to evaluating survival outcomes, investigators assessed postoperative quality of life using the Spitzer Index across multiple follow-up periods. More than 85% of patients maintained quality-of-life scores ?7 throughout follow-up, suggesting that minimally invasive surgery can preserve not only survival but also long-term well-being and daily functioning [2].

Similarly, the reconstructive surgery study emphasised individualised postoperative outcomes and objective anthropometric assessment rather than relying solely on procedural success [3]. Modern reconstructive and aesthetic surgery increasingly prioritises personalised outcomes, patient expectations, and functional satisfaction.

The rehabilitation robotics review strongly reinforces the importance of functional recovery in global health [5]. Stroke remains one of the leading causes of long-term motor disability worldwide, particularly in ageing LMIC populations. Improvements in gait speed, balance, endurance, and independence following robot-assisted gait training demonstrate how rehabilitation technologies may contribute not only to neurological recovery but also to social participation and long-term quality of life.

The reproductive health study from Lesotho also reflects patient-centred healthcare priorities [1]. The pooled prevalence of pregnancy termination among married women was 16.2%, emphasising the importance of reproductive autonomy, accessible family planning services, and informed reproductive decision-making. Across these studies, healthcare outcomes are increasingly conceptualised in broader terms encompassing functionality, autonomy, quality of life, and long-term patient wellbeing.

Social Determinants and Health Inequities

The continuing influence of social determinants on healthcare outcomes remains another major theme across this supplement. Despite technological advancement and increasing clinical sophistication, health outcomes continue to be shaped by education, socioeconomic conditions, healthcare accessibility, and structural inequities. The Lesotho reproductive health study demonstrates this clearly [1]. Older women aged 40-44 years had a significantly higher risk of pregnancy termination (aRR = 4.49), while internet users also demonstrated increased risk (aRR = 1.36). In contrast, modern contraceptive use was associated with lower risk (aRR = 0.72). These findings highlight the importance of reproductive health education, family planning accessibility, and accurate digital health information. The urology hospitalisation study also identified important structural determinants of healthcare utilisation [4]. Patients with self-pay status and out-of-network referrals were more likely to experience repeated hospitalisation, suggesting persistent inequities in healthcare financing and continuity of care.

Additionally, implementation of advanced rehabilitation technologies such as robot-assisted gait training may itself introduce new forms of inequity if access becomes concentrated within urban tertiary centres or financially privileged populations [5]. As LMICs adopt increasingly advanced technologies, ensuring equitable access becomes a central policy challenge. These studies collectively reinforce that biomedical innovation alone cannot eliminate health disparities. Sustainable global health progress requires simultaneous attention to education, healthcare financing, preventive services, rehabilitation accessibility, and healthcare equity.

Multidisciplinary Collaboration in Modern Global Health

A final overarching theme is the increasing importance of multidisciplinary collaboration in addressing modern global health challenges. The studies included in this supplement span epidemiology, reproductive health, oncologic surgery, reconstructive surgery, rehabilitation science, biomedical engineering, and healthcare systems research. Despite their disciplinary diversity, they collectively demonstrate the necessity of integrated approaches to healthcare innovation and healthcare delivery.

The reproductive health study combined epidemiologic analysis with public health and policy implications [1]. The urology investigation integrated clinical epidemiology with healthcare systems analysis by examining both disease burden and structural determinants of hospitalisation patterns [4]. The gastric cancer study required collaboration among surgeons, perioperative teams, oncologic specialists, and quality-of-life researchers to comprehensively evaluate long-term outcomes [2]. Likewise, the breast anthropometry investigation integrated reconstructive surgery, imaging technology, and quantitative digital analysis [4]. The rehabilitation robotics review most explicitly demonstrates the multidisciplinary nature of modern healthcare innovation [5]. Effective implementation of robot-assisted gait training requires collaboration among rehabilitation physicians, physical therapists, biomedical engineers, neurologists, and healthcare technology specialists.

Importantly, the broader supplement further expands this multidisciplinary perspective through additional studies addressing infectious diseases, haematology, critical care medicine, ophthalmology, otorhinolaryngology, oral health, and translational biomedical science. Such diversity reflects the increasingly interdisciplinary nature of global health itself. Modern LMIC healthcare systems, therefore, require collaboration among clinicians, epidemiologists, surgeons, rehabilitation specialists, engineers, public health experts, healthcare administrators, and policymakers. Multidisciplinary integration is essential for balancing innovation, sustainability, cost-effectiveness, and healthcare equity.

Implications

The studies included in this supplement have several important implications for global health policy and practice in LMIC settings. First, they demonstrate that advanced technologies such as minimally invasive surgery, digital imaging systems, and rehabilitation robotics can be successfully integrated into LMIC healthcare systems when supported by institutional development and specialised training.

Second, healthcare innovation must occur alongside broader health system strengthening efforts. High rates of prolonged hospitalisation and repeated admissions indicate substantial opportunities for improving continuity of care, outpatient management, and referral coordination.

Third, patient-centred outcomes, including quality of life, functional independence, and rehabilitation recovery, should become routine components of healthcare evaluation in LMICs.

Finally, social determinants remain deeply intertwined with healthcare outcomes. Policies addressing reproductive health education, healthcare financing, rehabilitation accessibility, and equitable healthcare delivery remain essential for reducing disparities.

Limitations

Several limitations should be acknowledged across the studies included in this supplement. Most investigations were conducted within single institutional or regional contexts, potentially limiting generalizability. Some studies involved relatively small sample sizes, particularly within specialised surgical and technological applications. Cross-sectional, retrospective, and narrative review designs were common, limiting causal inference and long-term evaluation. Additionally, the implementation feasibility of advanced technologies may vary substantially across different LMIC healthcare systems depending on infrastructure, financing, and workforce capacity. Nevertheless, these studies provide valuable context-specific evidence regarding evolving healthcare priorities and innovations in LMIC settings.

Future directions

Future research should continue strengthening multidisciplinary collaboration across surgery, rehabilitation science, epidemiology, public health, biomedical engineering, and healthcare systems research. Multicenter prospective studies with larger cohorts and longer follow-up are needed to improve evidence quality and external validity. Further investigation into the cost-effectiveness and scalability of advanced technologies such as rehabilitation robotics and digital surgical simulation systems is also necessary. Sustainable implementation in LMIC settings requires balancing technological sophistication with affordability and equitable access. Healthcare systems research should additionally focus on improving continuity of care, reducing prolonged hospitalisation, and expanding rehabilitation services for chronic disability management. In reproductive health, future studies should further explore the influence of digital information environments, reproductive counselling, and family planning accessibility on healthcare decision-making in LMIC populations. A manuscript on ovulatory cycle knowledge among women in Rwanda is currently under review and will appear in a future issue.

Conclusion

The studies featured in this supplement collectively illustrate the evolving landscape of healthcare innovation and healthcare system challenges in LMICs. Across reproductive health, minimally invasive surgery, reconstructive care, inpatient management, and rehabilitation technology, the findings highlight the growing importance of technological advancement, patient-centred outcomes, healthcare system strengthening, and multidisciplinary collaboration. Importantly, these studies demonstrate that contemporary global health challenges cannot be addressed solely through isolated biomedical approaches. Sustainable progress in LMIC healthcare requires integrated strategies combining clinical innovation, rehabilitation science, healthcare equity, public health intervention, and systems-level reform.

Competing interests     

Both authors declare no competing interests.

Authors' contributions     

Osman Alipour conceived the study, performed the analysis, and drafted the manuscript. Bisotoon Azizi revised the manuscript critically for intellectual content. Both authors read and approved the final version.

References