Abstract Fasting before elective abdominal ultrasound is widely recommended to improve image quality or visualization of abdominal structures although supporting evidence is limited. We examined whether fasting is associated with improved diagnostic or image quality-related outcomes in adult abdominal ultrasound. We conducted a systematic review and meta-analysis (PROSPERO CRD42024568514) of studies comparing fasting and non-fasting conditions in adults undergoing elective abdominal ultrasound (search date July 18, 2025; 5 databases). Study quality and risk of bias were assessed, and randomized trials were pooled using random effects models. Real-world preparation recommendations were evaluated across international ultrasound society guidelines and patient-facing sources. 14 studies (9 randomized trials, 5 observational studies; 2,208 participants) met the inclusion criteria. Five randomized trials were eligible for meta-analysis; three were included in the primary analysis ( n = 378). Two trials contributed organ-specific outcomes to sensitivity analyses. Fasting did not improve overall diagnostic sufficiency, defined as adequate visualization to answer the clinical question without repeat imaging (OR 0.97, 95% CI 0.51–1.86, p = 0.92; I 2 = 0%). Significant effects were limited to gallbladder visibility and detectability of the common bile duct, with no consistent benefit otherwise. Risk of bias was moderate and overall certainty of evidence was low. Real-world fasting instructions were highly variable and rarely evidence-based. Fasting before elective abdominal ultrasound does not improve diagnostic sufficiency. Observed benefits were limited to the biliary tract. Given the low certainty of evidence and limited observed benefits beyond the biliary tract, strict and prolonged fasting recommendations should be reconsidered.

Background Over 1.6 million refugees and asylum seekers from Myanmar reside in neighbouring countries. These populations face substantial mental health challenges, yet existing evidence remains fragmented, making a comprehensive review essential. Aims To synthesise evidence on common mental disorders among Myanmar refugees, examine associated factors and explore challenges across host countries and refugee subgroups. Method A systematic search of PubMed, PsycINFO, Web of Science, Embase, Scopus and grey literature was conducted through July 2025. Eligible studies reported on common mental disorders among Myanmar refugees of any age in regional host countries. Two reviewers independently screened studies and extracted data dually, assessed risk of bias with Joanna Briggs Institute checklists and synthesised findings narratively. Results Of 1614 records, 14 studies met inclusion criteria, covering >10 800 refugees in Bangladesh (n = 9), Thailand (n = 3) and Malaysia (n = 2). Reported prevalence was high for depression (30.0–89.0%), anxiety (39.3–41.8%) and post-traumatic stress disorder (3.7–61.2%). Risk factors associated with poorer mental health included potentially traumatic events, female gender, older age, family dependency, post-migration difficulties, lack of social support, food insecurity and pre-existing health conditions. Employment and income were identified as protective factors. Mental health challenges varied by country. Barriers to care included limited service access, lack of culturally appropriate interventions and stigma. Conclusions Myanmar refugees experience a high burden of mental disorders shaped by both potentially traumatic events and post-migration stressors. Effective interventions should be context-specific, focusing on person-centred care tailored to the refugee experience, improved living conditions, strengthened social support and enhanced economic opportunities.

Background: Cervical cancer is the second most common cancer and the second leading cause of cancer-related death among women in Cambodia. As screening rates remain low, this study evaluated HPV self-sampling as a primary screening method in rural Cambodia and identified barriers to screening participation. Methods: Amidst a large-scale HPV self-sampling screening study for cervical cancer (parent screening study) in rural areas in Siem Reap province, we conducted a questionnaire-based cross-sectional survey (acceptance sub-study). The questionnaire was mainly implemented by random walks between September 14th and September 23rd, 2023, and included different categories of potential screening influences. The participation rate in the parent screening study was estimated based on the random walk sample. Variable selection was performed by bootstrapped elastic net regression. Selected variables were included in a logistic regression model with parent screening study participation as the dependant variable. Findings: A total of 249 questionnaires was completed for this survey. The estimated participation rate in the parent screening study was 79.1% (95%CI [0.724, 0.845]). Screening participation was significantly influenced by perceived risk of contracting cervical cancer (OR = 4.1, 95%CI [2.0, 8.7]) and potential strain on participant’s relationships (OR = 4.7, 95%CI [1.7, 14.0]). Women who considered health screening unnecessary in the absence of symptoms were significantly more likely to decline HPV self-sampling (OR = 4.3, 95%CI [2.1, 9.2]). Greater feeling of self-efficacy concerning the sampling procedure meanwhile increased the chances of participation significantly (OR = 2.1, 95%CI [1.1, 5.3]). Interpretation: HPV self-sampling is a highly acceptable method for cervical cancer screening in Cambodia. The study findings highlight the importance of educating women about cervical cancer, its background and symptoms as well as screening procedure to improve the success of future campaigns.

BackgroundSnakebite envenomation (SBE) remains a significant but neglected public health problem among children in sub-Saharan Africa (SSA), with clinical predictors of severity and regional disparities in outcomes still poorly characterized.MethodsWe conducted a systematic review of peer-reviewed studies published from database inception to October 2024 on pediatric snakebite envenomation (SBE) in SSA, focusing on clinical and demographic predictors of severe outcomes. Data on study characteristics, SBE symptoms, risk factors, and outcomes were synthesized descriptively.ResultsEighteen studies from six SSA countries were included (totaling 2,687 pediatric patients). Children affected were predominantly under 12 years, with a male predominance. Severe outcomes including death, amputation, and permanent disability were closely associated with delayed hospital presentation (> 6-12 hours), certain traditional first aid practices, young age (<10 years old), severe local swelling, upper limb bites, and laboratory. Most identified SBE syndromes were cytotoxic or haematotoxic; neurotoxic cases were rarely reported. Antivenom availability and type varied by country and facility; adverse reactions were common (≈20-70%, definition-dependent; anaphylaxis up to ~57%). Mortality ranged from <5% in South Africa and Kenya to 14% in Gambia and 36% in Cameroon, correlating with both antivenom and essential emergency care access. Research gaps included limited data from several high-burden regions, lack of standardized pediatric protocols, and few long-term outcomes.ConclusionsPediatric SBE in SSA is characterized by substantial preventable morbidity and mortality, mainly due to delays in care and inconsistent access to essential emergency care and safe antivenom. Improved health system capacity, rapid referral, and standardized management are urgently needed.

Abstract Background Maternal, newborn, and child health (MNCH) remain a major public health challenge in Sub-Saharan Africa (SSA), where preventable mortality persists despite global commitments to reduce deaths. Weak leadership and management within primary health care (PHC) systems contribute to inefficiencies, inequities in access, and suboptimal quality and continuity of care. Methods This systematic review examined how leadership and management practices influence MNCH outcomes in SSA. The systematic review followed PRISMA 2020 guidelines and was conceptually informed by the WHO Health System Building Blocks framework and governance-oriented leadership concepts. Searches were conducted in PubMed/MEDLINE, Web of Science, Scopus, CINAHL, Embase, Google Scholar, and the WHO African Index Medicus (AIM) for peer-reviewed studies published between 1978 and July 2025. The protocol was registered in PROSPERO (CRD42024514304). Clinical trial number: Not applicable. Studies were eligible if they examined leadership or management practices in PHC settings and reported MNCH outcomes. Results Thirteen studies from seven countries and one multi-country analysis met the inclusion criteria. Leadership approaches clustered around three domains: leadership capacity building and supportive supervision, participatory and accountable governance, and community engagement mechanisms. These approaches were consistently associated with measurable improvements in service coverage and quality. Reported gains included increases in antenatal care utilization (+ 12% to + 48%), skilled birth attendance (+ 10% to + 34%), and immunization completion rate (+ 8% to + 27%). Management practices including mentorship, routine monitoring, and data-driven decision-making strengthened provider performance, coordination, and service delivery efficiency. Conclusion Leadership and management are critical system-level drivers of PHC performance and MNCH outcomes in SSA. Strengthening leadership and management capacity within PHC systems represents a high-impact strategy for improving service delivery and accelerating progress toward MNCH targets in SSA.

BACKGROUND:Children are vulnerable to heat, yet evidence on heat-related pediatric emergency department (ED) use in Germany remains limited. We quantified the acute short-term effects of extreme heat exposure on ED visits among children aged 0-18 years in Baden-Württemberg, Germany. METHODOLOGY:We assessed short-term effects of extreme heat on ED visits among children aged 0-18 years, including perinatal conditions in infants born at or after 22 weeks´ gestation, in Baden-Württemberg, Germany using 2.83 million records from (2014-2022). A time-stratified quasi-Poisson design with distributed lag non-linear model (lag 0-5 days) was applied, adjusting for air quality, spatiotemporal factors, and COVID-19 hospitalizations. RESULTS:Higher temperatures increased ED visits risk, strongest within 0-2 days. Cumulative relative risks increased by 4.2% (95% CI 3.7-4.8), 7.1% (6.1-8.1), and 9.6% (8.2-11.1) at the 95th, 99th, and 99.9th temperature percentiles, respectively. Heat-sensitive diagnoses included heat-related illnesses (+63%, 51-76), perinatal conditions (+57%, 26-92), and otitis media and externa (+25%, 16-33). Children < 5 years had higher ED visit rates share on hot days (RR 1.036, 1.02-1.05). CONCLUSION:Heat exposure increases pediatric ED use, highlighting the need of child-specific thresholds and targeted preparedness strategies. IMPACT:Extreme heat increases pediatric emergency visits, especially among infants and young children. By combining high resolution meteorological data with a large pediatric dataset and advanced time stratified modeling, the study provides detailed evidence on short-term effects of heat and identifies specific heat sensitive diagnoses. The study highlights rapid, lagged effects of heat and suggests pediatric specific temperature thresholds that may better capture risk than current heat warning thresholds. The findings support improving preparedness in pediatric emergency care and inform adaptations to heat warning-systems to better cater for child populations.

Objectives To apply the Haddon Matrix framework (HM) to examine factors associated with the severity of paediatric road traffic injuries (RTIs) in Ghana.Design Prospective hospital-based cross-sectional study. Variables were organised according to the three domains of the HM framework. Three negative binomial regression models were developed to identify the best-fitting model for predicting paediatric RTI severitySettings Three teaching hospitals in the Northern, Ashanti and Central Regions of Ghana.Participants A total of 484 consecutive children and adolescents aged 0–18 years presenting to the emergency department with RTIs between 18 September 2023 and 30 September 2024 were included. Data were collected using interviewer-administered questionnaires and medical record reviews.Main outcome measure The primary outcome was injury severity measured using the Injury Severity Score, an anatomical measure based on the sum of the squared Abbreviated Injury Scale scores for the three most severely injured body regions.Results The third model (variable selection threshold p≤0.1) demonstrated the best predictive model for paediatric RTI severity, with the lowest Akaike Information Criterion and the highest log-likelihood. Increased injury severity was independently associated with self-reported frequent alcohol use (β=1.54, p=0.016), Harmattan weather conditions (β=0.21, p=0.024), afternoon crashes (β=0.17, p=0.041) and referral cases (β=0.28, p=0.003). Whereas single bicycle crashes (β=−1.58, p=0.011) and walk-in hospital visits (β=−1.09, p=0.026) were associated with lower injury severity.Conclusion The HM identified modifiable environmental, behavioural and health system factors associated with paediatric RTI severity. Interventions targeting alcohol use, Harmattan-related road safety, timely referral and prehospital care may reduce injury severity among children in Ghana.

[This corrects the article DOI: 10.1371/journal.pntd.0013450.].

Background: Scarce human resources for health and high injury-related mortality coincide with inequities in accessing quality trauma education programs in low-and middle-income countries. Existing observational studies restrict assessments of trauma training program impacts on providers' knowledge. Evaluation of trauma education programs outside clinical trial settings hinders their effectiveness in influencing clinical practice and policy changes for patient outcomes. Objective: This study aimed to assess the impact of the Rural Trauma Team Development Course (RTTDC) on clinical processes and patient outcomes of motorcycle-accident-related neurological and/or musculoskeletal injuries in selected Ugandan hospitals. Methods: This was a pragmatic 2-arm, parallel, multiperiod, cluster randomized controlled trial. The participants were trauma care frontline personnel and patients aged 2-80 years at 3 intervention and 3 control Ugandan hospitals (1:1 allocation). Hospitals were randomly allocated to intervention or control groups using permuted block sequences. Sequence codes were generated off-site by an independent statistician using Sealed Envelope (version 1.23.1; Sealed Envelope Ltd). Both patient participants and outcome assessors were blinded to allocation. Hospital allocation codes were concealed until the point of assignment. In the intervention arm, 500 trauma care frontliners received RTTDC, whereas patients received standard care. In the control arm, patients received standard care without RTTDC for staff. The primary outcomes were time from accident to admission and from referral to dispatch. The secondary outcomes were all-cause 90-day mortality and morbidity related to neurological and/or musculoskeletal injuries. We followed the CONSORT (Consolidated Standards of Reporting Trials) guidelines for reporting cluster randomized trials. Results: We analyzed 1003 participants (501 intervention and 502 control). The intervention arm had a shorter median (IQR) prehospital time of 1 hour (0.50-2) and referral-to-dispatch interval during interfacility transfers of 2 hours (1.25-2.75). This contrasted with 2 hours (1.50-4) and 4 hours (2.50-4.10) in the control arm, respectively (P<.001). The 90-day mortality was more than halved in the intervention (5%, 24/457) vs in the control arm (13%, 58/430) (P<.001). Fewer participants in the intervention group had unfavorable Glasgow Outcome Scale scores (9%, 42/457) vs (20%, 87/430) (P<.001). No difference was found in musculoskeletal injury morbidity outcomes (P=.57). Conclusions: Rural trauma team development training demonstrated potential for improved organizational time efficiency and clinical outcomes for neurological injuries without negatively impacting musculoskeletal injury morbidity outcomes. Evidence from this trial supports that locally contextualized, trainee-led rural trauma team development interventional programs are feasible in low-and middle-income countries. However, despite being a multicenter study conducted across 6 geographically distinct hospitals, the research is limited in generalizability due to its focus on a single health care system within 1 country, retrospective trial registration, exclusion of prehospital deaths, and a relatively small number of clusters, which could introduce measurement bias.

BackgroundSerology is a valuable tool to estimate infections, case-fatality rates, and immunity. However, venipuncture and clinical infrastructure hinder scalability. This study evaluated the performance, feasibility and user experience of using a microsampling device for self-collected capillary blood and saliva to determine total SARS-CoV-2 S RBD antibodies.MethodsIt included 149 participants with (n = 48) or without (n = 101) a known history of SARS-CoV-2 infection and confirmed antibodies. Venous and capillary blood were self- or professionally collected from all, and saliva was self-collected by 46/48 participants with antibodies. The detection of SARS-CoV-2 S RBD antibodies in all sample types was tested using a high-throughput platform and agreement was calculated. Intra- and inter-rater agreement between serum and capillary blood in participants with an unknown antibody status was also assessed. Participants evaluated the device's user-friendliness through questionnaires.ResultsAmong the 48 participants with known past infection and antibodies, agreement was 100% (95% CI: 92.6-100) between serum and capillary blood (self-collected or professionally collected). Self-collected saliva had slightly lower agreement with paired serum samples (95.7%, CI: 85.2-99.5). For the 101 participants without prior evidence of antibodies or infection, serum and self-collected capillary blood had good intra-rater agreement and serum and professionally collected capillary blood had almost perfect intra-rater agreement. Inter-rater agreement was also almost perfect. While 81.8% found the self-finger prick easy, 53.4% found using the microsampler easy. Among those who collected saliva, 84.8% found capillary blood easier to collect compared to saliva (52.2%).ConclusionsOur results show that detecting SARS-CoV-2 antibodies from capillary blood and saliva collected with the VAMS microsampling device is feasible and yields valid results. To ensure accuracy and reliability, additional training in self-sampling techniques may be essential. The positive user experience further underscores the microsampling device's potential for scalable serosurveillance and strengthening pandemic preparedness efforts.

OBJECTIVE:Fall-related injuries are a global public health concern, and trauma registries aid in collecting data to develop measures to reduce their burden on individuals and communities. The aim of this review was to provide a comprehensive overview of the reporting of fall-related mortality in trauma registries and surveillance systems in sub-Saharan Africa. METHODS:A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched eight electronic databases, and studies set in countries of sub-Saharan Africa were included if the reported data originated from a trauma registry or surveillance system and contained a measurement of fall-related mortality. Results were synthesised in a descriptive manner. RESULTS:Of the 3574 records found, we included 21 studies in the analysis. Different definitions were inconsistently used in reporting fall-related mortality: studies reported either a percentage of fall deaths by total falls or of fall deaths by total deaths. Deaths due to falls by total falls ranged from 0.01% to 2.4% in studies with paediatric patient populations, and from 0.03% to 60% among studies not restricted to a specific age group. Reporting on other variables in relation to injury and trauma care was also inconsistent. CONCLUSIONS:The findings of this review were heterogeneous, and variables were collected irregularly among trauma registries. This led to a broad range of results and made comparisons and deductions difficult. A more standardised data collection across registries would heighten the intercomparability of results from different studies and, therefore, facilitate usage in data-based efforts for implementing prevention and optimising care.

Lung Cancer is one of the four most frequent malignant neoplasms in the world, and first in mortality. In 2020, lung cancer resulted in roughly 1.8 million deaths globally. Lung cancer is a major public health problem in low and lower-middle income countries, where high rates of tobacco smoking, environmental pollution, and limited access to healthcare resources contribute to a significant burden of the disease. The objective of our review was to compare costs among available countries and identify major cost drivers. A systematic database search was performed according to PRISMA guidelines on Web of Science, PubMed, Cochrane, EBSCO, ISPOR, and Google Scholar using a pre-defined search string. Studies were screened for eligibility and included if they provided information about the direct and indirect costs of lung cancer in low- and lower-middle-income countries. Search cut off was on August 4, 2025. The data from included studies were extracted, quantitatively synthesized, and compared. Of 2,383 articles, 15 met the inclusion criteria. All studies were conducted in low- and lower-middle-income countries, with a time frame ranging from 2003 to 2025. Most studies estimated costs based on prevalence. Most studies reported total healthcare costs as direct costs related to lung cancer; seven studies reported on indirect costs. Total average direct costs ranged from USD 2,540.66 per patient in Nepal to USD 10,179.98 per patient in the first year of treatment in Bolivia. Indirect costs varied from USD 140,995,744.13 in Bangladesh to USD 320,427,043.97 in Vietnam for their given respective sample sizes. Cost estimates varied substantially even for the same country depending on study’s analytical focus, timeframe, and other methodological considerations. In conclusion, the costs of lung cancer are substantial and increase with disease progression, encompassing both direct and indirect components. High out-of-pocket expenditures further intensify the economic burden on patients and may lead to an underestimation of the true societal costs. The lack of standardized methodologies and robust data highlights the need for further research to guide effective policy and resource allocation in LMICs. Registration: PROSPERO, ID CRD42020160370.

Background: Non-communicable diseases (NCDs) are the leading cause of mortality worldwide, and increasingly so in low- and middle-income countries. Afghanistan is dealing with a double burden of diseases, yet there has been no evidence synthesis on the prevalence of major NCDs and their risk factors. Objective: This study aims to provide a comprehensive synthesis of the existing data on the prevalence of major NCDs and the common related risk factors in Afghanistan. Method: We systematically reviewed scientific articles from 2000 to 2022 that reported the prevalence of diabetes, chronic respiratory diseases (CRDs), cardiovascular diseases (CVDs) or cancer, and their risk factors in Afghanistan. Four online databases (PubMed, Web of Science, Cochrane and Google Scholar) and two local journals in Afghanistan (not indexed online) were systematically searched and screened. Two reviewers independently screened and appraised the quality of the articles. Data extraction and synthesis were performed using tabulated sheets. Results: Among 51 eligible articles, 10 (19.6%) focused on cancer, 10 (19.6%) on diabetes, 4 (7.8%) on CVDs, 4 (7.8%) on CRDs and 23 (45.1%) on risk factors as the primary outcome. Few articles addressed major NCD prevalence; no evidence of CVDs, cancer was 0.15%, asthma ranged between 0.3% and 17.3%, and diabetes was 12%. Pooled prevalence of hypertension and overweight were 31% and 35%, respectively. Central obesity was twice as prevalent in females (76% versus 40%). Similarly, gender differences were observed in smoking and snuff use with prevalence rates of 14% and 25% among males and 2% and 3% among females, respectively. A total of 14% of the population engaged in vigorous activity. Pooled prevalence for physical inactivity, general obesity, fruit and vegetable consumption, dyslipidaemia and alcohol consumption couldn’t be calculated due to the heterogeneity of articles. Conclusion: Only little evidence is available on the prevalence of major NCDs in Afghanistan; however, the NCD risk factors are prevalent across the country. The quality of the available data, especially those of the local resources, is poor; therefore, further research should generate reliable evidence in order to inform policymakers on prioritizing interventions for controlling and managing NCDs.

Background This scoping review is a further step to build up the Mental Health Surveillance System for Germany. It summarizes and analyzes indicators used or described in Organization for Economic Co-operation and Development (OECD) countries for public mental health monitoring in children and adolescents aged 0–18 years. Methods We searched PubMed-MEDLINE, PsycINFO, Cochrane Databases, and Google Scholar from 2000 to September 2022. The search used five general keyword categories: 1) “indicators/monitoring/surveillance” at the population level, 2) “mental/psychological,” 3) “health/disorders,” 4) “children and adolescents,” and 5) 38 OECD countries. The search was complemented with an extensive grey literature search, including OECD public health institutions and an internet search using Google. A predefined set of inclusion and exclusion criteria was applied. Results Over 15,500 articles and documents were screened (scientific search N = 10,539, grey literature search more than 5,000). More than 700 articles and documents have been full-text assessed, with 382 being ultimately included. Out of 7,477 indicators extracted, an initial set of 6,426 indicators met our inclusion criteria for indicators. After consolidating duplicates and similar content, this initial set was categorized into 19 topics, resulting in a final set of 210 different indicators. The analysis highlighted an increasing interest in the topic since 2008, but indicators for the younger age, particularly those aged 0 to 2 years, were less readily available. Conclusion Our research provides a comprehensive understanding of the current state of mental health indicators for children and adolescents, identifying both (1) indicators of public mental health noted in a previous scoping review on adults and (2) new indicators specific to this age group. These findings contribute to the development of effective public health surveillance strategies for children and adolescents and inform future research in this field.

ObjectivePrevious research suggests an overall lower cardiovascular disease mortality among ethnic German Resettlers from the Former Soviet Union. However, evidence points to a high burden of metabolic risk factors and chronic conditions among Resettlers, factors which are correlated to lower levels of physical activity. Thus, this study aims to assess factors associated with physical activity among Resettlers, by investigating the interplay between biopsychosocial factors and physical activity between men and women.DesignWe conducted a cross-sectional study by administering questionnaires between 2011 and 2012. Data from 595 individuals were analysed, and total and extracurricular physical activity scores were generated. A backward stepwise linear regression was run to investigate the effect of various predictors on various physical activity domains.SettingAugsburg, Germany.ParticipantsWe targeted Resettlers who had moved to Augsburg, Germany between 1990 and 1999.ResultsDisease and psychological distress were linked to decreasing physical activity in men. Higher socioeconomic status was correlated with increasing physical activity except for work-related physical activity for both men and women. Single women were less likely to report extracurricular activity, and so did women who reported a shorter duration of stay and men who smoked.ConclusionsMigration experience and culture account for gender-related sex differences in physical activity alongwith other interlocking social factors such as psychological stressors and health status among Resettlers. Individual psychological stressors may hinder or motivate physical activity, but physical activity can reverse the influence of such stressors on Resettlers. Understanding migrant health and experiences is crucial due to the migration influx and health disparities. However, data on this topic are scarce in Germany.

Background After the unprecedented Zika virus (ZIKV) outbreak in the western hemisphere from 2015–2018, Aedes aegypti and Ae . albopictus are now well established primary and secondary ZIKV vectors, respectively. Consensus about identification and importance of other secondary ZIKV vectors remain. This systematic review aims to provide a list of vector species capable of transmitting ZIKV by reviewing evidence from laboratory vector competence (VC) studies and to identify key knowledge gaps and issues within the ZIKV VC literature. Methods A search was performed until 15 th March 2022 on the Cochrane Library, Lilacs, PubMed, Web of Science, WHOLIS and Google Scholar. The search strings included three general categories: 1) “ZIKA”; 2) “vector”; 3) “competence”, “transmission”, “isolation”, or “feeding behavior” and their combinations. Inclusion and exclusion criteria has been predefined and quality of included articles was assessed by STROBE and STROME-ID criteria. Findings From 8,986 articles retrieved, 2,349 non-duplicates were screened by title and abstracts,103 evaluated using the full text, and 45 included in this analysis. Main findings are 1) secondary vectors of interest include Ae . japonicus , Ae . detritus , and Ae . vexans at higher temperature 2) Culex quinquefasciatus was not found to be a competent vector of ZIKV, 3) considerable heterogeneity in VC, depending on the local mosquito strain and virus used in testing was observed. Critical issues or gaps identified included 1) inconsistent definitions of VC parameters across the literature; 2) equivalency of using different mosquito body parts to evaluate VC parameters for infection (mosquito bodies versus midguts), dissemination (heads, legs or wings versus salivary glands), and transmission (detection or virus amplification in saliva, FTA cards, transmission to neonatal mice); 3) articles that fail to use infectious virus assays to confirm the presence of live virus; 4) need for more studies using murine models with immunocompromised mice to infect mosquitoes. Conclusion Recent, large collaborative multi-country projects to conduct large scale evaluations of specific mosquito species represent the most appropriate approach to establish VC of mosquito species.