NSIDDx: A Design Framework for Neuro-Symbolic, Practitioner-First Differential Diagnosis in Low-Resource Settings

LLM-based diagnostic systems achieve high semantic accuracy on benchmarks, but open-ended evaluation on clinically uncommon presentations reveals a systematic gap between headline accuracy and verifiable clinical reliability. We evaluate an LLM+rare-disease-RAG pipeline across two cohorts and show that the paradigm produces confident outputs that are frequently unverifiable and systematically resistant to clinician interrogation. We present NSIDDx (Neuro-Symbolic Integrated Differential Diagnosis System), a design framework arguing that DDx systems in low-resource settings must treat the clinician as an active reasoning agent. We instantiate this through a neuro-symbolic pipeline with ternary symptom encoding, contradiction detection, audit strings, and practitioner override - running offline on consumer hardware. We distill five design principles for clinician-in-the-loop clinical NLP and invite the prospective studies needed to validate the claim at scale.

A corpus-specific clinical RAG system matches or outperforms newer frontier LLMs on HealthBench

General-purpose large language models (LLMs) have recently been reported to match or exceed specialized clinical AI tools on medical benchmarks, but such comparisons draw on a narrow set of systems and on benchmarks developed largely in high-income settings. We evaluate VITA, a retrieval-augmented generation (RAG) system purpose-built for contextual knowledge retrieval in India and other low- and middle-income (LMIC) settings. VITA retrieves from a curated corpus of disease-specific guidelines, India-specific antimicrobial resistance data, national formulary constraints, and resource-limited care protocols; its architecture and corpus are proprietary, but the benchmark, the physician-written rubrics, and our full response and scoring outputs are public for independent verification. On 4,023 English-language HealthBench questions (80.5% of the benchmark), scored with a GPT-4.1 judge, VITA ranked first with 51.9% of possible rubric points, ahead of GPT-5.4 (46.1%), o4-mini (44.3%), Gemini 3.1 Pro (42.6%), and Claude Sonnet 4.6 (37.3%), and scored highest on 45.4% of questions. To test robustness to newer models and judge lineage, a 500-question subset was re-run against current-generation models (GPT-5.5, Claude Opus 4.8, Gemini 3.5 Pro, Grok 4.3) and graded by a neutral open-weight judge (DeepSeek-V4-Pro) sharing no lineage with any system tested. Here the gap narrowed to parity: VITA and GPT-5.5 were statistically indistinguishable on mean per-question score, while VITA led on points-weighted score and won the most questions. VITA's advantages in accuracy and completeness persisted under the neutral judge; its communication scores were lower. These results indicate that a purpose-built clinical RAG system remains competitive with frontier LLMs on an open benchmark, consistent with corpus specificity as a design variable that improves grounding at some cost to communication polish.

From Manuals to Maintenance: Fine-Tuning MedGemma for Multi-Modal Imaging System Support in Low-Resource Settings

Imaging device downtime is a major barrier to healthcare delivery in low- and middle-income countries (LMICs), often driven by limited access to specialized biomedical engineering support. We present a multi-modality medical equipment maintenance question-answering (QA) framework and demonstrate the fine-tuning of a medical foundation model for specialized technical troubleshooting tasks. Guided by a multi-country survey across nine LMICs, we curated technical manuals from MRI and ultrasound systems to generate the INGENZI_DatasetV1, containing 10,294 high-quality, filtered QA-context pairs. Using QLoRA-based parameter-efficient fine-tuning, we adapted the MedGemma-4b-it model to interpret system error logs and generate step-by-step equipment repair instructions. Compared to the baseline model, the fine-tuned system achieved substantial improvements across metrics, including F1 score (0.22 to 0.38), ROUGE-2 (0.18 to 0.41), and BERTScore F1 (0.86 to 0.91). These metric gains demonstrate that the model generates significantly more precise and procedurally accurate technical responses to new troubleshooting queries. This work establishes a reliable foundation for AI-assisted diagnostic and maintenance tools in resource-constrained settings.

Aletheia: An Offline-First Clinical Decision Support System for Differential Diagnosis in Low-Resource Healthcare Settings

Access to specialist clinical expertise remains severely limited across sub-Saharan Africa, where physician-to-patient ratios can fall below 1:25,000 in rural settings. Existing AI-assisted diagnostic tools predominantly require reliable internet connectivity and high-specification hardware, rendering them impractical for frontline healthcare workers in district hospitals and health centres. This paper presents Aletheia, an offline-first clinical decision support system designed for low-resource healthcare contexts across sub-Saharan Africa. Aletheia is built upon Qwen2.5-3B-Instruct, fine-tuned using Quantised Low-Rank Adaptation (QLoRA) on a curated dataset of 27,000 clinical reasoning samples spanning 50 disease conditions with elevated prevalence in East Africa. Evaluation demonstrates a Top-1 diagnostic accuracy of 80% (8 of 10 cases; 95% CI 49.0-94.3%), Top-3 accuracy of 100% (10 of 10; 95% CI 72.2-100%), BERTScore-F1 of 0.909, and METEOR of 0.467. These diagnostic figures are computed over a deliberately small set of ten representative clinical case categories, one case each, and are therefore indicative rather than statistically robust; the wide confidence intervals should be read alongside them. The system achieves an Expected Calibration Error (ECE) of 0.275 and passes the Africa Deep Tech Challenge 2026 (ADTC 2026) memory budget constraint of 7,168 MB, achieving a peak inference RAM of approximately 3,630 MB on the standardised benchmark laptop. These results demonstrate the feasibility of deploying large language model-based clinical reasoning at the primary care level in resource-constrained settings without cloud infrastructure.

Explainable AI for Screening Abuse-Related Trauma in Bangladeshi Children: A Training-Free Multimodal Framework Evaluated on Noise-Aware Synthetic Data

Bangladesh has an estimated 1.17 mental-health professionals per 100,000 population and only six child psychiatrists nationwide. No Bengali-language, culturally adapted tool exists for early screening of abuse-related psychological trauma in children. We present ShishuRaksha AI, a decision-support (not diagnostic) framework that fuses four screening modalities: validated questionnaires (SDQ, CPSS), Bengali narrative text, House-Tree-Person (HTP) drawing features, and facial affect. The fusion is training-free and clinically weighted, uses cross-modal attention, and includes a single-modality override rule. Every risk score is explained through clinically weighted, perturbation-based additive attribution and rendered as a bilingual (Bangla/English) report with referral routing to national child-protection services (OCC, DSS, NMHH) under the Children Act 2013. No clinical dataset of abused children can be collected ethically at this stage, so we introduce a noise-aware synthetic benchmark (500 cases, 116 positive [23.2%], four deliberate noise layers, literature-grounded HTP priors) and evaluate tree-ensemble surrogates of the fusion design (facial channel excluded) under 5-fold stratified cross-validation. The fused model reaches an AUC of 0.874 [0.834-0.908], against 0.756 [0.705-0.803] for an SDQ-only baseline, with ablation, operating-point, subgroup, and calibration analyses. We state all limitations openly, including synthetic-only data, no held-out set, text-feature circularity, and an urban-rural subgroup gap. This work is a feasibility study and a design contribution toward ethically deployable child-protection screening in low-resource settings.

Teaching LLMs to Recommend and Defer in Underrepresented Epilepsy Care

Specialist epilepsy expertise is scarce in resource-constrained settings, making LLM-based decision support attractive for frontline clinicians managing longitudinal treatment. Such systems must adapt to local prescribing practice and know when to defer. We study this problem in Ugandan pediatric epilepsy care, predicting anti-seizure medication regimens from longitudinal unstructured clinic notes. Standard prompting achieves non-trivial agreement with physician prescriptions, but neurologist review shows that many errors reflect distribution-miscalibrated prescribing defaults rather than failures to parse the local record. We introduce MANANA, a non-parametric prompt-learning framework that learns local prescribing guidance from a small patient-level training set. MANANA converts observed prescription errors into auditable prompt memories, instantiated in single-agent and multi-agent variants, and improves over classical ML models, direct LLM prompting, and prompt-optimization baselines across two independently collected Ugandan cohorts. We further propose Bayesian prompt averaging, which converts the learned prompt trajectory into prescription likelihoods and an uncertainty-based deferral signal. On the independently collected held-out cohort, this improves visit-level top-3 prescription accuracy by 4-8 percentage points over prompt-optimization baselines and enables selective prediction: the system can auto-handle the most confident half of cases at 95% precision, or the most confident quarter at 99% precision, while deferring lower-confidence cases for specialist review.

ERN-Net : Evolving Reason Node-Net for Document Binarization

This paper presents ERN-Net, an Evolving Reason Node-Net for efficient document image binarization. ERN-Net enhances degradation-sensitive regions, such as faint strokes, broken characters, and noisy backgrounds, through evolving reason nodes and multi-scale reasoning. We further compare ResNet-101, ConvNeXt-Tiny, and ConvNeXt-Base, and find that ConvNeXt-Tiny provides the best practical trade-off between accuracy and memory usage. In addition, DIBCO-based pretraining improves binarization performance without increasing model memory consumption, requiring only about 1.5 additional training hours. Experiments on DIBCO-style benchmarks show that ERN-Net is effective under low-data and low-memory settings.