**Abstract**

The increasing threats of emerging and reemerging infectious disease outbreaks demand research and development (R&D) of effective and fit-for-all-purpose tools and technologies for international public health security. Recent advances in biomedical engineering, mostly related to the convergence of communication and network technology in health, i.e., mobile health with microfluidic Lab-ona-Chip technology can improve the international public health crises and employ in international public health security. Lab-on-a-Chip technology is now commonly found in most research centers, hospitals, and clinics where health care infrastructure is weak, and access to quality and timely medical care is challenging. Microfluidic devices—also known as Lab-on-a-Chip (LoC)—are an alternative for accessible, cost-effective, and early detection medical trials. The mHealth-based microfluidic LoC technology has been under rapid development, and they are becoming influential tools in a wide range of biomedical research and international public health applications. The perspective in this chapter demonstrates a potentially transformative opportunity for the deployment of mHealth with LoC with the fabrication protocols and their potential for strengthening and improving the international public health security. This attempt is not conclusive and exhaustive, and it is anticipated that such a discussion will enable the exchange of ideas between biomedical engineering, microfluidic LoC technology professionals, international public health, and health security experts.

**Keywords:** biomedical engineering, mobile health (mHealth), microfluidic, Lab-on-a-Chip, international public health security

### **1. Introduction**

Emerging and reemerging infectious diseases, and their pandemic potential, pose a challenge to international public health security in the twenty-first century that cannot be overlooked [1]. Though the historical threat to international security by epidemic diseases is not new, the threat has increased in recent years and is growing rapidly. Infectious disease emergencies can arise with little notice and have serious detrimental and lasting effects on international public health security [2]. In the past century, we have seen international health emergencies such as the 1981 influenza pandemic that killed approximately 50–100 million people [3], the

emergence of the deadly SARS coronavirus, and the 2013–2016 Ebola epidemic in West Africa [4] that resulted in more than 28,000 cases and 11,000 deaths and had devastating impacts on international health security, as just a few exemplar. Correspondingly, before 1970, only nine countries had experienced severe dengue epidemics; however, at present, dengue fever has affected more than 100 countries in tropical and subtropical regions [5]. It was estimated by the World Health Organization (WHO) that approximately 150 million dengue infections occur annually, with a 30-fold increase in global incidence observed over the past 50 years [6]. Reemergence of mosquito-borne infections such as chikungunya, zika, more virulent forms of malaria, and new more severe forms of viral respiratory infections has also evolved in recent years. Historically, literature on health and security has been scarce, and only in the past few years, a body of literature on health and security emerged. At the nexus of health and security lies many poignant examples of the growing threat of biological weapons, the negative impact of naturally occurring infectious diseases, and the migration and proliferation of emerging and reemerging infectious diseases to nonendemic areas that fabricate a strong case for including health concerns in the international public health security debate. Though international public health and health security traditionally occupied separate domains, in recent years, the imperative fusion between them has been recognized by policymakers and security and defense analysts in both developed and developing countries [7].

#### **1.1 International public health security**

International public health security is pretty new topic, and it has recently taken on a new urgency for policymakers and health security and defense analysts. The field of international public health security is an important one, closely related to people's lives, and essential for societies and countries to grow and develop. Traditionally, environmental health emergencies, humanitarian emergencies including natural and human-made disasters, conflicts and complex emergencies, civil strife, or human health rights violations constitute what has been considered the main threat to health security [8, 9]. Correspondingly, pandemics and epidemics also killed countless millions throughout human history. The 1918 flu pandemic killed 50–100 million, which is more than the combined total casualties of World War I and II [10]. In our time, highly virulent infectious diseases have not only repeatedly swept through human societies, causing death, economic chaos, and political and social disorders, but also placed sudden and intense demands on international public health security. In many countries, millions of people are suffering from avoidable health problems. Improvements to health and medical services are therefore emerging as a major priority in many countries, where many people continue to suffer due to common diseases such as HIV/AIDS, diabetes, and cancer, including tropical diseases, such as malaria, dengue fever, respiratory diseases, etc. [11]. Today, such diseases remain a serious international public health threat. According to the world health report released by the World Health Organization (WHO), noncommunicable diseases (NCDs) are responsible for approximately 71% of global deaths, with the leading causes being lower respiratory infections, HIV/AIDS, diarrheal diseases, and tuberculosis (TB) [12]. **Table 1** illustrates the top 10 leading causes of death in three categories, i.e., worldwide, low-income countries, and high-income countries. Many diseases need immediate attention and require new health technologies for their prevention and on-time diagnosis. One such promising solution can now be thought of because of the recent advances in the mobile health (mHealth) and Lab-on-a-Chip (LoC) technologies. On-going

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*mHealth-Based Microfluidic Lab-on-a-Chip for International Health Security*

2 Stroke Diarrheal diseases Stroke

4 Lower respiratory infections HIV/AIDS Lung cancers

7 Diabetes Tuberculosis Colon caners

9 Diarrheal diseases Birth asphyxia and trauma Kidney diseases 10 Tuberculosis Road injury Breast caner

**Rank Worldwide Low-income countries High-income countries**

infections

5 Alzheimer's disease Stroke Chronic obstructive pulmonary

6 Lung cancers Malaria Lower respiratory infections

complications

Heart disease

disease

Diabetes

Heart disease Alzheimer's disease

research in these technological fields leads to the rapid emergence of such devices that can prove to be very useful for improving the international public health and

mHealth is defined as the use of mobile communication and network technologies, i.e., smartphones, tablet PCs, and PDAs, for health service [13]. In broad, it is the employ of handy gadgets that are having ability of improving health and quality of care. mHealth is an evolving and swiftly rising field that holds the potential to play an imperative part in the transformation of healthcare and increase the quality of care. mHealth cover a range of hi-tech solutions, such as measure of vital signs, i.e., heart beating rate, blood sugar level, blood pressure, temperature of body, activities of brain, etc. [14]. The widespread use of mobile devices has offered a novel approach to address many health-related challenges. The mobile devices and mobile networks can be present in resource-limited regions where medical equipments are either unavailable or insufficiently portable for wide deployment. According to the data released by International Telecommunication Union (ITU), 96.8% of the people worldwide are mobile-cellular telephone subscribers, and 62.9% of them are active mobile-broadband users [15, 16]. The statistic in **Figure 1** shows the total number of mobile phone users worldwide from 2015 to 2020. In 2019, the number of mobile phone users was forecast to reach 4.68 billion [17]. The penetration of mobile devices in many regions has surpassed many other infrastructures, i.e., electricity, paved roads, and advanced healthcare resources. Such increasing accessibility of mobile devices can provide opportunities to transform the international public health and health security. Smartphones have been increasingly adapted in various healthcare applications in recent years [18], and according to applications, the use of mHealth-based healthcare practice can be divided into two categories, as demonstrated in **Table 2** in vivo test and in vitro test. Similarly, out-of-clinic smartphone use covers most of the software applications and the corresponding devices, external wearable sensors, for the daily monitoring of the health and wellness. On the other hand,

*DOI: http://dx.doi.org/10.5772/intechopen.90283*

3 Chronic obstructive pulmonary disease

1 Heart disease Lower respiratory

8 Road injury Preterm birth

employed in health security.

*The top 10 leading causes of death [12].*

**Table 1.**

**1.2 Mobile health (mHealth)**

*mHealth-Based Microfluidic Lab-on-a-Chip for International Health Security DOI: http://dx.doi.org/10.5772/intechopen.90283*


#### **Table 1.**

*Contemporary Developments and Perspectives in International Health Security - Volume 1*

emergence of the deadly SARS coronavirus, and the 2013–2016 Ebola epidemic in West Africa [4] that resulted in more than 28,000 cases and 11,000 deaths and had devastating impacts on international health security, as just a few exemplar. Correspondingly, before 1970, only nine countries had experienced severe dengue epidemics; however, at present, dengue fever has affected more than 100 countries in tropical and subtropical regions [5]. It was estimated by the World Health Organization (WHO) that approximately 150 million dengue infections occur annually, with a 30-fold increase in global incidence observed over the past 50 years [6]. Reemergence of mosquito-borne infections such as chikungunya, zika, more virulent forms of malaria, and new more severe forms of viral respiratory infections has also evolved in recent years. Historically, literature on health and security has been scarce, and only in the past few years, a body of literature on health and security emerged. At the nexus of health and security lies many poignant examples of the growing threat of biological weapons, the negative impact of naturally occurring infectious diseases, and the migration and proliferation of emerging and reemerging infectious diseases to nonendemic areas that fabricate a strong case for including health concerns in the international public health security debate. Though international public health and health security traditionally occupied separate domains, in recent years, the imperative fusion between them has been recognized by policymakers and security and defense analysts in both developed and develop-

International public health security is pretty new topic, and it has recently taken on a new urgency for policymakers and health security and defense analysts. The field of international public health security is an important one, closely related to people's lives, and essential for societies and countries to grow and develop. Traditionally, environmental health emergencies, humanitarian emergencies including natural and human-made disasters, conflicts and complex emergencies, civil strife, or human health rights violations constitute what has been considered the main threat to health security [8, 9]. Correspondingly, pandemics and epidemics also killed countless millions throughout human history. The 1918 flu pandemic killed 50–100 million, which is more than the combined total casualties of World War I and II [10]. In our time, highly virulent infectious diseases have not only repeatedly swept through human societies, causing death, economic chaos, and political and social disorders, but also placed sudden and intense demands on international public health security. In many countries, millions of people are suffering from avoidable health problems. Improvements to health and medical services are therefore emerging as a major priority in many countries, where many people continue to suffer due to common diseases such as HIV/AIDS, diabetes, and cancer, including tropical diseases, such as malaria, dengue fever, respiratory diseases, etc. [11]. Today, such diseases remain a serious international public health threat. According to the world health report released by the World Health Organization (WHO), noncommunicable diseases (NCDs) are responsible for approximately 71% of global deaths, with the leading causes being lower respiratory infections, HIV/AIDS, diarrheal diseases, and tuberculosis (TB) [12]. **Table 1** illustrates the top 10 leading causes of death in three categories, i.e., worldwide, low-income countries, and high-income countries. Many diseases need immediate attention and require new health technologies for their prevention and on-time diagnosis. One such promising solution can now be thought of because of the recent advances in the mobile health (mHealth) and Lab-on-a-Chip (LoC) technologies. On-going

**196**

ing countries [7].

**1.1 International public health security**

*The top 10 leading causes of death [12].*

research in these technological fields leads to the rapid emergence of such devices that can prove to be very useful for improving the international public health and employed in health security.

#### **1.2 Mobile health (mHealth)**

mHealth is defined as the use of mobile communication and network technologies, i.e., smartphones, tablet PCs, and PDAs, for health service [13]. In broad, it is the employ of handy gadgets that are having ability of improving health and quality of care. mHealth is an evolving and swiftly rising field that holds the potential to play an imperative part in the transformation of healthcare and increase the quality of care. mHealth cover a range of hi-tech solutions, such as measure of vital signs, i.e., heart beating rate, blood sugar level, blood pressure, temperature of body, activities of brain, etc. [14]. The widespread use of mobile devices has offered a novel approach to address many health-related challenges. The mobile devices and mobile networks can be present in resource-limited regions where medical equipments are either unavailable or insufficiently portable for wide deployment. According to the data released by International Telecommunication Union (ITU), 96.8% of the people worldwide are mobile-cellular telephone subscribers, and 62.9% of them are active mobile-broadband users [15, 16]. The statistic in **Figure 1** shows the total number of mobile phone users worldwide from 2015 to 2020. In 2019, the number of mobile phone users was forecast to reach 4.68 billion [17]. The penetration of mobile devices in many regions has surpassed many other infrastructures, i.e., electricity, paved roads, and advanced healthcare resources. Such increasing accessibility of mobile devices can provide opportunities to transform the international public health and health security.

Smartphones have been increasingly adapted in various healthcare applications in recent years [18], and according to applications, the use of mHealth-based healthcare practice can be divided into two categories, as demonstrated in **Table 2** in vivo test and in vitro test. Similarly, out-of-clinic smartphone use covers most of the software applications and the corresponding devices, external wearable sensors, for the daily monitoring of the health and wellness. On the other hand,

#### **Figure 1.**

*The number of mobile phone users worldwide from 2015 to 2020 [17].*


#### **Table 2.**

*Categories of smartphone-based test [14].*

the in-clinic applications of smartphones involve the diagnostics of specific types of diseases and are supposed to help make clinical decisions [19, 20]. For example, a single-channel electrocardiograph (ECG) can be integrated at the back case of an iPhone and a plug-and-play blood pressure monitor can wirelessly link to a smartphone. Smartphones, equipped with a computer-like platform and various types of sensors, have several properties promoting their uses in in vivo and in vitro test [14]. This confirms that mobile and network technologies are becoming widely accessible even in resource-limited areas lacking adequate healthcare facilities.

#### **1.3 Microfluidic Lab-on-a-Chip technology**

The idea of a technology for a device unifying data acquisition and measurement together with sensing and analysis and a response to analysis result was brought into practice for the first time in 1979. By the late 80s and early 90s, Lab-on-a-Chip technology experienced a fast development of total analysis microsystems (uTAS)

**199**

*mHealth-Based Microfluidic Lab-on-a-Chip for International Health Security*

[21–24]. These systems were formerly designed for improving chemical separation techniques, particularly capillary electrophoresis, and were later applied in experiments with biological materials [25], DNA and RNA, cells and bacteria, proteins, etc., motivated by the potential market for biomedical research [26]. Microfluidic-based biosensors, primarily dedicated to the detection of biomolecules such as proteins, enzymes, peptides, and DNA, are proposed in the biomedical field as tools to monitor cell behavior on a miniaturized scale, with high sensitivity and resolution and low costs [27]. By detecting cellular analytes, electrical activities, and chemical and physical signals transmitted by the cells, microfluidic-based biosensors provided insights into cellular activities and responses in real time [28]. As a result, microfluidic-based biosensors—also known as Lab-on-a-Chip (LoC)

LoC devices are promoted for biomedical, biotechnology, chemical, and environmental monitoring applications as a response to the necessity of time effective, low cost, automated laboratory tests by integrating one or more functions in one miniaturized device, such as sample transport, reagent mixing, heating, evaluation, analysis, and synthesis [29–32]. LoC technology integrates microfluidic and electronic components onto the same chip for the development of hybrid devices to reduce laboratory processes in a manner competitive to bench-top instruments [22]. LoC technology emphasizes integration, chip programmability, increased sensitivity, minimal reagent consumption, sterilization, and efficient sample detection and separation. A typical LoC device contains microchannels, which not only allow liquid samples to flow inside the chip, but also integrates measuring, sensing, and actuating components such as microvalves, micromixers, microelectrodes, thermal elements, and optical apparatuses [23]. Microfluidic-based LoC devices have also become very attractive nowadays as they force the development of personalized devices for point-of-care treatments, and enable the fabrication of the next generation of portable and implantable bioelectronic devices [24]. Due to their biosensing capability and embedding concept, the microfluidic-based LoC systems are attractive platforms for developing implantable bioinspired sensors that can be integrated with communication and

Because international public health security is a relatively new topic of interest and inquiry, one would not expect to find a well-established body of literature surrounding this theme. However, to identify potentially relevant technology solutions for international public health security, I conducted a horizon scan to understand the mHealth-based microfluidic Lab-on-a-Chip technology that could benefit international public health security. In order to identify potential transformative technology, I reviewed non-peer-reviewed gray literature, technology reviews, and peer-reviewed scientific literature for recent development in the LoC technology and fabrication protocols. Searches were conducted through PubMed, Google,

There are many fabrication protocols and materials for prototyping LoCs. A design framework can be used with these fabrication materials and methods in

*DOI: http://dx.doi.org/10.5772/intechopen.90283*

devices—became more and more popular.

network technology [33].

**2. Methodology: technology identification process**

Google Scholar, and Web of Science databases.

**3. Fabrication protocols and chip materials**

recourse-limited settings, discussed in the following section.

*mHealth-Based Microfluidic Lab-on-a-Chip for International Health Security DOI: http://dx.doi.org/10.5772/intechopen.90283*

[21–24]. These systems were formerly designed for improving chemical separation techniques, particularly capillary electrophoresis, and were later applied in experiments with biological materials [25], DNA and RNA, cells and bacteria, proteins, etc., motivated by the potential market for biomedical research [26]. Microfluidic-based biosensors, primarily dedicated to the detection of biomolecules such as proteins, enzymes, peptides, and DNA, are proposed in the biomedical field as tools to monitor cell behavior on a miniaturized scale, with high sensitivity and resolution and low costs [27]. By detecting cellular analytes, electrical activities, and chemical and physical signals transmitted by the cells, microfluidic-based biosensors provided insights into cellular activities and responses in real time [28]. As a result, microfluidic-based biosensors—also known as Lab-on-a-Chip (LoC) devices—became more and more popular.

LoC devices are promoted for biomedical, biotechnology, chemical, and environmental monitoring applications as a response to the necessity of time effective, low cost, automated laboratory tests by integrating one or more functions in one miniaturized device, such as sample transport, reagent mixing, heating, evaluation, analysis, and synthesis [29–32]. LoC technology integrates microfluidic and electronic components onto the same chip for the development of hybrid devices to reduce laboratory processes in a manner competitive to bench-top instruments [22]. LoC technology emphasizes integration, chip programmability, increased sensitivity, minimal reagent consumption, sterilization, and efficient sample detection and separation. A typical LoC device contains microchannels, which not only allow liquid samples to flow inside the chip, but also integrates measuring, sensing, and actuating components such as microvalves, micromixers, microelectrodes, thermal elements, and optical apparatuses [23]. Microfluidic-based LoC devices have also become very attractive nowadays as they force the development of personalized devices for point-of-care treatments, and enable the fabrication of the next generation of portable and implantable bioelectronic devices [24]. Due to their biosensing capability and embedding concept, the microfluidic-based LoC systems are attractive platforms for developing implantable bioinspired sensors that can be integrated with communication and network technology [33].

#### **2. Methodology: technology identification process**

Because international public health security is a relatively new topic of interest and inquiry, one would not expect to find a well-established body of literature surrounding this theme. However, to identify potentially relevant technology solutions for international public health security, I conducted a horizon scan to understand the mHealth-based microfluidic Lab-on-a-Chip technology that could benefit international public health security. In order to identify potential transformative technology, I reviewed non-peer-reviewed gray literature, technology reviews, and peer-reviewed scientific literature for recent development in the LoC technology and fabrication protocols. Searches were conducted through PubMed, Google, Google Scholar, and Web of Science databases.

#### **3. Fabrication protocols and chip materials**

There are many fabrication protocols and materials for prototyping LoCs. A design framework can be used with these fabrication materials and methods in recourse-limited settings, discussed in the following section.

*Contemporary Developments and Perspectives in International Health Security - Volume 1*

*The number of mobile phone users worldwide from 2015 to 2020 [17].*

**Category Explanation Examples**

sample consumption; biological signals are converted to electrical signals by various

Test that requires sample consumption; biological components or organisms are detected from samples, such as

blood, sweat, etc.

*Categories of smartphone-based test [14].*

In vivo test Test that does not require

sensors.

the in-clinic applications of smartphones involve the diagnostics of specific types of diseases and are supposed to help make clinical decisions [19, 20]. For example, a single-channel electrocardiograph (ECG) can be integrated at the back case of an iPhone and a plug-and-play blood pressure monitor can wirelessly link to a smartphone. Smartphones, equipped with a computer-like platform and various types of sensors, have several properties promoting their uses in in vivo and in vitro test [14]. This confirms that mobile and network technologies are becoming widely accessible even in resource-limited areas lacking adequate healthcare

Test with built-in sensor

Test with extra sensor

Tube strip and specimen inspection

Microfluidic testing

Use the built-in sensors, such as camera, to collect human body or

Use extra sensors, such as an ultrasound probe, to collect human body or environmental

Take a specimen of bodily fluid and directly inspect the result using the built-in camera or microscope connected to a

Take a specimen of bodily fluid and use microfluidic technique to perform complicated biochemical tests and visualize the result using

environmental signals

signals

smartphone

a smartphone

The idea of a technology for a device unifying data acquisition and measurement

together with sensing and analysis and a response to analysis result was brought into practice for the first time in 1979. By the late 80s and early 90s, Lab-on-a-Chip technology experienced a fast development of total analysis microsystems (uTAS)

**198**

facilities.

**Table 2.**

**Figure 1.**

In vitro test

**1.3 Microfluidic Lab-on-a-Chip technology**
