Lab-on-a-Chip Diagnostics for Resource-Limited Settings

Abstract

Lab-on-a-chip (LOC) platforms integrate sample preparation, biochemical reactions, and detection onto miniaturised microfluidic devices, offering rapid, low-cost, and portable diagnostics suitable for resource-limited settings (RLS) where centralised laboratories are unavailable. Despite substantial academic progress, fewer than 12% of published LOC prototypes have reached field deployment in low- and middle-income countries (LMICs). This study presents a systematic evaluation of five LOC architectures -- paper-based microfluidic analytical devices (muPADs), centrifugal microfluidics (lab-on-a-disc), droplet microfluidics, lateral flow immunoassays (LFIA) with integrated signal amplification, and elastomeric valve-based chips -- across four clinically relevant analytes: malaria (Plasmodium falciparum HRP2), HIV-1 viral load, blood glucose, and C-reactive protein (CRP). Analytical performance was benchmarked against WHO ASSURED criteria (Affordable, Sensitive, Specific, User-friendly, Rapid, Equipment-free, Deliverable). muPADs achieved the lowest per-test cost ($0.08 +- 0.03) and highest field-readiness score (ASSURED 5.8/7), while droplet microfluidics provided the best analytical sensitivity (LOD 1.2 pg/mL for CRP) but required external instrumentation incompatible with field deployment. The proposed integrated muPAD-LFIA hybrid platform achieved 94.6% sensitivity and 97.2% specificity for malaria HRP2 detection (n = 384 clinical samples, endemic setting), with time-to-result of 18 +- 3 minutes and no cold chain requirement. These findings establish muPAD-LFIA hybrids as the most deployment-ready LOC technology for RLS diagnostics and provide an evidence-based framework for selecting microfluidic architectures matched to target-product-profile constraints in global health applications