Evaluating Large Language Models on Historical Health Crisis Knowledge in Resource-Limited Settings: A Hybrid Multi-Metric Study

Artificial Intelligence (AI) technologies, while serving as a foundational enabler for modern social media and digital health services, exert a bivalent effect by simultaneously acting as a combatant against and a spread vector for misinformation. A prevalent challenge in mitigating this issue arises in non-English contexts and low socioeconomic classes, where limited data hinders the training of AI models for effective detection. Consequently, culturally and linguistically diverse (CALD) communities struggle to access trustworthy health information through AI-driven tools. Current AI tools underperform due to a lack of training data and are largely unable to consider language nuances and traditions in non-English contexts. This research addresses these gaps by proposing a CALD-friendly AI-based health misinformation detector and providing a dashboard for medical professionals to analyse this misinformation, a critical step toward mitigating a growing concern among CALD populations. To this end, we conduct a series of experiments using a Bangla-translated health misinformation dataset to evaluate the performance of various Small Language Models (SLMs). SLMs are particularly relevant in this context given the frequent underperformance of Large Language Models (LLMs), which often stems from insufficient domain-specific knowledge and the prohibitive costs of resource-intensive fine-tuning. The results demonstrate that Phi-4 is the superior model, achieving an ideal balance between precision and recall in claim extraction. Then, to mitigate the limitations of SLMs, we design and test a novel health misinformation detection framework grounded in Responsible Natural Language Processing (NLP), which incorporates cultural sensitivity, potential for harm, and communication quality, thereby providing a holistic lens for evaluating misinformation in low-resource languages.

Small open-source language models are gaining attention for healthcare applications in low-resource settings where cloud infrastructure and GPU hardware may be unavailable. However, the reliability of these models under different phrasings of the same clinical question remains poorly understood. We evaluate five open-source models (Gemma 2 2B, Phi-3 Mini 3.8B, Llama 3.2 3B, Mistral 7B, and Meditron-7B, a domain-pretrained model without instruction tuning) across three clinical question answering datasets (MedQA, MedMCQA, and PubMedQA) using five prompt styles: original, formal, simplified, roleplay, and direct. Model behavior is evaluated using consistency scores, accuracy, and instruction-following failure rates. All experiments were conducted locally on consumer CPU hardware without fine-tuning. Consistency and accuracy were largely independent across models. Gemma 2 achieved the highest consistency (0.845-0.888) but the lowest accuracy (33.0-43.5%), while Llama 3.2 showed moderate consistency (0.774-0.807) alongside the highest accuracy (49.0-65.0%). Roleplay prompts consistently reduced accuracy across all models, with Phi-3 Mini dropping 21.5 percentage points on MedQA. Meditron-7B exhibited near-complete instruction-following failure on PubMedQA (99.0% UNKNOWN rate), indicating that domain pretraining alone is insufficient for structured clinical question answering. These findings show that high consistency does not imply correctness: models can be reliably wrong, a dangerous failure mode in clinical AI. Llama 3.2 demonstrated the strongest balance of accuracy and reliability for low-resource deployment. Safe clinical AI requires joint evaluation of consistency, accuracy, and instruction adherence.

Despite continuous advances in medical technology, the global distribution of health care resources remains uneven. The development of large language models (LLMs) has transformed the landscape of medicine and holds promise for improving health care quality and expanding access to medical information globally. However, existing LLMs are primarily trained on high-resource languages, limiting their applicability in global medical scenarios. To address this gap, we constructed GlobMed, a large multilingual medical dataset containing more than 800,000 entries spanning 20 languages, including seven low-resource languages. Building on this, we established GlobMed-Bench, which systematically assesses 56 state-of-the-art proprietary and open-weight LLMs across 12 of the 20 languages represented in GlobMed, comprising over 20,000 independent experiments and more than 32 million model responses. This large-scale evaluation revealed significant performance disparities across languages, particularly for low-resource languages. Additionally, we introduced GlobMed-LLMs, a suite of multilingual medical LLMs trained across the 12 benchmark languages, with parameters ranging from 1.7B to 8B. GlobMed-LLMs achieved an average performance improvement of nearly 40% relative to baseline LLMs, with a maximum performance improvement of more than threefold in low-resource languages. These resources provide an important foundation for advancing the equitable development and application of LLMs globally, enabling broader language communities to benefit from technological advances.