Digital Commons Network^™

Short And Long-Term Lifestyle Coaching Approaches Used To Address Diverse Participant Barriers To Weight Loss And Physical Activity Adherence, Elizabeth M. Venditti, Judith Wylie-Rosett, Linda M. Delahanty, Lisa L. Mele, Mary A. Hoskin, Sharon Edelstein

GW Biostatistics Center

Background

Individual barriers to weight loss and physical activity goals in the Diabetes Prevention Program, a randomized trial with 3.2 years average treatment duration, have not been previously reported. Evaluating barriers and the lifestyle coaching approaches used to improve adherence in a large, diverse participant cohort can inform dissemination efforts.

Methods

Lifestyle coaches documented barriers and approaches after each session (mean session attendance = 50.3 +/- 21.8). Subjects were 1076 intensive lifestyle participants (mean age = 50.6 years; mean BMI = 33.9 kg/m2; 68% female, 48% non-Caucasian). Barriers and approaches used to improve adherence were ranked by the percentage of …

Impaired Fasting Glucose Level And Diabetes In Kaoma And Kasama Rural Districts Of Zambia: Prevalence And Correlates In 2008-2009 Population Based Surveys, Olesegun A. Babaniyi, Peter Songolo, Emmanuel Rudatsikira, Adamson S. Muula, David Mulenga, Mazyanga L. Mazaba-Liwewe, Idah Ndumba, Freddie Masaninga, Seter Siziya

Faculty Publications

Background: Impaired fasting glucose level has been associated with increased incidence of Type 2 Diabetes mellitus, and diabetes is becoming a major public health problem in developing countries. The objective of the study was to determine the prevalence and correlates for impaired fasting glucose level/diabetes in Kaoma and Kasama rural districts of Zambia. Methods and Findings: A cross sectional study using modified World Health Organization (WHO) global non communicable diseases (NCD) surveillance initiative NCD STEPwise approach was used in the study. Proportions were compared using the Yates’ corrected Chi-square test, and a result yielding a p value of less than …

Complexity Of Breastfeeding Health Policy In Tanzania, Africa, Theresa Thompson

Master of Public Health Program Student Publications

Background: The purpose of this study was to investigate Tanzanian health policy regarding the protection and promotion of breastfeeding.

Country Profile: Tanzania is a United Republic composed of the mainland and also the islands of Zanzibar. Tanzania is located in east Africa with a population of approximately 46 million. About 1.6 million babies are born each year in Tanzania, however only approximately 140,000 are registered annually. Tanzania’s infant mortality rate is 68 infant deaths per 1000 live births. Tanzania makes up for approximately 0.5% of the world population but 2% of the global infant death.

Approaches: In this study, the …

Impact Of Routine Immunization Coverage In Controlling Measles And Progressing Toward The Introduction Of Rubella Containing Vaccine: A Comparison Study Between Rwanda And Uganda, Carmen Kupangi Dibaya

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Despite the existence of safe and effective vaccines, measles and rubella present a major public health problem in many developing countries, disproportionally affecting low-income populations.1-3 Indeed, measles and rubella remain two of the leading causes of death and congenital defects in children worldwide.4-6 In 2008, an estimated 10 million new cases and 164,000 deaths were reported from measles alone.3 During the same time period, the United Nations International Children's Emergency Fund (UNICEF) reported an estimated 110,000 cases of Congenital Rubella Syndrome (CRS) in developing countries, with the continent of Africa shouldering 38% of the disease burden.7 Measles is a highly …

Barriers To Obstetric Fistula Treatment In Low-Income Countries: A Systematic Review, Benjamin Bellows, Rachel Bach, Zoe Baker, Charlotte E. Warren

Reproductive Health

Obstetric fistula is a maternal morbidity condition that occurs in some low-income countries and is caused by prolonged obstructed labor that results in a hole between the vagina and the bladder or rectum through which urine or feces leak. Unrepaired fistula can lead to lifelong ostracism, stigma, and shame. Obstetric fistula is preventable and treatable, but women in these countries experience delays in seeking repair due to a number of factors including awareness of their condition as well as the potential for treatment, resources necessary for seeking care, lack of skilled fistula surgeons, and long hospital waiting times. UNFPA estimates …

Clinical Features, Proximate Causes, And Consequences Of Active Convulsive Epilepsy In Africa, Symon M. Kariuki, William Matuja, Albert Akpalu, Angelina Kakooza-Mwesige, Martin Chabi, Ryan G. Wagner, Myles Connor, Eddie Chengo, Anthony K. Ngugi, Rachael Odhiambo, Christian Bottomley, Steven White, Josemir W. Sander, Brian G. R. Neville, Charles R. J. C. Newton

Internal Medicine, East Africa

Purpose: Epilepsy is common in sub-Saharan Africa (SSA), but the clinical features and consequences are poorly characterized. Most studies are hospital-based, and few studies have compared different ecological sites in SSA. We described active convulsive epilepsy (ACE) identified in cross-sectional community-based surveys in SSA, to understand the proximate causes, features, and consequences.

Methods: We performed a detailed clinical and neurophysiologic description of ACE cases identified from a community survey of 584,586 people using medical history, neurologic examination, and electroencephalography (EEG) data from five sites in Africa: South Africa; Tanzania; Uganda; Kenya; and Ghana. The cases were examined by clinicians to …

Exploring Perceptions And Experiences With Research Ethics In Bolivia, Sarah Sullivan, Armando Basagoitia, Annette Aalborg, Oscar Lanza, Jacqueline Cortez

Background: In Bolivia, there is increasing interest in the necessity of incorporating research ethics into study designs and procedures, but there is minimal data on the perceptions and experiences of Bolivian health science faculty, researchers, and national health administrators on research ethics. The Touro University California (TUC) Public Health Program is partnering with Bolivian universities to develop a comprehensive Research Education Ethics Program. In 2013, The Universidad Mayor de San Andrés received a National Institute of Health/Fogarty International Center Planning Grant award to develop the program. The two central aims of this program needs assessment are to describe the …

Cholera Vaccination Campaign Contributes To Improved Knowledge Regarding Cholera And Improved Practice Relevant To Waterborne Disease In Rural Haiti, Omowunmi Aibana, Molly F Franke, Jessica E Teng, Johanne Hilaire, Max Raymond, Louise C Ivers

Faculty, Staff and Student Publications

BACKGROUND: Haiti's cholera epidemic has been devastating partly due to underlying weak infrastructure and limited clean water and sanitation. A comprehensive approach to cholera control is crucial, yet some have argued that oral cholera vaccination (OCV) might result in reduced hygiene practice among recipients. We evaluated the impact of an OCV campaign on knowledge and health practice in rural Haiti.

METHODOLOGY/PRINCIPAL FINDINGS: We administered baseline surveys on knowledge and practice relevant to cholera and waterborne disease to every 10th household during a census in rural Haiti in February 2012 (N = 811). An OCV campaign occurred from May-June 2012 after …

The Influences Of Climatic And Socioeconomic Variables On Cholera Incidence In India During The Seventh Pandemic, 1961-2008, Kathleen M. Henschel

Master of Public Health Program Student Publications

Background: Cholera outbreaks result in significant morbidity worldwide. Transmission of the disease may be influenced by weather fluctuations, such as El Niño-Southern Oscillation (ENSO) and excessive rainfall, and socioeconomic status (SES), including income and education. El Niño events may influence many aspects of the climate, including the amount of rainfall occurring in a given year and surface water temperature. This study aimed to assess the influences of extreme weather and SES factors on cholera incidence in India during the seventh cholera pandemic (1961-2008).

Methods: Data for all variables were obtained for 1961-2008. Indian population estimates and cholera incidence (IR) were …

People Who Inject Drugs, Hiv Risk, And Hiv Testing Uptake In Sub-Saharan Africa, A K. Asher, J A. Hahn, Marie-Claude Couture, K Maher, Page

Nursing and Health Professions Faculty Research and Publications

Dramatic rises in injection drug use (IDU) in sub-Saharan Africa account for increasingly more infections in a region already overwhelmed by the HIV epidemic. There is no known estimate of the number of people who inject drugs (PWID) in the region, or the associated HIV prevalence in PWID. We reviewed literature with the goal of describing high-risk practices and exposures in PWID in sub-Saharan Africa, as well as current HIV prevention activities aimed at drug use. The literature search looked for articles related to HIV risk, injection drug users, stigma, and HIV testing in sub-Saharan Africa. This review found evidence …

The Contracting World Of Girls At Puberty: Violence And Gender-Divergent Access To The Public Sphere Among Adolescents In South Africa, Kelly Hallman, Nora Kenworthy, Judith A. Diers, Nick Swan, Bashi Devnarain

Poverty, Gender, and Youth

This Population Council working paper describes a participatory mapping project undertaken with single-sex groups of grade 5 and grade 8–9 children in urban and rural KwaZulu-Natal, South Africa. At grade 5, female self-defined community areas were equal to or larger in size than those of males in both sites. However, wide gender divergence in access to the public sphere was found among grade 8–9 children. Although curtailed spatial access, especially in urban areas, is intended to protect post-pubescent girls, grade 8–9 girls reported most spaces in their small navigable areas unsafe. Reducing girls’ access to the public sphere does not …

Feasibility Of Routine Screening For Intimate Partner Violence In Public Health Care Settings In Kenya, Chi-Chi Undie, Catherine Maternowska, Margaret Mak'anyengo, Ian Askew

Reproductive Health

This Population Council study tested the feasibility of implementing intimate-partner violence (IPV) screening protocols in healthcare settings in Kenya where sexual and gender-based violence service referrals could be executed. Providers drawn from these sites were trained to routinely screen for IPV and to refer IPV-positive clients identified through this process for further care. This study demonstrates that providers, given the training, are willing and able to incorporate IPV screening into their practice—one that they perform in a severely resource-constrained context. Likewise, the findings indicate that incorporating IPV screening questions into client intake forms in a variety of public healthcare settings …

Mitigating The Consequences Of Sexual Violence In Zambia By Decentralizing Emergency Medical Responses To Police Victim Support Units: Report On The Feasibility Of Police Provision Of Post-Exposure Prophylaxis For Hiv (Pep) In Zambia, Mary Zama, Mardieh Dennis, Jessica Price, Stephanie M. Topp, Jonathan Kaunda Mwansa, Jill Keesbury

Reproductive Health

The Zambian Ministry of Home Affairs (housing the Zambia Police Service); the Ministry of Health, the Ministry of Community Development, Mother and Child Health; and the Population Council collaborated on operations research studies to increase provision of emergency medical care to survivors of sexual violence via the Zambia Police Services (ZP). Recognizing the need to strengthen linkages between the police and the health sector and following up on the lessons learned from earlier models of police delivery of emergency contraception, this feasibility study was designed to: determine if victim support unit (VSU) officers could be trained to safely and effectively …

International Seminar On "Is Access Enough? Understanding And Addressing Unmet Need For Family Planning", Iussp Scientific Panel On Reproductive Health

Reproductive Health

The IUSSP Scientific Panel on Reproductive Health, in collaboration with STEP UP and AFIDEP, held a seminar in Nanyuki, Kenya, in May 2013. The seminar brought together 44 scientists, policymakers, and program managers to present and discuss a range of issues relating to the definition, determinants, and consequences of unmet need for family planning and program interventions designed specifically to reduce unmet need in groups at high risk. Based on discussions and presentations, unmet need (and family planning in general) should be looked at both from a development perspective and from a service-delivery and health-sector perspective. Overall, the seminar papers, …

Alcohol Consumption And Its Correlates Among Residents Of Mining Town, Kitwe, Zambia: 2011 Population Based Survey, Cosmas Zyaambo, Olesegun Babaniyi, Peter Songolo, Adamson S. Muula, Emmanuel Rudatsikira, Seter Siziya

Faculty Publications

Alcohol consumption is a risk factor for non-communicable diseases such as cardiovascular diseases, liver cirrhosis and cancers. It has also been associated with risky sexual behaviors, hence, attributed as a factor in the increase of HIV incidence and prevalence. A cross sectional study was conducted using a modified World Health Organizations Global Non Communicable Diseases (NCD) Surveillance Initiative NCD-STEPs 1and 2. Multivariate logistic regression was used to examine the determinants of alcohol consumption. A total of 1627 individuals participated in the survey, of which 42.3% were males. Some 22.3% (36.2% of male and 12.1% of female; p<0.001) participants reported to have consumed alcohol during the 30 days preceding the survey. The factors considered to be associated with alcohol consumption were age, sex and smoking. Compared to respondents age 25-34 years, respondents of age 35-44 years were 38% (AOR = 1.38, 95%CI [1.11, 1.70]) more likely to report having consumed alcohol and those aged 45 years or older were 26% (AOR = 0.74, 95%CI [0.60, 0.93]) less likely to report having consumed alcohol. Female respondents were 47% (AOR = 0.53, 95%CI [0.46, 0.60]) less likely to report consuming alcohol compared to male respondents. Compared to respondents who reported smoking cigarettes, those who did not smoke cigarettes were 51% (AOR = 0.49, 95%CI [0.40, 0.59]) less likely to consume alcohol. The rate of alcohol consumption is high in this mining town. Factors identified in this study as associated with alcohol consumption, i.e., male sex, age, cigarette smoking, should be considered in designing interventions to curtail the level of alcohol consumption.

Experience Of Caregivers With The Survivors Of Hepatitis C, Noureen Shehzad Jiwani, Raisa B. Gul, Rubina Sultan

School of Nursing & Midwifery

Objectives: To assess and describe the experiences of those caring for hepatitis C patients in Karachi, Pakistan.

Methods: Using a qualitative approach, the study adopted a descriptive exploratory design for which 8 caregirers were selected through snowball sampling technique from different parts of Karachi. Data was collected between May and July 2010 through semi-structured interviews from the caregivers. The interviews were recorded on tape and were transcribed verbatim. The data was manually analysed for extracting themes and categories.

Results: The analyses of data led to one theme - \'deadly, dangerous, and devastating. Two associated categories could also be noted: \'perceptions …

Commencement Program 2012, Loma Linda University

Commencement Programs

CONTENTS

1 | Message from the President

3 | 2012 Events of Commencement

5 | The Academic Procession

7 | Significance of Academic Regalia

9 The Good Samaritan

10 | University History Highlights

12 | Loma Linda University Song - "Healing Love"

13 | The Speakers

24 | The University Honorees

36 | The School Honorees

54 | The Program

• School of Medicine, 55
• School of Pharmacy, 72
• School of Dentistry, 79
• School of Science and Technology/School of Behavioral Health and School of Religion, 97
• School of Nursing, 109
• School of Allied Health Professions - Physical Therapy, 117
• School of …

Molecular Epidemiology Of Hiv-Associated Tuberculosis In Dar Es Salaam, Tanzania: Strain Predominance, Clustering, And Polyclonal Disease, Lisa V. Adams, Barry N. Kreiswirth, Robert D. Arbeit, Hanna Soini, Lillian Mtei, Mecky Matee, Muhammad Bakari, Timothy Lahey, Wendy Wieland-Alter

Dartmouth Scholarship

Molecular typing of Mycobacterium tuberculosis can be used to elucidate the epidemiology of tuberculosis, including the rates of clustering, the frequency of polyclonal disease, and the distribution of genotypic families. We performed IS6110 typing and spoligotyping on M. tuberculosis strains isolated from HIV-infected subjects at baseline or during follow-up in the DarDar Trial in Tanzania and on selected community isolates. Clustering occurred in 203 (74%) of 275 subjects: 124 (80%) of 155 HIV-infected subjects with baseline isolates, 56 (69%) of 81 HIV-infected subjects with endpoint isolates, and 23 (59%) of 39 community controls. Overall, 113 (41%) subjects had an …

Shaping The Operations Research Agenda For Antiretroviral-Based Prevention Products For Women: Gels And Rings, Martha Brady, C. Elizabeth Mcgrory

HIV and AIDS

This report summarizes discussions from a two-day international experts consultation meeting in 2012 on preparing for the successful introduction of women-centered antiretroviral-based HIV prevention methods. It examines the limits and expectations of operations research in antiretroviral health technologies.

Encounters With Witchcraft, Norman Miller

Dartmouth Scholarship

My first experience with witchcraft in Africa occurred in March 1960 in Mombasa, Kenya, just as I stepped off the gangway of the MS Inchanga following a voyage from India. Next to the ship in a dockside kiosk I saw a newspaper with the headline, “European Geologist Attacked in Gogoland: Witchcraft Suspected.” It was the story of a 22-year-old British geologist, William Hanning, who had been prospecting for minerals in a remote part of nearby Tanzania when by mistake he dug into a burial ground. He was believed to be a witch, disguised as a European, out to steal body …

Neonatal Vitamin A Supplementation For The Prevention Of Mortality And Morbidity In Term Neonates In Developing Countries, Batool A. Haider, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background:Vitamin A deficiency is a major public health problem in developing countries. Vitamin A supplementation in children greater than six months of age has been found to be beneficial, with no effect of supplementation between one to five months. Supplementation in the neonatal period has been suggested to have an impact by increasing body stores in early infancy.
Objectives: To evaluate the role of vitamin A supplementation in term neonates in developing countries with respect to the prevention of mortality and morbidity.
Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, May …

Food Insecurity And Sexual Risk In An Hiv Endemic Community In Uganda, Cari L. Miller, David R. Bangsberg, David M. Tuller, Jude Senkungu, Annet Kawuma, Edward A. Frongillo Jr., Sheri D. Weiser

Faculty Publications

Food insecurity has been linked to high-risk sexual behavior in sub-Saharan Africa, but there are limited data on these links among people living with HIV/AIDS, and on the mechanisms for how food insecurity predisposes individuals to risky sexual practices. We undertook a series of in-depth open-ended interviews with 41 individuals living with HIV/AIDS to understand the impact of food insecurity on sexual-risk behaviors. Participants were recruited from the Immune Suppression Clinic at the Mbarara University of Science and Technology in Mbarara, Uganda. Interviews were recorded, transcribed verbatim, translated, and coded following the strategy of grounded theory. Four major themes emerged …

Impact Of Interventions To Prevent And Manage Preeclampsia And Eclampsia On Stillbirths, Mehnaz Jabeen, Mohammad Yawar Yakoob, Aamer Imdad, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background:Pre-eclampsia and Eclampsia are relatively common complications of pregnancy, leading to considerable maternal and fetal mortality and morbidity. We sought to review the effect of aspirin, calcium supplementation, antihypertensive agents and magnesium sulphate on risk stillbirths.

Methods:

A systematic literature search was conducted to identify studies evaluating the above interventions. We used a standardized abstraction and grading format and performed meta-analyses where data were available from more than one studies. The estimated effect on stillbirths was determined by applying the standard Child Health Epidemiology Reference Group (CHERG) rules for multiple outcomes. For interventions with insufficient evidence for overall effect, …

Effect Of Screening And Management Of Diabetes During Pregnancy On Stillbirths, Madiha Syed, Hasan Javed, Mohammad Yawar Yakoob, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background:Diabetes during pregnancy is associated with significant risk of complications to the mother, fetus and newborn. We reviewed the potential impact of early detection and control of diabetes mellitus during pregnancy on stillbirths for possible inclusion in the Lives Saved Tool (LiST).

Methods:

A systematic literature search up to July 2010 was done to identify all published randomized controlled trials and observational studies. A standardized data abstraction sheet was employed and data were abstracted by two independent authors. Meta-analyses were performed with different sub-group analyses. The analyses were graded according to the CHERG rules using the adapted GRADE criteria …

Who Tests, Who Doesn't, And Why? Uptake Of Mobile Hiv Counseling And Testing In The Kilimanjaro Region Of Tanzania, Jan Ostermann, Elizabeth A. Reddy, Meghan M. Shorter, Charles Muiruri, Antipas Mtalo, Dafrosa K. Itemba, Bernard Njau, John A. Bartlett, John A. Crump, Nathan M. Thielman

Faculty Publications

Background: Optimally, expanded HIV testing programs should reduce barriers to testing while attracting new and highrisk testers. We assessed barriers to testing and HIV risk among clients participating in mobile voluntary counseling and testing (MVCT) campaigns in four rural villages in the Kilimanjaro Region of Tanzania.

Methods: Between December 2007 and April 2008, 878 MVCT participants and 506 randomly selected community residents who did not access MVCT were surveyed. Gender-specific logistic regression models were used to describe differences in socioeconomic characteristics, HIV exposure risk, testing histories, HIV related stigma, and attitudes toward testing between MVCT participants and community residents who …

Prevalence Of Hypertension And Its Correlates In Lusaka Urban District Of Zambia: A Population Based Survey, Fastone M. Goma, Selestine H. Nzala, Olusegun Babaniyi, Peter Songolo, Cosmos Zyaambo, Emmanuel Rudatsikira, Seter Siziya, Adamson S. Muula

Community & Environmental Health Faculty Publications

Background

Hypertension is a leading cause for ill-health, premature mortality and disability. The objective of the study was to determine the prevalence and associated factors for hypertension in Lusaka, Zambia.

Methods

A cross sectional study was conducted. Odds ratios and their 95% confidence intervals were calculated to assess relationships between hypertension and explanatory variables.

Results

A total of 1928 individuals participated in the survey, of which 33.0% were males. About a third of the respondents had attained secondary level education (35.8%), and 20.6% of males and 48.6% of females were overweight or obese. The prevalence for hypertension was 34.8% (38.0% …

The Prevention And Management Of Hiv And Sexual And Gender-Based Violence: Responding To The Needs Of Survivors And Those-At-Risk, Sarah Raifman, Ian Askew, Sajeda Amin, Jill Keesbury, Saiqa Mullick, Judith A. Diers, Meiwita P. Budiharsana, Chi-Chi Undie, Mary Zama, Mantshi Menziwa, Sherry Hutchinson, Naomi Rutenberg

Reproductive Health

The Population Council seeks to understand the social, economic, political, and physical context of risks for sexual and gender-based violence and HIV. Among the top priorities of Council research are supporting and evaluating efforts to prevent violence and HIV, including creating safe spaces for adolescent girls, and working with men and boys to change gender norms within the community; and comprehensively responding to the needs of survivors (including those who are HIV-infected) by strengthening health systems and integrating services. The purpose of this guide is to provide practical guidance on the steps necessary to establish and strengthen sexual violence (SV) …

Adolescence Is An Ocean: A Biocultural Investigation Of Youth Food Consumption In Tanzania, Elizabeth J. Danforth

USF Tampa Graduate Theses and Dissertations

This study investigates adolescents' relationships with food and other community and household members' perceptions of youth and their food consumption to understand the multifactorial dynamic processes which create nutritional outcomes among urban and rural youth in central Tanzania. Youth are an important and demographically large population in developing countries. The identities created during this distinct stage of cultural production can be reflected in youths' food consumption and relationships with food. Nutrition likely affects how youth transition through a variety of states, including their growth and development stages, primary to secondary to higher education, child to parent, or unemployed to employed. …

Individual, Socio-Cultural And Structural Factors Associated With Cervical Cancer Screening And Treatment In Tanzania, Renicha Tomeka Mccree-Hale

All ETDs from UAB

Most African countries including Tanzania have limited cervical cancer screening and treatment programs. Only about 5% of women have ever been screened for cervical cancer. A constellation of individual and structural factors contributes to the challenge of cervical cancer screening and treatment in countries that bear significant burdens of disease. Yet, little is known about country specific factors that may constrain or facilitate scale up of health services. This dissertation is an attempt to identify and understand the country specific individual and structural barriers along with facilitators to cervical cancer screening and treatment in Tanzania. Individual, institutional and structural level …

The Determinants Of Colorectal Cancer Survival Disparities In Nevada, Lucas N. Wassira

UNLV Theses, Dissertations, Professional Papers, and Capstones

Different population groups across Nevada and throughout the United States suffer disproportionately from colorectal cancer and its after-effects. Overcoming cancer health disparities is important for lessening the burden of cancer. There has been an overall decline in the incidence of and mortality from colorectal cancer (CRC). This is likely due, in part, to the increasing use of screening procedures such as Fecal Occult Blood Test (FOBT) and/or endoscopy, which can reduce the risk of CRC mortality by fifty percent. Nevertheless, screening procedures are routinely used by only fifty percent of Americans aged fifty years and older. Despite overall mortality decreasing …