Digital Commons Network^™

Building Capacity For Public And Population Health Research In Africa: The Consortium For Advanced Research Training In Africa (Carta) Model, Alex C. Ezeh, Chimaraoke O. Izugbara, Caroline W. Kabiru, Sharon Fonn, Kathleen Kahn, Lenore Manderson, Akinyinka Omigbodun, Margaret Thorogood, Ashiwel S. Undieh

Publications and Research

Background: Globally, sub-Saharan Africa bears the greatest burden of disease. Strengthened research capacity to understand the social determinants of health among different African populations is key to addressing the drivers of poor health and developing interventions to improve health outcomes and health systems in the region. Yet, the continent clearly lacks centers of research excellence that can generate a strong evidence base to address the region’s socio-economic and health problems. Objective and program overview: We describe the recently launched Consortium for Advanced Research Training in Africa (CARTA), which brings together a network of nine academic and four research institutions from …

Looking Back, Moving Forward: Promoting Gender Equity To Fight Hiv, Horizons Studies 1999 To 2007, Julie Pulerwitz, Annie P. Michaelis, Ellen Weiss

HIV and AIDS

In 1997, the Population Council initiated the Horizons Program—a decade-long USAID-funded collaboration with the International Center for Research on Women, the International HIV/AIDS Alliance, PATH, Tulane University, Family Health International, and Johns Hopkins University—designing, implementing, evaluating, and expanding innovative strategies for HIV prevention and care. Horizons developed and tested ways to optimize HIV prevention, care, and treatment programs; worked to reduce stigma and improve gender-biased behaviors; and greatly expanded knowledge about the best ways to support, protect, and treat children affected by HIV and AIDS. In all its projects, Horizons strengthened the capacity of local institutions by providing support and …

Introducing A Multi-Site Program For Early Diagnosis Of Hiv Infection Among Hiv-Exposed Infants In Tanzania, Harriet Nuwagaba-Biribonwoha, Bazghina Werq-Semo, Aziz Abdallah, Amy Cunningham, John G. Gamaliel, Sevestine Mtunga, Victoria Nankabirwa, Isaya Malisa, Luis F. Gonzalez, Charles Massambu, Denis Nash, Jessica Justman, Elaine J. Abrams

Publications and Research

Background: In Tanzania, less than a third of HIV infected children estimated to be in need of antiretroviral therapy (ART) are receiving it. In this setting where other infections and malnutrition mimic signs and symptoms of AIDS, early diagnosis of HIV among HIV-exposed infants without specialized virologic testing can be a complex process. We aimed to introduce an Early Infant Diagnosis (EID) pilot program using HIV DNA Polymerase Chain Reaction (PCR) testing with the intent of making EID nationally available based on lessons learned in the first 6 months of implementation.

Methods: In September 2006, a molecular biology laboratory at …

Oral Lesions As Clinical Markers For Antiretroviral Therapy Failure In Hiv Patients, Irene M. Tamí-Maury

All ETDs from UAB

The true nature of the association of oral lesions (OL) and gold standards of HIV progression, CD4+ T cell counts (CD4) and HIV-1 RNA viral load (VL), is not completely clear, especially when patients are on antiretroviral therapy (ART). Our aim was to assess the association between OL and virologic failure among HIV/AIDS patients on ART. We conducted a retrospective study of 744 HIV patients who entered care between 2000 and 2006 at the UAB 1917 Clinic. Data was collected for 2 years after enrollment. Prevalence of OL was 35.8%. Oropharyngeal candidiasis (OPC) was the most prevalent OL (74.9%). Among …

Constructions Of Disease In Mayo Village, Rachel Eades

Independent Study Project (ISP) Collection

Understanding how individuals and institutions negotiate illness and construct ideas about disease is important to public health efforts across the globe. Countries in sub-Saharan Africa suffer from a variety of health problems that many regions of the world have long since eradicated. Economic hardship, combined with high rates of communicable diseases, food poverty, lack of sanitation, and poor water quality make countries in sub-Saharan Africa some of the poorest and sickest in the world. Tanzania is a prime example. The purpose of this study was to explore how people in one rural, Tanzanian village construct ideas about disease – its …

Religion And Hiv In Tanzania: Influence Of Religious Beliefs On Hiv Stigma, Disclosure, And Treatment Attitudes, James Zou, Yvonne Yamanaka, Muze John, Melissa Watt, Jan Ostermann, Nathan Thielman

Faculty Publications

Background

Religion shapes everyday beliefs and activities, but few studies have examined its associations with attitudes about HIV. This exploratory study in Tanzania probed associations between religious beliefs and HIV stigma, disclosure, and attitudes toward antiretroviral (ARV) treatment.

Methods

A self-administered survey was distributed to a convenience sample of parishioners (n = 438) attending Catholic, Lutheran, and Pentecostal churches in both urban and rural areas. The survey included questions about religious beliefs, opinions about HIV, and knowledge and attitudes about ARVs. Multivariate logistic regression analysis was performed to assess how religion was associated with perceptions about HIV, HIV treatment, and …

The Adolescent Experience In-Depth: Using Data To Identify And Reach The Most Vulnerable Young People—Tanzania 2004, Population Council

Poverty, Gender, and Youth

“The Adolescent Experience In-Depth: Using Data to Identify and Reach the Most Vulnerable Young People: Tanzania 2004” is part of a series of Population Council guides that draw principally on data from the Demographic and Health Surveys to provide decisionmakers at all levels—from governments, nongovernmental organizations, and advocacy groups—with evidence on the situation of adolescent girls and boys and young women aged 10–24 years. The data are presented in graphs, tables, and maps (wherever possible), providing multiple formats to make the information accessible to a range of audiences. Section I is the Foreword. Section II offers brief technical notes specific …

Temporal And Spatial Stability Of Anopheles Gambiae Larval Habitat Distribution In Western Kenya Highlands, Li Li, Ling Bian, Laith Yakob, Guofa Zhou, Guiyun Yan

Political Science & Geography Faculty Publications

Background: Localized mosquito larval habitat management and the use of larvicides have been proposed as important control tools in integrated malaria vector management programs. In order to optimize the utility of these tools, detailed knowledge of the spatial distribution patterns of mosquito larval habitats is crucial. However, the spatial and temporal changes of habitat distribution patterns under different climatic conditions are rarely quantified and their implications to larval control are unknown.

Results: Using larval habitat data collected in western Kenya highlands during both dry and rainy seasons of 2003-2005, this study analyzed the seasonal and inter-annual changes in the spatial …

The Lived Experience Of Hiv-Positive Tanzanian Orphans, Carol A. Parker

Walden Dissertations and Doctoral Studies

The purpose of this investigation was to generate a context- specific model of the lived experience of HIV positive Tanzanian orphans. With the advent of anti-retroviral drugs, Sub-Saharan African populations with high burdens of human immunodeficiency virus (HIV) face annually accumulating increases in the number of HIV positive children, and ultimately adults. Perinatally infected, these children often become orphans while still young. Extended interviews were performed with a purposive sample of 12 HIV infected orphaned children between 9 and 12 years of age. Half of the research participants lived in an orphanage and half were children living with guardians in …

Using Decision Analysis To Improve Malaria Control Policy Making, Jonathan B. Wiener, Randall A. Kramer, Katherine L. Dickinson, Richard M. Anderson, Vance G. Fowler, Marie Lynn Miranda, Clifford M. Mutero, Kathryn A. Saterson

Faculty Scholarship

Malaria and other vector-borne diseases represent a significant and growing burden in many tropical countries. Successfully addressing these threats will require policies that expand access to and use of existing control methods, such as insecticide-treated bed nets (ITNs) and artemesinin combination therapies (ACTs) for malaria, while weighing the costs and benefits of alternative approaches over time. This paper argues that decision analysis provides a valuable framework for formulating such policies and combating the emergence and re-emergence of malaria and other diseases. We outline five challenges that policy makers and practitioners face in the struggle against malaria, and demonstrate how decision …

Basis For Treatment Of Tuberculosis Among Hiv-Infected Patients In Tanzania: The Role Of Chest X-Ray And Sputum Culture, Muhammad Bakari, Robert D. Arbeit, Lillian Mtei, Johnson Lyimo, Richard Waddell, Mecky Matee, Bernard F. Cole, Susan Tvaroha

Dartmouth Scholarship

Active tuberculosis (TB) is common among HIV-infected persons living in tuberculosis endemic countries, and screening for tuberculosis (TB) is recommended routinely. We sought to determine the role of chest x-ray and sputum culture in the decision to treat for presumptive TB using active case finding in a large cohort of HIV-infected patients. Ambulatory HIV-positive subjects with CD4 counts ≥ 200/mm3 entering a Phase III TB vaccine study in Tanzania were screened for TB with a physical examination, standard interview, CD4 count, chest x-ray (CXR), blood culture for TB, and three sputum samples for acid fast bacillus (AFB) smear and culture.

Moving Forward: Tackling Stigma In A Tanzanian Community, Laura Nyblade, Kerry Macquarrie, Gideon Kwesigabo, Aparna Jain, Lusajo Kajula, Fausta Philip, William Henerico Tibesigwa, Jessie K. Mbwambo

HIV and AIDS

The International Center for Research on Women, the Muhimbili University College of the Health Sciences, the Population Council, and Family Health International conducted an evaluation of a community-based effort to reduce stigma surrounding HIV infections in a peri-urban community in Tanzania. Results presented a mixed, but hopeful, picture for a way forward in tackling stigma at the community level. Tackling stigma requires that the individuals tasked with doing this undergo personal change. Programs can start by focusing stigma-reduction efforts on a smaller, more manageable geographical area and adding specific anti-stigma components to their portfolio of activities. Engaging community opinion leaders …

Testing The Effectiveness Of The Men As Partners Program (Map) In Soweto, South Africa, Prudence Ditlopo, Saiqa Mullick, Ian Askew, Ricardo Vernon, Edwin Maroga, Sgidi Sibeko, Mokgethi Tshabalala, Rabbuh Raletsemo, Dean Peacock, Andrew Levack

Reproductive Health

This project was conducted to evaluate the effectiveness of the Men as Partners (MAP) program in South Africa in terms of: changing men’s gender attitudes, norms and behaviors; changing aspects of gender dynamics in relationships; reducing the prevalence of unwanted pregnancy risk behaviors at individual and community levels; and increasing male involvement in gender based violence (GBV) and HIV prevention and in HIV care and support activities. The intervention activities implemented were MAP workshops, public demonstrations, and participation in community action teams. The evaluation of the interventions showed that about 30% of the workshop participants had also attended other MAP …

Commencement Program 2006, Loma Linda University

Commencement Programs

CONTENTS

2 | 2006 Events of Commencement

3 | The Academic Procession

4 | Significance of Academic Regalia

5 | The Good Samaritan

6 | The Speakers

15 | The University Honorees

23 | The School Honorees

37 | The Program

• School of Medicine, 38
• School of Pharmacy, 47
• School of Dentistry, 52
• School of Science and Technology and Faculty of Religion, 63
• School of Nursing, 74
• School of Allied Health Professions - Physical Therapy, 80
• School of Allied Health Professions, 86
• School of Public Health, 95

Association Between Tobacco Use And Body Mass Index In Urban Indian Population: Implications For Public Health In India, Mangesh S. Pednekar, Prakash C. Gupta, Heema C. Shukla, James R. Hébert

Faculty Publications

Background: Body mass index [BMI, weight (kg)/height (m2)], a measure of relative weight, is a good overall indicator of nutritional status and predictor of overall health. As in many developing countries, the high prevalence of very low BMIs in India represents an important public health risk. Tobacco, smoked in the form of cigarettes or bidis (handmade by rolling a dried rectangular piece of temburni leaf with 0.15–0.25 g of tobacco) or chewed, is another important determinant of health. Tobacco use also may exert a strong influence on BMI.

Methods: The relationship between very low BMI (< 18.5 kg/m2) and tobacco use was examined using data from a representative cross-sectional survey of 99,598 adults (40,071 men and 59,527 women) carried out in the city of Mumbai (formerly known as Bombay) in western India. Participants were men and women aged ≥ 35 years who were residents of the main city of Mumbai.

Results: …

Science-Based Organic Farming 2006: Toward Local And Secure Food Systems, Charles A. Francis, Katja Koehler-Cole, Twyla Hansen, Peter Skelton

Publications from the Center for Applied Rural Innovation (CARI)

Organic farming includes growing food and fiber—animals, agronomic crops, horticultural fruits and vegetables, related products—as one dynamic and rapidly evolving component of our complex U.S. food system. Even as more farmers are moving toward organic certification and participation in an environmentally sound and economically lucrative market, questions arise about the long-term social impacts and sustainability of a set of practices that has gone from a movement to an industry. Consolidations in the organic trade have brought multinational corporations to the table, as they have observed a grassroots activity that has grown by 20% per year for the past two decades, …

Social Relationships And Adolescents' Hiv Counseling And Testing Decisions In Zambia, Julie Denison, Nalakwanji Lungu, Wendy A. Dunnett-Dagg, Ann P. Mccauley, Michael D. Sweat

HIV and AIDS

No abstract provided.

Antenatal Syphilis Management In Sub -Saharan Africa: Public Health Management Challenges And The Impact Of New Hiv Programs In Zambia., Dara G. Potter

All ETDs from UAB

No abstract provided.

Non-Consensual Sexual Experiences Of Young People: A Review Of The Evidence From Developing Countries, Shireen J. Jejeebhoy, Sarah Bott

Reproductive Health

Although there is increasing evidence of risky consensual sex among young people in developing countries, non-consensual sexual experiences among them have rarely been studied and few interventions have been designed to protect them from the risks of such experiences. However, what is available suggests that coercion and unwantedness may play a considerable role in the sexual relations of young people—girls and young women but also boys and young men. The implications of non-consensual sexual experiences for young people’s rights, their health and development and the risks they pose in the transition to adulthood are enormous. This review collates what is …

Integrating Hiv Prevention And Care Into Maternal And Child Health Care Settings: Lessons Learned From Horizons Studies, Naomi Rutenberg, Sam Kalibala, Charles Mwai, James Rosen

HIV and AIDS

Many women in the developing world still lack access to high-quality HIV/AIDS prevention and care services. To address this problem, Horizons has undertaken a range of operations research efforts that examine the integration of HIV-related care in the maternal-child health setting. At a workshop held in Kenya in July 2001, participants discussed the experience to date and formulated practical strategies for improving the integration. This consultation report summarizes that discussion according to the following seven key program components: Training and Motivation to Improve the Performance of Health Workers; Supervision of HIV Services and Quality Assurance of HIV Testing; Caring for …

The Elderly And Aids: Coping Strategies And Health Consequences In Rural Tanzania, Julia Dayton, Martha Ainsworth

Poverty, Gender, and Youth

The elderly are often especially likely to be adversely affected by the death from AIDS of prime-aged adults. The authors use a longitudinal survey of households from northwestern Tanzania in 1991-94 to compare the activities and wellbeing of the elderly in households before and after the death of a prime-aged adult with those of the elderly in households that did not experience the death of an adult. A significant proportion of adults suffering from AIDS return to their parents’ home shortly before death. Time spent by the elderly performing household chores rises following an adult’s death, and their participation in …

Interventions To Reduce Hiv/Aids Stigma: What Have We Learned?, Lisanne Brown, Lea Trujillo, Kate Macintyre

HIV and AIDS

Stigma is a common human reaction to disease. Throughout history many diseases have carried considerable stigma, including leprosy, tuberculosis, cancer, mental illness, and many sexually transmitted diseases. HIV/AIDS is only the latest disease to be stigmatized. This paper reviews 21 interventions that have explicitly attempted to decrease AIDS stigma both in the developed and developing countries and 9 studies that aim to decrease stigma related with other diseases. The studies selected met stringent evaluation criteria in order to draw common lessons for future development of interventions to combat stigma. This paper assesses published and reported studies through comparison of audiences, …

Hiv And Partner Violence: What Are The Implications For Voluntary Counseling And Testing?, Carolyn Knapp

HIV and AIDS

Millions of women around the world face two great threats to their health and well-being: HIV/AIDS and violence by an intimate partner. One of the strongest associations between the two is the role that violence and the threat of violence play in limiting a woman’s ability to negotiate safer sex with a partner. A similar fear of violence also discourages women who receive HIV voluntary counseling and testing (VCT) from telling partners about test results. This study explored the links between HIV infection, serostatus disclosure, and partner violence among women attending a VCT clinic in Dar es Salaam, Tanzania. Researchers …

Hiv And Partner Violence: Implications For Hiv Voluntary Counseling And Testing Programs In Dar Es Salaam, Tanzania, Suzanne Maman, Jessie K. Mbwambo, Margaret Hogan, Gad P. Kilonzo, Michael D. Sweat, Ellen Weiss

HIV and AIDS

This study explored the links between HIV infection, serostatus disclosure, and partner violence among women attending a VCT clinic in Dar es Salaam, Tanzania. Men and women both perceive HIV testing as a way to plan for the future but are motivated to undergo testing by a number of different individual, relationship, and environmental factors. The women in our study described more barriers to HIV testing than did men, and women who have communicated with their partners about VCT before seeking services are significantly more likely to share their HIV test results than those who have not talked with their …

Commencement Program 1999, Loma Linda University

Commencement Programs

CONTENTS

2 | 1999 Events of Commencement

3 | The Academic Procession

4 | The Speakers

9 | The University Honorees

15 | The School Honorees

The Programs

• School of Medicine, 23
• School of Dentistry, 30
• Graduate School, 38
• School of Nursing, 47
• School of Allied Health Professions - Physical Therapy, 52
• School of Allied Health Professions, 58
• School of Public Health, 65

Urban Growth In Developing Countries: A Review Of Projections And Predictions, Martin Brockerhoff

Poverty, Gender, and Youth

Comparison of the United Nations’ earliest and most recent projections to the year 2000 suggests that urban and city growth in developing regions has occurred much more slowly than was anticipated as recently as 1980. A modified “urban population explosion” in developing countries since the 1970s conforms to explanatory models of urban growth developed by economists around 1980. Trends in productivity and terms of trade, in particular, have been highly favorable to agriculture as compared to manufacturing, presumably slowing migration to urban centers. Increases in national population growth rates have produced less than commensurate in rates of city growth, further …

Community-Based Aids Prevention And Care In Africa: Results Of Four Action-Research Interventions In East And Southern Africa, Ann Leonard, Esther Muia

HIV and AIDS

The Community Counseling Aides (CCA) project operating with support from the National AIDS Control Programme (NACP) in Uganda, is a government initiative being carried out in collaboration with local communities. As the Ministry of Health seeks to develop local capacity to support and operate these efforts at the community level, it has identified the need to improve the skills of local project staff so that they may begin to assume the responsibility for monitoring and evaluating their own program performance. This is part of an overall strategy on the part of the Ugandan Government to decentralize control and allocation of …

Clinic-Based Family Planning And Reproductive Health Services In Africa: Findings From Situation Analysis Studies, Kate Miller, Robert A. Miller, Ian Askew, Marjorie C. Horn, Lewis Ndhlovu

Reproductive Health

The United States Agency for International Development (USAID) supported publication of “Clinic-Based Family Planning and Reproductive Health Services in Africa: Findings from Situation Analysis Studies.” The book reflects USAID's commitment to improving quality of reproductive health (RH) care and expanding access for underserved groups. Nowhere are these efforts more important than in Africa, where use of family planning (FP) and other measures of RH status are lowest among the world’s regions. Providing high-quality health services that meet couples' reproductive needs is a socially just and humane goal in itself. Moreover, higher-quality services can be expected to result in better outcomes …

Integrating Sti/Hiv Management Strategies Into Existing Mch/Fp Programs: Lessons From Case Studies In East And Southern Africa, Baker Ndugga Maggwa, Ian Askew

Reproductive Health

Sub-Saharan Africa is confronting an HIV/AIDS epidemic and virtually all health programs in the region are seeking ways of preventing and reducing the spread of this virus. To compound the problem, the presence of certain sexually transmitted infections (STIs) is known to increase risk of the sexual transmission of HIV. The sub-Saharan region is believed to have some of the highest levels of STIs in the world, thus controlling STIs is not only an important reproductive health care strategy in itself but also a key strategy in reducing the spread of HIV. The strongest evidence to support this has come …

Community-Based Aids Prevention And Care In Africa—Dissemination Of Phase I Findings: Report Of Five National Workshops, Population Council

HIV and AIDS

Given the constraints faced by the health care infrastructure in responding to the AIDS crisis in sub-Saharan Africa, and the limitations of traditional educational approaches in motivating people to modify their sexual behavior within the African context, community-based efforts at AIDS prevention, and care of those affected, are the first lines of defense against the disease. Thus, they deserve greater scrutiny, to learn from the experiences and to continue and expand their efforts. The “Community-Based AIDS Prevention and Care in Africa: Building on Local Initiatives” project is being carried out by the Population Council with support from Glaxo Wellcome. The …