Digital Commons Network^™

A Qualitative Analysis Of Multi-Level Barriers To Hiv Testing Among Women In Lebanon, Kirsty Amy Clark

Public Health Theses

The Middle East and North Africa (MENA) is a region of concern in regards to the global HIV epidemic. In 2015, a call to action was released through the American University of Beirut urging an expansion of research and policy regarding women and HIV in the MENA region. Through individual, semi-structured interviews with sexual healthcare providers and NGO staff, we sought to understand barriers to HIV testing among women in Lebanon. Using purposive and snowball sampling strategies, key informants were recruited from neighborhoods in greater Beirut (N=21; 12 physicians, 9 NGO staff). Data were analyzed utilizing a Grounded Theory inductive …

Azithromycin Pharmacodynamics Against Non-Typeable H. Influenzae, James Fisher

Public Health Theses

Introduction

Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death in the United States. Significant clinical disease in COPD patients has been tied to non-typeable Haemophilus influenzae (NTHI) infection. However, reasons why some NTHI strains persist despite antimicrobial therapy remain unknown.

Objective

The primary objective was to characterize the pharmacodynamics of azithromycin against a persistent pair of NTHI isolates.

Methods

A persistent pair of NTHI isolates (5P28H1 and 5P54H1) cultured from the sputum of an adult with COPD and determined to be the same strain by multilocus sequence typing was carried for 819 days. The Minimum Inhibitory …

Neighborhood-Level Socioeconomic Status And County Fairs And The Risk Of Shiga Toxin-Producing Escherichia Coli Incidence In Connecticut, 2012 To 2014, Gili Hrusa

Public Health Theses

Abstract

Background: Shiga toxin-producing E. coli (STEC) is a reportable illness. It is associated with a spectrum of clinical manifestations that range from watery and/or bloody diarrhea to hemolytic uremic syndrome (HUS), a life threatening condition which causes acute renal failure in both children and adults. A study in Connecticut (CT) by Whitney et al. (2015) found a strong association between higher socioeconomic status (SES) and Shiga toxin-producing E. coli incidence. In the same study, there was a weaker association demonstrated between rurality and STEC incidence as well. The primary aim of this study is to investigate the relationship between …

Factors Influencing Care-Seeking Behavior Among Patients In Ethiopian Primary Health Care Units, Orit Abrahim

Public Health Theses

Abstract

Background

The utilization of primary health care in many countries in sub-Saharan Africa has been limited. The objective of this study was to evaluate the factors that influenced why patients sought care at health centers versus primary hospitals in the primary health care unit (PHCU) in three regions in Ethiopia. The study also examined whether these factors varied based on a patient’s clinical or demographic characteristics and by whether they had sought prior care.

Methods and Findings

We conducted a cross-sectional study using face-to-face interviews in the local language with 796 people (99% response rate) seeking outpatient care in …

Widespread Dissemination Of Diarrhea Due To Rotavirus Serotype G9p8 In The Solomon Islands After A Focal Flood-Related Outbreak, Forrest Kirby Jones

Public Health Theses

Background

Extreme weather events can precipitate epidemic transmission of diarrhea. We describe a large nationwide epidemic in the Solomon Islands following a focal flash flood disaster on April 3-5, 2015 in the capital city of Honiara.

Methods

The Early Warning Alert and Response Network surveillance system (EWARN) detected an outbreak of diarrhea in Honiara. We identified cases from EWARN and retrospective review of outpatient registries in Honiara prior to and during the outbreak. We reviewed data from the public adverse event system to identify diarrhea-related deaths. Rapid diagnostic testing for rotavirus was performed on stool samples from cases. RT-PCR analysis …

Prevalence Of Malaria And Glucose-6-Phosphate Dehydrogenase Deficiency In Malaria-Endemic Southwestern Uganda: Implications For Primaquine Use, Michelle Roh

Public Health Theses

Abstract

Introduction: Malaria transmission in Uganda is remarkably heterogeneous, and declines in prevalence have not been uniform. Previous surveys in southwestern Uganda have shown declines in parasite prevalence from 2004 to 2010. As malaria transmission continues to decline in southwestern Uganda, aggressive strategies, such as the addition of primaquine (PQ) to artemisinin-combination therapies (ACTs), are being considered in low transmission settings. Despite the potential benefit of PQ in reducing transmission, concerns over its safety and efficacy have hampered its deployment. In particular, those with glucose-6-phosphate dehydrogenase (G6PD) deficiency are at a higher risk of hemolytic toxicity.

Methods: To better assess …

Spatial Distribution And Sociodemographic Composition Of High Grade Cervical Lesion Clusters In Connecticut 2008-2013, Aref Senno

Public Health Theses

Introduction: HPV is necessary for the development of invasive cervical cancer. There were 530,000 cases and 275,000 deaths attributable to cervical cancer in 2008. Since the introduction of HPV vaccines in 2006, the incidence of high grade cervical lesions (HGCL)—precancerous lesions which may develop into cervical cancer—has decreased significantly. Some changing sociodemographic trends in disease burden have been previously reported since 2008.

Objectives: The objectives of this analysis were to identify regions of Connecticut with high rates of HGCLs and to describe how trends of disease changed over time in the post-vaccine era.

Methods: This is a descriptive analysis of …

The Impact Of Hurricane Sandy On Healthcare Workers In Nyc, Grace Barlet

Public Health Theses

There is a gap in the literature regarding whether training in emergency preparedness and response makes a difference in the overall health outcomes of healthcare workers who are responding to and working during a natural disaster. The objective of this study was to investigate whether emergency preparedness training lowers the risk of poor health outcomes as reported by healthcare workers in New York City responding to Hurricane Sandy. A survey created by 1199 SEIU United Healthcare Workers East was conducted between July and August 2014 to capture the health and safety experience of workers during and after Hurricane Sandy. The …

Protein Intake And Hookworm Infection Susceptibility In Rural Ghanaian School- Age Children: A Mixed-Methods Study, Luis Enrique Maldonado-Vásquez

Public Health Theses

Background: Because human and animal cross-sectional studies cannot assess temporality, a longitudinal study is needed to assess the association between protein intake and hookworm infection susceptibility. Cultural preferences and belief systems have been noted to affect the intake of food in some African societies but extensive research has not been conducted to characterize them.

Methods: Children (n=274) 7-13 years of age who attended school in the Kintampo North Municipality of Ghana were screened for participation in a longitudinal study assessing the relationship between protein intake and hookworm infection susceptibility. Protein intake was calculated by 24-hour recalls. A qualitative sub-study recruited …

Association Between Pediatric Vaccination Rates And Patterns Of Pneumococcal Disease In Adults In The Pcv7 And Pcv13 Eras, Sundia Cassandra Pingali

Public Health Theses

BACKGROUND: Pneumococcal conjugate vaccine (PCV) is now recommended for use in adults in the United States. Because vaccination of children with PCVs protects adults from the targeted serotypes, local variations in PCV uptake among children could influence the effectiveness of direct immunization of adults. The effect of variations in PCV7 and PCV13 uptake in children will be compared to assess the possible effectiveness of PCV vaccination in adults.

METHODS: We obtained ZIP Code-level invasive pneumococcal disease (IPD) data from an active population-based surveillance system in Connecticut (1998-2013) and ZIP Code-level data on immunization with 3+ or 4+ doses of PCV …

Determinants Of Early Feeding Practices Among Hiv+ Mothers In Sub- Saharan Africa: A Realist Review, Camille Adrianne Pottinger

Public Health Theses

INTRODUCTION: Exclusive breastfeeding has been shown to provide many benefits that can be life saving for the infant and mother in low resource settings7. Although the potential effects of breastfeeding appear large, exclusive breastfeeding rates remain low in this area of the world, and are even lower among the HIV population8-10. It is important to understand what influences HIV + mothers to exclusively breastfeed, as well as formula feed and adhere to ARV (antiretroviral) medication while breast feeding in order to make comprehensive policy recommendations that are as culturally sensitive and practical as possible. The objective of this review is …

Assessment Of Foodnet Population Survey Respondents As A Control Group To Determine Stec Risk Factors, Maria Andrea Rincon

Public Health Theses

Introduction: Shiga toxin-producing Escherichia coli (STEC) are important foodborne pathogens, causing approximately 30 deaths a year in the US. Case-control studies to monitor risk factors are challenging; finding representative controls can be labor-intensive. The FoodNet Population Survey (FNPS) is conducted periodically and asks about foodborne disease risk factors.

Objectives: To determine leading risk factors for STEC in Connecticut using the 2006 FNPS participant responses as controls.

Methods: Cases were reported STEC cases in Connecticut 2000-2009 who were interviewed for risk factors following onset. Controls were respondents to the Connecticut portion of the 2006 FNPS. Comparable questions for exposure to dietary, …

Leptospira In The Environmental Reservoir: Quantification And Persistence Of The Pathogen In An Urban Slum Setting Of Endemic Transmission, Andrew Gustav Schneider

Public Health Theses

Introduction

The ecology of Leptospira, the spirochete agent for leptospirosis, in its environmental reservoir is poorly understood. We quantified the presence of pathogenic leptospires in soil and sewage from a high-risk slum community for leptospirosis, and characterized its persistence in this environment.

Methods

We collected soil and sewage samples from three sites within a slum community in the city of Salvador, Brazil, and measured the concentration of leptospires using real-time quantitative PCR targeting lipL32, a gene exclusively present in pathogenic Leptospira. Additionally, we investigated the persistence of L. interrogans serovar Copenhageni, the agent for urban leptospirosis, in soil and sewage …

Intersection Of Religious And Antiretroviral Experiences And Its Implications For Medication Adherence In Hiv Positive Individuals In León, Nicaragua, Kimberly Stephanie Vasquez

Public Health Theses

Worldwide, in 2012, there were about 35.3 million people living with HIV/AIDS (PLWHA).1 Antiretroviral (ARV) significantly improved the livelihood of PLWHA through virological suppression, which has reduced HIV related mortality rates, and decreased the risk of HIV transmission through vaginal and anal sex.2,3 Optimal ARV adherence, around 95%, is required to maintain virological suppression.29 In 2000, a review paper reported that nonadherence rates were around 50-70%.30 Suboptimal adherence can lead to increased mortality, HIV transmission, and ARV resistance.2,3 Global suboptimal illustrates the importance of identifying barriers and facilitators to ARV adherence.7 Research is urgently needed to determine important barriers and …

Namati: Innovations In Legal Disempowerment For Health? A Sierra Leonean Case Study, Ikenna Okezie Achilihu

Public Health Theses

Drawing on eleven weeks of fieldwork for Namati’s Health Accountability and Social Empowerment Program, this case study investigates whether Namati interventions reinforce existing formal and customary structures for the amelioration of grievances between health clinics, their associated staff, and intended beneficiaries. Furthermore, this study questions Namati’s role as an organization that fosters sustainable change at: the level of the grassroots in its ability to influence government health policy, and at the level of the elites in its ability to improve administrative and policy deficiencies in the area of health access. Finally, this study answers critical questions on the equity-enhancing effects …

Who Gets An Iud: The Impact Of Patient Race And Number Of Past Sexual Partners On Clinical Decisions To Prescribe Intrauterine Devices, Tiffany Nicole Bell

Public Health Theses

While disparities by race/ethnicity in reproductive and sexual health outcomes are well documented, the role that healthcare providers play in contributing to these disparities is only beginning to be explored. This investigation sought to examine medical and nursing students' bias surrounding the prescription of intrauterine devices (IUDs, i.e., long-acting reversible contraception) to adolescents based on the patient's race and sexual history. An online survey presented participants with a clinical vignette of an IUD-seeking sexually active adolescent, with the patient's race and number of past sexual partners systematically manipulated. Participants reported predictions about patient risk of getting pregnant with and without …

A Mathematical Investigation Of The Drivers Of Lyme Disease Ecology At Two Ecologically Contrasting Sites, Malia Joy Carpio

Public Health Theses

INTRODUCTION: Lyme disease is an emerging tick-borne disease of increasing concern in the United States. In order to create and to implement effective public health interventions for Lyme disease, there must be a better understanding of the factors driving pathogen transmission.

OBJECTIVES: The primary objectives of this study were to determine how presence/absence of “super-spreaders” and observed differences between two ecologically contrasting sites influence Borrelia burgdorferi transmission.

METHODS: A next generation matrix R0 model was parameterized with field data from an island site (Block Island, Rhode Island) and a mainland site (Connecticut) in order to generate R0 estimates. A local …

Five-Year Resistance Trends Of Bacterial Isolates In Kigali, Rwanda, Makeda Aminah Carroll

Public Health Theses

Antimicrobial resistance (AMR), the phenomenon of decreased sensitivity to pharmaceutical agents that kill or inhibit the growth of bacterial pathogens, is a serious threat to public health worldwide. Many countries, including Rwanda, lack current information on antibiotic sensitivity profiles that would greatly aide clinicians and policy-makers. The current study aims to describe the time trends of antibiotic sensitivity for the isolates of six different bacterial pathogens from patients at King Faisal Hospital in Kigali, Rwanda and to make inference about future patterns of drug resistance in the study setting, to guide physicians in their prescribing practices and provide baseline data …

Community Systems, Health Knowledge, And The Role Of Promotoras De Salud In Rural Bolivia, Jennifer Grasso

Public Health Theses

Community Health Worker (CHW) programs have had a positive impact on public health across many settings worldwide. However, due to the nature of their vocation and the challenging health infrastructure in which they often work, these individuals commonly face significant barriers that threaten their performance as health promoters, educators, and liaisons. This qualitative research study assessed the perceived challenges for volunteers of a rural Promotoras de Salud program in Bolivia. Data were collected by way of in-person interviews with 20 active Promotoras de Salud of ten communities in the north central region. Results showed that two commonly reported sources of …

Drug Use And Smoking Among Hospitalized Influenza Patients, Connecticut 2011-2014, Georgiana E. Green

Public Health Theses

INTRODUCTION: Globally, influenza is responsible for 3-5 million cases of severe illness annually. In the United States alone, it is estimated that flu-associated infections account for 3.1 million hospitalized days per year. While the overall impact of flu is relatively well-studied, severe influenza is not well-characterized among the substance abuser and smoker populations.

OBJECTIVES: This study characterizes the risks for and complications associated with serious influenza infection among the substance abuser and smoking populations within Connecticut.

METHODS: Data were obtained via retrospective medical chart review. Cases were individuals within New Haven and Middlesex counties hospitalized with a positive influenza test …

Sex Differences Among Adult Influenza Hospitalizations Associated With Age, Race, And Socioeconomic Status In 14 Us Sites, 2010-2012, Kelly Elizabeth Kline

Public Health Theses

BACKGROUND: Previous studies have shown sex differences in influenza hospitalizations, but sex differences across the United States by demographic characteristics have not been well-established. We investigated potential sex differences across 14 FluSurv-NET (FSN) sites that conduct active population-based surveillance for laboratory-confirmed influenza-associated hospitalizations among residents of 76 counties in 2010-2012, stratifying by age, race, and census tract-level poverty.

METHODS: We used 6,292 laboratory-confirmed adult (>18 years) cases collected by the 14 FSN sites during the 2010-11 and 2011-12 influenza seasons linked to 2010 Census data to calculate overall age-adjusted and age-specific incidence and incidence rate ratios (IRRs) for sex …

Assessment Of The Capacity Of Ugandan Health Facilities, Personnel, And Resources To Prevent And Control Noncommunicable Diseases, Hilary Eileen Rogers

Public Health Theses

Due to the rapid rise of noncommunicable diseases (NCDs), the Uganda Ministry of Health (MoH) has prioritized NCD prevention, early diagnosis, and management. In partnership with the World Diabetic Foundation, MoH has embarked on a countrywide program to build capacity of the health facilities to address NCDs. A needs assessment was developed and conducted in 13 regional referral hospitals, 27 general hospitals, and 14 health center IVs in Uganda to: (1) assess the capacity of health units to detect and manage noncommunicable diseases; (2) describe provider knowledge, attitudes, resources, and practices, and (3) identify areas of improvement and areas in …

Evidence For Selection Acting On Immune-Related Iron Transport Genes In Wild Rodents, Dylan Adam Duchen

Public Health Theses

Every organism requires certain resources that they cannot endogenously produce; one such dietary component, iron, is essential for many basic cellular functions and the host-immune response. By studying patterns of genetic diversity within the genes involved in immune-related iron transport we can achieve a greater understanding of the evolutionary mechanisms which drive these processes, including those underlying host-pathogen interactions.

This thesis describes further evidence of patterns indicative of positive selection within apical regions of the transferrin receptor complex (Tfr1), sites known to be involved in an evolutionary arms race with pathogens, within two rodent species endemic to Europe and Asia, …

The Epidemiology Of Primary Varicella And Herpes Zoster Hospitalizations In The Post-Varicella Vaccine Era: Connecticut, 1996-2012, Elizabeth Humes

Public Health Theses

Background: A vaccine for primary varicella (VZV) was licensed and recommended for use in children as a single dose in 1996, and as two doses in 2006. A vaccine for herpes zoster (HZ) was licensed and recommended for use in adults ≥60 years in 2006. Both vaccines have the potential to modify the epidemiology of VZV and HZ. Rates of hospitalization due to VZV and HZ were examined in the post-vaccine era to characterize the epidemiology of severe disease and to assess the possible impact of vaccination on the incidence of hospitalization.

Methods: Statewide hospital discharge data in Connecticut were …

Household Food Insecurity And Obesity Risk In An Urban Slum In Brazil, Krysta Peterson

Public Health Theses

Background: The prevalence of obesity is growing among the poor. Household food insecurity (HFI) may partly explain this trend as individuals experiencing it may cope by consuming low-cost high calorie meals with little nutritive value. This study aimed to estimate the prevalence of HFI, identify its risk factors, and assess the relationship with obesity among adults in an urban slum community in Salvador, Brazil.

Design: This cross-sectional study interviewed participants at home to assess socioeconomic status, demographics, HFI (measured by the Brazilian Food Insecurity Scale (EBIA)), and health. Anthropometric measurements (height, weight, waist circumference) of each respondent were taken to …

Leptospirosis Pulmonary Hemorrhage Syndrome In Salvador, Brazil From 2003 - 2012, Annie J. Tsay

Public Health Theses

ABSTRACT

Objective: Leptospirosis pulmonary hemorrhage syndrome (LPHS) is a severe form of leptospirosis, with a case fatality rate exceeding 50%. Recently, LPHS has become the principal cause of mortality in leptospirosis patients in Salvador, Brazil. This study aims to describe the epidemiology of LPHS since 2003, characterize its clinical presentation, and identify risk factors.

Methods:

Patients admitted between January 1, 2003 and December 31, 2012 in the active hospital-based surveillance who met the clinical case definition for leptospirosis were included in the study. A standardized questionnaire was used to collect data from patient charts and in-person interviews. Unadjusted logistic regression …

The Impact Of Architecture And Natural Ventilation On The Risk Of Tuberculosis Transmission In Brazilian Prisons, Juliana Urrego

Public Health Theses

Tuberculosis (TB) incidence in Brazilian penitentiaries is extremely high as prisons provide ideal conditions for airborne contagion by congregating infectious and susceptible individuals for extended periods of time. We aimed to determine the effects of architectural, environmental, and ventilation factors that impact TB transmission probabilities across prison cells in three penitentiaries of Mato Grosso do Sul, Brazil. We collected descriptive data on cell architectural characteristics and estimated ventilation rates using steady-state exhaled carbon dioxide levels. A hierarchical linear, multivariable model was used to examine cell level architectural and environmental factors affecting absolute ventilation. We then estimated the probability of TB …

Modeling The Zoonotic Transmission Dynamics Of Nipah Virus: Implications For Outbreak Control And Model-Guided Fieldwork, Natasha Wenzel

Public Health Theses

Introduction: Nipah virus is considered a biosafety level-4 pathogen that is endemic to bats of the genus Pteropus. Infection in humans presents clinically as febrile encephalitis with an extremely high case-fatality rate (78.2%). Outbreaks of Nipah virus infection have occurred in Bangladesh and India almost annually since 2001, most recently in January 2013.

Methods: To elucidate Nipah virus persistence at the endemic host and human population level we developed a Susceptible-Exposed-Infectious-Recovered dynamic model and parameterized it from published epidemiological case data and serological bats surveys on the Nipah Virus-Bangladesh variant. We conducted a Markov Chain Monte Carlo simulation to estimate …

Conflict And Vaccine-Preventable Disease In Children Under Five In The Eastern Mediterranean Region: A Systematic Review, Alexandra Marion Adams

Public Health Theses

Background: Conflict is one of the main reasons for our failure to reach worldwide immunization targets. An objective of 90% immunization coverage is included in the fourth Millennium Development Goal to reduce under-five mortality by two thirds, which is still far from achieved in the conflict-ridden Eastern Mediterranean Region (EMR). Despite global progress, vaccine-preventable deaths still account for 20% of childhood mortality under five years of age in the EMR, and communicable disease a third of all mortality. Conflict remains a critical root cause of low vaccination coverage in the EMR, resulting in high levels of vaccine-preventable disease, disability, and …

Epidemiology, Risk Factors, And Effectiveness Of Treatment Of Crimean Congo Hemorrhagic Fever In Turkey, 2007-2012, Eda Akyar

Public Health Theses

Objective: Crimean Congo Hemorrhagic Fever (CCHF) is caused by a Nairovirus of the Bunyaviridae family. It was first reported in Turkey in 2002. Infections commonly result from bites from ticks of Hyalomma marginatum marginatum or Rhipicephalus bursa species. Nosocomial infections also occur. CCHF infection occurs in over 30 countries in Europe, Asia and Africa. No vaccine exists and the effectiveness of ribavirin treatment remains controversial. This study's objective was to identify significant epidemiological, environmental, and clinical risk factors associated with disease and death caused by CCHF in Turkey. This study also evaluated the effectiveness of ribavirin as treatment for patients …