Public Health Commons^™

Implementation Of Point-Of-Care Diagnostics Leads To Variable Uptake Of Syphilis, Anemia And Cd4+ T-Cell Count Testing In Rural Maternal And Child Health Clinics., Caroline De Schacht, Carlota Lucas, Nádia Sitoe, Rhoderick Machekano, Patrina Chongo, Laura Guay, Et Al.

Epidemiology Faculty Publications

INTRODUCTION: Anemia, syphilis and HIV are high burden diseases among pregnant women in sub-Saharan Africa. A quasi-experimental study was conducted in four health facilities in Southern Mozambique to evaluate the effect of point-of-care technologies for hemoglobin quantification, syphilis testing and CD4+ T-cell enumeration performed within maternal and child health services on testing and treatment coverage, and assessing acceptability by health workers.

METHODS: Demographic and testing data on women attending first antenatal care services were extracted from existing records, before (2011; n = 865) and after (2012; n = 808) introduction of point-of-care testing. Study outcomes per health facility were compared …

A Systematic Review And Meta-Regression Analysis Of Lung Cancer Risk And Inorganic Arsenic In Drinking Water., Steven H. Lamm, Hamid Ferdosi, Elisabeth K. Dissen, Ji Li, Jaeil Ahn

Epidemiology Faculty Publications

High levels (> 200 µg/L) of inorganic arsenic in drinking water are known to be a cause of human lung cancer, but the evidence at lower levels is uncertain. We have sought the epidemiological studies that have examined the dose-response relationship between arsenic levels in drinking water and the risk of lung cancer over a range that includes both high and low levels of arsenic. Regression analysis, based on six studies identified from an electronic search, examined the relationship between the log of the relative risk and the log of the arsenic exposure over a range of 1-1000 µg/L. The …

An Exploratory Study Of Dog Park Visits As A Risk Factor For Exposure To Drug-Resistant Extra-Intestinal Pathogenic E. Coli (Expec)., Lubna N. Ahmed, Lance B. Price, Jay P. Graham

Environmental and Occupational Health Faculty Publications

Background

Extraintestinal pathogenic E. coli (ExPEC) are common causative agents of urinary tract infections in humans. Dogs have been found to harbor ExPEC. This study tested stool samples from dogs (n = 16), the shoes of dog park visitors (n = 16) and the shoes of controls (n = 16) for ExPEC. Phenotypic resistance of isolates was characterized.

Findings

ExPEC were present in one-third of the dog stool samples, 9% of the samples from the shoes of dog park visitors and 6% of control samples. Half of the ExPEC isolates were multi-drug resistant.

Discussion

The findings suggest that dogs may …

Staphylococcus Aureus And The Ecology Of The Nasal Microbiome, Cindy M. Liu, Lance B. Price, Bruce A. Hungate, Alison G. Abraham, Lisbeth A. Larsen, Kaare Christensen, Marc Stegger, Robert Skov, Paal Skytt Andersen

Environmental and Occupational Health Faculty Publications

The human microbiome can play a key role in host susceptibility to pathogens, including in the nasal cavity, a site favored by Staphylococcus aureus. However, what determines our resident nasal microbiota—the host or the environment—and can interactions among nasal bacteria determine S. aureus colonization? Our study of 46 monozygotic and 43 dizygotic twin pairs revealed that nasal microbiota is an environmentally derived trait, but the host’s sex and genetics significantly influence nasal bacterial density. Although specific taxa, including lactic acid bacteria, can determine S. aureus colonization, their negative interactions depend on thresholds of absolute abundance. These findings demonstrate that …

Dose-Response Effects Of The Text4baby Mobile Health Program: Randomized Controlled Trial, William Douglas Evans, Peter E. Nielsen, Daniel R. Szekely, Jasmine W. Bihm, Elizabeth A. Murray, Jeremy Snider, Lorien C. Abroms

Prevention and Community Health Faculty Publications

BACKGROUND:

Mobile health (mHealth) is growing rapidly, but more studies are needed on how to optimize programs, including optimal timing of messaging, dose of exposure, and value of interactive features. This study evaluates final outcomes of text4baby (a text message service for pregnant and postpartum women) from a randomized trial performed in a population of pregnant female soldiers and family members.

OBJECTIVE:

The study aims were to evaluate (1) treatment effects and (2) dose-response effects of text4baby on behavioral outcomes compared to control (no text4baby) condition.

METHODS:

The study was a randomized trial of text4baby at Madigan Army Medical Center. …

Cost Effectiveness Of A Mail-Delivered Individually Tailored Physical Activity Intervention For Latinas Vs. A Mailed Contact Control, Britta Larsen, Todd Gilmer, Dori Pekmezi, Melissa A. Napolitano, Bess H. Marcus

Prevention and Community Health Faculty Publications

Background

Physical inactivity is high in Latinas, as are chronic health conditions. There is a need for physical activity (PA) interventions that are not only effective but have potential for cost-effective widespread dissemination. The purpose of this paper was to assess the costs and cost effectiveness of a Spanish-language print-based mail-delivered PA intervention that was linguistically and culturally adapted for Latinas.

Methods

Adult Latinas (N = 266) were randomly assigned to receive mail-delivered individually tailored intervention materials or wellness information mailed on the same schedule (control). PA was assessed at baseline, six months (post-intervention) and 12 months (maintenance phase) …

Interpersonal Communication As An Agent Of Normative Influence: A Mixed Method Study Among The Urban Poor In India, Rajiv N. Rimal, Pooja Sripad, Ilene S. Speizer, Lisa M. Calhoun

Prevention and Community Health Faculty Publications

Background

Although social norms are thought to play an important role in couples’ reproductive decisions, only limited theoretical or empirical guidance exists on how the underlying process works. Using the theory of normative social behavior (TNSB), through a mixed-method design, we investigated the role played by injunctive norms and interpersonal discussion in the relationship between descriptive norms and use of modern contraceptive methods among the urban poor in India.

Methods

Data from a household survey (N = 11,811) were used to test the underlying theoretical propositions, and focus group interviews among men and women were then conducted to obtain …

Assessing Seasonality Of Travel Distance To Harm Reduction Service Providers Among Persons Who Inject Drugs., Sean T. Allen, Monica S. Ruiz, Amira Roess, Jeff Jones

Prevention and Community Health Faculty Publications

BACKGROUND: Prior research has examined access to syringe exchange program (SEP) services among persons who inject drugs (PWID), but no research has been conducted to evaluate variations in SEP access based on season. This is an important gap in the literature given that seasonal weather patterns and inclement weather may affect SEP service utilization. The purpose of this research is to examine differences in access to SEPs by season among PWID in the District of Columbia (DC).

FINDINGS: A geometric point distance estimation technique was applied to records from a DC SEP that operated from 1996 to 2011. We calculated …

The Core Competencies For Mental, Neurological, And Substance Use Disorder Care In Sub-Saharan Africa, Pamela Y. Collins, Seggane Musisi, Seble Frehywot, Vikram Patel

Health Policy and Management Faculty Publications

The 2010 Global Burden of Disease Study points to a changing landscape in which non-communicable diseases, such as mental, neurological, and substance use (MNS) disorders, account for an increasing proportion of premature mortality and disability globally. Despite evidence of the need for care, a remarkable deficit of providers for MNS disorder service delivery persists in sub-Saharan Africa. This critical workforce can be developed from a range of non-specialist and specialist health workers who have access to evidence-based interventions, whose roles, and the associated tasks, are articulated and clearly delineated, and who are equipped to master and maintain the competencies associated …

Should We Put Our Feet In The Water? Use Of A Survey To Assess Recreational Exposures To Contaminants In The Anacostia River., Rianna Murray, Sacoby Wilson, Laura Dalemarre, Victoria Chanse, Janet Phoenix, Lori Baranoff

Health Policy and Management Faculty Publications

The Anacostia River, a tributary of the Potomac River that flows into the Chesapeake Bay, is highly contaminated with raw sewage, heavy metals, oil and grease, trash, pathogens, excessive sediments, and organic chemicals. Despite this contamination, recreation on the river is very popular, including kayaking, canoeing, rowing, and sport fishing. There is currently no information available on the potential health risks faced by recreational users from exposure to the river’s pollutants. A total of 197 recreational users of the Anacostia River were surveyed regarding general demographic information and their recreational behavior over the previous year, including frequency and duration of …

Health Care Access Dimensions And Cervical Cancer Screening In South Africa: Analysis Of The World Health Survey., Tomi F. Akinyemiju, Jasmine A. Mcdonald, Paula M. Lantz

Health Policy and Management Faculty Publications

Background

Cervical cancer is the most commonly diagnosed cancer and the leading cause of cancer mortality among women in sub-Saharan Africa. Recent recommendations for cervical cancer primary prevention highlight HPV vaccination, and secondary prevention through screening. However, few studies have examined the different dimensions of health care access, and how these may influence screening behavior, especially in the context of clinical preventive services.

Methods

Using the 2003 South Africa World Health Survey, we determined the prevalence of cervical cancer screening with pelvic examinations and/or pap smears among women ages 18 years and older. We also examined the association between multiple …

Transforming Health Professions' Education Through In-Country Collaboration: Examining The Consortia Among African Medical Schools Catalyzed By The Medical Education Partnership Initiative., Zohray M. Talib, Elsie Kiguli-Malwadde, Hannah Wohltjen, Miliard Derbew, Yakub Mulla, David Olaleye, Nelson Sewankambo

Health Policy and Management Faculty Publications

BACKGROUND: African medical schools have historically turned to northern partners for technical assistance and resources to strengthen their education and research programmes. In 2010, this paradigm shifted when the United States Government brought forward unprecedented resources to support African medical schools. The grant, entitled the Medical Education Partnership Initiative (MEPI) triggered a number of south-south collaborations between medical schools in Africa. This paper examines the goals of these partnerships and their impact on medical education and health workforce planning.

METHODS: Semi-structured interviews were conducted with the Principal Investigators of the first four MEPI programmes that formed an in-country consortium. These …

How Can We Better Evaluate Complex Global Health Initiatives? Reflections From The January 2014 Institute Of Medicine Workshop., Sangeeta Mookherji, Kate Meck

Global Health Faculty Publications

An IOM workshop on evaluation design drew on recent evaluations of 4 complex initiatives (PEPFAR; the Global Fund to Fight AIDS, TB and Malaria; the President’s Malaria Initiative; and the Affordable Medicines Facility-malaria). Key components for good evaluations: (1) a robust theory of change to understand how and why programs should work; (2) use of multiple analytic methods; and (3) triangulation of evidence to validate and deepen understanding of results as well as synthesis of findings to identify lessons for scale-up or broader application.

Adapting Pharmaceutical Reimbursement Policies To Manage Spending On High-Priced Drugs, Elizabeth Docteur, Ruth Lopert

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

Prevalence And Predictors Of Pap Smear Cervical Epithelial Cell Abnormality Among Hiv-Positive And Negative Women Attending Gynecological Examination In Cervical Cancer Screening Center At Debre Markos Referral Hospital, East Gojjam, Northwest Ethiopia, Melkamu Getinet, Baye Gelaw, Abinet Sisay, Eiman Mahmoud, Abate Assefa

Faculty Publications & Research of the TUC College of Osteopathic Medicine

Background: Cervical cancer is the leading cause of cancer related death among women in developing countries. Cervical cancer is preceded by cervical surface epithelial cell abnormalities (ECA) which can be detected by Pap smear test. Simultaneous human papillomavirus and human immunodeficiency virus (HIV) infection increases cervical cancer. Data on the prevalence and predictors of ECA among women in Ethiopia is limited. Hence, we aimed to determine the prevalence and associated factors of ECA among women.

Methods: A comparative cross-sectional study was conducted among HIV+ and HIV- women attending gynecological examination in cervical cancer screening center at the Debre …

Impact Of On-Site Training Of Neonatal Resuscitation Techniques In Shirati District Hospitals: Does On-Site Training Improve Knowledge, Attitude, And Practices?, Trista Fuchs, Yasmin Nibbe, Eiman Mahmoud

Faculty Publications & Research of the TUC College of Osteopathic Medicine

Program/Project Purpose: In Tanzania, early neonatal morality remains high despite the county’s efforts towards improving health indicators. It’s estimated that birth asphyxia is involved in up to 30% of early neonatal deaths in developing countries, and is associated with high neurological morbidity for those who survive. Early interventions targeting birth asphyxia were not successful; likely due to low national priority, limited resources, and targeting limited types of providers. Helping Babies Breath (HBB) is an evidence-based neonatal resuscitation program designed for resource- limited settings. The program follows a basic intervention approach which emphasizes the importance of skilled attendants at every …

Trends In Hiv Prevalence, Sexual And Health Seeking Behaviors, And Hiv-Related Discrimination Among Nigerian Youth, Population Council

HIV and AIDS

Nigeria, home to over 170 million people, has a disproportionately heavy youth population of 32 percent whose well-being is intricately tied to the country’s prospects for sustainable development. Nigeria has an HIV prevalence of 3.4 percent, the second highest number of infections in the world. In 2013, it was estimated that 160,000 adolescents in Nigeria were living with HIV. Although Nigeria has developed a national HIV strategic plan that forms a basis for the HIV response, national AIDS and related policies contain few youth-centered provisions. Overall, the national strategic plan targets youth as part of the general population. To fill …

Do Clinical Decision-Support Reminders For Medical Providers Improve Isoniazid Prescription Rates Among Hiv-Positive Adults?, Eric P. Green, Caricia Catalani, Aggrey Keny, Lameck Diero, Charity Ndwiga, Dennis Israelski, Paul Biondich

HIV and AIDS

People living with HIV (PLHIV) are at increased risk of developing active tuberculosis (TB) and dying from TB. Isoniazid preventive therapy (IPT) can prevent this, but only a small fraction of HIV-positive individuals are on IPT. Previous research suggests that clinical decision support systems (CDSS)—electronic systems that use existing patient data and established algorithms to generate alerts, reminders, or recommendations intended to aid clinical decision-making—have the potential to improve provider adherence to diagnostic and treatment guidelines. Researchers conducted a cluster randomized controlled trial of a new CDSS intervention for TB screening, prevention, and treatment in a high HIV and TB …

A Secondary Analysis Of Retention Across The Pmtct Cascade In Selected Countries: Rwanda, Malawi, Kenya, And Swaziland, Godfrey Woelk, Aida Y. Berhan, Kwashie Kudiabor, Martha Mukaminega, John On'gech, Epiphanie Nyirabahizi, Caspian Chouraya, David Kimosop, Dieudonne Ndatimana, Mafayo Phiri, Heather Hoffman

HIV and AIDS

There is global consensus that transmission of HIV from mother to child can be eliminated. The Global Task Team, co-chaired by UNAIDS and the US Office of the Global AIDS Coordinator, has developed a global framework with the goal of eliminating new HIV infections among children (transmission rate of less than 5 percent) by 2015. Reaching the goal depends on optimal execution of each step in a complex cascade of activities, including testing and counseling for HIV, early attendance for antenatal care to optimize antiretroviral prophylaxis for prevention of mother-to-child transmission (PMTCT), adherence to the drugs, CD4 count testing, and, …

Addressing Mental Health Disorders And Hiv Vulnerability Of Marginalized Adolescents In Addis Ababa, Ethiopia, Nrupa Jani, Lung Vu, Sam Kalibala, Gebeyehu Mekonnen, Kay Lynn

HIV and AIDS

Ethiopia is experiencing an increasingly urban, female-centered HIV epidemic alongside a rise in rural migration of adolescents to Addis Ababa. Often these migrants are confronted by social challenges such as lack of education, inadequate housing, unstable employment conditions, and physical and sexual abuse. These difficult living circumstances contribute to psychological and mental health problems among these adolescents, potentially putting them at greater risk of acquiring HIV. However, knowledge about how targeted mental health interventions can impact HIV-related outcomes worldwide, and in Ethiopia, remains limited. The goal of this study was to pilot test a strategy for addressing mental health problems, …

Sexual And Reproductive Health And Rights Among Young People Living With Hiv In Uganda: Findings From The Link Up Baseline Survey, Population Council

HIV and AIDS

An estimated 3.7 percent of young people aged 15–24 years are living with HIV in Uganda, and face unique challenges in navigating a wide array of social, health, and developmental challenges as they transition to adulthood. Like all young people, those who live with HIV are starting to learn about their sexuality, often beginning to have intimate relationships or marry. In addition, they confront a myriad of complex issues associated with HIV status disclosure, initiation of and adherence to antiretroviral therapy, and deeply entrenched HIV-related stigma and discrimination. Young women bear a disproportionate share of this burden. Compared with men …

Sexual Health And Hiv Risk Behaviors Of Men Who Have Sex With Men In Myanmar—Baseline Findings From Link Up, Population Council, Burnet Institute

HIV and AIDS

In 2013, an estimated 189,000 people were living with HIV in Myanmar. The overall adult HIV prevalence is estimated to be around 0.5 percent, but key populations such as men who have sex with men (MSM) bear a disproportionate disease burden. According to national estimates, HIV prevalence among MSM is 20 times higher than in the general population, at 10 percent. Effective, targeted, innovative, and culturally appropriate interventions that have been shown to significantly reduce high-risk sexual behaviors among MSM are needed to reduce the HIV burden among this population. In Myanmar, as part of the Link Up project, Alliance …

Annotated Bibliography Of Nigerian Youth-Focused Hiv And Sexual And Reproductive Health Project Publications (Grey Literature), Population Council

HIV and AIDS

Adolescents and young adults (15–24 years) constitute about one-third of the total population of Nigeria, and their well-being is intricately tied to the country’s prospects for sustainable development. The HIV prevalence among 15–24-year-old men and women is 2.5 percent and 3.1 percent, respectively. In 2013, it was estimated that 160,000 adolescents (aged 10–19) in Nigeria were living with HIV. Rightfully, an increasing focus is being paid to the sexual and reproductive health (SRH) of young Nigerians, however it is essential that the dialogue and interventions around young people’s SRH be informed and take into account the body of evidence available …

Arv-Based Hiv Prevention For Women: State Of The Science And Considerations For Implementation In Zimbabwe. Report From A Provider Workshop, Population Council

HIV and AIDS

This report provides an overview of the presentations and discussions emerging from a Provider Workshop on ARV-Based HIV Prevention for Women: State of the Science and Considerations for Implementation in Zimbabwe convened by the Ministry of Health and Child Care and the Population Council in Harare in May 2014. The workshop in Zimbabwe is part of a broader global process to begin paving the path for microbicides introduction while awaiting the results of the ongoing confirmatory trial (FACTS 001) of tenofovir gel in South Africa. USAID is spearheading a global effort toward a “Shared Vision and Strategic Plan for Microbicide …

Introducing Antiretroviral (Arv)-Based Prevention Products For Women: A Guide To Strategic Decisionmaking And Planning, Population Council

HIV and AIDS

As evidence mounts that antiretrovirals (ARVs) are effective for HIV prevention, policymakers and program managers will need to determine whether and how best to introduce specific products into health care systems. Determining the most appropriate users within a particular country will depend on the overall context, the nature of the HIV epidemic within the country, and the opportunities available to reach and serve HIV-negative women with ARV-based prevention products and services. This toolkit was developed by the Population Council for use by governments, organizations, and donors who are in a position to support or add new HIV-prevention products into programs. …

Reach: Randomized Evaluation Of Hiv/Fp Service Models, Paul C. Hewett, Mutinta Nalubamba, Fiammetta Bozzani, Mardieh Dennis, Jean Digitale, Lung Vu, Eileen Yam, Mary Nambao

HIV and AIDS

The REacH (Randomized Evaluation of HIV/FP Service Models) project compares health service uptake of two models for HIV prevention and family planning service linkage and integration. This report details results which indicate that the enhanced client add-on service referral and follow-up arm with and without the escort increased the uptake of HIV testing and counseling services among women who had entered at family planning care entry points. The effect of the intervention was greater in the shorter term, improving uptake within six weeks, but nonetheless remained important through six months. The results indicate that the intervention can increase the numbers …

Burundi Program Implementation Workshop, 3–5 June 2014: Link Up Meeting Report, Population Council, Alliance Burundaise Contre Le Sida

HIV and AIDS

Link Up is a global consortium of international and local nongovernmental organizations led by the International HIV/AIDS Alliance. Link Up aimed to improve the sexual and reproductive health and rights of young people in Bangladesh, Burundi, Ethiopia, Myanmar, and Uganda who are living with HIV or are affected by the HIV pandemic. At a workshop held in Burundi, 3–5 June 2014, the Population Council, Alliance Burundaise contre le SIDA, and local partners in Burundi identified successful activities, highlighted important challenges and best practices, and found innovative ways to improve Link Up programming. This document contains a selection of the most …

Sexual And Reproductive Health Among Young Female Sex Workers In Bangladesh Brothels—Baseline Findings From Link Up, Population Council

HIV and AIDS

Link Up is a global consortium of international and local nongovernmental organizations led by the International HIV/AIDS Alliance. Link Up aimed to improve the sexual and reproductive health and rights of young people in Bangladesh, Burundi, Ethiopia, Myanmar, and Uganda who are living with HIV or are affected by the HIV pandemic. Consortium members PIACT Bangladesh and Marie Stopes Bangladesh implemented a brothel-based program for female sex workers to address sexual and reproductive health and rights. Working in eight brothels in seven districts, trained female sex worker peer educators provided face-to-face education, including referrals to on-site and off-site health care …

The Adolescent Experience In-Depth: Using Data To Identify And Reach The Most Vulnerable Young People—Belize 2011, Population Council, Unicef Belize

Poverty, Gender, and Youth

“The Adolescent Experience In-Depth: Using Data to Identify and Reach the Most Vulnerable Young People: Belize 2011” 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 …

The Sub-Saharan Water Crisis: An Analysis Of Its Impact On Public Health In Urban And Rural Nigeria, Megan Hannemann 15

Honor Scholar Theses

Today, 11% of the global population still lacks access to clean water, one of humans’ most basic needs. Those who lack a safe water source are largely concentrated in sub-Saharan Africa, where only 61% have access to safe water. Within this region, large disparities exist that hide the severity of the problem for some communities. The term “water crisis” is often used to describe the lack of water access throughout the world and the resulting consequences. In this thesis, the impact the water crisis has on public health in sub-Saharan Africa was analyzed using Nigeria as a model nation. Specific …