Public Health Commons^™

Neonatal Unit Human Resources: Coverage For Six Cadres And Trends For Staff-To-Baby Ratios In 65 Neonatal Units Implementing With Nest360 In Kenya, Malawi, Nigeria, And Tanzania, Rebecca Penzias, Eric Ohuma, Opeyemi Odedere, Olabisi Dosunmu, George Okello, Hannah Mwaniki, Robert Tillya, Vincent Ochieng, Ekran Rashid, William Macharia

Paediatrics and Child Health, East Africa

Background Implementing small and sick newborn care (SSNC) requires skilled health workers; however, there is a shortage, adversely impacting patient outcomes and health worker well-being. There are limited data and no current World Health Organization (WHO) standards for staff-to-baby ratios in neonatal units in low- and middle-income countries (LMICs) to inform policy, planning, and investment.

Methods In 65 neonatal units (36 in Malawi, 13 in Kenya, 7 in Tanzania, and 9 in Nigeria), a health facility assessment (HFA) for SSNC and government-led quality improvement (QI) processes were implemented. Staffing data were collated from baseline HFA (Sept 2019–March 2021) and mid-2023 …

Food Insecurity Is Associated With Depressive And Anxiety Symptoms Among Caregivers Of Young Children In Arid And Semi-Arid Regions Of Kenya: A Cross-Sectional Study, Esther Chongwo, Daisy Chelangat, Eunice Njoroge, Barack Aoko, Martha Kaniala, Moses Wesala, Phillis Magoma, Joyce Marangu, Margaret Kabue, Daniel Rabok

Institute for Human Development, East Africa

Introduction: This study fills a critical gap by assessing the prevalence and association between food insecurity and depressive and anxiety symptoms among caregivers of young children in Kenya's arid and semi-arid lands (ASALs).

Methods: A cross-sectional design was used to collect data from caregivers of children aged 0–3 years from Lamu, Isiolo and Turkana Counties (N = 446). Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 scales were used to assess depressive and anxiety symptoms, respectively. We also administered the Household Food Insecurity Access Scale, alongside sociodemographic and health-related questionnaires.

Results: The mean caregiver age was 29.37 years …

Identifying Sex- And Gender-Specific Endocrinological, Lifestyle, Psychosocial, And Socio-Cultural Targets For Alzheimer's Disease Prevention In Africans: The Female Brain Health And Endocrine Research In Africa (Fember-Africa) Project, Chinedu Momoh, Benard Aliwa, Lukoye Atwoli, Karen Blackmon, Edna Bosire, Samuel Gitau, Harrison Kaleli, Ciru Kamanda, Linda Khakali, Rachel Maina, Peter Mativo, Sylvia Mbugua, Zul Merali, Kendi Muchungi, Anne Njogu, Douglas Nyankira, Alice Ondieki, Catherine Onyancha, Stanely Onyango, Jasmit Shah, Sheena Shah, Cynthia Smith, Dilraj Sokhi, Sheila Waa, Thomas Thesen

Brain and Mind Institute

Dementia rates are rising globally, with the burden increasing most rapidly in low- tomiddle-income countries. Despite this, research into Alzheimer’s disease and relateddementias (ADRD) among African populations remains limited, with existing modelsbased on Western cohorts that overlook sex-, gender-, and ancestry-specific factors.The Female Brain Health and Endocrine Research in Africa (FemBER-Africa) project,hosted at the Brain and Mind Institute, Aga Khan University, Kenya, will establish adeeply phenotyped cohort of 250 African individuals across the ADRD spectrum. Itwill assess sex-specific risk factors linked to ethnicity, lifestyle, and endocrinologicalvariables using fluid-based biomarkers (blood and saliva), neuroimaging (magneticresonance imaging and positron emission tomography), and …

Prevalence And Determinants Of Nomophobia Among Healthcare Workers In Nepal: A Cross-Sectional Study, Prakash Banjade, Asmita Itani, Munish Sharma, Reena Shah, Jasmit Shah, Aakansha Singh, Rahul Kashyap, Salim Surani

Brain and Mind Institute

Introduction: Nomophobia, the fear of being without a mobile phone, has become a significant concern in the current digital age. Healthcare professionals rely heavily on mobile devices for communication and information access. This cross-sectional study aimed to assess the prevalence and determinants of nomophobia among healthcare workers in Nepal.

Methods: A modified Nomophobia Questionnaire (NMP-Q) was used to determine nomophobia scores. Demographic characteristics such as age, gender, race, type of smartphone, hours spent on a smartphone, and type of medical specialty were considered to evaluate nomophobia in diverse groups of healthcare workers. Summary statistics were presented as frequencies …

Evaluating The Impact Of Alcohol On Dementia: Evidence From 13 Developing Countries, Cyprian Mostert

Brain and Mind Institute

Background: The 2024 Lancet Commission on Dementia Prevention identified alcoholconsumption as a risk factor contributing to a global increase in dementia cases by onepercent.

Method: We used a panel VAR model to analyze the impact of alcohol consumption ondementia prevalence in 13 developing countries with different alcohol tax systems.

Result: In countries with progressive alcohol tax systems, an increase in taxes onbeer and spirits leads to a 10 percent reduction in per capita alcohol consumption.This decline corresponds to a 4 percent reduction in dementia prevalence within fouryears. In countries with hybrid alcohol tax systems, a combination of alcohol bansand tax …

Small For Gestational Age Subgroups Have Differential Morbidity, Growth, And Neurodevelopment At Age 2: The Interbio-21st Newborn Study, Aris T. Papageorghiou, María C. Restrepo-Ménde, Rose Mcgready, Fernando C. Barros, Francois Nosten, Shama Munim, Roseline Ochieng, Rachel Craik, Hellen C. Barsosio, Zulfiqar Ahmed Bhutta

Department of Obstetrics & Gynaecology

Background: Small for gestational age is a complex perinatal syndrome associated with increased neonatal morbidity, mortality, and impaired childhood growth and neurodevelopment. Current classifications rely primarily on birthweight, which does not capture the heterogeneity of the condition nor predict long-term health outcomes. Here we aim to identify and characterize distinct small for gestational age subgroups and assess their neonatal and early childhood health trajectories.
Objective: To refine the classification of small for gestational age by identifying subgroups based on maternal, fetal, and environmental factors and evaluating their associations with neonatal morbidity, growth, and neurodevelopment at age 2.
Study design: Prospective …

Design And Implementation Of Data Quality Controls In The Eq-Daphnie Study: Insights From The Pilot Phase And 15-Country Analysis, Fatima Al Sayah, Hilary Short, Juan M. Ramos-Goñi, Rosalie Viney, Erica I. Lubetkin, Mathieu F. Janssen, Jeffrey A. Johnson

Publications and Research

Objective

The EQ-DAPHNIE (EuroQol Data for Assessment of Population Health Needs and Instrument Evaluation) project is a large, multi-country survey initiative designed to generate population norms and enable comparative research using self-reported health measures. This paper describes the quality control processes and summarizes data quality metrics from the United Kingdom (UK) pilot and full implementation across 15 countries.

Methods

Representative samples were recruited via Dynata, an online survey panel provider, using quota sampling by age, sex, income, community setting, and language (where applicable). The UK pilot (n = 3012) informed survey refinements ahead of full rollout (n = 68,411). Quality …

Enhancement Of Antimicrobial Activity Of Truncated Cecropin B Peptides With The Substitution Of Tryptophan Residues, Sarah Smith, Christopher Feudale, Josephina R. Vermillion, Joseph Feudale, Joshua Do, Sabrina Arroyo, Juan Barrera, Madeleine Whitsitt, Marion Duval, Colby Grames, Bret Hatzinger, Makenzie Hilling, Tia Kean, Jasayle Rivera, Mia Shum, Hannah Zyra, David Rovnyak, Moria C. Chambers

Faculty Journal Articles

Cecropins are a class of antimicrobial peptides (AMPs) expressed by insects that have broad-spectrum antimicrobial activity and low cytotoxicity. However, cecropins are also long (40–45 amino acids) peptides, making their adaptation for therapeutic use challenging. Here, we present a series of 16 amino acid-long peptides derived from cecropin B from Drosophila melanogaster. The native truncated peptide is cationic and expected to form an amphipathic α-helix, but does not have antimicrobial activity. The incorporation of two Trp residues, depending on the position in the peptide backbone, results in antibacterial activity compa-rable to that of full-length cecropin B against the gram-negative bacteria …

The Battle Over Water Fluoridation Comes To New York City: Organized Dentistry Is Quick To Respond To Ill-Conceived Effort To End 60-Year Practice And Vows To Stay With It Until The Threat Passes., Lance Plunkett Jd, Llm

The New York State Dental Journal

Water fluoridation has been experiencing its woes lately, beset by an adverse court decision, questionable science, collapsing federal public health priorities and public suspicion often fueled by hysteria. Against all this, New York City stood strong as a pioneering large municipality safely fluoridating its water since 1965 for the benefit of the public and reducing dental caries significantly over decades.

Female Genital Mutilation And Its Effects Among Women Of Reproductive Age In Kenya: Insights From Kenya Demographic And Health Survey 2022, Jovinary Adam, Joyce Jebet

School of Nursing & Midwifery, East Africa

Introduction Female genital mutilation (FGM) is a significant public health issue rooted in cultural traditions, affecting millions of women and girls. In Kenya, the practice is prevalent in various ethnic groups and is often associated with social and economic pressures.

Objective To determine the prevalence of FGM, the factors associated with FGM, and its effects among women of reproductive age in Kenya.

Methods This study used secondary data of a total 16,716 weighted women of reproductive age drawn from the 2022 Kenya Demographic and Health Survey. The study used the “svy” command in Stata to assign the sample weight. Multivariable …

Cabotegravir And Rilpivirine For Treatment Of Hiv Infection In Africa: Week 96 Results From The Phase 3b Randomized, Open-Label, Noninferiority Cares Trial, Cissy Kityo, Ivan Mambule, Joseph Musaazi, Simiso Sokhela, Henry Mugerwa, Henry Mugerwa, Ibrahim Yawe, Fiona Cresswell, Abraham Siika, Reena Shah

Internal Medicine, East Africa

Evaluation of the durable efficacy and safety of long-acting injectable therapy for HIV is needed in African populations. In a multicenter, open-label phase 3b trial, 512 African adults with HIV-1, stable on first-line oral therapy, with screening plasma viral load (VL) < 50 copies ml−1 and without past virologic failure were randomized (1:1) to continue oral therapy or switch to cabotegravir (600 mg) and rilpivirine (900 mg) intramuscular injections every 8 weeks (optional 4-week oral lead-in). VL was monitored every 24 weeks. Here the primary outcome for our analysis up to 96 weeks was VL < 50 copies ml−1, using the Food and Drug Administration snapshot algorithm (noninferiority margin 10%) in the intention-to-treat exposed population. At 96 weeks, 247/255 (97%) in the long-acting group and 250/257 (97%) in the oral therapy group had VL < 50 copies ml−1 (difference −0.4%; 95% confidence interval −3.1% to 2.0%), demonstrating noninferiority. Adverse events of severity grade ≥3 occurred in 41/255 (16%) in the long-acting group and in 22/257 (9%) in the oral therapy group, mostly considered unrelated to the study drug; only one treatment-related adverse event in the long-acting group led to a decision to discontinue treatment (injection-site abscess). Cabotegravir and rilpivirine long-acting therapy produced durable virologic suppression, met the prespecified noninferiority endpoint compared with oral therapy and demonstrated an acceptable safety and tolerability profile. Long-acting therapy may be considered for use in African treatment programs. PACTR registration: 202104874490818.

Implementation And Evaluation Of Infection Prevention And Control Training In Sub-Saharan Africa, David Odada, James Ndai, Ruth Thuku, Philip Adebayo

Internal Medicine, East Africa

No abstract provided.

State Of Menstrual Health Education In 2024: Content Analysis Of Us K-12 Public School Education Standards, Emily Richardson, Sarah Bemis, Page Dobbs, Hope Ballentine, Shristi Bhochhibhoya, Victor Kwaku Akakpo, Kylie Lovett

The Eleanor Mann School of Nursing Faculty Publications and Presentations

Background: Exploratory study aiming to assess the prevalence and time of initiation of menstrual health curriculum in US public school education standards by state. Methods: US public school Kindergarten-12th grade education standards from each state's Department of Education website, including D.C. (n = 51), were searched for menstruation, menstrual, menses, menopause, period, menarche, reproduction, puberty, and growth and development. Results25.5% (n = 13) of US education standards include menstruation. Of these, constructs of comprehensive menstrual health were recorded including abnormal menstruation (n = 6), menstrual hygiene (n = 6), menopause (n = 1), and stigma (n = 7). Education is …

Systemic Racism In Canadian Healthcare: A Policy And Equity Analysis, Kola Adegoke, Abimbola Adegoke, Deborah Dawodu, Temitope Kayode

Health & Biomedical Sciences Faculty Publications

Background: In Canadian healthcare, systemic racism subverts commitment to universal coverage by building inequities into the system of governance, regulation, and clinical practice. Although racial disparities have been documented, little attention has been paid to how institutional structures perpetuate these inequities.

Objective: This study critically examines the organizational aspects of racism in the Canadian healthcare system. It aims to identify structural obstacles faced by racialized patients and foreign-trained physicians and to provide policy recommendations grounded in evidence.

Methods: The authors employed a narrative review framework for qualitative analysis of documents. Public inquiries (eg, Truth and Reconciliation Commission and Viens Report), …

Structural-Level Stigma Within Emergency Food Assistance Programs: Perspectives From Delaware And Pennsylvania, Mckenna M Halverson, Evyn Y Appel, Valerie A Earnshaw, Raquelle Powell, Grace Sands, Nithila Chrisostam, Shreela V Sharma, Allison Karpyn

Faculty, Staff and Student Publications

To characterize the ways in which structural stigma manifests within emergency food program settings.

Methods : We conducted 30-minute semi-structured interviews with 18 emergency food program clients in Pennsylvania and Delaware between August and December of 2024. The discussion guide included open-ended questions regarding client experiences of structural stigma, with an emphasis on issues of access and quality. Demographic data and household food insecurity (Hunger Vital Sign) were also captured. A hybrid inductive and deductive coding approach was used to analyze the data.

Results : Structural stigma is a persistent issue within emergency food program environments, impacting both participant access …

Exploring The Future Of Occupational Safety Research: A Strategic Foresight Approach, Jessica M K Streit, Sarah A Felknor, Nicole T Edwards, John J Howard

Faculty, Staff and Student Publications

A team from the U.S. National Institute for Occupational Safety and Health conducted a strategic foresight project to explore the future of occupational safety research (OSR). Data collected via systematic horizon scanning and key informant interviews were synthesized into six drivers of OSR change: (1) technological advancement, (2) partnerships and public trust, (3) prioritizing research investments, (4) safety and health integration, (5) data and science quality, and (6) worker protections. These drivers served as the basis for envisioning four potential OSR futures. Analysis of the resulting scenarios identified opportunities to enhance and advance OSR methods and approaches, innovation, systems thinking, …

Mitigating Food Insecurity-Related Stigma: A Review Of Intervention Strategies, Evyn Y Appel, Mckenna M Halverson, Valerie A Earnshaw, Tania Cruz Cordero, Maya Rozin, Raquelle Powell, Grace Sands, Nithila Chrisostam, Sarah E Katz, Shreela V Sharma, Allison Karpyn

Faculty, Staff and Student Publications

Objective: To characterize intervention strategies addressing food insecurity-related stigma implemented in federal nutrition programs (e.g. SNAP, WIC) and emergency food programs (e.g. food pantries, food cupboards) within high income countries.

Methods: Six databases (PubMed, PsychINFO, Web of Science, CINAHL, Sociological Abstracts, Dissertations and Theses Global) and the Internet were searched through September 2024. Data on study characteristics and stigma intervention characteristics were extracted with a structured template. Descriptive statistics and thematic analysis were used.

Results: The review found 46 intervention strategies across 18 articles. The majority of articles were based in the United States (89.9%) with the remaining portion from …

Stomach Cancer Incidence In Asians As Compared To Other Ethnic Populations Over Time From 2000 To 2021 In Seer Areas Of The United States, Zhuoyun Li, Xianglin L Du

Faculty, Staff and Student Publications

Background: Stomach cancer is the fourth leading cause of cancer-related deaths globally, but its late-stage detection and its lack of early symptoms are still the main challenges ahead. Limited research has focused on detailed racial and ethnic disparities in stomach cancer incidence within the United States. This study aims to address these gaps by analyzing age-adjusted stomach cancer incidence rates from 2000 to 2021.

Methods: Using data from the US Surveillance, Epidemiology, and End Results (SEER) program (2000-2021), we identified a cohort of 138,628 individuals diagnosed with incident stomach cancer at age ≥ 20. Both crude and age-adjusted models were …

Estimating Daily Air Quality Exposure Of The Aging And Dementia Population, Wan-Tai Michael Au-Yeung, Moiz Usmani, Ryan Ramphul, Chao-Yi Wu, Hiroko Dodge, Joel Steele, Zachary Beattie, Jeffrey Kaye

Faculty, Staff and Student Publications

Background

To understand the effect of air quality on cognition, air quality measurements should reflect real-world exposure. Currently, air quality exposure is derived from outdoor air quality monitors despite older adults spending most of their time indoors.

Objective

To examine if there are discrepancies between indoor particulate matter 2.5 (PM2.5) at older adults’ personal residences, PM2.5 levels measured with nearest outdoor public air monitors, and remotely accessed gridded ensemble air quality data.

Methods

PM2.5 levels collected in older adults’ residences, collected from the nearest outdoor public air quality monitors and ensemble data from Hazardous Air Quality Ensemble System (HAQES) were …

Factors Associated With Cervical Cancer Screening Among Women Attending Maternal Child Health Clinics In Kenya, Loise Nthambi, Marleen Temmerman, William Macharia, Joshua Nyagol, Sophia Mogere, Jillian Neary, Edward Nyabs, Janet Itindi, Agnes Langat, Evelyn Wangari

Centre of Excellence in Women and Child Health

Background Cervical cancer is the second leading malignancy in incidence among women in sub-Saharan Africa. Early detection through screening and treatment of pre-cancerous cervical lesions is paramount in preventing cervical cancer. We sought to examine factors associated with ever being screened for cervical cancer among women attending infant immunization clinics in Kenya.

Methods We conducted secondary data analysis from a cross-sectional survey that enrolled mother-infant pairs attending 55 infant immunization clinics in Kenya between 2018 and 2019. Clinics were selected from high and medium/low HIV-burden counties using probability-proportionate-to-size sampling. The primary outcome was self-reported cervical cancer screening. To align with …

Women’S Unique Health Needs And The Sustainable Development Goals: A Meeting Report From The 79th United Nations General Assembly Science Summit, Irene Aninye, Sarah Chew, Nicole Althaus, Michele Barry, Ru-Fong Cheng, Carolyn Harris, Eleanor Nwadinobi, Beth Battaglino, Aisha Brooks, Marleen Temmerman

Centre of Excellence in Women and Child Health

Biological sex, hormones, and gender uniquely affect health and disease, often resulting in disparities for women across the lifespan and from different racial and ethnic groups, geographical locations, and socioeconomic backgrounds. Without intentional investment and infrastructure to support good health and wellbeing for women, half of the world’s population remains vulnerable to preventable morbidity and mortality. The Society for Women’s Health Research and ECHAlliance–The Global Health Connector convened a women’s health program as part of the 10th Annual Science Summit during the United Nations 79th General Assembly. This hybrid event was held in New York, NY, (USA) and virtually in …

Nonsteroidal Anti-Inflammatory Drug Use And Acute Kidney Injury In Nephrectomies: A Retrospective Propensity Score-Matched Cohort Study, Chun-Yan Ye, Long-Yan Li, Min-Jing Yang, Xing-Yang Liu, Ning Luo, Jing-Han Wu, Yu-Jie Xiao, Daniel I Sessler, E Wang

Faculty, Staff and Student Publications

Introduction: Nonsteroidal anti-inflammatory drugs (NSAID) are analgesic and spare opioids, but it remains unclear whether perioperative NSAID use worsens renal function after nephrectomy. We therefore tested the hypothesis that perioperative use of NSAID is associated with acute kidney injury (AKI) after nephrectomy surgery.

Methods: This retrospective cohort study included patients ≥18 years old who had partial or radical nephrectomies. Patients who were given intravenous NSAIDs for postoperative analgesia were defined as one group, whereas reference patients did not use any NSAIDs. The primary outcome was the occurrence of postoperative acute kidney injury (AKI), as defined by the Kidney Disease: Improving …

Aligning Surgical Decisions With Older Adults' Outcome Goals, Aanand D Naik, Margaret L Schwarze, Jack Banks, Suha Soni, Salman A Arain, Parag Goyal, Daniel D Matlock, Rachel Lampert, Mary E Tinetti

Faculty, Staff and Student Publications

No abstract provided.

Evaluating Interactions Between National And Subnational Governments In The Czech Republic For Physical Activity Policy Development And Implementation, Michael Pratt, Juliana Mejía-Grueso, Eugen Resendiz, Aleš Jakubec, Zdeněk Hamřík, Deborah Salvo, Andrea Ramírez Varela, Josef Mitáš

Faculty, Staff and Student Publications

Background: Most countries now have physical activity (PA) policies but translating them into action at national and subnational levels remains poor. To better understand the disconnect, the "Interaction between National and Local Government Levels in Development and Implementation of Physical Activity Policies Tool" (INTEGRATE-PA-Pol) was developed by the Global Observatory for Physical Activity (GoPA!).

Methods: The Czech Republic was chosen as a European pilot site based on existing research capacity and relationships. The INTEGRATE-PA-Pol tool was translated and adapted for use in the country. This questionnaire-based tool has 8 components assessing government levels, political system, and sectors across the 5 …

A Longitudinal Study Of The Association Between E-Cigarette Use Contexts And Alcohol Use Problems Among College Students, Tzung-Shiang Ou, Anne Buu, James J Yang, Hsien-Chang Lin

Faculty, Staff and Student Publications

Objective: Previous studies had explored the associations between e-cigarette use and alcohol use problems, yet they did not fully consider e-cigarette use contexts. This longitudinal study conducted a prospective examination of e-cigarette use contexts and alcohol use problems among college students.

Participants: College e-cigarette users at three public universities from Fall 2019 to Fall 2020 were included (N = 377).

Methods: A linear mixed model with a random intercept and random slope was employed to examine the longitudinal associations.

Results: Higher frequencies of e-cigarette use (β = 0.38, p < 0.001), being hooked on e-cigarettes (β = 0.96, p < 0.01), using e-cigarettes for socializing purposes (β = 0.58, p < 0.05), and more occasions of co-using e-cigarettes with alcohol (β …