Community Health and Preventive Medicine Commons^™

Testing Times: Trends In Availability, Price, And Market Share Of Malaria Diagnostics In The Public And Private Healthcare Sector Across Eight Sub-Saharan African Countries From 2009 To 2015., Kathryn A. O'Connell, Vamsi Vasireddy, Megan Littrell, Andria Rusk, Actwatch Group, Kara Hanson, Catherine Goodman

Collected Faculty Scholarship

BACKGROUND: The World Health Organization guidelines have recommended that all cases of suspected malaria should receive a confirmatory test with microscopy or a malaria rapid diagnostic test (RDT), however evidence from sub-Saharan Africa (SSA) illustrates that only one-third of children under five with a recent fever received a test. The aim of this study was to evaluate availability, price and market share of microscopy and RDT from 2009/11 to 2014/15 in 8 SSA countries, to better understand barriers to improving access to malaria confirmatory testing in the public and private health sectors.

RESULTS: Repeated national cross-sectional quantitative surveys were conducted …

Private Sector Opportunities And Threats To Achieving Malaria Elimination In The Greater Mekong Subregion: Results From Malaria Outlet Surveys In Cambodia, The Lao Pdr, Myanmar, And Thailand., Kathryn A. O'Connell, Vamsi Vasireddy, Megan Littrell, Andria Rusk, Actwatch Group, Sochea Phok, Saysana Phanalasy, Si Thu Thein, Asawin Likhitsup

Collected Faculty Scholarship

BACKGROUND: The aim of this paper is to review multi-country evidence of private sector adherence to national regulations, guidelines, and quality-assurance standards for malaria case management and to document current coverage of private sector engagement and support through ACTwatch outlet surveys implemented in 2015 and 2016.

RESULTS: Over 76,168 outlets were screened, and approximately 6500 interviews were conducted (Cambodia, N = 1303; the Lao People's Democratic Republic (PDR), N = 724; Myanmar, N = 4395; and Thailand, N = 74). There was diversity in the types of private sector outlets providing malaria treatment across countries, and the extent to which …

A Description Of The Methods Of The Aspirin Supplementation For Pregnancy Indicated Risk Reduction In Nulliparas (Aspirin) Study, Matthew K. Hoffman, Shivaprasad S. Goudar, Bhalachandra S. Kodkany, Norman Goco, Marion Koso-Thomas, Menachem Miodovnik, Elizabeth M. Mcclure, Dennis D. Wallace, Jennifer J. Emingway-Foday, Antoinette Tshefu, Adrien Lokangaka, Carl L. Bose, Elwyn Chomba, Musaku Mwenechanya, Waldemar A. Carlo, Ana Garces, Nancy F. Krebs, K. Michael Hambidge, Sarah Saleem, Robert L. Goldenberg, Archana Patel, Patricia L. Hibberd, Fabian Esamai, Edward A. Liechty, Robert Silver, Richard J. Derman

Community Health Sciences

Background: Preterm birth (PTB) remains the leading cause of neonatal mortality and long term disability throughout the world. Though complex in its origins, a growing body of evidence suggests that first trimester administration of low dose aspirin (LDA) may substantially reduce the rate of PTB.
Methods: Hypothesis: LDA initiated in the first trimester reduces the risk of preterm birth. Study Design Type: Prospective randomized, placebo-controlled, double-blinded multi-national clinical trial conducted in seven low and middle income countries. Trial will be individually randomized with one-to-one ratio (intervention/control) Population: Nulliparous women between the ages of 14 and 40, with a …

The Malaria Testing And Treatment Landscape In Benin., Kathryn A. O'Connell, Vamsi Vasireddy, Megan Littrell, Andria Rusk, Actwatch Group, Cyprien Zinsou, Adjibabi Bello Cherifath

Collected Faculty Scholarship

BACKGROUND: Since 2004, artemisinin-based combination therapy (ACT) has been the first-line treatment for uncomplicated malaria in Benin. In 2016, a medicine outlet survey was implemented to investigate the availability, price, and market share of anti-malarial treatment and malaria diagnostics. Results provide a timely and important benchmark to measure future interventions aimed at increasing access to quality malaria case management services.

METHODS: Between July 5th to August 6th 2016, a cross sectional, nationally-representative malaria outlet survey was conducted in Benin. A census of all public and private outlets with potential to distribute malaria testing and/or treatment was implemented among 30 clusters …

Anti-Malarial Landscape In Myanmar: Results From A Nationally Representative Survey Among Community Health Workers And The Private Sector Outlets In 2015/2016., Kathryn A. O'Connell, Vamsi Vasireddy, Megan Littrell, Andria Rusk, Actwatch Group, Si Thu Thein, Hnin Su Su Khin, Aung Thi

Collected Faculty Scholarship

BACKGROUND: In 2015/2016, an ACTwatch outlet survey was implemented to assess the anti-malarial and malaria testing landscape in Myanmar across four domains (Eastern, Central, Coastal, Western regions). Indicators provide an important benchmark to guide Myanmar's new National Strategic Plan to eliminate malaria by 2030.

METHODS: This was a cross-sectional survey, which employed stratified cluster-random sampling across four regions in Myanmar. A census of community health workers (CHWs) and private outlets with potential to distribute malaria testing and/or treatment was conducted. An audit was completed for all anti-malarials, malaria rapid diagnostic tests.

RESULTS: A total of 28,664 outlets were approached and …

Insights Into The Availability And Distribution Of Oral Artemisinin Monotherapy In Myanmar: Evidence From A Nationally Representative Outlet Survey., Kathryn A. O'Connell, Vamsi Vasireddy, Megan Littrell, Andria Rusk, Actwatch Group, Si Thu Thein, Hnin Su Su Khin, Aung Thi

Collected Faculty Scholarship

BACKGROUND: The containment of artemisinin resistance in Myanmar, historically an important probable origin and route of anti-malarial resistance to the India sub-continent and beyond, is crucial to global malaria control and elimination. This paper describes what is currently known about the sale and distribution of oral artemisinin monotherapy (AMT) across Myanmar, where this medicine is commonly found.

METHODS: A nationally representative 2015 outlet survey was conducted in the private sector, and among community health workers across four geographical domains. A national sample of outlets was screened for availability of malaria testing and treatment, and an audit was completed for all …

What Happened To Anti-Malarial Markets After The Affordable Medicines Facility-Malaria Pilot? Trends In Act Availability, Price And Market Share From Five African Countries Under Continuation Of The Private Sector Co-Payment Mechanism., Kathryn A. O'Connell, Vamsi Vasireddy, Megan Littrell, Andria Rusk, Actwatch Group, Sarah Tougher, Kara Hanson, Catherine Goodman

Collected Faculty Scholarship

BACKGROUND: The private sector supplies anti-malarial treatment for large proportions of patients in sub-Saharan Africa. Following the large-scale piloting of the Affordable Medicines Facility-malaria (AMFm) from 2010 to 2011, a private sector co-payment mechanism (CPM) provided continuation of private sector subsidies for quality-assured artemisinin combination therapies (QAACT). This article analyses for the first time the extent to which improvements in private sector QAACT supply and distribution observed during the AMFm were maintained or intensified during continuation of the CPM through 2015 in Kenya, Madagascar, Nigeria, Tanzania and Uganda using repeat cross-sectional outlet survey data.

RESULTS: QAACT market share in all …

Evidence On Anti-Malarial And Diagnostic Markets In Cambodia To Guide Malaria Elimination Strategies And Policies, Kathryn A. O'Connell, Vamsi Vasireddy, Megan Littrell, Andria Rusk, Actwatch Group, Sochea Phok, Dysoley Lek

Collected Faculty Scholarship

BACKGROUND: Understanding Cambodia's anti-malarial and diagnostic landscape in 2015 is critical for informing and monitoring strategies and policies as Cambodia moves forward with national efforts to eliminate malaria. The aim of this paper is to present timely and key findings on the public and private sector anti-malarial and diagnostic landscape in Cambodia. This evidence can serve as a baseline benchmark for guiding implementation of national strategies as well as other regional initiatives to address malaria elimination activities.

METHODS: From August 17th to October 1st, 2015, a cross sectional, nationally-representative malaria outlet survey was conducted in Cambodia. A census of all …

The Malaria Testing And Treatment Landscape In Mainland Tanzania, 2016., Kathryn A. O'Connell, Vamsi Vasireddy, Megan Littrell, Andria Rusk, Actwatch Group, Daniel Michael, Sigsbert Patila Mkunde

Collected Faculty Scholarship

BACKGROUND: Understanding the key characteristics of malaria testing and treatment is essential to the control of a disease that continues to pose a major risk of morbidity and mortality in mainland Tanzania, with evidence of a resurgence of the disease in recent years. The introduction of artemisinin combination therapy (ACT) as the first-line treatment for malaria, alongside policies to promote rational case management following testing, highlights the need for evidence of anti-malarial and testing markets in the country. The results of the most recent mainland Tanzania ACTwatch outlet survey are presented here, including data on the availability, market share and …

Utilizing Three Years Of Epidemiological Data From Medical Missions In Cambodia To Shape The Mobile Medical Clinic Formulary, Jeany Kim Jun, Junia S. Koo, Amy Y. Kang, Deborah B. Chien, Albert Shim, Dale Knutson, Eda M. Kim

Pharmacy Faculty Articles and Research

Objective: The purpose of this project was to gather epidemiological data on common diseases and medications dispensed during medical mission teams to Cambodia to shape the mobile medical clinic formulary.

Methods: Data for patients seen during week-long, mobile, medical clinics was collected in Cambodia during Septembers 2012 to 2014. Patient’s gender, age, weight, blood pressure, glucose, pertinent laboratory values, diagnoses, and medications dispensed were collected. Blood pressure and glucose were measured in patients 18 years and above. Data collected onto paper intake forms were transferred onto spreadsheets without patient identifying information and analyzed for aggregate means, common diseases, and most …

A Comparison Of Measured And Self-Reported Blood Pressure Status Among Low-Income Housing Residents In New York City, James H. Williams Ab, Dustin T. Duncan Scd, Jonathan Cantor Ms, Brian Elbel Phd Mph, Gbenga Ogedegbe Md Ms Mph, Joseph Ravenell Md Ms

Journal of Health Disparities Research and Practice

Self-report is widely used to measure hypertension prevalence in population-based studies, but there is little research comparing self-report with measured blood pressure among low-income populations. The objective of this study was to compare self-reported and measured blood pressure status among a sample of low-income housing residents in New York City (n=118). We completed a cross-sectional analysis comparing self-report with measured blood pressure status. We determined the sensitivity, specificity, and positive predictive value (PPV) of each self-report metric. Of the sample, 68.1% was Black, 71.1% had a household income under $25,000/year, and 28.5% did not complete high school. In our study, …

Chad : Hepatitis E, Hanna Pegarsch

Global Public Health

Contaminated drinking water in Chad is the main source for a Hepatitis E outbreak, leading Chad citizens to develop severe illness including jaundice, liver-failure, miscarriage, and death. There are 0.4 physicians for every 10,000 people living in Chad needing healthcare. Of the citizens in Chad, only 42% have access to uncontaminated drinking water. With such a long incubation period for Hepatitis E, the citizens don’t know they are spreading the illness to the rest of their community. Even with the symptoms, the citizens don’t have the access or the capacity for treatment, making Hepatitis E an epidemic in Chad.

Namibia : Hiv As A National Issue, Elisabeth Vlasak

Global Public Health

Namibia is located on the southwestern coast of Africa, bordering Angola, Botswana, Zambia, South Africa, and the Atlantic Ocean. Namibia has a population of 2,265,000, as of 2016. Namibia has many challenges, including food insecurity and malnutrition, access to health services, unequal distribution of wealth, but HIV/AIDS is one of the country’s leading challenges. It is estimated that the overall adult infection rate of HIV/AIDS is 15.4% and it is the leading cause of death in Namibia. Adults ages 18-24 are the most at-risk for the disease. Some of the major risk factors are declining condom use, misinformation, social stigma, …

Hiv-Care Access Among People With Incarceration Experience In St. Petersburg, Russia, Monica S. Ruiz, Robert Heimer, Olga Levina, N. Badosova, V. Rassokhin, A. Belyakov, N. Belyakov

Prevention and Community Health Faculty Publications

Background: Little is known about the clinical care experiences of HIV-infected persons in St. Petersburg who have experience with incarceration. To address this question, we conducted a capture-recapture study to identify individuals who had been diagnosed with HIV infection while incarcerated and who subsequently presented for medical care in St. Petersburg, Russia following release from prison.

Methods: We matched 292 HIV-positive prisoners tested by the prison system in 2010 to the medical records at the St. Petersburg AIDS Center in the following 4 years.

Results: The data analysis shows that as many as half of HIV+ prisoners fail to seek …

Israel : Translocation Of Rabies, Sarah Baker

Global Public Health

Israel is now faced with a steady growing public health threat as canine rabies has reemerged in the northern region of Israel. While the steady increase in cases is of notable alarm, moreover the close contact most often shared between dog and human populations is of much more concern from a public health prospective. Rabies is a vaccine-preventable disease. Vaccinating dogs has proven to be the most cost-effective strategy for preventing rabies in people. Additionally, education on bite prevention and rabid animal behaviors for both children and adults is an essential extension of the long term rabies vaccination program that …

A Neighborhood-Wide Association Study (Nwas): Example Of Prostate Cancer Aggressiveness, Shannon M. Lynch, Nandita Mitra, Michelle Ross, Craig Newcomb, Karl Dailey, Tara Jackson, Charnita M. Zeigler-Johnson, Harold Riethman

School of Medical Diagnostics & Translational Sciences Publications

Purpose

Cancer results from complex interactions of multiple variables at the biologic, individual, and social levels. Compared to other levels, social effects that occur geospatially in neighborhoods are not as well-studied, and empiric methods to assess these effects are limited. We propose a novel Neighborhood-Wide Association Study(NWAS), analogous to genome-wide association studies(GWAS), that utilizes high-dimensional computing approaches from biology to comprehensively and empirically identify neighborhood factors associated with disease.

Methods

Pennsylvania Cancer Registry data were linked to U.S. Census data. In a successively more stringent multiphase approach, we evaluated the association between neighborhood (n = 14,663 census variables) and prostate …

Plain Language Review Of Diabetes Among Aboriginal And Torres Strait Islander People, Kathy Ride

Research outputs 2014 to 2021

This review provides an overview of key information on diabetes among Aboriginal and Torres Strait Islander people in Australia. The review focuses mostly on type 2 diabetes among Aboriginal and Torres Strait Islander people because type 2 diabetes is responsible for the majority of cases of diabetes in this population. However, the review also refers to type 1 diabetes and gestational diabetes where information is available. It provides a historical, social and cultural background to the development of diabetes, and the behavioural and medical factors that contribute to diabetes among Aboriginal and Torres Strait Islander people.

It provides information on …

An Evaluation Of Mumps Antibody Titers Among Pharmacy Students Before And After A University Mumps Outbreak, Kiley Shelley

Undergraduate Honors Thesis Collection

Mumps outbreaks continue to transpire across the United States despite the available MMR (Measles-Mumps-Rubella) vaccine and seemingly high vaccination rates. There is limited evidence surrounding the management, impact, and prevention of mumps outbreaks. In particular, there are currently no formal recommendations from the CDC (Centers for Disease Control and Prevention) regarding the administration of additional doses of the MMR vaccine during a mumps outbreak. Furthermore, there are unanswered questions of possible waning of vaccine-induced mumps immunity and the impact of a third dose of the MMR vaccine to assist in mumps outbreak control. Existing studies suggest that administration of the …

University Of Montana Students And The Gardasil Vaccine, Markie C. Glidewell

Undergraduate Theses, Professional Papers, and Capstone Artifacts

Gardasil^® is a vaccine for human papilloma virus (HPV), a sexually transmitted virus that can cause genital warts, cervical cancer, and other diseases. Males and females ages 9-26 are recommended to receive the Gardasil^® vaccination. Most students attending the University of Montana (UM) are within the recommended age range for Gardasil^® vaccination and would benefit from receiving it if they have not yet done so. Gardasil^® is available at the Health Services Pharmacy on the UM campus and is often covered by insurance plans with no patient copay. In the fall semester of 2016, surveys were …

Development Of Health Education Materials To Prevent Sexually Transmitted Infections Among University Of Southern Maine Students, Lily Parenteau

Muskie School Capstones and Dissertations

The purpose of this project was to develop health education materials that can be used to educate college students about the risks, symptoms, and prevention measures associated with chlamydia and gonorrhea infections, as well as provide information about current disease information in the state of Maine.

Biomarkers Of Sepsis: A Retrospective Approach, Jose M. Roberts

Williams Honors College, Honors Research Projects

Background: Biomarkers are taking the spotlight in becoming the norm for early diagnoses. Sepsis is an inflammatory disease that increases metabolic rate in children. The first biomarker is hyponatremia. Hyponatremia is a frequent electrolyte imbalance in clinical practice, often observed in children with inflammatory disease and infection. Presence of hyponatremia is associated with electrical signaling imbalances, inflammation and renal dysfunction. The clinical value of hyponatremia in pediatric patients is unknown. The C-reactive protein is a second biomarker. Its presence signifies that necrotic cells and inflammation are present.

Objectives: To evaluate the use of biomarkers in children seen in the Emergency …

Reducing The Rate Of Late Stage Breast Cancer Through Effective Health Communication: An Opinion Piece, Rachele Hendricks-Sturrup

Internet Journal of Allied Health Sciences and Practice

Purpose: Health and illness are traditionally characterized and treated differently across various ethnic groups, which encourages American health systems serving these diverse populations to explore culturally competent and safe ways to effectively reduce illness within such populations. Certain ethnic groups of women in the United States (US) bear greater risk of late stage breast cancer because of various circumstances, which include but are not limited to a lack of insurance or underinsurance and discomfort with and/or resentment toward the US healthcare system. The dominant culture and the social aspects of the modern American health system often and most favorably serve …

Geographical Incidence Of Antimicrobial Resistant Gonorrhea, Christofer A. Rodriguez

Master's Projects and Capstones

Evolving throughout the last century, Gonorrhea has become a superbug, becoming difficult to treat. As the second most commonly reported notifiable disease, gonorrhea rates have been increasing, despite efforts in prevention and treatment. Populations at risk are mainly MSM and FSW. In 2015, men’s gonorrhea rates in the United States were higher compared to women, at 140.9 and 107.2 per 100,000 population, respectively. Illinois has consecutively had higher rates of infection compared to the US, at 133.5 per 100,000 population compared to the US rate of 123.9 per 100,000 population. The surveillance of gonococcal isolate resistance to current antimicrobials began …

Analysis Of Hiv Diversity In Hiv-Infected Black Men Who Have Sex With Men (Hptn 061), Iris Chen, Gordon Chau, Jing Wang, William Clarke, Mark A. Marzinke, Manya Magnus, +14 Additional Authors

Epidemiology Faculty Publications

Background

HIV populations often diversify in response to selective pressures, such as the immune response and antiretroviral drug use. We analyzed HIV diversity in Black men who have sex with men who were enrolled in the HIV Prevention Trials Network 061 study.

Methods

A high resolution melting (HRM) diversity assay was used to measure diversity in six regions of the HIV genome: two in gag, one in pol, and three in env. HIV diversity was analyzed for 146 men who were HIV infected at study enrollment, including three with acute infection and 13 with recent infection (identified …

Cost-Effectiveness Of Genomic-Based Warfarin Therapy, John Weissert, Kourosh Ravvaz

Journal of Patient-Centered Research and Reviews

Background: With over 40 years of demonstrated clinical efficacy, warfarin remains the world’s most used pharmaceutical to prevent ischemic stroke in patients with atrial fibrillation (AF). However, warfarin has many challenges. Thus, despite known effectiveness, warfarin is a leading cause to drug-induced morbidity and mortality. Over 50 different warfarin therapy protocols, including a number of pharmacogenomic-based (PG) protocols, with as many as 14 independent variables, have been developed to improve safety and efficacy, thereby reducing ischemic strokes and intracranial hemorrhages (ICH).

Purpose: To conduct a preliminary cost-effectiveness study to determine the price point at which using warfarin PG dosing to …

Reducing Disparities By Way Of A Cancer Disparities Research Training Program, Lee S. Caplan, Tabia H. Akintobi, Tandeca K. Gordon, Tiffany Zellner, Selina A. Smith, Daniel S. Blumenthal

Journal of Health Disparities Research and Practice

Background: For minority populations, there is a continuing disparity in the burden of death and illness from cancer. Research to address this disparity should be conducted by investigators who can best understand and address the needs of culturally diverse communities. However, minorities are under-represented in health-related research. The goal of this project was to develop and evaluate an approach to motivating and preparing master’s degree students for careers dedicated to cancer disparities research.

Method: A Cancer Disparities Research Training Program (CDRTP) was initiated in 2010. The program consists of coursework, practicum experiences, and research opportunities. Assessment of the curriculum is …

Feasibility Of A Community-Based Sickle Cell Trait Testing And Counseling Program, Ashley Housten, Regina Abel, Terianne Lindsey, Allison King

Journal of Health Disparities Research and Practice

Background: Sickle cell trait (SCT) screening is required at birth in the United States; however, adults rarely know their SCT status prior to having children.

Purpose: Assess feasibility of a community-based SCT education and testing intervention.

Methods: Participants were recruited from eight community sites to complete an educational program and offered a hemoglobin analysis. A genetic counselor met individually with participants to discuss lab results.

Results: Between July 14, 2010 and May 31, 2012, 637 participants completed the educational program. Five hundred seventy (89.5%) provided a blood sample, and 61 (10.9%) had SCT or other hemoglobinopathies. The genetic counselor met …

Continuous Care In Complex Contexts: Access To Health Services For Noncommunicable Diseases Among Syrian Refugee Women In Jordanian Host Communities, Jennifer Ostrowski

Independent Study Project (ISP) Collection

This study examines how, when and where Syrian refugee women living in a host community in central Jordan access health services related to noncommunicable diseases. Noncommunicable diseases are the leading cause of death and disability worldwide, but can be effectively managed through timely treatment. Examining access to care for these diseases in the context of humanitarian emergencies, such as war and displacement, is particularly important because they require continuous care, which may be interrupted during emergencies, and because they can cause acute complications, which may be exacerbated by emergencies (WHO, 2016).

Previous studies indicate a high burden of NCDs among …

Surveillance, Epidemiological, And Virological Detection Of Highly Pathogenic H5n1 Avian Influenza Viruses In Duck And Poultry From Bangladesh, Wahedul Karim Ansari, Md Safiullah Parvej, Mohamed E. El Zowalaty, Sally Jackson, Stephen A. Bustin, Adel K. Ibrahim, Md Tanvir Rahman, Han Zhang, Mohammad Ferdousur Rahman Khan, Md Mostakin Ahamd, Md. Fasiur Rahman, Marzia Rahman, Khm Nazmul H. Nazir, Sultan Ahmed, Md Liakot Hossenn, Md Abdul Kafi, Mat Yamage, Nitish C. Debnath, Graba Ahmed, Hossam Ashour, Md Masoud, Ayman Noreddin, Md B. Rahman

Pharmacy Faculty Articles and Research

Avian influenza viruses (AIVs) continue to pose a global threat. Waterfowl are the main reservoir and are responsible for the spillover of AIVs to other hosts. This study was conducted as part of routine surveillance activities in Bangladesh and it reports on the serological and molecular detection of H5N1 AIV subtype. A total of 2169 cloacal and 2191 oropharyngeal swabs as well as 1725 sera samples were collected from live birds including duck and chicken in different locations in Bangladesh between the years of 2013 and 2014. Samples were tested using virus isolation, serological tests and molecular methods of RT-PCR. …

Available Interventions For Prevention Of Cotton Dust-Associated Lung Diseases Among Textile Workers, Asaad Ahmed Nafees, Zafar Fatmi

Community Health Sciences

The authors reviewed literature on interventions for cotton dust-associated lung diseases among textile workers. Internet sources (PubMed, Cochrane Library, Google and Google Scholar) were accessed and interventions were categorized into: Engineering or administrative controls, or personal protective equipment (PPE). Ten relevant articles were shortlisted, five related to engineering controls (pre-processing, bactericidal treatment of cotton, improved workplace design, machinery and dust control measures). Administrative controls may involve setting standards, environmental surveillance, periodic medical examinations, and workers training. Although specific guidelines are available regarding the use of PPEs, but there was little literature on their effectiveness. It was concluded that there is …