International Public Health Commons^™

Evaluation Of The Benefits And Risks Of Introducing Ebola Community Care Centers, Sierra Leone, Adam J. Kucharski, Anton Camacho, Francesco Checchi, Ronald J. Waldman, Rebecca F. Grais, Jean-Clement Cabrol, Sylvie Briand, Marc Baguelin, Stefan Flasche, Sebastian Funk, W. John Edmunds

Global Health Faculty Publications

In some parts of western Africa, Ebola treatment centers (ETCs) have reached capacity. Unless capacity is rapidly scaled up, the chance to avoid a generalized Ebola epidemic will soon diminish. The World Health Organization and partners are considering additional Ebola patient care options, including community care centers (CCCs), small, lightly staffed units that could be used to isolate patients outside the home and get them into care sooner than otherwise possible. Using a transmission model, we evaluated the benefits and risks of introducing CCCs into Sierra Leone’s Western Area, where most ETCs are at capacity. We found that use of …

Designs Of Two Randomized, Community-Based Trials To Assess The Impact Of Influenza Immunization During Pregnancy On Respiratory Illness Among Pregnant Women And Their Infants And Reproductive Outcomes In Rural Nepal, James M. Tielsch, Mark Steinhoff, Joanne Katz, Janet A. Englund, Jane Kuypers, Subarna K. Khatry, Laxman Shrestha, Steven C. Leclerq

Global Health Faculty Publications

Background: Among the most important causes of illness and death in both pregnant women and their newborn infants are respiratory infections including influenza. Pregnant women in North America have a 4 to 5 fold excess rate of hospitalization compared to non-pregnant women. Rates of infant hospitalization associated with influenza are much higher than in their mothers. Fully half of children hospitalized for influenza in the US are in the age group 0–5 months, a group where no vaccine is licensed. Data on influenza are much fewer in low income countries where the risks of serious morbidity and mortality are …

A Systematic Review Of Community-To-Facility Neonatal Referral Completion Rates In Africa And Asia, Naoko Kozuki, Tanya Guenther, Lara Vaz, Sajid B. Soofi, Christine Nalwadda Kayemba, James M. Tielsch, Et Al.

Global Health Faculty Publications

Background

An estimated 2.8 million neonatal deaths occur annually worldwide. The vulnerability of newborns makes the timeliness of seeking and receiving care critical for neonatal survival and prevention of long-term sequelae. To better understand the role active referrals by community health workers play in neonatal careseeking, we synthesize data on referral completion rates for neonates with danger signs predictive of mortality or major morbidity in low- and middle-income countries.

Methods

A systematic review was conducted in May 2014 of the following databases: Medline-PubMed, Embase, and WHO databases. We also searched grey literature. In addition, an investigator group was established to …

Detecting Signals Of Seasonal Influenza Severity Through Age Dynamics, Elizabeth C Lee, Cécile Viboud, Lone Simonsen, Farid Khan, Shweta Bansal

Global Health Faculty Publications

BACKGROUND: Measures of population-level influenza severity are important for public health planning, but estimates are often based on case-fatality and case-hospitalization risks, which require multiple data sources, are prone to surveillance biases, and are typically unavailable in the early stages of an outbreak. To address the limitations of traditional indicators, we propose a novel severity index based on influenza age dynamics estimated from routine physician diagnosis data that can be used retrospectively and for early warning.

METHODS: We developed a quantitative 'ground truth' severity benchmark that synthesizes multiple traditional severity indicators from publicly available influenza surveillance data in the United …

Association Between Dietary Patterns During Pregnancy And Birth Size Measures In A Diverse Population In Southern Us, Uriyoan Colón-Ramos, Susan B. Racette, Jody M. Ganiban, Thuy G. Nguyen, Mehmet Kocak, Kecia N. Carroll, Eszter Volgyi, Frances A. Tylavsky

Global Health Faculty Publications

Despite increased interest in promoting nutrition during pregnancy, the association between maternal dietary patterns and birth outcomes has been equivocal. We examined maternal dietary patterns during pregnancy as a determinant of offspring’s birth weight-for-length (WLZ), weight-for-age (WAZ), length-for-age (LAZ), and head circumference (HCZ) Z-scores in Southern United States (n = 1151). Maternal diet during pregnancy was assessed by seven dietary patterns. Multivariable linear regression models described the association of WLZ, WAZ, LAZ, and HCZ with diet patterns controlling for other maternal and child characteristics. In bivariate analyses, WAZ and HCZ were significantly lower for processed and processed-Southern compared to healthy …

Co2 And H2o: Understanding Different Stakeholder Perspectives On The Use Of Carbon Credits To Finance Household Water Treatment Projects., Sarah K. Summers, Rochelle Rainey, Maneet Kaur, Jay P. Graham

Global Health Faculty Publications

Background

Carbon credits are an increasingly prevalent market-based mechanism used to subsidize household water treatment technologies (HWT). This involves generating credits through the reduction of carbon emissions from boiling water by providing a technology that reduces greenhouse gas emissions linked to climate change. Proponents claim this process delivers health and environmental benefits by providing clean drinking water and reducing greenhouse gases. Selling carbon credits associated with HWT projects requires rigorous monitoring to ensure households are using the HWT and achieving the desired benefits of the device. Critics have suggested that the technologies provide neither the benefits of clean water nor …

Challenges And Opportunities Associated With Neglected Tropical Disease And Water, Sanitation And Hygiene Intersectoral Integration Programs., E. Anna Johnston, Jordan Teague, Jay P. Graham

Global Health Faculty Publications

BACKGROUND:

Recent research has suggested that water, sanitation, and hygiene (WASH) interventions, in addition to mass drug administration (MDA), are necessary for controlling and eliminating many neglected tropical diseases (NTDs).

OBJECTIVES:

This study investigated the integration of NTD and WASH programming in order to identify barriers to widespread integration and make recommendations about ideal conditions and best practices critical to future integrated programs.

METHODS:

Twenty-four in-depth, semi-structured interviews were conducted with key stakeholders in the global NTD and WASH sectors to identify barriers and ideal conditions in programmatic integration.

RESULTS:

The most frequently mentioned barriers to WASH and NTD integration …

Tracking Global Fund Hiv/Aids Resources Used For Sexual And Reproductive Health Service Integration: Case Study From Ethiopia, Sangeeta Mookherji, Samantha Ski, Dale Huntington

Global Health Faculty Publications

Objective/Background

The Global Fund to Fight AIDS, Tuberculosis & Malaria (GF) strives for high value for money, encouraging countries to integrate synergistic services and systems strengthening to maximize investments. The GF needs to show how, and how much, its grants support more than just HIV/AIDS, TB and malaria.

Sexual and Reproductive Health (SRH) has been part of HIV/AIDS grants since 2007. Previous studies showed the GF PBF system does not allow resource tracking for SRH integration within HIV/AIDS grants. We present findings from a resource tracking case study using primary data collected at country level.

Methods

Ethiopia was the study …

Indoor Particulate Matter Concentration, Water Boiling Time, And Fuel Use Of Selected Alternative Cookstoves In A Home-Like Setting In Rural Nepal, Kristen D. Ojo, Sutyajeet I. Soneja, Carolyn G. Scrafford, Subarna K. Khatry, Steven C. Leclerq, William Checkley, Joanne Katz, Patrick N. Breysse, James M. Tielsch

Global Health Faculty Publications

Alternative cookstoves are designed to improve biomass fuel combustion efficiency to reduce the amount of fuel used and lower emission of air pollutants. The Nepal Cookstove Trial (NCT) studies effects of alternative cookstoves on family health. Our study measured indoor particulate matter concentration (PM2.5), boiling time, and fuel use of cookstoves during a water-boiling test in a house-like setting in rural Nepal. Study I was designed to select a stove to be used in the NCT; Study II evaluated stoves used in the NCT. In Study I, mean indoor PM2.5 using wood fuel was 4584 μg/m3 , 1657 μg/m3 , …

A Global Map Of Hemispheric Influenza Vaccine Recommendations Based On Local Patterns Of Viral Circulation, Wladimir J. Alonso, Christine Yu, Cecile Viboud, Stephanie A. Richard, Cynthia Schuck-Paim, Lone Simonsen, Wyller A. Mello, Mark A. Miller

Global Health Faculty Publications

Both the Northern and the Southern Hemisphere annual WHO influenza vaccine recommendations are designed to ensure vaccine delivery before the winter-time peak of viral circulation in each hemisphere. However, influenza seasonal patterns are highly diverse in tropical countries and may be out of phase with the WHO recommendations for their respective hemisphere. We modelled the peak timing of influenza activity for 125 countries using laboratory-based surveillance data from the WHO’s FLUNET database and compared it with the influenza hemispheric recommendations in place. Influenza vaccine recommendations for respectively 25% and 39% of the Northern and Southern Hemisphere countries were out of …

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.

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.

Death Patterns During The 1918 Influenza Pandemic In Chile, Gerardo Chowell, Lone Simonsen, Jose Flores, Mark A. Miller, Cecile G. Viboud

Global Health Faculty Publications

Scarce information about the epidemiology of historical influenza pandemics in South America prevents complete understanding of pandemic patterns throughout the continent and across different climatic zones. To fill gaps with regard to spatiotemporal patterns of deaths associated with the 1918 influenza pandemic in Chile, we reviewed archival records. We found evidence that multiple pandemic waves at various times of the year and of varying intensities occurred during 1918-1921 and that influenza-related excess deaths peaked during July-August 1919. Pandemic-associated mortality rates were elevated for all age groups, including for adults >50 years of age; elevation from baseline was highest for young …

Prevalence And Determinants Of Unintended Childbirth In Ethiopia, Yibeltal Tebekaw, Bezuhan Aemro, Charles Teller

Global Health Faculty Publications

Background

Ethiopia’s population policy specifically aims to reduce TFR from 7.7 to 4.0 and to increase contraceptive use from 4.0% to 44.0% between 1990 and 2015. In 2011, the use of contraceptive methods increased seven-fold from 4.0% to 27%; and the TFR declined by 38% to 4.8. The use of modern contraceptives is, however, much higher in the capital Addis Ababa (56%) and other urban areas but very low in rural areas (23%) far below the national average (27%). In 2011, one in four Ethiopian women had an unmet need for contraception. The main aim of this study was to …

Using A Theory Of Change Approach To Analyze Global Health Diplomacy Practice In Myanmar, Sangeeta Mookherji, Holly Greb, Rebecca Katz

Global Health Faculty Publications

The current picture of global health diplomacy (GHD) is one of increasing complexity, with multiple actors striving for multiple objectives, using a multitude of strategies and activities. Analysis and documentation of GHD practice is urgently needed to help identify the opportunities GHD provides for jointly improving global health and international relations, as well as possible unintended consequences. Systematic analysis of GHD practice is challenging without a conceptual framework. We identified a Theory of Change approach as one way to conceptualize GHD practice and potential impacts that could also depict its complexity and identify relationships and pathways for measuring success. We …

Household Wealth And Neurocognitive Development Disparities Among School-Aged Children In Nepal., Shivani A Patel, Laura E Murray-Kolb, Steven C Leclerq, Subarna K Khatry, James M. Tielsch, Joanne Katz, Parul Christian

Global Health Faculty Publications

BACKGROUND: Wealth disparities in child developmental outcomes are well documented in developed countries. We sought to (1) describe the extent of wealth-based neurocognitive development disparities and (2) examine potential mediating factors of disparities among a population-based cohort of children in rural Nepal.

METHODS: We investigated household wealth-based differences in intellectual, executive and motor function of n = 1692 children aged between 7 and 9 years in Nepal. Using linear mixed models, wealth-based differences were estimated before and after controlling for child and household demographic characteristics. We further examined wealth-based differences adjusted for three sets of mediators: child nutritional status, home …

The Influence Of Climatic Conditions On The Transmission Dynamics Of The 2009 A/H1n1 Influenza Pandemic In Chile, Gerardo Chowell, Sherry Towers, Cecile Viboud, Rodrigo Fuentes, Viviana Sotomayor, Lone Simonsen, Mark A. Miller, Mauricio Lima, Claudia Villarroel, Monica Chiu, Jose E. Villarroel, Andrea Olea

Global Health Faculty Publications

No abstract provided.

Mortality Burden Of The 2009 A/H1n1 Influenza Pandemic In France: Comparison To Seasonal Influenza And The A/H3n2 Pandemic, Magali Lematire, Fabrice Carrat, Gregoire Rey, Mark A. Miller, Lone Simonsen, Cecile Viboud

Global Health Faculty Publications

Background

The mortality burden of the 2009 A/H1N1 pandemic remains unclear in many countries due to delays in reporting of death statistics. We estimate the age- and cause-specific excess mortality impact of the pandemic in France, relative to that of other countries and past epidemic and pandemic seasons.

Methods

We applied Serfling and Poisson excess mortality approaches to model weekly age- and cause-specific mortality rates from June 1969 through May 2010 in France. Indicators of influenza activity, time trends, and seasonal terms were included in the models. We also reviewed the literature for country-specific estimates of 2009 pandemic excess mortality …

Smoking Susceptibility And Its Predictors Among Adolescents In China: Evidence From Ningbo City, Cheng Huang, Jeffrey Koplan, Jing Liu, Changwei Li, Jessica Silvaggio, Amanda K. Macgurn, Tao Zhang, Michael P. Erikson, Pam Redmon

Global Health Faculty Publications

Susceptibility to smoking is a risk factor of actual adolescent smoking behaviors. This study aimed to estimate the rate of smoking susceptibility and its predictors in China with a sample of 4,695 junior high school students in Ningbo, China. Core questions from the Global Youth Tobacco Survey (GYTS) were adapted to the China context and administered to these students. The rate of smoking susceptibility, measured by “Do you foresee yourself taking up smoking in the next 12 months”, is 6.1%. Results from logistic regression suggested that among boys, adolescents’ health knowledge that smoking can cause lung cancer (OR=2.73), the belief …

How Can Health Serve As A Bridge For Peace? Certi Crisis And Transition Tool Kit, Rosalia Rodriguez-Garcia, James Macinko, F. Xavier Solorzano, Marita Schlesser, George Washington University School Of Public Health And Health Services

Global Health Faculty Publications

No abstract provided.