International Public Health Commons^™

Localizing The International: Examining How Fieldworkers Combat Adolescent Pregnancy In Northern Ghana, Alexandra C. Sloss

Renée Crown University Honors Thesis Projects - All

International aid is often ineffective because it is delivered without an understanding of local ideologies and contexts. My Capstone examined whether or not international aid in northern Ghana could be effective when addressing adolescent pregnancy. The Ghanaian programs I address in my Capstone are six non-governmental organizations, a government sub-district clinic and government junior high schools. The majority of my data was collected through interviews with individuals at all levels of the organizations, including directors, staff members, volunteers and individuals seeking the organization’s services. Alongside interviews I also spent time in the field, participating in youth group discussions, visiting regional …

Occupational Health Risk Factors For Schistosomiasis: Systematic Review And Analysis, Sarah Grace Sawyer, Amira Roess, Gisela Butera

GW Research Days 2015

Schistosomiasis is a neglected tropical disease caused by a parasitic flatworm which afflicts over 200 million people in the poorest regions of Africa. Carried by snails living in fresh, stagnant water, the parasite penetrates human skin upon contact, causing the victim to suffer a range of symptoms including diarrhea, blood in the urine, and eventual death. Despite its prevalence, schistosomiasis is preventable, treatable, and curable once a control program is implemented. Substantial reduction of schistosomiasis would relieve suffering and produce many socio-economic benefits, including higher productivity and higher school attendance rates. Disease transmission is directly tied to the environment, and …

Investigating Barriers To Early Cancer Detection For Rural Indian Women: A Qualitative Analysis Of Cancer Outreach In Dehradun, Uttarakhand, Blair Burnett

Independent Study Project (ISP) Collection

This study examines barriers to early detection for women’s specific cancers in rural India in and around Dehradun, Uttarakhand, within the framework of existing health outreach programs from tertiary hospitals in the state. The burden of cancer mortality within India is disproportionately affecting women living in rural populations considering the current health education and health care infrastructure in place. Barriers of knowledge, access to knowledge, economic condition, geography, and cultural norms are all examined within this study in the context of early cancer detection. National Indian health policy is currently framed to address the burden of cancer within India; however, …

Deconstructing Unmade Examining The Capacity Of Ayurveda To Address India’S Mental Health Crisis, Cassie Sutten Coats

Independent Study Project (ISP) Collection

Though India does not have a credible, widespread system in place to recognize and focus on issues of mental health, especially in allopathic treatments, it is imperative to evaluate the existing practices and approaches in regards to mental health alongside the impact that these approaches may have on Indian society. In contrast to Westernized systems of medicine, the traditional Indian system of Ayurveda inherently addresses issues in mental health due to the holistic approach through mind-body medicine. This study evaluates the enormous potential that exists within Ayurvedic philosophy to provide adequate, culturally congruent, treatments and care in mental health, and …

Whom Do You Trust? Doubt And Conspiracy Theories In The 2009 Influenza Pandemic, Shawn Smallman

International & Global Studies Faculty Publications and Presentations

The 2009 pandemic of H1N1 influenza led people around the globe to create narratives about the epidemic defined by the question of trust; these narratives ranged from true conspiracy theories to simply accounts in which mistrust and betrayal formed a motif. In particular, most of these narratives reflected a fear of capitalism and globalization, although in specific regions, other issues—such as religion—played a more central role. These stories were not unique to the H1N1 pandemic but rather have appeared with every contemporary outbreak of infectious disease. This paper will examine conspiracy theories and moral panics related to the H1N1 pandemic …

Fighting The Obesity Epidemic: Challenges And Ethics, Grace Brown

Independent Study Project (ISP) Collection

In recent decades, a double burden of disease has emerged that requires public health workers to fight both hunger and obesity. The obesity epidemic is unlike other epidemics in that it is largely man-made and dependent on social factors and industry influences, making it difficult to fight. The high global prevalence of obesity is partially a result of globalization, which has encouraged development and the liberalizing of economies all around the world, which in turn has increased the marketing and consumption of obesogenic products. Policy solutions have been proposed and implemented in some countries, but an international solution has yet …

The Impact Of Vaccine Hesitancy On The Polio Vaccine In South Asia, Leah Everist

Independent Study Project (ISP) Collection

A disease that paralyzes hundreds of children each year, polio is incurable but also entirely preventable through vaccination. Though part of the reason some children are not reached for immunization is that they are in areas too volatile for healthcare workers to access, vaccine hesitancy is increasingly being recognized as an important player. The objective of this study is to ascertain the degree to which vaccine hesitancy affects polio vaccine campaigns in Afghanistan and Pakistan, the countries in South Asia where polio continues to be endemic, to assess the drivers behind hesitancy in this region, and to present recommendations for …

Babies First: Ensuring Proper Infant Nutrition During Emergencies, Abigail M. Alonso

Independent Study Project (ISP) Collection

Background: Breastfeeding is the best source of nutrition for an infant, living in all regions and cultures. Recommendations apply across the board, from developed nations to refugee camps, from women with HIV to those with time constraints regarding feeding. There also exists a complex relationship between corporations that provide BMS and the NGOs working to promote breastfeeding in emergency situations amongst vulnerable populations.

Objective: The objective of this paper is to expose breastfeeding promotion, using the Dadaab camps in Northeastern Kenya as a case study of IYCF programs and support of breastfeeding among low-literacy populations with an emphasis on women …

El Rol Del Parto Mapuche En El Mundo De La Medicina Moderna / The Role Of Mapuche Birth In A World Of Modern Medicine, Nita Chai

Independent Study Project (ISP) Collection

Research Question: Is there existing demand for Mapuche birth practices and what are the barriers to incorporating them in the Chilean healthcare system? Objective: Analyze the current role of Mapuche birth practicesby determining what is the demand from the Mapuche for their use, describing the quality of communication between Mapuche women andmodern professionals, and identifying the perspectives of modern professionals on Mapuche birth practices. Background: Childbirth is an integral process for the human race. For many indigenous communities, the arrival of a new life holds cultural significance that is recognized through ceremonies during or after childbirth. Chile has implemented health …

The Benefits Of Breastfeeding, Helen L. Byers

Senior Honors Theses

It is important to educate women of childbearing age, their families, and society of the benefits that breastfeeding has over bottle-feeding and formula-feeding. The benefits of breastfeeding are in three main categories. First, the developmental, physical, emotional, and spiritual benefits of the baby will be discussed. Then the physical, emotional, and spiritual benefits for the mother will be talked about along with possible contraindications or difficulties. Finally, the financial benefits of breastfeeding over feeding an infant from the bottle will be discussed as it relates to the family and government. The goal is to persuade that breastfeeding is a superior …

The Role Of Zinc And Iron-Folic Acid Supplementation On Early Child Temperament And Eating Behaviors In Rural Nepal: A Randomized Controlled Trial, Pamela J. Surkan, Mary Katherine Charles, Joanne Katz, Emily H. Siegel, Subarna K. Khatry, Steven C. Leclerq, Rebecca J. Stoltzfus, James M. Tielsch

Global Health Faculty Publications

Child eating behaviors play an important role in nutrient intake, ultimately affecting child growth and later outcomes in adulthood. The study assessed the effects of iron-folic acid and zinc supplementation on child temperament and child eating behaviors in rural Nepal. Children (N = 569) aged 4–17 months in Sarlahi district, southern Nepal were randomized to receive daily supplements of placebo, iron-folic acid, zinc, or zinc plus iron-folic acid and followed for approximately 1 year. At baseline and four follow-up visits mothers completed questionnaires including information on demographic characteristics and child temperament and eating behaviors. The main effects of zinc and …

Melding Data Collection Methodology With Community Assistance: Benefits To Both Researchers And The Indigenous Groups They Study, Douglas S. London

Journal of Ecological Anthropology

I present a description of a model of melding data collection with community aid in the form of health educator training that emerged in the process of research collaboration during 2009-2011 with the Kawymeno Waorani foragers of Amazonian Ecuador. Some guidelines are suggested as to how benefits to both parties might be achieved when collecting data with indigenous populations. In this article I describe some of the advantages and pitfalls of melding data collection and community aid with research when collaborating with vulnerable indigenous groups.

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 …

Bidirectional Global Health Education: The Rvcp-Jeff Health Exchange Program, Ellen J. Plumb Md, James D. Plumb Md, Mph, Komal S. Soin Md

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Salud Mesoamérica 2015 Initiative: Design, Implementation, And Baseline Findings, Ali H. Mokdad, Katherine Elliott Colson, Paola Zuniga-Brenes, Diego Rios-Zertuche, Erin B. Palmisano, Catherine W. Gillespie, +27 Additional Authors

Pediatrics Faculty Publications

Background

Health has improved markedly in Mesoamerica, the region consisting of southern Mexico and Central America, over the past decade. Despite this progress, there remain substantial inequalities in health outcomes, access, and quality of medical care between and within countries. Poor, indigenous, and rural populations have considerably worse health indicators than national or regional averages. In an effort to address these health inequalities, the Salud Mesoamérica 2015 Initiative (SM2015), a results-based financing initiative, was established.

Methods

For each of the eight participating countries, health targets were set to measure the progress of improvements in maternal and child health produced by …

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 …

Health Care In Bolivia: A First Hand Experience, Sanchi Malhotra

CwiC-PH

This research project is based on a one month work experience in Cochabamba, Boliva through the NGO Sustainable Bolivia at Hosptial Viedma, a major public hospital and Centre de Salud Pacata, a rural outpatient health clinic. The information presented below is derived from both research and personal experience. This trip was partially funded by Jefferson Office of International Affairs with the goal of gaining experience and knowledge about the Bolivian health care system.

Universal Healthcare: Costa Rica As A Model, Annie J. Ferris

CwiC-PH

What it Looks Like in Costa Rica

• Run by the Costa Rican Social Security Administration
• Financed by employers, employees, and the Ministry of Health. Employer and employee contributions together make up over 90% of contributions.
• Costa Rica is divided into 105 health areas, which are further divided up into primary care units called Basic Provision Units of Integrated Healthcare, or EBAIS. There are 947 of these primary care centers throughout Costa Rica, and everyone is assigned to one.
• The EBAIS clinics provide a wide range of services to cover the general and specific health needs of the community, including primary …

The Effect Of Peer Educators On Medication Adherence In Hiv Patients In Cochabamba, Bolivia, George Ru

CwiC-PH

BACKGROUND INFORMATION

• Bolivia is the least developed country in South America, with high levels of poverty, poor access to safe water, and low economic activity. Bolivia’s GDP, in US dollars, in 2013 was $30.60 billion and the gross national income, per capita in US dollars was $2,550, which both rank either at or near the bottom of the list for all South American countries (7).
• The Ministry of Health and Sports (MSD) is the national governing body responsible for formulating the strategy, policies, plans and programs in health. The Department of Health Services (SEDES) is the highest level of technical …

Globally Minded, Locally Serving: Refugee Health In Philadelphia, Sarah Jamieson, Angelica Montes, Gretchen Shanfeld, Mph, Rickie Brawer, Mph, Phd, Caryn Johnson, Ms, Otr/L, Faota, James D. Plumb, Md, Mph

CwiC-PH

Introduction

A refugee is someone who is forced to leave their country of origin due to war, violence, or persecution. The United States is the world’s top resettlement country. Out of the 50 states, Pennsylvania is 5^th in terms of the number of annually resettled refugees. Each year, Philadelphia resettles approximately 800 refugees. Bhutan, Burma, Iraq, Eritrea, Sudan, and Democratic Republic of Congo are the most frequent countries of origin in Philadelphia.

Cervical Cancer In Guatemala: Using Visual Inspection With Acetic Acid Screening To Reduce Incidence Of And Mortality From Cervical Cancer, Zachary Klock

CwiC-PH

Guatemala is a developing nation of nearly 16 million in Central America. Among the many health problems the nation suffers, cervical cancer remains a leading cause of cancer-related death. Cervical cancer, an easily detectable cancer, predominantly affects women in developing nations. Traditional cytology techniques have been used to screen women in the country for over 25 years, but less than 10% of the Guatemalan population is screened. The Visual Inspection with Acetic Acid (VIA) is a simple produce that uses acetic acid to visualize precancerous cervical lesions and has been proven to be more effective in resource-poor settings. The screening …

Evaluating And Responding To Medical Student Demand For Global Health Education, Angela Ugorets, Bs, Maria Montano, Mph, Michael Cafarchio, Md, Daniel Becchi, Ba, Annie Masterson, Ba, Nithin Paul, Ba, Ellen Plumb, Md

CwiC-PH

Introduction

With the constant interchange of people and diseases across continents, “the separation between domestic and international health problems is no longer useful.” (1) Look no further than the 80,000 refugees currently resettled in the United States for proof that health is a global phenomenon. The medical community needs to respond to the changing global landscape by training future healthcare leaders to think and act globally.

Medical students across the U.S. recognize this need with 68% of U.S. allopathic medical schools having an active student global or international health interest group. (2) Unfortunately, training opportunities lag behind student interest with …

Hernia Surgery In Rural Ghana, West Africa: Barriers To Health Care And Their Implications, Laura Traub

CwiC-PH

The information presented is a the product of a six week international rotation at Volta Regional Hospital and Royal Hospital through Blue-Med Africa, a non-governmental organization based out of Ho, Ghana. The goal of the rotation was to obtain an understanding of healthcare in Ghana and identify the differences between surgical procedures in West Africa and the U.S.

Alternative Income Generation For Kenyan Women: Preventing Prostitution And The Spread Of Hiv, Megan Elizabeth Lundy

CwiC-PH

HIV/AIDS in Mlolongo, Kenya

Mombasa Highway and Weigh Station

• Truckers spend 3+ days waiting to be processed, providing a costumer base for prostitution
• In Kenya, 27.6% of female sex workers are HIV positive and only 26.8% use condoms with all of their partners (Morris, Morris, and Ferguson, 2009).
• The rampant spread of HIV and lack of contraception has led to rapid growth in the population in an area that has little ability to support any residents
• Development of Slums that now line the highway

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 …

Improving Newborn Care Practices Through Home Visits: Lessons From Malawi, Nepal, Bangladesh, And Uganda., Deborah Sitrin, Tanya Guenther, Peter Waiswa, Sarah Namutamba, Gertrude Namazzi, Srijana Sharma, K. C. Ashish, Sayed Rubayet, Subrata Bhadra, Reuben Ligowe, Emmanuel Chimbalanga, Elizabeth Sewell, Kate Kerber, Allisyn Moran

Pediatrics Faculty Publications

Background: Nearly all newborn deaths occur in low- or middle-income countries. Many of these deaths could be prevented through promotion and provision of newborn care practices such as thermal care, early and exclusive breastfeeding, and hygienic cord care. Home visit programmes promoting these practices were piloted in Malawi, Nepal, Bangladesh, and Uganda.

Objective: This study assessed changes in selected newborn care practices over time in pilot programme areas in four countries and evaluated whether women who received home visits during pregnancy were more likely to report use of three key practices.

Design: Using data from cross-sectional surveys …

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 …

Factors Associated With Induced Abortion Among Female Entertainment Workers: A Cross-Sectional Study In Cambodia, Siyan Yi, Sovannary Tuot, Pheak Chhoun, Khuondyla Pal, Khimuy Tith, Carinne M. Brody

Objective: To explore risk factors associated with induced abortion among sexually active female entertainment workers (FEWs) in Cambodia.

Design: Cross-sectional study. Setting: Phnom Penh and Siem Reap, Cambodia.

Participants: This study included 556 FEWs aged 18–47 years randomly selected from entertainment establishments in the two cities in 2014 using a two-stage cluster sampling method. Data were collected through face-to-face interviews using a structured questionnaire.

Primary outcome measure: History of induced abortion during the time working as a FEW.

Results: Of the total sample, 45.6% reported currently using a contraceptive method with condom (42.4%) being the …

Ethical Perspectives Of Direct-To-Consumer Genetic Testing, Pawan Acharya, Rupesh Gautam

Journal of Health Ethics

Direct-to-consumer (DTC) genetic testing, which evolved from genomics is not free from controversies and ethical dilemmas. Conduction of genetic testing without direct communication between the users and certified medical professionals has aroused many ethical concerns. We discuss some ethical dilemmas surrounding DTC genetic testing in terms of quality assurance of the test, information communication process of the result, confidentiality of test result and the right to privacy, cost and price regulations, and user safety and harm mitigation. DTC genetic testing lies in the middle of a clash between liberal trade policies and state’s regulations as a case of extreme paternalism. …

Calling Science Pseudoscience: Fleck’S Archaeologies Of Fact And Latour’S ‘Biography Of An Investigation’ In Aids Denialism And Homeopathy, Babette Babich

Articles and Chapters in Academic Book Collections

Fleck’s Genesis and Development of a Scientific Fact foregrounds claims traditionally excluded from reception, often regarded as opposed to fact, scientific claims that are increasingly seldom discussed in connection with philosophy of science save as examples of pseudo-science. I am especially concerned with scientists who question the epidemiological link between HIV and AIDS and who are thereby discounted—no matter their credentials, no matter the cogency of their arguments, no matter the sobriety of their statistics—but also with other classic examples of so-called pseudo-science including homeopathy and other sciences, such as cold fusion. The pseudo-science version of the demarcation problem turns …