International Public Health Commons^™

Decomposing Differences In Coronavirus Disease 2019-Related Case-Fatality Rates Across Seventeen Nations, Ashley Wendell Kranjac, Dinko Kranjac

Sociology Faculty Articles and Research

As of 1 November 2020, estimated case-fatality rates associated with coronavirus disease 2019 are not uniformly patterned across the world and differ substantially in magnitude. Given the global spatial heterogeneity in case-fatality rates, we applied the Blinder-Oaxaca regression decomposition technique to identify how putative sociodemographic, structural, and environmental sources influence variation in case-fatality rates. We show that compositional and associational differences in country-level risk factors explain a substantial proportion of the coronavirus disease 2019-related case-fatality rate gap across nations. Asian countries fair better vis-à-vis case-fatality rate differences mainly due to variation in returns to sociodemographic, structural, and environmental sources among …

Right To Health In Gats: Can The Public Health Exception Pave The Way For Complementarity?, Swati Gola

Pace International Law Review

This paper demonstrates how a right to health approach in the interpretation of the public health exception outlined in GATS Article XIV(b) can bring about a harmonious application of international human rights and international trade law regimes. Focusing on the interpretive value of the right to health for the public health exception in GATS, it examines whether a WTO Member, who has committed itself under GATS to fully liberalize all service sectors that have implications for health (e.g., hospital and other healthcare services), still retains the regulatory space to undertake measures to fulfill their right to health obligations and can …

Healthcare Workers Hospitalized With Covid-19: Outcomes From The Burden Of Covid-19 Study At The University Of Louisville Center Of Excellence For Research In Infectious Diseases [Cerid], Ruth Carrico, T'Shura S. Ali, Maria Hill, Lucia B. Puga Sanchez, Catherine M. Bryan, Dawn Balcom, Stephen P. Furmanek, Amr Aboelnasr, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

Introduction: On March 6, 2020, the current ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as COVID-19, reached the commonwealth of Kentucky. Within days, the first cases of infection and hospitalization were identified among healthcare workers (HCW) in Kentucky, other states in the U.S., and around the world. There is little information available regarding the impact of COVID-19 on the HCW population within this area. The objective of this study was to describe the baseline characteristics of hospitalized HCWs infected with COVID-19.

Methods: Data collection was performed as part of a retrospective study of patients hospitalized …

Covid-19 & Pregnancy Complication During Early Pandemic: A Narrative Review, Ahmed A. Eladely, Maria Hill, Ahmed Abdelhaleem, Zahid Imran, Ahsan M. Khan, Daisy Sangroula

The University of Louisville Journal of Respiratory Infections

Background: Coronaviruses have caused three outbreaks in the past two decades. The novel one is SARS-COV-2, which causes COVID-19. Pregnant women have a somewhat altered immune state, which may make them more vulnerable to COVID-19 and its complications. Extensive research is needed to better understand the clinical course of COVID-19 in this population. This review article discusses the comparison of SARS-CoV-2 with previous coronavirus outbreaks, clinical presentations, and complications in pregnant women and newborns.

Methods: We conducted a literature search for case series and case reports about pregnancy outcomes in pregnant women with COVID-19 during the early phase of pandemic. …

The Case Of A Pregnant Woman With Ards Due To Covid-19 Treated With Hydroxychloroquine, Azithromycin, And Remdesivir And Delivery Of A Healthy Baby During Mechanical Ventilation Through Cesarean Section, Adria Madera-Acosta, Martin Gnoni, Bassman Tappuni, Monika Sadlak, Ravleen Grewal, Angel Mena, Yousef Ali-Ahwel

The University of Louisville Journal of Respiratory Infections

We are in the midst of a pandemic due to SARS-CoV-2. Pregnancy was identified among the risk factors for worse clinical outcomes in multiple studies. The optimal therapy in this group of patients remains to be defined. Here, we present the case of a 39-year-old Caucasian pregnant female at 31 weeks of gestation, who was treated successfully with hydroxychloroquine, azithromycin, remdesivir, prone therapy, and cesarean delivery of a healthy baby while on mechanical ventilation. She remained SARS-CoV-2-positive until the 39th day of hospitalization. We discuss the pathophysiology of the increased risk of infections during pregnancy and particularly the high risk …

Individual- And Country-Level Correlates Of Female Permanent Contraception Use In Sub-Saharan Africa, Babayemi O. Olakunde, Jennifer R. Pharr, Lung-Chang Chien, Rebecca D. Benfield, Francisco S. Sy

Environmental & Global Health Faculty Research

Background: Female permanent contraception is a cost-effective contraceptive method that can help clients with the desire to limit childbearing achieve their reproductive intention. However, despite its benefits, the use of FPC remains low in sub-Saharan Africa (SSA), and limited studies have examined the correlates of its uptake. In this study, we assessed the individual- and country-level factors associated with the use of FPC among married or in-union women using modern contraceptive methods to limit childbearing in SSA. Methods: This study was a secondary data analysis of individual- and country-level data obtained from the Demographic and Health Surveys (DHS) Program and …

Characteristics And Outcomes Of Adults Hospitalized With Sars-Cov-2 Community-Acquired Pneumonia In Louisville, Kentucky, Julio A. Ramirez, Jose Bordon, Rodrigo Cavallazzi, Stephen P. Furmanek, Amr Aboelnasr, Mahder A. Tella, William A. Mattingly, Ashley M. Wilde, Daisy Sangroula, Demetra Antimisiaris, Donghoon Chung, Guillermo Cabral, Gabino R Fernandez-Botran, Jiapeng Huang, Martin Gnoni, Ozan Akca, Paul Schulz, Phillip F. Bressoud, Priya Krishnan, Sally Suliman, Sathya Krishnasamy, Stephen S. Hanson, William P. Mckinney, Harpal Sandhu, Leslie A Wolf, Mark Burns, Ruth Carrico, Forest W. Arnold

The University of Louisville Journal of Respiratory Infections

Background: Patients infected with the novel coronavirus SARS-CoV-2 are frequently hospitalized with community-acquired pneumonia (CAP). The objective of this study was to define the clinical characteristics and outcomes of hospitalized patients with SARS-CoV-2 CAP in the city of Louisville, KY.

Methods: This was a retrospective observational study of 700 patients with SARS-CoV-2 infection hospitalized at eight of the adult hospitals in the city of Louisville. Patients with 1) a positive RT-PCR for SARS-CoV-2, 2) fever, cough, or shortness of breath, and 3) an infiltrate on chest imaging were defined as having SARS-CoV-2 CAP. Demographic characteristics of the study population were …

Implementation Of The University Of Louisville Covid-19 Biorepository: Experiences From The Center Of Excellence In Infectious Diseases (Cerid), Dawn Balcom, Leslie A Wolf, Subathra Marimuthu, William Johnson, Danial Malik, Chet Dhakal, Pavani Nathala, Mohammed Abbas, Sahaj Hardeep Singh, Basel Haddad, Rafik Elbeblawy, Fnu Deepti, Ahmed Ali, Evelyn Exposito Gonzalez, Ruth Carrico

The University of Louisville Journal of Respiratory Infections

The limited availability of biological samples from patients testing positive for SARS-CoV-2 for future research was quickly identified at the onset of the COVID-19 pandemic. In response to this need, a COVID-19 biobank was initiated by the University of Louisville Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID). The COVID-19 biobank contains waste samples obtained from patients hospitalized with COVID-19 in any of the nine Louisville, Kentucky, area hospitals during the timeframe of April 13 to September 20, 2020. The COVID-19 biobank stores approximately 1,623 waste samples with 2,127 aliquots for distribution. All samples are …

Acute Ischemic Stroke As The Presenting Feature Of Covid-19 In The Young And Pregnant, Nermila A. Ballmick, Jiri F. Kubac, Hossein Akhondi

HCA Healthcare Journal of Medicine

Introduction: Coronavirus disease (COVID-19) is an emerging and rapidly evolving public health issue that has become globally widespread and an overwhelming pandemic. Clinical manifestations of the disease include asymptomatic carrier states, acute respiratory distress syndrome, and even multiorgan dysfunction. Here, we present a unique and rare case of an acute ischemic stroke (AIS) in an asymptomatic pregnant woman with no predisposing medical illnesses.

Discussion: An 18-year-old G2P1 African American woman at 7 weeks gestational age with no significant medical or family history presenting to the Emergency Department during the initial phases of the pandemic with complaints of new onset left …

Bangladesh: Covid-19 Knowledge, Attitudes, Practices & Needs—Responses From Three Rounds Of Data Collection Among Adolescent Girls In Districts With High Rates Of Child Marriage, Sajeda Amin, Ubaidur Rob, Sigma Ainul, Md. Irfan Hossain, Forhana Rahman Noor, Iqbal Ehsan, Mehnaz Manzur

Poverty, Gender, and Youth

From April 20–30, 2020, during a nationwide lockdown, the Population Council Bangladesh conducted the first round of a rapid phone-based survey on COVID-19 knowledge, attitudes, and practices. The survey randomly selected girls who had provided phone numbers during enrollment in a skills-building program that began before the pandemic. The survey’s objective was to assess the impact of COVID-19 on adolescent lives and to design programs that would contribute to protecting girls and meet social distancing guidelines imposed by the government. Phone interviews were conducted with 479 girls living in the districts of Chapainawabganj, Kushtia, and Sherpur who were participants in …

Scales To Measure Motivation Among Community Health Workers, And Trust And Empowerment Among Their Clients: A Guide, Frontline Health Project

Reproductive Health

This How-To Guide presents five multi-item scales to measure motivation among community health workers (CHWs), as well as clients' trust in CHWs, and empowerment within community health systems. The scales presented are intended for use in community health programs and in combination with other indicators in the CHW Performance Measurement Framework (published by the Frontline Health project in 2019) for routine data monitoring to improve quality and accountability in community health.

Age, Comorbidities, And Mortality Correlation In Covid-19 Patients: A Review, Vidyulata Salunkhe, Amr Aboelnasr, Parul Pahal, Nida Qadir, Simra Kiran, Balaji Sekaran, Omar Fahmy, Farah Daas, Syed Shah

The University of Louisville Journal of Respiratory Infections

Background: The risk of death due to COVID-19 among hospitalized patients is known to be higher in older adults and those with underlying health conditions. Understanding the proportion of patients who are at increased risk of death due to COVID-19 and how this varies between age groups will inform the healthcare community as to how to evaluate the risk of COVID-19 and better design healthcare and economic policies.

Methods: We conducted a literature search for studies published between December 2019 and May 16, 2020 in PubMed, Embase, and Cochrane (CENTRAL). Descriptive statistics were performed.

Results: We reviewed 14 studies, of …

Experiences Among Adults And Adolescents During The Covid-19 Pandemic From Four Locations Across Kenya—Study Description, Timothy Abuya, Karen Austrian, Adan Isaac, Beth Kangwana, Faith Mbushi, Eva Muluve, Daniel Mwanga, Thoai Ngo, Mercy Nzioki, Rhoune Ochako, Jessie Pinchoff, Ben Tidwell, John Wanyungu, Corinne White

Poverty, Gender, and Youth

To control the spread of coronavirus, the COVID-19 National Emergency Response Committee (NERC) in Kenya, chaired by the Ministry of Health (MOH), has implemented prevention and mitigation measures. To inform the Government of Kenya’s shorter- and longer-term response strategies, the Population Council COVID-19 study team utilizes rapid phone-based surveys to collect information on knowledge, attitudes, practices and needs among a longitudinal cohort of heads of household sampled from existing prospective cohort studies. The first was carried out across five Nairobi urban informal settlements; the baseline survey (n=2,009) was conducted March 30–31 with subsequent follow-up surveys conducted April 13–14 (n=1,764), May …

Pulmonary Embolism Related To Covid-19 Quarantine, Eduardo J. Quinteros Md, Juan Bisonni Md

The University of Louisville Journal of Respiratory Infections

The mandatory quarantine imposed in response to the COVID-19 pandemic has been related to an increase in cases of thromboembolism in non-COVID-19 patients. Particularly in countries such as Argentina, where strict quarantine was mandated, individuals were far less likely to risk being outside or observe healthy practices that would avoid the exacerbation of diseases such as thromboembolism. We report the case of a patient with pulmonary thromboembolism without usual triggering causes during the quarantine period, related to a previously undiagnosed hypercoagulable condition.

Congregate Care In The Time Of Covid-19: Proposed Best Practices From The Inside, Linda Bergthold, Margan Zajdowicz, Thaddeus R. Zajdowicz, Elli Hall, Kimberley A. Buckner, Ruth Carrico

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Impact Of Mass Distribution Of Long-Lasting Insecticidal Nets (Llins) In Mozambique, 2011 To 2025: Retrospective And Prospective Modelling Of Child Mortality And Lives Saved, Erica Wetzler, Jorge A. H. Arroz, Chulwoo Park, Marta Chande, Figueiredo Mussambala

Faculty Publications

No abstract provided.

Availability And Affordability Of Medicines And Cardiovascular Outcomes In 21 High-Income, Middle-Income And Low-Income Countries, Clara Kayei Chow, Tu Ngoc Nguyen, Simone Marschner, Rafael Diaz, Omar Rahman, Alvaro Avezum, Scott A. Lear, Koon Teo, Karen E. Yeates, Khawar Kazmi

Section of Cardiology

Objectives: We aimed to examine the relationship between access to medicine for cardiovascular disease (CVD) and major adverse cardiovascular events (MACEs) among people at high risk of CVD in high-income countries (HICs), upper and lower middle-income countries (UMICs, LMICs) and low-income countries (LICs) participating in the Prospective Urban Rural Epidemiology (PURE) study.
Methods: We defined high CVD risk as the presence of any of the following: hypertension, coronary artery disease, stroke, smoker, diabetes or age >55 years. Availability and affordability of blood pressure lowering drugs, antiplatelets and statins were obtained from pharmacies. Participants were categorised: group 1-all three drug types …

Gender And Racial Disparity For Hospital Emergency Service Usage In Usa: A Quantitative Analysis For Various Age Groups During 2010–2017., Subhendra N. Sarkar, Anthony F. Devito, Evans Lespinasse, Faisal Khosa

Publications and Research

Background: Annually emergency department (ED) services are utilized by more than 100 million Americans making ED usage trends important determinants of healthcare quality, outcomes and cost. Previous workers have demonstrated the existence of disparity in various healthcare services in USA although a comprehensive analysis has not been undertaken. Dahlgren and Whitehead rainbow model has offered insights for multiple factors of influence on an individual’s health and focuses on the relationships among these factors. The Commission on Social Determinants of Health (CSDH; WHO initiatives) suggests that the social and environmental factors are at the root of most of the inequalities responsible …

Frontline Health: Harmonizing Metrics, Advancing Evidence, Accelerating Policy—Project Overview Brief, Frontline Health Project

Reproductive Health

Despite decades of technological and medical progress globally, half the world’s population still lacks access to essential health care due to insufficient numbers and types of health workers, especially in remote settings. There is growing recognition that well-supported community health workers (CHWs) are essential for effective delivery of primary health care (PHC). Despite broad consensus on the importance of CHWs, few countries have successfully integrated them as part of PHC at scale, and many lack official statistics on the performance of CHW programs. USAID, UNICEF, and the Bill & Melinda Gates Foundation developed a Memorandum of Understanding to collaborate on …

Covid-19 Contact Tracing Apps: How They Notify Users Of Potential Exposure, William A. Mattingly

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Considerations For A Covid-19 Research Data Warehouse In The Time Of Covid, William A. Mattingly

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Population Council-Led Partnership Influences National And Global Efforts To End Female Genital Mutilation/Cutting, Population Council

Research Utilization and Impact Briefs

The Evidence to End FGM/C program has filled critical data gaps, bolstered local capacity, and strengthened stakeholder relationships over the past five years. Through a collaborative, African-led approach, the program informed high-level national policy dialogue in several countries, including Kenya and Nigeria, and contributed to UNFPA’s new global estimates of girls at risk for FGM/C.

Project Soar Research Informs National Policy Change In Tanzania Expanding Access To Hiv Services For Marginalized Populations, Population Council

Research Utilization and Impact Briefs

A recent Project SOAR study evaluated community-based delivery of antiretroviral treatment to female sex workers (FSWs) in Tanzania, demonstrating the value of this approach to improve HIV care. Informed by these findings, the Government of Tanzania changed national guidance to allow for community-based HIV treatment to better meet the needs of marginalized populations, including FSWs.

Chronic Inflammation Was A Major Predictor And Determinant Factor Of Anemia In Lactating Women In Sidama Zone Southern Ethiopia: A Cross-Sectional Study, Tafere Gebreegziabher Belay, Taylor Roice, Barbara J. Stoecker

All Faculty Scholarship for the College of the Sciences

Anemia in women of reproductive age is highly prevalent globally and remains a public health problem. In Ethiopia, despite efforts to minimize the burden of anemia, it is still a moderate public health problem. Anemia has various etiologies including nutritional deficiency, parasitic infection, and inflammation. The aim of this study was to examine contributing factors to anemia in lactating women. Following ethical approval, and six months after delivery, all lactating women (n = 150) were recruited to participate in this study from eight randomly selected rural villages. Anthropometric and socio-economic factors were assessed. From each, a blood sample was collected …

The Role Of Rapid Diagnostic Point Of Care Igg/Igm Antibody Tests In The Diagnosis Of Sars-Cov-2 Infection, Nishita Tripathi, Daniya Sheikh, Dawn Balcom

The University of Louisville Journal of Respiratory Infections

Background: Current testing of symptomatic patients for SARS-CoV-2 involves the use of nucleic acid amplification tests, also known as genetic, RNA, or polymerase chain reaction (PCR), to detect viral RNA. The initial use of point of care (POC) antibody tests, also known as serological tests, in the management of SARS-CoV-2 infection was limited. In this review, we determine the significance of POC antibody serological tests and explore their possible role in the diagnosis and management of patients infected with the SARS-CoV-2 virus.

Methods: A literature search was conducted in Google Scholar, PubMed, and Embase, supplemented by searching the Centers for …

Changes In Preventive Care Utilisation And Its Influencing Factors Among Chinese Adults Before And After The Healthcare Reform: Cross-Sectional Evidence From The China Health And Nutrition Survey In 2004-2015, Tingting Wu, Wei Wei Liu, Mao Zou, Xun Lei, Qiang Yang, Manoj Sharma, Yong Zhao, Zu Min Shi

Environmental & Global Health Faculty Research

Objective China launched its health reform in 2009. This study aimed to assess changes in preventive care utilisation (PCU) and its relationship with the healthcare reform. Design A cross-sectional study using demographic characteristics, socioeconomic status, environmental factors, and lifestyle and health status data of adults from five waves (2004–2015) of the China Health and Nutrition Survey (CHNS) was conducted. Multilevel mixed-effects logistic regression models were used. Setting Data were derived from urban and rural communities of nine provinces in China. Participants Data were obtained from five waves of the CHNS, with 9960 participants in 2004, 9888 in 2006, 10 286 …

The Role Of Paraprofessionals In The Mental Health Structure Of India, Amy Abraham

Senior Theses

The mental health treatment gap in India is part of a growing public health crisis, with over 95% of those in need of services never receiving them. Over 197 million Indians suffer from at least one diagnosable mental health disorder, and this number continues to grow given the treatment gap. The treatment gap is a result of four major factors: lack of government support, stigma, limited treatment facilities, and the dearth of professionals able to provide treatment. The current study aimed to analyze several factors of paraprofessional led mental health interventions including setting, treatments delivered, treatment models, and client outcomes. …

Gastrointestinal Symptoms In Patients With Covid-19, Mohammed Abbas, Rafik Elbeblawy, Islam Gadelmoula, Suvarna Rekha, Bettina Sinanova, Jose Bordon

The University of Louisville Journal of Respiratory Infections

Introduction: Though coronavirus disease 2019 (COVID-19) is predominantly a respiratory illness, a growing number of studies reported gastrointestinal (GI) symptoms among these patients. We examined the incidence of GI symptoms in patients with COVID-19 and GI symptoms as the initial presentation of the disease.

Methods: We examined peer-reviewed studies in English of patients with COVID-19 that reported GI symptoms. We searched PubMed and Google Scholar for articles published up to June 30, 2020, by using the keywords ``COVID-19,'' ``Coronavirus,'' ``severe acute respiratory syndrome coronavirus 2,'', ``SARS-CoV-2,'' ``gastrointestinal tract,'' ``gastrointestinal diseases,'' and ``gastrointestinal symptoms and signs.'' Studies with fewer than 30 …

Midline Report: Accelerating Action To End Child Marriage In Bangladesh, Masuma Billah, Eashita Haque, Surojit Kundu, Md. Saddam Hossain, Momoe Makino, Sajeda Amin

Poverty, Gender, and Youth

This report describes results from the midline survey of Accelerating Action to End Child Marriage in Bangladesh. The objective of the program is to identify effective and scalable approaches to end child marriage by empowering girls and communities. To bring about social norms change, the program experiments with alternative means of community engagement that can be offered in conjunction with skills-development opportunities for adolescent girls. The program is being assessed in a multi-arm cluster randomized trial. This report explores the impact on the prevalence of child marriage in two districts of Bangladesh as well as on a range of other …

Availability Of Over-The-Counter Antibiotics In Guatemalan Corner Stores, Purificación Moreno, Alejandro Cerón, Karen Sosa, Marinees Morales, Laura M. Grajeda, Maria Renee Lopez, John P. Mccraken, Celia Cordón-Rosales, Guy H. Palmer, Douglas R. Call, Brooke M. Ramay

Anthropology: Faculty Scholarship

Widespread availability of antibiotics without prescription potentially facilitates overuse and contributes to selection pressure for antimicrobial resistant bacteria. Prior to this study, anecdotal observations in Guatemala identified corner stores as primary antibiotic dispensaries, where people purchase antibiotics without prescriptions. We carried out a cross sectional study to document the number and types of antibiotics available in corner stores, in four study areas in Guatemala. A total of 443 corner stores were surveyed, of which 295 (67%) sold antibiotics. The most commonly available antibiotics were amoxicillin, found in 246/295 (83%) stores, and tetracycline, found in 195/295 (66%) stores. Over the counter …