International Public Health Commons^™

A Survey Of Patients With Congenital Orthopedic Conditions In Malawi: Factors That Influence Late Presentation, Brianna Wallis

Undergraduate Honors Thesis Projects

Staff at CURE International, a non-profit organization that provides orthopedic care in Malawi, noticed a high prevalence of patients with congenital orthopedic conditions who are presenting late for treatment. Late presentation results in prolonged pain or discomfort for the patient and has the potential for increased cost to the institution, longer duration of treatment, and decreased quality of outcomes. To identify the factors that influenced presentation delays, we surveyed the caregivers of patients with congenital conditions that were seen in out-patient clinics, in-patient wards, and mobile clinics across the country. Sixty-two caregivers were surveyed; forty-two patients had a diagnosis of …

Congenital Zika Syndrome - Background And Nutrition Care Of Affected Infants, Ann Gaba, Ghada Soliman

Publications and Research

This review provides a history and overview of Zika infection, with special attention to resultant birth defects and the nutrition care required by Zika affected infants.

A Diagnostic Assessment Of The Health System’S Response To Female Genital Mutilation/Cutting Management And Prevention In Kenya, Samuel Kimani, Chantalle Okondo

Reproductive Health

Female genital mutilation/cutting (FGM/C) is a cultural practice associated with health consequences and rights violations. In Kenya, health sector–led FGM/C-related interventions are anchored in the legal and policy instruments and guidelines adapted from global/regional frameworks, as well as interventional tools approved by the World Health Organization. Despite the existence of the instruments, guidelines, and tools that should direct a robust health system response to FGM/C, the practice persists and quality of care of services for women and girls with FGM/C-related complications has not been ascertained. Evidence on whether the health sector implements relevant FGM/C-related legal and policy frameworks to address …

Vaccine Confidence, Coverage, And Hesitancy Worldwide: A Literature Analysis Of Vaccine Hesitancy And Potential Causes Worldwide, Jordan Hammond

Senior Theses

Vaccines are one of the world’s most impactful medical therapies. They are cost-effective, successfully proven, and one of the quickest treatment options available today (Clark et al., 2016). They save millions of lives every year and have eliminated certain diseases on a national and international level. However, millions of people worldwide still remain unvaccinated. In developed nations, mainly The United States (U.S.) and the European countries, many of the unvaccinated are a result of rising vaccine hesitancy of parents in conjunction with the anti-vaccination movement. Vaccine hesitancy is defined as “a delay in acceptance or refusal of vaccines despite availability” …

El Covid-19 Y El Derecho A La Información De Los Pueblos Indígenas En La Región De Arica Y Parinacota / Covid-19 And The Right To Information Of Indigenous Peoples In The Region Of Arica And Parinacota, Finn Odum

Independent Study Project (ISP) Collection

The present work tries to understand if the health communication programs in Chile are sufficient and, specifically, if the Chilean state guarantees the right to information of indigenous peoples in the context of COVID-19 in the Arica and Parinacota region. For this, semi-structured interviews were carried out and analyzed using the Atlas.ti software. The results showed that the indigenous peoples of Arica and Parinacota need intercultural programs that recognize their rights and cultures, and more access to information.

El presente trabajo pretende comprender si los programas de comunicación de salud en Chile son suficientes y, en específico, si el estado …

El Rol Del Gobierno En Las Campañas Sanitarias De Vih, Covid-19 E Influenza, Sydney Reyes

Independent Study Project (ISP) Collection

Research Question: What are the differences and similarities between the three health campaigns — the flu, HIV, and COVID-19 — that the Chilean government has spread to population?

Objectives: The primary objective of this study was to describe and compare the three public health campaigns — the flu, HIV, and COVID-19 — to examine the role that the Chilean government has in health education and heath promotion. The secondary objectives were to identify the differences in national health campaigns and regional campaigns as well as to show the interactions between health campaigns and indigenous people. Overall, the research project looked …

Defining The Burden Of Covid-19 In The Kentuckiana Area: Incidence, Epidemiology & Clinical Outcomes Of Patients With Covid-19, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

Rationale: Early evaluation of the burden of disease that COVID-19 may produce in a community is critical to appropriately allocate resources for COVID-19 prevention and treatment.

Objective: The primary objective of this study is to define the incidence, epidemiology, and clinical outcomes of patients with COVID-19 in the Louisville, Kentucky, and southern Indiana region (Kentuckiana) of the USA.

Methods: This will be a retrospective observational study of patients in the Kentuckiana region with the diagnosis of COVID-19.

On The Inadequacy Of Species Distribution Models For Modelling The Spread Of Sars-Cov-2: Response To Araújo And Naimi, Joseph D. Chipperfield, Blas M. Benito, Robert B. O'Hara, Richard J. Telford, Colin J. Carlson

United States Public Health Resources

The ongoing pandemic of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is causing significant damage to public health and economic livelihoods, and is putting significant strains on healthcare services globally. This unfolding emergency has prompted the preparation and dissemination of the article “Spread of SARS-CoV-2 Coronavirus likely to be constrained by climate” by Araújo and Naimi (2020). The authors present the results of an ensemble forecast made from a suite of species distribution models (SDMs), where they attempt to predict the suitability of the climate for the spread of SARS-CoV-2 over the coming months. They argue that climate is …

Anti-Corruption, Transparency And Accountability In Health: Concepts, Frameworks, And Approaches, Taryn Vian

Nursing and Health Professions Faculty Research and Publications

Background: As called for by the Sustainable Development Goals, governments, development partners and civil society are working on anti-corruption, transparency and accountability approaches to control corruption and advance Universal Health Coverage.

Objectives: The objective of this review is to summarize concepts, frameworks, and approaches used to identify corruption risks and consequences of corruption on health systems and outcomes. We also inventory interventions to fight corruption and increase transparency and accountability.

Methods: We performed a critical review based on a systematic search of literature in PubMed and Web of Science and reviewed background papers and presentations from two …

Promoting Anti-Corruption, Transparency And Accountability To Achieve Universal Health Coverage, Theadora Koller, David Clarke, Taryn Vian

Nursing and Health Professions Faculty Research and Publications

Anti-corruption, transparency and accountability measures are often missing from efforts to promote universal health coverage. Yet, if unchecked, corruption represents a significant drain on domestic health resource and a major barrier to achieving universal health coverage and the sustainable development goals. The World Health Organization is promoting a coordinated public health approach to anti-corruption, transparency and accountability, working with global partners to create new internal control and assurance models, increase monitoring and evaluation; develop capacity for multiple stakeholders to address corruption; and strengthen normative guidance to integrate anti-corruption, transparency and accountability into WHO’s work on health systems strengthening. The articles …

Two Implementation Models Of Workers' Health Education Programs In Egypt: What Works? What Doesn't Work?, Nahla G. Abdel-Tawab, Norhan Bader, Elizabeth Tobey, Aparna Jain

Reproductive Health

This brief presents findings from two models of workers’ health education programs implemented by the Evidence Project/Population Council in Egypt. The two interventions aimed to increase family planning (FP) service demand among young people aged 18–35 in Port Said and urban Souhag. In Port Said, male and female factory workers who were trained as peer educators shared family planning/reproductive health (FP/RH) information with fellow factory workers, distributed communication materials, and provided referrals to infirmary nurses trained in FP counseling. In Souhag, male and female peer educators were trained to provide integrated FP/RH and livelihood workshops to job seekers. Results of …

Abriendo Futuros: A Program For Rural Indigenous Girls In Yucatan, Mexico, Fabiola Romero, Ludivine Cicolella, Silvana Larrea, A. Fallone, Isabel Vieitez Martínez

Poverty, Gender, and Youth

The Abriendo Futuros (AF) program builds on the Council’s global experience of designing and implementing successful girl-centered programs in Africa, Asia, the Middle East, and Latin America and the Caribbean. AF aims to improve the living conditions of Mayan girls (10–18 years) and contribute to the achievement of gender equity in the Yucatan. The program’s community-focused strategy seeks to empower girls through interpersonal communication and participatory workshops. Girls in selected communities are divided into age groups (10–14 and 15–18) that meet weekly with a mentor in safe spaces. The program’s mentors are young women aged 20–30 from the communities, who …

Evaluating Implementation Effectiveness And Sustainability Of A Maternity Waiting Homes Intervention To Improve Access To Safe Delivery In Rural Zambia: A Mixed-Methods Protocol, Elizabeth G. Henry, Thandiwe Ngoma, Jeanette L. Kaiser, Rachel M. Fong, Taryn Vian, Davidson H. Hamer, Peter C. Rockers, Godfrey Biemba, Nancy A. Scott

Nursing and Health Professions Faculty Research and Publications

Background: In low-income countries such as Zambia, where maternal mortality rates are persistently high, maternity waiting homes (MWHs) represent one potential strategy to improve access to safe delivery, especially for women living in remote areas. The Maternity Homes Access in Zambia project (MAHMAZ) is evaluating the impact of a MWH model on women’s access to safe delivery in rural Zambia. There is a growing need to understand not only the effectiveness of interventions but also the effectiveness of their implementation in order to appropriately interpret outcomes. There is little evidence to guide effective implementation of MWH for both immediate uptake …

A Review Of The Literature On Corruption In Healthcare Organizations, Vincenzo Sforza, Riccardo Cimini, Alessandro Mechelli, Taryn Vian

Nursing and Health Professions Faculty Research and Publications

This paper provides a systematic and bibliometric review of 80 research articles on corruption in healthcare published in peer-reviewed journals between 2006 and 2017. Findings suggest that the number of studies has increased over time with a focus on low- and middle-income countries; academic researchers have published papers in a large variety of journals and have investigated different types of corruption with various methodologies. The interest is especially focused on low- and middle-income countries where corrupt behaviors are more common. The paper suggests future research directions to a dynamic research community to facilitate anticorruption actions by public authorities.

The Community Health System In Bangladesh: An Overview, Frontline Health Project

Reproductive Health

This brief provides an overview of the community health system in Bangladesh. Bangladesh is divided into eight administrative divisions, 64 districts, and 545 subdistricts, known as upazilas. Each rural area within an upazila is divided into union parishads and mouzas, which are further divided into villages. The Ministry of Health and Family Welfare has an extensive health infrastructure that is pluralistic and follows the country’s administrative pattern. Union parishads are the smallest administrative unit in rural areas. At the lowest administrative level, traditional healers, nonqualified allopathic practitioners, and community health workers (CHWs) are typically the only providers available. This brief …

Implementation Process Brief: Integrated Family Planning And Hiv Services At The Community Level In Kenya, Wilson Liambila, Sara Chace Dwyer, Charlotte E. Warren, Aparna Jain, Melsa Lutomia, Jane Loech, Elizabeth Washika

Reproductive Health

Enabling women living with HIV to use contraception effectively can decrease unintended pregnancies and in turn reduce maternal mortality and vertical transmission of HIV. This brief describes the implementation process and intervention tested under the Evidence Project for delivering integrated FP and HIV services at the community level in Kenya. It outlines the implementation steps, best practices, and lessons learned of an intervention that was tested within the existing community health structure. Community health volunteers were trained to offer FP as part of their routine services to women living with HIV, and community health units were prepared to sustain those …

The Community Health System In Haiti: An Overview, Frontline Health Project

Reproductive Health

This brief provides an overview of the community health system in Haiti. In Haiti, the health system is overseen at the national level by the Ministry of Public Health and Population (Ministère de la Santé Publique et de la Population-MSPP) which provides policies and standards for service delivery at all levels, including the community level. Health service delivery is managed and coordinated across three levels: national (level III), health department (level II), and district and community levels (level I). The national level is guided by the MSPP and provides policy guidance for community-level service delivery. The Health Department level is …

Louisville Coronavirus Surveillance Program, Julio A. Ramirez, Kenneth E. Palmer, Ruth Carrico, Forest W. Arnold, Donghoon Chung, Leslie A Wolf

The University of Louisville Journal of Respiratory Infections

An important feature of COVID-19, the disease produced by the new coronavirus SARS-CoV-2, is the high number of health care workers (HCWs) that acquire the disease. In an initial report of 138 patients hospitalized with COVID-19 pneumonia in China, 40 patients (29%) were HCWs. One reason why HCWs are at higher risk of acquiring COVID-19 is that some patients with COVID-19 are admitted to the hospital without the classical presentation and are therefore not tested for the disease early during hospitalization. Presently in the US, it is recommended to test for COVID-19 when physicians suspect the disease. This subjective approach …

Contraceptive Use Dynamics In India: A Prospective Cohort Study Of Modern Reversible Contraceptive Users, Arupendra Mozumdar, Elizabeth Tobey, Kumudha Aruldas, Rajib Acharya, Aparna Jain

Reproductive Health

This report highlights the contraceptive use dynamics among 2,699 married women in India who began using one of four reversible contraceptive methods over one year. Women aged 15-49 were enrolled into the study from Odisha and Haryana states within one month of starting their reversible method—interval intrauterine device (IUD), postpartum IUD (PPIUD), injectable contraceptive, or oral contraceptive pill (OCP)—and were interviewed at four time points: at enrollment into the study, and three, six, and 12 months after enrollment. Study findings include the quality of care received at the time of method adoption, experience and management of side effects, reasons for …

Risk Factors For Poor Birth Outcomes In Moderately Malnourished Pregnant Women In Sierra Leone, Candice A. Rodriguez

Master's Theses

Background: Maternal malnutrition in developing countries is associated with adverse pregnancy and birth outcomes. Malnourished mothers are often faced with additional risk factors as a circumstance of poverty. Supplementary nutrition can improve the outcomes of both mother and infant. Identifying maternal nutritional and socioeconomic risk factors is critical for developing effective interventions.

Objective: A secondary analysis to evaluate maternal risk factors associated with poor birth outcomes including pregnancy loss, low birth weight, stunting, and preterm delivery among moderately malnourished pregnant women in Sierra Leone. Maternal risk factors in the analysis are age, education, parity, BMI, MUAC, gestational weight gain, and …

Understanding Barriers To Clinical Management Of Rape (Cmr) Services Among Survivors Of Rape In Crisis Settings In Borno State, Osasuyi Dirisu

Reproductive Health

Sexual and gender-based violence (SGBV) is a global public health concern disproportionately affecting women, with negative consequences for their health, well-being, human rights, and equality. SGBV includes any act perpetrated against an individual that is against that person’s will and is predicated upon gender norms and unequal power relationships. SGBV occurs in crisis settings where vulnerability is increased, and social and legal sanctions are reduced. Internally Displaced Persons are vulnerable to SGBV during times of conflict as well as in post-conflict settings due to resultant losses of socioeconomic opportunities in addition to housing, security, lack of institutional protection, and familial …

Exploring Changes In Female Genital Mutilation/Cutting: Shifting Norms And Practices Among Communities In Fafan And West Arsi Zones, Ethiopia, Getaneh Mehari, Asabneh Molla, Ayantu Mamo, Dennis Matanda

Reproductive Health

Globally, more than 200 million women and girls have undergone FGM/C. More than half of these girls and women live in three high-prevalence countries: Egypt, Ethiopia, and Indonesia. Given the increase in population growth, recent estimates show that the number of girls and women subject to FGM/C will continue to rise in the coming years unless sufficient efforts are undertaken to encourage abandonment of the practice. A descriptive analysis of changes in FGM/C prevalence over time in Ethiopia shows that the percentage of women aged 15–49 years who report undergoing FGM/C has been declining. Despite the decline, the FGM/C prevalence …

Evidence To Support Hiv Prevention For Adolescent Girls And Young Women (Agyw) And Their Male Partners: Results From Malawi Dreams Studies With Agyw, Male Partners Of Agyw, Men Living With Hiv, And Program Implementing Partners, Nanlesta Pilgrim, Victor Mwapasa, Effie Chipeta, Wanangwa Chimwaza Manda, Nrupa Jani, Tracy Mcclair, Lyson Tenthani, Sanyukta Mathur

HIV and AIDS

Project SOAR, led by the Population Council, in partnership with the Center of Reproductive Health at the University of Malawi College of Medicine, conducted a research portfolio to generate evidence to reduce HIV risk among adolescent girls and young women (AGYW) and their male partners. The objectives of this implementation research were to generate evidence for describing HIV-related risk factors among AGYW; assess the extent to which the overall DREAMS project contributed toward the goal of reducing HIV risk among AGYW; and understand the characteristics of male partners and how to link them to HIV services, as well as retain …

Community-Based Hiv Treatment Service Delivery Model For Female Sex Workers In Tanzania: Evaluation Findings, Lung Vu, Waimar Tun, Louis Apicella, Jeremiah Kidola, Caterina Casalini, Gasper Mbita, Neema Makyao, Todd Koppenhaver, Erick Mlanga

HIV and AIDS

Project SOAR in collaboration with the National AIDS Control Program of the Government of Tanzania, National Institute of Medical Research, and Jhpiego’s Sauti Program, conducted an implementation science study to investigate the delivery of community-based antiretroviral treatment (ART) services to female sex workers (FSWs) in Tanzania. Studies from sub-Saharan Africa have shown improved HIV treatment outcomes, such as uptake of HIV services, retention in care, and increased dignity and quality of life, by using community-based delivery of HIV services. As detailed in this Project SOAR final report, the study assessed the effectiveness of the community-based ART delivery intervention in improving …

Strengthening Capacity For Assessment Of Hiv-Related Data Needs Among Key Populations To Inform Evidence-Based Responses, Amrita Rao, Nikita Viswasam, Stefan Baral

HIV and AIDS

Defining the HIV prevention and treatment needs of key populations who have disproportionate HIV acquisition and transmission risks has been particularly difficult in the context of generalized HIV epidemics where less attention has historically been placed on the HIV prevention and treatment needs of these groups. There is a gap in our understanding of the specific needs of—and ultimately the investment case for the added value of supporting—disproportionately burdened key populations in these settings. In response to this gap, Johns Hopkins University under the United States Agency for International Development (USAID)-funded Project SOAR implemented a project in partnership with collaborators, …

Considerations For Collecting And Documenting Fgm/C Data By Health Care Providers, Dennis Matanda

Reproductive Health

Data on female genital mutilation/cutting (FGM/C) are rarely collected in health facilities, yet routine collection of facility-based data through other health-seeking visits (e.g., during antenatal care) is considered good medical practice and can be an important source of data. Clinical exams provide an opportunity to identify women and girls who have undergone FGM/C, which is an important step in aiding the prevention of chronic complications that can be difficult to manage later in life. These exams also make it possible to refer those with FGM/C-related complications for specialized treatment. Clinical visits also present an opportunity to discuss prevention of the …

Female Genital Mutilation/Cutting In Senegal: Is The Practice Declining? Descriptive Analysis Of Demographic And Health Surveys, 2005–2017, Dennis Matanda, Glory Atilola, Zhuzhi Moore, Paul Komba, Lubanzadio Mavatikua, Chibuzor Christopher Nnanatu, Ngianga-Bakwin Kandala

Reproductive Health

To achieve the Sustainable Development Goals, female genital mutilation/cutting (FGM/C) is one of the most prominent issues world leaders and governments must address. In Senegal, estimates from the 2017 Senegal Demographic and Health Survey show that almost a quarter of women aged 15–49 have undergone FGM/C, while 14 percent of girls aged 0–14 years have been cut. Given the many interventions that have been implemented in Senegal with the intention of scaling down FGM/C rates, the key question is: To what extent has the practice declined? The aim of this study, as presented in this working paper, was to generate …

Understanding Female Genital Mutilation/Cutting Abandonment In Egypt, Nada Wahba, Hania El Banhawi, Amira El Ayouti

Reproductive Health

Although the prevalence of female genital mutilation/cutting (FGM/C) in Egypt among married women aged 15–49 years is high (92 percent), in the most recent (2014) Demographic and Health Survey, prevalence rates appear to be declining among younger cohorts of girls and women. Support for the discontinuation of the practice is more widespread in younger generations, among females, and among those living in urban areas. Variations in attitudes toward FGM/C by education level and wealth status are also documented. While numerous studies have examined the reasons why people practice FGM/C, few studies have examined the characteristics of the individuals who have …

Assessing The Role Of Law In Reducing The Practise Of Fgm/C In Kenya, Agnes K. Meroka-Mutua, Daniel Mwanga, Charles Owuor Olungah

Reproductive Health

Criminalization is an important aspect of anti-FGM/C policies and programs. In countries where FGM/C is practiced, the enactment of a law prohibiting the practice is an important indicator of progress toward abandonment. Criminalization is often seen as playing an important role in the declining prevalence of FGM/C. However, there is not much research on the link between the enactment of laws that prohibit and criminalize FGM/C and declining prevalence of the practice. The objectives of this study, therefore, were to assess the extent to which people obey the law on FGM/C; to investigate the reasons and causes that motivate people …

Examining Access To Sexual And Reproductive Health Care Services And Information For Young Women With Physical Motor Disabilities In Dakar, Senegal, Olivia Soule, Diatou Sonko

Undergraduate Research Symposium

Access to and use of sexual and reproductive health (SRH) services in Senegal remains low despite local and international interventions and campaigns to increase contraception use, increase knowledge regarding Sexually Transmitted Infections (STI), and increase access to reproductive health services. Among marginalized groups, such as people living with disabilities, access to and use of services and information are even lower, and there are gaps in research involving Senegalese people with disabilities and their access to and use of SRH services and information. This mixed-methods, community-based participatory research examines how Senegalese women navigate their sexual and reproductive health care. It seeks …