International Public Health Commons^™

Effect Of An Improved Biomass Stove On Acute Lower Respiratory Infections In Young Children In Rural Nepal: A Cluster-Randomised, Step-Wedge Trial, James M. Tielsch, Joanne Katz, Subarna K. Khatry, Laxman Shrestha, Patrick N. Breysse, Scott L. Zeger, +5 Additional Authors

Global Health Faculty Publications

Background

Acute lower respiratory infections (ALRI) are an important cause of death in young children in low income countries. High concentrations of fine particulate matter (PM2.5) indoors caused by open burning of biomass are associated with risk of ALRI. However, improved biomass stoves reduce emissions and might reduce the incidence of lower respiratory illness. A cluster-randomised, step-wedge, community-based trial was conducted to estimate the eff ect that a change from open burning of biomass to improved biomass stoves could have on rates of ALRI in children younger than 36 months in a rural area of southern Nepal.

Methods

Households were …

Comparing Global Alcohol And Tobacco Control Efforts: Network Formation And Evolution In International Health Governance, Uwe Gneiting, Hans Peter Schmitz

School of Leadership and Education Sciences: Faculty Scholarship

Smoking and drinking constitute two risk factors contributing to the rising burden of non-communicable diseases in low- and middle-income countries. Both issues have gained increased international attention, but tobacco control has made more sustained progress in terms of international and domestic policy commitments, resources dedicated to reducing harm, and reduction of tobacco use in many high-income countries. The research presented here offers insights into why risk factors with comparable levels of harm experience different trajectories of global attention. The analysis focuses particular attention on the role of dedicated global health networks composed of individuals and organizations producing research and engaging …

A Framework On The Emergence And Effectiveness Of Global Health Networks, Jeremy Shiffman, Kathryn Quissell, Hans Peter Schmitz, David L. Pelletier, Stephanie L. Smith, David Berlan, Uwe Gneiting, David Van Slyke, Ines Mergel, Mariela Rodriguez, Gill Walt

School of Leadership and Education Sciences: Faculty Scholarship

Since 1990 mortality and morbidity decline has been more extensive for some conditions prevalent in low- and middle-income countries than for others. One reason may be differences in the effectiveness of global health networks, which have proliferated in recent years. Some may be more capable than others in attracting attention to a condition, in generating funding, in developing interventions and in convincing national governments to adopt policies. This article introduces a supplement on the emergence and effectiveness of global health networks. The supplement examines networks concerned with six global health problems: tuberculosis (TB), pneumonia, tobacco use, alcohol harm, maternal mortality …

The Global Health Network On Alcohol Control: Successes And Limits Of Evidence-Based Advocacy, Hans Peter Schmitz

School of Leadership and Education Sciences: Faculty Scholarship

Global efforts to address alcohol harm have significantly increased since the mid-1990s. By 2010, the World Health Organization (WHO) had adopted the non-binding Global Strategy to Reduce the Harmful Use of Alcohol. This study investigates the role of a global health network, anchored by the Global Alcohol Policy Alliance (GAPA), which has used scientific evidence on harm and effective interventions to advocate for greater global public health efforts to reduce alcohol harm. The study uses process-tracing methodology and expert interviews to evaluate the accomplishments and limitations of this network. The study documents how network members have not only contributed to …

The Emergence And Effectiveness Of Global Health Networks: Findings And Future Research, Jeremy Shiffman, Hans Peter Schmitz, David Berlan, Stephanie L. Smith, Kathryn Quissell, Uwe Gneiting, David Pelletier

School of Leadership and Education Sciences: Faculty Scholarship

Global health issues vary in the amount of attention and resources they receive. One reason is that the networks of individuals and organizations that address these issues differ in their effectiveness. This article presents key findings from a research project on the emergence and effectiveness of global health networks addressing tobacco use, alcohol harm, maternal mortality, neonatal mortality, tuberculosis and pneumonia. Although networks are only one of many factors influencing priority, they do matter, particularly for shaping the way the problem and solutions are understood, and convincing governments, international organizations and other global actors to address the issue. Their national-level …

Validity Of Home-Based Sonographic Diagnosis Of Obstetric Risk Factors By Auxiliary Nurse Midwives In Rural Nepal, Naoko Kozuki, Luke C. Mullany, Subarna K. Khatry, Ram Ghimire, Sharma Paudel, James M. Tielsch, +5 Additional Authors

Global Health Faculty Publications

Background

Approximately 2·3 million fetal, neonatal, or maternal deaths occur annually during the intrapartum period or on the day of birth. Several risk factors for intrapartum-related complications require ultrasonography for accurate diagnosis, but sonographic services are scarce in low-resource settings. In this study, we aimed to assess the feasibility of community-based ultrasonography conducted by auxiliary nurse midwives to identify basic obstetric risk factors, in rural Sarlahi District, Nepal. We aimed to assess the validity at which these health workers can detect noncephalic position, multiple gestation, and placenta previa and to explore whether sonographic diagnosis could improve outcomes for women with …

Needle Exchange Programs And Hiv/Aids: A Comparison Of The Use Of Harm Reduction Methods In Switzerland And The United States Of America, Margaret House

Independent Study Project (ISP) Collection

This paper explores the connections between needle exchange programs and rates of HIV/AIDS in Switzerland and the United States of America. While these two countries are very similar in their general political philosophies, they have some key cultural and historical differences which has shaped their responses to HIV/AIDS and injection drug use. Switzerland’s unique experience with a very open injection drug use scene in the 1980s guided this country to a more pragmatic, harm reduction-based response. By contrast, United States responded to the AIDS epidemic that struck violently in the 1980s with a mix of fear and denial. Though both …

Healthcare Access For Syrian Refugees Lacking Legal Documentation In Jordan, Caroline Flynn

Independent Study Project (ISP) Collection

The purpose of this study is to analyze the access and utilization of health care services by Syrian refugees lacking documentation. This study focuses on the current procedures utilized by healthcare providers for addressing lack of legal documentation in their Syrian refugee patients, as well as broader policies and strategies for addressing the status and protection of these undocumented individuals. This study grapples with the relationship between legal documentation and access to services. The increased costs and barriers to healthcare that come with stateless and refugee status may influence health outcomes and socioeconomic opportunities that impact these individuals for the …

(Video) Income-Related Inequalities In Utilization Of Health Services Among Private Health Insurance Beneficiaries In Brazil, Heitor Werneck

GW Research Days 2016 - 2020

Brazil’s 1988 health reform created the Unified Health System (SUS). SUS is a universal health system that emulates British National Health Service, featuring an open-ended benefit package and a major goal of health equity. An unforeseen consequence of the reform was that former beneficiaries of the social health insurance sought to sustain their privileged access to health services through private health insurance. Despite achievements in expanding healthcare access and improved health outcomes, recurring opinion polls suggest that Brazilians are skeptical about SUS’ capacity to delivery timely and quality health services, making private insurance a priority to most households. The literature …

Predictors Of Malnutrition In Different Geographic Regions Of Peru, Elizabeth Lacroix

GW Research Days 2016 - 2020

Malnutrition is responsible for over 3 million childhood deaths each year. Those who survive early nutritional deficiencies and the subsequent growth failure face life-long consequences, including long-term deficits in cognitive development, decreased academic achievement, and reduced economic opportunities later in life. Low height for age, or stunting, indicates chronic malnutrition, while low weight for height (wasting) indicates acute malnutrition. Caloric deficiencies, micronutrient deficiencies, intestinal parasites, and diarrheal diseases all directly contribute to acute and chronic undernutrition.

Peru is an ethnically and geographically diverse country that has experienced great economic growth and dramatic health improvements in the last decade. Nationally, stunting …

Unintended Pregnancies In Brazil - A Challenge For The Recommendation To Delay Pregnancy Due To Zika, Cynthia Schuck-Paim, Daniel Lopez, Lone Simonsen, Wladimir Alonso

Global Health Faculty Publications

Because of the potential link between the ongoing Zika virus outbreak and a surge in the number of cases of congenital microcephaly, officials in Latin America have recommended that women postpone pregnancy until this association is firmly established or the outbreak subsides. However, in all these countries a large proportion of babies are still born out of unplanned pregnancies. Teenage girls are particularly at high risk, as they often lack access to preventive contraception methods, or the knowledge to use them appropriately. To gauge the magnitude of the barriers preventing the implementation of such a recommendation in Brazil, the country …

Infant Vaccination Timing: Beyond Traditional Coverage Metrics For Maximizing Impact Of Vaccine Programs, An Example From Southern Nepal., Michelle M Hughes, Joanne Katz, Janet A Englund, Subarna K Khatry, Laxman Shrestha, Steven C Leclerq, Mark Steinhoff, James M. Tielsch

Global Health Faculty Publications

Background

Immunization programs currently measure coverage by assessing the proportion of children 12–24 months who have been immunized but this does not address the important question of when the scheduled vaccines were administered. Data capturing the timing of vaccination in first 6 months, when severe disease is most likely to occur, are limited.

Objective

To estimate the time to Bacillus Calmette–Guérin (BCG) (recommended at birth), diphtheria-tetanus-pertussis-H, influenza b-hepatitis B (DTP-Hib-HepB), and oral polio vaccine (OPV) (recommended at 6, 10, and 14 weeks) vaccinations and risk factors for vaccination delay in infants <6 months of age in a district in southern Nepal where traditional coverage metrics are high.

Design/methods

Infants enrolled in a randomized controlled trial of …

Knowledge, Attitude And Practices: Assessing Maternal And Child Health Care Handbook Intervention In Vietnam, Hirotsugu Aiga, Vinh Duc Nguyen, Cuong Dinh Nguyen, Tho Thi Thi Nguyen, Lien Thi Phuong Nguyen

Global Health Faculty Publications

Background

Maternal and Child Health (MCH) Handbook, an integrated MCH home-based record, was piloted in four provinces of Vietnam (Dien Bien, Hoa Binh, Thanh Hoa and An Giang). The study is aimed at assessing the changes in pregnant women’s behavior towards the frequencies of their antenatal care service utilizations and their subsequent breastfeeding practices up to six months of age, through the MCH Handbook intervention. This is because the levels of pregnant women’s knowledge, attitude and practices (KAP) towards their antenatal care service utilizations and exclusive breastfeeding practices have been previously neither analyzed nor reported in relation to MCH home-based …

The Impact Of Climate Variability And Conflict On Childhood Diarrhea And Malnutrition In West Africa, Gillian Dunn

Dissertations, Theses, and Capstone Projects

Objectives: This dissertation aims to contribute to our understanding of how climate variability and armed conflict impacts diarrheal disease and malnutrition among young children in West Africa. Two studies examine the associations between climate and diarrheal disease across the whole study area – ten countries in West Africa during the period 2008-2013. The third study examines diarrheal disease and malnutrition in Northeast Nigeria before (2008) and after (2013) the start of the current armed conflict in the area.

Methods: Outcome variables and child, caregiver, and household characteristics for these studies are from the Demographic and Health Surveys. Additional datasets include …

Access To Essential Medicines In African Countries: An Introduction, Peter G. Danchin, Diane Hoffmann

Faculty Scholarship

No abstract provided.

Schools Of Public Health In Low And Middle-Income Countries: An Imperative Investment For Improving The Health Of Populations?, Fauziah Rabbani, Leah Shipton, Franklin White, Iman Nuwayhid, Leslie London, Rajiv Rimal, +11 Additional Authors

Prevention and Community Health Faculty Publications

BACKGROUND: Public health has multicultural origins. By the close of the nineteenth century, Schools of Public Health (SPHs) began to emerge in western countries in response to major contemporary public health challenges. The Flexner Report (1910) emphasized the centrality of preventive medicine, sanitation, and public health measures in health professional education. The Alma Ata Declaration on Primary Health Care (PHC) in 1978 was a critical milestone, especially for low and middle-income countries (LMICs), conceptualizing a close working relationship between PHC and public health measures. The Commission on Social Determinants of Health (2005-2008) strengthened the case for SPHs in LMICs as …

Fragmented Implementation Of Maternal And Child Health Home-Based Records In Vietnam: Need For Integration, Hirotsugu Aiga, Vinh Duc Nguyen, Cuong Dinh Nguyen, Tho Thi Thi Nguyen, Lien Thi Phuong Nguyen

Global Health Faculty Publications

Background: Home-based records (HBRs) are globally implemented as the effective tools that encourage pregnant women and mothers to timely and adequately utilise maternal and child health (MCH) services. While availability and utilisation of nationally representative HBRs have been assessed in several earlier studies, the reality of a number of HBRs subnationally implemented in a less coordinated manner has been neither reported nor analysed.

Objectives: This study is aimed at estimating the prevalence of HBRs for MCH and the level of fragmentation of and overlapping between different HBRs for MCH in Vietnam. The study further attempts to identify health …

Sub-Saharan Africa’S “Other Diseases”: A Comparison Of The Global Response To Neglected Tropical Diseases And Hiv/Aids In Ghana, Rebecca Brosch

Political Science: Student Scholarship & Creative Works

Neglected tropical diseases (NTDs) refer to a group of diseases that affect 1.4 billion people worldwide, most commonly in low and low-middle income nations. These conditions can cause disabling and disfiguring effects that keep those inflicted from escaping poverty, leading to increased economic losses in already impoverished areas in Ghana and the rest of Sub-Saharan Africa. Although NTDs affect significantly more of the Ghanaian population, more government resources are given to HIV/AIDS (which only affects an estimated 1.5% of citizens). This research identifies the current response to NTDs (including government policy and NGO support) as well as how more global …

Detectable Viral Load In Late Pregnancy Among Women In The Rwanda Option B+ Pmtct Program: Enrollment Results From The Kabeho Study., Michelle M Gill, Heather J Hoffman, Emily A Bobrow, Placidie Mugwaneza, Dieudonne Ndatimana, Gilles F Ndayisaba, Cyprien Baribwira, Laura Guay, Anita Asiimwe

Epidemiology Faculty Publications

There are limited viral load (VL) data available from programs implementing "Option B+," lifelong antiretroviral treatment (ART) to all HIV-positive pregnant and postpartum women, in resource-limited settings. Extent of viral suppression from a prevention of mother-to-child transmission of HIV program in Rwanda was assessed among women enrolled in the Kigali Antiretroviral and Breastfeeding Assessment for the Elimination of HIV (Kabeho) Study. ARV drug resistance testing was conducted on women with VL>2000 copies/ml. In April 2013-January 2014, 608 pregnant or early postpartum HIV-positive women were enrolled in 14 facilities. Factors associated with detectable enrollment VL (>20 copies/ml) were examined …

Project Soar's Approach To Research Utilization, Project Soar

HIV and AIDS

Project SOAR (Supporting Operational AIDS Research) conducts operations research (OR) with the aim of producing a large, multi-faceted body of high-quality evidence that can guide the planning and implementation of programs and policies for HIV prevention, care, and treatment. OR provides the needed evidence to make sound policy and program decisions at national, subnational, and service-delivery levels by identifying practical solutions to challenges delivering program services. Translating OR findings into action at these levels requires two-way information exchange between people who can apply research findings and researchers. Project SOAR’s premise is that this exchange will bring about eventual use of …