Browsing by Author "Ariely, Sumedha Gupta"

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Open Access
Analyzing the Connections Among Water Access, Sanitation, Malaria and Diarrhea Outcomes in Rural Central Uganda
(2016-04-22) Hu, Michael
Access to safe water and sanitation around the world has increased significantly in the past few decades. The United Nations claims that 91% of the world’s population has access to safe water, exceeding the Millennium Development Goal for water access. Yet, some evidence in the literature suggests that safe water and sanitation access is overestimated, as the common indicator used to estimate safe water is infrastructural. The usage of water, behaviors surrounding water acquisition and storage, and possible contamination along the source to point-of-use continuum is poorly understood. This cross-sectional epidemiological study used a combination of surveying, mapping and bacteriological water testing to identify some of the possible factors in water contamination, and relationships with malaria and diarrhea burden, in a parish in Central Uganda. Secondary goals included assessing the burden of malaria and diarrhea in the parish, and assessing the use of mapping and water testing as field research tools. The survey included questions on water acquisition and usage behavior, sanitary conditions, knowledge of diarrhea, and malaria and diarrhea burden. In this parish, 126 households across 9 villages were randomly chosen to be surveyed, mapped and water tested. All water sources in the parish were additionally mapped and water tested. Across all water sources, including piped water, the water quality at the household point-of-use level was drastically worse than quality measured at the source. In fact, among all water sources, piped water recipients showed the highest average bacterial loads, despite the clean quality of the source itself. Possible factors in lowering or raising contamination, as displayed by regression results, include the frequency of obtaining water and distance from the water source respectively. The malaria and diarrhea case sample size proved smaller than expected, and challenges remain in using mapping and water testing in the field. These results support the theories that the amount of people with access to safe water is overestimated, and that contamination exists along the source to point-of-use continuum. More research is needed to investigate the exact points of contamination in the spectrum and possible contaminating factors.
Open Access
Assessing Cardiovascular Disease Burden in Rural Uganda and Informing Future Interventions
(2018-01-07) Benson, Kathryn
This senior thesis seeks to investigate cardiovascular disease (CVD) risk in a rural region in Uganda and to use insights from field experience and the literature to explore possible interventions. The thesis research involved a total of 232 participants, including village residents (142), market workers (50), religious leaders (20), and village health workers (VHTs) (20). The village sample data are part of a larger longitudinal study, conducted under the Community Health Collaboration project of the Student Research Training Program (SRT) at Duke University. Recruitment for the other three cohorts of market workers, religious leaders, and VHTs began with this current study, conducted in the summer of 2016. The current study continued the biometric assessments of CVD risk within the village cohort and extended the testing to market workers. A total of 192 individuals participated in these three biometric assessments of their body mass index (BMI), systolic and diastolic blood pressure, and fasting blood glucose. In addition, the research team conducted surveys using an interview format with all four cohorts. The survey assessed demographic information, lifestyle factors, CVD perceptions, and CVD knowledge, and religious influences on CVD. Overall, the biometric findings show substantial CVD risk in the village sample and the persistence of risk for individuals over time, as evidenced by the results from longitudinal, linear mixed-effect models. Beyond this high, persistent CVD risk for villagers, the market workers had even higher CVD risk as evidenced by elevated BMI and fasting blood glucose. The elevated CVD risk for market workers is possibly due to differences in lifestyle factors including diet and exercise that are associated with urbanization. The survey results show near unanimous agreement among participants that CVD is a problem in their community. Despite the overall concern, the findings expose inaccuracies in knowledge about CVD across all cohorts. Regarding the role of religion, more than 90% of participants across all cohorts believe that religion can alleviate CVD symptoms. Further questioning about religion and CVD reflected a broad array of direct and indirect interpretations of the role of religion. Exploratory regression analyses, which link survey data to CVD risk indicators, yielded results that have implications for tailoring CVD interventions to rural Uganda. To further connect the findings to intervention strategies, the discussion summarizes the method and results of a literature review on possible CVD interventions. The literature review advances three principal categories of intervention: education, policy, and programming. For each of these categories, the study findings together with the literature review provide the basis for recommending three integrative strategy for CVD intervention: VHT CVD education programs, policy reform to address CVD medication stock-outs, and religiously-based CVD programs. The strategies have promise for reducing CVD risk and improving the lives of individuals in rural Uganda.
Open Access
Beyond Polio in Pakistan: Understanding the Development and Consequences of Eradication Strategies
(2024-04-18) Sheikh, Shanzeh
This thesis seeks to understand how the strategies of polio eradication and the development of the healthcare environment in Pakistan have led to the continued presence of polio in the country, despite its elimination in nearly every other country besides neighboring Afghanistan. Often the literature, focused on the execution of programs, overlooks the program design that in many ways occurs outside of Pakistan. I use a critical historical analysis to identify root causes of international and national stakeholders’ eradication strategies and rationale, paying close attention to how Pakistan’s history has shaped its perspectives and possibilities. I review archival sources from the Pakistani government, physicians, and international organizations, as well as research papers and reports on polio eradication and health infrastructure. I also conducted nine interviews with Pakistani physicians, researchers, and public health workers. Colonial medical interests have shaped international health regulations and Pakistan’s health system such that they are largely focused on combatting single diseases rather than investing in basic healthcare. The Pakistani state has created gaps in healthcare delivery that military conflict in the region has exacerbated, and that physicians struggle to fill within the politicized health environment. The failure to address community demands for other health services leads to mistrust and vaccine refusals, but international health organizations continue to focus efforts on disease-targeted strategies due to concerns about cost-effectiveness and sunk investments. Efforts to eradicate a disease like polio would be better served by a focus on basic health services. International organizations must re-evaluate what programs they prioritize to control diseases, center investment in public and primary health care as opposed to selective and targeted interventions, and empower the voices of those in marginalized communities to develop programs that respond to their needs, rather than the needs of high-income countries.
Open Access
Bringing Care to Patients: Evaluation and Implications of an Outreach Mobile Clinic Model in Rural North Carolina
(2024-04-08) Haddad, Nicholas
The goal of the DGHI and Hope Clinic partnership has evolved over time but has centered around understanding the services Hope Clinic offers to its patients, especially those with chronic conditions, and their access to care. Hope Clinic is a free and charitable clinic in Bayboro, NC that serves about 300 patients. Following previous studies that have highlighted the clinic’s current building constraints and patients’ transportation difficulties, an outreach care pilot was developed. This model rests on two pillars: “outreach locations” (six community sites where patients could go for clinic appointments) and community health workers. Using patient geospatial and clinical data, Duke students identified six community sites that would theoretically reduce the travel burden patients with chronic conditions currently face in making it to Bayboro. Second, a partnership with a now defunded community health worker program aimed to provide personalized check-ins for patients outside of clinic hours (e.g., calling to ensure that patients are taking their medications). The community health worker program lost its funding before this pilot began in its entirety; while specific data and implications from this portion of the program won’t be considered, the incorporation of community health workers will be considered in recommendations and when addressing current gaps in care that emerge from this analysis. Over the course of 2023, Hope Clinic has been holding quarterly clinics at five outreach locations. A joint pilot evaluation plan was developed at the forefront of this project. This study aims to evaluate this pilot from January 2023 through December 2023 by: analyzing qualitative and quantitative patient satisfaction data (survey and interview data from 2023), demographic and diagnosis data taken from the clinic’s health records (from 2023), clinic encounter and appointment adherence data (from 2022 and 2023), and interview data from other free and charitable clinics (collected November and December 2023); future implications of a program like this for similar clinics and recommendations for Hope Clinic’s existing program will be offered. Collected data includes patient encounter statistics (e.g., completed appointments, cancellations, and no-shows), pertinent demographic data (e.g., gender, age, race/ethnicity) pulled from Hope Clinic’s electronic health records system, conversations with patients and providers (e.g., satisfaction, travel time to locations, qualitative suggestions). This data paints a vivid picture of who is coming to outreach locations, their health status (e.g., vital signs, hypertension and/or diabetes diagnosis, frequency of appointments, prescription status), and how the program is impacting adherence to appointment times and patient maintenance of health conditions. Interviews with other free and charitable clinics are used to better understand their strategies addressing barriers to health care access for their most vulnerable clients with an eye towards identifying possible solutions for Hope Clinic. Overall, findings from Hope Clinic’s first year of piloting their outreach care model are overwhelmingly positive. With higher completion rates, fewer cancellations and no-shows, and shorter travel times to outreach sites than to the normal Bayboro location, staff have reduced barriers to access that patients have previously expressed in interviews. Talking to other free and charitable clinic leadership across the state has highlighted similar transportation and resource constraints that make it difficult for patients to receive care and has showcased strategies used to address those challenges. While implementation of this model has led to reductions in the number of completed patient appointments (down roughly 6% from 2022), the benefits of this model seem to outweigh this challenge, and recruiting another provider (given space exists at community sites) may increase capacity.
Open Access
Carceral Care: Examining the Quality of Health Care for Pregnant Women in Jails in North Carolina
(2021-12-06) Jain, Rhea
Most women who are incarcerated are of childbearing age and some individuals experience pregnancy while incarcerated. However, research on pregnancy in correctional facilities is limited to within prisons, even though healthcare provision in jails is more variable and inconsistent. This study aims to address the gap in the literature about the quality of health care for pregnant women in jails, rather than prisons, in North Carolina. This purpose of this study is to understand the provision of pregnancy-related health care in jail facilities, and to what extent jails meet the recommended standards of care established by public health agencies. To collect data, surveys were administered among administrators and health care providers from 45 jail facilities across North Carolina and 6 semi-structured interviews were conducted. The results indicate a high level of variability in the provision of pregnancy care across detention facilities in North Carolina. Moreover, jails could improve quality of care in the following categories: pregnancy testing, counseling and contraception, postpartum care, HIV screenings, and substance use treatment. Findings suggest that NC jails do not follow the standards of care set by public health agencies in all areas of pregnancy care except prenatal care. Therefore, policymakers should seek to standardize jail health policies according to the benchmark standards of care offered by the American Public Health Association, American College of Obstetricians and Gynecologists, and National Commission on Correctional Health Care, to improve reproductive health care for pregnant, justice-involved individuals.
Open Access
Dietary Patterns, Nutritional Status, Prevalence and Risk Factors for Anemia among School Children in Naama Community, Uganda
(2015) Zhao, Yi
Background: The disease burden of malnutrition, anemia, malaria and helminth infections among school-aged children is rarely studied in low- and middle-income countries (LMICs) although these children are still at a high risk for these diseases compared with other more studied populations, such as pregnant women and children under 5 years old. Even in countries where the prevalence and trend of anemia and malnutrition are relatively well documented, few studies relate this to dietary factors, which are considered major contributors to anemia and malnutrition in most age groups. Aims: The aims of the study are (1) To determine the prevalence of anemia, malaria, helminth infections and malnutrition in a sample of 95 children, ages 6 to 14, attending primary schools in Naama Community, Uganda, and to observe and quantify school children's dietary patterns and daily nutrient intakes. (2) To find out the association between dietary factors and the risk of anemia and malnutrition. Methods: Measures included school-based, cross-sectional surveys, dietary assessments, anthropometric measurements and biological tests among school children. Photo-assisted 24-hour recall was used to collect daily nutrient intakes, combined with a Food Frequency Questionnaire (FFQ) to capture the dietary patterns. Anthropometrical and biochemical data was collected using standardized protocols. Socioeconomic data was obtained from parent surveys. Results: Ninety-five children in total were enrolled in all or some components of the study. The prevalence of anemia was low (3.2%), and all were mildly anemic. However, the prevalence of malaria and hookworm infections was relatively high, representing 12.9% and 24.4% of the studied population, respectively. In the studied children, 2.8% were underweight, 15.6% stunted and 1.3% thin, using criteria based on the WHO Growth reference. According to the WHO recommendations for nutrient intake, 80% of participants consumed inadequate energy from their daily diet, especially boys. Dietary fat intake was insufficient in 78% of the children. About 25% of the children had a low protein intake and 93% had low intakes of vitamin A. Calcium intake was low in school children's diet- 97.6% of children lacked of calcium. Inadequate vitamin C intake was less common, appearing in one out of three participants (29.1%). Matooke and posho, the most common local staple food, were the major sources for children's energy. Avocado, beans and matooke contributed to the highest fat, protein and vitamin A intake, respectively. Every participant reported consuming cereal/cereal products, roots/tubers/plantain, pulses/nuts, oil/oil-rich foods and fruits during the previous month, while almost one-fifth never consumed milk/dairy products. Vegetables were consumed by most of the respondents. Few (1.6%) of the respondents reported no animal source food in their diet. In general, children ate 3.81(SD: 0.99) out of all five meals in the area. Dinner was consumed by most of the participants (93.7%) while afternoon tea was the least consumed meal and was skipped by half of the childrenNo significant association between dietary factors and anemia were found, mainly due to the small sample size and low prevalence of disease. None of the dietary factors of primary interest were found to be associated with children's Hb concentration, but secondary analysis found the frequency of eating oranges was a protective factor for higher Hb concentration (P=0.015). The association between diet and stunting was not significant, except children who had low dietary fat intakes had a lower risk of being stunted compared with those had adequate fat consumption (OR=0.27, P=0.046). Conclusions: Malaria and helminth infections, but not anemia, in this cohort of school children is relatively high. Stunting was the most prevalent type of malnutrition. Most of the nutrients studied were not adequate in children's diets. The dietary pattern in this sample of children was primarily high in carbohydrates from staple foods and a minimal intake of fat and protein from animal sources. Children generally ate four meals per day. Dietary factors do not explain anemia and stunting in this population.
Open Access
Exploring Machista Gender Roles and Psychosocial Well-being: An Exploratory Analysis in Camasca, Honduras
(2019-04-20) Malo, Vincenzo
There is a severe lack of mental health research in rural regions of Latin America like Camasca, Honduras, where typically there exists a societal construct of hypermasculinity and patriarchal authority termed machismo. Much of the current literature on psychosocial factors of mental health in settings with machismo report gender disparities with women experiencing worse outcomes. This study sought to characterize indicators of machismo through division of labor and perceived parental roles, and to then use these data to explore their interactions with psychosocial aspects of mental health. This study recruited 53 participants (41 female) from Camasca, Honduras to participate in orally-administered interviews. Three scales for resilience, general stress, and parental stress were administered in addition to open-ended questions to gauge satisfaction with and comfort discussing parental responsibilities across gender. Overall, the majority of participants reported there are gender differences in parental responsibilities with most explanations mentioning men working as a family’s economic provider and women taking on childcare responsibilities. There were trends towards men experiencing worse levels of general stress and parental stress, although there were no gender differences in resilience. These measurements did not vary by differences in perceived parental responsibilities. Most women reported being more comfortable discussing parental responsibilities with other women, while men typically reported no preference. In light of these results, machista societal organization creates a unique context in which to study psychosocial well-being and provides a useful lens for understanding health disparities in similar gender-rigid contexts. These results suggest that perhaps there is an internalization of traditional gender norms, such that men and women report stressors according to what is deemed stressful in their society, and that furthermore gender-disparate workforces may contribute to gender-specific experiences. Gender-specific differences may also emerge from the importance of agricultural industry, suggesting a possible factor perpetuating machista norms.
Open Access
Exploring the Link Between Mental Health of Caregivers and the Orphaned and Abandoned Children They Care for: An Investigation in Delhi, India
(2020-04) Vashisth, Shagun
Alternative care models for orphaned and abandoned children (OACs) have recently become a priority, especially in nations like India, with high populations of OACs. Despite the shift from institutional care towards a family-based model of alternative care in which caregivers are a central part of the residential care ecosystem, there is still a great lack of research exploring the mental health of OAC caregivers and the impact that caregiver mental health has on OAC wellbeing. This study involved interviewing 123 children and 34 caregivers within a residential care program that comprised 14 individual homes. Participants were administered psychometric questionnaires to gauge anxiety, depression, trauma, and caregiver attachment. The results identified the high trauma and negative psychological sequelae facing this program’s caregivers. Additionally, caregiver mental health outcomes were not found to be associated with child mental health outcomes. While this work did not statistically link caregiver mental health with child mental health, it is inevitable that a shared living environment intimately exposes each group to the other. To this end, more research is needed to understand the nuances of how traumatic life histories affect a caregiver’s mental health, parenting ability, and the mental health of the children they care for.
Open Access
Is Alternative Rite of Passage the Key to Abandonment of Female Genital Cutting? A case study of the Samburu of Kenya
(2016-04-25) Mepukori, Nash
While Female Genital Cutting (FGC) has been condemned worldwide and seen as a violation of women’s right, individuals in communities that still practice the rite claim that it is an integral and respectable component of their culture. Up to date, there have been numerous NGO- and government-led grassroots programs geared towards eradication of FGC. Yet, there remains a wide gap in the literature evaluating the impact of such anti-FGC interventions (WHO, 2011). This dearth of information poses a significant threat to the project of FGC abandonment as policy-makers are unable to assess which interventions have worked and why, and which ones are failing, and why. This study, which focuses on Female Genital Cutting among the Samburu of Kenya, seeks to begin bridging this knowledge gap by evaluating the Alternative Rite of Passage (ARP) intervention program. For close to a decade now, Amref Health Africa, an international NGO based in thirty African countries, has been implementing the Alternative Rite of Passage in the Samburu community. A key objective of this study is to conceptualize the ways in which stories and understandings of Female Genital Cutting in Samburu have changed (if at all), in light of Amref’s Alternative Rite of Passage program. Using qualitative data collected through Focus Group Discussions and Key Informant in-depth interviews, this study attempts to piece together a complex puzzle that brings together history, politics, economics, customs, and beliefs. Analysis of data will reveal present community attitudes towards female circumcision and the ARP program. Furthermore, the complex role of the NGO in the battle against FGC will be addressed leading to a discussion around the suitability and sustainability of alternative rites of passage in this community.

Browsing by Author "Ariely, Sumedha Gupta"

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