Browsing by Author "Clements, Dennis Alfred III"
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Item Open Access An Assessment of Urbanization as it Relates to Caries Prevalence and its Determinants in Children in Copan, Honduras(2012) Damgaard, Michael BoydObjective: To determine if a significant association exists between urbanization and dental caries prevalence, and whether or not similar relationships occur between community type and principal determinants of youth oral health in children ages 2 to 12 in the region of Copan, Honduras.
Methods: The investigator conducted a cross-sectional two-part interview with each participant. First, a survey was administered to the parent to collect information surrounding dental caries determinants. Second, the investigator performed a brief examination of child dentition to determine the number of existing caries. Data was collected from two separate patient populations: an urban sample of children within Copan Ruinas, and an indigenous sample from 15 surrounding rural villages.
Results: Samples consisted of 203 individuals from the urban population and 221 from the rural. While there was no visible association between caries prevalence and urbanization, teeth brushing, parent education, and sugar intake demonstrated highly significant correlations (P<0.01). Mean DMFT Score for the combined samples was 5.15.
Conclusion: There is a clear need for dental interventions both in urban and rural communities in Copan, Honduras. Sugar consumption is likely contributing to increased caries prevalence in the urban community. Other factors such as water fluoridation could be influencing DMFT scores in Copan's more rural villages.
Item Open Access Assessing the Effectiveness of a Health Education Campaign for Improving the Awareness and Preventative Health Behaviors of Buruli Ulcer Disease Affecting Cocoa Farmers in the Ashanti Region of Ghana(2014) Sholar, Paige WhitneyINTRODUCTION
Buruli ulcer disease (BU) is a necrotizing disease primarily affecting the skin, subcutaneous tissue, and bone. The disease, caused by Mycobacterium ulcerans, is the third most prevalent mycobacterial disease after tuberculosis and leprosy [1]. Although BU has been reported in regions throughout the world including Latin America, Western Pacific, Central Africa, and Asia, it disproportionately affects western Africa [2]. Among the western Africa countries, Ghana has reported the highest number of active cases [3]. Although the mode of transmission of Buruli ulcer disease is unknown, its prevalence is highly associated with stagnant water [4]. Therefore, rural areas where farming is a primary lifestyle are typically endemic areas.
In August 2012, Family Health International 360 (FHI360) and The Hershey's Company implemented The Buruli Ulcer Awareness, Prevention, and Treatment Project in the Ashanti Region of Ghana. The goal of this health education campaign was to improve farmers' knowledge, and attitudes of BU prevention and treatment methods
METHODS
In order to assess this campaign, interview-assisted surveys and focus group discussions were conducted within three districts where the campaign was implemented and two control districts. A structured questionnaire was used to collect data at the household level. A total of 340 participants was surveyed within five districts. Semi-structured focus group discussions were conducted in two intervention districts and two control districts to assess the health education campaign.
ANALYSIS
All questionnaire responses were entered into Qualtrics and exported in STATA 12.1. An adjusted logistic regression with districts clustered by intervention condition (intervention versus control) for each outcome variable of interest was performed. If there was no difference between the intervention and control districts, then a second adjusted logistic regression was performed where districts was used as an independent variable instead of the intervention variable.
All transcripts from the focus group discussion were entered and coded in NVivo. One member of the research team coded each discussion into the pre-determined themes: knowledge of pathology of BU, and knowledge of treatment and preventative behaviors. These themes were compared between each district to identify differences between the districts that were exposed to the health education campaign and the districts that were not exposed.
RESULTS
The quantitative data showed that there was no difference between the intervention and control districts in the participants' knowledge of the causes, signs and symptoms, available treatments, and preventative behavior of Buruli ulcer disease. The intervention districts showed significantly less negative attitudes toward Buruli ulcer victims when compared to those participants within the control districts. Generally, knowledge of pathology, treatment, and preventative behaviors were high in all districts regardless of the presence of the intervention.
Overall, the focus group discussion participants primarily demonstrated a clear understanding of correct BU knowledge of pathology, available treatments, and preventative behavior in all districts. In all FGDs, water and filth were mentioned as causes of BU prevalence. The FGDs expanded on participants' awareness of available treatments to include cost of treatment and travel to care as barriers to accessing said treatments.
CONCLUSION
The health education campaign had no impact on the general knowledge of Buruli ulcer disease. Due to the endemicity of all the districts, it is not surprising that all the participants properly identified the causes, signs and symptoms, available treatment, and preventative behaviors of BU. The participants in the intervention districts reported significantly less negative attitudes toward BU victims comparatively to the participants in the control districts. The districts where the health education campaign was implemented expressed less negative attitudes toward Buruli ulcer victims when compared to the control districts. Our data supports that follow-up health education campaigns should focus on creating neutral or positive attitudes toward BU victims.
Item Open Access Bringing Care to Patients: Evaluation and Implications of an Outreach Mobile Clinic Model in Rural North Carolina(2024-04-08) Haddad, NicholasThe 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.Item Open Access China's Health Aid to Africa(2017-04-29) Tesha, FlorenceSino-Africa relations involve China’s foreign aid to African countries. There are many questions surrounding China’s foreign aid, such as its scope, its impact, and whether it is altruistic or opportunistic. This thesis provides an analysis of China’s health aid to Sub-Saharan Africa, drawing in part on research I conducted in Dar es Salaam, Tanzania, on China’s health services. This paper begins with an analysis of the history of the relationship between China and Africa, while taking into account colonialism. This history is important in understanding the complexity of China’s engagement in African countries. This paper then focuses on two components of China’s health aid: Traditional Chinese Medicine (TCM) and the relationship between Chinese doctors and the African communities they work in. Results suggest that TCM offers an affordable alternative form of medicine to most Africans in low-income countries. However, there is still uncertainty about whether the provision of free TCM by the Chinese government is altruistic or a strategy to promote Chinese products in the African market. Additionally, the research shows that there is a lack of interaction between Chinese doctors and the African local communities. The thesis concludes that, regardless of China’s motivations, foreign aid alone does not result in the development of a country. There is a need for African governments and societies to take an active role in the allocation of health aid to their people so that it best serves communities. Thus, instead of indulging in the debate on whether health aid is altruistic or not, African countries should focus on finding ways to use aid to advance their own best interests.Item Open Access Increasing Glaucoma Detection in Roatán, Honduras: The Value of Education and Intraocular Pressure Screenings(2023-04-11) Pluenneke, MollyGlaucoma is an ocular neuropathy that damages the optic nerve, leading to vision loss and blindness. Insidious in its presentation and difficult to diagnose, glaucoma is asymptomatic until irreversible harm is caused. Accounting for 12.6% of preventable blindness in Honduras, glaucoma inflicts considerable clinical, economic, and personal burdens on thousands of lives (Rosa et al., 2022). Early detection and treatment halves the risk of disease progression by lowering the intraocular pressure so that permanent harm to the optic nerve is avoided (Leskea et al., 2004). However, in Roatán, where access to ophthalmic care is lacking and awareness of the disease is scarce, many cases of glaucoma go undiagnosed or are poorly managed, leading to higher rates of irreversible and avoidable blindness (Varma et al., 2011; Delgado et al., 2019). This paper seeks to understand if a two-pronged community-based strategy, which combined an educational campaign with an intraocular pressure screening, was an effective means to increase ophthalmic care seeking behavior in Roatán, Honduras. To do this, community members were given information about glaucoma and their pressure was taken with an iCare tonometer. Those with elevated pressures were recorded and contacted about follow-up. These data were then compared to the number and identity of patients who sought out ophthalmic care during a one-week medical brigade on the island to determine if the community-based approach was effective in increasing screening and detection of glaucoma. With a 7.56% follow-up rate, the analysis determined that the implemented strategy was ineffective. This study reveals a lack of timely follow-up in Roatán, demonstrating limitations in the utilized method of screening and referral. Additional interventions should be examined to determine more successful methods to increase detection of glaucoma in Roatán.Item Open Access Influence of social support on childhood vaccine uptake in a migrant community in Roatan, Honduras(2019-04-01) Watkins, KathrynAccording to the World Health Organization, greater social support from family, friends, and community members is correlated with better health outcomes. In the migrant community of La Colonia on the island of Roatán, Honduras, most residents are lower-income, young families who emigrate from the mainland seeking better job and educational opportunities. In the process of migration, families typically lose social support networks and structures they previously had access to. In a study in 2016, our team found that in comparison to the rest of Roatan, children living in La Colonia had lower vaccination coverage. In the current study, we sought to examine the role of social support on childhood vaccine uptake in La Colonia. In summer 2018, we completed fifty surveys of mothers with young children living in La Colonia. The survey included standardized social support questions to evaluate linkages between self-reported social connectedness and vaccine uptake. In addition, two focus groups with mothers of young children living in La Colonia were conducted to understand the ways that mothers leverage social support networks and CHW interactions to access and provide healthcare. Vaccination uptake among young children in La Colonia was above 97% for all but one vaccine; however, we found that some mothers reported difficulty accessing vaccines related to a lack of social support. We did not find any statistically significant relationship between vaccine uptake and social support from our survey social support scale, likely due to high vaccine uptake and small sample size of children with accessible vaccine cards at the time of the survey (n=35). We also found that mothers view churches as an acceptable social apparatus for dissemination of health knowledge and community-based childhood interventions. These results suggest that building social support in migrant communities is important for uptake of preventive behaviors, particularly vaccines, although more research is needed to determine if a statistically significant relationship exists between social support and vaccine uptake. Churches could be leveraged as venues to offer interventions aimed at increasing vaccine uptake and community knowledge about benefits of vaccinations.Item Open Access La Promoción de la Salud en Intibucá, Honduras: Empoderamiento, Conexión Comunitaria, Confianza en Atención Hondureña(2022-04-11) Linder, BrianEsta tesis tiene una colección de conocimientos que adquirí por la curiosidad que tenía acerca de las brigadas médicas y su impacto en la confianza en servicios de salud, la influencia neocolonial estadounidense en el país de Honduras, y el papel de los promotores de salud en Intibucá. El propósito de la tesis es determinar la importancia de confianza en sistemas y servicios de salud, explorar las historias relevantes de neocolonialismo y sus expresiones en instituciones actuales, y proponer una solución posible a través del rol indispensable de los promotores de la salud comunitarios. Esta tesis tiene el deseo de imaginar la posibilidad de una comunidad sana y autosostenible.Item Open Access Migration and Family Planning: A Qualitative Analysis in Jordan(2018) Price, Malena MPolitical upheaval in Syria makes Jordan a temporary home to over one million Syrian refugees. More than half of these individuals, due to limited resources and challenging financial circumstances, do not have adequate access to reproductive health and family planning mechanisms. Among pregnant refugee women in Jordan, approximately one in five are at risk for poor obstetrical outcomes, including premature and underweight births. Due to increased rates of birth in humanitarian and lower resource settings, and the crucial need for addressing sexual and reproductive health in these settings, this study conducted a comparative analysis of the sexual and reproductive health climate among Syrian refugee and Jordanian men and women.
Using a case study research design, semi-structured qualitative interviews were conducted with 34 study participants, including 15 Syrian women, 8 Jordanian women, 6 Syrian men, and 5 Jordanian men. These interviews examined participants’ migration experiences, pregnancy outcomes, influencers for reproductive decisions, and gaps in sexual and reproductive health care.
Qualitative interviews revealed that Syrian refugees indicated greater reproductive and sexual health need than Jordanians, more specifically related to education on reproductive health and contraceptive methods. Syrian refugees were married at earlier ages than Jordanians, and, overall, had more children. Additionally, Syrian refugees confirmed that healthcare in Syria was more accessible, affordable, and comprehensive in comparison to Jordan. The greatest contributors to gaps in care for both Jordanians and Syrians were financial constraints and apathy regarding refugee welfare among providers in public facilities.
Increasing access to comprehensive sexual and reproductive healthcare among refugees in low-resourced, humanitarian settings, while also continuing to meet the needs of the nation’s own population, is a healthcare priority. The findings of this study have the potential to guide and influence policy affecting family planning mechanisms afforded to migrants in Jordan in both public and private facilities. Action is required immediately by policymakers and government officials to create budgetary resources for sexual and reproductive health education programs in Jordan in order to meet the family planning needs of refugee and migrant populations residing there.
Item Open Access Reminders, Refugees, and Ramadan: Characterizing Missed Immunization Appointments among Palestinian Refugees in Jordan(2015) Schermerhorn, Jordan TaylorThere are currently over two million Palestinian refugees residing in Jordan, 370,000 of whom reside in refugee camps. Due to conflict-affiliated disease outbreaks among children in the region, the UN Relief and Works Agency for Palestine Refugees (UNRWA) has identified incomplete vaccination as a critical public health issue and has invested in the development and implementation of a text message reminder service for preventing loss-to-follow-up. Childhood immunization rates in UNRWA catchment regions are generally high, yet little is known about risk factors for missed appointments, which impose a substantial administrative burden due to the need to contact patients for rescheduling. Stronger user characterization is necessary for improved targeting and minimized cost as we develop a more robust SMS system capable of scaling across all health facilities.
This mixed-methods study prospectively recorded 6 months of immunization history among a cohort of children born in June 2014 at Taybeh Health Center in Amman. Demographic information was collected at the time of birth, and caregivers of cohort members were invited to participate in interviews that assessed immunization knowledge, preferences, decision-making, and experience with the SMS reminder system. Patients were more likely to significantly delay appointments during the Ramadan holiday and for doses further from the child date of birth. Future policies that might bridge these gaps include targeting pre-appointment SMS reminders to high-risk patients, implementing holiday shifts in clinic hours, and regularly updating patient contact information.
Item Open Access Social and Behavioral Determinants of Child Undernutrition in Camasca, Honduras(2020-04-17) Iskandarani, MayaChild undernutrition remains a significant health challenge around the world despite its high-priority status on the global health agenda. While the global burden of child undernutrition has reached historically low levels, it remains a pressing issue in rural communities of Central America. Through a partnership with a grassroots intervention targeting child undernutrition, this study sought to explore predictors of child nutrition knowledge and child growth outcomes in the community of Camasca in Honduras.Item Open Access Sugar Consumption and Prevalence of Dental Decay Among Children 12-Years of Age and Younger in Rural Honduras(2011) Wheeler, KendraObjectives: To determine the prevalence of dental caries among children 6-months to 12-years-old in rural Honduras, and to explore the hypothesis that sugar consumption is positively correlated with dental decay among children 6-months to 12-years old in rural Honduras.
Methods: An interviewer implemented a cross-sectional survey of dental health determinants using convenience sampling. The same interviewer then examined the dentition of survey participants for dental decay according to the dental caries criteria recommended by the World Health Organization (WHO).
Results: The study included a sample of 532 children from 8 rural communities. Seventy percent of children surveyed had decay of their primary dentition. The average dmft score in this population was 3.52 (SD=3.57). A logistic regression model yielded that children who eat more than 2.5 pieces of candy per day have at least twice the odds of dental decay compared to children who eat less candy.
Conclusion: These results establish that caries burden in primary dentition in these communities is higher than the WHO goal, and support the hypothesis that increased sugar consumption correlates positively to increased burden of decay.
Item Open Access The Timeliness of Childhood Vaccinations in Tanzania: A Literature Review and Analysis of Demographic Health Surveys Data(2017) Ghosh, SuvomitaBackground: Routine immunization is the most effective way to prevent mortality from vaccine preventable diseases. Though vaccination coverage rates have improved over the past decade, vaccinations still fail to be delivered and received within a proper timeframe. Across low and middle income countries the median vaccination delay falls between 2.3 to 6.2 weeks for birth through third dose vaccinations [1]. Countries in the African region have 5 to 6 percent lower coverage and face lower timeliness than LMICs overall, and in Tanzania, vaccination delays reach up to 70 percent [1, 2]. This study seeks to investigate the determinants of timely vaccination delivery using two approaches. First, a review is conducted to assess the causes of delayed vaccination in Sub-Saharan Africa (SSA) and, second, an analysis of the Tanzania Demographic and Health Surveys (DHS) data provides evidence of the timeliness factors of concern. Methods: Peer-reviewed literature on vaccination coverage and timeliness in SSA was searched on several databases and was subsequently selected if it pertained to the determinants of vaccination coverage or vaccination timeliness for humans. Pharmacological interventions and vaccine efficacy research was excluded. The literature is rigorously reviewed by classification of determinants into four framework clusters (family characteristics, immunization systems, parental knowledge/ attitudes, and communication and information). The 2015 Tanzania DHS data is used to measure timely immunization. Determinants of fully timely immunization are analyzed through logistic regression. Results: The results of the literature review provided 36 papers on vaccination timeliness and 15 papers on vaccination timeliness. Family characteristics are found to be the major determinants of both vaccination coverage and timeliness appearing 29 and 6 times, respectively. The immunizations system was also found to impact vaccination coverage and vaccination timeliness with 24 and 3 appearances. Our DHS analysis supports these findings, showing statistically significant links between complete timeliness and family characteristics (maternal age, wealth quintile, maternal education, and region) and the immunization system (antenatal care visits and tetanus toxoid vaccine). Conclusions: This investigation finds several family characteristics and the immunization system as determinants of delayed vaccination delivery. Escalating the number of vaccination facilities or health facilities in underserved regions could alleviate disparities found amongst families, as these characteristics are often clustered regionally. Further, action must be taken to improve the immunization system by ensuring availability of vaccines everywhere, good vaccine management, and adequate staff. Understanding the causes of poor vaccination timeliness is crucial in efforts to improve problems and provide timely vaccination to prevent child mortality.