Browsing by Subject "Public health"

Background: Church-based health promotion programs have been shown to be effective in improving health outcomes, but rarely do they approach wellness from a holistic standpoint. This is a missed opportunity for fuller integration within congregations. This study sought to assess and evaluate the feasibility of a holistic multi-site church-based health promotion program, through engagement, acceptability, and preliminary behavior change outcomes. Methods: This study utilized a concurrent mixed-methods approach in order to evaluate the “Congregational Wellness Challenge” (CWC), a pilot initiative that encouraged behavior change in three areas of holistic wellness: body, spirit, and soul, over six weeks. Participants were asked to complete one activity from each of the three categories every day for forty days, and congregations were encouraged to support those participating in the challenge. This study utilized a pre-post one-group design. Participants were surveyed at baseline and at six weeks about their health behaviors and opinions of the programs, as well as recording their behaviors on activity logs. Seventeen semi-structured in-depth interviews were conducted eight weeks post-challenge. Results: The 39 participants in the study completed 64.2% of the activities during the challenge. There was a significant increase in several of the body health variables. The number of people reporting 30 minutes of physical activity about once a week, two or three times a week or every day, compared to (no times a week?) nearly doubled, from 43.5% to 82.6% (p=0.012). Vegetable and fruit intake also significantly increased, from 52.2% of people reporting eating at least 5 servings of vegetables and fruits daily to 100% of respondents (p=0.001). Frequency of reading for pleasure significantly increased, as did Scripture meditation, bible study, and singing to the Lord. Qualitative results indicated an overall acceptability of the program. Participants had a variety of motivations for joining, and gave valuable feedback on the importance of recording their activities. Conclusion: The CWC pilot initiative was feasible in a wide variety of churches, and future research should focus on the effectiveness of holistic wellness programs and improving implementation practices.

Background: An estimated 2.6 million children under 15 years are living with HIV. Children often begin antiretroviral therapy (ART) without learning why they are sick or the purpose of their medication. The objective of this study was to estimate the prevalence of pediatric HIV disclosure in two districts in rural Zimbabwe, characterize the process of disclosure, and begin investigating the predictors and consequences of disclosure.

Methods: This was a cross-sectional survey of 372 primary caregivers of HIV-positive children between the ages of 9 and 15 years living in Bikita and Zaka districts and receiving ART or pre-ART from a network of 21 eligible clinics. Surveys were administered individually in Shona by trained Zimbabwean enumerators. Disclosure was referred to if a child knows he or she has a health condition called HIV. Full disclosure was defined as a caregiver's report that the child knows he or she has an illness called HIV, how he or she acquired the illness, and can pass the infection to someone else. The prevalence of disclosure was estimated for the overall sample, by district, and by clinic. Characteristics of the process of disclosure as well as predictors and consequences of disclosure were identified for the overall sample.

Results: The overall prevalence of disclosure in the sample is 66.9 percent (95% CI 62.0 to 71.5%). Disclosure rates are similar across districts: 64.1 percent in Bikita (56.5 to 71.7%) and 69.0 percent in Zaka (62.8 to 75.2%). Across the 21 study clinics, disclosure rates ranged from 47.8 to 85.7 percent. Among the children who know that they are HIV-positive, 69.9 percent know how they were infected (63.9 to 75.2%) and 48.6 percent know that they could pass the infection to someone else (42.5 to 54.8%). The average child learned about his or her illness at age 10.0 (SD=1.9). In the majority of cases, the caregiver informed the child directly (58.6%) and 28.5 percent of children learned of their status from a health worker. Most caregivers who have disclosed to their child reported that their overall disclosure experience was positive (81.5%), with 76.7 percent having improved their adherence to medication following disclosure. Predictors of disclosure were identified as follows: caregivers’ high level of self-efficacy to disclose (p<0.05); HIV-positive caregivers’ high level of HIV-related shame (p<0.001); HIV-positive caregivers’ high level of awareness of their own HIV symptoms and implications of HIV on their health and future (p<0.05); caregivers’ assessment that their child has cognitive skills and is emotionally mature (p<0.10); higher levels of child’s formal education (p<0.05); and caregivers who are not currently married or living with someone else (p<0.01). The following were not predictors of disclosure: caregivers’ assessment of benefits of disclosure outweighing the risks of disclosure, perception of HIV-related stigma and/or discrimination, access to health care, quality of health care, child or caregiver gender, or socioeconomic status did not appear to influence the caregivers’ decision to disclose to their child.

Conclusions: Caregivers who are taking care of children between the ages of 9 and 15 need proper support and assistance from health workers for pediatric HIV disclosure. More efforts are needed to encourage and assist caregivers to inform their child about his or her HIV status. In the future, helpful disclosure support interventions would address caregivers’ HIV-related shame, improve the psychosocial wellbeing of the caregivers, educate caregivers about HIV and HIV treatment, and help them improve parent-child communication, all of which may allow caregivers to increase their overall self-efficacy and therefore facilitate a successful, age-appropriate disclosure process for both the caregivers and their children.

Introduction: Extensive studies on tickborne pathogens (TBPs) have been conducted in developed nations, relatively less has been done in developing nations leaving a large gap of knowledge. Mongolia, a country built upon nomadic culture and pastoralism is an ideal system to study TBPs as the population is at an increased risk due to increased time spent outside herding livestock. Discoveries of TBPs in Mongolia include Babesia spp., Anaplasma spp., Borrelia spp., Rickettsia spp. and tick-borne encephalitis virus. While research has focused on TBPs in humans and ticks in Mongolia, little research has assessed animal reservoirs, specifically small mammal species, as reservoirs for TBPs. This project aimed to 1) identify the role of small mammal species in the ecology of TBPs in Mongolia, specifically Rickettsia spp., Anaplasma spp., and Borrelia spp. using serological and molecular analysis and 2) identify risk factors associated with the prevalence of TBPs in small mammal populations in Mongolia.

Methods: From June to July 2016, rodents were live-trapped, and whole blood, serum and ear biopsy samples were collected. Sixty-four rodents were trapped in three aimags (provinces) in northern Mongolia. Whole blood samples were tested by PCR to detect the presence of Rickettsia spp., Anaplasma spp., and Borrelia spp.. In addition, ear biopsy samples were tested by PCR to detect the presence of Borrelia spp.. All rodents were serologically tested for antibodies to Anaplasma phagocytophilum and Rickettsia rickettsii. A multivariate model was used to assess risk factors for the presence of tickborne pathogens. Risk factors examined included species and sex of animal, location and presence of ticks.

Results: 56.0%, 39.0% and 0.0% of animals were positive by PCR for Borrelia spp., Rickettsia spp. and Anaplasma spp., respectively. 41.9% and 24.2% of animals were seropositive for A. phagocytophilum and Rickettsia rickettsii, respectively. Risk factors found to be important predictors of Borrelia spp. molecular detection included small mammal capture in Tov aimag (OR, 4.1; 95% CI, 1.00 – 16.80), male small mammals (OR, 3.07; 95% CI, 0.99 – 9.51) and ground squirrel species type (OR, 3.24; 95% CI, 0.90 – 11.70). The risk factor found to be an important predictor of Rickettsia spp. molecular detection was Mongolian gerbil species type (OR, 246.5; 95% CI, 20.77 – 2925.88). Presence of ticks on small mammals (OR, 4.62; 95% CI, 0.92 – 23.24) was an important risk factor for A. phagocytophilum antibody detection. No risk factors were identified as being important predictors of antibody detection of R. Rickettsii.

Conclusion: The results of this study provide considerable evidence of TBPs circulating in small mammal populations in Northern Mongolia. Further information on TBPs in ticks, humans, livestock and wildlife reservoirs will be important to address public health interventions for TBPs in Mongolia in the future.

Traumatic brain injury (TBI) is the most common cause of death and disability globally. TBI is a leading cause of resource consumption and disproportionately affects LMICs. Innovative solutions are required to address this high burden of TBI. Prognostic models could provide a solution since the models enhance diagnostic ability of physicians, thereby helping to tailor treatments more effectively. This study aims to evaluate the feasibility of a prognostic model developed in Tanzania for TBI patients amongst Kilimanjaro Christian Medical Center (KCMC) healthcare providers and Duke affiliated healthcare providers. Duke health system participants were included primarily to gain insight from a different context with more established practices to inform the TBI tool implementation strategy at KCMC. To evaluate the feasibility of integrating the TBI tool into potential workflows co-design interviews were conducted with emergency physicians and nursing staff. Qualitatively, the tool was assessed using human centered design (HCD) techniques. Our research design methods were created using the Consolidated Framework for Implementation Research which considers overarching characteristics of successful implementation to contribute to theory development and verification of implementation strategies across multiple contexts. Findings of this study will aid in determining under what conditions a TBI prognostic model intervention will work at KCMC and the potential use of HCD in implementation research.

Background: In Kenya, approximately 14.5% of children and youth meet criteria for a mental disorder. Despite this high burden, research is very limited related to mental health problems this population. Research is needed on the measurement of child mental health problems and on the risk and protective factors associated with these conditions.

Objectives: (1) Evaluate a set of survey items, chosen from both standardized measures and locally developed items, to identify those that that best differentiate between children with and without mental health problems. (2) Identify and explore important individual- and family-level influences on child mental health.

Methods: Individual surveys and semi-structured interviews were administered to members (1-2 caregivers, 1 child age 8-17) of 22 families living in Eldoret, Kenya. We evaluated differences in survey item endorsement between children with and without mental health problems to identify the best performing items. We used mixed-methods analysis of semi-structured interview transcripts and associated rating scores to explore differences between children with and without mental health problems on a variety of family-level variables.

Results: Following an extensive cultural adaptation process, fourteen of 26 survey items were successful in differentiating between children with and without mental health problems. Successful survey items were all drawn from standardized measures; no locally developed items were successful. All family-level variables (e.g., overall family functioning, couples’ relationship quality, parent-child relationship quality, and caregiver mental health) were strongly associated with child mental health outcomes, evidenced by large effect sizes ranging from 0.86 to 4.16. Subsequent qualitative analysis identified specific components of these variables likely contributing to the large numerical differences in scores.

Conclusions: The results of this study both suggest that standardized measures are appropriate for use in this population and highlight the importance of cultural adaptation before implementing standardized assessment tools. Additionally, the results indicate that the family environment is a promising target for interventions aiming to reduce mental health problems in Kenyan children.

Although people frequently pursue multiple goals simultaneously, these goals often conflict with each other. For instance, consumers may have both a healthy eating goal and a goal to have an enjoyable eating experience. In this dissertation, I focus on two sources of enjoyment in eating experiences that may conflict with healthy eating: consuming tasty food (Essay 1) and affiliating with indulging dining companions (Essay 2). In both essays, I examine solutions and strategies that decrease the conflict between healthy eating and these aspects of enjoyment in the eating experience, thereby enabling consumers to resolve such goal conflicts.

Essay 1 focuses on the well-established conflict between having healthy food and having tasty food and introduces a novel product offering (“vice-virtue bundles”) that can help consumers simultaneously address both health and taste goals. Through several experiments, I demonstrate that consumers often choose vice-virtue bundles with small proportions (¼) of vice and that they view such bundles as healthier than but equally tasty as bundles with larger vice proportions, indicating that “healthier” does not always have to equal “less tasty.”

Essay 2 focuses on a conflict between healthy eating and affiliation with indulging dining companions. The first set of experiments provides evidence of this conflict and examine why it arises (Studies 1 to 3). Based on this conflict’s origins, the second set of experiments tests strategies that consumers can use to decrease the conflict between healthy eating and affiliation with an indulging dining companion (Studies 4 and 5), such that they can make healthy food choices while still being liked by an indulging dining companion. Thus, Essay 2 broadens the existing picture of goals that conflict with the healthy eating goal and, together with Essay 1, identifies solutions to such goal conflicts.

Background: Reports from the first monkeypox (MPX) active surveillance program in the Democratic Republic of Congo (DRC) in the 1980s determined that the disease was not of epidemic potential, with R0<1. However, during an active surveillance period from 2005-2007, researchers found a 20-fold increase during the last 30 years. The purpose of this study was to analyze the contact data from 2005-07 and compare characteristics to those of the 1980s, and toassess the change in R0 of MPX. Methods: Contact tracing information and samples from active lesions were collected. Samples were screened by PCR and positive cases were ranked by generation and grouped into chains of transmission according to date of rash onset, contact tracing, and location. R0 was determined using calculations provided in the 1980s study and chain size distribution was compared. Results: Of 1407 suspected cases of MPX investigated in 2005-07, 287 provided contact information with an average of 6.22 (range, 1-20) contacts each. Among the 703 positive cases, 408 distinct chains of transmission were identified. Average chain size was 1.75 cases (range, 1-12), with the longest reaching six generations. The crude secondary attack rate (AR) was 0.092, with an effective R0 of 0.576. Discussion: Contact characteristics and types of contacts differed from those of the 1980s program. This analysis found a higher crude secondary attack rate and effective R0. This could be the result of a higher proportion of unvaccinated contacts, or that the virus is better able to transmit between humans with a more limited amount of contact.

American cutaneous leishmaniasis (CL) is a severely understudied and neglected“disease of poverty” widespread throughout Peru. Transmission dynamics of CL are complex, requiring sandfly vectors and mammalian reservoir hosts to maintain the pathogen in a local environment whereby incidental hosts (people) can become infected. We employed a One-Health approach to understand CL transmission in rapidly changing region of northern Peru. We describe the characteristics of 529 CL positive patients from four participating clinics. Using conditional logistic regression, we assessed risk factors of CL for residents of small urban areas through a matched case-control study with 63 patients who had visited one of the same clinics for CL (cases) or other medical reasons (controls). We later enrolled 343 households as part of a community based study occurring in 15 urban and rural areas of Soritor. We found 256 positive humans (n= 914) as tested via the Montenegro Skin Test; we found 11 positive dogs (n = 236) via an immunofluorescence antibody test. Our results suggest that most- if not all- of CL transmission is occurring in rural areas and that urban women and urban children engage in many high risk activities typically attributed to men. We find evidence that prevalence of past infection is highest among rural residents and men. We believe dogs are unlikely Leishmania reservoirs in either rural or urban settings. It remains unknown if the high number of MST positive children in rural areas is a result of peridomestic or intradomestic transmission.

Tobacco has been recognized as a serious public health issue that threatens people’s health in Palau, Micronesia, especially as young people consume tobacco in multiple ways. The research of this thesis begins with a description of the complex mix of habits, social norms, history, and cultural practice that make up tobacco use in Palau. Then an intervention project using “journaling behavior change paradigm” among young adults based on their own reflections on tobacco use by writing journals, is described. A high prevalence of tobacco use in all forms was revealed in this study, among which chew betel nuts with tobacco is the most popular method. Friend and family members’ attitude play important roles in affecting people’s tobacco use. Also, the evaluation of journaling paradigm reveals potential in lowering tobacco consumption in Palau and other countries by raising awareness of the problem through the writing of journals and diaries.

Background: The prevalence of childhood obesity in the US is high; this includes young children living in low-income households. Many of these children are served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Digital interventions that target caregivers enrolled in WIC show potential for childhood obesity prevention. This study aims to describe 1) the formative research for developing a pilot digital intervention focused on improving diet quality and increasing redemption of WIC-approved foods, and 2) the challenges faced in developing the intervention due to the COVID-19 pandemic. Methods: In-depth interviews were conducted with 13 WIC caregivers. Interviews were recorded and transcribed. Transcripts were coded using structural themes, and analyzed using NVivo 12. A data reduction table was created afterwards and inter-coder reliability was achieved. Results: Fourteen themes clustered into four domains. The first domain centered on how caregivers perceived healthy eating. Definitions for healthy and unhealthy eating depended on the source of nutrition information and contributed to practices of healthy eating. The second domain described the caregiver’s purchasing of WIC-approved foods. Fruits, vegetables, milk, cheese, and eggs were the most purchased foods, while yogurt and peanut butter were the least purchased foods. The biggest facilitator to purchasing WIC-approved foods was taste preferences, and the biggest barrier was picky eating. The third domain described WIC’s helpfulness in healthy eating promotion; caregivers believed in the latter and provided suggestions for WIC to help them further. The last domain described the text messaging preferences. It showed that WIC caregivers believed that a text messaging program would help them eat healthier. They preferred receiving text messages weekly, in the morning, and receiving recipes and tips. The COVID-19 pandemic affected implementation of the intervention through disrupting contact with stakeholders, the recruitment process, and the completion of surveys used for intervention feasibility analysis. Conclusions: Future studies should consider utilizing and documenting formative research to guide intervention development. Comprehensive protocols for contacting stakeholders, recruitment, and follow up are important proactive tools during implementation.

Between 1890 and 1965, the ideology of government responsibility for maternal and child health represented a continuous and central goal that fueled programs and institutional networks of progressive and liberal social policy advocates. Beginning in the settlement houses of the 1890s, a cadre of female bureaucrats, social reformers, and their political allies developed an array of federally based programs. Conservative stakeholders--among them anti-feminists, representatives of the medical industry, anti-communists, and white supremacists--strenuously opposed this vision of health justice, arguing that health was a personal responsibility in which government should play no part. Despite the achievements of government-based progressive reformers in instituting their vision in urban settlement houses, under the Sheppard-Towner Act of the mid-1920s and during the years of the New Deal and World War II, the Cold War's approach to domestic social policy after 1947 clamped down on their vision. After this conservative turn against social democratic solutions to welfare needs, these progressive advocates shifted their attention to the international health rights movement and to community-based maternal and child health activities.

My dissertation introduces the concept of health justice as an interpretive lens to trace the history of health policy progressives and their institutional networks. On the one hand, health justice reflects the communitarian premise that the health of all members of society is essential for the common good. On the other hand, health justice implies that health and health care are individual rights that government ought to protect. While communitarian arguments were often on the tip of the tongues of social reformers, a passionate belief in citizenship-based rights and redistributive and humanitarian ideas of social justice undergirded their policy ideas and became a more explicitly stated position during the New Deal and World War II. This justice-based approach to maternal and child health policy was consistently undermined by the prevailing counter-ideologies of individual responsibility for health, local control of public services, racial segregation in health services, and the commodification of health care.

My work relies on primary evidence collected from the personal papers of key protagonists, the administrative records of the Children's Bureau housed at the National Archives, oral histories, and the presidential papers of Harry S. Truman. Published primary materials have been culled from memoirs, professional public health and medical journals, as well as the popular press. I also draw from a body of historical and political science scholarship of the past twenty-five years to contextualize the narrative.

In sub-Saharan Africa, women are burdened with gendered tasks of cooking and fuel gathering, leading to time poverty, gender inequality, unhappiness, physical health issues due to unclean cooking methods, and broader social implications including employment limitations and adverse effects on household food security. This scenario underscores an urgent need to scrutinize and reveal the existing patterns of time use, especially for women. By applying pairwise correlation and ordinary least squares regression analyses, this study assesses the consistency across three distinct time use methods and delves into potential causes for any observed discrepancies especially for time use on fuel preparation and acquisition, as well as cooking. Data sourced from primary cooks across four Sub-Saharan African countries indicate that: (a) there is significant difference in time use that is recorded across time use methods; and (b) individual and household characteristics, and specific behaviours related to cooking and fuel activities, partially account for the observed time gaps in both cooking activities and fuel preparation and collection. This research contributes to the field by: 1) highlighting the challenges in achieving consistent time measurements, underscoring the variations that different methods can produce; and 2) providing insights on the influence of individual and household factors, as well as cooking and fuel-related behaviours, on the perception and reporting of time use. These findings suggest directions for developing more reliable and valid methods for time use research, especially for interventions aimed at reducing the burden of uncompensated work on women in sub-Saharan Africa.

Background. Creating health equity—“the attainment of the highest level of health for all people”— is a core tenet of public health (American Public Health Association, 2015; United States Department of Health and Human Services, 2011, p. 1). Achieving health equity requires the identification and amelioration of patterns of systemic disadvantage and the elimination of health disparities (Gostin & Powers, 2006; United States Department of Health and Human Services, 2011). To do this, health researchers must address social determinants of health (SDOH) and of equity. I have selected women with migraine as a paradigmatic case for this exploration of health equity and agency.

Migraine is a common and debilitating neurobiological disorder without a cure (Goadsby, 2012). It affects almost three times as many women as men, and disproportionately disables women occupying low social locations, that is, occupying a low position on the social hierarchy (Burch, Loder, Loder, & Smitherman, 2015b; Stewart, Roy, & Lipton, 2013). A dearth of effective and affordable treatment options has rendered non-pharmacological self-management a crucial part of living with migraine, yet clinical treatment guidelines consistently emphasize pharmacological intervention (Becker et al., 2015; Diamond et al., 2007; Raphael, 2012). Much of migraine research is epidemiological (Burch et al., 2015b; Buse et al., 2013; Lipton, Serrano, Holland, et al., 2013). The resulting gap in knowledge around the experiences and needs of women navigating the complexities of life with migraine is especially pronounced for those who are less likely or able to access systems that document and treat the condition.

Objective and Methods. The overall purpose of this dissertation is to develop knowledge on the effects of social and structural determinants on the experiences of women living with migraine, with attention to their strategies and priorities for self-management through a systems thinking lens. To do this in the context of this dissertation, I first explore the benefits of critical systems approaches for health equity research (Chapter 2), followed by a description of the development and use of two systems thinking tools for data collection in community focus groups of women with migraine (Chapter 3). Our study team used the system support map tool (SSM) to identify and describe migraine triggers and features, self-management strategies, and the needs and outcomes associated with self-management (Chapter 4). The connection circle (CC) tool explored the relationships between triggers and features, self-management strategies, and outcomes (Chapter 5).

We conducted seven focus groups with 19 women with migraine from diverse social locations and analyzed the data using qualitative content analysis, dimensional analysis, and measures of complexity. We examined variation by social location in the data from both tools.

Findings. The tools we developed allowed us to feasibly and effectively collect rich and nuanced data from community-based women with migraine. One of the tools—the CC— may be more effective when coupled with problem solving techniques when used with women in low social locations (Chapter 3).

The SSM data underscored the distinctions in migraine experience by social location (Chapter 4). While women from all social locations identified stress as a top migraine trigger, descriptions and definitions of stress varied. Women in low social locations were more likely to engage in isolating and avoidant self-management activities, and women in higher social locations were more likely to use proactive, complementary, and integrative approaches. Women in low social locations had lower expectations for self-management and were more interested in pain management than women in higher social locations, who were more interested in self-improvement.

The CC data revealed that ‘conceptualization of complexity,’ or the way and degree to which participants contemplated dynamic interrelationships, was a key dimension in understanding how women in diverse social locations identified relationships between different aspects of their migraine experiences. There were clear differences in the conceptualizations of and capacities for complexity by social location. Women in high social locations demonstrated greater depth, breadth, and structure of this key dimension than women in low social locations.

Discussion and Conclusions. As a non-fatal, but highly disabling, condition with limited and costly treatment options, migraine provides an excellent paradigmatic case for exploring health equity. Ability to have a high quality of life with migraine may be deeply entwined with one’s social location. Therefore, to improve the experiences of the group most affected by migraine—women in low social locations—we cannot limit our research and treatment to the biological and behavioral. We need to think in terms of the social and structural. Creating equitable outcomes, wherein everyone has an equal opportunity for a fulfilling and healthy life, requires that we intervene on multiple levels, engage with affected women, and explicitly commit to addressing social and structural determinants of health AND equity.

Background: Healthcare systems such as that of Rwanda face barriers in terms of infrastructural, financial, human, and technical resources. The value-based care framework offers an approach to examining health delivery systems facing resource-constraints and to highlight areas for greater progression towards maximizing impact on health outcomes given resource limitations. Methods: A qualitative approach was used to explore One Family Health’s care delivery model and its challenges and successes using value-based care as an underlying analytic framework. Primary data in the form of 8 qualitative semi-structured interviews were combined with secondary data from 14 previously conducted semi-structured interviews. Thematic analysis was applied to analyze the data. Results: Successes indicate OFH contribution to expanding access to care in Rwanda and challenges of the OFH health post model point to financing model and its relation to Rwanda’s recent financing changes. Quality of service delivery at the OFH health post approximately indicate strengths in patient-centeredness and equity and weaknesses in safety and efficiency. An anecdotal exploration of health outcomes suggest that individual patients improve as a result of visiting the health post and that the health post contributes to community wellbeing particularly in terms of health education and reducing the burden on health centers. Barring a small and biased sample, OFH nurses seem to be satisfied with the health post model, though their experience could be improved with routine training and increased supervision. Insights in integration and alignment in the context of the public-private partnership were also discussed. Conclusions: The One Family Health qualitative case study utilizing the value-based care framework offers several lessons for One Family Health, Rwanda Ministry of Health as it continues to contract with private sector entrepreneurs, and for further research that involves the application of the value-based care framework. These lessons include aligning its financial model with the aims of government financing initiatives, providing infrastructural and financial supports, and routine monitoring of health outcomes centered on patients as well as provider satisfaction and support.

Background

Melioidosis is a neglected tropical disease that is highly prevalent in Southeast Asia. Misdiagnoses are common as the presenting symptoms are similar to other diseases including upper respiratory infections. When not treated with antibiotics, the disease can lead to severe morbidity or death. Current diagnostics in low- and middle-income countries are often not sensitive nor rapid. Point-of-care rapid diagnostic tests (POC-RDTs) are a potential solution. Few studies have compared the accuracy of POC-RDTs and molecular assays against blood culture. The goal of this study was to conduct such comparisons in detecting Burkholderia pseudomallei infections among infection-suspected patients in Kapit, Sarawak, Malaysia.

Methods

We used an informed consent process as approved by two institutional review boards. In this cross-sectional study, we engaged patients meeting a melioidosis-like case definition that included classical symptoms such as prolonged fever with joint pain and/or abscess. We studied the patients routinely collected clinical specimens with a POC-RDT (Active Melioidosis DetectTM) and a molecular assay compared with the B. pseudomallei bacterial culture for isolation of the bacterial organism.

Results

One hundred patients aged 6 months - 79 years from Kapit Hospital were enrolled in the study from June 12, 2018 to January 8, 2019. Of the 100 sera, 97 urine, and 16 bodily fluid samples (total n= 213) tested with the RDT, 23 samples gave positive results (7 sera, 15 urine, and 1 bodily fluids). Compared to the molecular assay, the POC-RDT had a sensitivity of 40% (95% CI, 5%- 85%), specificity of 94% (95% CI, 87% - 98%), and an accuracy of 90% (95 CI, 82% - 95%) for sera; and a sensitivity of 80% (95% CI, 28%- 99%),a specificity of 65% (95% CI, 55% - 75%), and an accuracy of 87% (95 CI, 77% - 94%) for urine; and a sensitivity of 80% (95% CI, 28%- 99%), a specificity of 65% (95% CI, 55% - 75%), and an accuracy of 81% (95 CI, 54% - 96%) for other bodily fluids. Additionally, when compared to the bacterial culture results, the POC-RDT showed a sensitivity of 38% (95% CI, 9%- 76%), specificity of 95% (95% CI, 88% - 99%), and an accuracy of 90% (95 CI, 82% - 95%) for sera; a sensitivity of 88% (95% CI, 47%- 100%), a specificity of 88% (95% CI, 77% - 95%), and an accuracy of 94% (95 CI, 84% - 98%) for urine; and a sensitivity of 25% (95% CI, 1%- 81%), a specificity of 100% (95% CI, 74% - 100%), and an accuracy of 81% (95 CI, 54% - 96%) for other bodily fluids.

Conclusion

While study enrollment will continue, data from the first 100 participants, suggests the POC-RDT had poor sensitivity, good accuracy, and high specificity in detecting B. pseudomallei infection. Thus far, the POC-RDT assay seems to work better on urine specimens. Due to low sensitivity, the study data do not support recommending POC-RDT strips as a single diagnostic method. However, as the POC-RDT had high specificity when the test is positive it seems appropriate for clinicians to assume the patient is infected and to prescribe specific antimicrobial therapy. While more participant data are needed, it seems likely that the POC-RDT could be useful in helping physicians to begin treatment early with the high specificity that the POC-RDT has exhibited. If paired with an RDT with high sensitivity, this POC-RDT would add a great value to infection management.

Background: Population aging and rural urbanization were two major trends in China. Past researches had shown that relocation and displacement could have a negative impact on the mental health of senior adults. Land expropriation and increasing rural migration due to China's urbanization process had created a growing but understudied group of "landless farmers." This study explored the impact of relocation from rural villages urban resettlement on the mental health of older adults in China in terms of depression.Method: The mixed-method study collected survey data from 219 adults aged ≥60 years in one relocated village (Zhangjia) and one non-relocated village (Xicheng) in Jinhua City, Zhejiang Province, China. Mental health measures included the Geriatric Depression Scale. Semi-structured interviews with 10 relocated older residents provided qualitative data. Quantitative analyses examined differences in social networks, amenities, and levels of depression between groups. Logistic regression analyzed predictors of depressive symptoms. Qualitative data were analyzed using thematic analysis. Result: No significant difference in depression was found between the two communities, but the social network scores of older adults in the resettlement community were significantly lower than those in the original village. Poor living facilities were associated with a higher rate of depression in both communities. In addition, a good social network was an important protective factor against depression in the relocated population. Qualitative findings revealed feelings of boredom, reduced social interaction, and changes in family relationships following the move. In summary, quantitative and qualitative data suggested that the disruption of living habits and isolation caused by relocation may have a negative impact on the mental health of older adults in rural China. Discussion: Quantitative and qualitative data suggested that the disruption of living habits and isolation caused by relocation may have a negative impact on the mental health of older adults in rural China. Conclusion: The study emphasized the need for targeted interventions to support mental well-being in this vulnerable population undergoing relocation.

Background: Harmful alcohol use and violence are both major contributors to global mortality and morbidity rates, despite being both predictable and preventable. This study seeks to quantitatively determine the scope of violence-related injury and Alcohol Use Disorders in a referral hospital in Moshi, and qualitatively determine 1) how violence-related injury patients perceive alcohol use influences the occurrence of violence and 2) how experiencing a violence-related injury influences patients’ subsequent alcohol use behavior.

Methods: This study was conducted at Kilimanjaro Christian Medical Center (KCMC). Survey data was obtained from a trauma registry including all injury patients ≥ 18 years admitted to the emergency room. Interview participants were included if they reported their injury was due to violence, tested positive for alcohol (by breathalyzer) upon admittance, medically stable, able to communicate and provide informed consent in Swahili or English, and clinically sober at the time of enrollment.

Results: From the 500 injury patients enrolled in the trauma registry from April 17, 2018 to January 12, 2019, 84 (16.8%) reported that their injury was due to violence. Patients with violent injuries were 2.21 times more likely to have a positive alcohol status compared to non-violent injuries (95% CI 1.36, 3.60, p<0.01). Among violent injuries, those with a positive alcohol status were 6.26 times more likely to have an Alcohol Use Disorder compared to those with a negative alcohol status (95% CI 2.13, 18.39, p<0.001). Interview respondents reported a perception that violent injuries were worse from other injuries, that the perpetrator was also under the influence of alcohol, that alcohol contributes to violence, and a desire to change alcohol use behavior following their injury.

Conclusion: Alcohol use and violence-related injury pose a significant threat to health and well-being globally. In Moshi, Tanzania, both issues are prevalent and contribute to a sufficient disease burden. This study has added to the data on alcohol-attributable harm, contributing to expanding information available on this issue from LMICs. To adequately reduce violence-related injuries in this setting, it is necessary to address harmful alcohol use as well.

Objectives: To compare measures of health and health quality between Orphans and Vulnerable Children (OVC) in different living arrangements-- institutional and community care; and to correlate different measures of OVC health and health quality using clinical, laboratory and quality of life instruments.

Design: Cross-sectional study.

Setting: Two rural districts (sites) in East Africa, Bungoma in Kenya, and Kilimanjaro in Tanzania.

Participants: 77 male and 45 female OVC aged 16-18 years (N=122). Participants, who had attained a minimum age of 16 at the date of interview, were selected from the larger sample of OVC in the Positive Outcomes for Orphans (POFO) study. POFO, a longitudinal study in five less wealthy countries that started in 2006, obtained its sample through cluster randomization.

Methods: To obtain self-ratings of OVC physical health, OVC responded to an interviewer administered SF-36 questionnaire, a multipurpose generic measure of health status. A neutral examiner then measured OVC physical health using 4 clinical variables: a physical health examination, body mass index, hemoglobin level, and the Harvard physical fitness score.

Main Outcome Measures: SF-36 scores presented as a two component score- the physical health and mental health composite sub-scores. For physical health, normal findings for age were considered as meeting the threshold for good physical health.

Results: Of the 122 OVC, 89 (73%) lived in the community while 33 (27%) lived in institutional settings. For the SF-36, the mean physical composite score for the entire study population was 50.6 (SD=6.2). Mean body mass index (BMI) was 19.3 (SD=2.4). Mean hemoglobin was found to be 13.2g/dl (SD=1.8). The average Harvard physical fitness score was found to be 40.7(SD=16.9). Pearson's correlations between SF-36 Physical Functioning and hemoglobin, BMI, and the Harvard Step-Test fitness score were 0.1, 0.1, and -0.1 respectively. There was no evidence that self-rating of OVC health outcomes differed by living arrangement. Using paired t-tests for continuous variables and chi-square tests for categorical variables, no significant p- values were obtained at the 95% level. Using a threshold of vision 20/20 for normal vision, 91.0% of community OVC and 78.8% of OVC in institutions had normal vision (p=0.07).

Conclusion: Although this study did not detect significant differences in self-reported measures of health among OVC in different living arrangements, physical examination revealed a slightly high incidence of poor vision among those living in institutions. In this sample, the correlations between SF-36 physical functioning sub-score and 3 physical health outcomes of BMI, hemoglobin, and the Harvard Step-test fitness score were weak.

Neurosurgical and neurological conditions account for a significant disease burden worldwide, with low- and middle-income countries bearing more than 90% of the burden. Uganda is a low-income nation with a high demand for neuro care services but limited access, especially in rural and remote areas. Mobile health clinics, which have proven to be effective in other specialties, could be adapted to provide neurological care in such regions. The objective of this research was to establish the feasibility, appropriateness, and usability of mobile neuro clinics for providing neurological care to people in Uganda's rural and remote communities. Participants who met the inclusion criteria were invited to participate in an education session. Following the education session, the participants participated in an interview session to evaluate the feasibility, appropriateness, and usability of mobile neuro clinics. The education and interview tools were developed using the Consolidated Framework for Implementation Research (CFIR). To weight provider views, a sentiment weighted scale was used, with total aggregate sentiment scores greater than 42 in each CFIR domain indicating high feasibility, acceptability, and usability. All the assessed CFIR domains scored above sentiment score of 49. The implementation process domain (167) received the best overall sentiment score, followed by the implementation climate structure (141), inner setting domain (102), innovation domain (59), and outer setting domain (55). According to the findings of the research, mobile neuro clinics are feasible, appropriate, and usable in Uganda. To achieve the best results, however, careful planning and integration involving stakeholders from conceptualization to execution are required.