Student Research Symposium

Are you an undergraduate, graduate or postgraduate student interested in global health? Have you done research or work on global health? Would you like to show your work to other interested students and professors who share your interest? We are pleased to invite you to register to share your work! Please fill out the following form: https://docs.google.com/a/umich.edu/forms/d/1CT-gpoB6tY_L-qzvyx0JMhRz5-cBbpHN-m4rfzoTshI/viewform?usp=send_form as soon as possible! We only have 20 spots available and they will go on a first come first serve basis. Accepted applicants will be added on this page so participants know who will be presenting!

Posters:

Comparing the syndromic approach with point-of-care testing in treatment of STIs at St. Paul’s Hospital in Addis Ababa, Ethiopia

Sarah Bell, Sunasia Echols, Emilia Iglesias, Ninette Musili, Azeb Kebede, Yeshwondm Mamuye, Balkachew Nigatu, Okeoma Mmeje, Jason Bell

Purpose: We sought to determine if point-of-care (POC) rapid testing at St. Paul’s Hospital Millennium Medical College (SPHMMC) in Ethiopia, was more effective at diagnosing STIs than the current standard of care, syndromic approach, which is solely based on visual and patient-reported symptoms.
Methods: This 12-week pilot study was conducted at SPHMMC among female patients aged 18-45 with vaginal discharge. Patients completed a questionnaire asking about demographics and current and prior gynecologic treatment. Vaginal and cervical swabs were collected and used for POC and molecular-based testing. After the exam was complete, the resident completed a short questionnaire to record their observations and treatment plan.
Results: We recruited 47 participants for our study. Of these women, four had a positive trichomonas vaginalis POC test and one had a positive wet mount test for trichomonas vaginalis. Overall, a total of 38% of patients were prescribed doxycycline, an antibiotic for treating chlamydia, and 34% of patients were prescribed metronidazole, an antibiotic that targets trichomonas vaginalis.
Conclusions: The physicians at SPHMMC do not have the resources to quickly and accurately diagnose their patients’ sexual health. We found that the residents at SPHMMC follow the prescription-based model promoted by the syndromic approach, though our results suggest that this may be leading to the overtreatment of patients.

Sexually Transmitted Infection Screening Among Asymptomatic Pregnant Women at St. Paul’s Hospital in Addis Ababa, Ethiopia

Sarah Bell, Sunasia Echols, Emilia Iglesias, Ninette Musili, Azeb Kebede, Yeshwondm Mamuye, Balkachew Nigatu, Okeoma Mmeje, Jason Bell

Purpose: The purpose of this study was to determine the rates of STIs among pregnant women at St. Paul’s Hospital Millennium Medical College (SPHMMC) in Addis Ababa, Ethiopia. We collected point-of-care (POC) rapid test results and molecular-based testing to confirm diagnoses.
Methods: This twelve week pilot study was conducted at SPHMMC among pregnant female patients aged 18-45 presenting to the hospital for a prenatal appointment. All patients completed a questionnaire asking about their demographics and current and prior clinical obstetric treatment. Vaginal and cervical swabs were collected from patients. These swabs were used for POC and molecular-based testing. Women were treated per standard of care at SPHMMC. Treatment was augmented when additional diagnoses were made outside of the clinical exam.
Results: We recruited 95 participants for the study. Of these women, fifteen had a positive KOH test, one had a positive trichomonas vaginalis POC test, one had a positive gonorrhea culture, and one had a positive wet mount test for trichomonas vaginalis. Molecular-based test results are pending.
Conclusions: The physicians at SPHMMC do not typically screen pregnant women for any sexually transmitted infections, which may lead to undiagnosed cases of sexually transmitted infections in pregnant asymptomatic women.

158% increase in Maternal Mortality Ascertainment via Community Based Surveillance Methods

Tiffany Anthony

Background: While there has been progress on a global scale, 99% of all maternal deaths still occur in the developing world; particularly Sub-Saharan Africa (World Health Organization, 2012). Every day, approximately 800 women die from preventable causes related to pregnancy and childbirth (Hunt & Bueno De Mesquita, 2010).
Methods: In July 2013 the District Health Directorate in the Bosomtwe district of central Ghana administered routine surveys to the families of women of reproductive age (WRA), 10-49, who had died between 2008 and 2013. Following standard district health protocol, a trained community health nurse or midwife followed up with a verbal autopsy to those women who answered positively to one of six indicative questions (administered in the Fall of 2013). Upon completion of verbal autopsies, two maternal mortality review committees took place (June 2013) to evaluate and discuss the factors contributing to each death.
Results: Active surveillance with RAMOS in 2013 identified 132 likely maternal deaths. Of the 100 women with RAMOS and verbal autopsies conducted, 59 died of direct maternal deaths and 49 died a non-maternal death. The most common causes of maternal death, as determined by maternal mortality review committees were hemorrhage (24%) followed by abortion (17%). Of these cases deemed maternal deaths, 32% had an unknown cause of death.
Conclusion: With community based surveillance methods the maternal mortality ratio from 2008- 2013 was 329.0 per 100,000 live births. Previously, the hospital ascertained only cases established an MMR of 128.4; a 158% increase.

Assessing Maternal Health in Urban Accra: A Pilot Study

Cachet Colvard

The Minority Health and Health Disparities International Research Training (MHIRT) Program provides international research opportunities to undergraduate and graduate students interested in biomedical and behavioral research. This program is dedicated to supporting the research training of students who will most likely contribute to the elimination of health disparities that exist among disadvantaged populations in the U.S. The research experience is structured to provide training in developing experimental research design, critical data analysis, cross-cultural communication, and written and oral presentation opportunities. My project’s main objective was to develop a Health and Demographic Surveillance Site that would monitor maternal and child health in an urban neighborhood in Accra, Ghana. This involves collecting demographic data on the psychosocial factors that impact maternal mortality.
My primary objective was to gain a better understanding of the connection between demographic health data and qualitative research theory and methodology. I accomplished this by conducting a literature review on existing validated surveillance instruments, observing antenatal care in Ghana, and developing the surveillance tool that will be used at the future site. I furthered my knowledge of the cultural, structural, and ecological factors that influence data collection and maternal and child health by doing field observations.

The Calciums Sensing Receptor (CaSR) in Response to Inflammatory Factors

Phillip Wachowiak, Cecilia Fuentes, Mariana Cifuentes

Health complications resulting from obesity are often associated with the chronic, low-grade inflammatory state in tissues. The calcium sensing receptor (CaSR) is a transmembrane protein that is expressed in a number of cells, including human adipose cells, human adipose cell line LS14 and human monocytic cell line THP1. The CaSR plays an important role in calcium homeostasis and inflammation-induced diseases. In this study, differentiated THP1 macrophages were activated with LPS and treated with the calcimimetic cinacalcet (allosteric activator of the CaSR). The LS14 cells were then incubated in media previously conditioned by the THP1 cells. The cytokines IL1β and IL6 showed the greatest levels of augmented expression, while CCL2 showed the same trend albeit with lower overall expression. Preliminary observations show a trend of CaSR-stimulated macrophages inducing proinflammatory cytokine expression in LS14 preadipocytes. Future experiments may explore blocking the CaSR and analyzing the ensuing inflammatory profile in order to determine worthwhile preventative care for clinical settings.

The Impact of Ebola on MDG5 Progress in Sierra Leone

Tara Dosumu Diener

My dissertation is entitled “Creolizing Childbirth: An Ethnographic History of Practice, Knowledge, and Clinical Imagination in an African Maternity Hospital.” My research focuses on Princess Christian Maternity Hospital the sole obstetric referral hospital in Sierra Leone, which is now also functions as a final destination for pregnant and laboring women suspected of having Ebola.
A mass exodus of healthcare workers during the long civil war of the 1990s left few trained professionals to cope with the reproductive needs of Sierra Leonean women. Abysmal maternal and infant mortality statistics prompted new approaches in the decade following the war, culminating in the introduction of free health care for pregnant women and children under age five in 2010. While statistics were improving before the current Ebola outbreak, cracks in the approach had begun to emerge, and fundamental questions about the provision of perinatal care remain.
The current state of crisis and panic will have lasting effects on the Sierra Leonean public’s perceptions of hospitals and medical care. For the purposes of this symposium I will bring ethnographic and historical analyses to bear on projecting how social and historical factors might interact with the Ebola epidemic and affect Sierra Leone’s progress toward MDG5.

Cultural Recognition of Mental Illness in Kenya

Hannah Wolfson

Background: Mental illness plagues people worldwide; however developing countries including Kenya struggle with psychiatric disorders more than developed countries as a result of limited resources and decreased awareness. The small percentage of the countrys existing psychiatric services is highly concentrated within urban settings, thus further limiting mental health services to rural populations. Therefore, this study examines alternative healing practices to treat such mental illnesses, while comparing and contrasting them to modern practices.
Methods: A systematic literature review and informal interview that evaluated techniques of traditional and modern health providers service deliveries.
Results: A lack of modern mental health resources limits treatment options for the mentally ill and thus results in patients’ continued reliance on alternative healing techniques from traditional healers. Although psychiatric prevalence is known to be similar across all populations, understandings of mental illness differ by healer. Mental health policies and associated acts have been developed to address concerns regarding poor access to mental health services, but the absence of realistic applications and failure to address changes in social norms inhibits the policys and act’s effectiveness. A continued, high demand for traditional and modern psychiatric services exists throughout Kenya.
Conclusion: Increased awareness of mental illness throughout the public and among traditional and modern healers will greatly improve perceptions of mental illness and negative stigmas will be reduced. Furthermore, actions to focus on the present rather than the future should be taken by training those who have the most interaction with psychiatric patients, such as community health workers.

Do Informed Consumers Reduce the Price and Prevalence of Counterfeit Drugs? Evidence from the Antimalarial Market

Anne Fitzpatrick

Asymmetric information between patients and providers is a defining characteristic of healthcare markets. Healthcare providers may strategically use this information advantage to maximize their own payoff. I conduct an audit study using study team confederates (“covert shoppers”) to test how providers adjust price and quality when customers demon- strate relatively more information about healthcare product choices. Shoppers purchase antimalarial drugs according to randomized scripts. The scripts experimentally vary in- formation about the patient’s diagnosis (malaria) and/or information about appropriate treatment (artemether-lumefantrine). I then test the purchased drugs to determine whether they are counterfeit or substandard. Shoppers who present information about either the diagnosis or recommended treatment pay approximately $0.18 (5 percent) less. Counter- intuitively, I find that customers who present information about either the diagnosis or the recommended treatment are 3.4 percentage points more likely to be sold a substandard drug. However, overall drug quality is high. I interpret results through a framework in which providers trade off the current benefits to strategic behavior against potential fu- ture profit losses if strategic behavior was detected. There are lower expected profit losses because more informed consumers are less likely to be repeat customers, and overall pay lower prices. I provide additional survey data from both providers and real customers to support this interpretation. I conclude that while customers who show more information may pay lower prices, providers also lower quality in order to maximize profits. Thus, more informed shoppers are not necessarily better off.

Education and Sickle Cell Disease within the Ghanaian SCD population

Marianna Yamamoto, Andrew Campbell, Sheri VanOmen, Charles Antwi-Boasiako, Rebekah Urbonya

This study sought to explore the patterns in education in relation to Sickle Cell Disease (SCD) and determine the phenotypic differences between adults and children with SCD. Comprehensive questionnaires were administered to 318 adult and pediatric SCD patients at Korle Bu Teaching Hospital in Accra, Ghana between 2006 and 2013. Patient and parent’s education levels were correlated with number of pain crises, SCD-related ER visits, hospitalizations, and days missed of school or work per year. In addition, education levels were also correlated with the mode of transportation and transportation time for any SCD related doctors visits. Mothers’ education levels of were strongly associated with the number of pain crises adult participants experienced per year and the mode of transport elected to reach a healthcare center by both adult and pediatric participants. These results demonstrate the contribution education has on SCD management and lifestyle.

Prevalence and Determinants of Self-reported Respiratory Illness in Rural Bangladesh

Allysha Choudhury, Malabika Sarker, Abram Wagner

Introduction: In this paper, we investigated the relationship between indoor and outdoor air pollution and respiratory illnesses and symptoms (RIS) in rural Bangladesh, noting the importance of certain household factors for at-risk populations for air pollution and their potential effects on respiratory conditions. We hypothesized that indoor air pollution in form of combustion from biomass fuel stoves and presence of a smoker in the household would pose as greater risk factors than other demographic factors.
Methods: In this cross-sectional study, household-level representative data were collected as part of a baseline survey. Several logistic regression models were created to find any associations between demographic factors or health behaviors and the self-reported negative respiratory health outcomes (asthma, chronic obstructive pulmonary disorder, breathlessness, or intense coughing).
Results: Respiratory conditions accounted for fourteen percent of total disease and acute symptom burden within the population. Several significant associations were found between demographic factors and RIS. These include increased odds of RIS for: the elderly and very young (OR=2.00, 95% CI=1.27,3.16) compared to middle-age individuals, non-skilled or farming labor in relation to skilled labor (OR=2.05,95% CI=1.07,3.93), and those in lowest-income subdistrict when compared to the highest-income subdistrict (OR=3.51, 95% CI=2.18, 6.54). High income within a household acted as a protective factor, and females living in a household with a smoker have higher odds of respiratory conditions compared to females in non-smoking households (OR=1.65, 95% CI=1.16, 2.34). Contrary to expectations, neither biomass fuel stove use nor smoking status was significantly linked to negative respiratory outcomes.
Conclusion: Further research should be carried out in order to account for temporality, thus a case-control study method is recommended for the future.

Treating Primary Postpartum Hemorrhage in Low-Resource Settings

Alison Climes, Bianca Pillarella, Karen Schumann, Lydia Su, Kathleen Sienko

Primary postpartum hemorrhage, or PPH, is the leading cause of maternal mortality worldwide and it causes over 100,000 deaths every year. It is defined as the excessive loss of blood in the 24 hours following childbirth. 80-90% of cases are due to uterine atony, which is the failure of the muscles in the uterine wall to properly contract. The blood loss originates from blood vessels that are left exposed after the delivery of the placenta. Over the past 4 years an average of 32 cases of PPH have occurred each month at Korle Bu Teaching Hospital in Accra, Ghana. Three of our team members had the unique opportunity to travel to Ghana to complete a needs assessment and to identify preliminary user requirements for the medical device. Our goal was to create a device to treat PPH at Korle Bu that would be effective, safe, easy to use, affordable and durable. While there are currently many existing solutions to this problem, gaps still occur in cost, time to set up, and availability of disposable materials. Our solution to this device comes in two parts: a device that applies pressure externally to the abdomen and a device that applies pressure internally to the uterine wall.

Sponsored by Design for Global Development and Prof. Samuel Obed

Determining the Prevalence and Risk Factors of Sickle Cell Nephropathy in the Ghanaian Sickle Cell Population

Fitz Tavernier Jr., Fatimah Farooq, Charles Antwi-Boasiako, Federicka Sey, Andrew Campbell

Sickle cell disease (SCD), an inherited blood disorder in which the body produces abnormally shaped red blood cells. This mutation leads to chronic hemolytic anemia, pain crisis, and widespread organ damage throughout the body, which increases with age. Renal manifestations of SCD range from various functional abnormalities to gross anatomical alterations of the kidneys. SCD causes patients’ kidneys to hyper-filtrate from a young age, decreasing kidney function with age (Powars, Chan et al. 2005; Scheinman 2009). Hyper-filtration causes abnormally low levels of creatinine and high levels of microalbumin (UMA) in the urine, a sign of kidney dysfunction. Sickle Cell nephropathy can contribute towards patient mortality and morbidity and once the kidneys are damaged, renal function cannot be recovered (Lanzkron et al 2012). A recent study done by Powars et al in 2005 showed that out of 1056 SCD patients, 15% (n=33) of the 232 deaths resulted from renal failure. Identifying early onset of kidney disease in SCD patients is critical in order to implement preventative treatment. In an ongoing (CASIRE Consortium Renal Cohort Study) multicenter, international Renal SCD Cohort Study, we investigated the association of microalbuminuria and gross proteinuria to patients’ blood pressure (SBP and DBP, hypertension based on CSSCD Group Age Defined BP for SCD patients >90% tile), and family history of hypertension and renal disease in a cross-sectional pediatric and adult group of SCD patients in Ghana.

Arsenic and Uranium Exposure via Drinking Water in Mongolia

Elise Tolbert, Jerome Nriagu, E. Erdenechimeg, Iqra Nasir

Arsenic and uranium exposure through drinking water is a major challenge in many parts of the world. In Mongolia, a landlocked country, water scarcity and large-scale industrial mining have contributed to both the lack of water and potential contamination of available water. This is concerning because exposure to arsenic and uranium can lead to numerous adverse health effects ranging from skin lesions and kidney damage to death. To address this issue, researchers from the Mongolian National University of Medical Sciences and University of Michigan collaborated on a study aimed to assess arsenic and uranium exposure through drinking water. Ground water samples were collected from 55 wells in Umnugobi, a province in the Gobi Desert. To assess exposure, urine and toenail samples were collected from participants (n=202). In addition, surveys were conducted to assess the frequency of water consumption, health status, family history, socioeconomic variables, and additional exposure to ground water. Water, urine and toenail samples were analyzed by inductively coupled plasma mass spectrometry (ICP-MS) using Clean Lab methods. Regression analysis was conducted using SPSS (Statistical Package for the Social Sciences) to obtain the correlation between water consumption, ground water concentrations of arsenic and uranium, and the occurrence of reported health symptoms associated with arsenic and uranium exposure. This study expands the pool of data on heavy metal exposure through drinking water. The results of this study are promising and will hopefully prompt policy makers and scientists to explore ways to reduce concentrations of heavy metals and chemical contaminants in found in drinking water.

Developing Sustainable and Appropriate Stoves and Toilet Systems in Dolatpura, Gujarat, India

Michael McGahren-Clemens, Erica Dombro

BLUElab India is a 25-member team (composed primarily of undergraduates) working to design and build sustainable and appropriate cooking and toilet system technology with family partners in Dolatpura, Gujarat, India. In the area of cooking, the team, along with the family partners, is working to design cost-effective stoves that decrease the prevalence of smoke-related discomfort while fitting into the culture. With regards to toilets, the team is looking to design cheaper, private, in-home systems (there are currently few toilets in the village). Both projects are primarily geared towards increasing quality of life for women. Women are the primary cooks and thus experience the most smoke discomfort. Due to social stigma surrounding bodily functions, women can only relieve themselves in the early morning and night. This restriction is inconvenient and physically uncomfortable, as well as dangerous (risk of assault, for example). Members of the team will travel to Dolatpura in March 2015 and May 2015 to survey for feasibility and implement technology, respectively.

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