Capstone Projects - Africa // Eck Institute for Global Health // University of Notre Dame

Eck Institute for Global Health

Capstone Projects - Africa



Name: Husein Badani  MS '12
Degree and Year: Biology
University of California-Irvine, 2009

Capstone Project:   Spatio-temporal analysis of diarrheal diseases in Dar es Salaam, Tanzania

badani

Abstract:  In order to understand the burden of diarrheal diseases in developing countries, it is important to determine the prevalence and causes of these illnesses. Through the Millennium Development Goals, the United Nations aims to increase access to potable water and improve basic sanitation, which both play roles in reducing diarrheal diseases. Diarrheal diseases rank fifth globally among the leading causes of death but predominantly afflict low to middle income countries. Here patient ward location, age, and gender information from 2006-2011 were analyzed from district reports of dispensaries, health centers, and hospitals throughout Dar es Salaam, Tanzania. Spatio-temporal analysis using SaTScan and R provided information on development of clusters. Monthly rainfall and land temperature data were analyzed to find a correlation between cases and weather events. Results depicted the diseases are highest in children under five years of age, but do not differentiate between genders. Multiple clusters were found, indicating the need to determine the causes of these hotspots. No significant correlation was found between weather patterns and cases. Taken together, clusters found from spatio-temporal analysis may be attributed to socioeconomic conditions and other possible spatial factors, and analysis of these assumptions should be investigated.
 



Name: Zoe Cross  MS '12
Degree and Year: Preprofessional Studies
University of Notre Dame, ‘12

Capstone Project:  Meta-analysis of helminth polyparasitism: Infection dynamics and morbidity

cross

Abstract:  Polyparasitism is common in endemic areas and contributes to morbidity and mortality burdens. The objectives of this study were: to quantitatively evaluate the burden of polyparasitic infections, to assess whether synergistic interactions were at play, and to examine polyparasitic­induced morbidity. Helrninth-only and helrninth-protozoa interactions were considered as well as specific helminth-mixed infections: malaria. tuberculosis and HIV. These infections were selected because geographical endemicity overlaps extensively with helminth distribution. We conducted a systematic review of published prevalence and association studies within PubMed and Web of Science databases. A total of 71 studies were identified for review. We found significant interactions among the soil-transmitted helminthes. The species appear to interact synergistically within the host. Mixed co-infections were prevalent and exerted varying pressure on endemic helrninthiasis impact. Polyparasitism was found to be more prevalent than monoparasitism in endemic areas. Additionally, a positive correlation was seen between increasing endemic species and the mean number of host infections. Our results have important implications for understanding the ubiquity and impact of these diseases in order to develop promising initiatives for control.
 



Name: Gabriela Austgen  MS '13
Degree and Year: Preprofessional Studies
University of Notre Dame, 2012

Capstone Project:  Malaria and Helminth co-infection: Measuring impact on Anemia

austgen

Abstract:  Malaria and helminth infections mainly impact tropical and subtropical regions, leading to a high potential for co-infection.  Because both infections cause anemia, it is important to study their combined effect.  In this paper, we compiled studies that measured both prevalence of anemia and mean hemoglobinin different infection groups and conducted meta-analyses to measure the impact of co-infection versus single malaria infection on anemia.  The first meta-analysis on odds ratio of anemia in co-infection versus single infection resulted in an odds ratio of 0.90 (p=0.6926). The second meta-analysis on mean hemoglobin in co-infection versus single infection groups yielded a weighted mean hemoglobin of 1.03 (p=0.4072).  Although both these results are statistically nonsignificant, they indicate that anemia may be more severe in single malaria infections. We explored possibilities and implications of this intriguing slight protective effect of helminth infection on malarial anemia.  Meta-regressions of prevalence data using malaria prevalence and co-infection prevalence as moderators revealed a statistically significant association between malaria and co-infection prevalence and odds ratio of anemia in co-infection versus single infection.  This indicated that the protective effect is more likely to be observed in populations with high malaria and co-infection prevalence.  Immunologically, it appears that the elevation of Th2 cytokines as a response to helminth infection leads to downregulation of the pro-inflammatory Th1 response to malaria.  The consequence of this downregulation is protection against cytokine-mediated dyserythropoiesis, which is the primary contributor to the severe anemia observed in clinical malaria. These findings suggest that helminth control interventions, though valuable, should not be implemented in the absence of malaria control programs because of an increased risk of anemia and other cytokine-mediated complications of malaria infection. Finally, the limited number of studies available, and consequently statistically nonsignificant results of the meta-analyses, indicate that more studies are needed to be confident in both interpretation and recommendations for treatment.

Gabriela did additional fieldwork in Uganda developing a Monitoring and Evaluation Framework for Palliative Care Association of Uganda.

“This allowed me not only to better understand PCAU’s mission, but also to experience and learn about healthcare in Uganda.  These experiences helped in the identification of communication and data collection barriers, enabling me to make reasonable suggestions for the organization to adopt.”
 



Name: Mackenzie Dome  MS '13
Degree and Year: Neuroscience
University of Michigan, 2012

Capstone Project:  Impact of mass drug treatment on disease of Lymphatic Filariasis in three endemic settings

dome

Abstract:  Currently, over 120 million people are infected by lymphatic filariasis, with 40 million disfigured and incapacitated by the disease. Lymphatic vessel damage and dysfunction, resulting from infection, causes the characteristic disease lesions presenting as both hydrocele and lymphodema. Implementing mass drug administration (MDA) is a critical challenge for the Global Program to Eliminate Lymphatic Filariasis (GPELF). While the impacts of MDA dynamics on infection are well studied, the effect on disease is much less certain, and in need of further exploration. Theoretical modeling of the impact of drug intervention programs will help examination of the unknown behavior of drug interventions on disease over time.

“Through these assessments we also came across a 7 year old with an advanced stage lymphedema of the leg, which is very rare. Following up on this patient, we were able to begin effective treatment on his condition, and are currently writing a case report, highlighting the unique danger of this condition in children.”
 



Name: Mark Fraser  MS '13
Degree and Year: Biochemistry
University of Notre Dame, 2012

Capstone Project: How Tyrosine 13 mutations of Ebola Zaire Virus VP40 affect viral egress

fraser

Abstract:  Ebola virus has been causing outbreaks of haemorrhagic fever in Africa since 1976. Four of the 5 species of the virus cause a diseased state in humans with 3 of them causing outbreaks, the most recent being 2012.  Key to the viral life cycle is the VP40 protein, which is necessary for viral assembly and budding. Recent evidence suggests that phosphorylation of Tyrosine 13 may be integral for virus like particle (VLP) egress mediate by VP40. To investigate the role of Tyr13 phosphorylation in VP40 egress, EGFP-tagged VP40 mutants in HEK293 cells and CHO-K1 cells were studied for plasma membrane localization and VLP egress with confocal imaging and western blot analysis, respectively. The Y13A mutant exhibited a reduction in plasma membrane localization of VP40 in HEK 293 cells but not in CHO-K1 cells. There was an increased amount of VP40 in cell lysates in the Y13A mutant and a decrease of intracellular VP40 in the Y13E mutant. The VLPs collected show that the wildtype and mutant proteins may degrade rapidly, and need to be performed immediately after collection to be accurate assessments of VLP VP40 protein levels.

“By investigating a sample of the infected population from 2000, which was representative of the outbreak population as a whole, I observed a number of correlations.”
 



Name: Colleen Huml  MS '13
Degree and Year: Preprofessional Studies
University of Notre Dame, 2010

Capstone Project:  Women’s health knowledge and its impact on the health of their children: A study of mothers in Lesotho

huml

Abstract:  Mothers’ formal education and maternal health knowledge are two separate indicators that have been explored as predictors for child health and development. In previous case studies, maternal education has demonstrated a positive association with overall child health and the reduction of child mortality.  Despite this correlation, recent evidence has suggested that maternal health knowledge may be a more specific marker for this association.  The purpose of this study was to provide an assessment of maternal health knowledge among mothers in the districts of Mokhotlong and Thaba Tseka, Lesotho and to determine whether this health knowledge is correlated with child health outcomes.  The initial assessment demonstrated that due to food insecurity and limited access to health facilities, mothers’ health behaviors regarding nutrition and maternal health were often inconsistent with their knowledge of best practice.  Though many women demonstrated a knowledge of HIV transmission, nutrition, and maternal health, qualitative observations suggested that health knowledge itself is not widely discussed in Lesotho culture.  Mothers’ health knowledge regarding personal hygiene practices and nutrition demonstrated an inverse correlation with their child’s frequency of illness, and a positive correlation with the nutritional status of their children.  This study suggests that despite mothers’ unfamiliarity with speaking openly about health knowledge, maternal health knowledge correlates with child health.

“Traveling with the TTL outreach team, I interviewed mothers about their health knowledge and behaviors regarding hygiene, maternal health, and nutrition.  I then collected data on the health and development of their children to explore the possible correlation between mothers’ health knowledge and the health outcomes of their children among this population.”
 



Name: Obiomachi Madukoma  MS '13
Degree and Year: BSN Nursing
Temple University, 2008

Capstone Project:  Relative efficiency of healthcare facilities in the Federal Capital Territory of Nigeria

madukoma

Abstract:  Healthcare in Nigeria has been criticized by many in the country and abroad as being inefficient. Access to quality healthcare is limited, and those who afford to travel abroad for medical treatment do so due to lack of trust in the Nigerian healthcare system. Many factors contribute to this inefficiency. Among these are poor infrastructure, failure to implement and/ or enforce pragmatic health policies, poor planning and constant change of government. In order to improve the performance of the nation’s health care system, there is need for a systematic and comprehensive countrywide assessment, through data analysis of individual health service unit performance. This study explores the role of health service unit data as a measure of health system performance and the use of Data Envelopment Analysis (DEA) as a tool for improving the management of healthcare provision in Nigeria. The findings suggest that most of these hospitals are using their resources efficiently. Wuse Hospital was the only facility that had slack in input utilization; the analysis result suggested a 9 bed reduction in order to maximize efficiency. There is still room for improvement as total output of hospitals sampled can be increased by almost 30% with current capacity. The absence of several slacks among the hospitals, coupled with an 86.64% average efficiency score, indicates a degree of efficiency in managing public healthcare facilities. I hope that the Nigerian healthcare system will benefit tremendously from large scale efficiency assessment of all healthcare service units.

“I worked on assessing the efficiency of healthcare systems in Abuja, the Federal Capital Territory, and did an envelopment analysis using data I got while in the country.”



Name: Brittany Ockenfels  MS '13
Degree and Year: Preprofessional Studies and Romance Languages & Literatures
University of Notre Dame, 2012

Capstone Project:  Meta-analysis of the effects of insect vector saliva on the host immune response and progression of disease

ockenfels

Abstract:  Here we present a meta-analysis of the effects of vector saliva on disease progression as it applies to three outcomes: pathology, parasite load, and cytokine levels. Only transient-feeding vectors were included (i.e. sand flies and mosquitoes), as long-term feeding results in a more complicated and not directly comparable interaction.  Due to their scarcity, human studies and studies on trypanosomes and their vectors were also excluded. Experiments were placed into two groups: naïve animals exposed to saliva during infection compared with a control group exposed to only pathogens, and animals pre-exposed to saliva before infection compared with a control group of naïve animals exposed to saliva only during infection.  A third group, pre-exposed animals compared with those needle inoculated and not exposed to saliva at all, was included in the pathology evaluation.  Other than expanding our knowledge of the biology of infection, the results of the analyses concerning the first group could have ramifications for vector control programs and vaccine studies.  If control programs are allowed to lapse, newly naïve populations could end up with more severe disease.  As for vaccine trials, it would be important to test against vector-borne infection as opposed to needle inoculation.

Brittany also did fieldwork in the Democratic Republic of Congo performing a program evaluation of the Bon Berger Clinic’s water and sanitation program. 

“At the end of my time there, we went back to the same houses for a mini evaluation of the program.  It seemed to be very effective, as people demonstrated improved knowledge and we observed water bottles sitting in the sun for treatment.”



Name: Ann Polcari  MS '13
Degree and Year: Biology
University of Notre Dame, 2012

Capstone Project:  Sex-biased parasitism in soil transmitted helminth infections

polcari

Abstract:  The Hamilton-Zuk hypothesis and immunocompetence handicap hypothesis led to an increase in research on sex-biased parasitism in the last 20 years.  Thus far, multiple studies have discovered a male-bias in parasitism within a variety of non-human species, but a lack of data exists to show if it holds true in Homo sapiens.  Soil-transmitted helminth (STH) parasites affect a large majority of the developing world and also have potential to display a sex-bias.  Therefore, a meta-analysis was conducted in R statistical software using STH prevalence and intensity data from males and females of 220 published scientific articles.  637 prevalence comparisons were made between males and females for infection with Ascaris lumbricoides, Trichuris trichiura, hookworm, and all three species combined.  Prevalence data showed a significant male-bias in hookworm (1.22 [1.14, 1.29]) and STH (1.04 [1.00, 1.08]) infection overall, but a significant female bias in Ascaris (0.91 [0.86, 0.97]) infection.  Intensity data was represented on frequency plots based upon the mean difference in eggs per gram of feces between males and females.  The results pointed towards a female bias for Ascaris, Trichuris, and all STHs.  However, only 61 comparisons were available leading to insignificant and possibly skewed results for each species.  In conclusion, it is quite possible that STH infections are more prevalent in males than females due to biological and behavioral factors, such as testosterone levels and occupational hazards.  This knowledge could lead to better prevention, control, and treatment strategies in the future.

Ann also did fieldwork with Touching Tiny Lives in Lesotho researching ART Patient Compliance.

“On most days I would travel for hours, deep into the Maloti mountains, with TTL’s outreach team to find the homes of malnourished and HIV positive children.  During these visits I conducted surveys on pill-taking behavior, work, and nutrition, in order to evaluate TTL’s outreach services with regard to antiretroviral therapy adherence.”
 



Name: Ashley Scott  MS '13
Degree and Year: Chemistry
Florida Southern College, 2012

Capstone Project:  Development of training program for detection of poor quality medicines in resource limited settings

scott

Abstract:  While the problem of counterfeit medications exists in countries across the world, developing countries are especially susceptible to a high prevalence and circulation of falsified drugs.  The associated challenges of death, drug resistance, and financial loss have a disproportional impact on the people residing in developing countries where the healthcare systems are already poor and a majority of society lives in poverty.  These countries lack strong regulatory agencies and the advanced technology and resources for analysis to combat the problem. The Paper Analytical Device (PAD) is a tool for counterfeit drug detection in a resource limited setting.  This study investigates the amount and method of training necessary to use and interpret the results of the PAD for counterfeit drug detection.  A facilitator-led training program was piloted with a sample size of thirteen people lasting about three hours.  A visual aid was also evaluated for its possibilities for a training tool.  Eleven out of thirteen people ran a PAD with perfect or adequate proficiency, but only four out of thirteen participants correctly interpreted the results.  An exit survey revealed a majority of people found the training program to be satisfactory and wanted to use the PAD technology in the future.  Further work should have training programs incorporate an edited visual aid to improve the proficiency levels and the development of an image analysis program for PAD interpretation.

“During my time in Kenya, I was able to train medical professionals in counterfeit drug detection while learning firsthand about the challenges of healthcare in resource limited settings.”
 



Name: Austin Atherton  MS '14
Degree and Year: Psychology and Pre-Health Studies
University of Notre Dame, 2013

Capstone Project:  Investigating determinants of healthy facility choice in rural Zambia

atherton

Abstract:  Bed occupancy rates are a commonly used tool for measuring hospital efficiency. Over the past 15 years, Chikankata Mission Hospital, a 200-bed mission hospital in Zambia’s Southern Province, has been experiencing a steady decline in bed occupancy rates an average decrease of 2.5 percent per year, resulting in a mere 29 percent occupancy rate at the end of 2013. This low level of bed utilization complicates the securement of government funding and results in inadequate training opportunities for students at adjacent training facilities. To better understand the negative trend, researchers conducted a multi-cluster two-stage probabilistic household survey to determine factors influencing health facility choice and related indicators, such as general health status and willingness to pay for health services. Focus groups were also carried out to gain a qualitative understanding of the views and opinions the catchment area has for their health facility options. The final goal was to identify avenues for the hospital to adapt to the current situation and improve their bed occupancy rates. The initial analyses provided descriptive statistics of the results. Identifying accessibility as one of the primary determinants of facility choice, researchers conducted a chi-square analysis and confirmed a significant relationship between the rural health center catchment area in which participants reside and their past (stated) facility choice. These findings support previous research that accessibility is a significant factor for health facility choice. While the hospital cannot directly address the issue of distance to increase their utilization, focus group discussions yielded many areas where adjustments and improvements can be made such as facility cleanliness and staff attitude in order for the hospital to better cater to their catchment area population.

“Even without the actual research, the experience I gained more than made the time there worth it.”
 



Name: Bianca Garcia  MS '14
Degree and Year: Biology and Chemistry
University of New Mexico, 2013

Capstone Project:  Assessing the effect of caregiver burden on the health outcomes of children in rural Lesotho

garcia

Abstract:  Caregiver burden, a multifaceted burden, and malnutrition in children have been negatively affected by the HIV/AIDS epidemic especially in Lesotho.  This study was conducted in Mokhotlong, Lesotho.  It explored if there was an association between caregiver burden and child health outcomes, specifically if there was an association between individual caregiver’s physical health and economic variables and child health outcomes, as well as an association between primary caregiver relationship (i.e. grandmother or mother) and child health outcomes.  Oral surveys were conducted among 38 caregivers, but only 30 were analyzed. Thirty-four children had their height and weight measured.  Of those 30 were analyzed.  In total 127 de-identified client records were extracted from Touching Tiny Lives’ database and 117 were analyzed.  Results from the surveys revealed all non-significant associations.  Results from the database collection revealed that earned household income has a negative effect on the level of stunting in children particularly when grandmothers are caregivers.  Earned household income also has a negative effect on the level of undernourishment particularly when mothers are caregivers.  The findings of this study provide sufficient evidence to justify further explanation of the relationship between caregiver burden and children’s health outcomes of wasting, stunting, and undernourishment in rural Lesotho.

“This research showed a significant association between the caregiver’s household monthly income and the child’s health outcomes.”
 



Name: Maria Hinson  MS '14
Degree and Year: Biology, Ecology, and Evolutionary Biology
University of Tennessee Knoxville, 2013

Capstone Project:  Transmission heterogeneities of onchocerciasis and its elimination in Uganda

hinson

Abstract:  Onchocerciasis affects more than 18 million people in 31 countries, 99% of whom live in sub-Saharan Africa.  Although elimination programs have been successful in South America, there is still work to do regarding elimination efforts in sub-Saharan hyperendemic communities. Despite reports of disease elimination in Mali, Senegal, and Nigeria, areas such as onchocerciasis endemic Uganda continue to be affected by the filarial Onchocerca volvulus parasite. The objective of this research is to understand the transmission heterogeneities of onchocerciasis and to verify a deterministic multi-species model with Ugandan data. Using entomologic and microfilariae prevalence data, the project aims to verify the multi-species model and evaluate the efficacy of the Carter Center River Blindness Elimination Program. As foci in Uganda have yet to reach elimination with ongoing control efforts, quantifying the efficacy of interventions and number of years required to reach elimination will allow control program officials to make more informed decisions regarding onchocerciasis eradication and cessation of their programs.

“It was because of my confidence in my organization that I was able to feel comfortable in my environment and complete my research. If I could do everything over again, I would not change one decision I made this year: going to Uganda is the best thing I have ever done.”
 



Name: Luke Peters  MS '14
Degree and Year: Biology
University of Notre Dame, 2013

Capstone Project:  Characterizing a vector: An investigation of polyandry & longevity in the dengue vector aedes aegypti in Trinidad

peters

Abstract:  Dengue is currently one of the world’s most devastating and widespread vector borne diseases. With infection rates estimated close to 400 million per year, and more than 100 countries at risk, it is clear that this global health issue needs to be addressed. Classical interventions such as vaccines, insecticides, indoor residual spraying, and bed nets have been inefficient ways of controlling Aedes aegypti and dengue, but innovative intervention strategies such as transgenic mosquitoes and the use of the Wolbachia bacteria have been particularly promising. In order for these innovative interventions to be well informed and accurately applied, a more complete understanding of the vector is needed, especially in regards to characteristics that affect population dynamics and disease transmission like polyandry and longevity. In this study, techniques are demonstrated for the investigation of polyandry and longevity in Aedes aegypti populations in Trinidad. With this goal in mind, male specific PCR primers that target polymorphic microsatellites were developed so that a molecular assay of polyandry could be achieved. In addition, survival analysis of field collected mosquitoes from Trinidad was prepared to investigate heritability and variation of lifespan. Application and development of these techniques will continue to provide more complete characterization of the Aedes aegypti vector that can be used to supplement innovative intervention strategies that can have a significant health impact.

“In this Capstone project, in partnership with the University of the West Indies at St. Augustine, Trinidad, techniques were demonstrated for the investigation of polyandry and longevity in Aedes aegypti populations in Trinidad.”
 



Name: Geoffrey Wright  MS '14
Degree and Year: Biology
Wabash College, 2012

Capstone Project:  Investigating determinants of healthy facility choice in rural Zambia

wright

Abstract:  Bed occupancy rates are a commonly used tool for measuring hospital efficiency. Over the past 15 years, Chikankata Mission Hospital, a 200-bed mission hospital in Zambia’s Southern Province, has been experiencing a steady decline in bed occupancy rates an average decrease of 2.5 percent per year, resulting in a mere 29 percent occupancy rate at the end of 2013. This low level of bed utilization complicates the securement of government funding and results in inadequate training opportunities for students at adjacent training facilities. To better understand the negative trend, researchers conducted a multi-cluster two-stage probabilistic household survey to determine factors influencing health facility choice and related indicators, such as general health status and willingness to pay for health services. Focus groups were also carried out to gain a qualitative understanding of the views and opinions the catchment area has for their health facility options. The final goal was to identify avenues for the hospital to adapt to the current situation and improve their bed occupancy rates. The initial analyses provided descriptive statistics of the results. Identifying accessibility as one of the primary determinants of facility choice, researchers conducted a chi-square analysis and confirmed a significant relationship between the rural health center catchment area in which participants reside and their past (stated) facility choice. These findings support previous research that accessibility is a significant factor for health facility choice. While the hospital cannot directly address the issue of distance to increase their utilization, focus group discussions yielded many areas where adjustments and improvements can be made such as facility cleanliness and staff attitude in order for the hospital to better cater to their catchment area population.

“The project helped me to develop countless life and career skills, such as human and resource management, financial budgeting, and conflict management.”
 



Name: Jingmeng Sally Xie  MS '14
Degree and Year: Nutrition Science
Purdue University, 2012

Capstone Project:  An investigation into breast cancer risk factors among Kenyans

xie

Abstract:  Moi University researchers found that the breast cancer seen in patients in Western Kenya is different from what is commonly seen in the United States. Patients are diagnosed at very young age and the cancer usually expresses in very aggressive forms. Aggressive breast cancer compared to normal breast cancer cells have later-stage tumors at diagnosis, present with larger tumors, have a greater likelihood of having positive lymph node involvement, have higher histologic and nuclear grade tumors, are more likely to be estrogen receptor (ER−) and/or progesterone receptor negative (PR−), are diagnosed at a younger age, are more likely to have inflammatory breast cancers and are less likely to survive a breast cancer diagnosis (Standish et al. 2008). In order to find out what causes this breast cancer and why it’s different from other types of breast cancers, a research effort was established through collaboration of University of Notre Dame and Moi University. As a part of this collaboration, this study provides general information about Kenyans and breast cancer in Kenya that will help current and future researchers to design new research projects. This research project is divided into three sections. In the first section, current cancer and breast cancer trends, literature of breast cancer risk factors in Kenya were reviewed. In the second section, I analyzed a dataset collected from patients in Eldoret, Kenya and their relations to the cancer and estrogen receptor (ER) status. The last section is a risk assessment study I conducted during this summer about 24 breast cancer risk factors in Kenyans in the U.S. Risk factors analyzed in the two risk assessment studies do not show strong association with cancer or ER status. Nevertheless, valuable information is gained through the literature review and the two studies to help us characterize Kenyan population and the breast cancer disparities.

“I designed a questionnaire which includes the commonly recognized risk factors associated with breast cancer. After recruitment through local news and online media, direct contact and referrals, I was able to include 36 Kenyans in the study from the local area. Through interviews to these participants, I studied the selected risk factors along with their health believes and living style changes.”