Capstone Projects - Class of 2014 // Eck Institute for Global Health // University of Notre Dame

Eck Institute for Global Health

Capstone Projects - Class of 2014

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: Macy Brusich  MS '14
Degree and Year: Integrative Biology and Environmental Science
University of Illinois- Urbana Champaign, 2012

Capstone Project:  Targeting educational campaigns for prevention of vector-borne disease: An assessment of rural vs. urban settings in Thailand

brusich

Abstract:  The goal of this study was to collect information that will help to reduce the risk of malaria and/or dengue fever diseases in at-risk populations. The study utilized a mixed method design to capture data using a forced choice and open-ended questionnaire that assessed household construction and knowledge, attitudes, and practices (KAP) of patients seeking point-of-care treatment for malaria and/or dengue fever in a rural and urban district of Thailand. Additional quantitative findings from household mosquito collections were also performed. Study objectives were to compare individual and household level health practices and to quantify differences in KAP between rural and urban settings. Sixty-four participants were recruited in total to assess differences in key variables at the individual and household level that may influence health behaviors related to the prevention of malaria and dengue fever disease. While statistically significant findings should be interpreted with caution, results from this pilot study indicate knowledge surrounding malaria and dengue fever exists, however gaps in behavior, perception, and adequate protection from mosquito vectors were found. Significant associations between study site and household construction were found to influence household level practices in the types of mosquito control products purchased and the abundance of mosquitoes in homes. Overall, education from malaria and dengue fever Ministry of Health intervention campaigns is reaching the intended target populations. Results are intended to guide future MOH health education campaigns in these study settings that target specific community needs.

“This field experience allowed me to gain transferrable skills that I can apply in future global health settings as I begin my exciting career path in Global Health.”


Name: Christiane Shizuko Cardoza  MS '14
Degree and Year: Environmental Sciences
University of Notre Dame, 2010

Capstone Project:  Non-partner sexual violence against women and children in Gujarat, India

cardoza

Abstract:  Non-partner sexual violence is a severe but undocumented problem within India as a whole and within Gujarat specifically. Sensationalized events have occurred in the past decade, bringing the spotlight to events of non-partner sexual violence. The purpose of this paper was to create a methodology for measuring and tracking non-partner sexual violence, to use this methodology to begin to evaluate non-partner sexual violence in India, to understand determinants of cyclical sexual violence, and to propose solutions to address both the problem of event monitoring and the determinants of non-partner sexual violence. A content analysis of Indian-based English-language newspapers and five informational interviews was performed. Although events data were not available for each month, this study demonstrated how aggregate levels of non-partner sexual violence could be illustrated and compared. In order to address sexual violence events, several interventions are recommended including continued and improved events monitoring, crowd-sourcing and crowd-feeding, and education and empowerment programs.

“Using data we gathered, Will developed a platform to map sexual violence event reports from eyewitnesses through texts on a basic cell phone, providing another option for victims to report these crimes.”


Name: Michael Clark  MS '14
Degree and Year: Biology
University of Notre Dame, 2012

Capstone Project:   Design and assessment of a mobile database management system for arthropod-borne disease surveillance in Belize

clark

Abstract:  Dengue fever is an emerging public health burden in the tropics and subtropics. With the looming threat of insecticide resistance and the lack of a vaccine, surveillance has been proposed as the most effective way to prevent outbreaks of this emerging disease. This project introduces a mobile database management system, Skeeter Tracker, to improve upon a paper based on dengue vector surveillance program in Belize, Central America. Members of the Belize Ministry of Health vector control program underwent a three-tier training program designed to compare data capture using a tablet and digitized form to data capture using the standard paper form, moving from a controlled setting to a more complex semi-field setting and finally routine surveillance environments. Weekly technical training sessions informed changes to tablet forms and provided knowledge transfer on the use of the tablet system. Proof of concept risk maps were generated from dengue vector surveillance data collected by the newly developed Skeeter Tracker system, environmental parameters, and human case data reported from Orange Walk, Cayo, and Corozal districts. Under controlled conditions the digitized premise inspection form was both more accurate and faster to populate per data field than the paper-and-pen model. These advantages were neutralized when tested under semi-field conditions; however, sunlight did not significantly negatively affect accuracy of data input when using the tablet outdoors. Collaborative data collection indicated tablet and paper data capture do not provide 100% agreement most likely based on observer bias during premise inspection. The newly developed system introduced in the current study matches or improves upon currently employed paper-and-pen model by: 1) potentially faster data entry, 2) potentially more accurate data recording, 3) not being limited by environmental parameters encountered during routine surveillance activities, such as sunlight, 4) the ability to geo-reference data, 5) the ability to transmit data in near real time with Wi-Fi connection, 6) diversified reporting capabilities, 7) potential to alter surveillance paradigms from response to preventative; and 8) potential for expansion of surveillance for other diseases and/or country settings using a single platform. Perhaps most important, data collected using the Skeeter Tracker system can be fed into complex mapping systems for development of disease transmission risk maps thereby reducing the probability of disease transmission in at-risk populations.

“For my project we introduced a novel mobile database management system, called the Skeeter Tracker surveillance system, and assessed the early successes and shortcomings.”


Name: Megan Finneran  MS '14
Degree and Year: Preprofessional Studies and Spanish
University of Notre Dame, 2013

Capstone Project:  An assessment of healthcare access and its limitations in Ecuador’s District 15D01

finneran

Abstract:  The Ministry of Health (MOH) in Ecuador and medical brigades conducted by the nonprofit Timmy Global Health (TGH) provide medical attention in district 15D01 of the Napo province. However, limited collective information exists about the services provided and the gaps that exist within the healthcare system. This study aims to explore the medical services available at various facilities and to compare patient demographics, health behaviors, obstacles in accessing medical attention, transportation details, and healthcare experience. A checklist was used to gather information about available services at three hospitals, fourteen MOH centers, two TGH brigade sites, and five miscellaneous providers. Patient interviews were conducted in Spanish with 28 patients in MOH facilities and 75 patients at brigade sites. The MOH facilities act as the permanent presence for healthcare but patient obstacles to seek care still exist. TGH brigades serve to overcome transportation-related obstacles by working directly in communities and allowing patients to walk and to travel less time to reach care. Medications were the number one patient motivator for choosing brigade care instead of an alternative facility. Collaboration between the MOH and TGH is essential to best attend to patient needs. Brigade focus should be put on rural communities distanced from an MOH facility that face the greatest obstacles in seeking care. The role of brigades as a medication dispenser calls for future work to better understand its effect on patients.

“I spent three weeks in Ministry of Health (MOH) centers, where I interviewed 28 patients to gather information about demographics, health behaviors, transportation methods, travel times, and level of satisfaction with the experience in the given facility.”


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: Katherine Kralievits  MS '14
Degree and Year: Mathematics and Spanish
University of Notre Dame, 2013

Capstone Project:  Cost analysis and qualitative assessment of the Catholic Medical Mission Board’s “Taking Care in the First 1,000 Days” Program in Trujillo, Peru

kralievits

Abstract:  Iron deficiency anemia is a severe public health problem that affects over 50% of children under 5 years of age and nearly half of pregnant women and adolescents in Peru. Iron supplementation has been identified as an efficient public health intervention; however, implementing anemia reduction programs that include both micronutrient supplementation and education components will yield more sustainable results.  The goal of this study was to perform an assessment of Catholic Medical Mission Board’s “Taking Care in the First 1,000 Days” program.  The objectives were to 1) evaluate the reduction in anemia prevalence among a sample population of those enrolled in the “Taking Care in the First 1,000 Days” program, 2) determine the number of children and pregnant women recovered from anemia among this sample population, and 3) estimate the total cost required to reduce anemia among this population of children 6-35 months and pregnant women in Trujillo, Peru.  Using the estimated total cost and health outcome data, the cost per participant recovered from anemia was calculated. When excluding costs for the participants who withdrew from the program, the cost per participant recovered from anemia was S/. 521 PEN ($186.54 USD) per child between 6 and 35 months and S/. 311 PEN ($111.35 USD) per pregnant woman.  The cost analysis was supplemented with in-depth interviews with participating mothers and pregnant women to better understand their perceptions, challenges, and barriers while enrolled in the program. Using the data collected, several recommendations for future program improvements were made.

“This rewarding field research experience through the University of Notre Dame and the Catholic Medical Mission Board in Peru allowed me to develop a specialized skillset that I will able to use in my future career in global health.”


Name: Marcos Marugan-Wyatt  MS '14
Degree and Year: Biology and Anthropology
University of Notre Dame, 2013

Capstone Project:  Assessment of clinical infrastructure and resource availability for antibiotic resistance testing, treatment, and prevention in Quito, Ecuador

marugan_wyatt

Abstract:  In the last few decades, antibiotic resistance in bacteria has increased at an alarming rate. The situation has quickly escalated from bacteria resistant to one or two treatment options to those that are resistant to all known forms of antibiotics. This is not merely a problem localized to a specific country; instead it is quickly becoming a global crisis. No one is more likely to be feeling the burden of this issue than the underdeveloped nations in which resources and clinical infrastructure necessary for early detection and treatment are not on par with those of the more developed countries. This research aimed to specifically study antibiotic use and resistance in southern Quito, Ecuador. The goal was to do an initial assessment of the current state of antibiotic resistance in the area, followed by the administering of surveys to better understand the public’s awareness and knowledge with regards to this growing problem. The findings of this research indicated a strong need for the implementation of educational programs aimed at teaching correct antibiotic use, regulations directed at controlling the over the counter administration of antibiotics by pharmacies, and campaigns against self-medication.

“My results were interesting, indicating that antibiotic resistance is a large, ongoing, and growing problem in southern Quito, Ecuador, that lack of antibiotic distribution control, a medical culture of self-medication, and deficient public awareness of antibiotic use and antibiotic resistance are among the main factors at fault.”


Name: Cesar Padilla  MS '14
Degree and Year: Biology
California State University- LA, 2012

Capstone Project:  Social determinants of intent to perform oral hygiene behavior in rural Dominican Republic

padilla

Abstract:  The goal of the study was to identify the psychosocial determinants of oral hygiene behavior centered on the theory of planned behavior in rural Dominican Republic. The cross sectional study included 150 participants. Participants completed a voluntary, 54 question, culturally adapted survey which included both demographic and oral health questions. Correlation and regression analyses were used to determine variable associations and construct a model determining the intent to perform the minimum recommended oral hygiene behavior. The statistically significant model of intent to perform oral hygiene behavior accounted for 58.8% of the variance (p<0.005). Perceived behavioral control and attitude were identified as the statistically significant social determinants of the intention to perform minimum oral hygiene behavior (p<0.05). This study further stresses the need to identify the social determinants of oral health behavior in order to create evidence-based interventions. In the case of rural Dominican Republic, oral health interventions need to be targeted at changing individuals attitudes and perception of their care in regards to ideal oral hygiene behavior.

“In the case of rural Dominican Republic, oral health interventions need to be targeted at changing individuals’ attitudes and perceptions of their care in regards to ideal oral hygiene behavior.”


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: Shereen Shojaat  MS '14
Degree and Year: Kinesiology and Health
Iowa State University, 2013

Capstone Project:  A health needs assessment at Basile Moreau School in Carrefour, Port-au-Prince, Haiti

shojaat

Abstract:  Environmental factors, food insecurities, poverty, political unrest, and natural disasters influence the health of Haitians, particularly children. A school setting as a health intervention site can be effective, due to high accessibility and enrollment rates of children in Haiti. To determine the health needs of the Basile Moreau School student population in Port-au-Prince Haiti, this study investigated the need for improving school-based health and health services for children attending the school through key informant interviews, observation, and a parent survey. Results suggest the need for addressing health-related issues at Basile Moreau School. Overall, our recommendation includes a coordinated school health approach consisting of eight core components, developed by the Centers for Disease Control, as an efficient and practical strategy for improving the health of students at Basile Moreau School. All component recommendations propose comprehensive program strategies, which extend beyond an onsite school healthcare facility. This approach may not only influence improved health outcomes for students at Basile Moreau, but has the potential to become a sustainable model for schools throughout Haiti.  

“I will use all the knowledge and skills I gained through this work and apply it in my future career in global health, as well as life outside of my career.”


Name: Andrew Taniguchi  MS '14
Degree and Year: Preprofessional Studies
University of Notre Dame, 2013

Capstone Project:  Recovery of leishmania promastigotes from infected sandflies: A study in phlebotomine artificial blood feeding

taniguchi

Abstract:  Leishmaniasis is a disease caused by the trypanosomatid parasite Leishmania and manifests itself in a variety of symptoms from cutaneous ulcers to degradation of mucosal areas, and is fatal in certain cases when left untreated. It is a neglected tropical disease that continues to be a burden for many countries because of the limited amount of diagnostic tools and complex treatments with severe side effects. The parasite causing the disease features a digenic lifecycle and requires the sand fly as an essential intermediary host and vector to continue propagating. This project explores the methods used for infecting Phlebotomus papatasi, Lutzomyia verrucarum, and Lutzomyia peruensis sandflies with Leishmania promastigotes. The sand fly infections with Leishmania major and Leishmania peruviana were accomplished via artificial membrane feeding procedures using a variety of animal skin membranes, and both human and mouse blood to mimic conditions in which natural infections are transmitted.  Detailed instructions on how to prepare membranes, blood meals, and dissections are outlined for successful recovery of motile promastigotes from infected sandflies and their subsequent re-culture for future molecular assays of Leishmania promastigotes. These protozoa contain a sophisticated signaling cascade system of phosphorylated proteins to transduce environmental signals. It is because of these signaling transductions that Leishmania are able to respond to stress and adapt to their environments in order to survive. Future experiments aimed at extracting these phosphorylated proteins, and identifying the associated kinases, phosphatases, and their downstream targets represent new avenues for the discovery of novel drug targets and therapies designed to mitigate the signaling pathways of Leishmania, effectively haling the lifecycle of Leishmania and/or preventing clinical disease from manifesting itself in treated hosts or vectors.

“This was a phenomenal opportunity to establish collaboration between the University of Notre Dame and NAMRU-6 and an immersion into a wonderful culture and group of people.”


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

Capstone Project:  Post-project sustainability study of the Child Health Opportunities Integrated with Community Empowerment (CHOICE) Project, Indonesia: correlations between cognitive and physical development and infant nutrition

tracy

Abstract:  Post-project sustainability studies allow for an analysis of the outcomes and the long-term benefits of a development programs. In this study Project Concern International’s (PCI) Child Health Opportunities Integrated with Community Engagement (CHOICE) program is evaluated seven years after its completion for its long term affects on children’s cognitive development. A survey of CATCH indicators was utilized along with an infant development checklist and the Raven’s Coloured

Progressive Matrices for data collection. Two populations (0-2 year olds and 8-10 year olds) were evaluated in order to look at the effects the CHOICE program had on development both from when the program was run and its lasting effects on the current population. The development of 0-2 year olds and 8-10 year olds was modeled using general linear modeling and analyzed based on different areas affected by CHOICE program activities in particular children’s nutrition and physical growth. While there were no overall significant differences found between CHOICE villages and control villages due to treatment, trends in the data suggest that CHOICE villages performed better on the development tests compared to control villages as well as on many of the outcome indicators the CHOICE program aimed to improve. Based on this analysis the CHOICE program activities related to nutrition, hygiene and maternal knowledge made an impact on the community, which was sustained seven years later. Based on the research presented in this paper development programs that aim to improve the nutritional status of mothers and children can have long-term positive effects on children’s cognitive development.

“My specific portion of this study was focused on one of the long-term aspects of nutrition and health improvement programs – cognitive development.”


Name: Thomas Ulsby  MS '14
Degree and Year: Biology
Gustuvus Adolphus College, 2012

Capstone Project:  The impact of globalization on nutrition, KAP, and health of type II diabetics at Dr. Mohan’s Diabetes Specialties Center

ulsby

Abstract:  Diabetes is now considered a global pandemic showing particularly severe effects in low and middle-income populations. Although all populations are affected, depending on a person’s genetic background, family history, health, and behavior, the susceptibly for the disease may rise or fall. Health, behavior, and knowledge impact the attention a person will devote to health challenges and changes in their life which may in turn be impacted by globalization. The current study aimed to investigate if rural-urban differences in these variables impact the spread of Diabetes Mellitus in India via the carrying out a comparative case study in two Indian population settings. The project investigated differences in 24 hour nutrition recall and Knowledge, Attitudes, and Practices (KAP) of type II diabetic patients from Dr. Mohan’s Diabetes Specialties Center at Gopalapuram, Chennai, Tamil Nadu (located in a major Indian urban setting) with Chunampet, Kanchipuram, Tamil Nadu (located in a more rural setting). 225 outpatients were surveyed in total (110 from Gopalapuram and 115 from Chunampet). 15 survey respondents (5 from Gopalapuram and 10 from Chunampet) were then interviewed to provide contextualization for the trends represented in the summarized survey. Respondent answers were scored by variable, analyzed, and summarized.  Differences in nutrition and knowledge scores were found between the study populations (< 0.05 = 95%). Nutrition and knowledge scores produced negative regressions when controlling for location (< 0.05 = 95%), suggesting that rural variables reduce nutrition and knowledge scores of diabetic patients. However, even with these differences diabetes, is still prevalent in both locations. Globalization may be influencing the opportunities of type II diabetes patients for practicing good nutrition and health. As interactions between urban and rural centers grow, the spread of more urban and non-communicable health problems will also spread into the rural environments. As this research shows, current differences in nutrition and knowledge between urban and rural centers may indicate an association with the presence of a disease and poor care experienced by rural patients. However, despite this finding, the fact that diabetes is still highly prevalent among the urban subjects indicates that other factors may need to be evaluated to explain the observed disease variability.  Health behavior models, Integral Human Development, and economic growth may help explain why these differences were observed and what can be done to change the epidemic.

“It has been a rewarding experience and I have felt extremely blessed to be here among such great researchers and doctors. Thank you for your help, guidance, hospitality, and care.”


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.”