Capstone Projects - Class of 2017 // Eck Institute for Global Health // University of Notre Dame

Eck Institute for Global Health

Capstone Projects - Class of 2017

Name:  Victoria Alexander

Capstone Project:  Establishment of a sample repository and molecular investigation of antibiotic-resistant bacterial isolates obtained from Hesburgh Hospital, Santo Domingo, Ecuador

Abstract:  Antibiotic resistance (ABR) has been universally recognized as one of society’s most important health concerns. As the threat continues to grow, the need for improved surveillance and assessment becomes increasingly vital. Resistant bacterial species create a high burden, which is compounded by the necessity for newer, more expensive, and more effective drugs. As a result, the use and benefit of such pharmaceutical compounds is restricted to areas of high wealth with the capacity to afford and administer them. Previously, Hesburgh Hospital in Santo Domingo, Ecuador had established protocol to collect patient samples, isolate bacterial species, and test for resistance to known pharmaceutical compounds. Preliminary data obtained using plate-based antibiogram methods demonstrated the widespread presence of ABR species. However, no further investigations have been conducted. This project aimed to establish a repository of resistant bacterial isolates to be stored for molecular testing. Additionally, it implemented functional protocol for analysis of β-lactamase genes using polymerase chain reaction (PCR) and visualization of isolated genes, with long-term goals of genotyping isolated DNA and creating a comprehensive profile of the ABR strains present in and around Santo Domingo. TEM type β-lactamases were found to be the most common. No statistically significant relationships were found between the TEM gene and bacterial species or between the gene and origin of the isolate. Other resistance genes observed were SHV, CTX-M1, and CTX-M9. Ampicillin resistance was observed in all isolates, as was carbapenem sensitivity. Penicillin and cephalosporin antibiotics, as well as tetracycline, exhibited the greatest proportions of resistance. Resistance to cephalosporins can potentially be attributed to β-lactamases of the CTX-M family. There is likely a link between resistance to the antibiotics aztreonam and cefepime. Continued surveillance of resistance genes and associated antibiogram data is necessary for confirmation of these trends. Future studies may include an epidemiological analysis of the origin of each β-lactamase resistant isolate and the application of protocol to other resistance genes. Dissemination of the protocol and results will allow researchers and health professionals to identify more efficacious treatment methods and tailor treatment provided to afflicted patients around the globe.




Name:  Joshua Anderson

Capstone Project:  Knowledge, Attitude, and Practice of Leishmaniasis in Districts of Amhara Region, Ethiopia

Abstract:  Leishmaniasis, a disease that is found only in the most impoverished communities on earth, is an endemic problem in Ethiopia. Specifically in Amhara Region, availability of data is insufficient to plan for efficient and cost effective leishmaniasis control (Gadisa et al., 2015). A knowledge, attitudes, and practices (KAP) study was performed to fill knowledge gaps and add valuable information in the effort to combat visceral and cutaneous leishmaniasis. Questionnaires were comprised of 28 questions total including questions involving socio-demographic characteristic and three KAP categories, vector knowledge, visceral leishmaniasis (VL) and cutaneous leishmaniasis (CL) disease knowledge, and VL/CL attitudes and practices. Questionnaires were distributed and collected in six different localities throughout Amhara Region, Ethiopia. Two lowland VL endemic localities, one highland VL endemic locality, and 3 highland CL endemic localities were chosen. Questions identified as gradable were categorized as correct (1) or incorrect (0). Gradable questions were categorized into the three KAP categories excluding socio-demographic characteristics. Three variables, VL/CL locality endemicity, migrant/non-migrant status, and educated/uneducated status were independent variables analyzed with respect to the KAP categories. Weighted data was compiled and Fisher’s exact tests were performed between data from each KAP category and independent variable. Odds ratios were then run to differentiate likeliness to correctly answer questions within independent variables subgroups. All independent variable subgroups recorded over 50% correct answers within VL/CL disease knowledge and VL/CL attitudes and practices. Only migrants and those living in VL endemic localities recorded above 50% correct answers in the vector knowledge category. Results vary, however, trends suggest those living in VL endemic localities, migrants, and those who are educated are more likely to answer KAP questions correctly.




Name:  Danielle Aragon

Capstone Project:  Mental Health Care Utilization Among People Living with HIV

Abstract:  With advanced antiretroviral therapy, people living with HIV (PLWH) are able to live long, healthy lives, but their ability to cope and keep up with day-to-day activities can be impeded by mental illness. While there are mental health care services available for PLWH, they are not always utilized. This study examines mental health care for PLWH in Northern Indiana, specifically clients served by AIDS Ministries-AIDS Assist (AMAA) of North Indiana. With Indiana ranked as the 47th best state for mental health and noted as one of the most highly HIV infected states in the Midwest, there is a need for more knowledge in this area (MHA, 2017). The following study is a cross sectional study, combining a quantitative analysis of data collected by AMAA and field notes collected by the primary researcher during shadowing of an AMAA care coordinator. The study identifies a significant relationship between viral load and mental health, differences in health care utilization between MSM and non-MSM males and discrepancies among different demographics.




Name:  Madison Bailey

Capstone Project:  Assessing Perceptions of Spatial Repellent Acceptability and Use in Iquitos, Peru

Abstract:  CONTEXT AND RATIONALE. Dengue and Zika are mosquito-transmitted viral diseases, with dengue being endemic to Peru. Dengue and Zika control methods are largely dependent on control of the vector Ae. aegypti.  Past vector control and eradication campaigns have largely failed, leading Ae. aegypti mosquitoes to flourish. Due to insecticide resistance, spatial repellents are becoming more accepted as a use of vector control and, therefore, disease control.

OBJECTIVES. The aim of this study is to understand community perceptions of spatial repellents in order to evaluate acceptability of spatial repellents as a vector control strategy.

DESIGN AND METHODS. A survey consisting of closed and open-ended questions was conducted in Iquitos, Peru to measure residents’ perceptions of spatial repellent health values. The survey was conducted using an Android tablet every weekday between April 27-June 15, with an average of 30 surveys being completed each day. Descriptive statistics were generated to determine perceptions of spatial repellent health value. Chi-square analysis was performed to determine association among independent and dependent variables. Lastly, a logistic regression model was performed to determine odds ratios.

RESULTS. A total of 980 people were surveyed. Males were more likely to pay for repellents than females, while women were 33% less likely to notice an increase in mosquito biting rate than men. Those who perceived a decrease in mosquito biting rate were more likely to pay for and recommend the repellent product under evaluation.

CONCLUSION. Because successful vector control relies on community engagement and acceptance, the results of this study provide insight into factors that will guide successful implementation of spatial repellents as a vector control strategy.





Name:  Jonah Barreto

Capstone Project:  Estimating Time-Varying Effects of Spatial Repellents on Aedes aegypti Behavior and Bionomics in Rural Thailand

Abstract:  Background. Dengue virus has been an increasing threat to human health throughout the world. Today, the most widely used intervention is lethal vector control. Some have called for an expansion of tools outside the use of insecticides to overcome the burden of dengue, especially in endemic areas such as Thailand. Spatial repellents have been increasingly studied for their effectiveness, but more research is necessary to understand specific properties, especially research that considers the decay of spatial repellent effects over time.

Methods/Results. To more accurately estimate the effects of spatial repellents on mosquito behavior under a rural Thai-style houses setting, a mark-release-recapture experiment was conducted using experimental huts. Female Aedes aegypti were monitored for exiting behavior and knockdown in the presence of a decaying spatial repellent product. A random effects model was developed and fitted to the observed data, and inferences about the effect of the product on mosquitoes were equivocal due to extensive day-to-day variability in mosquito behavior.

Conclusions. Mosquito exit behavior is extremely variable by day, and larger evaluations with alternative models will likely be needed in future studies to better understand the effects of spatial repellent in the presence of extensive natural variability under different environmental conditions.





Name:  Carson Bogatto

Capstone Project:  An Examination of the Soil-Transmitted Helminth Burden in Children in the Napo Province of Ecuador

Abstract:  The prevalence of soil-transmitted helminth (STH) infections was assessed in four rural communities in the Napo Province of Ecuador in May and June 2017. These four communities had access to a safe water source due to Timmy Global Health’s Safe Water Initiative. The parents of 125 children, 10 years of age and younger, answered survey questions about various demographic, behavioral, and environmental factors that could be associated with the presence of an STH infection. Fifty-four of the 125 children provided fecal samples that were tested for the presence of STH eggs by the Kato-Katz method. Thirty-one (57.4%) children who submitted a fecal sample had an STH infection. Twenty-eight (51.9%) children were infected by Ascaris lumbricoides, and 15 (27.8%) children were infected by Trichuris trichiura. Multiple logistic regression analysis of the risk factor data collected through the questionnaire showed an increase in the odds of having an STH infection for males and for children in larger families, but interestingly there was not a significant change in the odds of having an STH infection between water sources such as the river and Timmy Global Health’s safe water source. The results of this study may have implications for programs and initiatives implemented by Timmy Global Health in these communities in the future.




Name:  Rosalie DePaola

Capstone Project:  Evaluation of the Feasibility, Acceptability, and Safety of Policies and Procedures During Albendazole Distribution for Preschool-Aged Children

Abstract:  Soil-transmitted helminthiases (STH) have a detrimental health impact on preschool-aged children. The World Health Organization (WHO) recommends periodic mass deworming with albendazole in endemic areas to reduce STH burden. The WHO recommends crushing albendazole tablets to reduce risk of choking in children less than three years old.  However, Vitamin Angels (VA) has implemented a different deworming policy; they require crushing all tablets for children less than 59 months of age. The goals of this project are to assess current practices in delivery of albendazole to determine how they compare with VA’s recommended best practices, the VA approach, and to provide recommendations to improve feasibility, acceptability, and safety of albendazole distributions. Using observational checklists, children receiving albendazole and service providers administering the tablets were evaluated; 513 children were observed. This evaluation found that 14.4% of children experienced an adverse event and two children (0.4%) choked. Risk factors for adverse events were young age, fussy or upset demeanor of the child, and providing water with the crushed tablet. Under-dosing also seems to be common in two-year-old children. While the VA approach does not result in decreased risk of adverse events overall, it is recommended that service providers use the VA approach of crushing the tablet for all children less than five years old because it offers significant advantages over the non-VA approach, including correct form and better infection control methods.




Name:  Danika Dorelien

Capstone Project:  Evaluation of Breast and Cervical Cancer Awareness Program in Port-au-Prince, Haiti: A Mixed Method Analysis

Abstract:  Breast and cervical cancer are the leading causes of cancer and cancer mortality for women in Haiti. In Haiti, the lack of financial capital and healthcare infrastructure have proven to be major barriers in implementing comprehensive cancer control on a national level. Thus, creating an absence of wide spread prevention, population based screening, early diagnosis, treatment and palliative care. In response to this critical problem, Innovating Health International has implemented a cancer awareness and engagement program as well as a cervical cancer screening program. This study utilized a mixed method analysis to assess the impact of the awareness program on women’s knowledge of the causes and symptoms of breast and cervical cancer. This program assessment identified increases in participants’ awareness of the risk factors for breast and cervical cancer, changes in perception of cancer and remaining gaps in knowledge. Additionally, given the lack of evidence based data on the prevalence of cervical cancer in Haiti, the clinical data from the cervical cancer screenings was used to describe the incidence of cervical intraepithelial dysplasia within the sample of women screened from October 2016 to April 2017. This was discovered to be an overall rate of 8.8%.




Name:  Emma Forrest

Capstone Project:  Optimization of a Novel RNAi Arbovirus Control Strategy in Belize

Abstract:  CONTEXT AND RATIONALE. This research is designed to optimize the implementation of an RNAi larvicide in Belize as a novel vector control strategy.

OBJECTIVES. The study is made up of an entomological component and a social science component. The entomological component was designed to test the efficacy of a larviciding technique, using an RNAi strategy with Saccharomyces cerevisiae (baker’s yeast) as the carrier organism. The study tested the question: will the presence of yeast be an attractant to gravid Aedes aegypti? This was determined by counting eggs laid in each container. The social science component is an interview designed to assess the knowledge, attitudes and practices of adult residents of August Pine Ridge, Belize.

DESIGN AND METHODS.  The baseline entomological study was conducted in laboratory settings at the University of Notre Dame. The main entomology study was performed at the Belize Vector & Ecology Center in semi-field conditions. Ae. aegypti female mosquito cohorts of (n=750, n=800) were released in a netted enclosure (82x58x61 in) with eight oviposition cups of distilled water, and eight cups with water and yeast. They were allowed five days to lay eggs. The social science component consisted of door-to-door interviews in 45 households in August Pine Ridge, Belize. The study design was knowledge, attitudes and practices (KAP) interview in relation to mosquitoes, arboviruses, vector ecology and vector control.

RESULTS. For the baseline study, in a one-way ANOVA, there was a 0.423 p-value for Day 1 Egg Count and a 0.698 p-value for Day 2 Egg Count for Box 1. Therefore, we fail to reject the null hypothesis (p-value > 0.05). For the entomological trial 1, there was significant difference in the mean number of eggs laid in the control group versus the treatment group with a (p-value =0.000083) with 95% Confidence Interval (CI). For trial 2, there was a significant difference in the mean number of eggs laid in the control group compared to the yeast group (p=0.000140), with a 95% CI. We reject the null hypothesis

CONCLUSION. This research could provide insight for future studies to assess the use of an RNAi yeast larviciding technique. While this study showed that there was a significant preference in Aedes aegypti females for distilled water compared to yeast, more studies should be done to assess efficacy in field conditions. Further research on social components and attitudes should also be performed.





Name:  Katherine Ginsbach

Capstone Project:  International Frameworks and Domestic Regulations: An Evaluation of Pandemic Influenza Vaccines and their Uptake in Viet Nam

Abstract:  In 2006, Indonesia, withheld a deadly flu virus sample in order to draw attention to the inequalities embedded in global virus sharing and vaccine development networks. Indonesia had no obligation to share under international law. Currently the global health community is in the position of having to rely on individual nations to do what they believe is right when it comes to many issues of global health, including virus sharing. This may result in states acting solely in their own best interests, which may conflict with the overall goals of the global health effort, including protecting the world’s population in times of a pandemic or other health crisis.  As a first step to address the issue with respect to vaccines, a non-binding framework, the Pandemic Influenza Preparedness (PIP) Framework was created by the World Health Organization and Member States, to put virus sharing and reciprocal benefits on a more equal footing. Yet, other obstacles exist with respect to the delivery of vaccines across the globe.  For example, Viet Nam, due to its own import laws, is unlikely to benefit from vaccines developed during the time of a pandemic, even though it shares 30-50 virus samples with the Global Influenza Surveillance and Response System each year. This study explores the space between the international frameworks developed by the WHO and domestic regulations in Viet Nam. The methodology of this study was a multi-sited qualitative research design in Viet Nam and Geneva. The research began in Viet Nam where I conducted observations and interviews. I augmented these country-level investigations with an examination of international responses to emerging flu outbreaks, drawing on interviews with staff from the WHO. The findings indicate that better communication needs to happen across sectors; public and private, national and international, and non-state actors and state actors. The WHO needs to take a more commanding role in enforcing regulations. The loss of life during a future pandemic could be prevented or lessened with the pro-active adoption of agreements that are enforceable under international law.




Name:  Xander Jacobson

Capstone Project:  The Utility of Exosomes as Diagnostic Biomarkers for Visceral Leishmaniasis

Abstract:  Leishmaniasis is a Neglected Tropical Disease (NTD) caused by the Leishmania parasite throughout the tropical and subtropical regions of the globe. Visceral leishmaniasis (VL), the second most common form of leishmaniasis, manifest with the clinical symptoms of fever, weight loss, hepatosplenomegaly, pancytopenia, and possibly, death. Within Ethiopia, Leishmania donovani is responsible for the majority of the VL cases. In this study, a proteome was established for exosomes isolated and purified from a human THP-1 macrophage cell line infected with L. donovani. The background proteome has been analyzed for potential proteins unique to the L. donovani infection. Additionally, following the isolation and purification of exosomes from the serum of L. donovani infected VL patients, the exosome content will be determined and analyzed for the identification of potential diagnostic proteins.




Name:  Amber Johnson

Capstone Project:  Knowledge, Attitudes, and Practices (KAP) Survey of Outdoor Malaria Transmission and Interventions in Zambia

Abstract:  In southern Zambia, malaria elimination and control strategies are seeing success. However, despite high bed net use and coverage, malaria cases are still reported. These communities spend significant time after nightfall in open-sided outdoor cooking shelters when mosquitoes are active, putting them at risk of transmission not prevented by indoor interventions and highlighting the need for outdoor protection.  A survey was conducted in Macha, Southern Zambia to capture the knowledge, attitudes, and practices of local populations related to malaria, and how these influence intervention strategies and perceptions of transmission.  Pictures of three insecticide-treated kitchen screening prototypes, fitted screens, curtains or barriers set around such structures, were shown to participants to determine acceptability.  A semi-field system study evaluating the efficacy of these prototypes was also conducted.  The screening types did not have a significant effect on disrupting transmission or delayed kill.  Of the participants interviewed, 69.5% correctly reported a mosquito as the vector for malaria. Outdoor exposure is believed to be a problem by 73.9%. All participants believed screening kitchens would be beneficial, but only 63% could afford to purchase them. The fitted screens were the preferred prototype.  In the future, if data suggesting such screening methods are significantly beneficial and are envisioned to tackle outdoor transmission, ways to reduce or subsidize their cost must be investigated.




Name:  James Kernell

Capstone Project:  Evaluation of the Feasibility, Acceptability, and Safety of Policies and Procedures During Albendazole Distribution for Preschool-Aged Children

Abstract:  This evaluation assessed the acceptability, safety, and feasibility of the policies of the organization Vitamin Angels (VA) regarding the mass drug administration of the anthelminthic drug albendazole. The researchers observed 722 distribution events divided between 3 partner organizations at 25 sites throughout India. Data were collected on each albendazole distribution, the setting, and the practices of each service provider. The sites were categorized as to whether they followed VA’s recommendations for albendazole distribution including crushing the albendazole tablets for all children. Organizations following the VA policies were nearly 65 times more likely to follow the World Health Organization’s recommendation to crush tablets for all children under 3 years of age. Overall, incorrect dosing, similar for both VA and non-VA affiliated sites, was more prevalent for children ages 1 and 2 (9.5%) than for older children (0.6%). Adverse swallowing events were observed in 208 (28.8%) children including 14 with choking. Factors independently associated with adverse swallowing events included administration of crushed tablets (RR = 4.12), age < 3 years (RR = 5.19), and child combativeness (OR = 15.644). Organizations following the VA recommendations had better infection prevention practices than organizations not following the recommendations. The results highlight the benefits of VA recommendations for ensuring that tablets are crushed for children <3 years of age and for improved infection control. Additional attention is warranted to ensure correct dosing for children 1-2 years of age. Crushing tablets was associated with a greater risk of adverse swallowing events. However, other evidence indicates that crushing reduces the risk of choking-related mortality and therefore should continue to be practiced.




Name:  Corin Kim

Capstone Project:  Identifying Opportunities and Barriers of Implementing a Web-Based Health Intervention Among Waimānalo Residents in Hawaiʻi

Abstract:  A disproportionate burden of diabetes can be seen in the state of Hawai‘i, where people of Native Hawaiian, Japanese, and Filipino ancestries are two times more likely to have type 2 diabetes when compared to Caucasians. In order to address some of the health inequity in Hawai‘i, the non-profit Ke Ola Mamo is planning to implement a web-based intervention of their existing Partnership for Improving Lifestyle Intervention (PILI) ʻOhana curriculum, targeting weight loss for Native Hawaiians. This study used surveys and interviews to identify barriers, opportunities, and opinions of Waimānalo, Hawaiʻi residents towards a web-based intervention. The study included participants who had previously participated in a health intervention as well as those who had not. Survey and interview responses showed a strong desire for an in-person intervention, although the convenience of a web-based intervention was viewed as a strong positive aspect. A comprehensive understanding of participant responses was used to explain barriers and opinions of Waimānalo residents as well as compile a list of recommendations as Ke Ola Mamo moves forward with the web-based platform implementation.




Name:  Christopher Knaub

Capstone Project:  Combatting T. cruzi and Triatomines Through Drug Repurposing

Abstract:  Chagas disease is caused by the Trypanosoma cruzi parasite and it is very prevalent in Central and South America. A combination of both vector control and chemotherapies is an effective strategy to combat the issue. Currently there is not an affordable and accessible chemotherapy with mild side effects to treat the disease. A promising way to avoid the complications that arise from developing new treatments is through drug repurposing. This study found that Ivermectin and Miltefosine can be repurposed to effectively combat Chagas disease. While Miltefosine focuses on killing the parasite, Ivermectin is geared towards combatting Triatoma dimidiata. This study also gained information regarding the knowledge, attitudes, and practices of Chagas disease in rural villages of Belize, so that new vector control strategies can be implemented. Since both drugs have been shown to be effective in combatting Chagas disease in a controlled setting, further research should be performed to evaluate these drugs in a realistic and practical setting.




Name:  Danielle LaFleur

Capstone Project:  A Literature Review: How Can the Community Health Worker Impact Public Health?

Abstract:  The purpose of this literature review is to examine to possible impact community heath works can have on public health issues. The CHW has emerged as one of the most effective strategies to address human resources for health shortages while improving access to and quality of primary healthcare. These individuals generally work with the underserved and are indigenous to the community in which they work-ethnically, linguistically, socioeconomically, and experientially. CHWs are the frontline public health workers who serve as trusted bridged between the community members and health care providers. Among their varied roles, CHWs can educate and support patients in managing their risk factors and diseases and link these patients to needed resources. Implementation of CHWs helps patient medication adherence, increased patient involvement, and reduced health care costs. By implementing CHWs directed toward issues of lead exposure in St. Joseph County, communities can become more aware, educated, and healthier about this hazardous health risk. Examination of the literature can increase the basis of knowledge for CHW program sustainability for community organizations striving to reduce public health problems.




Name:  Amber Lalla

Capstone Project:  Exploring The Relationship Between Perceptions of Insecurity on Maternal Well-being and Health: An Ethnographic Approach

Abstract:  In refugee settings, the political economy of insecurity exacerbates the high stress environment for displaced residents. Women refugees, in particular, endure high conditions of external threat of sexual and gender-based violence (SGBV), which, in turn, creates an overarching social stressor that potentially contributes to adverse medical and future reproductive health outcomes.  The goal of this study was to better understand the broader implications of high stress and insecure environments on maternal wellbeing and health, particularly in the context of Somali and Oromo women living in Kakuma Refugee Camp. Though quantitative surveys and ethnographic analysis, the results of the study revealed that perception of insecurity is positively correlated with both heart rate and body fat percentage (BPF). These results suggest that through access to the commercial economy, insecurity contributes to the epidemiological transition within an encamped refugee setting. It is proposed that these relationships are mediated by higher stress that, in turn, increases coping through communal meal sharing, giving refugee women a sense of normalcy and dignity through access to calorie dense, non-rationed food and drinks. Additionally, increased body fat may further perpetuate this cycle and create more insecurity, as women are perceived as wealthy from the host community. Due to the increasing rates of displaced persons worldwide and increasing births occurring in refugee camps, the results of this study may be used to showcase the importance of providing a secure environment for women in refugee settings in order to foster a healthy environment for women and their children.




Name:  Paulina Luna

Capstone Project:  Using Photovoice for Evaluation of a Support Group Program for Caregivers of Children with Disabilities in Peru

Abstract:  Disability is a growing public health problem worldwide (WHO, 2011). In particular, childhood disabilities are becoming more prevalent, posing public health concerns because they hinder the education, social inclusion, health, and economic progress of affected children. The literature also indicates that disability affects the health of parents of children with disabilities. Yet, little attention has been given to how those parents experience disability as caregivers. This study explored how parents of children with disabilities from low socioeconomic backgrounds perceive stigma in two communities in Peru. The methodology utilized in this study was photovoice, a community-based participatory research method that invites community members to describe and explain their experiences through photography and focus group discussions. The findings indicate that parents perceive stigma as feelings of disdain towards their children and as judgment and blame for their children’s disabilities by others. This caused parents to become isolated. Parents also felt that what they perceived as stigma resulted from a lack of knowledge on the part of others about disabilities. However, support groups were found to increase parental self-esteem and social support, providing parents with the tools to cope and overcome feeling stigmatized in both communities.




Name:  Alec Maglione

Capstone Project:  Evaluation of the Feasibility, Acceptability, and Safety of Policies and Procedures During Albendazole Distribution for Preschool-Aged Children

Abstract:  The purpose of this evaluation was to assess the feasibility, safety, and acceptability of the policies of the organization Vitamin Angels (VA) regarding the mass drug administration (MDA) of the anthelminthic drug albendazole in Haiti.  The three main aims of the evaluation dealt with correct dose, adverse swallowing events, and infection control.  The evaluator collected data on 942 distributions by 7 organizational partners in 30 different sites, as well as data on the distribution settings and service provider practices.  The sites were categorized as to whether they followed the VA’s recommendations for albendazole distribution, which included crushing the tablets for all children under 5 years of age.  Organizations following the VA guidelines were 4.26 times more likely to follow the World Health Organization’s recommendations for crushing tablets given to children <3 years old and 1.93 times more likely to administer a correct dose.  Adverse swallowing events were observed in 124 (13.2%) of the children.  Factors independently associated with adverse swallowing events included half dose (OR=2.5), caregiver supports child’s head (OR=7.4), child supports his/her own head (OR=3.2), Age 1 year (OR=3.70), Age 3 (OR=2.79), Age 4 (OR=2.36), and child being non-content before administration (OR=9.01).  In addition, children receiving crushed tablets were 5.78 times more likely to experience an adverse swallowing event and 15.25 times more likely to experience a choke.  VA model affiliates were also found to have better infection prevention practices.  These results demonstrate the positive impact that the VA model has on administering the correct dose and increasing infection control.  Interestingly, the data shows that crushing the tablet may actually increase the incidence of adverse swallowing events.  However, it is important to continue further studies on this subject since contrary evidence has shown that crushing can help reduce the incidence.




Name:  Ellyn Milan

Capstone Project:  Mistreatment of women during facility-based childbirth in Dandora, Kenya: a mixed-methods study of the knowledge and perceptions of healthcare providers

Abstract:  Disrespect and abuse during facility-based childbirth are major barriers to accessing quality delivery services for many women. While the actions of healthcare workers have been described, the voices of the healthcare workers are largely missing from the literature regarding the dynamics of disrespectful care in Kenya. The objective of this study was to construct an understanding of the way mistreatment of women during childbirth is perceived, understood, and experienced by healthcare providers in maternity wards that serve the women of Dandora, an informal urban settlement in Nairobi. Both quantitative and qualitative methods were used during in-depth interviews with doctors and midwives currently employed in both public and private maternity wards to analyze the cultural domain of mistreatment. Ethical clearance was obtained from the University of Notre Dame Institutional Review Board and the National Commission for Science, Technology, and Innovation. A total of 37 healthcare workers participated in the studied. Results from the study suggest that healthcare workers not only have knowledge and experiences of mistreatment of women occurring during the intrapartum process, but regard various forms to be acceptable and normalized under certain circumstances. This study is significant because unlike previous studies, it focused on mistreatment as a cultural domain of knowledge held and shared by healthcare workers, and examined how various types of disrespect and abuse are contextualized within that domain. Moving forward, any approach to confront and prevent the occurrence of mistreatment must consider these important social contexts, and further research is needed on how it may be measured and prevented.




Name:  Shova Paudel

Capstone Project:  Retrospective Study of Feto-Infant Mortality in St. Joseph County, IN

Abstract:  Infant Mortality Rate (IMR) is one of the key indicators of the health of a country and, is affected by various factors like maternal characteristics, socio-economic status, access to quality care and health care practices. St. Joseph County, IN has an infant mortality rate that is higher than the state and national averages. A two-year retrospective analysis was done to understand the factors related to high feto-infant mortality in St. Joseph County. The BABIES matrix, a two-dimensional tool, was used for the descriptive study of the newborn health problem. Birth weight proportionate mortality rate and opportunity gap was calculated to find out the potential intervention to reduce feto-infant mortality in the county. High preterm births and low birth weight were identified as major contributing factors of feto-infant deaths in the county indicating poor health status of women before pregnancy. The racial disparity in feto-infant mortality persist with the rate more than four times higher in black than in white population. Mapping of density of feto-infant mortality shows the highest numbers of feto-infant deaths are in census tracts 6, 22, 23 and 34. The potential intervention to reduce feto-infant mortality and racial disparity in the county is the interventions that target to improve health of women before pregnancy.




Name:  Christine Quinones

Capstone Project:  Evaluation of a novel mosquito trapping system based on molecular species identification in Kisumu, Kenya

Abstract:  Mosquito sampling systems have enabled researchers to understand vector bionomics and contribute to the knowledge surrounding the transmission of vector-borne diseases such as malaria. Despite being recognized by the United Nations as a global health priority in the Sustainable Development Goals of 2015, malaria elimination and eradication is hindered by multiple obstacles. Understanding species specific malaria vector bionomic traits is vital for accomplishing this objective. The Host Decoy Trap (HDT) is a novel trapping system designed to incorporate essential sensory stimuli, particularly visual and olfactory attractants, to trap mosquitoes. The trap was successfully tested in Burkina Faso in 2015 but required further testing and evaluation, but in order to further optimize, it must continue to be tested. In May-June 2017, the HDT was evaluated in a three-fold study: comparing two versions of HDTs, HDT-Old and HDT-New, comparing HDTs against the Human Landing Catch (HLC), and conducting an indoor vs. outdoor comparison of two HDT variations and the HLC. Accurate species identification was vital to determining the species composition of the trapped specimens in order to differentiate members of the Anopheles gambiae s.l. complex and correctly identify other Anopheles species. Molecular analytical procedures, species ID polymerase chain reactions (PCRs) and ITS2 and CO1 sequencing, were used in conjunction with morphological identification to provide accurate species identification of trapped specimens. The study found that HLCs, compared to the HDTs, caught the most specimens and remained the most effective method of trapping mosquitoes. Chi-square values indicated that there are significant associations between trapping methods (HDT-Old, HDT-New, and HLC) and based on indoor or outdoor locations. The species composition of the samples based on trapping method supported known vector behaviors. An. gambiae was found to be trapped more frequently indoors than all other species and across all indoor trapping systems (n=120, 71.4%). An. arabiensis was trapped most frequently outdoors over all other species and across all outdoor trapping systems (n=186, 56.4%). By continuing to evaluate and optimize the HDT, it is possible for the system to be effectively comparable to HLCs. Using molecular techniques in conjunction with morphological identification can establish a comprehensive species profile of the study area and assist in optimizing current and future traps to maximize effectiveness.




Name:  Leah Ramaekers

Capstone Project:  Prevalence and Risk Factors for Protozoan Infections in Children from Communities with Access to Safe Water in the Napo Province of Ecuador

Abstract:  Diarrhea caused by waterborne pathogens affects millions of people worldwide. Appropriate access to water, sanitation, and hygiene (WASH) can greatly reduce the risk of transmission of gastrointestinal protozoa such as Giardia spp. and Entamoeba histolytica/E. dispar. Gastrointestinal protozoa are more common in areas with poor access to WASH.  The Napo Province of Ecuador has demonstrated high rates of gastrointestinal illness and no access to safe water. Timmy Global Health partnered with MedWater and implemented a pilot program, the Safe Water Initiative, to provide access to safe water for five rural communities in the region in 2015. In order to understand the prevalence of gastrointestinal protozoa and risk factors for infection, stool samples were collected from children ten and under and risk factors were assessed through short surveys completed by parents in communities with access to safe water. Infections included: Giardia lamblia, Iodamoeba bütschlii, Entamoeba histolytica/E. dispar, Entamoeba hartmanni, and Endolimax nana. This study provides an enhanced understanding of the role of WASH initiatives on parasite prevalence in rural Ecuadorian communities.




Name:  Lilian Ramos Drale

Capstone Project:  Assessing Perceptions of mHealth for Palliative Care Management Among Nursing Students and Tutors at Mulago School of Nursing & Midwifery, Uganda

Abstract:  The aim of this study was to understand the current perceptions of accepting and using mobile health technology from nursing students and tutors of Mulago School of Nursing and Midwifery.  The findings will offer recommendations as to whether a mHealth module must be integrated into the Diploma Palliative Care Curriculum that Mulago School of Nursing Plans to adopt.  This qualitative study utilized focus group discussions and in-depth interviews.  A recruitment script was used to identify participants for the sessions and a focus group guide and in-depth interview guide were used to facilitate interview questions.  Results revealed that all participants had access to mobile technology.  Most of the participants reported that they use their mobile phone for communication and study purposes, primarily to download pdf material.  There were also several concerns with utilizing mHealth technology in rural areas where there is irregular supply of electricity.  Overall, there was very low awareness on mHealth technology.  Explanation of mHealth, demonstration of Palliative Care Association Uganda’s mHealth surveillance app and two mHealth video clips were shown to the participants which helped them understand the scope of mHealth and its capabilities.  Many of the participants recognize the key role technology plays in the future of health care and supported the idea of having a mHealth module included in the palliative care curriculum.




Name:  Aidan Sweeney

Capstone Project:  Establishing a Framework for the Introduction of Genetic-based Mosquito Interventions against Dengue in Thailand

Abstract:  Dengue virus (DENV) is among the most prolific virus in countries of tropical and subtropical regions, and its disease burden is on the rise.  Traditional vector control strategies are dampened by unsustainability, urbanization, the globalization of travel and trade, and the expanding distribution of DENV vectors, Aedes aegypti and Aedes albopictus.  The Release of Insects with Dominant Lethality (RIDL) and Wolbachia-transformed mosquitoes are two new genetic-based (GB) vector control approaches that aim to reduce the burden of dengue by suppression or replacement of wild-type Aedes aegypti populations.  Recently, it has been shown that the implementation and success of these GB approaches are partially contingent upon a populations’ perception of GB approaches.  Here, researchers aimed to (1) investigate a correlation between mosquito burden and the knowledge, attitudes, practices, and perceptions (KAP) of dengue and GB approaches in rural and urban localities of Thailand and to (2) develop a framework for the eventual release of RIDL and Wolbachia-transformed mosquitoes in Thailand. Prokopack aspiration was conducted in association with KAP survey administration across 119 households in Sai Yok and Sam Phran Districts of Thailand. No significant correlation was found between mosquito burden and knowledge of dengue or perceptions on GB techniques. Moreover, based on the perceptions identified here, a framework is offered for the eventual release of GB techniques in Thailand.




Name:  Tiffany Tran

Capstone Project:  The Knowledge, Attitudes, and Practices (KAP) of Health Care Providers (HCPs) on HIV Pre-Exposure Prophylactic (PrEP) Treatment

Abstract:  Although there have been significant advances in antiretroviral treatment and chemoprophylaxis, there is still insufficient implementation of pre-exposure prophylaxis (PrEP) for HIV prevention. Health care providers (HCPs) play a critical role in the implementation of PrEP in a plethora of different health care settings. A quantitative study was performed through a knowledge, attitudes, and practices (KAP) survey for HCPs in St. Joseph County, Indiana. A data analysis was conducted to identify the different variables of KAP and its effects on PrEP.  The study will provide insight about the associations of various barriers and facilitators on PrEP implementation and utilization. The results of this research can provide knowledge about better interventions to improve HIV preventative education and promotion programs in St. Joseph County and to decrease HIV prevalence.




Name:  Megan Wright

Capstone Project:  Health System Factors Influencing Maternal and Newborn Birth Outcomes at Kagadi Hospital in Kagadi, Uganda

Abstract:  The care received before, during, and after birth has a significant impact on delivery outcomes. Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) services are critical to the delivery of quality care to mothers and newborns. Inadequate delivery of CEmONC services can contribute to poor maternal and newborn outcomes, such as high mortality rates. In the year 2015 the Republic of Uganda had a maternal mortality rate of 343 per 100,000 live births and a neonatal mortality rate of 18.7 per 1,000 live births. In this study, the potential contributing factors of mortality among mothers and newborns at Kagadi Hospital were explored. Utilizing a surveillance system known as Birthweight and Age-at-death Boxes for Intervention and Evaluation System (BABIES), birthweight proportionate and birthweight specific mortality rates were examined by comparing vaginal and cesarean section rates for deliveries that occurred in Kagadi Hospital in 2016. Lack of coordinated care, lack of human resources, poor labor progress monitoring, subpar documentation, and insufficient record keeping systems were identified as prospective contributing factors to high mortality rates. As a result of these findings, a corrective action plan, including recommendations and interventions is discussed. Improvements made in any one of these identified lacking areas may lead to a reduction of mortality rates among mothers and newborns in Uganda.




Name:  Cheska Zoleta

Capstone Project:  Entomological Investigation and Geographic Distribution of Simulium spp. Blackflies in relation to Nodding Syndrome in Northern Uganda

Abstract:  Nodding Syndrome (NS) is a neurological disorder that is prevalent in localized foci in northern Uganda, South Sudan, and Tanzania. NS is characterized by atonic epileptic seizures, stunted growth, and cognitive deterioration affecting children ages 3 to 18. There have been several studies that identified a strong association between NS and onchocerciasis endemic regions. Additionally, it has been discovered that NS may be caused by an immune reaction to the parasitic worm, Onchocerca volvulus, which causes onchocerciasis. Therefore, Simulium spp. blackflies, the vector that transmits O. volvulus, may play a key role in the transmission of NS as well. This study was performed in northern Uganda in 2 districts (Lamwo and Kitgum), where NS is present and 2 districts (Moyo and Adjumani) where the disorder is absent to further validate or refute the linkage between NS and Simulium spp. blackflies as an etiological agent for the disease. The blackflies were collected utilizing Esperanza Window Traps placed by rivers, gardens, and animal corrals/grazing lands and then morphologically identified and screened for O. volvulus. Results indicated that there was a significant difference in the median number of blackflies collected in the animal corrals between districts where NS was present versus absent. An ecological niche model created with MaxEnt utilized sites of known blackflies presence in conjunction with environmental data layers to model predictive niches of the vector in a region of northern Uganda. The environmental variables that contributed the most to the model were normalized difference vegetation index (NDVI), land cover, distance from rivers, and annual mean temperature. Furthermore, the predicted high probabilities of Simulium spp. blackflies in this model could potentially be a useful tool in vector surveillance efforts and public health planning for NS and onchocerciasis.