Capstone Projects - Class of 2013 // Eck Institute for Global Health // University of Notre Dame

Eck Institute for Global Health

Capstone Projects - Class of 2013

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


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: Melissa Baranay  MS '13
Degree and Year: Behavioral Neuroscience
Yale University, 2011

Capstone Project:  Polyandry and longevity in Aedes Aegypti: Implications for Dengue transmission and control


Abstract:  Dengue fever is currently the world’s most devastating arbovirus and it is rapidly becoming one of the most far-reaching and impacting diseases.  Its incidence has increased 30 fold in the last quarter century and continues to spread at an alarming rate.  The disease is spread primarily by Aedes aegypti mosquitoes and is a serious, endemic threat in more than 100 countries worldwide.  Due to the lack of effective vaccine protection against dengue viruses, the only available preventative measures lie in the vector realm, specifically control and/or elimination of the vector.  There are several ongoing efforts involving transgenic and sterilized males and females, however, these methods cannot be realized to their full potential until the vector itself is fully understood.  Chiefly among these unknowns are the mating behaviors of female Aedes aegypti and the lifespan of both males and females.  This paper examines the techniques available to analyze the presence or absence of polyandry, multiple mating, in both lab reared and field collected mosquitoes in addition to exploring the longevity of a lab reared strain believed to be longer living than average.  Both of these factors, polyandry and longevity, have the potential to greatly alter the perceived effectiveness of current control methods and may lead to the development of new and more advanced vector control programs.  Through longevity studies of birthing  “granny” mosquitos, DNA extractions, and spermathecae dissections, we showed that the lifespan of both male and female Ae. aegypti is considerable longer than anticipated. This information should greatly improve people’s study of dengue. My study also revealed several new techniques that can be used in the study of polyandry, including the lab methods I used in study. My research may improve the processes of people studying dengue throughout the research community.

“Overall, I had an amazing experience with my project as a whole and with my field placement. Going on field excursions to help on other projects were easily some of my favorite days during my field experience and I will always remember the crazy island roads, secret swimming streams, and critters I encountered along the way!”

Name: Amy Billow  MS '13
Degree and Year: Biology
University of Cincinnati, 2012

Capstone Project:  The impact of the diabetes epidemic in India: Establishing the prevalence and clinical profile of Metabolic Syndrome in Type 1 Diabetes patients in Chennai, India


Abstract:   The lifestyle shift that is taking place in India has introduced type 2 diabetes mellitus (T2DM), obesity and the metabolic syndrome (MS) in epidemic proportions. While the connection between MS and TD2M is well studied, the connection between type 1 diabetes mellitus (T1DM) and MS is less understood. Although lifestyle choices do not influence onset of T1DM, increasing obesity may be a key player in the evolution of insulin resistance and “double diabetes.”  This study sought to establish the prevalence of MS in T1DM and investigate how presence of MS affects prevalence of diabetes complications using a T1DM cohort at Dr. Mohan’s Diabetes Specialty Center in Chennai, India. A retrospective analysis using an electronic medical record system was done on 491 T1DM patients. Relevant clinical and biochemical data from patient first visit was collected and MS was diagnosed according to International Diabetes Federation (IDF) criteria. MS risk factors and macrovascular and microvascular complications data was analyzed for association with MS using t-test, chi-square and logistic regression.

Prevalence of MS was 7.9% overall. MS positive people had longer duration of T1DM, were overweight or obese, showed a family history of DM, showed signs of insulin resistance and had higher cholesterol. Presence of MS was not associated with poor glycemic control.  MS positive patients had higher prevalence of microvascular complications but not macrovascular complications, with a strong association between MS and presence of nephropathy even after adjusting for confounding variables. In general, the prevalence of microvascular but not macrovascular complications rose with number of MS components present. This study has established a baseline prevalence of MS in a T1DM cohort in Southern India. There is a clear association between certain risk factors such as duration of DM and obesity and presence of metabolic syndrome. Presence of MS at first visit increases the odds that patients have microvascular complications such as retinopathy, neuropathy and especially nephropathy at first visit, although further study is needed to determine a causal relationship between presence of MS and development of complications.

“I was able to learn what it takes to carry out a Global Health research project from start to finish. In doing this, I was able to improve upon my knowledge of a particular disease, adjust to cultural differences in a research setting, and improve upon both my analytical and my writing skills.”

Name: Michael Burton Jr.  MS '13
Degree and Year: Psychology and Preprofessional Study
University of Minnesota, 2012

Capstone Project:  Investigating the development and breadth of Quinolone resistance


Abstract:  Quinolones came into existence during the process of designing an antimalarial drug known as chloroquine (Andriole, 2005). A byproduct of this research was the discovery of nalidixic acid. The initial function of nalidixic acid was treatment of urinary tract infections (Dalhoff, 2012). Over time, however, a collection of quinolone antibiotics emerged from this drug. The reliance on the class of Quinolone antibiotics has contributed in part to an emerging trend of antibiotic resistance. The following literature review will explore the evolution of quinolone antibiotics, mechanisms of activity and the various classes of quinolones and derivatives. This launching point will inform a discussion on the rise of antibiotic resistance in quinolone drugs. Included in this discussion are the multiple pathways of resistance employed by numerous bacteria and the rates of resistance in various pathogenic bacterial species. A focal point of this review hinges on analyzing the emergence of quinolone resistance in Neisseria gonorrhoeae. This species, responsible for gonorrhea, has clinical relevance due to its insidious presentation in women, and long-term health consequences for millions of people. Additionally, in acknowledgment of the increasing globalization of the world, developing countries face a disproportionate burden of infection and resistance. Synthesizing the literature on quinolones, quinolone resistance, and Neisseria gonorrhoeae provides global health experts, researchers, physicians and laypeople an overview of a current crisis and its immediate implications. Furthermore, this body of literature heightens alarm over the possibility of an additional super bug in Neisseria gonorrheoe. Through this extensive literary review, I have found that further study of quinolone antibiotics could greatly advance the treatment of Neisseria gonorrheoe. At present though, as antibiotics are developed, communities must better their technology communication to inform the public and health care providers on sexually transmitted disease.

“My time in Ecuador challenged me to reflect on the systemic problems that lead to poor health. The culture enriched my life.”

Name: Brian Bush  MS '13
Degree and Year: Biology
University of Notre Dame, 2012

Capstone Project:  5 year (2008 -2012) retrospective analysis of the National Cancer Patient Registry - Colorectal Cancer Database in Kedah, Perlis, and Seberang Jaya, Malaysia


Abstract:  Assuming the validity of association between economic/human development and colorectal cancer, Malaysia is an especially important country to examine, given its recent developmental trajectory and commitment to development. Given the research demonstrating the lack of awareness among Malaysians about colorectal cancer, disease prevention and benefits of screening/early detection, it behooves both health care providers and the public at large to have accurate and up-to-date information about colorectal cancer on a longitudinal scale. The long-term goals of the research project are to assess colorectal cancer trends retrospectively on a national level. We gathered a population of colorectal cancer patients and determined specific causes of each case and symptoms and signs that can present in the disease. The results of this study suggest that males potentially are at more risk than females. The data does not provide conclusive evidence that any one ethnic group in the states of Kedah, Perlis, and Seberang Jaya are more at risk for colorectal cancer than any other. However the data suggests that age is one of the most significant risk factors associated with colorectal cancer. Ideally, the retrospective data obtained from this project may provide a sound basis for public health officials and heath care workers, as they develop new ways to publically address and treat colorectal cancer in Malaysia

“Conducting research abroad afforded me the chance to make a meaningful contribution to helping a serious health problem, colorectal cancer, in a country of need. Moreover, the independence that I had on this project was a great asset that has helped me to mature as a person and scientist.”

Name: Shannon Cawley  MS '13
Degree and Year: Chemistry and Biochemistry
Western Connecticut State, 2010

Capstone Project:  Helicobacter pylori in Haiti: An initial evaluation of potentially effective diagnostic antigens and health care professionals’ knowledge for use in future public health programs


Abstract:  Helicobacter pylori is a common bacterium that colonizes the gastric mucosa. It has become an important public health issue because of its association with serious diseases like gastric cancer and gastric mucosal-associated lymphoid tissue (MALT) lymphoma. The prevalence of H. pylori is much higher in developing countries, like Haiti, where the socioeconomic conditions are poor. Therefore, reduction of H. pylori prevalence and incidence in Haiti will require many years of work. One essential component of an H. pylori initiative is an affordable and effective diagnostic tool. A serology multiplex assay designed by the Centers for Disease Control (CDC) is one such tool, but it needs to be designed to detect H. pylori specific antibodies. A significant literature review was conducted to identify H. pylori antigens that have the potential to accurately diagnose H. pylori positive individuals. In addition a small group of patients were enrolled in a pilot study to determine their H. pylori status for use in the initial evaluation of the multiplex assay, once it has been developed. It is also critical to evaluate the current clinical practices of local health care providers to ensure that patients are receiving the appropriate care for H. pylori. A pilot study was carried out in order to identify the current status of H. pylori knowledge, attitudes and practices of the local health care professionals in Léogane, Haiti. This research has identified potential diagnostic antigens for future use in H. pylori diagnosis and has identified some of the current gaps that should be addressed if an educational program is developed, so that the people are receiving the best possible care for H. pylori infections. This initial data can be used to aid in the development of larger studies and programs to help reduce the H. pylori prevalence in Haiti. 

“These projects were the initial steps of what will hopefully develop into a larger program focused on developing capacities to reduce the prevalence of H. pylori in Haiti.”

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

Capstone Project:  An assessment of community health promoters in Ecuador’s Napo Province


Abstract:  The purpose of this study is to understand the role of TGH community health promoters in the Napo Province, in order to help TGH choose the best way to run their community health promoter program. TGH’s health promoter program in the Napo Province has never been evaluated before, and this exploratory study can act as a baseline to compare future evaluations of the health promoters and their impact on community health.  Because there is such wide variation in community health programs, there is no standardization or one-size fits all approach to evaluate community health worker programs. For the purposes of studying TGH’s Napo Province health promoters, qualification, outreach engagement, motivation, community recognition, and community perception of community health promoters were chosen as areas of interest by TGH to be examined in order to gain a thorough understanding of the role of a health promoter and possible areas for improvement. Surveys conducted found that while most people could recognize and liked their health promoter, they believed the promoter did not have an overly extensive or useful knowledge of healthcare. This could be solved through a promoter training program, one in which topics of community interest, like alcoholism and family planning, could be given greater attention. I believe this research will help TGH improve the efficiency of their community health promoter program and therefore better health in the Napo Province.

“Community health promoters are members of a community chosen to act as a bridge between the community and health care providers by giving basic health and medical promotion, education, and care to the community.”

ame: Sarah Dawson  MS '13
Degree and Year: Public Health
University of Washington, 2012

Capstone Project:  Centering pregnancy- improving satisfaction and delivery method of prenatal and maternal health care to women in South Bend, Indiana


Abstract:  Health disparities are prevalent among childbearing women in the state of Indiana. Preterm birth and low birth weights also affect minorities and women of low socio-economic status at disproportionate rates when compared to white women of higher income levels. As a means of reducing these disparities, and increasing access to care, the CenteringPregnancy model of group prenatal care has been implemented in the city of South Bend. CenteringPregnancy aims to enhance patient experience through a group setting, offering increased community support and ultimately improving perinatal outcomes. This study examined the patient perceptions of the CenteringPregnancy model and levels of satisfaction associated with the program. Using qualitative and quantitative methods, data was gathered to better understand the patients’ views on the program, as well as analyzed to determine the strengths and weaknesses of CenteringPregnancy and the associated curriculum. In conclusion, this study found that 100% of the program participants reported enjoying the group care experience, with the program receiving an overall average rating of 9.52 out of 10. It was found that CenteringPregnancy does build a network of social support between group participants, providing high levels of satisfaction and reducing patient stress. CenteringPregnancy should therefore be continued at Women’s Care Center and Memorial Hospital, and more participants should be recruited into the program in the future.

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

Capstone Project:  The development and assessment of a new bio-chip based rapid diagnostic test for Human Filariasis in Haiti


Abstract:  Diagnostic tools are essential for efficiently and cost-effectively diagnosing illness, selecting appropriate treatment, monitoring chronic diseases, and tracking the prevalence and impact of disease globally. Diagnostic tools that can be used in low resource areas are of essential importance.  In countries like Haiti, that have low resources and limited access to lab based diagnostics, testing for disease in the field or at a point of care (POC) becomes paramount.  One type of test that can be used is a rapid diagnostic test (RDT). These tests are designed to be used in a point of care situation, and can be used by minimally trained health workers, in order to provide a rapid diagnosis to the patient in the field. The current RDT that is endorsed by the WHO for the testing of Wuchereria bancrofti filariasis is the Immunochromatographic Card Test (ICT).  The ICT card test is a sensitive test, but must be read in a time dependent manner according to the instructions. If that is not done then false positives or negatives may result. The development of a new RDT with both high sensitivity and specificity would improve the ability to reliably diagnose the infection which is a fundamental need to both the management of individual patients as well as the public health efforts to control the disease. The purpose of this study was to assess a new bio-chip based rapid diagnostic test for human filariasis in Haiti, and compare its sensitivity, specificity, and cost effectiveness to the World Health Organization's field standard ICT-card test. Through testing I developed a new bio-chip study model, NESDEP IU. Though it did not prove to be a faster testing model than the RDT ICT, I think the NESDEP IU could serve as a diagnostic tool in point-of-care settings, as well as tool for monitoring and surveying current MDA programs.

“I was able to spend a week with my father operating on 25 patients who had developed scrotal hydroceles, one of the debilitating and deforming disease manifestations of bancroftian lymphatic filariasis.  We were unable to find any worms, but the trip and my experience was still a success, one that I enjoyed immensely.”

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


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.”

ame: 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


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: Brianna Geary  MS ' 13
Degree and Year: English
University of Notre Dame, 2012

Capstone Project:  Increasing the safety and efficacy of short-term medical mission trips via electronic referral systems


Abstract:  This research project was undertaken in order to understand, from the perspective of short-term medical mission physicians and managers, how EMR technologies can be improved to benefit medical missions. Additionally, it aimed to identify specific issues that impede medical mission work from being integrated with the strengths and weaknesses of the host country’s healthcare infrastructure. It was expected that interviewees would reveal needs for specific EMR features or applications that are not met by current products and that they anticipated would result in increased collaboration and interoperability amongst medical mission groups. Upon commencing interviews with physicians and others involved in this work, two points immediately and unexpectedly surfaced as consistent, major area of concern: duplication of efforts and follow-up care. Further, as several interviewees identified, these topics are strongly linked to each other and to the isolation of efforts among volunteer organizations and between organizations and in-country medical services. As expected, interviewees sought more appropriate technology for their in-country work. However, it quickly became apparent that interviewees did not prioritize improvements in medical software as expected. Rather than improving the office management aspect of EMR systems, with features such as biometric patient indicators, physicians expressed the need for technology that would enable them to send a patient to another practitioner and to be certain that the patient will receive quality treatment—in essence, they seek an effective and reliable electronically-traced referral system. Through my studies, I have recommended that short-term medical missions improve their electronic medical record systems, engage stakeholders in their effort, and work through third party suppliers. Hopefully these recommendations would enable international healthcare volunteers to be most impactful in their work to ease the medical hardships caused by the human resources for health crisis.

“My time at Peace Corps was invaluable in shaping my career goals and further catalyzing my passion for global health policy. I am honored to have had the opportunity to work with and learn from so many highly educated and passionate individuals within the field of global health.”

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


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: Brian Kaltenecker  MS '13
Degree and Year: Biology
Chapman University, 2010

Capstone Project:  HPV Vaccination in Honduras: Exploring the implementation, vaccination coverage and cost-analysis of a school based delivery model


Abstract:  Cancer rates continue to increase in the developing world. Cervical cancer rates heavily burden Latin America. Cervical cancer is the leading cause of cancer deaths in Central America.  HPV infections cause ~99% of cervical cancers cases. Two vaccines have been developed to prevent infection with 2 oncogenic strains of HPV. Implementation of these vaccines into the national vaccine schedule of developing countries remains a challenge. Completion of the three required doses of the vaccine contributes to the challenge of implementation. Along with this challenge, cost is one of the heaviest burdens facing implementation. In this research study we evaluated the three doses completion rate of girls in Honduras receiving the HPV vaccine Gardasil through a school based delivery model and performed a cost analysis to determine total cost of this particular program. Girls in Honduras showed a very high rate of compliance and vaccine completion rate (80.9%) but our cost analysis highlighted specifically the financial challenges facing such a task.

“The working environment at CMMB was very fun and laid back. I was able to volunteer while also working on my capstone project and report.”

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


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: Colleen McKenna  MS '13
Degree and Year: Biochemistry
University of Notre Dame, 2012

Capstone Project:   Analysis of child feeding practices in Huancayo and Trujillo, Peru


Abstract:  Worldwide, over 2.6 million children die each year from malnutrition alone; it is a big global health concern.  Today in Peru about 18% of children suffer from chronic malnutrition.  The purpose of this study was to assess the feeding practices of caregivers in two communities in Peru and to evaluate the impact that Catholic Medical Mission Board has had on the communities.  On average, the children in the communities ate a variety of foods and were fed at least four times daily.  The mothers had a good understanding of nutrition and hand washing practices.  Further investigation is needed to evaluate the quantity of food and to account for confounding factors in the study.

During my time at Peru, I was always amazed by the generosity of all the people I met and touched by their loving and inviting spirits. The children’s smiles warmed my heart and I hope to return to Peru soon to continue to work with CMMB to combat child malnutrition.”

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


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


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


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.”