Capstone Projects - Class of 2016 // Eck Institute for Global Health // University of Notre Dame

Eck Institute for Global Health

Capstone Projects - Class of 2016

Name: Samantha Adams

Supervisor: Brian McCarty

Capstone Project: Assessing Feto-Infant Mortality in the Republic of Moldova: Institute of Mother and Child 2008-2013

Abstract: Feto-infant mortality is a strong indicator of the overall health and well-being of a country due to its sensitivity to societal, economic, and political changes. The Institute of Mother and Child continuously aims to improve the maternal and child health outcomes of their patients. Despite political, economic, and societal obstacles, the IMC staff continues to invest in the development of their health system and their feto-infant mortality rate continues to improve. From 2008-2013, the overall FIMR has decreased in the Republic of Moldova. The aim of this study is to determine opportunities for improvement within the health system based on the BABIES matrix statistical analysis. Most of the FIMR decline from 2008 to 2013 in Moldova was a result of the improvement of intervention methods that target maternal health care. Based on this analysis, recommendations are made for further improvement of maternal and child health. Interventions to improve health prior to and during pregnancy, delivery, and newborn care hold the vital key to reducing mortality.

Name: Olivia Ahearn

Supervisor: Miguel Morales

Capsotne Project: Repurposing Miltefosine for the Treatment and Prevention of Chagas Disease

Abstract: Chagas, a vector-borne disease caused by the protozoan parasite Trypanosoma cruzi and transmitted by the feces of the triatomine insect vector, affects millions of individuals worldwide (WHO, 2015). Despite research efforts toward novel drug development, there are currently only two commercially available treatments with proven efficacy. Several limitations to these therapeutics underscore the need for drugs with lower toxicity and increased trypanocidal activity. Hexadecylphosphatidylcholine (HePC) is a drug known commercially as miltefosine with demonstrated activity against cancer cells and Leishmania. The promising, yet limited, research findings on the efficacy of HePC against T.cruzi introduces the possibility of its repurposing for Chagas disease treatment. Recent studies on the use of ivermectin, a drug frequently used as a human therapeutic for Neglected Tropical Diseases (NTDs), as a vector control tool against malaria introduces the possibility of also using HePC to suppress Chagas disease transmission. We determined the efficacy of HePC against T. cruzi and a primary transmission vector in Belize, Central America, Triatoma dimidiata. Parasite susceptibility and resistance to HePC were measured in vitro with IC50 values, and HePC dose-response values were generated against both laboratory-colonized and wild samples of triatomes collected in Belize. Current Chagas treatment strategies in Belize were explored in order to identify specific challenges for introducing and establishing new disease therapies. Results indicated that T. cruzi cultures grown in the presence of 20µM HePC concentration displayed reduced susceptibilities to the drug, in contrast to the control. Limited mortality was observed after exposing laboratory-colonized and wild samples of T. dimidiata to HePC blood meals. These findings suggest that T. cruzi resistance to HePC can be quickly generated, and that HePC may not serve as a human therapeutic vector control tool. This work highlights the need for new Chagas disease treatments and continued use of current vector control methods until improved strategies can be identified.

Name: Gulaiim Almatkyzy

Supervisor: Nicole Achee

Capstone Project: Facilitating Dengue Vector Surveillance for Disease Control

Abstract: Background - Dengue cases are increasing rapidly, infecting more than 50 million people annually, with 2.5 billion people at high risk of getting the disease. Due to the lack of curative treatments, to date, dengue control and prevention programs have relied on vector control and surveillance system. Dengue diagnosis is a part of the surveillance system, however most of the diagnostic tests are expensive, need high laboratory skills and facilities. Hence, there is a need for inexpensive, easy-to-use, rapid diagnostic tools with high sensitivity and specificity to detect the dengue virus (DENV) in both human and vector populations. The purpose of this research was to evaluate efficacy of the novel assays (VecTOR wicking dipstick assay and assay Rapisense) in detecting DENV in mosquitoes and assess their ease-of-use and practicality.  Rapisense assay is still under development process, therefore its acceptability was assessed by laboratory personnel, whereas VecTOR dipstick assay had never been tested outside of laboratory conditions, thus its sensitivity and specificity were tested by field-collected Aedes mosquitoes in Thailand. Then the results were compared with a gold standard method, PCR technique.  Methodology/Findings - From Bangkok metropolis and Nakhon Pathom province of Thailand, total of 281 Aedes female mosquitoes were collected and they were pooled into 30 samples. One pooled sample was identified as DENV-2 positive by PCR technique, but due to its low viral load, VecTOR dipstick assay could not detect the virus. However, when known DENV positive and negative control samples were used, Cohen’s Kappa calculation revealed that the VecTOR dipstick assay and a gold standard PCR technique had fair agreement in identifying the virus correctly (k=0.563 or 56.3%, p=0.00005), and end-user questionnaire demonstrated a high interest in integrating the VecTOR dipstick (n=9) and Rapisense assay (n=6) among surveyed laboratory personnel. Conclusion and Next Steps - The framework of this study can guide future rapid diagnostic tool developers to integrate the novel diagnostic techniques into the vector surveillance system.

Name: Katie Anderson

Supervisor: Lacey Ahern

Capstone Project: mHealth Palliative Care Surveillance System Scale up in Uganda

Abstract: Uganda is a leader in palliative care, but is not regularly collecting national level data to utilize in evidence-based decisions. The Palliative Care Association of Uganda (PCAU) pioneered an mHealth surveillance system for palliative care which required testing of data quality and acceptability before moving to national scale. Data quality of the mHealth system was assessed using a modified USAID data quality assessment tool with the indicators validity, reliability, timeliness, integrity, completeness, and accuracy. Over the course of a four-week period, barriers including insufficient training, unclear questions, format of the ODK survey, and unstandardized data collection methods, negatively affected the data quality. The mHealth system was widely accepted by providers and administrators at the 10 participating facilities. These results informed recommendations for PCAU to further develop the project toward the goal of regularly collecting quality palliative care data at the national level to employ in evidence-based decisions.

Name: Kaila Barber

Supervisor: Heidi Beidinger

Capstone Project: Distance and the health status of persons living with HIV

Abstract: This cross sectional, quantitative study determined how accessibility to health care facilities impacted the health status of persons living with Human Immunodeficiency Virus (PLWH) in Northern Indiana. This was done by identifying the relationship between distances traveled to health care facilities, CD4 count, and viral load status of study participants. Variables on 295 study participants were analyzed using Geographic Information Systems and software package SPSS. The results suggested the distance traveled to primary care providers and infectious disease specialists did not significantly impact the health status of study participants, yet study participants provided transportation by AIDS Ministries/AIDS Assists of Northern Indiana (AMAA) generally had a higher mean CD4 count than study participants not provided transportation. This suggested AMAA mitigated distance to health care facilities as a barrier to care, but not all study participants experienced improved accessibility to health care facilities. African Americans provided transportation had a lower health status than those not provided transportation. This indicated a disconnect between services provided and the health status of study participants. In order to maximize services provided to PLWH, more resources should be allocated to transportation services and services towards African American PLWH.

Name: Alexandria Bow

Supervisor: Shaun Lee

Capstone Project: Assessment of Antibiotic Resistance and Establishment of a Molecular Research Laboratory in Santo Domingo, Ecuador

Abstract: As antibiotic resistance (ABR) becomes an increasing global threat, the need for widespread monitoring and surveillance of antibiotic resistance becomes more critical. In countries that lack adequate reporting of resistance data, issues that limit the proper detection and analysis of ABR include shortage of capacity in the health systems, prioritization of other health issues, and the absence of a plan to collect and report such data (WHO, 2014). In many of these countries, accurate data on ABR bacterial pathogens are unavailable, ultimately hindering physicians from making well-informed decisions when prescribing antibiotics. In Ecuador, an upper-middle income country in highly ABR-burdened Latin America, a recent assessment of the clinical laboratory in Santo Domingo’s Hesburgh Hospital confirmed the presence of necessary equipment for collecting and testing bacterial isolates for resistance on a microbiological level via antibiogram analysis. However, the hospital lacks the necessary equipment to test for antibiotic resistance using molecular methods, such as polymerase chain reactions (PCR), which are considered to be a faster and more accurate method to test for resistance (Fluit, Visser, & Schmitz, 2001). Currently, there is no method in place for the cataloguing and subsequent molecular analysis of resistant bacterial isolates, suggesting that the hospital needs the appropriate equipment and knowledge to improve their resistance testing methods. It was our aim to evaluate the capacities of Hesburgh Hospital with regard to current testing methods for antibiotic resistance and make recommendations to begin a molecular research core at the hospital. These efforts encompassed assessment and acquisition of equipment needed to increase molecular capacity, and administration of protocols for cataloguing and storage of bacterial isolates, as well as a PCR detection method of  β-lactamase genes. In addition, antibiotic resistance data that was determined via antibiogram analysis was compiled and assessed. The results of this study were reported to the hospital so that molecular research could begin on site and the physicians could prescribe antibiotic treatment that is more likely to be effective towards targeted bacteria and not exacerbate the ABR burden in Ecuador.

Name: Jalen Carpenter

Supervisor: Marya Lieberman

Capstone Project: Antibiotic Analysis Using Paper Test Cards for the Improvement of Global Health

Abstract: The mass distribution of substandard pharmaceuticals is considered a world-wide phenomenon and is documented as most severe in low-income countries.  The countries that are in need of sophisticated analytical power for pharmaceutical testing are usually incapable of affording the methods.  The need for a less expensive, more efficient testing method is needed.  The method of iodometric back-titration has been translated onto paper test cards in order to meet the need for such a method. The test card underwent a blind validation study using 22 amoxicillin samples from Kenya.  Precision and percent error were calculated at 2 percent.  To gain more robust data and continue research, another blind validation study was conducted in the Lieberman Lab at University of Notre Dame. 32 amoxicillin samples sent from Kenya were chosen for the study.  The samples went through a thermal degradation process to mimic substandard pharmaceuticals and were re-assayed via HPLC analysis.  The HPLC results were blinded until after results for the 32 samples were assessed using the paper test cards.  Results indicated that 25 out of the 32 samples tested were analyzed correctly by the paper test cards.  Results from a preivous blind internal validation study of amoxicillin samples from Kenya were included in the final analysis to produce more robust results.  Sensitivity and specificity were calculated at 100% and 82%, respectively.  Cohen’s kappa was calculated at 70 percent, indicating substantial level of agreement between the paper test card method and the HPLC method.  With continued improvement and usability testing in the field, the paper test card can become the go-to method for in-field assaying of beta-lactam pharmaceuticals.  Through further study with larger pharmaceutical sample sizes, the card can eventually be proven a trustworthy method of pharmaceutical screening throughout different sectors of the pharmaceutical chain supply. 

Name: Kaya Garringer

Supervisor: John Grieco

Capstone Project: Assessing the Risk of Rickettsial Pathogens in Thailand

Abstract: Rickettsial diseases are caused by a group of zoonotic pathogens transmitted to humans by a variety of arthropod vectors, including ticks and mites. Certain rickettsial diseases are endemic in Southeast Asia, including scrub typhus disease, a common cause of human febrile illness and one of the most medically relevant rickettsioses. Leptotrombidium spp. mites are the only confirmed vectors of scrub typhus disease. This study was intended to provide additional, relevant insight to the distribution of scrub typhus risk throughout the country of Thailand. Vector collections were performed in Kachanaburi province, Thailand. Collection sites were mapped using hand-held GPS units and displayed using QGIS software. Collection methods employed resulted in no Leptotrombidium spp. being collected during the study period, so an existing dataset from South Korea was instead used to develop an ecological niche model to assess the selected variables associated with a presence of Leptotrombidium spp. A model was successfully developed that showed agreement between mite species presence and positive cases of scrub typhus for South Korea. This model showed that human population density had the greatest contribution to species presence. Additionally, most of the scrub typhus cases in South Korea in 2015 were located in areas with a higher estimated probability of mite presence. Future attempts at translating this model to Thailand could result in improved vector control and prediction of disease risk. Survey results revealed that a basic awareness of scrub typhus disease exists, but that detailed knowledge is lacking and it is generally not perceived as a threat; this may affect the diagnosis and provision of appropriate treatment for scrub typhus and other rickettsial diseases.

Name: Desmond Jumbam

Supervisor: Nicole Achee

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

Abstract: Background: Despite the rapid upscale of malaria control interventions, such as long-lasting insecticidal nets and indoor residual spraying, malaria remains a major source of morbidity and mortality in Zambia. A comprehensive understanding of community knowledge, attitudes and practices (KAP) is a crucial component for enhancing the uptake and use of current and novel malaria control interventions for sustained disease prevention. Findings are intended to guide Zambian National Malaria Control Programme educational campaigns and inform the implementation of malaria elimination tools.  Methods: A mixed-methods study was undertaken to assess the association between malaria-related KAP and total indoor mosquito abundance with ITN use, IRS acceptability and SHIELD (novel spatial repellent) acceptability, in a select cohort of primary caregivers within Luangwa and Nyimba districts, Zambia. A total of 75 forced-choice KAP surveys, 10 in-depth interviews (IDI) and 73 indoor mosquito collections using light traps were conducted at participant homes.  Results: Factors associated with ITN use included the presence of ITNs in the household, naming still water and rivers as mosquito breeding sites, all family members and children <5 sleeping under an ITN, and practices related to ITN washing, drying and tucking-in at night. IRS acceptance was found to be influenced by receiving malaria information from a neighbor, and total indoor mosquito abundance (in Nyimba). SHIELD acceptance was associated with total number of adults in a household, preference for interventions that are better at stopping mosquito bites and identifying IRS as a control tool. Trends also identified misconceptions about malaria transmission route and personal prevention practices as well as ITN and SHIELD characteristics that may influence use and acceptance.  Conclusions: The current study identified gaps in malaria knowledge among primary caregivers. Educational campaigns emphasizing the connection between mosquito bites, intervention use and malaria prevention will likely increase uptake and use of ITNs and IRS. Key messages about good practices related to proper use and upkeep of ITNs should also be stressed in educational campaigns as these have been shown to influence ITN use. Designing novel control strategies to match community aesthetic preferences and cultural needs will encourage acceptance and compliance within the communities.

Name: Scott Klein

Supervisor: Jennifer Robichaud

Capstone Project: Weathering the Storm: A Meta-Analysis of PTSD and Resilience in Latin America Following Natural Disasters

Abstract: Typical ideas of trauma in Latin America pertain to its history of revolutions, the several military regimes, or other internal conflicts.  However, the broad impact of natural disasters can also take a devastating toll on infrastructure, homes, and people.  Latin America experiences some of the highest occurrences of natural disasters in the world, which also leads to large numbers of deaths, injuries and displacements.  As with trauma through violence, these experiences also have the potential to cause Post-Traumatic Stress Disorder (PTSD).  Although work has been done in many countries related to this problem, there has not yet been any secondary analysis conducted to ascertain the similarities.  Therefore, this meta-analysis will seek to synthesis existing data regarding the prevalence of PTSD following natural disasters in Latin America.  It will look at both overall prevalence, as well as certain specific personal variables that may influence the occurrence of PTSD.

Name: Casey Macdonald

Supervisor: Brian McCarthy

Capstone Project: Down Syndrome Prenatal Diagnosis and Induced Termination Rates in Atlanta, Georgia

Abstract: Down syndrome is the most common chromosomal condition and reason for intellectual disabilities. It has been well established that higher maternal age is the largest contributing factor to increased risk of an affected pregnancy. We aimed to demonstrate that a recent increase in the population of mothers who elect to have children later in life increase the rate of induced abortions in the state of Georgia from (2003-2012). The data set provided through the Center for Disease Control and Prevention allowed us access to information on prevalence of trisomy 21 diagnoses as well as abortion data. Logistic regressions were run in order to determine that there has been a relationship between maternal age, cases of trisomy, and abortion to live birth ratio among older women. We found that the 701 (86%) cases expected to occur over this time period were not accounted for in our data set. We then attempted to explain this discrepancy by analyzing the abortion to live birth ratio, and suggested that there has been a significant relationship between ratio of abortions to live birth over years as well as the relationship between older mothers and induction of abortion rate (p-value 0.018 and 0.012, respectively).  Our evidence demonstrates that there is a need for further investigation into this data that would include reasons for termination, demographics on previous pregnancies, and a connection between the prenatal diagnosis of trisomy 21 and induced abortion.

Name: Elizabeth McCue

Supervisor: Heidi Beidinger

Capstone Project: Fresh Stillbirth in Kibaale District, Uganda: A Retrospective BABIES Analysis

Abstract: Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) services are an essential component of maternal and child health care. When failures or inadequacies exist in CEmONC systems, poor outcomes such as high rates of maternal mortality and fresh stillbirth tend to persist. Currently, an alarmingly high number of stillbirths, 40,000 per year, occur in The Republic of Uganda. The multi-donor Saving Mothers Giving Life initiative (SMGL) has implemented a surveillance system known as Birth Weight and Age-at-death Boxes for Intervention and Evaluation System (BABIES) in several Ugandan districts. Here the problem of fresh stillbirth in Kibaale District, Uganda is assessed using the BABIES methodology. Trends in birthweight proportionate and birthweight specific mortality are examined over the years 2012-2016 SMGL has been supporting maternal health efforts in the region. Poor referral systems, lack of intrapartum monitoring, human resource strain, and high-risk maternal age and parity are identified as potential explanatory factors. Additionally, suggestions to reduce high rates of fresh stillbirths observed in the regions are proposed based on the challenges identified there.

Name: Katherine Merritt

Supervisor: Lacey Ahern

Capstone Project: Establishing a Conceptual Framework for Community-Based Palliative Cancer Care in Rural and Peri-Urban Peru

Abstract: Palliative care services can improve the quality of life for people living with life-threatening illnesses such as cancer, yet these services are not easily accessible for a majority of the Peruvian population. To gain further information on Peruvian palliative care at the national and community levels, interviews and focus groups were conducted with current community-based palliative care programs, palliative care specialists in Peru, and community-based health workers. Results indicate that Peru is lacking appropriate national level palliative care strategies and employs no framework for community-based palliative care. A conceptual framework and recommendations for community-based palliative care are proposed based on the WHO palliative care public health model at the national level and thematic analysis of data at the community level. This information may be used for future implementation of community-based palliative care services in Peru.

Name: Philisha Mesidor

Supervisor: Heidi Beidinger

Capstone Project: Assessment of Resources for Persons Living with HIV/AIDS (PLHA) in Cayo and Stann Creek

Abstract: UNAIDS launched a global campaign, 90:90:90, which aims to ensure that by 2030: 90% of the people living with HIV will know their HIV status, 90% of those diagnosed with HIV will receive sustained ART, and 90% of those on ART will have durable viral suppression. Belize is striving towards completing this goal and contributing to international efforts for eliminating HIV globally. In order to successfully reach 90% of the population receiving sustained ART, barriers to care that decrease retention rates must be addressed. To combat barriers to care for Persons Living with HIV/AIDS (PLHA), resources must serve to eliminate the obstacles negatively affecting adherence to treatment. This study aimed to (a) assess treatment and care resources in Cayo and Stann Creek districts and (b) pose questions to key informants to gain deeper understanding of HIV services and patient utilization. The study focused in Belmopan, San Ignacio, and Dangriga to produce an HIV services inventory for the Cayo and Stann Creek districts. The final product of this study included a report based on the data produced, a patient-friendly brochure in English listing resources available, and an infographic summarizing the findings of this study.

Name: Brooke Miers

Supervisor: Lacey Ahern

Capstone Project: Assessing the Potential Risk Factors Associated with Nodding Syndrome in Northern Uganda

Abstract: Nodding Syndrome (NS) is a neurological disease of unknown etiology primarily affecting children and young adults in a few districts in Northern Uganda. NS has been classified as a form of atonic epilepsy and symptoms include uncontrolled head nodding, stunted growth and intellectual disability. Not only does NS cause debilitating symptoms in those affected, but also provokes stigma and unrest throughout affected communities. Although the etiology is unknown, some studies show an association between NS and onchocerciasis, and propose that the vector carrying the causative agent of NS is the Simulium spp. black flies. This project aimed to support the hypothesis of Simulium spp. as the vector for NS by exploring the prevalence of these black flies in areas affected by NS, and through spatial mapping of potential risk factors. The two objectives of this project were: 1) to better understand and spatially map possible NS risk factors through household assessments and surveys, and 2) to determine density and distribution through collection and identification of Simulium spp. black flies. Demographic and characteristic data was collected from area households both with and without reported NS cases. Black flies were collected using the Esperanza Window Trap and identified to genus. The Simulium spp. densities, data obtained from the households, and remotely sensed data were mapped using QGIS in order to visualize possible patterns and associations of risk factors of the disease. Maxent was also used to create a map to visualize predicted vector niches according to ecological variables. Associations between NS and onchocerciasis were found, supporting the link between NS and black flies as vectors. Also, we found age range of NS case onset possibly broader than previously reported. It is our hope that this research will increase knowledge on this disease and its hypothesized vector.

Name: John Nida

Supervisor: John Grieco

Capstone Project: Establishing a framework for the release of genetically modified mosquitoes in southern Mexico

Abstract: Over the past several decades, dengue and other arboviruses have reemerged as a major threat to global health. Past vector control strategies are no longer efficacious and new solutions are needed. A novel strategy using genetically modified mosquitoes (GMM) to combat dengue and other arboviruses is currently in open-field trials. Prior to implementation of this strategy in Mexico, a comprehensive evaluation is necessary. Mosquito monitoring in a local, semirural village as well as laboratory studies assessing the larval competition for nutrition between Aedes aegypti and Aedes albopictus was performed in conjunction with the Centro Regional de Investigación en Salud Pública (CRISP) in Tapachula, Chiapas, México. Community participation and perception will also play an integral role in the overall success of this strategy in a variety of settings. A survey assessing current knowledge, attitudes, and perceptions of local healthcare professionals on the use of GMM and mosquito-borne diseases was performed in order to help inform future development of educational platforms necessary prior to the implementation of GMM in field settings. A steady increase in the number of egg-positive ovitraps over a three-week period was observed in Buenos Aires, Chiapas, Mexico.  In laboratory conditions, data suggest Ae. aegypti are more tolerant of excess nutrients compared to Ae. albopictus. Support for the use of GMM is high in the healthcare professionals surveyed, with more than 60% indicating their support. This research could help introduce a new strategy capable of greatly reducing the burden of dengue and other mosquito-borne diseases.

Name: Scott Olehnik

Supervisor: Rob Stahelin

Capstone Project: Investigation of Staurosporine-mediated Changes in Ebola Virus Assembly and Egress 

Abstract: In the present study, we wished to determine whether treatment with staurosporines, specifically UCN-01 and 7OSS, could affect the phosphatidylserine (PS) concentration of the plasma membrane, and if this change in plasma membrane composition would have any effects on the ability of the Ebola matrix protein, VP40, to undergo oligomerization and budding at the membrane. We introduced EGFP-Lact-C2, D4H-mCherry, and EGFP-VP40 to HEK293 cells treated with various concentrations of the drugs UCN-01 and 7OSS. Cells were then imaged with confocal microscopy and the percent membrane fluorescence quantified using ImageJ software. Results showed that the staurosporines only decreased localization by 10 to 12 percentage points, respectively, for UCN-01 and 7OSS with the Lact-C2 and D4H constructs. Staurosporines did not delocalize Lact-C2 and D4H to the degree that was expected based upon previous studies by Maekawa and Fairn. This may be due to the fact that the drugs were obtained from two different suppliers. Further, we found that staurosporine-mediated delocalization of VP40 was possible, with a decrease of about 13 percentage points maximally for our study. Our study shows that staurosporine-mediated delocalization of PS is possible, though not to the degree that we expected. Additionally, we determined that staurosporines are able to delocalize VP40 from the membrane and affect the oligomerization and budding of the protein. 

Name: Alyssa Paul

Supervisor: Brian McCarthy

Capstone Project: Assessing Mortality and Morbidity of High-Risk Infants in the Republic of Moldova

Abstract: In the Republic of Moldova, feto-infant mortality rates have decreased since the country’s health care reform and regionalization. With this increase in survival, there has been a corresponding increase in disabilities seen in infants and children born at high-risk that survived the neonatal period. In order to provide adequate care for reduction of long-term impairment, a large-scale data analysis was performed to determine incidence of risk factors and morbidities. The Birth Weight and Age-at-death Boxes for Intervention and Evaluation System was used to complete the analysis. The results of this method show the attributable fractions and relative risk of pathologies that need to be taken into account in order to result in the greatest improvement in infant and child health. These indicators can inform the decisions necessary for coverage, quality, and equity of high-risk infant follow-up care.

Name: Michael Prough

Supervisor: Alex Perkins

Capstone Project: Analysis of Aedes aegypti Hotspots and Hot Zones in Two Neighborhoods of Santo Domingo, Ecuador

Abstract: Chikungunya virus (CHIKV) is an arthropod-transmitted virus spread by Aedes mosquitoes with no cure and few treatment options.  Due to a recent mutation, it now has potential to spread to new areas, such as Ecuador, likely resulting in massive epidemics.  Vector surveillance and control plays an important role in preventing such epidemics, and statistical analyses and mathematical modeling show promise in predicting spatial patterns of vector populations.  This five-week field study mapped and analyzed populations of adult Aedes aegypti mosquitoes in two neighborhoods of Santo Domingo, Ecuador.  During this time period, two surveys were conducted in each neighborhood in order to compare the spatial distribution of vector populations at two time points.  Local Getis hotspot analysis was used to determine locations of hotspots and hot zones, hotspots being houses with more mosquitoes than expected given the spatial distribution of houses and hot zones being those areas in which hotspots are likely to be found.  Hotspots were not usually temporally stable, whereas hot zones were shown to be more temporally stable.  This analysis shows potential as a predictive tool for vector populations on fine spatial and temporal scales to inform vector surveillance and control.

Name: Cassandra Sundaram

Supervisor: Edwin Michael

Capstone Project: Dynamic Modeling of Obesity and Diabetes Progression for an Urban South Indian Population in Chennai, Tamil Nadu

Abstract: Non-communicable diseases are a growing problem in developing countries despite the continued focus on infectious disease in global health agendas. Type 2 diabetes mellitus is one such non-communicable disease with growing incidence in India. Increased industrialization and urban migration have significantly impacted lifestyle changes and increased the prevalence of overweight and obesity in regions in India, where type 2 diabetes is reaching epidemic status. 

Imprecision in diabetes data in India, as well as the uncertainty of weight given to certain lifestyle changes in influencing diabetes progression are important issues that can be addressed using mathematical modeling.  Dynamic simulation models can allow not only a better understanding of diabetes disease dynamics for predicting future disease burdens, but will also support systematic exploration of interventions to reduce future disease effectively.

Here, we constructed a coupled obesity and diabetes population model, and used incidence data collected from different communities in the city of Chennai, Tamil Nadu, to serve as input parameters in the model to create the first dynamic forecasts of the future burdens of both conditions in this important urban setting in Southern India. We also use the model to evaluate the effects of life-style interventions for arresting the future development of these diseases in the Chennai population. We end by highlighting how these results can direct research in diabetes and steer public health strategies to better prevent and reduce the prevalence of the disease in India. 

Name: Victoria Wadman

Supervisor: John Grieco

Capstone Project: Long-Lasting Insecticide Net Campaign Evaluation in Belize, Central America

Abstract: Belize is on the verge of national elimination of malaria, but in order to maintain the gains the country has made towards malaria elimination, the Ministry of Health is completing a national long-lasting insecticide net (LLIN) campaign that requires evaluation. Monitoring and evaluation are necessary to determine the effectiveness of a long-lasting insecticide net. The goals of the evaluation are to determine the time between distribution and replacement so waste is minimal and to redistribute LLINs prior to the net losing efficacy due to damage, loss of chemical or insecticide resistance buildup. To assess the efficacy of the campaign, there are three indicators are used by industry and WHO as standard metrics and these include: ownership, fabric integrity, and bioefficacy. The primary purpose of this study was to assess the ability for the LLIN campaign to offer long-term protection against malaria in Southern Belize. The methodology followed the WHOPES guidelines for laboratory and field-testing of long-lasting insecticide nets with modifications. The information gathered from this study will inform the Ministry of Health on how to better manage their LLIN campaigns.