Faculty, Students Contribute to the Science of Global Health

Faculty and trainees from all parts of Duke University are producing new evidence that sheds light on some of  the most important global health challenges of our time --- including new information about disparities in cancer risk and effective strategies for controlling the spread of malaria, managing chronic diseases, and reducing road traffic injuries. Learn more about DGHI’s research.

Learning management system is effective for African medical education
DGHI faculty member John Bartlett,  Charles Muiruri and partners from the Kilimanjaro Christian Medical Centre (KCMC) have published new research in the African Journal of Health Professions Education showing the viability of implementing a learning management system for first-year medical students in Tanzania. The partnering organizations were jointly awarded a $10 million grant from the US government to strengthen medical education at KCMC through improvements to curriculum and information technology. The learning management system was found to be a useful and efficient tool for curriculum organization, presentation and testing. It was adopted by faculty and students quickly with favorable feedback. The team says lessons learned on the use of electronic aids in medical education may be useful for similar academic settings where faculty shortages are common.

Links found between blood pressure and mortality risk among HIV patients
New research by DGHI faculty member and cardiologist Gerald Bloomfield published in BMC Infectious Diseases explores the effect of blood pressure on mortality among adults with HIV in Kenya. The research team found that low blood pressure levels among Kenyan HIV patients led to a high risk of death. They found that high systolic blood pressure is linked with mortality among patients whose disease is not advanced.  The research is important because cardiovascular risk factors like high blood pressure are often overlooked among HIV patients in sub-Saharan Africa. Other researchers involved in this work include DGHI affiliate Eric Velazquez and Duke internal medicine physician and former global health fellow Thomas Holland.

Cell phones effective for chronic disease care in sub-Saharan Africa
Mobile phones may be an effective tool for follow-up and retention of patients with non-communicable diseases (NCDs) in sub-Saharan Africa, according to a new study in the journal Globalization and Health by DGHI faculty member Gerald Bloomfield. Although there is enthusiasm for the use of mHealth for NCDs in Africa, a comprehensive review of existing literature shows implementation is limited and evidence showing a positive impact on health is scarce. Of the small number of studies included in the review, mHealth programs seemed to work, could be integrated into a larger NCD program and facilitate peer support networks in sub-Saharan Africa. Bloomfield, along with other researchers including Velazquez and DGHI visiting scholar Lavanya Vasudevan, present a framework for cataloguing evidence on mHealth strategies that incorporates health system challenges and stages of NCD care.

Community buy-in for larviciding to reduce malaria risk
People living in rural Tanzania are receptive to larviciding as a key strategy to reduce malaria infection risk, according to new research in the International Journal of Environmental Research and Public Health by DGHI Deputy Director and environmental economist Randall Kramer and  Adriane Lesser. The use of insecticides to destroy mosquito larvae is less commonly used to control the spread of malaria, but has significant potential as a component of a vector management program. Researchers found that study participants were willing to pay a small contribution to a larviciding program and trust this form of malaria control as a safe, effective way to lower malaria risk in their community.

Evaluating the effectiveness of malaria control interventions
Kramer and Lesser are authors of a second paper in the same journal highlighting the protocol for assessing the effects and effectiveness of malaria control interventions. They evaluated two programs in Tanzania that focus on disease management and a community-supported larviciding project.  The authors present the methods they used to evaluate the interventions, emphasizing key contributions and lessons learned about malaria control and addressing a number of challenges for consideration in future programs. They stress the importance of community sensitization and engagement from local leaders. DGHI Doctoral Scholar Christopher Paul is also a part of this work.

Students, Trainees Publish as First Author:

Race tied to prostate cancer risk
Alexis Gaines, MSc-GH ’13, has published a paper in Cancer Causes and Control based on her MSc-GH thesis research on the links between race and prostate cancer risk. She found black man have a greater risk of prostate cancer on initial biopsy. Her findings support the idea that race is integrally linked with more aggressive prostate cancer at diagnosis, and differences in prevalence and mortality are unlikely due to access to care alone. She suggests the need for more studies to understand the link to race and potential programs that target black men more aggressively to diagnose prostate cancer early. DGHI faculty member Elizabeth Turner is also an author on this work.

Heart attack prevalence lower in Africa, but more data needed
The prevalence of acute myocardial infarction, commonly known as a heart attack, is substantially higher in wealthier countries compared to countries in sub-Saharan Africa, according to a new study in PLoS One led by former medical student and global health third year study trainee Julian Hertz. The review of existing literature produced limited results, and researchers are calling for more data. They suggest possible reasons for fewer heart attack cases in sub-Saharan Africa could be genetic differences, fewer risk factors for disease, different patterns of care for hospital patients with chest pain, or possible missed diagnoses of heart attack. Other researchers involved in this work include DGHI faculty members Bloomfield and Catherine Lynch, and Duke resident and former global health certificate student Joseph Reardon.

Studying the barriers to usage of protective gear to promote motorcycle safety
Cost could be a barrier to using reflective, fluorescent motorcycle safety vests in Tanzania, according to a new study published in the journal Injury by MSc-GH student Steve Sumner. Half of the participants in the study received the reflective vests for free, and the other half had to pay for them. Existing research shows reflective vests can reduce the risk of road traffic crashes by more than 30 percent. Researchers found the vests led to a significant increase in usage, but the absolute increase between the two groups was modest. The team stresses the importance of other strategies beyond economic barriers to encourage road safety and prevent injuries. Other authors on this research include DGHI faculty Catherine Lynch and Elizabeth Turner, Brian Pence and Elizabeth Reddy, and Joseph Egger.