Field research gives Master of Science in Global Health students the opportunity to take classroom experiences and use them in a real-world setting. Your field research project must be at least 10 weeks in length and mentored by a Duke faculty member. Projects vary year to year but fall under four general models:

• Faculty research projects: You can join a faculty research project and focus your thesis research on an individual question within the overall project activities and goals. The fieldwork activities may support research beyond an individual question. 
• Internship opportunities: You can complete an internship with a global health organization, completing an individual scope of work while contributing to larger ongoing projects and developing your final master's paper.
• Group or team-based models: DGHI faculty lead a number of team-based projects through our research collaborations and through the Bass Connections initiative. You can work with vertically integrated teams or across Duke, completing required individual thesis research within a team structure. Completion of individual projects with a group setting may also be possible at one of DGHI’s international research collaborations. 
• Data analysis and contextual fieldwork: In some cases, fieldwork activities will complement data already collected by others or enhance research activities. In such instances, you can focus your thesis on secondary analysis of existing data, with the field experience offering a contextual understanding of the topic or project environment.

Most students complete field-based projects during the summer between the first and second year in the program. We will share information about opportunities and how to work with faculty mentors throughout your first semester. We also provide a one-credit course to prepare you for the experience. 
 

These are some of the field projects our M.S. students have worked on in the past year. These projects are meant to provide examples of fieldwork; your specific project will be designed by you in consultation with your faculty mentor and our education team. 

 

Usability, feasibility, and acceptability testing of an integrated digital platform for use during cervical cancer screening in western Kenya

Location: Kisumu, Kenya | Faculty: Megan Huchko 

Description: This study sought to close gaps in cervical cancer screening programs in Kenya, which has some of the highest cervical cancer rates in the world, through the piloting and evaluation of a digital platform to be used by community health volunteers (CHVs). The platform offered educational messaging, treatment reminders, counseling/protocol support for CHVs and specimen tracking. A convergent mixed methods approach was used, employing in-depth interviews and cross-sectional surveys. The pre/post study spanned a six-month period with the intervention delivered three months into the study period.

 

Integrating HIV self-testing into adolescent and youth sexual and reproductive health care: assessing the feasibility and acceptability of HIV self-testing in adolescents in Zimbabwe

Location: Harare, Zimbabwe | Faculty: Kearsley Stewart

Description: HIV self-testing offers a potentially empowering test option for adolescents and young people. Ease of access to HIV testing and more flexibility surrounding the mode of delivery has the potential to bridge the considerable barriers and stigmas faced by adolescents and young people. In collaboration with the Biomedical Research and Training Institute of Zimbabwe, this study investigated: (1) the feasibility and acceptability of HIV self-testing for adolescents in urban communities in Harare, Zimbabwe; (2) the effect of HIV self-testing in adolescents on linkage to care; and (3) the social factors that underpin adolescent preferences for HIV testing.

 

Adapting novel molecular diagnostic methods for detection of Plasmodium knowlesi in Sarawak, Malaysia

Location: Sibu, Malaysia | Faculty: Gregory Gray 

Description: This study sought to determine the sensitivity, specificity, and practical value of two new molecular diagnostic assays compared to a more classical nested molecular diagnostic assay and the routine microscopy in detection of P.knowlesi. Study subjects were enrolled at Sibu and Kapit Hospitals, both hospitalized and outpatients, using an informed consent or assent process that permitted the completion of a questionnaire and collection of a 5ml blood sample. The enrollment questionnaire captured baseline demographic information, medical data, and behavioral and environmental risk factors. Patients were assigned a study number and personal identifying data was minimized. 

 

The epidemiology, risk profiles and outcomes of patients infected with carbapenem-resistant Gram-negative bacterial infections

Location: Sri Lanka | Faculty: L Gayani Tillekeratne 

Description: In 2014, the WHO reported that death attributable to resistant bacterial infections was double that of antimicrobial-susceptible bacterial infections. Carbapenem-resistant infections often fail to fit traditional risk profiles, suggesting community acquisition. Due to the high mortality rates and lack of effective drugs, carbapenem-resistant infections could add a significant burden to the Sri Lankan health system. This study used a case-control-control design to identify the epidemiology, risk profiles and outcomes of patients who were infected with carbapenem-resistant bacteria and admitted to Karapitiya Teaching Hospital in the Southern Province, Sri Lanka.

 

Development and validation of a nutrition screening tool for pediatric cancer patients in Uganda and Tanzania

Location: Kampala, Uganda | Faculty: Not Listed 

Description: Nutrition plays a key role in the disparity in the survival rates for pediatric cancer between low- and middle-income countries (LMIC) and high-income countries (HIC), and identifying children early who are at severe risk of malnutrition remains a challenge in sub-Saharan Africa (SSA). This is due to the absence of a standard nutritional assessment tool for predicting malnutrition in pediatric patients in SSA. This project aimed to develop a standard nutritional screening tool, validated specifically for LMIC, to predict nutritional status in pediatric cancer patients. The early detection of nutritional risk in these patients can avert the progression of the disease, thereby improving outcomes.

 

Disparities in HFpEF patient enrollment in Duke clinical trials and databases

Location: Durham, North Carolina | Faculty: Not Listed 

Description: Heart Failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome that accounts for approximately half of heart failure hospitalizations. Studies have shown black and Hispanic patients have significantly higher rates of heart failure rehospitalization, and black patients are likely to be younger at diagnosis and have more comorbidities as compared to non-black patients. Ensuring that clinical trials reach their intended target population is paramount. This study analyzed disparities in trial enrollment among HFpEF patients along indicators such as race, sex, geographic location and insurance status. A qualitative component to the study sought to understand the reasons for declining trial enrollment and potentially self-perceived discrimination during trial procedure along race and sex strata.

 

Expanding access to depression treatment in Kenya through automated psychological support

Location: Nairobi, Kenya | Faculty: Eric Green

Description: Depression during pregnancy and postpartum is associated with poor outcomes for women and their children. While effective interventions exist, most cases of depression in low- and middle-income countries (LMIC) go untreated due to a lack of trained professionals. "Task sharing" models have shown great potential to address this challenge but are difficult to scale. A novel intervention, Healthy Moms, was created using an existing artificial intelligence system (Zuri) to drive conversations with users. This project tested Zuri as a perinatal depression intervention with pregnant women and new mothers in Nairobi, Kenya. Participants rated their mood via SMS every three days. The team studied system logs and conducted in-depth interviews with participants to study engagement with the intervention, feasibility and acceptability.

 

Incidence of streptococcus pneumoniae among children in Sri Lanka

Location: Galle, Sri Lanka | Faculty: L Gayani Tillekeratne 

Description: The number of healthy children carrying S. pneumoniae and whether its serotypes are adequately covered by conjugate pneumococcal vaccine are unknown. Currently, pneumococcal vaccination is not offered through the public health care sector in Sri Lanka. The insufficient coverage of vaccines on isolated serotypes and the failure of antibiotics use have the potential to contribute to the increasing prevalence of antimicrobial resistance among S. pneumoniae. To provide better instructions for vaccine use and clinical treatment in Sri Lanka, this study explored the proportion of healthy children under age 5 colonized by S. pneumoniae in community settings in Galle, Sri Lanka, to further understand the serotype distribution, as well as their resistance to current antibiotics.

 

Ghana's transition away from donor aid for HIV: effects on vulnerable populations

Locations: Accra, Ghana and Geneva, Switzerland | Faculty: Gavin Yamey

Description: As Ghana transitions from low income to lower middle-income status, the country is transitioning away from donor assistance for health initiatives, including donor funding for HIV programs for the general population and for vulnerable populations, such as commercial sex workers and prisoners. This study aimed to understand the risks and opportunities that vulnerable populations face during and after Ghana´s transition from donor assistance for HIV programs to national (domestic) support. The study consisted of a literature review and semi-structured interviews with key informants from three main categories of actors who are involved in the AIDS response in Ghana: (1) governmental actors, (2) civil society organizations, and (3) external donors. The study results aimed to support stakeholders developing risk mitigation strategies for vulnerable groups, and hoped to be of use for other countries transitioning from donor aid for HIV.

 

To build and evaluate the feasibility of a prognostic model for TBI patients in Uganda and Tanzania

Locations: Moshi, Tanzania and Mbarara, Uganda | Faculty: João Ricardo Vissoci 

Description: This study sought to develop a diagnostic method based on machine learning to help clinical decision making on potential prognostic outcomes for traumatic brain injury (TBI) patients. Although risk calculators for TBI exist in high income countries, there has been limited development and validation in sub-Saharan Africa. The study was an innovative and promising attempt to help alleviate the problem of poor prognosis for TBI patients in Uganda.

 

The health effects of galamsey mining on households in Amansie West, Ghana

Location: Manso Nkwanta, Ghana | Faculty: Melissa Watt

Description: In Ghana, informal small-scale gold mining, colloquially known as galamsey (gather and sell), is an illegal process of harvesting gold using small, shallow open-air pits and liquid mercury, a known toxic with negative health effects. There are an estimated 7,000 active galamsey sites in Ghana, with more than 20,000 workers. This project explored the effects of secondhand mercury exposure on families and households of galamsey miners and the socioeconomic dimension of the work. Often, individuals turn to galamsey as a result of limited employment opportunities elsewhere. This project attempted to characterize some of the socioeconomic drivers that may lead individuals to conduct galamsey work.

 

HIV stigma among men in Tanzania: A mixed method study

Location: Kilimanjaro, Tanzania | Faculty: Melissa Watt

Description: HIV-related stigma is an important barrier to the success of programs targeting prevention and treatment of HIV. While men are disproportionately affected by stigma, interventions addressing HIV-related stigma are typically focused on women and children. As a result, men tend to be less likely to know their status and link to care, and therefore have worse clinical outcomes. This study aimed to (1) identify factors associated with HIV stigmatizing attitudes among men; (2) qualitatively examine the factors that contribute to HIV stigmatizing attitudes among men; and (3) explore whether stigmatizing attitudes mediate the relationship between stigma-related factors and anticipated stigma among men in Kilimanjaro, Tanzania. The study used baseline assessments and qualitative interviews at two urban health facilities serving pregnant women and their male partners.

 

Association between chronic pain and utilization of rehabilitation services post-injury and hospital discharge in Moshi, Tanzania

Location: Moshi, Tanzania | Faculty: Catherine Staton

Description: Despite the magnitude of injury-related deaths, research on the burden and characteristics of injuries in low-middle income countries (LMICs), particularly those in sub-Saharan Africa (SSA), has largely been neglected. This study aimed to provide a better understanding of issues related to access to post-hospitalization rehabilitation care, such as such as physical therapy, occupational therapy and mental health services, in Moshi, Tanzania. Demographic and medical information, including pain levels, was analyzed from a registry of injury patients from the Kilimanjaro Christian Medical Centre. These data were used to identify why certain patient groups with pain do not access rehabilitation services.

 

Economic analysis of universal health coverage in surgical care for children

Location: Guatemala City, Guatemala | Faculty: Henry Rice 

Description: Financing of surgical care remains challenging within universal health coverage (UHC) schemes. Unmet surgical needs is one of the main barriers to achieving the United Nations’ Sustainable Development Goal (SDG) #3, ensuring healthy lives and promoting well-being for all at all ages. The lack of population-level research about the financing of pediatric surgical care remains a critical research gap. This study aimed to assess how many UHCs provide coverage for pediatric surgical care across low middle-income countries (LMIC). The team surveyed experts from approximately 20 LMICs to measure how many UHC schemes offer a pre-identified pediatric surgical package of care and conducted a field study of UHC coverage for pediatric surgical care in Guatemala. The collection of data was a crucial step in strengthening pediatric surgical systems and achieving UHC for children as outlined in SDG targets.

 

A traumatic brain injury prognostic model to predict patient survival in LMICs

Location: Tanzania | Faculty: Catherine Staton

Description: Traumatic brain injury (TBI) is the leading cause of death and disability worldwide and disproportionately affects low- and middle-income countries (LMICs). Diagnostic and treatment delays in LMIC hospitals caused by limited health care providers and inadequate medical equipment have been shown to greatly increase the risk of TBI patient mortality. A prognostic model, a statistical model that uses patient data to predict a clinical outcome of interest, could provide a solution to combating poor TBI outcomes in LMICs. This study constructed a TBI prognostic model using a 3,000-patient TBI registry compiled at Kilimanjaro Christian Medical Centre in Moshi, Tanzania. Construction of this model to predict the probability of patient survival upon hospital admission could improve patient triage and optimize resource management in LMIC clinical settings, thereby reducing overall TBI morbidity and mortality.

 

Knowledge, attitudes and practices about cervical cancer screening procedures in women of reproductive age in Lima, Peru

Location: Lima, Peru | Faculty: Not Listed 

Description: Cervical cancer is the leading cause of death among women of reproductive age in Peru. Unfortunately, despite available and affordable screening methods, most women remain unscreened. Reported barriers to screening procedures are low awareness of the risk factors and symptoms, stigma, as well as misconceptions about cervical diseases. This study sought to asses the knowledge, attitudes and practices regarding cervical cancer screening in Peru to understand what some of the barriers are that women of reproductive age face when contemplating getting screened. For this study, approximately 24 women were interviewed and divided into two sub-groups: Half of the women had been or were planning on getting screened for cervical cancer and the other half had not been screened. Data were collected using a semi-structured guide, in Spanish, transcribed, and translated into English, and then analyzed using inductive thematic analysis.

 

Analyzing blood vitamin levels of pregnant women exposed to air pollution in Beijing, China

Location: Kunshan, China | Faculty: Jim Zhang

Description: Air pollution exposure during pregnancy is linked to adverse outcomes including low birth weight and altered fetal metabolic function and may contribute to a greater risk of childhood obesity. However, there is not enough research exploring the biological mechanisms connecting air pollution and fetal development to nutritional levels to characterize their connection. This study sought to address this gap by comparing the levels of several specific vitamins in the blood of pregnant women exposed to air pollution in order to characterize the vitamin levels’ relationship to the mothers’ reported nutrition intake. Vitamin levels in the mothers’ blood were compared to answers from a qualitative nutrition survey about food and vitamin intake. The blood vitamin analysis was conducted via high performance liquid chromatography mass spectrometry and findings were compared against ambient air pollution exposure levels for participants. 

 

The barriers and facilitators for the implementation of a nutrition supplement for pediatric oncology patients in Tanzania: a mixed methods analysis

Location: Mwanza, Tanzania | Faculty: Kristin Schroeder

Description: Successful pediatric cancer care depends on nutrition. However, the baseline incidence of malnutrition is unknown in sub-Saharan Africa, and patients with cancer often become malnourished by metabolically active tumors and starvation stemming from poverty. This project used a two-part study based at Bugando Medical Centre in Mwanza, Tanzania, to understand the barriers and facilitators to implementing a nutritional supplement. The first phase determined the prevalence and severity of undernutrition at diagnosis for pediatric patients enrolling at the hospital. The second phase used qualitative interviews and exploratory surveys focused on food availability and security, diet, eating behaviors, and overall knowledge of nutrition and nutritional supplements to assess the acceptability of a nutrition intervention. If cancer outcomes could be improved by optimizing nutrition via nutritional supplement interventions, the study could inform cost-effective interventions for future implementation and research. 

 

Relationship quality and early stimulation during pregnancy in Ghana

Location: Tamale, Ghana | Faculty: Joy Noel Baumgartner

Description: According to a recent Lancet article, 43% of children 5 years and younger in low- and middle-income countries are not reaching their developmental potential. Early stimulation behaviors related to prenatal bonding and attachment, such as talking and singing to the baby while still in the fetal stage, are shown to have a correlation with early childhood development (ECD) outcomes. However, understanding how the relationship quality between couples during pregnancy affects early stimulation behaviors is under-researched. This study aimed to examine factors that could have an effect on ECD. Results could support ECD programming in low- and middle-income countries (LIMCs), enabling communities to better focus their interventions and seek financial resources to use on prevention of adverse childhood outcomes, rather than treatment.

 

How are health policy makers managing donor exits: a policy analysis of Ghana´s transition from the United States President´s Emergency Plan for AIDS Relief (PEPFAR)

Locations: Ghana and Switzerland | Faculty: Gavin Yamey

Description: When Ghana undergoes economic growth and becomes a middle-income country, it faces the loss of PEPFAR's assistance. This study focused on (a) assessing Ghana’s response to the transition from PEPFAR, and (b) identifying potential mechanisms by which Ghana could improve its own capacity to manage HIV programs and further control the HIV epidemic after PEPFAR’s exit. The study also hoped to generate practical lessons that could be helpful to other countries in their transition from donor assistance and to provide information that could inform future studies about transition.

 

Male perspectives on their involvement with exclusive breastfeeding in Nairobi, Kenya: a qualitative study

Location: Nairobi, Kenya | Faculty: Nicholas Pearson 

Description: Exclusive breastfeeding in Kenya is on the rise, but there is still considerable room for improvement. Current literature cites that external support is a key contributing factor to a mother’s decision to continue or discontinue breastfeeding. This research targeted one specific pathway through which some mothers receive external support, their male partners. The primary aim of this study was to build a fundamental understanding of male partners’ common behaviors and perspectives. By conducting in-depth interviews and qualitative story completion with male partners in Kenya, this project sought to illuminate the current knowledge, perceptions and misconceptions they associate with breastfeeding. This study also sought to identify and assess discrepancies between how male partners idealize and actively participate in breastfeeding support. This information was used to understand the extent of influence male partners have on breastfeeding practices and to design new tools, programs and interventions centered around men to better support their partners’ breastfeeding practices.

 

The effects of land cover on anopheles population dynamics in Ann Township, Rakhine State, Myanmar

Location: Rakhine State, Myanmar (Burma) | Faculty: Myaing Nyunt

Description: This project focused on investigating vectors that are known and suspected to transmit the two most common forms of human malaria: Plasmodium falciparum (Pf) and P. vivax (Pv). The study aimed to measure differences in species-specific density of Anopheles mosquitoes in association with different types of land cover within Ann Township, Rakhine State, Myanmar. Adult mosquitoes were collected from multiple randomized indoor and outdoor locations and were identified via microscopy and confirmed by PCR. The vector densities and distribution were analyzed in association with the variety of land cover recorded at the time of collection. The research aimed to identify dominant malaria vector species that could be disproportionately affecting individual villages and larger townships within Myanmar, and was the first step in a much larger national entomological mapping study.

 

Assessing alternatives to institutional care for orphans and separated children in urban India: a qualitative case study

Location: New Delhi, India | Faculty: Rae Jean Proeschold-Bell

Description: Framed within the greater global context of orphans and separated children (OSC) residential care home closures in low- and middle-income countries, this study sought to better understand the Udayan Care innovative model of care for OSC. This study sought to define the Udayan Care innovative model of care for orphans and separated children (OSC); analyze how the Udayan Care model fits into the larger public policy landscape of India; and understand to what extent this model could be implemented on a greater scale. The study included qualitative interviews with Udayan care staff and caregivers and policy stakeholders within the New Delhi area. Interviewing the latter group aimed to shed light on the space that Udayan Care occupies within the broader child protection policy landscape of New Delhi and, more broadly, India. 

 

Internships

Read how DGHI master’s students are enhancing their studies by working with global health organizations in the Triangle.