New research by DGHI faculty members and trainees sheds light on a variety of global health topics through new published research, making new claims about problems like how best to address emotional problems of orphaned children, where to invest resources for HIV care and treatment, or even how to fully quantify the magnitude of a problem that is still largely unknown - like road traffic injury, disease from polluted drinking water or a pathogen that causes bloodstream infection.
A Common Pathogen Alongside Malaria in sub-Saharan Africa
Former Duke Infectious Diseases Fellow and Global Health Resident Holly Biggs sheds light on the health of children in Tanzania who suffer from fever in a new study published in Clinical Infectious Diseases that examines an unlikely pathogen, invasive nontyphoidal Salmonella. It is a leading cause of bloodstream infection in sub-Saharan Africa but little is known about its prevalence, and is often confused with malaria when diagnosed without a blood culture. In a study of more than 4,000 children with fever in Tanzania, Biggs and DGHI faculty member John Crump found that invasive nontyphoidal salmonella was common in regions where malaria prevalence was high. They also found that salmonella typhi, which causes typhoid fever, was not common in malaria-endemic areas. The study highlights the possible relationship between these pathogens, the environment, and the host.
Tooth Loss – Are some regions in the US worse off?
New research by DGHI and Nursing faculty member Bei Wu published in American Journal of Public Health finds that the Appalachia and Mississippi Delta regions had higher levels of tooth loss compared to the rest of the country in 1999. From 1999 to 2010, tooth loss declined in the US, but these two locations worsened. Wu and researchers argue the increasing regional disparity in oral health, a difference as large as 17% between the Mississippi Delta and the US average, is partly explained by an aging population. Other causes for the gap include behavioral and environmental factors.
Mapping Road Traffic Injuries in Brazil
Published in PLoS One, a new study by DGHI faculty member Catherine Lynch explored the main environmental factors that affect road traffic fatalities in low- and middle-income countries like Brazil, where deaths from injuries are high. By mapping road traffic fatalities on a Brazilian highway, Lynch and the research team found that factors like length of road in urban area, limited lighting, double lanes roadways, and fewer auxiliary lanes were associated with more fatalities. Of the 379 crashes between 2007 and 2009, 466 fatalities were reported. Researchers also identified five patterns associated with different types of fatal crashes. Three of the five patterns are in rural areas and involve more vehicle collisions. Crashes in urban areas more frequently led to pedestrian deaths.
Underreporting of road traffic injuries in Sri Lanka
DGHI faculty members Truls Ostbye and Lynch published new research in BMJ Open showing that at least 33 percent of road traffic injuries in the Kandy district of Sri Lanka go under-reported in a year. With data from more than 11,000 individuals from 3,000 households, 57 percent of the self-reported injuries were considered reported to authorities, while only 43 percent of those were matched with police records. These findings highlight the need for a nationwide community-based survey to better understand injury rates and reasons for under-reporting.
Newly-diagnosed HIV Patients Opt for Care at Hospital
Faculty at the Center for Health Policy and Inequalities Research have published a new study in AIDS Care showing that many patients in Northern Tanzania are bypassing HIV care and treatment centers at local health centers and opting for care at established hospitals. The study highlights shifts in patient preferences despite a wide effort to decentralize HIV care services in order to increase access to antiretroviral therapy in low- and middle-income countries. For more than three years, researchers followed 750 participants who enrolled in the Coping with HIV/AIDS in Tanzania study from a local care and treatment center. While most patients reported seeking care at a center in the last six months, the team found that nearly three out of four newly diagnosed clients listed a referral hospital as their primary care and treatment center. Nine in ten patients bypassed their closest center. Researchers say changing patient preferences could inform how best to allocate services and resources in the future. Researchers involved in the study include Jan Ostermann, Kathryn Whetten, Elizabeth Reddy, Brian Pence and Nathan Thielman.
* Global Health Doctoral Scholar Publications
Children Good Source for Information on Abuse
Global Health Doctoral Scholar Divya Guru Rajan published new study in Vulnerable Children and Youth Studies showing that children were significantly more likely than caregivers to report family violence, physical and sexual abuse. Along with Center for Health Policy and Inequalities Research faculty Kristen Shirey, Jan Ostermann, Karen O’Donnell, Rachel Whetten and Kathryn Whetten, Rajan suggests that child self-reports can be useful when evaluating trauma in the home. This work is part of the Positive Outcomes for Orphans study led by Kathryn Whetten exploring the overall physical, mental and emotional health of 1,000 orphaned and abandoned children across five low- and middle-income countries. As researchers learn the best ways to evaluate child trauma, they can develop interventions that effectively address the emotional and behavioral difficulties children face.
Toxic Drinking Water Affects Dental Health
Nine in ten people drink water with elevated fluoride levels in the Main Ethiopian Rift, and six in ten people suffer from dental fluorosis, according to new research published in Science of the Total Environment by Global Health Doctoral Scholar Chris Paul and DGHI faculty member Marc Jeuland. The research team conducted dental exams among more than 1,000 people from the region and water samples were collected. They also found that age, sex and milk consumption were also significantly linked with dental fluorosis, which can lead to skeletal fluorosis, vomiting and seizures. Researchers suggest implementing new water treatment strategies, water safety and quality regulations and lifestyle changes for high-risk populations.