Slideshow: Petersen travels to India to research visceral leishmaniasis

In July 2017, Christy Petersen, CPH associate professor of epidemiology, traveled to Bihar, India, to conduct research on visceral leishmaniasis. She recently shared photos and details of her trip.

I traveled to India as a part of the Banaras Hindu University (BHU) Tropical Medicine Research Center faculty. The center is an NIH Specialized Center (P50) that is entering its 15th year of funding located at the Kala-Azar Medical Research Centre (KAMRC).

I worked in and around a city called Muzaffarpur in the state of Bihar, which had the honor of being the last area of the world to eradicate smallpox. Bihar is in the northeastern corner of India, next to Nepal and Bangladesh, and home to the headwaters of the Ganges River. Bihar is still one of the poorest regions of India. The power is inconsistent throughout most of the day, the water isn’t potable, and raw sewage flows down the sides of the street.  As it was monsoon season while I was there, there was active malaria, Dengue, Zika, Japanese encephalitis, and other things circulating in the mosquitos, so I was sure to wear my bug spray each day.

Bihar is also endemic for visceral leishmaniasis (VL), the fatal protozoal parasite infection that is the research focus of my lab. The Muzaffarpur area had 44 new VL cases during June 2017, the month before I arrived. One of the villages I visited had 38 of 300 villagers recently seropositive for leishmaniasis; all were children under 18.

We drew crowds when we were out in the villages looking for “bimar kutta,” or sick dogs, to establish whether animals are part of the disease ecology (reservoirs). To date, this disease is believed to only circulate between humans and the vector sand flies, but in the rest of the world infection is also found in other mammals, particularly dogs and rodents as reservoirs.

I was working in the field with a team of 10 people total, myself included. This was a field team of four trained dog-catchers and three entomologists, one of whom was from the Walter Reed Army Institute of Research (the only other American present during my three weeks). Rounding out the 10 people was our driver, the PhD student from BHU whose dissertation will focus on this work, and a molecular parasitlogist who will aid us with the molecular studies stemming from these samples. She was the only other woman at KAMRC while I was there. As you might guess, as the only white woman around for miles, I was quite unusual and was the focus of many stares everywhere I went. That was probably one of the hardest things for me to adjust to as an understated Midwesterner.

Bihar was an amazing, troubling, fascinating place.

Study looks at role of social connections, socioeconomic inequalities in child nutrition in rural India

A girl in India eating watermelon.

Researchers are increasingly studying how people’s social connections affect poverty and health inequalities. However, little is known about how a family’s social relationships – who they know and what organizations they belong to – contribute to children’s health in low- and middle-income countries such as India, especially when it comes to addressing inequalities in child nutrition.

A recent study led by William Story, University of Iowa assistant professor of community and behavioral health, examined how different forms of social capital may mitigate as well as sustain or reproduce socioeconomic disparities in child underweight. The researchers define social capital as “household members’ actual or potential resources inherent within personal and organization-based networks that can be used for pursuing individual or collective goals.”

For example, a household may belong to community associations, clubs, or religious groups or have ties to influential individuals such as medical professionals, teachers, or government officials. In the context of child nutrition, these social connections may provide immediate access to necessities such as food, informational resources (e.g., parenting advice), and medical services to overcome socioeconomic constraints.

William Story

Story, along with his colleague Richard Carpiano, a sociology professor from the University of British Columbia, analyzed data on 9,008 rural-dwelling children from the 2005 India Human Development Survey. They examined how socioeconomic status shapes household access to and child health benefits from three different forms of social capital located inside and outside the community.

“We found that higher household wealth is associated with greater access to social capital,” says Story. “Additionally, we found that social capital can benefit poorer households in the absence of other resources. However, wealthier households can use social capital to further improve child health and, in some cases, reproduce child health inequalities.”

The study, published in the May 2017 issue of Social Science & Medicine, can be used to guide future research on social capital and disparities in child nutrition and health, and to inform the design of effective interventions in low- and middle-income countries.

Study looks at men’s roles in obstetric emergencies in Ghana

A recent study from the University of Iowa looked at ways in which men are involved in obstetric emergencies in Sub-Saharan Africa.

As men become more involved in childbirth in low- and middle-income countries such as Ghana, researchers believe it is important to identify the most effective ways to involve them during labor and delivery, especially during an obstetric emergency.

A portrait of William Story of the Department of Community and Behavioral Health in the College of Public Health at the University of Iowa.
William Story

The study, led by Will Story, assistant professor of community and behavioral health at the University of Iowa College of Public Health, used data that was collected as part of the Maternal and Newborns Referral Project funded by the Bill and Melinda Gates Foundation and led by Dr. Kavita Singh at the University of North Carolina’s Gillings School of Global Public Health.

The research team conducted and evaluated qualitative interviews with 39 mothers and fathers in two districts in Northern and Central Ghana who had experienced obstetric emergencies as well as interviews with six health facility workers and eight focus group discussions with community members.

According to Story, the research showed that male involvement during obstetric emergencies operated across a spectrum of behaviors—from helpful to harmful.

“Although most men provided money and transportation to help their partner obtain care or helped them find a blood donor during the emergency, some men were either absent or acted as ‘gatekeepers’ and caused delays in care seeking,” he says.

“Similarly, we found a spectrum of male accommodation in health facilities during an obstetric emergency—from ignoring or disrespecting men to accommodating them by providing appropriate spaces [such as a waiting room].”

Story says that simply identifying ways in which men can be supportive during an obstetric emergency will not lead to better health outcomes unless health facilities make accommodations that allow men to fulfill their roles.

The study concludes that policies and programs should promote supportive behavior by men during obstetric emergencies while empowering women to make decisions that are best for their own health and the health of their child.

Co-authors include Clare Barrington and Kavita Singh from the Gillings School of Global Public Health, University of North Carolina; Corinne Fordham from Johns Hopkins Center for Communication Programs; Sodzi Sodzi-Tettey from the Institute for Health Care Improvement, Africa Region; and Pierre M. Barker from the Institute for Healthcare Improvement.

Cook discusses Ponseti Method to treat clubfoot

Tom Cook, CPH professor emeritus of occupational and environmental health and director of global operations for Ponseti International, recently discussed clubfoot and its treatment with the Ponseti Method. The noninvasive technique uses a series gentle manipulations and plaster casts to correct the condition.

CPH students earn global health travel grants

A portrait of Jasmine Mangrum of the Department of MPH Program in the College of Public Health at the University of Iowa.
Jasmine Mangrum

The College of Public Health is pleased to announce that Jasmine Mangrum and Danielle Medgyesi are the latest recipients of CPH Global Public Health Student Travel Grant awards.

Mangrum, a student in the combined Doctorate of Pharmacy-Master of Public Health degree program, received funding to investigate smoking cessation practices of pharmacists at a community pharmacy in Cluj-Napoca, Romania. The project will collect data to develop a comprehensive smoking cessation toolkit for Romanian pharmacists and better integrate pharmacists into the global health workforce. Mangrum previously worked with public health officials in Cluj through the NIH-funded Minority Health and Health Disparities International Research Training internship.  Mangrum’s advisor for the project is Edith Parker, professor and head of community and behavioral health.

A portrait of Danielle Medgyesi of the University of Iowa College of Public Health
Danielle Medgyesi

Medgyesi, a master of science student in the Department of Occupational and Environmental Health, has been funded for a six-week project in Kisumu, Kenya, to conduct a study of children’s exposure to gastrointestinal (GI) pathogens in public areas. The project will allow researchers to better understand children’s daily behaviors and patterns leading to GI pathogen exposure. Worldwide, GI infection is the second leading cause of death in children under the age of five, including more than 27,000 child deaths in Kenya in 2007. Medgyesi’s advisor for the project is Kelly Baker, assistant professor of occupational and environmental health.

The CPH Global Public Health Student Travel Grant program, funded by generous philanthropic support from UI alumni Dale and Linda Baker, supports international research, practicums, and internships for graduate students seeking a degree in the College of Public Health. (Students in combined degree programs are eligible, but those in certificate and affiliated programs are not). Awards are available up to $5,000 per student and applications are accepted monthly. For application guidelines and more information, please see http://www.public-health.uiowa.edu/global-public-health-student-travel-grant/

Read more about Dale and Linda Baker’s support for global educational opportunities at the University of Iowa … Growing Global Citizens.