MUSC Center for Global Health announces 2014 Global Health Faculty Pilot grant recipients

MUSC Center for Global Health (CGH) recently awarded six faculty members global health seed funding of up to $20,000 to support global health research projects in low and middle-income countries. The CGH’s goal in releasing these funds is to bolster our faculty’s ability to collect vital preliminary data needed to secure extramural funding from governmental, private or non-governmental sources. Awardees were selected from a diverse pool of exceptional submissions through a competitive peer-review process. The following are 2014 Global Health Pilot Grant recipients.

Mulugeta Gebregziabher, Ph.D.
Associate Professor, Department of Public Health Sciences
College of Medicine

“Spatiotemporal and regional variation in HIV testing and infection rates in Sub-Saharan Africa”

Dr. Gebregziabher has worked with demographic health survey (DHS) data from sub-Saharan Africa for the past four years to assess markers associated with HIV using advanced statistical methodology. His interest was initiated by a class project of a student (Abeba Teklehaimanot) at MUSC, who is now pursuing a project on “Barriers and Facilitators of serological testing in Ethiopia” using DHS data under the guidance of Dr. Anbesaw Selassie. The World Health Organization (WHO) continues to characterize HIV as the single largest threat to health affecting sub-Saharan Africa. While HIV spread has continued in some areas such as Kenya and Rwanda, other countries like Ethiopia have sustained relatively low rates of HIV incidence over time. There has been an increase in HIV testing and counseling from two percent in 2005 to 20 percent in 2010, but the majority of Ethiopia’s population who are eligible for testing remain unreached.
In this study, Gebregziabher will use a Bayesian approach to analyze DHS data to further understand factors associated with regional spatiotemporal variation in HIV testing and HIV infection with collaborators at Mekelle University in Tigray, Ethiopia. The results will inform direction of research capacity and best practices for HIV testing strategies for population-based interventions in sub-Saharan Africa. Understanding what factors can influence rates of testing could prove critical to improving testing, treatment and prevention processes. Identifying additional risk factors or markers for HIV seropositivity may identify populations that would benefit from enhanced test and perhaps uncover approaches to engaging these populations.

MUSC co-investigators include Patrick Mauldin, Ph.D.; Preston Church, M.D.; Anbesaw Selassie, Dr.PH, Michael Sweat, Ph.D., and Andrew Lawson, Ph.D.

Andrea Summer, M.D., MSCR
Associate Professor, Department of Pediatrics
College of Medicine

“Establishment of a pilot telemedicine network in Honduras”

Honduras is the second poorest country in Central America, and lacks adequate access to heath services – with only nine physicians per 10,000 residents. Dr. Summer and colleagues are planning to determine the feasibility of establishing a telemedicine network in a rural community setting in Honduras in order to improve access to general and specialized pediatric care in areas where there are large unmet needs. The network will consist of integrating technologies between rural and urban sites in Honduras with those at the Medical University of South Carolina (MUSC). The researchers will facilitate an ability to transmit evaluation and diagnosis data to improve pediatric patient care management in underserved populations. If this pilot network is successful, the next step will be to develop a larger network with additional subspecialty representation and expanded capabilities, including inter-site collaboration for learning and professional development. These types of collaborations have the potential to motivate practitioners to remain in rural or inner-city locations, which has tremendous implications for improving the health of underserved populations worldwide.

MUSC co-investigators include James McElligott, M.D., and Kenton Holden, M.D.

Carolyn Jenkins, Dr.PH, MS, MSN, FAAN–Principal Investigator
Professor, College of Nursing

Bruce Obviagele, M.D., MSc, MAS–Co-Principal Investigator
Chair, Department of Neurology
Professor, College of Medicine

“Community assessment for phone-based intervention under nurse guidance after stroke”

Stroke is the leading cause of death, and a major contributor to disability, dementia and depression in sub-Saharan Africa. Among stroke survivors, recurrent stroke and myocardial infarction (MI) leads to functional decline and subsequent mortality. The goal of this study is to identify barriers to managing hypertension using mobile technology in Ghanaian stroke patients, thusly establishing culturally sensitive interventions for the catchment community.

Seizing on an opportunity to utilize growing mobile phone usage (of the world’s seven billion people, six billion own cell phones) for public health, Jenkins, Obviagele and their team plan to conduct a cross-sectional, nested mixed methods study with Komfo Anokye Teaching Hospital in Kumasi, Ghana using community based participatory approaches. Jenkins, Obviagele and their colleagues will be among the first researchers in Sub-Saharan Africa to appraise mHealth interventions for stroke patients, providers and administrators by engaging community members and groups to assist in developing a theory guided, culturally sensitive patient and provider centered medical regimen self-management program.

The researchers will develop a community-partnered approach (CBPR) for patients at highest risk for future stroke to design a system for a theoretical, multi-level, novel intervention to control the premier stroke risk factor, hypertension. The program will be empirically evaluated in a future randomized controlled trial.

Frank Treiber, Ph.D. is a co-investigator from MUSC who is also contributing to this study.

Jennifer Shearer, Ph.D.
Assistant Professor, College of Nursing

“Global Health and Simulation in Midwifery Curriculum”

The highest burden of neonatal deaths globally is attributed to India where 900,000 newborns die each year. In her study, Shearer addresses the need to increase the skillset of midwives in India to better improve infant and maternal outcomes. The goal of her project is to collaborate with Bangalore Baptist Hospital in Bangalore, India providing a birthing simulator and training for faculty, and collecting data to determine the effectiveness of simulation for improving the knowledge and skills of midwifery students. By examining skill performance as an outcome, this study will contribute to the scientific basis of simulation in nursing education and provide justification for the cost of simulation trainers in resource-poor countries.

The research contributes to the public health goal of reducing maternal and neonatal deaths, and supporting the World Health Organization effort to improve education training of midwifery practitioners using simulation as part of the standard curriculum. The long-term goal of this research is to support the establishment of a simulation program in Bangalore to increase the skill set of the midwives in order to provide better outcomes for maternal and neonatal care.

Cynthia Swenson, Ph.D.
Professor, Department of Psychiatry and Behavioral Sciences

“Improving health through implementation of a village-based complex biogas system”

Swenson and team will be funded to assist in implementing in rural Ghana, West Africa a green sanitation system that leaves no carbon footprint. The system is a waste-to-energy biogas system that is novel because it has three components: 1) a toilet in which waste enters a conversion chamber; 2) the waste is converted to gas that is piped to a cook stove for clean cooking; and, 3) waste is converted to bacteria free organic fertilizer. To date, biogas systems in Ghana have not had the three-component capacity and have been seen only in large institutions in the country. Swenson and team plan to test the implementation and uptake of this system in an economically distressed rural community where residents do not have access to sanitation systems.

The biogas system will address three major health hazards: 1) the practice of open defecation; 2) the use of charcoal and wood in cooking leading to heavy smoke inhalation and environmental risks; and 3) the use of heavy chemicals in farming. The biogas system implementation is part of a larger project that aims to improve water, sanitation, health, education, economic self-sufficiency and food security in the intervened community in Ghana. The research team will determine feasibility and acceptability of the biogas system; assess attitudes and knowledge of this technology over time; and better understand barriers to sustaining this intervention as well as factors that promote novel technology.

“If, through this project, we can implement and foster uptake of the biogas system that is planned, we will be able to reduce or perhaps stop open defecation, reduce use of wood and charcoal in cooking, and increase use of organic methods for farming,” said Swenson. “Addressing these three issues can have major health benefits to the community.”

Sarah Logan, Ph.D., an MUSC researcher, will also contribute to this study as a co-investigator.

Julie Kanter, M.D.
Assistant Professor, Department of Pediatrics
College of Medicine

“Partnership screening program for sickle-cell disease in St. Vincent and the Grenadines”

Sickle cell disease (SCD) is one of the most commonly inherited blood disorders worldwide. SCD affects one out of every 375 African-American infants just in the United States. In Jamaica, however, the estimated incidence rate for SCD is one out of every 150, showing a need for screening programs in the Caribbean. Kanter and her colleagues plan to design and implement a pilot program in St. Vincent and the Grenadines—where no screening program exists—to screen neonates to determine the incidence of sickle-cell disease. Preliminary data will be collected to assess the utility of universal neonate screening for sickle-cell disease as a means to develop a larger cost-effectiveness study. With these pilot results, Kanter and her colleagues seek to initiate a larger cost-effectiveness study to demonstrate the feasibility and utility of neonatal sickle-cell disease screening programs to reduce morbidity and mortality rates universally.

Shelly-Ann Williams, M.D., a Grenadian and Fellow in the Neonatal/Perinatal Medicine department, and Dr. Susan Reed, DDS, Dr.PH are co-investigators on this study.