Community Health Assessments Among Quechua Communities in Ecuador

Transcription

1 GLOBAL HEALTH EQUITY PROJECTS Community Health Assessments Among Quechua Communities in Ecuador Institution or Organization: Health Ministry of Ecuador, University de San Francisco de Quito Local/Site Project Mentor: Roberto Chiriboga, MD, Fernando Ortega, MD, PhD; UF Project Mentor: David Wood, MD, MPH Project title: Community Health Assessments Among Quechua Communities in Ecuador Specific Aims: Describe briefly your goals/ objectives for the project. Conduct a community health assessment in 4 Quechua communities in the highlands of Ecuador in order to assist the communities to improve the own health and target health care services by both the Ecuadorian health care system and UF outreach services. ***The 6 weeks (minimum) in the field students will be spent in approximately 70% working on the project described below and 30% in clinical observation in the Guangaje clinic and the Pujili Community Hospital in the clinic, surgery, OB or on the inpatient service. Project Design and Methods. In the summer of 2013 UF medical students conducted a focused health assessment of 2 communities in the Guangaje area that are composed of Quechua indigenous people (most are bilingual Spanish/Quechua). These same communities that are served each year through COM Project Heal (spring service learning trip). They found that high rates of anemia, fetal loss and infant and child mortality with limited preventive or acute care health services. This project will build on this initial effort to expand the survey in both content and scope. We will utilize the Demographic and Health Survey, which has been conducted in over 90 countries, to conduct a household survey in 4 Quechua communities each comprising approximately 50 households. We will assess maternal health, child health, anemia, family planning, adult health, use of tobacco and alcohol and their access to health insurance and health care under the expanding health care services in Ecuador. We will work with community leaders to identify key health issues that can be addressed through education, community action and support from our university and government partners. Project Evaluation: Development and completion of the survey and reports back to the community and other partners Project Timeline: Describe the timeline for your project development, implementation, and assessment.. Will be initiated in the spring of 2014, initial implementation during the summer of 2014 and then continued on through Human Subjects Protections: Is IRB approval required? If so, please describe the process for IRB approval. NOT NEEDED FOR THIS PHASE Role of Medical Students: Medical students will work with their mentors to: 1) do background research on community health assessments; 2) do background research on the region in Ecuador where the survey will be fielded; 3) help in communication with the Medical Director of the region; 4) design the survey; 5) conduct the survey in 2-4 small communities (approximately 200 individuals); 6) summarize the numerical findings of the survey using Excel or SPSS; 7) write a report summarizing the findings of the survey including background information and recommendations based on the results of the survey; 8) work with UF and local mentors to

2 distribute the findings of the survey including presenting the findings at a Local-Global Health Equity Track seminar and at Medical Student Research Day. Teen Pregnancy Prevention in Quito Ecuador Institution or Organization: Health Ministry of Ecuador, University de San Francisco de Quito Local/Site Project Mentor: Francisco Viteri, MD, Fernando Ortega, MD, PhD; UF Project Mentors: David Wood, MD, MPH, Robert Lawrence, MD Project title: Teen Pregnancy Prevention in Ecuador Specific Aims: To use qualitative methods (in-depth interviews and focus groups) to better evaluate an existing public teen pregnancy and sexual health program in the Canton of Tumbaco and to identify potential modification to increase penetrance to and acceptance by the target population. ***The 6 weeks (minimum) in the field students will be spent in approximately 70% working on the project described below and 30% in clinical observation in the Yaruqui clinic and hospital in the clinic, surgery, OB or on the inpatient service. Project Design and Methods. Background. In the United States teen pregnancy has declined over the past 2 decades. Some of this decline is attributable to effective education and social media campaigns developed through community participatory research with sexually active youth. However, in Latin America generally and in Ecuador in particular, women have had limited access to information or services related to pregnancy prevention and sexual health. According to the Economic Commission of Latin America and the Caribbean, 18 per cent of children born in the Ecuador have teenage mothers and one in 10 women years of age is either pregnant or has already had a live birth. The lack of information and services and ineffective prevention strategies are also reflected in the incidence of HIV / AIDS and other sexually transmitted infections in the teen population. Access to contraceptive information and services is a now a right guaranteed under the 2008 Ecuador constitution under the general area of gender rights and Equality. The public health department of Quito has implemented and outreach and education program to youth on pregnancy prevention and sexual health. The purpose of this project is to work with the Department of Public Health in the Canton of Tumbaco, a suburb of Quito, Ecuador to evaluate the current to prevent pregnancy and STIs in adolescents. Questions that will be addressed are: Which adolescents are being reached by the current Department of Public Health program? Is the information provided acceptable to them and has it resulted in change in knowledge, attitudes and personal practices concerning sex and pregnancy? How can the program be adapted to: a) reach unreached groups and b) be more effective in communicating with adolescents in a way that will result in behavior change. The student will work with Dr. Francisco Viteri, Director of Public Health in Tumbaco to design an interview and focus group format. The student will then conduct key informant

3 interviews and focus groups with adolescents and organizations serving adolescents. The final product will be a report to the Department of Public Health on the findings from the interviews and focus groups and recommendations. Note: Spanish language fluency is required. Project Evaluation: Development and completion of the survey and reports back to the community and other partners Project Timeline: Planning for the project will be initiated in the spring of 2014, implementation during the summer of Human Subjects Protections: Is IRB approval required? If so, please describe the process for IRB approval. NOT NEEDED FOR THIS PHASE Role of Medical Students. Medical students will work with their UF and local mentors to: 1) do background research on teen pregnancy and STI in Ecuador; 2) do background research on the region in Ecuador where the survey will be fielded; 3) help in communication with the Medical Director of the region; 4) design the interviews and focus group manual; 5) develop a sampling frame with the mentors; 6) conduct the interviews and focus groups; 7) work with the mentors to summarize the findings using quantitative and qualitative methods; 7) write a report summarizing the findings of the survey including background information and recommendations; 8) work with UF and local mentors to distribute the findings of the survey including presenting the findings at a Local-Global Health Equity Track seminar and at Medical Student Research Day. Improvement in Cervical Cancer Screening, Diagnosis and Treatment and Prevention at Casa Hogar del Campesino (CHDC) Institution or Organization: Casa Hogar del Campesino, Cuzco Peru Local/Site Project Mentor: Francisco Velasco, MD; UF Project Mentor: David Wood, MD, MPH Project title: Improvement in Cervical Cancer Screening, Diagnosis and Treatment and Prevention at Casa Hogar del Campesino (CHDC) Specific Aims: Building on the study conducted by students last summer we will develop, implement and evaluate a cervical cancer screening program for patients seen at Casa Hogar. ***The 6 weeks (minimum) at Casa Hogar del Campesino will be spent in approximately 70% working on the project described below and 30% in clinical observation in the clinic, surgery or on the inpatient service. Project Design and Methods. Cervical cancer is endemic in the indigenous population of the highlands of Peru and is a major killer of women, constituting 15% of all new cancers and at least 10% of female cancer deaths. Based on the 2013 survey at Casa Hogar, most women being seen at CH are not up-to-date for PAP smear testing. We also found that many did not understand cervical cancer and the risk it poses to female health. However, after cervical cancer was explained almost all were interested in having PAP testing. Building on these

4 results we will a) distribute an educational brochure developed in 2013; b) develop a system to identify women who need PAP testing; c) institute a PAP screening clinic and d) evaluate the impact of the program on the receipt of cervical cancer screening services by the population served by CH. The project will be designed and initiated prior to and during the summer of We will work with Dr. Velasco and the CHDC staff to implement a QI project to be initiated through PDSA cycles during the year and most intensively during the summer of 2014 Project Evaluation: Ongoing documentation of process and outcome measures for the Cervical Cancer screening education and program for PAP smear testing. Project Timeline: Will be initiated in the spring of 2014, initial implementation during the summer of 2014 and then continued on through Human Subjects Protections: NOT NEEDED FOR THIS PHASE Role of Medical Students: Medical students will work with their mentors to design and carry out the project as outlined above, evaluate the implementation of the project and develop a report; distribute the findings of the evaluation to the leadership at Casa Hogar and presente the findings at a Local-Global Health Equity Track seminar and at Medical Student Research Day. Tropical and Natural Medicine Research, Lima Peru Institution or Organization: Universidad Peruana Cayetano Heredia (UPCH) Local/Site Project Mentor: UF Project Mentor: Art Edison, PhD, Biology Project title: Tropical and Natural Medicine Research, Lima Peru Specific Aims: Project Design and Methods: Universidad Peruana Cayetano Heredia (UPCH) is a leading medical school in Lima, Peru. We are developing an international student exchange program between UF and UPCH, and we are interested in recruiting 2-4 UF medical students this summer to help kick off the program. There are many educational and research opportunities including: Research internships in: Bioinformatics-- Design of epitopes for the diagnosis of taeniasis, cysticercosis, and leptospirosis. Parasite immunology) Detection of parasite antigens in humans and animals. Pediatric infectious disease-- Studies in enteric pathogens. Development Natural Products--Anticancer, antidiabetes, mental disorders, etc. Educational requirements: UF-COM students would need to have at least some Spanish training and an interest in learning more Spanish. Role of Medical Students: Work with the Dr. Edison and the faculty of UPCH to plan and implement a focused project related to one of the topics above. IRB may be required to advanced planning will be important.

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6 Risk Assessment of Suicide in Sikkim Study (RASSS) Faculty mentor: Linda B. Cottler, PhD, MPH Dean s Professor and Chair of the Department of Epidemiology UF Lbcottler@ufl.edu The Department of Epidemiology at the University of Florida, led by Dr. Linda B. Cottler, PhD, MPH, has presented a plan for examining risk factors associated with completed suicides in the year 2012 in Sikkim, India. The proposed research aims to identify and examine for the first time, the risk factors of completed suicides in Sikkim, India in order to develop prevention intervention programs. The National Crime Records Bureau of India indicates a steady rise in unnatural deaths attributed to suicide in Sikkim since With a population of about 600,000, the suicide rate of Sikkim was the highest in the country, four times more than the national average in 2008 (48.2/100,000; national average 10.8/100,000); it has remained unchanged. The increasing trend in rates of suicide has caused major concern among the general public as well as the State Government of Sikkim. The proposed study will be a population based case control study and will take place across all four districts of Sikkim. The method of psychological autopsy will be used where family members and friends of the deceased are interviewed using a combination of open-ended questions and an inventory to assess psychological, developmental and environmental factors that are associated with suicide. We propose to review all cases of completed suicides from the Death Registry in Sikkim from which cases (N=100) will be selected and matched (ratio 1:1) to controls (N=100) on age, gender and area of residence. In addition, we propose to prospectively sample all incident suicide cases (N~144) that occur after study initiation for six months and assess them using the proposed psychological autopsy. Comparison of all cases and controls will be carried out to determine the most important factors linked to suicide. The RASSS study will: 1. Assess the incidence of suicide in Sikkim for the year Examine and identify risk factors highly associated with completed suicide 3. Monitor trends in suicide over two time periods and 4. Submit a report on study findings to the Department of Health Care, Family Welfare and Human Services, Government of Sikkim, Sikkim, India to assist in the development of a suicide intervention program Opportunity for students The project is a unique opportunity for medical students to invest their energies, abilities and talents to advance knowledge and understanding of public health and the biopsychosocial understanding of mental health. Through involvement in the project at various stages students can enroll in a research opportunity to get exposed to the overall planning, preparation and conduct of research in resource deficient settings. Working closely with the project investigators the project will educate and enrich medical school students understanding in international health through research experiences with special attention to suicide and mental health. Specific to the project, opportunities include working closely with the investigators in the: 1. Development of the study manuals, guide and protocols 2. Development of the key informant interviews for development of a psychological autopsy 3. Development of the Psychological Autopsy Inventory to be used for data collection 4. Training of interviewers for data collection 5. Participate and experience the ongoing conduct of international research collaboration 6. Fieldwork and data collection 7. Analyses 8. Formal report generation and dissemination of findings

7 Philippine Pediatric Learning Collaborative: Connecting for Kids! FACULTY MENTOR, DEPARTMENT and ADDRESS: Caprice Knapp, PhD, Health Outcomes and Policy, BACKGROUND AND SIGNIFICANCE The goal of this project is to bring 15 pediatric teams from around the Philippines together to improve care for children. Teams will meet face to face in April 2014 and learn about quality improvement techniques, as well as strategies they can use to improve care for children needing preventive, chronic, and life-threatening conditions. For example, practices will learn about using an asthma action plan and how to identify and create a care plan for children with life-threatening illnesses. After April 2014, practices will have an action phase where they will work on the pre-determined measures related to the topic areas. They will report back each month on data from 10 charts to show their progress in the measures as well as provide a narrative about their processes used. They will have quarterly conferences calls with 4 practice teams to describe their progress. In May 2015 they will convene again and discuss the final findings. SPECIFIC AIM(S) Improve the health care of Filipino children and build capacity for quality improvement in pediatrics. ROLE OF MEDICAL STUDENT If the medical student can travel, it would be good to conduct a site visit with as many sites as possible to conduct qualitative interviews with the practice teams on their progress and observe the processes they have in place. Having an independent person validate what they are doing will help the credibility of the data.

8 TITLE of Project: The Impact of Socioeconomic Hardship in Organo-phosphorous poisoning (OPP) in Rural India FACULTY MENTOR, DEPARTMENT and ADDRESS: Dr. Vishnumurthy S. Hedna, MD Assistant professor, Department of Neurology Associate program director, Neurology Residency Associate program director, Stroke Fellowship University of Florida; College of Medicine; Room L3-100, McKnight Brain Institute 1149 Newell Drive, Gainesville, FL Phone: (352) Fax: (352) BACKGROUND AND SIGNIFICANCE: According to hospital surveys of surviving patients, pesticide deaths are most often a result of conscious pesticide self-poisoning, rather than accident. The Global Burden of Disease study in 1990 estimated that nearly three-quarters of the 800,000 deaths related to pesticide selfpoisoning occurred in developing countries. This is a particularly troubling challenge in agrariandependent rural regions of India. Suicide rates in Southern India are considered to be high, 1,741 suicides out of a population of 100,000 were documented from 1986 to 2005, selfpoisoning accounted for 42.8% of these, with a higher distribution in males under age 50. Despite changes in numerous factors over the past three decades, official government statistics show the figures to have been relatively stagnant with occasional annual fluctuation. Psychiatric evaluations of self-poisoning in rural regions of developing nations, like India, indicates that in most cases suicide is a compulsive response as a result of social, economic, and cultural troubles, rather than the presence of severe mental illnesses. There has been great uproar and interest internationally over the cause(s) of farmer suicide in India, ranging from a lack of infrastructure, to failure of public policy, to unfavorable weather patterns, to the increased economic burden of genetically-modified seeds. Given the multifactorial basis of the factors leading to OPP suicide it is necessary to conduct numerous and continuous studies to accurately assess the reasons for the act as well as their potential evolution over time as the underlying factors may be subject to change. SPECIFIC AIM(S): This project aims to find the underlying socioeconomic factors responsible for farmers' self-harm by OPPs. These factors will be determined by method a chart review of patients treated at Gopala Gowda Shanthaveri Memorial Hospital in Mysore, India. Upon completion of data collection by chart review, it will be published in local journals and social networks with the aim of educating individuals as well as assisting local government in developing adequate measures to counteract self-harm by OPPs.

9 ROLE OF MEDICAL STUDENT: This project consists of a chart review. The medical staff at Gopala Gowda Shanthaveri Memorial Hospital will provide information relevant to the patient's suicide attempt that was routinely gathered during the course of their treatment. This information will include the age, sex, and ethnicity of the patient as well as their view on their condition as gathered during a routine History by medical staff. This project has already been approved by the IRB-equivalent in India. Only the charts of patients that have been selected as candidates for review by the medical staff in the hospital will have their charts reviewed, following consent by the patient. The medical staff will inform the patients that a project is being conducted that may utilize their information if they consent. The medical student involved in this project will have no interaction with the patients. Data will initially be recorded onto paper forms which will not contain the patient s name, contact information, home address, or any other direct identifiers. Paper data will then be transferred to a Toshiba 1.5TB, password protected, hard drive that only the Principal Investigator, Dr. Vishnumurthy S Hedna, and co-investigator, will have access to. Following digital back-up, paper files will be destroyed and disposed of at Gopala Gowda Shanthaveri Memorial Hospital in Mysore. Any electronic communications between investigators in this project will be conducted through secure networks (on-site UF network or VPN if off site) using UFL webmail accounts. The information to be reviewed on the chart will be from what has already been collected during routine medical care of patients. Data will not be collected in a prospective manner. There will be no questionnaire involved at this stage in the study. The goal of this first part of the project will be to look for common causes of suicide by OPP s (Organo-phosphate pesticides) within the patients existing medical records.