|Absorption of Zn and Fe from bio fortified pearl millet in young Indian children||Child Health, Nutrition||India||Hambidge, M.|
Michael Hambidge, MD, ScD, Professor Emeritus, Department of Pediatrics, University of Colorado School of Medicine, is the principal investigator of this project. The objective of this project is to determine Zn absorption from bio fortified maize meal at different levels of fortification, the determine the effect of milling on bioavailability, to compare increase in Zn absorption for each group, and to utilize data derived from these studies to develop a trivariate model which will predict the effect of dietary Zn and phyate on the total quantity of Zn absorbed each day. This project is being conducted between May 2009 and April 2011.
|Absorption of Zn form Zn-bio fortified and Zn-fortified maize in young Zambian children||Child Health, Nutrition||Zambia||Hambidge, M.|
Michael Hambidge, MD, ScD, Professor Emeritus, Department of Pediatrics, University of Colorado School of Medicine, is the principal investigator of this project. The objectives of this project is to determine Zn absorption from bio fortified maize meal at different levels of fortification, the determine the effect of milling on bioavailability, to compare increase in Zn absorption for each group, and to utilize data derived from these studies to develop a trivariate model which will predict the effect of dietary Zn and phyate on the total quantity of Zn absorbed each day. This project is being conducted between May 2009 and April 2011.
|Birth Attendant Training and Rural Obstetric Care Health Provison Access||Child Health, Maternal Health, Training/Education||Guatemala||Heinrichs, G., Niermeyer, S.|
Gretchen Heinrichs, MD, DTMH, Assistant Professor of Obstetrics and Gynecology at the University of Colorado School of Medicine and Denver Health, as Director of Maternal Health Initiatives for the Center for Global Health has formulated the maternal health objectives for the ongoing Guatemala Trifinio project being conducted by Center for Global Health.
Susan Niermeyer, MD, MPH, FAAP, Professor of Pediatrics, Section of Neonatology at the University of Colorado School of Medicine and Professor of Epidemiology at the Colorado School of Public Health is Co-Director of the Center for Global Heatlh's Maternal and Child Health Initiative along with Eric Simoes, MB, BS, DCH, MD, Professor of Pediatrics, Section of Pediatric Infectious Disease at the University of Colorado School of Medicine and Professor of Epidemiology at the Colorado School of Public Health.
Together they will work on current projects beginning in Guatemala in birth attendant training and rural obstetric care health provision access. The Guatemala Trinifio Project started in 2011 and is planned to conclude in 2017.
|Capacity building and education of health Promoters in the Loreto Region, Peru||Child Health, Training/Education||Peru||Bellows, J.|
Jennifer Whitfield Bellows, MD, MPH, Assistant Professor, Department of Emergency Medicine at the University of Colorado School of Medicine and Denver Health serves as a faculty mentor to a CU student-run non-profit organization called Comunidades Unidas Peru ("CU Peru"), whose goal is to provide trainings to lay health promoters in rural areas of the Loreto region of Peru. The trainings are based on the WHO's Integrated Management of Childhood Illness (IMCI) curriculum and include ongoing focus group, interview, and survey-based evaluation to determine reception and impact among populations served. Trainings occur over several weeks every summer.
|Case Control Study of Suicide Attempts Among Farmers in Jilin Province, China||Mental Health, Occupational Health||China||Stallones, L.|
This project is being conducted by Lorann Stallones, MPH, PhD, Professor of Psychology, Director of the Graduate Degree program in Public Health at Colorado State University. The project investigates the relationship between organophosphate pesticide (OP) exposures, agression, impulsivity, and attempted suicides. Although previous studies have suggested an association between suicide and OP exposure, no studies have assessed the relationship between suicide attempts and OP exposures.
This project ran from 2010-2011.
|CHA/PA Program||Health Systems Capacity Building, Training/Education||South Africa||Glicken, A.|
Anita Duhl Glicken, MSW, Associate Dean, Physician Assistant studies, University of Colorado School of Medicine, and Director, Child Health Associate/Physician Assistant (CHA/PA) program has been working on an ongoing partnership with the Walter Sisulu University (WSU), located in Eastern Cape, South Africa. As one of the first physician assistant programs in the United States, the CHA/PA program at the University of Colorado School of Medicine was recently selected by the American International Health Alliance (AIHA) to partner with WSU. The 3-year Clinical Assistant (CA) program is needed to produce qualified practitioners who can assess patients, make diagnoses, prescribe treatments and undertake minor surgical procedures. Additionally, WSU leaders would like to develop a student exchange program so their students can come to Colorado and learn what it means to be a physician assistant. The program recruits 20 students a year from the local population. Recruiting locally guarantees students can speak Xhosa, the local language. Often the region’s doctors are not from the local community so they find it hard to communicate directly with patients. CAs also have limited opportunities to work outside of their geographic area or country, which means they are more likely to be retained in the local health system.
|Cleft Lip and Palate Surgery ||Surgery||Guatemala||Winkler, A.|
Dr. Andrew Winkler, MD, Assistant Professor of Otolaryngology-Head & Neck Surgery leads a team to Antigua, Guatemala each year to perform cleft lip and palate repair surgery. These trips are coordinated with Faith In Practice (FIP), a non-profit, ecumenical Christian organization that works solely in Guatemala. This group organizes many short-term surgical and medical mission trips to Guatemala each year and has a permanent headquarters there. Each year, surgeries are performed at Obras Sociales del Santo Hermano Pedro, a church that has been converted into a hospital and treatment center for the mentally and chronically ill.
With the support of a grant from the FIP leadership, Dr. Winkler has initiated a cleft patient database to aid in continuity of care. His team is also devising a plan for short-, medium- and long-term expansion cleft services within the capabilities of the Obras. The most pressing need is to develop a speech therapy program to improve speech and language development in cleft children.
|Climate Change Impacts on Diarrheal Disease in Northern Coastal Ecuador||Infectious Disease||Ecuador||Carlton, E.|
Elizabeth Carlton, MPH, PhD, Assistant Professor at the Colorado School of Public Health, is evaluating the potential impacts of climate change, especially rainfall, on diarrheal disease in Northern Coastal Ecuador. Conducted in partnership with the Emory University, the University Central del Ecuador, and the University of Michigan, Ann Arbor, Dr. Carlton is evaluating weather-disease relationships and vulnerability to climate change in rural, low-income communities. Her study will run from March-August 2013.
|Collaborative Studies in Epidemiology and Molecular Virology: the Human Animal Interface||Infectious Disease, Training/Education||Indonesia||Simoes, E.|
Dr. Eric Simoes, MB, BS, DCH, MD, Professor of Pediatrics, Section of Pediatric Infectious Disease at the University of Colorado School of Medicine is conducting a 3-year study to investigate the role of the animal human interface in human and avian influenza virus infections in Bandung, Indonesia. The project will also build capacity in Indonesia to conduct molecular virologic and epidemiologic investigations using advanced techniques used in basic virology and epidemiology. This USAID-funded project is possible with the cooperation of the University of Padjajaran, the West Java Department of Animal Husbandry, and the Genome Institute of Singapore. This project will run from January 2013 to December 2016.
|Complementary Feeding and Micronutrient Supplements||Child Health, Maternal Health, Nutrition, Training/Education||China, Democratic Republic Congo, Guatemala, India, Kenya, Pakistan, Zambia||Krebs, N.|
Nancy Krebs, MD, FAAP, Professor, Department of Pediatrics, University of Colorado School of Medicine is working as Co‐PI on the NICHD/NIH supported Global Network for Women’s and Children’s Health Research. She works at the lead site for a multi‐country efficacy trial on complementary feeding. She is also working on projects related to interventions of micronutrient supplements, biofortification and plant breeding, and dietary diversification in Guatemala, China, India, Pakistan, Kenya, Zambia and Democratic Republic of Congo. An investigation of iron interventions in a malaria‐endemic area of Kenya and the impact on the gut microbiome is also underway.
|Complementary Feeding: A Global Network Cluster RCT||Child Health, Nutrition||Guatemala||Hambidge, M.|
Michael Hambidge, MD, ScD, Professor Emeritus, Department of Pediatrics, University of Colorado School of Medicine, is the principal investigator of this project. The broad objective of this proposal is to improve growth and health of infants and young children less than two years of age by improving the quality of complementary feeding. The proposed interventions will compare the potential benefits of incorporating meat into routine infant and toddler feeding versus optimized traditional plant based complementary feeding regimens. This is a multi-country study, of which our site [Colorado-Guatemala] is the lead site in the current Complementary Feeding Project, the CBA Survey and the pending Preconception intervention. This project began in September, 2001 and will continue through April 2012.
|Contributions of National Health Policies that Included Community Participation, Switzerland and Selected African and Asian Countries||Health Systems Capacity Building||Switzerland||Rifkin, S.|
Susan B Rifkin, PhD, adjunct faculty at the Colorado School of Public Health and a Senior Research Fellow, Institute of Social Psychology, at the London School of Economics, has been building on the results of a symposium held in Washington, DC in April 2010 with the Department of Preventive Medicine, University of Geneva, and analyzing experiences from countries that have evidence of improved health outcomes from including policies of community participation.
|Developing a Collaborative Health Geographic Information Systems (GIS) at Bugando University College of Health Sciences (BUCHS)||HIV/AIDS, Maternal Health||Tanzania||Thomas, D.|
Deborah Thomas, PhD, Associate Professor, Department of Geography and Environmental Sciences, University of Colorado Denver, is collaborating with local researchers to conduct this project. The University of Colorado Denver and the Department of Community Medicine at Bugando University College of Health Sciences in Tanzania have formed a collaborative partnership to build an area of concentration around health GIS and evidence-informed decision making, applying GIS as a research tool around a variety of projects, including HIV mapping in Misungwi District and disease mapping in the Ngorongoro Conservation Area (NCA) focusing on malaria.
|Developing Dental Capacities in Guatemala's Trifinio Region||Dental, Training/Education||Guatemala||Shick, E.|
Elizabeth Shick, DDS, MPH, Assistant Professor, Department of Pediatric Dentistry, University of Colorado, School of Dental Medicine, is working on the Trifinio project to provide dental services to patients of the future clinic. She plans to provide comprehensive care to patients by travelling multiple times per year to the Trifinio Clinic, and creating an elective rotation for 3rd and 4th year dental students. Students will travel to the clinic to provide dental care with an attending faculty member from the University of Colorado School of Dental Medicine. Shick is investigating possible funding opportunities to cover costs of dental chairs, instruments and materials. Another goal of this project is to collaborate with the local dental school at University of Francisco Marroqin to encourage their involvement in providing dental care at the Trifinio clinic to provide long-term sustainability and increased scope of services offered. The final objective is collaboration with the faculty of the dental school at University of Francisco Marroqin to provide education and training in the area of pediatric dentistry and encourage an exchange program between their school and University of Colorado School of Dental Medicine.
|Development and health of rural Chinese children fed meat as a daily complementary food from 6-18 months of age||Child Health, Nutrition||China||Hambidge, M.|
Michael Hambidge, MD, ScD, Professor Emeritus, Department of Pediatrics, University of Colorado School of Medicine, is the principal investigator of this project. The goal of this project is to determine the efficacy of a daily intake of locally available, low cost meat/liver as a complementary food from 6-18 months of age for young children of this age who are otherwise dependent only on continued breast feeding and locally available non-fortified plant foods. Efficacy will be determined by public health outcomes, including infectious disease morbidity and both physical and cognitive development, with linear growth as the primary outcome measure. Other outcome measures required for interpretation of these results are biomarkers of key micronutrient status, including zinc absorption. This project is being conducted between October 2008 and September 2011.
|Ecole Professional CAMEJO (EPC), Vocational Training School Development in Leogane||Child Health, Maternal Health, Training/Education||Haiti||Gifford, B.|
Blair Gifford, PhD, Professor, International Health Management, Business School, University of Colorado Denver, is currently working on this four-year project. Funding for this project will be used to develop midwifery auxilliare vocational training at the Ecole Professional CAMEJO (EPC) in Leogane, Haiti. Midwife auxilliare training is needed to combat the very high maternal and infant mortality rates in Haiti. Recent efforts to develop midwife assistants and other health human resources, by organizations like Partners in Health in Haiti, have helped lessen maternal and infant mortality rates by up to 50% since 1999 in specified work areas. Haiti has the worst maternal health statistics of any country (630 deaths per 100,000 live births) in the Western hemisphere and among the worst in the world. Prior to the quake, only a quarter of births were attended by trained personnel, compared with 98% of births in the neighboring Dominican Republic. Experiences from Afghanistan and Partners in Health work areas in central Haiti have shown that investing in midwifery can significantly reduce maternal mortality, even under the harshest conditions. Midwives are significantly less expensive to train and maintain than doctors; they can be drawn from local populations with low educational levels and as “local daughters;” and, they are more likely to be accepted and trusted by, and continue to serve, hard-to-reach rural communities.
|Effect of SprinklesTM with and without Fe on Zn Absorption from local foods in Kenyan toddlers||Child Health, Nutrition||Kenya||Hambidge, M.|
Michael Hambidge, MD, ScD, Professor Emeritus, Department of Pediatrics, University of Colorado School of Medicine, is the cooperating investigator of this project. The study will examine effects of Fe fortification on Zn absorption in malaria endemic area where Fe deficiency is common. This project will run from December 2009 until January 2013.
|Ethical and practical considerations of the medical student's global health elective||Health Systems Capacity Building, Training/Education||United States||Bellows, J.|
Global health electives have gained considerable popularity in the last decade among medical students wishing to travel, improve physical exam skills, enhance cultural knowledge and sensitivity, and gain clinical experience not always available at home institutions. Many students report these electives as positive experiences, however, true effects of these electives both on students and the patients they serve are unknown. Jennifer Whitfield Bellows, MD, MPH, Assistant Professor, Department of Emergency Medicine at the University of Colorado School of Medicine and Denver Health is in the process of literature review of studies that evaluate the effect of these electives, with the goal of creating a more rigorous, standardized evaluation method of evaluation.
|Evaluation of Indian Government Community Health Worker Scheme (ASHA)||Health Systems Capacity Building||India||Rifkin, S.|
Susan B Rifkin, PhD, adjunct faculty at the Colorado School of Public Health and a Senior Research Fellow, Institute of Social Psychology, at the London School of Economics has been working in collaboration of the National Health Systems Resource Center (Government of India) to implement a systematic review of community health workers using the ASHA scheme to assess the contribution of community participation and empowerment to the community health workers (women) and community people for improved health outcomes.
|Expanding Adherence in HIV and TB Patients||Infectious Disease, Health Systems Capacity Building||Haiti||Coffee, M.|
Dr. Coffee's work focuses on the treatment of critically ill HIV and TB patients in the public health system, caring for over 1000 patients per year. Long term successful treatment requires adherence to 6-8 months of medications for TB, and lifelong for HIV. Patients often face considerable challenges - moving frequently, living in temporary housing, with limited or no incomes, with limited formal education. We are working on technology that allows peers to support drug adherence. Patients call other patients to remind them to take their medications, using phone lists that even those with limited literacy can utilize. Past patients and counsellors are working to create directions and maps for informal housing with limited formal maps to allow for following patients throughout the course of care.
|Geographic mapping of penetrating trauma presenting to a tertiary care center in Cape Town, South Africa||Health Systems Capacity Building, Training/Education||South Africa||Bellows, J.|
Jennifer Whitfield Bellows, MD, MPH, Assistant Professor, Department of Emergency Medicine at the University of Colorado School of Medicine and Denver Health is collaborating, with Deborah Thomas, PhD, Associate Professor,Department of Geography and Environmental Sciences at the University of Colorado Denver and David Richards, MD, Department of Emergency Medicine at the University of Colorado School of Medicine, to create a GIS-based map of the locations of penetrating trauma events whose victims presented to a tertiary care center in Cape Town, South Africa. The map can potentially help inform further research into emergency medical and transfer systems, determinants and cofactors of interpersonal violence, and policy creation intended to address and reduce this violence in the Western Cape.
|Guatemala Trifinio Project||Child Health, Health Systems Capacity Building, Maternal Health||Guatemala||Asturias, E.|
Edwin Asturias, MD, Associate Professor, Department of Pediatrics, Section of Pediatric Infectious Disease at the University of Colorado School of Medicine, began this project in southwestern Guatemala in 2011 with a team of faculty and students from University of Colorado. Banasa Company, the Bolaños Foundation, and the Center for Global Health are currently funding this long-term project. Using data collected in a rapid needs assessment conducted in October of 2011, the team is creating a strategy to address multi-systemic health and infrastructure needs in this region. This developing initiative will cross academic disciplines and bring attention to areas of maternal and child health in the prenatal and neonatal contexts, as well as food security, vaccination coverage, and education. The development of the site and project are ongoing, however, the Center for Global health expects to provide high-quality educational experiences for University of Colorado students in the near future by working with communities in the trifinio area of Guatemala. Questions about this project may be directed to Dr. Edwin Asturias at email@example.com
|HIV in the Foreign-Born Population in the United States, Denver, Colorado||HIV/AIDS||United States||Castillo-Mancilla, J.|
Jose Castillo-Mancilla, MD, Department of Medicine at the University of Colorado School of Medicine has worked for the past several years with the foreign-born population in Denver. His work has confirmed that migration is a risk factor for acquiring HIV infection in any given population around the world. Other factors that immigrants face and that increase their risk of acquiring HIV infection are discrimination and racism, language barriers, modifications in the sexual identity after moving to the United States and lack of social support. Despite the extensive research produced in many areas of HIV/AIDS over the last 25 years, the HIV epidemic among immigrants in the United States has not been fully studied. This is due in part to the difficulty in accounting for immigrants in general (i.e. undocumented immigrants) and to the limited resources available to study this population. Some isolated studies have calculated the prevalence of HIV infection in different immigrant groups with a wide range of results (13% in Hispanic immigrants, up to 20% in African immigrants). The extent to which HIV among immigrants in the United Sates reflects infections acquired outside the United States versus ongoing transmission within the United States is uncertain and requires further research. We are interested in better understanding the HIV epidemic, the reasons for delayed diagnosis and the limitations in access to care that this population faces. We consider that the foreign-born individuals constitute a "nation within a nation," which requires special attention.
|Identification of nutritionally modifiable hormonal and epigenetic drivers of positive and negative growth deviance in rural African fetuses and infants. ||Nutrition||Gambia||Bernstein, R.|
Robin Bernstein, PhD, Department of Anthropology, University of Colorado Boulder, is the principal investigator of this project. The objective of this project is to undertake one of the most detailed longitudinal studies to date to examine the effects of epigenetic and hormonal factors on growth during the first 1000 days of life. Assessment of a variety of parameters, including infectious exposures and hormone levels, as well as epigenome and transcriptome analyses will be collected from gestation through infancy and early childhood from a cohort of 200 Gambian children. These extensive data sets will reveal the mechanisms contributing to growth faltering, and will aid in the development of targeted interventions to promote healthy growth and infant development. This project started in late 2012 and is planned to conclude in 2017.
|IMPAACT Clinical Trials||Child Health, HIV/AIDS, Maternal Health, Vaccines||Botswana, Tanzania, Zambia, Zimbabwe||Levin, M.|
Myron Levin, MD, Professor, Departments of Pediatrics and Medicine at the University of Colorado School of Medicine undertakes clinical research within the National Institute of Health (NIH)-supported clinical International Maternal Pediatric Adolescent Clinical Trials collaborative trials group (IMPAACT). This involves vaccine trials of rotavirus vaccine in infants born to HIV-infected mothers and of HPV vaccine in HIV-infected adolescents. IMPAACT has many opportunities to study the treatment of HIV in resource-poor countries, as well as infectious complications of HIV. The current trials are in Botswana, Zambia, Tanzania, and Zimbabwe. However, research opportunities exist in other African countries, as well as in Thailand, India, and Brazil.
|Implementation and scale-up of “Helping Babies Breathe"||Child Health, Training/Education||Bolivia, Peru, Tibet||Niermeyer, S.|
Susan Niermeyer, MD, MPH, FAAP, Professor, Department of Pediatrics, Section of Neonatology at the University of Colorado School of Medicine collaborates in the ongoing development of “Helping Babies Breathe,” an evidence-based educational program in neonatal resuscitation for resource-limited settings. The global curriculum is designed to be used by birth attendants at the first levels of the health system (from district hospital to the community) who are responsible for the care of both the pregnant woman and the newborn infant at delivery. The program emphasizes prompt action in the first minute after birth, The Golden Minute®, to help a baby breathe. The basic steps of drying, providing warmth, clearing the airway, stimulation to breathe and if necessary, ventilation with bag and mask, are sufficient to establish and support spontaneous breathing in more than 98% of newborns.
The educational program covers the following topics:
a. Preparation for birth
b. Routine care
c. Initial steps of help to breathe
d. Ventilation with bag and mask
e. Continued ventilation with normal and slow heart rate
The learning materials emphasize graphic, pictorial presentation of an action plan and hands-on learning of skills using a low-cost, high-fidelity neonatal simulator. Active learning occurs through practice of discrete resuscitation skills, combination of a series of skills into exercises, integration of skills and decision-making in case scenarios and group discussion to identify potential barriers and solutions to actual implementation of the practices learned.
|Improved therapy for childhood acute lymphoblastic leukemia (ALL) in the Dominican Republic||Pediatric Cancer||Dominican Republic||Hunger, S.|
Stephen Hunger, MD, Professor of Pediatrics, University of Colorado School of Medicine is the principal investigator of this project. Dr. Hunger has partnered with physicians at Robert Reid Cabral Hospital, the major public children's hospital in the Dominican Republic, and the Keira Grace Foundation to focus on ways to improve treatment outcomes for children with acute lymphoblastic leukemia (ALL) in the Dominican Republic. By implementing refined and less intensive therapies, outcomes have been improved significantly. The program has now expanded to include the pediatric cancer program at the Hospital Infantil Arthur Grullon in Santiago, the second largest city in the Dominican Republic.
This project began in 2005 and has no end date.
|Improving Maternal Mortality in Rural Western Ethiopia||Health Systems Capacity Building, Maternal Health||Ethiopia||Heinrichs, G.|
Gretchen Heinrichs, MD, DTMH, Assistant Professor of Obstetrics and Gynecology at the University of Colorado School of Medicine and Denver Health, is presently an Obstetrics and Gynecology Consultant to Village Health Partnership. In this capacity she plans screening assessments of women with Fistula and Prolapse, plans hospital assessments of Obstetric and OR facilities at the Dembi Dollo Regional Hospital, and planned an assessment of barriers and facilitators to Facility-based Obstetric care that will be carried out in December 2011-January 2012. Village Health Partnership is a 501c3 pending non-governmental organization focused on Vesico-vaginal Fistula, Pelvic Organ Prolapse screening and treatment, and improving maternal mortality in rural western Ethiopia. For more information, please visit www.villagehealthpartnership.org
|Improving Public Health Capacity||Health Systems Capacity Building, Training/Education||Rwanda||Wilson, C.|
Calvin L Wilson, MD, Associate Professor, Department of Family Medicine, University of Colorado Denver, has been conducting this project since December 2006, and will continue until September 2013. Based in Kigali, Rwanda, Dr. Wilson is partnering with Tulane University and the National University of Rwanda in helping to strengthen their specialty residency programs, develop a new Family and Community Medicine residency program, and help to develop the teaching skills of their faculty. He also worked with the Rwanda Medical Council to develop a national CME program for all physicians and dentists. He collaborates with two additional full-time UCD faculty in Rwanda, who are working with the four-year Masters of Medicine program in Family Medicine, as well as developing a new two-year diploma program in Family Medicine for new medical school graduates and a Community Medicine rotation for medical students in their clinical years. The first 6 qualified family physicians graduated in October 2012.
|Influenza Immunization of Children in India||Child Health, Vaccines||India||Sullender. W.|
Wayne Sullender, MD, FAAP, Visiting Professor of Pediatrics, Section of Pediatric Infectious Disease at the University of Colorado School of Medicine, is the principal investigator for this study. Influenza viruses are significant causes of human illness and death in developed and developing countries. This study will measure the ability of influenza vaccine given to children in India to protect both the children and unimmunized persons around them from influenza. It will also determine whether the best time to immunize in a country like India that has both summer and winter outbreaks of influenza is in the fall, as is done now, or whether immunization should be in the spring to protect against influenza infections in the summer. This study will run from 10/1/2011 to 9/30/2014.