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MSc Global Health 2007-2008

Behailu Merdekios

Country: Ethiopia
Background: Public Health
Research Project: Effectiveness of prevention of mother-to-child transmission of HIV service in Arba Minch, Southern Ethiopia

OBJECTIVES: To assess the effectiveness of PMTCT services by examining knowledge and behaviour of pregnant women towards PMTCT.

METHODOLOGYA cross-sectional, institution-based survey was conducted in purposively selected settings on a randomly selected sample of 113 pregnant women in Arba Minch. Qualitative and quantitative data was obtained.  

RESULTS: Of 113 respondents, 89.4% were from Arba Minch; 43.4% are 25 years of age and above; 73.4% have attended formal education of primary level and above; 100% reported acceptance of VCT; 92.0% were knowledgeable about MTCT, 90.3% were aware of the availability of the PMTCT service in the health facility. Of the total 74 HIV positive women in PMTCT, only 3(4.1%) have had skilled birth attendants. There was unreasonable loss of women from PMTCT. Maternal educational level has a statistical association with income (p=.000) and the importance of VCT for pregnant women (p= .021). Factors that determine use of PMTCT include: culture, socio-economic status and fear of stigma and discrimination.

CONCLUSION: In the studied area, PMTCT is failing to reach its goal. This is an alarming discovery requiring quick reconsideration and strengthening of preventive strategies at all levels.

Key wordsEffectiveness, PMTCT, Pregnant women, HIV, Ethiopia.

Brion Ó Loinsigh

Country: Ireland
Background: BA Psychology
Research Project: A cross sectional analysis of healthcare seeking behaviour by community caregivers of children orphaned by HIV/AIDS and other causes across 5 developing countries.

Carolyn Whitten

Country: USA
Background: BA Political Science
Research Project: Medicines procurement in Africa. Case of Sengal

Many developing countries struggle to ensure an uninterrupted supply of essential medicines that are efficacious and of good quality, financially accessible and well
prescribed. The Medicines Policy and Supply Management team of the Technical Cooperation for Essential Drugs and Traditional Medicine Department of the WHO has engaged with the Ministries of Health in 10 countries in the WHO AFRO Region to assess national medicines supply systems. While in line with previous research evaluating procurement system performance and auditing policy compliance, the study departs slightly from precedent by providing a visual representation of the current supply chain situation in the form of a map, before asking  if and how external influences may be contributing to systemic breakdowns. The purpose of this paper is to present some of the findings for Senegal, and to discuss implications and possible solutions for some of the key problems in the Senegalese medicines procurement and supply system. Results show that hefty procedural and administrative relationships with aid Partners may be hampering the equitable delivery of essential medicines in Senegal, and that reform upholding endorsed international principles for aid effectiveness needs to be seen at the top of Partners’ agendas and in action on the ground.

Jacqueline Mpanga

Country: Uganda
Background: Pharmacology
Research Project: The availability of paediatric antiretroviral formulations in Uganda

OBJECTIVE: To investigate the availability of age-appropriate antiretroviral (ARV) formulations for children receiving care at Baylor College of Medicine Children’s Foundation Uganda. 

METHODOLOGY: A quantitative, cross-sectional design was employed.  2,496 prescriptions dispensed to 1,012 different children living with HIV were analysed retrospectively.  A summary of product characteristics for the ARVs in relation to paediatric use was tabulated to determine their licensing status.  Variables included ARV formulation, age category and licensing status.  Analysis was conducted using SPSS version 14 to establish the age category and ARVs that were lacking in terms of age-adapted formulations.  

RESULTS: 61% of the prescriptions were authorised while 39% were off-label and unlicensed combined.  
Over 50% off-label/unlicensed use occurred among prescriptions for tenofovir (TDF), the fixed-dose combination of zidovudine/lamivudine (AZT/3TC) and lopinavir/low-dose ritonavir (LPV/r).  
Prescriptions for solid formulations were characterised by more off-label/unlicensed use especially among children aged 6 -12 years.  

CONCLUSIONS: Some age-adapted ARVs existed but more were needed to boost access to universal paediatric ARV therapy.  It is recommended that pharmaceutical manufacturers step up research and development of age-adapted, paediatric ARV medicines particularly for children aged 6-12 years and to extend options beyond second-line medicines

KEY TERMS: Paediatric, Antiretroviral Formulations, Essential Medicines, Off-label, Unlicensed.

Jacob Bell

Country: USA
Background: Psychology
Research Project: Reviewing the health impacts of climate changes and relevant adaptation strategies: A discussion document for the Bangladesh health sector.

Anthropogenic climate change is projected to have negative global health impacts. These impacts will disproportionately occur in middle and low-income countries already vulnerable to the climate system. Even with such projections, large research gaps persist in the study of climate change and human health. Bangladesh deserves such research attention as it is vulnerable to both extreme climate events and climate factors such as precipitation. Despite global development successes, it also still suffers a large communicable disease burden. This document reviews the projected climate change health impacts in Bangladesh, with specific focus on health sector response. In the review of such topics, this document employed comprehensive literature reviews and qualitative assessment methodologies. Results are presented on relevant topics, including: Climate change projections for Bangladesh, Climate-sensitive health outcomes in Bangladesh, Evidence of climate-health linkages in Bangladesh, Climate change adaptation health interventions, and Evaluation measures for adaptation interventions. These results indicate that Bangladesh will likely experience increasing temperatures, precipitation, extreme climate events and sea-level rise under climate change, and that such climatic factors influence diarrhoeal illness, malnutrition, vector-borne diseases, and morbidity and mortality from disaster events. The Bangladesh health sector must therefore implement climate change adaptation interventions which tackle these health outcomes in their current and future manifestations. Such adaptation interventions not only reduce the harmful potential of climate change, but support broader goals of sustainable development in Bangladesh.

Keywords: Bangladesh, Climate Change, Health, Adaptation

Jennifer Munoz

Country: USA
Background: BA English and Interdisciplinary Film
Research Project: Factors fuelling the continued spread of HIV in the females sex worker community in Ibadan, Nigeria.

Kadu Meribo

Country: Ethiopia
Background: BED Geography
Research Project: KAP: Survey study of ABC approach of HIV prevention at a community level in selected part of capital city Addis Ababa, Ethiopia

OBJECTIVES: The ABC approach to the prevention of HIV and other STI’s promotes abstinence 
from premarital sex and related activities, being faithful to one sexual partner and using 
condoms consistently and correctly. This study assessed the KAP–gap of HIV prevention 

METHODOLOGY: This cross-sectional survey was conducted from April-June, 2008 in the capital 
city of Ethiopia. The total number of participants was 107. Systematic sampling and the lottery 
technique was used to distribute the sample evenly  and select respondents among eligible 
participants. Data was collected using a structured interview questionnaire and focus group 
discussion guide. 

RESULTS: 107(100%) of the participants had heard about HIV/AIDS. Of the total single and 
married respondents 28(50.94%) and 11(26.82%) had never practiced abstaining from 
premarital sex and being faithful to one sexual partner respectively. 24(23.07%) of respondents 
report always using a condom correctly and consistently. Of the total 35(33.01%) condom users, 
23(65.71%) of them had used a condom during their last sexual intercourse; 11(31.42%) 
respondents had experienced condom failure. 

CONCLUSION: There are gaps in the present knowledge, attitudes and practices of respondents 
and the desired programme objectives. Therefore, more effort will be required to be successful 
in implementation. 

Key words: - HIV Prevention, Premarital sex, Abstinence, Be faithful, Condom use.

Kamal Abdurrahman

Country: Nigeria
Background: Medicine
Research Project: Barriers of adherence to highly active anti-retroviral therapy among HIV infected patients in Swaziland

Laoise Coady

Country: Ireland
Background: Medicinal Chemistry
Research Project: Experiences accessing services for autistic spectrum disorders: A comparative analysis between Dublin and New York

This study examined the experiences of parents with children who have an autistic spectrum disorder. A comparative case study analysis of legislation and parental 
experiences in Ireland and New York State was conducted to ascertain whether current service provision could be improved in either case context. Five parents in each of Ireland and New York were interviewed about the services they received during and after the diagnosis of their child, and the impact their child’s diagnosis had on their family life.  

This study showed that parents, in both case contexts, experience similar feelings of devastation, fear and grief on obtaining the diagnosis. More problems with regard to 
obtaining the diagnosis and services were reported in Ireland where public services are thin on the ground in comparison to New York. It was found that in Ireland parents were more likely to access services privately. Parents from both cases reported that the diagnosis had a considerable impact on family life and on other siblings. Existing policies were also examined and recommendations for future policy made.

Marianne Griffiths

Country: Ireland
Background: International Business
Research Project: An investigation into the existence of advocacy and empowerment strategies used by organisations representing people with disabilities in La Paz, Bolivia.

This study uses Interpretative Qualitative Analysis to understand the empowerment and advocacy strategies that are employed by the disability movement in La Paz, Bolivia. Using semi structured interviews, the study gains an insight into the issues that affect people with disabilities. Participants are all key informants; decision makers from a variety of civil society and government organisations. Although initially it seemed that the issue of advocacy was not important, throughout the course of the study it emerged that all of the participant groups advocate for their members in some way. Empowerment and the actions taken to empower people with disabilities were key parts of the study. Employment and education opportunities emerged as  the most important strategies for the empowerment of people with disabilities to become empowered. Barriers to empowerment included the culture of the disability movement and the attitude of Bolivian society towards people with disabilities. Money and a lack of resources were cross cutting themes throughout the study. The theme of government actions and the fact that disability is now on the national agenda were also considered to be important. It appears that communication is quite open at all levels but that actions and change do not always follow.

Mary Young-Aragbaiye

Country: Nigeria
Background: BSc Microbiology
Research Project: Access to support services after domestic violence: An exploration of African women’s experiences in Dublin, Ireland
BACKGROUND: Domestic violence is rampant within the African community in Ireland. Anecdotal evidence 
reveals that the home is the most violent social setting; spousal or partner abuse is an all too 
common occurrence among this population. In 2004, African human rights organisations based 
in Dublin became aware that increasing numbers of African women were seeking to access help, 
care, advice and accommodation services following domestic violence and sexual abuse.  They 
commissioned research in this area, which resulted in the publication of a report by AkiDwa in 
2006 entitled “Domestic violence against African women”. This report estimated that during an 
average day, between forty-five and ninety women sought support from services for help against 
violence and abuse. 
METHODOLOGY:  Qualitative, semi-structured interviews were conducted to explore the views and experiences of 
African women living in Dublin following domestic violence. Purposive sampling methods were 
used to recruit a sample of 15 African women seeking support services from a human rights 
organisation called AkiDwa. The study sample included women who were 18years of age and 
older. The interview was audio recorded and transcribed verbatim. Transcripts were subjected to 
thematic analysis. 
RESULTS: This study involved fifteen women (15) from a wide range of African countries. Findings of this 
study indicated that African immigrant women face multiple challenges when settling in a 
foreign country including: language barriers, poor communication skills, isolation from contact 
with family/community, lack of social networks, lack of information, lack of access to jobs, and 
difficulty in securing employment. These challenges along with social and cultural factors 
predispose African immigrant women to domestic violence. In addition, gender inequality 
exacerbates the vulnerability of these women to abuse.  
CONCLUSION: In conclusion, this study suggests that the services available to African women who have 
experienced domestic abuse are not culturally sensitive and do not meet this vulnerable 
population’s needs. Available services are poorly advertised, and advertisements are unavailable 
in relevant African languages. To adequately address the issue of domestic violence among 
African women in Ireland, an integrated effort will be required from all social and community 
support organisations servicing the African community to expand their capacity and deliver 
culturally sensitive  services to these women in need. 

Keywords: Domestic violence, African women, Culture, Migration, Qualitative

Niamh Barry

Country: Ireland
Background: History, Politics, Sociology and Social Studies
Research Project: Women’s empowerment and masculinity: The limitations of excluding men.

It was realised in the 1990s that it was necessary to include men into women’s empowerment programs in order to contribute to their success. Little has been done, in regards to research, program design or evaluation, especially in Africa. This study seeks to further understand the consequences of excluding men from women’s empowerment programs by examining the levels of women’s empowerment and attitudes to empowerment; expressed through the male viewpoint. Campaign for Female Education (CAMFED) an NGO working in Zambia implementing female empowerment programs was used as a sample. Qualitative research was used with interviews and Focus Group Discussions (FGDs), targeting married men whose wives have completed the CAMFED empowerment program, a control group of men whose wives have never undergone empowerment was also sampled. It was found that while the CAMFED women had higher levels of empowerment in spousal selection, contraceptives and domestic duties compared to the control group. However when it came to full social and economic empowerment high levels of resistance were demonstrated and focused on male control over women and gender stereotypes. Men are happy with their wives earning but this did not translate to an equal status in the household. Tenants of masculinity were the greatest barrier to success. 100% of men asked to be included in the empowerment program and the findings suggest that their education and inclusion is vital to the advancement of women’s empowerment.

Key words: women’s empowerment, male inclusion, masculinity, Zambia

Nicholas Connor

Country: Canada
Background: Health Science
Research Project: Monitoring the performance of moderately malnourished children on home-based therapy using mid-upper arm circumference (MUAC) in Southern Malawi.

Ola Owojori

Country: Nigeria
Background: BSc Psychology
Research Project: The role of organisational justice on the performance of job satisfication and organisational commitment among senior house officers in Dublin

Rachel Saunders-Higgins

Country: Ireland
Background: Social Studies
Research Project: Is the “Bias Free” Framework a useful tool for uncovering biases deriving from social hierarchies in a research priority setting process that uses tools such as the Global Forum for Health Research combined approach matrix (CAM) methodology?

BACKGROUND: With health research evolving constantly worldwide, it has come to light that research priority setting process is an essential tool to conduct which specific areas of health research is a priority. Today, there are many different varieties of non-dominant groups which are often eliminated or not seen as a priority for research not just in the field of health. This study focuses on two main tool frameworks which exists for research; that of Combined Approach Matrix and BIAS FREE Framework, both which have been developed by Global Forum for Health Research Geneva, Switzerland. 

METHODOLOGY: Reviewing both tool frameworks developed by the Global Forum for Health Research; 1)The Combined Approach Matrix; a priority-setting tool for health research and 2) The BIAS FREE Framework; a practical tool for identifying and eliminating social biases in health research as well as conducting  qualitative questionnaires to researchers worldwide who have used the CAM methodology in their research.

RESULTS: The study involved participants from different countries worldwide. The findings from the two main research tools; the CAM and BIAS FREE and the questionnaires indicated some main themes such as bias that influenced the process of priority settings in health research.

CONCLUSION: With the increasing population in today’s world, there is an importance to recognise the need to prioritise groups for health research, in order to carry out specified research to gain positive outcomes for both researchers, marginalized groups and to different stakeholders in the field of health and health research for past, present and the future.

Rebecca Comrie

Country: Canada
Background: BSc Science
Research Project: Tobacco control policy analysis for Lesotho

The global tobacco epidemic is presently one of the leading causes of preventable death and disability among adults. Although once predominantly seen in high-income countries, tobacco use is falling in these countries while it continues to increase in low- and middle-income countries, which now reportedly account for 80% of all tobacco users. Given the high prevalence of both HIV and TB in Lesotho, and the is evidence indicating that cigarette smoking is a risk factor for tuberculosis, tobacco control is of critical importance. This research identified contextual factors, both enabling and disabling, influencing tobacco control efforts in Lesotho. Key informant interviews with 12 tobacco control advocates were conducted to augment information gained through document review interpreted using content analysis. Results indicate that contextual influences include the HIV/AIDS epidemic, political will, economic status, degrees of urbanization, religious influences, public support, public awareness, literacy rates, international relationships and the role of the WHO and the FCTC. A conceptual diagram is presented of all factors clustered categorically. Mitigation strategies for disabling factors were also analyzed.

Silvia Stringhini

Country: Italy
Background: Developmental Studies, MSc in Economics
Research Project: Understanding informal payments in health care: the motivation of health workers in Malawi

Susan Dundon

Country: USA
Background: BA Politics and Economy
Research Project: Knowledge, attitudes and practices (KAP) survey of water, sanitation and hygiene in Jose Carlos Martiategui, San Juan de Lurigancho, Peru

It is estimated that 50% of all people in the developing world suffer at any given time from a 
health problem caused by water and sanitation deficits.  According to the WHO, 94% of 
diarrhoeal diseases are caused by environmental factors such as unsafe drinking water and poor 
sanitation and hygiene.   

Globally, diarrhoea is the second leading cause of death among children under 5 – taking 1.5 
million lives annually.  High levels of diarrhoea are associated with malnutrition, stunting, and 
long-term cognitive impairments.   

Utilizing a 32-question household survey and focus groups, this study focuses on the water, 
hygiene, and sanitation knowledge, attitudes, and practices of over 300 households in José 
Carlos Mariategui, an impoverished community near Lima.     

Survey results show per capita water usage of 13 liters per day.  Levels below 20 liters suggest 
water volumes inadequate to support basic personal hygiene and marginally adequate to support 
human consumption needs. 

Nearly 50% of all households and 35.5% of children under 5 reported diarrhoea during the 
three months preceding the survey.  Factors associated with higher levels of diarrhoea included 
handwashing, pit latrines, water usage, income, and education.   

Intervention recommendations include:  1) handwashing promotion; 2) ceramic filters for 
drinking water; and 3) sanitation upgrading. 

Keywords:  diarrhoea, hygiene, sanitation, water, handwashing.

Tirhas Gebremedhin

Country: Ethiopia
Background: BSc Public Health
Research Project: Knowledge, attitude and practice of mothers and other care takers towards prevention of malnutrition in under five children in Tigray, Northern Ethiopia

Uzma Siddiqui

Country: Pakistan
Background: Medicine
Research Project: A link between smoking and tuberculosis to study the smoking habits of patients attending a TB clinic

OBJECTIVE: The aim of this study is to address the following hypothesis;
“Are smokers more likely to be infectious for longer after the commencement of anti-TB treatment compared to non-smokers?” In other words, this will help address the issue of cigarette smoking on pulmonary TB patients’ response to anti-tubercular treatment in relation to infectivity status.

METHODOLOGY: A cross-sectional retrospective record-based hospital analysis was done. The charts of 53 confirmed cases of pulmonary TB on (ATT)* from April’07 to April’08 were reviewed; data was collected for their socio-demographic and clinical correlates, smoking and TB history. A proforma was set up for inputting the required information. Data was then tabulated and analyzed using the SPSS, Version 14.0.

RESULTS: According to the Multivariate analysis, ever smokers pulmonary TB patients on (ATT)* were 4 times more likely (OR: 4.42) to turn sputum negative after 6-8 weeks [delayed] compared to never-smokers after adjusting for age and sex. This shows a statistically significant difference between ever and never smokers (CI 95%; 1.23; 15.9).

CONCLUSION: Smoking caused delayed sputum smear conversion beyond 6-8 weeks in Pulmonary TB patients on (ATT)*, thereby increasing or prolonging their infectivity status.

KEY WORDS: Tobacco, Smoking, Tuberculosis, Sputum Smear, Culture, Conversion.

Woldemariam Hirpa

Country: Ethiopia
Background: Nursing, BSc Public Health
Research Project: Determinants of current family size and prospective fertility desire for more children by sex preference among employees of federal ministry of health, Addis Ababa, Ethiopia.

BACKGROUND: Although the Total Fertility Rate (TFR) in Ethiopia as a whole stood at 5.4 
children per woman, the TFR in urban areas like Addis Ababa is below the replacement level. 
This study aimed at examining factors that determine current family size, desire of prospective 
fertility by sex preference and the result of the study then compared with the findings of recent 
Ethiopian Demographic and Health Survey (EDHS), 2005.  

METHODOLOGY: 265 (50%) employees of Ministry of Health out of total 529 were selected using 
both stratified and Simple Random Sampling methods. Face- to- face interview and focus group 
discussions were undertaken to collect quantitative and qualitative data. Quantitative data were 
analyzed using SPSS software  

RESULTS:  Average actual and preferred ideal family size of the respondents was 2.7 and 3.1 
children per family respectively.  In spite of prevailing social and demographic constraints, these 
averages were still far above current TFR of Addis Ababa. The promising finding is that roughly 
more than two third (69%) of married respondents had already  decided to stop  child bearing. 
Sex- selectiveness was common behavior among the study groups, strong son preference was 
found. On the other hand, the impressed finding has been that decision making power in terms of 
prospective fertility was equally shared between husband and wife with no interference from the 
third parties. 

CONCLUSION: Although both the actual family size and prospective fertility preferences measures 
are higher than the current TFR of Addis Ababa,  there have been some indications for fertility 
decline in the study group as compared to national TFR.