The Columbia University Journal of Global Health

Chagas Disease Outbreaks in South America from 2000 to 2022: A Systematic Review

Hillary Smith — 2026-02-06

Chagas disease (CD), an emerging neglected tropical disease endemic to Latin America, causes 12,000 deaths annually. Its ecological and epidemiological complexities, including rural-urban shifts in disease distribution, have complicated outbreak control. Further understanding of the conditions that promote outbreaks will support improved public health response design. Outbreak investigations of CD in South America were reviewed and the investigative methods used across outbreaks were assessed to provide important insight into the disease epidemiology. Primary and secondary database searches resulted in 77 and 83 articles describing outbreaks of CD in South America, respectively. This review included articles that provided an extensive description of the outbreak investigation and the use of appropriate epidemiological methods. Outbreaks primarily occurred in urban areas (62.5%), some linked to rural-based food production and handling facilities. They resulted in 186 cases of CD and five deaths. Oral transmission was identified in all outbreaks. Non-specific symptoms common in endemic diseases (malaria and dengue) led to initial misdiagnosis and delayed treatment. The considerable impact of CD on morbidity and mortality, shifting ecology, and diagnostic difficulties demands improvements in disease surveillance, training in the health sector, development of new diagnostic tools, and public education on prevention measures.

Artificial Intelligence Tools for Diabetic Retinopathy Screening in Low-Resource Environments: Review of Global Implementation and Challenges

Martena Grace — 2026-02-06

Diabetic retinopathy (DR) remains a leading cause of preventable blindness worldwide, with the burden falling disproportionately on populations in low- and middle-income countries (LMICs), where access to timely screening is limited. Advances in artificial intelligence (AI) have enabled the development of automated DR screening tools with diagnostic accuracy comparable to expert graders, offering a potential solution to overcome some of the unique challenges LMICs face. This review examines the performance, global implementation, and unique barriers of AI-based DR screening in low-resource environments, focusing on five leading systems: IDx-DR, EyeArt, Medios AI, Google’s Automated Retinal Disease Assessment (ARDA), and SELENA+. Evidence shows these systems can increase detection rates, reduce referral delays, and improve access to care. However, their integration into healthcare faces unique challenges including data generalizability, infrastructure, regulation, and clinician and patient acceptance. Strategies such as federated learning, offline-capable devices, and easily-comprehensible AI may help overcome these barriers, enabling AI-driven screening to play a critical role in reducing vision loss from DR globally.

Antimicrobial Resistance in Vollum Anthrax: Current Status and Concerns

Eliana Martinez Sasson — 2026-02-06

Antimicrobial resistance (AMR) poses a significant threat to the effectiveness of standard healthcare. The World Health Organization (WHO) identifies AMR as a critical global public health threat, exacerbated by limited access to effective medications and healthcare infrastructure in low and middle-income countries. As such, the current status and implications of AMR in Bacillus anthracis are increasingly concerning, both as a serious disease, as well as potential usage in bioterrorism. The Vollum strain, known for its potential use as a bioweapon due to high virulence, is of particular concern. Novel computational studies into the genetic mechanisms driving AMR in B. anthracis, highlight resistance genes - bla, bla2, fosB, among others- potentially conferring resistance to various antibiotic classes, particularly first-line treatment beta-lactams and macrolides, including Ciprofoaxin. Historical and recent instances of Vollum's use in bioweapons programs underscore the urgency of developing effective diagnostic, treatment, and prevention strategies. Enhanced surveillance, novel pharmaceutical development, and targeted vaccination efforts are imperative to mitigate the impact of AMR in B. anthracis.

Determinants of Childhood Immunization Non-Compliance Among Nursing Mothers in a Resource-Constrained Setting, Southwest Nigeria

Mary Adeleye Abidemi — 2026-02-06

Immunization remains one of the most effective strategies to reduce childhood morbidity and mortality, yet non-compliance with recommended regimens persists in resource-constrained settings. This study assessed factors influencing immunization non-compliance among nursing mothers attending a health facility in Nigeria. Data on mothers’ knowledge, attitudes, and compliance were collected using structured questionnaires and analyzed with descriptive statistics and chi-square tests. The mean knowledge score was 16.4, with about one quarter of respondents demonstrating low knowledge. Although nearly all mothers (96.3%) reported initiating immunization for their children, only a fraction (68.8%) completed the full regimen. Further assessment suggests a positive attitude towards compliance among the respondents. Chi-square analysis indicated no significant association between socio-economic status and compliance, but significant associations were observed with maternal education and ethnic background. These findings highlight the influence of knowledge and socio-demographic characteristics on immunization adherence. The study is limited by its cross-sectional design, reliance on self-reported data, and focus on a single health facility, which may restrict generalizability. Nevertheless, it provides valuable insights to guide educational campaigns and policy strategies aimed at improving immunization uptake in low resource settings.

The Burden of Vision Loss Due to Diabetic Retinopathy in Asia from 1990-2021

Dongyan Zhang — 2026-02-06

Diabetic Retinopathy (DR) has become the leading cause of vision impairment (VI) worldwide. Leveraging the most recent data and analytical techniques from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced comprehensive estimates of VI due to DR in Asia. These estimates were segmented by location, age, and gender for the period between 1990 and 2021. Furthermore, we projected the burden of DR up to 2050. We analyzed data from the GBD 2021 to assess the prevalence and Years Lived with Disability (YLDs) due to DR in Asia, examining age structure, trends over time, and gender differences. The study included an analysis of DR-induced VI severity across Asian countries. The Estimated Annual Percentage Change (EAPC) was calculated to illustrate trends at regional and national levels. Bayesian age-period-cohort (BAPC) analysis was used to project future prevalence trends up to 2050. From 1990 to 2021, the age-standardized prevalence rate (ASR) and YLDs rate of DR in Asia significantly increased, with higher rates consistently observed in women (p>0.05). The elderly experienced a greater burden, with increasing rates of VI and YLDs with age. Moderate vision impairment (MVI) constituted the majority of DR-related ASR in Asia. There were notable differences in the burden of DR among Asian countries. In 2021, Mauritius, Seychelles, Malaysia, and Brunei had the highest ASR, while Bangladesh, Bhutan, Mongolia, and Japan had the lowest. Cambodia exhibited the fastest growth, whereas Singapore and Pakistan showed a decline. Most Asian countries have a Sociodemographic Index (SDI) at low-medium to medium levels, and correspondingly low ASR. According to BAPC projections, by 2050, the YLDs rate for DR in Asia will decrease to 3.92 for males and 4.96 for females. Over the past 30 years, the burden of DR in Asia has increased, with persistent gender disparities and substantial variation among countries. This study displayed the importance of DR prevention, particularly for women and the elderly. BAPC projections suggested a decreasing trend in YLDs rate due to DR over the next 30 years.

Sustaining Health Outside of Hospitals: Home Infusion Therapy for Value-Based Long Term Care

Afiana Shiferaw — 2026-02-06

Home infusion therapy (HIT) is a value-based healthcare delivery model where patients receive intravenous medications with home health services (HHS) outside the hospital. Our objective was to provide a comprehensive review of HIT services, tracing its historical development and examining its current role as a critical component of healthcare delivery worldwide. We evaluated peer-reviewed papers and online resources on HIT and HHS, published in English from 1959 to May 2025. Our review supports HIT services globally for three reasons: advance long-term care for the aging population, decrease antimicrobial resistance, and improve healthcare affordability, efficiency and access with continuation of post-acute complex care. The US has pioneered and dominated this field of HIT since 1970’s, providing affordable, safe, effective and convenient services to patients, especially those requiring long-term care. While Canada, Europe, and Australia have offered HIT services, many other countries, including low- and middle-income countries (LMICs), provide limited to absent HIT services due to lack of regulations, experience, knowledge and training. HIT is viewed as a cost-effective alternative to hospital care, and payers have generally accepted higher home-based charges as long as they remain below inpatient costs. The strategic roadmap to safe and cost-effective HIT implementation must include provisions for a robust regulatory framework; competitive reimbursement structures to foster scalability; accreditation and certification standards to ensure patient safety; and access with modern technologies and digital transformation. Both HIT and HHS offer a safe, effective, and economical alternative to inpatient care. Policy reforms that initiate or expand coverage and streamline provider entry can strengthen this growing industry while improving patient outcomes and system-wide efficiency.

Letter from the Editor

Rose Liu — 2026-03-09

Dear Reader,

We are proud to introduce The Columbia University Journal of Global Health Fall 2025 issue, The Futures of Global Health Vol. 15. Over the past decade, global health has undergone rapid transformation—driven by breakthroughs ranging from AI-enabled diagnostics to large-scale improvements in health system delivery, including expanded vaccination programs, digital medical records, and decentralized care models. As these advances redefine the present, they also raise critical questions about the future of health systems, innovation, and global equity. This issue is dedicated to examining those questions and imagining the paths forward for global health in an era of unprecedented change.

This edition features compelling research articles that examine the future of global health across diverse geographic and thematic contexts. We are pleased to present “Artificial Intelligence Tools for Diabetic Retinopathy Screening in Low-Resource Environments: Review of Global Implementation and Challenges” by Grace et al., which evaluates the performance, real-world implementation, and context-specific barriers of AI-based diabetic retinopathy screening tools in low- and middle-income countries.

Next, “Determinants of Childhood Immunization Non-Compliance Among Nursing Mothers in a Resource-Constrained Setting, Southwest Nigeria” by Olasupo et al. investigates key barriers to childhood vaccination and proposes strategies to improve immunization uptake in Nigeria. “Sustaining Health Outside of Hospitals: Home Infusion Therapy for Value-Based Long-Term Care” by Graham et al. examines the evolving landscape of home infusion therapy across the United States, Canada, Europe, and Australia, highlighting its role in value-based care models.

In “The Little Country that Could: Creative Solutions to Early COVID-19 Vaccination in the Republic of Moldova,” Cobb et al. analyze innovative pandemic responses and identify lessons applicable to future infectious disease management. Additionally, “Antimicrobial Resistance in Vollum Anthrax: Current Status and Concerns” by Sasson explores emerging antimicrobial resistance patterns in anthrax, underscoring significant public health implications. Finally, “Chagas Disease Outbreaks in South America from 2000 to 2022: A Systematic Review” by Smith synthesizes two decades of outbreak data to inform improved prevention strategies and early detection methods.

Collectively, the research in this issue spans contributions from the United States, Canada, Australia, multiple European countries, Singapore, India, and Nigeria, reflecting the truly global scope of this edition.

Beyond these peer-reviewed research articles, the Journal remains committed to fostering scholarly dialogue in global health. On campus, we were proud to host a BioInnovation Panel on November 13, 2025, featuring Dr. Miranda of Barnard College, Professor of Biological Sciences and a renowned virologist, and Dr. Hess of Columbia Engineering, Professor of Biomedical Engineering and tissue engineer. The discussion highlighted emerging innovations in healthcare technology and their implications for the future of global health. We were pleased to welcome more than 30 attendees to this engaging and interdisciplinary panel.

In addition to our peer-reviewed research, the Journal’s online team continues to expand public-facing engagement through blogs and podcasts that address timely global health issues. This semester’s blog features explore a wide range of topics, including food deserts and fast food industry exploitation in Black communities in New York City, the ways low-income status shapes medical decision-making, housing instability’s role in the growing diabetes crisis, and community-based mental health interventions such as the Friendship Bench. Other pieces examine emerging technologies—such as the brain–computer interfaces—and the global human impact of fast fashion. Through both written and audio formats, the Online Team works to translate complex global health challenges into accessible, compelling narratives for a broader audience. Our commitment to making research as accessible as possible could not have been done without our online team.

The Fall 2025 issue represents a significant milestone for our journal and a moment of celebration for our editorial staff, who stewarded each manuscript from submission through publication. As a double–peer-reviewed journal, we are profoundly grateful to all those who make this publication possible. We extend our sincere thanks to the authors who entrusted us with their rigorous and impactful scholarship, and to the peer reviewers whose thoughtful and incisive feedback strengthened every contribution.

We are grateful to our publisher, Columbia University Library Partners, and especially to our librarian, Esther Jackson, for her unwavering support and guidance throughout the publication process. We also sincerely thank our faculty advisors—Mr. Ron Guido, Dr. Dana March Palmer, PhD, and Dr. Merlin Chowkwanyun, PhD—for their continued mentorship, expertise, and commitment to the Journal’s mission.

Finally, to our readers, thank you. You are an essential part of the Columbia University Journal of Global Health community. We hope this issue offers work that is intellectually engaging, socially relevant, and impactful in advancing global health discourse.

Sincerely,

Rose Liu and Manan Vij

Co-Editors-In-Chief

The Columbia University Journal of Global Health

The Little Country that Could: Creative Solutions to Early Covid-19 Vaccination in the Republic of Moldova

Ashlynn Cobb — 2026-02-06

This article examines novel approaches to the initial Covid-19 vaccination campaign in the Republic of Moldova, a developing nation in Eastern Europe. Moldova’s vaccination initiatives displayed tenacity and creativity in the rapid creation of a vaccination campaign that attempted to overcome barriers related to available resources, public access to vaccination sites, and anti-vaccination sentiment. This article focuses on highlighting Moldova’s interesting approaches to vaccination as well as the implementation strategies that proved most effective. Examples of Moldova’s initiatives include those aimed at 1) flexible use of resources, 2) meeting people where they are at, 3) ensuring equal accessibility of public health offerings, and 4) engaging with local community leaders. Information was primarily obtained via interviews with local public health officials from June to August 2024. The takeaways and solutions presented in this article may provide insight and inspiration in implementing similar, rapid public health campaigns, including those in resource-limited settings.