The Columbia University Journal of Global Health

Letter from the Editor

Kairaluchi Oraedu — 2024-06-02

Dear Reader,

We are deeply honored to announce the publication of The Columbia University Journal of Global Health Spring 2024 Issue. In the face of global health crises spanning from the Democratic Republic of the Congo, Sudan, and Palestine as well as restrictions to free speech on our campus, we as a journal remain steadfast in our belief that the exchange of knowledge from all corners of the globe holds immense power. Our goal has always been to center diverse perspectives and communities that have been marginalized, which is especially pertinent in the present. In our Spring 2024 issue you will find four manuscripts that investigate the pitfalls and untapped potential of health systems in Latin America, Africa, or Asia to maintain the well-being of vulnerable populations and ecosystems. We hope that as you delve into the state of child malnutrition in Dhaka or Ugandan perspectives on preventing malaria during pregnancy, you are able to recognize universal themes concerning access and multi sectoral approaches for ensuring health equity globally.

We are immensely proud of the range and depth of topics investigated by our online team, who have been able to highlight the work of global health professionals such as Professor Bill Bower, MPH, who serves as a Senior Lecturer at the Heilbrunn Department of Population and Family Health, and whose interview centered on Tuberculosis and the training of lay health workers. Related to the topic of global pandemics, we published a blog post about the current state of Covid-19, which continues to shape the landscape of global health. Our online team has also served as a space for students to share their unique experiences. We have enjoyed the thoughtful perspectives of our online team members on a blog post about the modern increase in allergen reactivity, as well as a podcast that discusses what this allergen sensitivity looks like in practice, with a student interview about living with dietary restrictions in college. We hope to continue to provide spaces for our members to explore their interests and share their perspectives.

In a climate that has left many of our members feeling unsettled and anxious for the future, we would like to extend the utmost gratitude to our incredible team. Their fortitude and resilience has been inspiring to witness and it is not lost upon us the crucial role that each member plays in making our journal a reality. We are additionally thankful for the support of our faculty advisors, Esther Jackson, Dr. Julianna A. Bol, PhD, and Dr. Ana Navas-Acien, MD, PhD, MPH whose guidance has been invaluable. Thank you to our peer reviewers and the authors for their insightful comments and pieces, respectively. Lastly, we give a special thanks to our readers and listeners for their continuous engagement with our issues, blogs, and podcasts. You hold a special place within The Columbia University Journal of Global Health.

Sincerely,

Kairaluchi Oraedu & Ann Thanh Phan

Co-Editors-in-Chief,

The Columbia University Journal of Global Health

Persistent Child Malnutrition in Dhaka: Integrating Political Considerations and Multisectoral Interventions for Solutions Moving Forward

Shafkat Meraj — 2024-06-02

One of the world’s most densely populated cities in the World, Dhaka continues to grapple with its persisting challenge of child malnutrition. While food shortages, food insecurity, and inadequate feeding practices contribute to child malnutrition, various social and economic determinants, including maternal education, family household income, and geographic residence further exacerbate the problem. While existing interventions like the Health Sector Support Project and National Nutrition Programme have made strides in reducing short-term and long-term child malnutrition, challenges such as insufficient coverage hamper its overall scope and effectiveness. In order to address issues hampering funding capacity and the breadth and quality of nutrition-related services, it is necessary to understand the factors affecting them, including political commitment toward child nutrition, policy alignment, program design and implementation, monitoring and evaluation, and intervention strategies and service delivery. Moving forward, comprehensive strategies taking into account political prioritization, multisectoral coordination, and targeted primary intervention strategies are crucial for tackling child malnutrition effectively in LMICs and cities like Dhaka and beyond.

One Health: The Future of Ecosystem Health and Where to Start

Alyssa Persano — 2024-06-02

Highly relevant to our current and future global state is the need for ecosystem conservation. Rewilding, the process of introducing wildlife to degraded areas, is one such method of conservation. Rewilding is primarily applied from an ecological point of view and largely fails to consider the public health and systemic implications of habitat restoration. As such, a new conservation paradigm is warranted. One Health is a global health approach that considers the complex interplay between humans, animals, and their shared environment. While One Health examines the social, political, and economic context of degraded areas to prioritize systemic advancement and disease prevention in conjunction with conservation, the large scope and transdisciplinary nature of One Health make it challenging to implement. Rewilding efforts conducted by the Conservation Landscape Institute (CLI) in South Africa’s Eastern Cape is an ideal candidate for a One Health approach. With stable funding, infrastructure, and institutional support, CLI is prime for a transition to a One Health framework that can serve as a model for One Health implementation worldwide. As concerns about systemic inequality, disease prevalence, and ecosystem degradation increase, it is necessary to take advantage of the opportunity provided at CLI to establish the new global health paradigm that is One Health.

Preliminary analysis of the disability landscape on Roatán, Honduras

Julia Lin — 2024-06-02

Understanding the needs of persons with disabilities (PWDs) is vital to improving targeted healthcare and resources. The project seeks to assess the prevalence of disabilities, resources used, and care and treatment needs for PWDs on Roatán, Honduras. There is little to no prior research about disabilities on the island of Roatán, and few disability studies available in the country of Honduras. We surveyed 581 community members on the island of Roatán over a period of 6 weeks, on questions surrounding the disability status of themselves and their family members, and resources used by PWDs. Interviews were conducted with physicians, promotoras (community health promoters), and staff at the local Rehabilitation Clinic to assess the social experiences and resource needs of PWDs on the island. Of the 613 subjects obtained from our surveys, 258 (42%) had one or more disabilities. The most common disabilities were vision impairment, mobility impairment, and diabetes. 44.98% reported that the PWD did not visit any medical care facility to receive treatment. We found that there was a lack of disability-specific resources on Roatán, and no consistent definition of disability among community members and healthcare providers. Barriers to care include discrimination; caretaker burden; lack of medications, assistive devices, and specialists; and transportation. Our research highlights the need for more education on disabilities within communities, as well as increasing the amount and depth of disability-specific resources accessible on the island. This study was conducted at the request of Clinica Esperanza to determine how it could better support PWDs on Roatán, and the potential benefit of developing a day home for PWDs.

Attitudes and Behaviors Around Preventative Measures Against Malaria During Pregnancy in The Luwero District of Uganda

Alyssa Robb — 2024-06-02

Background: In Uganda, the rate of malaria in pregnancy ranges from 8.9-50% depending on the level of transmission within the region. It is estimated that malaria may contribute to 8-14% of low birth weight, 3-8% of infant mortality, and 3-15% of maternal anemia. There is limited information on the attitudes and behaviors of pregnant women related to malaria prevention-health impacts for the child, including infant and maternal death.

Methods: A cross-sectional study was conducted in June of 2023. A structured interview was used to collect data on demographics, attitudes, and preventative behaviors related to malaria during pregnancy. Interviews conducted in participants’ homes took approximately 50 minutes. Descriptive statistics were run for demographic data. Chi-squared test and Pearson Product Moment Correlation with a significance level set at p < 0.05 were conducted to test relationships between variables of interest.

Results: Data were collected from 63 women with a mean age of 37. All women had at least one pregnancy resulting in a live birth. Almost one-third of women (31.7%, n = 20) reported getting malaria during their most recent pregnancy. Most respondents (82%, n = 52) received prenatal care and 87.3% (n = 55) used at least one prevention measure against malaria during their last pregnancy. For the participants that reported not protecting themselves (12.7%, n = 8) it was found to be statistically significant in preventing malaria (χ2 = 9.744, p = .008). Bed net use was found significant in preventing malaria during pregnancy (χ2 = 7.113, p = .029) and SP/Fansidar (χ2 = 46.534, p = < .001) during their most recent pregnancy. Receiving prenatal care was found to be significant (χ2 = 24.186, p = <.001). Education level was also found to be significant in to whether women received prenatal care (χ2 = 14.634, p = .023) and in the attitudes that pregnant women should receive malaria treatment during pregnancy (χ2 = 17.084, p = .009).

Conclusion: This study sheds light on the attitudes and behaviors surrounding preventative measures against malaria during pregnancy among a sample of women in rural Uganda. The study emphasizes the need for targeted health campaigns to promote bed net use, addressing barriers to IPTp implementation, and advocacy for improved policy change and antenatal care attendance. Improving access to prenatal care services, particularly in rural communities, is needed to keep women and children healthy.

Implications for Practice: Recognizing the challenges related to policy implementation, there is a pressing need to advocate for policies that support effective prevention strategies during pregnancy. Advocacy efforts should be directed towards improved policy implementation and encouraging regular antenatal care visits.