The Columbia University Journal of Global Health

Ebola and the Evolving Ethics of Quarantine

Daniel Hughes — 2019-12-21

Within the context of the history of quarantine, both worldwide and in the United States, this essay analyzes current quarantine policies related to Ebola with an inquiry into both related bio-ethical concerns and an analysis of the ways in which emerging Ebola pharmaceutical treatments, particularly the rVSV-ZEBOV vaccine, may shift quarantine policies. By way of background, the historical roots of quarantine are first briefly examined alongside an analysis of why quarantine policies were not instituted in relationship to the HIV/AIDS pandemic. Then, current quarantine policies and procedures in both the developed and developing world are delineated, with an analysis of the application of these quarantine policies to Ebola. An overview is provided of how new treatment protocols may change Ebola quarantine alongside related bio-ethical concerns.

How the #MeToo Movement Can Help End the HIV Epidemic in Sub-Saharan Africa

Ishani Mathur — 2019-12-21

Submitted by the author

Promoting a More Inclusive Definition of Global Health in U.S. Medical Schools

Vishal Khetpal — 2020-11-22

Due to increased funding opportunities, faculty recruitment, and growing interest among medical students, global health has evolved into a mainstay in American medical education. However, medical schools continue to engage with global health through fundamentally different definitions of the term itself.1,2,3 These interpretations range widely, from emphasis on neglected tropical diseases, to health systems strengthening. This essay offers a more concise and inclusive definition of global health for academic inquiry undertaken by medical schools in this field - to interpret the word global as global in scope, rather than global in geography alone. Clarifying the definition of global health in this manner offers three distinct advantages. First, it would better align American medical schools’ global health interests to the Sustainable Development Goals passed in 2015 by the United Nations, and other consensus documents shaping the current global health agenda.4 Second, this definition would encourage researchers from non-traditional disciplines in academic medicine to collaborate with medical schools on global health projects. Finally, it would facilitate smoother translation of global health practices between developed and developing countries. Reforming the definition of global health in this nature would ultimately preserve the problem-solving ethos of this field, while streamlining its commendable efforts to improve society.

Food beliefs and practices during pregnancy in Northern Ghana: Implications for nutrition counseling

Abdulai Abubakari — 2020-10-29

Cultural practices and beliefs are important factors that could influence a woman’s dietary choices during pregnancy. We investigated food beliefs among pregnant women in Northern Ghana. In-depth interviews were conducted with thirty women, selected from three districts. We describe food beliefs regarding ‘recommended’ and ‘prohibited’ foods during pregnancy. There was a general agreement among participants about the recommended foods but not on the prohibited foods. For example, for some banana was regarded as prohibited, while for others it was recommended. Hypersensitivity to smell was attributed to nausea, vomiting and spiting and was largely the most important factor that could modify dietary habits of those who experienced it. Pregnancy is a sensitive phase and thus requires critical care and attention. Therefore, individualized counseling during antenatal clinics instead of the ongoing mass education is recommended as this will help address conditions peculiar to individual pregnancies.

Outbreak investigation of acute diarrheal disease (ADD) during a religious mass gathering associated with drinking contaminated pipeline water, Radhakund, Uttar Pradesh, India, October— November 2016

Sushma Choudhary — 2019-12-21

Background: In 2015, there were >12 million acute diarrheal disease (ADD) cases with 1,216 deaths reported in India; 75,347 cases and 320 deaths were reported from Uttar Pradesh state. A suspected ADD outbreak was reported from Radhakund town, Uttar Pradesh (population = 11,488 as per census 2011) on November 11, 2016 during a religious festival with >10,000 pilgrims. We investigated to describe the epidemiology, identify risk factors and recommend preventive measures.

Methods: We defined a suspect case as ≥3 loose stools within 24 hours in anyone residing in Radhakund town between October 31 and November 11, 2016. We identified cases by reviewing hospital records and by house—to—house survey. We conducted a 1:2 unmatched case—control study using a structured questionnaire to identify risk factors. Stool for cultures were not collected by hospitals and no active cases were present during the investigation for testing. We assessed water supply and sanitation of the town and tested water samples for fecal contamination.

Results: We identified 339 cases (hospital records=273; house-to-house=66) ; 285 (84%) were pilgrims. Median age was 60 years (range 1—80 years), 69% female. There were 117 (35%) hospitalizations and two deaths. Symptoms were vomiting (94%), abdominal pain (23%), and fever (3%). Cases were clustered around areas receiving drinking water from pipeline A and peaked on 3 and 5 November 2016. Among 44 cases and 81 controls, only drinking water from pipeline A (aOR=9.6 [95% CI = 3.0—29.5]) and illiteracy (aOR=23.2 [95% CI = 5.9—91.0]) were associated with illness in multivariate analysis. We observed sewage overflow from community toilets near tube-wells supplying pipeline A. Pipeline A is >40 years old with frequent cracks and leaks. Among four water samples from pipeline A, two were positive for Vibrio cholerae.

Conclusions: This was a point-source localized ADD outbreak, probably cholera, predominantly among pilgrims in Radhakund associated with drinking water from a pipeline contaminated with Vibrio cholerae. Despite the limitation of pilgrims not being available for the analytical study, we were able to determine the likely source epidemiologically based on affected residents in the community. We recommended chlorination of water, relocation of public toilets away from tube—wells, repair of pipeline A, routine water surveillance and enhanced sanitation facilities for pilgrims.

The Vehicle Gap: Wealth Inequality and Road Injury Risk Characterization in Vietnam

Jeffrey KiHyun Park — 2019-12-21

Road traffic injury (RTI) is a frequently overlooked issue in the literature of global health. This perspective examines the ways in which wealth inequality exacerbates RTI risk characterization in the specific model of Vietnam. The framework of the Equality-Sustainability Hypothesis, as suggested by Cushing et. al, is used, with a specific focus on three factors: political misrepresentation, discrepancy in consumption intensity, and lack of social cohesion. Policies regarding helmet coverage, healthcare infrastructure, road quality and social psychology are critically analyzed, with sources drawn primarily from epidemiological study designs. Such analyses provide the basis for various policy suggestions towards the end of the perspective that focus specifically on wealth inequality as the primary point of intervention. Overall, this perspective suggests that the Equality-Sustainability Hypothesis holds true in the example of RTIs in Vietnam, which is specifically referred to as a “Vehicle Gap”, and that this hypothesis be made more comprehensive by liberalizing its definition of environment to also include man-made infrastructure.

Undernutrition Determinants Among Under Five Children in Ethiopia

Tsegahun Worku Brhanie — 2019-12-21

The objective of this study was to estimate undernutrition determinants among under-five children in Ethiopia. Multiple logistic regression was computed to estimate explanatory variables. P-value < 0.05, 95% CI and odds ratio (OR) were considered. The analysis was done using SPSS, version 24. There was an association between distances from the borders and out of the borders with height for age Z score (P-value <0.05), but not associated with weight for height Z score (P value=0.18), and weight for age Z score (P value=0.16). Education of mother (P-value < 0.05), nutrition status of mothers (P-value <0.05), the wealth index of the households (P-value <0.05), employment status of mothers (P-value <0.05), place of residence (P-value < 0.05), age of the child (P-value <0.05), birth intervals (P-value < 0.05) and breastfeeding (P-value <0.05), were determinant factors for the stunting of children. Wealth index, region and place of residence, age of the child, the size of the child at birth, nutrition and employment status of the mothers, a birth interval of the child, and breastfeeding status of the child were the determinant factors.

Is Exercise Extra? A Mixed Methods Examination of Cultural Barriers and Enablers of Physical Activity in Management of Type 2 Diabetes in M’Bour, Senegal

Rhoda K. Moise — 2019-12-21

Objective:

This study seeks to produce culturally-attuned recommendations for disease management in individuals with type 2 diabetes in M’Bour, Senegal.

Methods:

The PEN-3 Cultural Model (PEN-3) framed this mixed methods study to capture a) the qualitative barriers and enablers to participating in physical activity through narrative interviews; as well as b) the quantitative extent to which participants engaged in physical activity through the International Physical Activity Questionnaire (IPAQ). Content analysis identified emergent themes from interviews and descriptive statistics summarized IPAQ responses.

Results:

Among 41 individuals formally diagnosed with diabetes, the mean age was 58 (SD=11.8). Results elicited from PEN-3 included several barriers and enablers to physical activity. Barriers included prohibitive costs of gym membership and exercise equipment; limb pain; and feeling ill. Participants reported walking as their main source of exercise, with an average frequency of 4 days per week (SD=2.8). Although patients reported a lack of others with whom to exercise, familial support aided in maintaining exercise behaviors such as walking.

Conclusions:

Given participants’ need for exercise companions, group-based activities may be useful. Patients with diabetes may also benefit from complimentary home-based exercises that are gentle and pain alleviating.