Graduate Students Take on Global Health Challenges

With help from the Global Health Institute’s 2013 Graduate Student Research Awards, seven students are tackling health challenges around the world, from the spread of dengue fever in Colombia to the impact of health care changes in the highlands of Thailand.

The results of their research could provide information that will lead to improved health for children and adults. Graduate students Ephrem Aboneh, Andrew Bennett, Yangsun Hong, Jinho Kim, Stephanie Koning, Gail Rosen and James Weger have spent hundreds of hours developing individual research questions that they wish to test. The monetary award given to them from GHI has allowed each to make their plan a reality, which usually involves traveling to another country. Here are their stories:

Improving safety for patients

“I have found that hospitals in the United States have successfully implemented strategies that may be leveraged to support patient safety in hospitals in developing countries.” ̶ Ephrem Aboneh

Ephrem A. Aboneh, a graduate student in Social and Administrative Sciences in the School of Pharmacy, came to UW-Madison because it is one of the few pharmacy schools in the United States with a strong focus on medication safety and patient safety research. Prior to coming to Madison, Aboneh was a lecturer in Ethiopia, where he worked with different health professionals at Addis Ababa University’s teaching hospital. “My work has provided me with an opportunity to understand the scope of problems affecting the current health care system,” Aboneh says.

ED Crowding

Those problems include fragmentation of care, multiple patients safety issues and lack of standardization in Black Lion Hospital’s emergency departments. All are associated with the risk of medication errors that can lead to patient harm.

As those things began to sink in, he became interested in finding a graduate program that could help him get an advanced level training to become an independent researcher. His goal is to study patient safety/medication safety issues.

The GHI research fellowship will allow Aboneh to study medical safety in Ethiopia. He will identify hazards, suggest strategies and make recommendations to improve medication safety in Ethiopia.

“I am hoping to use this as an opportunity to jump start discussion in the area as well as broaden future work,” Aboneh says. He will perform an extensive literature review, observe hospital procedures and conduct two sets of interviews at the Black Lion Hospital to address the problem and identify its main cause.

“I believe that application of human factors engineering approaches in such settings can help identify medication/patient safety hazards,” he says. Aboneh will use the data he collects to analyze rigorous qualitative methods in order to develop a set of recommendations for hospitals like Black Lion to follow. His goal is to identify hazards and strategies to improve medication safety in developing countries.

Improving HIV/AIDS prevention

“Examining school context is important because the high HIV prevalence rates in sub-Saharan Africa including Malawi appear to be closely linked to the majority of teenagers experiencing early sexual debut.” ̶ Jinho Kim

In 2003, the concept of combining several medical interventions to prevent HIV/AIDS was introduced, and since then, much attention has been paid to this approach. Jinho Kim, a Seoul, South Korea citizen and Ph.D. student in the Department of Sociology, found that despite the attention and interest, little is known about the effects of combined HIV/AIDS prevention efforts.

Kim spent two years as director of a public health program in Malawi before coming to UW-Madison. “The program funded by the Korean government had two components, one for providing HIV prevention interventions and the other for evaluating their effects. I want to see what the combined efforts can do,” Kim says.

Kim’s research will provide unique opportunities to examine adolescents’ sexual norms, behaviors and networks in the context of a school environment. His focus will be on friend networks and how they influence students’ sexual behavior.

Kim developed a module of friend networks as part of a project initiated by the Africa Future Foundation in partnership with Daeyang Luke Hospital in Malawi and the Korea International Cooperation Agency. He will add information he gathered previously into a follow-up survey.

“I spent a large part of the award in supporting my summer field trip to Malawi, which is essential for improving the quality of follow-up survey data,” Kim says. “Consequently, the award was extremely helpful to improve my work.” By understanding how friend networks influence students’ sexual attitudes, Kim hopes his work will help stop the spread of HIV/AIDS. He will publish his work as well as use it as his master’s thesis.

Understanding the impact of health care reform

“This research has important implications for global health research and utilizes an interdisciplinary approach to study the social and political motivations behind changing health behaviors.” ̶ Stephanie Koning

Stephanie Koning, from Wenatchee, Wash., is a Ph.D. student in the Department of Population Health. Her work looks at how health care changes affect populations. Stephanie Koning-Thailand“My work is motivated by my desire to understand the social and political motivations behind changing individual and population health behaviors, the broader impacts of health system reform and the best way to promote the protection of human rights through health promotion,” Koning says.

She will study how Thailand’s rural primary health care expansion impacted maternal and infant mortality and the social enfranchisement of ethnic minorities. Using mixed methods, Koning will determine whether intervention in highland villages produced an immediate or lagged increase in hospital childbirths, an increase in childbirth registration and a reduction in maternal and infant mortality.

“We need to see the broader impacts of health system reform and the protection of human rights through health promotion,” she says. The GHI Graduate Student Research Award will allow Koning to visit Thailand to meet with colleagues and mentors, conduct an exploratory pilot study, finalize her dissertation research aims and methods, and find a research assistant.

Grant allows field research

“My overall objective is to determine whether small forest fragments in a highly relevant setting has value for reducing water-borne pathogens.” ̶ Gail Rosen

Gail Rosen, a Ph.D. student in Population Health Sciences, came to UW-Madison to work with Dr. Tony Goldberg, her advisor who leads the Kibale EcoHealth Project in Uganda and sparked her interest in reducing water-borne pathogens.

Rosen is proposing a holistic, interdisciplinary approach to examining the value of small fragments of forest for reducing pathogens in surface water that cause human and animal disease. “First, it represents an opportunity to apply theories and methods from multiple disciplines to science that may have practical, actionable implications,” she says. “I’m using molecular techniques in a sampling strategy informed by ecology and epidemiology to look at interactions between things as small as a virus and as large as an ecosystem, all with the aim of protecting human health. That’s exciting. The work should also provide insight into how ecosystem services related to health hold up under conditions of landscape change, which is of course a very relevant question as forests become increasingly fragmented.”

Rosen’s study will take place in western Uganda, where forest fragments persist in low-lying areas through which water flows and where water-borne pathogens are highly likely to cause disease. Rosen will test whether small forest fragments act as “filters” and can stop water pollution. She hopes to prove the forest fragments can be used to remove pathogens from water.

“I’m so grateful to GHI for this award,” Rosen said. “It’s giving me the chance to get into the field for the whole month of January. Aside from the fact that I need to be there to collect my samples, I think it’s really important to put in the field time. It’s hard to understand a system you haven’t seen firsthand.” The project fits GHI’s interdisciplinary approach to public health that includes examining and addressing environmental impacts on well-being.

 Combating mosquito-borne disease

“Seeing and understanding the dire nature of how infectious disease affects society puts these diseases and their afflictions into perspective. This was powerful and I think is something that scientists sometimes talk too nonchalantly about without first-hand experience.” ̶ James Weger

By studying human dengue fever in northern Columbia, master’s student James Weger hopes to help avert a massive viral outbreak. Weger, a Madison, Wis., native is a third year graduate student in the Department of Pathobiological Sciences.

Weger’s work will increase understanding of the mosquito-borne viruses circulating in Magdalena and La Guajira, Columbia. These regions support many arboviruses, which could emerge from the forest to cause massive disease outbreaks in the human population, Weger says. The work also will augment Weger’s research and global health experience.

Weger’s work focuses on human dengue fever, an infectious tropical disease that is spread by mosquitoes and also known as break bone fever. Symptoms include fever, headache, muscle and joint pains and a characteristic skin rash that is similar to measles. In a small portion of cases the disease develops into the life-threatening dengue hemorrhagic fever, resulting in bleeding, low levels of blood platelets and blood plasma leakage.

Dengue fever represents a massive threat to the public health in tropical climates, Weger says.

He has found that relevant data is necessary for continued understanding of transmission dynamics, predicting outbreaks and developing an effective vaccine. To do this, Weger will isolate mosquitoes from the tropical areas and test them for a panel of virus pathogens in order to understand infection rates in the areas.

The GHI fellowship allowed Weger to travel to Columbia, which he had not done before, and see close up how infectious disease affects people. The trip helped him appreciate the impact of infectious diseases and inspires him to work to find a cure for human dengue virus that will contribute to public health. Weger says. “The award meant a lot to me and allowed me to experience something that I would have otherwise not had the opportunity to experience,” Weger says. “It also provides valuable funds to a project which I feel is important and can hopefully have good results.”

May 13, 2014 | by Carley Eisenberg

Graduate Students Take on Global Health Challenges

With help from the Global Health Institute’s 2013 Graduate Student Research Awards, seven students are tackling health challenges around the world, from the spread of dengue fever in Colombia to the impact of health care changes in the highlands of Thailand. The results of their research could provide information that will lead to improved health for children and adults. Read more.