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Global Health, NTDs and STHs Lunch and Learn September 19, 2012

Global Health, NTDs and STHs Lunch and Learn September 19, 2012. Theresa W. Gyorkos Professor, McGill University theresa.gyorkos@mcgill.ca. Outline. Introduction to Global Health, NTDs and STHs Research examples Research questions Study designs Study populations Research implications

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Global Health, NTDs and STHs Lunch and Learn September 19, 2012

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  1. Global Health, NTDs and STHsLunch and LearnSeptember 19, 2012 Theresa W. Gyorkos Professor, McGill University theresa.gyorkos@mcgill.ca

  2. Outline • Introduction to Global Health, NTDs and STHs • Research examples • Research questions • Study designs • Study populations • Research implications • Opportunities for students • Scholarships, plus • Careers

  3. Global health can be regarded as population health on a trans-national scale. • Global health research therefore focuses on the determinants and distribution of health and disease that affect human populations in more than one country. Examples: pandemic transmission/control; migration-related health concerns; communicable disease transmission from contamination of imported foods; health personnel migration issues

  4. 06-01-12 The Gazette

  5. Global Health Journals Global Public Health Global Health Action Global Health Governance Global Health Promotion Journal of Global Health Protection (now Emerging Health Threats) International Health (via TRSTMH) Lancet Bulletin of the WHO PLoS ONE, PLoS NTD, etc. ... Journal of Globalization and Development ...

  6. Why study global health? • learn from past to improve current and future health • health concerns are not restricted to any one country, region or continent • address current/future health in a collaborative way • address health disparities at all levels (local, provincial, national, regional, international) • intricate link between health and development • make more effective and efficient use of increased funding for global health activities • …

  7. Neglected Tropical Diseases (NTDs) (N= 17) Buruli ulcer Chagas disease Cysticercosis Dengue Dracunculiasis Echinococcosis Fasciolosis Sleeping sickness Leishmaniasis Leprosy Lymphatic filariasis Onchocerciasis Rabies Schistosomiasis Soil-transmitted helminthiasis Trachoma Yaws

  8. Neglected Tropical Diseases (NTDs) > 1 billion people affected... in 149 countries... > 70% with ≥ 2 NTDs... (Ref: WHO 2009)

  9. Neglected Tropical Diseases (N = 17) Buruli ulcer Chagas disease Cysticercosis Dengue Dracunculiasis Echinococcosis Fasciolosis Sleeping sickness Leishmaniasis Leprosy Lymphatic filariasis Onchocerciasis Rabies Schistosomiasis Soil-transmitted helminthiasis Trachoma Yaws

  10. Burden of STH Disease (infecteds and ill in millions; deaths in thousands) ParasitolToday 1997; WHO 2002; Crompton & Nesheim 2002; WHO 2006

  11. Roundworms: adverse effects • Acute pulmonary disease • Hypersensitivity • Intestinal obstruction

  12. Whipworms: adverse effects • Rectal bleeding • Rectal prolapse • Iron-deficiency anemia • Chronic dysentery

  13. Hookworms: adverse effects • Iron-deficiency anemia • Blood loss: • Up to.4 ml/day/worm

  14. HIGH RISK GROUPS • PRE-SCHOOL CHILDREN • SCHOOL-AGE CHILDREN • WOMEN of REPRODUCTIVE AGE

  15. DEWORMING... improves cognition, growth, nutrientuptake… decreasesabsenteeism…leads to higherwages increasesenrollment; improves dropout/retention improvessurvival, growth and development reducesmaternalanaemia reducesotherdiseases/improvesoverallhealth decreasesenvironmental contamination mobilizesdrugresources

  16. Research partnership Canada- Peru: 2001 - present Belen Health/education systems School Household 2001 2002 2003-05 2005 2005-06 2006-11 2012- RCT KAP DIET Tropical Medicine Research Centre pregnant women infants schoolchildren community parasitology nutrition multidisciplinary

  17. POLICY • Regular (anthelminthic) chemotherapy to at least 75% of all school-age children at risk of morbidity by 2010 (and to promote health education through intersectoral collaboration) • Developed1998-1999 • Approved by WHO Cabinet - October 2000 • Approved by World Health Assembly - May 2001

  18. Pregnant women N=1042 Mebendazole + Iron supplementation Placebo + Iron supplementation BW BW Previousresearch: RCT in Peru 2003-2005 PhD student; Renee Larocque One RESULT:VLBW (0% vs 1.5%, p=0.007) OR=0.10 (0.0, 0.68)

  19. PhD student: Serene Joseph

  20. Lactating women N=1010 Albendazole Placebo Infant weight gain from birth to 6 months of age Plannedresearch: RCT in Peru2012-2014 PhD student; Layla Mofid Infant weight gain from birth to 6 months of age Infant weight gain from birth to 24 months of age Infant weight gain from birth to 24 months of age

  21. Student research questions • François Thériault: Short and long-term effects of a health education program on helminth infection and absenteeism rates in Grade 5 students of the Peruvian Amazon • Brittany Blouin: The effect of early versus late umbilical cord clamping on newborn anemia: implications for clinical practice in the Peruvian Amazon • Kathleen Rollet: Exploring health inequalities: determinants of home-based versus hospital-based deliveries in the Peruvian Amazon • Sarah Carsley: Sex and gender differences in hookworm infection in school-age children in Peru • Sonya Cnossen: Determinants of participation in a milk subsidy program (Vaso de Leche) in a poor community in the Peruvian Amazon • Mathieu Maheu-Giroux: An eco-epidemiological study of the impact of fish farming (‘pisicigranjas’) on malaria occurrence in the Peruvian Amazon • Hélène Carabin: Enviro-net: Efficacité d’un programme de contrôle des infections et des contaminants de l’environnement dans les garderies

  22. Challenges of field-basedevidence • Multidisciplinary/participatoryapproach • Local supervision • Rigorousstudy designs • Sufficientsamplesizes • Properassembly of study populations • Rigorousstoolexaminationmethods • Rigorousstatistical analyses • Resultsdissemination to appropriate audiences

  23. Ultimate goal: providerigorousevidence base for cost-effective preventionand control activities

  24. Opportunities for Students • Thesis research • Primary epidemiology, primarily • Manuscript-based • LMIC-based (Peru, etc.) • Scholarships • CIHR, FRQ-S,NSERC,IDRC ... • STIHR (GHR-CAPS) - Ēcoled’été 2013, • Travel awards • Best theses (RRSPQ)

  25. Opportunities for Students • Leadership • CCGH (Ottawa, October 21-24, 2012) • CCGHR (UAC, etc.) • Internships • WHO • PAHO • Bulletin SantéPop (RRSPQ) • Bulletin de Nouvelles, Axe en santé mondiale, (RRSPQ)

  26. Careers in Global Health • Academia • Government agencies • CIDA, IDRC, PHAC, PAHO, WHO,... • NGOs • Micronutrient Initiative • Médecins Sans Frontières • .... • Industry • Pharmaceutical • ...

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