The Explorations in Global Health faculty research grants are designed to foster the development of research partnerships and projects in global health. Grants are made to UNC faculty for international travel or to bring international colleagues to campus to establish or maintain research relationships (with the aim of applying for external funding) or to undertake small-scale, discrete research projects with international collaborators.
This year, the IGHID is supporting six, diverse projects in Nicaragua, Liberia, Zambia, Burkina Faso, Chile and Brazil.
Zika in Nicaragua
“Diagnostics to define epidemiology and clinical aspects of Zika Virus infection”
Natalie Bowman, MD, MPH, Assistant Professor, Division of Infectious Diseases, UNC School of Medicine and Aravinda de Silva, PhD, Professor of Microbiology and Immunology, UNC School of Medicine
In recent months, Zika virus has been prominent in the scientific news as well as the popular press. This was largely catalyzed by reports from Brazil that Zika infection might be linked to a massive increase in cases of microcephaly. There is now both an urgent need to better understand the epidemiology and potential for pathogenesis of ZIKV via sustained and systematic research programs that focus on this emerging pathogen. This research proposal seeks to understand the epidemiology of emerging Zika virus in León, Nicaragua and to define exposure to Zika virus in a flavivirus immune population.
Ebola in Liberia
“Understanding the impact of stigma on sexual behaviour and relationships of female survivors of Ebola”
Kavita Singh, PhD, Research Associate Professor, Department of Maternal and Child Health, UNC Gillings School of Global Public Health, and Christine Godwin, MSPH, Doctoral Student
The unprecedented scale of the recent West African Ebola outbreak, together with
improvements in patient care and treatment, has resulted in over 17,000 individuals who
became infected with Ebola and survived, an estimated 5,800 of whom live in Liberia. Thus, the current outbreak has created a unique need and opportunity to understand the farreaching social, psychosocial, and sexual implications of Ebola infection on survivors, especially for women. Given the limited nature of previous Ebola outbreaks, prior to 2014, only a handful of studies had investigated the stigma and social rejection that many survivors face upon exiting the Ebola Treatment Unit. To date, no studies have explored the complex impact that Ebola survivorship can have on the sexual relationships of female survivors. The proposed study would seek to quantify and understand the mechanisms through which Ebola can affect social and sexual relationships for women. The findings from this study will be used to develop recommendations for counseling and support services to women who survive Ebola.
HPV in Zambia
“Human Papillomavirus (HPV) and Preterm Birth (PTB) in Lusaka, Zambia”
Lisa Rahangdale, MD, MPH, Associate Professor, Department of OB/GYN, UNC School of Medicine, and Nurain Fuseini, MD, MHS, Master’s of Science in Clinical Research Fellow, UNC Gillings School of Global Public Health
There are over 13 million annual preterm births (PTBs) worldwide, which are responsible for approximately one-third of global neonatal deaths. Children who survive a preterm birth are at significant risk for developmental delay and increased risk of life long non-communicable diseases. PTB in Zambia is estimated at 12.9 percent. Placental human papillomavirus (HPV) infection has been associated with PTB and in a recent systemic review and meta-analysis, HPV has been associated with an odds ratio of PTB of 2.12 (95 percent CI 1.51-2.98). This project aims to add to the growing literature and assess whether HPV is associated with PTB in sub-Sahara Africa where such research has not been conducted before. Sub-Sahara Africa has a higher prevalence of (3.2 percent to 47.9 percent) and sequelae from HPV than any other continent in part due to insufficient vaccination,screening, and treatment. If an association between PTB and HPV is validated, the role of the HPV vaccine and screening for and treating HPV infection can be expanded to support the prevention of PTB.
Food Insecurity in Burkina Faso
“Exploring the Geography of Food Insecurity: Assessing sub-National Patterns in West Africa”
Colin West, PhD, Assistant Professor, UNC Department of Anthropology
Africa is too often portrayed as a continent wracked by hunger, famine and extreme food insecurity. Africans and researchers who work with them, however, recognize that food security is highly variable over space and time. According to the latest Food and Agriculture Organization (FAO) estimate, 805
million people are chronically undernourished and this figure indicates a global decline of 23.4
to 13.5 percent in developing countries. On the one hand, these figures are staggering and show how food insecurity is an enormous problem. On the other, however, they also show we are making substantial progress toward reducing global hunger. These FAO statistics represent decades of careful monitoring of key health indicators through multiple surveys by FAO, the World Health Organization (WHO), USAID, and other international agencies. In recent years, access to this “big data” has drastically improved and researchers are becoming increasingly able to use these datasets for their own particular studies. This project will integrate quantitative USAID Demographic Health Survey (DHS), qualitative USAID Famine Early Warning System (FEWS) food insecurity report, and remotely sensed satellite imagery to identify areas of food insecurity within Burkina Faso. This project will develop a methodology for investigating geographic patterns and temporal trends in food insecurity for the Sahelian country of Burkina Faso.
Unhealthy Food Consumption in Chile
“Beyond Sugar sweetened beverages and food /beverage taxes: Impacts of restrictive labelling and marketing regulations on unhealthy food consumption in Chile”
Francesca R. Dillman Carpentier, PhD, Associate Professor, UNC School of Media and Journalism
In Chile, nutrition- and obesity-related non-communicable diseases (NCDs) account for 83 percent of all deaths. Chile’s continued economic growth has been accompanied by increased expenditures on ultra-processed food and other food high in refined sugar, unhealthy saturated fats, added salt, and low amounts of fiber; these types of foods are linked to increased obesity across gender and age groups. Chile also leads the globe in consumption of sugar-sweetened beverages (SSBs). Unlike other Latin American countries, Chile is taking very different regulatory measures beyond introducing SSB or other food/beverage taxes to reduce unhealthy food consumption. In April 2012, the Chilean Senate passed the country-wide National Law of Food Labeling and Advertising, which has 2 major components: (i) mandatory front-of-package labels that identify foods high in added sugar, saturated fats, sodium, and energy, and (ii) restrictions on marketing, advertising, and sales of unhealthy foods to children under age 14y over an array of media including television, internet, and school environments. The situation in Chile provides a unique opportunity to provide the first evaluation of an SSB tax in addition to an increasingly restrictive labeling and marketing regulation on key nutrients.
Lead Exposure in Brazil
“Using Participatory Action Research to Engage Multiple Stakeholders”
Courtney Woods, PhD, Lecturer, Department of Environmental Sciences and Engineering, UNC Gillings School of Global Public Health
Globally, there are close to 700,000 deaths attributed to lead exposure, many of which are from cardiovascular diseases. There is a large body of epidemiological evidence of chronic disease from lead exposure in adults, including anemia, cardiovascular changes, kidney damage, hypertension, cerebrovascular disease, and neurobehavioral disorders. There is even greater concern for exposure in infants and children, which can lead to low birth weight and behavioral and cognitive impairments. The most widespread and ongoing instance of environmental lead exposure in Brazil is in Santo Amaro, Bahia. The city was home to a lead smelter COBRAC/PLUMBUM from 1960 – 1990s, which eventually closed and relocated due to controversy over high levels of occupational exposure to lead. One of the complaints of the population refers to the number of surveys and research conducted over 40 years, with no implementation of health intervention. This fact has led to disinterest on the part of the population to participate in research and disappointment in local and state government responses to improve the health of the affected population. An important aspect of this project is the use of participatory action research (PAR) methods that will engage a range of stakeholders, particularly community residents. While PAR methods are quite common in the social sciences in Brazil, they are not commonly used in public health, even for program implementation or evaluation research, though they have shown effectiveness in other countries for improving health outcomes among participants.