Glocal Fellows 2013-2014 | UC Global Health Institute

Arti Kundu's PhD was based in the Civil and Environmental Engineering department at the University of California, Davis. Her dissertation research focused on estimating human health risks from enteric pathogens in environmental matrices using a probabilistic approach. Dr. Kundu has been involved with national and international research as she has pursued her passion for a career in public health. She recently finished working on a quantitative microbial risk assessment project and its application in the USA and also in a threshold country. These experiences have given her a solid motivation as a researcher and inspired her to make a difference in the world by doing more health-related research. As a result of these multi-cultural experiences, she is aware of the importance of One Health research in a developing country. Her career aspiration is to work with an international organization serving developing countries to improve human health.

Project

Use of Molecular Techniques and Quantitative Microbial Health Risk Assessment (QMRA) to Predict Human Health Risk Assessment in India from Water-borne Pathogens

The goal of Dr. Kundu's proposed research is to investigate the water-borne illnesses in developing countries using molecular techniques and risk assessment approach. Specifically, to characterize the source of fecal contamination in polluted water bodies with the help of real time qPCR. This will help identify the sources of fecal pollution in water bodies in India. This research has two significant attributes – Microbial source tracking (MST) and Quantitative microbial risk assessment (QMRA), that have not been applied in many developing country settings. The overall objectives of this proposed research are: (1) to identify and collect data related to infectious pathogens from contaminated waters; and (2) to compile and analyze the data in a QMRA framework. Over time, it is envisioned that real-time pathogen monitoring and QMRA will help to protect public health and reduce potential health risks associated with fecal pathogens. This is a stepping stone towards application of molecular techniques with risk assessment studies in less developed countries. This research will help the diarrheal disease research group at All India Institutes of Medical Sciences (AIIMS) in developing cutting edge methods to analyze the water-borne disease.

Mentors: Dr. Woutrina Miller (UCD), Dr. Sanjeev Sinha (AIIMS), Dr.Stefan Wuertz (UCD/SCELSE)

akundu@ucdavis.edu

John Rose is a resident physician in General Surgery aspiring to an academic career in health systems analysis to improve global health delivery. Over the last five years he participated in various projects aimed at increasing efficiency, reducing costs, and improving quality of surgical care at multiple levels. While a medical student at UC Irvine he collected and published data to assess the utility of pelvic radiography in the American College of Surgeons' (ACS) Adult Trauma Life Support (ATLS) protocol, providing evidence for the elimination of unnecessary scanning to reduce costs and save time for surgical teams. He also worked with the national Ministry of Health in Nicaragua to develop a screening program to address international disparities in cervical cancer mortality. During his MPH degree at the Harvard School of Public Health, he collaborated with the World Health Organization's Safe Surgery Saves Lives team and led a coalition of 1200 students to disseminate the WHO Safety Checklist in 14 countries. Research interests include surgical care quality and the reduction of disparities.

Project

Developing quality metrics for surgical delivery in low-income countries

In an effort to improve the quality of healthcare delivery, provider organizations in the United States have mounted numerous quality improvement initiatives. Such programs include the Health and Human Services' Surgical Care Improvement Project and the American College of Surgeons' National Surgical Quality Improvement Program. The latter example has become increasingly complex and accounts for over 130 clinical variables. However, such programs overlook resource-poor settings where labor-intensive systems of data-gathering are not feasible. As a result, low-income countries cannot and do not routinely participate in efforts to improve the quality of surgical care. As a Fellow, Dr. Rose will implement an innovative data-gathering protocol to monitor the quality of surgical interventions in a resource-poor hospital setting in Mozambique, Africa. The protocol includes less than 10 clinical variables and will be validated in its ability to predict risk-adjusted mortality. This pilot project will eliminate a critical barrier to deploying quality improvement techniques in resource-poor settings around the globe.

Mentors: Dr. Steven Bickler (UCSD), Dr. David Chang (UCSD), Dr. Emilia Virginia Noormahomed (UEM), Dr. Robert Riviello (BWH).

jorose@ucsd.edu

Aggrey S. Semeere, M.B., Ch.B, M.Med, M.A.S, is a Clinical Research Fellow at the Infectious Diseases Institute (IDI), Makerere University College of Health Sciences in Kampala, Uganda. Dr. Semeere is a certified Internal Medicine physician in Uganda and a graduate of the Advanced Training in Clinical Research program at the University of California, San Francisco (UCSF) as a beneficiary of an NIH funded D43 training grant program. He was also a recipient of the NIH Fogarty Clinical Research Scholar (FICRS) award in 2010, tenured at IDI. Dr. Semeere has previously worked with various clinical HIV research programs in Uganda, over time developing interest in the epidemiology of chronic disease complications and comorbidities (especially cancer and cardiovascular disease) associated with HIV infection and its attendant therapy. More recently, using HIV clinic databases from Sub Saharan Africa, he is working to provide key epidemiologic information concerning HIV related chronic disease complications and comorbidities. Specifically, he is implementing projects to describe the epidemiology of Kaposi's sarcoma (KS) in the antiretroviral therapy era using the NIH-sponsored International Epidemiologic Database to Evaluate AIDS (IeDEA) consortium databases in Sub-Saharan Africa.

Project

Kaposi's Sarcoma Survival in sub-Saharan Africa in the Antiretroviral Therapy Era

Dr Semeere's GloCal project will focus on evaluating survival after a diagnosis of Kaposi's sarcoma (KS) among adult HIV infected patients in sub-Saharan Africa. While data from resource-rich settings have shown substantial improvement in survival among patients with KS since the availability of antiretroviral therapy, little is known about KS survival in the resource-limited settings where majority of the KS is found, especially now that ART is more available. Moreover, the few available estimates are unreliable since they are plagued by substantial losses to follow-up usually as high as 40%. In his project, Dr Semeere will examine over 1000 patients diagnosed with KS from all 4 African regions in the NIH-sponsored IeDEA consortium (East Africa, Central Africa, West Africa, and Southern Africa) to estimate KS survival in the antiretroviral therapy era, while addressing the key concern of loss to follow-up. Differences in survival will be evaluated by region, mode of clinical presentation, and calendar date. Finally, he shall also evaluate the reasons why patients with KS in sub-Saharan Africa become lost to follow-up across the regions.

Mentors: Dr. Jeffrey Martin (UCSF), Dr. Andrew Kambugu (MaKCHS), Dr. Elvin Geng (UCSF)

asemeere@gmail.com

Kedar Radhakrishna, MD is a Senior Resident in the Division of Medical Informatics at St. John's Research Institute, Bangalore, India. He is also a PhD Scholar registered with the University of Maastricht Medical Centre, Netherlands where he is studying systems for developing predictive models for outcomes measurement and quality control in Indian critical care units. After receiving his medical degree, he pursued a Master's in Health Systems Research. He has worked extensively in the field of Electronic Health Records and Data Management. He has been working with developers for designing and developing solutions for clinical documentation, clinical decision support, and laboratory information systems and data portability. In 2010, he was chosen as one of the lead coordinators for writing up a proposal for India's National Health Portal which would be responsible for the dissemination of multi-lingual health information to the masses. His research objectives include using the tools of informatics to improve clinical workflows, improve clinical outcomes and thereby improve access and delivery of quality care to the masses especially in resource-constrained settings.

Project

A novel way for monitoring hand hygiene compliance and infection control protocols: The use of sustainable technology to bring about a change in behavior that decreases healthcare associated infections.

Dr. Radhakrishna's study focuses on hand hygiene compliance and healthcare associated infections (HCAIs) in critical care units. It is a known fact that unclean health-workers' hands are the most common vehicle for transmission of pathogens from one patient to another within a healthcare setting. Prior research suggests that there is a need to develop efficient, reliable and reproducible methods for establishing adherence to hand hygiene. Evidence also indicates that multimodal interventional strategies are required to improve compliance and reduction in HCAIs. Therefore, the pilot study aims to (1) design and develop low-cost technologies that will increase hand hygiene compliance among the staff in critical care units and (2) bring about a reduction in the occurrence of HCAIs in these critical areas. This combined with healthcare provider interactions with patients will add value and continue to build evidence and possibly initiate the development of newer strategies for decreasing the occurrence of HCAIs. The study provides an excellent opportunity to utilize and analyze data meaningfully to improve patient outcomes.

Mentors: Dr. Maria Ekstrand (UCSF), Dr. Sriram Sampath (SJRI), Dr. Tony Raj (SJRI)

kedar@sjri.res.in