Poster Title: Evaluating Mobile Health Capacity for Congenital Heart Disease Screening in Low and
Middle-Income Countries
Pouya Hemmati, Medical School, MS4 Student
Emily Dale, Children’s HeartLink
BACKGROUND/HYPOTHESIS: In low and middle-income countries (LMIC), detection and treatment of
congenital heart disease (CHD) remains a challenge due to limited access to pediatric cardiac
professionals. CHD affects more than one in 120 children worldwide and can be catastrophic with
delayed or missed diagnosis. Thus, there is a need for novel screening methods in LMIC. We have
developed a smart phone-compatible electronic stethoscope and a novel iPhone app to store and
transmit digital heart sounds and phonocardiograms via a secure cloud server, allowing experts
worldwide to instantaneously and remotely diagnose and initiate management of CHD. This system’s
functionality and accuracy were assessed in 2013 during an outreach mission to Lanzhou, China. To
assess willingness to use this screening system and identify barriers to implementation, we surveyed
Chinese providers in a subsequent training mission. We hypothesized that participants would be willing
to use smart phones to connect with remote experts for CHD screening and distance learning.
METHODS: A survey evaluating practice settings, CHD referral indications, mobile health capabilities, and
willingness to implement telemedicine systems was developed. Questions were constrained with yes/no
and multiple choice answers to minimize language barriers and facilitate statistical analysis. After
evaluating for face, construct and content validity, the paper survey was translated and collected
anonymously. Respondents were providers from across the Yunnan Province at a First Affiliate Hospital
of Kunming Medical University (FAHKMU) training seminar in February 2014.
RESULTS: Of 218 respondents, 213 completed the entire survey. A bimodal distribution showed that 40%
of providers were based within five km of FAHKMU and 43% practiced more than 100 km away. All but
one provider was willing to set up a pediatric cardiac referral program with FAHKMU (214/215). When
analyzing echocardiography referral indications, 89% of providers reported that they would refer patients
with a murmur. Assessments of mobile technology demonstrated that 98% of respondents had smart
phones with internet access with an approximate 2:1 ratio of Android to iPhone operating platforms
(67% versus 31%, respectively). Overall, there was strong willingness by providers to learn how to use a
digital stethoscope (203/214) and to engage in remote CHD learning courses (214/216).
CONCLUSIONS: Survey results demonstrated a strong willingness by physicians in rural Yunnan Province
of China to adopt a novel mHealth system for CHD screening and distance learning. This reflects the
prevailing trends of expansion of mobile technology in LMIC and openness to telemedicine for remote
diagnostics. Our evaluation demonstrated that we need an Android version of the app. Additional
outreach missions are necessary for developing other mHealth referral networks, testing distance
learning modules, expanding implementation of this device, recording data to further analyze
functionality and accuracy, and accumulating a digital heart sound and phonocardiogram database for
training.
Page 1
2014 Global Health Day Poster Abstracts
Poster Title: Delta-like 1 ligand (DLL) in cerebrospinal fluid for detection of Mycobacterium tuberculosis
meningitis
Nathan Bahr, Department of Medicine - Division of Infectious Disease and International Medicine, Fellow
Bio: Dr. Nathan Bahr is an infectious disease fellow at the University of Minnesota and spent the past
year as National Institutes of Health Fogarty International Center Global Health Fellow in Kampala
Uganda at the Infectious Disease Institute conducting research on cryptococcal meningitis and
tuberculosis meningitis.
Nathan C Bahr MD, MA1,2, 3, Grace Linder2, Ryan Halupnick2, Reuben Kiggundu MBChB3, Henry W
Nabeta MBChB3, Darlisha Williams MPH1,3, David B Meya MMed1,3, Joshua Rhein MD1,2,3, David R
Boulware MD, MPH 1,2
Affiliations:
1 Division of Infectious Diseases and International Medicine, Department of Medicine, University of
Minnesota, Minneapolis, MN
2 Center for Infectious Diseases & Microbiology Translational Research, University of Minnesota,
Minneapolis, MN
3 Infectious Disease Institute, Makerere University, Kampala, Uganda
Abstract
Background: Tuberculosis meningitis (TBM) diagnosis is notoriously difficult, new biomarkers are needed
to allow for improved diagnostic accuracy. We evaluated the diagnostic utility of a novel biomarker,
delta-like ligand 1 (DLL1), a Notch ligand, which selectively drives antigen-specific CD4 T helper1 cell
responses. DLL1 polymorphisms increase susceptibility to other intraceullar (Th1) organisms (e.g.
leishmaniasis).
Methods: CSF DLL1 concentrations were measured by ELISA in 116 patients with suspected meningitis, of
which 18 patients had TBM, 65 patients cryptococcal meningitis (CM), and 33 patients tested negative for
both CM and TBM (termed “other”). TBM was diagnosed either by GeneXpert MTB/Rif assay (Cepheid,
Sunnyvale, CA) or Bactec MGIT culture. We evaluated the diagnostic performance of DLL1 for TBM.
Results: Patient characteristics were similar at diagnosis except for CSF protein and CSF WBC count.
Protein was higher in TBM patients than ‘other’ meningitis, and CSF WBC count, was higher in TBM than
in non-TBM meningitis. Mean DLL1 CSF concentrations were significantly higher in patients with TBM
(1293 pg/mL; 95%CI, 602-1985 pg/mL) than CM (447 pg/mL; 95%CI, 398-495pg/mL) or other meningitis
(534 pg/mL; 95%CI, 290-669pg/mL). A cutoff of >600pg/mL in CSF for TBM had 72% sensitivity, 77%
specificity, 36% positive predictive value (PPV), and 94% negative predictive value (NPV) 94%
(AUC=0.794). As the DLL1 level increased, the likelihood of TBM increased with specificity of 92% and
PPV of 56% above >800pg/mL.
Conclusions: CSF DLL1 exhibited good diagnostic performance, and may have a role as a low cost
adjunctive diagnostic tool for TBM. Misclassification bias (of non-detection of TBM classified as ‘other’)
hampers diagnostic studies, and larger studies are required in the future.
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2014 Global Health Day Poster Abstracts
Poster Title: Prevalence of diabetes mellitus, hypertension, and dyslipidemia in indigenous populations
of Puebla, Mexico
Sean Navin, College of Pharmacy, PharmD Student
Rationale: Hypertension, diabetes mellitus, and dyslipidemia are major risk factors for the development
of cardiovascular disease. National prevalence data for the Mexican population regarding these diseases
are known for the general population, but they are limited with respect to specific Mexican indigenous
populations.
Objective: The purpose of this study was to measure the prevalence of hypertension, diabetes mellitus,
and dyslipidemia in indigenous populations of the Sierra Norte of Puebla, Mexico using patient data from
free screening services established by pharmacy students.
Methods: Data was collected from patients participating in free student-run screening clinics, taking
place in multiple rural, Mexican towns. Participants consented to have their de-identified information
pooled for research. Data was analyzed as a retrospective chart review. Screenings provided at the clinics
included blood pressure readings, cholesterol levels, blood glucose levels, and A1C values. In addition,
students collected participants’ previous medical diagnoses, medical history, demographic information,
and current medication use. Hypertension was defined as having one of the following: systolic blood
pressure ≥ 140 mmHg; diastolic blood pressure ≥ 90 mmHg; previous diagnosis; or current
antihypertensive medication use. Diabetes was defined as having one of the following: A1c > 6.5%;
fasting blood glucose ≥ 126 mg/dL; non-fasting blood glucose ≥ 200 mg/dL; previous diagnosis; or current
diabetic medication use. Hypercholesterolemia was defined as having total cholesterol ≥ 200 mg/dl.
Hypertriglyceridemia was defined as having fasting triglycerides ≥ 150 mg/dl. Low HDL was defined as
having HDL < 40 mg/dL. This study was exempt from IRB review November 15, 2013.
Results: Records from 483 patients were collected from a total of 12 clinics. The prevalence of
hypertension was 38.3% with 28.4% of patients reporting a previous diagnosis. The prevalence of
diabetes mellitus was 20.3% with 18.8% of patients reporting a previous diagnosis. Median lipid
concentrations were the following: total cholesterol 169 mg/dL, triglycerides 180.5 mg/dL, HDLcholesterol 38 mg/dL, and LDL-cholesterol 88 mg/dL. The most frequent lipid panel abnormality was
hypertriglyceridemia with a prevalence of 66.3% followed by low HDL with a prevalence of 55.8%. The
prevalence of hypercholesterolemia was 24.4%. Previously diagnosed dyslipidemia was reported in 15.1%
of patients.
Conclusion: Indigenous populations of the Sierra Norte of Puebla have a prevalence of hypertension and
diabetes mellitus that exceeds that of the national level. Multiple forms of dyslipidemia are highly
prevalent. Pharmacy students who participate in future outreach efforts should focus on expanding
services for these disease states, especially diabetes, in order to prevent morbidity and mortality in this
underserved population."
Page 3
2014 Global Health Day Poster Abstracts
Poster Title: Sumak Kawsay: 'Good living' in Ecuador
Brooke Dugdale, Medical School, MD Student
Bio: Brooke Dugdale is an M.D. candidate in the second year of study at the University of Minnesota’s
Medical School-Twin Cities. She has had international healthcare experiences in India, where she aided in
providing pre-natal and obstetric care as well as helping in a children’s vaccination program, and now in
Ecuador where she completed an internship in Public Health and Medicine.
Abstract
My internship in medicine and public health sought to explore the practice of medicine, especially among
underserved populations. I also investigated the role of primary care and preventative medicine within a
public health system where resources are limited, but care is guaranteed for all and is free of cost.
To complete this project, I did an internship under the Ministry of Public Health in Ecuador, where I
worked in a rural hospital’s Emergency department and participated in population-based health outreach
programming with the hospital’s team of community health workers.
To understand the health policy overhaul in Ecuador one must first step back and examine the newly
rewritten constitution and the development policies of Ecuador’s president, Rafael Correa. The health
reforms and the improvements within the public health system enacted over the past six years are
encapsulated in the phrase “Sumak Kumsay”, which in the indigenous language of Kichwa means ‘living in
harmony’. Principles adapted from indigenous Kichwa communities, such as pluralism, reciprocity,
connection to the community and acts of charity, were incorporated into the healthcare system. I also
saw the on-going inequities still existent in Ecuadorian hospitals. As in our own system, resources are
limited and a society must wrestle with how to apportion these in order to best serve its people. Ecuador
is re-directing its funding away from expensive emergency room service, to instead support enhanced
preventative care, community health workers and education classes for chronic disease management.
My study presents what I learnt from my time in Ecuador about universal health coverage, preventative
medicine and the importance of education to public health, including principles that are relevant to the
healthcare debate going on in the U.S.
Page 4
2014 Global Health Day Poster Abstracts
Poster Title: What predicts HIV late testing in low HIV/AIDS prevalence areas?
Bruce Rwabasonga Mandela, School of Public Health, MPH Student
Bio: Bruce Rwabasonga Mandela is an internationally trained physician with over 2 years of clinical HIV
practice in Uganda. This is his masters of public health thesis. The project was undertaken under
supervision of personnel at the Minnesota Department of Health and Faculty at the University of
Minnesota.
Abstract
Background: Despite scaling up HIV/AIDS interventions, one in three are diagnosed with HIV/AIDS at an
advanced stage of disease. These so-called HIV late testers often have worse health outcomes and
represent a missed opportunity to prevent onward HIV transmission. Few studies have investigated HIV
late testing in low-to-medium HIV prevalence regions in the United States.
Objectives:
 To describe trends of HIV late testing in Minnesota
 To compare two definitions of HIV late testing
 To identify factors associated with HIV late testing
Methods: Demographic and clinical data on new HIV/AIDS diagnoses between 2008 and 2011 in
Minnesota were obtained from the state’s enhanced HIV/AIDS Reporting System (eHARS) database. The
proportion of late testers was calculated using a time-based (developing AIDS within 12 months of
diagnosis) or laboratory-based (having a baseline
CD4 count ≤ 350 cells/μL) definition. Predictors of HIV late testing were assessed through multivariate
logistic regression.
Results: Between 2008 and 2011, 1,313 individuals were newly diagnosed with HIV/AIDS in Minnesota, of
whom 411 (31.3%) were late testers (Time-based criteria). 666 (50.7%) were eligible for the laboratory
based criteria. Of these 348 (52.3%) were late testers. The rate of HIV late testing using either measure
was stable over time. People over 45 years old, Hispanics, African-born immigrants, and those without an
indicated risk were more likely to be late testers than other groups.
Conclusion: Despite efforts to diagnose HIV/AIDS in a timely manner, the proportion of late testers
remains high. The demographic characteristics of HIV late testers in Minnesota are different from the risk
groups traditionally targeted by HIV testing programs."
Page 5
2014 Global Health Day Poster Abstracts
Poster Title: Early Undernutrition and Risk of Diabetes in Adult Life: Challenges for Public Health
Systems in South Asia
Satlaj Dighe, School of Public Health, MPH Student
Bio: Satlaj Dighe is a second year student of the Maternal and Child Health Program in the School of
Public Health at the University of Minnesota. Before joining the program, Satlaj was working in the
community health sector of India and South-east Asia. The areas of interest for Satlaj include chronic
disease management for low-income communities, global reproductive health and program evaluations.
Abstract
Currently 347 million people in the world have diabetes. This number is expected to reach 438 million by
the year 2030, with two-thirds of all diabetes cases occurring in low- to middle-income countries (Hu,
2011). India, Pakistan and Bangladesh currently feature in the list of top ten countries with highest
number of diabetes people. For all these three countries, the number of people with diabetes is expected
to rise by more than double by 2030 (Wild, Roglic, Green, Sicree, & King, 2004).
Undernutrition and Diabetes - Double burden of Poverty: A growing body of research also indicates a
strong association between maternal or early childhood under nutrition and risk of diabetes in the later
life(Yajnik, 2004)(Le Clair, Abbi, Sandhu, & Tappia, 2009)(Langley-Evans, 1999)(Barker, Eriksson, Forsén, &
Osmond, 2002). Low preconception weight of mother, low birth weight and low weight for age in the
early childhood are considered as risk markers for type 2 diabetes. The research hypothesize that
exposure to undernutrition in early life increases an individual's vulnerability to diabetes disorders, by
'programming' permanent metabolic changes that predisposes body to acquire higher proportion of fats
(C, 2009).
Impact- This association of early undernutrition with diabetes presents a double burden of diseases for
the low income populations. They suffer from protein-energy undernutrition and micronutrient
deficiencies as well as from metabolic disorders and cardiovascular conditions. Lack of balanced diet,
diabetes education and availability of comprehensive diabetes care addressing risk factors such as
smoking, alcohol consumption and stress result in speedy progression of diabetes, complications and
early mortality. Due to current dominant perception of diabetes as a disease of over nutrition the Public
Health System in South Asia lacks a comprehensive diabetes policy. This results in lack of resources,
trained staff and program interventions specifically designed for low-income populations.
Next steps for the Public health systems:
1.
Adopting a life-cycle approach for nutrition, especially for women and adolescent girls could
prevent diabetes in the later generations.
2.
Exploring innovative nutrition solutions such as school gardens and community gardens could
improve the dietary intake of poor communities.
3.
Integrating diabetic care and diabetes education in the larger nutrition programs would orient
the system to address diabetes as an important health issue for low-income community.
4.
Training existing staff such nutrition workers, Community Health workers, and Primary Health
Center staff to identify early signs of diabetes, to provide diabetes education and diabetes
care for resource poor families.
5.
Introducing diabetes screening tests in the primary health centers.
Page 6
2014 Global Health Day Poster Abstracts
References:
Barker, D. J. P., Eriksson, J. G., Forsén, T., & Osmond, C. (2002). Fetal origins of adult disease: strength of
effects and biological basis. International Journal of Epidemiology, 31(6), 1235–1239.
doi:10.1093/ije/31.6.1235
C, F. (2009). Maternal nutrition: effects on health in the next generation. The Indian Journal of Medical
Research, 130(5), 593–599.
Hu, F. B. (2011). Globalization of Diabetes The role of diet, lifestyle, and genes. Diabetes Care, 34(6),
1249–1257. doi:10.2337/dc11-0442
Langley-Evans, S. C. (1999). Fetal origins of adult disease. British Journal of Nutrition, 81(01), 5–6.
doi:10.1017/S0007114599000070
Le Clair, C., Abbi, T., Sandhu, H., & Tappia, P. S. (2009). Impact of maternal undernutrition on diabetes
and cardiovascular disease risk in adult offspring. Canadian Journal of Physiology and Pharmacology,
87(3), 161–179. doi:10.1139/y09-006
Wild, S., Roglic, G., Green, A., Sicree, R., & King, H. (2004). Global prevalence of diabetes: estimates for
the year 2000 and projections for 2030. Diabetes Care, 27(5), 1047–1053.
Yajnik, C. S. (2004). Early Life Origins of Insulin Resistance and Type 2 Diabetes in India and Other Asian
Countries. The Journal of Nutrition, 134(1), 205–210."
Page 7
2014 Global Health Day Poster Abstracts
Poster Title: Virucidal Effect of Cold Atmospheric Gaseous Plasma on Feline Calicivirus, A Human
Norovirus Surrogate
Hamada Aboubakr, College of Veterinary Medicine, Fellow
Abstract
Foodborne viruses, particularly human norovirus (NV) are a cause of concern for public health and world
economies. The low inactivation efficiency of most minimal food processing methods against foodborne
viruses makes it necessary to explore novel and effective non-thermal technologies for decontamination
of fresh-eaten, ready-to-eat foods and food processing surfaces. We studied the in vitro virucidal activity
of cold atmospheric gaseous plasma (CAGP) against feline calicivirus (FCV), a surrogate of human NV. A
radio frequency-based plasma generating setup was used. Factors affecting antiviral activity of CAGP
were: plasma generation power, exposure time, exposure distance, feeding gas mixture and virus
suspending medium. Exposure to 2.5-Watt argon plasma caused a reduction in FCV titer of 5.55 Log10
TCID50 within 120 s. The titer reduction increased with increasing exposure time and decreasing
exposure distance. Among the four studied-feeding gas mixtures (Ar, Ar+1% O2, Ar + 1% dry air and Ar +
0.27% water), the highest anti-FCV effect was seen with Ar+1% O2 plasma treatment since approximately
more than 6 Logs of the virus was inactivated after 15 s. at small distance. Also, the highest reduction in
FCV titer was observed when the virus was suspended in distilled water. Suspension in MEM resulted in
minimum virucidal activity. Based on SEM images, molecular and proteomics studies, damage to viral
capsid protein was the key effect of CAGP. A comprehensive study was conducted to determine the
chemical species and radicals generated by plasma treatment. FCV was exposed to CAGP in presence and
absence of several specific scavengers to certain chemical species and radicals that are thought to be
responsible for the virucidal effect of CAGP. The results indicate that O2*, reactive nitrogen species, NO*
and ONOO− are the most effective species affecting the virus in solutions. In conclusion, CAGP is a
promising technology for combating viral contamination in foods and food preparing surfaces. Further in
situ experiments in food and surfaces are being planned.
Page 8
2014 Global Health Day Poster Abstracts
Poster Title: Pathways Program Mid-Term Review: A Qualitative Evaluation
Eliza Cowan, School of Public Health, MPH Student
Bio: Eliza is a second year Master's of Public Health student concentrating in global environmental health.
This past summer she worked as a Qualitative Research Intern in Bhubaneswar, India, where she helped
conduct a med-term program evaluation for Care India's ""Pathways Program"". Overseeing data
collection, then analyzing qualitative data allowed Eliza to utilize skills that she had developed in the
School of Public Health and apply them to a global health scenario. Eliza is passionate about global health
issues and plans to continue her career in program implementation and metrics abroad.
Abstract
Objective: The primary purpose of the Pathways Mid-Term Review (MTR) was to explain why, how, and
in what direction changes are occurring among Pathways program participants and their families at the
household and community levels.
Methods: The MTR used qualitative methods to monitor the program’s progress and evaluate its efficacy
thus far. Pathways staff conducted 37 focus groups and 11 interviews in 2 districts in Orissa to gain
insight into participants’ experience with the program and to get direct feedback regarding personal and
community-wide changes.
Results: Female participants most commonly reported increases in self-confidence, mobility, and
capacity. For men, two of the major changes reported were increased workload sharing with spouses,
and decreased consumption of alcohol.
Implications: Preliminary analysis of qualitative data indicates that Pathways is on track to accomplishing
the goal of improving livelihood, security, and promoting gender equity. Pathways will continue to work
closely with women’s groups to ensure stability and provide support and trainings for Self Help Groups
(SHGs), to monitor gender-based violence and alcohol consumption, and agricultural productivity and
marketing.
Page 9
2014 Global Health Day Poster Abstracts
Associations of antibody responses to protection from clinical malaria in a highland Kenya area of low
transmission
Karen Hamre, School of Public Health, PhD Student
Karen E.S. Hamre1, Bartholomew Ondigo2, Chandy C. John1,2
1Division of Global Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States of
America
2KEMRI-University of Minnesota Malaria Research Program, Centre for Global Health Research, Kenya
Medical Research Institute, Kisumu, Kenya
Abstract
Background
Establishing markers of protection in low transmission settings is important in determining how to assess
risk in these less-immune populations. It is inherently difficult to predict correlates of protection in low
transmission settings due to the limited number of cases, but our longitudinal prospective study allowed
for this testing of antibody responses to multiple antigens over a time period of 6 years.
Objective
Assess markers of protection to clinical malaria in a low transmission setting.
Methods
Nested case-control study with 3 controls matched to every case on village and age. Plasma samples
from a blood collection that targeted the entire cohort performed from April–June 2007 were used to
test antibody responses to 11 antigens (10 using Multiplex assay, 1 using enzyme-linked immunosorbant
assay). Cases were identified as having a measured fever or reported fever or headache in the presence
of Plasmodium falciparum malaria detected by microscopy from the Ministry of Health dispensary-based
clinical malaria surveillance performed from June 2007¬–June 2013. Controls were followed for the same
time period as cases without detection of clinical malaria.
Results
Conditional logistic regression performed on laboratory results of 620 plasma samples (155 cases, 465
controls) identified 2 antigens where a positive antibody response, defined as >= 1 arbitrary unit, was
statistically significantly associated with protection from clinical malaria over a 6 year period in a highland
Kenya area with unstable malaria transmission. Specifically, subjects whom elicit a positive response to
GLURP-R2 have a 42% decrease in odds of developing clinical malaria compared to subjects who do not
elicit a positive response over this time period (OR = 0.58, 95% CI: 0.37, 0.90, p=0.016). Similarly, subjects
whom elicit a positive response to LSA-NRC have a 42% decrease in odds of developing clinical malaria
(OR= 0.58, 95% CI: 0.38, 0.89, p=0.013).
When cases are restricted to only those with a measured fever, these trends are strengthened (GLURPR2 OR=0.40, 95% CI: 0.23, 0.69, p=0.001, LSA-NRC OR=0.47, 95% CI: 0.29, 0.76, p=0.002) and subjects
eliciting a positive response to an additional antigen, GLURP-R0, also show statistically significant
protection from clinical malaria (OR = 0.57, 95% CI: 0.35, 0.94, p=0.026).
Discussion
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2014 Global Health Day Poster Abstracts
Identifying markers of protection in less-immune individuals are important for future vaccine
development as malaria control efforts continue to increase, transmission will continue to decrease,
leaving many populations living in transmission settings similar to our highland cohort."
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2014 Global Health Day Poster Abstracts
Poster Title: The Pharmacist’s Roles in the Global Health Context
Joy Hwang, College of Pharmacy, 3rd Year Student
Sirikan Rojanasarot, College of Pharmacy, PhD Student
Abstract
Background: Global health disparity is a multifaceted issue that requires an interdisciplinary effort to
resolve. Currently, one third of the world’s population lacks access to essential medicines. Primary care
professionals including doctors and nurses have played an active role in mitigating such disparity.
However, pharmacists are underrepresented and their role in global health has not been clearly defined.
Aim: The main intents of this research are to 1) explore the roles of pharmacists in the global health
setting, and 2) define how pharmacists’ involvement can help to mitigate disparity in medication
accessibility and enhance drug utilization.
Methods: Ovid Medline and Google scholar were used to find relevant articles based on the following
terms: pharmacists, pharmaceutical care, pharmacy services, global health, healthcare, disparities, and
drug utilization.
Results: From the reviewed articles, pharmacists were found to play a diversity of roles in different
countries. One of the current challenges pharmacists face in providing their services includes the
limitation in number of essential medicines available per each country. Since the expansion of the
formulary would entail a policy change at the national level, this prevents pharmacists from actively
playing a role in alleviating medication accessibility at the local level. In some developing nations,
pharmacist’s duties are mainly focused on their dispensary role. The barriers to their professional
development are primarily due to the lack of governmental support and limitation in funding. Current
number of pharmacists in the developing countries’ workforce also does not meet the WHO’s
recommended average number per 1,000 patients. This shortage represents another challenge in
ensuring sufficient pharmacy service provision for those in scare resource settings. Meanwhile,
pharmacists in developed countries such as U.S. and Canada are trained to provide pharmaceutical
services and ensure optimal drug utilization. Through current collaborations between U.S. and African
pharmacy schools, future pharmacists can be better trained with the global health knowledge to help
alleviate pharmaceutical issues in developing nations.
Conclusions: Pharmacists have advanced their profession in more developed countries. Therefore, they
possess the wealth of knowledge that could greatly contribute towards mitigating issues in less
developed nations. There are several issues faced by developing countries that prevent them from
successfully distributing medications to those who need it. These include the limitation in number of
drugs presented on their national formulary list. Such issues call for more collaboration between
pharmacy institutions and organizations around the world to provide better training in global health for
pharmacists.
Page 12
2014 Global Health Day Poster Abstracts
Poster Title: Demystifying an Ancient Curse: Leprosy
Hope Pogemiller, Global Health Chief Resident for Internal Medicine
Bio: Hope Pogemiller graduated Internal Medicine and Pediatrics combined residency in
June. Pogemiller is currently the Internal Medicine Global Health Chief Resident at the University of
Minnesota. This position entails strengthening the global health pathway and traveling to Tanzania to
strengthen medical education in a hospital setting. Pogemiller earned her MPH in International Health at
Tulane University and traveled to Benin as a Peace Corps Volunteer through the Masters Internationalist
Program.
Abstract
Dermatologic manifestations in refugee populations may be challenging for the primary care physician.
Leprosy continues to affect millions of people worldwide including here in the United States of America.
A 32 year old female Burmese refugee presented to her primary refugee screening exam with complaints
of a red rash over her right forearm. She described the rash as present for about 3 years, expanding,
intermittently pruritic, without pain, with dulled sensation, but without ulceration. A refugee health
screening was negative for HIV, Syphilis, Chlamydia, Gonorrhea, and Hepatitis C. She had immunity to
Hepatitis A and B due to prior disease. TB-Quantiferon Gold was negative. She had no past medical
history, since prior to her arrival, she had never seen a doctor. Physical exam revealed a 3 x 7 cm annular
macular lesion with a faint erythematous border and central clearing on the right dorsal forearm. There
was a 1/2 cm hyperpigmented lesion centered in the middle of the rash that was attributed to a burn
from many years ago. She was prescribed an OTC fungal ointment for presumptive tinea corporis, but
this only minimally decreased her erythema and inflammation. She was able to recall a close
acquaintance in the refugee camp having a similar rash. After a few weeks of transportation
coordination, she was able to visit a dermatologist. The dermatologist noted a very subtle annular
macule on her right forearm with a 5 mm faint pink rim with central clearing. Examination with a Wood's
light did not reveal any pigment loss. Sensation to light touch was faintly diminished at the site of the
macule. She did not have any similar lesions or depigmentation on the remainder of her skin exam. The
pathology from her skin biopsy revealed acid fast organisms on FITE stain, consistent with the clinical
suspicion of indeterminate leprosy. She began taking Rifampin and Dapsone for the treatment of
Mycobacterium Leprae. After 2 months of this regimen, she developed hemolytic anemia, with her
hemoglobin decreasing from 13.8 to 10.2. Diminishing her Dapsone dose allowed her hemoglobin to rise
back to 12.6 after an additional month. This case illustrates the need for a wider differential when
presented with dermatologic concerns in refugee populations. A thorough history and physical as well as
awareness of disease prevalence by region is crucial for accurate diagnosis.
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2014 Global Health Day Poster Abstracts