Graduate Projects
Chloroquine, hydroxychloroquine, and COVID-19
A scoping review
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Early in 2020, researchers from China and France reported on chloroquine and hydroxychloroquine’s effectiveness for inhibition of SARS-CoV-2 viral replication in vitro. This scoping review mapped
published knowledge until March 25, 2020, on the use of chloroquine and its derivates in patients with COVID-19. It included Pubmed, Embase (Ovid), LILACS, and 15 primary registries from the WHO Registry Network.
Status: Ongoing
Members: Anne Cockcroft, Juan Pimentel
Partners:
Centro de Investigación de Enfermedades Tropicales (CIET) de la Universidad Autónoma de Guerrero
Grupo de Estudios en Sisteas Tradicionales de Salud de la Universidad del Rosario
Departamento de Medicina Familiar y Salud Pública de la Universidad de La Sabana
Countries: Mexico, Colombia, Canada
Safe birth in cultural safety:
A cluster randomised controlled trial.
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Culturally safe actions promote health without further undermining the culture of the patients and allow interaction between indigenous and Western health systems. This interaction leads to intercultural dialogue, in which both parties collaborate in the solution of health needs. Several interventions have explored training birth attendants in Western birthing skills, but there is little research focused on supporting traditional midwives by recognizing their knowledge and enhancing their interface with the official health system. This trial was part of an ongoing initiative in partnership with academics at the Centro de Investigación de Enfermedades Tropicales (CIET) and four indigenous groups in Guerrero, Mexico (Nahua, Na savi/ Mixteco, Me’phaa/Tlapaneco, and Nancue ñomndaa/Amuzgo). The parallel-group cluster randomized controlled trial aimed to test non-inferiority of maternal and neonatal health outcomes with an intervention to support traditional midwifery. Cognitive mapping of stakeholder knowledge defined participatory theories of change to promote maternal health. A narrative mid-term evaluation identified mechanisms of change triggered by the intervention.
Members: Sergio Paredes-Solis, Jose Legorreto-Soberanis, Neil Andersson, Iván Sarmiento
Partners:
Centro de Investigación de Enfermedades Tropicales (CIET) de la Universidad Autónoma de Guerrero
Centro de Estudios Médicos Interculturales
Grupo de Estudios en Sisteas Tradicionales de Salud de la Universidad del Rosario
Country: Mexico
Dates: 2013 to 2017
Funding: The National Council of Science and Technology of Mexico (CONACyT, PDCPN-2013-214858) funded the cluster-RCT.
McGill University funded fieldwork for middle-term evaluation of the intervention (T244294C0G).
The Quebec Population Health Research Network (QPHRN) funded fieldwork and publications.
The Fonds de la recherche en santé du Québec, the Canadian Institutes of Health Research, CeiBA fundation and the Centro de Estudios Médicos Interculturales funded one doctoral student.
Transcultural psychiatry
Reincorporating men in safe birth in cultural safety
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Indigenous communities in Guatemala face high rates of common mental disorders and limited access to mental health services. Social and structural inequities contribute to psychosocial distress in these communities, and there is a recognized need for participatory, community-based approaches to address them. We piloted one such approach with indigenous communities in Guatemala. Facilitators convened groups of men and women (youth, adults, elders), health workers and traditional healers to map local knowledge on determinants of wellbeing, to participate in monthly deliberative dialogue sessions to prioritize issues and strategies to tackle them, and to implement their chosen strategies. Inspired by a realist approach to evaluation, this project used mixed methods to describe the impact of the participatory intervention on psychosocial wellbeing in indigenous communities in Guatemala, as well as the mechanisms underpinning impact. Methods included a pre-post participant survey, individual interviews with local coordinators and participants, observation of collective evaluation workshops, and analysis of coordinators’ monitoring logs. Preliminary findings suggest a positive impact on participants’ psychosocial wellbeing via reduced social isolation, empowerment of marginalized community members to express themselves, increased awareness of conditions impacting wellbeing, and an increased sense of community solidarity.
Status: Ongoing
Degree: PhD McGill
Student: Katherine Pizarro
Costs of dengue
Its prevention, and ineffective strategies.
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Dengue imposes an important economic burden on households, in addition to its costs for health services. This doctoral research examined household cost implications of dengue and the effects on these costs of the successful Camino Verde community mobilization program. An evaluation of coverage and beliefs about pesticide (temephos) application for control of the dengue mosquito vector showed low coverage with temephos but indicated that most households continued to believe that chemicals are the best control method. An analysis of data from the Camino Verde trial showed high expenditures on mosquito-control products and found that the proportion of households who purchased anti-mosquito products was significantly lower in the intervention clusters than in the control clusters. An analysis of the costs of dengue illness on households, including days of work lost and treatment costs, indicated a substantial economic impact of dengue on households, and confirmed that the Camino Verde intervention contributed to reducing these household costs.
Partner: Centro de Investigación de Enfermedades Tropicales (CIET) de la Universidad Autónoma de Guerrero
Status: Completed
Degree: PhD UAGro
Student: Jose Legoretta-
Soberanis
Community participation as a strategy for control of Aedes aegypti:
Three epidemiological studies
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This PhD was related to the Camino Verde trial of community mobilization for dengue
prevention in Mexico and Nicaragua.
The work included a systematic review and meta-analysis of cluster randomised controlled
trials of interventions for Aedes aegypti control. From 848 papers identified by the search, eighteen met the inclusion criteria: eight for chemical control, one for biological control and
nine for community mobilisation. Seven of the nine CRCTs of community mobilisation reported
significantly lower entomological indices in intervention than control clusters; findings from the eight CRCTs of chemical control were more mixed. In the meta-analysis of 10 studies, community mobilisation (four studies) was consistently effective, the single CRCT of biological control was effective, but the five studies of chemical control did not show a significant impact on indices. The review concluded that governments should consider adding community mobilization to their prevention efforts and recommended more well-conducted CRCTs of
complex interventions, including measurement of impact on dengue risk.
A secondary analysis of data from the Camino Verde trial examined associations between
social capital and mosquito vector indices. Factor analysis combined responses to questions
about aspects of social capital to create a social capital index with four constructs, combined
into a single scale. Among the 10,112 households, those in rural communities were much more likely to have a high social capital score. Households in intervention sites had higher social capital, although the association was not significant at the 5% level. Households with high social capital were more likely to be negative for mosquito vector indices. There was interaction between intervention status and social capital; in multivariate analysis, a combined variable of intervention/high social capital was associated with vector indices. The findings support the idea that the Camino Verde intervention worked partly through an interaction with social capital.
Finally, a compartmental mathematical model, using data from the Camino Verde cluster
randomized controlled trial, examined the dynamics of dengue infection with different levels of community participation, taking account of gender of respondents and exposure to temephos.
Simulation of dengue endemicity showed community participation affected the basic
reproductive number of infected people. The greatest short-term effect, in terms of people
infected with the virus, was the combination of temephos intervention and community participation. There was no evidence of a protective effect of temephos longer term.
Status: completed
Degree: PhD UAGro
Student: Victor Alvarado-Castro
Effect of the administration of dipyrone
In patients with severe dengue
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Dengue is a serious public health problem in tropical regions from low- and middle-income countries. This case control study aimed to identify demographic and clinical factors associated with mortality due to severe dengue in five departments in Colombia. The analysis included 58 cases and 121 controls and identified four factors: in-hospital administration of dipyrone and paracetamol, comorbidities and a prior visit to the hospital.
Members: Juan Pablo Pimentel, Neil Andersson
Partners:
- Grupo de Estudios en Sisteas Tradicionales de Salud de la Universidad del Rosario
- Departamento de Medicina Familiar y Salud Pública de la Universidad de La Sabana
Status: Completed
Degree: MSc McGill
Student: Juan Pablo
Country: Colombia
Dates: 2012 to 2020
Funding: Fundación Santa Fe de Bogota (Colombia); COLCIENCIAS (Colombia)
Publications:
Pimentel J, Zuluaga G, Borreo E, Andersson N. Factores clínicos y demográficos asociados con mortalidad por dengue en Colombia: estudio de casos y controles. Salud Pública de México. https://www.researchgate.net/publication/343463632_Factores_clinicos_y_demograficos_asociados_con_la_mortalidad_por_dengue_en_Colombia_estudio_de_casos_y_controles
Nutrition education
Using video-drama with young women in Ghana
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Adolescent girls in the Upper Manya Krobo district (UMKD), Ghana lack access to nutrition
education. A research project aimed to asses the influence of a participatory video education
(PV) on the nutrition literacy of adolescent girls, 13-16 y of age. A school-based cluster
randomized control pilot trial was conducted in 20 schools with over 350 girls in the district.
Clusters were randomized to either participate in existing educational clubs or the PV
intervention. In each PV school, adolescent girls planned, produced, acted and screened two
short videos on prevalent nutritional issues. A mixed methods approach assessed the outcomes
of interest: nutrition literacy and psychosocial indicators, and dietary habits. The Most
Significant Change methodology was used to gather stories of change from participants, and to
collaborate with local stakeholders in evaluating the influence of the intervention.
Status: Ongoing
Student: Mona Ghadirian
Degree: PhD McGill
The role of traditional medicine
In acute respiratory infections and asthma
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Eighty per cent of the world’s population uses traditional medicines, and asthma remains the most common chronic disease among children worldwide. A systematic review and meta-analysis of published literature found that asthma was more likely in patients exposed to cold (observational studies ORp 2.0 IC95% 1.28-3.14 and experimental studies ORp 3.8 IC95% 1.7-8.86).
A case-control study with children (2-14 year-old) from 8 municipalities near Bogotá, Colombia, assessed the association between traditional health care, including the use of medicinal plants, and asthma. Multivariate analysis showed that children were less likely to have asthma if they lived in a household in which people grew and used medicinal plants (OR 0.49 IC95% 0.25-0.99).
A retrospective case series with 26 medical histories described the effect and safety of outpatient medical treatment for asthma incorporating knowledge and resources from traditional medicine (municipality of Cota). Among the 26 patients, 16 presented controlled asthma after treatment with traditional medicine, and nine had no episodes of uncontrolled asthma during the entire follow-up.
These findings suggest an association between concepts, resources and practices of traditional medicine and prevention, lower prevalence and effective treatment of asthma, even given the limitations of this study.
Status: Completed
Student: Germán Zuluaga
Degree: PhD UAGro
Partners:
Centro de Investigación de Enfermedades Tropicales (CIET) de la Universidad Autónoma de Guerrero
Centro de Estudios Médicos Interculturales
Social network analysis
To reach the most vulnerable in HIV prevention
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The INSTRUCT trial in Botswana aimed to prevent HIV but reaching the young women that are at risk was challenging. We carried out a survey and held discussion groups to understand who marginalized young women turn to for support. The goal was to understand how to reach these young women with information about government support programs that could help them find employment or return to education. Based on survey responses we created network maps that showed how young women were connected to each other, and we described the types of people in their support networks. We found that young women in rural areas were better connected to each others than those in urban areas. We also found that these young women usually went to other women, to others with a similar level of education, and to other women with children if they themselves had children. In discussion groups, participants made many suggestions including creating committees of young women. They emphasized the need to create new connections between communities and government service providers, to strengthen existing communities connections to ensure local spread of information, and to diversify dissemination strategies to acknowledge the diversity of marginalized young women in these communities.
Status: Completed
Student: David Loutfi
Degree: PhD McGill
Partner: CIET Trust Botswana
Improving HIV prevention services
For marginalised young women
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This doctoral project aims to improve HIV-sensitivity of promotive social support programs in Moshupa sub-district in order to enhance income and capabilities, and reduce choice disability in vulnerable young women (15-29 years old; unemployed and out of school). It is part of the INSTRUCT initiative in Botswana.
Status: Ongoing
Student: Ran van der Wal
Degree: PhD McGill
Partner: CIET Trust Botswana