Using GIS Spatial Mapping to Enumerate the Risk of Loss-to-Follow-up for Cervical Cancer Treatment in Western Kenya

Using GIS Spatial Mapping to Enumerate the Risk of Loss-to-Follow-up for Cervical Cancer Treatment in Western Kenya

By Moreen Njoroge, T-19 Cervical cancer is the second most common cancer in women worldwide and the most common cancer among women in sub-Saharan Africa. The risk for cervical pre-cancer and cancer is increased by the biological effects of co-infection with HIV and HPV, both of which have a higher prevalence in sub-Saharan Africa and especially in Migori, Kenya where the seroprevalence of HIV/AIDS is not uncommon. The social and economic factors in Migori, Kenya make cervical cancer control more difficult to achieve with the established standard of care in developed countries. A major barrier to accessing screening and treatment services for cervical cancer in this region is poor health literacy associated with the lower educational-attainment rates in Kenya, especially for women. Structural barriers associated with increased cervical cancer mortality rates include lack of diagnostic tools for screening, understaffing in clinics and hospitals, a paucity of pathology laboratories and the long waiting times associated with screening-result transmission. The lack of treatment...
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Sex Ed Goes Global: the Netherlands

Sex Ed Goes Global: the Netherlands

The sex education I received was decent, by American standards. When I was eight, my female peers and I were ushered to the music room, where we ate our boxed lunches on the floor and learned about the menstrual cycle. I shuddered at the thought of ever bleeding from “down there” and spent the next several years terrified that I would get my first period in public. When I was twelve, my middle school health teacher projected grainy slides of STD-afflicted genitals and explained that pregnancy and childbirth would ruin your life. The class did, however, cover various forms of contraception and a very brief lesson on consent. When a classmate asked if sperm could, like, crawl up your leg, we all laughed at her question while secretly waiting to hear the answer. When I was fifteen, and approaching a time in my life where comprehensive sexuality education might be especially useful, my otherwise progressive high school recommended an online...
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Community Health Campaign: Thoughts Station by Station

Community Health Campaign: Thoughts Station by Station

Not much changes yet everything seems different whenever I return to my home country of Kenya. I was reminded of my first time in Kisumu last year with Dr. Megan Huchko & Katelyn Bryant-Comstock and how anxious I was, even though I was in Kenya, I was completely unfamiliar with this region, the local language, and the culture. Last year, I was a rising junior filled with high hopes, yet naïve of the intricacies of proposing a project and carrying it out. This year, I have returned with much more practical expectations as well as a greater capacity to carry out my project: using GIS spatial mapping to enumerate the risk of loss-to-follow up for treatment of HPV. My project is taking place in Migori, Kenya as a part of the ongoing Cervical Cancer Screening & Prevention Study. The use of geographic information systems will help us create correlations between women’s sociodemographic variables as risk-factors and treatment loss-to-follow up rates....
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Patient Barriers to Cervical Cancer Prevention in Kenya

Patient Barriers to Cervical Cancer Prevention in Kenya

Starting at age 21, you get regular pap smears. You get in your car, drive on a paved road to an Ob/Gyn or primary care clinic, and have the pap done, with relatively little effort on your part. That’s how cervical cancer screening works for most women in the United States and most other developed countries. In these countries, pap smears have significantly reduced rates of cervical cancer and resulting deaths. It’s a different story in developing countries like Kenya. In East Africa, cervical cancer is the most common cancer in women, even surpassing breast cancer. In Kenya, only 3.5%[1] of eligible women ever get screened for cervical cancer, and it’s difficult for those that screen positive for precancer or cancer to access treatment. Some barriers relate to infrastructure, as cervical cancer prevention and treatment requires resources including skilled providers, supplies, and transportation of specimens. To try to overcome some of these systems issues, Dr. Megan Huchko (director of the Center for...
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Self-Induced Abortion in Times of Crisis, Part 3

Self-Induced Abortion in Times of Crisis, Part 3

Passersby could hardly miss the bright pink stucco building near downtown Jackson, Mississippi in the southern United States. But the unusual color is not all that makes the building unique. The Pink House, as it’s called, is home to the Jackson Women’s Health Organization, the only remaining abortion clinic in the state of Mississippi. With some of the toughest abortion restrictions in the nation, Mississippi is one of 29 states classified as “extremely hostile” to abortion by leading SRHR research organization the Guttmacher Institute. Women currently cannot obtain an abortion after 15 weeks of gestation, the most restrictive ban in the nation. State governor Phil Bryant has repeatedly pledged to make Mississippi “the safest place in American for the unborn child,” joining other lawmakers in a crusade against reproductive freedom.   Yet this ostensible commitment to safety is less a compassion toward Mississippi’s children than a powerful political tool. Despite their professed desire to protect women and children, Governor Bryant and Mississippi state legislators...
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When words in Washington translate to tragedy across the globe

When words in Washington translate to tragedy across the globe

When people ask how my summer internship is going, I never know what exactly to say. I usually end up blurting out a rapid mix of emotions: “It’s great!” “I love it!” “But it’s also really sad!” “Super depressing day to day, but I care a lot about the work.” “An awesome place to work but a sad field to be working in right now.” I’m interning at the United Nations Foundation in Washington, DC on the Universal Access Project, which convenes donors and advocates working to improve women’s and girls’ access to family planning around the world. Family planning is a fundamental human right and undeniably one of the best investments countries can make towards sustainable development—it can enable girls to stay in school, prevent maternal deaths, improve women’s financial independence and economic productivity, and has even been identified as a top solution to combat climate change. The Duke Center for Global Reproductive Health and other NGOs have reported frequently about...
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Director’s Blog: Summer 2018

Director’s Blog: Summer 2018

As we close out the academic year and head into the hot North Carolina summer, the halls of Trent get a lot quieter. To some, this calm may suggest a mass exodus to the beach or some other vacation destination. However, for faculty, students and staff, the empty offices belie a frenzy of work, as many head off to field sites around the world. Summer break represents a time to re-focus on the work that inspires students, trainees and faculty to put in the hours teaching, writing and learning throughout the year. We use this time to launch new projects, reconnect with their research teams and develop or deepen our partnerships. As we previously described, we have a very busy summer planned with work and site visits in western Kenya, while back at home, continuing with the launch of the Collaboratory project and the Big Data for Reproductive Health Summer team. I spent the last two weeks in June in Nairobi,...
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So… what are you going to do about it?

So… what are you going to do about it?

I’m currently in Amansie West, Ghana as part of a team conducting research on the barriers and facilitators to family planning use and the role community health workers play in family planning uptake. During this time, I was invited to attend Ghana Health Service’s first National Maternal, Child Health and Nutrition Conference by Millennium Promise,  a co-sponsor of the conference and our collaborator in country. The collaboration with Millennium Promise first began back in September when Chief Nat Ebo Nsarko, the Country Director visited Duke University. From the beginning this team has been our guide for conducting research in Ghana through assisting us in each task and facilitating our learning experience. It is through their contributions and dedication which have allowed this research to not only be possible but successful. The theme of the conference was “Strengthening Partnerships for Achieving Universal Health Coverage in Reproductive, Maternal, Newborn, Child and Adolescent Health and Nutrition.” Gladys Ghartey (Head of UN System Unit at...
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Self-Induced Abortion in Times of Crisis, Part Two

Self-Induced Abortion in Times of Crisis, Part Two

Content warning: sexual violence Despite rampant criminalization of abortion around the world, the international community tends to agree on one thing: an exception in cases of rape or incest. Even in the United States, where abortion is a hotly debated political issue, a majority of Americans support legalized abortion in cases where the pregnancy was caused by rape or incest. Most people agree that women should not have to be doubly traumatized by being forced to carry a pregnancy conceived through violence. Yet in Myanmar and Bangladesh, Rohingya refugees have little choice but to do just that. Since August 2017, a military campaign of ethnic cleansing in Myanmar’s Rakhine State has forced hundreds of thousands of Rohingya Muslims to flee their homes, causing the fastest growing refugee crisis in the world. As one of many ethnic minorities in Myanmar, the Rohingya numbered nearly one million in early 2017. But the government of Myanmar, a predominantly Buddhist country, refuses to recognize...
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Reproductive Health Victories

Reproductive Health Victories

This week has seen an onslaught of negative health news from the United States and around the world. Crisis pregnancy centers in the United States are now allowed to withhold legally available medical options, women in Guam no longer have access to abortion services, and we continue to see daily impacts from the reinstatement of the global gag rule and hear reports of lack of access to reproductive health services from women in refugee camps. It’s easy to get depressed from the seemingly impenetrable amount of work that needs to be done to protect the health and human rights of people around the world. But that’s exactly what we need to do. We need to dig deep, understand the depth of the problems, and develop new partnerships and solutions. I’d like to highlight some exciting news from this past week of just that: people digging deep and developing new solutions to positively impact the health and rights of people across the world. Preventing...
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