From the Field – Page 8 – Global Reproductive Health at Duke

Patient Barriers to Cervical Cancer Prevention in Kenya

July 17, 2018November 12, 2024 by kb330@duke.eduNo Comments

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...

When words in Washington translate to tragedy across the globe

July 12, 2018November 12, 2024 by kb330@duke.eduNo Comments

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...

Director’s Blog: Summer 2018

July 9, 2018November 12, 2024 by Megan HuchkoNo Comments

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,...

So… what are you going to do about it?

July 5, 2018November 12, 2024 by kb330@duke.eduNo Comments

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...

New studies show HPV screening is less expensive and more efficient when offered at community health campaigns compared to health clinics in rural Kenya

May 29, 2018November 12, 2024 by Megan HuchkoNo Comments

Cost concerns now dominate considerations for the expanded use of HPV screening for cervical cancer prevention in high and low-resource settings. As part of a trial comparing two implementation strategies for HPV testing offered via self-collection, our team recently published innovative analyses of the material and time costs for each strategy. In the larger trial, the team showed that HPV-screening through community-health campaigns (CHCs) reached more women than testing in government-supported health facilities. These new papers show that HPV-screening through CHCs was also lower in cost and provided a quicker and more efficient experience for women compared to offering HPV screening at health clinics in rural Kenya. The next step is a cost-effectiveness analysis to compare alternative screening and treatment strategies using primary data from this study along with, published data to determine the cost per disability-adjusted life year (DALY). These results can be used to help policy-makers and funders make key decisions about how to implement cervical cancer prevention...

Blandina Mmbaga

December 13, 2017November 12, 2024 by Joy StuttsNo Comments

Faculty Profile: Blandina Mmbaga Dr. Blandina Mmbaga is the Director of the Kilimanjaro Clinical Research Institute and a pediatrician at the Kilimanjaro Christian Medical Center (KCMC). She has collaborated with Duke University for over 10 years and currently serves as a site leader for the KCMC-Duke collaboration. Her work in reproductive health includes evaluating strategies to prevent mother-to-child-transmission of HIV and working to improve transitions of care and addressing RH needs for perinatally infected adolescents. We sat down with Dr. Blandina Mmbaga to talk about her work in Tanzania and what she believes are some of the biggest reproductive health challenges in her region. What are the key reproductive health priorities for Tanzania? Dr. Mmbaga described several systemic health challenges such as infant nutrition, maternal health, and unmet need for family planning. She feels that one of the biggest challenges, despite available treatment mechanisms, is the prevention of mother to child transmission of HIV. “It remains a challenge because there are still new infections”....

Notes from the Field: Uganda

November 9, 2017November 1, 2024 by kb330@duke.eduNo Comments

This summer, after a long, solo trip across the world, I arrived in East Africa for the first time. As a Master of Science in Global Health student at Duke University, I spent my first year paired with a mentor, Dr. Megan Huchko, working as a research assistant. During that time we worked together to design a research study which I would conduct the following summer in Kenya. Dr. Huchko and I chose to interview HPV positive women from her ongoing cluster-randomized trial to find ways to reduce the substantial loss to follow up seen with a two-visit screen and treat strategy. Upon entering this program, I knew I wanted to work in women’s reproductive health. Cervical cancer is the leading cause of cancer in women in Africa, so having the opportunity to have a hand in research being conducted to reduce that burden is a privilege. Our goal was to improve treatment acquisition among HPV positive women, to reduce...

Let’s Talk About Sex: Peer-Led Comprehensive Sexuality Education in Rural Kenya

November 1, 2017November 1, 2024 by kb330@duke.eduNo Comments

What is the function of the clitoris? Before I began teaching comprehensive sexuality education (CSE) at WISER Girls’, a secondary school located in Muhuru Bay, Kenya, I never imagined that this would be the most frequently asked question. Especially among a class of female third-year high school students. When I was first asked, I gave a cursory – and yes, somewhat bashful – reply, explaining the clitoris as the “anatomical source of sexual pleasure in females.” But this answer did not satisfy the students, and they probed for more information. As we engaged in a discussion, I learned that many weren’t familiar with an external representation of the female genitalia – especially one with a “non-reproductive” function. As my answers became more justificatory about the significance of the clitoris, I realized that my attitudes about legitimized female sexuality had begun to leak into my responses. While I tried to remove any bias from my answers, I struggled with leaving my...

Visualizing the Risk

October 19, 2017November 1, 2024 by kb330@duke.eduNo Comments

When I landed in the airport in Kisumu, Kenya, I was brought back to the day I first left Kenya for the U.S. as a young girl. Although I have returned to Kenya since then, I was overwhelmed by this particular experience as I never envisioned returning to my home country as a college student pursuing research in a field I always knew I was passionate about. From an early age, I found myself burdened by the needs and suffering of women. Women who never put themselves first so I can be where I am today. After committing to the Global Health major at Duke, I began searching for a mentor to engage in a research project with that would challenge my problem-solving abilities, and provide me with ample support to learn independently. I connected with Dr. Megan Huchko, and spent a few weeks this summer with her Cervical Cancer Screening & Prevention study based in Migori, Kenya, while also shadowing...

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