From the Field – Page 9 – Global Reproductive Health at Duke

Gaining Insight into Kenyan Community Health

August 17, 2018November 13, 2024 by Megan HuchkoNo Comments

Blog by Amber Fleck, MS2, University of Colorado: In the United States, health education is seemingly everywhere: ads online reminding women of the importance of pap smears, TV commercials advising against smoking, or posters in bar bathrooms providing safe sex advice. With this abundance of exposure to health education, it is a striking difference to visit a country where many communities don’t have regular access to this kind of information, especially if that information regards sexual or reproductive health. In an effort to bridge this gap and enhance community health education the Kenya Ministry of Health began using lay workers, also known as community health volunteers (CHVs). CHVs travel door-to-door in their assigned communities to educate individuals about disease management, including reproductive and maternal health, and provide referrals to the clinic when necessary. In theory, this is an excellent way to increase access to health information and care; however, these programs have had some significant challenges. One challenge is that these are...

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

August 2, 2018November 13, 2024 by Yujung ChoiNo Comments

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...

Community Health Campaign: Thoughts Station by Station

July 19, 2018November 12, 2024 by kb330@duke.eduNo Comments

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....

Patient Barriers to Cervical Cancer Prevention in Kenya

July 17, 2018April 4, 2025 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, 2018April 4, 2025 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, 2017April 4, 2025 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...

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