Implementing Jali Watoto: Childcare in Lumumba Hospital

Implementing Jali Watoto: Childcare in Lumumba Hospital

What had changed: Compared to our trip in the summer of 2023, Melat and I felt much more comfortable navigating Kisumu, Kenya. Sure, we were working in a different location, with new people, on a completely separate project, but the distinct uncertainty at every turn was nowhere to be found. It was a welcome shift.   What had not changed: The core reason for our visit. Mothers attending Lumumba Hospital still struggled with finding childcare while they attended healthcare appointments. This meant mothers arrived late, left early, or missed their appointments entirely. Alternatively, they brought their children to appointments which affected the quality of services when the children cried, held on to their mothers, ran around, or generally distracted both the mother and the healthcare provider. It was our hope that the childcare center we worked on over the year would ease the choice mothers often have to make between caring for themselves or their children.    We were also grateful to find another...
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Establishing a Child Care Center in a Kenyan Hospital and the Summer Ahead

Establishing a Child Care Center in a Kenyan Hospital and the Summer Ahead

Babies were crying. Mothers were patting them on the back. Names were being called for appointments. “With all this information, what will you do about it?” Florence Mawere, a research technician with the Center for Global Reproductive Health, was taking us on a tour of the Lumumba Sub-County hospital in Kisumu, Kenya and specifically demonstrating her work testing samples for HPV in the lab. She asked us that question at the end of the day, referring to a different project we were working on. At that moment, though, we had a different idea.   Isabel, Melat, and I (Sydney) spent two months in Kisumu working on launching the pilot study of a mobile health app that facilitates HPV screening for cervical cancer prevention. Part of our work was to understand how Florence processes samples at her lab, hence our presence at Lumumba. In our conversations with her, she explained the barriers to reproductive health and mentioned how the lack of childcare sometimes...
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Effects of vaccine hesitancy have now reached pregnant individuals as the winter season approaches

Effects of vaccine hesitancy have now reached pregnant individuals as the winter season approaches

Vaccine hesitancy has long remained a pervasive and global issue. The unwillingness to receive vaccines despite their availability and accessibility, remains a major global health issue. This phenomenon was especially felt during the COVID-19 pandemic four years ago. Misinformation and limited trust in institutions are main factors that increased vaccine hesitancy during this time. Unfortunately, we are still seeing patterns of vaccine hesitancy today, particularly in pregnant individuals. As winter approaches, 2023 will be the first year that four vaccines are recommended during pregnancy. However, trends already show that fewer pregnant individuals are getting vaccinated. A maternal-fetal medicine specialist at UCLA Health Dr. Neil Silverman, expresses that he has never seen this kind of pushback before the pandemic. Now, he says that all vaccines are lumped together as “bad”. Before COVID-19, the CDC reported that about 17.2% of pregnant people were “very hesistant” about getting a flu shot. Now, that hesitancy has been raised to almost 25%. Luckily, people tend...
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Tori Bowie: Don’t ever stop saying her name.

Tori Bowie: Don’t ever stop saying her name.

*trigger warning: mention of death   Say her name. Frentorish “Tori” Bowie.  Dr. Shalon Irving.  Tatia Oden French.  Kira Dixon Johnson.  Yolanda “Shiphrah” Kadima.  Amber Rose Isaac. The list could continue extensively.   I lead with these women’s names because sometimes they get lost in the horrific statistics that that show a Black women is almost 3 times more likely to die from pregnancy or childbirth related causes than a non-Hispanic white women (Craft-Blacksheare & Kahn, 2023). The maternal mortality rate for Black women in 2021 was 69.9 deaths per 100,000 live births (Hoyert, 2023) with 393 deaths in 2019 alone (Fleszar et al., 2023), and most of these maternal deaths were deemed preventable (Fleszar et al., 2023). Further, Black newborns are over two times greater to die in their first year than white newborns. The role of racism in these preventable deaths is highlighted in the fact that the mortality rate of infants of college-educated African American mothers experience an infant mortality rate that is greater than those of white...
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Meet Our Research Team in Kisumu, Kenya This Summer

Meet Our Research Team in Kisumu, Kenya This Summer

This summer, we have 5 Duke Scholars working with the Duke Center for Global Reproductive Health in Kisumu, Kenya. We have 3 undergraduate students joining the Center as part of the Student Research Training Program (SRT), a Masters of Global Health Student, and a 3rd year OB/GYN resident all conducting research in Kenya. Read below to learn a bit about these passionate students and hear about their work and what they are most looking forward to.    SRT Students: Sydney Chen (she/her) Sydney is a double major in Global Health and International Comparative Studies with a Biology Minor. She calls Herndon, Virginia home. When asked about what her time spent in Kisumu looks like, she reflected that “The team and I are working on various ways to improve an app called mSaada which helps women in East Africa receive screening for cervical cancer. I’m specifically working on the FAQ portion of the app by making sure that the answers are clinically accurate and using...
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How OPT Sexual and Reproductive Health is Shaped by Israeli Forces

How OPT Sexual and Reproductive Health is Shaped by Israeli Forces

In “SRH in Palestine: A Medical Student’s Experience in Health Education,” Duha Shelah, a medical student at An-Najah National University, explains the strengths and weakness in sexual reproductive health care in Palestine. Shelah has worked as a volunteer health educator for the Palestinian medical Relief Society since 2020, working with communities in the Occupied Palestinian Territories. Surprisingly, the majority of Palestinian women receive adequate antenatal care and had a skilled health staff at livebirths. However, a lot of the research on Palestinian reproductive and sexual health is incomplete, especially on menopause, preconception, and psychosocial services. Shelah found that the Israeli involvement in Occupied Palestinian Territories, and the imposition of closures and military checkpoints, restricts access to medical facilities. Therefore, sexual and reproductive health is heavily impacted by times of heightened violence, such as the 2014 bombing of the Gaza strip. Moreover, between 1999 and 2002, home births grew by over 20% due to increased Israeli military presence. Shelah argues that...
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Deep Learning for Breast Cancer Diagnosis via MRI

Deep Learning for Breast Cancer Diagnosis via MRI

Magnetic resonance imaging (MRI) is a sensitive modality for detection of breast cancer; yet, as its use in screening is expanded from high-risk patients to intermediate- and average-risk individuals, positive predictive value deteriorates, leading to unnecessary biopsies and follow-up. To improve the overall accuracy of breast cancer diagnosis and allow for personalization of patient management, Witowski et al., reporting in Science Translational Medicine(1), propose an artificial intelligence-based solution. A system of deep neural networks was trained to output the probability of malignancy given the MRI sequences of a patient’s breast. The deep learning system performed equivalently to board-certified breast radiologists, generalized well to different patient populations in three external test sets, and was unbiased with respect to patient race. Importantly, the model predictions could serve as an aid for downgrading certain breast lesions from BI-RADS 4 to BI-RADS 3, enabling patients with lower risk of malignancy to opt of unnecessary biopsies. The results of the study underscore the value of...
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News: Harmful Vaginal Cleaning Practice

News: Harmful Vaginal Cleaning Practice

Almost 20% of women aged 15 to 44 years old douche, which is the harmful act of cleaning or washing out the inside of the vagina with a mixture of fluids. Douches are often sold at as prepackaged mixtures containing water with some combination of iodine, vinegar, or baking soda and squirted into the vagina. While it is popularly known to be a sterilizing practice, douching actually changes the balance of vaginal flora (which is the good, natural bacteria inside the vagina) and increases rates of harmful vaginal bacteria. This bacterial increase can lead to yeast infections, bacterial vaginosis (a vaginal infection), or STIs including HIV and pelvic inflammatory disease (an infection in female reproductive organs).   Douching can also cause fertility challenges. It can make it more difficult to get pregnant, as women who did not douche had an easier time getting pregnant than women who douched often (at least once a month). Douching can also increase the risk of ectopic...
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The Use of Liquefaction Inhibitors as a Non-Hormonal Birth Control Method

The Use of Liquefaction Inhibitors as a Non-Hormonal Birth Control Method

A recent study from researchers at Washington State University has shown success in keeping semen in its gel form to block sperm movement and possibly prevent pregnancy. The methods used in this study may eventually materialize into a non-hormonal female contraception method that could be available for over-the-counter purchase. Past research on mice found that the use of a non-specific protease inhibitor called AEBSF prevented the degradation of the protein of Semenogelin 1. Semenogelin 1 (SEMG1) is a protein that traps semen and prevents movement; therefore, its degradation is necessary for sperm liquefaction, where semen is transformed from a gel-like consistency to liquid. By inhibiting the degradation of SEMG1, the researchers were able to prevent the female mice from becoming pregnant. To determine the efficacy of these inhibitors in humans for contraception, the study tested the effects of AEBSF on SEMG1 degradation, which prevented degradation and reduced sperm motility. They next tested the results of a neutralizing antibody that directly inhibited...
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Hormonal Contraceptive Use and Risk of Sexually Transmitted Infection

Hormonal Contraceptive Use and Risk of Sexually Transmitted Infection

The global incidence of sexually transmitted infections (STIs) is high, which has adverse effects on sexual and reproductive health outcomes. Given the widespread use of hormonal contraceptives (HC), it is important to consider their potential etiological association with acquisition of STIs. In a systematic review and meta-analysis recently published in Scientific Reports(1), Akter et al. examined associations between HC use (progesterone-only, combined estrogen-progesterone, or unspecified) and prevalence, incidence, or recurrence of STIs, compared with a control group of non-users of HC. A positive association with HC use was observed for risk of chlamydia trachomatis and herpes simplex virus type 2, in contrast to a negative association for risk of trichomoniasis and bacterial vaginosis. Importantly, only around half of all associations included in the meta-analysis were adjusted for condom use. Furthermore, while a plausible biological explanation based on the interaction between pathogen, host immune response, and vaginal microbiome can be proposed for these findings, the effects of differential sexual behavior, testing,...
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