DGHI’s research program transcends traditional disciplinary and geographic boundaries, infusing research teams with new energy and a breadth of perspectives that take projects in interesting new directions. Anthropologist meets infectious disease physician, psychologist meets nutritionist, biomedical engineer meets economist: this is how we work to reduce health disparities locally and around the world.
DGHI has developed a dynamic research agenda that reflects the changing global burden of disease and catalyzes discovery among faculty across Duke University and with our broad network of collaborators around the world.
The DGHI Evidence Lab works with Duke colleagues as well as global NGOs and social enterprises working in low-resource settings, on USAID, NIH and foundation-funded research projects to evaluate interventions, programs and technologies.
In 2015-2016, the Evidence Lab worked to develop lean evaluation tools for health care enterprises in East Africa and India, funded by USAID through the Social Entrepreneur Accelerator at Duke (SEAD) program. The Evidence Lab also consults with USAID on evaluation challenges faced by private sector innovators.
DGHI professor Gregory Gray and a camel merchant in Nouakchott, Mauritania, where Gray is conducting research funded by the U.S. Department of Defense on novel viruses contracted by people from exposure to camels
DGHI faculty are on the forefront of global health research in critical areas such as One Health, which studies the emergence of animal infections in humans, and global mental health, an increasingly recognized cause of global morbidity and mortality.
Associate Director for Research
Diverse Partners Unite to Understand Causes of Severe Fever
As of 2008, more than 60 percent of patients admitted with fever in northern Tanzania were diagnosed with malaria, but less than two percent of those patients actually had the disease. Rather, the patients’ illnesses included bacterial, mycobacterial, fungal and arboviral infections and diseases.
In a new NIH study, adjunct DGHI faculty member John Crump is co-leading a research team that is attempting to better understand the causes of death among patients admitted to hospital with severe fever in northern Tanzania. Ultimately, the team plans to identify interventions that could avert fatal outcomes among these patients.
Crump is co-leading the project with DGHI’s Matthew Rubach and longtime collaborator Venance Maro of the Kilimanjaro Christian Medical Centre (KCMC); other team members include DGHI’s Linfa Wang, Elizabeth Turner and Chris Woods, as well as researchers from other institutions. Each partner brings unique expertise, including pathogen discovery, biostatistics, diagnostics, health systems, medical anthropology and infectious diseases pathology.
Another project goal is to strengthen pathology services in northern Tanzania, where these services are among the most neglected components of the health system. International experts will mentor KCMC pathologists and other scientists on infectious diseases pathology, autopsy and pathogen discovery techniques.
DGHI Research Leads to Emergency Declaration
It’s gratifying when global health research affects policy. This was the case when Peru’s federal government declared a state of emergency after the publication of a report by DGHI researchers showing the distressing impact of gold mining on the health of people living downriver from mines in the Peruvian Amazon.
Mercury used in the gold extraction process ends up in waterways and accumulates in fish—a key source of food for people in Peru’s Madre de Dios region. William Pan, assistant professor of global environmental health, and his colleagues found high levels of mercury in hair samples in 40 percent of the residents they tested. According to Pan, the presence of mercury in hair indicates a person’s exposure to mercury through something they ate.
Mercury can have toxic effects on the nervous, digestive and immune systems, and it’s particularly dangerous to developing fetuses. The World Health Organization considers mercury one of the top ten chemicals representing a major public health concern.
DGHI research analyst Ernesto Ortiz tests a child for anemia as part of the mercury exposure study that led to the state of emergency
The Peruvian government’s response includes providing the local population with a protein source other than fish. They’re also considering distributing quinoa, the consumption of which has been correlated with lower mercury levels.
“Protecting the health of Americans includes empowering them with the tools they need to make healthy choices in their daily lives,” said global health and community and family medicine professor Mary Story, who was among a group of prestigious researchers who served on the advisory committee that developed the 2015-2020 Dietary Guidelines for Americans.
By focusing on small shifts in what we eat and drink, eating healthy becomes more manageable.
Professor of Community and Family Medicine and Global Health
Associate Professor Sallie Permar
Building on her extensive work on perinatal virus infections and HIV vaccine development, affiliate DGHI faculty member Sallie Permar is leading a DGHI-funded pilot study that will help build the knowledge needed to inform a successful Zika vaccine.
Permar is working with DGHI’s Ralph Corey and Reynaldo Dietze, professor at Universidade Federal do Espírito Santo in Victoria, Brazil, to define natural maternal antibody responses against Zika and how they relate to fetal outcomes.
Mobile App Improves Stroke Care and Outcomes
Stroke is the leading cause of death in China, and the socioeconomic burden of stroke survivors in China is substantial. Duke global health researcher Lijing Yan and her colleagues are addressing this challenge through several research projects aimed at primary care providers and family caregivers. And they’re capitalizing on the ubiquity of mobile phones in China in their work.
Health care in rural Chinese villages is typically provided by community health workers who are not trained physicians. In one study, physicians trained community health workers to help participants in the intervention group manage their cardiovascular health by offering them medication and lifestyle reminders. The health workers received prompts and assistance to implement the intervention via a smartphone app that was custom-designed for the study.
Yan and her team found that this simple program improved quality of primary care and clinical outcomes. Participants in the intervention group had a 25 percent increase in their use of blood pressure medication, significantly greater use of aspirin and lower blood pressure compared to the control group. The results were published in Circulation.
Technology appears to be a valuable tool to help community health workers achieve the goals of preventing and managing chronic disease. We are encouraged by the results of this study.
Associate Research Professor of Global Health
The Effect of Antidepressant Treatment on HIV and Depression Outcomes: The SLAM DUNC Randomized Trial | AIDS | Brian Wells Pence, Bradley Gaynes, Julie Adams, Nathan Thielman, Amy Heine, Michael Mugavero, Tina McGuinness, James Raper, James Willig, Kristen Shirey, Michelle Ogle, Elizabeth Turner, E. Byrd Quinlivan
Preferences for End-Of-Life Care Among Community-Dwelling Older Adults and Patients with Advanced Cancer: A Discrete Choice Experiment | Health Policy | Eric Finkelstein, Marcel Bilger, Terry Flynn, Chetna Malhotra
Seroepidemiological Study of Interepidemic Rift Valley Fever Virus Infection among Persons with Intense Ruminant Exposure, Madagascar and Kenya | American Journal of Tropical Medicine and Hygiene | Gregory Gray, Benjamin Anderson, Desirée LaBeaud, Jean-Michel Heraud, Eric Fèvre, Soa Fy Andriamandimby, Elizabeth Cook, Saidi Dahir, William de Glanville, Gary Heil, Salah Khan, Samuel Muiruri, Marie-Marie Olive, Lian Thomas, Hunter Merrill, Mary Merrill, Juergen Richt
Vaginal Self-Sampling for Human Papillomavirus Infection as a Primary Cervical Cancer Screening Tool in a Haitian Population | Sexually Transmitted Diseases | Joel Boggan, David Walmer, Gregory Henderson, Nahida Chakhtoura, Schatzi McCarthy, Harry Beauvais, Jennifer Smith
“Thinking Too Much”: A Systematic Review of a Common Idiom of Distress | Social Science and Medicine | Bonnie Kaiser, Emily Harozc, Brandon Kohrt, Paul Boltone, Judith Bass, Devon Hinton High Road Utilizers Surveys Compared to Police Data for Road Traffic Crash Hotspot Localization in Rwanda and Sri Lanka | BMC Public Health | Catherine Staton, Vijitha De Silva, Elizabeth Krebs, Luciano Andrade, Stephen Rulisa, Badra Chandanie Mallawaarachchi, Kezhi Jin, Joao Ricardo Vissoci, Truls Ostbye
Prioritizing Surgical Care on National Health Agendas: A Qualitative Case Study of Papua New Guinea, Uganda, and Sierra Leone | PLOS Medicine | Anna Dare, Katherine Lee, Josh Bleicher, Alex Elobu, Thaim Kamara, Osborne Liko, Samuel Luboga, Akule Danlop, Gabriel Kune, Lars Hagander, Andrew Leather, Gavin Yamey
Intellectual Property Rights and Challenges for Development Of Affordable Human Papillomavirus, Rotavirus and Pneumococcal Vaccines: Patent Landscaping and Perspectives of Developing Country Vaccine Manufacturers | Vaccine | Subhashini Chandrasekharan, Tahir Amin, Joyce Kim, Eliane Furrer, Anna-Carin Matterson, Nina Schwalbec, Aurélia Nguyen
The Complex Relationship between Diet and Health | Health Affairs | Sara Bleich, Jessica Jones-Smith, Julia Wolfson, Xiaozhou Zhu, Mary Story
This list represents a small sample of the more than 150 journal articles and book chapters published by DGHI faculty in 2015-2016.