1. Global Health, NTDs and STHs Lunch and Learn September 19, 2012 Theresa W. Gyorkos Professor, McGill University theresa.gyorkos@mcgill.ca

2. Outline Introduction to Global Health, NTDs and STHs Research examples – Research questions – Study designs – Study populations Research implications Opportunities for students – Scholarships, plus – Careers

3. Global health can be regarded as population health on a trans-national scale. Global health research therefore focuses on the determinants and distribution of health and disease that affect human populations in more than one country. Examples: pandemic transmission/control; migration- related health concerns; communicable disease transmission from contamination of imported foods; health personnel migration issues

4. 06-01-12 The Gazette

5. Global Health Journals Global Public Health Global Health Action Global Health Governance Global Health Promotion Journal of Global Health Protection (now Emerging Health Threats) International Health (via TRSTMH) Lancet Bulletin of the WHO PLoS ONE, PLoS NTD, etc.... Journal of Globalization and Development...

6. Why study global health? learn from past to improve current and future health health concerns are not restricted to any one country, region or continent address current/future health in a collaborative way address health disparities at all levels (local, provincial, national, regional, international) intricate link between health and development make more effective and efficient use of increased funding for global health activities …

7. Neglected Tropical Diseases (NTDs ) (N= 17) Buruli ulcer Chagas disease Cysticercosis Dengue Dracunculiasis Echinococcosis Fasciolosis Sleeping sickness Leishmaniasis Leprosy Lymphatic filariasis Onchocerciasis Rabies Schistosomiasis Soil-transmitted helminthiasis Trachoma Yaws

8. Neglected Tropical Diseases (NTDs) > 1 billion people affected... in 149 countries... > 70% with ≥ 2 NTDs... (Ref: WHO 2009)

9. Neglected Tropical Diseases (N = 17) Buruli ulcer Chagas disease Cysticercosis Dengue Dracunculiasis Echinococcosis Fasciolosis Sleeping sickness Leishmaniasis Leprosy Lymphatic filariasis Onchocerciasis Rabies Schistosomiasis Soil-transmitted helminthiasis Trachoma Yaws

10. Burden of STH Disease (infecteds and ill in millions; deaths in thousands) Parasitol Today 1997; WHO 2002; Crompton & Nesheim 2002; WHO 2006

11. Roundworms: adverse effects Acute pulmonary disease Hypersensitivity Intestinal obstruction

12. Whipworms: adverse effects Rectal bleeding Rectal prolapse Iron-deficiency anemia Chronic dysentery

13. Hookworms: adverse effects Iron-deficiency anemia Blood loss: – Up to.4 ml/day/worm

14. HIGH RISK GROUPS PRE-SCHOOL CHILDREN SCHOOL-AGE CHILDREN WOMEN of REPRODUCTIVE AGE

16. improves cognition, growth, nutrient uptake… decreases absenteeism…leads to higher wages increases enrollment; improves dropout/retention improves survival, growth and development reduces maternal anaemia reduces other diseases/improves overall health decreases environmental contamination mobilizes drug resources DEWORMING...

17. 2001 2002 2003-05 2005 2005-06 2006-11 2012- KAP DIET RCT parasitology nutrition multidisciplinary pregnant women infants schoolchildren community Belen School Household Health/education systems Research partnership Canada- Peru: 2001 - present Tropical Medicine Research Centre

18. POLICY Regular (anthelminthic) chemotherapy to at least 75% of all school-age children at risk of morbidity by 2010 (and to promote health education through intersectoral collaboration) Developed 1998-1999 Approved by WHO Cabinet - October 2000 Approved by World Health Assembly - May 2001

20. Pregnant women N=1042 Mebendazole + Iron supplementation Placebo + Iron supplementation BW One RESULT: VLBW (0% vs 1.5%, p=0.007) OR=0.10 (0.0, 0.68) Previous research: RCT in Peru 2003-2005 PhD student; Renee Larocque

21. PhD student: Serene Joseph

22. Planned research: RCT in Peru 2012-2014 Lactating women N=1010 Albendazole Placebo Infant weight gain from birth to 6 months of age Infant weight gain from birth to 6 months of age Infant weight gain from birth to 24 months of age Infant weight gain from birth to 24 months of age PhD student; Layla Mofid

23. Student research questions François Thériault: Short and long-term effects of a health education program on helminth infection and absenteeism rates in Grade 5 students of the Peruvian Amazon Brittany Blouin: The effect of early versus late umbilical cord clamping on newborn anemia: implications for clinical practice in the Peruvian Amazon Kathleen Rollet: Exploring health inequalities: determinants of home-based versus hospital-based deliveries in the Peruvian Amazon Sarah Carsley: Sex and gender differences in hookworm infection in school-age children in Peru Sonya Cnossen: Determinants of participation in a milk subsidy program (Vaso de Leche) in a poor community in the Peruvian Amazon Mathieu Maheu-Giroux: An eco-epidemiological study of the impact of fish farming (‘pisicigranjas’) on malaria occurrence in the Peruvian Amazon Hélène Carabin: Enviro-net: Efficacité d’un programme de contrôle des infections et des contaminants de l’environnement dans les garderies

24. Challenges of field-based evidence Multidisciplinary/participatory approach Local supervision Rigorous study designs Sufficient sample sizes Proper assembly of study populations Rigorous stool examination methods Rigorous statistical analyses Results dissemination to appropriate audiences

25. Ultimate goal: provide rigorous evidence base for cost-effective prevention and control activities

26. Opportunities for Students Thesis research – Primary epidemiology, primarily – Manuscript-based – LMIC-based (Peru, etc.) Scholarships – CIHR, FRQ-S,NSERC,IDRC... – STIHR (GHR-CAPS) - Ēcole d’été 2013, – Travel awards – Best theses (RRSPQ)

27. Opportunities for Students Leadership – CCGH (Ottawa, October 21-24, 2012) – CCGHR (UAC, etc.) Internships – WHO – PAHO Bulletin SantéPop (RRSPQ) Bulletin de Nouvelles, Axe en santé mondiale, (RRSPQ)

28. Careers in Global Health Academia Government agencies – CIDA, IDRC, PHAC, PAHO, WHO,... NGOs – Micronutrient Initiative – Médecins Sans Frontières –.... Industry – Pharmaceutical –...