Global Health Education Day Center for global health education

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Global Health Education Day is an exciting opportunity to draw together global health researchers, educators, and students. Led by Robert J. Havey, MD Institute for Global Health's Center for Global Health Education, this year's event included a poster session where students, trainees, and faculty members presented posters on projects relevant to global health. All posters can be enlarged by clicking the link underneath each image.

Swinging Toward Inclusion: Global Disparities in Injury and Illness Among Golfers with Disabilities

Sports participation amongst individuals with disabilities is expanding worldwide, offering crucial physical, psychological, and social benefits. Individuals with disabilities are disproportionally impacted by obesity, cardiovascular disease, and social isolation; inclusive sports, such as golf, provide an intriguing modality to combat poor health outcomes. As golf participation grows amongst athletes with disabilities, understanding health risks associated with the sport is essential to improving health status. We conducted a cross-sectional international survey of 241 adult golfers with disabilities, recruited through the intercontinental European Disability Golf Association (EDGA), Midwestern Amputee Golf Association (MWAGA), and Shirley Ryan AbilityLab. Participants self-reported injuries, illnesses, sleep quantity, adaptive equipment use, and disability over a three-month recall period. Disabilities were classified as falling into one of four categories: musculoskeletal (e.g., amputation), neurologic (e.g., spinal cord injury, stroke), other (e.g., intellectual or visual impairments), or multiple; multiple disabilities were defined as impairments in at least two of the preceding categories: musculoskeletal, neurologic, or other. Associations were analyzed using odds ratios and chi-square testing.Overall, 63.1% reported injury or illness within three months—markedly higher than the general golf population (~4%). European participants had greater odds of injury compared to North Americans (75% vs. 56%; OR 2.40 [95% CI 1.10–5.23], p=0.0106) and were more likely to use adaptive equipment (51% vs. 31%; OR 2.38 [95% CI 1.12–5.05], p=0.0092). Paradoxically,Europeans reported greater equipment use and higher injury rates, suggesting that adaptive sports equipment access alone does not mitigate risk. Poor sleep also trended toward an association with increased injury/illness risk (70% vs. 58%; p=0.062), with individuals with multiple disabilities at highest risk for sleep disruption (ORs 5.54–7.09, p<0.012). Limited participation from resource-constrained countries reflects ongoing disparities in sports access for people with disabilities. Minimizing health risks in golfers with disabilities will require improving sleep health and enhancing equipment safety. Further study should investigate the impact of international course terrain variation and disability severity on injury and illness risk among golfers with disabilities.

Presenting author: Alyssa Levitt

Poster 1

PNC3: Advancing Pediatric Neurocritical Care Through Scalable Multidisciplinary Training Tailored for Resource-Limited Settings

Introduction The Pediatric Neurocritical Care Curriculum (PNC3) seeks to address the critical unmet need for Pediatric Neurocritical Care (PNCC) training in resource-limited settings (RLS) by developing and implementing a scalable, multidisciplinary, simulation-based curriculum. Pediatric neurological disorders contribute significantly to premature mortality, lifelong disability, and loss of human potential worldwide, with the greatest burden in RLS. The lack of highly trained personnel and inequitable systems of care are largely responsible for disparities in care delivery and outcomes in RLS. The PNC3 project aims to bridge this gap by providing a tailored, sustainable, multidisciplinary educational program to healthcare professionals in RLS. The long-term objective of this project is to achieve equity in access to outstanding pediatric neurocritical care, that optimizes health outcomes for children with neurological conditions in RLS. Methods The project has two primary aims: (1) to develop and implement a simulation-based, train-the-trainer program for PNCC in RLS, and (2) to assess the program's impact on participants' knowledge, retention, and confidence in care delivery. The curriculum is adaptable and tailored to the specific levels of care required, ranging from basic to advanced, based on World Health Organization (WHO) resource criteria. It consists of seven self-study modules addressing common presentations of pediatric neurologic critical illness, all designed using an experiential adaptive learning platform. These modules include neurologic examination, status epilepticus, pediatric stroke, traumatic brain injury, intracranial hypertension, nervous system infection, and acute neuromuscular weakness. Each module includes a self-study chapter, a WHO-tiered management checklist and algorithm (Figure), and an educator presentation and assessment. There are three simulation scenarios, including status epilepticus, pediatric stroke, and traumatic brain injury, taught in a hybrid fashion. The curriculum has been developed and peer-reviewed by local healthcare experts and an international panel of PNCC specialists, ensuring that it is both relevant and optimized for the target regions. We will use a mixed-methods approach to evaluate the program's effectiveness. Participant knowledge and confidence will be measured with pre- and post-training assessments, and their perceptions of the training will be evaluated using the Simulation Effectiveness Tool – Modified (SET-M). Results The anticipated results include improved healthcare knowledge and application of skills, more effective recognition and management of neurological emergencies, and sustainability within local healthcare communities through the education of local trainers. Conclusions By addressing the specific needs of healthcare providers in RLS, this project aims to create a profound and lasting impact on PNCC that transcends geographical and economic boundaries, broadening expertise in PNCC and ultimately improving care and outcomes for children suffering from acute neurological illnesses worldwide.

Presenting author: Andrea C. Pardo

Poster 2

Rehabilitation Outcomes of Patients That Travel Internationally for Medical Care in Comparison to Mainland US Patients: A Retrospective Study

Background: A recent study of ours examined the characteristics of patients who travelled internationally for their medical care within inpatient rehabilitation, yet no prior study has compared outcomes of this specific patient population to those not travelling internationally for their medical care. The objective of our study is to compare the functional outcomes of patients travelling internationally for their medical care to those not participating, who were admitted to an inpatient rehabilitation facility during the same time frame. Methods: This is a retrospective cohort study consisting of a total of 310 patients divided into two groups: 155 patients travelling internationally for their medical care (GPS) and 155 patients not travelling for their medical care (n-GPS) at an inpatient rehabilitation facility between 2018 and 2023. Our groups were matched by gender and primary rehabilitation diagnosis. The primary outcomes of our study included change in functional independence score (FIM) between admission and discharge, specifically bathing, toileting hygiene, bed to chair transfers, ambulation, communication expression, and social interaction. Secondary outcomes included length of stay (LOS), discharge destination, and demographic features. We used an unpaired t-test to evaluate differences between both groups. Results: Demographically, both groups consisted of mostly men (GPS & n-GPS n=104, 67.01%), white (n=114, 73.55% [GPS], n=87, 56.13% [n-GPS]), non-Hispanic (n=147, 94.84% [GPS]; n=138, 89.03% [n-GPS]) with the most common diagnosis being stroke (GPS & n-GPS, n= 36, 23.3%). The average age (SD) for GPS & n-GPS groups were 45.85 and 52.36 years, respectively. Predominant country of origin and language for GPS group was Middle East (n=125, 80.65%) and Arabic (n=113, 72.90%) while for n-GPS group it was, USA (n=155, 100%), and English (n=147, 94.83 %), respectively. On admission, patients in the GPS group had significantly lower baseline FIM scores for expression (3.83 [GPS] vs 4.71 [n-GPS], p-value: 0.0004) and social interaction (4.46 [GPS] vs 5.12 [n-GPS], p-value: 0.006). Both groups significantly improved in their FIM scores from admission to discharge for all subcategories. Average FIM score improvement was comparable between both groups (1.26 [GPS] vs 1.62[n-GPS], p-value 0.38). GPS (n=117, 75.45%) and n-GPS (n=129, 83.22%) groups were primarily discharged home with patients in the GPS group having a significantly longer LOS (58.28 days [GPS] vs 32.89 days [n-GPS], p-value <0.0001). Conclusion: Our study highlights that individuals who travel for medical care start more functionally limited in communication expression and social interaction. Despite this, they make significant gains in function throughout multiple functional subcategories that are comparable to those not travelling for their medical care.

Presenting author: Antonio Mondriguez-Gonzalez

Poster 3

Association of Vascular and Inflammatory Markers with Neurocognitive Test Performance among Ugandan Youth with Perinatally Acquired HIV on Dolutegravir

Background: The association between neuroinflammation and neurocognition in youth with perinatally acquired HIV (YPHIV) has been documented. However, mechanisms underlying neurocognition in YPHIV on contemporary ART (cART) in Sub-Saharan Africa remain unclear. This study examined associations of vascular, inflammatory, and gut markers with neurocognition in YPHIV virally suppressed on dolutegravir vs. youth without HIV (YWoH). Methods: A cross-sectional study of 101 youth in Kampala, Uganda was conducted (52 YWoH and 49 YPHIV). Neurocognition was measured with NeuroScreen (NS), a tablet-based test battery adapted for Uganda. YWoH based individual test z-scores and a global z-score were calculated. Plasma markers of inflammation, chemokines, gut microbial translocation, and vascular markers were measured using ELISA and Legendplex. Wilcoxon rank sum test compared neurocognitive measures. Spearman correlations assessed associations of neurocognitive test performance with biomarkers. General linear regression models assessed the association between neurocognition and biomarkers after adjusting for demographic, socioeconomic, and HIV factors. Results: The median [IQR] age was 16.90 years [15.11, 17.08] and 42% were females. Compared with YWoH, YPHIV participants performed worse in all neurocognitive domains and had lower global z-scores (p ≤ 0.038, Figure 1). Gut integrity marker IFAB and chemokines MIP3 and RANTES were greater in YPHIV compared to YWoH (p ≤ 0.024). After adjustment, the vascular marker myeloperoxidase (MPO) was associated with worse processing speed, learning/memory, and global z-scores in YPHIV, while MPO was only associated with worse attention/concentration in YWoH. Among YPHIV only, monocyte activation marker sCD14 and fungal translocation marker BDG were associated with worse processing speed and learning/memory, respectively. Conclusions: Despite viral suppression on cART regimens, Ugandan YPHIV performed poorly on neurocognitive tests compared to YWoH. Immune markers associated with mortality and cardiovascular disease in HIV, such as MPO, sCD14 and BDG, were associated with worse neurocognitive performance in Ugandan youth with HIV, suggesting vascular inflammation and gut barrier dysfunction processes that persist with cART therapy.

Presenting author: Caroline Carlson

Poster 4

Small group dinners increase faculty-student engagement in global health at Feinberg

Background Research has shown that medical students benefit from both in-person and virtual global health experiences. The Student Advisory Committee on Global Health (SACGH) aims to increase student interest in and engagement with global health at Northwestern, with a focus on increasing transparency in faculty engagement and research opportunities for health professions students. Students attending SACGH events have identified interest in networking with faculty members in a small-group intimate setting. To connect students with global health faculty mentors, SACGH piloted a novel dinner program over the 2024-2025 academic year. Methods Groups of up to 12 Feinberg School of Medicine students and 1-2 faculty mentors were invited for a one hour dinner. Dinners were advertised as providing students with an opportunity to engage with the faculty member's work, ask questions, connect with like-minded classmates, and discover additional opportunities for involvement with global health work at Northwestern. Four dinners were conducted over the 2024-25 academic year. Students were sent a post-dinner survey to identify perceptions on dinner organization and quality, with free text boxes for suggested improvements. Results 31 post-dinner surveys were completed. 28 (90.3%) rated 5/5 each on dinner organization and enjoyment. Students enjoyed the casual environment and small group size, which made it less intimidating to ask questions. They appreciated when faculty provided personalized advice or connections to other faculty, and the convenience of combining a meal with an area of interest. Several connected with faculty members post-dinner and began discussing independent research or fieldwork experiences. Students disliked how each group was mostly composed of new people, so introductions took up a fair portion of the time. In addition, they would have preferred more guiding questions instead of the fully open-ended format. Conclusions Findings suggest that the SACGH dinner pilot was effective in raising awareness of global health opportunities at Northwestern. Strengths of this study include student direct engagement with faculty post-dinner, survey completion immediately after each dinner session, and responses across MD, MSTP, PA, and PT programs, as well as across multiple years within each program. Limitations include a relatively low survey response rate and some nonspecific feedback. Planned expansion of the dinner program to 2025-2026, with higher frequency of sessions and increased diversity of faculty guests, will include greater structure from the SACGH team, including guiding questions and streamlined introductions.

Presenting author: Emily Guo

Poster 5

Co-Creating Health Equity Training in the Swiss Learning Health System

Background: Globally, health systems are plagued by hard-to-define health problems such as rising healthcare costs, recent pandemics, and a growing digital divide. Thus, health systems are becoming a complex network of social interdependencies struggling to resolve health delivery issues and the many causes. Learning health systems (LHS) work to address these challenges by continuously aggregating and analyzing data from ongoing healthcare interactions to define best practices and embed these insights into the delivery process for improved care. LHS are aspirational models as they aim to increase ongoing dialogue among researchers, policymakers, practitioners, and patients for continuous healthcare improvement and innovation. By creating networks that link a broad range of health system partners, LHSs facilitate the dissemination of knowledge and enable the development and implementation of evidence-based solutions to a community's health problems. The healthcare system in Europe, designed to be universal, still faces significant gaps between evidence and policy responses to health inequities. In Switzerland, gaps are partially rooted in highly decentralized healthcare as its 26 cantons independently govern and promote healthcare. The Swiss LHS (SLHS) was established to provide a bridging mechanism for exchanges among healthcare partners to address current and emerging challenges in healthcare delivery in Switzerland. Its methodological approach involves identifying key challenges in the Swiss health system, engaging doctoral researchers to produce policy briefs that inform partner dialogues, and providing a platform to discuss and support implementation. Embedded within the SLHS, this project aims to better understand health inequities in Switzerland by incorporating health equity principles into the research training of doctoral researchers. Methods: We used the co-creation of the curriculum method and the ADDIE model for instructional design to collaboratively develop a health equity course for doctoral researchers within an LHS framework. Two modified Delphi rounds of surveys and virtual consensus workshops were conducted with co-creators, (e.g., academics, clinicians, social service providers, policy experts and patients) from Switzerland, to promote diversity and inclusivity. This project also facilitated the involvement of LHS health equity experts from the United States, enriching the development process of the SLHS training set to take place in November 2024. Results: A threshold of 75% agreement was deemed as "consensus" among 28 co-creators. Two live virtual sessions in late October will address health inequities at individual and system levels and explore participatory research methods. The in-person block sessions will focus on practical topics, such as measurement tools, analysis methods, and translating research into policy and practice. The course will highlight community narratives and lived experiences, culminating in a group design challenge and evaluation. Most co-creators (93%, N=14), who completed the co-creation process evaluation, agreed that the process enhanced the course's relevance to current community needs. Additionally, 80% (N=12) believe this collaborative approach will help learners produce more useful knowledge for informing policy and practice decisions. Conclusions: The course will extend the learning competencies within the SLHS to improve skills in health equity assessment, disparity identification, and LHS methods to measure and promote equity on a system level for individuals and populations.

Presenting author: Emily Lynott

Poster 6

Resource Collection and Distribution for Migrants in the Emergency Department

Since 2022, over 50,000 migrants - primarily from Central and South America—have arrived in Chicago, driven by economic instability, violence, political unrest, and natural disasters, all compounded by the COVID-19 pandemic. Immigration status, a critical but often overlooked social determinant of health, significantly restricts access to essential services, especially among undocumented individuals. In response to the growing number of undocumented patients seeking care in the Emergency Department (ED), this project aimed to identify prevalent social risks and unmet needs, and to develop a comprehensive, categorized directory of local resources tailored to this population. Through collaboration with ED social workers and the University of Illinois’ Mobile Migrant Health Team, 174 community resources were identified, with 51 ultimately selected for inclusion based on relevance and provider usability. These were organized into eight categories—Comprehensive, Healthcare, Mental Health and Counseling, Social Services and Support, Housing, Nutrition, LGBTQ+, and Legal—and made accessible in English and Spanish on the Northwestern Memorial Hospital ED Resources platform. This initiative addresses critical gaps in non-clinical support for undocumented patients and provides ED staff with an accessible tool for resource distribution. Future efforts will focus on evaluating the tool’s impact and refining it through patient and provider feedback.

Presenting author: Emma Greever

Poster 7

Evaluating the Impact of Financial Navigation on Financial Toxicity and Treatment Adherence for Cancer Care: A Randomized Control Trial

Introduction Nigeria, with more than 100,000 new cancer cases annually, experiences poor cancer survival outcomes, partly due to poverty-associated delayed diagnosis and suboptimal treatment. Consequently, many patients are at high risk for financial catastrophe (FC) and financial distress (FD). Limited evidence exists on the impact of Financial Navigation Programs (FNP) in resource-constrained settings. To address this gap, we designed a prospective randomized controlled trial (RCT) to evaluate whether a Financial Navigation Program can reduce FC and FD among cancer patients in Nigeria. This abstract presents baseline data on financial toxicity in newly diagnosed cancer patients and offers preliminary insights into the potential impact of FNP in mitigating financial hardship. Methods This prospective randomized controlled trial enrolled newly diagnosed (< 6 weeks from diagnosis) adults (≥18 years) with breast, colorectal, or prostate cancer at two sites in Nigeria. Participants were randomized 1:1 to either the intervention (FNP) or control arm. Structured interviews captured demographic, treatment, and financial data. Financial catastrophe (FC) was defined as health expenditures exceeding 10% of household income, 25% of total household spending, or 40% of non-subsistence spending. The COST-FACIT (Comprehensive Score for Financial Toxicity–Functional Assessment of Chronic Illness Therapy) tool—a 12-item survey with scores ranging from 0–44—measured financial distress (FD). Statistical comparisons were made between baseline data, FC, and FD in both arms. Results One hundred patients, median age 55 years (range 32–87), were recruited. The majority were female (68%), married (79%), Christian (80%), and either in full-time employment (41%) or retired (35%). Breast cancer was most common (n=64; 66%), followed by prostate (n=18; 19%), colon (n=14; 14%), and rectal cancer (n=1; 1%). A quarter (26%) had metastatic disease at diagnosis. Most reported delays in diagnosis (68.7%) and treatment (62.2%), primarily due to financial constraints. About one-sixth (15%) had health insurance (9.3% intervention vs. 22% control). Median monthly household income was 35,000 Naira (intervention) and 40,000 Naira (control). Treatment and drugs constituted the largest share of costs (62.1%), followed by laboratory and testing (9.1%) and consultation/professional services (7.2%). Over half (51.1%) of these expenses were out-of-pocket. Stage 3 breast cancer had the highest aggregated costs (30,000,000 Naira). Most patients experienced moderate or severe FD, both in the intervention group (87.5%) and control group (75.5%). Severe FD incidence (31.3% vs. 29.2%; p=1.000) and moderate FD incidence (34.8% vs. 46.2%; p=0.562) did not differ significantly between arms. Severe FD was most frequent in breast cancer (68.9%), followed by colon (18.2%) and prostate (13.7%). Similarly, a large majority (85.1%) experienced FC: highest in breast (88.0%), colon (87.5%), and prostate (72.7%). Conclusion A significant proportion of patients with cancer in Nigeria experience delayed diagnosis, delayed treatment, and substantial financial hardship. The incidence of FD and FC is extremely high in this setting. While these findings provide early insights, additional analyses will be conducted once more participants reach the six-month follow-up to further evaluate the impact of financial navigation on financial toxicity.

Presenting author: George Gutierrez

Poster 8

Global Disparities in the Diagnosis and Management of Pulmonary Hypertension and CTEPH

Pulmonary hypertension (PH) is a significant global health issue, affecting 1% of the population and up to 10% of individuals over 65. Despite it's prevalence, PH is often underdiagnosed, particularly in low-and middle-income countries (LMIC), due to limited access to diagnostic tools like right heart catheterization (RHC), which remains the gold standard for diagnosis. This review highlights the disparities that exist in PH diagnosis, management, and outcomes between high-income countries (HIC) and LMIC as well as those disparities that exist within HIC in low-resource settings and among subpopulations. Unsurprisingly, advances in PH care have been drive by data from affluent nations, often neglecting the unique challenges faced by LMIC, namely access to RHC, the presence of PH centers, and the availability of PH-specific therapies. We underscore the need for region-specific guidelines and improved data collection to better understand PH epidemiology in LMIC. We also emphasize the importance of non-invasive diagnostic tools, such as echocardiography, to bridge the gap in PH care, with many tools relying on echocardiographic data for risk assessment and treatment decisions already well-established. Additionally, the review addresses the impact of socioeconomic status, gender, race, and environmental factors, all of which contribute to disparities in PH diagnosis, management, and outcomes. As the field of PH advances, it is critical to focus on the global burden of the disease and minimize disparities through targeted policies and international collaboration. The creation of a central patient registry and a standardized diagnostic algorithm using echocardiographic parameters are essential to better characterize the epidemiology, as well as improve detection and management of PH globally.

Presenting author: Jared Larson

Poster 9

SHELTER Tea Champions: Supporting Health, Education & Livelihood Towards Empowerment and Resilience in Assam's Tea Plantations

SHELTER Tea Champions: Supporting Health, Education & Livelihood Towards Empowerment and Resilience in Assam's Tea Plantations Introduction Tea plantation workers in Assam, India, face persistent socioeconomic disadvantages, including poor educational access, malnutrition, and high dropout rates. These challenges contribute to a cycle of poverty, early marriage, and child labor. The SHELTER Tea Champions project aims to break this cycle by improving health, education, and livelihood opportunities for children of tea plantation workers. By aligning with Sustainable Development Goals (SDGs) related to health (SDG3), education (SDG4), gender equality (SDG5), and economic growth (SDG8), the project seeks to foster resilience and sustainable development within these marginalized communities. Methods and Design This community-based intervention was implemented across 20 villages in Assam with children aged 5-14. Phase I included formative assessments to understand health, education, and livelihood needs, and the identification and training of youth tutors—local mentors with leadership potential. To assess baseline learning levels of students in Math's and Reading we used ASER test, a validated tool developed in Indian and used globally to measure foundational skills. To assess health, we modified the Health Literacy School-Age Children (HLSAC) tool previously validated in various European cohorts. Phase II of our project will focus on structured tutoring, health education, nutrition programs, and vocational guidance to support long-term learning and well-being. Findings The baseline assessment for education revealed major gaps in foundational learning. In mathematics, 63% of Grade 7 students struggled to solve a problem from a Grade 3 textbook. Similarly, 70% of Grade 7 students were unable to read a simple story from a Class 2 textbook. For heath, on the HLSAC scale, 28% of participants had low scores, 56% scored at a moderate level, and only 16% achieved high scores. Health literacy scores at baseline may have been associated with gender, age, and general educational proficiency, and that sub-scores in the "theoretical knowledge" and "self-awareness" components of health literacy were lowest. Qualitative responses also revealed gaps in knowledge of nutrition, first-aid, and health information access that will be reassessed with additional health/education outcomes following interventions. Conclusion and Next Steps The baseline data highlight the urgent need for targeted interventions to improve both academic and health literacy. To create a sustainable impact, we have collaborated closely with tea plantation community members, empowering them as key agents of change in developing effective, locally driven solutions. Youth tutors now lead community learning centers, combining education and health awareness with arts and sports to foster holistic learning and engagement. The program's impact will be evaluated through endline assessments using the same tools, along with school attendance records, academic performance data, and participant feedback. In the long term, we aim to expand this model to other districts in Assam to ensure a broader and more sustainable impact. By integrating data-driven insights, teacher empowerment, and community engagement, the SHELTER Tea Champions Project has the potential to become a replicable model for breaking intergenerational poverty and fostering lasting, community-led change.

Presenting author: Jyothy Puthumana

Poster 10

Global Health in the Post-USAID Era: Lessons from the US's Global Gag Rule and its Impact on Health NGOs in Kenya

Introduction: In February 2025, USAID (United States Agency for International Development) was abruptly shuttered. Foreign aid was halted and contracts with NGOs in low and middle-income countries (LMICs) were canceled. This ended USAID’s 63-year history of expanding US soft power to LMICs through health and development programming. In Kenya, health services are decentralized, and community health needs are largely met by NGOs, which are not directly funded by the government. Instead, NGOs rely on outside donor funding. Like most LMICs, Kenya receives the bulk of its health funding from USAID, which funds health departments both nationally and at the county level. What happens when health diplomacy, or health-centered foreign policy, turns malignant? This research project answers this question by examining the US Global Gag Rule (GGR) and its impact on non-governmental organizations (NGOs) in Kenya providing sexual and reproductive health (SRH) service delivery and advocacy. Since 1984, the GGR, a policy that withdraws family planning aid from NGOs who perform or advocate for abortion, has been implemented four times (1984, 2001, 2017, 2025) and repealed three times (1993, 2009, 2021). While aid withdrawal for family planning occurs on a smaller scale than USAID’s recent shutdown, lessons from SRH NGOs’ experiences can be applied to other health NGOs who suddenly lost US funds. Methods: From February 2020 to March 2022, I conducted 55 key informant interviews with government health officials, researchers, healthcare providers and directors of SRH NGOs who had firsthand knowledge of SRH policy, planning, advocacy, and service delivery in Kenya. Interview notes were anonymized and coded in Dedoose using a deductive approach. Inductive analysis techniques, such as open coding and constant comparison, were also applied to allow novel insights, themes, and patterns to emerge. Results: This research answers: 1. What are the political costs of aid withdrawal?; 2. What is the impact of aid withdrawal on NGO service delivery?; And 3. What is the impact of aid withdrawal on NGO partnerships? Findings demonstrate that the GGR’s effects were wide-reaching. USAID suffered reputational costs and NGOs partnered with US geopolitical rivals. Aid withdrawal impacted NGO service delivery, leading to a decline in women’s health outcomes. Results also show that NGOs in Kenya demonstrated resiliency through a bottom-up coordination effort. When the GGR was reinstated in 2017, SRH NGOs adapted so they could continue to provide comprehensive SRH care and advocacy. Instead of aligning their work to meet the US’s new anti-abortion demands or competing with other organizations, they established relationships with alternative donors and increased their collaborative efforts with other NGOs by coordinating advocacy campaigns, educating and training peer organizations, and forming strategic partnerships and new consortia. Implications: As USAID has ceased operations, the lessons learned from the GGR, particularly how NGOs built coalitions and cooperated in the face of scarcity, can provide a model for other health NGOs in LMICs striving to survive funding cuts.

Presenting author: Kelly Hunter

Poster 11

Discrimination Against People with Chronic Hepatitis B Infection in Ibadan: A potential threat to hepatitis B elimination

Introduction: Global efforts are ongoing to eliminate hepatitis B as a public health challenge in 2030. Screening and linkage to care are important in achieving this vision. Nigeria is endemic for chronic hepatitis B (CHB) which affects at least 8% of the population. Nigerian National guidelines recommend screening of all adults at least once in their lifetime. Discrimination against those with hepatitis B has been reported as an impediment to voluntary screening. Unlike for persons living with HIV, the frequency and types of discrimination against people with CHB in Nigeria is not well documented. The aim of the study was to assess the burden and type of discrimination among adults with CHB attending clinics at the University College Hospital, Ibadan, Nigeria. Methods: This mixed method cross sectional study recruited 150 participants from the gastroenterology clinic of the University College Hospital, Ibadan between June 2024 and February 2025. A questionnaire adapted from the Joint United Nations Programme on HIV/AIDS protocol for discrimination against people with HIV was used to assess perceived and actual household, job, health care facility, school and travel related discriminations related to living with CHB. Results were summarized with frequency tables and measures of central tendency. Associations were tested for with chi square. Results: One Hundred and Fifty subjects with CHB (mean age 43 ± SD 10, 47% males) were recruited. 120 (80%), 23 (15%) and 7 (5%) had tertiary, secondary and primary education, respectively. 39 (26%) became aware of their CHB status through antenatal screening, 16% through blood donation, 27% through routine care and 31% other means. 58% were on antiviral medications. Discrimination due to HBV seropositive status was reported among 43 (29%). Discrimination in health facilities was reported in 11 (26%), job denial or office related in 13 (30%), discrimination within the household/family 17 (40%). Denial of school admission and travel related discrimination were reported by 1 (2%) each. The types of discrimination reported in health facilities included refusal of treatment (n=4), delayed treatment (n=1) and treatment with disdain (n=6). Domestic discrimination reported included being jilted by a potential spouse (n=6) withholding intimate contact (n=4), , accusation of infidelity (n= 2), divorce (n= 2) and sibling to sibling discrimination ( n=3). There was no significant association between reported discrimination and sex (p=0.52), education (p=0.76), marital status (p=0.1) and medication status (p=0.1). Conclusion: Discrimination was reported in over a quarter of persons with CHB in Ibadan. Discrimination within the household/family was the most reported form of discrimination. Qualitative interviews are being conducted to further explore and understand the types of discrimination experienced by participants to inform future interventions to reduce HBV related stigma.

Presenting author: Kolawole Oluseyi Akande

Poster 12

Espacio para Mejorar: Examining Barriers to Care at a Free Clinic in the Rural Bolivian Amazon

The Centro Medico Susan Hou (CMSH) is a medical primary care clinic in the rural Bolivian Amazon focused on providing free healthcare to local low-income patients. Since the COVID-19 pandemic, the clinic has faced many new challenges including a substantial decrease in clinic utilization as reported by the staff. This study aims to describe the patient population, explore patient health behaviors, and investigate barriers to care in order to serve as a reference for future quality improvement (QI) projects. Utilizing a 75-item survey administered orally and unstructured interviews (n=54), we examined socioeconomic factors, health behaviors, screening compliance, and patient attitudes. Following survey completion, patients were asked for their opinions on how the services of the clinic could be improved, how medical mistrust in their communities could be amended, and additional questions based on their responses to specific survey questions. Interviews were transcribed and summarized using local Large Language Model tools. 40% of patients have not continued their education past primary school (n=54), 22% have difficulties reading (n=31), and 65% have difficulties understanding when to take medications and in which quantities (n=32). The average income of patients is lower than $72 USD per month (n=54), which is around 1/10 of the average Bolivian income. Because many patients cannot afford to own their own vehicles, many cited transportation as a barrier to accessing care and purchasing food. The cost to carpool to the clinic is around $6 per trip, and carpools to the nearest markets are infrequent. This patient population generally consumes a high-carb diet with sugar-sweetened beverages (SSBs), potatoes, and rice. Diet could be a factor contributing to the high prevalence of cardiometabolic disease. 77% of patients have a BMI that would be considered overweight, obese, or morbidly obese (n=54). 41% of patients have diabetes, 45% have hypertension, and 25% have both conditions (n=54). An unclear number of diabetes patients have discontinued seeking care from the clinic after they were switched off insulin to metformin in an effort to preserve resources. 55% of patients said that there were members of their community that had lost trust in the clinic (n=46). Compliance with screening guidelines could be improved. 61% of diabetes patients had not had their feet examined annually (n=18), 78% had not had their eyes examined annually (n=18), 83% had experienced problems with diabetic peripheral neuropathy (n=18), and 0% were receiving treatment (n=5), despite a surplus of pregabalin. 37% of patients have a history of Chagas disease (CD) (n=45), 55% of CD patients had not received an EKG within the last year (n=44), and 87% had not received an echocardiogram in the last 5 years (n=44). The CMSH is a lifesaving resource to patients who otherwise would have no access to medical care or medicine. We have identified several key areas for improvement, such as routine screening, nutrition, health literacy, transportation, and medical mistrust. Future volunteers from Northwestern have the potential to create QI projects in collaboration with the clinic staff targeted to address these specific barriers and improve the services provided by the clinic.

Presenting author: Kyle Freedman

Poster 13

Enhancing Women's Health Education: Addressing Pelvic Floor Dysfunction in Women at the CommunityHealth Clinic

Introduction / Background: Pelvic floor dysfunction (PFD) is a significant health issue for women, with lifetime prevalence estimated between 6-26% in heterosexual women. PFD can manifest in various ways, including incontinence, pelvic pain, and sexual dysfunction, and negatively impacts quality of life. There is often a lack of education and awareness of PFD, particularly in underserved communities. The CommunityHealth Clinic, one of the largest volunteer-based health centers in the nation, offers health services and health education at no charge to low-income, uninsured and underinsured adults in Chicago. To address this gap in knowledge of PFD, we partnered with the Women’s Wellness Group at the CommunityHealth Clinic to create participant driven content in the form of an interactive lecture. The aim was to increase knowledge and comfort in discussing pelvic floor health, including the signs, symptoms, risk factors, and prevention of PFD. Methods / Strategies / Activities: To understand the needs of the Women’s Wellness Group, we met with the group coordinator who identified an interest in PFD in the aging woman. We developed a curriculum focusing on an overview of PFD including the anatomy of the pelvic floor muscles, common symptoms, risk factors, practical exercises for managing PFD, and when to see a doctor. The 90-minute session included an image-based lecture, interactive group discussions, and small group breakout sessions. All materials were offered in both English and Spanish. The pre- and post-session surveys assessed participants’ knowledge (7 questions) and comfort level when discussing pelvic floor symptoms with their community and physicians (3 questions) before and after the session. Results / Findings / Lessons Learned: Twenty-four participants registered for the session. Eight participants attended and completed the pre- and post-session surveys. The median age participants was 54.5 years, with the ages ranging from 27-67. Seven of the eight participants noted Spanish as their primary language. Perception of knowledge and comfort in discussing pelvic floor dysfunction with family, friends and medical professionals increased significantly in nearly all participants between pre- and post-session surveys. However, content-based question response improvement varied, with 4 out of the 8 participants improving their knowledge in the post-session survey. Conclusions / Implications / Next Steps: Although content-based survey results were variable, perception of understanding and comfort discussing pelvic floor dysfunction significantly increased after session completion. This project underscores the importance of culturally and linguistically tailored health education in addressing sensitive health issues, like pelvic floor dysfunction, identified by a liaison of the community. The findings suggest that educational interventions can reduce stigma and empower women to engage in their health. To help sustain our curriculum, we have tied this lecture series into our residency program’s “Pelvic Rehab Interest Group” and developed an outline that can be used by future lecturers. Further research could explore the long-term impact of such education on pelvic floor health outcomes and the effectiveness of repeated workshops to reinforce learning and promote behavior change.

Presenting author: Lisa Laurenzana

Poster 14

Geographic Variation and Climate Change's Impact on Pediatric Atopic Dermatitis: A Scoping Review

Background In recent decades, climate change has brought about significant changes in precipitation, temperature, and airborne particulate matter around the globe, contributing to more extreme weather events. These environmental changes have had dire effects on the prevalence of atopic dermatitis (AD), a skin condition known to be aggravated by environmental irritants. While some existing research has explored this relationship, it has primarily focused on adult populations. This scoping review aims to fill this gap by mapping the impact of climate change on AD risk in pediatric populations, with an emphasis on geographic variation. By capturing articles published in countries around the world, our goal is to identify relationships between different environmental exposures and pollutants, providing a more nuanced understanding of how climate change affects AD in children worldwide. Methods We used the Joanna Briggs Institute guidance for scoping reviews. The review will consider studies that include infants and children up to 18 years of age, and exclude studies not published in English. An exploratory search was conducted using PubMed, and identification of five exemplary articles was made. A comprehensive search strategy was developed and ran against exemplary articles to validate the search procedure. This was followed by an in-depth search using the online platforms PubMed, Embase, and Cochrane Library. After refining our search strategy with MeSH terms, we yielded 969 articles. MeSH terms included items related to pediatrics, environmental pollution and climate change, atopic dermatitis, and geography. An initial pilot screening of 100 titles and abstracts will be done using Rayyan with Galter (KM) support, followed by a full-text screening of all articles. Author, year of publication, population, and outcome will be extracted and tabulated with Microsoft Excel. Findings Our preliminary search suggests that geographic variation in environmental pollutants may be associated with the risk of AD in children. Our primary objective is to examine the specific roles of pollutants, wildfire risks, and food scarcity, as well as the broader population-level effects of climate change, on AD prevalence and severity. Our secondary objective is to identify comorbidities commonly associated with AD in pediatric populations, which will help tailor targeted interventions in diverse global settings. Next Steps Further exploration must be done into global variation of atopic dermatitis and the effect of changing climate. Our next steps will be to: - Identify themes, propagators of AD, and factors affecting geographic variability within extracted data - Update search strategy as needed - Compile extracted data into tables - Conduct qualitative synthesis of findings - Identify areas for further exploration Conclusions This scoping review will provide insights into how climate change exacerbates AD in children globally, highlighting the critical need for additional research into geographic and environmental variation. By understanding these dynamics, we can develop well-informed interventions and protect vulnerable children with AD from the escalating effects of climate change.

Presenting author: Liza Yusem Carstens

Poster 15

A community engaged approach to adapt an evidence-based suicide prevention package for Ethiopian youth

Background Youth suicide is a global public health crisis, with an estimated 88% of all yearly youth suicide deaths occurring in low and middle-income countries (LMICs). In Ethiopia, national data indicates that 9% of the population experiences suicidal ideation. However, there is a lack of culturally adapted, effective evidence-based suicide prevention interventions for Ethiopian youth. As a result, the Ministry of Health in Ethiopia has identified suicide prevention as a key national priority. Previous work validated a brief suicide screener, the Ask Suicide-screening Questions (ASQ), in Amharic. The next step to reducing suicide is to systematically implement this screener and an evidence-based suicide prevention package in additional medical settings throughout the country. This work outlines the methodology to create an adapted screening, safety planning intervention, and psychiatric referral package for Ethiopian youths ages 10-18 using a community-engaged and cultural appropriate process for four outpatient hospitals in Ethiopia. Methods A Community Advisory Board (CAB) has been deployed by the Ethiopian Pediatric Society to collaborate throughout every step of the adaptation process. This study uses ADAPT-ITT, an established and rigorous eight-step approach, to adapt the suicide prevention package. The initial needs assessment step will involve conducting semi-structured, in-person interviews with policymakers, mental health professionals, and community members with lived experience, as well as eliciting community perspectives on suicide prevention, existing clinical workflows, and potential barriers to implementation. Following the needs assessment, the decision and administration steps of ADAPT-ITT will follow the WHO guidelines for translation involving forward and back linguistic translation of intervention materials by bilingual experts into Amharic. CAB members and clinicians will participate in theater testing, role-playing clinical interactions, evaluating context, and giving feedback on the practicality of the intervention package. Collected feedback will inform any modifications to the intervention package during the production and integration steps. Topical experts, including psychologists, psychiatrists, and youth with lived experience, will then review the modifications to determine which adaptations to integrate. Training materials for clinicians will be developed based on the reviewed adaptation modifications. In this study, the final two phases of ADAPT-ITT, training and testing, will be included in the trial phase piloting the intervention package. Findings The initial needs assessment phase is underway following the kickoff meeting and training with the research team and the CAB in Ethiopia. Preliminary findings will provide insights into constituent perspectives on suicide prevention, linguistic and cultural adaptations (e.g., need for additional languages or suicide content modifications, safety planning considerations regarding emotional expression, stigma, and family involvement), and acceptability and feasibility of integrating suicide screening and safety planning into existing clinical workflows. Conclusion This work will produce a linguistically and culturally adapted suicide prevention package to be used among youth across four geographically and demographically diverse sites in Ethiopia. Findings from this study can provide a framework for systematic adaptation processes and inform future culturally relevant adaptations of evidence-based practices to local contexts in LMICs. Future steps for this research will involve piloting and evaluating the effectiveness of the adapted suicide prevention package through a hybrid effectiveness-implementation trial.

Presenting author: Mallika Pandey

Poster 16

EFFECTS OF DIGITALIZED ANTENATAL EDUCATION ON PREVENTION OF MOTHER-TO-CHILD TRANSMISSION OF HIV AMONG PREGNANT WOMEN AND RECENTLY DELIVERED MOTHERS IN NIGERIA

Background: The magnitude of new pediatric HIV infection in Nigeria has made it one of the priority countries for the elimination of mother-to-child transmission (MTCT) of HIV infection. Effective antenatal education has been identified as being associated with prevention of MTCT. However, mothers infected with HIV stay away from attending antenatal clinics because of stigmatization associated with physical presence during the clinic. Hence, the introduction of technology has been found to improve maternal health. Therefore, this study assessed the effects of digitalized antenatal education on prevention of mother-to-child transmission (PMTCT) among pregnant women and recently delivered mothers living with HIV and receiving antiretroviral therapy (ART). Methods: The study adopted a quasi-experimental two-group pre and post-test design. Two out of six states were randomly selected from Southwestern Nigeria and were randomized into intervention and control groups. Primary and secondary healthcare facilities providing ART were purposively selected, and 223 pregnant women, and recently delivered mothers receiving ART were purposively selected to participate in the study. A validated online questionnaire was used for data collection at baseline and post-intervention. The participants in the intervention group received Digitalized Antenatal Education (DAE), while those in the control group received routine physical antenatal education. The DAE is a 3D animation graphic, which provides information on PMTCT, Self-management skills (SMSs), and Treatment compliance (CTx) for pregnant women living with HIV. A YouTube link to the animation was shared with the participants in intervention group. Data analysis was done using Stata version 17. Descriptive statistics was used to assess knowledge of PMTCT, SMSs, and CTx within the group, while student t-test was used to test for the significant difference between the two groups at α 0.05. Logistic regression was used to identify facilitators of the use of DAE. Ethical approval was obtained before commencement of data collection. Results: At baseline, the intervention group and the control group had 73(62.9%), and 67(62.6%) good KPMTCT, respectively. However, at post-intervention, 78(83.9%) had good KPMTCT in intervention group, while 67(62.6%) had good KPMTCT in the control group. Also, 66(56.9%) of the participants in the intervention group had good SMSs at baseline, while 81(75.7%) had good SMSs in the control group. At post-intervention, 54(58.1%) had good SMSs in intervention group, while 81(75.7%) had good SMSs in the control group. At baseline, 76(65.5%), and 75(70.1%) had good CTx in intervention group and control group, respectively, while, at post-intervention, 55(59.1%) had good CTx, and 75(70.1%) had good CTx. A significant difference (p<0.001) was observed in KPMTCT and SMSs between the intervention group and control group, while no significant difference (p=0.409) was observed in the CTx between the two groups. Key facilitators to DAE were found to be internet access (OR = 4.429, p = 0.032). and digital literacy (OR = 15.529, p = 0.001). Conclusion: Digitalized antenatal education could improve PMTCT, while internet access and digital literacy are strong predictors of DAE use. Therefore, improving digital literacy among childbearing women can increase the effectiveness of digital health interventions.

Presenting author: Margaret Omowaleola Akinwaare

Poster 17

Access to specialty care for patients at a higher weight: A multi-city survey

Background For patients who are obese, access to general medical care is limited and obesity bias contributes to poorer patient health outcomes (1,2). Yet, to our knowledge, no studies have captured the impact of obesity bias on obtaining specialized care. Methods Dermatology, endocrinology, otolaryngology, gynecology, and orthopedics clinics across the Cleveland, Boston, Houston, and Portland metropolitan areas were given a telephone survey to schedule an appointment for a fictional patient who was obese. The survey collected data on specialty clinics' basic standards of care– such as exam table weight limits, presence of widened hallways or doorways, gowns with extended sizing, and accessible chairs in the waiting room. Results Of the 300 active, unique clinics surveyed, 58.3% (n=175) could accommodate the fictional patient with basic standards of care. Only 43.3% (n=130) of clinics surveyed could sufficiently conduct the pertinent patient exam in a sensitive manner. Endocrinology clinics (n=60, Odds ratio [OR]=2.07, p=0.021, Confidence interval [CI]=1.12-3.83), and clinics in Portland (n=75, OR=2.03, p=0.010, CI=1.17-3.50), independently, were the most likely to accommodate a patient of a higher weight. Conclusions Many specialty clinics could not accommodate a patient at a higher-weight because of exam table weight limits, and accessibility to specialty care varies across both specialty types and major U.S. metropolitan areas. Better awareness among providers about the standards of care for patients who are obese is needed.

Presenting author: Maya Navarro

Poster 18

Educating the Next Generation on Lifestyle Medicine in Belize

Introduction/background: Hillside Health Clinic is a health clinic located in the Toledo district, which is the poorest district in all of Belize. Hillside provides free services and medications to patients to fill the unmet needs of the local community. Additionally, the clinic collaborates with local schools to provide public health education to children and adults. Given some of the most common diagnoses treated at Hillside are lifestyle diseases, such as cardiovascular disease and diabetes mellitus, nutrition and exercise teaching clinics were established with partnering local schools. Methods/strategies/activities: In order to address this need, Hillside created a School Health Program, where it paired up with local schools to educate children on healthy lifestyles with an emphasis on nutrition, exercise, and sleep and their impact on overall health and well-being. Learning objectives were created and a lesson plan was developed which included a pre-evaluation and three dynamic activities with post-lesson games focused on either nutrition, exercise, or sleep. The lesson plan concluded with a post-evaluation activity to assess effectiveness of the activities by gauging the children's understanding of the information and to build confidence to make positive choices for their health. Results/findings/lessons learned: This activity is currently planned for next week, after which the results will be shared in this section. Conclusions/implications/next steps: Depending on the effectiveness of the School Health Program, the lesson plan will be improved and presented at other schools in the surrounding area. Next steps include continued outreach throughout other districts of Belize.

Presenting author: Miriam Alpert

Poster 19

Adaptation of NeuroScreen, a tablet-based Neurocognitive test battery among adolescents with Perinatally acquired HIV (PHIV) in Southwestern Uganda

Introduction Neurocognitive impairment (NCI) is common among youth with perinatally acquired HIV (PHIV) and is difficult to measure in Low- and Middle-Income Countries (LMIC). Assessing NCI in LMICs, such as Uganda, faces major challenges, as current neurocognitive testing methods are burdensome and require expert administration, severely limiting the capacity to study, detect, and manage NCI. Neurocognitive tests deployed on tablet devices (e.g., iPads) offer a new platform to assess NCI, reduce administration times and reliance on experts, as well as improve tests for different contextual requirements. NeuroScreen is a tablet-based neurocognitive test battery application (app) comprising twelve subtests assessing working memory, learning, memory, executive functions, processing speed, and motor speed. In this qualitative study, we adapted NeuroScreen for Runyankole-speaking adolescents in rural South Western Uganda. Methods Adaptation of NeuroScreen followed the following process: 1) Forward translation; 2) backward translation by two proficient bilingual English and Runyankole speakers; 2) Review and adjustment of forward and backward translation by Ugandan and bilingual (English and Runyankole-speaking) Psychologists. Audio recordings were made for the finalized translations which were integrated into the app. 3) Focus group discussions (FGD) were conducted to review the new Runyankole version for usability, acceptability and understandability. We then conducted FGDs among 10 adolescents aged 12-19 years with perinatally acquired HIV. The data were analyzed using thematic content analysis. Results Participants were 16 years of age on average, and 6 were females. All adolescents were on a Dolutegravir based regimen and had an undetectable viral load (< 20 copies/ml). Three major themes were generated including 1) understandability and usefulness of activity instructions 2) test-taking experience and 3) usability of a tablet-based Neurocognitive test. The adolescents found the instructions useful and understandable, but needed to be attentive to understand some instructions. Regarding the test-taking experience and tablet usability, the adolescents enjoyed using the tablet and taking the test. Some (n=3) felt like they were playing a mind-stimulating game. Conclusions The Runyankole version of NeuroScreen was deemed to be a highly understandable, acceptable, and usable tablet-based neurocognitive test battery app among adolescents with PHIV in rural Uganda. These results will be used to inform future validation, and implementation of NeuroScreen in rural Uganda, assess NCI in youth with and without PHIV, and lastly build capacity to conduct epidemiological research in neurocognition in PHIV populations.

Presenting author: Moses Ochora

Poster 20

PREVALENCE AND FACTORS ASSOCIATED WITH RETINOPATHY OF PREMATURITY AT TWO REFERRAL HOSPITALS IN NORTHWEST TANZANIA

INTRODUCTION: Retinopathy of prematurity (ROP) is a condition characterized by the development of abnormal retinal vessels secondary to an incomplete vascularization of the retinal tissue. It is one of the leading causes of preventable childhood blindness. There are five stages of ROP stage 1, less severe form and stage 5 is total retinal detachment which is the most severe form of the disease vessels. PURPOSE: There has been a rapid increase in the capacity for care of premature infants in Northwest Tanzania (TZ). However, little is known about the prevalence and staging of Retinopathy of Prematurity (ROP) and associated clinical and maternal factors in this region. This study aimed to determine the prevalence of, and factors associated with, ROP among preterm infants born at two referral hospitals in Mwanza, TZ. METHODS: Preterm infants managed at Bugando Medical Centre (BMC) and Sekou Toure Regional Referral Hospital (SRRH) from July 2024 to December 2024 were enrolled in this cross-sectional hospital-based study. Infants born before 37 weeks gestational age (GA) with a chronological age of 4-7 weeks were included. Retinal findings were assessed using a Heine Omega 500 LED Binocular Indirect ophthalmoscope on a dilated fundus. Data was analyzed using STATA version 15 and a P value < 0.05 was considered significant. Ethical approval was granted by appropriate authorities. RESULTS: A total of 220 of participants were enrolled, 60% (132/220) from BMC and 88/220 40% 88/220 from SRRH. Among enrolled participants, GA was < 28 weeks in 1.4% (3/220), 28-32 weeks in 31.3% (69/220), 28-32 weeks in 25.5% (56/220) and 32+1-34 weeks in 41.8% (92/220). Birth weight was < 1000 grams in 4.1% (9/220), 1000-1500 grams in 38.2% (84/220) and 1501-2500 grams in 53.2% (117/220) of participants. The average chronological age on day of screening was 5 ± 1 weeks. Surfactant therapy was administered to 16% (35/220) participants. More than half 68.6% (151/220) of all participants received oxygen therapy, with CPAP applied in 58.2% (88/151). Overall, any stage of ROP was diagnosed in 8.6% (19/220) participants, of these 73.7 % (14/19) had a GA of < 32 weeks. The majority 73.3% (14/19) were in Zone II, with 57.9% (11/19) having stage one ROP. However, 6 participants had stage 3 ROP and of these 3 had plus disease. In a multivariate analysis adjusting for confounders GA (OR=0.5, 95%CI 0.3-0.8: P=0.001), ≥ 7 days of oxygen therapy (OR=12, 95%CI; 1.7-98: P=0.014) and history of maternal third trimester urinary tract infection (OR=4: 95% C;1.1-17: P=0.035) were associated with ROP. Each additional week of gestation reduced the odds of ROP by 50%. Chorioretinitis was observed on retinal exam in 10.9% (24/220) participants and attributed to maternal TORCH infection. CONCLUSIONS: This is the first study of ROP in preterm infants in the Mwanza region of TZ, finding a prevalence of ROP of 8.6%. Due to the possibility of differences in survival rates of very low and low birth weight infants, and differences in availability of resources including surfactant, comparisons of the prevalence of ROP found in our study with other regions in TZ are limited. Additional studies in the greater Mwanza region are warranted to inform the design of a regional screening program.

Presenting author: Neema Chami

Poster 21

Challenges in Managing Type 2 Diabetes Among Jordanian Adults: A Literature Review

Title: Challenges in Managing Type 2 Diabetes Among Jordanian Adults: A Literature Review Introduction: Jordan has a significantly higher prevalence of type 2 diabetes (T2DM) than the global average (14.8% vs. 10.5%, p < 0.00001), and its prevalence is expected to rise, leading to higher healthcare costs throughout the nation. This review aims to identify the barriers in adequate diabetes care in Jordanian adults. Methods: A systematic literature search was conducted with PubMed and EMBASE databases, using a combination of keywords and MeSH terms including "diabetes", "diabetes management" "healthcare delivery", "access to care", "quality of care", "patient adherence", and "Jordan." Peer-reviewed articles and grey literature published within the last 15 years were screened and synthesized to identify barriers that impact adequate T2DM care in Jordan. Results: T2DM care for Jordanian adults is hindered by a combination of healthcare-system limitations and patient-level challenges. Healthcare-system barriers include issues with access, cost, and service delivery. Although the majority of Jordanians live near healthcare facilities and ~80% of patients report minimal issues with access, those in remote or underserved areas still struggle with having regular healthcare services. Nearly a third of the population is uninsured, making out-of-pocket costs for medications, glucose test strips, and specialist visits a significant barrier. High patient-to-physician ratios lead to brief consultations, leaving little time for education or counseling. There are also gaps in preventative care, with only about one-quarter of patients receiving the recommended foot exams and less than half getting annual eye screenings. The healthcare workforce, while dedicated, often lacks specialized training in T2DM management (such as few providers being trained in nutrition counseling). Lastly, weak coordination between primary, secondary, and tertiary care leads to interruptions in follow-up, impeding consistent management of their condition. At the patient level, both limited health literacy and cultural factors play a major role in poor T2DM care. Many with T2DM do not fully understand their disease, nor how to effectively manage it. Both this knowledge gap and the asymptomatic nature of early T2DM lead to delayed care and sub-optimal self-management. Cultural dietary habits and social gatherings make it difficult for those with T2DM to comply with the strict diets required for adequate glycemic control - traditional foods and family expectations tend to conflict with medical advice. Cultural norms may restrict outdoor physical activity which contributes to low exercise rates. Financial hardships also affect patients' ability to sustain a healthy lifestyle; some cannot afford foods with low glycemic indices or transportation to appointments. Adherence to treatment is another key challenge: while most patients take their prescribed medications, far fewer follow exercise or diet-based recommendations and underestimate their value. Additionally, the psychological resistance to certain therapies such as insulin leads to treatment delays. Some common patient-reported barriers include forgetfulness, fear of side effects, reliance on herbal remedies, and lack of social support. All together, these factors result in poor glycemic control for a majority of those with T2DM, despite the availability of effective therapies. Next Steps: Addressing both the system-level and individual barriers is essential to improve T2DM outcomes in Jordan.

Presenting author: Nevin Kamal

Poster 22

Expanding Healthcare Access in Immigrant Communities: The Role of Telehealth Kiosks in Addressing Social Determinants of Health

Introduction/Background The U.S. immigrant population, particularly undocumented individuals, faces significant healthcare disparities due to social determinants such as poverty, housing insecurity, and limited access to medical services. In 2017, an estimated 44.5 million foreign-born individuals resided in the U.S., with 12.1 million undocumented. Many immigrants experience migration-related trauma and economic distress, contributing to poor physical and mental health outcomes. In Chicago, immigrants comprise 18% of the total population, with 790,000 non-citizens potentially at risk of deportation. Immigrant-dense neighborhoods such as West Ridge and Armor Square exhibit high social vulnerability, low primary care provider (PCP) availability, and lower rates of preventive screenings, underscoring the need for alternative healthcare models. Telehealth kiosks offer an innovative approach to bridging these gaps by providing accessible, culturally competent care. This proposal is currently conceptual and has not been implemented. Further research, funding, and collaboration with community stakeholders are necessary to assess its feasibility and potential impact. Methods/Strategies/Activities The Telehealth Kiosk initiative aims to enhance healthcare access in high-need immigrant communities by deploying kiosks in libraries and community centers. These kiosks offer: • Preventive care screenings for breast, colorectal, lung, and cervical cancers. • Social determinants of health assessments, addressing food insecurity, housing instability, and mental health needs. • Virtual primary care consultations using AI-based translators to overcome linguistic barriers. • Vitals monitoring, including blood pressure, temperature, pulse oximetry, heart rate, height, weight, and a digital stethoscope for remote auscultation. • Personalized health information sheets, generated based on a user's education level and preferred language, ensuring comprehension and engagement. Each kiosk is a private, enclosed space with physical barriers for privacy. It is equipped with a touchscreen interface featuring a high-quality microphone, speakers, and video camera for virtual consultations. The kiosks operate on a wired internet connection to ensure reliable access. Neighborhoods such as West Ridge (38% foreign-born, 22% limited English proficiency) and Armor Square (48% foreign-born, 24% limited English proficiency) were selected due to their high hardship indices (West Ridge: 75, Armor Square: 87, vs. 55 for Chicago) and low PCP availability (West Ridge: 41 per 100k residents, Armor Square: 67 per 100k, vs. 107 for Chicago). These communities also exhibit high unmet psychological distress rates (West Ridge: 76%, Armor Square: 91%) and lower preventive screening rates, further emphasizing the need for improved healthcare access. Results/Findings/Lessons Learned These findings suggest that telehealth kiosks can effectively address healthcare disparities by: • Reducing logistical and financial barriers to care for immigrant populations. • Improving access to preventive services in areas with limited provider availability. • Enhancing mental health support, particularly for communities with high distress rates. • Increasing health literacy and engagement with personalized, language-specific health materials. Conclusions/Implications/Next Steps The Telehealth Kiosk represents a scalable, community-centered solution to healthcare disparities in immigrant communities. By leveraging technology to provide accessible and culturally competent care, telehealth kiosks can enhance preventive healthcare utilization and social support in vulnerable populations. The ability to generate customized health education materials based on literacy and language preferences ensures that users receive understandable and actionable health information. Future steps include investigating kiosk development, integrating additional screening tools, collaborating with community stakeholders, and evaluating long-term health outcomes.

Presenting author: Nithin Charlly

Poster 23

Community Health Worker Stroke Education in Toledo District, Belize

Background: The Toledo District is the least populated district of Southern Belize with a population of approximately 42,000 people, with only 6,800 occupants in its district capital of Punta Gorda. Because of the presence of many cultural and topographically diverse villages, community health workers (CHWs) serve as vital links between healthcare systems and remote populations in the Toledo District. Stroke is a leading cause of death and disability in Belize, yet delays in recognition and treatment are common. Stroke was one of the most requested topics for CHWs at their monthly educational workshop. Objective: To evaluate the effectiveness of a stroke education workshop in improving stroke symptom recognition and risk-factor counseling among CHWs in Toledo District, Belize. Methods: A three-hour stroke education workshop was conducted for 21 CHWs on March 14, 2025. The curriculum was developed in collaboration with local healthcare professionals, specifically a local non-profit service provider in Toledo called Hillside Health Care. The CHW Stroke Workshop included a PowerPoint lecture and interactive breakout sessions focusing on the BEFAST mnemonic to identify stroke symptoms and lifestyle modification counseling to reduce stroke risk factors. Pre- and post-workshop surveys assessed stroke knowledge (6 multiple choice questions) and self-reported comfort with symptom identification and lifestyle counseling using Likert scales. Descriptive statistics and paired t-tests were used for analysis. Results: Of the 21 participants, 18 completed both pre- and post-surveys. Stroke knowledge scores significantly improved from a pre-workshop average of 62.7% to 89.7% post-workshop (p = 0.00). Comfort in identifying stroke symptoms increased from 2.71 to 4.19 (p = 0.00), and confidence in lifestyle counseling improved from 3.95 to 4.48 (p = 0.02). BEFAST recognition accuracy rose from 38% to 95%. Participants reported the workshop and focus groups were helpful, though limitations included knowledge gaps on medical terminology and CT scan use. Conclusion: The educational intervention significantly enhanced CHW stroke knowledge and confidence in patient counseling. Future efforts will focus on simplifying medical content, measuring long-term retention, and expanding educational initiatives in collaboration with local health organizations.

Presenting author: Nova Hou

Poster 24

Challenges to Utilization of Regional Anesthesia in Resource Limited Settings: A Literature Review

With growing focus on surgery as an essential component of global health, there is increasing demand for effective and safe delivery of anesthesia. Anesthesia care in low resource countries is limited by several factors including cost and lack of trained personnel. Furthermore, anesthesia care in these settings is often accompanied by higher morbidity and mortality rates than in high income countries. Regional anesthesia utilization in low resource settings has the potential to lower complication rates, reduce systemic drug use, and offer faster recovery times. This review aims to identify barriers to implementation and utilization of regional anesthesia as well as efforts to increase regional anesthesia use in low resource countries. Utilizing online databases including Pubmed, Google scholar, and Cochrane library, a literature search was conducted to explore the challenges associated with use of regional anesthesia in low-resource countries. Articles chosen were published between 2000 and 2025. Findings revealed barriers to utilization were related to clinical and educational challenges such as lack of trained personnel, infrastructure and equipment limitations, economic barriers, as well as policy and cultural attitudes towards anesthesia. Despite these challenges, there are growing efforts to overcome these barriers through regional anesthesia training programs and increasing access to low cost and portable equipment. This review highlights the importance of a multifaceted approach that incorporates investments in infrastructure, education, and policy to improve access and utilization of regional anesthesia in low resource countries.

Presenting author: Oluchi Nwoke

Poster 25

The Burden of Multimorbidity Among Non-Communicable Disease Patients attending the PEN Plus Clinics in Tanzania: A Cross-Sectional Study

Background Non-communicable diseases (NCDs) such as diabetes mellitus, sickle cell disease, and heart disease are surging in prevalence, particularly in low- and middle-income countries (LMICs). Patients with two or more chronic conditions (multimorbidity) have an increased risk of complications, which raises the cost of healthcare and lowers an individual's quality of life. The WHO Package of Essential NCDs Interventions for Primary Health Care (WHO PEN Plus) is a global strategy aimed at decentralising and integrating care for severe NCDs at district hospitals (primary healthcare first referral level hospitals), specifically in LMICs. In Tanzania, the model focuses on improving access to essential medications, diagnostics, and specialised care for conditions such as sickle cell disease (SCD), type 1 diabetes (T1D), type 2 diabetes on insulin (T2D), and a number of cardiac conditions. For targeted interventions like PEN Plus, it is essential to understand the burden and risk factors for multimorbidity. This paper describes the prevalence and determinants of multimorbidity among patients with NCDs attending PEN Plus clinics in Karatu and Kondoa district hospitals in Tanzania, which were established in 2023. Methods This cross-sectional study was conducted on a cohort of 314 patients diagnosed with cardiovascular diseases, diabetes mellitus, and/or sickle cell disease enrolled at PEN Plus clinics during the first 20 months of the project's implementation. Sociodemographic characteristics and additional co-morbidities including hypertension, diabetic retinopathy, HIV, chronic kidney disease, stroke, and tuberculosis, were collected for all patients at baseline. Multimorbidity was defined as having two or more ill conditions in an individual. The chi-square test, ANOVA, and regression models were used for analysis. Results The majority (55.4%) of the patients were female. The average age of patients with cardiac disease or diabetes was 37 years, whereas those with sickle cell disease had a mean age of 8.5 years. The overall prevalence of multimorbidity was 17.2%. The most common comorbidities were hypertension (11.1%), diabetic retinopathy (3.8%), diabetes mellitus (2.9%), and cardiovascular diseases (1.6%). Factors significantly associated with multimorbidity included older age (adjusted prevalence ratio [aPR] 1.03; 95% CI: 1.02-1.04; p < 0.001), living in Kondoa (aPR 2.2; 95% CI: 1.4-3.6; p = 0.001), and high BMI (aPR 2.0; 95% CI: 1.0-4.3; p = 0.066). Conclusion. Multimorbidity is a significant burden among patients with NCDs enrolled in a PEN plus cohort in Tanzania, with age, geographical location, and obesity or overweight emerging as key determinants. This presence of multimorbidity further complicates interventions to reduce NCD morbidity and mortality, particularly in rural settings where health services may be limited. The findings emphasise the need for NCD prevention, comprehensive screening for early detection, effective management of modifiable risk factors like weight, as well as understanding geographic differences. These findings underscore the urgent need for comprehensive healthcare approaches, including patient-centred care, to address NCDs holistically and improve patient outcomes.

Presenting author: Peter M. Karoli

Poster 26

Human Papillomavirus Genotypes in the Oral Mucosa of HIV-positive and HIV-negative Pregnant Women in Northcentral Nigeria: Preliminary Findings

BACKGROUND: Increased age, parity, hormonal, and immune system changes in pregnancy increase the frequency and risks of oral HPV infection among pregnant women. Oral human papillomavirus (HPV) infection is a growing public health concern, particularly among immunocompromised individuals, such as those living with HIV. Despite extensive research on cervical HPV, limited studies have examined oral HPV prevalence in pregnant women, especially in sub-Saharan Africa where HIV is most prevalent. METHODS: A cross-sectional study was conducted among HIV-positive and HIV-negative pregnant women in 4 secondary and 2 tertiary hospitals in Jos, Nigeria. Data was collected with an interviewer-administered semi-structured questionnaire followed by an oral examination, and oral epithelial biospecimens collection. The biospecimens were analysed and genotyped for 28 HPV types using Seegene Allplex™ system and results interpreted with the manufacturer’s viewer software. The association between HIV status and prevalence of HPV was assessed with X2 tests and correlation analysis. RESULTS: Eighty-one (47.4%) HIV-positive and 90 (52.6%) HIV-negative pregnant women were recruited. Among the participants, HPV DNA was detected in 19.9% (34/171). The most prevalent genotype detected overall was HPV70 (5.3%, 9/171) followed by HPV39 (3.5%, 6/171). Of the HIV-negative women 4.4% (4/90) were positive for HPV39 a high-risk HPV. HIV-positive pregnant women had a statistically significantly higher (p = 0.001) HPV prevalence (30.9%) than HIV-negative women (10.0%). CONCLUSION: The preliminary findings reveal a significant association between HIV-positive status and HPV infection in the oral mucosa of pregnant women in Nigeria, with HIV-positive women exhibiting a threefold higher prevalence of HPV compared to their HIV-negative counterparts. The immunosuppressant effect of HIV may account for the increased presence of oral HPV among the HIV-positive women. The findings highlight the need for integrated screening programs for both HIV and HPV during antenatal care to enable early detection and prevention strategies. A logistic regression model would allow us to adjust for potential confounders such as age, gravidity, sexual behaviour, ART use, and HIV viral load when the project is completed.

Presenting author: Priscilla O. Ameh

Poster 27

Social Media Usage and Mental Health: Insights from Ghana

Background: The COVID-19 pandemic increased the global prevalence of mental disorders across all age groups, with effects persisting beyond its peak. Lockdown and social distancing policies have led to increased reliance on social media (SM) for social support and interaction. However, a surge in cyberbullying, along with decreased sleep duration and physical activity, has emerged as negative consequences. This study investigates the association between SM use and mental health among Ghanaian adults in the post-COVID-19 digital era. Methods: Cross-sectional data from a nationwide sample of 5,631 adults aged 18 and over were drawn from the fourth round of the Ghana Socioeconomic Panel Survey (GSPS IV), conducted in 2022/23. I employed a random forest algorithm to identify key predictors of mental distress, which were then included as controls in a linear regression model (with distress scale as the outcome) and a logistic regression model (with moderate-to-severe distress as the outcome). Results: Controlling for prior mental distress and key predictors selected by the random forest—including region of residence, rural-urban locality, physical health, household assets, food insecurity, community and household composition, internet access and quality, healthcare access, education, and awareness of the Planting for Food and Jobs policy—I found a negative association between time spent on SM and mental distress (β = -0.31, p < 0.05; Adjusted odds ratio [AOR] = 0.83, 95% confidence interval [CI]: 0.71 - 0.98) with some evidence of nonlinearity (β = 0.04, p < 0.05; AOR = 1.03, 95% CI: 1.001 - 1.05). Further analysis showed that, compared to non-users, individuals who spent 2.5 to 5 hours per day on SM had a lower likelihood of experiencing symptoms of mental distress (β = -0.77, p < 0.05; AOR = 0.66, 95% CI: 0.45 - 0.96). In the analysis focusing on the type of primary SM use—which additionally controlled for time spent—predominantly passive users reported significantly higher distress than non-users (β = 0.77, p < 0.05), suggesting that the nature of primary SM use may influence mental health independently of usage duration. These findings did not vary significantly by age group, gender, religious affiliation, educational level, or rural-urban residence. Conclusions: The findings of this study highlight the need for strategies aimed at reducing harmful SM use to enhance mental well-being. Next Steps: As a next step, I plan to implement a randomized controlled trial to test the effectiveness of educating youth who spend over five hours daily on SM about its potential risks, promoting self-regulation using the RescueTime app, and offering monetary incentives to reduce harmful SM use and associated mental distress.

Presenting author: Samuel Ampaw

Poster 28

Scoping Current Opportunities for Health Professions Education in Eastern, Southern, and Western Africa

Background: As the global demand for physicians and other health care professionals grows around the world, there is increasing emphasis on promoting high quality health sciences education on an institutional level. Health Professions Education (HPE) Units and Departments of Medical Education in low- and middle-income countries have been created in recent years for curriculum reform, faculty training, development of scholarship in teaching and learning, quality assurance, research, and academic support. This study aims to understand the structure and function of HPE units in eastern, southern, and western Africa and develop recommendations for establishment and strengthening of HPE units in similar contexts. Methods/Activities: Northwestern University and AFREHealth designed and distributed a 33-item survey using REDCap to gather information on various HPE activities sent to anglophone schools as identified via the World Directory of Medical Schools and professional networks. Duplicate responses from institutions and responses not identifying a school were removed. Descriptive statistics and rapid summary analysis were conducted. In parallel, team members conducted semi-structured interviews with leaders of existing or in-development HPE units with a focus on structures, activities, facilitators and challenges. We conducted a focused content analysis to understand the structures, activities of, and facilitators and challenges experienced by HPE units. We used a purposive sampling to achieve representation by country as well as interviewed survey respondents who indicated interest. Results: The survey collected responses from 32 unique institutions in nine countries. 18 had a dedicated HPE unit, with 78% having internal and 33% having external funding. 32% of full-time and 25% of part-time faculty had medical degrees. Activities noted included capacity building, curriculum development, research in HPE, and faculty mentorship and advising. 30 interviews were completed with HPE leaders from 29 institutions in 10 countries. 22 of the 30 had an existing HPE unit. Need and impetus for HPE unit creation included accreditation, professional development, curriculum review, patient safety, and pedagogical teaching. Interviews provided further insight into the establishment of units including champions and key stakeholders, the heterogeneity of unit staffing, funding sources, future planning, and achievements. The breadth of HPE activities indicated opportunities for improving HPE education within institutions as well as more broadly through research and scholarship. Challenges identified by HPE units include financial, infrastructure, and human resource limitations. Facilitators to successful HPE unit operation include institutional financial support, strong collaborations within and between institutions, and leadership and faculty buy-in. Suggestions for faculty buy-in included focusing on both the structures, such as promotion policies or hiring practices, as well internal motivators such as informing faculty about and convincing them of the importance of HPE strategies. Conclusion and Next Steps: HPE units engage in a variety of activities, all with the potential to strengthen HPE in the region. While challenges to HPE unit sustainability exist—particularly regarding funding and faculty availability—their ability to enhance educational initiatives across these regions remains significant. Understanding the challenges faced by and the successes of current HPE units can help emerging departments prepare and advance HPE in the eastern, southern, and western regions of Africa.

Presenting author: Sarah Welch

Poster 29

Capacity Building to Enhance Women's Health Pathology Training in Jamaica: Observership Program Development

Background: Pathology and Laboratory Medicine (PALM) services are a cornerstone of effective healthcare delivery, particularly in diagnosing and managing diseases that disproportionately affect women, such as breast and cervical cancer. In low- and middle-income countries, there are numerous challenges in women's health not only concerning disease burden but also access to appropriate healthcare and diagnostic services. In Jamaica, these conditions contribute significantly to morbidity and mortality, with late-stage diagnosis and limited access to screening and treatment posing significant challenges. Strengthening pathology education and diagnostic capacity is essential to improving women's health outcomes, which is a key priority identified at the anatomic pathology graduate medical program in Jamaica. Through a sustainable, bi-directional collaboration with The University of the West Indies (UWI) in Jamaica, one of the only two graduate medical education pathology training programs serving the Caribbean region, this project aims to address identified educational gaps and enhance women's health pathology training in Jamaica through an international observership program at Northwestern University's (NU) Department of Pathology. Methods/Strategies: A systematic literature review was conducted to identify articles focusing on global health electives in pathology. The search encompassed PubMed and MEDLINE databases using the following keywords: "pathology global health elective," "pathology residency international rotation," "global health education in pathology," "pathology training in low-resource settings," and "global health electives in medical education" (Figure 1). In addition to the literature review, a needs assessment has been designed for pathology trainees and faculty at UWI using survey methods and focus groups. Key areas of this assessment will be to identify available resources, understand context-based diagnostic workflow, specific training gaps, and priority areas in women's health pathology. To design the curriculum, literature review and findings from the needs assessment will be combined with Kern's model for curriculum development. An educational framework will be established, incorporating virtual didactic lectures, case-based discussions, and an in-person rotation for UWI trainees at NU. Proposed Intervention: Following utilization of the Kern model to develop this educational program, we propose to implement this curriculum co-led by NU and UWI pathologists, with NU pathologists serving as subject-matter experts and UWI pathologists serving as contextual experts for UWI residents. This will take place during an elective block for senior residents over four weeks, using a hybrid rotational model. The goal of the curriculum is to expose UWI pathology residents to current, evidence-based practices in PALM for women's health and demonstrate competency in identified educational gaps (Figure 2). All virtual content will be recorded and stored as an ongoing educational resource for all current and future UWI residents. Monitoring and Evaluation: Throughout the process, there will be ongoing assessments to measure knowledge gained by participants and feedback mechanisms to evaluate the program's effectiveness from both participants and faculty. Conclusion and Future Directions This observership initiative will demonstrate the impact of international collaboration in strengthening pathology education in low-resource settings. Future efforts will focus on program scalability, sustainability, and continued bi-directional knowledge exchange. The long-term goal is to expand the initiative to include additional participants, incorporate local mentorship structures, and explore funding avenues to support ongoing training.

Presenting author: Steven H. Smith

Poster 30

Global and U.S. Funding Disparities in Pregnancy-Related Cardiovascular Research

Background: Pregnancy-related cardiovascular complications, including hypertensive disorders, cardiomyopathies, and thromboembolic events, are leading causes of maternal morbidity and mortality worldwide. Despite the growing field of cardio-obstetrics, disparities in research funding may hinder progress, particularly in low- and middle-income countries (LMICs). This study examines global and U.S. funding patterns for pregnancy-related cardiovascular research, highlighting disparities in allocation and research priorities. Methods: A systematic search of the NIH RePORTER and World Report databases was conducted to identify cardio-obstetrics research projects funded between 2014 and 2025, using predefined cardiovascular and pregnancy-related search terms. Following deduplication and screening, 186 relevant projects were analyzed. Thematic and co-occurrence analyses, supported by natural language processing and Python-based data visualization, were employed to identify research trends and funding gaps. Results: Total research funding amounted to $85.2 million, with the United States receiving the largest share ($71.2 million). The National Institutes of Health (NIH) was the primary global funding agency ($71 million). In the U.S., Pennsylvania received the highest allocation ($11 million), while 22 states had no funded institutions in Cardio-Obstetrics research. Hypertensive disorders were the most frequently funded topic (51 projects), followed by diabetes and metabolic health (36) and postpartum care (34), whereas preventive interventions (14) and maternal health disparities (13) remained significantly underfunded. Co-occurrence analysis revealed strong thematic associations between hypertensive disorders and long-term cardiovascular risk but weak connections between preventive interventions and cardiovascular risk reduction. Conclusion: Despite the substantial burden of pregnancy-related cardiovascular complications, research funding remains concentrated in high-income countries, with limited investment in LMICs. Underfunded areas, particularly preventive interventions and maternal health disparities, require targeted support to enhance maternal cardiovascular outcomes globally. Addressing these funding inequities could facilitate region-specific interventions and promote equitable maternal health advancements. Keywords: Cardio-obstetrics, maternal cardiovascular health, global health disparities, research funding, pregnancy-related complications, hypertensive disorders, maternal health equity.

Presenting author: Toluwalase Awoyemi

Poster 31

Barriers and Facilitators to the Implementation of Palliative Care Services at Five Tertiary Hospitals in Nigeria: A Qualitative Formative Study

Background Palliative care (PC) is defined as an active, total care approach to addressing the psychological, physical, social, and spiritual needs of individuals with life-limiting illnesses and their families. The demand for PC is rising, yet it remains inaccessible or underdeveloped in low- and middle-income countries like Nigeria. Understanding the factors influencing PC implementation is a crucial first step toward strengthening health system readiness and responsiveness to meet the growing demand for PC services in Nigeria and similar settings. Methods The primary aim of this study is to examine the barriers to and facilitators of implementing PC services from the perspective of health providers, patients and caregivers at tertiary public hospitals in Nigeria. We conducted five in-depth interviews and ten focus group discussions to explore health provider, patient and caregiver perspectives on barriers and facilitators to PC implementation at five geographically diverse PC units in Nigeria. Guided by the Consolidated Framework for Implementation Research (CFIR), qualitative data were analyzed using the framework approach. Results Barriers and facilitators spanned all five CFIR domains (Innovation, Outer Setting, Inner Setting, Individuals, and Implementation Process). Barriers to PC implementation included 1) patient financial constraints, 2) inadequate facility funding and resources, 3) shortage of PC providers, 4) delayed/late referrals, 5) Inaccurate knowledge and negative beliefs about PC among health providers and patients, and (6) substandard opioid medications. Facilitators included 1) high value for PC among patients and caregivers, 2) positive attitudes, 3) desire for PC knowledge and training among PC providers, and (4) strong provider motivation and commitment to improve patient quality of life. Conclusions This study captures perspectives from individuals across multiple geographically diverse PC units including providers, patients and their caregivers. It has identified key multi-level factors influencing PC delivery models at PC centers in Nigeria. These findings are informing the expansion and integration of PC services into local health systems across Nigeria, and potentially, to health systems in other African countries and LMICs.

Presenting author: Tory Grisanti

Poster 32