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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.
From Treatment to Survivorship: A Mixed-Methods Study of a Breast Cancer Survivorship Program in Lagos, Nigeria
Background: Breast cancer care is a multidisciplinary effort requiring collaboration amongst various specialties. With increased breast cancer awareness and treatment options in Sub-Saharan Africa (SSA), there is now a larger incidence of women living with a breast cancer diagnosis. However, there is a gap in literature in relation to social support systems and survivorship programs utilized by patients in SSA. This includes understanding the presence and effects of possible underdiagnosed physical and/or psychosocial side effects of having breast cancer and undergoing breast cancer treatment. Thus, this project aims to evaluate the current breast cancer survivorship program (Dew Drops) at Lakeshore Cancer Center in Lagos, Nigeria by assessing patient utilization of the program and patient-perceived needs that may be further met through the program. Methods: Patients greater than 18 years of age, currently or previously diagnosed with breast cancer, and being treated at Lakeshore Cancer Center in Lagos, Nigeria are eligible for inclusion. This is a mixed methods study utilizing both a survey questionnaire and qualitative interviews. Study tools include investigator-defined questions related to program utilization and awareness, and the ULL-27 validated questionnaire that evaluates quality of life and upper extremity lymphedema risk in breast cancer patients. This assesses domains of physical and psychosocial well-being. Recruitment fliers are shared at the Lakeshore Cancer Center and through the Dew Drops breast cancer support program. This project is supported and funded by the University of Lagos, Northwestern University, and Havey Global Health Institute. Results: IRB approval has been obtained by the University of Lagos and is currently pending from Northwestern University. We expect about 10-30 patients to complete both survey questionnaire and interviews. It has also provided an opportunity to understand the basic function of the Dew Drops Breast Cancer support program, which was necessary for baseline understanding of the programmatic structure during project development. Conclusion: This study is designed to inform future survivorship programming at Lakeshore Cancer Center by identifying patterns of program utilization and unmet physical and psychosocial needs among breast cancer survivors.
Presenting author: Adaure Nwaba
Poster 1
International Perspectives on Rehabilitation Intensity and Length of Stay following Spinal Cord Injury
Introduction / Background: Rehabilitation length of stay reflects how nations finance, organize, accredit, and deliver acute and post-acute care. We know little about how variations in length of stay across health systems relate to patient outcomes and experiences including patient perspectives regarding inpatient rehabilitation, discharge readiness, and long-term adjustment. Understanding these lived experiences may help contextualize variation in LOS and inform patient-centered rehabilitation practices. This study explores inpatient rehabilitation experiences among individuals with SCI across five countries with differing health care structures to better understand how system-level factors shape perceived readiness, recovery, and outcomes. Methods / Strategies / Activities: An international team of rehabilitation researchers and clinicians from Australia, Canada, the Netherlands, the United Kingdom and the United States conducted a qualitative study using semi-structured interviews and focus groups. Participants included adults with SCI and, in some cases, caregivers who had completed inpatient rehabilitation. Interview guides were collaboratively developed to ensure consistency across sites while allowing exploration of country-specific contexts. Discussions focused on inpatient rehabilitation experiences, discharge planning, access to resources, and perceptions of rehabilitation intensity and duration. Transcripts were analyzed using thematic analysis, with investigators identifying cross-cutting and country-specific themes through iterative coding and consensus-building. Results/Findings/Lessons Learned: Across countries, participants with chronic spinal cord injury described rehabilitation as foundational yet variably effective in preparing them for community reintegration. Major themes included discharge preparedness, home and community reintegration, rehabilitation goals, length of stay, balancing loss and acceptance, and overall rehabilitation experience. While some reported strong interdisciplinary support and meaningful skill-building, others felt unprepared for environmental barriers, limited outpatient access, and insufficient caregiver training. Experiences differed by health system context, with gaps in community resources, funding, and coordinated care shaping long-term outcomes. Regardless of setting, many participants encountered unanticipated challenges after discharge, underscoring the complexity of transitioning from inpatient care to community living. Conclusions / Implications / Next Steps: Findings highlight the need to strengthen discharge planning, caregiver education, and community-based rehabilitation infrastructure globally. Standardizing transitional care processes, improving access to outpatient and home services, and incorporating patient-centered goal setting may enhance long-term participation. Future efforts should prioritize context-specific, scalable models that integrate interdisciplinary care with community resources to promote sustainable reintegration.
Presenting author: Alexandra Wolfe
Poster 2
HCC Screening in Patients with Hepatitis C in Low and Middle Income Countries : A Literature Review
Intro: Hepatocellular carcinoma (HCC) represents a major global health burden and is a leading cause of global cancer mortality with increasing incidence and poor survival. HCC is the third leading cause of cancer death worldwide. This burden falls disproportionately on low- and middle-income countries (LMICs), where hepatitis C virus (HCV) is a leading etiology of chronic liver disease and HCC. Globally, approximately 71 million individuals have active HCV viremia, with sub-Saharan Africa having over 10 million cases. The World Health Organization has set a target of eliminating viral hepatitis as a public health threat by 2030, including a 65% reduction of HCV-related deaths and treatment of 80% eligible persons. Objectives: This literature review aims to synthesize current evidence on HCC screening practices in patients with hepatitis C in LMICs, evaluate the efficacy and cost-effectiveness of surveillance strategies in resource-limited settings, identify multi-level barriers to implementation, and propose evidence-based recommendations for improving surveillance adherence and clinical outcomes. Methods: A comprehensive search of medical literature online databases was conducted to identify studies examining HCC surveillance in HCV-infected populations in LMICs. Studies included addressed surveillance efficacy, diagnostic screening modalities, cost-effective analysis, multi-system barriers, and guideline recommendations based on outcomes. Results: International guidelines uniformly recommend semiannual surveillance of patients with HCV-related cirrhosis with an abdominal ultrasound and alpha-fetoprotein (AFP), which detects early-stage HCC with 63% sensitivity compared to 45% with ultrasound alone. A meta-analysis of 47 studies (15,158 patients) demonstrated that HCC surveillance led to improved early detection, curative treatment rates, and significantly prolonged survival. The combined testing is cost-effective when annual HCC incidence exceeds 0.2-1.5% per year, a threshold commonly met in LMICs. A meta-analysis in sub-Saharan Africa found that HCV-positivity was associated with a 9.4-fold increased risk of HCC; the incidence of HCV-related HCC in Africa has increased over the last four decades. Implementation of HCC surveillance in LMIC is limited by multilevel barriers, including the absence of national cancer registries, poor access to diagnostic imaging, variable ultrasound quality due to inconsistent operator training, and limited patient access to consistent care. Emerging strategies to improve surveillance in LMICs include point-of-care ultrasound and AFP testing, community-based screening programs, and emphasis on primary- care practitioners. There is potential in using the GALAD score, a serum biomarker-based model that predicts the probability of having HCC, as a cost-effective alternative to ultrasound-based surveillance. Conclusions: HCC surveillance in patients with HCV in LMICs is clinically impactful and cost effective with the potential to substantially reduce HCC-related mortality through early detection and subsequent curative treatment. However, realizing this potential requires systematic, context-appropriate interventions. Priorities of an effective implementation include: strengthened healthcare infrastructures with national surveillance programs, improved access to diagnostic tools, resource-sensitive treatment algorithms, educational programs, and integrated surveillance programs. Future research should emphasize prospective trials to evaluate context-appropriate surveillance strategies in diverse LMIC settings across regions with the highest HCV-related HCC burden.
Presenting author: Amanda Pirola
Poster 3
From Static to Dynamic: A Scoping Review of Analytic Methodologies for Chronic Disease Care Cascades in Global Health
Background Care cascades are widely used in global health to measure how patients move through care—from diagnosis to treatment and disease control. However, most cascades rely on a static "leaky pipe" model that assumes patients either progress forward or drop out permanently. This linear framing does not reflect the lived reality of chronic disease management, particularly in low- and middle-income countries (LMICs), where patients frequently cycle in and out of care due to structural challenges such as financial instability, mobility, and limited access to services. This dynamic pattern ("churn") has important implications for how health systems are evaluated and designed. This study examines analytic methodologies that better capture these dynamic patient trajectories and explores their relevance for global health education and implementation. Methods We conducted a scoping review of studies published through October 2025 using MEDLINE, Embase, CINAHL, and Scopus. We included studies from LMICs that applied dynamic, patient-level analytic methods (e.g., multi-state models, survival analysis, or systems-based approaches) to evaluate care cascades. Static and serial cross-sectional studies were excluded. Data were extracted and synthesized to characterize methodological approaches, key outputs, and their applicability to global health research, implementation, and training contexts. Results Of 5,091 records identified, 8 studies met inclusion criteria, all focused on HIV. No studies in hypertension or diabetes used dynamic analytic methods. Four key methodological approaches were identified: (1) multi-state models to capture bidirectional transitions in and out of care; (2) survival analysis to measure time to key outcomes while accounting for censoring; (3) stochastic optimization to model resource allocation and system performance; and (4) population reconstruction to account for migration and demographic change. These approaches generate actionable insights beyond traditional cascades, including transition probabilities, duration in care states, and rates of disengagement and re-engagement. Across studies, dynamic methods revealed substantial patient cycling and demonstrated that static models may overestimate retention and obscure critical gaps in care. These findings are directly relevant to ongoing global health work, including hypertension care cascade analyses in rural Burkina Faso (Nouna) and implementation efforts in Botswana, where longitudinal data suggest similar patterns of intermittent engagement that are not captured by conventional methods. Conclusions and Implications A critical gap exists between how global health systems measure care and how patients experience it. While HIV research has begun to adopt dynamic methodologies that reflect real-world patient movement, non-communicable disease (NCD) research remains largely reliant on static models. Bridging this gap is essential for designing health systems that align with the realities of lifelong chronic disease management in LMICs. For global health education, integrating dynamic analytic frameworks can shift training from identifying "dropouts" to understanding patient movement over time and designing systems that support re-engagement. Next steps include applying these methods to longitudinal NCD datasets in settings such as Botswana and Nouna and incorporating dynamic modeling into global health curricula to support more responsive, patient-centered, and equitable health systems. Ultimately, moving from static to dynamic measurement is not just a methodological improvement—it is a necessary step toward building health systems that reflect, rather than simplify, the realities of patients' lives.
Presenting author: Arielle Bell
Poster 4
Traditional Healers and Multiple Sclerosis in the Republic of Guinea: Implications for Referral Pathways, Early Diagnosis, and Health System Integration
Background: MS is increasingly recognized across sub-Saharan Africa. In the Republic of Guinea (2024 GNI per capita: 1440 USD) — home to five practicing neurologists for 14.8 million people — traditional healers frequently serve as first-contact providers for individuals seeking healthcare. In this work, we aim to characterize traditional healers' knowledge, explanatory models, and healthcare practices related to MS and neurological symptoms in Guinea. Methods: We conducted semi-structured interviews with 30 traditional healers recruited through snowball sampling in Guinea's Kindia Region. Interviews were conducted by a local physician in the participants' preferred language. Data were analyzed using thematic qualitative methods. Results: Healers were predominantly from rural villages (97%, n=29), with a mean age of 40.5 years (range 18–80 years); 43% were female (n=13). All completed interviews in the indigenous Susu language (30% were multilingual). Most had no formal education (60%, n=18), though 13% had a high school or university level of education. Nearly all entered practice through family tradition (97%), and the mean length of practice was 12.5 years (range 3–45). Awareness of the terms 'multiple sclerosis' and 'neuromyelitis optica or Devic's disease' was low (20%, n=6, and 17%, n=5, respectively), yet many reported treating patients with vision loss (50%, n=15) and motor weakness or paralysis (70%, n=21). Explanatory models were primarily spiritual (63%, n=19), while 30% (n=9) endorsed mixed spiritual and physical etiologies. Treatment mechanisms included botanical remedies either ingested or applied topically (93%), ritual and animal sacrificial practices (93%), and religious (Quranic) counseling (60%). One-third of healers had referred patients to physicians in the past, and all expressed willingness to collaborate with allopathic physicians. Conclusions: Although formal biomedical knowledge and awareness of MS was limited, traditional healers recognize MS-like symptom patterns and report managing affected individuals. Their openness to collaboration represents an opportunity to strengthen referral pathways, reduce diagnostic delay, and support culturally responsive, integrated neurological care in Guinea.
Presenting author: Dylan Rice
Poster 5
Determinants and Implementation of Hypertensive Disorders of Pregnancy Screening by Nonphysician Health Workers in Nigeria: A Mixed-Methods Study
Introduction: Hypertensive disorders of pregnancy (HDP) are a major contributor to maternal morbidity and mortality in Nigeria. Although blood pressure (BP) measurement and urinalysis are recommended components of antenatal care (ANC), there is limited evidence on how HDP screening and referral are implemented in routine primary healthcare by nonphysician health workers. This study evaluated implementation outcomes of HDP screening in primary healthcare facilities and identified determinants shaping practice in Kuje Area Council, Nigeria. Methods: Guided by Proctor's implementation outcomes framework and the Consolidated Framework for Implementation Research, we used an explanatory sequential mixed-methods design in 48 primary healthcare centres and clinics. Quantitative data included a Service Availability and Readiness Assessment, a retrospective ANC register review from 2021 to 2023, and a knowledge, attitudes, and practices survey of 124 nonphysician health workers. Qualitative data were collected through interviews and focus groups with providers, policymakers, and women with prior HDP, as well as 23 structured ANC observations. Quantitative and qualitative findings were integrated using joint displays. Results: BP screening demonstrated high acceptability, feasibility, penetration, and uptake across facilities. Functional BP devices were available in 98% of facilities and urinalysis kits in 100%; however, emergency and referral readiness were limited, with magnesium sulfate available in 30%, antihypertensive medication in 21.7%, and ambulance support in 4%. Overall readiness was moderate (median 58.8%, IQR 50.0–64.7). Among 8,824 ANC records reviewed, BP was documented for 98.6% of women, whereas urinalysis was documented for only 45.8%. Elevated BP was recorded in 1.4% of women; among those with elevated BP, 30.6% had a documented referral, and among referred women, only 47.4% had documented feedback. Provider attitudes toward screening were generally favorable, but only 46% correctly identified the hypertension diagnostic threshold, and 33% recognized that hypertension can occur at any stage in pregnancy. Qualitative findings showed that workforce shortages, workload pressures, training gaps, documentation burden, weak referral communication, and financial barriers constrained fidelity, continuity, and reach. Outreach activities, facility proximity, and responsive care supported acceptance and engagement. Conclusions: Routine BP screening is embedded within ANC in primary healthcare settings in Kuje, but important gaps in provider competency, urinalysis implementation, documentation, and referral communication limit effective HDP detection and continuity of care. Strengthening provider training, referral systems, and facility readiness at multiple levels may improve screening quality and maternal outcomes in low-resource primary care settings.
Presenting author: Emmanuel Iroboudu Okpetu
Poster 6
A 12-Month Media Narrative Analysis of Kenyan Coverage of the 2025 PEPFAR Funding Freeze
Background: In January 2025, the Trump Administration issued an Executive Order freezing all foreign assistance funds impacting the President's Emergency Plan for AIDS Relief (PEPFAR). Lack of these funds disrupted HIV programs in Kenya, a country with substantial reliance on external HIV financing. Early reporting emphasized acute disruptions worldwide in multiple PEPFAR-funded countries; less is known about how media narratives evolved over time, particularly in Kenya. Understanding these shifts provides insight into how global health crises are interpreted, sustained, and ultimately normalized in public discourse. Methods: We conducted a qualitative media narrative analysis of approximately 50–60 articles published between January and December 2025 from major Kenyan media outlets, including Daily Nation, The Standard, The Star, and Taifa Leo. Articles were identified through systematic keyword searches and coded using a structured framework capturing dominant narrative frames: crisis, human impact, health system fragility, political responsibility, adaptation, and normalization. Temporal analysis was performed by grouping articles into five phases: acute crisis (Jan–Feb), disruption and human impact (Mar–May), critique of current health structure (Jun–Aug), adaptation and policy response (Sep–Oct), and normalization and reframing (Nov–Dec). Results: Media framing evolved substantially over the study period. Early coverage (Jan–Feb) was dominated by framing the PEPFAR defunding as an acute crisis, emphasizing program disruptions, workforce instability, and urgent threats to HIV service delivery. In the subsequent phase (Mar–May), narratives shifted toward human impact, highlighting patient experiences, medication access concerns, and Kenya's reliance on donor funding. Mid-year coverage (Jun–Aug) increasingly focused on critiques of the current health system, framing the funding freeze as evidence of systemic vulnerability and insufficient domestic investment. By September–October, media narratives transitioned toward adaptation and policy response, with greater attention to government mitigation strategies and financing reforms. In the final phase (Nov–Dec), coverage demonstrated normalization and reframing, characterized by reduced urgency, diminished prominence of human-interest stories, and a shift toward broader discussions of sustainability of the health system, national responsibility, and global aid politics. Conclusion: Over 12 months, Kenyan media narratives evolved from acute crisis reporting to normalization and policy-oriented discourse. This progression underscores how global health crises expose underlying structural vulnerabilities and catalyze policy debate, often leading to expedited government reform efforts. This analysis seeks to highlight the critical role of media in shaping not only public perception of health crises, but also longer-term discourse around sustainability, resilience, and national accountability in global health systems.
Presenting author: Emmy Wanjiku
Poster 7
Northwestern University-University of Lagos Palliative Care (NULU Pall) Partnership Educational Symposium
Palliative care (PC) is an approach for addressing physical, social, and spiritual needs of individuals with lifelimiting and serious illnesses. PC is essential for better quality of life for these individuals, but is in initial stages of development in low- and middle-income countries. Nigeria has a population of 200 million, but there are few educational opportunities for healthcare providers to train/practice in PC with only 21 PC centers, 4 located in State of Lagos. In response to this need, the Northwestern University-University of Lagos Palliative Care partnership (NULUPall) formed in 2019 to develop a PC educational program tailored to the Nigerian context. The initial program launched as an online training initiative in 2020-21, followed by 3 years of an annual in-person symposium hosted at Lagos University Teaching Hospital. All trainings were developed with the Education in Palliative and End-of-Life Care (EPEC) curricula, which teaches fundamental PC skills, has been adapted to multiple specialties and has trained colleagues for more than two decades from more than 25 countries. EPEC served as a foundation, with additional content aligned with each year's annual theme. Themes included general PC, pediatric PC, and the role of nursing in PC. Symposium sessions are co-taught by Nigerian and international facilitators over two days with the third day structured as a train-the-trainer half-day session. Participants originally came from University of Lagos but now are from both private and public nearby hospitals and institutions. The most recent feedback and data came from a pre-registration survey and post-session survey of participants. The online program had 3 sessions with 35 participants. 70% had no previous training in palliative care and all were interested in continued training. Once the in-person symposium launched in 2023, the number of participants each year has grown from 42 to most recently over 80. From the most recent symposium, all respondents (N=83) agreed that the symposium provided practical strategies for integrating PC into daily practice. Communication (N=22), Ethical Issues (N=20), and Train the Trainer (N=7) were rated as the most valuable sessions. From the 5-year collaboration of PC training at Lagos, there continues to be significant demand for PC education. Based on the results from our post-survey, future symposia will focus on communication practices and have an interdisciplinary approach to include wide range of clinicians. Expansion to other institutions in Nigeria or an integration with online recordings can grow the availability of training to a wider audience.
Presenting author: Grace Nelson
Poster 8
Agrotoxin Exposure and Reproductive Health in Latin America
1. Agrotoxin exposure poses a serious health risk for communities who live in close proximity to agricultural activities across Latin America. Pesticide use in agricultural production has resulted in chronic exposure to these toxins through contaminated water sources, pesticide drift and direct occupational contact. These exposures fall disproportionately on rural populations, including women and families living near these agricultural operations. Growing evidence links commonly used pesticides, including glyphosate, to adverse reproductive and developmental health outcomes, including miscarriage, infertility, low birth weight and endocrine disruption. In the spring of 2026, an interdisciplinary team of graduate students in Northwestern's Health & Human Rights course developed a project to examine how international advocacy pathways may help address agrotoxins-related reproductive health harms in Latin America and respond to their broader public health implications. Latin America is the world's largest consumer of pesticides, accounting for more than 50% of global agrotoxin use as of 2020, and many pesticides banned in Europe continue to be exported to the region. This pattern reflects a broader structural asymmetry in which Global North companies profit from exporting substances banned in their own jurisdiction to countries with weaker regulatory frameworks, while around 95% of the 385 million people who suffer unintentional pesticide poisoning annually live in the Global South. 2. Working in collaboration with the Center for Reproductive Rights, our team conducted a qualitative review of advocacy strategies involving two international legal mechanisms: the Rotterdam Convention on hazardous chemicals and pesticides in international trade and the OECD Guidelines for Multinational Enterprises. Using case-based analysis, we examined how these mechanisms have been used to advance chemical regulation and achieve greater corporate accountability related to the trade and use of toxic substances, like pesticides, that harm human health. 3. Across both mechanisms, several common themes emerged. Scientific evidence alone is often insufficient to drive regulatory or other forms of concrete change for affected communities. Instead, successful advocacy frequently combines scientific findings with public health framing, coalition building, and strategic engagement with international institutions. 4. This project highlights the challenges communities face in seeking protection from agrotoxin-related reproductive harms, while also identifying international advocacy pathways that may strengthen international regulation of these chemicals or enhance accountability for the actors who use them. Future work will continue exploring strategies to support and protect reproductive and environmental health for communities living with the impacts of pesticide use in Latin America.
Presenting author: Hadia Mohammadzadah
Poster 9
Teaching Ankle Taping for Injury Prevention Among Soccer Coaches in Punta Gorda, Belize: A Quality Improvement Initiative
Introduction/Background: Ankle injuries are among the most common musculoskeletal injuries in soccer players, due to the frequent acceleration and deceleration of players, abrupt changes of direction, and repetitive kicks. In soccer, ankle injuries account for a substantial portion of time lost from play and recurrent injuries. Punta Gorda, Belize is considered a resource limited setting, with the population there having little to no access to athletic trainers, physical therapists, and preventative education, placing the population more at risk for sustaining injuries. Furthermore, while soccer remains the most popularly spectated and played sport in Belize, soccer athletes playing in rural Belize often play in competitive settings with uneven fields and protective equipment, placing them more at risk for sustaining injuries. This quality improvement project aimed to improve local Belizean soccer coaches with injury prevention skills by teaching local soccer coaches in Punta Gorda, Belize how to perform effective ankle taping techniques that can be applied to players during training and competition. Methods This QI initiative will be conducted through a single in-person educational workshop for coaches of local soccer teams. These local soccer teams are composed of athletes ranging from youth to adult ages. The workshop is scheduled for April 15, 2026 and will begin with a pre-workshop survey to evaluate baseline knowledge of familiarity with ankle taping techniques, indications for ankle taping, confidence in performing ankle taping, and the frequency in which they are currently employing ankle taping for their athletes. We will then proceed with the didactic portion of the workshop, in which two fourth year resident physicians trained in Physical Medicine & Rehabilitation will discuss indications for ankle taping. Following the didactics, instructors will then demonstrate ankle taping technique, including ankle preparation, application of anchor strips, stirrups, heel locks, and figure-eight reinforcement patterns designed to limit degrees of inversion and provide greater ankle stability. This will then be followed by coaches performing hands-on practice, applying the taping technique on peers under guided supervision to reinforce key principles. Visual step-by-step guides will also be distributed to aid with long-term retention that the coaches can refer to during practices and competitive play. Results: As this is a workshop that has yet to occur, outcome data are not currently available yet. This abstract will be updated with data prior to Global Health Education day to determine if ankle taping workshops can help improve knowledge and self-efficacy among soccer coaches in Punta Gorda, Belize. Conclusions: This QI project aims to provide a practical, low-cost, and sustainable intervention to prevent ankle injuries for soccer players in Punta Gorda, Belize. By training soccer coaches rather than individual soccer players themselves, we hope to employ the global health principle of "training-the-trainer" so that these local soccer coaches can disseminate this knowledge to their athletes over time. Future steps can include follow-up assessments of ankle-taping technique retention, pre and post intervention studies on rates of ankle injuries in soccer players in Punta Gorda, Belize, or implementation projects on improving access to taping materials.
Presenting author: Irene Tseng
Poster 10
Evaluating the Long-Term Impact of a Community-Wide HPV and Cervical Cancer Education Campaign on Health Seeking Behavior
BACKGROUND: What is the long-term impact of a community-wide HPV and cervical cancer education campaign on health seeking behavior? How do these impacts differ by individual characteristics such as age, marital status, and employment status? How do these impacts differ by community characteristics such as the degree to which the community is supportive, trusting, and accepting? Despite its status as a preventable disease, cervical cancer is the leading cause of cancer deaths in women in Kenya (Sung et al. 2021). In 2020, the World Health Organization formally adopted a cervical cancer elimination strategy. The "90-70-90" targets for vaccination, screening, and treatment call for 90% of girls under 15 to undergo HPV vaccination; 70% of women to be screened twice (before 35 and again by age 45); and 90% of women with pre-cancer and cervical cancer to be treated and managed (WHO 2023). Increasing health seeking behavior, specifically for HPV testing, is crucial to meet these WHO targets. METHODS AND PRELIMINARY RESULTS: This research builds on a two-phase cluster-randomized trial conducted in 2016 to evaluate the effectiveness of a community-wide HPV and cervical cancer education and screening intervention in promoting follow-up care in Migori County, Kenya (Huchko et al. 2018). Women in both the intervention and control groups received HPV and cervical cancer education and outreach from community health volunteers over a 2-week dedicated community health campaign. Following which, women in the intervention group received HPV screening in a centralized location within their village, and women in the control villages were screened at the local government health facility. A follow-up survey conducted in 2022 was administered to 1,080 women living in these control and intervention villages to assess the long-term impacts of the RCT. Six years post-intervention, were women in the study area likely to follow the WHO guidelines to undergo HPV screening a second time? Did they exhibit other health seeking behaviors? Drawing on these survey data, this project uses linear probability models and OLS regression models to: 1. Identify if participation in the HPV and cervical cancer education intervention increases health seeking behavior in general, and specifically around HPV testing; 2. Identify individual factors associated with these health seeking behaviors; and 3. Identify community factors associated with these health seeking behaviors. Preliminary results suggest that there exists variation in receptiveness to the community education campaign within both individuals and communities. Complete results will be available in the updated abstract prior to the poster session. IMPLICATIONS: Meeting the WHO's "90-70-90" targets requires effective educational outreach. By examining characteristics associated with uptake at the individual-level and community-level, this research provides insights into how both factors contribute to a successful community education campaign. On a micro level, this research documents the link between health education and health seeking behavior amongst women in rural Kenya. On a macro level, these results are useful for scholars, practitioners, and policy makers seeking to identify ways to increase HPV testing in low- and middle-income countries where the disease burden of cervical cancer remains high.
Presenting author: Kelly Hunter
Poster 11
Expanding Infrastructure for Genomic Surveillance and Bioinformatics in West Africa
Introduction Antimicrobial resistance (AMR) is a growing global health crisis, with fungal pathogens emerging as a neglected but deadly threat. In western sub-Saharan Africa, where HIV prevalence and limited access to effective antifungal therapies heighten vulnerability, invasive fungal infections are a major cause of morbidity and mortality. However, genomic surveillance of pathogenic fungi which is critical for identifying resistance mechanisms, tracing outbreaks, and guiding public health interventions, remains severely underdeveloped in low- and middle-income countries, including Nigeria. Methods This project sought to expand genomic surveillance capacity for pathogenic fungi in Lagos, Nigeria, through a partnership between Northwestern University's Center for Pathogen Genomics and Microbial Evolution (CPGME), the University of Lagos College of Medicine, and the Mycology Reference Laboratory at the Lagos University Teaching Hospital. Project goals were to establish on-site infrastructure and training for fungal genome sequencing using the Oxford Nanopore MinION platform, coupled with a bioinformatics and phylogenetics workshop to strengthen local expertise, and (2) support the development of fungal specimen and sequence databases, with ongoing remote mentorship and collaborative analysis to monitor antifungal resistance and transmission dynamics. The four-day workshop was hosted on-site at the Mycology Reference Laboratory at the Lagos University Teaching Hospital. The training cohort included participants from eight African countries, with 65% of participants residing in Nigeria. Ninety percent of participants held an advanced degree and held academic, medical or public health positions at their respective institutions. The workshop was structured to include didactic lectures on molecular epidemiology and sequencing technology, hands-on laboratory training for DNA extraction and next generation sequencing preparation and execution; and computational training was also provided for command line, sequence assembly and phylogenetics. Participants had the opportunity to analyze data from the sequencing run completed during the workshop as part of their practical application training. Participants organized into groups and developed project proposals leveraging their newly acquired genomics skills. Participants were also given resources to expand their training online as well as study abroad opportunities. Results Knowledge was assessed through administration of a pre and post-training assessment. The post-training assessment demonstrated a substantial improvement in participant performance, with mean scores increasing from 44.0% pre-training to 72.8% post. Improvements were most pronounced in sequencing workflow concepts, including barcoding, flow cell quality control, and de novo assembly tools. Variability in scores decreased, and minimum performance improved, suggesting effective knowledge transfer across participants with diverse baseline experience. Conclusions By integrating laboratory and computational training, infrastructure, and sustained collaboration, this initiative will create a sustainable platform for genomic surveillance in West Africa, filling critical gaps in fungal AMR monitoring. The project will enhance Nigeria's preparedness for fungal disease outbreaks, contribute essential data to global surveillance efforts, and foster long-term capacity for research and public health response to antimicrobial resistance.
Presenting author: Lacy Simons
Poster 12
Clinical Diagnosis and Treatment Across Different Resource Settings: A Two-Patient Comparative Case Report
BACKGROUND: Neurological conditions are the leading cause of global disease burden, with disproportionate impact in low- and middle-income countries (LMICs) that operate with the fewest neurologists, least imaging, and smallest critical-care capacity. Stroke alone accounts for ~25% of neurological DALYs globally, with the highest age-standardized rates in sub-Saharan Africa. We compare two patients with a similar neurological presentation and imaging findings — multiple ring-enhancing intracranial lesions in immunocompromised hosts — cared for in very different settings. CASE DESCRIPTIONS: Patient Z is a 48-year-old man with HIV (CD4 24, viral load 56,800) admitted to University Teaching Hospital in Lusaka, Zambia, with one month of progressive headache, weakness, and encephalopathy. Non-contrast CT demonstrated multiple hyperdense ring-enhancing lesions with surrounding edema. The diagnostic workup was impeded by imaging access (non-functional hospital MRI) and cost-rationed CSF studies, where a single meningitis PCR cost more than a month of urban wages. He received empiric multi-agent therapy (TB regimen, toxoplasmosis treatment, meropenem) on hospital day 16 and passed away four days later, without a clear etiologic diagnosis. Patient A is a 58-year-old woman on mycophenolate for autoimmune hepatitis admitted to Northwestern Memorial Hospital in Chicago with subacute cognitive change after a witnessed fall with head strike. CT showed right basal ganglia hemorrhage; MRI demonstrated multiple ring-enhancing lesions; lumbar puncture revealed lymphocytic pleocytosis with atypical lymphoid cells. Parallel workup including CT-CAP, CTV, TTE, MR spine, PET-CT, and day-16 brain biopsy yielded a diagnosis of CNS histoplasmosis. Hospital course was complicated by bilateral pulmonary emboli, DVTs requiring IVC filter, and prolonged mechanical ventilation ultimately leading to tracheostomy, Patient was discharge to long-term acute care. DISCUSSION: Disease class did not predict outcome — cascade access did. Patient Z’s care was delayed early in the cascade (diagnostic evaluation → treatment planning), driven by imaging access, financial constraints, and limited ICU capacity. Patient A’s care was delayed later (treatment monitoring → rehabilitation), driven by diagnostic uncertainty, biopsy timing, and respiratory complications. We review the differential for ring-enhancing lesions, host- and resource-driven shifts in pre-test probability, and biases shaping cascade-level decisions. CONCLUSIONS: Outcomes diverged not because of disease but cascade access. Emerging strategies — point-of-care molecular diagnostics, portable low-field MRI, tele-mentoring, CSF metagenomic sequencing, and AI-augmented diagnostic stewardship — aim to flatten the resource gradient.
Presenting author: Naomi Ayele
Poster 13
Bright IDEAS Problem-Solving Skills Training for Uganda Professionals Caring for Pediatrics with Cancer: A Pilot Study
Background: Bright IDEAS was designed to aid caregivers of children with cancer. Although promising in high-income settings, the feasibility and utility of this intervention in relatively resource-poor countries have only been partially explored. This pilot study examined whether Bright IDEAS was perceived as workable, usable, and useful by professionals in Uganda caring for patients and caregivers within pediatric oncology services. Methods: We used a single-arm pilot feasibility study design applied in the period from 2023 to 2025. The participants included 24 Ugandan health and psychosocial professionals trained in the Bright IDEAS model. Quantitative data were acquired using a post-training survey of usability, feasibility, comfort, practicality, and perceived utility on a 5-point Likert scale (1 = Poor to 5 = Excellent). Open-ended items addressed barriers, enablers, and experiences of implementation. Descriptive statistics and thematic content analysis were conducted. Results: Respondents rated both overall feasibility and usability highly (M = 4.3, SD = 0.6). They reported high comfort in teaching caregivers about the intervention (M = 4.1) and that the Bright IDEAS strategies were easy for caregivers to understand (M = 4.4). The major themes with a qualitative focus were empowerment of caregivers, strengthened problem-solving skills, and enhanced therapeutic engagement. Relevant challenges included lack of support from the institution, time constraints, and inadequate resources. Conclusion: Bright IDEAS was also widely believed to work for Ugandan professionals, and the study reports strong impact on caregiver coping and communication. These results support additional contextual refinement and robust testing of Bright IDEAS in Ugandan oncology and psychosocial care contexts.
Presenting author: Nicole Schneider
Poster 14
Understanding HPV Vaccination Knowledge, Barriers, and Willingness to Vaccinate in Toledo, Belize
Introduction / Background: Cervical cancer is the fourth most common cancer among women worldwide, causing approximately 350,000 deaths in 2022, with nearly 90% of cases occurring in low- and middle-income countries. Human papillomavirus (HPV) is the primary etiologic agent of cervical cancer and is preventable through vaccination. The World Health Organization has prioritized achieving 90% HPV vaccination coverage globally as a key strategy for cervical cancer elimination. Belize carries one of the highest cervical cancer incidence and mortality rates in Latin America and the Caribbean. HPV prevalence remains high, particularly among younger women, and despite the introduction of HPV vaccination into the national immunization program in 2016, coverage remains suboptimal, with approximately 62% of the eligible population vaccinated in 2024. Barriers to uptake in low-resource settings include knowledge gaps, sociocultural stigma linking HPV to sexual activity, structural access challenges, and mistrust in healthcare systems. There is limited research specific to Belize, particularly rural districts such as Toledo, in examining community beliefs and barriers related to HPV vaccination. Methods / Strategies / Activities: This mixed-methods study will recruit two participant groups in Toledo District, Belize: (1) adults from clinic waiting rooms at Hillside Health Care International and affiliated sites, including parents, vaccine-eligible adults, and healthcare providers; and (2) community leaders recruited through local outreach and professional networks. Data collection will include structured questionnaires, one-on-one interviews, focus groups, and limited ethnographic observation. Quantitative data will assess knowledge, awareness, and vaccination status, while qualitative methods will explore sociocultural beliefs, perceived barriers, facilitators, and health communication strategies influencing vaccine uptake. Comparative data will also examine rural versus urban vaccination patterns where feasible. Results / Findings / Lessons Learned: Anticipated findings include identification of multilevel barriers to HPV vaccination, including informational deficits, stigma, structural access limitations, and trust-related concerns. The study expects to highlight differences in perceptions between community members and healthcare providers and to identify trusted communication channels and culturally relevant strategies to improve uptake. Conclusions / Implications / Next Steps: This study aims to generate actionable, community-informed recommendations to strengthen HPV vaccination programs in Toledo District. Findings will inform the development of targeted educational resources and outreach interventions designed to increase vaccine confidence and coverage. Improved vaccination uptake has the potential to reduce cervical cancer burden, decrease long-term healthcare costs, and advance Belize's progress toward global cervical cancer elimination goals.
Presenting author: Nikita Gourishetty
Poster 15
Interventions to Improve Blood Pressure Control Among Hypertensive Patients in South Asia: A Systematic Review
Background: Hypertension is a leading modifiable risk factor for cardiovascular morbidity and mortality in South Asia, where prevalence is rising, and blood pressure control rates remain suboptimal despite the availability of antihypertensive therapy. Although epidemiologic data describing disease burden are well established, less is known about which implemented interventions have demonstrated measurable improvements in medication adherence and blood pressure outcomes across diverse South Asian settings. To bridge that knowledge gap, we conducted a systematic review to identify and synthesize intervention studies conducted in South Asia that aim to improve antihypertensive medication adherence and blood pressure control, and to characterize their implementation features to inform scalable public health strategies. Methods: A systematic review was conducted following PRISMA guidelines. Eligible studies were conducted in South Asia, included hypertensive patients prescribed antihypertensive medication, evaluated an implemented intervention, and reported medication adherence and/or systolic or diastolic blood pressure outcomes. Intervention study designs (RCTs, cluster RCTs, quasi-experimental, controlled before–and–after, or pre–post) were included. Databases were searched using structured librarian-developed strategies. Screening and data extraction were conducted in Covidence using standardized forms. Findings will be synthesized descriptively, with quantitative summaries conducted in R. Preliminary Results: A total of 2,451 records were imported for screening; 115 (4.7%) studies advanced to full-text review. Full-text screening is in progress. For eligible studies, we will extract and synthesize: country and setting (rural/urban), study design, sample size, intervention components (e.g., community health worker–based care, mHealth/SMS reminders, pharmacist-led models, financial or structural supports), medication adherence measurement method (self-report, pill count, MPR/PDC), blood pressure outcomes (change in systolic and/or diastolic blood pressure), presence of a comparison group, duration of follow-up, and key implementation characteristics categorized using Proctor's framework (e.g., adoption, feasibility, fidelity, sustainability). Conclusions: This review will provide the first comprehensive synthesis of implemented hypertension control strategies across South Asia. By identifying effective intervention models and contextual implementation factors, the findings aim to inform scalable, equity-focused cardiovascular health programming and help reduce preventable cardiovascular mortality in the region.
Presenting author: Nivedita Kumar
Poster 16
Understanding the Care Cascade for Hypertension Among Older People in Urban and Rural Rwanda: Barriers and Opportunities for Improved Access and Outcomes
Introduction Many countries in Sub-Saharan Africa (SSA), including Rwanda, are undergoing an epidemiological transition characterized by a rising burden of non-communicable diseases (NCDs), particularly cardiovascular disease. Despite efforts to strengthen healthcare access, many individuals with hypertension (HTN) remain undiagnosed, untreated, or poorly controlled. To address these gaps, we analyzed the hypertension care cascade in Rwanda from a large, population-based household survey of adults aged 40 years and above in rural and urban areas factors associated with stage along the HTN cascade. Methods We conducted a population based cross-sectional study of people age 40 and older in rural and urban Rwanda between March and June 2024. Surveys captured sociodemographic and health factors and measurements including blood pressure (BP), glucose and frailty. For HTN care cascade analysis, individuals were categorized based on how far along the cascade they were: 1. Previously Diagnosed, 2. Diagnosed and Ever Treated, 3. Diagnosed and Recently Treated, 4. Diagnosed and BP Controlled, and 5. Diagnosed and BP Controlled on Treatment. We used descriptive statistics and multivariable logistic regression models to calculate adjusted odds ratios (aORs) and 95% CI. Statistical significance was defined as p < 0.05. Results Overall, 4369 individuals were included in the analysis. Two-thirds of the survey respondents were female (63.1%, n=2757). Reflecting planned sampling, Most participants lived in urban areas (80.9%, n=3536). One fifth (21.4% (n/N=933/4369)) reported a previous diagnosis of HTN with 60.9% (n/N=568/933) ever been prescribed HTN treatment with 62.1% (n/N=353/568) having used their prescribed medication within the past 2 weeks (recent use). Of those who had been previously diagnosed 21.9% (n/N=205/933) were controlled on treatment with an additional 11.9% (n/N=111/933) controlled without treatment. 18.4% (n/N=317/1724) of those with survey-measured elevated BP had never been screened (Missed Screen), while 44.3% (n/N=763/1724) had never been told they had HTN (Missed Diagnosis). Compared to females, male participants were less likely to have been previously diagnosed (aOR=0.53, 95%CI:0.44-0.64), ever treated (aOR=0.46, 95%CI:0.36-0.58) or report control of their HTN (aOR= 0.59, 95%CI:0.45-0.77). Compared to those 40-49, older participants were more likely to have been previously diagnosed, ever treated, and controlled. Trend p-value for age across the different stages of the cascade: < 0.001. Compared to those in the lowest wealth quintile, those in the highest quintile were more likely to have been previously diagnosed (aOR= 2.09, 95%CI:1.58-2.78), recently treated (aOR=3.09, 95%CI:1.99-4.86), and controlled (aOR= 1.79, 95%CI:1.19 - 2.72). Conclusions: Substantial gaps persist in the HTN care cascade in Rwanda, with many older adults remaining undiagnosed, untreated, and uncontrolled. Targeted strategies to improve screening, treatment, and control are particularly needed among people ager 40-49, men, and those with lower socio-economic status.
Presenting author: Oluwatobi Ogunbiyi
Poster 17
Barriers to Hearing Healthcare for Deaf Refugee Children: A Case Study of Humanitarian Service Delivery
Hearing loss is a significant global public health concern that disproportionately affects children in low- and middle-income regions, where access to diagnosis and treatment remains limited. For refugee populations, these challenges are further intensified by displacement, disrupted healthcare systems, and limited access to specialized services. Deaf refugee children face compounded barriers to communication, education, and healthcare, and are often described as being "displaced twice": first by navigating a predominantly hearing world, and second by displacement due to conflict or war. Despite the known impact of untreated hearing loss on language development and long-term outcomes, access to hearing healthcare and language support in humanitarian settings remains limited. Humanitarian audiology missions have emerged as one approach to addressing these gaps. Organizations such as Deaf Defy provide hearing assessments, hearing aids, and language support to underserved communities in regions such as the Levant. However, there is limited research examining how these services are delivered in practice or how providers navigate the structural and logistical challenges of working in conflict-affected environments. This study examines barriers to hearing healthcare for Deaf refugee children through a qualitative case study of humanitarian missions conducted by Deaf Defy. Drawing on provider reflections and mission documentatio, the study explores how providers adapt service delivery in resource-constrained settings. Findings identify key structural barriers, provider adaptations, and the perceived impact of hearing interventions on children and families. By documenting these experiences, this study contributes to a limited body of research on humanitarian audiology and highlights implications for improving access to hearing healthcare in refugee populations.
Presenting author: Rama Darayyad
Poster 18
Financial Navigation for Cancer Care in Nigeria: Interim Findings from the COST-FIN Trial
Introduction / Background: Cancer outcomes in low- and middle-income countries (LMICs) are shaped by both disease burden and financial barriers that delay, interrupt, or prevent access to care. In Nigeria, most cancer patients pay out-of-pocket (OOP), placing households at risk for financial catastrophe (FC), financial distress (FD), and treatment interruption. Financial navigation (FN), a structured intervention that helps patients anticipate costs, develop financial plans, and connect to available resources, has shown benefit in high-income settings but has not been rigorously evaluated in sub-Saharan Africa (SSA). COST-FIN is, to our knowledge, the first randomized controlled trial in the region to evaluate whether FN reduces FC and FD among patients with breast, colorectal, and prostate cancer. Methods / Strategies / Activities: COST-FIN is a pragmatic randomized controlled trial conducted within the African Research Group for Oncology (ARGO) network. This interim randomized analysis includes participants enrolled at Lakeshore Cancer Center and Obafemi Awolowo University Teaching Hospitals Complex. Adults with newly diagnosed breast, colorectal, or prostate cancer were randomized 1:1 to structured FN or usual care and followed at baseline, 3, 6, and 12 months. The intervention included financial literacy assessment, individualized financial planning, resource linkage, and risk-stratified follow-up. The primary FC definition was OOP cancer spending exceeding 40% of non-subsistence household expenditure, with 10% household income and 25% total household expenditure thresholds assessed in sensitivity analyses. FD was measured using FACIT-COST, where higher scores indicate better financial well-being. As of the January 23, 2026 interim data lock, 159 participants had been randomized. After excluding two participants lost before baseline survey completion and one ineligible randomized participant, 156 were eligible for analysis. Results / Findings / Lessons Learned: Using the 40% non-subsistence household expenditure definition, FC was highly prevalent at baseline, affecting 62% of control participants and 56% of FN participants. At 3 months, FC was lower in the FN arm than in the control arm (64% control vs. 44% FN; p = 0.070). A similar directional difference was observed at 6 months, with FC affecting 58% of control participants versus 39% of FN participants. In sensitivity analysis using the 25% household expenditure threshold, 3-month FC was significantly lower in the FN arm than in the control arm (51% control vs. 29% FN; p = 0.049). Longitudinal modeling suggested a protective association between FN and FC, although this did not reach statistical significance (OR = 0.43; p = 0.11). Predictors of FC included non-breast cancer diagnosis, female sex, lower household income, and lower discretionary expenditure. Notably, 81% of analyzable participants lacked health insurance. FACIT-COST scores showed modest directional improvement in the FN arm over follow-up, with mean scores of 13 at baseline, 15 at 3 months, and 17 at 6 months, compared with 16, 14, and 15 in the control arm, respectively. Following prespecified interim review, the Data and Safety Monitoring Board recommended crossover; beginning in October 2025, control participants were offered access to FN. Conclusions / Implications / Next Steps: FC was highly prevalent and remained common during early follow-up. Interim findings suggest that structured FN may reduce FC, particularly during early treatment, with the strongest signal observed at 3 months. These findings support scalable financial protection strategies in LMIC oncology systems. Ongoing follow-up will assess durability of effect, impact on FD, and associations with cost-related treatment interruption and adherence.
Presenting author: Ricky Hill
Poster 19
Cumulative Health Insurance Coverage and Adolescent Cognitive Performance in Ghana
Background: Health insurance is closely linked to access to care, yet its association with broader cognitive development remains understudied. Most research has focused on school-related outcomes, with limited attention to specific cognitive functions and to cumulative coverage. This study examines the association between cumulative enrollment in Ghana’s National Health Insurance Scheme (NHIS) from early childhood through adolescence and higher-order cognitive skills in mid-to-late adolescence. Methods: Cross-sectional data from 919 individuals aged 14–18 in Wave 4 (2022/23) of the Ghana Socioeconomic Panel Survey were analyzed. Cumulative coverage was measured using longitudinal data from all four survey waves (2009/10–2022/23), beginning when participants were under age 5. Baseline socioeconomic characteristics and prior cognitive performance were included in Ordinary Least Squares (OLS) models to adjust for pre-existing differences. Results: Descriptive evidence indicates that continued NHIS participation is socially patterned and positively associated with early-life and contemporaneous socioeconomic advantages. Despite the association between cumulative NHIS coverage and adolescent cognitive performance, evidence of a dose-response pattern is limited. The adjusted OLS estimates show that, compared with adolescents who were never insured, those insured across all four waves scored higher on verbal fluency (β = 3.04, 95% CI: 0.46–5.62) and math (β = 0.74, 95% CI: 0.19–1.28). Effect sizes increased with longer coverage duration, though at lower exposure levels, they were not statistically significant. Reading scores were likewise modestly higher only among those insured across all waves (β = 0.56, 95% CI: 0.07–1.05). No statistically significant association was observed for Raven’s score. Conclusions: Sustained coverage during childhood is more strongly associated with adolescent cognitive performance than intermittent coverage. These associations are concentrated in school-specific and executive domains rather than in abstract reasoning. Policies that reduce financial and administrative barriers to enrollment and renewal can minimize coverage gaps and support cognitive development. Keywords: Cumulative coverage; Adolescent cognitive performance; Raven's Progressive Matrices; semantic verbal fluency; Ghana
Presenting author: Samuel Ampaw
Poster 20
Global Patterns in Child Supervision and Pediatric Burn Outcomes: A Multinational WHO Burn Registry Analysis
INTRODUCTION: Burn injuries remain a significant cause of childhood morbidity and mortality worldwide. The World Health Organization (WHO) identifies inadequate supervision as an important risk factor for pediatric burn injury, yet differences in burn severity and clinical outcomes between injuries occurring with and without adult supervision remain poorly characterized. Using data from 17 countries in the WHO Global Burn Registry (GBR), we aim to address this gap by conducting the largest and first multi-national cohort analysis characterizing differences in burn severity and clinical outcomes among pediatric burn injuries occurring with and without adult supervision. METHODS: The WHO Global Burn Registry (GBR) was queried from its inception through November 2025. Children aged 0–5 years with documented supervision status at the time of burn injury were included. Descriptive statistics were used to compare demographics, burn characteristics, and clinical outcomes between cohorts. Outcomes included burn etiology, total body surface area burned (TBSA%), inhalation injury, length of hospitalization, presence of disability at discharge, and mortality. Multivariable logistic regression adjusting for age, sex, and country resource level was used to estimate the effect of supervision status on burn severity and mortality. RESULTS: A total of 2,374 pediatric burn injuries from 17 countries were analyzed, of which 596 (25.1%) occurred without adult supervision. Unsupervised injuries were significantly more common in low-resource countries than in high-resource countries (71.3% vs. 31.5%, P< 0.001) and were most prevalent in the African (41.0%) and Southeast Asian (32.4%) regions (P< 0.001). Median TBSA burned was higher in unsupervised children compared to supervised children (15% vs 10%; P< 0.001). Unsupervised children experienced longer hospital stays (11.6 vs. 9.4 days, P< 0.001), higher rates of disability at discharge (7.72% vs. 4.66%, P< 0.01), and increased mortality (10.23% vs. 6.74%, P< 0.01). After adjustment for demographic factors, unsupervised children had increased odds of sustaining a severe burn (TBSA ≥ 20%) (OR 1.29, P< 0.05) and elevated odds of mortality (OR 1.42, P< 0.05). CONCLUSIONS: Pediatric burn injuries occurring without adult supervision are associated with increased burn severity, disability, and mortality. These findings emphasize the need for targeted burn prevention strategies that prioritize adult supervision, particularly in low-resource settings.
Presenting author: Satyam Singh
Poster 21
Asthma Education Curriculum for Healthcare Providers at Hillside Clinic in Belize
Asthma Education Curriculum for Healthcare Providers at Hillside Clinic in Belize Background: Asthma is one of the most prevalent chronic respiratory diseases impacting 260 million people worldwide. In Central America, Belize has one of the highest asthma prevalence rates, estimated at 6.2%. Limited resources and gaps in provider training may contribute to asthma under diagnosis and suboptimal management. Objective: This study aims to develop and implement an asthma educational curriculum for healthcare providers with varying levels of training in a resource-limited setting. Methods: A structured asthma curriculum was developed and presented to multidisciplinary cohort of healthcare providers at Hillside clinic, an adult and pediatric clinic located in southern Belize. This curriculum aimed to enhance provider knowledge and confidence in diagnosing and managing asthma in a resource-limited setting. Core components of the curriculum included: (1) diagnosing asthma clinically (2) administration and interpretation of the Asthma Control Test (3) development of personalized Asthma Action Plans (4) instruction on proper inhaler technique (5) construction of a low-cost water bottle spacer. Providers completed pre- and post intervention surveys to assess changes in confidence related to asthma diagnosis and management. Results: In process Conclusion: In process
Presenting author: Shabnam Elahi
Poster 22
Kicking and Screaming: Bringing the FIFA 11+ to Punta Gorda, Belize for Injury Prevention in Soccer
1. Introduction / Background Soccer, or football as it is known outside of the United States, is the most played sport in the world with 270 million registered players alone, not including those who play more casually. The most common injuries sustained during soccer include ankle sprains, hamstring strains, and knee ligament injuries such as anterior cruciate ligament (ACL) and medial collateral ligament (MCL) tears due to the cutting and pivoting nature of the sport. The Fédération Internationale de Football Association (FIFA) and its Medical Assessment and Research Centre (F-MARC) developed the FIFA 11+ warm-up program in 2006 in an effort to reduce injury rates/risk in soccer players. Since then, several randomized controlled trials have shown significant decreases in injury incidence with implementation of the FIFA 11+ warm-up as compared to standard warm-ups in both males and females regardless of sex and level of play. Longo et al. showed that the FIFA 11+ was effective even in a different sport, showing reduced overall injuries in elite male basketball players. Not only does the FIFA 11+ prevent injuries, but it also improves performance by increasing strength and enhancing neuromuscular control. Studies have shown that implementation and adherence are most successful when introduced, led, and taught by coaches. 2. Methods / Strategies / Activities In Punta Gorda, Belize, there are several local soccer teams and organizations, yet no formal injury prevention program or education. Given the rural and low-resource setting, players do not have access to training facilities with dedicated personnel/trainers. Most players only receive treatment after they have sustained an injury. We reached out to local teams who indicated that this was a need in their community. We plan to hold an injury prevention workshop which will include education on general injury prevention principles as well as teaching of the FIFA 11+ warm-up program to coaches of the local teams. We will assess understanding with a deidentified pre-test and post-test survey. 3. Results / Findings / Lessons Learned We hypothesize that there will be improvement in understanding of the risk factors for injury in soccer as well as the indications for, evidence supporting, and components of the FIFA 11+ warm-up program. 4. Conclusions / Implications / Next Steps By providing education on injury prevention to the local soccer community in Punta Gorda, Belize, we hope to be able to guide development of injury prevention strategies or implementation of a specific injury prevention program ie. FIFA 11+ into their routine training environment. Future studies could assess whether teams/clubs were able to successfully integrate the FIFA 11+ and could incorporate tracking of injuries per season to evaluate for any significant change. If this model is successful, future directions could involve expanding the injury prevention workshops to include other sports.
Presenting author: Sharon Woo
Poster 23
Domestic Violence Screening in Female Latin American Immigrants in the U.S.
Background: Intimate partner violence (IPV) is a pervasive public health issue affecting individuals worldwide, with unique cultural, social, and structural factors influencing its prevalence and detection among recently immigrated Latin American women. Cultural and societal pressures and expectations have historically determined discussion of IPV to be a private matter often not reported to law enforcement in many Latin American communities, resulting in a lack of screening tools and adequate education regarding the subject for both providers and the general population. Upon immigration to the United States, other barriers commonly arise—including, but not limited to, cultural differences regarding family structures, language barriers, and stressors regarding legal status—further inhibiting the ability to report IPV. Analyzing the cultural differences, history of reporting within this community, and resources currently in place in their countries of origin and in the US are essential in determining the accuracy of current IPV screening tools available to recent Latin American immigrants. Objective: This literature review aims to analyze current IPV screening tools available to women recently immigrated from Latin America, as well as determine their adequacy and accuracy in capturing IPV experiences given recognized cultural differences between those from a Latin American country and those from the United States. Further, it aims to elucidate the factors that limit the effectiveness of current screening tools. Methods: To characterize how IPV is understood, screened for, and dealt with in the recent immigrants' home countries in Latin America compared to in the United States, this literature review utilizes specific search terms like "Intimate partner violence/IPV", "domestic violence/DV" , "Latin American" and "immigrant" to search for studies addressing IPV prevalence, cultural perceptions of violence, and screening practices. Results and Conclusions: Studies suggest that due to a host of reasons, particularly cultural factors, education regarding IPV and thus screening for IPV in Latin American countries is still largely inadequate. In the US, IPV is generally underreported by recent immigrant populations of Latin Americans, due to the aforementioned factors as well as the new barriers in place as recent immigrants. Many instruments fail to account for differing definitions of violence, migration-related stressors, and barriers to disclosure, leading to reduced sensitivity and potential misclassification. Newer screening tools like HITS are beginning to bridge the gaps between recently immigrated individuals of Latin American descent and other demographics of women in the US. Further research on IPV screening tools, culturally responsive and trauma-informed care, advances in adequate access, and comprehensive IPV education in, not just Latin American populations, but others based in the US (providers and the general public alike) as well are desperately needed to improve our outcomes in IPV screening in this vulnerable population.
Presenting author: Sydney O'Neal
Poster 24
Barriers to HPV Prevention and Cervical Cancer Screening Among Women in Rural Eastern Samar, Philippines
Introduction: Cervical cancer, almost always caused by chronic infection with human papillomavirus (HPV), is the second most frequent cancer and causes the most cancer-related mortality in women in the Philippines. While comprehensive Pap smear screening, HPV vaccination, and cancer treatment have successfully lowered mortality rates in high-income countries, limited-resource settings in the rural Philippines lack laboratory facilities and trained personnel. In 2020-2021, fewer than 1 in 10 women had been screened for cervical cancer in the past 5 years and fewer than 1 in 10 girls had received the HPV vaccine. Other suggested factors contributing to low screening rates include financial constraints, fear or embarrassment, lack of awareness, and lack of promotion. This study assessed the awareness of HPV, practices of cervical cancer screening, and barriers to preventive care among women attending a rural health clinic in Eastern Samar. Methods: We conducted semi-structured interviews with 15 women at Salcedo Doctors Hospital. Demographic information collected included languages spoken, partnered status, education, monthly income, employment, chronic disease history, insurance status, and subjective health assessment. Questions addressed familiarity with HPV testing, vaccination, and Pap smears. Interviews were audio-recorded, de-identified, transcribed, and recorded in an Excel matrix. Closed responses were summarized descriptively. Open-ended responses were inductively coded using a constant comparative approach. Results: Zero participants had received the HPV vaccine, and 86.7% did not know what HPV was. However, 80% correctly identified HPV as a cause of cancer, and 73.3% believed vaccination can prevent cervical cancer. Reported barriers to vaccination included fear, low awareness, cost, and perceived lack of necessity. Regarding Pap smears, 86.7% had never been screened and 60% did not know what a Pap was. Similar barriers were cited, with stigma and time constraints rarely mentioned (one time each). Despite knowledge and uptake, 93.3% would recommend HPV vaccination and Pap smears to friends and relatives, and 75% expressed interest in learning more. Conclusions: This research demonstrates a willingness for Filipino women to engage in these health interventions which 1) suggests lack of knowledge as a primary barrier to vaccination and screening rates and 2) encourages solutions that focus on spreading information in rural regions of the country. By identifying specific knowledge gaps and structural obstacles in this underserved population, we can inform targeted educational campaigns and policy initiatives to improve screening rates and reduce cervical cancer mortality in resource-limited settings.
Presenting author: Tanya Kukreja
Poster 25
Implementation of Pediatric Palliative Care Interventions in Eastern, Central, Southern, and Western Africa (ECSWA): A Scoping Review
Pediatric palliative care addresses the physical, psychosocial, and spiritual needs of children with life-limiting illness through a family-centered approach. In Eastern, Central, Southern, and Western Africa (ECSWA), access to pediatric palliative care remains limited, and although intervention efforts are increasing, there is limited synthesis of how these interventions are implemented and what outcomes they achieve. This study aimed to characterize pediatric palliative care interventions and examine the domains addressed and outcomes reported across studies in ECSWA. A systematic scoping review was conducted following PRISMA guidelines. Embase, MEDLINE, Google Scholar, and African Index Medicus were searched for studies published from 2014 onward. Eligible studies described pediatric palliative care interventions in ECSWA. Data were extracted on intervention characteristics, palliative care domains addressed, and reported outcomes, and findings were synthesized using descriptive analysis. Ten studies met inclusion criteria, representing diverse settings including hospitals, community programs, and home-based care across multiple countries in ECSWA. Interventions most commonly focused on health system strengthening and workforce training, including education, mentorship, and integration of palliative care into existing services. Psychosocial care was moderately represented, while spiritual care, communication, and end-of-life care were less frequently addressed. Reported outcomes were predominantly provider- and system-level, including improvements in knowledge, clinical practices, and service delivery. In contrast, caregiver- and patient-centered outcomes, such as quality of life and caregiver burden, were less consistently measured across studies. Current pediatric palliative care interventions in ECSWA emphasize system and workforce capacity but do not fully reflect the multidimensional scope of palliative care. Greater attention to holistic care domains and standardized measurement of caregiver and patient outcomes is needed to strengthen the evidence base and support more comprehensive, family-centered care delivery in resource-limited settings.
Presenting author: Zoey Hall
Poster 26
Doula Care and How Maternal Age May Determine its Impacts on Reducing Maternal Morbidity Rates in the United States
Background: Maternal morbidity rates are a crisis in the United States. High rates of potentially risky obstetric interventions in the US may be partially to blame for the US's maternal morbidity rate being such an outlier among economically wealthy countries. Birth doulas are a suggested solution to mitigate obstetric interventions. Despite women of different maternal ages facing different risks during pregnancy, research is not yet conclusive on whether the benefits of doulas may vary for different age groups. Methods: A literature review was conducted through PubMed and CINAHL with the inclusion criteria that the article be published in English between 2000-2025, be about doula care and its impact on cesarean sections and/or forceps assisted deliveries, and include age as a measure demographic. Articles must be from a peer-reviewed journal. Findings: Insignificant literature was found regarding forceps assisted deliveries. Doulas likely reduce the risk of cesarean sections for adolescents (< 20 years old) by connecting adolescents with needed food and housing resources, accompanying adolescents to medical appointments they may have otherwise skipped for fear of stigma, and reducing maternal stress. Stronger evidence exists showing doulas reduce cesarean section rates for adults (20-34 years old) by screening for maternal mental health, assisting mothers in accessing needed resources, and providing culturally competent care. Insignificant literature was identified for pregnant people in the advanced age group (35+ years old). Conclusion: Existing literature has the strongest evidence that doulas reduce cesarean section rates for pregnant women in the adult age category. More research must be conducted to confirm the differences in degree of benefit between the age groups and concretely identify the benefits of doula care for women in the adolescent and advanced age categories.
Presenting author: Zora Warren
Poster 27