1 . 1 .

3
204 From Communicable to Noncommunicable Diseases and Injuries

patients seen since 2010 were included in this study. The burden of Sciences between April and December 2013 were invited to partici-
disease, measured as the ratio of unique diagnoses per total patient pate. Women between 50 and 70 years of age were eligible if they had
encounters, was determined. Prevalence of intestinal helminthiasis, initiated treatment for BC at least 5 years prior to enrollment, and
representing the greatest burden to the total patient population, was had no evidence of metastatic bone disease. Study procedures
compared between 25 communities using bivariate and multivariate included a self-administered questionnaire regarding risk factors for
analysis. and personal history of fracture and a thoracolumbar x-ray to assess
Results (Scientific Abstract)/Collaborative Partners (Program- for presence of vertebral fractures (VF).
matic Abstract): FD patient records over the past 2 years indicate Results (Scientific Abstract)/Collaborative Partners (Program-
that intestinal helminthiasis represents the greatest perceived health matic Abstract): 100 women were enrolled with a mean age of
burden in all 21 Ngobe communities visited, with 32% (95% CI, 575 years, and BMI of 26.64.8 kg/m2. Mean years since BC
5.99) of patients seeking treatment for worms, while non-indige- diagnosis was 6.00.8. The majority of cases were stage I or II at
nous patients present with worms in only 10% (95% CI, 4.53) of diagnosis (79.2%) and estrogen and/or progesterone receptor positive
421 consultations. Integrating the data from each community into (87%). In total, 12 VFs were identified via thoracolumbar x-ray. In
geographic information systems (GIS) has allowed for meaningful terms of fracture risk, average reported lifetime height loss was
graphic data presentation. 1.71.1 cm, 11% reported a parental history of fracture, 9% reported
Summary/Conclusion: The overwhelming burden of helminthiasis a personal history of fracture, and 22% of women reported falling
is well known to FD clinicians and quantifying this burden in each within the past year. Forty-five percent of all participants reported
community has provided both FD and the local Ministry of Health taking calcium supplements, but only 4% reported taking vitamin D
with an improved understanding of 1) geographic distribution of supplements. Only 25% of women reported having a bone density
helminth burden, 2) the effectiveness of individual anthelmintic scan since being diagnosed with BC and 14.4% had been diagnosed
programs, and 3) regions that may require novel anthelmintic by a physician with low bone density or osteoporosis.
approaches. Summary/Conclusion: Prevalence of VF among our cohort of
As a consequence of this research and the partnership between Chinese BC survivors was 12%, much higher than recently reported
Floating Doctors, US medical schools, and local Ministry of Health, a rates among age-matched healthy Chinese women in Beijing of less
group of first-year medical students from Stony Brook University will than 5%. Chinese women undergoing BC therapy should be
be conducting a fecal sample study in the indigenous town of Nor- routinely evaluated for osteoporotic fracture risk. Larger studies are
teno this summer. In addition to identifying the types of helminths necessary to identify sub-groups at particularly high risk in order to
burdening the community they will coordinate with the school’s inform screening and prevention guidelines.
principal, teachers, and Peace Corps volunteer to implement a hel-
minth education curriculum. This winter MD and MPH students will
also be applying for a grant to install a Pan-American Health Orga- Design of the Dhulikhel Heart Study (DHS): The
nization (PAHO) chlorine filtration system for Norteno’s largest aq- epidemiology of emerging cardiovascular disease in
ueduct. Nepal
R.P. Koju1, B.M. Karmacharya2, A. Shrestha3, S. Shrestha4,
P.R. Shakya4, C.M. Yogal4, S. Humagain5, P. Gyawali6, B. Amatya4,
Risk and prevalence of vertebral fractures among breast
A.L. Fitzpatrick7; 1Dhulikhel Hospital, Kathmandu University School of
cancer survivors in China
Medical Sciences, Internal Medicine/Cardiology/Global Health, Bag-
E. Hsieh1, Q. Wang2, R. Zhang3, J. Li3, C.-W. Zhou3, Y. Qiao4, mati/NP, 2Dhulikhel Hospital, Kathmandu University Hospital, Com-
L. Fraenkel5, E. Bradley6, J. Smith7, P. Zhang2; 1Yale School of Medicine, munity Programs, Seattle, WA/US, 3Karuna Foundation Nepal, Seattle,
Section of Rheumatology, Hamden, CT/US, 2Cancer Institute and Hos- WA/US, 4Dhulikhel Hospital, Kathmandu University Hospital,
pital, Chinese Academy of Medical Sciences & Peking Union Medical Department of Community Programs, Dhulikhel/NP, 5Dhulikhel Hospi-
College, Department of Medical Oncology, Beijing/CN, 3Cancer Institute tal, Kathmandu University Hospital, Department of Cardiology/Medi-
and Hospital, Chinese Academy of Medical Sciences & Peking Union cine, Dhulikhel/NP, 6Dhulikhel Hospital, Kathmandu University
Medical College, Department of Diagnostic Imaging, Beijing/CN, Hospital, Department of Clinical Biochemistry, Dhulikhel/NP, 7Univer-
4
Cancer Institute and Hospital, Chinese Academy of Medical Sciences & sity of Washington, Epidemiology, Seattle, WA/US
Peking Union Medical College, Department of Cancer Epidemiology,
Background: The burden of disease in developing countries is
Beijing/CN, 5Yale School of Medicine, Section of Rheumatology, New
shifting from infectious to noncommunicable diseases with devas-
Haven, CT/US, 6Yale School of Public Health, New Haven, CT/US,
7 tating consequences to public health. As in most of the developing
University of North Carolina, Department of Epidemiology, Chapel Hill,
countries Nepal is currently experiencing a rapid growth in cardio-
NC/US
vascular disease (CVD) but there is little community-based data
Background: Osteoporotic fractures lead to significant morbidity and available to measure its impact and track trends. The Dhulikhel Heart
mortality worldwide. Women with breast cancer (BC) are at high risk for Study (DHS), based out of Dhulikhel Hospital, Kathmandu Uni-
fracture due to the deleterious impact of BC therapies on bone density. versity, was designed to address this need by providing comprehen-
In China, BC survival is improving as screening, diagnosis and treat- sive data using standardized protocols to evaluate CVD prevalence,
ment programs expand, however, the long-term impact of BC therapy on incidence, and risk factors.
fracture risk among Chinese women remains unknown and no guide- Structure/Method/Design: The DHS is a prospective, longitudinal
lines exist to prevent BC treatment-induced bone loss. We designed a cohort study targeting all adults age 18 years and residing in the
pilot study to evaluate the scope of this problem among BC survivors at a town of Dhulikhel, in central Nepal, for a baseline examination and
large cancer referral hospital in Beijing. planned 20-year follow-up. The home visit includes collection of
Structure/Method/Design: BC survivors receiving care at the informed consent, demographic and socio-economic characteristics,
Cancer Institute and Hospital of the Chinese Academy of Medical medical history, health behaviours, physical and cognitive function,
Annals of Global Health 205

anthropometry, and blood pressure measurement. A fasting blood 14.17% of patients met criteria for common depressive disorder. This
sample will be collected for blood glucose, HbA1c, and lipid profile. study revealed 30.25% of patients to be noncompliant with medica-
Participants will be invited to Dhulikhel Hospital to undergo elec- tions, and 42.02% of patients to be moderately compliant with
trocardiography, echocardiography, carotid doppler and adipose tissue medications, which is a lower rate than in previous studies in the
measurement. Outcome measures will focus on mortality and CVD- region. When correlation coefficients were determined between
related morbidities. Cause of death will be ascertained using hospital Morisky score and various other variables, the strongest correlation
records and verbal autopsy while CVD events will be identified from was found between noncompliance and depression score.
medical records and measured during regular surveillance. Logistic Summary/Conclusion: This study suggests that, in spite of treat-
and linear regression along with mixed models and survival analysis ment, hypertension is not adequately controlled within this popula-
will be used to estimate factors related to risk of specific outcomes. tion. Factors that may influence blood pressure control in this cohort
Collaborative writing groups will be convened to develop manuscripts include high rates of obesity, underlying depression, and noncom-
and publish results. pliance with medications.
Results (Scientific Abstract)/Collaborative Partners (Program-
matic Abstract): The baseline examination is currently underway
with an expected sample of 9000 adults to be completed by summer Impacting the global trauma burden—Training
2014 with repeat visits to occur every 2 years. laypersons in basic resuscitation in Mozambique
Summary/Conclusion: Results of the DHS will provide important A. Merchant1, K. McQueen2; 1Vanderbilt University, Nashville, TN/
data on the epidemiology of hypertension, diabetes, coronary heart US, 2Vanderbilt University Medical Center, Anesthesia, Nashville, TN/
disease and stroke in Nepal to help develop evidence-based programs US
for their prevention and treatment. Methods may be used as a model
for other low-income countries that are developing plans to address Background: The cost of trauma remains exorbitant, accounting for
this emerging epidemic. over 300 million years of healthy life, along with 11% of disability-
adjusted life years (DALYs) worldwide. In fact, road accidents are the
number 1 cause of death among under 40-year-olds and thus
Noncompliance with medications among hypertensives responsible for the greatest loss in terms of years of life. Reduction of
in Ghana DALYs and mortality are linked to adequate prehospital care and
decreased transport times to definitive care. Given the financial and
P. Krass1, F. Agyekum2, V. Boima2, O. Ogedegbe3, N. Bertelsen3; 1New
resource constraints in low-income countries, simple but systematic
York University School of Medicine, New York, NY/US, 2University of
prehospital training programs for laypersons have been implemented
Ghana Medical School, Accra/GH, 3New York University School of
in rural villages to stabilize patients. Most prehospital deaths are the
Medicine, Center for Healthful Behavior Change, New York, NY/US
result of airway compromise, respiratory failure or uncontrolled
Background: Prevalence of hypertension in Ghana is estimated to hemorrhage; all three of these conditions can be addressed by lay-
be between 25.5% and 48% in urban areas. In spite of this growing persons using basic first aid measures.
burden of noncommunicable disease, there has been limited research Structure/Method/Design: The hypothesis is that basic prehospital
into hypertension treatment patterns or noncompliance rates. This and primary hospital interventions made by layperson first re-
study aims to understand the factors that influence patient compli- sponders and health care personnel will decrease trauma mortality
ance and treatment outcomes in this region. and increase the number of capable first responders. In order to test
Structure/Method/Design: 120 patients were recruited between this hypothesis, two communities of similar size, resources, and
December 2012 and August 2013 at Korle-Bu Hospital in Accra. hospital capacities in Mozambique were selected. A trauma registry
Questionnaires that collected information on age, sex, religion, that included the patient’s age, comorbidities, mechanism of injury,
occupation, socioeconomic status, monthly blood pressure medica- vitals on admission, interventions performed, and outcomes was
tion expenditures and house ownership were administered to eligible established.
patients who agreed to participate in the study. The eight-item One community and hospital served as the intervention group that
Morisky scale was used to assess non-compliance; the Patient Health receives training on four basic resuscitative and stabilizing efforts in their
Questionnaire-9 was used to assess depression; the Beliefs about native language. Community members received a 4-hour seminar that
Medication Questionnaire was used to assess patient views about taught four basic resuscitative and stabilizing interventions prior to
medication, and the 14-item hypertension knowledge scale was used transport by ambulance or taxi/bus. These techniques include a modi-
to assess patients’ knowledge about hypertension. The correlation fied ABCD (airway, breathing, circulation, disability) noted in developed
coefficient was used to determine correlation between Morisky score nations. A is for airway opening that allows victims to receive oxygen by
and other patient variables. simply opening their mouths and removing any foreign objects if pre-
Results (Scientific Abstract)/Collaborative Partners (Program- sent. B is for bleeding and laypersons were taught how to apply
matic Abstract): 27.73% of patients had controlled hypertension, compression or a tourniquet to control bleeding. C represents cervical
with an average systolic BP of 151.57. The most commonly pre- spine immobilization with simple tools such as rice bags and newspa-
scribed antihypertensive was a calcium channel blocker, comprising pers. D is for disability which is reduced by transporting victims with a
75% of patients. Several risk factors were revealed in the aggregate flat, immobile, safe method. Hospital personnel received the same
data that may help explain the poor BP control. Weight is a known ABCD training as the community with two additions—assessment that
risk factor for hypertension, and in this patient population the average involves vital sign monitoring and IV fluid resuscitation as they are
BMI was 29.95, which is borderline between the overweight and markers of shock and injury.
obese categories. Psychosocial stress is also a known risk factor for Results (Scientific Abstract)/Collaborative Partners (Program-
hypertension, and a significant number of patients in this population matic Abstract): Pre- and post-tests were administered to partici-
met criteria for depressive disorder. Based on the PHQ-9 screening, pants in their native language. Results of the study suggest community
10.83% of patients met criteria for major depressive disorder, and members can be trained in basic resuscitative techniques.