Migration patterns and the impact of internal transfers on consumption and human capital in Timor-Leste

This thesis reports findings from a Migration and Remittance study conducted among 654 households across 3 districts of Timor-Leste in 2010. A mixed methods design was adopted employing a cross-sectional household survey combined with interviews. Findings highlight that internal migration and remittances are having a positive impact on human capital and household expenditure. This research contributes to the limited knowledge on remittance flows in post-conflict and transitional nations

Epidemiology for Neglected Populations: International Public Health

This thesis presents the results of four field research projects I completed to meet the competency requirements of the Masters of Philosophy (Applied Epidemiology) at the Australian National University from February 2015 to December 2016. During this period I was employed as the Epidemiologist for Médecins Sans Frontières (MSF) in New Delhi, India. Data Analysis: The validation of mental health screening instruments in the Kashmir Valley, India. This data analysis resulted in validated cut-off scores for the Hopkins Symptoms Checklist-25 for anxiety and depression for use in the Kashmiri population. Validated cut-off scores were subsequently used to estimate the prevalence of symptoms of anxiety and depression from survey data. For the first time, mental health practitioners have culturally adapted, translated and validated mental health screening tools for use in the primary care setting to facilitate early detection and referral. Epidemiology Project: Estimating the prevalence of depression, anxiety and posttraumatic stress related symptoms in the Kashmir Valley and access to mental health services: Mixed methods research, 2015. The burden of mental distress and overt gap in service delivery found in the Kashmir Mental Health Survey and focus group discussions highlighted the need for a comprehensive, decentralised and integrated approach to mental health care in the Kashmir Valley. Based on the results a working group was established to implement programmatic and policy change recommended by key mental health stakeholders. In collaboration with these stakeholders, MSF plan to implement a community based model of care in 2017. Evaluation of a Surveillance System: Evaluation of the Nigerian Emergency Response Unit Surveillance (NERU) System, 2016. This evaluation demonstrated the effectiveness of an integrated surveillance system where collaboration between the Ministry of Health and a Non-government Organisation can be used to strengthen current national systems, and ensure rapid response to diseases with outbreak potential. The evaluation provides recommendations for both the Nigerian Emergency Response Unit and other MSF Emergency Response Units (ERUs) for implementation or improvement of disease surveillance systems. Outbreak Investigation: Investigating an outbreak of sepsis in a Médecins Sans Frontières run neonatal intensive care unit in Pakistan, 2016. Findings from this investigation showed that high mortality in a neonatal intensive care unit in Pakistan was attributable to ineffective antibiotic protocols and not due to an outbreak of a specific pathogen as originally suspected. The treatment algorithms for neonatal sepsis were revised based on the findings from this investigation. This investigation highlighted the need for community-based and hospital-based surveillance of antimicrobial resistance patterns of pathogens causing neonatal sepsis. In this thesis I also provide an overview of my placement with MSF as an MAE scholar and present two teaching sessions conducted in the course of my MAE while highlighting other teaching and capacity building roles I have actively been engaged in during my placement. This thesis illustrates the utility of field epidemiology in informing policy and programmatic activities in the context of international humanitarian health care

An outbreak and case-control study of Salmonella Havana linked to alfalfa sprouts in South Australia, 2018

An epidemiological investigation and a retrospective case-control study were conducted into an outbreak of Salmonella Havana in alfalfa sprouts, in Adelaide, Australia. In total, 31 cases of S. Havana were notified during June and July 2018 and linked to the outbreak. Eighteen cases and 54 unmatched controls were included in a case-control study. Results from the case-control study indicated an increased risk of illness linked to the consumption of alfalfa sprouts; this was supported by trace-back, sampling and environmental investigations. This outbreak of S. Havana was caused by consumption of alfalfa sprouts from one local sprouts producer. It is unclear as to when in the production of alfalfa sprouts the contamination occurred. However, contaminated seeds and poor pest control are the most likely causes. This investigation highlights the importance of ensuring that producers take appropriate action to minimise the likelihood of contamination and to comply with legislation and standards for primary production and food safety

The PFAS Health Study Focus Groups Research Protocol

This protocol sets out the methodology for the collection and analysis of data for the PFAS Health Study: Focus Groups Study.The Australian Government Department of Health has commissioned the Australian National University to undertake the PFAS Health Study

Prevalence of anxiety, depression and post-traumatic stress disorder in the Kashmir Valley.

BACKGROUND: Following the partition of India in 1947, the Kashmir Valley has been subject to continual political insecurity and ongoing conflict, the region remains highly militarised. We conducted a representative cross-sectional population-based survey of adults to estimate the prevalence and predictors of anxiety, depression and post-traumatic stress disorder (PTSD) in the 10 districts of the Kashmir Valley. METHODS: Between October and December 2015, we interviewed 5519 out of 5600 invited participants, ≥18 years of age, randomly sampled using a probability proportional to size cluster sampling design. We estimated the prevalence of a probable psychological disorder using the Hopkins Symptom Checklist (HSCL-25) and the Harvard Trauma Questionnaire (HTQ-16). Both screening instruments had been culturally adapted and translated. Data were weighted to account for the sampling design and multivariate logistic regression analysis was conducted to identify risk factors for developing symptoms of psychological distress. FINDINGS: The estimated prevalence of mental distress in adults in the Kashmir Valley was 45% (95% CI 42.6 to 47.0). We identified 41% (95% CI 39.2 to 43.4) of adults with probable depression, 26% (95% CI 23.8 to 27.5) with probable anxiety and 19% (95% CI 17.5 to 21.2) with probable PTSD. The three disorders were associated with the following characteristics: being female, over 55 years of age, having had no formal education, living in a rural area and being widowed/divorced or separated. A dose-response association was found between the number of traumatic events experienced or witnessed and all three mental disorders. INTERPRETATION: The implementation of mental health awareness programmes, interventions aimed at high risk groups and addressing trauma-related symptoms from all causes are needed in the Kashmir Valley

Study protocol: building an evidence base for epidemiology emergency response, a mixed-methods study

Introduction: Determinants and drivers for emergencies, such as political instability, weak health systems, climate change and forcibly displaced populations, are increasing the severity, complexity and frequency of public health emergencies. As emergencies become more complex, it is increasingly important that the required skillset of the emergency response workforce is clearly defined. To enable essential epidemiological activities to be implemented and managed during an emergency, a workforce is required with the right mix of skills, knowledge, experience and local context awareness. This study aims to provide local and international responders with an opportunity to actively contribute to the development of new thinking around emergency response roles and required competencies. In this study, we will develop recommendations using a broad range of evidence to address identified lessons and challenges so that future major emergency responses are culturally and contextually appropriate, and less reliant on long-term international deployments. Method and analysis: We will conduct a mixed-methods study using an exploratory sequential study design. The integration of four data sources, including key informant interviews, a scoping literature review, survey and semistructured interviews will allow the research questions to be examined in a flexible, semistructured way, from a range of perspectives. The study is unequally weighted, with a qualitative emphasis. We will analyse all activities as individual components, and then together in an integrated analysis. Thematic analysis will be conducted in NVivo V.11 and quantitative analysis will be conducted in Stata V.15. Ethics and dissemination: All activities have been approved by the Science and Medical Delegated Ethics Review Committee at the Australian National University (protocol numbers 2018-521, 2018-641, 2019-068). Findings will be disseminated through international and local deployment partners, peer-reviewed publication, presentation at international conferences and through social media such as Twitter and Facebook.AEP receives Commonwealth and ANU science merit scholarships, along with funding from the Australian National Health and Medical Research Council (NHMRC) Integrated Systems for Epidemic Response (APP1107393). MDK is supported by an NHMRC fellowship (APP1145997) and receives funding from the NHMRC for Integrated Systems for Epidemic Response

Antibiotic Resistance (ABR) in Neonates with Suspected Sepsis admitted to a Medecins Sans Frontieres (MSF) supported Medium Care Unit in Quetta, Pakistan

BACKGROUND: Neonatal Sepsis is a major cause of infant death, especially if associated with ABR. Choice of empirical antibiotics is particularly challenging without access to culture/DST, as in most resource limited settings. MSF care included blood cultures (BCs) since 2015. Here we describe the characteristics of babies, etiologies, ABR, treatment and outcomes

Barriers and enablers experienced by health care workers in swabbing for COVID-19 in Papua New Guinea: A multi-methods cross-sectional study.

OBJECTIVE: We aimed to identify the barriers and enablers that Health Care Workers (HCWs) in Papua New Guinea experienced in swabbing for COVID-19. METHODS: We conducted a cross-sectional multi-methods study: a qualitative scoping exercise and a telephone survey. The target population was COVID-19-trained HCWs from all provinces of Papua New Guinea. A descriptive analysis of survey responses was conducted alongside a rapid qualitative analysis of interviews and open-ended survey questions. RESULTS: Four thematic areas were identified: human resources, logistics, HCW attitudes and community attitudes. The survey response rate was 70.3% (407/579). Commonly reported barriers to COVID-19 swabbing were insufficient staff trained (74.0%, n = 301), inadequate staffing in general (64.9%, n = 264), insufficient supply of personal protective equipment (60.9%, n = 248) and no cold chain to store swabs (57.5%, n = 234). Commonly reported enablers to swabbing were community awareness and risk communication (80.8%, n = 329), consistent and sufficient supplies of personal protective equipment (67.8%, n = 276), increased surge workforce (63.9%, n = 260) and having a fridge to store swabs (59.7%, n = 243). CONCLUSIONS: A comprehensive community and HCW engagement strategy combined with innovations to improve the supply chain are needed to increase COVID-19 swabbing in Papua New Guinea to reach national testing targets. Investments in increasing numbers of frontline workforce, consistent supplies of PPE, swabs, transport medium, cold boxes and ability to make ice packs, in addtion to establishing regular tranport of specimens from the facility to the testing site will strengthen the supply chain. Innovations are needed to address these issues

The PFAS Health Study Component One: Oakey, Williamtown and Katherine Focus Groups Study

This report details the findings from a series of focus group discussions held in Oakey (Qld), Williamtown (NSW), and Katherine (NT) between January and August 2018. The main aim of this study was to understand participants’ views and experiences of PFAS (per- and polyfluoroalkyl substances) contamination in their local area, with a focus on participants’ health concerns. Residents in these communities have been potentially exposed to PFAS chemicals. Potential exposure pathways varied between communities but include the use of contaminated water, including bore and river water on their properties, as well as town water. Less important potential exposure sources were eating locally produced foods and bush foods, through work activities, and in some instances through direct contact with firefighting foams. Four focus group discussions were held in each community, with 46, 36 and 29 participants attending in each of Williamtown, Oakey and Katherine respectively. One focus group discussion in each of the three communities was dedicated to Defence staff, contractors and family members. In Oakey, there were slightly more men than women, Williamtown focus groups contained roughly the same number of men and women, and in Katherine, there were predominately more women who attended the focus groups. Overall, the non-Aboriginal community groups contained slightly more people over the age of 50, more people who owned their own properties, and more who had lived in the area for longer than ten years. In Katherine, an additional three focus groups of 69 participants were held in local Aboriginal communities. The Aboriginal focus groups were larger, included more women who were often accompanied by children, and were held on community land. Participants voiced concerns related to their health and PFAS exposure. Children were considered more vulnerable due to their young age and exposure from growing up in affected areas. Participants were particularly concerned about the onset of cancers and the deterioration of existing health conditions. Another major concern for many participants was the stress and anxiety related to the duration of the PFAS contamination and uncertainty with respect to the long-term impact on health, specifically for their children. In addition to the above concerns, Aboriginal participants were also worried about the health of their children, contamination of river foods and bush tucker, and the overall impacts on country. Many participants were concerned about continuation of uncertainty and feeling unable to sell their property, being “stuck” in their community and lacking options to “move on”. Participants in the group discussions asked for greater transparency and consistency in the information they received. They discussed options that they thought would reduce their anxiety and provide information or pathways that could lead them out of their current situation soon. The findings from the focus group discussions have been used to contribute to the questionnaire design for a cross-sectional survey on health effects of PFAS. This report details the experiences and emotions of people who have been affected by the PFAS contamination.The Australian Government Department of Health has commissioned the Australian National University to undertake the PFAS Health Study