Epidemiology for Neglected Populations: International Public Health
Creators: name: Housen, Tambri
Publisher: name: The Australian National University
Year: 2016
Subjects: Epidemiology
Public Health
International
Neglected Populations
Surveillance
Survey
Mental Health
Kashmir
Validation
psychometric tools
conflict
neonates
antimicrobial resistance

description: 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.