Friday, August 19, 2011

Global Health Research at MassGeneral Hospital for Children

Patricia L. Hibberd, MD, PhD

Patricia L. Hibberd, MD, PhD
Chief, Division of Global Health, MassGeneral Hospital for Children

The Division of Global Health at Massachusetts General Hospital was founded in March 2010 under the leadership of Dr. Patricia L. Hibberd to address the ever increasing interest of faculty and trainees in Global Health and harness that interest into an action plan for MGHfC to contribute on the global stage.  The Division’s goals are to build and foster international partnerships for interdisciplinary research, education and service to address Millennium Development Goal (MDG) #4 and reduce health disparities and achieve optimal health for neonates, infants, young children and adolescents in resource limited settings. MDG#4 is to reduce by two-thirds, between 1990 and 2015, the under-five mortality rate and in 2011, we are way off track globally although there are some important successes in high burden countries such as Bangladesh, Eritrea, Indonesia and Malawi.

The Division’s research agenda focuses on 5 unacceptable statistics – every year 4 million babies are born dead; 1.5 million neonates die on the first day of life, another 1.5 million neonates die on day 2-7 of life, another 1 million die between day 8 and 28 of life and 6.5 million die in the first year of life.  The 9 Division faculty work on prematurity, birth asphyxia, neonatal sepsis, diarrhea, innovative methods of vaccine delivery, point of care diagnostics and HIV in Africa and are funded by NIH and other major foundations to conduct this work. 

Global Health Research is a major area of interest at MGHfC, not only within the Division of Global Health. One of the Division staff members, Dr. Brett Nelson conducted a departmental survey in March and April 2011.  The opportunity to participate in the web-based survey was sent to all faculty and trainees.  Of the 132 respondents, 18% reported that they had been or are involved in global health research -- more specifically, 22% of residents, 50% of fellows, and 18% of faculty respondents.  Many MGHfC faculty expressed an interest in applying their expertise to global health research specifically relating to

  • Anesthesia and Critical Care
  • Asphyxia
  • Burn Care
  • Children in Crisis, Refugee and Disaster Health
  • Gastrointestinal illness and diarrhea
  • HIV
  • Health Policy
  • Neonatal Sepsis
  • Nutrition, Malnutrition, Breast feeding issues
  • Malaria
  • Pneumonia
  • Tobacco Control

Despite the excitement about Global Health Research, faculty and trainees are aware of the barriers to actually participating in research projects.  Among trainees, these barriers include scheduling difficulties (79%), family/personal responsibilities (58%), perceived inadequate funding opportunities for travel (47%), difficulty knowing what global health activities are available (32%), and lack of faculty mentorship for projects (21%).  Among faculty members, barriers include other clinical responsibilities (60%), family/personal responsibilities (50%), scheduling difficulties (50%), perceived inadequate funding for travel (41%), limited previous experience and training (37%), other research responsibilities (29%), and lack of mentorship (21%). 

Dr. Hibberd and her staff including Drs. Michele Duke, Nupur Gupta, Miriam Haverkamp, Jason Harris, Ann Kao, Jennifer Kasper, Brett Nelson, Kate Powis and Linda Wang are accepting the MGHfC challenges identified in the survey.   Well established Global Health Research efforts are currently based in India (Drs. Hibberd, Gupta, Nelson and Wang for Birth Asphyxia, Prematurity, Neonatal Sepsis and Childhood Pneumonia), Bangladesh (Drs. Harris for Diarrheal Disease and Hibberd for Neonatal Sepsis) Botswana (Drs. Haverkamp and Powis for Neonatal Sepsis and HIV) and Cambodia (Drs. Kao and Hibberd for HIV and Childhood Pneumonia) and Uganda (Drs. Kasper and Duke for HIV).   We are delighted that Dr Kasper just received the 2011 HMS/HSDM Dean’s Community Service Lifetime Achievement Award for her work with Doctors for Global Health.

Dr. Hibberd is one of the 7 principal investigators for NICHD’s Global Network for Women’s and Children’s Health Research, a worldwide collaborative research network committed to expanding scientific knowledge, to improve health outcomes of mothers and their babies. Dr. Hibberd and her collaborator, Dr. Archana Patel, based in Nagpur, India, at the Lata Medical Research Foundation and Indira Gandhi Government Medical College are currently participating in two Global Network protocols that are running all global network locations.  The EmONC Study is a cluster-randomized trial to evaluate whether an intervention that includes a continuum of basic training for the mother, all the way through to sophisticated training in tertiary care hospitals reduces neonatal and maternal mortality. Hospital/clinic-based staff members are trained to address the primary causes of maternal and infant mortality, birth attendants are trained in Home-Based Life Saving Skills (HBLSS) and the mothers (and their families) are trained/educated by community mobilization. The Maternal Newborn Health Registry is a prospective, population-based study of pregnancy and neonatal outcomes in all Global Network sites. All pregnant women who consent to participate join the study and are followed until their babies are 6 weeks old. The primary purpose of this study is to quantify and understand the trends in pregnancy and neonatal outcomes in well-characterized and defined low-resource geographic areas over time, and to inform and prepare for future Global Network studies. Drs. Hibberd and Patel are leading 2 other Global Network Studies, one focusing on the effects of indoor air pollution on maternal and neonatal outcomes and another focusing introduction of low cost pulse oximetry to improve outcomes in childhood pneumonia.  

Dr. Haverkamp is studying ways to improve outcomes in children with WHO defined very severe pneumonia and is developing a test to diagnosis neonatal sepsis using urinary proteomics in collaboration with Dr. Hanno Steen at Children’s Hospital Boston.  Dr. Harris has long-standing interest in childhood diarrheal illness, and enteric bacterial infections and is an NIH-funded investigator in the field of cholera immunity. To better understand the immune response to cholera and typhoid fever, Dr. Harris has been working in collaboration with other investigators at Massachusetts General Hospital and the International Centre for Diarrhoeal Disease Research in Dhaka, Bangladesh since 2003. He is a recipient of an International Research Scientist Development Award (IRSDA: Fogarty Institute, NIH) and a Childhood Health Research Award from the Charles H. Hood Foundation.  Dr. Brett Nelson is working on reducing perinatal mortality, particularly focusing on birth asphyxia in resource poor settings.  Dr. Kate Powis is an investigator in two NIH-funded Botswana-based randomized controlled trials investigating mother-to-child transmission (MTCT) of HIV. She is using data collected in the Mashi and Mma Bana studies to evaluate any difference in growth patterns over the first six months of life for HIV-exposed uninfected infants born to HIV-infected women who either took HAART or zidovudine during pregnancy for prevention of MTCT.  She is also working on the Mpepu study which is the first RCT to provide evidence-based outcomes of HIV-transmission rates and HIV-free survival outcomes comparing 6 months to 12 months of breastfeeding.  Dr. Powis was recently awarded a CFAR grant to study vitamin D levels in HIV infected individuals.  Finally, Dr. Powis, in conjunction with the Botswana Ministry of Health, is rolling out an Emergency Obstetric and Neonatal Care training curriculum that all midwives, key medical officers and obstetricians will be required to complete over the next year.  This course, consisting of didactics, field training and objective structured clinical exams represents a strategic response targeting reduction of Botswana’s maternal and neonatal mortality. 

Concepts in development in the Division include needleless, thermostable vaccines for the developing world and mHealth point of care devices for the diagnosis and management of neonatal sepsis and pneumonia.

Exciting global health projects outside the Division include Dr. Jonathan Spector’s work with the World Health Organization to study the effect of the Safe Childbirth Checklist in India, recently funded by the Bill and Melinda Gates Foundation.

The Division of Global Health at MGHfC is well connected within Massachusetts General Hospital and its Center for Global Health as well as the numerous global health activities that are ongoing throughout the Harvard Wide Institutions.

Please visit the Division of Global Health website at for new and upcoming opportunities and events.

Some recent publications from the Division of Global Health:

Allison GM, Rogers KA, Borad A, Ahmed S, Karim MM, Kane AV, Hibberd PL, Naumova EN, Calderwood SB, Ryan ET, Khan WA, Ward HD. Antibody Responses to the Immunodominant Cryptosporidium gp15 Antigen and gp15 Polymorphisms in a Case-Control Study of Cryptosporidiosis in Children in Bangladesh. Am J Trop Med  Hyg. 2011 Jul;85(1):97-104. PubMed PMID: 21734132; PubMed Central PMCID: PMC3122351.

Coghill M, Ambalavanan N, Chatburn RL, Hibberd PL, Wright LL, Carlo WA; for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Global Network for Women's and Children's Health Research. Accuracy of a Novel System for Oxygen Delivery to Small Children. Pediatrics. 2011 Aug;128(2):e382-e387. Epub 2011 Jul 4. PubMed PMID: 21727103.

Hira KG, Mackay MR, Hempstead AD, Ahmed S, Karim MM, O'Connor RM, Hibberd PL, Calderwood SB, Ryan ET, Khan WA, Ward HD. Genetic diversity of Cryptosporidium spp. from Bangladeshi children. J Clin Microbiol. 2011 Jun;49(6):2307-10. Epub 2011 Apr 6. PubMed PMID: 21471344; PubMed Central PMCID: PMC3122776.

Pasha O, Goldenberg RL, McClure EM, Saleem S, Goudar SS, Althabe F, Patel A, Esamai F, Garces A, Chomba E, Mazariegos M, Kodkany B, Belizan JM, Derman RJ, Hibberd PL, Carlo WA, Liechty EA, Hambidge KM, Buekens P, Wallace D, Howard-Grabman L, Stalls S, Koso-Thomas M, Jobe AH, Wright LL. Communities, birth attendants and health facilities: a continuum of emergency maternal and newborn care (the Global Network's EmONC trial). BMC Pregnancy Childbirth. 2010 Dec 14;10:82. PubMed PMID: 21156060; PubMed Central PMCID: PMC3017016.

Davidson LE, Fiorino AM, Snydman DR, Hibberd PL. Lactobacillus GG as an immune adjuvant for live-attenuated influenza vaccine in healthy adults: a randomized double-blind placebo-controlled trial. Eur J Clin Nutr. 2011 Apr;65(4):501-7. Epub 2011 Feb 2. PubMed PMID: 21285968; PubMed Central PMCID: PMC3071884.

Moore JH, Lari RC, Hill D, Hibberd PL, Madan JC. Human microbiome visualization using 3d technology. Pac Symp Biocomput. 2011:154-64. PubMed PMID:  21121043.

Weil AA, Chowdhury F, Khan AI, Larocque RC, Ryan ET, Calderwood SB, Qadri F, Harris JB.   Clinical outcomes in household contacts of cholera patients. Clin Infect Dis. 2009 Nov 15;49(10):1473-9. PMID: 19842974

Harris JB, Ivers LC, Ferraro MJ. Case records of the Massachusetts General Hospital. Case 19-2011. A 4-year-old Haitian boy with vomiting and diarrhea. N Engl J Med. 2011 Jun 23;364(25):2452-61.

Chin CS, Sorenson J, Harris JB, Robins WP, Charles RC, Jean-Charles RR, Bullard J, Webster DR, Kasarskis A, Peluso P, Paxinos EE, Yamaichi Y, Calderwood SB, Mekalanos JJ, Schadt EE, Waldor MK. The origin of the Haitian cholera outbreak strain. N Engl J Med. 2011 Jan 6;364(1):33-42. Epub 2010 Dec 9. PMID: 21142692

Harris JB, Larocque RC, Charles RC, Mazumder RN, Khan AI, Bardhan PK. Cholera's western front. The Lancet. 2010 Dec 11;376(9757):1961-5. Epub 2010 Nov 25. PMID: 21112083

Kuchta A, Rahman T, Sennott EL, Bhuyian TR, Uddin T, Rashu R,  Chowdhurry F, Kahn AI, Arifuzzaman M, Weil AA, Podolsky A, LaRocque RC, Ryan ET, Calderwood SB, Qadri F, Harris JB. Vibrio cholerae O1 Infection Induces Pro-inflammatory CD4+ T Cell Responses in Blood and Intestinal Mucosa of Infected Humans. Clinical and Vaccine Immunology 2011 Aug;18(8):1371-7.

Harris JB, Pietroni MA.  Approach to the Child with Diarrhea in Developing Countries.  UpToDate.  Version 19.1 Published in online. ( a-in-developing-countries)

Nelson BD, Saltzman A, Lee PT. Bridging the global health training gap: Design and evaluation of a new clinical global health course at Harvard Medical School. Med Teach. 2011 May 19. [Epub ahead of print] PubMed PMID: 21592020.

Rouhani S, Meloney L, Ahn R, Nelson BD, Burke TF. Alternative rehydration methods: a systematic review and lessons for resource-limited care. Pediatrics.2011 Mar;127(3):e748-57. Epub 2011 Feb 14. Review. PubMed PMID: 21321023.

Nelson BD, Getchell M, Rosborough S, Atwine B, Okeyo E, Wall E, Greenough PG. A participatory approach to assessing refugee perceptions of health services World Health Popul. 2010;11(4):13-22. PubMed PMID: 20739836.

Olson KR, Caldwell A, Nelson BD. Newborn-care training in developing countries. N Engl J Med. 2010 Jun 24;362(25):2427-8; author reply 2428. PubMed PMID: 20573935.

Balsari S, Lemery J, Williams TP, Nelson BD. Protecting the children of Haiti. N Engl J Med. 2010 Mar 4;362(9):e25. Epub 2010 Feb 17. PubMed PMID: 20164477.

Powis KM, Kitch D, Ogwu A, Hughes MD, Lockman S, Leidner J, van Widenfelt E, Moffat C, Moyo S, Makhema J, Essex M, Shapiro RL. Increased Risk of Preterm Delivery Among HIV-Infected Women Randomized to Protease Versus Nucleoside Reverse Transcriptase Inhibitor-Based HAART During Pregnancy. J Infect Dis. 2011  Aug;204(4):506-14. PubMed PMID: 21791651; PubMed Central PMCID: PMC3144169.

Parekh N, Ribaudo H, Souda S, Chen J, Mmalane M, Powis K, Essex M, Makhema J, Shapiro RL. Risk factors for very preterm delivery and delivery of very-small-for-gestational-age infants among HIV-exposed and HIV-unexposed infants in Botswana. Int J Gynaecol Obstet. 2011 Jul 16. [Epub ahead of print] PubMed PMID: 21767835.

Dryden-Peterson S, Shapiro RL, Hughes MD, Powis K, Ogwu A, Moffat C, Moyo S, Makhema J, Essex M, Lockman S. Increased Risk of Severe Infant Anemia Following Exposure to Maternal HAART, Botswana. J Acquir Immune Defic Syndr. 2011 Jan 24. [Epub ahead of print] PubMed PMID: 21266910; PubMed Central PMCID: PMC3112252.

Powis KM, Smeaton L, Ogwu A, Lockman S, Dryden-Peterson S, van Widenfelt E, Leidner J, Makhema J, Essex M, Shapiro RL. Effects of in utero antiretroviral exposure on longitudinal growth of HIV-exposed uninfected infants in Botswana. J  Acquir Immune Defic Syndr. 2011 Feb 1;56(2):131-8. PubMed PMID: 21124227; PubMed  Central PMCID: PMC3023002.

Shapiro RL, Hughes MD, Ogwu A, Kitch D, Lockman S, Moffat C, Makhema J, Moyo S, Thior I, McIntosh K, van Widenfelt E, Leidner J, Powis K, Asmelash A, Tumbare  E, Zwerski S, Sharma U, Handelsman E, Mburu K, Jayeoba O, Moko E, Souda S, Lubega E, Akhtar M, Wester C, Tuomola R, Snowden W, Martinez-Tristani M, Mazhani L, Essex M. Antiretroviral regimens in pregnancy and breast-feeding in Botswana. N Engl J Med. 2010 Jun 17;362(24):2282-94. PubMed PMID: 20554983; PubMed Central PMCID: PMC2999916.

Back to Top