Browsing by Author "Thomas, Melissa R."

Now showing 1 - 4 of 4
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    A Global Health Reciprocal Innovation grant programme: 5-year review with lessons learnt
    (BMJ Publishing, 2023) Ruhl, Laura J.; Kiplagat, Jepchirchir; O'Brien, Rishika; Wools-Kaloustian, Kara; Scanlon, Michael; Plater, David; Thomas, Melissa R.; Pastakia, Sonak; Gopal-Srivastava, Rashmi; Morales-Soto, Nydia; Nyandiko, Winstone; Vreeman, Rachel C.; Litzelman, Debra K.; Laktabai, Jeremiah; Medicine, School of Medicine
    Unilateral approaches to global health innovations can be transformed into cocreative, uniquely collaborative relationships between low-income and middle-income countries (LMICs) and high-income countries (HIC), constituted as 'reciprocal innovation' (RI). Since 2018, the Indiana Clinical and Translational Sciences Institute (CTSI) and Indiana University (IU) Center for Global Health Equity have led a grants programme sculpted from the core elements of RI, a concept informed by a 30-year partnership started between IU (Indiana) and Moi University (Kenya), which leverages knowledge sharing, transformational learning and translational innovations to address shared health challenges. In this paper, we describe the evolution and implementation of an RI grants programme, as well as the challenges faced. We aim to share the successes of our RI engagement and encourage further funding opportunities to promote innovations grounded in the RI core elements. From the complex series of challenges encountered, three major lessons have been learnt: dedicating extensive time and resources to bring different settings together; establishing local linkages across investigators; and addressing longstanding inequities in global health research. We describe our efforts to address these challenges through educational materials and an online library of resources for RI projects. Using perspectives from RI investigators funded by this programme, we offer future directions resulting from our 5-year experience in applying this RI-focused approach. As the understanding and implementation of RI grow, global health investigators can share resources, knowledge and innovations that have the potential to significantly change the face of collaborative international research and address long-standing health inequities across diverse settings.
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    Association of severe malaria with cognitive and behavioural outcomes in low- and middle-income countries: a meta-analysis and systematic review
    (BMC, 2023-08-03) Ssemata, Andrew Sentoogo; Nakitende, Ann Jacquelline; Kizito, Simon; Thomas, Melissa R.; Islam, Sumaiya; Bangirana, Paul; Nakasujja, Noeline; Yang, Ziyi; Yu, Yunpeng; Tran, Tuan M.; John, Chandy C.; McHenry, Megan S.; Social and Behavioral Sciences, School of Public Health
    Background: Malaria affects 24 million children globally, resulting in nearly 500,000 child deaths annually in low- and middle-income countries (LMICs). Recent studies have provided evidence that severe malaria infection results in sustained impairment in cognition and behaviour among young children; however, a formal meta-analysis has not been published. The objective was to assess the association between severe malaria infection with cognitive and behavioural outcomes among children living in LMICs. Methods: Six online bibliographic databases were searched and reviewed in November 2022. Studies included involved children < 18 years of age living in LMICs with active or past severe malaria infection and measured cognitive and/or behaviour outcomes. The quality of studies was assessed. Definitions of severe malaria included cerebral malaria, severe malarial anaemia, and author-defined severe malaria. Results from all studies were qualitatively summarized. For studies with relevant data on attention, learning, memory, language, internalizing behaviour and externalizing behaviour, results were pooled and a meta-analysis was performed. A random-effects model was used across included cohorts, yielding a standardized mean difference between the severe malaria group and control group. Results: Out of 3,803 initial records meeting the search criteria, 24 studies were included in the review, with data from 14 studies eligible for meta-analysis inclusion. Studies across sub-Saharan Africa assessed 11 cohorts of children from pre-school to school age. Of all the studies, composite measures of cognition were the most affected areas of development. Overall, attention, memory, and behavioural problems were domains most commonly found to have lower scores in children with severe malaria. Meta-analysis revealed that children with severe malaria had worse scores compared to children without malaria in attention (standardized mean difference (SMD) -0.68, 95% CI -1.26 to -0.10), memory (SMD -0.52, 95% CI -0.99 to -0.06), and externalizing behavioural problems (SMD 0.45, 95% CI 0.13-0.78). Conclusion: Severe malaria is associated with worse neuropsychological outcomes for children living in LMICs, specifically in attention, memory, and externalizing behaviours. More research is needed to identify the long-term implications of these findings. Further interventions are needed to prevent cognitive and behavioural problems after severe malaria infection.
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    Cultivating Cultural Humility to Address the Healthcare Burnout Epidemic-Why It Matters
    (Sage, 2023-05-11) Elbanna, May F.; Thomas, Melissa R.; Patel, Palka R.; McHenry, Megan S.; Radiation Oncology, School of Medicine
    Physician burnout is a major problem that has long been facing our healthcare system. The COVID-19 pandemic has unfortunately deepened this problem and shed the light on the multiple structural shortcomings of our healthcare system that need immediate attention. Demoralization is one of the core features of “physician burnout,” which results from a breakdown of genuine physician-patient interaction. A healthcare system that embraces cultural humility, where we find ourselves rewarded for supporting, uplifting, and respecting our patients’ diverse voices could pave the way for battling burnout. Unlike cultural competency, which suggests that one should know everything about another’s culture (an unfeasible task), cultural humility is a continuum of self-reflection and critique that aims to foster a deep connection between the physician and patient; a connection that sits at the core of the humanistic and multicultural experience of medicine.
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    Pesticides and neurodevelopment of children in low and middle-income countries: A systematic review
    (Public Library of Science, 2025-06-11) Coleman, Bailey; Asad, Iqra; Heng, Yi Yan; Menard, Laura; Hussein Were, Faridah; Thomas, Melissa R.; Karr, Catherine J.; McHenry, Megan S.; Pediatrics, School of Medicine
    Background: Pesticides are increasingly common in low- and middle-income countries (LMICs), where weaker regulations and multiple risk factors for poor neurodevelopment exist. Due to biological and behavioral factors, children are vulnerable to chronic pesticide exposure at a time when brain development is critical. The objective of this study is to systematically review studies assessing pesticides use with child neurodevelopment in LMICs. Methods: Using terms developed by a medical librarian, a search was performed in June 2023 across online databases, including OVID MEDLINE and EMBASE. For inclusion, studies required a measurement of pesticide exposure and neurodevelopmental outcomes using a standardized tool and study participants ≤18 years within an LMIC, as determined by World Bank criteria. Descriptive analyses were performed using extracted data, including published outcomes of significance. Results were assessed for internal validity and reported by the method of exposure measurement (biomarkers or questionnaires/region of residence). Results: A total of 31 studies spanning 11 LMICs met the inclusion criteria. An adverse association was found between pesticide exposure and at least one domain of neurodevelopment in 23 studies, including 12 studies with child-level measurements, 10 studies with maternal measurements in pregnancy, and one questionnaire-based study. Exposure to organochlorines, carbamates, chlorpyrifos, and fungicides were consistently associated with worse outcomes for neurodevelopment, specifically executive functioning, cognition, motor development, and behavior. Few studies found adverse associations with urine/serum organophosphate levels. Due to the heterogeneity of existing data, we were unable to quantify the relationship between pesticide exposure and neurodevelopment. Conclusions: While studies suggest that some domains of neurodevelopment may be negatively associated with pesticide exposure, extrapolation is limited due to the challenges in measuring pesticide exposure within these contexts and differing study designs. Several research gaps must be addressed to develop policy and regulations that protect children from potential neurodevelopmental deficits associated with pesticide exposure.