Pursch,  Benita

Zambia

Efficacy of biofortified maize to improve maternal and infant vitamin A status

Over the past decade, plant breeders have made considerable progress towards the development of nutrient-rich staple crops. These include a number of conventional maize hybrids with provitamin A carotenoid contents up to 20 times greater than regularly consumed white varieties. “Provitamin Amaize” or “orange maize” is currently being rolled out in Sub-Saharan Africa as a strategy to reduce the prevalence of vitamin A deficiency, which remains a major public health challenge. JHSPH, in collaboration with the Zambian Ministry of Health and the University of California at Davis are conducting efficacy trials of orange maize in rural Zambia. This is the 3rd in a series of trials and will consider impact on maternal vitamin A status (serum & milk retinol; dark adaptation) and infant vitamin A stores (total body stores).

Global Health Mentor: Amanda C. Palmer, PhD

As I arrived in Zambia, coming off of a six-month study abroad stint in Gaborone, Botswana, my emotions were mixed. Happy as I was to be continuing my time in Southern Africa, as well as gaining experience in the world of Global Health, I was definitely homesick. Not homesick for the U.S. or the comforts of Baltimore, but for Botswana, my host-family, my little host nephews and the life I had made there. Because of the connection I felt with Gaborone, despite my best efforts, for the first few weeks I judged everything in Zambia by Botswana’s standards. Luckily, Zambia more than lived up to the challenge.

My time in Zambia was incredibly challenging, exhausting and life changing. I have embarked on various public health projects in the past, but never before have had the opportunity to be in the field, aiding in building a research trial from the ground up. Because of this, I had never previously thought about the amount of groundwork that is needed before a clinical trial can be got off the ground. From establishing relationships with local health care workers, to recruiting trial employees and maintaining the reputation of the project in order to gain the trust of the local population, I was able to participate in almost every step of the process. Although I had not considered these things before, I learned quickly. Those three months gave me a crash course in working with front line health workers, conducting trainings, and learning the “elevator talk” to explain our study to people from different backgrounds, communities and education levels.

Becoming immersed in the health care system of Zambia, having previously spent time studying the health system of Botswana, was particularly interesting. I found that that the challenges met by the two countries’ different health care systems were remarkably similar, despite their differences in wealth and resources. As might be expected, the particular challenges lie in providing health care access to rural and “hard to reach” populations while balancing limited resources and over-worked staff.  This challenge was further convoluted in the lack of accurate data reporting systems, meaning that although it was common knowledge that there were children falling through the cracks, staff lacked adequate databases to know who or where those children were. From the perspective of the Johns Hopkins trial, this challenge also directly affected us, as without a current database and in the absence of an accurately conducted census, we were unable to determine the mother and child pairs who would become eligible for the trial.

As a result of these challenges, the implementation of accurate data recording using an electronic registry database in the local health care centre became my main task while in Zambia, and has since spun off into my senior thesis project. With the help of local staff and the medical officials in Mkushi, we were able to implement our own E-Register in the clinic to collect immunization data on children. I was able to learn huge amounts about the issues in implementing eHealth technologies in rural, underdeveloped areas, and having a specific project to which I could dedicate my time made life in Mkushi all the more rewarding.

Three months in Zambia was not enough for me to determine my future career goals. There are still too many aspects of global health that fascinate me to determine that yet. However, I did learn that the general direction I’ve been heading it, that of working on access to health care for vulnerable populations is one that I continue to be passionate about, and my time in Mkushi helped to solidify that fact.

Captions:

1) Daily life at Under-5 clinic
2) Front of Under-5
3) Measuring Orange Maize
4) Training Staff on Anthropometry
5) Implementing an E-Registry at the Under-5 clinic

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