Globally, poor and underserved countries tend to have an elevated incidence of infectious disease, often contributing to increased mortality rates. One health issue resulting from this is diarrhea, the 6th leading cause of mortality in developing countries.  Because pregnant women are already vulnerable to infections due to an immune system that is rapidly adapting to a developing fetus, they may be more susceptible to diarrhea and the complications that come with it.  We sought to identify whether diarrhea during pregnancy was associated with adverse birth outcomes, such as preterm birth and being small for gestational age. We used data from a prospective longitudinal study of maternal influenza immunization of pregnant women and their infants conducted in rural Nepal from 2011-2014. Diarrhea episodes were defined as three or more watery bowel movements per day for one or more days. The chi-square test, two-sample t-test, and log-binomial regression were performed to evaluate baseline characteristics and the association between diarrhea during pregnancy and adverse birth outcomes. From our study, we found that average weight and BMI at enrollment for women with diarrhea was significantly lower than those without diarrhea during pregnancy (47.6kg vs. 48.5kg, p=0.01, 20.72 BMI vs 21.06 BMI, p=0.01) and women with diarrhea during pregnancy were significantly more likely to have small for gestational age infants (42.6% vs. 36.8%, p=0.03). We also found that the incidence of non-live birth, preterm, and low birth weight did not significantly differ between mothers with and without diarrhea. By understanding the risks diarrhea during pregnancy poses for both mothers and infants, we can assess the severity of this problem, and whether or not a possible means of prevention should be prioritized. Further research should examine whether methods to improve weight and BMI during pregnancy prevents diarrheal illness and thus negative birth outcomes. 

Chlamydia trachomatis is a human urogenital pathogen and the leading cause of bacterial sexually transmitted infection worldwide.  A major aim of the Hybiske Lab is to develop a functional genetic understanding for Chlamydia. I am studying a set of newly generated C. trachomatis chimeric mutants that were generated from interspecies lateral gene transfer between C. trachomatis and the mouse adapted species C. muridarum. This series of recombinant strains contain a differing extent of genetic exchange surrounding the predicted inclusion membrane protein (Inc) CT147. CT147 is predicted to be secreted into the Chlamydia-containing vacuole (inclusion) membrane by type III secretion and subsequently mediate molecular interactions with host proteins. In cultured cells, strains lacking CT147 prematurely rupture inclusions at 24 hours post infection, in stark contrast to wildtype C. trachomatis or control recombinant strains that grow normally inside host cells and do not exhibit inclusion lysis at any stage of infection. We therefore hypothesized that the C. muridarum ortholog of CT147 is incompatible with the series of ~30 Inc proteins normally secreted by C. trachomatis, in such a way that inclusion integrity is not properly maintained during this strain’s developmental growth. I have used quantitative RT-PCR to evaluate transcript levels early and late in each strain’s life cycle to determine if the diversion in phenotypes is due to an alteration in the Inc’s promoter. I have expressed in trans CT147 in the chimeric strain lacking the Inc and analyze if CT147 can rescue the premature rupturing phenotype. Similarly, I expressed the C. muridarum ortholog TC0424 into wild type C. trachomatis to determine if the phenotype is dominant. Overall, we anticipate that a molecular and functional characterization of this novel Inc protein will reveal new insight into the mechanisms by which Chlamydia manipulate host cell function to facilitate their infection.

African-born individuals in the United States face unique barriers in accessing preventative healthcare. We conducted a mixed-methods study to implement community-based health fairs and learn in the process the barriers regarding accessing preventative healthcare. From April to May 2018, we held six health fairs at three apartment complexes with high numbers of African-born residents. Fairs included free point-of-care screening for glucose, cholesterol, BMI, blood pressure, and HIV along with social services and health education. The health fairs were hosted in apartment complex common areas with HIV testing conducted in private rooms. Health fair participants were asked to complete a series of questionnaires to evaluate demographics, access to health services, and HIV testing history. We conducted 18 key informant interviews with health fair participants and community leaders to identify barriers to preventative healthcare among African-born individuals. Of the 111 adults who accessed at least one service at a health fair, 92 completed questionnaires. 61% were female, 52% were born in Africa, and 63% had health insurance. Among the 18 interviewed, the most commonly reported barriers were language, logistical barriers, a distrust of health professionals, and lack of health literacy. These barriers create a disconnect between patients and health providers and impedes access to health-related information. A high prevalence of non-communicable diseases was also identified among participants, including obesity, high blood pressure, and high cholesterol. Residential health fairs are a feasible method to increase engagement of African-born individuals in preventative care. Key considerations are providing culturally-competent care, easily accessible services, and staffing services with healthcare providers who speak the primary languages of the populations being served or have adequate interpretation services. Preventative healthcare services will also be more acceptable if all services (e.g. cardiometabolic and HIV screenings) are incorporated into one package and promoted as routine activities.