India

Dr. Khan spent his fellowship year the Public Health Research Institute in Mysore under the mentorship of A. Desiree LaBeaud, MD, MS, Purnima Madhivana, PhD, MBBS, MPH, Vijaya Srinivas, MMBS and Kiranmayee Muralidhar, MBBS, MP. His research focused on investigating the epidemiology and risk factors for dengue and chikungunya virus infections in southern India. Dr. Khan is a pediatric infectious diseases physician at the Stanford University School of Medicine. He has research interests in studying infectious diagnostics in resource-limited settings and promoting antibiotic stewardship. Dr. Khan has recently been studying arboviral infections (dengue and chikungunya) in western and coastal Kenya with aspirations to impact global child health. Project title: Investigating the epidemiology and risk factors for dengue and chikungunya virus infections in southern India Project description: Arboviral infections have re-emerged as a significant global public health problem with chikungunya virus (CHIKV) transmission now occurring in 45 countries and dengue virus (DENV) transmission in 128 countries, placing nearly 4 billion people at risk (Fritzell, 2018; Bhatt, 2013). India has suffered repeated outbreaks of CHIKV and DENV in addition to other infections which can present with similar symptoms (Sharif, 2021; Ganeshkumar, 2018). Seroprevalence studies have attempted to estimate the true burden of CHIKV and DENV in India but often are hampered by spatial heterogeneity given the diversity across the country (Murhekar, 2019). Furthermore, although numerous studies have detailed molecular phylogenetic analysis for both viruses, there are few studies exploring the local risk factors and behaviors associated with infection in southern India (Rai, 2021). Interestingly, we and others have shown there is bidirectional transmission of DENV and CHIKV between Kenya and India (Sharif, 2021; Langat, 2020; Shah, 2020). CHIKV and DENV overlap in symptomatology and both are transmitted by diurnal Aedes aegypti mosquitoes, in contrast to malaria-transmitting nocturnal Anopheles spp. which feed at night (Karungu, 2019). In India and other parts of the world, as malaria diagnosis has become easier with high sensitivity point-of-care testing, vector-control strategies typically center around nocturnally-feeding Anopheles spp. mosquitoes. In Kenya, our laboratory has partnered with county and national members in the Ministry of Health to promote an integrated vector-control program that expands on the existing focus on malaria. Through this proposed pilot study, we aim to identify relationships that can be further explored in larger studies to uncover the burden of infection and better inform policy makers when considering resource allocation in southern India. To better understand these viruses in southern India we propose a pilot study to estimate community prevalence and associated risk factors. Through a cross-sectional study of adults and children we can survey the community to characterize their household factors, location, demographics, movement behavior, and built environment. In collaboration with the Public Health Research Institute in Mysore, India and the LaBeaud laboratory at Stanford University, I will work in the community to identify and survey participants, applying skills I have gained while working in Kenya. After participants are identified and surveyed, we will collect their serum to perform testing for DENV IgG and CHIKV IgG by ELISA to determine baseline seroprevalence. I will compare seropositive individuals with seronegative individuals to identify relationships pertaining to demographics, space, activity, behavior, and built environment factors. We have early data demonstrating an increased risk of arboviral infection with more surrounding trash and can also further explore this relationship in southern India. This can highlight important relationships when thinking about risk factors for infection. The goal of this pilot study is to generate meaningful data to further explore in a larger prospective study, similar to our prior and current laboratory work in western and coastal Kenya (Hortion, 2020; Grossi-Soyster, 2017).

Dr. Patil spent her fellowship year at Sri Ramachandra Institute of Higher Education and Research in Chennai under the mentorship of Naveen Puttaswamy, PhD and Andres Cardenas, PhD. Her research focused on assessing the relationship between secondhand smoke (SHS) exposure and dental caries in children of the Household Air Pollution Intervention Network (HAPTN) cohort. Dr. Patil is a Pediatric Dentist and is currently pursuing her PhD. Through this fellowship, she hopes to bridge the gap between children's environment and oral health. She aspires to leverage the unique expertise of environmental health and dentistry fields to understand how environmental exposure (i.e., exposome) might influence ECC susceptibility - and determine a way to reverse or mitigate it.

Fellowship Site: Manipal Academy Of Higher Education, IndiaProject Title: Lived experience of the double burden of COVID-19 and cardiac diseases among women in a coastal town of South India: An exploratory studyCOVID-19 patients with underlying cardiac diseases have an extremely poor prognosis, with higher mortality compared to those without a cardiac history. In the Indian subcontinent, with patriarchal societies, the double burden of COVID-19 infection and a cardiac complication can increase the health care expenditure of the families. Social security schemes and Direct Benefit Transfer policies might sometimes fall short to meet the demands and might not be timely due to bureaucracy issues. The present study is aimed to focus on the lived experience of these women during the unexpected pandemic. Aim 1: Using qualitative methods, to explore the experiences of women with cardiac diseases during COVID-19 pandemic from their own perspectives. Aim 2: Using qualitative methods, to understand the constraints faced by women with cardiac dieases with respect to health seeking behaviour and treatment in the context of COVID-19 pandemic. For Aim 1, we intend to explore the familial and in-patient experiences of women with cardiac manifestations adopting a descriptive, qualitative design with a phenomenological approach. Purposive sampling and in-depth interviews will be conducted to uncover the stressors, challenges and barriers faced by women to access and avail diagnosis and treatment services in the region. These interviews would provide insights and reveal the interpersonal and sociocultural context affecting their experience during the pandemic situation For Aim 2, the interviews will explore how the participants faced the changes in health care services due to COVID-19 situation. This will help comprehend contextual changes like loss of jobs, home bound spouse domestic violence, home-bound children with online mode of schooling with increased demands on their personal time and space. The changing family and social dynamics will be explored to understand their influence on the treatment seeking behaviour and if any coping strategies were adopted to circumvent the transition in familial and community environment. The outcome of this research can enable the frontline health workers and skilled health care providers to put in place guidelines for co-existent emergencies in future.