A global rise in humanitarian emergencies, driven by conflict, poses significant health challenges, especially for children under five years old. While the source of such crises and the challenges affected healthcare systems face may be confined to man-made borders, the resulting spread of health problems such as antimicrobial resistant (AMR) infections and diarrheal diseases are not bound geographically. To address concerns in such dynamic environments, healthcare workers utilize simple, fast acting solutions to save as many children as possible. For diarrheal diseases, this entails initially treating with zinc supplements and oral rehydration solutions (ORS), saving antibiotics for the cases that do not respond to this treatment. Determining who needs this care is often assessed through proxy data tracked via routine vaccination records, such as “zero dose communities”. However, both protocols are not without their shortcomings. The goal of this thesis is to examine their risks. We first examine how zinc might impact resistance development in Escherichia coli in vitro. We further demonstrate by computational modeling that slight changes in fitness have disproportionate changes on the rate of resistance onset. After discovering that the use of zinc for diarrhea treatment may be contributing to the AMR crisis, we next focus on ensuring that children suffering from diarrheal diseases can access treatment. We find that using zero dose communities as a means of determining which children could access care, while suitable for other services, is ultimately insufficient for diarrheal diseases in crisis settings such as Democratic Republic of Congo, Afghanistan and Bangladesh. Finally, we look at developing a tool that could be used to better understand access to care patterns for diarrheal disease and show the impacts that conflict, weather and travel infrastructure have on altering access to care in Yemen, which has been in the midst of the world’s worst humanitarian crisis. Overall, this body of work demonstrates how both current treatment practices and access to care assessments for diarrheal diseases have previously overlooked risks which can contribute to poor health outcomes especially for children under five years old living in areas affected by humanitarian crises.
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/47938 |
| Date | 18 January 2024 |
| Creators | Suprenant, Mark Paladin |
| Contributors | Zaman, Muhammad H. |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
| Rights | Attribution 4.0 International, http://creativecommons.org/licenses/by/4.0/ |
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