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Epidemiology of Malaria Infections and Drug Resistance in Haiti

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Epidemiology of Malaria Infections and Drug Resistance in Haiti EPIDEMIOLOGY OF MALARIA INFECTIONS AND DRUG RESISTANCE IN HAITI By MAHA A. ELBADRY A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 2015 © 2015 Maha A Elbadry To my parents, for always believing in me ACKNOWLEDGMENTS I would like to acknowledge and thank the many collaborators, both in the United States and in Haiti, who made this thesis possible. I would like to dedicate a very special gratitutde to my thesis committee members for their continuous support, extended guidance, and mentorship, which allowed me to craft, design and implement this study. They helped shape my growth as a scientist, enabling me to become a better researcher and develop in the field of public health. Special thanks goes to Dr. Bernard Okech, my advisor and mentor who has been with me along the way from my very first day till the last one, never letting me down and always believing in me. I owe you much , Dr. Okech, and I hope one day I can make you proud of my achievements and pleased to say you were my mentor. If there is one person that I owe a debt that I can never repay, it would be Dr. John Dame. I always believed- he was sent to me by God. Dr. Dame constantly reminded me I should never forget to be the human God wants us to be. Dr. Dame taught me how to think like a scientist, to be in control of all my work, and above all, how to be the best critic of my own work. He taught me extremely valuable lessons regarding how to prepare and plan ahead for field trips and research, how to think of all the details that may and will come along the way, and these he taught not by words but by example. Not enough words are present in the English vocabulary to help me express my gratitude for his continuous and extended support. I profusely thank Dr. Gregory Gray, the preson who made my career plans possible. I would have not had the opportunity to be a graduate student at UF and flourish without him. I am extremely grateful to Dr. Sabo-Attwood, who has been a gracious and wonderful leader during my time of need as a graduate student. I thank 4 Dr. Madsen Beau De Rochars who has been my Haitian godfather,for doing everything possible to guarantee that my work in Haiti was possible and went smoothly. I thank Dr. John Lednicky, who opened the door of his lab and worked with me closely on side projects that will definitely support my future academic career. I dedicate sincere and special gratitude to Dr. Daniel Impoinvil, the Haitian-American Entomologist who held nothing back from helping me. He acted as an escort and provided transportation to rural sites far inside Haiti, and assiged his crew members to support my sampling efforts and help respondants among the public as they filled-out questionnaire. To my Haitian colleagues and collaborators In Hinch, I thank Dr. Stephen Eads, Jenny, and Emily for their support and friendship that made my stay in Hinch comfortable and productive. Thanks to Evie, whom I met by coincidence; she has been very helpful during field activities in arranging pariticipanants in lines and facilitating the work flow. My new friends in Dame Marie, Dr. Tellus, Dr. Elysa Gay and Ms. Dejni the nurse in La Hopital de Dame Marie, worked with me in harmony despite the short notice to coordinate my sample collection and processing efforts. Dr. Elysa Gay made the maternity clinic available for patient enrollment, and her nurses acted like troops in explaining to the public the benefits of enrolling in the study as well as encouraging other women from the local community to join. I would like to thank Mr. Yvan Saint Jean and Mr. Josef Fredric from the National Malaria Control Programme of the Haitian MSPP who assited with the trip to Grand Anse. Even though I could only communicate with them in Spanish, in which I am not entirely fluent, they nevertheless understood me and showered me with love and care, 5 and despite being 7,000 miles away from my home I felt safe and secure as if I was among my own family. A special thanks to my colleague and friend Massimiliano Tagliamonte for all the academic and field support he showered me with, and for his company during long hours of work under dim hotel lights in Haiti, and all the bioinformatics support he provided and helped understand and master. Thanks to my friends from the Department of Environmental and Global Health: Jessica Rowland, Helena Chapman, Marrissa Valentine, Sarah White, Mary Leigh Morris, Tara Wilfong, who became a second family to me during my years in the USA. Many thanks to Alex Weppelman, for teaching me how to use STATA and for helping me create GIS maps and understand software codings. I owe you a lot Alex; you are a great asset to any place you work in. Thanks to Dr. Atiat Gomaa, my second mother; she was my family member in a country where my nearest relative is in Canada. Thanks to Amira, Nihal, Amal, Nadia, Razan, Yasmin, Nada, Eman and all the amazing people that I had the pleasure and blessings of meeting during my stay in USA. You have been a family to me and for that I’m grateful for eternity. Special thanks to my friends in Egypt, Amira Haridy and Hammour Ziada. They made sure no matter how long I’m away from home, I will never forget how warm and caring it is; you have all been the hands sent to me from heaven to help me pass this tough journey. I’m single but certainly with you, I’m not alone. Finally I kept to the last my blood family; my father Dr. Adel Elbadry, the role model of my life, the man who gave me and my siblings wings and helped us fly, the leader by example, who doesn’t talk much but does much. My mother Dr. Fatma 6 Ghanem, the example of a perfect woman in my eyes, who taught me how to pray, how to connect to my deep spiritual side. The woman that showed me by example, how to be a scientist, a mother and a wonderful wife without losing yourself in the path. I owe everything in my life to my parents; without their support and guidance, their consistant care and endless unconditional love, I wouldn’t be where I am today. And if there is one thing I thank them both for the most, it is the gift of my siblings, Mohamed and Menna, the backbone that I know I can count on, my everlasting fire exit that I know will always protect and rescue me in times of need. This dissertation has been funded by a multiple funding sources, starting with a grant from the Armed Forces Health Suveillance Center, Global Emerging Infections Surveillance and Response Division, to Dr. Bernard Okech. Secondary funding was obtained from the university of Florida Department of Environmental and Global Health, College of Public Health and Health Professions, to Maha A. Elbadry, and funds from the University of Florida Emerging Pathogens Institute to Dr. John Dame. The author declares an absence of competing interests with the information presented in this dissertation. In addition, the author assumes full responsibility for the collection and analysis of all data. 7 TABLE OF CONTENTS page ACKNOWLEDGMENTS .................................................................................................. 4 LIST OF TABLES .......................................................................................................... 10 LIST OF FIGURES ........................................................................................................ 11 LIST OF ABBREVIATIONS ........................................................................................... 12 ABSTRACT ................................................................................................................... 14 CHAPTER 1 INTRODUCTION .................................................................................................... 16 Malaria in Haiti ........................................................................................................ 19 Focus of Research .................................................................................................. 22 Study 1) Determination of the prevalence of malaria in Haiti within the asymptomatic population............................................................................... 22 Study 2) Measure the prevalence of malaria in pregnant women in Haiti, a neglected high-risk population, and assess demographic risk factors ........... 23 Study 3) Evaluating the sensitivity of Plasmodium falciparum to chloroquine using genetic markers. .................................................................................. 24 Approach to Fieldwork ............................................................................................ 25 Ethical Approval ............................................................................................... 25 University of Florida Research capacity ..................................................... 25 Study sites ................................................................................................. 26 Participant Enrollment for Study 1 &2 ............................................................... 26 Artibonite: ................................................................................................... 26 Central plateau ........................................................................................... 27 Grand Anse ................................................................................................ 28 Nord ........................................................................................................... 29
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