Clinical Focus

  • Internal Medicine
  • Tropical Diseases

Administrative Appointments

  • Director of Center for Innovation in Global Health, Stanford University (2009 - Present)
  • Senior Associate Dean of Global Health, Stanford University (2009 - Present)
  • Board of Global Health, National Academy of Medicine (2019 - 2024)
  • Chair of Board, Consortium of Universities for Global Health (2020 - 2022)
  • Member, American Academy of Arts & Sciences (2020 - Present)
  • Vice Chair of the Board, Consortium of Universities for Global Health (2019 - 2020)
  • Senior Fellow, Woods Institute (2011 - Present)
  • Senior Fellow, Freeman Spogli Institute (2011 - Present)
  • Director, Yale/Stanford Johnson & Johnson Global Health Scholars Program, Stanford University Site (2009 - Present)
  • Paul Rogers Ambassador to US Congress, US Congress (2008 - Present)
  • President, American Society of Tropical Medicine and Hygiene (2001 - 2002)
  • Health Consultant Overseas Programs, Ford Foundation (1995 - 2011)
  • C-Director of Yale/Stanford Johnson and Johnson Global Physician Scholars Program, Stanford University and Yale University (1986 - Present)

Honors & Awards

  • Humanitarian Award, Migration and Refugee, Catholic Services (1981)
  • Elm-Ivy Mayor's Award-New Haven CT, New Haven Mayor's Office (1993)
  • Best Doctors in America, Peer Selection--conducted by Connolly-Castle (1996-present)
  • President, American Society of Tropical Medicine and Hygiene (2001-2002)
  • Christopher Krogh Award for caring for the underserved, GHEC (2002)
  • Distinguished Teacher's Award, Yale University (2002)
  • Institute of Medicine Elected Member, National Academy of Sciences (2002-present)
  • Ben Kean Medal, American Society of Tropical Medicine & Hygiene (2010)
  • Elizabeth Blackburn Award, American Medical Woman's Association (2017)

Boards, Advisory Committees, Professional Organizations

  • Councilor, National Council for American Society of Tropical Medicine and Hygiene (1991 - 1996)
  • Chair, ASTMH Committee for Certification Exam in the United States (1993 - 1996)
  • Advisory Board, Global Health Corps (2008 - Present)
  • Advisory Board, Foundation for Advancement of International Education (2009 - Present)
  • Advisory Board, Harmony in Health, Borneo, Indonesia (2009 - Present)
  • Founding Board Member, (CUGH) Consortium of University for Global Health (2009 - Present)
  • Board Member, (FAIMER) Foundation for Advancement of International Medical Education and Research (2010 - 2016)
  • Advisory Board, NIH-Fogarty Center (2012 - 2018)

Program Affiliations

  • Center for Latin American Studies

Professional Education

  • Residency: Yale New Haven Dept of Internal Medicine (1980) CT
  • Residency: Yale New Haven Medical Center (1981) CT
  • Medical Education: Albert Einstein College of Medicine (1977) NY
  • Board Certification: American Board of Internal Medicine, Internal Medicine (1980)
  • Fellowship, Yale-New Haven Hospital, Rheumatology (1983)
  • Chief Residency, Yale-New Haven Hospital, Medicine (1981)
  • Residency, Yale-New Haven Hospital, Medicine (1980)
  • Internship, Yale-New Haven Hospital, Medicine (1978)
  • Diploma, Walter Reed Hospital, DC, Tropical Medicine (1980)
  • M.D., Albert Einstein College (AOA), Medicine (1977)
  • A.B., Bryn Mawr College (Magna cum laude), A.B. (1974)

Community and International Work

  • Global Scholars program, Uganda, Borneo,Bangladesh,Eritrea,Liberia,Haiti,South Africa,Liberia


    Education in Subsaharan Africa

    Partnering Organization(s)

    Twinned with various overseas institutions

    Populations Served




    Ongoing Project


    Opportunities for Student Involvement


  • Stanford Global Fellows, Haiti, Uganda,Liberia,Eritrea,Liberia.Borneo


    Global Health

    Partnering Organization(s)

    Makerere University - Uganda, Tugela Ferry - South Africa, Orotta Medical School - Eritrea

    Populations Served




    Ongoing Project


    Opportunities for Student Involvement


Current Research and Scholarly Interests

Michele Barry, MD, FACP is the Senior Associate Dean for Global Health and Director of the Center for Innovation in Global Health. As a co-Founder and co-Director of the Yale/Stanford Johnson and Johnson Global Health Scholar Award,she has sent over 1000 physicians overseas to underserved areas to help strengthen health infrastructure in low resource settings. She also is current co-PI of two NIH initiatives: Global Health Equity Scholars Program and the NIH-MEPI to twin University of Zimbabwe Health Sciences with Stanford. As a past President of the American Society of Tropical Medicine and Hygiene, she led an educational initiative in tropical medicine and travelers health which culminated in diploma courses in tropical medicine both in the U.S. and overseas, as well as a U.S. certification exam. Dr. Barry is an elected member of the Institute of Medicine and National Academy of Science. She also sits on the the Board of Directors of the Consortium of Universities involved in Global Health (CUGH), the Foundation for Advancement in International Education (FAIMER and Fogarty-NIH advisory board.
Areas of scholarly interest include ethical issues involving research overseas, clinical tropical medicine, emerging infectious diseases, problems of underserved populations and globalization’'s impact upon health in the developing world.


  • Stanford Global Health Consortium: Innovation, Design, Evaluation, and Action, Stanford University (2010 - Present)

    CIDEA Stanford Global Health Consortium: Innovation, Design, Evaluation, and Action



  • Yale/Stanford Johnson and Johnson Global Health Scholars Mary Duke Scholar program, Stanford University

    The Office of Global Health funds Stanford faculty, residents and students to the above sites for clinical, educational and research purposes depending upon the site chosen. Independent research projects can be developed especially at the Bangladesh site.


    Eritrea, Bangladesh, Liberia, Indonesia, Malawi, Nepal, Uganda, South Africa

  • 49729-Programmic: Novel, Stanford University

    Programmatic: Novel Education Clinical Trainees and Researchers (NECTAR) Program



  • Bangladesh Stanford Global Health Collaboration, Stanford University




  • Global Health Fellows and Scholars Research and Training Program, Stanford University

    We propose to establish a Support Center (Consortium) involving University of California- Berkeley, Yale University, Stanford University and Florida International University to train postdoctoral fellows, PhD graduate students, and medical students


    Bangladesh, Kenya, Zimbabwe

  • Fogarty Global Health Equity Scholars Fellowship, Stanford University

    The Global Health Equity Scholars (GHES) fellowship is a one-year research training program for post-doctoral fellows, upper-level PhD students and professional school (MD, DVM, DrPH, DDS, PharmD) students.


    Bangladesh, Kenya, Zimbabwe

  • Chair of CUGH 2020-2022, NA

    Consortium of Universities in Global Health


    washington dc

All Publications

  • A Call to Action for Gender Equity in Climate Leadership. The American journal of tropical medicine and hygiene Wray, B., Veidis, E. M., Flores, E. C., Phillips, A. A., Alani, O., Barry, M. 2023


    Climate action is not advancing quickly enough to prevent catastrophic harm. Understanding why might require looking at existing leadership structures and the inequitable gender representation therein. Critically examining dominant power structures could pave the way toward more comprehensive, innovative, and expedient environmental solutions-and we argue that elevating women's climate leadership is key to safeguarding planetary health. Women have historically been left out of climate science and governance leadership. Women are disproportionately impacted by the health effects of climate change, particularly in Indigenous and low- and middle-income settings. Therefore, our call for women's climate leadership is both an issue of justice and a matter of effectiveness, given evidence that inclusive leadership rooted in gender justice leads to more equitable outcomes. Here, we present evidence for why gender equity in climate leadership matters along with considerations for how to attain it across sectors and stakeholders.

    View details for DOI 10.4269/ajtmh.22-0674

    View details for PubMedID 37127272

  • What We Lost in the Fire: Endemic Tropical Heart Diseases in the Time of COVID-19. The American journal of tropical medicine and hygiene Chang, A. Y., Zühlke, L., Ribeiro, A. L., Barry, M., Okello, E., Longenecker, C. T. 2023


    The COVID-19 pandemic has profoundly influenced the effort to achieve global health equity. This has been particularly the case for HIV/AIDS, tuberculosis, and malaria control initiatives in low- and middle-income countries, with significant outcome setbacks seen for the first time in decades. Lost in the calls for compensatory funding increases for such programs, however, is the plight of endemic tropical heart diseases, a group of disorders that includes rheumatic heart disease, Chagas disease, and endomyocardial fibrosis. Such endemic illnesses affect millions of people around the globe and remain a source of substantial mortality, morbidity, and health disparity. Unfortunately, these conditions were already neglected before the pandemic, and thus those living with them have disproportionately suffered during the time of COVID-19. In this perspective, we briefly define endemic tropical heart diseases, summarizing their prepandemic epidemiology, funding, and control statuses. We then describe the ways in which people living with these disorders, along with the healthcare providers and researchers working to improve their outcomes, have been harmed by the ongoing COVID-19 pandemic. We conclude by proposing the path forward, including approaches we may use to leverage lessons learned from the pandemic to strengthen care systems for these neglected diseases.

    View details for DOI 10.4269/ajtmh.22-0514

    View details for PubMedID 36746666

  • Ecological and socioeconomic factors associated with the human burden of environmentally mediated pathogens: a global analysis LANCET PLANETARY HEALTH Sokolow, S. H., Nova, N., Jones, I. J., Wood, C. L., Lafferty, K. D., Garchitorena, A., Hopkins, S. R., Lund, A. J., MacDonald, A. J., LeBoa, C., Peel, A. J., Mordecai, E. A., Howard, M. E., Buck, J. C., Lopez-Carr, D., Barry, M., Bonds, M. H., De Leo, G. A. 2022; 6 (11): E870-E879
  • Characterization and regulation of microplastic pollution for protecting planetary and human health. Environmental pollution (Barking, Essex : 1987) Jung, Y. S., Sampath, V., Prunicki, M., Aguilera, J., Allen, H., LaBeaud, D., Veidis, E., Barry, M., Erny, B., Patel, L., Akdis, C., Akdis, M., Nadeau, K. 2022: 120442


    Microplastics are plastic particles <5 mm in diameter. Since the 1950s, there has been an exponential increase in the production of plastics. As of 2015, it is estimated that approximately 6300 million metric tons of plastic waste had been generated of which 79% has accumulated in landfills or the natural environment. Further, it is estimated that if current trends continue, roughly 12,000 million metric tons of plastic waste will accumulate by 2050. Plastics and microplastics are now found ubiquitously-in the air, water, and soil. Microplastics are small enough to enter the tissues of plants and animals and have been detected in human lungs, stools, placentas, and blood. Their presence in human tissues and the food chain is a cause for concern. While direct clinical evidence or epidemiological studies on the adverse effects of microplastic on human health are lacking, in vitro cellular and tissue studies and in vivo animal studies suggest potential adverse effects. With the ever-increasing presence of plastic waste in our environment, it is critical to understand their effects on our environment and on human health. The use of plastic additives, many of which have known toxic effects are also of concern. This review provides a brief overview of microplastics and the extent of the microplastic problem. There have been a few inroads in regulating plastics but currently these are insufficient to adequately mitigate plastic pollution. We also review recent advances in microplastic testing methodologies, which should support management and regulation of plastic wastes. Significant efforts to reduce, reuse, and recycle plastics are needed at the individual, community, national, and international levels to meet the challenge. In particular, significant reductions in plastic production must occur to curb the impacts of plastic on human and worldwide health, given the fact that plastic is not truly recyclable.

    View details for DOI 10.1016/j.envpol.2022.120442

    View details for PubMedID 36272609

  • Experiences of United States Graduates at the Latin American Medical School in Cuba: A Road Less Traveled JOURNAL OF HEALTH CARE FOR THE POOR AND UNDERSERVED Kirkland, D. A., Meschke, L. L., Zamora-Kapoor, A., Salomon, M., Barry, M., Erwin, P. C. 2022; 33 (2): 790-805


    Determine if United States graduates of the Latin American Medical School in Cuba: 1) provide primary health care to disadvantaged populations; 2) complete licensing exams and obtain residencies; and 3) accrue additional debt during their medical education.A Qualtrics secure web-based survey was provided to 158 graduates via email, completed anonymously. Responses were compiled and descriptive statistics generated.Fifty-six valid surveys were returned, for a response rate of 35.4%. Chi-square analysis showed no statistically significant differences between survey respondents and the sampling frame. Most graduates are people of color; 68% work in clinical medicine; of these, 90% are in primary care, with 100% serving disadvantaged populations. Most accrued no further educational loan debt.United States graduates of the Latin American Medical School work in primary care with disadvantaged populations. Graduates accrue little additional student loan debt.

    View details for Web of Science ID 000802975700003

    View details for PubMedID 35574877

  • The Stanford Global Health Media Fellowship: Training the Next Generation of Physician Communicators to Fight Health Misinformation. Academic medicine : journal of the Association of American Medical Colleges Krohn, K. M., Yu, G., Lieber, M., Barry, M. 2022


    PROBLEM: The COVID-19 pandemic and the spread of related health misinformation, especially on social media, have highlighted the need for more health care professionals to produce and share accurate health information to improve health and health literacy. Yet, few programs address this problem by training health care professionals in the art of science writing and medical journalism.APPROACH: Created in 2011, the Stanford Global Health Media Fellowship aims to train medical students and residents in public communication strategies. Each year, 1 physician-in-training is selected to complete the fellowship, which includes 3 rotations: (1) 1 academic quarter at Stanford's Graduate Program in Journalism, (2) 3 to 5 months with a national news network (previously NBC and ABC, now CNN), and (3) a placement at an international site. During the year-long program, fellows also complete a capstone project tackling a global health equity issue.OUTCOMES: Since 2011, 10 fellows have completed the program, and they have acquired skills in reporting, writing, multimedia, social media, and medical communications. During the news network rotation, they have completed more than 200 medical news pieces and improved the quality of the health information in a myriad of other pieces. Alumni have continued to write and report on medical stories throughout residency, other fellowships, and as practicing physicians. One alumnus is now a medical news producer at CNN.NEXT STEPS: Expanding high-quality training in medical journalism for physicians through partnerships with journalism schools, communications departments, and local, national, and international journalists can greatly improve physicians' ability to communicate with the public. It also has the potential to greatly improve the health information the public receives. Educators should consider embedding mass health communications training in medical education curricula and increasing opportunities for physicians to engage with diverse public audiences.

    View details for DOI 10.1097/ACM.0000000000004630

    View details for PubMedID 35213399

  • Climate Change and Global Health: A Call to more Research and more Action. Allergy Agache, I., Sampath, V., Aguilera, J., Akdis, C., Akdis, M., Barry, M., Bouagnon, A., Chinthrajah, S., Collins, W., Dulitzki, C., Erny, B., Gomez, J., Goshua, A., Jutel, M., Kizer, K. W., Kline, O., LaBeaud, A. D., Pali-Scholl, I., Perrett, K. P., Peters, R. L., Plaza, M. P., Prunicki, M., Sack, T., Salas, R. N., Sindher, S. B., Sokolow, S. H., Thiel, C., Veidis, E., Wray, B. D., Traidl-Hoffmann, C., Witt, C., Nadeau, K. C. 1800


    There is increasing understanding, globally, that climate change and increased pollution will have a profound and mostly harmful effect on human health. This review brings together international experts to describe both the direct (such as heat waves) and indirect (such as vector-borne disease incidence) health impacts of climate change. These impacts vary depending on vulnerability (i.e., existing diseases) and the international, economic, political and environmental context. This unique review also expands on these issues to address a third category of potential longer-term impacts on global health: famine, population dislocation, and environmental justice and education. This scholarly resource explores these issues fully, linking them to global health in urban and rural settings in developed and developing countries. The review finishes with a practical discussion of action that health professionals around the world in our field can yet take.

    View details for DOI 10.1111/all.15229

    View details for PubMedID 35073410

  • Mortality Along the Rheumatic Heart Disease Cascade of Care in Uganda. Circulation. Cardiovascular quality and outcomes Chang, A. Y., Barry, M., Bendavid, E., Watkins, D., Beaton, A. Z., Lwabi, P., Ssinabulya, I., Longenecker, C. T., Okello, E. 1800; 15 (1): e008445

    View details for DOI 10.1161/CIRCOUTCOMES.121.008445

    View details for PubMedID 35041475

  • What Do Global Health Practitioners Think about Decolonizing Global Health? Annals of global health Finkel, M. L., Temmermann, M., Suleman, F., Barry, M., Salm, M., Bingawaho, A., Kilmarx, P. H. 2022; 88 (1): 61


    The growing awareness of colonialism's role in global health partnerships between HICs and LMICs and the associated calls for decolonization in global health has led to discussion for a paradigm shift that would lead to new ways of engagement and partnerships, as well as an acknowledgement that colonialism, racism, sexism, and capitalism contribute to inequity. While there is general agreement among those involved in global health partnerships that the current system needs to be made more equitable, suggestions for how to address the issue of decolonization vary greatly, and moving from rhetoric to reform is complicated. Based on a comprehensive (but not exhaustive) review of the literature, there are several recurring themes that should be addressed in order for the inequities in the current system to be changed. The degree to which decolonization of global health will be successful depends on how the global health community in both the HICs and LMICs move forward to discuss these issues. Specifically, as part of a paradigm shift, attention needs to be paid to creating a more equal and equitable representation of researchers in LMICs in decision-making, leadership roles, authorship, and funding allocations. There needs to be agreement in defining basic principles of best practices for global partnership, including a universal definition of 'decolonization of global health'; the extent to which current policies allow the perpetuation of power imbalance between HICs and LMICs; a set of principles, best practices, and models for equitable sharing of funds and institutional costs among partners; a mechanism to monitor progress prospectively the equitable sharing of credits (e.g., leadership, authorship), including a set of principles, best practices, and models; and, a mechanism to monitor progress prospectively the extent to which decolonialization will contribute to strengthening institutional capacity in the LMIC institutions.

    View details for DOI 10.5334/aogh.3714

    View details for PubMedID 35974980

  • Editorial: Planetary health impacts of pandemic coronaviruses. Frontiers in public health Lopez-Carr, D., Sokolow, S., De Leo, G., Murray, K., Barry, M. 2022; 10: 987167

    View details for DOI 10.3389/fpubh.2022.987167

    View details for PubMedID 36016892

  • Ecological and socioeconomic factors associated with the human burden of environmentally mediated pathogens: a global analysis. The Lancet. Planetary health Sokolow, S. H., Nova, N., Jones, I. J., Wood, C. L., Lafferty, K. D., Garchitorena, A., Hopkins, S. R., Lund, A. J., MacDonald, A. J., LeBoa, C., Peel, A. J., Mordecai, E. A., Howard, M. E., Buck, J. C., Lopez-Carr, D., Barry, M., Bonds, M. H., De Leo, G. A. 2022; 6 (11): e870-e879


    BACKGROUND: Billions of people living in poverty are at risk of environmentally mediated infectious diseases-that is, pathogens with environmental reservoirs that affect disease persistence and control and where environmental control of pathogens can reduce human risk. The complex ecology of these diseases creates a global health problem not easily solved with medical treatment alone.METHODS: We quantified the current global disease burden caused by environmentally mediated infectious diseases and used a structural equation model to explore environmental and socioeconomic factors associated with the human burden of environmentally mediated pathogens across all countries.FINDINGS: We found that around 80% (455 of 560) of WHO-tracked pathogen species known to infect humans are environmentally mediated, causing about 40% (129 488 of 359 341 disability-adjusted life years) of contemporary infectious disease burden (global loss of 130 million years of healthy life annually). The majority of this environmentally mediated disease burden occurs in tropical countries, and the poorest countries carry the highest burdens across all latitudes. We found weak associations between disease burden and biodiversity or agricultural land use at the global scale. In contrast, the proportion of people with rural poor livelihoods in a country was a strong proximate indicator of environmentally mediated infectious disease burden. Political stability and wealth were associated with improved sanitation, better health care, and lower proportions of rural poverty, indirectly resulting in lower burdens of environmentally mediated infections. Rarely, environmentally mediated pathogens can evolve into global pandemics (eg, HIV, COVID-19) affecting even the wealthiest communities.INTERPRETATION: The high and uneven burden of environmentally mediated infections highlights the need for innovative social and ecological interventions to complement biomedical advances in the pursuit of global health and sustainability goals.FUNDING: Bill & Melinda Gates Foundation, National Institutes of Health, National Science Foundation, Alfred P. Sloan Foundation, National Institute for Mathematical and Biological Synthesis, Stanford University, and the US Defense Advanced Research Projects Agency.

    View details for DOI 10.1016/S2542-5196(22)00248-0

    View details for PubMedID 36370725

  • An Online Ethics Curriculum for Short-Term Global Health Experiences: Evaluating a Decade of Use. Annals of global health Modlin, C. E., DeCamp, M., Barry, M., Rockney, D., Sugarman, J. 2022; 88 (1): 74


    Background: Medical students and early career healthcare professionals commonly participate in short-term experiences in global health (STEGH).Objective: The authors evaluate the use of a free-to-access, case-based online curriculum addressing ethical issues trainees should consider prior to engaging in STEGH.Methods: Demographic data and feedback on specific cases were collected from 5,226 respondents accessing the online curriculum between November 1, 2011 and October 31, 2021. Feedback on the curriculum included 5-point Likert scale and open-ended responses. Quantitative data were analyzed using standard descriptive statistics. Qualitative data were independently dual coded and analyzed thematically in NVivo.Findings: The curriculum reached respondents from 106 countries. Undergraduate (36%) and graduate (38%) respondents included those from several different professional specialties. Less than a quarter of all of respondents, less than half with previous global health experience, and one-third with planned future global health experiences had received prior global health ethics training. Overall, the curriculum was highly rated; respondents felt it provided necessary tools to improve their thought processes, confidence, and behavior when encountering ethical issues during STEGH. Areas for curriculum improvement include balancing case specificity with generalizability.Conclusion: This curriculum has met a need for accessible introductory global health ethics education and demonstrates successful use of an online platform in case-based ethics learning.

    View details for DOI 10.5334/aogh.3716

    View details for PubMedID 36072830

  • Health system and patient-level factors serving as facilitators and barriers to rheumatic heart disease care in Sudan. Global health research and policy Edwards, J. G., Barry, M., Essam, D., Elsayed, M., Abdulkarim, M., Elhossein, B. M., Mohammed, Z. H., Elnogomi, A., Elfaki, A. S., Elsayed, A., Chang, A. Y. 2021; 6 (1): 35


    BACKGROUND: Rheumatic heart disease (RHD) remains a leading cause of morbidity and mortality in Sub-Saharan Africa despite widely available preventive therapies such as prophylactic benzathine penicillin G (BPG). In this study, we sought to characterize facilitators and barriers to optimal RHD treatment with BPG in Sudan.METHODS: We conducted a mixed-methods study, collecting survey data from 397 patients who were enrolled in a national RHD registry between July and November 2017. The cross-sectional surveys included information on demographics, healthcare access, and patient perspectives on treatment barriers and facilitators. Factors associated with increased likelihood of RHD treatment adherence to prophylactic BPG were assessed by using adjusted logistic regression. These data were enhanced by focus group discussions with 20 participants, to further explore health system factors impacting RHD care.RESULTS: Our quantitative analysis revealed that only 32% of the study cohort reported optimal prophylaxis adherence. Younger age, reduced primary RHD healthcare facility wait time, perception of adequate health facility staffing, increased treatment costs, and high patient knowledge about RHD were significantly associated with increased odds of treatment adherence. Qualitative data revealed significant barriers to RHD treatment arising from health services factors at the health system level, including lack of access due to inadequate healthcare staffing, lack of faith in local healthcare systems, poor ancillary services, and patient lack of understanding of disease. Facilitators of RHD treatment included strong interpersonal support.CONCLUSIONS: Multiple patient and system-level barriers to RHD prophylaxis adherence were identified in Khartoum, Sudan. These included patient self-efficacy and participant perception of healthcare facility quality. Strengthening local health system infrastructure, while enhancing RHD patient education, may help to improve treatment adherence in this vulnerable population.

    View details for DOI 10.1186/s41256-021-00222-2

    View details for PubMedID 34598719

  • Global health security as it pertains to Zika, Ebola, and COVID-19. Current opinion in infectious diseases Pannu, J., Barry, M. 2021


    PURPOSE OF REVIEW: Due to the impact of the COVID-19 pandemic this past year, we have witnessed a significant acceleration in the science, technology, and policy of global health security. This review highlights important progress made toward the mitigation of Zika, Ebola, and COVID-19 outbreaks. These epidemics and their shared features suggest a unified policy and technology agenda that could broadly improve global health security.RECENT FINDINGS: Molecular epidemiology is not yet in widespread use, but shows promise toward informing on-the-ground decision-making during outbreaks. Point-of-care (POC) diagnostics have been achieved for each of these threats; however, deployment of Zika and Ebola diagnostics lags behind those for COVID-19. POC metagenomics offers the possibility of identifying novel viruses. Vaccines have been successfully approved for Ebola and COVID-19, due in large part to public-private partnerships and advance purchase commitments. Therapeutics trials conducted during ongoing epidemics have identified effective antibody therapeutics for Ebola, as well as steroids (both inhaled and oral) and a broad-spectrum antiviral for COVID-19.SUMMARY: Achieving global health security remains a challenge, though headway has been made over the past years. Promising policy and technology strategies that would increase resilience across emerging viral pathogens should be pursued.

    View details for DOI 10.1097/QCO.0000000000000775

    View details for PubMedID 34334661

  • More Women Must Lead in Global Health: A Focus on Strategies to Empower Women Leaders and Advance Gender Equality. Annals of global health Batson, A., Gupta, G. R., Barry, M. 2021; 87 (1): 67


    Despite comprising 70% of the health workforce, women fill only 25% of senior and 5% of top health organization positions. Greater diversity in global health leadership, particularly greater representation of women, is essential to ensure diverse perspectives and ideas inform policies and priorities. Interviews and literature reviews surfaced many of the key challenges that women in global health face at individual, organizational and societal levels. Initiatives working to advance women's leadership are encouraged to consider 5 key priorities that address these challenges.

    View details for DOI 10.5334/aogh.3213

    View details for PubMedID 34307070

    View details for PubMedCentralID PMC8284502

  • Virtual Exchange in Global Health: an innovative educational approach to foster socially responsible overseas collaboration. International journal of educational technology in higher education Bowen, K., Barry, M., Jowell, A., Maddah, D., Alami, N. H. 2021; 18 (1): 32


    Educators who design and manage study abroad programs face a series of ethical responsibilities. Meeting these responsibilities is critical in the field of global health, where study abroad programs are often designed to provide healthcare services in under-resourced communities. Leaders in global health have thus formed working groups to study the ethical implications of overseas programming and have led the way in establishing socially responsible best practices for study abroad. Their recommendations include development of bidirectional programming that is designed for mutual and equitable benefits, focused on locally identified needs and priorities, attentive to local community costs, and structured to build local capacity to ensure sustainability. Implementation remains a key challenge, however. Sustainable, bidirectional programming is difficult and costly. In the present study, authors questioned how technology could be used to connect students of global health in distant countries to make socially responsible global health programming more accessible. Drawing on empirical research in the learning sciences and leveraging best practices in technology design, the authors developed a Virtual Exchange in Global Health to connect university students in the U.S. with counterparts in Lebanon, who worked in teams to address humanitarian problems in Syrian refugee camps. Early results demonstrate the value of this approach. At dramatically lower cost than traditional study abroad-and with essentially no carbon footprint-students recognized complementary strengths in each other through bidirectional programming, learned about local needs and priorities through Virtual Reality, and built sustaining relationships while addressing a difficult real-world problem. The authors learned that technology could effectively facilitate socially responsible global health programming and do so at low cost. The program has important implications for teaching and learning during the COVID-19 crisis and beyond.

    View details for DOI 10.1186/s41239-021-00266-x

    View details for PubMedID 34778528

    View details for PubMedCentralID PMC8189728

  • Virtual Exchange in Global Health: an innovative educational approach to foster socially responsible overseas collaboration INTERNATIONAL JOURNAL OF EDUCATIONAL TECHNOLOGY IN HIGHER EDUCATION Bowen, K., Barry, M., Jowell, A., Maddah, D., Alami, N. H. 2021; 18 (1)
  • The state inoculates: vaccines as soft power. The Lancet. Global health Pannu, J., Barry, M. 2021

    View details for DOI 10.1016/S2214-109X(21)00091-7

    View details for PubMedID 33713632

  • Estimating the local spatio-temporal distribution of malaria from routine health information systems in areas of low health care access and reporting. International journal of health geographics Hyde, E., Bonds, M. H., Ihantamalala, F. A., Miller, A. C., Cordier, L. F., Razafinjato, B., Andriambolamanana, H., Randriamanambintsoa, M., Barry, M., Andrianirinarison, J. C., Andriamananjara, M. N., Garchitorena, A. 2021; 20 (1): 8


    BACKGROUND: Reliable surveillance systems are essential for identifying disease outbreaks and allocating resources to ensure universal access to diagnostics and treatment for endemic diseases. Yet, most countries with high disease burdens rely entirely on facility-based passive surveillance systems, which miss the vast majority of cases in rural settings with low access to health care. This is especially true for malaria, for which the World Health Organization estimates that routine surveillance detects only 14% of global cases. The goal of this study was to develop a novel method to obtain accurate estimates of disease spatio-temporal incidence at very local scales from routine passive surveillance, less biased by populations' financial and geographic access to care.METHODS: We use a geographically explicit dataset withresidencesof the 73,022 malaria cases confirmed at health centers in the Ifanadiana District in Madagascar from 2014 to 2017. Malaria incidence was adjusted to account for underreporting due to stock-outs of rapid diagnostic tests and variable access to healthcare. A benchmark multiplier was combined with a health care utilization index obtained from statistical models of non-malaria patients. Variations to the multiplier and several strategies for pooling neighboring communities together were explored to allow for fine-tuning of the final estimates. Separate analyses were carried out for individuals of all ages and for children under five. Cross-validation criteria were developed based on overall incidence, trends in financial and geographical access to health care, and consistency with geographic distribution in a district-representative cohort. The most plausible sets of estimates were then identified based on these criteria.RESULTS: Passive surveillance was estimated to have missed about 4 in every 5 malaria cases among all individuals and 2 out of every 3 cases among children under five. Adjusted malaria estimates were less biased by differences in populations' financial and geographic access to care. Average adjusted monthly malaria incidence was nearly four times higher during the high transmission season than during the low transmission season. By gathering patient-level data and removing systematic biases in the dataset, the spatial resolution of passive malaria surveillance was improved over ten-fold. Geographic distribution in the adjusted dataset revealed high transmission clusters in low elevation areas in the northeast and southeast of the district that were stable across seasons and transmission years.CONCLUSIONS: Understanding local disease dynamics from routine passive surveillance data can be a key step towards achieving universal access to diagnostics and treatment. Methods presented here could be scaled-up thanks to the increasing availability of e-health disease surveillance platforms for malaria and other diseases across the developing world.

    View details for DOI 10.1186/s12942-021-00262-4

    View details for PubMedID 33579294

  • Puerto Rico Health System Resilience After Hurricane Maria: Implications for Disaster Preparedness in the COVID-19 Era FRONTIERS IN COMMUNICATION Rios, C. C., Ling, E. J., Rivera-Gutierrez, R., Sanchez, J., Merrell, S., Bruce, J., Barry, M., Perez, V. 2021; 5
  • The political and security dimensions of the humanitarian health response to violent conflict. Lancet (London, England) Wise, P. H., Shiel, A. n., Southard, N. n., Bendavid, E. n., Welsh, J. n., Stedman, S. n., Fazal, T. n., Felbab-Brown, V. n., Polatty, D. n., Waldman, R. J., Spiegel, P. B., Blanchet, K. n., Dayoub, R. n., Zakayo, A. n., Barry, M. n., Martinez Garcia, D. n., Pagano, H. n., Black, R. n., Gaffey, M. F., Bhutta, Z. A. 2021


    The nature of armed conflict throughout the world is intensely dynamic. Consequently, the protection of non-combatants and the provision of humanitarian services must continually adapt to this changing conflict environment. Complex political affiliations, the systematic use of explosive weapons and sexual violence, and the use of new communication technology, including social media, have created new challenges for humanitarian actors in negotiating access to affected populations and security for their own personnel. The nature of combatants has also evolved as armed, non-state actors might have varying motivations, use different forms of violence, and engage in a variety of criminal activities to generate requisite funds. New health threats, such as the COVID-19 pandemic, and new capabilities, such as modern trauma care, have also created new challenges and opportunities for humanitarian health provision. In response, humanitarian policies and practices must develop negotiation and safety capabilities, informed by political and security realities on the ground, and guidance from affected communities. More fundamentally, humanitarian policies will need to confront a changing geopolitical environment, in which traditional humanitarian norms and protections might encounter wavering support in the years to come.

    View details for DOI 10.1016/S0140-6736(21)00130-6

    View details for PubMedID 33503458

  • The Need to Expand the Framework of Environmental Determinants of Cardiovascular Health From Climate Change to Planetary Health: Trial by Wildfire. Circulation Chang, A. Y., Barry, M., Harrington, R. A. 2021; 143 (21): 2029-2031

    View details for DOI 10.1161/CIRCULATIONAHA.120.051892

    View details for PubMedID 34029138

  • Tackling the Ubiquity of Plastic Waste for Human and Planetary Health. The American journal of tropical medicine and hygiene Veidis, E. M., LaBeaud, A. D., Phillips, A. A., Barry, M. 2021

    View details for DOI 10.4269/ajtmh.21-0968

    View details for PubMedID 34749307

  • Clinical Outcomes, Echocardiographic Findings, and Care Quality Metrics for People Living with HIV and Rheumatic Heart Disease in Uganda. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Chang, A. Y., Rwebembera, J., Bendavid, E., Okello, E., Barry, M., Beaton, A. Z., Haeffele, C., Webel, A. R., Kityo, C., Longenecker, C. T. 2021


    Rheumatic Heart Disease (RHD) affects 41 million people worldwide, mostly in low- and middle-income countries, where it is co-endemic with HIV. HIV is also a chronic inflammatory disorder associated with cardiovascular complications, yet the epidemiology of patients affected by both diseases is poorly understood.Utilizing the Uganda National RHD Registry, we described the echocardiographic findings, clinical characteristics, medication prescription rates, and outcomes of all 73 people carrying concurrent diagnoses of HIV and RHD between 2009 and 2018. These individuals were compared to an age- and sex-matched cohort of 365 subjects with RHD only.The median age of the HIV-RHD group was 36 years (IQR 15) and 86% were women. The HIV-RHD cohort had higher rates of prior stroke/transient ischemic attack (12% vs 5%, p=0.02) than the RHD-only group, with this association persisting following multivariable adjustment (OR 3.08, p=0.03). Prevalence of other comorbidities, echocardiographic findings, prophylactic penicillin prescription rates, retention in clinical care, and mortality were similar between the two groups.Patients living with RHD and HIV in Uganda are a relatively young, predominantly female group. Although RHD-HIV comorbid individuals have higher rates of stroke, their similar all-cause mortality and RHD care quality metrics (such as retention in care) compared to those with RHD alone suggest rheumatic heart disease defines their clinical outcome more than HIV does. We believe this study to be one of the first reports of the epidemiologic profile and longitudinal outcomes of patients who carry diagnoses of both conditions.

    View details for DOI 10.1093/cid/ciab681

    View details for PubMedID 34382644

  • More Women Must Lead in Global Health: A Focus on Strategies to Empower Women Leaders and Advance Gender Equality Annals of Global Health Batson, A., Gupta, G. R., Barry, M. 2021

    View details for DOI 10.5334/aogh.3213

  • Improving rural health care reduces illegal logging and conserves carbon in a tropical forest. Proceedings of the National Academy of Sciences of the United States of America Jones, I. J., MacDonald, A. J., Hopkins, S. R., Lund, A. J., Liu, Z. Y., Fawzi, N. I., Purba, M. P., Fankhauser, K., Chamberlin, A. J., Nirmala, M., Blundell, A. G., Emerson, A., Jennings, J., Gaffikin, L., Barry, M., Lopez-Carr, D., Webb, K., De Leo, G. A., Sokolow, S. H. 2020


    Tropical forest loss currently exceeds forest gain, leading to a net greenhouse gas emission that exacerbates global climate change. This has sparked scientific debate on how to achieve natural climate solutions. Central to this debate is whether sustainably managing forests and protected areas will deliver global climate mitigation benefits, while ensuring local peoples' health and well-being. Here, we evaluate the 10-y impact of a human-centered solution to achieve natural climate mitigation through reductions in illegal logging in rural Borneo: an intervention aimed at expanding health care access and use for communities living near a national park, with clinic discounts offsetting costs historically met through illegal logging. Conservation, education, and alternative livelihood programs were also offered. We hypothesized that this would lead to improved health and well-being, while also alleviating illegal logging activity within the protected forest. We estimated that 27.4 km2 of deforestation was averted in the national park over a decade (70% reduction in deforestation compared to a synthetic control, permuted P = 0.038). Concurrently, the intervention provided health care access to more than 28,400 unique patients, with clinic usage and patient visitation frequency highest in communities participating in the intervention. Finally, we observed a dose-response in forest change rate to intervention engagement (person-contacts with intervention activities) across communities bordering the park: The greatest logging reductions were adjacent to the most highly engaged villages. Results suggest that this community-derived solution simultaneously improved health care access for local and indigenous communities and sustainably conserved carbon stocks in a protected tropical forest.

    View details for DOI 10.1073/pnas.2009240117

    View details for PubMedID 33106399

  • The Impact of Novel Coronavirus COVID-19 on Non-Communicable Disease Patients and Health Systems: A Review. Journal of internal medicine Chang, A. Y., Cullen, M. R., Harrington, R. A., Barry, M. 2020


    Coronavirus Disease 2019 (COVID-19) is an ongoing global pandemic affecting all levels of health systems. This includes the care of patients with noncommunicable diseases (NCDs) who bear a disproportionate burden of both COVID-19 itself and the public health measures enacted to combat it. In this review, we summarize major COVID-19 related considerations for NCD patients and their care providers, focusing on cardiovascular, pulmonary, renal, hematologic, oncologic, traumatic, obstetric/gynecologic, operative, psychiatric, rheumatologic/immunologic, neurologic, gastrointestinal, ophthalmologic, and endocrine disorders. Additionally, we offer a general framework for categorizing the pandemic's disruptions by disease-specific factors, direct health system factors, and indirect health system factors. We also provide references to major NCD medical specialty professional society statements and guidelines on COVID-19. COVID-19 and its control policies have already resulted in major disruptions to the screening, treatment, and surveillance of NCD patients. In addition, it differentially impacts those with pre-existing NCDs and may lead to de novo NCD sequelae. Likely, there will be long-term effects from this pandemic that will continue to affect practitioners and patients in this field for years to come.

    View details for DOI 10.1111/joim.13184

    View details for PubMedID 33020988

  • A life-course model for healthier ageing: lessons learned during the COVID-19 pandemic LANCET HEALTHY LONGEVITY Jowell, A., Carstensen, L. L., Barry, M. 2020; 1 (1): E9-E10

    View details for Web of Science ID 000659222500005

    View details for PubMedID 34173611

    View details for PubMedCentralID PMC7574716

  • Health interventions among mobile pastoralists: A systematic review to guide health service design. Tropical medicine & international health : TM & IH Wild, H., Mendonsa, E., Trautwein, M., Edwards, J., Jowell, A., GebreGiorgis Kidanu, A., Tschopp, R., Barry, M. 2020


    OBJECTIVE: Mobile pastoralists are one of the last populations to be reached by health services and are frequently missed by health campaigns. Since health interventions among pastoralists have been staged across a range of disciplines but have not yet been systematically characterized, we set out to fill this gap.METHODS: We conducted a systematic search in PubMed/MEDLINE, Scopus, EMBASE, CINAL, Web of Science, WHO Catalog, AGRICOLA, CABI, ScIELO, Google Scholar, and grey literature repositories to identify records that described health interventions, facilitators and barriers to intervention success, and factors influencing healthcare utilization among mobile pastoralists. No date restrictions were applied. Due to the heterogeneity of reports captured in this review, data were primarily synthesized through narrative analysis. Descriptive statistical analysis was performed for data elements presented by a majority of records.RESULTS: Our search yielded 4,884 non-duplicate records, of which 140 eligible reports were included in analysis. 89.3% of reports presented data from sub-Saharan Africa, predominantly in East Africa (e.g. Ethiopia, 30.0%; Kenya, 17.1%). Only 24.3% of reports described an interventional study, while the remaining 75.7% described secondary data of interest on healthcare utilization. Only two randomized controlled trials were present in our analysis, and only five reports presented data on cost. The most common facilitators of intervention success were cultural sensitivity (n=16), community engagement (n=12), and service mobility (n=11).CONCLUSION: Without adaptations to account for mobile pastoralists' unique subsistence patterns and cultural context, formal health services leave pastoralists behind. Research gaps, including neglect of certain geographic regions, lack of both interventional studies and diversity of study design, and limited data on economic feasibility of interventions must be addressed to inform the design of health services capable of reaching mobile pastoralists. Pastoralist-specific delivery strategies, such as combinations of mobile and "temporary fixed" services informed by transhumance patterns, culturally acceptable waiting homes, community-directed interventions, and combined joint human-animal One Health design as well as the bundling of other health services, have shown initial promise upon which future work should build.

    View details for DOI 10.1111/tmi.13481

    View details for PubMedID 32881232

  • Challenges for the female academic during the COVID-19 pandemic. Lancet (London, England) Gabster, B. P., van Daalen, K., Dhatt, R., Barry, M. 2020

    View details for DOI 10.1016/S0140-6736(20)31412-4

    View details for PubMedID 32563275

  • Global Health in the Age of COVID-19: Responsive Health Systems Through a Right to Health Fund HEALTH AND HUMAN RIGHTS Friedman, E. A., Gostin, L. O., Maleche, A., Nilo, A., Foguito, F., Rugege, U., Stevenson, S., Gitahi, G., Ruano, A., Barry, M., Hossain, S., Lucien, F., Rusike, I., Hevia, M., Alwan, A., Cameron, E., Farmer, P., Flores, W., Hassim, A., Mburu, R., Mukherjee, J., Mulumba, M., Puras, D., Roses Periago, M. 2020; 22 (1): 199–207
  • Global Health in the Age of COVID-19: Responsive Health Systems Through a Right to Health Fund. Health and human rights Friedman, E. A., Gostin, L. O., Maleche, A., Nilo, A., Foguito, F., Rugege, U., Stevenson, S., Gitahi, G., Ruano, A. L., Barry, M., Hossain, S., Lucien, F., Rusike, I., Hevia, M., Alwan, A., Cameron, E., Farmer, P., Flores, W., Hassim, A., Mburu, R., Mukherjee, J., Mulumba, M., Pūras, D., Periago, M. R. 2020; 22 (1): 199-207


    We propose that a Right to Health Capacity Fund (R2HCF) be created as a central institution of a reimagined global health architecture developed in the aftermath of the COVID-19 pandemic. Such a fund would help ensure the strong health systems required to prevent disease outbreaks from becoming devastating global pandemics, while ensuring genuinely universal health coverage that would encompass even the most marginalized populations. The R2HCF's mission would be to promote inclusive participation, equality, and accountability for advancing the right to health. The fund would focus its resources on civil society organizations, supporting their advocacy and strengthening mechanisms for accountability and participation. We propose an initial annual target of US$500 million for the fund, adjusted based on needs assessments. Such a financing level would be both achievable and transformative, given the limited right to health funding presently and the demonstrated potential of right to health initiatives to strengthen health systems and meet the health needs of marginalized populations-and enable these populations to be treated with dignity. We call for a civil society-led multi-stakeholder process to further conceptualize, and then launch, an R2HCF, helping create a world where, whether during a health emergency or in ordinary times, no one is left behind.

    View details for PubMedID 32669801

    View details for PubMedCentralID PMC7348449

  • We are living in the geologic age when human activities have dramatically affected our planet and its environment MEDICC REVIEW Barry, M. 2020; 22 (2): 12–13
  • Archaeology and contemporary emerging zoonosis: A framework for predicting future Rift Valley fever virus outbreaks INTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY Seetah, K., LaBeaud, D., Kumm, J., Grossi-Soyster, E., Anangwe, A., Barry, M. 2020

    View details for DOI 10.1002/oa.2862

    View details for Web of Science ID 000512278200001

  • Outcomes and Care Quality Metrics for Women of Reproductive Age Living With Rheumatic Heart Disease in Uganda. Journal of the American Heart Association Chang, A. Y., Nabbaale, J. n., Okello, E. n., Ssinabulya, I. n., Barry, M. n., Beaton, A. Z., Webel, A. R., Longenecker, C. T. 2020: e015562


    Background Rheumatic heart disease disproportionately affects women of reproductive age, as it increases the risk of cardiovascular complications and death during pregnancy and childbirth. In sub-Saharan Africa, clinical outcomes and adherence to guideline-based therapies are not well characterized for this population. Methods and Results In a retrospective cohort study of the Uganda rheumatic heart disease registry between June 2009 and May 2018, we used multivariable regression and Cox proportional hazards models to compare comorbidities, mortality, anticoagulation use, and treatment cascade metrics among women versus men aged 15 to 44 with clinical rheumatic heart disease. We included 575 women and 252 men with a median age of 27 years. Twenty percent had New York Heart Association Class III-IV heart failure. Among patients who had an indication for anticoagulation, women were less likely than men to receive a prescription of warfarin (66% versus 81%; adjusted odds ratio, 0.37; 95% CI, 0.14-0.96). Retention in care (defined as a clinic visit within the preceding year) was poor among both sexes in this age group (27% for men, 24% for women), but penicillin adherence rates were high among those retained (89% for men, 92% for women). Mortality was higher in men than women (26% versus 19% over a median follow-up of 2.7 years; adjusted hazard ratio, 1.66; 95% CI, 1.18-2.33). Conclusions Compared with men, women of reproductive age with rheumatic heart disease in Uganda have lower rates of appropriate anticoagulant prescription but also lower mortality rates. Retention in care is poor among both men and women in this age range, representing a key target for improvement.

    View details for DOI 10.1161/JAHA.119.015562

    View details for PubMedID 32295465

  • Mobile Pastoralists in Africa: A Blind Spot in Global Health Surveillance. Tropical medicine & international health : TM & IH Wild, H. n., Mohammed Ali, S. n., Bassirou, B. n., Tschopp, R. n., Barry, M. n., Zinsstag, J. n. 2020


    Mobile pastoralists subsist primarily on herds of livestock such as camels, cattle, and goats, migrating seasonally to access water and grazing areas. Speculative estimates of their global population have ranged from 50-200 million, while others have suggested that the number of pastoralists in Africa alone may equal these figures.

    View details for DOI 10.1111/tmi.13479

    View details for PubMedID 32865274

  • Global Health Education in the Time of COVID-19: An Opportunity to Restructure Relationships and Address Supremacy. Academic medicine : journal of the Association of American Medical Colleges Rabin, T. L., Mayanja-Kizza, H. n., Barry, M. n. 2020; Publish Ahead of Print


    Global health and its predecessors, tropical medicine and international health, have historically been driven by the agendas of institutions in high-income countries (HICs), with power dynamics that have disadvantaged partner institutions in low- and middle-income countries (LMICs). Since the 2000s, however, the academic global health community has been moving toward a focus on health equity and reexamining the dynamics of global health education (GHE) partnerships. Whereas GHE partnerships have largely focused on providing opportunities for learners from HIC institutions, LMIC institutions are now seeking more equitable experiences for their trainees. Additionally, lessons from the COVID-19 pandemic underscore already important lessons about the value of bidirectional educational exchange, as regions gain new insights from one another regarding strategies to impact health outcomes. Interruptions in experiential GHE programs due to COVID-19-related travel restrictions provide an opportunity to reflect on existing GHE systems, to consider the opportunities and dynamics of these partnerships, and to redesign these systems for the equitable benefit of the various partners. In this commentary, the authors offer recommendations for beginning this process of change, with an emphasis on restructuring GHE relationships and addressing supremacist attitudes at both the systemic and individual levels.

    View details for DOI 10.1097/ACM.0000000000003911

    View details for PubMedID 33394665

  • US withdrawal from WHO is unlawful and threatens global and US health and security. Lancet (London, England) Gostin, L. O., Koh, H. H., Williams, M. n., Hamburg, M. A., Benjamin, G. n., Foege, W. H., Davidson, P. n., Bradley, E. H., Barry, M. n., Koplan, J. P., Periago, M. F., El Sadr, W. n., Kurth, A. n., Vermund, S. H., Kavanagh, M. M. 2020

    View details for DOI 10.1016/S0140-6736(20)31527-0

    View details for PubMedID 32653080

  • COVID-19: A Matter of Planetary, not Only National Health. The American journal of tropical medicine and hygiene Jowell, A. n., Barry, M. n. 2020


    The COVID-19 pandemic highlights the multidimensional and inseparable connection between human health and environmental systems. COVID-19, similar to other emerging zoonotic diseases, has had a devastating impact on our planet. In this perspective, we argue that as humans continue to globalize and encroach on our surrounding natural systems, societies must adopt a "planetary health lens" to prepare and adapt to these emerging infectious diseases. This piece further explores other critical components of a planetary health approach to societal response, such as the seasonality of disease patterns, the impact of climate change on infectious disease, and the built environment, which can increase population vulnerabilities to pandemics. To address planetary health threats that cross international borders, such as COVID-19, societies must practice interdependence sovereignty and direct resources to organizations that facilitate shared global governance, and thus can enable us to adapt and ultimately build a more resilient world.

    View details for DOI 10.4269/ajtmh.20-0419

    View details for PubMedID 32431286

  • Africa's Nomadic Pastoralists and Their Animals Are an Invisible Frontier in Pandemic Surveillance. The American journal of tropical medicine and hygiene Hassell, J. M., Zimmerman, D. n., Fèvre, E. M., Zinsstag, J. n., Bukachi, S. n., Barry, M. n., Muturi, M. n., Bett, B. n., Jensen, N. n., Ali, S. n., Maples, S. n., Rushton, J. n., Tschopp, R. n., Madaine, Y. O., Abtidon, R. A., Wild, H. n. 2020


    The effects of COVID-19 have gone undocumented in nomadic pastoralist communities across Africa, which are largely invisible to health surveillance systems despite the fact that they are of key significance in the setting of emerging infectious disease. We expose these landscapes as a "blind spot" in global health surveillance, elaborate on the ways in which current health surveillance infrastructure is ill-equipped to capture pastoralist populations and the animals with which they coexist, and highlight the consequential risks of inadequate surveillance among pastoralists and their livestock to global health. As a platform for further dialogue, we present concrete solutions to address this gap.

    View details for DOI 10.4269/ajtmh.20-1004

    View details for PubMedID 32918410

  • Ten-year survival with analysis of gender difference, risk factors, and causes of death during 13 years of public antiretroviral therapy in rural Kenya Medicine Hodgkinson, L. M., Abwalaba, R. A., Arudo, J., Barry, M. 2020; 99 (21)
  • Making Pastoralists Count: Geospatial Methods for the Health Surveillance of Nomadic Populations. The American journal of tropical medicine and hygiene Wild, H., Glowacki, L., Maples, S., Mejia-Guevara, I., Krystosik, A., Bonds, M. H., Hiruy, A., LaBeaud, A. D., Barry, M. 2019


    Nomadic pastoralists are among the world's hardest-to-reach and least served populations. Pastoralist communities are difficult to capture in household surveys because of factors including their high degree of mobility over remote terrain, fluid domestic arrangements, and cultural barriers. Most surveys use census-based sampling frames which do not accurately capture the demographic and health parameters of nomadic populations. As a result, pastoralists are "invisible" in population data such as the Demographic and Health Surveys (DHS). By combining remote sensing and geospatial analysis, we developed a sampling strategy designed to capture the current distribution of nomadic populations. We then implemented this sampling frame to survey a population of mobile pastoralists in southwest Ethiopia, focusing on maternal and child health (MCH) indicators. Using standardized instruments from DHS questionnaires, we draw comparisons with regional and national data finding disparities with DHS data in core MCH indicators, including vaccination coverage, skilled birth attendance, and nutritional status. Our field validation demonstrates that this method is a logistically feasible alternative to conventional sampling frames and may be used at the population level. Geospatial sampling methods provide cost-affordable and logistically feasible strategies for sampling mobile populations, a crucial first step toward reaching these groups with health services.

    View details for DOI 10.4269/ajtmh.18-1009

    View details for PubMedID 31436151

  • Timely access to care for patients with critical burns in India: a prehospital prospective observational study EMERGENCY MEDICINE JOURNAL Newberry, J. A., Bills, C. B., Pirrotta, E. A., Barry, M., Rao, G., Mahadevan, S., Strehlow, M. C. 2019; 36 (3): 176–82
  • Prospective Biopsy-Based Study of Chronic Kidney Disease of Unknown Etiology in Sri Lanka. Clinical journal of the American Society of Nephrology : CJASN Anand, S., Montez-Rath, M. E., Adasooriya, D., Ratnatunga, N., Kambham, N., Wazil, A., Wijetunge, S., Badurdeen, Z., Ratnayake, C., Karunasena, N., Schensul, S. L., Valhos, P., Haider, L., Bhalla, V., Levin, A., Wise, P. H., Chertow, G. M., Barry, M., Fire, A. Z., Nanayakkara, N. 2019


    BACKGROUND AND OBJECTIVES: A kidney disease of unknown cause is common in Sri Lanka's lowland (dry) region. Detailed clinical characterizations of patients with biopsy-proven disease are limited, and there is no current consensus on criteria for a noninvasive diagnosis.DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We designed a prospective study in a major Sri Lankan hospital servicing endemic areas to ascertain pathologic and clinical characteristics of and assess risk factors for primary tubulointerstitial kidney disease. We used logistic regression to determine whether common clinical characteristics could be used to predict the presence of primary tubulointerstitial kidney disease on kidney biopsy.RESULTS: From 600 new patients presenting to a tertiary nephrology clinic over the course of 1 year, 87 underwent kidney biopsy, and 43 (49%) had a biopsy diagnosis of primary tubulointerstitial kidney disease. On detailed biopsy review, 13 (30%) had evidence of moderate to severe active kidney disease, and six (15%) had evidence of moderate to severe chronic tubulointerstitial kidney disease. Patients with tubulointerstitial kidney disease were exclusively born in endemic provinces; 91% spent a majority of their lifespan there. They were more likely men and farmers (risk ratio, 2.0; 95% confidence interval, 1.2 to 2.9), and they were more likely to have used tobacco (risk ratio, 1.7; 95% confidence interval, 1.0 to 2.3) and well water (risk ratio, 1.5; 95% confidence interval, 1.1 to 2.0). Three clinical characteristics-age, urine dipstick for protein, and serum albumin-could predict likelihood of tubulointerstitial kidney disease on biopsy (model sensitivity of 79% and specificity of 84%). Patients referred for kidney biopsy despite comorbid diabetes or hypertension did not experience lower odds of tubulointerstitial kidney disease.CONCLUSIONS: A primary tubulointerstitial kidney disease occurs commonly in specific regions of Sri Lanka with characteristic environmental and lifestyle exposures.PODCAST: This article contains a podcast at

    View details for PubMedID 30659059

  • Timely access to care for patients with critical burns in India: a prehospital prospective observational study. Emergency medicine journal : EMJ Newberry, J. A., Bills, C. B., Pirrotta, E. A., Barry, M., Ramana Rao, G. V., Mahadevan, S. V., Strehlow, M. C. 2019


    BACKGROUND: Low/middle-income countries carry a disproportionate burden of the morbidity and mortality from thermal burns. Nearly 70% of burn deaths worldwide are from thermal burns in India. Delays to medical care are commonplace and an important predictor of outcomes. We sought to understand the role of emergency medical services (EMS) as part of the healthcare infrastructure for thermal burns in India.METHODS: We conducted a prospective observational study of patients using EMS for thermal burns across five Indian states from May to August 2015. Our primary outcome was mortality at 2, 7 and 30 days. We compared observed mortality with expected mortality using the revised Baux score. We used Chi2 analysis for categorical variables and Wilcoxon two-sample test for continuous variables. ORs and 95% CIs are reported for all modelled predictor variables.RESULTS: We enrolled 439 patients. The 30-day follow-up rate was 85.9% (n=377). The median age was 30 years; 56.7% (n=249) lived in poverty; and 65.6% (n=288) were women. EMS transported 94.3% of patients (n=399) to the hospital within 2hours of their call. Median total body surface area (TBSA) burned was 60% overall, and 80% in non-accidental burns. Sixty-eight per cent of patients had revised Baux scores greater than 80. Overall 30-day mortality was 64.5%, and highest (90.2%) in women with non-accidental burns. Predictors of mortality by multivariate regression were TBSA (OR 7.9), inhalation injury (OR 5.5), intentionality (OR 4.7) and gender (OR 2.2).DISCUSSION: Although EMS rapidly connects critically burned patients to care in India, mortality remains high, with women disproportionally suffering self-inflicted burns. To combat the burn epidemic in India, efforts must focus on rapid medical care and critical care services, and on a burn prevention strategy that includes mental health and gender-based violence support services.

    View details for PubMedID 30635272

  • Evaluating Barriers and Opportunities in Delivering High-Quality Oncology Care in a Resource-Limited Setting Using a Comprehensive Needs Assessment Tool. Journal of global oncology Nwachukwu, C. R., Mudasiru, O., Million, L., Sheth, S., Qamoos, H., Onah, J. O., Okemini, A., Rhodes, M., Barry, M., Banjo, A. A., Habeebu, M., Olasinde, T. A., Bhatt, A. S. 2018: 1–9


    PURPOSE: Despite recognition of both the growing cancer burden in low- and middle-income countries and the disproportionately high mortality rates in these settings, delivery of high-quality cancer care remains a challenge. The disparities in cancer care outcomes for many geographic regions result from barriers that are likely complex and understudied. This study describes the development and use of a streamlined needs assessment questionnaire (NAQ) to understand the barriers to providing quality cancer care, identifies areas for improvement, and formulates recommendations for implementation.METHODS: Using a comprehensive NAQ, in-depth interviews were conducted with 17 hospital staff involved in cancer care at two teaching hospitals in Nigeria. Data were analyzed using content analysis and organized into a framework with preset codes and emergent codes, where applicable.RESULTS: Data from the interviews were organized into six broad themes: staff, stuff, system, space, lack of palliative care, and provider bias, with key barriers within themes including: financial, infrastructural, lack of awareness, limited human capacity resources, lack of palliative care, and provider perspective on patient-related barriers to cancer care. Specific solutions based on ability to reasonably implement were subcategorized into short-, medium-, and long-term goals.CONCLUSION: This study provides a framework for a streamlined initial needs assessment and a unique discussion on the barriers to high-quality oncology care that are prevalent in resource-constrained settings. We report the feasibility of collecting and organizing data using a streamlined NAQ and provide a thorough and in-depth understanding of the challenges in this setting. Knowledge gained from the assessments will inform steps to improve oncology cancer in these settings.

    View details for PubMedID 30532992

  • Institutionalizing healthcare hackathons to promote diversity in collaboration in medicine. BMC medical education Wang, J. K., Roy, S. K., Barry, M., Chang, R. T., Bhatt, A. S. 2018; 18 (1): 269


    BACKGROUND: Medical students and healthcare professionals can benefit from exposure to cross-disciplinary teamwork and core concepts of medical innovation. Indeed, to address complex challenges in patient care, diversity in collaboration across medicine, engineering, business, and design is critical. However, a limited number of academic institutions have established cross-disciplinary opportunities for students and young professionals within these domains to work collaboratively towards diverse healthcare needs.METHODS: Drawing upon best practices from computer science and engineering, healthcare hackathons bring together interdisciplinary teams of students and professionals to collaborate, brainstorm, and build solutions to unmet clinical needs. Over the course of six months, a committee of 20 undergraduates, medical students, and physician advisors organized Stanford University's first healthcare hackathon (November 2016). Demographic data from initial applications were supplemented with responses from a post-hackathon survey gauging themes of diversity in collaboration, professional development, interest in medical innovation, and educational value. In designing and evaluating the event, the committee focused on measurable outcomes of diversity across participants (skillset, age, gender, academic degree), ideas (clinical needs), and innovations (projects).RESULTS: Demographic data (n=587 applicants, n=257 participants) reveal participants across diverse academic backgrounds, age groups, and domains of expertise were in attendance. From 50 clinical needs presented representing 19 academic fields, 40 teams ultimately formed and submitted projects spanning web (n=13) and mobile applications (n=13), artificial intelligence-based tools (n=6), and medical devices (n=3), among others. In post-hackathon survey responses (n=111), medical students and healthcare professionals alike noted a positive impact on their ability to work in multidisciplinary teams, learn from individuals of different backgrounds, and address complex healthcare challenges.CONCLUSIONS: Healthcare hackathons can encourage diversity across individuals, ideas, and projects to address clinical challenges. By providing an outline of Stanford's inaugural event, we hope more universities can adopt the healthcare hackathon model to promote diversity in collaboration in medicine.

    View details for PubMedID 30458759

  • Advancing Women Leaders in Global Health: Getting to Solutions. Annals of global health Moyer, C. A., Abedini, N. C., Youngblood, J., Talib, Z., Jayaraman, T., Manzoor, M., Larson, H. J., Garcia, P. J., Binagwaho, A., Burke, K. S., Barry, M. 2018; 84 (4): 743–52


    BACKGROUND: Women comprise 75% of the health workforce in many countries and the majority of students in academic global health tracks but are underrepresented in global health leadership. This study aimed to elucidate prevailing attitudes, perceptions, and beliefs of women and men regarding opportunities and barriers for women's career advancement, as well as what can be done to address barriers going forward.METHODS: This was a convergent mixed-methods, cross-sectional, anonymous, online study of participants, applicants, and those who expressed an interest in the Women Leaders in Global Health Conference at Stanford University October 11-12, 2017. Respondents completed a 26-question survey regarding beliefs about barriers and solutions to addressing advancement for women in global health.FINDINGS: 405 participants responded: 96.7% were female, 61.6% were aged 40 or under, 64.0% were originally from high-income countries. Regardless of age or country of origin, leading barriers were: lack of mentorship, challenges of balancing work and home, gender bias, and lack of assertiveness/confidence. Proposed solutions were categorized as individual or meta-level solutions and included senior women seeking junior women for mentorship and sponsorship, junior women pro-actively making their desire for leadership known, and institutions incentivizing mentorship and implementing targeted recruitment to improve diversity of leadership.INTERPRETATION: This study is the first of its kind to attempt to quantify both the barriers to advancement for women leaders in global health as well as the potential solutions. While there is no shortage of barriers, we believe there is room for optimism. A new leadership paradigm that values diversity of thought and diversity of experience will benefit not only the marginalized groups that need to gain representation at the table, but ultimately the broader population who may benefit from new ways of approaching long-standing, intractable problems.

    View details for PubMedID 30779525

  • Community outreach programs and major adherence lapses with antiretroviral therapy in rural Kakamega, Kenya. AIDS care Hodgkinson, L. M., Makori, J., Okwiri, J., Tsisiche, C., Arudo, J., Barry, M. 2018; 30 (6): 696-700


    We investigated features of major adherence lapses in antiretroviral therapy (ART) at public Emusanda Health Centre in rural Kakamega County, Kenya using medical records from 2008 to 2015 for all 306 eligible patients receiving ART. Data were modelled using survival analysis. Patients were more likely to lapse if they received stavudine (hazard ratio (HR) 2.54, 95% confidence interval (95%CI):1.44-4.47) or zidovudine (HR 1.64, 95%CI:1.02-2.63) relative to tenofovir. Each day a patient slept hungry per month increased risk of major adherence lapse by 3% (95%CI:0-7%). Isolated home visits by community health workers (CHWs) were more effective to assist patients to return to the health centre than isolated phone calls (HR 2.52, 95%CI:1.02-6.20).

    View details for DOI 10.1080/09540121.2017.1391987

    View details for PubMedID 29058457

  • Health Education Advanced Leadership for Zimbabwe (Healz): Developing the Infrastructure to Support Curriculum Reform. Annals of global health Aagaard, E. M., Connors, S. C., Challender, A., Gandari, J., Nathoo, K., Borok, M., Chidzonga, M., Barry, M., Campbell, T., Hakim, J. 2018; 84 (1): 176-182


    An economic crisis in Zimbabwe from 1999-2009 resulted in a shortage of faculty at the University of Zimbabwe College of Health Sciences (UZCHS) and declining enrollment and graduation rates. To improve proficiency and retention of graduates, the college sought to develop a competency-based curriculum using evidence-based educational methodologies. Achievement of this goal required a cadre of highly qualified educators to lead the curriculum review and innovation processes. The Health Education Advanced Leadership for Zimbabwe (HEALZ) program was established in 2012 to rapidly develop the needed faculty leadership. HEALZ is a one-year program of rigorous coursework delivered face-to-face in three intensive one-week sessions. Between sessions, scholars engage with mentors to conduct a needs assessment and to develop, implement, and evaluate a competency-based curriculum. Forty scholars completed training from 2012-15. All participants reported they were satisfied or extremely satisfied with the training after each week. Pre-post surveys identified significant knowledge gains in all key content domains. The program garnered significant organizational support. Scholars showed significant variation in progress toward implementing and evaluating their curricula as well as the quality of the work demonstrated by program end. Interviews of scholars and UZCHS leaders revealed important impacts of the program on the quality and culture of medical education at the college.

    View details for DOI 10.29024/aogh.19

    View details for PubMedID 30873767

  • Child malnutrition in Ifanadiana district, Madagascar: associated factors and timing of growth faltering ahead of a health system strengthening intervention GLOBAL HEALTH ACTION McCuskee, S., Garchitorena, A., Miller, A. C., Hall, L., Ouenzar, M., Rabeza, V. R., Ramananjato, R. H., Razanadrakato, H., Randriamanambintsoa, M., Barry, M., Bonds, M. H. 2018; 11 (1): 1452357


    Child malnutrition, a leading cause of death and disability worldwide, is particularly severe in Madagascar, where 47% of children under 5 years are stunted (low height-for-age) and 8% are wasted (low weight-for-height). Widespread poverty and a weak health system have hindered attempts to implement life-saving malnutrition interventions in Madagascar during critical periods for growth faltering.This study aimed to shed light on the most important factors associated with child malnutrition, both acute and chronic, and the timing of growth faltering, in Ifanadiana, a rural district of Madagascar.We analyzed data from a 2014 district-representative cluster household survey, which had information on 1175 children ages 6 months to 5 years. We studied the effect of child health, birth history, maternal and paternal health and education, and household wealth and sanitation on child nutritional status. Variables associated with stunting and wasting were modeled separately in multivariate logistic regressions. Growth faltering was modeled by age range. All analyses were survey-adjusted.Stunting was associated with increasing child age (OR = 1.03 (95%CI 1.02-1.04) for each additional month), very small birth size (OR = 2.32 (1.24-4.32)), low maternal weight (OR = 0.94 (0.91-0.97) for each kilogram, kg) and height (OR = 0.95 (0.92-0.99) for each centimeter), and low paternal height (OR = 0.95 (0.92-0.98)). Wasting was associated with younger child age (OR = 0.98 (0.97-0.99)), very small birth size (OR = 2.48 (1.23-4.99)), and low maternal BMI (OR = 0.84 (0.75-0.94) for each kg/m2). Height-for-age faltered rapidly before 24 months, then slowly until age 5 years, whereas weight-for-height faltered rapidly before 12 months, then recovered gradually until age 5 years but did not reach the median.Intergenerational transmission of growth faltering and early life exposures may be important determinants of malnutrition in Ifanadiana. Timing of growth faltering, in the first 1000 days, is similar to international populations; however, child growth does not recover to the median.

    View details for PubMedID 29595379

  • Medical Education Partnership Initiative (MEPI) in Zimbabwe: Outcomes and Challenges GLOBAL HEALTH-SCIENCE AND PRACTICE Hakim, J. G., Chidzonga, M. M., Borok, M. Z., Nathoo, K. J., Matenga, J., Havranek, E., Cowan, F., Abas, M., Aagaard, E., Connors, S., Nkomani, S., Ndhlovu, C. E., Matsika, A., Barry, M., Campbell, T. B. 2018; 6 (1): 82–92


    Sub-Saharan Africa has an inadequate number of health professionals, leading to a reduced capacity to respond to health challenges, including HIV/AIDS. From 2010 to 2015, the Medical Education Partnership Initiative (MEPI)-sponsored by the U.S. Presidents Emergency Plan for AIDS Relief (PEPFAR) and the National Institutes of Health (NIH)-was enthusiastically taken up by the University of Zimbabwe College of Health Sciences (UZCHS) and 12 other sub-Saharan African universities to develop models of training to improve medical education and research capacity. In this article, we describe the outcomes and challenges of MEPI in Zimbabwe.UZCHS in partnership with the University of Colorado, Denver; Stanford University; University of Cape Town; University College London; and King's College London designed the Novel Education Clinical Trainees and Researchers (NECTAR) program and 2 linked awards addressing cardiovascular disease and mental health to pursue MEPI objectives. A range of medical education and research capacity-focused programs were implemented, including faculty development, research support, mentored scholars, visiting professors, community-based education, information and technology support, cross-cutting curricula, and collaboration with partner universities and the ministries of health and education. We analyzed quantitative and qualitative data from several data sources, including annual surveys of faculty, students, and other stakeholders; workshop exit surveys; and key informant interviews with NECTAR administrators and leaders and the UZCHS dean.Improved Internet connectivity and electronic resource availability were early successes of NECTAR. Over the 5-year period, 69% (115 of 166) of faculty members attended at least 1 of 15 faculty development workshops. Forty-one faculty members underwent 1-year advanced faculty development training in medical education and leadership. Thirty-three mentored research scholars were trained under NECTAR, and 52 and 12 in cardiovascular and mental health programs, respectively. Twelve MEPI scholars had joined faculty by 2015. Full-time faculty grew by 36% (122 to 166), annual postgraduate and medical student enrollment increased by 61% (75 to 121) and 71% (123 to 210), respectively. To institutionalize and sustain MEPI innovations, the Research Support Center and the Department of Health Professions Education were established at UZCHS.MEPI has synergistically revitalized medical education, research capacity, and leadership at UZCHS. Investments in creating a new research center, health professions education department, and, programs have laid the foundation to help sustain faculty development and research capacity in the country.

    View details for PubMedID 29602867

  • Health Education Advanced Leadership for Zimbabwe (Healz): Developing the Infrastructure to Support Curriculum Reform ANNALS OF GLOBAL HEALTH Aagaard, E. M., Connors, S. C., Challender, A., Gandari, J., Nathoo, K., Borok, M., Chidzonga, M., Barry, M., Campbell, T., Hakim, J. 2018; 84 (1): 176–82

    View details for DOI 10.29024/aogh.19

    View details for Web of Science ID 000441346800021

  • A new vision for global health leadership LANCET Barry, M., Talib, Z., Jowell, A., Thompson, K., Moyer, C., Larson, H., Burke, K., Steering Comm Women Leaders 2017; 390 (10112): 2536–37
  • Gender myths in global health - Authors' reply. The Lancet. Global health Talib, Z., Burke, K. S., Barry, M. 2017; 5 (9): e872

    View details for DOI 10.1016/S2214-109X(17)30265-6

    View details for PubMedID 28807186

  • The impact of megacities on health: preparing for a resilient future. The Lancet. Planetary health Jowell, A., Zhou, B., Barry, M. 2017; 1 (5): e176–e178

    View details for PubMedID 29851637

  • Women leaders in global health. The Lancet. Global health Talib, Z., Burke, K. S., Barry, M. 2017; 5 (6): e565-e566

    View details for DOI 10.1016/S2214-109X(17)30182-1

    View details for PubMedID 28495255

  • Making Online Outbreak Surveillance Work for all ANNALS OF GLOBAL HEALTH Wang, Y., Barry, M. 2017; 83 (3-4): 625–29
  • The Perils of Trumping Science in Global Health — The Mexico City Policy and Beyond New England Journal of Medicine Lo, N. C., Barry, M. 2017: 1399-1401

    View details for DOI 10.1056/NEJMp1701294

  • The Perils of Trumping Science in Global Health - The Mexico City Policy and Beyond. New England journal of medicine Lo, N. C., Barry, M. 2017

    View details for DOI 10.1056/NEJMp1701294

    View details for PubMedID 28225666

  • Medical Education Partnership Initiative in Zimbabwe: partnerships for transformation. The Lancet. Global health Hakim, J. G., Barry, M., Matenga, J., Cowan, F., Campbell, T. B. 2017; 5 (2): e143-e144

    View details for DOI 10.1016/S2214-109X(17)30005-0

    View details for PubMedID 28104181

  • Community outreach programs and major adherence lapses with antiretroviral therapy in rural Kakamega, Kenya AIDS Care Hodgkinson, L. M., Makori, J., Okwiri, J., Tsisiche, C., Arudo, J., Barry, M. 2017: 696–700


    We investigated features of major adherence lapses in antiretroviral therapy (ART) at public Emusanda Health Centre in rural Kakamega County, Kenya using medical records from 2008 to 2015 for all 306 eligible patients receiving ART. Data were modelled using survival analysis. Patients were more likely to lapse if they received stavudine (hazard ratio (HR) 2.54, 95% confidence interval (95%CI):1.44-4.47) or zidovudine (HR 1.64, 95%CI:1.02-2.63) relative to tenofovir. Each day a patient slept hungry per month increased risk of major adherence lapse by 3% (95%CI:0-7%). Isolated home visits by community health workers (CHWs) were more effective to assist patients to return to the health centre than isolated phone calls (HR 2.52, 95%CI:1.02-6.20).

    View details for DOI 10.1080/09540121.2017.1391987

  • Minimally Symptomatic Infection in an Ebola 'Hotspot': A Cross-Sectional Serosurvey PLOS NEGLECTED TROPICAL DISEASES Richardson, E. T., Kelly, J. D., Barrie, M. B., Mesman, A. W., Karku, S., Quiwa, K., Marsh, R. H., Koedoyoma, S., Daboh, F., Barron, K. P., Grady, M., Tucker, E., Dierberg, K. L., Rutherford, G. W., Barry, M., Jones, J. H., Murray, M. B., Farmer, P. E. 2016; 10 (11)


    Evidence for minimally symptomatic Ebola virus (EBOV) infection is limited. During the 2013-16 outbreak in West Africa, it was not considered epidemiologically relevant to published models or projections of intervention effects. In order to improve our understanding of the transmission dynamics of EBOV in humans, we investigated the occurrence of minimally symptomatic EBOV infection in quarantined contacts of reported Ebola virus disease cases in a recognized 'hotspot.'We conducted a cross-sectional serosurvey in Sukudu, Kono District, Sierra Leone, from October 2015 to January 2016. A blood sample was collected from 187 study participants, 132 negative controls (individuals with a low likelihood of previous exposure to Ebola virus), and 30 positive controls (Ebola virus disease survivors). IgG responses to Ebola glycoprotein and nucleoprotein were measured using Alpha Diagnostic International ELISA kits with plasma diluted at 1:200. Optical density was read at 450 nm (subtracting OD at 630nm to normalize well background) on a ChroMate 4300 microplate reader. A cutoff of 4.7 U/mL for the anti-GP ELISA yielded 96.7% sensitivity and 97.7% specificity in distinguishing positive and negative controls. We identified 14 seropositive individuals not known to have had Ebola virus disease. Two of the 14 seropositive individuals reported only fever during quarantine while the remaining 12 denied any signs or symptoms during quarantine.By using ELISA to measure Zaire Ebola virus antibody concentrations, we identified a significant number of individuals with previously undetected EBOV infection in a 'hotspot' village in Sierra Leone, approximately one year after the village outbreak. The findings provide further evidence that Ebola, like many other viral infections, presents with a spectrum of clinical manifestations, including minimally symptomatic infection. These data also suggest that a significant portion of Ebola transmission events may have gone undetected during the outbreak. Further studies are needed to understand the potential risk of transmission and clinical sequelae in individuals with previously undetected EBOV infection.

    View details for DOI 10.1371/journal.pntd.0005087

    View details for Web of Science ID 000392154400022

    View details for PubMedID 27846221

  • Mortality outcomes for Chinese and Japanese immigrants in the USA and countries of origin (Hong Kong, Japan): a comparative analysis using national mortality records from 2003 to 2011. BMJ open Hastings, K. G., Eggleston, K., Boothroyd, D., Kapphahn, K. I., Cullen, M. R., Barry, M., Palaniappan, L. P. 2016; 6 (10)


    With immigration and minority populations rapidly growing in the USA, it is critical to assess how these populations fare after immigration, and in subsequent generations. Our aim is to compare death rates and cause of death across foreign-born, US-born and country of origin Chinese and Japanese populations.We analysed all-cause and cause-specific age-standardised mortality rates and trends using 2003-2011 US death record data for Chinese and Japanese decedents aged 25 or older by nativity status and sex, and used the WHO Mortality Database for Hong Kong and Japan decedents in the same years. Characteristics such as age at death, absolute number of deaths by cause and educational attainment were also reported.We examined a total of 10 458 849 deaths. All-cause mortality was highest in Hong Kong and Japan, intermediate for foreign-born, and lowest for US-born decedents. Improved mortality outcomes and higher educational attainment among foreign-born were observed compared with developed Asia counterparts. Lower rates in US-born decedents were due to decreased cancer and communicable disease mortality rates in the US heart disease mortality was either similar or slightly higher among Chinese-Americans and Japanese-Americans compared with those in developed Asia counterparts.Mortality advantages in the USA were largely due to improvements in cancer and communicable disease mortality outcomes. Mortality advantages and higher educational attainments for foreign-born populations compared with developed Asia counterparts may suggest selective migration. Findings add to our limited understanding of the racial and environmental contributions to immigrant health disparities.

    View details for DOI 10.1136/bmjopen-2016-012201

    View details for PubMedID 27793837

    View details for PubMedCentralID PMC5093623

  • Sex differences in obesity, dietary habits, and physical activity among urban middle-class Bangladeshis. International journal of health sciences Saquib, J., Saquib, N., Stefanick, M. L., Khanam, M. A., Anand, S., Rahman, M., Chertow, G. M., Barry, M., Ahmed, T., Cullen, M. R. 2016; 10 (3): 363-372


    The sustained economic growth in Bangladesh during the previous decade has created a substantial middle-class population, who have adequate income to spend on food, clothing, and lifestyle management. Along with the improvements in living standards, has also come negative impact on health for the middle class. The study objective was to assess sex differences in obesity prevalence, diet, and physical activity among urban middle-class Bangladeshi.In this cross-sectional study, conducted in 2012, we randomly selected 402 adults from Mohammedpur, Dhaka. The sampling technique was multi-stage random sampling. We used standardized questionnaires for data collection and measured height, weight, and waist circumference.Mean age (standard deviation) was 49.4 (12.7) years. The prevalence of both generalized (79% vs. 53%) and central obesity (85% vs. 42%) were significantly higher in women than men. Women reported spending more time watching TV and spending less time walking than men (p<.05); however, men reported a higher intake of unhealthy foods such as fast food and soft drinks.We conclude that the prevalence of obesity is significantly higher in urban middle-class Bangladeshis than previous urban estimates, and the burden of obesity disproportionately affects women. Future research and public health efforts are needed to address this severe obesity problem and to promote active lifestyles.

    View details for PubMedID 27610059

  • Medical "Brain Drain" and Health Care Worker Shortages: How Should International Training Programs Respond? AMA journal of ethics Karan, A., DeUgarte, D., Barry, M. 2016; 18 (7): 665-675


    The movement of health care workers from countries with resource scarcity and immense need ("source" countries) to areas of resource abundance and greater personal opportunity ("destination" countries) presents a complex set of decisions and relationships that affect the development of international health care systems. We explore the extent to which ethical quandaries arising from this movement are the responsibility of the said actors and the implications of these ethical quandaries for patients, governments, and physicians through the case of Dr. R, a surgeon from Nigeria who is considering working in the United States, where he is being trained to help develop surgical capacity in his country. We suggest how Dr. R, the United States, and Nigeria all contribute to "brain drain" in different but complementary ways.

    View details for DOI 10.1001/journalofethics.2016.18.7.ecas1-1607

    View details for PubMedID 27437816

  • The Global Health Implications of e-Cigarettes. JAMA Chang, A. Y., Barry, M. 2015; 314 (7): 663-664

    View details for DOI 10.1001/jama.2015.8676

    View details for PubMedID 26284714

  • Is a Cholera Outbreak Preventable in Post-earthquake Nepal? PLoS neglected tropical diseases Nelson, E. J., Andrews, J. R., Maples, S., Barry, M., Clemens, J. D. 2015; 9 (8)

    View details for DOI 10.1371/journal.pntd.0003961

    View details for PubMedID 26270343

  • Is a Cholera Outbreak Preventable in Post-earthquake Nepal? PLoS neglected tropical diseases Nelson, E. J., Andrews, J. R., Maples, S., Barry, M., Clemens, J. D. 2015; 9 (8): e0003961

    View details for DOI 10.1371/journal.pntd.0003961

    View details for PubMedID 26270343

  • Effects of Land Use on Plague (Yersinia pestis) Activity in Rodents in Tanzania AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE McCauley, D. J., Salkeld, D. J., Young, H. S., Makundi, R., Dirzo, R., Eckerlin, R. P., Lambin, E. F., Gaffikin, L., Barry, M., Helgen, K. M. 2015; 92 (4): 776-783


    Understanding the effects of land-use change on zoonotic disease risk is a pressing global health concern. Here, we compare prevalence of Yersinia pestis, the etiologic agent of plague, in rodents across two land-use types-agricultural and conserved-in northern Tanzania. Estimated abundance of seropositive rodents nearly doubled in agricultural sites compared with conserved sites. This relationship between land-use type and abundance of seropositive rodents is likely mediated by changes in rodent and flea community composition, particularly via an increase in the abundance of the commensal species, Mastomys natalensis, in agricultural habitats. There was mixed support for rodent species diversity negatively impacting Y. pestis seroprevalence. Together, these results suggest that land-use change could affect the risk of local transmission of plague, and raise critical questions about transmission dynamics at the interface of conserved and agricultural habitats. These findings emphasize the importance of understanding disease ecology in the context of rapidly proceeding landscape change.

    View details for DOI 10.4269/ajtmh.14-0504

    View details for Web of Science ID 000352828200018

    View details for PubMedID 25711606

    View details for PubMedCentralID PMC4385772

  • International aid and natural disasters: a pre- and post-earthquake longitudinal study of the healthcare infrastructure in leogane, haiti. American journal of tropical medicine and hygiene Kligerman, M., Barry, M., Walmer, D., Bendavid, E. 2015; 92 (2): 448-453


    The reconstruction of healthcare systems in developing countries after natural disasters is poorly understood. Using data collected before and after the 2010 Haiti earthquake, we detail the response of aid agencies and their interaction with local healthcare providers in Leogane, the city closest to the epicenter. We find that the period after the earthquake was associated with an increase in the total number of healthcare facilities, inpatient beds, and surgical facilities and that international aid has been a driving force behind this recovery. Aid has funded 12 of 13 new healthcare facilities that have opened since the earthquake as well as the reconstruction of 7 of 8 healthcare facilities that have been rebuilt. Despite increases in free, aid-financed healthcare, private Haitian healthcare facilities have remained at a constant number. The planned phase-out of several aid-financed facilities, however, will leave Leogane with fewer inpatient beds and healthcare services compared with the pre-earthquake period.

    View details for DOI 10.4269/ajtmh.14-0379

    View details for PubMedID 25510716

    View details for PubMedCentralID PMC4347354

  • Innovations to Enhance the Quality of Health Professions Education at the University of Zimbabwe College of Health Sciences-NECTAR Program ACADEMIC MEDICINE Ndhlovu, C. E., Nathoo, K., Borok, M., Chidzonga, M., Aagaard, E. M., Connors, S. C., Barry, M., Campbell, T., Hakim, J. 2014; 89 (8): S88-S92


    The University of Zimbabwe College of Health Sciences (UZCHS) is Zimbabwe's premier health professions training institution. However, several concerns were raised during the past decade over the quality of health education at UZCHS. The number of faculty and students declined markedly until 2010, when there was a medical student intake of 147 while the faculty comprised only 122 (39%) of a possible 314 positions. The economic and political crises that the country experienced from 1999 to 2009 compounded the difficulties faced by the institution by limiting the availability of resources. The Medical Education Partnership Initiative funding opportunity has given UZCHS the stimulus to embark on reforms to improve the quality of health education it offers. UZCHS, in partnership with the University of Colorado School of Medicine, the University of Colorado Denver Evaluation Center, and Stanford University, designed the Novel Education Clinical Trainees and Researchers (NECTAR) program to implement a series of health education innovations to meet this challenge. Between 2010 and 2013, innovations that have positively affected the quality of health professions education at UZCHS include the launch of comprehensive faculty development programs and mentored clinical and research programs for postgraduate students. A competency-based curriculum reform process has been initiated, a health professions department has been established, and the Research Support Center has been strengthened, providing critical resources to institutionalize health education and research implementation at the college. A core group of faculty trained in medical education has been assembled, helping to ensure the sustainability of these NECTAR activities.

    View details for DOI 10.1097/ACM.0000000000000336

    View details for Web of Science ID 000340290200023

    View details for PubMedID 25072588

  • Treating hepatitis C in lower-income countries. New England journal of medicine Jayasekera, C. R., Barry, M., Roberts, L. R., Nguyen, M. H. 2014; 370 (20): 1869-1871

    View details for DOI 10.1056/NEJMp1400160

    View details for PubMedID 24720680

  • High prevalence of chronic kidney disease in a community survey of urban Bangladeshis: a cross-sectional study. Globalization and health Anand, S., Khanam, M. A., Saquib, J., Saquib, N., Ahmed, T., Alam, D. S., Cullen, M. R., Barry, M., Chertow, G. M. 2014; 10 (1): 9-?


    The burden of chronic kidney disease (CKD) will rise in parallel with the growing prevalence of type two diabetes mellitus in South Asia but is understudied. Using a cross-sectional survey of adults living in a middle-income neighborhood of Dhaka, Bangladesh, we tested the hypothesis that the prevalence of CKD in this group would approach that of the U.S. and would be strongly associated with insulin resistance.We enrolled 402 eligible adults (>30 years old) after performing a multi-stage random selection procedure. We administered a questionnaire, and collected fasting serum samples and urine samples. We used the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation to estimate glomerular filtration rate, and sex-specific cut offs for albuminuria: > 1.9 mg/mmol (17 mg/g) for men, and >2.8 mg/mmol (25 mg/g) for women. We assessed health-related quality of life using the Medical Outcomes Study Short Form-12 (SF-12).A total of 357 (89%) participants with serum samples comprised the analytic cohort. Mean age of was 49.5 (± 12.7) years. Chronic kidney disease was evident in 94 (26%). Of the participants with CKD, 58 (62%) had albuminuria only. A participant with insulin resistance had a 3.6-fold increase in odds of CKD (95% confidence interval 2.1 to 6.4). Participants with stage three or more advanced CKD reported a decrement in the Physical Health Composite score of the SF-12, compared with participants without CKD.We found an alarmingly high prevalence of CKD-particularly CKD associated with insulin resistance-in middle-income, urban Bangladeshis.

    View details for DOI 10.1186/1744-8603-10-9

    View details for PubMedID 24555767

    View details for PubMedCentralID PMC3944963

  • Meeting the Challenges of Global Health; pages 37-41 Stanford Social Innovation Review Denend, L., Lockwood, A., Barry, M., Zenios, S. 2014; 12 (Number 2)
  • An ethics curriculum for short-term global health trainees GLOBALIZATION AND HEALTH Decamp, M., Rodriguez, J., Hecht, S., Barry, M., Sugarman, J. 2013; 9


    Interest in short-term global health training and service programs continues to grow, yet they can be associated with a variety of ethical issues for which trainees or others with limited global health experience may not be prepared to address. Therefore, there is a clear need for educational interventions concerning these ethical issues.We developed and evaluated an introductory curriculum, "Ethical Challenges in Short-term Global Health Training." The curriculum was developed through solicitation of actual ethical issues experienced by trainees and program leaders; content drafting; and external content review. It was then evaluated from November 1, 2011, through July 1, 2012, by analyzing web usage data and by conducting user surveys. The survey included basic demographic data; prior experience in global health and global health ethics; and assessment of cases within the curriculum.The ten case curriculum is freely available at An average of 238 unique visitors accessed the site each month (standard deviation, 19). Of users who had been abroad before for global health training or service, only 31% reported prior ethics training related to short-term work. Most users (62%) reported accessing the site via personal referral or their training program; however, a significant number (28%) reported finding the site via web search, and 8% discovered it via web links. Users represented different fields: medicine (46%), public health (15%), and nursing (11%) were most common. All cases in the curriculum were evaluated favorably.The curriculum is meeting a critical need for an introduction to the ethical issues in short-term global health training. Future work will integrate this curriculum within more comprehensive curricula for global health and evaluate specific knowledge and behavioral effects, including at training sites abroad.

    View details for DOI 10.1186/1744-8603-9-5

    View details for Web of Science ID 000315939700001

    View details for PubMedID 23410089

  • Reflecting on Short-Term International Service-Learning Trips ACADEMIC MEDICINE Crump, J. A., Decamp, M., Barry, M., Sugarman, J. 2013; 88 (1): 10-11

    View details for DOI 10.1097/ACM.0b013e3182753f25

    View details for Web of Science ID 000312795900009

    View details for PubMedID 23267221

  • High prevalence of type 2 diabetes among the urban middle class in Bangladesh. BMC public health Saquib, N., Khanam, M. A., Saquib, J., Anand, S., Chertow, G. M., Barry, M., Ahmed, T., Cullen, M. R. 2013; 13: 1032-?


    The prevalence of type-2 diabetes and metabolic syndrome are increasing in the developing world; we assessed their prevalence among the urban middle class in Bangladesh.In this cross-sectional survey (n = 402), we randomly selected consenting adults (≥ 30 years) from a middle-income neighborhood in Dhaka. We assessed demography, lifestyle, and health status, measured physical indices and blood pressure and obtained blood samples. We evaluated two primary outcomes: (1) type-2 diabetes (fasting blood glucose ≥ 7.0 mmol/L or hemoglobin A1C ≥ 6.5% (48 mmol/mol) or diabetes medication use) and (2) insulin resistance (type-2 diabetes or metabolic syndrome using International Diabetes Federation criteria).Mean age and Quételet's (body mass) index were 49.4 ± 12.6 years and 27.0 ± 5.1 kg/m²; 83% were married, 41% had ≥12 years of education, 47% were employed, 47% had a family history of diabetes. Thirty-five percent had type-2 diabetes and 45% had metabolic syndrome. In multivariate models older age and family history of diabetes were significantly associated with type-2 diabetes. Older age, female sex, overweight or obese, high wealth index and positive family history of diabetes were significantly associated with insulin resistance. Participants with type-2 diabetes or insulin resistance had significantly poorer physical health only if they had associated cardiovascular disease.The prevalence of type-2 diabetes and metabolic syndrome among the middle class in Dhaka is alarmingly high. Screening services should be implemented while researchers focus on strategies to lessen the incidence and morbidity associated with these conditions.

    View details for DOI 10.1186/1471-2458-13-1032

    View details for PubMedID 24172217

  • Reuters - Opinion, The Great Debate Internet access is a vital healthcare tool Barry, M. 2013
  • Transient Facial Swellings in a Patient With a Remote African Travel History JOURNAL OF TRAVEL MEDICINE Richardson, E. T., Luo, R., Fink, D. L., Nutman, T. B., Geisse, J. K., Barry, M. 2012; 19 (3): 183-185


    We present a case of Loa loa infection in a patient, 21 years after visiting an endemic area for only 4 days. To our knowledge, this case represents the longest time for the diagnosis of loiasis to be made post-exposure in a traveler and emphasizes that even short exposures can place travelers at risk.

    View details for DOI 10.1111/j.1708-8305.2012.00612.x

    View details for Web of Science ID 000303197900009

    View details for PubMedID 22530826

    View details for PubMedCentralID PMC3437052

  • Tb in a Global Health Exchange Program JOURNAL OF GENERAL INTERNAL MEDICINE Decamp, M., Crump, J. A., Rodriguez, J., Richardson, G., Barry, M., Sugarman, J. 2012; 27 (1): 7-7

    View details for DOI 10.1007/s11606-011-1908-1

    View details for Web of Science ID 000298883900004

    View details for PubMedID 22012345

  • Health Technologies and Innovation in the Global Health Arena NEW ENGLAND JOURNAL OF MEDICINE Sinha, S. R., Barry, M. 2011; 365 (9): 779-782

    View details for Web of Science ID 000294405200002

    View details for PubMedID 21879894

  • Short-Term Global Health Research Projects by US Medical Students: Ethical Challenges for Partnerships AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE Provenzano, A. M., Graber, L. K., Elansary, M., Khoshnood, K., Rastegar, A., Barry, M. 2010; 83 (2): 211-214


    Recent interest in global health among medical students has grown drastically, and many students now spend time abroad conducting short-term research projects in low-resource settings. These short-term stints in developing countries present important ethical challenges to US-based students and their medical schools as well as the institutions that host such students abroad. This paper outlines some of these ethical issues and puts forth recommendations for ethically mindful short-term student research.

    View details for DOI 10.4269/ajtmh.2010.09-0692

    View details for Web of Science ID 000280694300003

    View details for PubMedID 20682858

  • GLOBAL HEALTH Fifty Years of US Embargo: Cuba's Health Outcomes and Lessons SCIENCE Drain, P. K., Barry, M. 2010; 328 (5978): 572-573

    View details for DOI 10.1126/science.1189680

    View details for Web of Science ID 000277159800024

    View details for PubMedID 20430999

  • Ethics and Best Practice Guidelines for Training Experiences in Global Health Am J Trop Med Hyg Crump JA, Sugarman J, Barry, M et al 2010; 83 (6): 1178-1182
  • Talking Dirty-The Politics of Clean Water and Sanitation NEJM Barry M, Hughes J. 2008; 359 (8): 784-787
  • The Tail End of Guinea Worm - Global Eradication without a Drug or Vaccine NEJM Barry M 2007; 356 (25): 2561-2564
  • Suburban Leptospirosis: Atypical Lymphocytosis and Gamma-delta T cell response. Clinical Infectious Diseases Barry M, Wisnewski A, Matthias M, Inoye S, Vinetz J. 2006; 43 (Nov 15): 1306
  • Presidential Address - Disease without borders: globalization's challenge to the American Society of Tropical Medicine and Hygiene: A call for public advocacy and activism. Am J Trop Med Hyg Barry M 2003; 69 (1): 3-7
  • The International Health Program: The fifteen year experience with Yale University's Internal Medicine Residency Program. Am J Trop Med Hyg Gupta A, Wells C, Horwitz R, Bia F, Barry M. 1999; 61 (6): 1019-1023
  • Treatment of a Laboratory Acquired Infection of Sabiá Virus. NEJM Barry M, Armstrong L, Russi M, Dembry L, Geller D, Tesh R, Gonzalez JP, Khan A, Peters CJ. 1995; 333: 294-296
  • Zimbabwe: Health care changes after independence and transition to majority rule. JAMA Barry M, Cullen M, Thomas JEP, Loewenson R. 1990; 263 (5): 638-640
  • Ethical considerations of human investigation in developing countries: The AIDS dilemma. NEJM Barry M. 1988; 319 (16): 1083-1086