Research Projects

In late June and early July, 2019, a team of U.S. and Guatemalan students and Guatemalan staff members enrolled 1,414 participants from 15 Trifinio middle and high schools in a comprehensive Student Health Survey that is currently being analyzed.  The survey included questions related to the student’s opinion of the sexual health curriculum that had recently been implemented in some of the schools surveyed. The responses documented that the course was very well received and appreciated by both girls and boys. Most of those enrolled in the program had never had sexual intercourse (n = 1152, 85%). Of those who had, 43% were 14 or younger. In the last 30 days, 37% of participants stated that they had gone hungry at least once because of lack of food in their household. Mental health problems were common as 19% of participants stated that they had little interest in doing things almost every day during the last two weeks and (51%) stated that they felt sad, without hope, or run down at least a few days in the last two weeks. Concerning was the finding that 12.5% stated that they had made a plan to harm themselves or die during the last 6 months. The findings from this survey will help design new mental health interventions and evaluate the impact of the “Big Decisions” program.

This prospective cohort study enrolled a total of 1,371 subjects, including 500 infants, from June 2017-July 2018, and followed them for one year to determine the incidence of postnatal Zika infection and its possible association with neurodevelopmental delay. The final study visits were in July 2019, with 1,127 subjects completing all study procedures (82%), and most dropouts occurring within the first two months of the study, a great cohort retention rate in this challenging setting. The study captured a total of 407 flavivirus-like illnesses from 289 subjects. Dengue, Zika and Chikungunya testing is underway.

The most significant finding is the severe neurodevelopmental delays for all ages. The Mullen (MSEL) neurodevelopment scores The mean MSEL scores in Guatemala were around 2SD below the US (<5th %ile). This tool has a mean score of 100 (composite) and 50 (each of the 5 subdomains) in US children. These incredible delays finally put a number on a phenomenon that we’ve been observing for a long time at the site. Multiple analyses are ongoing to better understand the predictive factors, though malnutrition likely plays a significant role: 37% of the children in the study suffered from stunting, and this was significantly associated with neurodevelopmental delay (p=0.0039). We also found that 17% of the children had microcephaly (an extremely high incidence not seen in other countries, confirming our previous data, which was also strongly associated with neurodevelopmental delay (p<0.0025).

Dr. Asturias and Dr. Anne-Marie Rick started a study of cervical group B strep carriage in pregnant women enrolled in our program to identify the risk of subsequent life-threatening newborn group B strep infections. This study has important implications given a high rate of neonatal morality documented in the  initial needs assessment.

Dr. Harrison is studying the antepartum factors and postpartum outcomes among women enrolled in our prenatal program to better understand the reasons for the observed high rate of C-sections. She has also  initiated a qualitative study to develop interventions to reduce the frequency of unnecessary C-sections, especially in first time pregnancies.