BackgroundTetraethyl lead was phased out of gasoline in Uganda in 2005. Recent mitigation of an important source of lead exposure suggests examination and re-evaluation of the prevalence of childhood lead poisoning in this country. Ongoing concerns persist about exposure from the Kiteezi landfill in Kampala, the country’s capital.ObjectivesWe determined blood lead distributions among Kampala schoolchildren and identified risk factors for elevated blood lead levels (EBLLs; ≥ 10 μg/dL).Analytical approachUsing a stratified, cross-sectional design, we obtained blood samples, questionnaire data, and soil and dust samples from the homes and schools of 163 4- to 8-year-old children representing communities with different risks of exposure.ResultsThe mean blood lead level (BLL) was 7.15 μg/dL; 20.5% of the children were found to have EBLL. Multivariable analysis found participants whose families owned fewer household items, ate canned food, or used the community water supply as their primary water source to have higher BLLs and likelihood of EBLLs. Distance < 0.5 mi from the landfill was the factor most strongly associated with increments in BLL (5.51 μg/dL, p < 0.0001) and likelihood of EBLL (OR = 4.71, p = 0.0093). Dust/soil lead was not significantly predictive of BLL/EBLL.ConclusionsLead poisoning remains highly prevalent among school-age children in Kampala. Confirmatory studies are needed, but further efforts are indicated to limit lead exposure from the landfill, whether through water contamination or through another mechanism. Although African nations are to be lauded for the removal of lead from gasoline, this study serves as a reminder that other sources of exposure to this potent neurotoxicant merit ongoing attention.

The Mount Sinai Global Health Center established a new multidisciplinary Global Health Residency Track (GHRT) in 2006. The goal of the GHRT is to provide participants with a foundation in global health issues and population-based health care, a chance to develop basic research and public health skills in the field, and guidance for career development. The authors describe how the GHRT was created, present its structure, and discuss their experience implementing this new program. Other selected global health residency training programs are also reviewed. The Mount Sinai GHRT is a two-year program that comprises a didactic curriculum, with participants required to take selected classes in the Master of Public Health Program of the Mount Sinai School of Medicine of New York University, and "field experience," which consists of a public health project that is implemented during a two-month elective period during the second year. Core competencies include (1) epidemiology and research skills, (2) health disparities, human rights, and cultural competency, (3) needs assessment and project development, (4) tropical medicine and infectious disease, and (5) reproductive, maternal, and child health. Nine residents were selected from four Mount Sinai residency programs to participate in the GHRT in its first year, and, during the winter of 2007, senior residents conducted public health projects in the Dominican Republic, India, Kenya, and East Harlem. All components of the track performed well in evaluations. An outcomes survey is ongoing to track career choices among graduates and to identify barriers to continuing involvement in global health.

Ugandan adolescents lack sufficient reproductive health knowledge, which accounts in part for the staggering rates of teen pregnancies and sexually transmitted (STI) infections in this population. This study aimed to (1) examine Ugandan adolescents' baseline STI and contraceptive knowledge; (2) determine whether this knowledge varies by demographic factors, prior sexual experience or school grade; and (3) evaluate the effectiveness of an educational program to increase and retain STI and contraceptive knowledge among Ugandan adolescents. This study surveyed 129 adolescents (ages 15-19) regarding knowledge of STIs and contraceptive methods at schools and community non-governmental organizations at three time points. Findings demonstrated that at baseline the mean test scores for contraceptive knowledge and STI knowledge were 44% and 72%, respectively. Participants in higher secondary school grade-levels had greater odds of having prior STI knowledge (OR=19.6, 95% CI 2.0-187.6); participants who had previously engaged in sex had greater odds of having prior contraceptive knowledge (OR=4.62, 95% CI 1.45-14.72). A higher grade level was not associated with better knowledge of contraception; and being sexually active was not associated with better knowledge of STI information. Participants' knowledge of STIs and contraceptives improved after the education session (p<0.001), and knowledge was retained 3-weeks later (p<0.001). Findings suggest that Ugandan adolescents do not have adequate education regarding contraceptive methods and that implementation of reproductive health modules by an outside party can be effective in improving knowledge.

Population, health, and environment programs are cross-sectoral development initiatives that link conservation, health, and family planning interventions. These programs are generally located in biodiversity hotspots, where population pressure is among the factors contributing to environmental degradation. This review describes the general structure of population, health, and environment programs and provides selected examples to highlight various aspects of this approach. We focus in depth on a case study from the Integrating Population and Health into Forestry Management Agendas program in Nepal that simultaneously addressed deforestation from fuel-wood harvesting, indoor air pollution from wood fires, acute respiratory infections related to smoke inhalation, as well as family planning in communities in Nepal's densely populated forest corridors. Keys to the success of the Nepal project included empowerment of community forest user groups with population, health, and environment program know-how and appropriate technology. Lessons learned in Nepal point to the critical role that nongovernmental organizations can play as catalysts of cross-sectoral responses to complex development issues such as this one. The population, health, and environment approach can be an effective method for achieving sustainable development and meeting both conservation and health objectives.

Despite diverse perspectives on the meaning and sustainability of GH work, this analysis provides a nascent framework that may inform curricular development for GH trainees. Suggestions are offered for elaborating this framework to fully exploit the transformative potential of GH training in medical education.

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