One afternoon in July, I found myself driving up the shoulder of Mount Kilimanjaro to a Tanzanian village called Marangu. There I visited a clinic where two Duke undergraduates from the Pratt School of Engineering were fixing a piece of broken dental equipment. They were living with a Tanzanian family, without familiar amenities but open to and appreciative of the vivid experiences of a different culture, and using things they had learned in Duke classrooms to try to solve problems in real-world settings.

We later drove uphill through an exquisite green landscape to Mwika Uuwo, a somewhat smaller village. There we dropped in on a classroom to observe two Duke undergraduate women teaching biology to a group of students who had come for extra classes although it was a holiday.  

Connecting Farms and Our Children 

It's a great start toward providing quality nutrition to low-income children. But because early eating habits impact weight gain and health issues across a child's life, the need for healthy meals starts much earlier than grade school.

North Carolina has the 11th-highest rate of childhood obesity in the nation, and about 30 percent of children under the age of 5 in the state are overweight or obese. This puts these children at a higher risk of developing asthma, diabetes, hypertension and cardiovascular disease. The stigma of obesity also means these children are more likely to face bullying and teasing and have higher rates of depression.

For people living throughout sub-Saharan Africa, retail drug shops are a common source of antimalarial treatment. Duke Master of Science in Global Health student Andria Smith suggests it's critical to understand the knowledge and behavior of retail drug shop workers in order to improve the diagnosis and treatment of diseases like malaria.   

"What was of great concern to me was that even though many of the study participants correctly identified symptoms of malaria, they also included symptoms that are not likely to cause malaria, such as spinal cord pain and anorexia," said Smith.

Smith found that shop owners are less likely to be registered with the Kenyan Pharmacy and Poisons Board since they are required to obtain an expensive permit each year. Fifteen percent of the shop keepers in her study claimed to have a professional health qualification such as being a pharmacist, pharmacy assistant, nurse assistant or clinical officer, but they did not have more than a secondary education. Oftentimes, shop workers identify themselves as health leaders, yet they lack the professional or academic credentials.

Despite this, shop workers who dispense medications according to Ministry of Health guidelines are more likely to recommend correct treatment than those who dispense based on customer demand.

Smith also evaluated whether drug retailers would find it acceptable and feasible to administer malaria rapid diagnostic tests (MRDTs) at their shops. MRDTs are believed to save time and money, spur business and increase confidence in accurate diagnosis and treatment. Many retailers thought the tests could improve malaria diagnosis, but factors such as price, local competition and cultural perception could disrupt its implementation in the community.

A pivotal discovery of Smith's research is that patients can often have a strong influence over the behavior of shop workers.