The burden of chronic kidney disease (CKD) is rapidly rising in developing countries due to astro... more The burden of chronic kidney disease (CKD) is rapidly rising in developing countries due to astronomical increases in key risk factors including hypertension and diabetes. We sought to assess the burden and predictors of CKD among Ghanaians with hypertension and/or diabetes mellitus in a multicenter hospital-based study. We conducted a cross-sectional study in the Ghana Access and Affordability Program (GAAP) involving adults with hypertension only (HPT), hypertension with diabetes mellitus (HPT + DM), and diabetes mellitus only (DM) in 5 health facilities in Ghana. A structured questionnaire was administered to collect data on demographic variables, medical history, and clinical examination. Serum creatinine and proteinuria were measured, and estimated glomerular filtration rate derived using the CKD-EPI formula. A multivariable logistic regression model was used to identify factors associated with CKD. A total of 2781 (84.4%) of 3294 participants had serum creatinine and proteinuria data available for analysis. The prevalence of CKD was 242 (28.5%) among participants with both DM and HPT, 417 (26.3%) among participants with HPT, and 56 (16.1%) among those with DM alone. Predictors of CKD were increasing
American Journal of Tropical Medicine and Hygiene, 2009
Genetic polymorphisms in Plasmodium falciparum are associated with resistance to a number of drug... more Genetic polymorphisms in Plasmodium falciparum are associated with resistance to a number of drugs, but data on their prevalence are limited from many areas. We explored the prevalence of key polymorphisms in patients presenting with malaria in Kinshasa. Prevalences of pfcrt K76T; pfmdr1 N86Y; pfdhfr N51I, C59R, and S108N; and pfdhps A437G were well above 50% and of pfmdr1 Y184F, N1042D, and D1246Y; pfdhfr I164L; and pfdhps K540E were low. These results suggest an intermediate level of resistance to aminoquinoline and antifolate antimalarials in Kinshasa compared with other areas of Africa.
With increasing population displacement and worsening water insecurity after the 2010 earthquake,... more With increasing population displacement and worsening water insecurity after the 2010 earthquake, Haiti experienced a large cholera outbreak. Our goal was to evaluate the strengths and weaknesses of seven community health facilities’ ability to respond to a surge in cholera cases.Since 2010, Catholic Relief Services (CRS) with a number of public and private donors has been working with seven health facilities in an effort to reduce morbidity and mortality from cholera infection. In November 2012, CRS through the Centers for Disease Control and Prevention (CDC)’s support, asked the Johns Hopkins Center for Refugee and Disaster Response to conduct a cholera surge simulation tabletop exercise at these health facilities to improve each facility’s response in the event of a cholera surge. Using simulation development guidelines from the Pan American Health Organization and others, a simulation scenario script was produced that included situations of differing severity, supply chain, as w...
The efficacy of daily oral antiretroviral (ARVs), even when combined with supplemental adherence ... more The efficacy of daily oral antiretroviral (ARVs), even when combined with supplemental adherence strategies, remains limited by non-adherence. Resistance and treatment failure resulting from missed ARV doses continue to hamper efforts to curb the epidemic. This commentary argues that we must simplify ARV regimens even further, and highlights the potential for long-acting injectable (LAI) formulations to facilitate weekly, monthly, and multi-month ARV regimens in both resource rich and resource poor settings. We summarize the latest progress in LAI development and reflect on the potential of LAIs to revolutionize HIV management and define the next frontier of HIV medicine.
A 17-year-old boy was assaulted by 3 men wielding baseball bats. Among multiple injuries, he sust... more A 17-year-old boy was assaulted by 3 men wielding baseball bats. Among multiple injuries, he sustained an injury to his left thorax (Fig. 1) with an associated pulmonary contusion but without pneumothorax or rib fractures. The patient's initial troponin I level of 1.35 ng/mL peaked 2 days later at 3.43 ng/mL. In addition, the initial electrocardiogram was markedly abnormal, with precordial R-wave and T-wave changes similar to those seen in apical hypertrophic cardiomyopathy (Fig. 2). A transthoracic echocardiogram revealed a left ventricular intramyocardial mass that extended from the mid lateral and apical lateral segments to the apex (Fig. 3). However, a diagnosis of left ventricular free-wall rupture with pseudoaneurysm formation could not be excluded. Cardiac magnetic resonance showed the intramyocardial location of the mass (Fig. 4). This finding, along with the history, was consistent with an intramyocardial hematoma from blunt chest trauma. While hospitalized, the patient...
The coronavirus disease 2019 (COVID-19) pandemic has exacerbated health disparities across ethnic... more The coronavirus disease 2019 (COVID-19) pandemic has exacerbated health disparities across ethnic and socioeconomic groups. Non-communicable diseases (NCDs) - such as hypertension, diabetes, and obstructive lung diseases – are key drivers of this widening gap, because they disproportionately afflict vulnerable populations. Vulnerable populations with non-communicable diseases, in turn, are disproportionately affected by COVID-19 itself – but also at increased risk of poor outcomes from those underlying conditions. Proven strategies for NCD control must be adapted to help vulnerable patients react to these dual threats. We detail six key policy interventions – task shifting, workforce protection, telehealth and mobile services, insurance restructuring and increased funding for NCDs, prescription policies for NCDs and community partnerships - to bridge this care gap. Long-term integration of these care models post-COVID-19 may prevent care shocks during future pandemics, bolstering em...
The burden of chronic kidney disease (CKD) is rapidly rising in developing countries due to astro... more The burden of chronic kidney disease (CKD) is rapidly rising in developing countries due to astronomical increases in key risk factors including hypertension and diabetes. We sought to assess the burden and predictors of CKD among Ghanaians with hypertension and/or diabetes mellitus in a multicenter hospital-based study. We conducted a cross-sectional study in the Ghana Access and Affordability Program (GAAP) involving adults with hypertension only (HPT), hypertension with diabetes mellitus (HPT + DM), and diabetes mellitus only (DM) in 5 health facilities in Ghana. A structured questionnaire was administered to collect data on demographic variables, medical history, and clinical examination. Serum creatinine and proteinuria were measured, and estimated glomerular filtration rate derived using the CKD-EPI formula. A multivariable logistic regression model was used to identify factors associated with CKD. A total of 2781 (84.4%) of 3294 participants had serum creatinine and proteinuria data available for analysis. The prevalence of CKD was 242 (28.5%) among participants with both DM and HPT, 417 (26.3%) among participants with HPT, and 56 (16.1%) among those with DM alone. Predictors of CKD were increasing
Background: Access to medicines for hypertension and diabetes mellitus (DM) management is challen... more Background: Access to medicines for hypertension and diabetes mellitus (DM) management is challenging in resource-limited countries. We sought to assess whether differential pricing of medicines based on socio-economic status would improve affordability of antihypertensive and anti-diabetic medications. A quasi-experimental, prospective cohort study was implemented at five Ghanaian health facilities, using medicines differentially priced by three pharmaceutical companies. Methods: Adult patients ≥18 years with hypertension or DM were enrolled and assigned to a lower tiered differential price (DP arm) or market price (MP arm) based on minimum wage earning or a score >6/18 on a multi-dimensional poverty index scale. Study medicines were purchased at either the DP or MP when prescribed. Participants were followed for 18 months to assess blood pressure (BP) and glycemic control. Predictors of ability to purchase study medicines were assessed using parsimonious logistic regression mod...
The 2014-2016 Ebola virus disease (EVD) outbreak in West Africa was of unprecedented magnitude wi... more The 2014-2016 Ebola virus disease (EVD) outbreak in West Africa was of unprecedented magnitude with a total of 28,616 suspected, probable, and confirmed cases reported in Guinea, Liberia, and Sierra Leone. The international humanitarian community utilized its expertise in rapid response and scale up in emergency situations to manage a threat different from the more common humanitarian emergencies resulting from conflict or natural disaster. Unique multisectoral partnerships forged between traditional public health actors and humanitarian actors facilitated mutual learning and opened the door to ongoing working relationships that will hasten efficient and effective response to future global public health emergencies.
Background: Extensive documentation exists on a range of negative sexual and reproductive health ... more Background: Extensive documentation exists on a range of negative sexual and reproductive health outcomes and rights violations occurring during humanitarian emergencies. We explore two central questions: Do existing policies, services, and research adequately address the SRH rights, priorities and HIV risks of adolescent girls and young women in emergency settings? What are the missed opportunities for holistically addressing the vulnerabilities experienced by those living with HIV during rapid onset disasters and long term, protracted emergencies? Authors review considerations informing real-time decision making, and highlight missed opportunities to apply a gendered lens in the delivery of AGYW-centered SRHR/HIV services. Methods: A scoping review identified studies on HIV intervention and outcomes in emergency settings, published in the peer-reviewed literature (2002-2017). This exercise was complemented with a desk review of normative guidance, frameworks, and implementation guidelines on HIV and SRH in emergency responses, and by consultations with subject matter experts. Results: The existing frameworks and guidance pay scant attention to the sexual reproductive health and rights of young women living with HIV (WLHIV), focusing mainly on prevention of mother to child transmission (PMTCT), antiretroviral therapy (ART), HIV testing services, and linkage to treatment services. Applying a gendered sexual and reproductive health lens to the response offers opportunities to identify critical implementation questions, and highlight promising practices, to better tailor current services for AGYW. Conclusions: A plurality of competing needs crowds out dedicated time and space to effectively integrate HIV and sexual and reproductive health interventions in emergency settings. Political will is required to advance multisectoral cooperation, through joint planning, rights-informed learning and integrative responses, and to promote creative solutions for ART continuation, drug supply and HIV testing, treatment and care. Recent advancements in policy and practice would suggest that a more AGYW-centered response is feasible.
The global burden of non-communicable diseases (NCDs) is growing, and access to prevention and tr... more The global burden of non-communicable diseases (NCDs) is growing, and access to prevention and treatment strategies remain limited, especially for those in low- and middle-income countries (LMICs). Novel approaches are needed to improve access and affordability of medicines that can treat NCDs in LMICs. An integrated approach including differential pricing, health systems strengthening, improved supply chain management and greater affordability can improve access to innovative branded medicines for NCDs. While differential pricing has several advantages for improving the affordability of NCD medicines in LMICs, it can’t overcome all access barriers as a standalone approach. An integrated approach to health systems strengthening, supply chain management and affordability are needed to overcome key challenges in getting medicines for NCD to patients in LMICs. The Access and Affordability Initiative (AAI) is a public private partnership aiming to improve access to and availability of ...
The burden of chronic kidney disease (CKD) is rapidly rising in developing countries due to astro... more The burden of chronic kidney disease (CKD) is rapidly rising in developing countries due to astronomical increases in key risk factors including hypertension and diabetes. We sought to assess the burden and predictors of CKD among Ghanaians with hypertension and/or diabetes mellitus in a multicenter hospital-based study. We conducted a cross-sectional study in the Ghana Access and Affordability Program (GAAP) involving adults with hypertension only (HPT), hypertension with diabetes mellitus (HPT + DM), and diabetes mellitus only (DM) in 5 health facilities in Ghana. A structured questionnaire was administered to collect data on demographic variables, medical history, and clinical examination. Serum creatinine and proteinuria were measured, and estimated glomerular filtration rate derived using the CKD-EPI formula. A multivariable logistic regression model was used to identify factors associated with CKD. A total of 2781 (84.4%) of 3294 participants had serum creatinine and proteinuria data available for analysis. The prevalence of CKD was 242 (28.5%) among participants with both DM and HPT, 417 (26.3%) among participants with HPT, and 56 (16.1%) among those with DM alone. Predictors of CKD were increasing
American Journal of Tropical Medicine and Hygiene, 2009
Genetic polymorphisms in Plasmodium falciparum are associated with resistance to a number of drug... more Genetic polymorphisms in Plasmodium falciparum are associated with resistance to a number of drugs, but data on their prevalence are limited from many areas. We explored the prevalence of key polymorphisms in patients presenting with malaria in Kinshasa. Prevalences of pfcrt K76T; pfmdr1 N86Y; pfdhfr N51I, C59R, and S108N; and pfdhps A437G were well above 50% and of pfmdr1 Y184F, N1042D, and D1246Y; pfdhfr I164L; and pfdhps K540E were low. These results suggest an intermediate level of resistance to aminoquinoline and antifolate antimalarials in Kinshasa compared with other areas of Africa.
With increasing population displacement and worsening water insecurity after the 2010 earthquake,... more With increasing population displacement and worsening water insecurity after the 2010 earthquake, Haiti experienced a large cholera outbreak. Our goal was to evaluate the strengths and weaknesses of seven community health facilities’ ability to respond to a surge in cholera cases.Since 2010, Catholic Relief Services (CRS) with a number of public and private donors has been working with seven health facilities in an effort to reduce morbidity and mortality from cholera infection. In November 2012, CRS through the Centers for Disease Control and Prevention (CDC)’s support, asked the Johns Hopkins Center for Refugee and Disaster Response to conduct a cholera surge simulation tabletop exercise at these health facilities to improve each facility’s response in the event of a cholera surge. Using simulation development guidelines from the Pan American Health Organization and others, a simulation scenario script was produced that included situations of differing severity, supply chain, as w...
The efficacy of daily oral antiretroviral (ARVs), even when combined with supplemental adherence ... more The efficacy of daily oral antiretroviral (ARVs), even when combined with supplemental adherence strategies, remains limited by non-adherence. Resistance and treatment failure resulting from missed ARV doses continue to hamper efforts to curb the epidemic. This commentary argues that we must simplify ARV regimens even further, and highlights the potential for long-acting injectable (LAI) formulations to facilitate weekly, monthly, and multi-month ARV regimens in both resource rich and resource poor settings. We summarize the latest progress in LAI development and reflect on the potential of LAIs to revolutionize HIV management and define the next frontier of HIV medicine.
A 17-year-old boy was assaulted by 3 men wielding baseball bats. Among multiple injuries, he sust... more A 17-year-old boy was assaulted by 3 men wielding baseball bats. Among multiple injuries, he sustained an injury to his left thorax (Fig. 1) with an associated pulmonary contusion but without pneumothorax or rib fractures. The patient's initial troponin I level of 1.35 ng/mL peaked 2 days later at 3.43 ng/mL. In addition, the initial electrocardiogram was markedly abnormal, with precordial R-wave and T-wave changes similar to those seen in apical hypertrophic cardiomyopathy (Fig. 2). A transthoracic echocardiogram revealed a left ventricular intramyocardial mass that extended from the mid lateral and apical lateral segments to the apex (Fig. 3). However, a diagnosis of left ventricular free-wall rupture with pseudoaneurysm formation could not be excluded. Cardiac magnetic resonance showed the intramyocardial location of the mass (Fig. 4). This finding, along with the history, was consistent with an intramyocardial hematoma from blunt chest trauma. While hospitalized, the patient...
The coronavirus disease 2019 (COVID-19) pandemic has exacerbated health disparities across ethnic... more The coronavirus disease 2019 (COVID-19) pandemic has exacerbated health disparities across ethnic and socioeconomic groups. Non-communicable diseases (NCDs) - such as hypertension, diabetes, and obstructive lung diseases – are key drivers of this widening gap, because they disproportionately afflict vulnerable populations. Vulnerable populations with non-communicable diseases, in turn, are disproportionately affected by COVID-19 itself – but also at increased risk of poor outcomes from those underlying conditions. Proven strategies for NCD control must be adapted to help vulnerable patients react to these dual threats. We detail six key policy interventions – task shifting, workforce protection, telehealth and mobile services, insurance restructuring and increased funding for NCDs, prescription policies for NCDs and community partnerships - to bridge this care gap. Long-term integration of these care models post-COVID-19 may prevent care shocks during future pandemics, bolstering em...
The burden of chronic kidney disease (CKD) is rapidly rising in developing countries due to astro... more The burden of chronic kidney disease (CKD) is rapidly rising in developing countries due to astronomical increases in key risk factors including hypertension and diabetes. We sought to assess the burden and predictors of CKD among Ghanaians with hypertension and/or diabetes mellitus in a multicenter hospital-based study. We conducted a cross-sectional study in the Ghana Access and Affordability Program (GAAP) involving adults with hypertension only (HPT), hypertension with diabetes mellitus (HPT + DM), and diabetes mellitus only (DM) in 5 health facilities in Ghana. A structured questionnaire was administered to collect data on demographic variables, medical history, and clinical examination. Serum creatinine and proteinuria were measured, and estimated glomerular filtration rate derived using the CKD-EPI formula. A multivariable logistic regression model was used to identify factors associated with CKD. A total of 2781 (84.4%) of 3294 participants had serum creatinine and proteinuria data available for analysis. The prevalence of CKD was 242 (28.5%) among participants with both DM and HPT, 417 (26.3%) among participants with HPT, and 56 (16.1%) among those with DM alone. Predictors of CKD were increasing
Background: Access to medicines for hypertension and diabetes mellitus (DM) management is challen... more Background: Access to medicines for hypertension and diabetes mellitus (DM) management is challenging in resource-limited countries. We sought to assess whether differential pricing of medicines based on socio-economic status would improve affordability of antihypertensive and anti-diabetic medications. A quasi-experimental, prospective cohort study was implemented at five Ghanaian health facilities, using medicines differentially priced by three pharmaceutical companies. Methods: Adult patients ≥18 years with hypertension or DM were enrolled and assigned to a lower tiered differential price (DP arm) or market price (MP arm) based on minimum wage earning or a score >6/18 on a multi-dimensional poverty index scale. Study medicines were purchased at either the DP or MP when prescribed. Participants were followed for 18 months to assess blood pressure (BP) and glycemic control. Predictors of ability to purchase study medicines were assessed using parsimonious logistic regression mod...
The 2014-2016 Ebola virus disease (EVD) outbreak in West Africa was of unprecedented magnitude wi... more The 2014-2016 Ebola virus disease (EVD) outbreak in West Africa was of unprecedented magnitude with a total of 28,616 suspected, probable, and confirmed cases reported in Guinea, Liberia, and Sierra Leone. The international humanitarian community utilized its expertise in rapid response and scale up in emergency situations to manage a threat different from the more common humanitarian emergencies resulting from conflict or natural disaster. Unique multisectoral partnerships forged between traditional public health actors and humanitarian actors facilitated mutual learning and opened the door to ongoing working relationships that will hasten efficient and effective response to future global public health emergencies.
Background: Extensive documentation exists on a range of negative sexual and reproductive health ... more Background: Extensive documentation exists on a range of negative sexual and reproductive health outcomes and rights violations occurring during humanitarian emergencies. We explore two central questions: Do existing policies, services, and research adequately address the SRH rights, priorities and HIV risks of adolescent girls and young women in emergency settings? What are the missed opportunities for holistically addressing the vulnerabilities experienced by those living with HIV during rapid onset disasters and long term, protracted emergencies? Authors review considerations informing real-time decision making, and highlight missed opportunities to apply a gendered lens in the delivery of AGYW-centered SRHR/HIV services. Methods: A scoping review identified studies on HIV intervention and outcomes in emergency settings, published in the peer-reviewed literature (2002-2017). This exercise was complemented with a desk review of normative guidance, frameworks, and implementation guidelines on HIV and SRH in emergency responses, and by consultations with subject matter experts. Results: The existing frameworks and guidance pay scant attention to the sexual reproductive health and rights of young women living with HIV (WLHIV), focusing mainly on prevention of mother to child transmission (PMTCT), antiretroviral therapy (ART), HIV testing services, and linkage to treatment services. Applying a gendered sexual and reproductive health lens to the response offers opportunities to identify critical implementation questions, and highlight promising practices, to better tailor current services for AGYW. Conclusions: A plurality of competing needs crowds out dedicated time and space to effectively integrate HIV and sexual and reproductive health interventions in emergency settings. Political will is required to advance multisectoral cooperation, through joint planning, rights-informed learning and integrative responses, and to promote creative solutions for ART continuation, drug supply and HIV testing, treatment and care. Recent advancements in policy and practice would suggest that a more AGYW-centered response is feasible.
The global burden of non-communicable diseases (NCDs) is growing, and access to prevention and tr... more The global burden of non-communicable diseases (NCDs) is growing, and access to prevention and treatment strategies remain limited, especially for those in low- and middle-income countries (LMICs). Novel approaches are needed to improve access and affordability of medicines that can treat NCDs in LMICs. An integrated approach including differential pricing, health systems strengthening, improved supply chain management and greater affordability can improve access to innovative branded medicines for NCDs. While differential pricing has several advantages for improving the affordability of NCD medicines in LMICs, it can’t overcome all access barriers as a standalone approach. An integrated approach to health systems strengthening, supply chain management and affordability are needed to overcome key challenges in getting medicines for NCD to patients in LMICs. The Access and Affordability Initiative (AAI) is a public private partnership aiming to improve access to and availability of ...
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Papers by Linda Mobula