Duncan Smith-Rohrberg Maru

Duncan Smith-Rohrberg Maru
Icahn School of Medicine at Mount Sinai | MSSM · Global Health

MD, PHD

About

110
Publications
15,896
Reads
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1,696
Citations
Introduction
I am an epidemiologist and physician trained in internal medicine and pediatrics who currently conducts implementation science research on strategies to improve the delivery of evidence-based healthcare interventions in settings of extreme poverty.
Additional affiliations
October 2013 - present
Brigham and Women's Hospital
Position
  • Instructor
Description
  • We test pragmatic and innovative solutions that improve healthcare delivery in settings of poverty: hsdg.partners.org
October 2013 - present
Harvard Medical School
Position
  • Instructor
Description
  • Our research site: hsdg.partners.org
October 2013 - present
Boston Children's Hospital
Position
  • Complex Care Service Staff Physician

Publications

Publications (110)
Article
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Objectives To examine the factors associated with COVID-19 vaccine receipt among healthcare workers and the role of vaccine confidence in decisions to vaccinate, and to better understand concerns related to COVID-19 vaccination. Design Cross-sectional anonymous survey among front-line, support service and administrative healthcare workers. Settin...
Article
Rationale: Risk factors for COVID-19 mortality may include environmental exposures, such as air pollution. Objectives: Determine whether, amongst adults hospitalized with PCR-confirmed COVID-19, long-term air pollution exposure is associated with risk for mortality, intensive care unit (ICU) admission or intubation. Methods: We performed a ret...
Article
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Objective: Estimate the seroprevalence of SARS-CoV-2 antibodies among New York City Health and Hospitals (NYC H+H) healthcare workers during the first wave of the COVID-19 pandemic, and describe demographic and occupational factors associated with SARS-CoV-2 antibodies among healthcare workers. Design: Descriptive, observational, cross-sectional...
Article
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Introduction Despite carrying a disproportionately high burden of depression, patients in low-income countries lack access to effective care. The collaborative care model (CoCM) has robust evidence for clinical effectiveness in improving mental health outcomes. However, evidence from real-world implementation of CoCM is necessary to inform its expa...
Article
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Background/Rationale: Anti-colonialism in global health aims to eliminate colonial power imbalances inherent in Western scholar-driven work. Central to anti-colonial global health are more equitable grant application processes, particularly within NIH’s Fogarty International Center (FIC), a global arm of the largest public biomedical research funde...
Preprint
Full-text available
Objective: Estimate the seroprevalence of SARS-CoV-2 antibodies among New York City Health + Hospitals healthcare workers, and identify demographic and occupational factors associated with SARS-CoV-2 antibodies among healthcare workers. Methods: This was an observational, cross-sectional study using data from SARS-CoV-2 serological tests accompanie...
Article
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Background Motivational Interviewing (MI) has a robust evidence base in facilitating behavior change for several health conditions. MI focuses on the individual and assumes patient autonomy. Cross-cultural adaptation can face several challenges in settings where individualism and autonomy may not be as prominent. Sociocultural factors such as gende...
Preprint
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Objectives To examine factors associated with COVID-19 vaccine receipt among healthcare workers, including healthcare worker job type, race, and gender, as well as the role of vaccine confidence in decisions to vaccinate, and to better understand specific concerns related to COVID-19 vaccination among healthcare workers. Design Cross-sectional anon...
Article
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Unmet need for postpartum contraception in rural Nepal remains high and expanding access to sexual and reproductive healthcare is essential to achieving universal healthcare. We evaluated the impact of an integrated intervention that employed community health workers aided by mobile technology to deliver patient-centred, home-based antenatal and po...
Article
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Background Universal screening for SARS-CoV-2 infection on Labor and Delivery (L&D) units is a critical strategy to manage patient and health worker safety, especially in a vulnerable high-prevalence community. We describe the results of a SARS-CoV-2 universal screening program at the L&D Unit at Elmhurst Hospital in Queens, NY, a 545-bed public ho...
Preprint
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Background Universal screening for SARS-CoV-2 infection on Labor and Delivery (L&D) units is a critical strategy to manage patient and health worker safety, especially in a vulnerable high-prevalence community. We describe the results of a SARS-CoV-2 universal screening program at the L&D Unit at Elmhurst Hospital in Queens, NY, a 545-bed public ho...
Article
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Community health workers (CHWs) are essential to primary health care systems and are a cost-effective strategy to achieve the Sustainable Development Goals (SDGs). Nepal is strongly committed to universal health coverage and the SDGs. In 2017, the Nepal Ministry of Health and Population partnered with the nongovernmental organization Nyaya Health N...
Article
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Background: The Collaborative Care Model (CoCM) for mental healthcare, where a consulting psychiatrist supports primary care and behavioral health workers, has the potential to address the large unmet burden of mental illness worldwide. A core component of this model is that the psychiatrist reviews treatment plans for a panel of patients and prov...
Article
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Background: In Nepal, the burden of noncommunicable, chronic diseases is rapidly rising, and disproportionately affecting low and middle-income countries. Integrated interventions are essential in strengthening primary care systems and addressing the burden of multiple comorbidities. A growing body of literature supports the involvement of frontli...
Article
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Background: Access to high-quality antenatal care services has been shown to be beneficial for maternal and child health. In 2016, the WHO published evidence-based recommendations for antenatal care that aim to improve utilization, quality of care, and the patient experience. Prior research in Nepal has shown that a lack of social support, birth p...
Preprint
Full-text available
Background In Nepal, the burden of non-communicable, chronic diseases is rapidly rising, and disproportionately affecting low- and middle-income countries. Integrated interventions are essential in strengthening primary care systems and addressing the burden of multiple comorbidities. A growing body of literature supports the involvement of frontli...
Preprint
Full-text available
Background: Strategic purchasing mechanisms, including national health insurance, provide opportunities to improve quality and progress towards universal health coverage. Nepal’s health insurance program (HIP), begun in 2016, is a national insurance platform aiming to improve financial risk protection, and efficiency, quality, and access to health...
Preprint
Full-text available
Background In Nepal, the burden of non-communicable, chronic diseases is rapidly rising, and disproportionately affecting low- and middle-income countries. Integrated interventions are essential in strengthening primary care systems and addressing the burden of multiple comorbidities. A growing body of literature supports the involvement of frontli...
Article
Full-text available
Background: Reducing the maternal mortality ratio to less than 70 per 100,000 live births globally is one of the Sustainable Development Goals. Approximately 830 women die from pregnancy- or childbirth-related complications every day. Almost 99% of these deaths occur in developing countries. Increasing antenatal care quality and completion, and in...
Preprint
Background In Nepal, the burden of non-communicable, chronic diseases is rapidly rising, and disproportionately affecting low- and middle-income countries. Integrated interventions are essential in strengthening primary care systems and addressing the burden of multiple comorbidities. A growing body of literature supports the involvement of frontli...
Article
Full-text available
Objectives The study aimed to qualitatively examine the perspectives of US-based physicians and academic global health programme leaders on how global health work shapes their viewpoints, values and healthcare practices back in the USA. Design A prospective, qualitative exploratory study that employed online questionnaires and open-ended, semi-str...
Article
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Low-income and middle-income countries are struggling with a growing epidemic of non-communicable diseases. To achieve the Sustainable Development Goals, their healthcare systems need to be strengthened and redesigned. The Starfield 4Cs of primary care—first-contact access, care coordination, comprehensiveness and continuity—offer practical, high-q...
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Background Chronic obstructive pulmonary disease accounts for a significant portion of the world’s morbidity and mortality, and disproportionately affects low/middle-income countries. Chronic obstructive pulmonary disease management in low-resource settings is suboptimal with diagnostics, medications and high-quality, evidence-based care largely un...
Article
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Background: Traditional medical education in much of the world has historically relied on passive learning. Although active learning has been in the medical education literature for decades, its incorporation into practice has been inconsistent. We describe and analyze the implementation of a multidisciplinary continuing medical education curricul...
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The collaborative care model can deliver high-quality mental health care. In rural regions, clinical supervision is conducted remotely rather than in person. The authors implemented a remote teleconsultation model in rural Nepal, where the consulting psychiatrist is over 30 hours away. This column describes strategies for several challenges: poor m...
Article
Integrating care at the home and facility level is a critical yet neglected function of healthcare delivery systems. There are few examples in practice or in the academic literature of affordable, digitally-enabled integrated care approaches embedded within healthcare delivery systems in low- and middle-income countries. Simultaneous advances in af...
Article
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Background: Evidence-based medicines, technologies, and protocols exist to prevent many of the annual 300,000 maternal, 2.7 million neonatal, and 9 million child deaths, but they are not being effectively implemented and utilized in rural areas. Nepal, one of South Asia's poorest countries with over 80% of its population living in rural areas, exe...
Article
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Background Mental illnesses are the largest contributors to the global burden of non-communicable diseases. However, there is extremely limited access to high quality, culturally-sensitive, and contextually-appropriate mental healthcare services. This situation persists despite the availability of interventions with proven efficacy to improve patie...
Article
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Over the past decade the Ministry of Health of Nepal and the nonprofit Possible have partnered to deliver primary and secondary health care via a public-private partnership. We applied an accountable care framework that we previously developed to describe the delivery of their integrated reproductive, maternal, newborn, and child health services in...
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Background Patients in isolated rural communities typically lack access to surgical care. It is not feasible for most rural first-level hospitals to provide a full suite of surgical specialty services. Comprehensive surgical care thus depends on referral systems. There is minimal literature, however, on the functioning of such systems. Methods We u...
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Background: Global health academic partnerships are centered around a core tension: they often mirror or reproduce the very cross-national inequities they seek to alleviate. On the one hand, they risk worsening power dynamics that perpetuate health disparities; on the other, they form an essential response to the need for healthcare resources to re...
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Introduction: Globally, electronic medical records are central to the infrastructure of modern healthcare systems. Yet the vast majority of electronic medical records have been designed for resource-rich environments and are not feasible in settings of poverty. Here we describe the design and implementation of an electronic medical record at a pub...
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The earthquakes in Nepal killed nearly 9000 people, destroyed over 600 000 homes, displaced more than 1 million people, and destroyed over 1200 public health-care facilities. Given the technological tools of the 21st century, such destruction is almost entirely the result of poor planning and poor enforcement of building code regulations. A product...
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Background Increasing institutional births rates and improving access to comprehensive emergency obstetric care are central strategies for reducing maternal and neonatal deaths globally. While some studies show women consider service availability when determining where to deliver, the dynamics of how and why institutional birth rates change as comp...
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Community health workers form the backbone of healthcare systems globally. The rapid expansion of mobile communications systems represents an opportunity to improve the productivity of community health workers in rural areas. Here, we describe a programme in rural Nepal that aimed to implement a mobile phone system for collecting health surveillanc...
Article
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Child mortality measurement is essential to the impact evaluation of maternal and child healthcare systems interventions. In the absence of vital statistics systems, however, assessment methodologies for locally relevant interventions are severely challenged. Methods for assessing the under-5 mortality rate for cross-country comparisons, often used...
Article
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Background Encouraging institutional birth is an important component of reducing maternal mortality in low-resource settings. This study aims to identify and understand the determinants of persistently low institutional birth in rural Nepal, with the goal of informing future interventions to reduce high rates of maternal mortality. Methods Postpart...
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Background Surveillance systems are increasingly relying upon community-based or crowd-sourced data to complement traditional facilities-based data sources. Data collected by community health workers during the routine course of care could combine the early warning power of community-based data collection with the predictability and diagnostic regu...
Article
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Introduction: Diagnostic radiology services are severely lacking in many rural settings and the implementation of these services poses complex challenges. The purpose of this paper is to describe the implementation of diagnostic radiology services at a district-level hospital in Achham, a rural district in Nepal. Methods and Materials: We conducted...
Article
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Background Nepal’s Female Community Health Volunteer (FCHV) program has been described as an exemplary public-sector community health worker program. However, despite its merits, the program still struggles to provide high-quality, accessible services nation-wide. Both in Nepal and globally, best practices for community health worker program implem...
Article
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Household indoor air pollution from open-fire cookstoves remains a public health and environmental hazard which impacts negatively on people's right to health. Technologically improved cookstoves designed to reduce air pollution have demonstrated their efficacy in laboratory studies. Despite the tremendous need for such stoves, in the field they ha...
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Background: In many rural areas at risk for enteric fever, there are few data on Salmonella enterica serotypes Typhi (S. Typhi) and Paratyphi (S. Paratyphi) incidence, due to limited laboratory capacity for microbiologic culture. Here, we describe an approach that permits recovery of the causative agents of enteric fever in such settings. This app...
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The social movements of the last two decades have fostered a rights-based approach to health systems development within the global discourse on national and international health governance. In this piece, we discuss ongoing challenges in the cavernous "implementation gap": translating legislative human rights victories into actual practice and deli...
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Over the last decade, extensive scientific and policy innovations have begun to reduce the "quality chasm" - the gulf between best practices and actual implementation that exists in resource-rich medical settings. While limited data exist, this chasm is likely to be equally acute and deadly in resource-limited areas. While health systems have begun...
Data
Figure S1. Strategies for a Global Quality Improvement Movement.
Article
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Recently, Bayalpata Hospital, in the rural district of Achham, Nepal almost collapsed under the weight of its own staff's discontent. The hospital had been largely abandoned until 2009 when our organization, Nyaya Health, renovated and opened it in partnership with the Nepali government. Since then, the hospital has seen great progress and has expe...
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Patient and regimen persistence in HIV-infected drug users are largely unknown. We evaluated patterns of medication non-persistence among HIV-infected drug users enrolled in a prospective, 6-month randomized controlled trial of directly administered antiretroviral therapy (DAART). Medication-taking behavior was assessed via direct observation and M...
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In hospitals in rural, resource-limited settings, there is an acute need for simple, practical strategies to improve healthcare quality. A district hospital in remote western Nepal. To provide a mechanism for systems-level reflection so that staff can identify targets for quality improvement in healthcare delivery. Strategies for change To develop...