Bio

Academic Appointments


Professional Education


  • MPH, Johns Hopkins Bloomberg School of Public Health, Public Health (2007)
  • MD, Yale University School of Medicine, Medicine (2008)

Community and International Work


  • Addressing sustainability of WASH in rural healthcare facilities in Uganda, Uganda

    Partnering Organization(s)

    Makerere University

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

  • Evaluation of a Typhoid Conjugate Vaccine Introduction Program in Navi Mumbai, India, India

    Topic

    Typhoid fever

    Partnering Organization(s)

    CDC; WHO India; NICED India; GGMC Mumbai

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

  • Comparing hospital hand hygiene in Liberia: soap, alcohol, and hypochlorite, Liberia

    Partnering Organization(s)

    Uniformed Services University; U.S. Naval Medical Research Unit No. 3; NPHIL Liberia

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

  • Bangladesh National Hygiene Survey - Hospital Hand Hygiene, Bangladesh

    Partnering Organization(s)

    International Centre for Diarrhoeal Disease Research, Bangladesh

    Location

    International

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

  • Promoting mother-mother networking for child health and immunizations in Bangladesh slums, Bangladesh

    Partnering Organization(s)

    International Centre for Diarrhoeal Disease Research, Bangladesh

    Location

    International

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

Teaching

Graduate and Fellowship Programs


Publications

All Publications


  • Effect of household relocation on child vaccination and health service utilisation in Dhaka, Bangladesh: a cross-sectional community survey. BMJ open Horng, L., Kakoly, N. S., Abedin, J., Luby, S. P. 2019; 9 (3): e026176

    Abstract

    OBJECTIVE: To explore the relationship between household relocation and use of vaccination and health services for severe acute respiratory illness (ARI) among children in Dhaka, Bangladesh.DESIGN: Analysis of cross-sectional community survey data from a prior study examining the impact of Haemophilus influenzae type b vaccine introduction in 2009 on meningitis incidence in Bangladesh.SETTING: Communities surrounding two large paediatric hospitals in Dhaka, Bangladesh.PARTICIPANTS: Households with children under 5 years old who either recently relocated <12 months or who were residentially stable living >24 months in their current residence (total n=10020) were selected for this study.PRIMARY OUTCOME MEASURES: Full vaccination coverage among children aged 9-59 months and visits to a qualified medical provider for severe ARI among children under 5 years old.RESULTS: Using vaccination cards with maternal recall, full vaccination was 80% among recently relocated children (n=3795) and 85% among residentially stable children (n=4713; chi2=37.2, p<0.001). Among children with ARI in the prior year, 69% of recently relocated children (n=695) had visited a qualified medical provider compared with 82% of residentially stable children (n=763; chi2=31.9, p<0.001). After adjusting for demographic and socioeconomic characteristics, recently relocated children were less likely to be fully vaccinated (prevalence ratio [PR] 0.97; 95% CI 0.95 to 0.99; p=0.016) and to have visited a qualified medical provider for ARI (PR 0.88; 95%CI 0.84 to 0.93; p<0.001).CONCLUSIONS: Children in recently relocated households in Dhaka, Bangladesh, have decreased use of vaccination and qualified health services for severe ARI.

    View details for PubMedID 30878989

  • Understanding the reasons for using methamphetamine by sexual minority people in Dhaka, Bangladesh. The International journal on drug policy Khan, S. I., Khan, M. N., Hasan, A. M., Irfan, S. D., Horng, L. M., Chowdhury, E. I., Azim, T. 2019; 73: 64?71

    Abstract

    Internationally, methamphetamine use is prevalent among males who have sex with males (MSM) and transgender women (hijra), with studies showing its association with risky sexual behaviours leading to HIV transmission. This study aimed to explore the underlying reasons for methamphetamine use among MSM and hijra in Bangladesh.We conducted 30 in-depth interviews with MSM and hijra and six focus groups with MSM, hijra and service providers. Data were thematically analysed using manual data analysis procedures.Reasons cited for using methamphetamine varied across feminized MSM (i.e. kothis), masculine MSM (i.e. panthis), male sex workers and hijra. For sex workers, increased sexual pleasure and consequent ability to take more clients increased their income. For panthis, methamphetamine enhanced feelings of masculinity and sexual prowess. Kothis were able to feel more feminine due to their ability to receive multiple partners each night. For all participants, methamphetamine restored self-esteem and relieved the stress resulting from stigma.Findings indicate that reasons for using methamphetamine are not only rooted in the individual's psyche but also grounded in the socio-cultural expectations about masculinities and femininities in Bangladeshi society. Limited knowledge about the complexities concerning methamphetamine use mean that appropriate counselling and treatment services are non-existent in Bangladesh. The study findings can be used to refine national and international harm reduction policies so as to incorporate and address methamphetamine use.

    View details for DOI 10.1016/j.drugpo.2019.07.009

    View details for PubMedID 31344562

  • Health-Care Facility Water, Sanitation, and Health-Care Waste Management Basic Service Levels in Bangladesh: Results from a Nation-Wide Survey. The American journal of tropical medicine and hygiene Unicomb, L., Horng, L., Alam, M., Halder, A. K., Shoab, A. K., Ghosh, P. K., Islam, M. K., Opel, A., Luby, S. P. 2018; 99 (4): 916?23

    Abstract

    We conducted a nationally representative cross-sectional study of 875 health-care facilities (HCFs) to determine water, sanitation, and health-care waste disposal service levels in Bangladesh for doctors, staff, and patients/caregivers in 2013. We calculated proportions and prevalence ratios to compare urban versus rural and government versus other HCFs. We report World Health Organization (WHO)-defined basic HCF service levels. The most common HCF was nongovernmental private (80%, 698/875), with an average of 25 beds and 12 admissions per day. There was an improved water source inside the HCF for doctors (79%, 95% confidence intervals [CI]: 75, 82), staff (59%, 95% CI: 55, 64), and patients/caregivers (59%, 95% CI: 55, 63). Improved toilets for doctors (81%, 95% CI: 78, 85) and other staff (73%, 95% CI: 70, 77) were more common than for patients/caregivers (54%, 95% CI: 50, 58). Forty-three percentage (434/875) of HCFs had no disposal method for health-care waste. More urban than rural and more government than other HCFs had an improved water source on the premises and improved toilets for staff. WHO-defined basic service levels were detected in > 90% of HCFs for drinking water, among 46-77% for sanitation, and 68% for handwashing at point of care but 26% near toilets. Forty-seven percentage of HCFs attained basic health-care waste management service levels. Patient/caregiver access to water, sanitation, and hygiene facilities is inadequate in many HCFs across Bangladesh. Improving facilities for this group should be an integral part of accreditation.

    View details for PubMedID 30152311

  • Healthcare worker and family caregiver hand hygiene in Bangladeshi healthcare facilities: results from the Bangladesh National Hygiene Baseline Survey JOURNAL OF HOSPITAL INFECTION Horng, L. M., Unicomb, L., Alam, M., Halder, A. K., Shoab, A. K., Ghosh, P. K., OPEL, A., Islam, M. K., Luby, S. P. 2016; 94 (3): 286-294

    Abstract

    Healthcare facility hand hygiene impacts patient care, healthcare worker safety, and infection control, but low-income countries have few data to guide interventions.To conduct a nationally representative survey of hand hygiene infrastructure and behaviour in Bangladeshi healthcare facilities to establish baseline data to aid policy.The 2013 Bangladesh National Hygiene Baseline Survey examined water, sanitation, and hand hygiene across households, schools, restaurants and food vendors, traditional birth attendants, and healthcare facilities. We used probability proportional to size sampling to select 100 rural and urban population clusters, and then surveyed hand hygiene infrastructure in 875 inpatient healthcare facilities, observing behaviour in 100 facilities.More than 96% of facilities had 'improved' water sources, but environmental contamination occurred frequently around water sources. Soap was available at 78-92% of handwashing locations for doctors and nurses, but just 4-30% for patients and family. Only 2% of 4676 hand hygiene opportunities resulted in recommended actions: using alcohol sanitizer or washing both hands with soap, then drying by air or clean cloth. Healthcare workers performed recommended hand hygiene in 9% of 919 opportunities: more after patient contact (26%) than before (11%). Family caregivers frequently washed hands with only water (48% of 2751 opportunities), but with little soap (3%).Healthcare workers had more access to hand hygiene materials and performed better hand hygiene than family, but still had low adherence. Increasing hand hygiene materials and behaviour could improve infection control in Bangladeshi healthcare facilities.

    View details for DOI 10.1016/j.jhin.2016.08.016

    View details for Web of Science ID 000388542500020

    View details for PubMedID 27665311

  • Use of mobile phones for improving vaccination coverage among children living in rural hard-to-reach areas and urban streets of Bangladesh VACCINE Uddin, M. J., Shamsuzzaman, M., Horng, L., Labrique, A., Vasudevan, L., Zeller, K., Chowdhury, M., Larson, C. P., Bishai, D., Alam, N. 2016; 34 (2): 276-283

    Abstract

    In Bangladesh, full vaccination rates among children living in rural hard-to-reach areas and urban streets are low. We conducted a quasi-experimental pre-post study of a 12-month mobile phone intervention to improve vaccination among 0-11 months old children in rural hard-to-reach and urban street dweller areas. Software named "mTika" was employed within the existing public health system to electronically register each child's birth and remind mothers about upcoming vaccination dates with text messages. Android smart phones with mTika were provided to all health assistants/vaccinators and supervisors in intervention areas, while mothers used plain cell phones already owned by themselves or their families. Pre and post-intervention vaccination coverage was surveyed in intervention and control areas. Among children over 298 days old, full vaccination coverage actually decreased in control areas - rural baseline 65.9% to endline 55.2% and urban baseline 44.5% to endline 33.9% - while increasing in intervention areas from rural baseline 58.9% to endline 76*8%, difference +18.8% (95% CI 5.7-31.9) and urban baseline 40.7% to endline 57.1%, difference +16.5% (95% CI 3.9-29.0). Difference-in-difference (DID) estimates were +29.5% for rural intervention versus control areas and +27.1% for urban areas for full vaccination in children over 298 days old, and logistic regression adjusting for maternal education, mobile phone ownership, and sex of child showed intervention effect odds ratio (OR) of 3.8 (95% CI 1.5-9.2) in rural areas and 3.0 (95% CI 1.4-6.4) in urban areas. Among all age groups, intervention effects on age-appropriate vaccination coverage were positive: DIDs +13.1-30.5% and ORs 2.5-4.6 (p<0.001 in all comparisons). Qualitative data showed the intervention was well-accepted. Our study demonstrated that a mobile phone intervention can improve vaccination coverage in rural hard-to-reach and urban street dweller communities in Bangladesh. This small-scale successful demonstration should serve as an example to other low-income countries with high mobile phone usage.

    View details for DOI 10.1016/j.vaccine.2015.11.024

    View details for Web of Science ID 000368214300016

  • Endocarditis due to Coccidioides spp: The Seventh Case. Open forum infectious diseases Horng, L. M., Yaghoubian, S., Ram, A., Johnson, R., Castro, L., Kuo, J., Deresinski, S. 2015; 2 (3): ofv086-?

    Abstract

    Coccidioides, a dimorphic fungus endemic within the Americas, primarily causes pulmonary disease but may disseminate. We describe a case of confirmed Coccidioides endocarditis, the seventh reported in literature. Coccidioides endocarditis often requires tissue diagnosis and combined surgical and medical treatment.

    View details for DOI 10.1093/ofid/ofv086

    View details for PubMedID 26180835

    View details for PubMedCentralID PMC4498286

  • Receptor tyrosine phosphatase-dependent cytoskeletal remodeling by the hedgehog-responsive gene MIM/BEG4 JOURNAL OF CELL BIOLOGY Gonzalez-Quevedo, R., Shoffer, M., Horng, L., Oro, A. E. 2005; 168 (3): 453-463

    Abstract

    During development, dynamic remodeling of the actin cytoskeleton allows the precise placement and morphology of tissues. Morphogens such as Sonic hedgehog (Shh) and local cues such as receptor protein tyrosine phosphatases (RPTPs) mediate this process, but how they regulate the cytoskeleton is poorly understood. We previously identified Basal cell carcinoma-enriched gene 4 (BEG4)/Missing in Metastasis (MIM), a Shh-inducible, Wiskott-Aldrich homology 2 domain-containing protein that potentiates Gli transcription (Callahan, C.A., T. Ofstad, L. Horng, J.K. Wang, H.H. Zhen, P.A. Coulombe, and A.E. Oro. 2004. Genes Dev. 18:2724-2729). Here, we show that endogenous MIM is induced in a patched1-dependent manner and regulates the actin cytoskeleton. MIM functions by bundling F-actin, a process that requires self-association but is independent of G-actin binding. Cytoskeletal remodeling requires an activation domain distinct from sequences required for bundling in vitro. This domain associates with RPTPdelta and, in turn, enhances RPTPdelta membrane localization. MIM-dependent cytoskeletal changes can be inhibited using a soluble RPTPdelta-D2 domain. Our data suggest that the hedgehog-responsive gene MIM cooperates with RPTP to induce cytoskeletal changes.

    View details for DOI 10.1083/jcb.200409078

    View details for Web of Science ID 000226925500011

    View details for PubMedID 15684034

    View details for PubMedCentralID PMC2171717

  • MIM/BEG4, a Sonic hedgehog-responsive gene that potentiates Gli-dependent transcription GENES & DEVELOPMENT Callahan, C. A., Ofstad, T., Horng, L., Wang, J. K., Zhen, H. H., Coulombe, P. A., Oro, A. E. 2004; 18 (22): 2724-2729

    Abstract

    Sonic hedgehog (Shh) signaling plays a critical role during development and carcinogenesis. While Gli family members govern the transcriptional output of Shh signaling, little is known how Gli-mediated transcriptional activity is regulated. Here we identify the actin-binding protein Missing in Metastasis (MIM) as a new Shh-responsive gene. Together, Gli1 and MIM recapitulate Shh-mediated epidermal proliferation and invasion in regenerated human skin. MIM is part of a Gli/Suppressor of Fused complex and potentiates Gli-dependent transcription using domains distinct from those used for monomeric actin binding. These data define MIM as both a Shh-responsive gene and a new member of the pathway that modulates Gli responses during growth and tumorigenesis.

    View details for DOI 10.1101/gad.1221804

    View details for Web of Science ID 000225170900004

    View details for PubMedID 15545630

    View details for PubMedCentralID PMC528890

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