Acknowledgements

I would like to thank my dear mother, Ana Bojorge, for the continuous support and motivation to pursue my dream as a public health worker and educator. Her commitment and determination have inspired me to follow her advice: "Whatever you do, do your best".

My deepest thanks and fondest regards to Dr. Clara Isabel Gonzalez from the Universidad Nacional Autónoma de Nicaragua, Managua (UNAN-Managua). Dr. Gonzalez was my Professor at the Faculty of Medical Sciences and later on my colleague and friend. She introduced me to the world of academia and thought me most of what I know today, including professionalism and moral virtues that will forever accompany me.

Lastly, I want to thank my colleagues and friends at UNAN-Managua and at the College of Public Health-USF for helping me grow as a public health worker and most importantly, as a human being.