1. A
Qualita)ve
Analysis
of
Social
and
Environmental
Influences
on
Waterborne
Pathogen
Transmission
Presented
by:
John
Brandon
Fazal
Research
Mentor:
Jessica
Dimka
Background
This
study
examines
the
experiences
of
22
study
villages
in
northern
coastal
Ecuador.
Residents
belong
to
two
ethnic
groups,
the
Chachi
and
the
Afro-­‐Ecuadorian
communi)es,
and
villages
vary
widely
in
hygiene
prac)ces,
access
to
sanita)on,
and
water
sources.
As
part
of
the
Ecologia,
Desarrollo,
Salud,
y
Sociedad
(EcoDESS-­‐
Ecology,
Development,
Health,
and
Society)
project,
interdisciplinary
researchers
have
worked
in
this
area
since
2003,
collec)ng
data
on
demographic
and
disease
paVerns,
climate
trends,
social
rela)onships,
and
changes
resul)ng
from
socioeconomic
development
and
road
construc)on.
Methods
This
poster
draws
on
primary
and
secondary
sources,
par)cularly
results
from
focus
groups
on
climate
change
concerns2
and
a
large
database
that
includes
over
800
documents
containing
interviews
and
ethnographic
field
notes.
From
this
database,
we
extracted
quotes
related
to
local
epidemiological
knowledge,
family
organiza)on,
gender
roles,
employment,
and
social
interac)ons
in
the
village
and
river.
These
materials
were
translated
from
Spanish
and
reviewed
for
informa)on
relevant
to
this
project,
including
effects
of
climate
change
and
subsequent
behavioral
changes.
Conclusions
Diarrheal
diseases
kill
more
children
worldwide
than
AIDS,
malaria,
and
measles
combined.1
Even
in
more
developed
countries,
climate
disasters,
growing
popula)ons,
and
poor
or
uninformed
management
decisions
can
overwhelm
aging
or
inadequate
infrastructure,
leading
to
outbreaks
of
diarrheal
diseases
or
other
health
problems.3
Understanding
the
daily
lives
of
and
resources
available
to
people
in
affected
regions,
as
well
as
the
barriers
that
impede
sanita)on
and
hygiene
interven)ons,
is
key
to
implemen)ng
change.
This
qualita)ve
review
will
inform
further
research,
including
development
of
an
agent-­‐based
computer
model
of
disease
transmission.
Models
help
improve
understanding
of
system-­‐level
interac)ons
and
evaluate
poten)al
public
health
solu)ons
at
the
local,
state,
and
ins)tu)onal
levels.
For
example,
model
analyses
are
likely
to
focus
on
how
varia)on
in
water
supply
and
quality
influences
compe)ng
priori)es
for
water
use
(e.g.
agriculture),
within
and
between
community
transmission,
social
interac)ons,
and
daily
ac)vi)es
of
individuals
and
households,
as
well
as
adapta)ons
such
as
water
treatment
or
latrine
use
and
access.
Results
Informa)on
provided
by
villagers
and
documented
by
researchers
revealed
several
important
themes
related
to
lifestyle
and
ac)vi)es
that
contribute
to
the
spread
of
disease.
These
components
of
life
are
further
affected
by
changes
in
weather
and
other
condi)ons,
thus
further
influencing
disease
suscep)bility
and
transmission.
This
poster
provides
a
brief
overview
of
three
major
themes
commonly
raised
by
study
par)cipants.
Agriculture:
Villagers
usually
plant
crops
along
river
banks
because
the
soil
is
fer)le
and
for
ease
of
irriga)on.
While
they
acknowledge
the
risk
of
crop
loss
due
to
flooding,
they
believe
the
benefits
outweigh
the
risks.
Other
concerns
include:
• Intense
droughts
can
dry
out
crops
and
cause
a
loss
of
harvest
• Livestock
can
be
killed
during
floods
and
farming
infrastructure
can
be
destroyed
• Flooding
spreads
pathogens
among
animals,
agricultural
plots,
and
homes
• Loss
of
resources
and
income,
as
well
as
related
food
and
nutri)on
concerns,
can
further
impact
health
and
suscep)bility
to
disease
Introduc6on
Diarrheal
diseases
kill
2,195
children
every
day,
primarily
in
the
developing
word.1
Transmission
of
pathogens
occurs
through
mul)ple
pathways,
including
water,
sanita)on,
food,
and
person-­‐to-­‐person.
The
distribu)on
and
impact
of
diarrheal
diseases
are
likely
to
change
as
a
result
of
both
socioeconomic
development
and
climate
change.
The
purpose
of
this
study
is
to
inves)gate
the
rela)onship
between
climate
change,
socioeconomic
and
cultural
factors,
and
disease
transmission
at
the
household
and
village
level.
For
example,
climate
change
results
in
increased
magnitude
and
frequency
of
floods,
causing
people
to
change
their
habits
and
infrastructure
to
be
destroyed.
By
understanding
how
villagers
in
the
study
region
are
affected
by
and
respond
to
these
disasters
and
climate
change
as
a
whole,
public
health
interven)ons
can
be
developed
for
use
there,
as
well
as
in
areas
with
similar
environmental
and/or
socioeconomic
condi)ons.
Acknowledgements
Joe
Eisenberg,
Jim
Trostle,
Karen
Levy,
Velma
Lopez,
Hayden
Hedman,
the
study
and
field
team
members
of
the
EcoDESS
project,
and
the
residents
of
the
study
villages
1) Liu
L,
Johnson
HL,
et.
al;
Child
Health
Epidemiology
Reference
Group
of
WHO
and
UNICEF.
Global,
regional,
and
na)onal
causes
of
child
mortality:
an
updated
systema)c
analysis
for
2010
with
)me
trends
since
2000.
Lancet.
2012;379(9832):2151-­‐61.
2) Focus
group
data
provided
by
Karen
Levy
(Emory
University),
with
previous
summaries
and
analyses
conducted
by
Victoria
Salinas
3) For
example,
Auld
et
al.
(2004)
Journal
of
Toxicology
and
Environmental
Health,
Part
A
67:1879-­‐1887;
Cann
et
al.
(2013)
Epidemiology
and
Infec)on
141:671-­‐686;
Rose
et
al.
(2001)
Environmental
Health
Perspec)ves
109(S2):211-­‐220
River
Interac)ons:
Villagers
use
the
rivers
daily
for
drinking
water,
transporta)on,
bathing,
laundry,
fishing,
and
disposal
of
waste;
houses
are
also
located
near
rivers.
This
proximity
interacts
with
climate
and
disease
spread
factors
in
a
variety
of
ways,
including:
• Intense
flooding
destroys
infrastructure
and
interrupts
daily
ac)vi)es
• Floods
contaminate
the
river
water
with
dirt
and
debris,
with
waters
ojen
reaching
houses,
latrines
and
walkways
• Conversely,
droughts
create
stagnant
pools
of
water,
which
facilitates
the
birth
of
mosquitos
that
spread
disease
person-­‐to-­‐person
Travel:
Villagers
travel
to
nearby
communi)es,
as
well
as
larger
popula)on
centers,
for
trade,
employment,
school
and
various
social
interac)ons.
The
rivers
serve
as
major
routes
for
transporta)on,
while
numerous
roads
have
also
been
constructed
in
recent
years.
• Higher
rates
of
travel
are
linked
to
increased
disease
transmission,
as
villagers
introduce
pathogens
to
other
communi)es
• Floods
or
droughts
can
change
water
level
and
access
to
the
river,
poten)ally
limi)ng
the
ability
to
obtain
medicine
or
health
care
• Changes
to
the
environment
from
road
construc)on
affect
the
vulnerability
of
communi)es
to
flooding
and
other
climate
events
Villages
in
the
study
region,
circa
2009
Photo
Credit:
Velma
Lopez
Photo
Credit:
Hayden
Hedman
Photo
Credit:
Velma
Lopez