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American Chemical Society Presentation on Diarrhea and Child Stunting
- 1. Environmental Health and Household Demographics Impacting Diarrhea and Child Stunting in a Complex System By Lee Voth-Gaeddert, PhD Student Daniel Oerther, PhD Adviser Environmental Systems Engineer Missouri University of Science and Technology Twitter handle: @LeeVG11
- 2. Outline • Diarrhea Issues • Structural Equation Modeling • Dan Divelbiss Research in Guatemala • My Thesis Research in Brazil • Child Stunting Issues • Dissertation Research in Guatemala • Mycotoxins • Enteric Infections • Time Variant Issues • Data Collection • Conclusion
- 4. Latent Variables Structural Equation Modeling Ex: • Symptoms of disease • Intelligence • Depression • SES, Educ., Health Burdens
- 5. Latent Variables Path Analysis Structural Equation Modeling • Direct/Indirect effects • Regression based • Covariance matrices
- 6. Latent Variables Path Analysis Structural Equation Modeling Structural Equation Model
- 7. Improved Water Storage Diarrheal Occurrences Socio- economic Status Household Education Level Filter Operation and Maintenance Additional Water Treatment Improved Water Source Improved Sanitation Soap Present in Home Structural Model on Diarrhea
- 9. Additional Water Treatment Diarrheal Occurrences Socio- economic Status Household Education Level Filter Operation and Maintenance Soap Present in Home Improved Water Source 0.139 -0.122 -0.095 -0.119 -0.170 -0.169 -0.527 Quiche, Guatemala Divelbiss et al. 2013. “Environmental Health and Household Demographics Impact Biosand Filter Maintenance and Diarrhea in Guatemala: An Application of Structural Equation Modeling”. Environmental Science & Tech. 47: 1638-1645
- 10. Improved Water Storage Diarrheal Occurrences Socio- economic Status Household Education Level Filter Operation and MaintenanceAdditional Water Treatment Improved Water Source Improved Sanitation Soap Present in Home Structural Model on Diarrhea
- 11. Para, Brazil
- 12. Socio- economic Status Household Education Level Filter Operation and Maintenance Additional Water Treatment Improved Water Source Improved Sanitation 0.353 0.256 -0.344 0.094 0.401 -0.278 -0.071 -0.200 Para, Brazil Diarrheal Occurrences 0.277
- 13. Confirmatory Data and Tests Secondary data used: Demographic and Health Survey data, selected by department and demographics Statistical techniques used: 1) Mahalanobis Taguchi Strategy, 2) Canonical Correlation Analysis, and 3) Latent Factor Regression Guatemala • Education (maternal and paternal) • Water Source • Family Planning and Structure Brazil • Education • Sanitation • Socio-economic Status • Family Structure Voth-Gaeddert et al. 2015. “Measuring multidimensional poverty in a complex environment; identifying the sensitive links”. Procedia Engineering 107: 172-180
- 14. Improved Water Storage Diarrheal Occurrences Socio- economic Status Household Education Level Filter Operation and MaintenanceAdditional Water Treatment Improved Water Source Improved Sanitation Soap Present in Home Structural Model on Diarrhea
- 15. Child stunting World Health Organization: “a failure to reach linear growth potential as a result of suboptimal health and/or nutritional conditions. A height that is 2 Standard Deviations below the WHO Child Growth Standards median” Why is it important and why should Environmental Engineers focus on it? - Our measures of success (microbial prevalence, trihalomethane (THMs), neoicotinoids, etc.) have all been linked to child stunting - Stunting impacts long term physical and mental societal contributions, and can be multigenerational
- 16. Sustainable Development Goals (SDGs) The SDGs are a [proposed] set of 17 goals and 169 targets to follow the Millennium Development Goals, focused on global sustainable development including ending poverty and hunger, improving health and education, improving cities, combating climate change, and protecting our oceans and forests. Child health underlies many goals. What do the SDGs incorporate that is of interest to Environmental Engineers? - These are a set of internationally negotiated areas of high importance - Research and development play a critical role in reaching these goals - Environmental Engineering plays a critical underlying role in a majority of the goals
- 17. Improved Water Storage Diarrheal Occurrences Socio- economic Status Household Education Level Filter Operation and MaintenanceAdditional Water Treatment Improved Water Source Improved Sanitation Soap Present in Home Structural Model on Diarrhea
- 18. Improved Water Storage Diarrheal Occurrences Socio- economic Status Household Education Level Filter Operation and MaintenanceAdditional Water Treatment Improved Water Source Improved Sanitation Soap Present in Home
- 19. Improved Water Storage Diarrheal Occurrences Socio- economi c Status Househol d Education Level Filter Operation and MaintenanceAdditional Water Treatment Improved Water Source Improved Sanitation Soap Present in Home
- 23. Child Stunting Swaddling/ Baby Wearing Pre-natal Maternal Health Household Mycotoxin Burden Micronutrient IntakeBreastfeeding Caloric Intake Environmental Enteropathy / Enteric Infections
- 24. Child Stunting Swaddling/ Baby Wearing Pre-natal Maternal Health Household Mycotoxin Burden Micronutrient IntakeBreastfeeding Caloric Intake Environmental Enteropathy / Enteric Infections
- 25. Mycotoxins
- 26. Household Mycotoxin Burden Personal storage facilities Selection style of maize from market Food Miles/ time to market Nixtomalization usage Exposure from market maize Exposure from Personal crops Mycotoxin Consumption Model Local Climate of Region (temp/elev.) Origin of maize to market Women’s time spent in field/ storage bin SES (to buy better maize)
- 27. Child Stunting Swaddling/ Baby Wearing Pre-natal Maternal Health Household Mycotoxin Burden Micronutrient IntakeBreastfeeding Caloric Intake Environmental Enteropathy / Enteric Infections
- 28. Child Stunting Swaddling/ Baby Wearing Pre-natal Maternal Health Household Mycotoxin Burden Micronutrient IntakeBreastfeeding Caloric Intake Environmental Enteropathy / Enteric Infections
- 30. WaSH Model Environmental Enteropathy / Enteric Infections Hygienic environment/ hand washing practices Probability of pathogen exposure due to type/location of latrine Probability of pathogen exposure due to water source Water Treatment Food Preparation Habits
- 31. Child Stunting Swaddling/ Baby Wearing Pre-natal Maternal Health Household Mycotoxin Burden Micronutrient IntakeBreastfeeding Caloric Intake Environmental Enteropathy / Enteric Infections
- 33. Child Stunting Swaddling/ Baby Wearing Pre-natal Maternal Health Household Mycotoxin Burden Micronutrient IntakeBreastfeeding Caloric Intake Water Storage Practice Hygiene/ Hand Washing Sanitation/ Latrine Use Water Source Water Treatment Kangaroo Cared at Birth Vitamin D Levels Swaddling Tightness Time Carried (per day/ month/year) Lack of mobility Swaddling Skin Coverage Vitamin D in diet Sun Exposure Personal storage facilities Selection style of maize from market Food Miles/ time to market Nixtalization usageExposure from market maize Exposure from Personal crops Local Climate of Region (temp/elev.) Origin of maize to market Women’s time spent in field/ storage bin SES (to buy better maize) Skin Tone Environmental Enteropahthy / Enteric Infections
- 34. Child Stunting Swaddling/ Baby Wearing Pre-natal Maternal Health Household Mycotoxin Burden Micronutrient IntakeBreastfeeding Caloric Intake Water Storage Practice Hygiene/ Hand Washing Sanitation/ Latrine Use Water Source Water Treatment Kangaroo Cared at Birth Vitamin D Levels Swaddling Tightness Time Carried (per day/ month/year) Lack of mobility Swaddling Skin Coverage Vitamin D in diet Sun Exposure Personal storage facilities Selection style of maize from market Food Miles/ time to market Nixtalization usageExposure from market maize Exposure from Personal crops Local Climate of Region (temp/elev.) Origin of maize to market Women’s time spent in field/ storage bin SES (to buy better maize) Skin Tone Environmental Enteropahthy / Enteric Infections
- 35. Child Stunting Swaddling/ Baby Wearing Pre-natal Maternal Health Household Mycotoxin Burden Micronutrient IntakeBreastfeeding Caloric Intake Water Storage Practice Hygiene/ Hand Washing Sanitation/ Latrine Use Water Source Water Treatment Kangaroo Cared at Birth Vitamin D Levels Swaddling Tightness Time Carried (per day/ month/year) Lack of mobility Swaddling Skin Coverage Vitamin D in diet Sun Exposure Personal storage facilities Selection style of maize from market Food Miles/ time to market Nixtalization usageExposure from market maize Exposure from Personal crops Local Climate of Region (temp/elev.) Origin of maize to market Women’s time spent in field/ storage bin SES (to buy better maize) Skin Tone Example Environmental Enteropahthy / Enteric Infections
- 36. Child Stunting Swaddling/ Baby Wearing Pre-natal Maternal Health Household Mycotoxin Burden Micronutrient IntakeBreastfeeding Caloric Intake Hygiene/ Hand Washing Sanitation/ Latrine Use Vitamin D Levels Time Carried (per day/ month/year) Lack of mobility Sun Exposure Exposure from market maize Origin of maize to market Example Environmental Enteropahthy / Enteric Infections
- 37. Child Stunting Time Carried (per day/ month/ year) Pre-natal Maternal Health Origin of maize to market Micronutrient IntakeBreastfeeding Caloric Intake Hygiene/ Hand Washing Sanitation/ Latrine Use Example Environmental Enteropahthy / Enteric Infections
- 38. • Analysis uses structural equation modeling which is based on regression analysis • Temporal issues are a key driver in understanding a system (i.e. feedback loops, lags/delays, oscillatory variables, etc.) • Primary temporal issues could be; seasonality of rains, harvest, food security, diet, others? • How does that affect child stunting? Time Variant Issues
- 40. Structural Equation Model to System Dynamics Model Child Stunting Swaddling/ Baby Wearing Pre-natal Maternal Health Household Mycotoxin Burden Micronutrient IntakeBreastfeeding Caloric Intake • Regression/probability based equations • Parameter estimates & confidence intervals • Cross sectional/static • Differential equation based equations • Feedback loops with stocks and flows • Time variant/dynamic Child stunting Mycotoxin Nutrition intervention Becoming sicker Becoming healthier Breast- feeding Baby wearing % household $$ spent on healthcare Enteric infections Micronutrient intake Caloric intake Access to nutritious foods Poor prenatal health Environmental Enteropahthy / Enteric Infections
- 41. • iPad or Tablet surveys uploaded to cloud • SMS self reporting and reward system • Simple or smart phone game with intermittent questions or tasks • Hospital data collection through incentives • Midwives • Internet café/school Data Collection Options
- 42. Goals of Research • Synthesize academic literature on child stunting • Identify causal factors of child stunting and potential cross cutting solutions (technical OR non-technical) • Find cost effective solutions AND cost effective assessments • Bridge the gap between SEM (frequentist/bayesian statistics) and SDM (differential equation based dynamics)
- 43. Acknowledgements Funding: • John A. and Susan Mathis Grant • Chancellors Fellow Scholarship • NCAA Postgraduate Scholarship • Schowalter Foundation Grant Persons: • Gil Serique • Tommy Goodwin • Andrew Schrank • Gerber and Michelle Perez, Mission Impact • Mennonite Central Committee
Editor's Notes
- SES also might effect ‘exposure from market maize’ by having access to more, if you have the money, why grow it your self? Possibly at a certain level of SES (upper end) or those that soley rely on markets (80% and up), then look at relationship (control for confounder).
- SES and HEL has been shown not to be a factor in this issue due to the wide spread nature of it (Gong et al. 2004). More towards the cultural practices pathway model…