american chemical society presentation on diarrhea and child stunting

Environmental Health and Household Demographics

Impacting Diarrhea and Child Stunting in a Complex System

ByLee Voth-Gaeddert, PhD Student

Daniel Oerther, PhD AdviserEnvironmental Systems Engineer

Missouri University of Science and Technology

Twitter handle: @LeeVG11

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

Latent Variables

Structural Equation Modeling

Ex:• Symptoms of disease• Intelligence • Depression• SES, Educ., Health Burdens

Latent Variables Path Analysis

Structural Equation Modeling

• Direct/Indirect effects• Regression based• Covariance matrices

Latent Variables Path Analysis

Structural Equation Modeling

Structural Equation Model

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

Quiche, Guatemala

Additional Water

Treatment

Diarrheal Occurrences

Socio- economic

Status

Household Education

Level

Filter Operation and

MaintenanceSoap 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

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

Para, Brazil

Socio- economic

Status

Household Education

Level

Filter Operation and

MaintenanceAdditional

Water Treatment

Improved Water Source

Improved Sanitation

0.3530.256

-0.344

0.094

0.401

-0.278

-0.071

-0.200

Para, Brazil

Diarrheal Occurrences

0.277

Confirmatory Data and TestsSecondary data used: Demographic and Health Survey data, selected by department and demographicsStatistical 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

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

Child stuntingWorld 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

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

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

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

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

Environmental Enteropathy /

Enteric Infections

Household Mycotoxin

Burden

Environmental Enteropathy /

Enteric Infections

Household Mycotoxin

Burden

Child Stunting

Environmental Enteropathy /

Enteric Infections

Child Stunting

Swaddling/ Baby Wearing

Pre-natal Maternal

Health

Household Mycotoxin

Burden

Micronutrient IntakeBreastfeeding

Caloric Intake

Environmental Enteropathy /

Enteric Infections

Child Stunting

Swaddling/ Baby Wearing

Pre-natal Maternal

Health

Household Mycotoxin

Burden

Micronutrient IntakeBreastfeeding

Caloric Intake

Environmental Enteropathy /

Enteric Infections

Mycotoxins

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)

Child Stunting

Swaddling/ Baby Wearing

Pre-natal Maternal

Health

Household Mycotoxin

Burden

Micronutrient IntakeBreastfeeding

Caloric Intake

Environmental Enteropathy /

Enteric Infections

Child Stunting

Swaddling/ Baby Wearing

Pre-natal Maternal

Health

Household Mycotoxin

Burden

Micronutrient IntakeBreastfeeding

Caloric Intake

Environmental Enteropathy /

Enteric Infections

WaSH/ Enteric Infections

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

Child Stunting

Swaddling/ Baby Wearing

Pre-natal Maternal

Health

Household Mycotoxin

Burden

Micronutrient IntakeBreastfeeding

Caloric Intake

Environmental Enteropathy /

Enteric Infections

Child Stunting

Swaddling/ Baby

Wearing

Pre-natal Maternal

Health

Household Mycotoxin

Burden

Environmental Enteropahthy /

Enteric Infections

Micronutrient IntakeBreastfeeding

Caloric Intake

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 ToneEnvironmental Enteropahthy /

Enteric Infections

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 ToneEnvironmental Enteropahthy /

Enteric Infections

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

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

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

• 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

FEWSNET 2010

Guatemalan Seasonal Fluctuations

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

• 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

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)

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

Thank you

lv6w3@mst.edu@LeeVG11

Leevg11.wordpress.com