Ayse Ercumen

This project is to provide an 8-week international research experience for NC State students to work in Malawi, with partners from Malawi University of Science and Technology and Mzuzu University. The research will focus on research gaps in Water, Sanitation, and Hygiene (WaSH).

Enteric infections and diarrhea are responsible for a large burden of morbidity and mortality among children under 5 years and are associated with increased growth faltering, anemia, impaired child development, and mortality. The primary public health interventions to prevent enteric infections are household water, sanitation, and hygiene (WASH) interventions. However, recent WASH intervention trials found only modest impacts on enteric infection prevalence in children. Observational studies have found that children in households with concrete floors have lower prevalence of diarrhea, soil-transmitted helminth infection, and Giardia infection than those in households with soil floors. However, these findings may be strongly confounded by household wealth. We propose a randomized trial in rural Bangladesh to measure whether installing concrete floors in households with soil floors reduces child enteric infection. We will randomize 800 eligible households with pregnant women and install concrete floors before index children are born. We will collect follow-up measurements when children are ages 6, 12, 18, and 24 months. Our team is comprised of experts in environmental and infectious disease epidemiology, including Bangladeshi scientists. We have extensive experience implementing large-scale health intervention trials in Bangladesh and other low resource settings. Aim 1 is to determine the effect of household concrete floors on child enteric illness in households. The primary endpoint is Ascaris lumbricoides prevalence at any follow-up measurement. Secondary endpoints include prevalence of other soil-transmitted helminths, Giardia duodenalis and diarrhea. Aim 2 is to measure effects of household concrete floors on household fecal contamination over time. In a subset, we will detect molecular markers of enteric bacteria (N=200) and parasites (N=800) in floors, child hands, and sentinel toy samples. Aim 3 is to assess whether household concrete floors reduce child soil contact and ingestion. We will conduct video observations in a subsample (N=60) to estimate the frequency of child activities inside vs. outside the home each day. This trial will determine whether concrete floors reduce enteric infection, and further determine how concrete floors reduce enteric infection or if they do not, why. Our findings will provide rigorous, policy-relevant evidence about whether concrete flooring installation should be delivered as a public health intervention to reduce child enteric infection. More broadly, this study marks a paradigm shift in intervention design for improving child health by expanding its scope to include housing improvements.

Industrial agriculture disproportionately affects minority, low-income, and Tribal communities, propagating environmental injustice. Concentrated Animal Feeding Operations (CAFOs) apply massive amounts of untreated waste annually to nearby farmlands. Environmental health impacts of CAFOs are documented; however, studies almost exclusively rely on known CAFO locations from public records, which are incomplete. This is because only CAFOs discharging into US waters need a permit; poultry CAFOs generate dry waste and operate without permits. North Carolina (NC) communities have observed a dramatic but poorly documented expansion of poultry CAFOs since the 2007 swine CAFO moratorium but the locations of these facilities are essentially unknown and their environmental impacts therefore undocumented. Researchers have attempted to manually scan satellite/aerial data for CAFOs or automate detection but no complete dataset exists. We will use heuristics from the literature on poultry CAFO barn types (number, size, orientation) on a recently developed poultry CAFO layer derived using deep learning of Earth Observations to detect poultry CAFOs in eastern NC (where CAFOs are heavily clustered). We will use these locations to assess impacts on surface water contamination using public water quality data and examine how CAFO density correlates with census-block level race/income and EPA’s environmental justice indices on other stressors/contaminants. This study will generate the first full record of non-permitted poultry CAFOs in eastern NC for accurate assessment of their environmental impacts and how these impacts intersect with sociodemographic/environmental vulnerabilities. These data will support R01-scale NIH applications to scale up our approach and assess impacts on broader environmental health outcomes.