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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