Effects of geospatial factors and health worker characteristics on child health: implications for interventions in low-resource settings

研究者的职业目标是成为一名独立的流行病学家， 建立和利用多学科框架，研究和设计改善生活的干预措施 低资源环境中的儿童。拟议研究的目标是了解地理空间因素， 社区卫生工作者的特点与更好的儿童生长和健康有关。研究 将分析在孟加拉国农村进行的一项随机分组对照试验中儿童的现有数据 （n = 4 708）。研究者将使用儿童生长的数据、环境生物标志物的实验室数据， 每个研究中心家庭约1500名儿童的肠道功能障碍（一种拟议的生长不良原因） 信息（包括地理位置和报告的到村庄资源的步行时间）和特征数据 提供水、环境卫生和个人卫生干预措施的社区卫生工作者。我们建议 目标1：估计距离对不同资源的独立影响， 孩子的成长和EED将进行多元回归，以测试步行时间对医疗保健的影响 中心、市场、水源和主要道路对儿童生长和EED生物标志物的影响。目标2：创建一个 家庭无障碍评分，并确定其与儿童成长和EED的关联。一个家喻户晓 可达性得分将使用主成分分析的旅行时间，在村里的资源 我们将使用地理空间分析来确定家庭可达性和 儿童生长和EED生物标志物。目标3：确定社区卫生工作者的特征， 儿童成长的背景下，WASH干预措施。机器学习和变量重要性分析将是 用于了解独立预测儿童生长的特征。通过了解 空间风险因素及其与儿童生长和健康的关系，我们可以针对家庭 儿童发展不良风险增加，并为有效实施干预措施提供信息， 农村、低资源环境中的儿童成长和健康。研究者、申办者制定的培训计划 博士Lia Fernald和共同赞助人Alan Hubbard博士和Justin Remais博士将支持研究者的目标 获得流行病学，生物统计学和数据科学的高级培训，更好地了解高级主题 在全球儿童健康方面，并提高口头和书面科学交流技能。训练研究 将在加州大学伯克利分校举行，该大学以导师和支持科学研究而闻名 在对多学科感兴趣的教师中进行严格的方法论研究 健康结果的原因。总体而言，机构环境、赞助团队、培训计划和 拟议的研究项目将促进研究者的过渡到一个独立的研究生涯， 学术机构实施严格的干预措施，将改善健康和发展， 农村、资源匮乏环境中的儿童。

The career goal of the investigator is to become an independent epidemiologist at an academic institution and utilize a multidisciplinary framework to research and design interventions that improve the lives of children in low-resource settings. The goal of the proposed study is to understand geospatial factors and characteristics of community health workers that are associated with better child growth and health. The study will analyze existing data on children from a cluster-randomized controlled trial conducted in rural Bangladesh (n = 4,708). The investigator will use data on child growth, laboratory data on biomarkers of environmental enteric dysfunction (a proposed cause of poor growth) in a subset of ~1500 children per site, household information (including geolocation and reported walking time to village resources), and data on characteristics of community health workers that delivered the water, sanitation, and hygiene interventions. We propose to accomplish the following aims: Aim 1: Estimate the independent effects of distance to different resources on child growth and EED. Multiple regression will be performed to test the impact of walking time to healthcare center, markets, water source, and major roads on child growth and EED biomarkers. Aim 2: Create a household accessibility score and determine its association with child growth and EED. A household accessibility score will be created using principal components analysis on travel time to resources in the village and we will use geospatial analyses to determine the spatial association between household accessibility and child growth and EED biomarkers. Aim 3: Determine characteristics of community health workers that improve child growth in the context of WaSH interventions. Machine learning and a variable importance analysis will be used to understand characteristics that independently predict child growth. By understanding the heterogeneity of spatial risk factors and their associations with child growth and health, we may be able to target households with children at increased risk for poor development and inform the effective implementation of interventions for child growth and health in rural, low-resource settings. The training plan developed by the investigator, sponsor Dr. Lia Fernald, and co-sponsors Dr. Alan Hubbard and Dr. Justin Remais will support the investigator’s goals to gain advanced training in epidemiology, biostatistics, and data science, better understand advanced topics in global child health, and improve on oral and written scientific communication skills. Training and research will occur at University of California, Berkeley, which has a reputation for mentorship and supporting scientific research with rigorous methodology among a diverse pool of faculty members interested in multidisciplinary causes of health outcomes. Overall, the institutional environment, sponsorship team, training plan, and proposed research project will facilitate the investigator’s transition to an independent research career at an academic institution implementing rigorous interventions that will improve the health and development of children in rural, low-resource settings.