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Pakistan-US Science and Technology Cooperation Program                                                            
Phase 4 (2009 Deadline)

 NIH-KIU Health Interventions Project Street View
Village of Oshikhandass (photo courtesy of Ms. Elizabeth Thomas)

Water, Sanitation, Health, and Hygiene Interventions in a Northern Pakistani Village

Mark Miller and Zeba Rasmussen, National Institutes of Health, Fogarty International Center (FIC)
Khalil Ahmad, Karakoram International University, Gilgit
Pakistani Funding (HEC):  $138,019.90
US Funding (Department of State): $146,372
Project Dates: November 15, 2010 - November 14, 2013 (Extended through February 28, 2015)
Project Overview
Diarrheal disease and pneumonia are major causes of morbidity and mortality in children worldwide. Interventions to decrease these have focused on water and sanitation, vaccines, and handwashing. Interventions for water and sanitation must be specific to local ecological niches and water delivery and source management. In the Pakistani region of Gilgit-Baltitstan, water is primarily obtained from glacier melt, and sanitation facilities include the use of traditional latrines, the contents of which are used as agricultural manure. It is necessary to determine the extent of benefit obtained from specific interventions made to improve water quality and sanitation and whether use of latrine contents is perpetuating a cycle of parasitic infestation and diarrheal disease. A unique opportunity exists to evaluate such interventions in the village of Oshikhandass, where extensive surveillance of more than 1,800 children under age 5 was carried out from 1989-1996. Water treatment plants were introduced in this area in 1996 and 2001 and new latrines in 2003. These circumstances also provide an opportunity to assess how early childhood diarrhea and pneumonia have affected subsequent growth and academic achievement 15-20 years later. This project has the potential to influence and inform policy and program decision making about long-term disease-control investments, and it can be instructive in terms of how health, water, and sanitation interventions can improve quality of life. Working on the project in cooperation with US partners will also improve training and research capabilities at the Karakoram International University (KIU) and will promote linkages with other educational and healthcare institutions, including University of the Punjab and Aga Khan University (AKU). A new cadre of younger women will also be involved in the project, training a new generation in public health work. In addition to capacity building at KIU and the public health force in Gilgit, this effort should also help to enhance the skills of microbiological lab technicians at the District Hospital of Gilgit. The Pakistani principal investigator on this study will continue to serve the local health infrastructure in this regard and train students in the basic skills of outbreak investigation, which should provide excellent preparation in case of future emergency preparedness situations such as disease outbreaks.

Quarterly Update

The last quarter saw the research team maintain and recruit new staff. A volunteer summer intern, Mr. Mohammad Jafri, assisted with literature reviews and data analysis while Dr. Rasmussen rehired Mr. Arif Hussain, a full-time data entry operator. Mr. Iqbal Azam, a project statistician from Aga Khan University (AKU) has also hired a data entry operator in Karachi. As part of an effort to meet with Dr. Ahmed and other project staff involved with data entry and analysis and manuscript work, Dr. Rasmussen traveled to Karachi, Islamabad and Gilgit over the summer.  In this regard, data analysis, literature reviews and manuscript writing related to the following data continues: Mothers' Knowledge of Health and Hygiene, Socioeconomic and Environmental Survey, and Young Adult Follow-Up.

The field coordinator Ms. Assis Jahan completed the pneumonia registry to assist with data comparison with lab samples already obtained. Coding, entry and cleaning of most Pneumonia Data and Young Adult Follow-Up data were completed at AKU. Team members are entering the Diarrhea Data and Surveillance Assessment Form Data as the team continues to link new IDs in the Young Adult Follow-Up database with data from the original project (1989-1996).

Project members used the ELISA, a test that uses antibodies and color change to identify substances, as part of its research. Dr. Khalil and his team at Karakoram International University (KIU) reviewed the ELISA kits and machine manuals in preparation for testing. Two local laboratory technologists, one trained at AKU in molecular biology, conducted the stool sample ELISA testing at KIU in September. 

Beyond laboratory and field work, NIH research associate Julia Baker’s presentation, “Unexpected high frequency of viral agents in asymptomatic children and low influenza representation in pneumonia cases among children in rural north Pakistan,” was shown during the Multinational Influenza Seasonal Mortality Study (MISMS) international research workshop in Bethesda, MD in June and July.

Progress Reports

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