International research: Tackling environmental health issues in South Asia

This is the first part in a five-part series highlighting the work of the President's International Research Award recipients. 

As one of the nation's most internationally engaged universities, IU is committed to supporting faculty and students engaged in international work. Part of that support includes the President's International Research Awards, a university-wide grant that supports high-impact international collaborative research projects that engage one or more of IU's Global Gateway Offices and the communities they serve.

This five-part series will highlight recipients of the 2018 awards and the work they are doing throughout the world.

Description of the following video:

[Video: An animated slide with text appears on a red background. Next to the text is a white graphic shaped like the country of India.]

[Words appear on animated slide: A two-year study in New Delhi, India.]

[Words appear in upper-left corner: Indiana University presents]

Khalid Khan, an assistant professor of environmental and occupational health at the Indiana University School of Public Health-Bloomington, speaks in voiceover: Our project is a two-year study ...

[Video: Khan appears on camera.]

[Words appear: Khalid Khan, assistant professor of environmental and occupational health]

Khan speaks: ... where we are going to develop an intervention program for elementary school children on handwashing and safe water.

[Video: The video slowly zooms in on a photograph of a group of researchers standing in front of a school in New Delhi.]

[Video: The video slowly zooms in on a a photograph of a group of researchers sitting in chairs talking to an elementary school principal sitting behind her desk in New Delhi.]

Khan speaks in voiceover: Globally, especially in the developing countries, infectious diseases are often due to different environmental factors, and two major environmental factors ...

[Video: Khan appears on camera.]

Khan speaks: ... responsible for infectious diseases, especially childhood infectious diseases ...

[Video: An animated slide appears with white text and white graphics on a red background. Above a hand is the word "Handwashing," and above a faucet with water dripping from it are the words "Safe water."]

Khan speaks in voiceover: ... are handwashing and safe water.

[Video: Khan appears on camera.]

Khan speaks: So, preventing exposures by improving handwashing and water quality could drastically ...

[Video: An animated slide appears with white text and white graphics on a red background. The word "Reduce" appears, above graphics of a hospital with the words "Childhood morbidity" and a schoolhouse with the words "Missing school."]

Khan speaks in voiceover: ... reduce childhood morbidity and missing school days among children.

[Video: The video slowly zooms in on a photograph of a group of researchers sitting around a desk talking to an elementary school principal in New Delhi.]

Khan speaks in voiceover: So in this globalized society, it is important to think about a problem from global context.

[Video: Khan appears on camera.]

Khan speaks: So, whatever happens in one part of the world could affect ...

[Video: An animated slide of a globe on a red background appears. Lines appear on the globe and connect various countries together.]

Khan speaks in voiceover: ... another part of the world very easily. It was important for us to do ...

[Video: Khan appears on camera.]

Khan speaks: ... global health research so that we could bring knowledge from another part of the world and actually apply it here and vice versa.

[Video: The video slowly zooms in on a photograph of a group of researchers sitting at a table behind computers, listening to a woman lecturing in a New Delhi conference room.]

Khan speaks in voiceover: Global health research, or global research, actually gives you the opportunity to interact with each other and ...

[Video: Khan appears on camera.]

Khan speaks: ... to learn from each other, and at the end of the day, both parties could work together to come up with a common solution.

[Screen goes to black]

[IU trident appears]

[Words appear: Indiana University]

[Words appear: Fulfilling the promise]

[Words appear: iu.edu]

[END OF TRANSCRIPT]

Video by Samatha Thompson, Indiana University

Environmental health education

Poor personal hygiene habits and a lack of safe drinking water are two of the leading causes of diarrheal diseases and respiratory infections among elementary school children in India and many parts of South Asia.

Diarrheal disease, while preventable and treatable, is a leading cause of child mortality and morbidity in the world, according to the World Health Organization.

Khalid Khan, assistant professor of environmental and occupational health in the Indiana University School of Public Health-Bloomington, is working to change that in New Delhi, through research he is conducting with some IU colleagues thanks to an IU President's International Research Award.

"My passion, the research I have been pursuing over many years, is community-based environmental health intervention," said Khan, whose previous work took place in Bangladesh. "My focus is community-based intervention, using educational approaches in reducing environmental exposures and therefore improving the quality of lives for people in low-income communities. That has been the theme of my research and the main focus of the work we will complete in New Delhi."

Khalid Khan stands with a group in front of a school in IndiaView print quality image
Khalid Khan poses with a group of educators outside a school in India. Photo courtesy of Khalid Khan

The project, titled "School-based intervention using participatory approach and microbiological risk characterization on safe water and personal hygiene for children in low-income communities in urban New Delhi," will take place over two years. The goal is to develop a school-based intervention curriculum about safe water and handwashing practices in public elementary schools in urban slums in New Delhi.

"Many of the diseases that happens to children in these types of areas are infectious disease, especially diarrheal disease and respiratory diseases," Khan said. "It originates from very poor hygiene practice, which includes hand washing, which is caused by a number of things: lack of infrastructure in schools and at home, lack of education, and poor water quality."

Following a collaborative, multidisciplinary approach, Khan will work with researchers from the IU Bloomington College of Arts and Sciences' Department of Biology and Department of Anthropology; the Sustainable Environment and Ecological Development Society, a nonprofit organization in India; Ambedkar University Delhi; and Amity University Uttar Pradesh. IU undergraduate and graduate students will also have the opportunity to be part of the work by getting involved in field research activities in New Delhi.

Since July, the team has been participating in numerous meetings and activities at the IU India Gateway office in New Delhi and visiting with community leaders and school teachers in East Delhi to collect data from the area. Collaborator Rasheda Sultana, a lecturer in IU's Department of Biology, also visited the country to design the sample collection and create a laboratory investigation plan with partners from Amity University Delhi.

The data, including samples from children's hands and water to detect the presence of bacteria, will determine the types of infectious disease threats the children are facing from poor hygiene and water quality, what types of activities are needed to educate the children and their parents, etc.

This project is just the beginning and will hopefully help us develop larger projects that will address important environmental and public health issues affecting millions of people in developing countries.

Khalid Khad

Once that information collection is completed, the team will begin working on the educational component of the project that will involve about 300 students in 12 public elementary schools. Developing the curriculum will involve a close collaboration among researchers, teachers and parents who will help design an intervention process, and implementation of the program, which Khan said will ultimately help sustain the efforts.

"Many educational interventions in low- and middle-income countries tend to be top-down and do not take into account cultural adaptability and affordability of the community," said Khan, who will also collaborate with Anne Pyburn, provost professor in IU's Department of Anthropology, to develop a plan. "We are looking to establish a participatory, educational intervention. The plan for exactly how the intervention will take place will come from the parents and the teachers, who so far seem excited about addressing this issue."

Researchers also will look into communicating information on antibiotic-resistant bacteria, which has made it more challenging to prevent transmission of diarrhea and respiratory infections and is considered one of the world's most pressing public health problems by the Centers for Disease Control and Prevention. Although India has been identified as the origin of some of the most threatening sources of antibiotic resistance -- due, in part, to the easy access to antibiotics on the streets -- education on antibiotic-resistant bacteria has been poor in the educational system, according to Karen Bush, professor of practice in biotechnology at IU and collaborator on the project.

While the Indian government has worked to address this issue in part by limiting access to antibiotics, Bush said it is too little, too late.

"Unfortunately, once the genes responsible for antibiotic resistance get into the water supply or other environmental sources, it is almost impossible to eliminate them completely," Bush said. "Thus, effective hand washing is critical to minimize the exposure to bacteria carrying antibiotic-resistance genes."

Khalid Khan speaks at Ambedkar UniversityView print quality image
Khalid Khan speaks with students and faculty at Ambedkar University in Delhi. Photo courtesy of Khalid Khan

As part of the project, researchers will study the microbial contamination of children's hands and drinking water at both school and home and characterize the antibiotic resistance in these samples. The risk factor of those antibiotic-resistant bacteria will also be communicated to teachers and children as part of the educational process.

After one year, the team will evaluate what improvements have been made through student class absences and hand bacterial counts. The team also will host symposia at the IU India Gateway focused on environmental and public health issues in the area.

Improving hygiene habits and providing access to safe water not only has the potential to improve the lives of millions of children living in poverty, researchers said; it will also improve their education by reducing school absences due to illness.

Khan said that the ultimate goal is to provide information on the effectiveness of safe water and good hygiene practices in schools to government agencies and international organizations that work with underprivileged populations to then establish policies and strategies for sustainable programs in South Asia. He is thankful for the grant award and the use of the IU India Gateway office and the staff at the office who have provided invaluable support.

"For me, this project is a starting point for establishing an international team of collaborators for projects in South Asia," Khan said. "This project is just the beginning and will hopefully help us develop larger projects that will address important environmental and public health issues affecting millions of people in developing countries."

Read part 2 of the series Read part 3 of the series