Environmental epidemiology and public health in rural Ecuador
Abstract
The purpose of the present research was to determine the frequency and risk factors for common causes of morbidity in Santa Ana, Ecuador. Initial studies on intestinal parasitism identified several host-environment-related risk factors for Entamoeba histolytica/dispar, Ascaris lumbricoides , and Giardia lamblia among children. A survey of 200 households revealed 65.6% of children were infected with these parasites. In the final multivariate logistic model, risk factors (p < 0.05) for parasitic infections included low socioeconomic status, infrequent antiparasitic treatment, not adding chlorine to drinking water, and children not washing their hands before eating. During the course of the parasite study, women were often observed cooking indoors with open wood fires. Based on a high prevalence of respiratory disease in children, a cross sectional study was conducted to examine exposure-response relationships between indoor air pollution from biomass combustion and respiratory health. Four groups of 20 households each were selected based on the relative amount of liquid petroleum gas and biomass fuel used for cooking. An adult living in each household was asked a series of questions relating to the household environment, history of infant mortality, and history of respiratory symptoms for each household member. Pulmonary function tests were conducted on 77 children (< 16 years) and 135 adults (≤ 16 years). A positive exposure-response relationship was found for both history of infant mortality (p = 0.02) and increasing number of infant deaths (p = 0.01) with increasing use of biomass fuel. A similar exposure-response relationship was found for a history of respiratory symptoms among children. In addition, children living in homes that used biomass fuel for cooking had a lower forced vital capacity (FVC) (p < 0.05) and forced expiratory volume in one second (FEV1) (p < 0.10) when compared with children living in homes that cooked with liquid petroleum gas only, though no difference in pulmonary function was observed among adults in different cooking categories. The results of these studies add to our understanding of the epidemiology of common diseases in the developing world and are important for designing effective public health campaigns in Santa Ana.
Degree
Ph.D.
Advisors
Glickman, Purdue University.
Subject Area
Public health
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