Interdisciplinary approaches to global health: A cross-sectional cluster sample survey examining health risks at the human–animal interface in Madagascar

Abstract

Background: University of Maryland undergraduate students, graduate students, and faculty from the Schools of Engineering and Public Health conducted field water tests and a health needs assessment in a traditional farming community in the Andean mountain region of Southern Peru. This innovative project focuses on health as a cross-cutting issue best addressed as an interdisciplinary team. The project provides an opportunity to develop relationships among different fields and expands leadership capacity through multi-level teams of undergraduate students, graduate students, and faculty. Structure/Method/Design: The first phase was a multi-method needs assessment to examine health issues and priorities among residents and to assess water quality. The public health team used principles of cultural competency and health literacy to develop a qualitative questionnaire. Fourteen interviews were conducted with health clinic staff, school personnel, community leaders, and community members. The teams worked together to conduct seven field tests of the local water supply at various points in the distribution system. Results (Scientific Abstract)/Collaborative Partners (Programmatic Abstract): Residents and leaders identified animal contamination, flooding, and standing water as health priorities. Some residents objected to neighbors' overuse of water, particularly at the end of the distribution branch. Without a consistent water supply, the community risked financial sustainability.Common health problems identified by residents and leaders were diarrhea, acute respiratory infections, cold/flu, alcoholism, and skin problems. Other issues were nutrition, general hygiene, and disorganization within the community. Social mapping analysis revealed that communication between residents and leaders is not prioritized.Total coliform results revealed that after incubation, contamination ranged from w10-108 CFU (EPA MCL ¼ 0), indicating high fecal coliform and E. coli contamination. Community leaders expressed interest in chlorination of the existing water supply system. While community members prioritize water quantity and reliability, they were aware of contamination. One resident boils water "because it is bad for us." Another resident noted that boiling water was practical, for "if we don't, there are little bugs and sand." However, researchers observed use of tap water to wash vegetables. Summary/Conclusion: Qualitative data from a representative sample of community members, school personnel, and health providers along with field water tests substantiated speculation by Engineers without Borders that health problems may be related to contaminated water. These data provided information to guide design of a water disinfection system and curriculum addressing the health issues identified by community members. This case study illustrates the opportunities of cross-discipline collaborations to simultaneously address technical, infrastructural, and behavioral challenges in sustainable global health projects.Guidelines for global hea...