Research at Boston University

BU Joins AAU

Unravelingthe Mysteries of aPublic Health Emergency

By Maggie Bucholt
Global Health

Many of the public health challenges Boston University researchers engage on a daily basis occur thousands of miles from campus. The University’s global initiative to improve health in low-income countries around the world includes projects such as an evidence-based study of childhood pneumonia that changed the World Health Organization’s guidelines for treatment. A Spanish immersion program for School of Medicine students that benefits local citizens and community health care projects in Ecuador. In Nicaragua, researchers are seeking answers to a kidney disease epidemic affecting young workers, and in Peru, a theater arts pilot program has shown promise in improving public health.

At the heart of these efforts is the Center for Global Health & Development, where numerous research projects in Africa and Asia contribute to the body of knowledge about HIV/AIDS, malaria, and infant mortality. A new focus is rapid urbanization in India and its impact on public health. To support the complex strategic and operational issues involved with international research, education, and community service, the University established the Global Programs Office and is encouraging cross-disciplinary collaborations to address major global challenges.

Four years ago, Daniel Brooks, a School of Public Health epidemiologist, had never been to Nicaragua. Since he began researching an epidemic of chronic kidney disease, he has logged more than a dozen trips to this Central American country as the pressure mounts to pinpoint the cause of the outbreak.

“We’re not responding to a research-driven question,” says Brooks, the principal investigator for the study coordinated through the World Bank’s Office of the Compliance Advisor/Ombudsman (CAO), the governing body of the World Bank’s private sector lenders. “This is an urgent public health emergency.”

The economic and social repercussions are huge: the disease hits primarily younger men working in various industries, leaving families in need of assistance. Brooks became involved in the study after former employees of Ingenio San Antonio (ISA), a sugar producer that received a loan from the World Bank, filed a complaint to the CAO. ISA employs thousands of workers in the states of León and Chinandega. The former workers blame the company—in particular, agricultural chemicals—for the outbreak. It is a sensitive, complex situation that is highly political in nature.

“Our first research report found no evidence that agrichemicals are causing chronic kidney disease here,” says Brooks, who leads a team of epidemiologists; nephrologists; and occupational, environmental health, and preventive medicine experts. Former workers met this conclusion with disbelief, and heated community meetings followed. Public education regarding the research process is an integral part of the study.

Brooks found that this is not a small-scale epidemic; it affects manual workers in hot climates from Mexico to Costa Rica, and even Sri Lanka, India, and Egypt. In developed countries, chronic kidney disease is typically caused by diabetes or hypertension, but this pattern does not bear out with this epidemic. The characteristics of the work environment are leading researchers to hypothesize that the disease has to do with heat stress. ISA addressed the concern by shortening the workday and introducing more water breaks, but more research is needed.

“We’re trying to broaden the funding to pursue different causes, but the one we are giving priority to has to do with working in a hot climate: insufficient hydration, likely acting with other factors we do not yet know,” says Brooks, who is optimistic about obtaining grant support to continue the research program. “It’s been three years of thinking about it every day. There’s always a deadline. It’s a long, wearing process, full of highs and lows. But it’s the project of a lifetime. I’m drawing on everything I’ve done before to make this work and find the cause.”

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