Past Projects & Collaborations
CAO Process, Dialogue Between NSEL and ASOCHIVIDA: 2008-2012, BUSPH Studies
In 2008, the BUSPH team responded to a competitive request for proposals by the Office of the Compliance Advisor Ombudsman (CAO) of the International Finance Corporation (IFC) and Multilateral Investment Guarantee Agency (MIGA) of the World Bank Group. The proposal submitted by BUSPH was selected by members of a Dialogue Table, which included representatives of the Chichigalpa Association for Life (ASOCHIVIDA) and Nicaragua Sugar Estates Limited (NSEL). ASOCHIVIDA is an association of ~2,000 former sugar cane workers afflicted with CKD, as well as the widows of deceased former workers. NSEL is,a major sugar producer in western Nicaragua that operates the Ingenio San Antonio (ISA) and formerly employed the members of ASOCHIVIDA. BUSPH first conducted a scoping study to compile a review of existing literature on CKD, identify hypotheses, and propose research activities. Next, from 2009-2012, BUSPH conducted an industrial hygiene/occupational health assessment, a preliminary investigation of water quality, interviews with physicians and pharmacists, a pilot cohort study of ISA workers, a biomonitoring study of Nicaraguan workers, and a biomonitoring study of adolescents. Finally, we prepared a final report than summarizes all of the work described above. Additional information about the CAO process is available here: http://www.cao-ombudsman.org. Links to the reports that provide the details of each activity are provided below. The results are also in various stages of publication in peer-reviewed journals (see Publications).
This report summarized the available information on CKD in the region, identified data gaps, and recommended research activities to address those gaps.
Industrial Hygiene/Occupational Health Assessment
This study evaluated the potential hazards associated with chemicals and work practices at ISA.
Investigation of Water Quality
A large number of contaminants in water samples collected from locations selected by ASOCHIVIDA were sampled in this study.
Qualitative Analysis of Interviews with Physicians and Pharmacists
This included semi-structured interviews with 19 health professionals in Nicaragua to assess their perceptions regarding the burden, etiology and treatment of renal disease in the region. The final analysis and findings are published in the BMC Public Health Journal (Ramirez-Rubio et al. “Chronic Kidney Disease in Nicaragua: a qualitative analysis of semi-structured interviews with physicians and pharmacists.” BMC Public Health. 2013 Apr 16; 13:350. PubMed).
Pilot Cohort Study
This pilot study assessed the feasibility of conducting a complete retrospective cohort study to evaluate the relationship between work practices at ISA and CKD.
Investigation of Biomarkers in Workers
Biological markers of kidney injury and CKD in ISA workers, miners, construction workers, and port workers were analyzed in this study.
Investigation of Urinary Biomarkers in Adolescents
This project evaluated evidence of subclinical kidney damage among adolescents in different areas of Nicaragua.
This report summarizes the work conducted by BUSPH from 2009-2012. It offers the researchers’ perspective on the possible causes of the CKD epidemic, and suggests some areas for future research.
Investigating an epidemic of Chronic Kidney Disease in Western Nicaragua
In Central America, an epidemic of chronic kidney disease (CKD) of unknown etiology has been described among young, male agricultural workers. Though many occupational and nonoccupational causes have been hypothesized (i.e. heat stress, heavy metals), the etiologic agent remains unknown. The objectives of this project were to: (1) evaluate repeated measures of biomarkers of kidney injury and CKD among sugarcane workers by investigating differences by job task; (2) determine whether there was evidence of kidney injury and CKD among miners, construction workers, and stevedores who had never worked in the sugarcane industry; and (3) characterize biomarkers of exposure to nephrotoxic heavy metals (i.e. cadmium, lead, uranium, arsenic) and examine the association with biomarkers of kidney damage. The data analyzed had been collected in past projects conducted by the research group. The results are in various phases of publication in peer reviewed journals (see Publications).
Investigators/Funding: Rebecca Laws and the BUSPH team collaborated with Dr. Chirag Parikh at Yale University. Rebecca’s work on this project was funded by the Environmental Protection Agency “Science to Achieve Results” (STAR) Fellowship program.
GeoHealth Hub for Agriculture and Informal Work in Nicaragua
Aurora Aragon (UNAN-Leon)
The BUSPH team and the Center for Research on Health, Work and Environment (CISTA) at the National Autonomous University of Nicaragua at Leon (UNAN-Leon) partnered to build a network of institutions (academic, governmental, and other) capable of carrying out a research and training that will inform public policy to address occupational and environmental risks faced by workers in agriculture and the informal economy and, more broadly, by rural residents. The goal of this three-year grant was to develop a viable and sustainable plan for this network, called a Global Environmental and Occupational Health Hub (GEOHealth Hub), based in Nicaragua but which includes partners from throughout Central America.
Investigators/Funding: The team at BUSPH was lead by Dr. Brooks and the team at UNAN-Leon was lead by Dr. Aragon. The project was funded by the Fogarty International Center at the U.S. National Institutes of Health (NIH).
Conference Support: 2nd International Workshop on Epidemic of MeN
Madeleine Scammell, BUSPH
Sub-contract Principal Investigator:
Jennifer Crowe, Universidad Nacional (UNA), Costa Rica
The 2nd International Workshop on the Epidemic of Mesoamerican Nephropathy (MeN) took place in San José, Costa Rica in November 2015 and the experts that attended collectively wrote a technical report. (Read the report here: MeN 2015 Scientific Report). The workshop and the report were directly supported in part by the National Institute of Environmental Health Sciences of the National Institutes of Health (USA) under Award Number R13ES026050 (PI: Scammell). The content of the report is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Support for the organization of the workshop was also provided by El Programa de Salud, Trabajo y Ambiente (SALTRA), the Vice-Rectory for Academics at Universidad Nacional in Costa Rica (UNA), the Instituto Regional de Estudios en Sustancias Tóxicas (IRET) and the Pan American Health Organization. The National Institute of Occupational Safety and Health (USA) provided the translation of the scientific report into Spanish.