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Empirical evidence suggests that the prevalence of soil-transmitted helminth (STH) infections in remote and poor rural areas is still high among children, the most vulnerable to infection. There is concern that STH infections may detrimentally affect children’s healthy development, including their cognitive ability, nutritional status, and school performance. Medical studies have not yet identified the exact nature of the impact STH infections have on children. The objective of this study is to examine the relationship between STH infections and developmental outcomes in 2,180 school-aged children in seven nationally-designated poverty counties in rural China. We conducted a large-scale survey in Guizhou province in southwest China in May, 2013. Overall, 42 percent of elementary school-aged children were infected with one or more of the three types of STH—Ascarislumbricoides (ascaris), Trichuris trichuria (whipworm) and the hookworms Ancylostoma duodenaleor Necator americanus. After controlling for socioeconomic status, we observed that children infected with one or more STHs have worse cognitive ability, worse nutritional status, and worse school performance than their uninfected peers.

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Alexis Medina
Scott Rozelle
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Zack Bonzell came to Stanford with a strong interest in human biology and political science. Last summer, the undergraduate had the chance to fuse his interests while doing field research with faculty at the university’s Freeman Spogli Institute for International Studies (FSI). 

During a two-week internship, he travelled to Guatemala with FSI senior fellows Paul Wise, Beatriz Magaloni, Alberto Díaz-Cayeros and Scott Rozelle to learn about the country’s rural health care system by shadowing doctors and interviewing mothers in an impoverished area about the issues leading to the area’s high rates of child malnutrition.

“That experience was an ideal way to blend my interests and gave me a better idea of how to craft my course of study at Stanford,” said Bonzell, who is now a junior. “One of the things that really struck me was when Paul Wise said the health outcomes we were seeing are the result of extreme material deprivation. These people are sick because they are poor. That gave me more of an interest in political economy.”

Students conduct interviews about nutrition with REAP in China. Photo Credit: Matt Boswell

FSI is now expanding its educational opportunities for students, like Bonzell, who want to do research on global issues in Asia, Latin America, Europe and Africa.

The Stanford Global Student Fellows program (SGSF) is being funded in large part through a $1.25 million anonymous gift that will help grow existing programs and create new offerings for graduates and undergraduates.

“This program deepens FSI’s commitment to its mission of educating the next generation of leaders in international affairs,” said FSI Director Mariano-Florentino Cuéllar. “It also offers outstanding opportunities for Stanford students to work closely with the leading thinkers on global policy issues.”

The program, which is part of FSI’s efforts to expand student opportunities, will build on the institute’s undergraduate mentorship programs that allow students to work on faculty research projects each quarter. Those positions will now be available during the summer. Some of the positions will be connected to projects in FSI’s new International Policy Implementation Lab, an initiative that gives students a close-up view of how academics and policy influencers can address some of the world’s thorniest issues.

PoliSci 114S students work together in a UN conflict simulation. Photo Credit: Rod Searcey

Building on FSI’s experience placing students in research opportunities, the program will create and expand summer field research internships. The two- to six-week internships this summer will give undergraduates the opportunity to work with FSI senior fellows in China, Guatemala, India and Mexico who study global health, conflict resolution, governance and poverty reduction.  In coming years, the program will likely include additional fieldwork projects in Rwanda, Tanzania and Brazil. The SGSF program covers all travel expenses for students and provides students with an opportunity to work closely with a faculty member and a team of other students on an ongoing research project addressing real-world problems in a specific region. 

“What makes FSI such an incredible institution is that it attracts faculty who have very pragmatic interests,” Bonzell said. “It seeks to wed academic work with a more direct impact, and there’s a lot of potential for more students to think along similar lines.”

The Stanford Global Student Fellows will also allow FSI to work closely with its partners, including the Program in International Relations, the Haas Center for Public Service, and Stanford in Government to provide opportunities for graduate and undergraduate students. 

Mexican Ambassador Eduardo Medina Mora and Jorge Olarte, '13, speaking with students at the US-Mex FoCUS event. Photo Credit: Rod Searcey

One of the program’s new initiatives geared toward undergraduates is the Global Policy Summer Fellowships. The fellowships help secure placement and a $6,000 stipend for students interested in interning at international policy and international affairs organizations. This summer,The Europe Center at FSI is placing students at the Center for European Policy Studies and Bruegel, two Brussels-based think tanks. Future positions will be created with six offerings abroad and two based in the United States.including the Program in International Relations, the Haas Center for Public Service, and Stanford in Government to provide opportunities for graduate and undergraduate students. 

The Stanford Global Student Fellows program will also commit $400,000 to create a Mentored Global Research Fellowship that will provide research opportunities for students to conduct their own overseas research under the close mentorship of a faculty member. The program will award stipends of $6,000 for summer undergraduate projects and $9,000 for summer graduate projects, and $1,500 for smaller projects executed during the school year.

Thomas Hendee '13 chatting with children in rural Guatemala. Photo Credit: Maria Contreras

The faculty advisory committee overseeing the development and implementation of these new programs includes Scott Rozelle, the Helen F. Farnsworth Senior Fellow and the co-director of FSI’s Rural Education Action ProgramStephen Stedman, a senior fellow at FSI and the deputy director of CDDRL; and Lisa Blaydes, assistant professor of political science.

The application deadline for all summer programs is Feb. 28, 2015. The deadline to apply for academic quarterly programs is the end of the first week of each quarter, beginning in the fall of 2014. 

For more information, students should contact Elena Cryst at ecryst@stanford.edu and watch for postings on FSI’s student program Facebook page. Students can also sign up for the program’s distribution and announcement list.

 

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More than 70 percent of U.S. child health care resources are committed to the 5 percent of children with the most complex of medical conditions.  Fiscal pressures, reforms to the Medicaid program, and implementation of the Affordable Care Act (ACA) provide opportunities to reduce inefficiencies and to expand access to high-quality subspecialty care for these children. 

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Children in rural Kenya are more susceptible to disease and death the farther away they live from clean drinking water, according to Stanford researchers.

In a survey of families in Asembo – a small farming community at the edge of Lake Victoria that has high rates of chronic diarrhea, child malnutrition and child death – a research team from the Center on Food Security and the Environment found that most people live just over a quarter-mile from clean water sources. About 200 feet closer to home are ponds and springs contaminated with E. coli bacteria. Sixty-six percent of families primarily use this contaminated surface water for drinking.

A child in Asembo, Kenya sits next to her family's water storage containers.

A child in Asembo, Kenya sits next to her family's water storage containers.
Photo Credit: Amy Pickering

While water is essential for farming, collecting it is time-consuming and physically exhausting in remote places like Asembo. Previous research has shown that when families must travel long distances for water, child health suffers. The harder it is to collect, the less of it a family will use. A shortage of water for cooking and drinking compromises children’s nutrition and hydration. And it limits hand washing and bathing, making children more susceptible to disease. Quality and availability of water also varies widely from source to source, and the time required to collect water can force families to use dirtier, unimproved water sources that are closer to home. 

In 2011, the FSE researchers partnered with the Centers for Disease Control Kenya Medical Research Institute (CDC-KEMRI), which was already conducting an extensive survey of household-level health indicators in the region. Combining resources with CDC-KEMRI allowed the team – led by FSE Director Rosamond Naylor, a professor of environmental earth system science, and Jenna Davis, an assistant professor of civil and environmental engineering – to use a robust set of data. The information covered about 3,000 households in a five kilometer radius and was collected on a bi-weekly basis for six months. In exploring the links between water, food and health in Asembo, FSE researchers first expanded the definition of water “access” to account for both physical distance and the quality of water sources.

Researchers take a child's measurements in Asembo, Kenya.

Researchers take a child's measurements in Asembo, Kenya.
Photo Credit: Amy Pickering

Researchers then mapped the distance of each household from its nearest water source, and recorded whether the source was improved (such as a deep borewell) or unimproved (surface water like a pond, spring or shallow well). To get the most precise possible data on local water quality, the research team collected samples from each household’s water source and sent them to a local hospital lab for testing. Surveyors then collected data on each household’s water management practices, including water treatment. They measured agricultural output, dietary diversity, and perceived food insecurity, then recorded the weight and height measurements of each child in the household. Respondents also reported the frequency of recent cases of diarrheal disease among children of the household.

Results of the initial survey highlight sobering realities about water access in Asembo. Households in the survey reported average per capita water consumption of only 31 liters per day, including water used for cooking, drinking, hygiene and agriculture. The average walk time to the nearest water source was approximately 15 minutes. The average distance to the nearest improved source was 428 meters, whereas the average distance to unimproved surface water was 374 meters. Water quality tests confirmed that these sources, used by the majority of families, were highly contaminated with E. coli bacteria, while improved water sources were significantly cleaner. Thirty percent of children showed stunted growth, and 11 percent were underweight for their age.

A researcher collects a sample of stored water at a household in Asembo, Kenya.

A researcher collects a sample of stored water at a household in Asembo, Kenya.
Photo Credit: Amy Pickering

Researchers found that close proximity to an abundant water source, regardless of quality, correlated with an increase in food production and diversity, as well as a lower hunger score. Having enough extra water for crop irrigation clearly improves children’s diets – particularly their access to the micronutrients essential for normal physical and cognitive development – and helps them resist disease. Households further from water sources reported lower and less diverse crop yields, as well as poorer child health indicators. Quality was also an important factor, as households with access to clean, improved water reported better child health outcomes than those relying on contaminated surface water.

The ultimate goal of the project, “Rural health and development at the food-water nexus” is to design interventions and policy incentives that help people absorb nutrients in environments where food and water are limited and disease is prevalent. In the next stage of the project, researchers will focus on links between water access and the progression of HIV, and will also investigate how improved diets from better water access can impact household income.

About the Stanford Research Team:

Jenna Davis is Associate Professor of Civil and Environmental Engineering, Higgins-Magid Faculty Senior Fellow at the Stanford Woods Institute for the Environment, and an affiliate of the Center on Food Security and the Environment.
Rosamond Naylor is the Director of the Center on Food Security and the Environment, Professor of Environmental Earth System Science, and the William Wrigley Senior Fellow at the Stanford Woods Institute.
Eran Bendavid is an infectious diseases physician and Assistant Professor of Medicine in the Division of General Internal Medicine, as well as an affiliate of the Center on Food Security and the Environment and the Stanford Health Policy center.
Amy Pickering is a lecturer in the School of Earth Sciences, and a research associate in Civil and Environmental Engineering, the Woods Institute for the Environment, and the Center on Food Security and the Environment.
Glwadys Gbetibouo is a postdoctoral scholar at the Center on Food Security and the Environment.
Katrina ole-MoiYoi is a Ph.D. student at the Center on Food Security and the Environment.

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Researchers take a child's measurements in Asembo, Kenya.
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This study uses a randomized controlled trial of a school-based anemia reduction program in rural China to examine how increased school emphasis on health promotion affects academic performance. Although education and health promotion are complementary functions of schools, they do compete for finite school resources. We compare the effects of a traditional program that provided only information about anemia and subsidies to an otherwise identical program that included performance incentives for school principals based on school-level anemia prevalence. By the end of the trial, exam scores among students who were anemic at baseline improved under both versions of the program, but scores among students in the incentive group who were healthy at baseline fell relative to healthy students in the control group. Results suggest that performance incentives to improve student health increase the impact of school-based programs on student health outcomes, but may also lead to reallocation of school resources.

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Alexis Medina
Scott Rozelle
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Lina Khatib is the co-founding Head of the Program on Arab Reform and Democracy at the Center on Democracy, Development, and the Rule of Law at Stanford University. She joined Stanford University in 2010 from the University of London where she was an Associate Professor. Her research is firmly interdisciplinary and focuses on the intersections of politics, media, and social factors in relation to the politics of the Middle East. She is also a consultant on Middle East politics and media and has published widely on topics such as new media and Islamism, US public diplomacy towards the Middle East, and political media and conflict in the Arab world, as well as on the political dynamics in Lebanon and Iran. She has an active interest in the link between track two dialogue and democratization policy. She is also a Research Associate at SOAS, University of London, and, from 2010-2012, was a Research Fellow at the USC Center on Public Diplomacy at the Annenberg School.

Lina is one of the core authors of the forthcoming Arab Human Development Report (2013) published by the UNDP, and a member of the Board of Directors of the Syria Justice and Accountability Center. She is also a founding co-editor of the Middle East Journal of Culture and Communication, a multidisciplinary journal concerned with politics, culture and communication in the region, and in 2009 co-edited (with Klaus Dodds) a special issue of the journal on geopolitics, public diplomacy and soft power in the Middle East. She edited the Journal of Media Practice from 2007-2010.

Paul Wise is the Richard E. Behrman Professor of Child Health and Society, Professor of Pediatrics at Stanford University School of Medicine, and Senior Fellow in the Freeman Spogli Institute for International Studies at Stanford University.  He is Director of the Center for Policy, Outcomes and Prevention and a core faculty of the Centers for Health Policy and Primary Care Outcomes Research, at Stanford University.

Dr. Wise received his A.B. degree summa cum laude and his M.D. degree from Cornell University, a Master of Public Health degree from the Harvard School of Public Health and did his pediatric training at the Children's Hospital in Boston.  His former positions include serving as the Director of Emergency and Primary Care Services at the Children's Hospital, Boston, Director of the Harvard Institute for Reproductive and Child Health at Harvard Medical School, and Special Assistant to the U.S. Surgeon General.  Prior to moving to Stanford University, Dr. Wise was Vice-Chief of the Division of Social Medicine and Health Inequalities in the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, the academic and research base of Partners in Health.

Rajaie Batniji is a resident physician in internal medicine at Stanford and a CDDRL affiliate. His research examines the selection of priority diseases and countries in global health, and he is interested in global health financing and the priority-setting process of international institutions. His work has also examined social determinants of health in the Middle East. At FSI, Dr. Batniji is co-investigator on Global Underdevelopment Action Fund projects explaining U.S. global health financing and political causes of public health crisis.

Dr. Batniji received his doctorate in international relations (D.Phil) from Oxford University where he studied as a Marshall Scholar. He also earned a M.D. from the University of California, San Francisco School of Medicine and M.A. and B.A. (with distinction) degrees in History from Stanford University. Dr. Batniji was previously based at Oxford's Global Economic Governance Program, and he has worked as a consultant to the World Health Organization.

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Dr. Paul Wise is dedicated to bridging the fields of child health equity, public policy, and international security studies. He is the Richard E. Behrman Professor of Child Health and Society and Professor of Pediatrics, Division of Neonatology and Developmental Medicine, and Health Policy at Stanford University. He is also co-Director, Stanford Center for Prematurity Research and a Senior Fellow in the Center on Democracy, Development, and the Rule of Law, and the Center for International Security and Cooperation, Freeman Spogli Institute for International Studies, Stanford University. Wise is a fellow of the American Academy of Arts and Sciences and has been working as the Juvenile Care Monitor for the U.S. Federal Court overseeing the treatment of migrant children in U.S. border detention facilities.

Wise received his A.B. degree summa cum laude in Latin American Studies and his M.D. degree from Cornell University, a Master of Public Health degree from the Harvard School of Public Health and did his pediatric training at the Children’s Hospital in Boston. His former positions include Director of Emergency and Primary Care Services at Boston Children’s Hospital, Director of the Harvard Institute for Reproductive and Child Health, Vice-Chief of the Division of Social Medicine and Health Inequalities at the Brigham and Women’s Hospital and Harvard Medical School and was the founding Director or the Center for Policy, Outcomes and Prevention, Stanford University School of Medicine. He has served in a variety of professional and consultative roles, including Special Assistant to the U.S. Surgeon General, Chair of the Steering Committee of the NIH Global Network for Women’s and Children’s Health Research, Chair of the Strategic Planning Task Force of the Secretary’s Committee on Genetics, Health and Society, a member of the Advisory Council of the National Institute of Child Health and Human Development, NIH, and the Health and Human Secretary’s Advisory Committee on Infant and Maternal Mortality.

Wise’s most recent U.S.-focused work has addressed disparities in birth outcomes, regionalized specialty care for children, and Medicaid. His international work has focused on women’s and child health in violent and politically complex environments, including Ukraine, Gaza, Central America, Venezuela, and children in detention on the U.S.-Mexico border.  

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Paul H. Wise Richard E. Behrman Professor of Child Health and Society and CHP/PCOR Core Faculty Member; CDDRL and CISAC Affiliated Faculty Member Speaker

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Rajaie Batniji is a resident physician in internal medicine at Stanford and a CDDRL affiliate. His research examines the selection of priority diseases and countries in global health, and he is interested in global health financing and the priority-setting process of international institutions.  His work has also examined social determinants of health in the Middle East.  At FSI, Dr. Batniji is co-investigator on Global Underdevelopment Action Fund projects explaining U.S. global health financing and political causes of public health crisis.

Dr. Batniji received his doctorate in international relations (D.Phil) from Oxford University where he studied as a Marshall Scholar. He also earned a M.D. from the University of California, San Francisco School of Medicine and M.A. and B.A. (with distinction) degrees in History from Stanford University.   Dr. Batniji was previously based at Oxford's Global Economic Governance Program, and he has worked as a consultant to the World Health Organization. 

Publications

Protecting Health: Thinking Small. Sidhartha Sinha and Rajaie Batniji. Bulletin of the World Health Organization 2010; BLT.09.071530  http://www.ncbi.nlm.nih.gov/pubmed/20865078

Health as human security in the occupied Palestinian territory. Rajaie Batniji, Yoke Rabai’a, Viet Nguyen-Gillham, Rita Giacaman, Eyad Sarraj, Raija Leena Punamaki, Hana Saab, and Will Boyce. Lancet 2009 373:1133-43  http://www.ncbi.nlm.nih.gov/pubmed/19268352

Misfinancing global health: the case for transparency in disbursements and decision making. Devi Sridhar and Rajaie Batniji. Lancet 2008; 372: 1185-91  http://www.ncbi.nlm.nih.gov/pubmed/18926279

Coordination and accountability in the World Health Assembly. Rajaie Batniji. Lancet 2008; 372: 805 http://www.ncbi.nlm.nih.gov/pubmed/18774416

Barriers to improvement of mental health services in low-income and middle-income countries.  Benedetto Saraceno, Mark van Ommeren, Rajaie Batniji, Alex Cohen, Oye Gureje, John Mahoney, Devi Sridhar and Chris Underhill. Lancet 2007; 370:1164-74     http://www.ncbi.nlm.nih.gov/pubmed/17804061

An Evaluation of the International Monetary Fund's Claims about Public Health. David Stuckler, Sanjay Basu, Rajaie Batniji, Anna Gilmore, Gorik Ooms, Akanksha A. Marphatia, Rachel Hammonds, and Martin McKee. International Journal of Health Services 2010; 40:327-32  http://www.ncbi.nlm.nih.gov/pubmed/20440976

Reviving the International Monetary Fund: concerns for the health of the poor. Rajaie Batniji. International Journal of Health Services 2009; 39: 783-787    http://www.ncbi.nlm.nih.gov/pubmed/19927415

Mental and social aspects of health in disasters: relating qualitative social science research and the sphere standard. R Batniji, M van Ommeren, B Saraceno. Social Science & Medicine 2006; 62:1853–1864  http://www.ncbi.nlm.nih.gov/pubmed/16202495

Averting a crisis in global health: 3 actions for the G20. Rajaie Batniji & Ngaire Woods, 2009. Global Economic Governance Programme, http://www.globaleconomicgovernance.org/wp-content/uploads/averting-a-crisis-in-global-health.pdf.

Report of a High-Level Working Group, 11-13 May 2008. Rajaie Batniji, Devi Sridhar and Ngaire Woods, Global Economic Governance Programme, 2008, http://www.globaleconomicgovernance.org/project-health

Rajaie S. Batniji CDDRL Affiliated Scholar 2011-2012; Resident Physician in Internal Medicine, Stanford Medical Center Speaker
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