Epidemiologic studies are critical for understanding the diverse drivers of enteric infections and malnutrition, which lead to recurrent diarrheal illnesses and poor growth among children in low-resource settings. To accelerate the translation of population-based data into policy-ready, actionable evidence, novel epidemiologic methods have recently been developed to assess the generalizability of results and estimate the impact of potential interventions from observational data. In this K01 Mentored Research Scientist Development Award application, Dr. Elizabeth T. Rogawski, an Assistant Professor in Public Health Sciences at the University of Virginia (UVA), proposes to apply these innovative methods to inform the implementation of results from two multisite observational studies of enteric infections and two single-site randomized intervention trials in South Africa and Tanzania. The observational studies are MAL-ED, an 8-site birth cohort study of enteric infections, diarrhea, and child development, and GEMS, a 7-site case-control study of moderate-to-severe diarrhea. Specifically, Dr. Rogawski will: 1) identify site-specific social and environmental factors that modify the impact of risk factors for diarrhea and poor growth in MAL-ED and translate effect estimates to GEMS sites using inverse-probability weighting methods; 2) estimate the impact of realistic public health interventions to reduce diarrheal risk and improve child growth from the observational data using the parametric g-formula; and 3) estimate the impact of interventions assessed in the randomized trials of a drinking water quality intervention (South Africa) and a multifactorial child health intervention (Tanzania) at the other MAL-ED and GEMS sites. Key risk factors and potential targets of intervention include water, sanitation, and hygiene-associated factors, enteric pathogens, antimicrobial use, macro- and micronutrients, and illnesses. Dr. Rogawski proposes a career development plan that includes mentorship, fieldwork, coursework, publications, and presentations. Her proposal will be supervised by an outstanding mentoring team with complementary methodological, substantive, and clinical skills. The wealth of research and mentorship experience, robust training infrastructure, and longstanding international collaborations at UVA make this institution the ideal environment to support these activities. Her goals for the award are to become an expert in enteric infections and environmental enteropathy, develop proficiency in novel epidemiologic causal inference methods that are relevant to implementation research, and successfully transition to independence Through an academic career in epidemiology maintain an international research program in pediatric infectious diseases based in the US, while developing . , she plans to novel analytic methods to facilitate the presentation of impactful epidemiologic results. The K01 Mentored Research Scientist Development Award will facilitate her transition to independence as an investigator who bridges the gap between epidemiology and public health policy implementation to reduce infectious disease burden and improve global child development.
This work will bridge the gap between epidemiologic research and public health practice by accelerating the translation of scientific results from two observational and two intervention studies of enteric disease into findings more directly applicable to policy decision-making. Specifically, this work will identify social and environmental factors that differ between low-resource settings and may modify the effectiveness of interventions that target water and sanitation access, enteric pathogen exposure, antimicrobial use, and nutrition to reduce diarrheal risk and improve child growth. The distributions of these factors in study sites will be leveraged to estimate the impact of such interventions across diverse settings and will facilitate the design as well as implementation of future epidemiologic and intervention studies of enteric disease.