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.

Public Health Relevance

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.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Research Scientist Development Award - Research & Training (K01)
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Microbiology and Infectious Diseases B Subcommittee (MID)
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Baqar, Shahida
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University of Virginia
Public Health & Prev Medicine
Schools of Medicine
United States
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Platts-Mills, James A; Liu, Jie; Rogawski, Elizabeth T et al. (2018) Use of quantitative molecular diagnostic methods to assess the aetiology, burden, and clinical characteristics of diarrhoea in children in low-resource settings: a reanalysis of the MAL-ED cohort study. Lancet Glob Health 6:e1309-e1318
Scharf, Rebecca J; Rogawski, Elizabeth T; Murray-Kolb, Laura E et al. (2018) Early childhood growth and cognitive outcomes: Findings from the MAL-ED study. Matern Child Nutr 14:e12584
Rogawski, Elizabeth T; Platts-Mills, James A; Colgate, E Ross et al. (2018) Quantifying the Impact of Natural Immunity on Rotavirus Vaccine Efficacy Estimates: A Clinical Trial in Dhaka, Bangladesh (PROVIDE) and a Simulation Study. J Infect Dis 217:861-868
Richard, Stephanie A; McCormick, Benjamin J J; Seidman, Jessica C et al. (2018) Relationships among Common Illness Symptoms and the Protective Effect of Breastfeeding in Early Childhood in MAL-ED: An Eight-Country Cohort Study. Am J Trop Med Hyg 98:904-912
Lima, Aldo A M; Soares, Alberto M; Filho, José Q S et al. (2018) Enteroaggregative Escherichia coli Subclinical Infection and Coinfections and Impaired Child Growth in the MAL-ED Cohort Study. J Pediatr Gastroenterol Nutr 66:325-333
Rogawski, Elizabeth T; Liu, Jie; Platts-Mills, James A et al. (2018) Use of quantitative molecular diagnostic methods to investigate the effect of enteropathogen infections on linear growth in children in low-resource settings: longitudinal analysis of results from the MAL-ED cohort study. Lancet Glob Health 6:e1319-e1328
Schnee, Amanda E; Haque, Rashidul; Taniuchi, Mami et al. (2018) Identification of Etiology-Specific Diarrhea Associated With Linear Growth Faltering in Bangladeshi Infants. Am J Epidemiol 187:2210-2218
Lima, Aldo A M; Soares, Alberto M; Filho, José Q S et al. (2017) Enteroaggregative E. coli Subclinical Infection and co-Infections and Impaired Child Growth in the MAL-ED Cohort Study. J Pediatr Gastroenterol Nutr :