We propose to develop a Global Network for Women's and Children's Health Research site in Eldoret, Kenya. This East African site will be a joint partnership between Indiana University and Moi University School of Medicine, one of two medical schools in Kenya. The 17 year partnership of Moi University and Indiana University will bring unique strengths to the Global Network. These include an established administrative, scientific, and collegial relationship between the institutions, an extensive research infrastructure that includes an established network of rural health centers from which to draw subjects, a well functioning Kenyan Institutional Review Board with a OHRP Assurance number, and an established expanding coverage of subjects by an electronic medical record. The Senior Foreign Investigator is Dean of the Medical School, and has well established relationships with high level Ministry of Health personnel. A large number of other Moi University investigators with expertise in Obstetrics, Public Health, Nutrition, Epidemiology, and Behavioral Sciences are also eager to join the Global Network. US based expertise is also present in Obstetrics, Biostatistics, and Bioethics. We propose to the Network a cluster randomized protocol evaluating the efficacy of both Community Mobilization for the use of a Safe Water System (SWS) and for zinc supplementation in partially weaned infants less than 6 months of age. The SWS includes specially designed narrow neck water storage containers and point of use home chlorination using dilute sodium hypochlorite. Hypotheses to be tested are that 1.) Community Mobilization will result in sustained, consistent use of point of use water treatment 2.) This will lead to a decreased incidence of diarrhea in less than 6 month old infants. 3.) Zinc supplementation beginning at partial weaning will lead to a further decrease in the incidence of diarrhea in these infants. 4.) Growth will be improved and failure to thrive decreased in experimental groups. 5.) All cause mortality in >6 month old infants will be decreased in experimental groups. If efficacy is shown, these are highly sustainable interventions that will improve the health and well being of vulnerable infants.
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