Work Study in the Democratic Republic of the Congo: Implementing a WASH Database
Ariel Caldwell, MPH ’18 (right) with field researchers Jean-Claude Bisimwa (left) and Claude Lunyelunye (center) in the Democratic Republic of the Congo.
When Ariel Caldwell, MPH ’18, came to Baltimore for the MPH program in 2017, she was fresh from a Peace Corps volunteer post in Zambia. She hoped an MPH would prepare her for a career in global health informatics and planned to apply to positions in Africa after graduation.
What she didn’t expect: the opportunity to work on the ground floor of project implementation in the Democratic Republic of the Congo—as a student.
Through the Federal Work Study program, Caldwell applied for and landed a position with the DRC-based project. She liked that the work was based in a country neighboring Zambia and that the research focused on children.
JHSPH faculty member Christine Marie George, PhD directs this study which focuses on identifying risk factors for enteric infections, environmental enteropathy and impaired growth among young children in the DRC and on developing intervention strategies to reduce exposure to fecal pathogens among this population. Caldwell focused on designing the database to collect data for this complex field trial along with Khaled Hasan, a data manager, and Jamie Perin, PhD, the study biostatistician.
In sub-Saharan Africa, nutritional interventions have been critical in improving children’s health and development. But researchers believe that environmental pathogens may be inhibiting the success of nutritional interventions. For example, crawling babies who come into contact with animal feces might contract diarrheal diseases, causing growth and developmental issues that negate any potential gains from nutritional supplements. Water, sanitation and hygiene (WASH) interventions are necessary not only to further improve children's health but to support nutritional interventions in critical areas like the DRC.
George’s study is enrolling 3,000 participants in Walungu province in the DRC. This study includes observations of child play activities, clinical surveillance and collection of water, soil, food, and surface samples in child play spaces. The study also includes in-depth interviews and focus group discussions with caregivers of young children and key stakeholders in the community about social norms around WASH practices.
In Baltimore, Christine Marie George (left) works with data manager Khaled Hasan (right) and Caldwell to ready the database for implementation in the field.
“The database is an important component of our cohort study which is investigating potential intervention approaches that can be used to improve child growth in the DRC,” says George.
Hasan, who has worked in research data management for over 15 years, worked closely with Caldwell to guide her through database development. A barcode system, for example, was implemented for bio-specimen tracking, and export tools were incorporated for data analysis. To ensure accuracy during data collection, the interface was built with selection buttons and dropdown lists to minimize entry error.
Tech-savvy Caldwell traveled to the DRC for eight weeks beginning in March 2018 to help load and launch the new database on lightweight laptop computers that would be used in the field. Part of her charge was also to train researchers to use the database and help troubleshoot basic issues.
George is partnering with Food for the Hungry, an organization that has been on the ground in the DRC for 30 years. The research team for this study has 18 field research assistants and four lab technicians who analyzed the stool and environmental samples brought in by field researchers. As part of implementation, Caldwell followed some of the field researchers, primarily Congolese nationals, on their daily data collection to see the database in action and troubleshoot as needed.
Straight away, Caldwell says, she realized one of the biggest challenges for data gathering had nothing to do with the database.
“The DRC is super hilly, and when you’re trying to reach households each day and there’s a torrential rainstorm, it can be really muddy,” she says. “We sometimes had only one vehicle. There’s a lot of coordination … before the day even starts about who is going where, the priorities, which households and times.”
On a single day while reviewing all of the active households in the area, Caldwell says, the team she shadowed visited 18 homes. “It was about 10,000 steps but 50 flights of stairs.” A good pair of hiking boots, she says, made all the difference.
Caldwell with study coordinator Patrick Mirindi outside a dwelling. (Photo, left)
The study requires administration of a series of surveys to participating households over a six month period. Each field researcher visited four to five of the households per day so another logistical issue involved adjusting to different schedules and routines. “These research participants are whole families with their own lives that we need to work around while still trying to get our data,” she says.
The participants she met were friendly, open and happy to participate. “Some of the survey questions take time,” Caldwell says, but “people care for their families and want the best for their children. I think that made it a lot easier for people to say, ‘Ok, we’ll do this.’”
Caldwell found working on this ground floor introduction to a project an incomparable experience. “There are so many moving pieces and different partners,” Caldwell says. “Everything is so detailed and has to be so precise. Learning how to work with everyone’s needs—and with completely different perspectives—while on this same journey was just really new to me. It wasn’t just ‘get the project done.’ It was ‘get the project done well.’”
She also learned that maintaining an open attitude to whatever the day might bring—especially in the DRC which, in March and April, can be extremely hot with fierce afternoon downpours and lightning storms—was key.
“You never know what each day is going to bring. I got to go out into the field a lot more than I was expecting as a computer person, and that ended up bringing a richness to the project and helped me to see things about the work I was doing in a different way.”
By the end of the trip, Caldwell got to see some of the preliminary data—a thrilling end to her months of work on the new database. George said the cohort study will continue until early next year. All of this, they hope, will lead to successful intervention approaches to improve child growth in the DRC.
Ariel Caldwell, MPH ’18, has accepted a PHI-CDC Global Health Fellowship in Zambia, which begins in September. There, she’ll continue her work with tech-based interventions to help expand the national electronic health record system.
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