Project #10476

Mapping Cholera in Bangladesh

by The Village Zero Project
It's almost summer time!

These past couple of months, the Village Zero team has been hard at work re-analyzing cholera data from Matlab per the advice of our PLOS reviewers. We're using a wide variety of techniques - from machine learning to set theory and poisson regression - to assess how infrastructural AND environmental factors impact the geospatial and temporal spread of cholera in Bangladesh. So far, it seems that water and sanitation access as well as proximity to the Meghna Delta - which serves as a natural reservoir for the cholera bacterium - are the primary indicators of disease distribution in Matlab. In addition to personal infrastructural and environmental risk factors, we're also exploring how the risk profiles of one's neighbors impacts one's likelihood of contracting cholera.

By using three different analytical techniques to approach the same question, we're hoping to get the most accurate picture possible of how, where, and why cholera spreads the way it does in Bangladesh. After wrapping up our analysis, we plan on publishing our findings in an open access journal over the summer. Following manuscript submission, we plan to develop several open access tools that are based on our findings in Matlab. Ideas currently on the drawing board include (1) a cholera risk calculator that takes user-inputted information such as location, temperature, and rainfall to assess likelihood - and magnitude - of an outbreak occurring in the near future; and (2) a decision-support tool that indicates what combination of water and/or sanitation access would be least expensive but also most helpful in preventing cholera given user-inputted information on location, temperature, rainfall, etc. These tools - designed to help practitioners on the ground make the best use of their time and money - will be made available on our website on a rolling basis.

Needless to say, we have an exciting couple of months ahead. Thank you so much for your support as we work to prevent cholera in Bangladesh!

Maia Majumder

Can you believe it's 2014 already? We've been busy working on manuscript revisions after receiving some excellent feedback from PLoS One and brainstorming our next steps with respect to data analysis. One of the topics we're most interested in exploring is how clean water and access to sanitation - as well as distance to the Meghna Delta - impact the likelihood of cholera clustering in Matlab, Bangladesh. While the Meghna Delta is often considered the biological reservoir for the cholera bacterium, we are curious about whether potable water and sanitary latrines can reduce the likelihood of contracting cholera - even if a village is geo-spatially close to the disease reservoir. At present, most literature agrees that both water and sanitation as well as hydro-climatic factors - such as proximity to the naturally-occurring disease reservoir - are critical to the spread of cholera; however, we have yet to establish a clear understanding of how such infrastructural and environmental elements interact. Additionally, we're looking forward to investigating how the state of water and sanitation in neighboring villages impacts the vulnerability of a given village. For instance, there are some villages in Bangladesh that have excellent access to clean water and sanitation; however, they are surrounded by neighbors that do not. Does this change how vulnerable they are to cholera? Is there a threshold to their vulnerability? Is that threshold contingent on distance from the Meghna Delta? This kind of knowledge is vital to improving disease management and ensuring that the right resources get to the right place at the right time.

We're excited about what's ahead as we start moving forward and answering these questions. Our goal at V0P is to create actionable knowledge that enables water, sanitation, and health organizations and helps them better understand and control cholera in Bangladesh. With your help, we've been able to continue forth in our mission, and for that we could never thank you enough!

Hello All!

Can you believe it's October already?

For the past three months, the Village Zero team has been actively reviewing our paper, which we submitted just before our last project report. It should be just a few more weeks till we have a decision out! We're hopeful that the content we included in our manuscript will be aligned with the mission of PLoS - the "Public Library of Science".

While there were several journals to which we could have submitted our initial findings from our work in Matlab, Bangladesh, we chose PLoS because of its dedication to open access, peer-reviewed scientific literature and ethical conduct of research. In discussions among our team, we realized how essential it was to ensure that our findings were easily accessible to those who need it most - the people of Matlab, Bangladesh and the water, sanitation, and health organizations that serve them. Because access to many high quality peer-reviewed journals comes with a price tag, the reach of articles published in them can be limited. Given that the purpose of our work is not purely academic but instead humanitarian in nature, publishing in an acclaimed open access journal like PLoS is ideal. By providing free access to our findings, we move one step closer to getting important information on the proliferation of cholera in Bangladesh to those who can use it best to prevent it.

As we wait to hear back from PLoS, the creative juices at V0P are flowing. We're thinking about how tools like system dynamics, dynamic programming, and agent-based simulations can help us learn more about cholera in Bangladesh. Over the next several months, our goal is to create an intelligent model that will help us predict when and where outbreaks may occur and how severe we should expect them to be. Once we've built this model, we'll be creating an applet that works around the model - allowing users to input parameters like date, temperature, rainfall, humidity, etc. to pull up a spatiotemporal forecast of the disease. As we ask ourselves at V0P, "What if we could predict cholera like we can predict the weather?" With your continued support, we'll be able to discover just how much impact we've got in store!

With Gratitude,
Maia Majumder

How quickly the past three months have gone!

In May, I gave a talk at the Tufts Environmental Literacy Institute's annual conference. This year's theme - One Health - couldn't be more perfect. It was an amazing opportunity for Village Zero to get our name out among global game-changers who have a vested interest in both health and the environment. Interested in checking out the presentation? You can find it here.

June and July have been primarily dedicated to putting the final touches on our manuscript "Spatiotemporal Patterns of Annual Cholera Outbreaks in Matlab, Bangladesh", which we recently submitted to PLoS ONE. Though we can't share the draft of our paper until it's been accepted, I wanted to share our abstract to offer a glimpse into what eye-opening and incredible work we've been able to do with your help:

"Endemic cholera demonstrates bimodal seasonality in Bangladesh, peaking before and after the monsoon season every year. While this temporality has been researched extensively, geospatial trends have received less attention in the current literature. This is perhaps the first attempt to explore the spatiotemporal trajectory of endemic cholera in the near-coastal, rural community of Matlab, Bangladesh using 10 years of geographically referenced survey data from the International Centre of Diarrheal Disease Research, Bangladesh (ICDDR,B). Cholera cases were plotted in time and space, and Getis-Ord Gi* was utilized to quantify geospatial clustering of disease from one month to the next. Our analysis indicates that villages closer to the Meghna River in the southeast region of the study area experience greatest overall cholera incidence and statistically significant, positive case clustering (p = .05). April/May and November/December represent 25% and 23% of total annual case counts respectively. The first and second peaks also represent 19% and 20% of positive case clusters respectively, all of which are within the southeast corner of the study area. Such initial results demonstrate great promise in advancing our present knowledge of endemic cholera in Bangladesh. By improving our understanding of cholera proliferation, disease mitigation resources can be distributed to the most susceptible areas when they need them most. The next step forward involves the use of mobile health (mHealth) case surveillance for real-time spatiotemporal cholera data acquisition and forecasting model development."

The Village Zero Team prides itself in being a "humanitarian research organization"; our goal is to create scientifically verifiable, intellectually credible information that can help key water, sanitation, and health organizations in Bangladesh utilize their resources for the greatest possible impact against endemic cholera. In the fall, our next steps include testing some of the environmental models that we've been developing against existing data sets and creating a user-friendly applet that utilizes these models to accurately predict the probability of cholera incidence in a given vilalge given humidity, rainfall, and temperature. We hope that these tools prove useful to our partner organizations like the ICDDR,B that work tirelessly to cure Bangladesh of endemic cholera. Moreover, we expect that once our first paper has been published, we'll be able to garner the funding necessary to implement the dynamic, mHealth surveillance portion of our mission; with real-time data, we'll be able to better hone the tools we develop and thus, better inform cholera mitigation strategies in Bangladesh. It's bound to be an exciting several months ahead!

With Gratitude,
Maia Majumder

Dear Friends, Family, and Supporters, 

As the summer of 2013 approaches, the Village Zero Project is one year past our first phase of data collection in Matlab, Bangladesh. In one year, we have moved from being data analysists to being informed actors. The data  collected last year has become compelling visualizations of the progression of cholera in space and time. The visualizations show that the number of cholera cases show clear trends both geospatially and temporally. 

Over the course of the last few months, we focused on creating new visualizations to help us understand the areas most affected during each month with greater statistical precision. Our next step was to investigate why we were observing the trends that we observed. By doing extensive research on the causes of endemic cholera, we learned a great deal about the strong link between climate and cholera. We collected climate data, and used this data to understand which factors are strong predictors of disease occurrence. 

We are in the process of publishing our findings in a peer-reviewed journal. In addition to writing up our findings, we have also given two presentations of our findings at the Water: Systems, Science and Society Sympossium, and the Education for Public Inquiry and International Citizenship Symposium: Global Health and Security. 

Apart from our findings, we also presented briefly about another project currently in progress: an interactive applet that enables data discovery. We are currently in the process of designing the interactive system that would allow the user to find connections between climactic data and disease incidence data. This applet will be posted on our website in the coming months as it is developed. 

With so much that has already been achieved in a year in the way of data analysis, we look towards a future of informed action. Now that we have conclusive evidence for the geospatial and temporal trends in endemic cholera, the next step is to increase the scope of Village Zero. We plan on using mHealth (mobile health) to collect realtime data about disease incidence to help create a prediction system for cholera based on all the data analysis we have done this year. This prediction system will eventually allow resources to be diverted to the right place at the right time. 

We have gotten through the data analysis phase of the Village Zero project with the support of our donors. The next phase of our project involves implementing an mHealth data collection system, and creating a framework for resource allocation. As we now move into the action phase, we need more support then ever.

Thank you for your support, and help us transform data analysis into informed action!

-The Village Zero Project



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Organization Information

The Village Zero Project

Location: Boston, MA - USA
The Village Zero Project
Project Leader:
Maia Majumder
Medford, MA United States

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