Dr. Warren Wilson

PI: Warren Wilson

Co-PIs: Barbara Piperata (The Ohio State U.), Jason DeCaro (U. Alabama, Birmingham)

Collaborators:  Comunidad Connect (Nicaragua)

Goal:  To improve the health of mothers and children in rural Nicaragua by documenting their health challenges and their associated cultural practices.

Summary:  Each year millions of pregnant women, mothers, and children experience severe illness or death, largely from preventable or treatable causes. Of these, 99% occur in the developing world. Consequently, attention to maternal and child health (MCH) has been growing, and improving MCH is seen as critical to fostering economic development. The urgency of this issue is reflected in the fact the MCH is a top international development priority for the Canadian government and one of the three strategic priorities of the United States government.  It was also reflected in two of the Millennium Development Goals (MDGs); MDG 4-reduce child mortality and MDG 5-improve maternal health.  Of the eight MDGs, by the 2015 deadline these two goals were the furthest from being met.  Further, in 2015 the 2 goals have were combined in the UN’s Sustainable Development Goal #3 “Good Health and Well-being”.  Efforts to improve maternal and child health have been hobbled by two problems.  First, decades of research demonstrates that health outcomes are strongly influenced by culture, yet maternal and child health data are generally collected without a clear understanding of the cultural context in which these women and children live. Second, challenges such as poverty, food insecurity, low social capital, and psychological stress affect a wide array of physiological systems, causing diverse health problems. However, most maternal and child health research focuses on a single health outcome at a time, obscuring the bigger picture of how stressors are affecting general health.  The first problem can be addressed via participant observation in the community of interest, an approach taken by anthropologists who conduct ethnographic research.  The second problem can be addressed by pooling variables in an innovative model known as allostatic load.  Allostatic load captures the cumulative dysregulation of biological systems confronting chronic environmental challenges, providing a holistic consideration of the well-being of a population.  Addressing both of these gaps in the literature is essential for improving maternal and child health.  Toward that end, in collaboration with a Nicaraguan NGO and front-line health workers in the region, this project is designed to document health outcomes and causes of these outcomes among rural women and children who inhabit Nicaragua’s poorest region.  The first round of fieldwork for this project was completed in January-June & November-December 2015 during which time health outcome variables (nutritional status, mental health, blood pressure, and biomarkers of immune function, stress, diet, and metabolism) and predictor variables (food insecurity, social capital, and other cultural and demographic factors) were collected for 250 caregiver-child dyads.  In 2017 a second line of work was initiated, combing ethnography with the One-Health approach to assess the impact of household animals on the gut microbiome and health in children.  In 2022-23, we sought to understand the variables that shaped subjective social status and in 2025 will begin fieldwork to better understand breastfeeding practices by mothers in Los Robles.  The immediate outcome of the project will be the identification of barriers to maternal and child health in this region and, in the long term, the development of new evidence-based and locally-relevant solutions.

Narrative:  Improving maternal and child health is a critical population health issue, particularly relevant in developing country settings where mothers and children suffer high rate of illness and premature mortality. This research advances our understanding of maternal and child health by investigating the effects of low levels of SES, social capital, and food security on an integrated measure of physiological status (allostatic load) based on biomarkers collected in a sample of mothers and children in rural Nicaragua. The findings will inform health disparities research and policies aimed at improving maternal and child health in low- and middle-income countries.