Center Member Secures R01 Grant to Explore Impact of Persistent Disadvantage on Children's Health in Nepal

View the original article — Emily Treleaven, an affiliate of the Population Studies Center at the University of Michigan Institute for Social Research and member of the Center for Global Health Equity, has received R01 funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) to assess how persistent, intergenerational social and economic disadvantages shape disparities in health, infections, and healthcare utilization in early childhood. 

Building on data from the longitudinal Chitwan Valley Family Study (CVFS) that includes multi-generational data on children, their parents and families, and their communities in Nepal, the new project will document the frequency and duration of diarrheal disease and acute respiratory infection (ARI) to assess the effects of persistent disadvantage on young children’s health. The results will help child health programs and systems to better address disparities in illness and healthcare utilization, and will inform our understanding of the consequences of growing up in persistently disadvantaged families for children globally. 

The project will have parents of children under 5 document their children’s illness symptoms every day for a year, and complete weekly phone interviews to collect information about healthcare utilization and expenditures for children who were sick in the preceding week. Household data already collected by the CVFS for up to 30 years will allow Treleaven and the research team to fill a critical gap in the literature of global health: Revealing the distinct ways that persistent disadvantage intersects with health by linking prospectively collected measures of parents’ own childhood circumstances with their children’s health and family environments. 

Are kids whose families are persistently disadvantaged over multiple generations getting sick more frequently? Are they sick for longer? Are they reaching trained and qualified providers of healthcare at similar rates to their peers? The availability of detailed, high-frequency measures of the incidence and duration of diarrheal disease and ARI in combination with data on household and community context and health services over time provides a unique opportunity to study these questions. 

“Because these children’s parents were themselves in the CVFS as young children, we have high-quality measures of their childhood circumstances, which is unique for this type of study,” said Treleaven. “We hypothesize that children under 5 who live in persistently disadvantaged households will have more frequent episodes and longer duration of ARI and diarrhea, and will be less likely to access quality, timely health care. We will also assess whether proximity to healthcare will modify these associations.” 

The project pilot is now in its third month in the field with a checklist developed for parent reporting with seed funding from the Population Studies Center at the University of Michigan Institute for Social Research. 

The data collection for the project will be conducted by the Institute for Social and Environmental Research – Nepal (ISER-N), which has led CVFS data collections since the study’s inception in 1995. 

“The effects of persistent, intergenerational social and economic disadvantage are increasingly important considerations for providers and policymakers who are seeking to improve children’s health and health service utilization, and to reduce health disparities that emerge in early childhood,” said Treleaven. “This work will highlight potential intervention points and strategies to improve the health of the most vulnerable children.” If expanded in the future, the project could collect biosamples and delve further into the intersection of socioeconomic disadvantage and infectious disease dynamics, Treleaven added. 

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Emily Treleaven is a member of the Center for Global Health Equity. She is also an affiliate of the Population Studies Center and a Research Assistant Professor with the Survey Research Center at the University of Michigan Institute for Social Research, where the Chitwan Valley Family Study is housed.