Making good health of world’s poor This is the ultimate goal of U.Va.’s Center for Global Health

Photos by Fariss Samarrai

Above: Because addresses are marked inconsistently in the poorest areas of Fortaleza, Brazil, where Dr. Richard Guerrant conducts much of his research on sick children, his research team often uses satellite maps to find children’s homes. Below right: Guerrant and nurse Sayonara Sadio Bezerra de Alancar visit the home of a child in their study. Below left: These are some of the children and health care workers in Guerrant’s study.

By Fariss Samarrai

Dr. Richard Guerrant, director of the Center for Global Health, can see a child in Brazil and infer with little more than a glance whether or not that child was repeatedly sick with diarrhea as an infant and toddler.

How can he tell?

Because chronic diarrhea can stunt growth, making a child of seven years about 8 percent smaller than peers who were not routinely sick as very young children. He knows this because he has been treating and conducting research on sick children in Brazil and other developing countries for more than 25 years.

His long-term studies are showing that the debilitating effects of childhood diarrhea are long lasting. His recent findings show that a person frequently afflicted with diarrhea as a child may also wind up with an IQ deficiency of up to 10 points. This is the equivalent of losing an entire school year, and can have a lingering effect on overall productivity for the individual as a citizen, and on the whole society.

To work on solutions for the problems of poverty in the Third World, the Center for Global Health brings researchers and physicians from developing countries to U.Va., and sends U.Va. students around the world for study and research on those problems.

Throughout the years, Guerrant has brought 65 fellows from developing countries in South American, Africa and Asia to study and conduct research in international health programs at U.Va. All of these fellows have returned to their home countries to continue their work, reversing the “brain drain” that often typifies such programs. More than 150 U.Va. students from across disciplines also have traveled to Third World countries to work on health problems and issues under Guerrant’s programs.

This year, the Ellison Medical Foundation committed $810,000 to the center to support these international exchange projects and
research on the diseases of the poor. The grant also is funding interdisciplinary courses and an annual symposium on international health. The University is providing matching funds to the three-year grant.

Studies show that three out of four children in the poorest areas of Brazil suffer from repeating bouts of debilitating diarrhea during their first two years — the same period when the children’s minds and bodies are undergoing the most rapid and crucial development period of their lives. Some of these children do not survive these “chronic, smoldering, terrible gut infections,” but for the ones who do, they will likely live with the negative effects throughout their lives, Guerrant said.

“Some people in the developed world may not think this matters very much. But when disease takes a slice of life and intellect out of a segment of society, it ultimately affects us all,” Guerrant said.

Many of the poor children in Brazil and throughout the Third World will be sick up to half of each month and will lose up to 10 percent of their body weight. A sick child can be orally rehydrated with a sugar-water-and-salt concentration, but with each evacuation of the bowels, important micronutrients are flushed away rather than absorbed into the body.

Guerrant and his international team of colleagues, particularly Dr. Aldo Lima, director of the Institute for Biomedicine at the Federal University of Ceará, have developed a host of new vitamin-enhanced medicines. They are hoping to repair damage to the intestines caused by diarrhea and improve absorption of essential micro-nutrients with the new medicines. If the treatments succeed, and clinical trials are promising, these children may grow and develop normally despite their repeated exposure to disease.

Michael Timko, a U.Va. professor of biology and colleague of Guerrant’s, is looking for ways to genetically engineer essential
nutrients into widely consumed Third World foods, such as bananas and cow peas. If this cutting-edge research succeeds, children could ingest diarrhea-fighting vitamins simply by consuming their everyday foods.
Additional research is being conducted by Reinaldo Oriá, a pharmacologist who recently earned his Ph.D. at the Federal University of Ceará while serving a two-year fellowship at U.Va. Oriá is putting together the puzzle that may someday explain which micronutrients are most important for normal brain development, and the best ways to deliver them. He hopes his answers will lead to new medicines that will put sick kids on track for a healthier and more productive life.

In recent years, Brazil’s poor neighborhoods have seen improvements. Just over a decade ago, 70 percent of the people in the slums of Fortaleza, the city where Guerrant conducts much of his research, had no sewer systems or chlorinated water. Today, 70 percent have sewers and cleaner water. As a result, the infant mortality rate has dropped from 8 percent to 2.5 percent – from 80 children dying at birth per 1,000 to 25. This is still considerably higher than the 6.8 deaths per 1,000 live births in the United States, but well below the 35 deaths per 1,000 for all of Brazil. These improvements occurred under the leadership of Anastácio de Queiroz Sousa, a former fellow at U.Va. who served as the secretary of health for Ceará, the city where Fortaleza is.

Guerrant’s next dream is to form an international network of global health centers modeled on the work done at U.Va. This would link universities in the United States with colleagues worldwide, sharing people and resources, in an effort to make good the health of the poor.

To learn more about Richard Guerrant’s work in Brazil, see the Winter 2004 issue of the University of Virginia Alumni News magazine, to be published Nov. 6.