In parts of the world where clean water is in short supply and sanitation is limited, non-viral gastroenteritis is a major public health issue. Now, a collaboration of scientists from the UK and Pakistan are taking a multi-disciplinary approach to tackling its effects.
As anyone who has ever had a stomach bug will know, the symptoms can be intensely upsetting and painful. But, in the UK, our access to clean water, public health advice, and medicine means most of us are likely to be up and about again in a couple of days.
In parts of the world where clean water is in short supply and sanitation is limited, it is a different story.
Non-viral gastroenteritis, is an infection of the stomach and intestine by harmful microorganisms, causes diarrhoea, sickness, and dehydration. In Pakistan it is a killer.
Dr Chris Quince, from the Earlham Institute and Quadram Institute, is co-lead for the GastroPak project. This is a ground-breaking, multi-disciplinary initiative - simultaneously exploring cultural, social, sanitary, and microbiological factors influencing the spread of microorganisms responsible for the illness.
“Gastroenteritis - in all forms - is a major public health burden in Pakistan,” says Dr Quince. “It’s estimated to be responsible for nearly 60pc of infant and child deaths every year, in this country of more than 225 million people.”
He says more than a third of children in Pakistan under five years old have received treatment for diarrhoea.
“We also know that bacterial gastroenteritis is more likely to contribute to stunting of growth and cognitive impairment in children,” he adds.
The GastroPak project team includes social scientists, microbiologists, engineers, epidemiologists, chemists and statisticians. They are looking at agriculture, sanitation, drinking water, food, general hygiene and person-to-person contact
“We’re attempting to understand the various factors affecting spread. The project team is interdisciplinary – we’re not just looking at biological factors but also elements including how food is grown, social dynamics, and engineering solutions to sanitation.
“This is not a problem which will be solved by just one approach.”
International partners from Pakistan were hosted by the Earlham Institute earlier this year for two weeks of training, focusing on microbiome, bioinformatics, and statistical analysis.
The group is looking to develop rapid detection tests based on qPCR for common bacteria and parasites associated with gastroenteritis. These could include bacteria Campylobacter and E.coli, as well as parasites Cryptosporidium and Giardia.
The team hopes to use the tests to track the source of harmful microorganisms. This can be done through whole genome sequencing across multiple environments, allowing researchers to test for transmission routes. For example, bacteria can be transferred from the soil onto fruit or vegetables.
The project team is interdisciplinary – we’re not just looking at biological factors but also elements including how food is grown, social dynamics, and engineering solutions to sanitation. . This is not a problem which will be solved by just one approach.
Dr Chris Quince
“We are working on low-cost, easily portable, fast, and reliable tests using DNA sequencing technology,” says Dr Quince. “These have the potential to break new ground when it comes to disease surveillance and prevention.”
He says the information gained, and the new molecular tools developed to combat non-viral gastroenteritis transmission, will be transferable to other countries where there is a higher risk of gastroenteritis.
Members of the GastroPak team on a recent visit to the Earlham Institute.
A second line of attack will be increasing awareness of social issues. The group is also working with local and national partners in Pakistan to meet anyone with a stake in clean water and food, good sanitation, and public health.
Many bacteria and parasites can cause gastroenteritis, in a variety of ways. Some are found in water, some in meat, some in salads. Short supply of clean water also contributes to higher rates of non-viral gastroenteritis in Pakistan.
Dr Quince said: “If we can identify the major sources of bacterial gastroenteritis then we - or our NGO partners such as the WHO -can properly target campaigns to address transmission.
“For example, if most contamination is through drinking water then we emphasise water treatment, rather than hygiene practices. In fact, this information is potentially very useful to people themselves by providing them with evidence to take to policy makers to create real change.
“A large portion of this work will involve tackling cultural issues, and our partners in Pakistan are identifying how best to work on these.”
Conducting the work across multiple disciplines with Pakistani partners means the work will be embedded in Pakistan’s culture from the beginning, created and shaped by the people it is intended to benefit. It is hoped that lessons learned in Pakistan could be adapted to other countries where non-viral gastroenteritis is endemic.
We are working on low-cost, easily portable, fast, and reliable tests using DNA sequencing technology. These have the potential to break new ground when it comes to disease surveillance and prevention.
Dr Chris Quince is one of the co-leads on the project. The others are:
Professor Liz Wellington from the University of Warwick, who is leading on microbiology
Dr Ruben Sakrabani from the University of Cranfield, specialising in soil sampling
Professor Lyla Mehta from the University of Sussex, leading on social science
Dr Fahd Rasul, who is the lead at the University of Agriculture Faisalabad (UAF) in Pakistan
Professor Noel McCarthy, Trinity College Dublin
Professor Xavier Didelot, University of Warwick
Professor Imran Hashmi , National University of Science and Techonology (NUST), Islamabad
Professor Sher Jamal Khan, National University of Science and Techonology (NUST), Islamabad
Dr. Aneela Javed, National University of Science and Techonology (NUST), Islamabad
GastroPak is a partnership between the Earlham Institute, the National University of Sciences & Technology in Islamabad, the University of Warwick, the University of Agriculture Faisalabad, Trinity College Dublin, the Institute of Developmental Sciences at the University of Southampton, and Cranfield University.
Also on the team is Dr Sumara Masood who is the dedicated social scientist for GastroPak, at the National University of Science and Technology (NUST), Islamabad.
GastroPak is funded by UKRI’s Global Challenges Research Fund.
