Global warming and more days of extreme heat are exacerbating the health risks of pregnancy, particularly among African-American women, according to new Stanford-led research.

The maternal mortality rate among all women in the United States is already the worst of any industrialized nation. And black women are three to four times more likely to die from pregnancy-related problems than white women.

“It is truly a crisis that in America, one of the wealthiest countries in the world, more women are dying from pregnancy or childbirth complications than in any other developed country,” said Maya Rossin-Slater, a core faculty member at Stanford Health Policy and a faculty fellow at the Stanford Institute for Economic Policy Research.

In a new working paper published by the National Bureau of Economic Research, Rossin-Slater and two other health economists underscore how little research is out there about the impact of rising temperatures on the health of mothers and their newborns.

Pregnant women, for example, are not able to regulate body temperature as efficiently as non-pregnant individuals due to the physiological changes they undergo during gestation. Heat exposure can alter blood flow in the placenta, which can weaken the placenta and lead to complications. And high heat can lead to other pregnancy complications, such as hypertension, preeclampsia and prolonged premature rupture of membranes.

“All of these issues can translate into women needing to be hospitalized during pregnancy and experiencing complications during childbirth,” wrote Rossin-Slater, an assistant professor of health research and policy at Stanford Medicine. Her co-authors are Jiyoon Kim, assistant professor of economics at Elon University, and Ajin Lee, an assistant professor of economics at Michigan State University.

The researchers said most of the discussion about maternal health focuses on the health-care system, but that other determinants of poor maternal health and racial disparities are much less understood, particularly when it comes to how the environment is impacting pregnancy.

So they launched what they believe is the first study to identify the causal effects of prenatal exposures to extreme temperatures on the health of the mothers themselves.

As the Earth Warms, So Does Exposure to Extreme Heat

Their paper focuses on an environmental factor that is becoming increasingly relevant due to the growing consensus that climate change is contributing to a gradual warming of the earth: exposure to extreme heat.

The researchers studied the effects of exposure to extreme temperatures during pregnancy on maternal and child hospitalizations, using inpatient discharge records from three U.S. states with different climates: Arizona, New York and Washington. Their data comes from the State Inpatient Databases from the Healthcare Cost and Utilization Project, including 2.7 million inpatient records of 2.7 million infants and 2.2 million mothers in those three states.

And to measure temperature exposure, the researchers obtained data from the National Oceanic and Atmospheric Administration (NOAA).

For every county in their data, the researchers calculated the average temperature for every month. Then for every given day in a specific month in that county, they looked at the historic average for how high or low that day’s temperature was relative to the overall temperature in that month in that county.

For example, a 90-degree day in Arizona in September would not be classified as extreme heat since it’s relatively common. But a 90-degree day in New York would be, since temperatures that high are much less common. They classified “extreme heat” as a given day when the temperature is more than three standard deviations (3SD) above that historic county mean.

Then, they compared the outcomes of women who are of the same race giving birth in the same county and calendar month, but in different years. These women are likely similar in terms of their demographics and socioeconomic status, but may be exposed to different temperatures during pregnancy. For example, consider a black woman giving birth in November 2011 in Queens County, New York, and a black woman giving birth in November 2012 in the same county. If there were a heat wave in Queens in the August 2012, then the latter woman is exposed to more extreme heat during pregnancy than the former. 

The economists found that each additional day with heat that is at least 3SDs — or substantially higher than the historic county-month average — during the second trimester of pregnancy increases the likelihood that a newborn is diagnosed with dehydration by .008 percentage points.

“Our results provide new estimates of the health costs of climate change and identify environmental drivers of the black-white maternal health gap,” they wrote. “Understanding the health consequences of this increase in extreme heat is critical information for discussions about the costs of climate change and the possible benefits of mitigating policies.”

The researchers found that each additional day of extreme heat exposure during pregnancy increases black women’s likelihood of hospitalization during pregnancy. Since black women on average are exposed to more extreme heat than white women — due to different residence patterns and access to mitigating technologies like air conditioning — extreme heat may contribute to exacerbating the already large gap in maternal health between black and white women.

Detrimental Consequences of Rising Temperatures

Scientists predict global average temperatures will continue to rise over the next 50 to 100 years as greenhouse gases continue to trap more heat in the Earth’s atmosphere. The U.N. Intergovernmental Panel on Climate Change last year warned that nations worldwide must quickly reduce fossil fuel use to keep the rise in global temperatures below 1.5°C by 2050. 

The panel also said the number of days with mean temperatures above 32°C in the average American county is forecasted to increase from about 1 to 43 days per year by 2070-2099.

That could have detrimental consequences for babies and mothers alike.

“Overall, our findings on infant health suggest that exposure to extreme heat during the second trimester increases the likelihood of the baby being dehydrated at the time of birth,” the researchers wrote. “This, in turn, appears to increase the likelihood of subsequent readmission to the hospital many months later for causes linked to dehydration.”

And these impacts are typically missed when researchers only measure infant health using more standard variables, such as birth weight.

The authors note dehydration is one of the leading causes of morbidity and mortality in children. Studies show that children under 5 years old who have an average of two episodes of gastroenteritis associated with dehydration per year leads to 2 to 3 million pediatric office visits and accounts for 10% of all pediatric hospital admissions in the United States. 

Experts believe black women are three- to four-times more likely to die from pregnancy-related causes due to lack of access to and the poor quality of health care, as well as clinicians not monitoring black women as closely — or actually dismissing their symptoms altogether.

“The fact that the adverse impacts on health during pregnancy are larger for black than for white mothers suggests that climate change may exacerbate the already large racial gap in maternal health,” the researchers said.

In its 46-year history, SPICE, Freeman Spogli Institute for International Studies (FSI), has collaborated with numerous Stanford-affiliated organizations on educational programs. One of the most meaningful and significant collaborations has been with TeachAids, an award-winning global leader in designing, producing, and distributing research-based health education. With programs used in 82 countries, TeachAids released its newest product, CrashCourse, seeking to decrease the stigma surrounding concussion reporting and empower youth athletes with much needed knowledge. All TeachAids education content is available for free.

The SPICE staff highly encourages teachers in SPICE’s network to access the CrashCourse Concussion Education content and share it with their colleagues in their school’s science-, health-, and sports-related programs. The following is noted on CrashCourse’s main webpage:

One in five high school athletes will get a concussion. With proper care, most concussions can heal within 10 days, but the overwhelming majority of students, parents, and coaches are unaware of the latest science about prevention and treatment of concussions. If not treated properly, a concussion may have lasting physical, emotional, and cognitive effects.

Since many schools are now in the midst of football season, this is an ideal time to raise awareness of the prevention and treatment of concussions. In particular, the content will be especially helpful if it can be shared with the school’s athletic or health leadership. In less than a year, CrashCourse has gained great momentum and recognition throughout the country with leading organizations such as Pop Warner, USA Synchro, and USA Football (which offers free Certification for CrashCourse content) using the content to educate their young athletes and larger sports communities (ABC, Fox, CBS).

Through our special partnership, SPICE will be distributing all CrashCourse products for free to our network of more than 10,000 schools reaching all major school districts in the United States.

The CrashCourse initiative was developed under the leadership of TeachAids Founder and Adjunct Affiliate at FSI’s Center for Health Policy Dr. Piya Sorcar. Several other Stanford faculty members affiliated with FSI—including Dr. Douglas Owens, Director of Stanford Health Policy, Dr. Lee Sanders, Chief of General Pediatrics, and Dr. Paul Wise, Richard E. Behrman Professor of Child Health and Society—have served as close advisors for TeachAids so teachers can feel extremely confident in its products. CrashCourse is an excellent example of “engagement beyond our university,” which is one of Stanford’s four long-range planning key areas.

SPICE looks forward to continuing its partnership with TeachAids as both organizations strive to continue to make Stanford scholarship accessible to students not only in the United States but also in many other countries around the world.

Early Childhood Development Takes Center Stage in China: Questions & Answer with Scott Rozelle and James Heckman

【编者按】2018年11月17日，詹姆斯·赫克曼(James J. Heckman)教授在西安召开的“2018年儿童早期发展国际论坛”上发表主旨演讲，出席会议的有来自世界各地和中国各地的政要和顶尖学者。赫克曼教授就儿童早期发展(ECD)质量对生活在贫困和富裕社区的婴幼儿的重要性进行了广泛和深入的概述。他在演讲中阐明儿童早期发展质量对一个人的童年及其终生的健康、经济和社会性结果都有重大影响。高质量的儿童早期发展项目对整个社会的影响也是巨大的。他特别强调了儿童早期发展的经济学意义，认为政府投资弱势儿童的早期发展，其社会回报率非常高。赫克曼教授借鉴了世界各地的研究成果，包括他自己以及美国和其他发达国家的其他学者的研究成果。

演讲结束后，他与会议组织团队进行了座谈，回答了关于他的研究以及其他科学家和社会科学家近期研究的一些基本问题。问答阶段的总目标是总结儿童早期发展对国家发展的重要性以及决策者在这一进程中的作用。在可能的情况下，赫克曼教授尝试从国际文献中为中国案例提供经验与启示。与詹姆斯·赫克曼教授的问答，由罗斯高(Scott Rozelle)教授主要负责。问答后附有对“赫克曼曲线”的简要述评。

Read the full story here.

Image

I know your research interest in early childhood development grew after interning with REAP, but what first sparked your interest in early childhood development and language acquisition?

Image

Language develops naturally over time, but what we’re hoping to illuminate is how the language environment of a couple of families might be richer than another, showing a better trajectory of language acquisition. 

[[{"fid":"236489","view_mode":"crop_870xauto","fields":{"format":"crop_870xauto","field_file_image_description[und][0][value]":"","field_file_image_alt_text[und][0][value]":false,"field_file_image_title_text[und][0][value]":false,"field_credit[und][0][value]":"Rural Education Action Program","field_caption[und][0][value]":"Laura interacts with a baby in rural China on her first trip to a village in Shaanxi Province with REAP. ","thumbnails":"crop_870xauto"},"link_text":null,"type":"media","field_deltas":{"3":{"format":"crop_870xauto","field_file_image_description[und][0][value]":"","field_file_image_alt_text[und][0][value]":false,"field_file_image_title_text[und][0][value]":false,"field_credit[und][0][value]":"Rural Education Action Program","field_caption[und][0][value]":"Laura interacts with a baby in rural China on her first trip to a village in Shaanxi Province with REAP. ","thumbnails":"crop_870xauto"}},"attributes":{"style":"float: left; height: 350px; width: 350px; margin-left: 10px; margin-right: 10px;","class":"media-element file-crop-870xauto","data-delta":"3"}}]]

The United States is the only country in the 35-member Organization for Economic Cooperation and Development that offers no paid leave to new mothers. The U.S. also has relatively poor infant health ratings, particularly for preterm births and infant mortality.

So why has the federal government been so reluctant to join other industrialized nations in paying new mothers to stay at home so they can nurture and nourish these new citizens?

“There’s opposition from business interests arguing that any type of mandate on employers imposes too large costs, especially for small businesses,” said Stanford Health Policy’s Maya Rossin-Slater. “There’s not much empirical evidence supporting this argument, but I think the strong political opposition from business supporters may be a central reason for a lack of action on the federal level.”

In a policy brief published March 28 in Health Affairs, Rossin-Slater, an assistant professor of health research and policy, lays out the evidence that suggests the introduction of paid family leave (PFL) for up to one year in duration may yield significant child and maternal health benefits, both in the short and long term. Her co-author on the brief is Lindsey Uniat, a predoctoral research fellow at the Stanford Institute for Economic Policy Research.

“Existing research suggests that when leave is paid, take-up rates are higher among low-income and disadvantaged families than when it is unpaid, which enables more families to benefit,” they wrote.

Some of the short- and long-term health benefits include decreased incidence of low birthweight and preterm births, increased breast-feeding, reduced rates of hospitalizations among infants and improved maternal health.

Family and Medical Leave Act

The federal Family and Medical Leave Act (FMLA) of 1993 provides 12 weeks of unpaid, job-protected leave with continued health insurance coverage to attend to a newborn or adopted child, a family member, or an employee’s own serious health condition. There are strict eligibility requirements for the FMLA, such as needing to have worked at least 1,250 hours for an employer with 50 or more employees during the 12 months before the start of the leave.

The most recent data, according to the authors, indicate that only about 60 percent of private-sector workers are eligible for FMLA, and 46 percent of those eligible report not being able to afford taking unpaid time off work.

Six states and the District of Columbia have passed paid family leave policies, and the issue has been receiving attention at both state and federal levels in recent years. California, Hawaii, New Jersey, New York and Rhode Island, as well as Puerto Rico, have State Disability Insurance (SDI), which provides partial wage-replaced leave for workers with temporary disabilities and for mothers preparing for and recovering from childbirth. These policies offer up to six weeks of leave postpartum for vaginal deliveries and eight weeks for C-section deliveries.

“The majority of existing research on the health effects of PFL focuses on children’s outcomes,” the authors write. Earlier work on the impacts of unpaid leave provided through the FMLA shows that it led to small increases in birthweight and large reductions in infant mortality rates.

However, these health benefits were apparent only for children of relatively advantaged mothers, the authors wrote, which is consistent with prior evidence that such mothers were most likely to be eligible for, and able to afford to use, unpaid leave.

“In contrast, mothers and children from less advantaged backgrounds particularly benefit from access to paid leave,” they said, noting that one study showed that the introduction of paid maternity leave through the SDI system in five states led to a reduction in the share of low birthweight and preterm births, especially for unmarried and black mothers.

Rossin-Slater and Uniat believe paid family leave may affect population health through multiple channels:

• Children of parents who take leave may receive more parental care, breast-feeding and immunizations if parents are able to stay home longer after birth;
• Child health may improve from the extra resources that parents get form PFL benefits, such as more nutritious food;
• Infant and long-term health outcomes may improve if PFL access lowers maternal stress during pregnancy, perhaps due to increased financial and job security;
• Taking time off from work without the financial strain may improve the parental bond with the infant — leading to long-term health benefits for the child.

The Labor Market

Finally, existing research indicates that paid family leave may benefit the labor market by leading to fewer high-school dropouts, thus an increase in children’s future wages.

“Several policy takeaways are evidence from the research to date,” the authors wrote. “Paid leave, in contrast to unpaid leave, increases leave usage and duration, especially among disadvantaged parents who are least able to afford unpaid time off.”

More research is needed, they said, to understand how paid family leave legislation could impact employers.

“We know little about how employers deal with work interruptions due to employees’ taking leave or whether employers respond to PFL mandates by changing their own benefits packages, hiring practices, or other aspects of jobs,” they said.

A place that a news story should exist but this is here to show what one looks like in Internal

A place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in InternalA place that a news story should exist but this is here to show what one looks like in Internal

A cutting-edge treatment for blood cancer in children with promising short-term remission rates has nevertheless come under intense scrutiny due to its unprecedented cost.

Acute lymphoblastic leukemia (ALL) is the most commonly diagnosed pediatric cancer. Though treatment advances have driven five-year survival rates above 90 percent, relapse is common and ALL remains a leading cause of death from childhood cancer. Those surviving relapse typically require hematopoietic stem cell transplant (HSCT) to remain in remission.

The Food and Drug Administration last year approved tisagenlecleucel as the first anti-CD19 CAR T-cell therapy for relapsed or refractory pediatric ALL. While tisagenlecleucel-induced remission rates are encouraging compared with those of established therapies — more than 80 percent compared with less than 50 percent — a one-time infusion costs $475,000.

That makes it one of  the most expensive oncologic therapies out there, even though no studies exist to show how the therapy maintains remission in the long term.

So Stanford Health Policy’s John K. Lin, Jeremy Goldhaber-Fiebert and Douglas K. Owens, in collaboration with Kara Davis, an assistant professor of pediatrics at Stanford’s Lucile Packard Children’s Hospital, set out to determine whether the treatment is cost-effective. 

Their study was recently published in the Journal of Clinical Oncology.

“CAR-T cells are an exciting new therapy to help us cure more patients with ALL,” said Davis. “They use a patient’s own immune system to precisely target their leukemia and remission rates are impressive for patients with relapsed disease.”

The researchers note, however, it remains unknown whether tisagenlecleucel is sufficient to cure relapsed or refractory disease without a transplant.

Not only is it a very expensive treatment, it also has expensive and serious side effects, such as cytokine release syndrome, which can cause symptoms ranging from fevers and muscle aches to lethal drops in blood pressure and difficulty breathing, requiring ICU-level care.

“Given [its] high cost and broad applicability in other malignancies, a pressing question for policymakers, payers, and clinicians is whether the therapy’s cost represents reasonable value,” the authors wrote.

In order to evaluate the economic value of tisagenlecleucel, the authors created a computer simulation that modeled children with relapsed or refractory ALL. Since the durability of the therapy’s effects are unknown, they evaluated the therapy at different levels of long-term effectiveness.

Through their analyses, the authors found that at the simulation’s most optimistic projections, patients receiving tisagenlecleucel would, on average, live over a decade longer than those receiving alternative therapies. At these projections, the therapy would be cost-effective. However, at more modest long-term outcomes, its clinical and economic benefits declined.

Image

“The durability of CAR-T cell therapy is the main question. For many children with relapsed or refractory ALL, their disease is fatal — if the therapy results in sustained remissions, it would represent an important advance,” said lead author Lin, who is a VA Health Services Research and Development Fellow at Stanford Health Policy.

In the end, the researchers concluded that at tisagenlecleucel’s current price, its economic value is “uncertain,” as the true cost-effectiveness depends on its long-term performance, which has yet to be determined. They noted that substantial price reductions would improve its cost-effectiveness even if its long-term performance is relatively modest.

“A commonly asked question for many expensive, novel therapies is why can’t prices be lowered at least until we know how well they work,” said Goldhaber-Fiebert. 

The “Catch-22” here is that long-term effectiveness data are needed to justify a drug’s price, but current uncertainty about its effectiveness, along with its high price, means developing the data to justify its price occurs much more slowly.

“CAR-T is an individually tailored treatment that has thus far been produced for a relatively small number of patients,” Goldhaber-Fiebert said. “Its current production costs may well be very high, and certainly the companies that have spent heavily on its research and development are interested in achieving returns on their investments.”

When the effectiveness of a therapy is uncertain, some pharmaceutical companies and health policy experts have proposed something called outcomes-based payment, which is essentially a “money-back guarantee” if the therapy doesn’t work as intended.

Novartis, which developed tisagenlecleucel, has a money-back guarantee; if the patient does not achieve initial remission within the first month, they are not responsible for the payment of the therapy.

“However, we find that because most children have an initial remission, this does not materially improve cost-effectiveness,” Lin said.

He suggested that if the money-back guarantee were extended to see whether the patient relapses within a year, such a guarantee would improve the treatment’s cost-effectiveness.

The other co-authors of the study are James I. Barnes, Alex Q.L. Robinson, Benjamin J. Lerman, Brian C. Boursiquot and Yuan Jin Tan.

More children die from the indirect impact of armed conflict in Africa than those killed in the crossfire and on the battlefields, according to a new study by Stanford researchers. 

The study is the first comprehensive analysis of the large and lingering effects of armed conflicts — civil wars, rebellions and interstate conflicts — on the health of noncombatants.

The numbers are sobering: 3.1 to 3.5 million infants born within 30 miles of armed conflict died from indirect consequences of battle zones between 1995 and 2005. That number jumps to 5 million deaths of children under 5 in those same conflict zones.

“The indirect effects on children are so much greater than the direct deaths from conflict,” said Stanford Health Policy's Eran Bendavid, senior author of the study published today in The Lancet.

The authors also found evidence of increased mortality risk from armed conflict as far as 60 miles away and for eight years after conflicts. Being born in the same year as a nearby armed conflict is riskiest for young infants, the authors found, with the lingering effects raising the risk of death for infants by over 30 percent.

On the entire continent, the authors wrote, the number of infant deaths related to conflict from 1995 to 2015 were more than three times the number of direct deaths from armed conflict. Further, they demonstrated a strong and stable increase of 7.7 percent in the risk of dying before age 1 among babies born within 30 miles of an armed conflict.

The authors recognize it is not surprising that African children are vulnerable to nearby armed conflict. But they show that this burden is substantially higher than previously indicated. 

“We wanted to understands the effects of war and conflict, and discovered that this was surprisingly poorly understood,” said Bendavid, an associate professor of medicine at Stanford Medicine.  “The most authoritative source, the Global Burden of Disease, only counts the direct deaths from conflict, and those estimates suggest that conflicts are a minuscule cause of death.”

Paul Wise, a professor of pediatrics at Stanford Medicine and a senior fellow at the Freeman Spogli Institute for International Studies, has long argued that lack of health care, vaccines, food, water and shelter kills more civilians than combatants from bombs and bullets. 

This study has now put data behind the theory when it comes to children.

“We hope to redefine what conflict means for civilian populations by showing how enduring and how far-reaching the destructive effects of conflict have on child health,” said Bendavid, an infectious disease physician whose co-authors include Marshall Burke, PhD, an assistant professor of earth systems science and fellow at the Center on Food Security and the Environment.

“Lack of access to key health services or to adequate nutrition are the standard explanations for stubbornly high infant mortality rates in parts of Africa,” said Burke. “But our data suggest that conflict can itself be a key driver of these outcomes, affecting health services and nutritional outcomes hundreds of kilometers away and for nearly a decade after the conflict event”. 

The results suggest efforts to reduce conflict could lead to large health benefits for children.

The Data

The authors matched data on 15,441 armed-conflict events with data on 1.99 million births and subsequent child survival across 35 African countries. Their primary conflict data came from the Uppsala Conflict Data Program Georeferenced Events Dataset, which includes detailed information about the time, location, type and intensity of conflict events from 1946 to 2016. 

The researchers also used all available data from the Demographic and Health Surveys conducted in 35 African countries from 1995 to 2015 as the primary data sources on child mortality in their analysis.

The data, they said, shows that the indirect toll of armed conflict among children is three-to-five times greater than the estimated number of direct casualties in conflict. The indirect toll is likely even higher when considering the effects on women and other vulnerable populations.

Zachary Wagner, a health economist at RAND Corporation and first author of the study, said he knows few are surprised that conflict is bad for child health.

“However, this work shows that the relationship between conflict and child mortality is stronger than previously thought and children in conflict zones remain at risk for many years after the conflict ends.” 

He notes that nearly 7 percent of child deaths in Africa are related to conflict and reiterated the grim fact that child deaths greatly outnumber direct combatant deaths.

“We hope our findings lead to enhanced efforts to reach children in conflict zones with humanitarian interventions,” Wagner said. “But we need more research that studies the reasons for why children in conflict zones have worse outcomes in order to effectively intervene.” 

Another author, Sam Heft-Neal, PhD, is a research fellow at the Center for Food Security and the Environment and in the Department of Earth Systems Science. He, Burke and Bendavid have been working together to identify the impacts of extreme climate events on infant mortality in Africa.

Malaria claims nearly half-a-million lives worldwide each year — and yet we still know so little about the immunology of the disease that has plagued humanity for centuries.

There were 216 million cases in 2016, according to the World Health Organization. Sub-Saharan Africa carries 80 percent of the global burden of the mosquito-borne infectious disease which devastates families, disrupts education, and promotes the vicious cycle of poverty.

It is particularly brutal to pregnant women, who are three times more likely to suffer from a severe form of the disease, leading to lower birthweight among their newborns and higher rates of miscarriage, premature and stillborn deliveries.

“Pregnant women and their unborn children are more susceptible to the adverse consequences of malaria, so we are working to investigate new strategies and even lay the foundation for a vaccine to prevent malaria in pregnancy,” said Prasanna Jagannathan, MD, an assistant professor of medicine who is this year’s recipient of the Rosenkranz Prize.

Jagannathan, an infectious disease physician who is also a member of Stanford’s Child Health Research Institute, said the $100,000 stipend that comes with the prize will allow his lab members to ramp up their research in Uganda. A member of the nonprofit Infectious Disease Research Collaboration in Kampala, his team is particularly interested in how strategies that prevent malaria might actually alter the development of natural immunity to malaria.

“With support from the Rosenkranz Prize, we hope to identify maternal immune characteristics and immunologic targets that are associated with protection of malaria in pregnancy and infancy,” Jagannathan said.

The Dr. George Rosenkranz Prize for Health Care Research in Developing Countries is awarded each year by the Freeman Spogli Institute for International Studies and Stanford Health Policy to a young Stanford researcher who is trying to improve health care in underserved countries. It was established in 2009 by the family or Dr. George Rosenkranz, a chemist who first synthesized cortisone in 1951, and later progesterone, the active ingredient in oral birth control pills.

“My father has held a lifelong commitment to scientific research as a way to improve the lives and well-being of communities around the world,” said Ricardo T. Rosenkranz, MD. “In particular, he has always sought to improve the health of at-risk populations. Dr. Jagannathan’s work offers the very sort of innovative ingenuity that characterized my father’s early research, as well as his vision towards the future.”

Jagannathan and his collaborators at UCSF and in Uganda are currently conducting a randomized control trial of 782 Ugandan women who are receiving intermittent preventive treatment with a fixed dose of dihydroartemisinin-piperaquine(or IPTp-DP), a medication that has dramatically reduced the risk of maternal parasitemia, anemia, and placental malaria. Their preliminary data suggests that among 684 infants born to these women, maternal receipt of IPTp-DP may lead to a reduced incidence of malaria in the first year of life.

Image

“Having the discretionary support of the Rosenkranz Prize will allow us to generate some preliminary ideas from this trial that could lead to larger studies, to push this agenda further along,” Jagannathan said.

That agenda is to create a vaccine that targets pregnant women to prevent malaria both during pregnancy — but also potentially preventing malaria in infants, giving them a better start in life.

“We’re not the first ones to think of this, but we have the opportunity to test these hypotheses in incredibly unique settings, with really well-studied cohorts that have real-world implications in terms of what we find,” Jagannathan said. “I’m hopeful that the data that’s generated over the new few years will allow us to keep moving forward.”

Jagannathan has been traveling to Uganda for a decade to study malaria. He’s seen firsthand the relentless, gnawing impact the disease has on daily life.

“Before I went to Uganda I really didn’t understand the burden that malaria causes in communities — and it’s just incredible,” he said. His first study was on children aged 5 and under who had on average six episodes of malaria a year.

“They just get it over and over again, and the toll on society is enormous,” he said. The clinics are overwhelmed and a parent or sibling must miss work or school to stay home with that child.

Yet, in highly endemic settings, children eventually develop an immunity that protects against the adverse outcomes from malaria. If he and his colleagues can understand how pregnant women and children develop this clinical immunity to malaria, it could lead to better treatments and preventative strategies.

“If we understand the mechanisms that underlie naturally acquired immunity, that would offer some clues as to how we can develop a vaccine that actually allows either that immunity to occur more quickly or prevents us from developing immunity that allows for the parasite to persist without symptoms,” he said.

There is currently a malaria vaccine undergoing testing in Africa. The vaccine, known as RTS,S, was developed by GlaxoSmithKline and the PATH Malaria Vaccine Initiative, with support from the Bill and Melinda Gates Foundation. Decades in the making, four doses of the vaccine are required to reduce malaria infection in humans.

“It’s a remarkable vaccine in that it’s effective in the beginning, but the problem is that the efficacy wanes very rapidly,” Jagannathan said, noting that some studies show that beyond three years, the effectiveness drops to 15-20 percent.

“That’s the big issue and why people are really interested in trying to find new strategies and new approaches for a next-generation malarial vaccine,” he said. “That’s the overarching aspect of what motivates my work.”