Disease, Food, Energy, & Water Solutions

Food, water, and energy shortages and infectious diseases torment marginalized populations in the developing world. By removing aquatic vegetation from water access points, we can increase open water access needed by villagers and reduce schistosomiasis, a neglected tropical disease caused by snails with >1/10th of the global population at risk. Converting this vegetation to compost or livestock feed significantly increases food production, and using it as fuel in biodigesters offers both fertilizer and cooking gas. Thus, a single intervention has enormous potential to simultaneously and sustainably address food, water, and energy shortages and a rampant infectious disease. To scale this solution in West and East Africa, we use satellite imagery to map locations of this vegetation, machine learning to geographically target this intervention, and cell phone alert systems. There is also potential to mechanize vegetation removal and scale throughout Africa, Southeast Asia, Latin America, and the Caribbean (see https://dfews.nd.edu). 

Food, water, and energy shortages and infectious diseases torment historically marginalized people in the developing world. For example, i) >225 million people are undernourished in Africa, ii) Sub-Saharan Africa loses 40 billion hours per year collecting water, partly because vegetation is choking-out water access points, iii) the World Bank has declared 32 of 48 African nations in an energy crisis, and iv) 75% of deaths in the developing world can be attributable to infectious disease. Our team works to solve food, water, and energy issues and schistosomiasis, the second most socioeconomically burdensome neglected tropical disease globally. Schistosomiasis is caused by snail-transmitted flatworms that penetrate human skin, reinforces poverty, devastates children, and defies control efforts because drug-treated humans quickly get re-infected when they return to snail-infested waterbodies. In Senegal, >99% of snails are captured in Ceratophyllum demersum, an aquatic plant that has a mutualistic relationship with Schistosoma-harboring snails and is found throughout Africa, Southeast Asia, and Latin America where schistosomiasis is endemic. What is needed is a sustainable, local solution with stakeholder commitment to maintain cleared waterways, and a viable scaling plan to reduce schistosomiasis while simultaneously addressing food, water, and energy shortages.

Our solution is elegantly simple. Remove aquatic vegetation quarterly from water access points to remove snail habitat and snails that cause human schistosomiasis. This will increase open water necessary for obtaining water for cooking and washing clothes. Open water can be in shortage because of aquatic plant overgrowth. The next step is to close the nutrient loop, returning aquatic plant biomass fueled by runoff back to food and energy production. To accomplish this, we are assessing the cost-effectiveness of three complementary approaches: 1) convert aquatic vegetation to compost to increase crop yields, 2) feed aquatic vegetation to livestock to increase milk and meat production, and/or 3) use the vegetation to fuel biodigesters that produce fertilizer and gas for cooking or electricity production. Finally, through satellite imagery, we can detect the aquatic vegetation preferred by schistosomiasis-causing snails to target our intervention where it is needed the most. We are also evaluating mechanization approaches to remove aquatic vegetation, incentives for communities to maintain cleared waterways, and cell-phone-alert systems guided by “real-time” remote sensing to inform communities of spatiotemporal risk and need for vegetation removal. 

Targeted Population and Impact: Schistosomiasis and food, water, and energy shortages are everyday problems for hundreds of millions of people in the developing world. We propose to implement our solution in Africa where these problems are most urgent and severe and will worsen given projected population growth. Our targeted population is children, youth, and adults of African descent that are economically disadvantaged and at-risk of schistosomiasis.  Villagers there are intimately aware of these problems as they repeatedly point in sorrow to the swollen bellies of their children, a by-product of both schistosomiasis and undernutrition. Moreover, the WHO recently recommended adding snail control to MDA to control schistosomiasis. Villagers and governments are desperate for a sustainable and easy-to-implement solution to schistosomiasis and food, water, and energy shortages, and we have already built the capacity in Africa to execute and scale our solution. In fact, we have documentation of villagers removing aquatic vegetation and farmers collecting data on and profiting from increased crop yields associated with compost (see video).

Our goal is to reduce poverty and social inequities by providing Africans with self-sustaining skills that will reduce rampant schistosomiasis, improve access to open water, and increase food and energy production. Moreover, to assess equity, we will implement surveys to establish who benefits from our intervention, by how much, and whether benefits vary systematically by gender, landholdings, initial wealth, and other traits. We believe that our solution can have the same positive impacts in Southeast Asia, Latin America and the Caribbean, where similar issues are prevalent.

We will know we are making progress by tracking 1) schistosomiasis prevalence, 2) open water access, 3) crop, milk, livestock, and energy production, and 4) adoption of the intervention. Over five years, we expect to have adoption throughout West Africa and nascent, widespread training and adoption programs in East Africa. We expect these programs to have both deep, intense impacts locally and broad impacts across Africa.  More specifically, our short-term goals are to train villagers in Africa to implement this solution, to test different methods of inducing compliance with ongoing vegetation clearing, and track compliance by quantifying vegetation and open water in their water access points over time. The intermediate goals are to: 1) reduce schistosomiasis by ≥25%, 2) increase open water by ≥75%, 3) increase crop, milk, livestock, and/or energy production and household assets by ≥25%, and 4) have sustained adoption of the intervention. Our long-term goal is to show that reductions in schistosomiasis and increases in water access and food and energy production have improved quality of life. We will implement a widely used quality of life survey (WHO quality-of-life, DHS Wealth-Index, or the World Bank Living-Standard- Measurement survey) before and after our solution is implemented.

Durability for our targeted population: By training Africans to implement our solution, we expect to build capacity throughout Africa, increasing the likelihood of i) durability of our solution through time after funding expires and ii) spread of our solution through space to new villages not targeted by the initial funding. Moreover, our solution is complementary to the typical approach to treating schistosomiasis, which is with mass drug administration (MDA) of praziquantel. MDA can continue in locations that are easy to visit repeatedly, whereas our solution can be employed in more remote schistosomiasis and food-, water-, and energy-shortage hotspots. This further improves durability because the solution is complementary to, rather than competitive with, alternative approaches to addressing these problems.

We are applying technology- and evidence-based solutions that protect Africans—an underserved population and at risk because of their race, ethnicity, and income—from the impacts of disease, food, water and energy issues.  We train villages to remove aquatic vegetation and use it as compost, livestock feed, or fuel for biodigesters to sustainably reduce schistosomiasis and increase open water access, food and energy. Thus, through information campaigns and training, we provide a sustainable solution to reduce disease and poverty in the developing world, addressing both the Health Security & Pandemics and the Resilient Ecosystems Global Challenges.

We conducted a before-after-control-impact clinical trial where we quantified snail abundance, Schistosoma prevalence in snails, water quality, aquatic vegetation removed, and S. haematobium and S. mansoni re-infection rates in schoolchildren (after treatment with praziquantel) of eight aquatic-vegetation-removal villages and eight control villages. Removal of vegetation resulted in a 103-fold reduction in snails, which significantly increased open water access and significantly decreased reinfection rates in schoolchildren a year and two years later.  Some of the removed vegetation was converted to compost, which significantly increased pepper and onion production independent of fertilizer and tilling. The vegetation was also shown to be a suitable livestock feed for sheep and cattle. Trials using the vegetation to fuel biodigesters were postponed due to COVID-19 but are planned. Finally, we have shown that we can use satellite imagery to detect locations of submerged vegetation, allowing us to map potential hotspots for schistosomiasis and thus properly target our intervention.

Schistosomiasis and food, water, and energy shortages have defied solutions for millennia.  Here, we simultaneously address these problems for disadvantaged populations of Africa. Our approach innovatively removes snail-infested vegetation and opens critical waterway access necessary for sustenance of the poor.  This innovation is completely sustainable, because it returns fertilizer that runs off the landscape and is captured in schistosomiasis-causing aquatic plants back to food production by transforming the vegetation into compost or livestock feed or using it to fuel biodigesters that produce both a nutrient amendment for crops and gas that can be used for cooking or electricity production.  Our economist collaborators have demonstrated that the benefits of this innovation far exceed its costs.  This innovation is also scalable because we can use remote sensing technology to locate aquatic vegetation that supports the schistosoma pathogen, thus allowing us to train villagers to implement our innovation where it is needed the most.  Importantly, this innovation enhances health equity and social justice and helps people escape the poverty-disease trap.  Currently, we are working in West Africa, but schistosomiasis and food, energy, and water challenges are problems throughout Africa, Southeast Asia, Latin America, and the Caribbean, and thus the reach of our innovation is vast and the number of people that it could benefit is in the hundreds of millions. In summary, we offer a scalable and sustainable innovation that crosses the sectors of environmental sustainability, human health, health inequities, social justice, food production, energy production, and water access in the developing world.

We are currently serving 16 villages in the St. Louis and Richard Toll regions of northern Senegal.  We have worked in other villages as well, be these are our primary villages currently.  They average approximately 1000 people each.  In the next year, we intend to expand our innovation throughout Senegal, Mauritania, and The Gambia and begin work in Kenya.  We will train people to implement our intervention and encourage them to train others.  Thus, in the next year, we hope to serve two to five times the number of people we are currently serving.  In the next five years, we intend to expand to East Africa as well.  If the innovation spreads, it could benefit millions of people.

We will know we are making progress by tracking 1) schistosomiasis prevalence, 2) open water access, 3) crop, milk, livestock, and energy production, and 4) adoption and spread of the intervention. Over five years, we expect to have adoption throughout West Africa and nascent, widespread training and adoption programs in East Africa. We expect these programs to have both deep, intense impacts locally and broad impacts across Africa.  More specifically, our short-term goals are to train villagers in Africa to implement this solution, to test different methods of inducing compliance with ongoing vegetation clearing, and track compliance by quantifying vegetation and open water in their water access points over time. The intermediate goals are to: 1) reduce schistosomiasis by ≥25%, 2) increase open water by ≥75%, 3) increase crop, milk, livestock, and/or energy production and household assets by ≥25%, and 4) have sustained adoption of the intervention. Our long-term goal is to show that reductions in schistosomiasis and increases in water access and food and energy production have improved quality of life. We will implement a widely used quality of life survey (WHO quality-of-life, DHS Wealth-Index, or the World Bank Living-Standard- Measurement survey) before and after our solution is implemented.  These measurements will allow us to assess progress towards our project's goals, as well as towards UN Sustainable Development Goals.

Approximately 15 full-time employees and 5 part-time employees and contractors as needed.

The University of Notre Dame is partnering with EPLS in Senegal, Cornell University, and FHI (responsible for Monitoring, Evaluation and Learning, ME&L). Our preliminary research was conducted with EPLS, which has a long-standing partnership with the Senegalese Ministry of Health (MoH). Economic and remote sensing work occurred with Chris Barrett, Ying Sun, and T.H. Culhane (biodigester expert). Thus, our team has a history of working together successfully, has complementary skills, and is well positioned to scale our solution. See Sustainability and ME&L plans for details (https://drive.google.com/drive/folders/1-sMapspdwmXOj9r1SU3Rjh8zGuI7zFfB?usp=sharing). All the organizations on this team have a common mission of finding innovative, evidence-based, and environmentally sustainable solutions to disease, poverty, and food, water, and energy shortages experienced by disadvantaged people in the developing world – a mission that draws us all to this work. Our team is uniquely positioned to deliver results because they have worked towards this mission for years. Moreover, we have collected copious data through NIH-funded clinical trials that support the effectiveness of the intervention. We have considerable data demonstrating that remote sensing technology can facilitate scaling this intervention. To estimate economic gains from this intervention and design community incentives to maintain cleared waterways, we work with Barrett who has conducted socioeconomic research on agriculture and poverty in Africa for decades.  Additionally, based on a multidecadal collaboration between Notre Dame and Kenya Medical Research Institute (KEMRI), we are beginning discussions of scaling this work to East Africa.  All partners have been involved in several multimillion-dollar scaling projects in Africa.

Our proposal is designed to target, include, and build capacity within the most marginalized and vulnerable populations in the developing world. Our solution embraces diversity, equity, and inclusion. Our goal is to reduce poverty and social inequities by providing Africans with self-sustaining skills that will reduce rampant schistosomiasis, improve access to open water, and increase food and energy production. Moreover, to assess equity, we will implement surveys to establish who benefits from our intervention, by how much, and whether benefits vary systematically by gender, landholdings, initial wealth, and other traits. We believe that our solution can have the same positive impacts in Southeast Asia, Latin America and the Caribbean, where similar issues are prevalent.

Our team involves a balance of men (Rohr and Barrett) and woman (Sun Bowerman from FHI), religions (most staff in Senegal are Muslim and many staff at Notre Dame are Catholic), and ethnicities (most staff in Africa are black, Rohr is supporting a black PhD in Senegal, Sun is Asian, Riveau is French). Our planned scaling within Africa will employ in-country staff, MoHs, and other government agencies training and empowering local communities. Additionally, we will draw upon an African training program directed by Barrett in collaboration with the African Development Bank (http://barrett.dyson.cornell.edu/staars/). We will hire all sexual orientations and gender identities, religious affiliations, ethnicities, and levels of physical and mental capacities, and will be sure to protect these employees from unfair treatment and discrimination.

We are looking for additional funding opportunities to further increase the scale and scope of our project.  We are also looking for additionally publicity so that more and more scientists and lay individuals are aware of our noble work.  We are also looking for innovative ideas to overcome any unexpected barriers.

We are really looking for additional access to funders and philanthropists that can help increase the scope of our project.  Any increased access to networks of funders and expertise would be valuable.

We could partner with MIT faculty and Solve Members.  We don't have any specifically in mind and they would need to complement the expertise already on the project.  This project is somewhat advanced so there would have to be clear added value by taking on additional partners.