WHAT ARE THE MAJOR GOALS OF THE PROJECT?
B. ACCOMPLISHMENTS
As the grant funding agencies are well aware, the U2R research training grant held by University of Michigan, is closely aligned with the parallel U01 research study grant held by the University of Ghana. In almost all aspects, the research training aims are shared across the two grants. Also, even though the specific aims of the research study proper in the U01 grant are not shared, the Agbogbloshie e-waste study site in Accra, Ghana is intended to provide a setting for high-quality research training in EOH for doctoral and masters students, postdoctoral fellows, and junior faculty from academic institutions of the several participating countries to accelerate thusly the development of a robust West African EOH hub. Thus this study site serves as a critical research training ground for both grants. For these reasons, most of the text and information presented in the U2R and U01 RPPRs are identical—any places where they differ are duly noted.
The broad aims of the core U01 research study are to increase multi-disciplinary understanding of the risks at the Agbogbloshie electronic waste site in central Accra, Ghana, and to use study findings to inform evidence-based implementation activities and policy options at the national, regional, and international levels. The specific scientific goals of this study include: 1) characterize work-related, time-varying, job-specific exposures of 132 electronic waste recycling workers at the Agbogbloshie site as well as 40 'controls' of similar age, gender, ethnicity/culture, and socioeconomic position, residing in an area of greater Accra more than 10 km from Agbogbloshie, and assess repeated measures, at 0-, 12-, and 24-months for each participant, of biological markers of dose, to metals, organic compounds, and markers of combustion products; 2) provide estimates of potentially increased lifetime, work-exposure-associated cancer risks; and, 3) evaluate covariate-adjusted associations of exposures with measures of acute and chronic respiratory morbidity (symptoms and spirometry) in workers.
The major research training goals of the U2R grant, which are shared by the U01 grant, include:
1) organize the approach to the conduct of innovative multidisciplinary scientific research studies with high public health relevance so as to assure the carefully mentored, interactive participation of trainees at various levels (post-docs, doctoral students, etc.) from multiple complementary disciplines in all study stages (conceptualization; design; detailed protocol; data collection, management, and analysis; manuscript preparation);
2) increase sustainable capacity to conduct EOH research in West Africa through:
a. strengthening of existing, and launching of new, Master’s and doctoral EOH research training programs through curriculum sharing, cross-country curriculum development workshops, and consultation by faculty from well-established programs,
b. enhancing training of West African postdoctoral fellows and doctoral students organized into interdisciplinary, inter-country project teams spending 4 months on the UM or McGill campus, followed by 6 months in WA home countries executing research projects,
c. implementing innovations in mentoring and team-building such as having WA senior scientist mentors reside on the UM/McGill campus for the 1st two months the postdoctoral teams are there.
B.2 WHAT WAS ACCOMPLISHED UNDER THESE GOALS?
During the second year of the U01 and U2R grants, outstanding progress was made in meeting the research and research training goals. Most notably, the study of the exposure and health status of Agbogbloshie electronic waste site workers was launched, and the first of three planned rounds of data collection was successfully completed in March/April 2017. As described below, preparation for this successful launch included: a) a series of meetings among the key investigators to finalize the study design, b) intensive on-site pilot work to ensure that all aspects of the study approach and design would reflect “on-the-ground” conditions, c) vigorous engagement with stakeholders and involved workers at the Agbogbloshie site, as well as with stakeholders representing the comparison population in the Madina Zongo area of greater Accra, d) finalization of an innovative exposure assessment plan, e) intensive training of study staff on recruitment strategies, exposure measurement protocols, administration of survey instruments, and collection of health variables. In addition, with respect to the research training aspects of the two parallel grants, three West African PhD students and a postdoctoral fellow were recruited, begin participating in the study design and conduct and receiving intensive research training. Thus far 5 postdocs, 4 doctoral students, and 3 senior mentors from 4 institutions representing 3 West African countries have already been identified and selected for participation in research training activities at the University of Michigan and McGill University, which will be initiated in the third year of the grant.
Meetings to plan and launch the Agbogbloshie study and other grant activities:.
On August 18-19 2016, a planning meeting was held in Ann Arbor (Michigan, USA) to discuss the design and development of the field instruments and refining of study protocols. This meeting brought together key team members of the study team including Tom Robins, Stuart Batterman, and Zoey Laskaris from the University of Michigan (UM), Julius Fobil from the University of Ghana (UG), Nil Basu from McGill University (MU), Marius Kedote from the University of Abomey at Calavi, Cotonou in Benin, and Michelle Heacock from the National Institute of Environmental Health Sciences. The meeting also finalized discussion on the allocation of U01 project funds to participating LMIC institutions; including agreement to develop sub-contracts for the allocations. This meeting was followed up by a usually biweekly series of virtual and in-person project preparatory meetings. Stakeholder and participant buy-in and support of the planned study was further cemented by a formal community entry activity (Durbar) held at Agbogbloshie (Accra, Ghana) on Feb 16, 2017. More than 60 persons from the involved communities (Agbogbloshie and Madina Zongo), representing both influential stakeholders as well as potential study participants, joined us for a 2 hour session in which we introduced the project and fielded questions as well as a demonstrating the wearing of backpacks for personal air sampling [These custom-designed backpacks introduced components of the exposure analysis, which had never been attempted before at the Agbogbloshie site, combining personal air sampling through both collection of dust on filters for laboratory analyses and instantaneous real-time measures with once per minute photographs aligned with the participants gaze (using GoPro cameras ) to better document specific work activities and their potential associations with exposure measures. We believe that the introduction of the backpacks at this event, being ‘modeled’ (worn) by particularly respected members of the Agbogbloshie workforce, played a critical role in the essentially 100% agreement of study participants to wear backpacks during the subsequent first round of data collection, despite their representing additional modest weight for workers doing strenuous work in a typically hot and humid environment]. The Durbar was graced with the presence of local Chiefs, Imams, and key Government representatives (e.g., from the Ghana Health Service, Ministry of Youth and Sports and municipal authorities).
Intensive training of study staff (including doctoral students and postdocs directly supported on the U01 grant). Prior to the launch of the study and the commencement of the fieldwork, members of the North American team came to Accra and worked together with the Ghanaian senior researchers to deliver intensive on-site training in instrumentation (e.g., air sampling devices and spirometry), administration of survey instruments including reaching concurrence on translation from English to Dagbani (a language preferred by many of the study participants) to the local GEOHealth team to help guarantee best practices and data quality assurance. At the same time, this training represented a very practical component of the broader research training of a number of the West African doctoral students and postdocs (as well as participating Masters students) who were selected for direct support under the grant, while also serving as study staff (these directly involved postdocs and students are enumerated further below).
On the agreement that the local team would hold a subsequent meeting with the translators to review the questionnaire to ensure that its wording reflected the local context, the team met to review the final questionnaire and the review comments were sent to Prof. Robins and Ms. Zoey Laskaris, a current doctoral student at the University of Michigan with many years of experience in the conduct of field studies, on Dec 1, 2016 to make final edits and formatting; this producing the version administered in the field. Owing to the relatively informal structure of the work environment at Agbogbloshie, the desire to capture variations in job title and work activities on hourly, daily, and weekly, and monthly time frames, increased the complexity of the survey. Prof. Robins and Ms. Laskaris paid a second training visit to Ghana on Feb 12-19, 2017 to conduct additional training and piloting of the questionnaire, especially with the translators who would be administering the instrument in Dagbani. Also during this visit, Prof. Robins and Ms. Laskaris conducted a follow-up intensive training in spirometry for field studies. This visit overlapped the study launch date on February 16 to ensure cost-effectiveness of the visit. Figures 4-6 show training sessions of both the training in spirometry and survey administration. Figure 4 shows Prof. Robins conducting spirometry training with UG doctoral students (Oct, 2016).
In connection with personal and ambient air quality monitoring, Prof. Stuart Batterman visited University of Ghana on December 16-21, with shipment of backpacks and other equipment for air quality measurement. During this visit, he conducted a 4-day training on the deployment of equipment for personal and ambient environmental air quality sampling. Cages that housed the air monitoring devices were fabricated locally and at the end of the training, the devices were put in the cages, securely locked and deployed on the field for ambient air quality monitoring. The design of the air monitoring program is based on 3 fixed sites; upwind, burning area/recycling and downwind sites. These sites were carefully identified in consultation with the electronic waste workers and prepared for deployment of the air quality monitoring devices. On Feb 18, 2017, we began the deployment of fixed-sites air quality monitoring devices and micro-climate station (see Fig 7). The Agbogbloshie electronic waste recycling area is located between the upwind and downwind sites. The upwind site serves as the control site whiles the downwind site serves as a location exposed to the combustion products from Agbogbloshie electronic wastes site.
Field work and data collection: As of March 13, 2017, we commenced field work in Agbogbloshie and Madina Zongo (the control community) – recruiting subjects, conducting interviews, obtaining blood and urine samples, spirometry, measurement of cardiovascular parameters (blood pressure, SPO2 (peripheral capillary oxygen saturation), heart rate, and ECG) wearing of backpacks for personal air sampling, weight and height measurement, etc. Owing to extensive preparation of the study staff, as well as extensive pre-study interactions with the community stakeholders and potential participants, the field data collection was highly efficient. We obtained informed consent, enrolled participants, and, with the exception of the wearing of personal backpacks, collected all intended field data in less than two weeks (March 13-23, 2017). Because we chose to create only five (5) of the highly instrumented, and thus relatively expensive, backpacks for personal air sampling together with once-per-minute photos, collection of this data required the rest of March, all of April and concluded on May 8, 2017. The participants wore backpacks containing personal air samplers and GoPro cameras for approximately half shift or equivalent (i.e., four hours plus) a day in order to be able to track recycling activities that are associated with specific exposures and which activity generates what exposures. Overall, we recruited and sampled 100 participants at Agbogbloshie and 51 participants at Madina Zongo (total of 151), slightly exceeding our target numbers of 92 and 40, respectively (target total of 132). There were no refusals among those solicited to participate. For each participant we created personal files which, given the relatively unstructured informal sector work setting, in order to be able to successfully re-identify and re-contact, the same participants for the second and third rounds of data collection, included cell phone numbers (owned by the majority of participants) and passport-sized photographs of each participant. During this whole personal data collection timeframe, and still continuing, the fixed-sites air sampling (upwind, in the area used for active burning, downwind) was ongoing in which we sample every sixth day.
During and since the collection of the first round of data, numerous data management activities have been initiated, including data entry, cleaning, and review of preliminary findings to guide any needed adjustments to subsequent data collection methodologies (e.g., review of spirometry tracings for quality assurance). Secure methods for sharing data across the participating institutions have been established and set in operation. Blood and urine samples have been split and properly stored. A first set of such samples have been shipped to North America. Sample analysis plans include a comparison of results obtained in North American laboratories (at UM and McGill) to those obtained in the Ecological Laboratory (EcoLab) in Ghana.
Recruitment of doctoral students, postdocs and Research training: Other parallel project activities included recruitment of PhD students and hiring of postdoctoral fellows and for that matter on October 3, 2016, PhD scholarships were awarded to 3 PhD students, Lawrencia Kwarteng, Sylvia Takyi and Afua Amoabeng, at the University of Ghana - with Emmanuel Blankson subsequently joining the local GEOHealth team as the first UG-based postdoctoral fellow on March 13, 2017. As has been the case in the past, 5 of the strongest M.Sc dissertation research works were selected and awarded modest research support from GEOhealth II research funds this (2016-17) academic year and below is a table listing the names and the corresponding dissertation topics.
M.Sc students supported by GEOHealth II in 2016-17 academic year with thesis topics
| • Araba Aubin Krampah | Pesticide residues in fish and environmental media from a major cocoa growing area in Ghana |
| • Benessa Acquah | Heavy metal exposure via consumption of meat from major abattoirs in the Accra-Tema metropolis |
| • Maxwell Oduro Yeboah | Levels of heavy metals in leachates of mix-wastes obtained from major waste dumps in Accra |
| •Sandra Boatemaa Takyi | An assessment of occupational hazards associated with informal electronic waste processing at Agbogbloshie using an adapted German Standardized Survey Instrument (GSSI) |
| • Yaw Twum Barima | Respiratory health among Ga Kenkey makers in Accra |
Thus far the following individuals have been identified to be supported on the grants and participate in intensive research training at either UM or McGill in Year 3 of the grant.
M.Sc students supported by GEOHealth II in 2016-17 academic year with thesis topics
| Name | Institution | Country |
| • Carl Osei | MoH/Ghana Health Service | Ghana |
| • Comfort Antwi | MoH/Ghana Health Service | Ghana |
| • Edith Clarke | MoH/Ghana Health Service | Ghana |
| • Afua A. Amoabeng | University of Ghana | Ghana |
| • Lawrencia Kwarteng | University of Ghana | Ghana |
| • Sylvia T. Takyi | University of Ghana | Ghana |
| • Emmanuel Blankson | University of Ghana | Ghana |
| • John Arko-Mensah | University of Ghana | Ghana |
| • Nick Harvey Attoh-Toure | Félix Houphouët- Boigny University | Côte d’Ivoire |
| • Gédéon Karel Houessionon | University of Abomey-Calavi (UAC) | Benin |
| • Marius Kedoté | University of Abomey-Calavi (UAC) | Benin |
| • Benjamin Fayomi | University of Abomey-Calavi (UAC) | Benin |
Other achievements: On December 2016, our work was highlighted in the U.S. NIEHS Global Environmental Health Newsletter. The report highlighted capacity building for a regional EOH research in West Africa.
Following that event, in January 2017:
• We formally unveiled our project's logo. This can be seen on our website (http://www.geohealthwestafrica.org)
• We commenced drafting of subcontract agreements between UG and its LMIC partner institutions, which is now complete and funds transferred,
• We began preparation for the launch of study after we had completed the design and production field research instrument.
On April 3, 2017, we started the design and content development of a UG-based website (http://www.geohealthwestafrica.org); which is now 90 percent complete, for the West Africa GEOHealth network. Emmanuel Acquah Baiden serves as the website developer and the web administrator. We hope to launch the UG-hosted West Africa GEOHealth network website soon.
By May 8, 2017, we successfully completed personal air sampling at both sites as well as other field data collection and on May 10, 2017, the local GEOHealth team met to discuss and assign responsibilities for the shipment of samples to North America (University of Michigan and McGill University). The intention to ship the samples was communicated to the North American and at the recommendation of Tom, a bigger Skype meeting of all members of North America and Ghana teams was called on May 15 2017. This meeting discussed the data collected, data entry for the questionnaires and the shipment of samples to North America (University of Michigan and McGill University). The meeting discussed the next activities following shipment of the samples and we agreed to make changes to the timelines for the second round of field data collection, including a plan to modify the structure of spirometry data collection by incorporating before and after work spirometry data to reflect acute respiratory changes due to work activities.
Greater amount of the Skype conference call time was devoted to discussion on the timing and details for visits by doctoral students and postdocs to North America (University of Michigan and McGill University) for 4-month stints of intensive study and further professional training and career development.
E.1 WHAT IS THE IMPACT ON THE DEVELOPMENT OF HUMAN RESOURCES?
The call focus of the funding supporting this project was the overall objective to support the development of institutions in the Low- or Middle-Income Countries (LMICs) that will serve as regional hubs for collaborative research, data management, training, curriculum and outreach material development, and policy support around high priority local, national, and regional environmental and occupational health threats. The progress made in our activities intricately aligns with the call objective by supporting advanced skills training at both master’s and doctoral levels in research skills development, data and project management as well as other advanced academic skills and preparations necessary for products to play indirect active roles in national and regional development by way of its direct impact on institutions and individuals at multiple levels.
At the University of Ghana for example (and at varying numbers of trainees per institution across the participating institutions and countries), a dozen M.Sc graduates have been supported by providing modest dissertation research support, three doctoral students have received full scholarships and a fully supported postdoctoral fellow for advanced training. At the institutional level, the 12 M.Sc graduates are back delivering high quality programmatic and policy activities. The 3 doctoral students are already supporting teaching and research activities in Department and upon completion; plans are mapped up for their retention which will strengthen institutional teaching and research. The postdoctoral fellow is already on course developing an additional and related grant proposal in a direction of establishing independent research career at the individual level and if successful, the alignment of his research with the hub’s activities would provide opportunities for further advanced training. These activities put together, directly feeds into national and regional development when viewed at institutional levels across the participating institutions and countries.
At the community level the participating subjects have built confidence in their recycling activities; although well aware that these livelihood activities are clearly somewhat outlawed by municipal authorities, are now being supported by researchers and by science and the threat of eviction has now been conquered. A feeling of belongingness to the wider society and gradual integration into the society has therefore set in; providing for an opportunity to conduct their livelihood activities without fear many of the poorest urban sub-populations groups in the region.