About

Jade Benjamin-Chung is an Assistant Professor of Epidemiology and Population Health at Stanford University. Her research applies causal inference and machine learning techniques to study interventions aimed at controlling, eliminating, or eradicating environmentally-transmitted infectious diseases, including malaria, diarrhea, soil-transmitted helminths, and influenza. She is a Chan Zuckerberg Biohub Investigator and has received a K01 Career Development Award from the National Institute of Allergy and Infectious Diseases to estimate spillover effects of malaria eradication interventions in southern Africa. Dr. Benjamin-Chung completed her graduate training in epidemiology and biostatistics at UC Berkeley, earning a PhD in Epidemiology in 2014, an MA in Biostatistics in 2013, and an MPH in Epidemiology & Biostatistics in 2008. She joined Stanford University in May 2021.

Selected publications

• Impact of intermittent preventive treatment of malaria in pregnancy with sulfadoxine–pyrimethamine on sexually transmitted and reproductive tract infections: results from a randomized trial in Uganda

  International Journal of Epidemiology · 2026-01-02

  articleOpen access

  BACKGROUND: In sub-Saharan Africa, sexually transmitted and reproductive tract infections (STIs/RTIs) are important but underdiagnosed risk factors for adverse pregnancy outcomes. Sulfadoxine-pyrimethamine (SP), used for the intermittent preventive treatment of malaria in pregnancy (IPTp), may reduce the STI/RTI burden due to its antimicrobial activity. We assessed the impact of IPTp regimens on STI/RTI prevalence and evaluated associations between STIs/RTIs and adverse birth outcomes. METHODS: We conducted a secondary analysis of a randomized-controlled trial comparing monthly IPTp with SP, dihydroartemisinin-piperaquine (DP), or DP+SP among pregnant women in Uganda. Vaginal swabs collected at or near delivery were tested for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Group B Streptococcus (GBS) by using GeneXpert; bacterial vaginosis was assessed by using Nugent scoring. Log-binomial regression was used to compare STI/RTI prevalence between IPTp arms; IPTp-DP served as the reference arm. Multivariable Poisson regression with robust standard errors was used to evaluate associations between infections and preterm delivery, term low birthweight (LBW), overall LBW, and small-for-gestational age. RESULTS: Among the 2265 participants assessed, the IPTp-SP arm had an 80% [95% confidence interval (CI): 67%-88%] lower prevalence of C. trachomatis (2.5% vs 12.4%) and a 35% (95% CI: 1%-57%) lower prevalence of GBS (7.7% vs 11.7%) at delivery compared with the IPTp-DP arm. Chlamydia trachomatis was associated with increased preterm delivery [prevalence ratio (PR) = 1.86, 95% CI: 1.07-3.25] and GBS was associated with increased term LBW (PR = 2.08, 95% CI: 1.06-4.08). CONCLUSION: Monthly IPTp-SP may reduce the risk of adverse birth outcomes through its activity against C. trachomatis and GBS, highlighting its potential non-malarial benefits.

  PublisherOA PDFDOI

• Investigating Cement-Based Surfaces as a Sustainable Flooring Solution to Improve <i>Ascaris</i> Egg Removal and Inactivation in Low-Resource Settings

  bioRxiv (Cold Spring Harbor Laboratory) · 2025-02-21

  preprintOpen accessSenior author

  Abstract Soil-transmitted helminths, like Ascaris , are significant contributors to disease burden in low- and middle-income countries (LMICs). Infections are associated with growth faltering and mortality in children and are often transmitted through contact with eggs in fecally contaminated soil. Interventions, like replacing household soil floors with cement-based alternatives, may reduce exposure to Ascaris eggs, but there are currently no estimates on the removal or survival of Ascaris eggs on cement-based surfaces. This study addresses that knowledge gap by evaluating the removal of Ascaris eggs from mopping and the survival of Ascaris eggs on two cement-based mixes: an Ordinary Portland Cement (OPC) mortar and an OPC mortar with fly ash, which provides a more sustainable alternative to the OPC mortar mix. We assessed egg survival at two temperatures representing the dry (15°C) and wet (34°C) seasons in Bangladesh using two different egg enumeration methods. After mopping, over 92% of viable eggs were removed from surfaces, with no significant differences between cement-based mixes (p = 0.51). The first-order decay rate constants ( k ) of Ascaris eggs were similar between mix designs (p = 0.62) but varied significantly between temperatures (p = 4.2 x 10 -25 ) and egg enumeration methods (p = 2.4 x 10 -8 ). The k values were of greater magnitude at 34°C compared to at 15°C. At 15°C, k values were not significantly different from zero, indicating no inactivation. The k values we obtained were comparable to those reported in previous studies for different matrices, indicating comparable inactivation of Ascaris eggs on cement-based surfaces compared to liquid and semi-solid matrices. These results provide some of the first estimates of removal efficiencies and inactivation times in realistic environmental conditions for Ascaris on surfaces while supporting the use of OPC mortar mix designs with fly ash in interventions to reduce Ascaris transmission in rural LMIC households. Author Summary Soil-transmitted helminths, like Ascaris , are parasites that are major contributors to disease in children and women of childbearing age in low- and middle-income countries. Interventions, like replacing soil floors in households with cement-based flooring, may reduce exposure to Ascaris eggs which cause infections, but there is little information on how or why these interventions may be effective. This study investigates the effectiveness of simple cleaning methods, like mopping, in removing Ascaris eggs from cement-based surfaces and explores how long these eggs can survive on these surfaces under different environmental conditions. We tested two types of cement-based surfaces, a traditional cement-based mortar mix, and a more sustainable cement-based mortar mix, and found that mopping removed over 92% of Ascaris eggs, with no differences between cement mixes. Experiments simulating wet and dry seasonal conditions showed that Ascaris eggs survive longer in cooler environments, again with no differences between cement mixes. These findings provide important insights into the role of cement-based flooring in interrupting disease transmission and suggest sustainable cement-based mortar mixes are a feasible alternative to traditional cement-based mortar mixes.

  PublisherDOI

• Evaluating the survival and removal of <i>Escherichia coli</i> from surfaces made with traditional and sustainable cement-based materials in field-relevant conditions

  Applied and Environmental Microbiology · 2025-03-10 · 1 citations

  articleOpen accessSenior author

  ABSTRACT Soil household floors are common in low- and middle-income countries (LMICs) and can serve as reservoirs of enteric pathogens. Cement-based floors may interrupt pathogen transmission, but little is known about pathogen survival or removal from cement-based surfaces. This study investigated the survival of Escherichia coli , an indicator of fecal contamination, on cement-based surfaces and evaluated its reduction through common household activities (mopping, sweeping, and walking). We compared E. coli fate on three mixes: (i) ordinary Portland cement (OPC) concrete (used in the United States), (ii) OPC mortar (used in Bangladesh), and (iii) OPC mortar with fly ash (a sustainable alternative to the Bangladesh mix). Additionally, we compared outcomes on cement-based surfaces with and without soil and at two temperatures representing the dry and wet seasons in Bangladesh. After 4 hours on the cement-based surfaces, E. coli decayed more than 1.1 log 10 ( C / C o ) under all conditions tested, which is significantly faster than in bulk soils. The higher temperature increased the decay rate constant ( P = 5.56 × 10 −8 ) while soil presence decreased it ( P = 2.80 × 10 −6 ). Sweeping and mopping resulted in high levels of removal for all mixes, with a mean removal of 71% and 78%, respectively, versus 22% for walking. The concrete and mortar mix designs did not impact E. coli survival or removal ( P &gt; 0.20). Cement-based floors made with a fly ash mix performed similarly to traditional cement-based floors, supporting their potential use as a more sustainable intervention to reduce fecal contamination in rural LMIC household settings. IMPORTANCE Cement-based surfaces may serve as a health intervention to reduce the fecal-oral transmission of pathogens in household settings, but there is a critical lack of evidence about the fate of indicator organisms on these surfaces, especially in field-relevant conditions. This study provides some of the first insights into Escherichia coli survival on cement-based surfaces and the effectiveness of daily activities for removing E. coli . Additionally, this study explores the fate of E. coli on cement-based surfaces made with fly ash (which contributes fewer CO 2 emissions) versus traditional cement mixes. We found that E. coli had similar survival and removal efficiencies across all mix designs, demonstrating that fly ash mixes are feasible for use in household settings (e.g., in floors). The findings enhance understanding of fecal-oral transmission pathways and support the use of fly ash mixes in cement-based flooring in future epidemiologic studies assessing effects on enteric disease burdens.

  PublisherDOI

• Investigating cement-based surfaces as a sustainable flooring solution to improve Ascaris Suum egg removal and inactivation in low-resource settings

  PLoS neglected tropical diseases · 2025-10-23

  articleOpen accessSenior authorCorresponding

  Soil-transmitted helminths, like Ascaris lumbricoides, are significant contributors to disease burden in low- and middle-income countries (LMICs). Infections are associated with morbidity and mortality in children and are often transmitted through eggs in fecally contaminated soil. Interventions, like replacing household soil floors with cement-based alternatives, may reduce exposure to A. lumbricoides eggs, but there are currently no estimates on the removal or survival of Ascaris species eggs on cement-based surfaces. This study addresses that knowledge gap by evaluating the removal of Ascaris suum eggs from mopping and the survival of A. suum eggs on two cement-based mixes: an traditional mortar and a mortar with fly ash, which provides a more sustainable alternative to the traditional mortar mix. We assessed egg survival at two temperatures representing the dry (15°C) and wet (34°C) seasons in Bangladesh using two different egg enumeration methods. After mopping, a mean of 95.6% (SD = 4.0%) of viable eggs were removed from surfaces, with no significant differences between cement-based mixes (p = 0.51). The mean first-order decay rate constants (k) of A. suum eggs across all conditions was 0.029 day-1 (SD = 0.074 day-1). Values of k were similar between mix designs (p = 0.62) but varied significantly between temperatures (p = 4.2x10-25) and egg enumeration methods (p = 2.4x10-8). The k values were greater at 34°C compared to at 15°C, where they showed no significant inactivation. Our k values were comparable to those reported previously for different matrices, indicating comparable inactivation of Ascaris species eggs on cement-based surfaces compared to liquid and semi-solid matrices. These results provide some of the first estimates of removal efficiencies and decay rate constants in realistic environmental conditions for Ascaris species on surfaces while supporting the use of mortar mix designs with fly ash in interventions to reduce Ascaris species transmission in rural LMIC households.

  PublisherDOI

• Effects of household concrete floors on maternal and child health: the CRADLE trial – a randomised controlled trial protocol

  BMJ Open · 2025-03-01 · 4 citations

  articleOpen accessSenior authorCorresponding

  Introduction Early life soil-transmitted helminth (STH) infection and diarrhoea are associated with growth faltering, anaemia, impaired child development and mortality. Exposure to faecally contaminated soil inside the home may be a key contributor to enteric infections, and a large fraction of rural homes in low-income countries have soil floors. The objective of this study is to measure the effect of installing concrete floors in homes with soil floors on child STH infection and other maternal and child health outcomes in rural Bangladesh. Methods and analysis The Cement-based flooRs AnD chiLd hEalth trial is an individually randomised trial in Sirajganj and Tangail districts, Bangladesh. Households with a pregnant woman, a soil floor, walls that are not made of mud and no plan to relocate for 3 years will be eligible. We will randomise 800 households to intervention or control (1:1) within geographical blocks of 10 households to account for strong geographical clustering of enteric infection. Laboratory staff and data analysts will be blinded; participants will be unblinded. We will instal concrete floors when the birth cohort is in utero and measure outcomes at child ages 3, 6, 12, 18 and 24 months. The primary outcome is prevalence of any STH infection ( Ascaris lumbricoides , Necator americanus or Trichuris trichiura ) detected by quantitative PCR at 6, 12, 18 or 24 months follow-up in the birth cohort. Secondary outcomes include household floor and child hand contamination with Escherichia coli , extended-spectrum beta-lactamase producing E. coli and STH DNA; child diarrhoea, growth and cognitive development; and maternal stress and depression. Ethics and dissemination Study protocols have been approved by institutional review boards at Stanford University and the International Centre for Diarrheal Disease Research, Bangladesh. We will report findings on ClinicalTrials.gov, in peer-reviewed publications and in stakeholder workshops in Bangladesh. Trial registration number NCT05372068 .

  PublisherOA PDFDOI

• Associations between floor material and E. coli contamination in rural Bangladeshi households

  International Journal of Hygiene and Environmental Health · 2025-07-29 · 1 citations

  articleOpen access

  BACKGROUND: Soil floors are common in low-income countries and can harbor contamination from fecal waste. Soil/dust ingestion from floors or indirectly via hands, water and food can contribute to children's ingestion of fecal organisms. We assessed if finished (e.g., concrete) floors are associated with lower E. coli contamination in the domestic environment in rural Bangladesh. METHODS: We collected samples from 1864 households over 3.5 years, including stored drinking water, child and caregiver hand rinses, courtyard soil, food, and flies (n = 24,118 samples), and enumerated E. coli using IDEXX Quanti-Tray/2000. RESULTS: Controlling for socio-demographics, water/sanitation status, and animal ownership, households with finished floors had slightly lower log10-transformed E. coli counts (Δlog10 = -0.10 (-0.20, 0.00)) and prevalence (prevalence ratio [PR] = 0.90 (0.83, 0.98)) on child hands than households with soil floors; floor material was not associated with contamination levels in other sample types. In subgroup analyses, finished floors were associated with lower E. coli on child hands following heavy rainfall (Δlog10 = -0.23 (-0.39, -0.07)), above-median temperature (Δlog10 = -0.18 (-0.30, -0.06)), and in households with more domestic animals (Δlog10 = -0.16 (-0.32, -0.01)). Finished floors were also associated with slightly lower contamination of stored water following heavy rainfall (PR = 0.89 (0.81, 0.99)) and above-median temperature (PR = 0.91 (0.84, 0.98)), and lower contamination of stored food following higher rainfall and temperature but the associations for food were not statistically significant. DISCUSSION: Measures to control enteric infections in low-income countries should test flooring improvements to reduce exposure to fecal contamination.

  PublisherDOI

• A framework for guiding integrated disease control measures through multipathogen surveillance

  medRxiv · 2025-11-04

  preprintOpen access

  Global health programs have traditionally focused on single diseases. There is potential for synergy through integrated intervention delivery, particularly in areas with overlapping geographic disease burden, but there is limited methodology developed for assessing potential efficiency gains through integration. Here, we applied a measure of diversity, Rao's quadratic index, to quantify multipathogen burden across two large-scale surveys: Bangladesh (90 clusters, 2,396 children) and Cambodia (100 clusters, 2,150 women). In both settings, we observed geographic clustering of multiple pathogens, indicating potential for more efficient, integrated disease control strategies. We assessed the efficiency of a multipathogen-targeted strategy compared to traditional single-pathogen approaches by calculating the percent reduction in the number of spatial clusters needed to reach 75% of the disease burden (infections or unvaccinated individuals) in a hypothetical intervention. In Bangladesh, integrating deworming with measles vaccination guided by Rao's quadratic index improved efficiency by 15% for Ascaris lumbricoides, 31% for hookworm, and 38% for Trichuris trichiura, compared to a measles-focused approach. In Cambodia, a Rao-guided strategy performed similarly to the best single-pathogen strategy for Strongyloides stercoralis, and reduced the number of spatial clusters that would need to be targeted by 57% (lymphatic filariasis), 83% (Plasmodium falciparum), and 59% (Plasmodium vivax). We also found that higher multipathogen burden was significantly associated with lower household wealth, suggesting that Rao-guided strategies may be more effective in reaching under-resourced populations. These findings support the use of multipathogen burden metrics to guide integrated program delivery, offering potential for greater efficiency in disease control.

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• Characterisation of between-cluster heterogeneity in malaria cluster randomised trials to inform future sample size calculations

  Nature Communications · 2025-07-18 · 2 citations

  reviewOpen access

  Cluster randomised trials (CRTs) are important tools for evaluating the community-wide effect of malaria interventions. During the design stage, CRT sample sizes need to be inflated to account for the cluster heterogeneity in measured outcomes. The coefficient of variation (k), a measure of such heterogeneity, is typically used in malaria CRTs yet is often predicted without prior data. Underestimation of k decreases study power, thus increases the probability of generating null results. In this meta-analysis of cluster-summary data from 24 malaria CRTs, we calculate true prevalence and incidence k values using methods-of-moments and regression modelling approaches. Using random effects regression modelling, we investigate the impact of empirical k values on original trial power and explore factors associated with elevated k. Results show empirical estimates of k often exceed those used in sample size calculations, which reduces study power and effect size precision. Elevated k values are associated with incidence outcomes (compared to prevalence), lower endemicity settings, and uneven intervention coverage across clusters. Study findings can enhance the robustness of future malaria CRT sample size calculations by providing informed k estimates based on expected prevalence or incidence, in the absence of cluster-level data.

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• Associations Between Intimate Partner Violence, Depression, Perceived Stress, and Child Growth

  Current Developments in Nutrition · 2025-05-01

  articleOpen access

  Fortification and Biofortification Meal/Menu, and Food Group Diversity Meal/Menu).The purpose of this study was to validate benchmarks for these metrics and sub-metrics.Methods: The validation of the GDQS-Meal and Menu benchmarks included identifying school meal/menu data from five countries; tabulating the GDQS-Meal and Menu metrics for each of the meals/menus for three age groups (24-59 months, 5-9 years, 10-14 years); matching food items in the school meal/ menu data with energy and 11 critical nutrients of public health concern; comparing the nutrient levels of the meals/menus with the recommended meal/menu amount for each nutrient; calculating nutrient ratios to compare the nutrient level provided in each meal/menu to the recommended amount for each nutrient (1/3 of age-and sex-specific Recommended Dietary Allowances); and comparing the set of nutrient ratios to the GDQS-Meal and Menu scores and benchmarks.Results: The results from the validation analyses show that across the meals and menus analyzed the proposed benchmarks meaningfully discriminate between meals and menus that are of lower and higher nutritional quality.Results were consistent across the 5-9-and 10-14-year age groups for all metrics and submetrics.Limited data for the 24-59-month age group precluded robust analyses but indicated validity for the Fortification and Biofortification Meal/Menu sub-metric.Conclusions: The results from the validation study suggest that the GDQS-Meal and Menu benchmarks provide an objective measure by which to evaluate the nutritional quality of school meals and menus comparably over time, across schools, contexts, and countries.The benchmarks provide interpretable cut-points on which to make decisions for improving the quality of the meals and menus in institutional settings.

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• Healthy homes: Stakeholder perspectives on housing interventions to reduce environmentally mediated infections

  PLOS Global Public Health · 2025-04-21 · 3 citations

  articleOpen accessSenior author

  Housing conditions are intrinsically linked to human health, with inadequate housing potentially increasing exposure to environmentally mediated pathogens. Beyond efforts to improve water and sanitation and reduce household air pollution, housing improvements remain relatively under-explored as health interventions. This study explored facilitators of and barriers to funding, implementing, and scaling up of housing improvements as health interventions to reduce environmentally mediated infectious diseases. Sixteen key informants (KIs) with direct experience conducting housing interventions with a goal to reduce environmentally mediated infectious diseases in low- and middle-income countries were interviewed using a semi-structured interview format. KIs had diverse backgrounds, including academics researching housing interventions, housing policy advisors, and practitioners implementing housing interventions. A thematic analysis approach was used to identify key themes in interview transcripts, highlighting patterns, commonalities, and variations in participants' responses. KIs emphasized that housing interventions can deliver across a broad set of health outcomes, including physical and mental health, as well as environmental, social, and economic dimensions. Funding and financial mechanisms to address housing interventions were highlighted as key barriers, alongside the need to provide more rigorous evidence and cost-benefit analyses for housing interventions. KIs indicated that funding limitations were likely driven by a deficiency in awareness regarding the significance of housing among decision-makers, and suggested that efforts are needed to foster more intersectoral collaboration. The interviews also revealed a need for more context-specific housing policies and a need to contextualize interventions to their specific setting in order to foster community involvement and successful implementation and scale-up. Housing interventions play a pivotal role in mitigating many environmentally mediated diseases. By integrating these interventions with existing programs, such as water and sanitation or efforts to reduce household air pollution, there is the potential to create a more comprehensive approach to healthy housing in the face of climate change.

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Awards & honors

• Chan Zuckerberg Biohub Investigator
• K01 Career Development Award from the National Institute of…