| 21. |
- Fottrell, Edward, et al.
(author)
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Probabilistic methods for verbal autopsy interpretation : InterVA robustness in relation to variations in a priori probabilities
- 2011
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In: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 6:11, s. e27200-
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Journal article (peer-reviewed)abstract
- Background: InterVA is a probabilistic method for interpreting verbal autopsy (VA) data. It uses a priori approximations of probabilities relating to diseases and symptoms to calculate the probability of specific causes of death given reported symptoms recorded in a VA interview. The extent to which InterVA's ability to characterise a population's mortality composition might be sensitive to variations in these a priori probabilities was investigated.Methods: A priori InterVA probabilities were changed by 1, 2 or 3 steps on the logarithmic scale on which the original probabilities were based. These changes were made to a random selection of 25% and 50% of the original probabilities, giving six model variants. A random sample of 1,000 VAs from South Africa, were used as a basis for experimentation and were processed using the original InterVA model and 20 random instances of each of the six InterVA model variants. Rank order of cause of death and cause-specific mortality fractions (CSMFs) from the original InterVA model and the mean, maximum and minimum results from the 20 randomly modified InterVA models for each of the six variants were compared.Results: CSMFs were functionally similar between the original InterVA model and the models with modified a priori probabilities such that even the CSMFs based on the InterVA model with the greatest degree of variation in the a priori probabilities would not lead to substantially different public health conclusions. The rank order of causes were also similar between all versions of InterVA.Conclusion: InterVA is a robust model for interpreting VA data and even relatively large variations in a priori probabilities do not affect InterVA-derived results to a great degree. The original physician-derived a priori probabilities are likely to be sufficient for the global application of InterVA in settings without routine death certification.
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| 22. |
- Fottrell, Edward, et al.
(author)
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Revealing the burden of maternal mortality : a probabilistic model for determining pregnancy-related causes of death from verbal autopsies
- 2007
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In: Population Health Metrics. - : BioMed Central (BMC). - 1478-7954. ; 5:1
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Journal article (peer-reviewed)abstract
- Background: Substantial reductions in maternal mortality are called for in Millennium Development Goal 5 (MDG-5), thus assuming that maternal mortality is measurable. A key difficulty is attributing causes of death for the many women who die unaided in developing countries. Verbal autopsy (VA) can elicit circumstances of death, but data need to be interpreted reliably and consistently to serve as global indicators. Recent developments in probabilistic modelling of VA interpretation are adapted and assessed here for the specific circumstances of pregnancy-related death.Methods: A preliminary version of the InterVA-M probabilistic VA interpretation model was developed and refined with adult female VA data from several sources, and then assessed against 258 additional VA interviews from Burkina Faso. Likely causes of death produced by the model were compared with causes previously determined by local physicians. Distinction was made between free-text and closed-question data in the VA interviews, to assess the added value of free-text material on the model's output.Results: Following rationalisation between the model and physician interpretations, cause-specific mortality fractions were broadly similar. Case-by-case agreement between the model and any of the reviewing physicians reached approximately 60%, rising to approximately 80% when cases with a discrepancy were reviewed by an additional physician. Cardiovascular disease and malaria showed the largest differences between the methods, and the attribution of infections related to pregnancy also varied. The model estimated 30% of deaths to be pregnancy-related, of which half were due to direct causes. Data derived from free-text made no appreciable difference.Conclusion: InterVA-M represents a potentially valuable new tool for measuring maternal mortality in an efficient, consistent and standardised way. Further development, refinement and validation are planned. It could become a routine tool in research and service settings where levels and changes in pregnancy-related deaths need to be measured, for example in assessing progress towards MDG-5.
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| 23. |
- Fottrell, Edward, et al.
(author)
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Risk of psychological distress following severe obstetric complications in Benin : the role of economics, physical health and spousal abuse
- 2010
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In: British Journal of Psychiatry. - : Royal College of Psychiatrists. - 0007-1250 .- 1472-1465. ; 196:1, s. 18-25
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Journal article (peer-reviewed)abstract
- BACKGROUND: Little is known about the impact of life-threatening obstetric complications ('near miss') on women's mental health in low- and middle-income countries.AIMS: To examine the relationships between near miss and postpartum psychological distress in the Republic of Benin. METHOD: One-year prospective cohort using epidemiological and ethnographic techniques in a population of women delivering at health facilities.RESULTS: In total 694 women contributed to the study. Except when associated with perinatal death, near-miss events were not associated with greater risk of psychological distress in the 12 months postpartum compared with uncomplicated childbirth. Much of the direct effect of near miss with perinatal death on increased risk of psychological distress was shown to be mediated through wider consequences of traumatic childbirth.CONCLUSIONS: A live baby protects near-miss women from increased vulnerability by giving a positive element in their lives that helps them cope and reduces their risk of psychological distress. Near-miss women with perinatal death should be targeted early postpartum to prevent or treat the development of depressive symptoms.
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| 24. |
- Fottrell, Edward, et al.
(author)
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Sickle Cell Anaemia in a Changing World
- 2013
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In: PLoS Medicine. - : Public Library of Science (PLoS). - 1549-1277 .- 1549-1676. ; 10:7, s. e1001483-
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Journal article (other academic/artistic)
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| 25. |
- Fottrell, Edward, et al.
(author)
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The distribution and effects of child mortality risk factors in Ethiopia : a comparison of estimates from DSS and DHS
- 2009
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In: Ethiopian Journal of Health Development. - : Ethiopian Public Health Association. - 1021-6790 .- 2309-7388. ; 23:2, s. 163-168
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Journal article (peer-reviewed)abstract
- Objectives: To conduct a comparative analysis of the distribution and effects of under-five mortality correlates using Demographic and Health Survey (DHS) and Demographic Surveillance System (DSS) data from Ethiopia, and to investigate the methodological bias in DHS-based childhood mortality rates due to the impossibility of including children whose mothers were deceased.Methods: Using all-cause under-5 mortality as an outcome variable, the distribution and effects of risk factors were modeled using survival analysis. All live births in rural Ethiopia in the 5-year period before the 2005 DSS+ survey and between 01/01/2000 and 31/12/2004 in the DSS in the Butajira Rural Health Program (in the Southern Nations, Nationalities, and People's (SNNP) region of Ethiopia) were included.Results: Overall, similar estimates of hazard rate ratios were derived from both DHS and DSS data and the child mortality risk profile is similar between each data source, with multiple births and living in less populous households being significant risk factors for under-five mortality. Nevertheless, some notable differences were observed. The DSS data was more sensitive to local variations in population composition and health status, whilst the more dispersed DHS approach tended to average out local variation across the country. Excluding children whose mothers were deceased from the DSS analysis had no important effect on risk profiles or estimates of survival functions at age 5 years. DHS survival functions were somewhat lower than DSS estimates (BRHP=0.87, DHS rural Ethiopia=0.67, DHS SNNP=0.66).Conclusion: Despite differing methodologies, cross-sectional DHS and longitudinal DSS data produce estimates of the distribution and effects of under-five mortality risk factors that are broadly similar. The differing methodological characteristics of DHS and DSS mean that when combined, these two data sources have the potential to provide a comprehensive picture of national population composition and health status as well as the extent of local variation both of which are important for health monitoring and planning.
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| 26. |
- Fottrell, Edward, et al.
(author)
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The effect of increased coverage of participatory women's groups on neonatal mortality in Bangladesh : A cluster randomized trial
- 2013
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In: JAMA pediatrics. - : American Medical Association. - 2168-6211 .- 2168-6203. ; 167:9, s. 816-25
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Journal article (peer-reviewed)abstract
- IMPORTANCE: Community-based interventions can reduce neonatal mortality when health systems are weak. Population coverage of target groups may be an important determinant of their effect on behavior and mortality. A women's group trial at coverage of 1 group per 1414 population in rural Bangladesh showed no effect on neonatal mortality, despite a similar intervention having a significant effect on neonatal and maternal death in comparable settings.OBJECTIVE: To assess the effect of a participatory women's group intervention with higher population coverage on neonatal mortality in Bangladesh.DESIGN: A cluster randomized controlled trial in 9 intervention and 9 control clusters.SETTING: Rural Bangladesh.PARTICIPANTS: Women permanently residing in 18 unions in 3 districts and accounting for 19 301 births during the final 24 months of the intervention.INTERVENTIONS: Women's groups at a coverage of 1 per 309 population that proceed through a participatory learning and action cycle in which they prioritize issues that affected maternal and neonatal health and design and implement strategies to address these issues.MAIN OUTCOMES AND MEASURES: Neonatal mortality rate.RESULTS: Analysis included 19 301 births during the final 24 months of the intervention. More than one-third of newly pregnant women joined the groups. The neonatal mortality rate was significantly lower in the intervention arm (21.3 neonatal deaths per 1000 live births vs 30.1 per 1000 in control areas), a reduction in neonatal mortality of 38% (risk ratio, 0.62 [95% CI, 0.43-0.89]) when adjusted for socioeconomic factors. The cost-effectiveness was US $220 to $393 per year of life lost averted. Cause-specific mortality rates suggest reduced deaths due to infections and those associated with prematurity/low birth weight. Improvements were seen in hygienic home delivery practices, newborn thermal care, and breastfeeding practices.CONCLUSIONS AND RELEVANCE: Women's group community mobilization, delivered at adequate population coverage, is a highly cost-effective approach to improve newborn survival and health behavior indicators in rural Bangladesh.TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN01805825.
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| 27. |
- Fottrell, Edward, et al.
(author)
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The epidemiology of 'bewitchment' as a lay-reported cause of death in rural South Africa
- 2012
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In: Journal of Epidemiology and Community Health. - : BMJ Publishing Group. - 0143-005X .- 1470-2738. ; 66:8, s. 704-709
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Journal article (peer-reviewed)abstract
- Background Cases of premature death in Africa may be attributed to witchcraft. In such settings, medical registration of causes of death is rare. To fill this gap, verbal autopsy (VA) methods record signs and symptoms of the deceased before death as well as lay opinion regarding the cause of death; this information is then interpreted to derive a medical cause of death. In the Agincourt Health and Demographic Surveillance Site, South Africa, around 6% of deaths are believed to be due to ‘bewitchment’ by VA respondents.Methods Using 6874 deaths from the Agincourt Health and Socio-Demographic Surveillance System, the epidemiology of deaths reported as bewitchment was explored, and using medical causes of death derived from VA, the association between perceptions of witchcraft and biomedical causes of death was investigated.Results The odds of having one's death reported as being due to bewitchment is significantly higher in children and reproductive-aged women (but not in men) than in older adults. Similarly, sudden deaths or those following an acute illness, deaths occurring before 2001 and those where traditional healthcare was sought are more likely to be reported as being due to bewitchment. Compared with all other deaths, deaths due to external causes are significantly less likely to be attributed to bewitchment, while maternal deaths are significantly more likely to be.Conclusions Understanding how societies interpret the essential factors that affect their health and how health seeking is influenced by local notions and perceived aetiologies of illness and death could better inform sustainable interventions and health promotion efforts.
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| 28. |
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| 29. |
- Fottrell, Edward, et al.
(author)
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Verbal autopsy : methods in transition
- 2010
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In: Epidemiologic reviews. - : Oxford University Press (OUP). - 0193-936X .- 1478-6729. ; 32:1, s. 38-55
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Journal article (peer-reviewed)abstract
- Understanding of global health and changing morbidity and mortality is limited by inadequate measurement of population health. With fewer than one-third of deaths worldwide being assigned a cause, this long-standing dearth of information, almost exclusively in the world's poorest countries, hinders understanding of population health and limits opportunities for planning, monitoring, and evaluating interventions. In the absence of routine death registration, verbal autopsy (VA) methods are used to derive probable causes of death. Much effort has been put into refining the approach for specific purposes; however, there has been a lack of harmony regarding such efforts. Subsequently, a variety of methods and principles have been developed, often focusing on a single aspect of VA, and the resulting literature provides an inconsistent picture. By reviewing methodological and conceptual issues in VA, it is evident that VA cannot be reduced to a single one-size-fits-all tool. VA must be contextualized; given the lack of "gold standards," methodological developments should not be considered in terms of absolute validity but rather in terms of consistency, comparability, and adequacy for the intended purpose. There is an urgent need for clarified thinking about the overall objectives of population-level cause-of-death measurement and harmonized efforts in empirical methodological research.
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| 30. |
- Hall, Charles S, et al.
(author)
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Assessing the impact of mHealth interventions in low- and middle-income countries : what has been shown to work?
- 2014
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In: Global Health Action. - Rockville Pike, Bethesda MD, USA : National Center for Biotechnology Information,U.S. National Library of Medicine. - 1654-9716 .- 1654-9880. ; 7, s. 1-12
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Research review (peer-reviewed)abstract
- BACKGROUND: Low-cost mobile devices, such as mobile phones, tablets, and personal digital assistants, which can access voice and data services, have revolutionised access to information and communication technology worldwide. These devices have a major impact on many aspects of people's lives, from business and education to health. This paper reviews the current evidence on the specific impacts of mobile technologies on tangible health outcomes (mHealth) in low- and middle-income countries (LMICs), from the perspectives of various stakeholders.DESIGN: Comprehensive literature searches were undertaken using key medical subject heading search terms on PubMed, Google Scholar, and grey literature sources. Analysis of 676 publications retrieved from the search was undertaken based on key inclusion criteria, resulting in a set of 76 papers for detailed review. The impacts of mHealth interventions reported in these papers were categorised into common mHealth applications.RESULTS: There is a growing evidence base for the efficacy of mHealth interventions in LMICs, particularly in improving treatment adherence, appointment compliance, data gathering, and developing support networks for health workers. However, the quantity and quality of the evidence is still limited in many respects.CONCLUSIONS: Over all application areas, there remains a need to take small pilot studies to full scale, enabling more rigorous experimental and quasi-experimental studies to be undertaken in order to strengthen the evidence base.
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