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Haeuser E, Nguyen JQ, Rolfe S, Nesbit O, Fullman N, Mosser JF. Assessing Geographic Overlap between Zero-Dose Diphtheria–Tetanus–Pertussis Vaccination Prevalence and Other Health Indicators. Vaccines (Basel) 2023; 11:vaccines11040802. [PMID: 37112714 PMCID: PMC10144604 DOI: 10.3390/vaccines11040802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/17/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023] Open
Abstract
The integration of immunization with other essential health services is among the strategic priorities of the Immunization Agenda 2030 and has the potential to improve the effectiveness, efficiency, and equity of health service delivery. This study aims to evaluate the degree of spatial overlap between the prevalence of children who have never received a dose of the diphtheria–tetanus–pertussis-containing vaccine (no-DTP) and other health-related indicators, to provide insight into the potential for joint geographic targeting of integrated service delivery efforts. Using geospatially modeled estimates of vaccine coverage and comparator indicators, we develop a framework to delineate and compare areas of high overlap across indicators, both within and between countries, and based upon both counts and prevalence. We derive summary metrics of spatial overlap to facilitate comparison between countries and indicators and over time. As an example, we apply this suite of analyses to five countries—Nigeria, Democratic Republic of the Congo (DRC), Indonesia, Ethiopia, and Angola—and five comparator indicators—children with stunting, under-5 mortality, children missing doses of oral rehydration therapy, prevalence of lymphatic filariasis, and insecticide-treated bed net coverage. Our results demonstrate substantial heterogeneity in the geographic overlap both within and between countries. These results provide a framework to assess the potential for joint geographic targeting of interventions, supporting efforts to ensure that all people, regardless of location, can benefit from vaccines and other essential health services.
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Affiliation(s)
- Emily Haeuser
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98195, USA
| | - Jason Q. Nguyen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98195, USA
| | - Sam Rolfe
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98195, USA
| | - Olivia Nesbit
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98195, USA
| | - Nancy Fullman
- Department of Global Health, School of Medicine and School of Public Health, University of Washington, Seattle, WA 98195, USA
| | - Jonathan F. Mosser
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98195, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA 98195, USA
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2
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Macharia PM, Joseph NK, Sartorius B, Snow RW, Okiro EA. Subnational estimates of factors associated with under-five mortality in Kenya: a spatio-temporal analysis, 1993-2014. BMJ Glob Health 2021; 6:e004544. [PMID: 33858833 PMCID: PMC8054106 DOI: 10.1136/bmjgh-2020-004544] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To improve child survival, it is necessary to describe and understand the spatial and temporal variation of factors associated with child survival beyond national aggregates, anchored at decentralised health planning units. Therefore, we aimed to provide subnational estimates of factors associated with child survival while elucidating areas of progress, stagnation and decline in Kenya. METHODS Twenty household surveys and three population censuses conducted since 1989 were assembled and spatially aligned to 47 subnational Kenyan county boundaries. Bayesian spatio-temporal Gaussian process regression models accounting for inadequate sample size and spatio-temporal relatedness were fitted for 43 factors at county level between 1993 and 2014. RESULTS Nationally, the coverage and prevalence were highly variable with 38 factors recording an improvement. The absolute percentage change (1993-2014) was heterogeneous ranging between 1% and 898%. At the county level, the estimates varied across space and over time with a majority showing improvements after 2008 which was preceded by a period of deterioration (late-1990 to early-2000). Counties in Northern Kenya were consistently observed to have lower coverage of interventions and remained disadvantaged in 2014 while areas around Central Kenya had and historically have had higher coverage across all intervention domains. Most factors in Western and South-East Kenya recorded moderate intervention coverage although having a high infection prevalence of both HIV and malaria. CONCLUSION The heterogeneous estimates necessitates prioritisation of the marginalised counties to achieve health equity and improve child survival uniformly across the country. Efforts are required to narrow the gap between counties across all the drivers of child survival. The generated estimates will facilitate improved benchmarking and establish a baseline for monitoring child development goals at subnational level.
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Affiliation(s)
- Peter M Macharia
- Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Noel K Joseph
- Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Benn Sartorius
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Robert W Snow
- Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Emelda A Okiro
- Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Thomson DR, Rhoda DA, Tatem AJ, Castro MC. Gridded population survey sampling: a systematic scoping review of the field and strategic research agenda. Int J Health Geogr 2020; 19:34. [PMID: 32907588 PMCID: PMC7488014 DOI: 10.1186/s12942-020-00230-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/04/2020] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION In low- and middle-income countries (LMICs), household survey data are a main source of information for planning, evaluation, and decision-making. Standard surveys are based on censuses, however, for many LMICs it has been more than 10 years since their last census and they face high urban growth rates. Over the last decade, survey designers have begun to use modelled gridded population estimates as sample frames. We summarize the state of the emerging field of gridded population survey sampling, focussing on LMICs. METHODS We performed a systematic scoping review in Scopus of specific gridded population datasets and "population" or "household" "survey" reports, and solicited additional published and unpublished sources from colleagues. RESULTS We identified 43 national and sub-national gridded population-based household surveys implemented across 29 LMICs. Gridded population surveys used automated and manual approaches to derive clusters from WorldPop and LandScan gridded population estimates. After sampling, some survey teams interviewed all households in each cluster or segment, and others sampled households from larger clusters. Tools to select gridded population survey clusters include the GridSample R package, Geo-sampling tool, and GridSample.org. In the field, gridded population surveys generally relied on geographically accurate maps based on satellite imagery or OpenStreetMap, and a tablet or GPS technology for navigation. CONCLUSIONS For gridded population survey sampling to be adopted more widely, several strategic questions need answering regarding cell-level accuracy and uncertainty of gridded population estimates, the methods used to group/split cells into sample frame units, design effects of new sample designs, and feasibility of tools and methods to implement surveys across diverse settings.
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Affiliation(s)
- Dana R Thomson
- Department of Social Statistics and Demography, University of Southampton, Building 58, Southampton, SO17 1BJ, UK.
- WorldPop, Department of Geography and Environmental Science, University of Southampton, Building 44, Southampton, SO17 1BJ, UK.
| | - Dale A Rhoda
- Biostat Global Consulting, 330 Blandford Drive, Worthington, OH, 43085, USA
| | - Andrew J Tatem
- WorldPop, Department of Geography and Environmental Science, University of Southampton, Building 44, Southampton, SO17 1BJ, UK
| | - Marcia C Castro
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
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Macharia PM, Joseph NK, Okiro EA. A vulnerability index for COVID-19: spatial analysis at the subnational level in Kenya. BMJ Glob Health 2020; 5:e003014. [PMID: 32839197 PMCID: PMC7447114 DOI: 10.1136/bmjgh-2020-003014] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/22/2020] [Accepted: 07/15/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Response to the coronavirus disease 2019 (COVID-19) pandemic calls for precision public health reflecting our improved understanding of who is the most vulnerable and their geographical location. We created three vulnerability indices to identify areas and people who require greater support while elucidating health inequities to inform emergency response in Kenya. METHODS Geospatial indicators were assembled to create three vulnerability indices; Social VulnerabilityIndex (SVI), Epidemiological Vulnerability Index (EVI) and a composite of the two, that is, Social Epidemiological Vulnerability Index (SEVI) resolved at 295 subcounties in Kenya. SVI included 19 indicators that affect the spread of disease; socioeconomic deprivation, access to services and population dynamics, whereas EVI comprised 5 indicators describing comorbidities associated with COVID-19 severe disease progression. The indicators were scaled to a common measurement scale, spatially overlaid via arithmetic mean and equally weighted. The indices were classified into seven classes, 1-2 denoted low vulnerability and 6-7, high vulnerability. The population within vulnerabilities classes was quantified. RESULTS The spatial variation of each index was heterogeneous across Kenya. Forty-nine northwestern and partly eastern subcounties (6.9 million people) were highly vulnerable, whereas 58 subcounties (9.7 million people) in western and central Kenya were the least vulnerable for SVI. For EVI, 48 subcounties (7.2 million people) in central and the adjacent areas and 81 subcounties (13.2 million people) in northern Kenya were the most and least vulnerable, respectively. Overall (SEVI), 46 subcounties (7.0 million people) around central and southeastern were more vulnerable, whereas 81 subcounties (14.4 million people) were least vulnerable. CONCLUSION The vulnerability indices created are tools relevant to the county, national government and stakeholders for prioritisation and improved planning. The heterogeneous nature of the vulnerability indices underpins the need for targeted and prioritised actions based on the needs across the subcounties.
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Affiliation(s)
- Peter M Macharia
- Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Noel K Joseph
- Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Emelda A Okiro
- Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Deribe K, Fronterre C, Dejene T, Biadgilign S, Deribew A, Abdullah M, Cano J. Measuring the spatial heterogeneity on the reduction of vaginal fistula burden in Ethiopia between 2005 and 2016. Sci Rep 2020; 10:972. [PMID: 31969662 PMCID: PMC6976656 DOI: 10.1038/s41598-020-58036-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 01/09/2020] [Indexed: 12/18/2022] Open
Abstract
Vaginal fistula is a shattering maternal complication characterized by an anomalous opening between the bladder and/or rectum and vagina resulting in continuous leakage of urine or stool. Although prevalent in Ethiopia, its magnitude and distribution is not well studied. We used statistical mapping models using 2005 and 2016 Ethiopia Demographic Health Surveys data combined with a suite of potential risk factors to estimate the burden of vaginal fistula among women of childbearing age. The estimated number of women of childbearing age with lifetime and untreated vaginal fistula in 2016 were 72,533 (95% CI 38,235-124,103) and 31,961 (95% CI 11,596-70,309) respectively. These figures show reduction from the 2005 estimates: 98,098 (95% CI 49,819-170,737) lifetime and 59,114 (95% CI 26,580-118,158) untreated cases of vaginal fistula. The number of districts having more than 200 untreated cases declined drastically from 54 in 2005 to 6 in 2016. Our results show a significant subnational variation in the burden of vaginal fistula. Overall, between 2005 and 2016 there was substantial reduction in the prevalence of vaginal fistula in Ethiopia. Our results help guide local level tracking, planning, spatial targeting of resources and implementation of interventions against vaginal fistula.
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Affiliation(s)
- Kebede Deribe
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK. .,School of Public Health, Collage of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Claudio Fronterre
- Lancaster Medical School, Faculty of Health and Medicine Lancaster University, LA1 4YB, Lancaster, UK
| | - Tariku Dejene
- Center for Population Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Amare Deribew
- St. Paul Millennium Medical College, Addis Ababa, Ethiopia.,Nutrition International (former Micronutrient Initiative), Addis Ababa, Ethiopia
| | - Muna Abdullah
- United Nations Population Fund (UNFPA), East and Southern Africa Regional Office, 9 Simba Road, Sunninghill, Johannesburg, 2157, South Africa
| | - Jorge Cano
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Victora C, Boerma T, Requejo J, Mesenburg MA, Joseph G, Costa JC, Vidaletti LP, Ferreira LZ, Hosseinpoor AR, Barros AJD. Analyses of inequalities in RMNCH: rising to the challenge of the SDGs. BMJ Glob Health 2019; 4:e001295. [PMID: 31297251 PMCID: PMC6590961 DOI: 10.1136/bmjgh-2018-001295] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/19/2019] [Accepted: 02/25/2019] [Indexed: 01/31/2023] Open
Abstract
The Sustainable Development Goal (SDG) 17.18 recommends efforts to increase the availability of data disaggregated by income, gender, age, race, ethnicity, migratory status, disability and geographic location in developing countries. Surveys will continue to be the leading data source for disaggregated data for most dimensions of inequality. We discuss potential advances in the disaggregation of data from national surveys, with a focus on the coverage of reproductive, maternal, newborn and child health indicators (RMNCH). Even though the Millennium Development Goals were focused on national-level progress, monitoring initiatives such as Countdown to 2015 reported on progress in RMNCH coverage according to wealth quintiles, sex of the child, women’s education and age, urban/rural residence and subnational geographic regions. We describe how the granularity of equity analyses may be increased by including additional stratification variables such as wealth deciles, estimated absolute income, ethnicity, migratory status and disability. We also provide examples of analyses of intersectionality between wealth and urban/rural residence (also known as double stratification), sex of the child and age of the woman. Based on these examples, we describe the advantages and limitations of stratified analyses of survey data, including sample size issues and lack of information on the necessary variables in some surveys. We conclude by recommending that, whenever possible, stratified analyses should go beyond the traditional breakdowns by wealth quintiles, sex and residence, to also incorporate the wider dimensions of inequality. Greater granularity of equity analyses will contribute to identify subgroups of women and children who are being left behind and monitor the impact of efforts to reduce inequalities in order to achieve the health SDGs.
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Affiliation(s)
- Cesar Victora
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.,International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Ties Boerma
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | - Gary Joseph
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Janaína Calu Costa
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Luis Paulo Vidaletti
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | | | - Ahmad Reza Hosseinpoor
- Partnership for Maternal, Newborn & Child Health, World Health Organization, Geneva, Switzerland
| | - Aluisio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
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7
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Blanc AK, Ngo TD. Data Papers. Stud Fam Plann 2019; 50. [PMID: 30950518 DOI: 10.1111/sifp.12091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Howes RE, Hawa K, Andriamamonjy VF, Franchard T, Miarimbola R, Mioramalala SA, Rafamatanantsoa JF, Rahantamalala MAM, Rajaobary SH, Rajaonera HDG, Rakotonindrainy AP, Rakotoson Andrianjatonavalona C, Randriamiarinjatovo DNAL, Randrianasolo FM, Ramasy Razafindratovo RM, Ravaoarimanga M, Ye M, Gething PW, Taylor CA. A stakeholder workshop about modelled maps of key malaria indicator survey indicators in Madagascar. Malar J 2019; 18:90. [PMID: 30902070 PMCID: PMC6431047 DOI: 10.1186/s12936-019-2729-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/14/2019] [Indexed: 11/29/2022] Open
Abstract
The Demographic and Health Surveys (DHS) Program has supported three household Malaria Indicator Surveys (MIS) in Madagascar. The results of 13 key malaria indicators from these surveys have been mapped as continuous surfaces using model-based geostatistical methods. The opportunities and limitations of these mapped outputs were discussed during a workshop in Antananarivo, Madagascar in July 2018, attended by 15 representatives from various implementation, policy and research stakeholder institutions in Madagascar. Participants evaluated the findings from the maps, using these to develop figures and narratives to support their work in the control of malaria in Madagascar.
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Affiliation(s)
- Rosalind E Howes
- Malaria Atlas Project, Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, UK.
| | - Kaleem Hawa
- Malaria Atlas Project, Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, UK
| | | | - Thierry Franchard
- Ministry of Health, Antananarivo, Madagascar.,Faculty of Science, University of Antananarivo, Antananarivo, Madagascar
| | - Raharizo Miarimbola
- Ministry of Health, Antananarivo, Madagascar.,Department of Public Health, Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
| | - Sedera Aurélien Mioramalala
- Ministry of Health, Antananarivo, Madagascar.,Department of Public Health, Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
| | | | - Mirana Ando Mbolatiana Rahantamalala
- National Malaria Control Programme, Ministry of Health, Antananarivo, Madagascar.,Department of Public Health, Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
| | | | | | | | | | | | | | | | | | - Maurice Ye
- MEASURE-Evaluation, ICF, Antananarivo, Madagascar
| | - Peter W Gething
- Malaria Atlas Project, Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, UK
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