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1. Low-dose aspirin and racial disparities in spontaneous preterm delivery in low-risk individuals

Author

Kane, Veronica A, Andrikopoulou, Maria, Bertozzi-Villa, Clara, Mims, Joseph, Pinson, Kelsey, and Gyamfi-Bannerman, Cynthia

Subjects
Reproductive Medicine, Midwifery, Biomedical and Clinical Sciences, Health Sciences, Pediatric, Prevention, Clinical Research, Preterm, Low Birth Weight and Health of the Newborn, Cardiovascular, Infant Mortality, Clinical Trials and Supportive Activities, Perinatal Period - Conditions Originating in Perinatal Period, Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Reproductive health and childbirth, Good Health and Well Being, African American, Black, White, health equity, low-dose aspirin, nulliparous, placental disease, platelet aggregation, preeclampsia, preterm birth, racial and ethnic disparities, spontaneous preterm birth
Abstract

Preterm birth is a leading cause of perinatal morbidity and mortality. There are significant racial disparities in the rates of preterm delivery in the United States, with Black individuals at disproportionately higher risk than their White counterparts. Although low-dose aspirin is currently under investigation for reducing the rates of preterm delivery, limited data are available on how the use of low-dose aspirin might affect racial and ethnic disparities in the rates of preterm delivery. Our group and others have shown that low-dose aspirin decreases spontaneous preterm delivery in low-risk parturients. This study aimed to examine whether the relationship between low-dose aspirin and the risk of spontaneous preterm delivery is modified by race and ethnicity. This was a secondary analysis of a randomized clinical trial examining low-dose aspirin for preeclampsia prevention in low-risk nulliparous individuals. The parent trial defined low risk as the absence of preexisting hypertension or other medical comorbidities. Participants received 60-mg aspirin or placebo between 13 and 25 weeks of gestation. Here, multiple pregnancies, fetal anomalies, terminations or abortions at

Published
2023

2. Supporting contraceptive self-care and reproductive empowerment with a digital health game in Barbados: Development and Pre-implementation study for What’s My Method? [version 2; peer review: 2 approved, 1 approved with reservations]

Author

Clara Bertozzi-Villa, Nicole Alleyne, Erin Sabato, Anderson Langdon, Elena Bertozzi, Tiffany Jordan, and Sonia Watson-Miller

Subjects
contraceptive self-efficacy, videogame, reproductive empowerment, family planning method, education, eng, Medicine
Abstract

Effective contraceptive education is essential to reducing unwanted pregnancy, increasing uptake of modern contraceptive methods, and thoughtfully planning desired births. New World Health Organization (WHO) and family planning organization guidelines recommend situating contraceptive education and counseling within a broader context of self-care that emphasizes individual agency and reproductive empowerment. Digital health interventions, and games for health specifically, have been validated as effective and scalable tools for self-guided and interactive health education, especially among younger tech-savvy individuals. Barbados currently supplements provider-based contraceptive counseling with analog materials (pamphlets and posters) and informational videos that play on a screen in the waiting room. As part of an implementation framework, this study seeks to conduct a formative evaluation of the What’s My Method? (WMM) game intervention as a tool to support contraceptive counseling and increase reproductive empowerment among childbearing persons in Barbados. We test-deployed the WMM game in Bridgetown, Barbados, conducting playtests and unstructured discussions with prototypes of the WMM game among three groups of stakeholders (youth contraception ambassadors: n=8; healthcare providers: n=7; and nursing students: n=27) to determine acceptability of the intervention, efficacy of the game as a learning tool, and willingness to adopt the tool in their healthcare context. Feedback on acceptability of the game was largely positive. Detailed constructive comments informed modifications and improvements to the game. The questionnaire used to assess contraceptive knowledge gain did not prove effective. Results indicate that the WMM game is well-received and accepted by the healthcare professionals who would be deploying it. This pilot testing has informed the design of the modified WMM for a randomized controlled trial (RCT) to test the deployment of the game in a healthcare setting.

Published
2024
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4. Spatiotemporal mapping of malaria prevalence in Madagascar using routine surveillance and health survey data

Author

Arambepola, Rohan, Keddie, Suzanne H., Collins, Emma L., Twohig, Katherine A., Amratia, Punam, Bertozzi-Villa, Amelia, Chestnutt, Elisabeth G., Harris, Joseph, Millar, Justin, Rozier, Jennifer, Rumisha, Susan F., Symons, Tasmin L., Vargas-Ruiz, Camilo, Andriamananjara, Mauricette, Rabeherisoa, Saraha, Ratsimbasoa, Arsène C., Howes, Rosalind E., Weiss, Daniel J., Gething, Peter W., and Cameron, Ewan

Subjects
Statistics - Applications
Abstract

Malaria transmission in Madagascar is highly heterogeneous, exhibiting spatial, seasonal and long-term trends. Previous efforts to map malaria risk in Madagascar used prevalence data from Malaria Indicator Surveys. These cross-sectional surveys, conducted during the high transmission season most recently in 2013 and 2016, provide nationally representative prevalence data but cover relatively short time frames. Conversely, monthly case data are collected at health facilities but suffer from biases, including incomplete reporting. We combined survey and case data to make monthly maps of prevalence between 2013 and 2016. Health facility catchments were estimated and incidence surfaces, environmental and socioeconomic covariates, and survey data informed a Bayesian prevalence model. Prevalence estimates were consistently high in the coastal regions and low in the highlands. Prevalence was lowest in 2014 and peaked in 2015, highlighting the importance of estimates between survey years. Seasonality was widely observed. Similar multi-metric approaches may be applicable across sub-Saharan Africa.

Published
2020

6. The utility of merging mechanistic and geospatial models for malaria intervention planning and policy guidance

Author

Bertozzi-Villa, Amelia, Hollingsworth, Teresa, and Gething, Peter

Subjects
epidemiology, malaria, Modeling
Abstract

This thesis describes the development and refinement of two frameworks for usefully combining mechanistic and geospatial models in malaria research. The first framework, focused on malaria transmission, uses machine learning tools and spatial data to identify key features for a mechanistic transmission model, then utilizes spatial data again to place mechanistic model results in a global context. This strategy is novel, flexible, customizable, and computationally efficient. The second, focused on insecticide-treated net coverage, uses a mechanistic commodity tracking model as the backbone for a spatiotemporal regression model in order to appropriately capture different countries' unique histories of net procurement, distribution, and retention. Examples of the on-the-ground policy impact of this work are included for stakeholders such as the World Health Organization, the Clinton Health Access Initiative, and the Bill and Melinda Gates Foundation. Both of these modeling frameworks showcase the value of combining the flexibility and versatility of mechanistic modeling with the statistical rigor and geographical tools of geospatial modeling.

Published
2021

7. Outcomes assessment pitfalls: challenges to quantifying knowledge gain in a sex education game.

Author

Bertozzi, Elena, Bertozzi-Villa, Amelia, Padankatti, Swathi, and Sridhar, Aparna

Subjects
India, family planning, games for health, outcomes assessment, serious games, sexual education
Abstract

Background: The use of videogames as a public health tool is rapidly expanding. Accurate assessment of the efficacy of such games is complicated by many factors. We describe challenges associated with measuring the impact of playing a videogame with information about human sexual anatomy and reproduction and discuss motivations for, and solutions to, these challenges. Methods: The My Future Family Game (MFF) is a validated tool for collecting data about family planning intentions which includes information about human anatomy and sexual reproduction. We sought to assess the efficacy of the game as a tool for teaching sexual education using a pre-post model which was deployed in three schools in and around Chennai, India in summer of 2018. Results: The MFF game was successfully modified to collect data about players pre-gameplay knowledge of sexual anatomy and processes. The post gameplay assessment process we used did not effectively assess knowledge gain. Designing assessments for games dealing with sexuality presents challenges including: effectively communicating about biological parts and processes, designing usable and intuitive interfaces with minimal text, ensuring that all parts of the process are fun, and integrating assessments into the game in a way that makes them invisible. Conclusion: Games can be an effective means of gathering data about knowledge of sex and reproduction that it is difficult to obtain through other means. Assessing knowledge about human sexual reproduction is complicated by cultural norms and taboos, and technical hurdles which can be addressed through careful design. This study adds to the sparse literature in the field by providing information about pitfalls to avoid and best practices in this evolving area.

Published
2020

10. Collecting family planning intentions and providing reproductive health information using a tablet-based video game in India.

Author

Bertozzi, Elena, Bertozzi-Villa, Amelia, Kulkarni, Praveen, and Sridhar, Aparna

Subjects
Family planning, India, adolescents, education, games for health, reproductive health, sexuality, videogame
Abstract

Background: In response to a Grand Challenges in Global Health call for action to collect data about family planning intentions and increase the uptake of family planning methods in India, our team designed, developed, and piloted the My Future Family video game in Karnataka Province. The game educates adolescents about human sexuality and reproduction while asking players when they would like to achieve five important family planning milestones.  Participants were also asked to report who influences them the most when making family planning decisions. Methods: Focus groups were conducted and the resulting data used to design the game which was iteratively tested and then piloted in 11 schools in rural and urban areas of southern India. Data was collected throughout gameplay and cross-checked with paper questionnaires.  Results: In August 2017, we successfully piloted the game with 382 adolescents and validated its efficacy both as an educational tool and as an innovative means of accurate data collection.  Conclusion: It has historically been problematic to gather accurate data about adolescents in India on this culturally sensitive topic for a variety of reasons. These include difficulties obtaining consent, developing appropriate survey methods, and framing questions in language that young people can understand. Our game met these challenges by working within a single school system with approval from senior administration, delivering information via a game environment which freed players from societal constraints, and communicating information via images and audio in addition to text in both English and Kannada (the local language).

Published
2018

11. Maps and metrics of insecticide-treated net access, use, and nets-per-capita in Africa from 2000-2020

Author

Amelia Bertozzi-Villa, Caitlin A. Bever, Hannah Koenker, Daniel J. Weiss, Camilo Vargas-Ruiz, Anita K. Nandi, Harry S. Gibson, Joseph Harris, Katherine E. Battle, Susan F. Rumisha, Suzanne Keddie, Punam Amratia, Rohan Arambepola, Ewan Cameron, Elisabeth G. Chestnutt, Emma L. Collins, Justin Millar, Swapnil Mishra, Jennifer Rozier, Tasmin Symons, Katherine A. Twohig, T. Deirdre Hollingsworth, Peter W. Gething, and Samir Bhatt

Subjects
Science
Abstract

Insecticide treated nets (ITNs) are an important part of malaria control in Africa and WHO targets aim for 80% coverage. This study estimates the spatio-temporal access and use of ITNs in Africa from 2000-2020, and shows that both metrics have improved over time but access remains below WHO targets.

Published
2021
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12. Indirect effects of the COVID-19 pandemic on malaria intervention coverage, morbidity, and mortality in Africa: a geospatial modelling analysis

Author

Weiss, Daniel J, Bertozzi-Villa, Amelia, Rumisha, Susan F, Amratia, Punam, Arambepola, Rohan, Battle, Katherine E, Cameron, Ewan, Chestnutt, Elisabeth, Gibson, Harry S, Harris, Joseph, Keddie, Suzanne, Millar, Justin J, Rozier, Jennifer, Symons, Tasmin L, Vargas-Ruiz, Camilo, Hay, Simon I, Smith, David L, Alonso, Pedro L, Noor, Abdisalan M, Bhatt, Samir, and Gething, Peter W

Published
2021
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15. Global estimation of anti-malarial drug effectiveness for the treatment of uncomplicated Plasmodium falciparum malaria 1991–2019

Author

Giulia Rathmes, Susan F. Rumisha, Tim C. D. Lucas, Katherine A. Twohig, Andre Python, Michele Nguyen, Anita K. Nandi, Suzanne H. Keddie, Emma L. Collins, Jennifer A. Rozier, Harry S. Gibson, Elisabeth G. Chestnutt, Katherine E. Battle, Georgina S. Humphreys, Punam Amratia, Rohan Arambepola, Amelia Bertozzi-Villa, Penelope Hancock, Justin J. Millar, Tasmin L. Symons, Samir Bhatt, Ewan Cameron, Philippe J. Guerin, Peter W. Gething, and Daniel J. Weiss

Subjects
Falciparum malaria, Anti-malarial drug effectiveness, Drug quality, Global, Arctic medicine. Tropical medicine, RC955-962, Infectious and parasitic diseases, RC109-216
Abstract

Abstract Background Anti-malarial drugs play a critical role in reducing malaria morbidity and mortality, but their role is mediated by their effectiveness. Effectiveness is defined as the probability that an anti-malarial drug will successfully treat an individual infected with malaria parasites under routine health care delivery system. Anti-malarial drug effectiveness (AmE) is influenced by drug resistance, drug quality, health system quality, and patient adherence to drug use; its influence on malaria burden varies through space and time. Methods This study uses data from 232 efficacy trials comprised of 86,776 infected individuals to estimate the artemisinin-based and non-artemisinin-based AmE for treating falciparum malaria between 1991 and 2019. Bayesian spatiotemporal models were fitted and used to predict effectiveness at the pixel-level (5 km × 5 km). The median and interquartile ranges (IQR) of AmE are presented for all malaria-endemic countries. Results The global effectiveness of artemisinin-based drugs was 67.4% (IQR: 33.3–75.8), 70.1% (43.6–76.0) and 71.8% (46.9–76.4) for the 1991–2000, 2006–2010, and 2016–2019 periods, respectively. Countries in central Africa, a few in South America, and in the Asian region faced the challenge of lower effectiveness of artemisinin-based anti-malarials. However, improvements were seen after 2016, leaving only a few hotspots in Southeast Asia where resistance to artemisinin and partner drugs is currently problematic and in the central Africa where socio-demographic challenges limit effectiveness. The use of artemisinin-based combination therapy (ACT) with a competent partner drug and having multiple ACT as first-line treatment choice sustained high levels of effectiveness. High levels of access to healthcare, human resource capacity, education, and proximity to cities were associated with increased effectiveness. Effectiveness of non-artemisinin-based drugs was much lower than that of artemisinin-based with no improvement over time: 52.3% (17.9–74.9) for 1991–2000 and 55.5% (27.1–73.4) for 2011–2015. Overall, AmE for artemisinin-based and non-artemisinin-based drugs were, respectively, 29.6 and 36% below clinical efficacy as measured in anti-malarial drug trials. Conclusions This study provides evidence that health system performance, drug quality and patient adherence influence the effectiveness of anti-malarials used in treating uncomplicated falciparum malaria. These results provide guidance to countries’ treatment practises and are critical inputs for malaria prevalence and incidence models used to estimate national level malaria burden.

Published
2020
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16. Global maps of travel time to healthcare facilities

Author

Weiss, D. J., Nelson, A., Vargas-Ruiz, C. A., Gligoric, K., Bavadekar, S., Gabrilovich, E., and Bertozzi-Villa, A.

Subjects
Management, Social aspects, Analysis, Health aspects, Company business management, Travel time (Traffic engineering) -- Analysis -- Health aspects -- Social aspects, Medical care utilization -- Management, Health care services accessibility -- Analysis, Medical care -- Utilization
Abstract

Author(s): D. J. Weiss [sup.1] [sup.2] [sup.3] , A. Nelson [sup.4] , C. A. Vargas-Ruiz [sup.1] , K. Gligoric [sup.5] , S. Bavadekar [sup.6] , E. Gabrilovich [sup.6] , A. [...], Access to healthcare is a requirement for human well-being that is constrained, in part, by the allocation of healthcare resources relative to the geographically dispersed human population.sup.1-3. Quantifying access to care globally is challenging due to the absence of a comprehensive database of healthcare facilities. We harness major data collection efforts underway by OpenStreetMap, Google Maps and academic researchers to compile the most complete collection of facility locations to date. Leveraging the geographically variable strengths of our facility datasets, we use an established methodology.sup.4 to characterize travel time to healthcare facilities in unprecedented detail. We produce maps of travel time with and without access to motorized transport, thus characterizing travel time to healthcare for populations distributed across the wealth spectrum. We find that just 8.9% of the global population (646 million people) cannot reach healthcare within one hour if they have access to motorized transport, and that 43.3% (3.16 billion people) cannot reach a healthcare facility by foot within one hour. Our maps highlight an additional vulnerability faced by poorer individuals in remote areas and can help to estimate whether individuals will seek healthcare when it is needed, as well as providing an evidence base for efficiently distributing limited healthcare and transportation resources to underserved populations both now and in the future. A global analysis generating high-resolution maps of travel time shows that 91.1% of the world's population can reach a hospital or clinic within an hour if they have access to motorized transportation, but only 56.7% can do so by walking, highlighting additional inequities for underserved populations accessing healthcare.

Published
2020
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17. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Author

Collaborators, Global Burden of Disease Study 2013, Vos, Theo, Barber, Ryan M, Bell, Brad, Bertozzi-Villa, Amelia, Biryukov, Stan, Bolliger, Ian, Charlson, Fiona, Davis, Adrian, Degenhardt, Louisa, Dicker, Daniel, Duan, Leilei, Erskine, Holly, Feigin, Valery L, Ferrari, Alize J, Fitzmaurice, Christina, Fleming, Thomas, Graetz, Nicholas, Guinovart, Caterina, Haagsma, Juanita, Hansen, Gillian M, Hanson, Sarah Wulf, Heuton, Kyle R, Higashi, Hideki, Kassebaum, Nicholas, Kyu, Hmwe, Laurie, Evan, Liang, Xiofeng, Lofgren, Katherine, Lozano, Rafael, MacIntyre, Michael F, Moradi-Lakeh, Maziar, Naghavi, Mohsen, Nguyen, Grant, Odell, Shaun, Ortblad, Katrina, Roberts, David Allen, Roth, Gregory A, Sandar, Logan, Serina, Peter T, Stanaway, Jeffrey D, Steiner, Caitlyn, Thomas, Bernadette, Vollset, Stein Emil, Whiteford, Harvey, Wolock, Timothy M, Ye, Pengpeng, Zhou, Maigeng, Ãvila, Marco A, Aasvang, Gunn Marit, Abbafati, Cristiana, Ozgoren, Ayse Abbasoglu, Abd-Allah, Foad, Aziz, Muna I Abdel, Abera, Semaw F, Aboyans, Victor, Abraham, Jerry P, Abraham, Biju, Abubakar, Ibrahim, Abu-Raddad, Laith J, Abu-Rmeileh, Niveen ME, Aburto, Tania C, Achoki, Tom, Ackerman, Ilana N, Adelekan, Ademola, Ademi, Zanfina, Adou, Arsène K, Adsuar, Josef C, Arnlov, Johan, Agardh, Emilie E, Khabouri, Mazin J Al, Alam, Sayed Saidul, Alasfoor, Deena, Albittar, Mohammed I, Alegretti, Miguel A, Aleman, Alicia V, Alemu, Zewdie A, Alfonso-Cristancho, Rafael, Alhabib, Samia, Ali, Raghib, Alla, Francois, Allebeck, Peter, Allen, Peter J, AlMazroa, Mohammad AbdulAziz, Alsharif, Ubai, Alvarez, Elena, Alvis-Guzman, Nelson, Ameli, Omid, Amini, Heresh, Ammar, Walid, Anderson, Benjamin O, Anderson, H Ross, Antonio, Carl Abelardo T, Anwari, Palwasha, Apfel, Henry, Arsenijevic, Valentain S Arsic, Artaman, Al, Asghar, Rana J, Assadi, Reza, and Atkins, Lydia S

Subjects
Burden of Illness, Infectious Diseases, Brain Disorders, Pain Research, Mental Health, 2.4 Surveillance and distribution, Aetiology, 2.1 Biological and endogenous factors, 2.2 Factors relating to the physical environment, Good Health and Well Being, Acute Disease, Adolescent, Adult, Age Distribution, Aged, Aged, 80 and over, Child, Child, Preschool, Chronic Disease, Cost of Illness, Developed Countries, Developing Countries, Disabled Persons, Female, Global Health, Humans, Incidence, Infant, Infant, Newborn, Male, Middle Aged, Neglected Diseases, Prevalence, Residence Characteristics, Sex Distribution, Wounds and Injuries, Young Adult, Global Burden of Disease Study 2013 Collaborators, Medical and Health Sciences, General & Internal Medicine
Abstract

BackgroundUp-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013.MethodsEstimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally and at the country level for 2013. In total, 35 620 distinct sources of data were used and documented to calculated estimates for 301 diseases and injuries and 2337 sequelae. The comorbidity simulation provides estimates for the number of sequelae, concurrently, by individuals by country, year, age, and sex. Disability weights were updated with the addition of new population-based survey data from four countries.FindingsDisease and injury were highly prevalent; only a small fraction of individuals had no sequelae. Comorbidity rose substantially with age and in absolute terms from 1990 to 2013. Incidence of acute sequelae were predominantly infectious diseases and short-term injuries, with over 2 billion cases of upper respiratory infections and diarrhoeal disease episodes in 2013, with the notable exception of tooth pain due to permanent caries with more than 200 million incident cases in 2013. Conversely, leading chronic sequelae were largely attributable to non-communicable diseases, with prevalence estimates for asymptomatic permanent caries and tension-type headache of 2·4 billion and 1·6 billion, respectively. The distribution of the number of sequelae in populations varied widely across regions, with an expected relation between age and disease prevalence. YLDs for both sexes increased from 537·6 million in 1990 to 764·8 million in 2013 due to population growth and ageing, whereas the age-standardised rate decreased little from 114·87 per 1000 people to 110·31 per 1000 people between 1990 and 2013. Leading causes of YLDs included low back pain and major depressive disorder among the top ten causes of YLDs in every country. YLD rates per person, by major cause groups, indicated the main drivers of increases were due to musculoskeletal, mental, and substance use disorders, neurological disorders, and chronic respiratory diseases; however HIV/AIDS was a notable driver of increasing YLDs in sub-Saharan Africa. Also, the proportion of disability-adjusted life years due to YLDs increased globally from 21·1% in 1990 to 31·2% in 2013.InterpretationAgeing of the world's population is leading to a substantial increase in the numbers of individuals with sequelae of diseases and injuries. Rates of YLDs are declining much more slowly than mortality rates. The non-fatal dimensions of disease and injury will require more and more attention from health systems. The transition to non-fatal outcomes as the dominant source of burden of disease is occurring rapidly outside of sub-Saharan Africa. Our results can guide future health initiatives through examination of epidemiological trends and a better understanding of variation across countries.FundingBill & Melinda Gates Foundation.

Published
2015

18. Malaria eradication within a generation: ambitious, achievable, and necessary

Author

Feachem, Richard G A, Chen, Ingrid, Akbari, Omar, Bertozzi-Villa, Amelia, Bhatt, Samir, Binka, Fred, Boni, Maciej F, Buckee, Caroline, Dieleman, Joseph, Dondorp, Arjen, Eapen, Alex, Sekhri Feachem, Neelam, Filler, Scott, Gething, Peter, Gosling, Roly, Haakenstad, Annie, Harvard, Kelly, Hatefi, Arian, Jamison, Dean, Jones, Kate E, Karema, Corine, Kamwi, Richard Nchabi, Lal, Altaf, Larson, Erika, Lees, Margaret, Lobo, Neil F, Micah, Angela E, Moonen, Bruno, Newby, Gretchen, Ning, Xiao, Pate, Muhammad, Quiñones, Martha, Roh, Michelle, Rolfe, Ben, Shanks, Dennis, Singh, Balbir, Staley, Kenneth, Tulloch, James, Wegbreit, Jennifer, Woo, Hyun Ju, and Mpanju-Shumbusho, Winnie

Published
2019
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19. Mapping the global prevalence, incidence, and mortality of Plasmodium falciparum, 2000–17: a spatial and temporal modelling study

Author

Weiss, Daniel J, Lucas, Tim C D, Nguyen, Michele, Nandi, Anita K, Bisanzio, Donal, Battle, Katherine E, Cameron, Ewan, Twohig, Katherine A, Pfeffer, Daniel A, Rozier, Jennifer A, Gibson, Harry S, Rao, Puja C, Casey, Daniel, Bertozzi-Villa, Amelia, Collins, Emma L, Dalrymple, Ursula, Gray, Naomi, Harris, Joseph R, Howes, Rosalind E, Kang, Sun Yun, Keddie, Suzanne H, May, Daniel, Rumisha, Susan, Thorn, Michael P, Barber, Ryan, Fullman, Nancy, Huynh, Chantal K, Kulikoff, Xie, Kutz, Michael J, Lopez, Alan D, Mokdad, Ali H, Naghavi, Mohsen, Nguyen, Grant, Shackelford, Katya Anne, Vos, Theo, Wang, Haidong, Smith, David L, Lim, Stephen S, Murray, Christopher J L, Bhatt, Samir, Hay, Simon I, and Gething, Peter W

Published
2019
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21. Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Author

Kassebaum, Nicholas J, Bertozzi-Villa, Amelia, Coggeshall, Megan S, Shackelford, Katya A, Steiner, Caitlyn, Heuton, Kyle R, Gonzalez-Medina, Diego, Barber, Ryan, Huynh, Chantal, Dicker, Daniel, Templin, Tara, Wolock, Timothy M, Ozgoren, Ayse Abbasoglu, Abd-Allah, Foad, Abera, Semaw Ferede, Abubakar, Ibrahim, Achoki, Tom, Adelekan, Ademola, Ademi, Zanfina, Adou, Arsène Kouablan, Adsuar, José C, Agardh, Emilie E, Akena, Dickens, Alasfoor, Deena, Alemu, Zewdie Aderaw, Alfonso-Cristancho, Rafael, Alhabib, Samia, Ali, Raghib, Al Kahbouri, Mazin J, Alla, François, Allen, Peter J, AlMazroa, Mohammad A, Alsharif, Ubai, Alvarez, Elena, Alvis-Guzmán, Nelson, Amankwaa, Adansi A, Amare, Azmeraw T, Amini, Hassan, Ammar, Walid, Antonio, Carl AT, Anwari, Palwasha, Arnlöv, Johan, Arsenijevic, Valentina S Arsic, Artaman, Ali, Asad, Majed Masoud, Asghar, Rana J, Assadi, Reza, Atkins, Lydia S, Badawi, Alaa, Balakrishnan, Kalpana, Basu, Arindam, Basu, Sanjay, Beardsley, Justin, Bedi, Neeraj, Bekele, Tolesa, Bell, Michelle L, Bernabe, Eduardo, Beyene, Tariku J, Bhutta, Zulfiqar, Bin Abdulhak, Aref, Blore, Jed D, Basara, Berrak Bora, Bose, Dipan, Breitborde, Nicholas, Cárdenas, Rosario, Castañeda-Orjuela, Carlos A, Castro, Ruben Estanislao, Catalá-López, Ferrán, Cavlin, Alanur, Chang, Jung-Chen, Che, Xuan, Christophi, Costas A, Chugh, Sumeet S, Cirillo, Massimo, Colquhoun, Samantha M, Cooper, Leslie Trumbull, Cooper, Cyrus, da Costa Leite, Iuri, Dandona, Lalit, Dandona, Rakhi, Davis, Adrian, Dayama, Anand, Degenhardt, Louisa, De Leo, Diego, del Pozo-Cruz, Borja, Deribe, Kebede, Dessalegn, Muluken, deVeber, Gabrielle A, Dharmaratne, Samath D, Dilmen, Uğur, Ding, Eric L, Dorrington, Rob E, Driscoll, Tim R, Ermakov, Sergei Petrovich, Esteghamati, Alireza, Faraon, Emerito Jose A, Farzadfar, Farshad, Felicio, Manuela Mendonca, Fereshtehnejad, Seyed-Mohammad, and de Lima, Graça Maria Ferreira

Subjects
2.4 Surveillance and distribution, Aetiology, Infection, Reproductive health and childbirth, Good Health and Well Being, Age Distribution, Cause of Death, Female, Global Health, HIV Infections, Humans, Maternal Mortality, Models, Statistical, Organizational Objectives, Pregnancy, Pregnancy Complications, Infectious, Risk Factors, Socioeconomic Factors, Time Factors, Medical and Health Sciences, General & Internal Medicine
Abstract

BackgroundThe fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100,000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery.MethodsWe used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values.Findings292,982 (95% UI 261,017-327,792) maternal deaths occurred in 2013, compared with 376,034 (343,483-407,574) in 1990. The global annual rate of change in the MMR was -0·3% (-1·1 to 0·6) from 1990 to 2003, and -2·7% (-3·9 to -1·5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0·4% (0·2-0·6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956·8 (685·1-1262·8) in South Sudan to 2·4 (1·6-3·6) in Iceland.InterpretationGlobal rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa.FundingBill & Melinda Gates Foundation.

Published
2014

22. Travel time to health facilities in areas of outbreak potential: maps for guiding local preparedness and response

Author

E. N. Hulland, K. E. Wiens, S. Shirude, J. D. Morgan, A. Bertozzi-Villa, T. H. Farag, N. Fullman, M. U. G. Kraemer, M. K. Miller-Petrie, V. Gupta, R. C. Reiner, P. Rabinowitz, J. N. Wasserheit, B. P. Bell, S. I. Hay, D. J. Weiss, and D. M. Pigott

Subjects
Preparedness, Viral hemorrhagic fevers, Travel time, Health facility access, Ebola, Marburg, Medicine
Abstract

Abstract Background Repeated outbreaks of emerging pathogens underscore the need for preparedness plans to prevent, detect, and respond. As countries develop and improve National Action Plans for Health Security, addressing subnational variation in preparedness is increasingly important. One facet of preparedness and mitigating disease transmission is health facility accessibility, linking infected persons with health systems and vice versa. Where potential patients can access care, local facilities must ensure they can appropriately diagnose, treat, and contain disease spread to prevent secondary transmission; where patients cannot readily access facilities, alternate plans must be developed. Here, we use travel time to link facilities and populations at risk of viral hemorrhagic fevers (VHFs) and identify spatial variation in these respective preparedness demands. Methods and findings We used geospatial resources of travel friction, pathogen environmental suitability, and health facilities to determine facility accessibility of any at-risk location within a country. We considered in-country and cross-border movements of exposed populations and highlighted vulnerable populations where current facilities are inaccessible and new infrastructure would reduce travel times. We developed profiles for 43 African countries. Resulting maps demonstrate gaps in health facility accessibility and highlight facilities closest to areas at risk for VHF spillover. For instance, in the Central African Republic, we identified travel times of over 24 h to access a health facility. Some countries had more uniformly short travel times, such as Nigeria, although regional disparities exist. For some populations, including many in Botswana, access to areas at risk for VHF nationally was low but proximity to suitable spillover areas in bordering countries was high. Additional analyses provide insights for considering future resource allocation. We provide a contemporary use case for these analyses for the ongoing Ebola outbreak. Conclusions These maps demonstrate the use of geospatial analytics for subnational preparedness, identifying facilities close to at-risk populations for prioritizing readiness to detect, treat, and respond to cases and highlighting where gaps in health facility accessibility exist. We identified cross-border threats for VHF exposure and demonstrate an opportunity to improve preparedness activities through the use of precision public health methods and data-driven insights for resource allocation as part of a country’s preparedness plans.

Published
2019
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24. Outcomes assessment pitfalls: challenges to quantifying knowledge gain in a sex education game [version 3; peer review: 2 approved, 1 not approved]

Author

Elena Bertozzi, Amelia Bertozzi-Villa, Swathi Padankatti, and Aparna Sridhar

Subjects
Medicine
Abstract

Background: The use of videogames as a public health tool is rapidly expanding. Accurate assessment of the efficacy of such games is complicated by many factors. We describe challenges associated with measuring the impact of playing a videogame with information about human sexual anatomy and reproduction and discuss motivations for, and solutions to, these challenges. Methods: The My Future Family Game (MFF) is a validated tool for collecting data about family planning intentions which includes information about human anatomy and sexual reproduction. We sought to assess the efficacy of the game as a tool for teaching sexual education using a pre-post model which was deployed in three schools in and around Chennai, India in summer of 2018. Results: The MFF game was successfully modified to collect data about players’ pre-gameplay knowledge of sexual anatomy and processes. The post gameplay assessment process we used did not effectively assess knowledge gain. Designing assessments for games dealing with sexuality presents challenges including: effectively communicating about biological parts and processes, designing usable and intuitive interfaces with minimal text, ensuring that all parts of the process are fun, and integrating assessments into the game in a way that makes them invisible. Conclusion: Games can be an effective means of gathering data about knowledge of sex and reproduction that it is difficult to obtain through other means. Assessing knowledge about human sexual reproduction is complicated by cultural norms and taboos, and technical hurdles which can be addressed through careful design. This study adds to the sparse literature in the field by providing information about pitfalls to avoid and best practices in this evolving area.

Published
2021
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25. Quantifying Inequitable Access to Rapid Burn and Reconstructive Care through Geospatial Mapping

Author

Steven Lo, FRCS Plast, Opoku Ampomah, FRCS Plast, Levi Ankrah, FWACS, Kwame Darko, FWACS, and Amelia Bertozzi-Villa, MPH

Subjects
Surgery, RD1-811
Abstract

Summary:. Time-critical pathologies, such as the care of burn-injured patients, rely on accurate travel time data to plan high-quality service provision. Geospatial modeling, using data from the Malaria Atlas Project, together with census data, permits quantification of the huge global discrepancies in temporal access to burn care between high-income and low-resource settings. In this study, focusing on the United Kingdom and Ghana, we found that a 3-fold population difference exists with, respectively, 95.6% and 29.9% of the population that could access specialist burn care within 1-hour travel time. Solutions to such inequalities include upscaling of infrastructure and specialist personnel, but this is aspirational rather than feasible in most low- to middle-income countries. Mixed models of decentralization of care that leverage eHealth strategies, such as telemedicine, may enhance quality of local burns and reconstructive surgical care through skills transfer, capacity building, and expediting of urgent transfers, while empowering local healthcare communities. By extending specialist burn care coverage through eHealth to 8 district hospitals in rural Ghana, we demonstrate the potential to increase specialist population coverage within 1-hour travel time from 29.9% to 45.3%—equivalent to an additional 5.1 million people.

Published
2020
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26. Variation in life expectancy and mortality by cause among neighbourhoods in King County, WA, USA, 1990–2014: a census tract-level analysis for the Global Burden of Disease Study 2015

Author

Dwyer-Lindgren, Laura, Stubbs, Rebecca W, Bertozzi-Villa, Amelia, Morozoff, Chloe, Callender, Charlton, Finegold, Samuel B, Shirude, Shreya, Flaxman, Abraham D, Laurent, Amy, Kern, Eli, Duchin, Jeffrey S, Fleming, David, Mokdad, Ali H, and Murray, Christopher J L

Published
2017
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27. An archetypes approach to malaria intervention impact mapping:a new framework and example application

Author

Bertozzi-Villa, Amelia, Bever, Caitlin A., Gerardin, Jaline, Proctor, Joshua L., Wu, Meikang, Harding, Dennis, Hollingsworth, T. Deirdre, Bhatt, Samir, Gething, Peter W., Bertozzi-Villa, Amelia, Bever, Caitlin A., Gerardin, Jaline, Proctor, Joshua L., Wu, Meikang, Harding, Dennis, Hollingsworth, T. Deirdre, Bhatt, Samir, and Gething, Peter W.

Abstract

Background As both mechanistic and geospatial malaria modeling methods become more integrated into malaria policy decisions, there is increasing demand for strategies that combine these two methods. This paper introduces a novel archetypes-based methodology for generating high-resolution intervention impact maps based on mechanistic model simulations. An example configuration of the framework is described and explored. Methods First, dimensionality reduction and clustering techniques were applied to rasterized geospatial environmental and mosquito covariates to find archetypal malaria transmission patterns. Next, mechanistic models were run on a representative site from each archetype to assess intervention impact. Finally, these mechanistic results were reprojected onto each pixel to generate full maps of intervention impact. The example configuration used ERA5 and Malaria Atlas Project covariates, singular value decomposition, k-means clustering, and the Institute for Disease Modeling’s EMOD model to explore a range of three-year malaria interventions primarily focused on vector control and case management. Results Rainfall, temperature, and mosquito abundance layers were clustered into ten transmission archetypes with distinct properties. Example intervention impact curves and maps highlighted archetype-specific variation in efficacy of vector control interventions. A sensitivity analysis showed that the procedure for selecting representative sites to simulate worked well in all but one archetype. Conclusion This paper introduces a novel methodology which combines the richness of spatiotemporal mapping with the rigor of mechanistic modeling to create a multi-purpose infrastructure for answering a broad range of important questions in the malaria policy space. It is flexible and adaptable to a range of input covariates, mechanistic models, and mapping strategies and can be adapted to the modelers’ setting of choice., Background: As both mechanistic and geospatial malaria modeling methods become more integrated into malaria policy decisions, there is increasing demand for strategies that combine these two methods. This paper introduces a novel archetypes-based methodology for generating high-resolution intervention impact maps based on mechanistic model simulations. An example configuration of the framework is described and explored. Methods: First, dimensionality reduction and clustering techniques were applied to rasterized geospatial environmental and mosquito covariates to find archetypal malaria transmission patterns. Next, mechanistic models were run on a representative site from each archetype to assess intervention impact. Finally, these mechanistic results were reprojected onto each pixel to generate full maps of intervention impact. The example configuration used ERA5 and Malaria Atlas Project covariates, singular value decomposition, k-means clustering, and the Institute for Disease Modeling’s EMOD model to explore a range of three-year malaria interventions primarily focused on vector control and case management. Results: Rainfall, temperature, and mosquito abundance layers were clustered into ten transmission archetypes with distinct properties. Example intervention impact curves and maps highlighted archetype-specific variation in efficacy of vector control interventions. A sensitivity analysis showed that the procedure for selecting representative sites to simulate worked well in all but one archetype. Conclusion: This paper introduces a novel methodology which combines the richness of spatiotemporal mapping with the rigor of mechanistic modeling to create a multi-purpose infrastructure for answering a broad range of important questions in the malaria policy space. It is flexible and adaptable to a range of input covariates, mechanistic models, and mapping strategies and can be adapted to the modelers’ setting of choice.

Published
2023

28. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition

Author

Murray, Christopher J L, Barber, Ryan M, Foreman, Kyle J, Ozgoren, Ayse Abbasoglu, Abd-Allah, Foad, Abera, Semaw F, Aboyans, Victor, Abraham, Jerry P, Abubakar, Ibrahim, Abu-Raddad, Laith J, Abu-Rmeileh, Niveen M, Achoki, Tom, Ackerman, Ilana N, Ademi, Zanfina, Adou, Arsène K, Adsuar, José C, Afshin, Ashkan, Agardh, Emilie E, Alam, Sayed Saidul, Alasfoor, Deena, Albittar, Mohammed I, Alegretti, Miguel A, Alemu, Zewdie A, Alfonso-Cristancho, Rafael, Alhabib, Samia, Ali, Raghib, Alla, François, Allebeck, Peter, Almazroa, Mohammad A, Alsharif, Ubai, Alvarez, Elena, Alvis-Guzman, Nelson, Amare, Azmeraw T, Ameh, Emmanuel A, Amini, Heresh, Ammar, Walid, Anderson, H Ross, Anderson, Benjamin O, Antonio, Carl Abelardo T, Anwari, Palwasha, Arnlöv, Johan, Arsenijevic, Valentina S Arsic, Artaman, Al, Asghar, Rana J, Assadi, Reza, Atkins, Lydia S, Avila, Marco A, Awuah, Baffour, Bachman, Victoria F, Badawi, Alaa, Bahit, Maria C, Balakrishnan, Kalpana, Banerjee, Amitava, Barker-Collo, Suzanne L, Barquera, Simon, Barregard, Lars, Barrero, Lope H, Basu, Arindam, Basu, Sanjay, Basulaiman, Mohammed O, Beardsley, Justin, Bedi, Neeraj, Beghi, Ettore, Bekele, Tolesa, Bell, Michelle L, Benjet, Corina, Bennett, Derrick A, Bensenor, Isabela M, Benzian, Habib, Bernabé, Eduardo, Bertozzi-Villa, Amelia, Beyene, Tariku J, Bhala, Neeraj, Bhalla, Ashish, Bhutta, Zulfiqar A, Bienhoff, Kelly, Bikbov, Boris, Biryukov, Stan, Blore, Jed D, Blosser, Christopher D, Blyth, Fiona M, Bohensky, Megan A, Bolliger, Ian W, Başara, Berrak Bora, Bornstein, Natan M, Bose, Dipan, Boufous, Soufiane, Bourne, Rupert R A, Boyers, Lindsay N, Brainin, Michael, Brayne, Carol E, Brazinova, Alexandra, Breitborde, Nicholas J K, Brenner, Hermann, Briggs, Adam D, Brooks, Peter M, Brown, Jonathan C, Brugha, Traolach S, Buchbinder, Rachelle, Buckle, Geoffrey C, Budke, Christine M, Bulchis, Anne, Bulloch, Andrew G, Campos-Nonato, Ismael R, Carabin, Hélène, Carapetis, Jonathan R, Cárdenas, Rosario, Carpenter, David O, Caso, Valeria, Castañeda-Orjuela, Carlos A, Castro, Ruben E, Catalá-López, Ferrán, Cavalleri, Fiorella, Çavlin, Alanur, Chadha, Vineet K, Chang, Jung-Chen, Charlson, Fiona J, Chen, Honglei, Chen, Wanqing, Chiang, Peggy P, Chimed-Ochir, Odgerel, Chowdhury, Rajiv, Christensen, Hanne, Christophi, Costas A, Cirillo, Massimo, Coates, Matthew M, Coffeng, Luc E, Coggeshall, Megan S, Colistro, Valentina, Colquhoun, Samantha M, Cooke, Graham S, Cooper, Cyrus, Cooper, Leslie T, Coppola, Luis M, Cortinovis, Monica, Criqui, Michael H, Crump, John A, Cuevas-Nasu, Lucia, Danawi, Hadi, Dandona, Lalit, Dandona, Rakhi, Dansereau, Emily, Dargan, Paul I, Davey, Gail, Davis, Adrian, Davitoiu, Dragos V, Dayama, Anand, De Leo, Diego, Degenhardt, Louisa, Del Pozo-Cruz, Borja, Dellavalle, Robert P, Deribe, Kebede, Derrett, Sarah, Jarlais, Don C Des, Dessalegn, Muluken, Dharmaratne, Samath D, Dherani, Mukesh K, Diaz-Torné, Cesar, Dicker, Daniel, Ding, Eric L, Dokova, Klara, Dorsey, E Ray, Driscoll, Tim R, Duan, Leilei, Duber, Herbert C, Ebel, Beth E, Edmond, Karen M, Elshrek, Yousef M, Endres, Matthias, Ermakov, Sergey P, Erskine, Holly E, Eshrati, Babak, Esteghamati, Alireza, Estep, Kara, Faraon, Emerito Jose A, Farzadfar, Farshad, Fay, Derek F, Feigin, Valery L, Felson, David T, Fereshtehnejad, Seyed-Mohammad, Fernandes, Jefferson G, Ferrari, Alize J, Fitzmaurice, Christina, Flaxman, Abraham D, Fleming, Thomas D, Foigt, Nataliya, Forouzanfar, Mohammad H, Fowkes, F Gerry R, Paleo, Urbano Fra., Franklin, Richard C, Fürst, Thomas, Gabbe, Belinda, Gaffikin, Lynne, Gankpé, Fortuné G, Geleijnse, Johanna M, Gessner, Bradford D, Gething, Peter, Gibney, Katherine B, Giroud, Maurice, Giussani, Giorgia, Dantes, Hector Gomez, Gona, Philimon, González-Medina, Diego, Gosselin, Richard A, Gotay, Carolyn C, Goto, Atsushi, Gouda, Hebe N, Graetz, Nicholas, Gugnani, Harish C, Gupta, Rahul, Gupta, Rajeev, Gutiérrez, Reyna A, Haagsma, Juanita, Hafezi-Nejad, Nima, Hagan, Holly, Halasa, Yara A, Hamadeh, Randah R, Hamavid, Hannah, Hammami, Mouhanad, Hancock, Jamie, Hankey, Graeme J, Hansen, Gillian M, Hao, Yuantao, Harb, Hilda L, Haro, Josep Maria, Havmoeller, Rasmus, Hay, Simon I, Hay, Roderick J, Heredia-Pi, Ileana B, Heuton, Kyle R, Heydarpour, Pouria, Higashi, Hideki, Hijar, Martha, Hoek, Hans W, Hoffman, Howard J, Hosgood, H Dean, Hossain, Mazeda, Hotez, Peter J, Hoy, Damian G, Hsairi, Mohamed, Hu, Guoqing, Huang, Cheng, Huang, John J, Husseini, Abdullatif, Huynh, Chantal, Iannarone, Marissa L, Iburg, Kim M, Innos, Kaire, Inoue, Manami, Islami, Farhad, Jacobsen, Kathryn H, Jarvis, Deborah L, Jassal, Simerjot K, Jee, Sun Ha, Jeemon, Panniyammakal, Jensen, Paul N, Jha, Vivekanand, Jiang, Guohong, Jiang, Ying, Jonas, Jost B, Juel, Knud, Kan, Haidong, Karch, André, Karema, Corine K, Karimkhani, Chante, Karthikeyan, Ganesan, Kassebaum, Nicholas J, Kaul, Anil, Kawakami, Norito, Kazanjan, Konstantin, Kemp, Andrew H, Kengne, Andre P, Keren, Andre, Khader, Yousef S, Khalifa, Shams Eldin A, Khan, Ejaz A, Khan, Gulfaraz, Khang, Young-Ho, Kieling, Christian, Kim, Daniel, Kim, Sungroul, Kim, Yunjin, Kinfu, Yohannes, Kinge, Jonas M, Kivipelto, Miia, Knibbs, Luke D, Knudsen, Ann Kristin, Kokubo, Yoshihiro, Kosen, Soewarta, Krishnaswami, Sanjay, Defo, Barthelemy Kuate, Bicer, Burcu Kucuk, Kuipers, Ernst J, Kulkarni, Chanda, Kulkarni, Veena S, Kumar, G Anil, Kyu, Hmwe H, Lai, Taavi, Lalloo, Ratilal, Lallukka, Tea, Lam, Hilton, Lan, Qing, Lansingh, Van C, Larsson, Anders, Lawrynowicz, Alicia E B, Leasher, Janet L, Leigh, James, Leung, Ricky, Levitz, Carly E, Li, Bin, Li, Yichong, Li, Yongmei, Lim, Stephen S, Lind, Maggie, Lipshultz, Steven E, Liu, Shiwei, Liu, Yang, Lloyd, Belinda K, Lofgren, Katherine T, Logroscino, Giancarlo, Looker, Katharine J, Lortet-Tieulent, Joannie, Lotufo, Paulo A, Lozano, Rafael, Lucas, Robyn M, Lunevicius, Raimundas, Lyons, Ronan A, Ma, Stefan, Macintyre, Michael F, Mackay, Mark T, Majdan, Marek, Malekzadeh, Reza, Marcenes, Wagner, Margolis, David J, Margono, Christopher, Marzan, Melvin B, Masci, Joseph R, Mashal, Mohammad T, Matzopoulos, Richard, Mayosi, Bongani M, Mazorodze, Tasara T, Mcgill, Neil W, Mcgrath, John J, Mckee, Martin, Mclain, Abigail, Meaney, Peter A, Medina, Catalina, Mehndiratta, Man Mohan, Mekonnen, Wubegzier, Melaku, Yohannes A, Meltzer, Michele, Memish, Ziad A, Mensah, George A, Meretoja, Atte, Mhimbira, Francis A, Micha, Renata, Miller, Ted R, Mills, Edward J, Mitchell, Philip B, Mock, Charles N, Ibrahim, Norlinah Mohamed, Mohammad, Karzan A, Mokdad, Ali H, Mola, Glen L D, Monasta, Lorenzo, Hernandez, Julio C Montañez, Montico, Marcella, Montine, Thomas J, Mooney, Meghan D, Moore, Ami R, Moradi-Lakeh, Maziar, Moran, Andrew E, Mori, Rintaro, Moschandreas, Joanna, Moturi, Wilkister N, Moyer, Madeline L, Mozaffarian, Dariush, Msemburi, William T, Mueller, Ulrich O, Mukaigawara, Mitsuru, Mullany, Erin C, Murdoch, Michele E, Murray, Joseph, Murthy, Kinnari S, Naghavi, Mohsen, Naheed, Aliya, Naidoo, Kovin S, Naldi, Luigi, Nand, Devina, Nangia, Vinay, Narayan, K M Venkat, Nejjari, Chakib, Neupane, Sudan P, Newton, Charles R, Ng, Marie, Ngalesoni, Frida N, Nguyen, Grant, Nisar, Muhammad I, Nolte, Sandra, Norheim, Ole F, Norman, Rosana E, Norrving, Bo, Nyakarahuka, Luke, Oh, In-Hwan, Ohkubo, Takayoshi, Ohno, Summer L, Olusanya, Bolajoko O, Opio, John Nelson, Ortblad, Katrina, Ortiz, Alberto, Pain, Amanda W, Pandian, Jeyaraj D, Panelo, Carlo Irwin A, Papachristou, Christina, Park, Eun-Kee, Park, Jae-Hyun, Patten, Scott B, Patton, George C, Paul, Vinod K, Pavlin, Boris I, Pearce, Neil, Pereira, David M, Perez-Padilla, Rogelio, Perez-Ruiz, Fernando, Perico, Norberto, Pervaiz, Aslam, Pesudovs, Konrad, Peterson, Carrie B, Petzold, Max, Phillips, Michael R, Phillips, Bryan K, Phillips, David E, Piel, Frédéric B, Plass, Dietrich, Poenaru, Dan, Polinder, Suzanne, Pope, Daniel, Popova, Svetlana, Poulton, Richie G, Pourmalek, Farshad, Prabhakaran, Dorairaj, Prasad, Noela M, Pullan, Rachel L, Qato, Dima M, Quistberg, D Alex, Rafay, Anwar, Rahimi, Kazem, Rahman, Sajjad U, Raju, Murugesan, Rana, Saleem M, Razavi, Homie, Reddy, K Srinath, Refaat, Amany, Remuzzi, Giuseppe, Resnikoff, Serge, Ribeiro, Antonio L, Richardson, Lee, Richardus, Jan Hendrik, Roberts, D Allen, Rojas-Rueda, David, Ronfani, Luca, Roth, Gregory A, Rothenbacher, Dietrich, Rothstein, David H, Rowley, Jane T, Roy, Nobhojit, Ruhago, George M, Saeedi, Mohammad Y, Saha, Sukanta, Sahraian, Mohammad Ali, Sampson, Uchechukwu K A, Sanabria, Juan R, Sandar, Logan, Santos, Itamar S, Satpathy, Maheswar, Sawhney, Monika, Scarborough, Peter, Schneider, Ione J, Schöttker, Ben, Schumacher, Austin E, Schwebel, David C, Scott, James G, Seedat, Soraya, Sepanlou, Sadaf G, Serina, Peter T, Servan-Mori, Edson E, Shackelford, Katya A, Shaheen, Amira, Shahraz, Saeid, Levy, Teresa Shamah, Shangguan, Siyi, She, Jun, Sheikhbahaei, Sara, Shi, Peilin, Shibuya, Kenji, Shinohara, Yukito, Shiri, Rahman, Shishani, Kawkab, Shiue, Ivy, Shrime, Mark G, Sigfusdottir, Inga D, Silberberg, Donald H, Simard, Edgar P, Sindi, Shireen, Singh, Abhishek, Singh, Jasvinder A, Singh, Lavanya, Skirbekk, Vegard, Slepak, Erica Leigh, Sliwa, Karen, Soneji, Samir, Søreide, Kjetil, Soshnikov, Sergey, Sposato, Luciano A, Sreeramareddy, Chandrashekhar T, Stanaway, Jeffrey D, Stathopoulou, Vasiliki, Stein, Dan J, Stein, Murray B, Steiner, Caitlyn, Steiner, Timothy J, Stevens, Antony, Stewart, Andrea, Stovner, Lars J, Stroumpoulis, Konstantinos, Sunguya, Bruno F, Swaminathan, Soumya, Swaroop, Mamta, Sykes, Bryan L, Tabb, Karen M, Takahashi, Ken, Tandon, Nikhil, Tanne, David, Tanner, Marcel, Tavakkoli, Mohammad, Taylor, Hugh R, Ao, Braden J Te, Tediosi, Fabrizio, Temesgen, Awoke M, Templin, Tara, Ten Have, Margreet, Tenkorang, Eric Y, Terkawi, Abdullah S, Thomson, Blake, Thorne-Lyman, Andrew L, Thrift, Amanda G, Thurston, George D, Tillmann, Taavi, Tonelli, Marcello, Topouzis, Fotis, Toyoshima, Hideaki, Traebert, Jefferson, Tran, Bach X, Trillini, Matias, Truelsen, Thomas, Tsilimbaris, Miltiadis, Tuzcu, Emin M, Uchendu, Uche S, Ukwaja, Kingsley N, Undurraga, Eduardo A, Uzun, Selen B, Van Brakel, Wim H, Van De Vijver, Steven, van Gool, Coen H, Van Os, Jim, Vasankari, Tommi J, Venketasubramanian, N, Violante, Francesco S, Vlassov, Vasiliy V, Vollset, Stein Emil, Wagner, Gregory R, Wagner, Joseph, Waller, Stephen G, Wan, Xia, Wang, Haidong, Wang, Jianli, Wang, Linhong, Warouw, Tati S, Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G, Wenzhi, Wang, Werdecker, Andrea, Westerman, Ronny, Whiteford, Harvey A, Wilkinson, James D, Williams, Thomas N, Wolfe, Charles D, Wolock, Timothy M, Woolf, Anthony D, Wulf, Sarah, Wurtz, Brittany, Xu, Gelin, Yan, Lijing L, Yano, Yuichiro, Ye, Pengpeng, Yentür, Gökalp K, Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Younis, Mustafa Z, Yu, Chuanhua, Zaki, Maysaa E, Zhao, Yong, Zheng, Yingfeng, Zonies, David, Zou, Xiaonong, Salomon, Joshua A, Lopez, Alan D, and Vos, Theo

Published
2015
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29. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Author

Vos, Theo, Barber, Ryan M, Bell, Brad, Bertozzi-Villa, Amelia, Biryukov, Stan, Bolliger, Ian, Charlson, Fiona, Davis, Adrian, Degenhardt, Louisa, Dicker, Daniel, Duan, Leilei, Erskine, Holly, Feigin, Valery L, Ferrari, Alize J, Fitzmaurice, Christina, Fleming, Thomas, Graetz, Nicholas, Guinovart, Caterina, Haagsma, Juanita, Hansen, Gillian M, Hanson, Sarah Wulf, Heuton, Kyle R, Higashi, Hideki, Kassebaum, Nicholas, Kyu, Hmwe, Laurie, Evan, Liang, Xiofeng, Lofgren, Katherine, Lozano, Rafael, MacIntyre, Michael F, Moradi-Lakeh, Maziar, Naghavi, Mohsen, Nguyen, Grant, Odell, Shaun, Ortblad, Katrina, Roberts, David Allen, Roth, Gregory A, Sandar, Logan, Serina, Peter T, Stanaway, Jeffrey D, Steiner, Caitlyn, Thomas, Bernadette, Vollset, Stein Emil, Whiteford, Harvey, Wolock, Timothy M, Ye, Pengpeng, Zhou, Maigeng, Ãvila, Marco A, Aasvang, Gunn Marit, Abbafati, Cristiana, Ozgoren, Ayse Abbasoglu, Abd-Allah, Foad, Aziz, Muna I Abdel, Abera, Semaw F, Aboyans, Victor, Abraham, Jerry P, Abraham, Biju, Abubakar, Ibrahim, Abu-Raddad, Laith J, Abu-Rmeileh, Niveen ME, Aburto, Tania C, Achoki, Tom, Ackerman, Ilana N, Adelekan, Ademola, Ademi, Zanfina, Adou, Arsène K, Adsuar, Josef C, Arnlov, Johan, Agardh, Emilie E, Al Khabouri, Mazin J, Alam, Sayed Saidul, Alasfoor, Deena, Albittar, Mohammed I, Alegretti, Miguel A, Aleman, Alicia V, Alemu, Zewdie A, Alfonso-Cristancho, Rafael, Alhabib, Samia, Ali, Raghib, Alla, Francois, Allebeck, Peter, Allen, Peter J, AlMazroa, Mohammad AbdulAziz, Alsharif, Ubai, Alvarez, Elena, Alvis-Guzman, Nelson, Ameli, Omid, Amini, Heresh, Ammar, Walid, Anderson, Benjamin O, Anderson, H. Ross, Antonio, Carl Abelardo T, Anwari, Palwasha, Apfel, Henry, Arsenijevic, Valentain S Arsic, Artaman, Al, Asghar, Rana J, Assadi, Reza, Atkins, Lydia S, Atkinson, Charles, Badawi, Alaa, Bahit, Maria C, Bakfalouni, Talal, Balakrishnan, Kalpana, Balalla, Shivanthi, Banerjee, Amitava, Barker-Collo, Suzanne L, Barquera, Simon, Barregard, Lars, Barrero, Lope H, Basu, Sanjay, Basu, Arindam, Baxter, Amanda, Beardsley, Justin, Bedi, Neeraj, Beghi, Ettore, Bekele, Tolesa, Bell, Michelle L, Benjet, Corina, Bennett, Derrick A, Bensenor, Isabela M, Benzian, Habib, Bernabe, Eduardo, Beyene, Tariku J, Bhala, Neeraj, Bhalla, Ashish, Bhutta, Zulfiqar, Bienhoff, Kelly, Bikbov, Boris, Abdulhak, Aref Bin, Blore, Jed D, Blyth, Fiona M, Bohensky, Megan A, Basara, Berrak Bora, Borges, Guilherme, Bornstein, Natan M, Bose, Dipan, Boufous, Soufiane, Bourne, Rupert R, Boyers, Lindsay N, Brainin, Michael, Brauer, Michael, Brayne, Carol EG, Brazinova, Alexandra, Breitborde, Nicholas JK, Brenner, Hermann, Briggs, Adam DM, Brooks, Peter M, Brown, Jonathan, Brugha, Traolach S, Buchbinder, Rachelle, Buckle, Geoffrey C, Bukhman, Gene, Bulloch, Andrew G, Burch, Michael, Burnett, Richard, Cardenas, Rosario, Cabral, Norberto L, Nonato, Ismael R Campos, Campuzano, Julio C, Carapetis, Jonathan R, Carpenter, David O, Caso, Valeria, Castaneda-Orjuela, Carlos A, Catala-Lopez, Ferran, Chadha, Vineet K, Chang, Jung-Chen, Chen, Honglei, Chen, Wanqing, Chiang, Peggy P, Chimed-Ochir, Odgerel, Chowdhury, Rajiv, Christensen, Hanne, Christophi, Costas A, Chugh, Sumeet S, Cirillo, Massimo, Coggeshall, Megan, Cohen, Aaron, Colistro, Valentina, Colquhoun, Samantha M, Contreras, Alejandra G, Cooper, Leslie T, Cooper, Cyrus, Cooperrider, Kimberly, Coresh, Josef, Cortinovis, Monica, Criqui, Michael H, Crump, John A, Cuevas-Nasu, Lucia, Dandona, Rakhi, Dandona, Lalit, Dansereau, Emily, Dantes, Hector G, Dargan, Paul I, Davey, Gail, Davitoiu, Dragos V, Dayama, Anand, De la Cruz-Gongora, Vanessa, de la Vega, Shelley F, De Leo, Diego, del Pozo-Cruz, Borja, Dellavalle, Robert P, Deribe, Kebede, Derrett, Sarah, Des Jarlais, Don C, Dessalegn, Muluken, deVeber, Gabrielle A, Dharmaratne, Samath D, Diaz-Torne, Cesar, Ding, Eric L, Dokova, Klara, Dorsey, E R, Driscoll, Tim R, Duber, Herbert, Durrani, Adnan M, Edmond, Karen M, Ellenbogen, Richard G, Endres, Matthias, Ermakov, Sergey P, Eshrati, Babak, Esteghamati, Alireza, Estep, Kara, Fahimi, Saman, Farzadfar, Farshad, Fay, Derek FJ, Felson, David T, Fereshtehnejad, Seyed-Mohammad, Fernandes, Jefferson G, Ferri, Cluesa P, Flaxman, Abraham, Foigt, Nataliya, Foreman, Kyle J, Fowkes, F Gerry R, Franklin, Richard C, Furst, Thomas, Futran, Neal D, Gabbe, Belinda J, Gankpe, Fortune G, Garcia-Guerra, Francisco A, Geleijnse, Johanna M, Gessner, Bradford D, Gibney, Katherine B, Gillum, Richard F, Ginawi, Ibrahim A, Giroud, Maurice, Giussani, Giorgia, Goenka, Shifalika, Goginashvili, Ketevan, Gona, Philimon, de Cosio, Teresita Gonzalez, Gosselin, Richard A, Gotay, Carolyn C, Goto, Atsushi, Gouda, Hebe N, Guerrant, Richard l, Gugnani, Harish C, Gunnell, David, Gupta, Rajeev, Gupta, Rahul, Gutierrez, Reyna A, Hafezi-Nejad, Nima, Hagan, Holly, Halasa, Yara, Hamadeh, Randah R, Hamavid, Hannah, Hammami, Mouhanad, Hankey, Graeme J, Hao, Yuantao, Harb, Hilda L, Haro, Josep Maria, Havmoeller, Rasmus, Hay, Roderick J, Hay, Simon, Hedayati, Mohammad T, Pi, Ileana B Heredia, Heydarpour, Pouria, Hijar, Martha, Hoek, Hans W, Hoffman, Howard J, Hornberger, John C, Hosgood, H. Dean, Hossain, Mazeda, Hotez, Peter J, Hoy, Damian G, Hsairi, Mohamed, Hu, Howard, Hu, Guoqing, Huang, John J, Huang, Cheng, Huiart, Laetitia, Husseini, Abdullatif, Iannarone, Marissa, Iburg, Kim M, Innos, Kaire, Inoue, Manami, Jacobsen, Kathryn H, Jassal, Simerjot K, Jeemon, Panniyammakal, Jensen, Paul N, Jha, Vivekanand, Jiang, Guohong, Jiang, Ying, Jonas, Jost B, Joseph, Jonathan, Juel, Knud, Kan, Haidong, Karch, Andre, Karimkhani, Chante, Karthikeyan, Ganesan, Katz, Ronit, Kaul, Anil, Kawakami, Norito, Kazi, Dhruv S, Kemp, Andrew H, Kengne, Andre P, Khader, Yousef S, Khalifa, Shams Eldin AH, Khan, Ejaz A, Khan, Gulfaraz, Khang, Young-Ho, Khonelidze, Irma, Kieling, Christian, Kim, Daniel, Kim, Sungroul, Kimokoti, Ruth W, Kinfu, Yohannes, Kinge, Jonas M, Kissela, Brett M, Kivipelto, Miia, Knibbs, Luke, Knudsen, Ann Kristin, Kokubo, Yoshihiro, Kosen, Soewarta, Kramer, Alexander, Kravchenko, Michael, Krishnamurthi, Rita V, Krishnaswami, Sanjay, Defo, Barthelemy Kuate, Bicer, Burcu Kucuk, Kuipers, Ernst J, Kulkarni, Veena S, Kumar, Kaushalendra, Kumar, G Anil, Kwan, Gene F, Lai, Taavi, Lalloo, Ratilal, Lam, Hilton, Lan, Qing, Lansingh, Van C, Larson, Heidi, Larsson, Anders, Lawrynowicz, Alicia EB, Leasher, Janet L, Lee, Jong-Tae, Leigh, James, Leung, Ricky, Levi, Miriam, Li, Bin, Li, Yichong, Li, Yongmei, liang, Juan, Lim, Stephen, Lin, Hsien-Ho, Lind, Margaret, Lindsay, M Patrice, Lipshultz, Steven E, Liu, Shiwei, Lloyd, Belinda K, Ohno, Summer Lockett, Logroscino, Giancarlo, Looker, Katharine J, Lopez, Alan D, Lopez-Olmedo, Nancy, Lortet-Tieulent, Joannie, Lotufo, Paulo A, Low, Nicola, Lucas, Robyn M, Lunevicius, Raimundas, Lyons, Ronan A, Ma, Jixiang, Ma, Stefan, Mackay, Mark T, Majdan, Marek, Malekzadeh, Reza, Mapoma, Christopher C, Marcenes, Wagner, March, Lyn M, Margono, Chris, Marks, Guy B, Marzan, Melvin B, Masci, Joseph R, Mason-Jones, Amanda J, Matzopoulos, Richard G, Mayosi, Bongani M, Mazorodze, Tasara T, McGill, Neil W, McGrath, John J, McKee, Martin, McLain, Abby, McMahon, Brian J, Meaney, Peter A, Mehndiratta, Man Mohan, Mejia-Rodriguez, Fabiola, Mekonnen, Wubegzier, Melaku, Yohannes A, Meltzer, Michele, Memish, Ziad A, Mensah, George, Meretoja, Atte, Mhimbira, Francis A, Micha, Renata, Miller, Ted R, Mills, Edward J, Mitchell, Philip B, Mock, Charles N, Moffitt, Terrie E, Ibrahim, Norlinah Mohamed, Mohammad, Karzan A, Mokdad, Ali H, Mola, Glen L, Monasta, Lorenzo, Montico, Marcella, Montine, Thomas J, Moore, Ami R, Moran, Andrew E, Morawska, Lidia, Mori, Rintaro, Moschandreas, Joanna, Moturi, Wilkister N, Moyer, Madeline, Mozaffarian, Dariush, Mueller, Ulrich O, Mukaigawara, Mitsuru, Murdoch, Michele E, Murray, Joseph, Murthy, Kinnari S, Naghavi, Paria, Nahas, Ziad, Naheed, Aliya, Naidoo, Kovin S, Naldi, Luigi, Nand, Devina, Nangia, Vinay, Narayan, K.M. Venkat, Nash, Denis, Nejjari, Chakib, Neupane, Sudan P, Newman, Lori M, Newton, Charles R, Ng, Marie, Ngalesoni, Frida N, Nhung, Nguyen T, Nisar, Muhammad I, Nolte, Sandra, Norheim, Ole F, Norman, Rosana E, Norrving, Bo, Nyakarahuka, Luke, Oh, In Hwan, Ohkubo, Takayoshi, Omer, Saad B, Opio, John Nelson, Ortiz, Alberto, Pandian, Jeyaraj D, Panelo, Carlo Irwin A, Papachristou, Christina, Park, Eun-Kee, Parry, Charles D, Caicedo, Angel J Paternina, Patten, Scott B, Paul, Vinod K, Pavlin, Boris I, Pearce, Neil, Pedraza, Lilia S, Pellegrini, Carlos A, Pereira, David M, Perez-Ruiz, Fernando P, Perico, Norberto, Pervaiz, Aslam, Pesudovs, Konrad, Peterson, Carrie B, Petzold, Max, Phillips, Michael R, Phillips, David, Phillips, Bryan, Piel, Frederic B, Plass, Dietrich, Poenaru, Dan, Polanczyk, Guilherme V, Polinder, Suzanne, Pope, C A, Popova, Svetlana, Poulton, Richie G, Pourmalek, Farshad, Prabhakaran, Dorairaj, Prasad, Noela M, Qato, Dima, Quistberg, D A, Rafay, Anwar, Rahimi, Kazem, Rahimi-Movaghar, Vafa, Rahman, Sajjad ur, Raju, Murugesan, Rakovac, Ivo, Rana, Saleem M, Razavi, Homie, Refaat, Amany, Rehm, Jurgen, Remuzzi, Giuseppe, Resnikoff, Serge, Ribeiro, Antonio L, Riccio, Patricia M, Richardson, Lee, Richardus, Jan Hendrik, Riederer, Anne M, Robinson, Margot, Roca, Anna, Rodriguez, Alina, Rojas-Rueda, David, Ronfani, Luca, Rothenbacher, Dietrich, Roy, Nobhojit, Ruhago, George M, Sabin, Nsanzimana, Sacco, Ralph L, Ksoreide, Kjetil, Saha, Sukanta, Sahathevan, Ramesh, Sahraian, Mohammad Ali, Sampson, Uchechukwu, Sanabria, Juan R, Sanchez-Riera, Lidia, Santos, Itamar S, Satpathy, Maheswar, Saunders, James E, Sawhney, Monika, Saylan, Mete I, Scarborough, Peter, Schoettker, Ben, Schneider, Ione JC, Schwebel, David C, Scott, James G, Seedat, Soraya, Sepanlou, Sadaf G, Serdar, Berrin, Servan-Mori, Edson E, Shackelford, Katya, Shaheen, Amira, Shahraz, Saeid, Levy, Teresa Shamah, Shangguan, Siyi, She, Jun, Sheikhbahaei, Sara, Shepard, Donald S, Shi, Peilin, Shibuya, Kenji, Shinohara, Yukito, Shiri, Rahman, Shishani, Kawkab, Shiue, Ivy, Shrime, Mark G, Sigfusdottir, Inga D, Silberberg, Donald H, Simard, Edgar P, Sindi, Shireen, Singh, Jasvinder A, Singh, Lavanya, Skirbekk, Vegard, Sliwa, Karen, Soljak, Michael, Soneji, Samir, Soshnikov, Sergey S, Speyer, Peter, Sposato, Luciano A, Sreeramareddy, Chandrashekhar T, Stoeckl, Heidi, Stathopoulou, Vasiliki Kalliopi, Steckling, Nadine, Stein, Murray B, Stein, Dan J, Steiner, Timothy J, Stewart, Andrea, Stork, Eden, Stovner, Lars J, Stroumpoulis, Konstantinos, Sturua, Lela, Sunguya, Bruno F, Swaroop, Mamta, Sykes, Bryan L, Tabb, Karen M, Takahashi, Ken, Tan, Feng, Tandon, Nikhil, Tanne, David, Tanner, Marcel, Tavakkoli, Mohammad, Taylor, Hugh R, Te Ao, Braden J, Temesgen, Awoke Misganaw, Have, Margreet Ten, Tenkorang, Eric Yeboah, Terkawi, Abdullah Sulieman, Theadom, Alice M, Thomas, Elissa, Thorne-Lyman, Andrew L, Thrift, Amanda G, Tleyjeh, Imad M, Tonelli, Marcello, Topouzis, Fotis, Towbin, Jeffrey A, Toyoshima, Hideaki, Traebert, Jefferson, Tran, Bach X, Trasande, Leonardo, Trillini, Matias, Truelsen, Thomas, Trujillo, Ulises, Tsilimbaris, Miltiadis, Tuzcu, Emin M, Ukwaja, Kingsley N, Undurraga, Eduardo A, Uzun, Selen B, van Brakel, Wim H, van de Vijver, Steven, Dingenen, Rita Van, van Gool, Coen H, Varakin, Yuri Y, Vasankari, Tommi J, Vavilala, Monica S, Veerman, Lennert J, Velasquez-Melendez, Gustavo, Venketasubramanian, Narayanaswamy, Vijayakumar, Lakshmi, Villalpando, Salvador, Violante, Francesco S, Vlassov, Vasiliy V, Waller, Stephen, Wallin, Mitchell T, Wan, Xia, Wang, Linhong, Wang, JianLi, Wang, Yanping, Warouw, Tati S, Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G, Werdecker, Andrea, Wessells, K. Ryan R, Westerman, Ronny, Wilkinson, James D, Williams, Hywel C, Williams, Thomas N, Woldeyohannes, Solomon M, Wolfe, Charles DA, Wong, John Q, Wong, Haidong, Woolf, Anthony D, Wright, Jonathan L, Wurtz, Brittany, Xu, Gelin, Yang, Gonghuan, Yano, Yuichiro, Yenesew, Muluken A, Yentur, Gokalp K, Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Younis, Mustafa, Yu, Chuanhua, Kim, Kim Yun, Zaki, Maysaa El Sayed, Zhang, Yong, Zhao, Zheng, Zhao, Yong, Zhu, Jun, Zonies, David, Zunt, Joseph R, Salomon, Joshua A, and Murray, Christopher JL

Published
2015
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32. Collecting family planning intentions and providing reproductive health information using a tablet-based video game in India [version 2; referees: 2 approved]

Author

Elena Bertozzi, Amelia Bertozzi-Villa, Praveen Kulkarni, and Aparna Sridhar

Subjects
Medicine
Abstract

Background: In response to a Grand Challenges in Global Health call for action to collect data about family planning intentions and increase the uptake of family planning methods in India, our team designed, developed, and piloted the My Future Family video game in Karnataka Province. The game educates adolescents about human sexuality and reproduction while asking players when they would like to achieve five important family planning milestones. Participants were also asked to report who influences them the most when making family planning decisions. Methods: Focus groups were conducted and the resulting data used to design the game which was iteratively tested and then piloted in 11 schools in rural and urban areas of southern India. Data was collected throughout gameplay and cross-checked with paper questionnaires. Results: In August 2017, we successfully piloted the game with 382 adolescents and validated its efficacy both as an educational tool and as an innovative means of accurate data collection. Conclusion: It has historically been problematic to gather accurate data about adolescents in India on this culturally sensitive topic for a variety of reasons. These include difficulties obtaining consent, developing appropriate survey methods, and framing questions in language that young people can understand. Our game met these challenges by working within a single school system with approval from senior administration, delivering information via a game environment which freed players from societal constraints, and communicating information via images and audio in addition to text in both English and Kannada (the local language).

Published
2018
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33. Collecting family planning intentions and providing reproductive health information using a tablet-based video game in India [version 1; referees: 2 approved]

Author

Elena Bertozzi, Amelia Bertozzi-Villa, Praveen Kulkarni, and Aparna Sridhar

Subjects
Medicine
Abstract

Background: In response to a Grand Challenges in Global Health call for action to collect data about family planning intentions and increase the uptake of family planning methods in India, our team designed, developed, and piloted the My Future Family video game in Karnataka Province. The game educates adolescents about human sexuality and reproduction while asking players when they would like to achieve five important family planning milestones. Participants were also asked to report who influences them the most when making family planning decisions. Methods: Focus groups were conducted and the resulting data used to design the game which was iteratively tested and then piloted in 11 schools in rural and urban areas of southern India. Data was collected throughout gameplay and cross-checked with paper questionnaires. Results: In August 2018, we successfully piloted the game with 382 adolescents and validated its efficacy both as an educational tool and as an innovative means of accurate data collection. Conclusion: It has historically been problematic to gather accurate data about adolescents in India on this culturally sensitive topic for a variety of reasons. These include difficulties obtaining consent, developing appropriate survey methods, and framing questions in language that young people can understand. Our game met these challenges by working within a single school system with approval from senior administration, delivering information via a game environment, which freed players from societal constraints, and communicating information via images and audio in addition to text in both English and Kannada (the local language).

Published
2018
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34. Socioeconomic, demographic and environmental factors inform malaria intervention prioritization in urban Nigeria

Author

Chilochibi Chiziba, Ousmane Diallo, Amelia Bertozzi-Villa, Dan Weiss, Laina Mercer, Jaline Gerardin, and Ifeoma D. Ozodiegwu

Abstract

Background Nigeria is one of three countries projected to have the largest absolute increase in the size of its urban population and this could intensify malaria transmission in cities. Accelerated urban population growth is outpacing the availability of affordable housing and basic services and resulting in living conditions that foster vector breeding and heterogeneous malaria transmission. Understanding community determinants of malaria transmission in urban areas informs the targeting of interventions to populations at greatest risk. Methods In this study, we analyzed cluster-level data from the Demographic and Health Surveys (DHS) and the Malaria Indicator Survey (MIS) as well as geospatial covariates to describe malaria burden and its determinants in areas administratively defined as urban in Nigeria. Univariate and multivariable models were respectively used to identify potential intervention prioritization thresholds and likely casual impact of individual variables. Results Overall, we found low malaria test positivity across urban areas. We observed declines in test positivity rate over time and identified the percentage of individuals with post-primary education, the percentage of individuals in the rich wealth quintiles, the percentage of individuals living in improved housing in 2015, all age population density, median age, the percentage of children under the age of five that sought medical treatment for fever, total precipitation, and enhanced vegetation index as key community predictors of malaria transmission intensity. Conclusions The unrepresentativeness of the DHS and MIS in urban settings at the state and geopolitical zonal level, regional differences in malaria seasonality across Nigeria, and information detection bias were among likely factors that limited our ability to compare malaria burden across geographic space and ultimately drove model uncertainty. Nevertheless, study findings provide a starting point for informing decisions on intervention prioritization within urban spaces and underscore the need for improved regionally focused surveillance systems in Nigeria.

Published
2023
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37. Mapping Malaria by Sharing Spatial Information Between Incidence and Prevalence Data Sets

Author

Anita Nandi, Peter W. Gething, Rohan Arambepola, Susan F. Rumisha, Emma L. Collins, Daniel J. Weiss, Punam Amratia, Rosalind E. Howes, Tim C.D. Lucas, Katherine E. Battle, Penelope A. Hancock, Suzanne H. Keddie, Ewan Cameron, Andre Python, Katherine A. Twohig, Michele Nguyen, Amelia Bertozzi-Villa, and Elisabeth G. Chestnutt

Subjects
Statistics and Probability, Computer science, Approximation error, Incidence (epidemiology), Polygon, Covariate, Statistics, Regression analysis, Statistics, Probability and Uncertainty, Baseline (configuration management), Spatial analysis, Gaussian random field
Abstract

As malaria incidence decreases and more countries move towards elimination, maps of malaria risk in low-prevalence areas are increasingly needed. For low-burden areas, disaggregation regression models have been developed to estimate risk at high spatial resolution from routine surveillance reports aggregated by administrative unit polygons. However, in areas with both routine surveillance data and prevalence surveys, models that make use of the spatial information from prevalence point-surveys might make more accurate predictions. Using case studies in Indonesia, Senegal and Madagascar, we compare the out-of-sample mean absolute error for two methods for incorporating point-level, spatial information into disaggregation regression models. The first simply fits a binomial-likelihood, logit-link, Gaussian random field to prevalence point-surveys to create a new covariate. The second is a multi-likelihood model that is fitted jointly to prevalence point-surveys and polygon incidence data. We find that in most cases there is no difference in mean absolute error between models. In only one case, did the new models perform the best. More generally, our results demonstrate that combining these types of data has the potential to reduce absolute error in estimates of malaria incidence but that simpler baseline models should always be fitted as a benchmark.

Published
2021
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39. Outcomes Assessment Pitfalls: Challenges to Quantifying Knowledge Gain in a Sex Education Game

Author

Bertozzi-Villa, Amelia, Bertozzi, Elena, and Sridhar, Aparna

Subjects
International Public Health, Adolescent Health, Game, India, Health Information Technology, Sex Education, Education, Other Education, Medicine and Health Sciences, Secondary Education, FOS: Educational sciences, Public Health, Family planning, Public Health Education and Promotion
Abstract

Analysis of pre- and post-game knowledge assessment test for a sex education game distributed to teens in Chennai, India.

Published
2022
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40. Collecting family planning intentions and providing reproductive health information using a tablet-based video game in India

Author

Bertozzi-Villa, Amelia, Bertozzi, Elena, and Sridhar, Aparna

Abstract

Our aim in this study was to develop, pilot, and assess an innovative tool: a tablet-based game which provides adolescents with information about puberty, reproductive health, and family planning while collecting data. Data points include: desired family size, timing of important life events, and identity of principal influencers of these decisions.

Published
2022
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42. Obstetric Inpatient and Ultrasound Clinical Personnel Absences during the COVID-19 Pandemic in New York City

Author

Russell S. Miller, Janice Aubey, Dena Goffman, Lynn L. Simpson, Karin Fuchs, Natali E. Valderrama, Kenya E. Robinson, Cynthia Gyamfi-Bannerman, Timothy Wen, Jessica Spiegelman, Noelia Zork, Alexander M. Friedman, Jean-Ju Sheen, Mary E. D'Alton, and Clara Bertozzi-Villa

Subjects
Inpatients, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), business.industry, Staffing, Columbia university, MEDLINE, COVID-19, Obstetrics and Gynecology, Retrospective cohort study, Test (assessment), Pregnancy, Family medicine, Pediatrics, Perinatology and Child Health, Pandemic, medicine, Humans, Female, New York City, Child, business, Pandemics, Obstetrical nursing, Retrospective Studies
Abstract

Objective To review obstetric personnel absences at a hospital during the initial peak of coronavirus disease 2019 (COVID-19) infection risk in New York City from March 25 to April 21, 2020. Study Design This retrospective study evaluated absences at Morgan Stanley Children's Hospital. Clinical absences for (1) Columbia University ultrasonographers, (2) inpatient nurses, (3) labor and delivery operating room (OR) technicians, (4) inpatient obstetric nurse assistants, and (5) attending physicians providing inpatient obstetric services were analyzed. Causes of absences were analyzed and classified as illness, vacation and holidays, leave, and other causes. Categorical variables were compared with the chi-square test or Fisher's exact test. Results For nurses, absences accounted for 1,052 nursing workdays in 2020 (17.2% of all workdays) compared with 670 (11.1%) workdays in 2019 (p Conclusion COVID-19 outbreak surge planning represents a major operational issue for medical specialties such as critical care due to increased clinical volume. Findings from this analysis suggest it is prudent to devise backup staffing plans. Key Points

Published
2021
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43. Socioeconomic, demographic and environmental factors inform intervention prioritization in urban Nigeria

Author

Chilochibi Chiziba, Ousmane Diallo, Amelia Bertozzi-Villa, Dan Weiss, Laina Mercer, Jaline Gerardin, and Ifeoma D. Ozodiegwu

Subjects
parasitic diseases
Abstract

Nigeria is one of three countries projected to have the largest absolute increase in the size of its urban population and this could intensify malaria transmission in cities. Accelerated urban population growth is out-pacing the availability of affordable housing and basic services and resulting in living conditions that foster vector breeding and heterogeneous malaria transmission. Understanding community determinants of malaria transmission in urban areas informs the targeting of interventions to populations at greatest risk. In this study, we analyzed cluster-level data from the Demographic and Health Surveys (DHS) and the Malaria Indicator Survey (MIS) as well as geospatial covariates to describe malaria burden and its determinants in areas administratively defined as urban in Nigeria. Overall, we found low malaria test positivity across urban areas,. We observed declines in test positivity rate over time and identified the percentage of individuals with post-primary education, the percentage of individuals in the rich wealth quintiles, the percentage of individuals living in improved housing in 2015, all age population density, median age, the percentage of children under the age of five that sought medical treatment for fever, total precipitation and enhanced vegetation index as key community predictors of malaria transmission intensity. The unrepresentativeness of the DHS and MIS in urban settings at the state and geopolitical zonal level, regional differences in malaria seasonality across Nigeria, and information detection bias were among likely factors that limited our ability to compare malaria burden across geographic space and ultimately drove model uncertainty. Nevertheless, study findings provide a starting point for informing decisions on intervention prioritization within urban spaces and underscore the need for improved regionally-focused surveillance systems in Nigeria.

Published
2022
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47. The utility of merging mechanistic and geospatial models for malaria intervention planning and policy guidance

Author

Bertozzi-Villa, A, Gething, P, Bhatt, S, and Hollingsworth, T

Subjects
malaria, Modeling, epidemiology
Abstract

This thesis describes the development and refinement of two frameworks for usefully combining mechanistic and geospatial models in malaria research. The first framework, focused on malaria transmission, uses machine learning tools and spatial data to identify key features for a mechanistic transmission model, then utilizes spatial data again to place mechanistic model results in a global context. This strategy is novel, flexible, customizable, and computationally efficient. The second, focused on insecticide-treated net coverage, uses a mechanistic commodity tracking model as the backbone for a spatiotemporal regression model in order to appropriately capture different countries' unique histories of net procurement, distribution, and retention. Examples of the on-the-ground policy impact of this work are included for stakeholders such as the World Health Organization, the Clinton Health Access Initiative, and the Bill and Melinda Gates Foundation. Both of these modeling frameworks showcase the value of combining the flexibility and versatility of mechanistic modeling with the statistical rigor and geographical tools of geospatial modeling.

Published
2021

48. Travel time to health facilities in areas of outbreak potential: maps for guiding local preparedness and response

Author

Nancy Fullman, Brent Bell, Robert C. Reiner, Judith N. Wasserheit, E. N. Hulland, Peter M. Rabinowitz, Daniel J. Weiss, Shreya Shirude, David M. Pigott, Tamer H. Farag, Kirsten E. Wiens, Vandana Gupta, Simon I. Hay, Molly K. Miller-Petrie, Julia D. Morgan, Moritz U. G. Kraemer, and Amelia Bertozzi-Villa

Subjects
medicine.medical_specialty, Time Factors, Geospatial analysis, Travel time, Preparedness, 030231 tropical medicine, lcsh:Medicine, computer.software_genre, Disease Outbreaks, 03 medical and health sciences, Marburg, 0302 clinical medicine, Spillover effect, Health facility, CCHF, Humans, Medicine, 030212 general & internal medicine, Environmental planning, Travel, business.industry, Public health, lcsh:R, Civil Defense, Outbreak, Health facility access, General Medicine, Hemorrhagic Fevers, Ebola, Resource allocation, Health Facilities, business, computer, Viral hemorrhagic fevers, Research Article, Lassa fever
Abstract

Background Repeated outbreaks of emerging pathogens underscore the need for preparedness plans to prevent, detect, and respond. As countries develop and improve National Action Plans for Health Security, addressing subnational variation in preparedness is increasingly important. One facet of preparedness and mitigating disease transmission is health facility accessibility, linking infected persons with health systems and vice versa. Where potential patients can access care, local facilities must ensure they can appropriately diagnose, treat, and contain disease spread to prevent secondary transmission; where patients cannot readily access facilities, alternate plans must be developed. Here, we use travel time to link facilities and populations at risk of viral hemorrhagic fevers (VHFs) and identify spatial variation in these respective preparedness demands. Methods and findings We used geospatial resources of travel friction, pathogen environmental suitability, and health facilities to determine facility accessibility of any at-risk location within a country. We considered in-country and cross-border movements of exposed populations and highlighted vulnerable populations where current facilities are inaccessible and new infrastructure would reduce travel times. We developed profiles for 43 African countries. Resulting maps demonstrate gaps in health facility accessibility and highlight facilities closest to areas at risk for VHF spillover. For instance, in the Central African Republic, we identified travel times of over 24 h to access a health facility. Some countries had more uniformly short travel times, such as Nigeria, although regional disparities exist. For some populations, including many in Botswana, access to areas at risk for VHF nationally was low but proximity to suitable spillover areas in bordering countries was high. Additional analyses provide insights for considering future resource allocation. We provide a contemporary use case for these analyses for the ongoing Ebola outbreak. Conclusions These maps demonstrate the use of geospatial analytics for subnational preparedness, identifying facilities close to at-risk populations for prioritizing readiness to detect, treat, and respond to cases and highlighting where gaps in health facility accessibility exist. We identified cross-border threats for VHF exposure and demonstrate an opportunity to improve preparedness activities through the use of precision public health methods and data-driven insights for resource allocation as part of a country’s preparedness plans.

Published
2019

50. Mapping malaria by sharing spatial information between incidence and prevalence data sets

Author

Lucas, Tim CD, Nandi, Anita K, Chestnutt, Elisabeth G, Twohig, Katherine A, Keddie, Suzanne H, Collins, Emma L, Howes, Rosalind E, Nguyen, Michele, Rumisha, Susan F, Python, Andre, Arambepola, Rohan, Bertozzi‐Villa, Amelia, Hancock, Penelope, Amratia, Punam, Battle, Katherine E, Cameron, Ewan, Gething, Peter W, and Weiss, Daniel J

Abstract

As malaria incidence decreases and more countries move towards elimination, maps of malaria risk in low-prevalence areas are increasingly needed. For low-burden areas, disaggregation regression models have been developed to estimate risk at high spatial resolution from routine surveillance reports aggregated by administrative unit polygons. However, in areas with both routine surveillance data and prevalence surveys, models that make use of the spatial information from prevalence point-surveys might make more accurate predictions. Using case studies in Indonesia, Senegal and Madagascar, we compare the out-of-sample mean absolute error for two methods for incorporating point-level, spatial information into disaggregation regression models. The first simply fits a binomial-likelihood, logit-link, Gaussian random field to prevalence point-surveys to create a new covariate. The second is a multi-likelihood model that is fitted jointly to prevalence point-surveys and polygon incidence data. We find that in most cases there is no difference in mean absolute error between models. In only one case, did the new models perform the best. More generally, our results demonstrate that combining these types of data has the potential to reduce absolute error in estimates of malaria incidence but that simpler baseline models should always be fitted as a benchmark.

Published
2021

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