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Bassett IV, Yan J, Giddy J, Ross D, Bogart LM, Stuckwisch A, Zionts D, Naidoo R, Parker RA. Geographic variation in 5-year mortality following HIV diagnosis: implications for clinical interventions. AIDS Care 2023; 35:2016-2023. [PMID: 36942651 PMCID: PMC10511661 DOI: 10.1080/09540121.2023.2189224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 03/01/2023] [Indexed: 03/23/2023]
Abstract
Characterizing spatial distribution of HIV outcomes is vital for targeting interventions to areas most at risk. We performed spatial analysis to identify geographic clusters and factors associated with mortality in KwaZulu-Natal, South Africa. We utilized Sizanani trial (NCT01188941) data, which enrolled participants August 2010-January 2013 and obtained vital status at 5.8 (IQR 5.0-6.4) years of follow-up. We mapped geocoded addresses to 2011 Census-defined small area layer (SAL) centroids, used Kulldorff's spatial scan statistic to identify mortality clusters, and compared socio-demographic factors for SALs within and outside mortality clusters. We assigned 1,143 participants living with HIV (260 [23%] of whom died during follow-up) to 677 SALs. One lower mortality cluster (n = 90, RR = 0.23, p = 0.022) was identified near a hospital outside Durban. SALs in the cluster were younger (24y vs 25y, p < 0.001); had fewer bedrooms/household (3 vs 4, p < 0.001); had more females (52% vs 51%, p = 0.013) and residents with no schooling past age 20 (4% vs 3%, p < 0.001) or no education at all (4% vs 3%, p < 0.001); had fewer residents with income >3,200 ZAR/month (5% vs 9%, p < 0.001); and had reduced access to piped water (p < 0.001), refuse disposal (p < 0.001), and toilets (p < 0.001). Targeted interventions may improve outcomes in areas with similar characteristics.
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Affiliation(s)
- Ingrid V. Bassett
- Massachusetts General Hospital, Division of Infectious Diseases, Boston, Massachusetts, United States of America
- Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, Massachusetts, United States of America
- Harvard University, Center for AIDS Research (CFAR), Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Joyce Yan
- Massachusetts General Hospital, Biostatistics Center, Boston, Massachusetts, United States of America
| | | | - Douglas Ross
- St. Mary’s Hospital, Mariannhill, Durban, South Africa*
| | - Laura M. Bogart
- RAND Corporation, Santa Monica, California, United States of America
| | - Ashley Stuckwisch
- Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, Massachusetts, United States of America
| | - Dani Zionts
- Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, Massachusetts, United States of America
| | - Ravi Naidoo
- Statistics South Africa, KwaZulu-Natal Provincial Office, Durban, South Africa
| | - Robert A. Parker
- Massachusetts General Hospital, Biostatistics Center, Boston, Massachusetts, United States of America
- Harvard University, Center for AIDS Research (CFAR), Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
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Manda S, Haushona N, Bergquist R. A Scoping Review of Spatial Analysis Approaches Using Health Survey Data in Sub-Saharan Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3070. [PMID: 32354095 PMCID: PMC7246597 DOI: 10.3390/ijerph17093070] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 01/03/2023]
Abstract
Spatial analysis has become an increasingly used analytic approach to describe and analyze spatial characteristics of disease burden, but the depth and coverage of its usage for health surveys data in Sub-Saharan Africa are not well known. The objective of this scoping review was to conduct an evaluation of studies using spatial statistics approaches for national health survey data in the SSA region. An organized literature search for studies related to spatial statistics and national health surveys was conducted through PMC, PubMed/Medline, Scopus, NLM Catalog, and Science Direct electronic databases. Of the 4,193 unique articles identified, 153 were included in the final review. Spatial smoothing and prediction methods were predominant (n = 108), followed by spatial description aggregation (n = 25), and spatial autocorrelation and clustering (n = 19). Bayesian statistics methods and lattice data modelling were predominant (n = 108). Most studies focused on malaria and fever (n = 47) followed by health services coverage (n = 38). Only fifteen studies employed nonstandard spatial analyses (e.g., spatial model assessment, joint spatial modelling, accounting for survey design). We recommend that for future spatial analysis using health survey data in the SSA region, there must be an improve recognition and awareness of the potential dangers of a naïve application of spatial statistical methods. We also recommend a wide range of applications using big health data and the future of data science for health systems to monitor and evaluate impacts that are not well understood at local levels.
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Affiliation(s)
- Samuel Manda
- Biostatistics Research Unit, South African Medical Research Council, Pretoria 0001, South Africa
- Department of Statistics, University of Pretoria, Pretoria 0002, South Africa
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg 3209, South Africa
| | - Ndamonaonghenda Haushona
- Biostatistics Research Unit, South African Medical Research Council, Pretoria 0001, South Africa
- Division of Epidemiology and Biostatistics, University of Stellenbosch, Cape Town 8000, South Africa
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Makanga PT, Sacoor C, Schuurman N, Lee T, Vilanculo FC, Munguambe K, Boene H, Ukah UV, Vidler M, Magee LA, Sevene E, von Dadelszen P, Firoz T. Place-specific factors associated with adverse maternal and perinatal outcomes in Southern Mozambique: a retrospective cohort study. BMJ Open 2019; 9:e024042. [PMID: 30782892 PMCID: PMC6367983 DOI: 10.1136/bmjopen-2018-024042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To identify and measure the place-specific determinants that are associated with adverse maternal and perinatal outcomes in the southern region of Mozambique. DESIGN Retrospective cohort study. Choice of variables informed by literature and Delphi consensus. SETTING Study conducted during the baseline phase of a community level intervention for pre-eclampsia that was led by community health workers. PARTICIPANTS A household census identified 50 493 households that were home to 80 483 women of reproductive age (age 12-49 years). Of these women, 14 617 had been pregnant in the 12 months prior to the census, of which 9172 (61.6%) had completed their pregnancies. PRIMARY AND SECONDARY OUTCOME MEASURES A combined fetal, maternal and neonatal outcome was calculated for all women with completed pregnancies. RESULTS A total of six variables were statistically significant (p≤0.05) in explaining the combined outcome. These included: geographic isolation, flood proneness, access to an improved latrine, average age of reproductive age woman, family support and fertility rates. The performance of the ordinary least squares model was an adjusted R2=0.69. Three of the variables (isolation, latrine score and family support) showed significant geographic variability in their effect on rates of adverse outcome. Accounting for this modest non-stationary effect through geographically weighted regression increased the adjusted R2 to 0.71. CONCLUSIONS The community exploration was successful in identifying context-specific determinants of maternal health. The results highlight the need for designing targeted interventions that address the place-specific social determinants of maternal health in the study area. The geographic process of identifying and measuring these determinants, therefore, has implications for multisectoral collaboration. TRIAL REGISTRATION NUMBER NCT01911494.
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Affiliation(s)
- Prestige Tatenda Makanga
- Surveying and Geomatics Department, Midlands State University Faculty of Science and Technology, Gweru, Midlands, Zimbabwe
| | | | - Nadine Schuurman
- Department of Geography, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Tang Lee
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Khatia Munguambe
- Centro de Investigacao em Saude de Manhica, Manhica, Maputo, Mozambique
| | - Helena Boene
- Centro de Investigacao em Saude de Manhica, Manhica, Maputo, Mozambique
| | - Ugochinyere Vivian Ukah
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Marianne Vidler
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura A Magee
- Department of Obstetrics and Gynaecology, Kings College London, London, London, UK
| | - Esperanca Sevene
- Centro de Investigacao em Saude de Manhica, Manhica, Maputo, Mozambique
- Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, Kings College London, London, London, UK
| | - Tabassum Firoz
- Department of Medicine, Yale New Haven Health System, New Haven, Connecticut, USA
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Ranabhat CL, Kim CB, Park MB, Acharaya S. Multiple disparities in adult mortality in relation to social and health care perspective: results from different data sources. Global Health 2017; 13:57. [PMID: 28789698 PMCID: PMC5549395 DOI: 10.1186/s12992-017-0283-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/28/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Disparity in adult mortality (AM) with reference to social dynamics and health care has not been sufficiently examined. This study aimed to identify the gap in the understanding of AM in relation to religion, political stability, economic level, and universal health coverage (UHC). METHODS A cross-national study was performed with different sources of data, using the administrative record linkage theory. Data was created from the 2013 World Bank data catalogue by region, The Economist (Political instability index 2013), Stuckler David et al. (Universal health coverage, 2010), and religious categories of all UN country members. Descriptive statistics, a t-test, an ANOVA followed by a post hoc test, and a linear regression were used where applicable. RESULT The average AM rate for males and females was 0.20 ± 0.10 and 0.14 ± 0.10, respectively. There was high disparity of AM between countries with and without UHC and between groups with low and high income. UHC and political stability would significantly reduce AMR by >0.41 in both sexes and high economic status would reduce male AMR by 0.44, and female AMR by 0.70. CONCLUSIONS It can be concluded that effective health care; UHC and political stability significantly reduce AM.
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Affiliation(s)
- Chhabi Lal Ranabhat
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do 26426 Republic of Korea
- Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, Ganwon 26493 Republic of Korea
- Health Science Foundations and Study Center, Kathmandu, Nepal
| | - Chun-Bae Kim
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do 26426 Republic of Korea
- Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, Ganwon 26493 Republic of Korea
| | - Myung-Bae Park
- Department of Gerontal Health and Welfare, Pai Chai University, Seo-gu, Daejeon, Republic of Korea
| | - Sambhu Acharaya
- Department of Country Cooperation and Collaboration with the UN System Office of the Director-General, World Health Organization, Geneva, Switzerland
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Global infant mortality trends and attributable determinants – an ecological study using data from 192 countries for the period 1990–2011. Popul Health Metr 2014. [DOI: 10.1186/s12963-014-0029-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Stringhini S, Rousson V, Viswanathan B, Gedeon J, Paccaud F, Bovet P. Association of socioeconomic status with overall and cause specific mortality in the Republic of Seychelles: results from a cohort study in the African region. PLoS One 2014; 9:e102858. [PMID: 25057938 PMCID: PMC4109956 DOI: 10.1371/journal.pone.0102858] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 06/24/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Low socioeconomic status (SES) is consistently associated with higher mortality in high income countries. Only few studies have assessed this association in low and middle income countries, mainly because of sparse reliable mortality data. This study explores SES differences in overall and cause-specific mortality in the Seychelles, a rapidly developing small island state in the African region. METHODS All deaths have been medically certified over more than two decades. SES and other lifestyle-related risk factors were assessed in a total of 3246 participants from three independent population-based surveys conducted in 1989, 1994 and 2004. Vital status was ascertained using linkage with vital statistics. Occupational position was the indicator of SES used in this study and was assessed with the same questions in the three surveys. RESULTS During a mean follow-up of 15.0 years (range 0-23 years), 523 participants died (overall mortality rate 10.8 per 1000 person-years). The main causes of death were cardiovascular disease (CVD) (219 deaths) and cancer (142 deaths). Participants in the low SES group had a higher mortality risk for overall (HR = 1.80; 95% CI: 1.24-2.62), CVD (HR = 1.95; 1.04-3.65) and non-cancer/non-CVD (HR = 2.14; 1.10-4.16) mortality compared to participants in the high SES group. Cancer mortality also tended to be patterned by SES (HR = 1.44; 0.76-2.75). Major lifestyle-related risk factors (smoking, heavy drinking, obesity, diabetes, hypertension, hypercholesterolemia) explained a small proportion of the associations between low SES and all-cause, CVD, and non-cancer/non-CVD mortality. CONCLUSIONS In this population-based study assessing social inequalities in mortality in a country of the African region, low SES (as measured by occupational position) was strongly associated with overall, CVD and non-cancer/non-CVD mortality. Our findings support the view that the burden of non-communicable diseases may disproportionally affect people with low SES in low and middle income countries.
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Affiliation(s)
- Silvia Stringhini
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Valentin Rousson
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Jude Gedeon
- Ministry of Health, Victoria, Republic of Seychelles
| | - Fred Paccaud
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Pascal Bovet
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
- Ministry of Health, Victoria, Republic of Seychelles
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