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Barry CV, Chrysanthopoulou SA, Tallo V, Jarilla B, Vargas Z, McDonald E, Gundogan F, Friedman JF. The Impact of Prenatal Alcohol Exposure on Longitudinal Growth, Nutritional Status, and Insulin-Like Growth Factor 1 in Early Childhood in Leyte, the Philippines. J Pediatr 2024; 269:113977. [PMID: 38401788 PMCID: PMC11096041 DOI: 10.1016/j.jpeds.2024.113977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/24/2024] [Accepted: 02/16/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE To assess the impact and potential mechanistic pathways of prenatal alcohol exposure (PAE) on longitudinal growth and nutritional status in early childhood. STUDY DESIGN A cohort of 296 mother-infant dyads (32% with PAE vs 68% unexposed) were recruited in Leyte, the Philippines, and followed from early gestation through 24 months of age. PAE was assessed using serum phosphatidylethanol (PEth) captured twice prenatally and in cord blood and supplemented with self-reported alcohol consumption. Linear mixed models were used to examine longitudinal effects of PAE on growth from birth through 2 years including key potential mediating factors (placental histopathology, and infant serum leptin and Insulin-like Growth Factor 1 [IGF-1]). RESULTS After adjusting for potential confounders, we found that PAE was significantly associated with a delayed blunting of linear growth trajectories (height-for-age z-score, body length) and weight (weight-for-age z-score, body weight) that manifested between 4 and 6 months and continued through 12-24 months. PAE was also associated with a decreased rate of mid-upper-arm circumference growth from birth to 12 months, and a lower mean IGF-1 levels at birth and 6 months. CONCLUSION This study demonstrates a delayed impact of PAE on growth that manifested around 6 months of age, underscoring the importance of routine clinical monitoring in early childhood. Furthermore, the findings supported prior animal model findings that suggest a mechanistic role for IGF-1 in PAE-induced growth delay.
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Affiliation(s)
- Christopher V Barry
- Warren Alpert Medical School of Brown University, Providence, RI; Department of Epidemiology, Brown University School of Public Health, Providence, RI
| | | | - Veronica Tallo
- Research Institute for Tropical Medicine, Manila, Philippines
| | - Blanca Jarilla
- Research Institute for Tropical Medicine, Manila, Philippines
| | - Zorimel Vargas
- Center for International Health Research, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Emily McDonald
- Center for International Health Research, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI
| | - Fusun Gundogan
- Department of Pathology, Warren Alpert Medical School of Brown University, Providence, RI; Women and Infants' Hospital, Care New England, Providence, RI
| | - Jennifer F Friedman
- Warren Alpert Medical School of Brown University, Providence, RI; Department of Epidemiology, Brown University School of Public Health, Providence, RI; Center for International Health Research, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI
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Lee Y, McDonald E, Gundogan F, Barry CV, Tallo V, Colt S, Friedman JF. Early-life matters: The role of fetal adrenal steroids in the relationship between cytokines within the placental circulation and cognitive development among infants in the Philippines. Brain Behav Immun 2024; 118:510-520. [PMID: 38431237 DOI: 10.1016/j.bbi.2024.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 02/08/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024] Open
Abstract
Prenatal exposure to inflammation is related to the risk for cognitive impairment in offspring. However, mechanisms underlying the link between inflammatory cytokines at the maternal-fetal interface and human cognitive development are largely unknown. This study addressed this research gap by examining whether i) cytokines within the placenta are associated with different domains of neurocognitive development during infancy, and ii) if DHEA-S in cord blood mediates these associations. We also explored the role of early-life socioeconomic status (SES) in moderating the effect of fetal adrenal steroids on cognitive development in low- and middle-income country contexts. A cohort of 242 mother-infant dyads in Leyte, the Philippines participated in the study and all of them were followed from early pregnancy until 12-months. Concentrations of pro- and anti-inflammatory cytokines in the placenta, and DHEA-S in cord blood collected at delivery were evaluated. The multifactorial aspects of the infant's cognitive functioning were assessed based on the Bayley Scales of Infant Development, third edition (BSID-III). We used Structural Equation Modelling (SEM) with an orthogonal rotation to examine associated paths among latent variables of pro- and anti-inflammatory cytokines in the placenta, fetal neuroendocrine factors, and cognitive development. Pathway analyses showed that both pro- and anti-inflammatory cytokines in the placenta were indirectly related to cognitive (p < 0.05) and language developmental outcomes (p < 0.1) via DHEA-S in cord blood among the low SES group. Yet, we found no statistically significant indirect effect of pro- or anti-inflammatory cytokines on neurocognitive development among the high SES sub-sample. This study extends our understanding of how early-life socioeconomic conditions modify biological pathways underlying the relationship between prenatal factors and postpartum cognitive development.
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Affiliation(s)
- Yeonjin Lee
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States; Department of Sociology, Kookmin University, Seoul, South Korea.
| | - Emily McDonald
- Center for International Health Research, Rhode Island Hospital, Providence, RI, United States; Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Fusun Gundogan
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Christopher V Barry
- Center for International Health Research, Rhode Island Hospital, Providence, RI, United States; Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Veronica Tallo
- Research Institute for Tropical Medicine, Manila, Philippines
| | - Susannah Colt
- Center for International Health Research, Rhode Island Hospital, Providence, RI, United States; Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Jennifer F Friedman
- Center for International Health Research, Rhode Island Hospital, Providence, RI, United States; Warren Alpert Medical School of Brown University, Providence, RI, United States; Department of Epidemiology, Brown University, Providence, RI, United States; Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, United States
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Colt S, Barry CV, Sagliba MJ, Amoylen AJ, Tallo V, Friedman JF, Gundogan F, McDonald EA. Associations between placental pathology and poor intrauterine growth among a cohort of mother-infant singleton pairs in Leyte, the Philippines. Int J Gynaecol Obstet 2024; 164:750-757. [PMID: 37589399 PMCID: PMC10841323 DOI: 10.1002/ijgo.15047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/24/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE Poor intrauterine growth has negative impacts for child growth and development and disproportionately affects children living in low-resource settings. In the present study, we investigated relationships between placental pathologies and indicators of poor intrauterine growth. METHODS We enrolled a longitudinal cohort of 279 mother-infant pairs from Leyte, the Philippines. Placental measures included characteristics, pathological findings, and immunohistochemistry. At birth, intrauterine growth was assessed using anthropometric measures, weight-for-gestational age, and the clinical assessment of nutritional status score (CANSCORE) for determining fetal malnutrition. Multivariate linear regression and log-binomial regression models were applied, controlling for potential confounding factors. RESULTS Maternal vascular malperfusion (MVM) was related to reduced birthweight (P < 0.0001), birth length (P = 0.002), head circumference (P = 0.001), and weight-to-length ratio (P = 0.016). MVM increased the risk for preterm delivery (P = 0.0005) and small for gestational age (SGA) (P = 0.016). Acute chorioamnionitis (P = 0.013) and MVM (P = 0.021) both led to an increased risk for fetal malnutrition defined by CANSORE<25. Villous tissue activated caspase-3 was associated with lower birth length (P = 0.0006), higher weight-to-length ratio (P = 0.004), reduced risks for SGA (P = 0.011) and low weight-to-length ratio for gestational age (P = 0.004). CONCLUSION The present study applied comprehensive measures for intrauterine growth and demonstrates that low placental weight and placental pathology, chiefly MVM, contribute to poor intrauterine growth. A better understanding of the mechanistic role of specific placental pathologies on adverse newborn outcomes will provide opportunities for reducing incidence of poor intrauterine growth and associated long-term morbidities.
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Affiliation(s)
- Susannah Colt
- Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Christopher V. Barry
- Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | | | | | - Veronica Tallo
- Research Institute of Tropical Medicine, Manila, The Philippines
| | - Jennifer F. Friedman
- Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Fusun Gundogan
- Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Emily A. McDonald
- Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
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Huang AM, Neale MN, Darveau SC, Sagliba MJ, Moreno AJ, Urbina MPG, Tallo V, McDonald EA, Jiz MA, Friedman JF. Knowledge, attitudes, practices, and beliefs regarding prenatal alcohol consumption among women in Leyte, the Philippines. Front Glob Womens Health 2023; 4:1156681. [PMID: 37621416 PMCID: PMC10445536 DOI: 10.3389/fgwh.2023.1156681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/14/2023] [Indexed: 08/26/2023] Open
Abstract
Objectives Fetal alcohol spectrum disorder (FASD) captures the broad range of emotional, cognitive, behavioral, and congenital abnormalities associated with maternal alcohol consumption, and women living in resource-limited settings may be higher risk. This study aims to examine knowledge, attitudes, practices, and beliefs (KAPB) of women in Leyte, The Philippines regarding prenatal alcohol consumption. Methods One hundred postpartum women were recruited from a birth cohort in Leyte. A prenatal alcohol use KAPB survey was constructed in Waray, the local language. The survey was administered in June-September 2019. Descriptive statistics, chi-squared test, and Fisher's exact test were used to analyze responses. Results Seventy-five percent of subjects reported drinking tuba, a local palm wine, during pregnancy. Most participants (75%) did not believe tuba contained alcohol. Women who believed tuba contains no alcohol were more likely to drink tuba during pregnancy (81.3%) than women who believed tuba contains alcohol (56.0%), X2(1, N = 100) = 6.41, p = .011. Women who drank tuba during pregnancy were more likely to believe tuba has health benefits (60%) than women who did not drink tuba during pregnancy (12%), Fisher's exact p < .05, citing increased red blood cell count and unproven antiparasitic qualities. Fifteen percent of subjects reported having fed their babies tuba. Nearly all (98%) were willing to attenuate tuba/alcohol consumption if told that this practice negatively impacts pregnancies. Conclusion Misinformation about tuba appears widespread in Leyte. Educating women of reproductive age in Leyte regarding prenatal tuba use may lead to a reduction in tuba use.
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Affiliation(s)
- Alice M. Huang
- The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Matthew N. Neale
- The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Spencer C. Darveau
- The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | | | | | | | - Veronica Tallo
- Research Institute for Tropical Medicine, Manila, Philippines
| | - Emily A. McDonald
- Center for International Health Research at Rhode Island Hospital, Providence, RI, United States
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Mario A. Jiz
- Research Institute for Tropical Medicine, Manila, Philippines
| | - Jennifer F. Friedman
- Center for International Health Research at Rhode Island Hospital, Providence, RI, United States
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI, United States
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Barry MA, Colt S, Vargas Z, Barry CV, Tallo V, Sagliba MJ, Amoylen AJ, Friedman JF, McDonald EA. Impaired Intrauterine Growth in the Context of Maternal Hookworm Infection During Gestation. J Infect Dis 2022; 225:1856-1860. [PMID: 35091745 PMCID: PMC9113511 DOI: 10.1093/infdis/jiac025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/25/2022] [Indexed: 01/31/2023] Open
Abstract
Hookworm infection is associated with poor nutritional outcomes, anemia, and impaired cognitive performance. We examined the association between maternal hookworm infection and birth outcomes in a cohort of women in Leyte, Philippines. We observed poor intrauterine growth characteristics associated with maternal hookworm only among male offspring, with lower birth weight, head circumference, and placental surface area. Male neonates also had higher insulin-like growth factor 2 (IGF-2) and lower adiponectin in cord blood. These data intriguingly suggest nutritional impacts of maternal hookworm infection during pregnancy may be divergent based on sex of the offspring.
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Affiliation(s)
- Meagan A Barry
- Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Susannah Colt
- Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Zorimel Vargas
- Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Christopher V Barry
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Veronica Tallo
- Research Institute of Tropical Medicine, Manila, Philippines
| | | | | | - Jennifer F Friedman
- Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island, USA,Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Emily A McDonald
- Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island, USA,Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA,Correspondence: Emily McDonald, PhD, Center for International Health Research, Rhode Island Hospital, Warren Alpert Medical School, Brown University, 55 Claverick Street, Room 320, Providence, RI 02903 ()
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Hazard RH, Chowdhury HR, Flaxman AD, Joseph JC, Alam N, Riley ID, Streatfeld PK, Gouda H, Maraga S, Rarau P, Sanvictores D, Tallo V, Lucero M, Lopez AD. Correction to: Improving methods to measure comparable mortality by cause (IMMCMC): gold standard verbal autopsy dataset. BMC Res Notes 2022; 15:21. [PMID: 35073978 PMCID: PMC8785448 DOI: 10.1186/s13104-022-05909-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Riley H Hazard
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.
| | | | - Abraham D Flaxman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jonathan C Joseph
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nurul Alam
- International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Ian Douglas Riley
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | | | - Hebe Gouda
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Seri Maraga
- PNG Institute of Medical Research, Goroka, Papua New Guinea
| | - Patricia Rarau
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | | | - Veronica Tallo
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Marilla Lucero
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Alan D Lopez
- Department of Health Metrics Science, University of Washington, Seattle, WA, USA
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Hazard RH, Chowdhury HR, Flaxman AD, Joseph JC, Alam N, Riley ID, Streatfield PK, Gouda H, Maraga S, Rarau P, Sanvictores D, Tallo V, Lucero M, Lopez AD. Improving methods to measure comparable mortality cause (IMMCMC) gold standard verbal autopsy dataset. BMC Res Notes 2021; 14:422. [PMID: 34814930 PMCID: PMC8609765 DOI: 10.1186/s13104-021-05834-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/04/2021] [Indexed: 11/10/2022] Open
Abstract
Objectives Gold standard cause of death data is critically important to improve verbal autopsy (VA) methods in diagnosing cause of death where civil and vital registration systems are inadequate or poor. As part of a three-country research study—Improving Methods to Measure Comparable Mortality by Cause (IMMCMC) study—data were collected on clinicopathological criteria-based gold standard cause of death from hospital record reviews with matched VAs. The purpose of this data note is to make accessible a de-identified format of these gold standard VAs for interested researchers to improve the diagnostic accuracy of VA methods. Data description The study was conducted between 2011 and 2014 in the Philippines, Bangladesh, and Papua New Guinea. Gold standard diagnoses of underlying causes of death for deaths occurring in hospital were matched to VAs conducted using a standardized VA questionnaire developed by the Population Health Metrics Consortium. 3512 deaths were collected in total, comprised of 2491 adults (12 years and older), 320 children (28 days to 12 years), and 702 neonates (0–27 days).
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Affiliation(s)
- Riley H Hazard
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.
| | | | - Abraham D Flaxman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Jonathan C Joseph
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Nurul Alam
- International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Ian Douglas Riley
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | | | - Hebe Gouda
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Seri Maraga
- PNG Institute of Medical Research, Goroka, Papua New Guinea
| | - Patricia Rarau
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | | | - Veronica Tallo
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Marilla Lucero
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Alan D Lopez
- Department of Health Metrics Science, University of Washington, Seattle, WA, USA
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Colt S, Jarilla B, Baltazar P, Tallo V, Acosta LP, Wu HW, Barry CV, Kurtis JD, Olveda RM, Friedman JF, Jiz MA. Effect of maternal praziquantel treatment for Schistosoma japonicum infection on the offspring susceptibility and immunologic response to infection at age six, a cohort study. PLoS Negl Trop Dis 2021; 15:e0009328. [PMID: 33861768 PMCID: PMC8081342 DOI: 10.1371/journal.pntd.0009328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/28/2021] [Accepted: 03/25/2021] [Indexed: 01/19/2023] Open
Abstract
In areas endemic to schistosomiasis, fetal exposure to schistosome antigens prime the offspring before potential natural infection. Praziquantel (PZQ) treatment for Schistosoma japonicum infection in pregnant women has been demonstrated to be safe and effective. Our objectives were to evaluate whether maternal PZQ treatment modifies the process of in utero sensitization to schistosome antigens potentially impacting later risk of infection, as well as immune response to S. japonicum. We enrolled 295 children at age six, born to mothers with S. japonicum infection who participated in a randomized control trial of PZQ versus placebo given at 12-16 weeks gestation in Leyte, The Philippines. At enrollment, we assessed and treated current S. japonicum infection and measured serum cytokines. During a follow-up visit four weeks later, we assessed peripheral blood mononuclear cell (PBMC) cytokine production in response to soluble worm antigen preparation (SWAP) or soluble egg antigen (SEA). Associations between maternal treatment group and the child's S. japonicum infection status and immunologic responses were determined using multivariate linear regression analysis. PZQ treatment during pregnancy did not impact the prevalence (P = 0.12) or intensity (P = 0.59) of natural S. japonicum infection among children at age six. Among children with infection at enrollment (12.5%) there were no significant serum cytokine concentration differences between maternal treatment groups. Among children with infection at enrollment, IL-1 production by PBMCs stimulated with SEA was higher (P = 0.03) in the maternal PZQ group compared to placebo. Among children without infection, PBMCs stimulated with SEA produced greater IL-12 (P = 0.03) and with SWAP produced less IL-4 (P = 0.01) in the maternal PZQ group compared to placebo. Several cytokines produced by PBMCs in response to SWAP and SEA were significantly higher in children with S. japonicum infection irrespective of maternal treatment: IL-4, IL-5, IL-10, and IL-13. We report that maternal PZQ treatment for S. japonicum shifted the PBMC immune response to a more inflammatory signature but had no impact on their offspring's likelihood of infection or serum cytokines at age six, further supporting the safe use of PZQ in pregnant women. Trial Registration: ClinicalTrials.gov NCT00486863.
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Affiliation(s)
- Susannah Colt
- Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
- * E-mail:
| | - Blanca Jarilla
- Research Institute for Tropical Medicine, Manila, The Philippines
| | - Palmera Baltazar
- Research Institute for Tropical Medicine, Manila, The Philippines
- Remedios Trinidad Romualdez Hospital, Tacloban City, Leyte, The Philippines
| | - Veronica Tallo
- Research Institute for Tropical Medicine, Manila, The Philippines
| | - Luz P. Acosta
- Research Institute for Tropical Medicine, Manila, The Philippines
| | - Hannah W. Wu
- Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Christopher V. Barry
- Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Jonathan D. Kurtis
- Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
- Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | | | - Jennifer F. Friedman
- Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Mario A. Jiz
- Research Institute for Tropical Medicine, Manila, The Philippines
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Chan K, Carosone-Link P, Bautista MTG, Sanvictores D, Uhler K, Tallo V, Lucero MG, De Jesus J, Simoes EAF. Population-based otoscopic and audiometric assessment of a birth cohort recruited for a pneumococcal vaccine trial 15-18 years earlier: a protocol. BMJ Open 2021; 11:e042363. [PMID: 33597137 PMCID: PMC7893663 DOI: 10.1136/bmjopen-2020-042363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION A cohort of 12 000 children in the Philippines who had enrolled in a 2000-2004 (current ages 16 to 20 years) Phase 3 11-valent pneumococcal conjugate vaccine for the prevention of radiographically confirmed pneumonia are now being asked to participate in a separate study (expected completion date September 2021) to assess the cohort's current long-term audiometric and otologic status. This new study would allow assessments of the utility of the pneumococcal vaccine in conferring its protective effects on the long-term sequelae of otitis media (OM), if any. Lack of trained local healthcare providers in otolaryngology/audiology and testing equipment in Bohol, Philippines, necessitates the development of a distinct methodology that would lead to meaningful data analysis. METHODS AND ANALYSIS Reliable data collection and transfer are achieved by a US otolaryngologist/audiologist team training local nurses on all procedures in a didactic and hands-on process. An assortment of portable otolaryngologic and audiologic equipment suitable for field testing has been acquired, including an operating otoscope (Welch-Allyn), a video-otoscope (JedMed), a tympanometer with distortion product otoacoustic emission measurements (Path Sentiero) and a screening audiometer (HearScreen). Data will then be uploaded to a Research Electronic Data Capture database in the USA.Tympanometric and audiologic data will be codified through separate conventional algorithms. A team of paediatric otolaryngology advanced practice providers (APPs) have been trained and validated in interpreting video otoscopy. The protocol for classification of diagnostic outcome variables based on video otoscopy and tympanometry has been developed and is being used by APPs to evaluate all otoscopy data. ETHICS AND DISSEMINATION The study was approved by the Research Institute of Tropical Medicine, Alabang, Manila, Philippines, and the institutional review board and the Colorado Multiple Institutional Review Board of the University of Colorado School of Medicine, Aurora, Colorado, USA.Research results will be made available to children and their caregivers with abnormal audiologic outcomes, the funders and other researchers. TRIAL REGISTRATION NUMBER ISRCTN 62323832; Post-results.
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Affiliation(s)
- Kenny Chan
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Phyllis Carosone-Link
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Mary Thatcher G Bautista
- Department of Clinical Trials, Epidemiology, and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Diozele Sanvictores
- Department of Clinical Trials, Epidemiology, and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Kristin Uhler
- Department of Audiology, Speech-Pathology, and Learning, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Veronica Tallo
- Department of Clinical Trials, Epidemiology, and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Marilla G Lucero
- Department of Clinical Trials, Epidemiology, and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Joanne De Jesus
- Department of Clinical Trials, Epidemiology, and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Eric A F Simoes
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
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Chandna A, Aderie EM, Ahmad R, Arguni E, Ashley EA, Cope T, Dat VQ, Day NPJ, Dondorp AM, Illanes V, De Jesus J, Jimenez C, Kain K, Suy K, Koshiaris C, Lasry E, Mayxay M, Mondal D, Perera R, Pongvongsa T, Rattanavong S, Rekart M, Richard-Greenblatt M, Shomik M, Souvannasing P, Tallo V, Turner C, Turner P, Waithira N, Watson JA, Yosia M, Burza S, Lubell Y. Prediction of disease severity in young children presenting with acute febrile illness in resource-limited settings: a protocol for a prospective observational study. BMJ Open 2021; 11:e045826. [PMID: 33495264 PMCID: PMC7839891 DOI: 10.1136/bmjopen-2020-045826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/03/2020] [Accepted: 01/11/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION In rural and difficult-to-access settings, early and accurate recognition of febrile children at risk of progressing to serious illness could contribute to improved patient outcomes and better resource allocation. This study aims to develop a prognostic clinical prediction tool to assist community healthcare providers identify febrile children who might benefit from referral or admission for facility-based medical care. METHODS AND ANALYSIS This prospective observational study will recruit at least 4900 paediatric inpatients and outpatients under the age of 5 years presenting with an acute febrile illness to seven hospitals in six countries across Asia. A venous blood sample and nasopharyngeal swab is collected from each participant and detailed clinical data recorded at presentation, and each day for the first 48 hours of admission for inpatients. Multianalyte assays are performed at reference laboratories to measure a panel of host biomarkers, as well as targeted aetiological investigations for common bacterial and viral pathogens. Clinical outcome is ascertained on day 2 and day 28.Presenting syndromes, clinical outcomes and aetiology of acute febrile illness will be described and compared across sites. Following the latest guidance in prediction model building, a prognostic clinical prediction model, combining simple clinical features and measurements of host biomarkers, will be derived and geographically externally validated. The performance of the model will be evaluated in specific presenting clinical syndromes and fever aetiologies. ETHICS AND DISSEMINATION The study has received approval from all relevant international, national and institutional ethics committees. Written informed consent is provided by the caretaker of all participants. Results will be shared with local and national stakeholders, and disseminated via peer-reviewed open-access journals and scientific meetings. TRIAL REGISTRATION NUMBER NCT04285021.
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Affiliation(s)
- Arjun Chandna
- Angkor Hospital for Children, Cambodia Oxford Medical Research Unit, Siem Reap, Cambodia
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Endashaw M Aderie
- Médecins Sans Frontières Operational Centre Barcelona, Barcelona, Spain
| | - Riris Ahmad
- Centre for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Daerah Istimewa Yogyakart, Indonesia
| | - Eggi Arguni
- Centre for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Daerah Istimewa Yogyakart, Indonesia
| | - Elizabeth A Ashley
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
- Microbiology Department, Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Vientiane, Lao People's Democratic Republic
| | - Tanya Cope
- Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | | | - Nicholas P J Day
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
- Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Arjen M Dondorp
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
- Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Victor Illanes
- Médecins Sans Frontières Operational Centre Barcelona, Barcelona, Spain
| | - Joanne De Jesus
- Clinical Trials, Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Carolina Jimenez
- Médecins Sans Frontières Operational Centre Barcelona, Barcelona, Spain
| | - Kevin Kain
- Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Keang Suy
- Angkor Hospital for Children, Cambodia Oxford Medical Research Unit, Siem Reap, Cambodia
- Angkor Hospital for Children, Siem Reap, Siem Reap, Cambodia
| | | | - Estrella Lasry
- Médecins Sans Frontières Operational Centre Barcelona, Barcelona, Spain
| | - Mayfong Mayxay
- Microbiology Department, Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Vientiane, Lao People's Democratic Republic
- Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao People's Democratic Republic
| | - Dinesh Mondal
- Centre for Nutrition and Food Security (CNFS), icddr,b, Dhaka, Dhaka, Bangladesh
| | - Rafael Perera
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tiengkham Pongvongsa
- Microbiology Department, Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Vientiane, Lao People's Democratic Republic
- Savannakhet Provincial Health Department, Savannakhet, Lao People's Democratic Republic
| | - Sayaphet Rattanavong
- Microbiology Department, Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Vientiane, Lao People's Democratic Republic
| | - Michael Rekart
- Médecins Sans Frontières Operational Centre Barcelona, Barcelona, Spain
| | | | - Mohammad Shomik
- Centre for Nutrition and Food Security (CNFS), icddr,b, Dhaka, Dhaka, Bangladesh
| | | | - Veronica Tallo
- Clinical Trials, Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Claudia Turner
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
- Angkor Hospital for Children, Siem Reap, Siem Reap, Cambodia
| | - Paul Turner
- Angkor Hospital for Children, Cambodia Oxford Medical Research Unit, Siem Reap, Cambodia
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Naomi Waithira
- Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - James A Watson
- Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Mikhael Yosia
- Médecins Sans Frontières Operational Centre Barcelona, Barcelona, Spain
| | - Sakib Burza
- Médecins Sans Frontières Operational Centre Barcelona, Barcelona, Spain
| | - Yoel Lubell
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
- Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
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Furuse Y, Tamaki R, Suzuki A, Kamigaki T, Okamoto M, Saito-Obata M, Nakagawa E, Saito M, Segubre-Mercado E, Tallo V, Lupisan S, Oshitani H. Epidemiological and clinical characteristics of children with acute respiratory viral infections in the Philippines: a prospective cohort study. Clin Microbiol Infect 2020; 27:1037.e9-1037.e14. [PMID: 32950713 DOI: 10.1016/j.cmi.2020.09.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/31/2020] [Accepted: 09/10/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Viral acute respiratory infection (ARI) remains a major global health problem, especially among children in low- and middle-income countries. The study was conducted to reveal aetiological significance of respiratory viruses among both non-hospitalized and hospitalized children. METHODS A cohort study of children with ARI at the household, primary healthcare facility, and hospital levels was conducted alongside a hospital-based study including non-cohort children from 2014 to 2016 in the Philippines. The ARI cases were recorded at households and healthcare facilities, and a clinical investigation was performed. Nasopharyngeal swabs were collected from the symptomatic children and tested for respiratory viruses via polymerase chain reaction. Then, the association between healthcare facility utilization and viral detection was investigated. RESULTS Overall, 18,514 ARI cases were enrolled in the cohort study, and samples were collected from 4735 of these cases. The hospital-based study detected 648 ARI cases, all of which were sampled. Rhinovirus (22.2%; 1052/4735) was most frequently detected followed by respiratory syncytial virus (12.0%; 566/4735). Enterovirus (adjusted odds ratio, 1.8; 95% confidence interval, 1.1-2.8), human metapneumovirus (2.1, 1.4-3.2), rhinovirus (2.1, 1.8-2.6), and respiratory syncytial virus (1.6, 1.2-1.9) were significantly more prevalent in the ARI cases at healthcare facilities than in those in households. Of all ARI cases, 0.6% required hospitalization while 1.8% were hospitalized among the respiratory syncytial virus-positive cases (3.8, 3.0-4.9). CONCLUSIONS We determined the prevalence of respiratory viruses among children with ARIs at the household, primary healthcare facility, and hospital levels and the association with clinical characteristics. In particular, we discovered a significant disease burden and impact of respiratory syncytial virus infections as well as a considerable aetiological implication of rhinovirus infections.
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Affiliation(s)
- Yuki Furuse
- Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, Japan; Hakubi Center for Advanced Research, Kyoto University, Kyoto, Japan.
| | - Raita Tamaki
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Suzuki
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Taro Kamigaki
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Michiko Okamoto
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mariko Saito-Obata
- RITM-Tohoku Collaborating Research Center on Emerging and Reemerging Infectious Diseases, Muntinlupa, Philippines
| | - Emiko Nakagawa
- RITM-Tohoku Collaborating Research Center on Emerging and Reemerging Infectious Diseases, Muntinlupa, Philippines
| | - Mayuko Saito
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Veronica Tallo
- Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Socorro Lupisan
- Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Hitoshi Oshitani
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
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12
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Furuse Y, Tamaki R, Okamoto M, Saito-Obata M, Suzuki A, Saito M, Imamura T, Khandaker I, Dapat I, Ueno F, Alday PP, Tan AG, Inobaya MT, Segubre-Mercado E, Tallo V, Lupisan S, Oshitani H. Association Between Preceding Viral Respiratory Infection and Subsequent Respiratory Illnesses Among Children: A Prospective Cohort Study in the Philippines. J Infect Dis 2019; 219:197-205. [PMID: 30189092 PMCID: PMC6306022 DOI: 10.1093/infdis/jiy515] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 08/23/2018] [Indexed: 11/30/2022] Open
Abstract
Background Acute respiratory infection (ARI) is of great concern in public health. It remains unclear whether viral infections can affect the host’s susceptibility to subsequent ARIs. Methods A prospective cohort study on ARIs of children below 5 years old was conducted in the Philippines from 2014 to 2016. The respiratory symptoms were recorded daily, and nasopharyngeal swabs were collected at both household and health facilities. The specimens were tested for respiratory viruses. We then determined whether viral etiology was associated with the severity of the present ARI and whether previous viral infections was associated with subsequent ARIs. Results A total of 3851 children and 16337 ARI episodes were enrolled and recorded, respectively. Samples were collected from 24% of all ARI episodes; collection rate at the healthcare facilities was 95%. Enterovirus D68, rhinovirus species C, and respiratory syncytial virus were significantly associated with severe ARIs. The risk for subsequent ARIs was significantly enhanced after infections with adenovirus, influenza A virus, parainfluenza virus type 4, and rhinovirus species C. Conclusions This study revealed that viral etiology plays a significant role in the severity of the present ARI and that viral infection affects the host’s susceptibility to subsequent ARIs.
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Affiliation(s)
- Yuki Furuse
- Institute for Frontier Life and Medical Sciences, Kyoto University, Japan.,Hakubi Center for Advanced Research, Kyoto University, Japan.,Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Sendai, Japan
| | - Raita Tamaki
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Michiko Okamoto
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mariko Saito-Obata
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan.,RITM-Tohoku Collaborating Research Center on Emerging and Reemerging Infectious Diseases, Muntinlupa, Philippines
| | - Akira Suzuki
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mayuko Saito
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tadatsugu Imamura
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Irona Khandaker
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Isolde Dapat
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Fumihiko Ueno
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Alvin Gue Tan
- Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | | | | | - Veronica Tallo
- Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Socorro Lupisan
- Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Hitoshi Oshitani
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
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13
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Abioye AI, McDonald EA, Park S, Ripp K, Bennett B, Wu HW, Pond-Tor S, Sagliba MJ, Amoylen AJ, Baltazar PI, Tallo V, Acosta LP, Olveda RM, Kurtis JD, Friedman JF. Maternal anemia type during pregnancy is associated with anemia risk among offspring during infancy. Pediatr Res 2019; 86:396-402. [PMID: 31129681 PMCID: PMC6702090 DOI: 10.1038/s41390-019-0433-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 02/05/2019] [Accepted: 05/06/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND We evaluated the association between etiology of maternal anemia and iron status throughout infancy. METHODS Samples from a study designed to examine Praziquantel treatment during pregnancy were used (n = 359). All women were infected with schistosomiasis and randomized to Praziquantel or placebo at 16 ± 2 weeks' gestation. Hemoglobin, serum ferritin (SF), soluble transferrin receptor (sTfR), hepcidin, C-reactive protein, and interleukin-6 were measured in maternal and infant blood. The relationship between both maternal Praziquantel treatment and etiology of anemia and infant iron status was evaluated. RESULTS Maternal iron-deficiency anemia was associated with increased risk of infant anemia at 6 months of age. Infants of mothers with the lowest levels of circulating hepcidin during gestation, likely a marker for iron deficiency, had higher sTfR:SF levels and lower hemoglobin levels, particularly at 12 months of age. Maternal non-iron-deficiency anemia (NIDA) did not impact infant anemia risk or iron status. Maternal treatment for schistosomiasis had no effect on infant hematologic status. CONCLUSIONS Maternal iron deficiency anemia was associated with an increased risk for anemia or iron deficiency during late infancy. We did not observe an association between maternal NIDA and increased risk for iron deficiency during infancy.
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Affiliation(s)
- Ajibola I Abioye
- The Warren Alpert Medical School of Brown University, Providence, RI,Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI,Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Emily A McDonald
- The Warren Alpert Medical School of Brown University, Providence, RI,Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI,Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Sangshin Park
- The Warren Alpert Medical School of Brown University, Providence, RI, USA. .,Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA. .,Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI, USA. .,Graduate School of Urban Public Health, University of Seoul, Seoul, Republic of Korea.
| | - Kelsey Ripp
- The Warren Alpert Medical School of Brown University, Providence, RI,Department of Medicine, University of Pennsylvania, Philadelphia, PA,Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Brady Bennett
- Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI,School of Public Health, Brown University, Providence, RI,The Health Council of South Florida, Miami, FL
| | - Hannah W Wu
- The Warren Alpert Medical School of Brown University, Providence, RI,Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI,Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Sunthorn Pond-Tor
- The Warren Alpert Medical School of Brown University, Providence, RI,Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI,Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School of Brown University, Providence, RI
| | | | | | - Palmera I Baltazar
- Remedios Trinidad Romualdez Hospital, Tacloban City, Leyte, The Philippines
| | - Veronica Tallo
- Research Institute for Tropical Medicine, Manila, Philippines
| | - Luz P Acosta
- Research Institute for Tropical Medicine, Manila, Philippines
| | | | - Jonathan D Kurtis
- The Warren Alpert Medical School of Brown University, Providence, RI,Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI,Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Jennifer F Friedman
- The Warren Alpert Medical School of Brown University, Providence, RI,Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI,Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI
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14
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Ueno F, Tamaki R, Saito M, Okamoto M, Saito-Obata M, Kamigaki T, Suzuki A, Segubre-Mercado E, Aloyon HD, Tallo V, Lupisan SP, Oshitani H. Age-specific incidence rates and risk factors for respiratory syncytial virus-associated lower respiratory tract illness in cohort children under 5 years old in the Philippines. Influenza Other Respir Viruses 2019; 13:339-353. [PMID: 30891896 PMCID: PMC6586181 DOI: 10.1111/irv.12639] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/09/2019] [Accepted: 02/14/2019] [Indexed: 11/30/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) is one of the main viral causes of lower respiratory tract illness (LRTI), especially in young children. RSV vaccines, including maternal and infant vaccines, are under development; however, more epidemiological studies are needed to develop effective vaccination strategies. Objectives To estimate detailed age‐specific incidence rates and severity of RSV‐associated LRTI (RSV‐LRTI) using data from a community‐based prospective cohort study in the Philippines. Patients/Methods Cohort children who visited health facilities due to acute respiratory symptoms were identified, and nasopharyngeal swabs were collected to detect RSV. The severity of RSV‐LRTI was assessed using the severity definition proposed by the World Health Organization. Risk factors for developing RSV‐LRTI and contribution of SpO2 measurement were also evaluated. Results A total of 395 RSV episodes which occurred in children aged 2‐59 months were categorised as 183 RSV‐LRTI, 72 as severe RSV‐LRTI and 29 as very severe RSV‐LRTI. Children aged 3‐5 months had the highest incidence rate of RSV‐LRTI, at 207.4 per 1000 child‐years (95% CI: 149.0‐279.5). Younger age group, place of living and low educational level of caregivers were associated with developing RSV‐LRTI. Clinical manifestations had low levels of agreement with hypoxaemia as measured by pulse oximeter. Conclusion The highest burden of RSV was observed in young infants aged 3‐5 months, whereas the burden was also high in those aged 12‐20 months. Future vaccination strategies should consider the protection of older children, especially those aged one year, as well as young infants.
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Affiliation(s)
- Fumihiko Ueno
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Raita Tamaki
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Nagasaki Women's Junior College, Nagasaki, Japan
| | - Mayuko Saito
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Michiko Okamoto
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mariko Saito-Obata
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan.,RITM-Tohoku Collaborating Research Center on Emerging and Reemerging Infectious Diseases, Muntinlupa, Philippines
| | - Taro Kamigaki
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Suzuki
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | | | - Veronica Tallo
- Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | | | - Hitoshi Oshitani
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
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15
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Otomaru H, Kamigaki T, Tamaki R, Okamoto M, Alday PP, Tan AG, Manalo JI, Segubre-Mercado E, Inobaya MT, Tallo V, Lupisan S, Oshitani H. Transmission of Respiratory Syncytial Virus Among Children Under 5 Years in Households of Rural Communities, the Philippines. Open Forum Infect Dis 2019; 6:ofz045. [PMID: 30882012 PMCID: PMC6411217 DOI: 10.1093/ofid/ofz045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/21/2018] [Accepted: 02/01/2019] [Indexed: 01/03/2023] Open
Abstract
Background To develop a more effective vaccination strategy for reducing the impact of respiratory syncytial virus (RSV) infection, especially in young infants (<6 months old), it is necessary to understand the transmission dynamics of RSV. Methods We conducted a community-based prospective cohort study from 2014 to 2016 in Biliran Province, the Philippines, on children <5 years old. We collected nasopharyngeal swabs from symptomatic children with acute respiratory infection (ARI) during household visits and at health facilities. In households (n = 181) with RSV-positive ARI cases (RSV-ARI), we also identified ARI episodes among other children <5 years old in the same household. In addition, we determined the serial interval to estimate the basic reproduction number (R0), the average number of secondary cases generated by a single primary case. Results In the 181 households analyzed, we found 212 RSV-ARI in 152 households with a single case and 29 households with multiple cases, which included 29 1st RSV-ARI and 31 2nd RSV-ARI. We also found possible index cases among children <5 years old in the same household for 29.0% (18 of 62) of young infants with RSV-ARI. The estimated mean serial interval was 3.2 days, and R0 was estimated to be 0.92–1.33 for RSV-A and 1.04–1.76 for RSV-B, which varied between different times (2014 and 2015) and places. Conclusions Young infants are likely to acquire RSV infection from older children in the same household. Therefore, vaccination targeting older children might protect infants from RSV infection.
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Affiliation(s)
- Hirono Otomaru
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Taro Kamigaki
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Raita Tamaki
- Department of Life Creation, Nagasaki Women's Junior College, Japan
| | - Michiko Okamoto
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Alvin Gue Tan
- Research Institute for Tropical Medicine, Metro Manila, Philippines
| | | | | | | | - Veronica Tallo
- Research Institute for Tropical Medicine, Metro Manila, Philippines
| | - Socorro Lupisan
- Research Institute for Tropical Medicine, Metro Manila, Philippines
| | - Hitoshi Oshitani
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
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16
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Williams GM, Riley ID, Hazard RH, Chowhury HR, Alam N, Streafield PK, Tallo V, Sanvictores D, Lucero M, Adair T, Lopez AD. On the estimation of population cause-specific mortality fractions from in-hospital deaths. BMC Med 2019; 17:29. [PMID: 30732593 PMCID: PMC6367755 DOI: 10.1186/s12916-019-1267-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/22/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Almost all countries without complete vital registration systems have data on deaths collected by hospitals. However, these data have not been widely used to estimate cause of death (COD) patterns in populations because only a non-representative fraction of people in these countries die in health facilities. Methods that can exploit hospital mortality statistics to reliably estimate community COD patterns are required to strengthen the evidence base for disease and injury control programs. We propose a method that weights hospital-certified causes by the probability of death to estimate population cause-specific mortality fractions (CSMFs). METHODS We used an established verbal autopsy instrument (VAI) to collect data from hospital catchment areas in Chandpur and Comilla Districts, Bangladesh, and Bohol province, the Philippines, between 2011 and 2014, along with demographic covariates for each death. Hospital medical certificates of cause of death (death certificates) were collected and mapped to the corresponding cause categories of the VAI. Tariff 2.0 was used to assign a COD for community deaths. Logistic regression models were created for broad causes in each country to calculate the probability of in-hospital death, given a set of covariate values. The reweighted CSMFs for deaths in the hospital catchment population, represented by each hospital death, were calculated from the corresponding regression models. RESULTS We collected data on 4228 adult deaths in the Philippines and 3725 deaths in Bangladesh. Short time to hospital and education were consistently associated with in-hospital death in the Philippines and absence of a disability was consistently associated with in-hospital death in Bangladesh. Non-communicable diseases (excluding stroke) and stroke were the leading causes of death in both the Philippines (33.9%, 19.1%) and Bangladesh (46.1%, 21.1%) according to the reweighted method. The reweighted method generally estimated CSMFs that fell between those derived from hospitals and those diagnosed by Tariff 2.0. CONCLUSIONS Statistical methods can be used to derive estimates of cause-specific probability of death in-hospital for Bangladesh and the Philippines to generate population CSMFs. In regions where hospital death certification is of reasonable quality and routine verbal autopsy is not applied, these estimates could be applied to generate cost-effective and robust CSMFs for the population.
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Affiliation(s)
- Gail M Williams
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Ian Douglas Riley
- School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Riley H Hazard
- School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Hafizur R Chowhury
- School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Nurul Alam
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Veronica Tallo
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | | | - Marilla Lucero
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Tim Adair
- School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Alan D Lopez
- School of Population and Global Health, University of Melbourne, Parkville, Australia.
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Lucero M, Riley ID, Hazard RH, Sanvictores D, Tallo V, Dumaluan DGM, Ugpo JM, Lopez AD. Assessing the quality of medical death certification: a case study of concordance between national statistics and results from a medical record review in a regional hospital in the Philippines. Popul Health Metr 2018; 16:23. [PMID: 30594186 PMCID: PMC6311069 DOI: 10.1186/s12963-018-0178-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 12/09/2018] [Indexed: 11/17/2022] Open
Abstract
Background Medical certificates of cause of death (MCCOD) issued by hospital physicians are a key input to vital registration systems. Deaths certified by hospital physicians have been implicitly considered to be of high quality, but recent evidence suggests otherwise. We conducted a medical record review (MRR) of hospital MCCOD in the Philippines and compared the cause of death concordance with certificates coded by the Philippines Statistics Authority (PSA). Methods MCCOD for adult deaths in Bohol Regional Hospital (BRH) in 2007–2008 and 2011 were collected and reviewed by a team of study physicians. Corresponding MCCOD coded by the PSA were linked by a hospital identifier. The study physicians wrote a new MCCOD using the patient medical record, noted the quality of the medical record to produce a cause of death, and indicated whether it was necessary to change the underlying cause of death (UCOD). Chance-corrected concordance, cause-specific mortality fraction (CSMF) accuracy, and chance-corrected CSMF were used to examine the concordance between the MRR and PSA. Results A total of 1052 adult deaths were linked between the MRR and PSA. Median chance-corrected concordance was 0.73, CSMF accuracy was 0.85, and chance-corrected CSMF accuracy was 0.58. 74.8% of medical records were deemed to be of high enough quality to assign a cause of death, yet study physicians indicated that it was necessary to change the UCOD in 41% of deaths, 82% of which required addition of a new UCOD. Conclusions Medical records were generally of sufficient quality to assign a cause of death and concordance between the PSA and MRR was reasonably high, suggesting that routine mortality statistics data are reasonably accurate for describing population level causes of death in Bohol. While overall agreement between the PSA and MRR in major cause groups was sufficient for public health purposes, improvements in death certification practices are recommended to help physicians differentiate between treatable (immediate) COD and COD that are important for public health surveillance. Electronic supplementary material The online version of this article (10.1186/s12963-018-0178-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marilla Lucero
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Ian Douglas Riley
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Riley H Hazard
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.
| | | | - Veronica Tallo
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | | | - Juanita M Ugpo
- Ramiro Community Hospital, Tagbilaran City, Philippines.,Holy Name University Medical Center, Bohol, Philippines
| | - Alan D Lopez
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
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18
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McDonald EA, Stuart R, Joshi A, Wu HW, Olveda RM, Acosta LP, Tallo V, Baltazar PI, Bailey JA, Kurtis JD, Friedman JF. Endotoxin at the Maternal-Fetal Interface in a Resource-Constrained Setting: Risk Factors and Associated Birth Outcomes. Am J Trop Med Hyg 2018; 99:495-501. [PMID: 29968554 DOI: 10.4269/ajtmh.17-0949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Low- and middle-income countries (LMICs) carry a high burden of infectious diseases associated with impaired gut integrity, leading to microbial translocation. Pregnancies in this setting are at high risk of fetal growth restriction (FGR). We examined the association among specific risk factors for impaired gut integrity (schistosomiasis, hookworm infection, and alcohol consumption), blood endotoxin levels, and FGR. Endotoxins, lipopolysaccharide-binding proteins (LBPs), and cytokines were measured in blood from women at 32 weeks gestation, the maternal-fetal interface (MFI) at delivery, and cord blood at delivery. Resolution of schistosomiasis had no impact on endotoxin levels; however, maternal hookworm infection and alcohol consumption were associated with modest increases in endotoxin at the MFI. Cytokines responses within the maternal peripheral blood and blood from the MFI were positively associated with endotoxins, but many cord blood cytokines were negatively associated with endotoxins. Newborns with FGR also had higher levels of endotoxins at the MFI. Risk factors for microbial translocation may lead to increased levels of endotoxins at the MFI, which may contribute to poor growth in utero.
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Affiliation(s)
- Emily A McDonald
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island.,Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island
| | - Ronald Stuart
- Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island
| | - Ayush Joshi
- Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island
| | - Hannah W Wu
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island.,Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island
| | - Remigio M Olveda
- Department of Immunology, Research Institute for Tropical Medicine, Manila, Philippines
| | - Luz P Acosta
- Department of Immunology, Research Institute for Tropical Medicine, Manila, Philippines
| | - Veronica Tallo
- Department of Immunology, Research Institute for Tropical Medicine, Manila, Philippines
| | - Palmera I Baltazar
- Department of Immunology, Research Institute for Tropical Medicine, Manila, Philippines
| | - Jeffrey A Bailey
- Program in Bioinformatics and Integrative Biology, University of Massachusetts Medical School, Worcester, Massachusetts.,Division of Transfusion Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jonathan D Kurtis
- Department of Pathology and Laboratory Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.,Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island
| | - Jennifer F Friedman
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island.,Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island
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19
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Root ED, Lucero M, Nohynek H, Stubbs R, Tallo V, Lupisan SP, Sanvictores DM, Nillos LT, Simões EA. Distance to health services modifies the effect of an 11-valent pneumococcal vaccine on pneumonia risk among children less than 2 years of age in Bohol, Philippines. Int J Epidemiol 2018; 46:706-716. [PMID: 27605588 DOI: 10.1093/ije/dyw217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 11/13/2022] Open
Abstract
Background Both vaccine trials and surveillance studies typically use passive surveillance systems to monitor study outcomes, which may lead to under-reporting of study outcomes in areas with poor access to care. This detection bias can have an adverse effect on conventional estimates of pneumonia risk derived from vaccine trials. Methods We conducted a secondary analysis of a randomized, placebo-controlled, double-blind vaccine trial that examined the efficacy of an 11-valent pneumococcal vaccine (PCV) among children less than 2 years of age in Bohol, Philippines. Trial data were linked to the residential location of each participant using a geographical information system. The study was conducted using 11 729 children who received three doses of any study vaccine (PCV11) or placebo. Multivariate Cox proportional hazards models were used to examine major risk factors for pneumonia diagnosis and the relationship between distance to Bohol Regional Hospital (BRH) and vaccination with PCV with risk for pneumonia diagnosis. Results There was a significant interaction effect between distance from BRH and vaccination with PCV11 on pneumonia risk. Among children living 12 km from BRH, vaccination with PCV11 was associated with a decreased hazard ratio for radiographic pneumonia, compared with vaccination with the study placebo [0.57, 95% confidence interval (CI) 0.37-0.86). However, for children living 1 km from BRH, there was little difference in risk of radiographic pneumonia diagnosis between children vaccinated with PCV11 and those given the study placebo. Conclusion Children living close to BRH had no documented reduction in the primary study outcome from PCV11, whereas those at greater distance experienced a substantial reduction. Because of detection bias caused by distance to BRH, in spatial analysis of vaccine trial results it may be necessary to adjust estimates of pneumonia risk and vaccine efficacy. Failure to consider the geographical dimension of trials may lead to underestimates of efficacy which might influence public health planning efforts.
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Affiliation(s)
- Elisabeth Dowling Root
- Department of Geography and Division of Epidemiology, Ohio State University, Columbus, OH, USA
| | - Marilla Lucero
- Research Institute for Tropical Medicine, Manila, Philippines
| | - Hanna Nohynek
- Department of Vaccination and Immune Protection, National Institute for Health and Welfare, Helsinki, Finland
| | - Rebecca Stubbs
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA and
| | - Veronica Tallo
- Research Institute for Tropical Medicine, Manila, Philippines
| | | | | | | | - Eric Af Simões
- Children's Hospital of Colorado, University of Colorado, Denver, CO, USA
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20
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Abioye AI, Park S, Ripp K, McDonald EA, Kurtis JD, Wu H, Pond-Tor S, Sharma S, Ernerudh J, Baltazar P, Acosta LP, Olveda RM, Tallo V, Friedman JF. Anemia of Inflammation during Human Pregnancy Does Not Affect Newborn Iron Endowment. J Nutr 2018; 148:427-436. [PMID: 29546300 PMCID: PMC6454452 DOI: 10.1093/jn/nxx052] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/27/2017] [Indexed: 12/20/2022] Open
Abstract
Background To our knowledge, no studies have addressed whether maternal anemia of inflammation (AI) affects newborn iron status, and few have addressed risk factors for specific etiologies of maternal anemia. Objectives The study aims were to evaluate 1) the contribution of AI and iron deficiency anemia (IDA) to newborn iron endowment, 2) hepcidin as a biomarker to distinguish AI from IDA among pregnant women, and 3) risk factors for specific etiologies of maternal anemia. Methods We measured hematologic biomarkers in maternal blood at 12 and 32 wk of gestation and in cord blood from a randomized trial of praziquantel in 358 pregnant women with Schistosoma japonicum in The Philippines. IDA was defined as anemia with serum ferritin <30 ng/mL and non-IDA (NIDA), largely due to AI, as anemia with ferritin ≥30 ng/mL. We identified cutoffs for biomarkers to distinguish IDA from NIDA by using area under the curve (AUC) analyses and examined the impact of different causes of anemia on newborn iron status (primary outcome) by using multivariate regression modeling. Results Of the 358 mothers, 38% (n = 136) had IDA and 9% (n = 32) had NIDA at 32 wk of gestation. At 32 wk of gestation, serum hepcidin performed better than soluble transferrin receptor (sTfR) in identifying women with NIDA compared with the rest of the cohort (AUCs: 0.75 and 0.70, respectively) and in identifying women with NIDA among women with anemia (0.73 and 0.72, respectively). The cutoff that optimally distinguished women with NIDA from women with IDA in our cohort was 6.1 µg/L. Maternal IDA, but not NIDA, was associated with significantly lower newborn ferritin (114.4 ng/mL compared with 148.4 µg/L; P = 0.042). Conclusions Hepcidin performed better than sTfR in identifying pregnant women with NIDA, but its cost may limit its use. Maternal IDA, but not NIDA, is associated with decreased newborn iron stores, emphasizing the need to identify this cause and provide iron therapy. This trial was registered at www.clinicaltrials.gov as NCT00486863.
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Affiliation(s)
- Ajibola I Abioye
- The Warren Alpert Medical School of Brown University, Providence, RI,Department of Pediatrics, Center for International Health Research, and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI,Department of Center for International Health Research, and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI
| | - Sangshin Park
- The Warren Alpert Medical School of Brown University, Providence, RI,Department of Pediatrics, Center for International Health Research, and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI,Department of Center for International Health Research, and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI,Address correspondence to SP (e-mail: or )
| | - Kelsey Ripp
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Emily A McDonald
- The Warren Alpert Medical School of Brown University, Providence, RI,Department of Pediatrics, Center for International Health Research, and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI,Department of Center for International Health Research, and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI
| | - Jonathan D Kurtis
- The Warren Alpert Medical School of Brown University, Providence, RI,Department of Center for International Health Research, and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI,Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI
| | - Hannah Wu
- The Warren Alpert Medical School of Brown University, Providence, RI,Department of Pediatrics, Center for International Health Research, and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI,Department of Center for International Health Research, and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI
| | - Sunthorn Pond-Tor
- Department of Center for International Health Research, and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI
| | - Surendra Sharma
- The Warren Alpert Medical School of Brown University, Providence, RI,Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Jan Ernerudh
- Departments of Clinical Immunology and Transfusion Medicine and Clinical and Experimental Medicine, Linkoping University, Linkoping, Sweden,Departments of Clinical and Experimental Medicine, Linkoping University, Linkoping, Sweden
| | - Palmera Baltazar
- Research Institute for Tropical Medicine, Manila, Philippines,Remedios Trinidad Romualdez Hospital, Tacloban City, Leyte, Philippines
| | - Luz P Acosta
- Research Institute for Tropical Medicine, Manila, Philippines
| | | | - Veronica Tallo
- Research Institute for Tropical Medicine, Manila, Philippines
| | - Jennifer F Friedman
- The Warren Alpert Medical School of Brown University, Providence, RI,Department of Pediatrics, Center for International Health Research, and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI,Department of Center for International Health Research, and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI
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21
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Flaxman AD, Stewart A, Joseph JC, Alam N, Alam SS, Chowdhury H, Mooney MD, Rampatige R, Remolador H, Sanvictores D, Serina PT, Streatfield PK, Tallo V, Murray CJL, Hernandez B, Lopez AD, Riley ID. Collecting verbal autopsies: improving and streamlining data collection processes using electronic tablets. Popul Health Metr 2018; 16:3. [PMID: 29391038 PMCID: PMC5793369 DOI: 10.1186/s12963-018-0161-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 01/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is increasing interest in using verbal autopsy to produce nationally representative population-level estimates of causes of death. However, the burden of processing a large quantity of surveys collected with paper and pencil has been a barrier to scaling up verbal autopsy surveillance. Direct electronic data capture has been used in other large-scale surveys and can be used in verbal autopsy as well, to reduce time and cost of going from collected data to actionable information. METHODS We collected verbal autopsy interviews using paper and pencil and using electronic tablets at two sites, and measured the cost and time required to process the surveys for analysis. From these cost and time data, we extrapolated costs associated with conducting large-scale surveillance with verbal autopsy. RESULTS We found that the median time between data collection and data entry for surveys collected on paper and pencil was approximately 3 months. For surveys collected on electronic tablets, this was less than 2 days. For small-scale surveys, we found that the upfront costs of purchasing electronic tablets was the primary cost and resulted in a higher total cost. For large-scale surveys, the costs associated with data entry exceeded the cost of the tablets, so electronic data capture provides both a quicker and cheaper method of data collection. CONCLUSIONS As countries increase verbal autopsy surveillance, it is important to consider the best way to design sustainable systems for data collection. Electronic data capture has the potential to greatly reduce the time and costs associated with data collection. For long-term, large-scale surveillance required by national vital statistical systems, electronic data capture reduces costs and allows data to be available sooner.
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Affiliation(s)
- Abraham D Flaxman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
| | - Andrea Stewart
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jonathan C Joseph
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nurul Alam
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Sayed Saidul Alam
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Hafizur Chowdhury
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Meghan D Mooney
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Rasika Rampatige
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Hazel Remolador
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | | | - Peter T Serina
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Veronica Tallo
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | | | - Bernardo Hernandez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Alan D Lopez
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Ian Douglas Riley
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
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22
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McDonald E, Zhao A, Stuart R, Olveda R, Tallo V, Baltazar P, Kurtis J, Friedman J. Fetal adiponectin in the context of maternal helminthiasis. Placenta 2017. [DOI: 10.1016/j.placenta.2017.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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23
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Flaxman AD, Stewart A, Joseph JC, Alam N, Alam S, Chowdhury H, Gamage S, Gouda H, Joshi R, Lucero M, Mooney MD, Praveen D, Rampatige R, Remolador H, Sanvictores D, Serina PT, Streatfield PK, Tallo V, Wijesekera N, Murray CJL, Hernandez B, Lopez AD, Riley ID. Implementing the PHMRC shortened questionnaire: Survey duration of open and closed questions in three sites. PLoS One 2017; 12:e0178085. [PMID: 28570596 PMCID: PMC5453488 DOI: 10.1371/journal.pone.0178085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 05/07/2017] [Indexed: 11/25/2022] Open
Abstract
Background More countries are using verbal autopsy as a part of routine mortality surveillance. The length of time required to complete a verbal autopsy interview is a key logistical consideration for planning large-scale surveillance. Methods We use the PHMRC shortened questionnaire to conduct verbal autopsy interviews at three sites and collect data on the length of time required to complete the interview. This instrument uses a novel checklist of keywords to capture relevant information from the open response. The open response section is timed separately from the section consisting of closed questions. Results We found the median time to complete the entire interview was approximately 25 minutes and did not vary substantially by age-specific module. The median time for the open response section was approximately 4 minutes and 60% of interviewees mentioned at least one keyword within the open response section. Conclusions The length of time required to complete the interview was short enough for large-scale routine use. The open-response section did not add a substantial amount of time and provided useful information which can be used to increase the accuracy of the predictions of the cause of death. The novel checklist approach further reduces the burden of transcribing and translating a large amount of free text. This makes the PHMRC instrument ideal for national mortality surveillance.
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Affiliation(s)
- Abraham D. Flaxman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
- * E-mail:
| | - Andrea Stewart
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Jonathan C. Joseph
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Nurul Alam
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Saidul Alam
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Hafizur Chowdhury
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Saman Gamage
- WHO Collaborating Centre for Public Health Workforce Development, National Institute of Health Sciences, Kalutara, Sri Lanka
| | - Hebe Gouda
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
- School of Public Health, University of Queensland, QLD, Australia
- Queensland Centre for Mental Health Research, QLD, Australia
| | - Rohina Joshi
- The George Institute for Global Health, Sydney, Australia
| | - Marilla Lucero
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Meghan D. Mooney
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Devarsetty Praveen
- The George Institute for Global Health, Sydney, Australia
- George Institute of Global Health India, Hyderabad, India
| | - Rasika Rampatige
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Hazel Remolador
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | | | - Peter T. Serina
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | | | - Veronica Tallo
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Nandalal Wijesekera
- WHO Collaborating Centre for Public Health Workforce Development, National Institute of Health Sciences, Kalutara, Sri Lanka
| | - Christopher J. L. Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Bernardo Hernandez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Alan D. Lopez
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Ian Douglas Riley
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
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24
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Park S, Bellinger DC, Adamo M, Bennett B, Choi NK, Baltazar PI, Ayaso EB, Monterde DBS, Tallo V, Olveda RM, Acosta LP, Kurtis JD, Friedman JF. Mechanistic Pathways From Early Gestation Through Infancy and Neurodevelopment. Pediatrics 2016; 138:peds.2016-1843. [PMID: 27940699 PMCID: PMC5127069 DOI: 10.1542/peds.2016-1843] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To identify pathways through which pre- and postnatal factors directly or indirectly affect infant neurodevelopment at 12 months of age among Filipino infants. METHODS The Bayley Scales of Infant Development, third edition was used to assess the development of 314 infants of mothers enrolled in a trial examining the safety and efficacy of praziquantel during pregnancy. Maternal covariates included socioeconomic status, iron and nutritional status, cognitive performance, and alcohol intake. Infant covariates included birth weight and feeding practices, longitudinal growth and nutritional status, hemoglobin and iron status captured at birth, and 6 and 12 months of age. Multivariable regression and structural equation modeling were used to identify significant factors associated with infant development. RESULTS In regression models, maternal education, cognition, and iron status as well as infant weight-for-age z-score (WAZ), weight-for-length z-score, and WAZ gains were significantly associated with infant development at 12 months of age. Structural equation modeling demonstrated a direct effect of maternal cognition on most subscales of infant development and indirect effects on expressive language through effects on infant WAZ. Maternal iron status was a stronger predictor of infant cognition subscale scores than was infant iron status. Exclusive breastfeeding had a direct influence on expressive language rather than acting through improved infant iron or nutritional status. CONCLUSIONS We identified key modifiable risk factors for impaired neurodevelopment, including prenatal risk factors such as maternal iron status. Integrated nutritional interventions that impact both maternal and infant nutritional status are likely to positively affect infant neurodevelopment through identified pathways.
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Affiliation(s)
- Sangshin Park
- Center for International Health Research, Rhode Island Hospital, and .,Departments of Pediatrics, and
| | - David C. Bellinger
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts;,Department of Neurology, Children’s Hospital, Boston, Massachusetts
| | - Meredith Adamo
- Center for International Health Research, Rhode Island Hospital, and
| | - Brady Bennett
- Center for International Health Research, Rhode Island Hospital, and
| | - Nam-Kyong Choi
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea;,Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts;,Department of Health Convergence, Ewha Womans University, Seoul, Republic of Korea
| | - Palmera I. Baltazar
- Remedios Trinidad Romualdez Hospital, Tacloban City, Leyte, Philippines; and,Research Institute for Tropical Medicine, Manila, Philippines
| | - Edna B. Ayaso
- Remedios Trinidad Romualdez Hospital, Tacloban City, Leyte, Philippines; and
| | | | - Veronica Tallo
- Research Institute for Tropical Medicine, Manila, Philippines
| | | | - Luz P. Acosta
- Research Institute for Tropical Medicine, Manila, Philippines
| | - Jonathan D. Kurtis
- Center for International Health Research, Rhode Island Hospital, and,Pathology and Laboratory Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jennifer F. Friedman
- Center for International Health Research, Rhode Island Hospital, and,Departments of Pediatrics, and
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25
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Serina P, Riley I, Hernandez B, Flaxman AD, Praveen D, Tallo V, Joshi R, Sanvictores D, Stewart A, Mooney MD, Murray CJL, Lopez AD. The paradox of verbal autopsy in cause of death assignment: symptom question unreliability but predictive accuracy. Popul Health Metr 2016; 14:41. [PMID: 27833460 PMCID: PMC5101673 DOI: 10.1186/s12963-016-0104-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 09/29/2016] [Indexed: 11/23/2022] Open
Abstract
Background We believe that it is important that governments understand the reliability of the mortality data which they have at their disposable to guide policy debates. In many instances, verbal autopsy (VA) will be the only source of mortality data for populations, yet little is known about how the accuracy of VA diagnoses is affected by the reliability of the symptom responses. We previously described the effect of the duration of time between death and VA administration on VA validity. In this paper, using the same dataset, we assess the relationship between the reliability and completeness of symptom responses and the reliability and accuracy of cause of death (COD) prediction. Methods The study was based on VAs in the Population Health Metrics Research Consortium (PHMRC) VA Validation Dataset from study sites in Bohol and Manila, Philippines and Andhra Pradesh, India. The initial interview was repeated within 3–52 months of death. Question responses were assessed for reliability and completeness between the two survey rounds. COD was predicted by Tariff Method. Results A sample of 4226 VAs was collected for 2113 decedents, including 1394 adults, 349 children, and 370 neonates. Mean question reliability was unexpectedly low (kappa = 0.447): 42.5 % of responses positive at the first interview were negative at the second, and 47.9 % of responses positive at the second had been negative at the first. Question reliability was greater for the short form of the PHMRC instrument (kappa = 0.497) and when analyzed at the level of the individual decedent (kappa = 0.610). Reliability at the level of the individual decedent was associated with COD predictive reliability and predictive accuracy. Conclusions Families give coherent accounts of events leading to death but the details vary from interview to interview for the same case. Accounts are accurate but inconsistent; different subsets of symptoms are identified on each occasion. However, there are sufficient accurate and consistent subsets of symptoms to enable the Tariff Method to assign a COD. Questions which contributed most to COD prediction were also the most reliable and consistent across repeat interviews; these have been included in the short form VA questionnaire. Accuracy and reliability of diagnosis for an individual death depend on the quality of interview. This has considerable implications for the progressive roll out of VAs into civil registration and vital statistics (CRVS) systems. Electronic supplementary material The online version of this article (doi:10.1186/s12963-016-0104-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Peter Serina
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA USA
| | - Ian Riley
- School of Public Health, University of Queensland, Brisbane, Australia ; Melbourne School of Population and Global Health, The University of Melbourne, Building 379, 207 Bouverie St, Carlton, 3053 VIC Australia
| | - Bernardo Hernandez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA USA
| | - Abraham D Flaxman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA USA
| | | | - Veronica Tallo
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Rohina Joshi
- The George Institute for Global Health, University of Sydney, Level 10, King George V Building 83-117 Missenden Rd, PO Box M201, Camperdown, 2050 NSW Australia
| | | | - Andrea Stewart
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA USA
| | - Meghan D Mooney
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA USA
| | | | - Alan D Lopez
- Melbourne School of Population and Global Health, The University of Melbourne, Building 379, 207 Bouverie St, Carlton, 3053 VIC Australia
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Serina P, Riley I, Hernandez B, Flaxman AD, Praveen D, Tallo V, Joshi R, Sanvictores D, Stewart A, Mooney MD, Murray CJL, Lopez AD. What is the optimal recall period for verbal autopsies? Validation study based on repeat interviews in three populations. Popul Health Metr 2016; 14:40. [PMID: 27833459 PMCID: PMC5101705 DOI: 10.1186/s12963-016-0105-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 09/29/2016] [Indexed: 11/10/2022] Open
Abstract
Background One key contextual feature in Verbal Autopsy (VA) is the time between death and survey administration, or recall period. This study quantified the effect of recall period on VA performance by using a paired dataset in which two VAs were administered for a single decedent. Methods This study used information from the Population Health Metrics Research Consortium (PHMRC) Study, which collected VAs for “gold standard” cases where cause of death (COD) was supported by clinical criteria. This study repeated VA interviews within 3–52 months of death in PHMRC study sites in Andhra Pradesh, India, and Bohol and Manila, Philippines. The final dataset included 2113 deaths interviewed twice and with recall periods ranging from 0 to 52 months. COD was assigned by the Tariff method and its accuracy determined by comparison with the gold standard COD. Results The probability of a correct diagnosis of COD decreased by 0.55 % per month in the period after death. Site of data collection and survey module also affected the probability of Tariff Method correctly assigning a COD. The probability of a correct diagnosis in VAs collected 3–11 months after death will, on average, be 95.9 % of that in VAs collected within 3 months of death. Conclusions These findings suggest that collecting VAs within 3 months of death may improve the quality of the information collected, taking the need for a period of mourning into account. This study substantiates the WHO recommendation that it is reasonable to collect VAs up to 1 year after death providing it is accepted that probability of a correct diagnosis is likely to decline month by month during this period. Electronic supplementary material The online version of this article (doi:10.1186/s12963-016-0105-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Peter Serina
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA 98121 USA
| | - Ian Riley
- University of Queensland, School of Public Health, Level 2 Public Health Building School of Public Health, Herston Road, Herston, QLD 4006 Australia ; University of Melbourne, School of Population and Global Health, Building 379, 207 Bouverie St., Parkville, 3010 VIC Australia
| | - Bernardo Hernandez
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA 98121 USA
| | - Abraham D Flaxman
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA 98121 USA
| | - Devarsetty Praveen
- The George Institute for Global Health - India, Unit No. 301, Second Floor, ANR Center Road No.1, Banjara Hills, Hyderabad, Telangana 500 034 India
| | - Veronica Tallo
- Research Institute for Tropical Medicine, Corporate Ave, Muntinlupa City, 1781 Philippines
| | - Rohina Joshi
- The George Institute for Global Health - Australia, Level 10, King George V Building, 83-117 Missenden Rd, PO Box M201, Camperdown, NSW 2050 Australia
| | - Diozele Sanvictores
- Research Institute for Tropical Medicine, Corporate Ave, Muntinlupa City, 1781 Philippines
| | - Andrea Stewart
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA 98121 USA
| | - Meghan D Mooney
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA 98121 USA
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA 98121 USA
| | - Alan D Lopez
- University of Melbourne, School of Population and Global Health, Building 379, 207 Bouverie St., Parkville, 3010 VIC Australia
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Ross AGP, Olveda RM, McManus DP, Harn DA, Chy D, Li Y, Tallo V, Ng SK. Risk factors for human helminthiases in rural Philippines. Int J Infect Dis 2016; 54:150-155. [PMID: 27717859 DOI: 10.1016/j.ijid.2016.09.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND A cross-sectional survey was performed in 2012 among 18 rural barangays in Northern Samar, the Philippines in order to determine the prevalence of single and multiple species helminth infections and the underlying risk factors of acquiring one or more parasites. METHODS A total of 6976 participants who completed a medical questionnaire and provided a stool sample for examination were included in the final analysis. RESULTS The overall prevalence rates of Schistosoma japonicum, Ascaris lumbricoides, Trichuris trichiura, and hookworm were found to be moderate to high at 28.9%, 36.5%, 61.8%, and 28.4%, respectively. However, the prevalence of harbouring any of the helminths was found to be higher at 75.6%. Significant variation was evident among the predicted barangay-specific random effects for infection with S. japonicum (barangay variance of 0.66, 95% confidence interval 0.31-1.40) and for any helminth infection (barangay variance of 0.63, 95% confidence interval 0.30-1.29). The predictive models showed, with greater than 80% sensitivity and specificity, that low socio-economic status, low levels of education, poor sanitation, proximity to water sources, occupation (i.e., farming and fishing), and male sex were all reliable indicators of infection status. CONCLUSIONS This study will aid in the targeting of limited resources for national treatment and WASH (water, sanitation, and hygiene) efforts in low- and middle-income countries.
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Affiliation(s)
- Allen G P Ross
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia.
| | - Remigio M Olveda
- Research Institute for Tropical Medicine, Department of Health, Muntinlupa, Philippines
| | - Donald P McManus
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Donald A Harn
- The Center for Tropical and Emerging Global Health Diseases, University of Georgia, Athens, Georgia, USA
| | - Delia Chy
- Municipal Medical Officer of Health, Palapag, Northern Samar, Philippines
| | - Yuesheng Li
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Veronica Tallo
- Research Institute for Tropical Medicine, Department of Health, Muntinlupa, Philippines
| | - Shu-Kay Ng
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
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McDonald E, Park S, Pond-Tor S, Olveda R, Acosta L, Tallo V, Baltazar P, Kurtis J, Friedman J. The impact of cord blood leptin levels on growth in early infancy. Placenta 2016. [DOI: 10.1016/j.placenta.2016.06.187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rao S, Lucero MG, Nohynek H, Tallo V, Lupisan SP, Garcea RL, Simões EAF. WU and KI polyomavirus infections in Filipino children with lower respiratory tract disease. J Clin Virol 2016; 82:112-118. [PMID: 27479174 DOI: 10.1016/j.jcv.2016.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 07/13/2016] [Accepted: 07/24/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND WU and KI are human polyomaviruses initially detected in the respiratory tract, whose clinical significance remains uncertain. OBJECTIVES To determine the epidemiology, viral load and clinical characteristics of WU and KI polyomaviruses. STUDY DESIGN We tested respiratory specimens collected during a randomized, placebo-controlled pneumococcal conjugate vaccine trial and related epidemiological study in the Philippines. We analyzed 1077 nasal washes from patients aged 6 weeks to 5 years who developed lower respiratory tract illness using quantitative real-time PCR for WU and KI. We collected data regarding presenting symptoms, signs, radiographic findings, laboratory data and coinfection. RESULTS The prevalence and co-infection rates for WU were 5.3% and 74% respectively and 4.2% and 84% respectively for KI. Higher KI viral loads were observed in patients with severe or very severe pneumonia, those presenting with chest indrawing, hypoxia without wheeze, convulsions, and with KI monoinfection compared with co-infection. There was no significant association between viral load and clinical presentation for WU. CONCLUSIONS These findings suggest a potential pathogenic role for KI, and that there is an association between KI viral load and illness severity.
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Affiliation(s)
- Suchitra Rao
- University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Marilla G Lucero
- Research Institute for Tropical Medicine, Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Hanna Nohynek
- National Institute for Health and Welfare, Helsinki, Finland
| | - Veronica Tallo
- Research Institute for Tropical Medicine, Department of Health, Muntinlupa City, Metro Manila, Philippines
| | | | | | - Eric A F Simões
- University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA; Center for Global Health, Colorado School of Public Health, Aurora, CO, USA.
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Blake RA, Park S, Baltazar P, Ayaso EB, Monterde DBS, Acosta LP, Olveda RM, Tallo V, Friedman JF. LBW and SGA Impact Longitudinal Growth and Nutritional Status of Filipino Infants. PLoS One 2016; 11:e0159461. [PMID: 27441564 PMCID: PMC4956033 DOI: 10.1371/journal.pone.0159461] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/01/2016] [Indexed: 11/26/2022] Open
Abstract
We performed this study to longitudinally compare rates of stunting, wasting and underweight among low birthweight (LBW), non-LBW, and/or small-for-gestational age (SGA) and non-SGA infants in Leyte, The Philippines and factors that predicted catch up. Birthweights of 357 infants born in Leyte, The Philippines were obtained within 48 hours of delivery and infants were evaluated at one, six and 12 months. Newborns were classified as LBW, SGA, or both. We derived length-for-age, weight-for-length and weight-for-age Z-scores using WHOAnthro. Generalized estimating equations models were used to compare the differences in prevalence and mean Z-scores for these growth and nutritional outcomes, with separate models made with LBW and SGA as distinct primary predictors. We compared the longitudinal risk of stunting, wasting and underweight during infancy among LBW versus non-LBW and SGA versus non-SGA infants, while also evaluating key potential confounding, explanatory and modifying covariates. Overall, 9.0% of infants were born prematurely, 14.0% of infants were LBW and 22.9% were SGA. LBW infants had significantly increased odds of stunting, wasting and underweight persisting to 12 months of age, and SGA infants had significantly increased odds of stunting and underweight. LBW and SGA infants had higher rates of weight-for-length gain in the first month of life. Maternal educational attainment and exclusive breastfeeding decreased the risk of stunting and undernutrition. In this setting, LBW and SGA infants have higher rates of growth stunting and undernutrition during the first year of life and do not exhibit catch-up growth by 12 months of age.
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Affiliation(s)
- Rachel A. Blake
- The Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Sangshin Park
- The Warren Alpert Medical School of Brown University, Providence, RI, United States of America
- Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, United States of America
- * E-mail:
| | - Palmera Baltazar
- Research Institute for Tropical Medicine, Manila, Philippines
- Remedios Trinidad Romualdez Hospital, Tacloban City, Leyte, The Philippines
| | - Edna B. Ayaso
- Remedios Trinidad Romualdez Hospital, Tacloban City, Leyte, The Philippines
| | | | - Luz P. Acosta
- Research Institute for Tropical Medicine, Manila, Philippines
| | | | - Veronica Tallo
- Research Institute for Tropical Medicine, Manila, Philippines
| | - Jennifer F. Friedman
- The Warren Alpert Medical School of Brown University, Providence, RI, United States of America
- Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, United States of America
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Kadji FMN, Okamoto M, Furuse Y, Tamaki R, Suzuki A, Lirio I, Dapat C, Malasao R, Saito M, Pedrera-Rico GAG, Tallo V, Lupisan S, Saito M, Oshitani H. Differences in viral load among human respiratory syncytial virus genotypes in hospitalized children with severe acute respiratory infections in the Philippines. Virol J 2016; 13:113. [PMID: 27350282 PMCID: PMC4924256 DOI: 10.1186/s12985-016-0565-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 06/17/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Human respiratory syncytial virus (HRSV) is a leading viral etiologic agent of pediatric lower respiratory infections, including bronchiolitis and pneumonia. Two antigenic subgroups, HRSV-A and B, each contain several genotypes. While viral load may vary among HRSV genotypes and affect the clinical course of disease, data are scarce regarding the actual differences among genotypes. Therefore, this study estimated and compared viral load among NA1 and ON1 genotypes of HRSV-A and BA9 of HRSV-B. ON1 is a newly emerged genotype with a 72-nucleotide duplication in the G gene as observed previously with BA genotypes in HRSV-B. FINDINGS Children <5 years of age with an initial diagnosis of severe or very severe pneumonia at a hospital in the Philippines from September 2012 to December 2013 were enrolled. HRSV genotypes were determined and the viral load measured from nasopharyngeal swabs (NPS). The viral load of HRSV genotype NA1 were significantly higher than those of ON1 and BA9. Regression analysis showed that both genotype NA1 and younger age were significantly associated with high HRSV viral load. CONCLUSIONS The viral load of NA1 was higher than that of ON1 and BA9 in NPS samples. HRSV genotypes may be associated with HRSV viral load. The reasons and clinical impacts of these differences in viral load among HRSV genotypes require further evaluation.
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Affiliation(s)
| | - Michiko Okamoto
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuki Furuse
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Raita Tamaki
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Suzuki
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Irene Lirio
- Tohoku-RITM Collaborating Research Center on Emerging and Reemerging Diseases, Muntinlupa City, the Philippines
| | - Clyde Dapat
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Mariko Saito
- Tohoku-RITM Collaborating Research Center on Emerging and Reemerging Diseases, Muntinlupa City, the Philippines
| | | | - Veronica Tallo
- Research Institute for Tropical Medicine, Muntinlupa City, the Philippines
| | - Socorro Lupisan
- Research Institute for Tropical Medicine, Muntinlupa City, the Philippines
| | - Mayuko Saito
- Tohoku University Graduate School of Medicine, Sendai, Japan.
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Furuse Y, Odagiri T, Tamaki R, Kamigaki T, Otomaru H, Opinion J, Santo A, Dolina-Lacaba D, Daya E, Okamoto M, Saito-Obata M, Inobaya M, Tan A, Tallo V, Lupisan S, Suzuki A, Oshitani H. Local persistence and global dissemination play a significant role in the circulation of influenza B viruses in Leyte Island, Philippines. Virology 2016; 492:21-4. [PMID: 26896931 DOI: 10.1016/j.virol.2016.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 01/31/2016] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
Abstract
The local and global transmission dynamics of influenza B virus is not completely understood mainly because of limited epidemiological and sequence data for influenza B virus. Here we report epidemiological and molecular characteristics of influenza B viruses from 2010 to 2013 in Leyte Island, Philippines. Phylogenetic analyses showed global dissemination of the virus among both neighboring and distant areas. The analyses also suggest that southeast Asia is not a distributor of influenza B virus and can introduce the virus from other areas. Furthermore, we found evidence on the local persistence of the virus over years in the Philippines. Taken together, both local persistence and global dissemination play a significant role in the circulation of influenza B virus.
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Affiliation(s)
- Yuki Furuse
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Odagiri
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Raita Tamaki
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Taro Kamigaki
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hirono Otomaru
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jamie Opinion
- Tacloban City Health Office, Tacloban City, Philippines
| | | | | | - Edgard Daya
- Leyte Provincial Health Office, Palo, Philippines
| | - Michiko Okamoto
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mariko Saito-Obata
- Tohoku-RITM Research Center for Emerging and Reemerging Infectious Diseases, Muntinlupa City, Philippines
| | | | - Alvin Tan
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Veronica Tallo
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Socorro Lupisan
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Akira Suzuki
- Virus Research Center, Clinical Research Division, Sendai Medical Center, Sendai, Japan
| | - Hitoshi Oshitani
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan.
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Olveda RM, Acosta LP, Tallo V, Baltazar PI, Lesiguez JLS, Estanislao GG, Ayaso EB, Monterde DBS, Ida A, Watson N, McDonald EA, Wu HW, Kurtis JD, Friedman JF. Efficacy and safety of praziquantel for the treatment of human schistosomiasis during pregnancy: a phase 2, randomised, double-blind, placebo-controlled trial. Lancet Infect Dis 2016; 16:199-208. [PMID: 26511959 PMCID: PMC4752899 DOI: 10.1016/s1473-3099(15)00345-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/10/2015] [Accepted: 09/16/2015] [Indexed: 12/02/2022]
Abstract
BACKGROUND Despite WHO recommendations to offer pregnant women treatment with praziquantel, many nations continue to withhold treatment, awaiting data from controlled trials addressing safety and efficacy. The objectives of this study were to assess whether treatment of pregnant women with schistosomiasis at 12-16 weeks gestation leads to improved maternal and newborn outcomes and to collect maternal and newborn safety data. METHODS This phase 2, randomised, double-blind, placebo-controlled trial was done in 72 baranguays (villages) serviced by six municipal health centres in a schistosomiasis endemic region of northeastern Leyte, Philippines. Pregnant women (at 12-16 weeks gestation) who were otherwise healthy but infected with Schistosoma japonicum were enrolled and randomly assigned (1:1) to receive either over-encapsulated praziquantel (total dose 60 mg/kg given as two split doses) or placebo. Participants, investigators, midwives, and laboratory staff were all masked to treatment. The primary outcome was birthweight. Safety data were collected including immediate reactogenicity, post-dosing toxicology ascertained 24 h after study drug administration, and maternal and newborn serious adverse events. Analysis followed the intention-to-treat principle. Analyses were done using hierarchical generalised linear models to adjust for identified confounders and account for potential clustering of observations within villages and municipalities. This trial is registered with ClinicalTrials.gov, number NCT00486863. FINDINGS Between Aug 13, 2007, and Dec 3, 2012, 370 pregnant women were enrolled and randomly assigned to each treatment group (184 to the placebo group, 186 to the praziquantel group). Most women had low-intensity infections (n=334, 90%). Treatment with praziquantel did not have a significant effect on birthweight (2·85 kg in both groups, β=-0·002 [95% CI -0·088 to 0·083]; p=0·962). Treatment was well tolerated with reactogenicity rates similar to those seen in non-pregnant participants (severe reactions occurred in five patients in the praziquantel group and two in the placebo group, and included headache, fever, and malaise). There were no significant differences in key safety outcomes including abortion, fetal death in utero, and congenital anomalies. INTERPRETATION Results from this study provide important data from a controlled trial in support of the expansion of treatment policies to include pregnant women as recommended by WHO. FUNDING National Institutes of Health, National Institute of Allergy and Infectious Diseases (U01AI066050).
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Affiliation(s)
- Remigio M Olveda
- Department of Immunology, Research Institute of Tropical Medicine, Manila, Philippines
| | - Luz P Acosta
- Department of Immunology, Research Institute of Tropical Medicine, Manila, Philippines
| | - Veronica Tallo
- Department of Epidemiology, Research Institute of Tropical Medicine, Manila, Philippines
| | - Palmera I Baltazar
- Department of Immunology, Research Institute of Tropical Medicine, Manila, Philippines
| | - Jenny Lind S Lesiguez
- Department of Immunology, Research Institute of Tropical Medicine, Manila, Philippines; Remedios Trinidad Romualdez Hospital, Tacloban City, Leyte, Philippines
| | - Georgette G Estanislao
- Department of Immunology, Research Institute of Tropical Medicine, Manila, Philippines; Remedios Trinidad Romualdez Hospital, Tacloban City, Leyte, Philippines
| | - Edna B Ayaso
- Department of Immunology, Research Institute of Tropical Medicine, Manila, Philippines; Remedios Trinidad Romualdez Hospital, Tacloban City, Leyte, Philippines
| | - Donna Bella S Monterde
- Department of Immunology, Research Institute of Tropical Medicine, Manila, Philippines; Remedios Trinidad Romualdez Hospital, Tacloban City, Leyte, Philippines
| | - Antonio Ida
- Department of Immunology, Research Institute of Tropical Medicine, Manila, Philippines
| | | | - Emily A McDonald
- Center for International Health Research, Rhode Island Hospital, Providence, RI, USA; Department of Pediatrics, Alpert Medical School of Brown University and Hasbro Children's Hospital, Providence, RI, USA
| | - Hannah W Wu
- Center for International Health Research, Rhode Island Hospital, Providence, RI, USA; Department of Pediatrics, Alpert Medical School of Brown University and Hasbro Children's Hospital, Providence, RI, USA
| | - Jonathan D Kurtis
- Center for International Health Research, Rhode Island Hospital, Providence, RI, USA; Department of Pathology and Laboratory Medicine, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA
| | - Jennifer F Friedman
- Center for International Health Research, Rhode Island Hospital, Providence, RI, USA; Department of Pediatrics, Alpert Medical School of Brown University and Hasbro Children's Hospital, Providence, RI, USA.
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Olveda RM, Tallo V, Olveda DU, Inobaya MT, Chau TN, Ross AG. National survey data for zoonotic schistosomiasis in the Philippines grossly underestimates the true burden of disease within endemic zones: implications for future control. Int J Infect Dis 2016; 45:13-7. [PMID: 26820760 DOI: 10.1016/j.ijid.2016.01.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/13/2016] [Accepted: 01/19/2016] [Indexed: 12/25/2022] Open
Abstract
Zoonotic schistosomiasis has a long endemic history in the Philippines. Human mass drug administration has been the cornerstone of schistosomiasis control in the country for the past three decades. Recent publications utilizing retrospective national survey data have indicated that the national human prevalence of the disease is <1%, hence the disease is now close to elimination. However, the evidence for such a claim is weak, given that less than a third of the human population is currently being treated annually within endemic zones and only a third of those treated actually swallow the tablets. For those who consume the drug at the single oral dose of 40mg/kg, the estimated cure rate is 52% based on a recent meta-analysis. Thus, approximately 5% of the endemic human population is in reality receiving the appropriate treatment. To compound this public health problem, most of the bovines in the endemic communities are concurrently infected but are not treated under the current national control programme. Given this evidence, it is believed that the human prevalence of schistosomiasis within endemic regions has been grossly underestimated. Inherent flaws in the reporting of national schistosomiasis prevalence data are reported here, and the problems of utilizing national retrospective data in making geographic information system (GIS) risk maps and advising policy makers of the outcomes are highlighted.
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Affiliation(s)
- Remigio M Olveda
- Research Institute for Tropical Medicine, Department of Health, Manila, The Philippines
| | - Veronica Tallo
- Research Institute for Tropical Medicine, Department of Health, Manila, The Philippines
| | - David U Olveda
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Marianette T Inobaya
- Research Institute for Tropical Medicine, Department of Health, Manila, The Philippines; Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Thao N Chau
- Discipline of Public Health, Flinders University, Adelaide, Australia
| | - Allen G Ross
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
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Serina P, Riley I, Stewart A, Flaxman AD, Lozano R, Mooney MD, Luning R, Hernandez B, Black R, Ahuja R, Alam N, Alam SS, Ali SM, Atkinson C, Baqui AH, Chowdhury HR, Dandona L, Dandona R, Dantzer E, Darmstadt GL, Das V, Dhingra U, Dutta A, Fawzi W, Freeman M, Gamage S, Gomez S, Hensman D, James SL, Joshi R, Kalter HD, Kumar A, Kumar V, Lucero M, Mehta S, Neal B, Ohno SL, Phillips D, Pierce K, Prasad R, Praveen D, Premji Z, Ramirez-Villalobos D, Rampatige R, Remolador H, Romero M, Said M, Sanvictores D, Sazawal S, Streatfield PK, Tallo V, Vadhatpour A, Wijesekara N, Murray CJL, Lopez AD. A shortened verbal autopsy instrument for use in routine mortality surveillance systems. BMC Med 2015; 13:302. [PMID: 26670275 PMCID: PMC4681088 DOI: 10.1186/s12916-015-0528-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 11/13/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Verbal autopsy (VA) is recognized as the only feasible alternative to comprehensive medical certification of deaths in settings with no or unreliable vital registration systems. However, a barrier to its use by national registration systems has been the amount of time and cost needed for data collection. Therefore, a short VA instrument (VAI) is needed. In this paper we describe a shortened version of the VAI developed for the Population Health Metrics Research Consortium (PHMRC) Gold Standard Verbal Autopsy Validation Study using a systematic approach. METHODS We used data from the PHMRC validation study. Using the Tariff 2.0 method, we first established a rank order of individual questions in the PHMRC VAI according to their importance in predicting causes of death. Second, we reduced the size of the instrument by dropping questions in reverse order of their importance. We assessed the predictive performance of the instrument as questions were removed at the individual level by calculating chance-corrected concordance and at the population level with cause-specific mortality fraction (CSMF) accuracy. Finally, the optimum size of the shortened instrument was determined using a first derivative analysis of the decline in performance as the size of the VA instrument decreased for adults, children, and neonates. RESULTS The full PHMRC VAI had 183, 127, and 149 questions for adult, child, and neonatal deaths, respectively. The shortened instrument developed had 109, 69, and 67 questions, respectively, representing a decrease in the total number of questions of 40-55%. The shortened instrument, with text, showed non-significant declines in CSMF accuracy from the full instrument with text of 0.4%, 0.0%, and 0.6% for the adult, child, and neonatal modules, respectively. CONCLUSIONS We developed a shortened VAI using a systematic approach, and assessed its performance when administered using hand-held electronic tablets and analyzed using Tariff 2.0. The length of a VA questionnaire was shortened by almost 50% without a significant drop in performance. The shortened VAI developed reduces the burden of time and resources required for data collection and analysis of cause of death data in civil registration systems.
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Affiliation(s)
- Peter Serina
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA.
| | - Ian Riley
- University of Queensland, School of Public Health, Level 2 Public Health Building School of Public Health, Herston Road, Herston, QLD, 4006, Australia.
| | - Andrea Stewart
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA.
| | - Abraham D Flaxman
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA.
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA. .,National Institute of Public Health, Av. Universidad 655, Buena Vista, 62100, Cuernavaca, Morelos, Mexico.
| | - Meghan D Mooney
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA.
| | - Richard Luning
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA.
| | - Bernardo Hernandez
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA.
| | - Robert Black
- Institute for International Programs, Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, 21205, USA.
| | - Ramesh Ahuja
- Community Empowerment Lab, Shivgarh, India. .,The INCLEN Trust International, New Delhi, India.
| | - Nurul Alam
- International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh.
| | - Sayed Saidul Alam
- International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh.
| | - Said Mohammed Ali
- Public Health Laboratory-IdC, P.O.BOX 122, Wawi, Chake Chake, Pemba, Zanzibar, Tanzania.
| | - Charles Atkinson
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA.
| | - Abdulla H Baqui
- Institute for International Programs, Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, 21205, USA.
| | - Hafizur R Chowdhury
- University of Melbourne, School of Population and Global Health, Building 379, 207 Bouverie St., Parkville, 3010, VIC, Australia.
| | - Lalit Dandona
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA. .,Public Health Foundation of India, Plot 47, Sector 44, Gurgaon, 122002, National Capital Region, India.
| | - Rakhi Dandona
- Public Health Foundation of India, Plot 47, Sector 44, Gurgaon, 122002, National Capital Region, India.
| | - Emily Dantzer
- Malaria Consortium Cambodia, 113 Mao Tse Toung, Phnom Penh, Cambodia.
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94304, USA.
| | - Vinita Das
- CSM Medical University, Shah Mina Road, Chowk Lucknow, Uttar Pradesh, 226003, India.
| | - Usha Dhingra
- Institute for International Programs, Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, 21205, USA. .,Public Health Laboratory-IdC, P.O.BOX 122, Wawi, Chake Chake, Pemba, Zanzibar, Tanzania.
| | - Arup Dutta
- Institute for International Programs, Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, 21205, USA. .,Public Health Laboratory-IdC, P.O.BOX 122, Wawi, Chake Chake, Pemba, Zanzibar, Tanzania.
| | - Wafaie Fawzi
- Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115-6018, USA.
| | - Michael Freeman
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA.
| | - Saman Gamage
- WHO Collaborating Centre for Public Health Workforce Development, National Institute of Health Sciences, Kalutara, Sri Lanka.
| | | | - Dilip Hensman
- WHO Collaborating Centre for Public Health Workforce Development, National Institute of Health Sciences, Kalutara, Sri Lanka.
| | - Spencer L James
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA.
| | - Rohina Joshi
- The George Institute for Global Health, Sydney, Australia.
| | - Henry D Kalter
- Institute for International Programs, Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, 21205, USA.
| | - Aarti Kumar
- Community Empowerment Lab, Shivgarh, India. .,The INCLEN Trust International, New Delhi, India.
| | - Vishwajeet Kumar
- Community Empowerment Lab, Shivgarh, India. .,The INCLEN Trust International, New Delhi, India.
| | - Marilla Lucero
- Research Institute for Tropical Medicine, Corporate Ave., Muntinlupa City, 1781, Philippines.
| | - Saurabh Mehta
- Cornell University, Division of Nutritional Sciences, 314 Savage Hall, Ithaca, NY, 14853, USA.
| | - Bruce Neal
- The George Institute for Global Health, University of Sydney and Royal Prince Albert Hospital, Sydney, Australia. .,Imperial college, London, London, UK.
| | - Summer Lockett Ohno
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA.
| | - David Phillips
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA.
| | - Kelsey Pierce
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA.
| | - Rajendra Prasad
- CSM Medical University, Shah Mina Road, Chowk Lucknow, Uttar Pradesh, 226003, India.
| | | | - Zul Premji
- Muhimbili University of Health and Allied Sciences, United Nations Rd., Dar es Salaam, Tanzania.
| | - Dolores Ramirez-Villalobos
- National Institute of Public Health, Av. Universidad 655, Buena Vista, 62100, Cuernavaca, Morelos, Mexico.
| | - Rasika Rampatige
- University of Queensland, School of Public Health, Level 2 Public Health Building School of Public Health, Herston Road, Herston, QLD, 4006, Australia.
| | - Hazel Remolador
- Research Institute for Tropical Medicine, Corporate Ave., Muntinlupa City, 1781, Philippines.
| | - Minerva Romero
- National Institute of Public Health, Av. Universidad 655, Buena Vista, 62100, Cuernavaca, Morelos, Mexico.
| | - Mwanaidi Said
- Muhimbili University of Health and Allied Sciences, United Nations Rd., Dar es Salaam, Tanzania.
| | - Diozele Sanvictores
- Research Institute for Tropical Medicine, Corporate Ave., Muntinlupa City, 1781, Philippines.
| | - Sunil Sazawal
- Institute for International Programs, Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, 21205, USA. .,Public Health Laboratory-IdC, P.O.BOX 122, Wawi, Chake Chake, Pemba, Zanzibar, Tanzania.
| | | | - Veronica Tallo
- Research Institute for Tropical Medicine, Corporate Ave., Muntinlupa City, 1781, Philippines.
| | - Alireza Vadhatpour
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA.
| | - Nandalal Wijesekara
- WHO Collaborating Centre for Public Health Workforce Development, National Institute of Health Sciences, Kalutara, Sri Lanka.
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA.
| | - Alan D Lopez
- University of Melbourne, School of Population and Global Health, Building 379, 207 Bouverie St., Parkville, 3010, VIC, Australia.
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Serina P, Riley I, Stewart A, James SL, Flaxman AD, Lozano R, Hernandez B, Mooney MD, Luning R, Black R, Ahuja R, Alam N, Alam SS, Ali SM, Atkinson C, Baqui AH, Chowdhury HR, Dandona L, Dandona R, Dantzer E, Darmstadt GL, Das V, Dhingra U, Dutta A, Fawzi W, Freeman M, Gomez S, Gouda HN, Joshi R, Kalter HD, Kumar A, Kumar V, Lucero M, Maraga S, Mehta S, Neal B, Ohno SL, Phillips D, Pierce K, Prasad R, Praveen D, Premji Z, Ramirez-Villalobos D, Rarau P, Remolador H, Romero M, Said M, Sanvictores D, Sazawal S, Streatfield PK, Tallo V, Vadhatpour A, Vano M, Murray CJL, Lopez AD. Improving performance of the Tariff Method for assigning causes of death to verbal autopsies. BMC Med 2015; 13:291. [PMID: 26644140 PMCID: PMC4672473 DOI: 10.1186/s12916-015-0527-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 11/13/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Reliable data on the distribution of causes of death (COD) in a population are fundamental to good public health practice. In the absence of comprehensive medical certification of deaths, the only feasible way to collect essential mortality data is verbal autopsy (VA). The Tariff Method was developed by the Population Health Metrics Research Consortium (PHMRC) to ascertain COD from VA information. Given its potential for improving information about COD, there is interest in refining the method. We describe the further development of the Tariff Method. METHODS This study uses data from the PHMRC and the National Health and Medical Research Council (NHMRC) of Australia studies. Gold standard clinical diagnostic criteria for hospital deaths were specified for a target cause list. VAs were collected from families using the PHMRC verbal autopsy instrument including health care experience (HCE). The original Tariff Method (Tariff 1.0) was trained using the validated PHMRC database for which VAs had been collected for deaths with hospital records fulfilling the gold standard criteria (validated VAs). In this study, the performance of Tariff 1.0 was tested using VAs from household surveys (community VAs) collected for the PHMRC and NHMRC studies. We then corrected the model to account for the previous observed biases of the model, and Tariff 2.0 was developed. The performance of Tariff 2.0 was measured at individual and population levels using the validated PHMRC database. RESULTS For median chance-corrected concordance (CCC) and mean cause-specific mortality fraction (CSMF) accuracy, and for each of three modules with and without HCE, Tariff 2.0 performs significantly better than the Tariff 1.0, especially in children and neonates. Improvement in CSMF accuracy with HCE was 2.5%, 7.4%, and 14.9% for adults, children, and neonates, respectively, and for median CCC with HCE it was 6.0%, 13.5%, and 21.2%, respectively. Similar levels of improvement are seen in analyses without HCE. CONCLUSIONS Tariff 2.0 addresses the main shortcomings of the application of the Tariff Method to analyze data from VAs in community settings. It provides an estimation of COD from VAs with better performance at the individual and population level than the previous version of this method, and it is publicly available for use.
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Affiliation(s)
- Peter Serina
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, Suite 600, Seattle, WA, 98121, USA.
| | - Ian Riley
- University of Queensland, School of Population Health, Level 2 Public Health Building School of Population Health, Herston Road, Herston, QLD, 4006, Australia.
| | - Andrea Stewart
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, Suite 600, Seattle, WA, 98121, USA.
| | - Spencer L James
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, Suite 600, Seattle, WA, 98121, USA.
| | - Abraham D Flaxman
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, Suite 600, Seattle, WA, 98121, USA.
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, Suite 600, Seattle, WA, 98121, USA. .,National Institute of Public Health, Universidad 1299 Buena Vista, 62115, Cuernavaca, Morelos, Mexico.
| | - Bernardo Hernandez
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, Suite 600, Seattle, WA, 98121, USA.
| | - Meghan D Mooney
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, Suite 600, Seattle, WA, 98121, USA.
| | - Richard Luning
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, Suite 600, Seattle, WA, 98121, USA.
| | - Robert Black
- Institute for International Programs, Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA.
| | - Ramesh Ahuja
- Community Empowerment Lab, Shivgarh, India. .,The INCLEN Trust International, New Delhi, India.
| | - Nurul Alam
- International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh.
| | - Sayed Saidul Alam
- International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh.
| | - Said Mohammed Ali
- Public Health Laboratory Ivo de Carneri (PHL-IdC), PO Box 122, Wawi Chake Chake Pemba, Zanzibar, Tanzania.
| | - Charles Atkinson
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, Suite 600, Seattle, WA, 98121, USA.
| | - Abdulla H Baqui
- Institute for International Programs, Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA.
| | - Hafizur R Chowdhury
- University of Melbourne, School of Population and Global Health, Building 379, 207 Bouverie Street, Parkville, VIC, 3010, Australia.
| | - Lalit Dandona
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, Suite 600, Seattle, WA, 98121, USA. .,Public Health Foundation of India, Plot 47, Sector 44, Gurgaon, 12002, National Capital Region, India.
| | - Rakhi Dandona
- Public Health Foundation of India, Plot 47, Sector 44, Gurgaon, 12002, National Capital Region, India.
| | - Emily Dantzer
- Malaria Consortium Cambodia, 113 Mao Tse Toung, Phnom Penh, Cambodia.
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94304, USA.
| | - Vinita Das
- CSM Medical University, Shah Mina Road, Chowk Lucknow, Uttar Pradesh, 226003, India.
| | - Usha Dhingra
- Institute for International Programs, Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA. .,Public Health Laboratory Ivo de Carneri (PHL-IdC), PO Box 122, Wawi Chake Chake Pemba, Zanzibar, Tanzania.
| | - Arup Dutta
- Institute for International Programs, Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA. .,Public Health Laboratory Ivo de Carneri (PHL-IdC), PO Box 122, Wawi Chake Chake Pemba, Zanzibar, Tanzania.
| | - Wafaie Fawzi
- Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115-6018, USA.
| | - Michael Freeman
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, Suite 600, Seattle, WA, 98121, USA.
| | | | - Hebe N Gouda
- University of Queensland, School of Population Health, Level 2 Public Health Building School of Population Health, Herston Road, Herston, QLD, 4006, Australia. .,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - Rohina Joshi
- The George Institute of Global Health, University of Sydney, Sydney, NSW, 2000, Australia.
| | - Henry D Kalter
- Institute for International Programs, Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA.
| | - Aarti Kumar
- Community Empowerment Lab, Shivgarh, India. .,The INCLEN Trust International, New Delhi, India.
| | - Vishwajeet Kumar
- Community Empowerment Lab, Shivgarh, India. .,The INCLEN Trust International, New Delhi, India.
| | - Marilla Lucero
- Research Institute for Tropical Medicine, Corporate Avenue, Muntinlupa City, 1781, Philippines.
| | - Seri Maraga
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - Saurabh Mehta
- Cornell University, Division of Nutritional Sciences, 314 Savage Hall, Ithaca, NY, 14853, USA.
| | - Bruce Neal
- The George Institute of Global Health, University of Sydney, Sydney, NSW, 2000, Australia. .,Royal Prince Albert Hospital, Sydney, Australia. .,Imperial College, London, UK.
| | - Summer Lockett Ohno
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, Suite 600, Seattle, WA, 98121, USA.
| | - David Phillips
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, Suite 600, Seattle, WA, 98121, USA.
| | - Kelsey Pierce
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, Suite 600, Seattle, WA, 98121, USA.
| | - Rajendra Prasad
- CSM Medical University, Shah Mina Road, Chowk Lucknow, Uttar Pradesh, 226003, India.
| | - Devarsatee Praveen
- The George Institute of Global Health, University of Sydney, Sydney, NSW, 2000, Australia. .,George Institute of Global Health India, Hyderabad, India.
| | - Zul Premji
- Muhimbili University of Health and Allied Sciences, United Nations Road, Dar es Salaam, Tanzania.
| | | | - Patricia Rarau
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - Hazel Remolador
- Research Institute for Tropical Medicine, Corporate Avenue, Muntinlupa City, 1781, Philippines.
| | - Minerva Romero
- National Institute of Public Health, Universidad 1299 Buena Vista, 62115, Cuernavaca, Morelos, Mexico.
| | - Mwanaidi Said
- Muhimbili University of Health and Allied Sciences, United Nations Road, Dar es Salaam, Tanzania.
| | - Diozele Sanvictores
- Research Institute for Tropical Medicine, Corporate Avenue, Muntinlupa City, 1781, Philippines.
| | - Sunil Sazawal
- Institute for International Programs, Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA. .,Public Health Laboratory Ivo de Carneri (PHL-IdC), PO Box 122, Wawi Chake Chake Pemba, Zanzibar, Tanzania.
| | | | - Veronica Tallo
- Research Institute for Tropical Medicine, Corporate Avenue, Muntinlupa City, 1781, Philippines.
| | - Alireza Vadhatpour
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, Suite 600, Seattle, WA, 98121, USA.
| | - Miriam Vano
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, Suite 600, Seattle, WA, 98121, USA.
| | - Alan D Lopez
- University of Melbourne, School of Population and Global Health, Building 379, 207 Bouverie Street, Parkville, VIC, 3010, Australia.
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Thomas DSK, Anthamatten P, Root ED, Lucero M, Nohynek H, Tallo V, Williams GM, Simões EAF. Disease mapping for informing targeted health interventions: childhood pneumonia in Bohol, Philippines. Trop Med Int Health 2015; 20:1525-1533. [PMID: 26104587 DOI: 10.1111/tmi.12561] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acute lower respiratory tract infections (ALRI) are the leading cause of childhood mortality worldwide. Currently, most developing countries assign resources at a district level, and yet District Medical Officers have few tools for directing targeted interventions to high mortality or morbidity areas. Mapping of ALRI at the local level can guide more efficient allocation of resources, coordination of efforts and targeted interventions, which are particularly relevant for health management in resource-scarce settings. METHODS An efficacy study of 11-valent pneumococcal vaccine was conducted in six municipalities in the Bohol Province of central Philippines from July 2000 to December 2004. Geocoded under-five pneumonia cases (using WHO classifications) were mapped to create spatial patterns of pneumonia at the local health unit (barangay) level. RESULTS There were 2951 children with WHO-defined clinical pneumonia, of whom 1074 were severe or very severely ill, 278 were radiographic, and 219 were hypoxaemic. While most children with pneumonia were from urban barangays, there was a disproportionately higher distribution of severe/very severe pneumonia in rural barangays and the most severe hypoxaemic children were concentrated in the northern barangays most distant from the regional hospital. CONCLUSIONS Mapping of ALRI at the local administrative health level can be performed relatively simply. If these principles are applied to routinely collected IMCI classification of disease at the district level in developing countries, such efforts can form the basis for directing public health and healthcare delivery efforts in a targeted manner.
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Affiliation(s)
- Deborah S K Thomas
- Department of Geography & Environmental Sciences, University of Colorado, Denver, CO, USA
| | - Peter Anthamatten
- Department of Geography & Environmental Sciences, University of Colorado, Denver, CO, USA
| | - Elisabeth Dowling Root
- Department of Geography and Institute of Behavioral Sciences, University of Colorado, Boulder, CO, USA
| | - Marilla Lucero
- Research Institute for Tropical Medicine, Metro Manila, Philippines
| | - Hanna Nohynek
- Department of Vaccination and Immune Protection, National Institute for Health and Welfare, Helsinki, Finland
| | - Veronica Tallo
- Research Institute for Tropical Medicine, Metro Manila, Philippines
| | - Gail M Williams
- School of Population Health, University of Queensland, Brisbane, Qld, Australia
| | - Eric A F Simões
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado, School of Medicine, Aurora, CO, USA.,Department of Epidemiology and Center for Global Health, Colorado School of Public Health, Aurora, CO, USA
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Villanueva-Uy ME, Wongsiridej P, Sangtawesin V, Chiu V, Tallo V, Nazaire-Bermal N, Bock H, Cunnington M, Nan C, Boudville I. THE BURDEN OF INVASIVE NEONATAL GROUP B STREPTOCOCCAL (GBS) DISEASE IN THAILAND AND THE PHILIPPINES. Southeast Asian J Trop Med Public Health 2015; 46:728-737. [PMID: 26867393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Group B Streptococcus (GBS) is a leading cause of meningitis and sepsis in infancy, but burden of disease data are scarce for Asia. We performed two hospital-based, prospective, descriptive, observational studies using similar protocols in the Philippines and Thailand to evaluate neonatal GBS disease epidemiology. Infants aged <90 days with a GBS-positive culture from normally sterile sites using routine microbiological standards were eligible for inclusion. Awareness of GBS symptoms was raised by informing all women at delivery and follow-up for 90 days post-delivery. Infections were classified as early onset disease (EOD) if they occurred within 6 days of birth and late Onset disease (LOD) if they occurred 7-89 days after birth. Due to ethical requirements in Thailand, consent for study participation, including periodic post-discharge telephone calls, was obtained at delivery. Parents in the Philippines gave consent for study participation at case identification. The clinical outcomes of GBS infections were recorded. During the 6-month study period, two cases (one fatal) of EOD were identified among 8,409 live births at the study hospitals in Thailand and three cases (two fatal) of EOD were identified among 11,768 live births reported at the study hospitals in the Philippines. Incidence rates per 1,000 live births were 0.2 (95% CI: 0.0-0.8) and 0.3 (95% CI: 0.1-0.8) in Thailand and the Philippines, respectively. There were no cases of reported LOD. The low number of cases precluded analysis of serotype distribution and case fatality rates. Large epidemiological studies are needed to better understand the factors influencing GBS infection incidence in Asia.
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Kosai H, Tamaki R, Saito M, Tohma K, Alday PP, Tan AG, Inobaya MT, Suzuki A, Kamigaki T, Lupisan S, Tallo V, Oshitani H. Incidence and Risk Factors of Childhood Pneumonia-Like Episodes in Biliran Island, Philippines--A Community-Based Study. PLoS One 2015; 10:e0125009. [PMID: 25938584 PMCID: PMC4418693 DOI: 10.1371/journal.pone.0125009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 03/19/2015] [Indexed: 11/21/2022] Open
Abstract
Pneumonia is a leading cause of deaths in infants and young children in developing countries, including the Philippines. However, data at the community level remains limited. Our study aimed to estimate incidence and mortality rates and to evaluate risk factors and health-seeking behavior for childhood pneumonia. A household level interview survey was conducted in Biliran Island, the Philippines. Caregivers were interviewed using a semi-structured questionnaire to check if children had symptoms suggesting pneumonia-like episodes from June 2011 to May 2012. Of 3,327 households visited in total, 3,302 (99.2%) agreed to participate, and 5,249 children less than 5 years of age were included in the study. Incidence rates of pneumonia-like episodes, severe pneumonia-like episodes, and pneumonia-associated mortality were 105, 61, and 0.9 per 1,000 person-years, respectively. History of asthma [hazard ratio (HR): 5.85, 95% confidence interval (CI): 4.83–7.08], low socioeconomic status (SES) (HR: 1.11, 95% CI: 1.02–1.20), and long travel time to the healthcare facility estimated by cost distance analysis (HR: 1.32, 95% CI: 1.09–1.61) were significantly associated with the occurrence of pneumonia-like episodes by the Cox proportional hazards model. For severe pneumonia-like episodes, a history of asthma (HR: 8.39, 95% CI: 6.54–10.77) and low SES (HR: 1.30, 95% CI: 1.17–1.45) were significant risk factors. Children who had a long travel time to the hospital were less likely to seek hospital care (Odds ratio: 0.32, 95% CI: 0.19–0.54) when they experienced severe pneumonia-like episodes. Incidence of pediatric pneumonia-like episodes was associated with a history of asthma, SES, and the travel time to healthcare facilities. Travel time was also identified as a strong indicator for health-seeking behavior. Improved access to healthcare facilities is important for early and effective management. Further studies are warranted to understand the causal relationship between asthma and pneumonia.
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Affiliation(s)
- Hisato Kosai
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Raita Tamaki
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mayuko Saito
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kentaro Tohma
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Alvin Gue Tan
- Research Institute for Tropical Medicine, Metro Manila,The Philippines
| | | | - Akira Suzuki
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Taro Kamigaki
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Soccoro Lupisan
- Research Institute for Tropical Medicine, Metro Manila,The Philippines
| | - Veronica Tallo
- Research Institute for Tropical Medicine, Metro Manila,The Philippines
| | - Hitoshi Oshitani
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
- * E-mail:
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Otomaru H, Kamigaki T, Tamaki R, Opinion J, Santo A, Daya E, Okamoto M, Saito M, Tallo V, Lupisan S, Suzuki A, Oshitani H. Influenza and other respiratory viruses detected by influenza-like illness surveillance in Leyte Island, the Philippines, 2010-2013. PLoS One 2015; 10:e0123755. [PMID: 25893441 PMCID: PMC4404362 DOI: 10.1371/journal.pone.0123755] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 02/23/2015] [Indexed: 01/06/2023] Open
Abstract
This study aimed to determine the role of influenza-like illness (ILI) surveillance conducted on Leyte Island, the Philippines, including involvement of other respiratory viruses, from 2010 to 2013. ILI surveillance was conducted from January 2010 to March 2013 with 3 sentinel sites located in Tacloban city, Palo and Tanauan of Leyte Island. ILI was defined as fever ≥38°C or feverish feeling and either cough or running nose in a patient of any age. Influenza virus and other 5 respiratory viruses were searched. A total of 5,550 ILI cases visited the 3 sites and specimens were collected from 2,031 (36.6%) cases. Among the cases sampled, 1,637 (75.6%) were children aged <5 years. 874 (43.0%) cases were positive for at least one of the respiratory viruses tested. Influenza virus and respiratory syncytial virus (RSV) were predominantly detected (both were 25.7%) followed by human rhinovirus (HRV) (17.5%). The age distributions were significantly different between those who were positive for influenza, HRV, and RSV. ILI cases were reported throughout the year and influenza virus was co-detected with those viruses on approximately half of the weeks of study period (RSV in 60.5% and HRV 47.4%). In terms of clinical manifestations, only the rates of headache and sore throat were significantly higher in influenza positive cases than cases positive to other viruses. In conclusion, syndromic ILI surveillance in this area is difficult to detect the start of influenza epidemic without laboratory confirmation which requires huge resources. Age was an important factor that affected positive rates of influenza and other respiratory viruses. Involvement of older age children may be useful to detect influenza more effectively.
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Affiliation(s)
- Hirono Otomaru
- Department of Virology, Tohoku University School of Medicine, Sendai, Japan
| | - Taro Kamigaki
- Department of Virology, Tohoku University School of Medicine, Sendai, Japan
- * E-mail:
| | - Raita Tamaki
- Department of Virology, Tohoku University School of Medicine, Sendai, Japan
| | - Jamie Opinion
- Tacloban City Health Office, Tacloban City, the Philippines
| | - Arlene Santo
- Tanauan Rural Health Unit, Tanauan, the Philippines
| | - Edgard Daya
- Leyte Provincial Health Office, Palo, the Philippines
| | - Michiko Okamoto
- Department of Virology, Tohoku University School of Medicine, Sendai, Japan
| | - Mariko Saito
- Department of Virology, Tohoku University School of Medicine, Sendai, Japan
- Tohoku-RITM Research Center for Emerging and Reemerging Infections, Muntinlupa City, the Philippines
| | - Veronica Tallo
- Research Institute for Tropical Medicine, Muntinlupa City, the Philippines
| | - Soccoro Lupisan
- Research Institute for Tropical Medicine, Muntinlupa City, the Philippines
| | - Akira Suzuki
- Virus Research Center, Clinical Research Division, Sendai Medical Center, Sendai, Japan
| | - Hitoshi Oshitani
- Department of Virology, Tohoku University School of Medicine, Sendai, Japan
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Inobaya MT, Olveda RM, Tallo V, McManus DP, Williams GM, Harn DA, Li Y, Chau TNP, Olveda DU, Ross AG. Schistosomiasis mass drug administration in the Philippines: lessons learnt and the global implications. Microbes Infect 2014; 17:6-15. [PMID: 25448635 DOI: 10.1016/j.micinf.2014.10.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 10/16/2014] [Accepted: 10/17/2014] [Indexed: 10/24/2022]
Abstract
Schistosomiasis was first reported in the Philippines in 1906. A variety of treatments have been deployed to cure infection and to control the disease in the long-term. We discuss the journey to combat the disease in the Philippines and the lessons learnt which have implications for schistosomiasis control globally.
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Affiliation(s)
- Marianette T Inobaya
- Griffith Health Institute, Griffith University, Gold Coast Campus, Australia; Research Institute for Tropical Medicine, Department of Health, The Philippines
| | - Remigio M Olveda
- Research Institute for Tropical Medicine, Department of Health, The Philippines
| | - Veronica Tallo
- Research Institute for Tropical Medicine, Department of Health, The Philippines
| | | | - Gail M Williams
- School of Population Health, University of Queensland, Australia
| | - Donald A Harn
- Department of Infectious Diseases, College of Veterinary Medicine and Center for Tropical and Emerging Global Diseases, University of Georgia, USA
| | - Yuesheng Li
- QIMR Berghofer Medical Research Institute, Australia
| | - Thao N P Chau
- Discipline of Public Health, Flinders University, Australia
| | - David U Olveda
- Griffith Health Institute, Griffith University, Gold Coast Campus, Australia
| | - Allen G Ross
- Griffith Health Institute, Griffith University, Gold Coast Campus, Australia.
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Ross AGP, Olveda RM, Chy D, Olveda DU, Li Y, Harn DA, Gray DJ, McManus DP, Tallo V, Chau TNP, Williams GM. Can mass drug administration lead to the sustainable control of schistosomiasis? J Infect Dis 2014; 211:283-9. [PMID: 25070942 DOI: 10.1093/infdis/jiu416] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In the Philippines, the current national control strategy for schistosomiasis is annual mass drug administration (MDA) with 40 mg/kg of praziquantel in all schistosomiasis-endemic villages with a prevalence ≥10%. METHODS A cross-sectional survey of schistosomiasis was conducted in 2012 on 18 221 individuals residing in 22 schistosomiasis-endemic villages in the province of Northern Samar. The prevalence of schistosomiasis, intensity of Schistosoma infection, and morbidity of disease were assessed. RESULTS Despite an active schistosomiasis-control program in Northern Samar for >30 years, which included a MDA campaign in the last 5 years, the mean prevalence of schistosomiasis among 10 435 evaluated subjects was 27.1% (95% confidence interval [CI], 26.3%-28.0%), and the geometric mean intensity of infection among 2832 evaluated subjects was 17.2 eggs per gram of feces (95% CI, 16.4-18.1). Ultrasonography revealed high levels of schistosomiasis-induced morbidity in the schistosomiasis-endemic communities. Left lobe liver enlargement (≥70 mm) was evident in 89.3% of subjects. Twenty-five percent of the study population had grade II/III liver parenchyma fibrosis, and 13.3% had splenomegaly (≥100 mm). CONCLUSIONS MDA on its own was insufficient to control the prevalence of schistosomiasis, intensity of Schistosoma infection, or morbidity of the disease. Alternative control measures will be needed to complement the existing national MDA program.
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Affiliation(s)
- Allen G P Ross
- Griffith Health Institute, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Remigio M Olveda
- Department of Health, Research Institute for Tropical Medicine, Manila
| | - Delia Chy
- Municipal Medical Officer of Health, Palapag, The Philippines
| | - David U Olveda
- Griffith Health Institute, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Yuesheng Li
- QIMR Berghofer Medical Research Institute, Brisbane, Australia Hunan Institute of Parasitic Diseases, WHO Collaborating Center for Research and Control of Schistosomiasis in the Lake Region, Yueyang, China
| | - Donald A Harn
- Department of Infectious Diseases, College of Veterinary Medicine and Center for Tropical and Emerging Global Diseases, University of Georgia
| | - Darren J Gray
- School of Population Health, University of Queensland, Brisbane
| | | | - Veronica Tallo
- Department of Health, Research Institute for Tropical Medicine, Manila
| | - Thao N P Chau
- Discipline of Public Health, Flinders University, Adelaide, Australia
| | - Gail M Williams
- School of Population Health, University of Queensland, Brisbane
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McManus DP, Bieri FA, Li YS, Williams GM, Yuan LP, Henglin Y, Du ZW, Clements AC, Steinmann P, Raso G, Yap P, Magalhães RJS, Stewart D, Ross AG, Halton K, Zhou XN, Olveda RM, Tallo V, Gray DJ. Health education and the control of intestinal worm infections in China: a new vision. Parasit Vectors 2014; 7:344. [PMID: 25060336 PMCID: PMC4117961 DOI: 10.1186/1756-3305-7-344] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 07/21/2014] [Indexed: 11/23/2022] Open
Abstract
Background The transmission of soil-transmitted helminths (STHs) is associated with poverty, poor hygiene behaviour, lack of clean water and inadequate waste disposal and sanitation. Periodic administration of benzimidazole drugs is the mainstay for global STH control but it does not prevent re-infection, and is unlikely to interrupt transmission as a stand-alone intervention. Findings We reported recently on the development and successful testing in Hunan province, PR China, of a health education package to prevent STH infections in Han Chinese primary school students. We have recently commenced a new trial of the package in the ethnically diverse Xishuangbanna autonomous prefecture in Yunnan province and the approach is also being tested in West Africa, with further expansion into the Philippines in 2015. Conclusions The work in China illustrates well the direct impact that health education can have in improving knowledge and awareness, and in changing hygiene behaviour. Further, it can provide insight into the public health outcomes of a multi-component integrated control program, where health education prevents re-infection and periodic drug treatment reduces prevalence and morbidity.
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Paynter S, Yakob L, Simões EAF, Lucero MG, Tallo V, Nohynek H, Ware RS, Weinstein P, Williams G, Sly PD. Using mathematical transmission modelling to investigate drivers of respiratory syncytial virus seasonality in children in the Philippines. PLoS One 2014; 9:e90094. [PMID: 24587222 PMCID: PMC3937436 DOI: 10.1371/journal.pone.0090094] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 01/31/2014] [Indexed: 12/02/2022] Open
Abstract
We used a mathematical transmission model to estimate when ecological drivers of respiratory syncytial virus (RSV) transmissibility would need to act in order to produce the observed seasonality of RSV in the Philippines. We estimated that a seasonal peak in transmissibility would need to occur approximately 51 days prior to the observed peak in RSV cases (range 49 to 67 days). We then compared this estimated seasonal pattern of transmissibility to the seasonal patterns of possible ecological drivers of transmissibility: rainfall, humidity and temperature patterns, nutritional status, and school holidays. The timing of the seasonal patterns of nutritional status and rainfall were both consistent with the estimated seasonal pattern of transmissibility and these are both plausible drivers of the seasonality of RSV in this setting.
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Affiliation(s)
- Stuart Paynter
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia
- * E-mail:
| | - Laith Yakob
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia
| | - Eric A. F. Simões
- University of Colorado School of Medicine, Aurora, Colorado, United States of America
- Colorado School of Public Health, University of Colorado, Aurora, Colorado, United States of America
| | - Marilla G. Lucero
- Research Institute for Tropical Medicine, Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Veronica Tallo
- Research Institute for Tropical Medicine, Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Hanna Nohynek
- Department of Vaccines and Immune Protection, National Institute for Health and Welfare, Helsinki, Finland
| | - Robert S. Ware
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia
- Queensland Children’s Medical Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Philip Weinstein
- Barbara Hardy Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Gail Williams
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia
| | - Peter D. Sly
- Queensland Children’s Medical Research Institute, University of Queensland, Brisbane, Queensland, Australia
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Murray CJL, Lozano R, Flaxman AD, Serina P, Phillips D, Stewart A, James SL, Vahdatpour A, Atkinson C, Freeman MK, Ohno SL, Black R, Ali SM, Baqui AH, Dandona L, Dantzer E, Darmstadt GL, Das V, Dhingra U, Dutta A, Fawzi W, Gómez S, Hernández B, Joshi R, Kalter HD, Kumar A, Kumar V, Lucero M, Mehta S, Neal B, Praveen D, Premji Z, Ramírez-Villalobos D, Remolador H, Riley I, Romero M, Said M, Sanvictores D, Sazawal S, Tallo V, Lopez AD. Using verbal autopsy to measure causes of death: the comparative performance of existing methods. BMC Med 2014; 12:5. [PMID: 24405531 PMCID: PMC3891983 DOI: 10.1186/1741-7015-12-5] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 12/10/2013] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Monitoring progress with disease and injury reduction in many populations will require widespread use of verbal autopsy (VA). Multiple methods have been developed for assigning cause of death from a VA but their application is restricted by uncertainty about their reliability. METHODS We investigated the validity of five automated VA methods for assigning cause of death: InterVA-4, Random Forest (RF), Simplified Symptom Pattern (SSP), Tariff method (Tariff), and King-Lu (KL), in addition to physician review of VA forms (PCVA), based on 12,535 cases from diverse populations for which the true cause of death had been reliably established. For adults, children, neonates and stillbirths, performance was assessed separately for individuals using sensitivity, specificity, Kappa, and chance-corrected concordance (CCC) and for populations using cause specific mortality fraction (CSMF) accuracy, with and without additional diagnostic information from prior contact with health services. A total of 500 train-test splits were used to ensure that results are robust to variation in the underlying cause of death distribution. RESULTS Three automated diagnostic methods, Tariff, SSP, and RF, but not InterVA-4, performed better than physician review in all age groups, study sites, and for the majority of causes of death studied. For adults, CSMF accuracy ranged from 0.764 to 0.770, compared with 0.680 for PCVA and 0.625 for InterVA; CCC varied from 49.2% to 54.1%, compared with 42.2% for PCVA, and 23.8% for InterVA. For children, CSMF accuracy was 0.783 for Tariff, 0.678 for PCVA, and 0.520 for InterVA; CCC was 52.5% for Tariff, 44.5% for PCVA, and 30.3% for InterVA. For neonates, CSMF accuracy was 0.817 for Tariff, 0.719 for PCVA, and 0.629 for InterVA; CCC varied from 47.3% to 50.3% for the three automated methods, 29.3% for PCVA, and 19.4% for InterVA. The method with the highest sensitivity for a specific cause varied by cause. CONCLUSIONS Physician review of verbal autopsy questionnaires is less accurate than automated methods in determining both individual and population causes of death. Overall, Tariff performs as well or better than other methods and should be widely applied in routine mortality surveillance systems with poor cause of death certification practices.
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Affiliation(s)
- Christopher JL Murray
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue Suite 600, Seattle, WA 98121, USA
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue Suite 600, Seattle, WA 98121, USA
- National Institute of Public Health, Universidad 655, 62100 Cuernavaca, Morelos, Mexico
| | - Abraham D Flaxman
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue Suite 600, Seattle, WA 98121, USA
| | - Peter Serina
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue Suite 600, Seattle, WA 98121, USA
| | - David Phillips
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue Suite 600, Seattle, WA 98121, USA
| | - Andrea Stewart
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue Suite 600, Seattle, WA 98121, USA
| | - Spencer L James
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue Suite 600, Seattle, WA 98121, USA
| | - Alireza Vahdatpour
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue Suite 600, Seattle, WA 98121, USA
| | - Charles Atkinson
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue Suite 600, Seattle, WA 98121, USA
| | - Michael K Freeman
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue Suite 600, Seattle, WA 98121, USA
| | - Summer Lockett Ohno
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue Suite 600, Seattle, WA 98121, USA
| | - Robert Black
- Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe St #5041, Baltimore, MD 21205, USA
| | - Said Mohammed Ali
- Public Health Laboratory-IdC, P.O. BOX 122 Wawi Chake Chake Pemba, Zanzibar, Tanzania
| | - Abdullah H Baqui
- Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe St #5041, Baltimore, MD 21205, USA
| | - Lalit Dandona
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue Suite 600, Seattle, WA 98121, USA
- Public Health Foundation of India, ISID Campus, 4 Institutional Area, Vasant Kunj, New Delhi 110070, India
| | - Emily Dantzer
- Brigham and Women's Hospital, 75 Francis St, Boston, MA 02215, USA
| | - Gary L Darmstadt
- Global Development, Bill and Melinda Gates Foundation, PO Box 23350, Seattle, WA 98012, USA
| | - Vinita Das
- CSM Medical University, Shah Mina Road, Chowk, Lucknow, Uttar Pradesh 226003, India
| | - Usha Dhingra
- Dept of International Health, Johns Hopkins Bloomberg School of Public Health, E5521, 615 N. Wolfe Street, Baltimore, MD 21205, USA
- Public Health Laboratory-Ivo de Carneri, Wawi, Chake-Chake, Pemba, Zanzibar, Tanzania
| | - Arup Dutta
- Johns Hopkins University, 214A Basement, Vinobapuri Lajpat Nagar-II, New Delhi 110024, India
| | - Wafaie Fawzi
- Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115-6018, USA
| | - Sara Gómez
- National Institute of Public Health, Universidad 655, 62100 Cuernavaca, Morelos, Mexico
| | - Bernardo Hernández
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue Suite 600, Seattle, WA 98121, USA
| | - Rohina Joshi
- The George Institute for Global Health, The University of Sydney, 83/117 Missenden Rd, Camperdown, NSW 2050, Australia
| | - Henry D Kalter
- Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe St #5041, Baltimore, MD 21205, USA
| | | | | | - Marilla Lucero
- Research Institute for Tropical Medicine, Corporate Ave, Muntinlupa City 1781, Philippines
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, 314 Savage Hall, Ithaca, NY 14853, USA
| | - Bruce Neal
- The George Institute for Global Health, The University of Sydney, 83/117 Missenden Rd, Camperdown, NSW 2050, Australia
| | - Devarsetty Praveen
- The George Institute for Global Health, 839C, Road No. 44A, Jubilee Hills, Hyderabad 500033, India
| | - Zul Premji
- Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania
| | | | - Hazel Remolador
- Research Institute for Tropical Medicine, Corporate Ave, Muntinlupa City 1781, Philippines
| | - Ian Riley
- School of Population Health, University of Queensland, Level 2 Public Health Building School of Population Health, Herston Road, Herston, QLD 4006, Australia
| | - Minerva Romero
- National Institute of Public Health, Universidad 655, 62100 Cuernavaca, Morelos, Mexico
| | - Mwanaidi Said
- Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania
| | - Diozele Sanvictores
- Research Institute for Tropical Medicine, Corporate Ave, Muntinlupa City 1781, Philippines
| | - Sunil Sazawal
- Dept of International Health, Johns Hopkins Bloomberg School of Public Health, E5521, 615 N. Wolfe Street, Baltimore, MD 21205, USA
- Public Health Laboratory-Ivo de Carneri, Wawi, Chake-Chake, Pemba, Zanzibar, Tanzania
| | - Veronica Tallo
- Research Institute for Tropical Medicine, Corporate Ave, Muntinlupa City 1781, Philippines
| | - Alan D Lopez
- University of Melbourne School of Population and Global Health, Building 379, 207 Bouverie St., Parkville 3010, VIC, Australia
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Libraty DH, Capeding RZ, Obcena A, Brion JD, Tallo V. Breastfeeding During Early Infancy is Associated with Higher Weight-Based World Health Organization Anthropometry. Open Pediatr Med Journal 2013; 7:10.2174/1874309920130610001. [PMID: 24416089 PMCID: PMC3886916 DOI: 10.2174/1874309920130610001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The World Health Organization (WHO) Expert Committee on Physical Status: The Use and Interpretation of Anthropometry established reference anthropometric standards for the growth of healthy infants and children. As part of a prospective clinical study of dengue virus infections in infants, we measured the length and weight of healthy infants in San Pablo, Laguna, Philippines at two scheduled study visits. We examined the correlation between breastfeeding and WHO anthropometric z scores during early infancy in San Pablo, Laguna, Philippines. We found that breastfeeding status and the frequency of breastfeeding during early infancy positively correlated with weight-based WHO anthropometric z scores.
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Affiliation(s)
- Daniel H. Libraty
- Division of Infectious Disease and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Rosario Z. Capeding
- Department of Medicine, Research Institute for Tropical Medicine, Manila, Philippines
- Department of Microbiology, Research Institute for Tropical Medicine, Manila, Philippines
| | - AnaMae Obcena
- Department of Medicine, Research Institute for Tropical Medicine, Manila, Philippines
| | - Job D. Brion
- San Pablo City Health Office, San Pablo, Philippines
| | - Veronica Tallo
- Department of Epidemiology, Research Institute for Tropical Medicine, Manila, Philippines
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Paynter S, Ware RS, Lucero MG, Tallo V, Nohynek H, Simões EAF, Weinstein P, Sly PD, Williams G. Poor growth and pneumonia seasonality in infants in the Philippines: cohort and time series studies. PLoS One 2013; 8:e67528. [PMID: 23840731 PMCID: PMC3695907 DOI: 10.1371/journal.pone.0067528] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 05/20/2013] [Indexed: 11/18/2022] Open
Abstract
Children with poor nutrition are at increased risk of pneumonia. In many tropical settings seasonal pneumonia epidemics occur during the rainy season, which is often a period of poor nutrition. We have investigated whether seasonal hunger may be a driver of seasonal pneumonia epidemics in children in the tropical setting of the Philippines. In individual level cohort analysis, infant size and growth were both associated with increased pneumonia admissions, consistent with findings from previous studies. A low weight for age z-score in early infancy was associated with an increased risk of pneumonia admission over the following 12 months (RR for infants in the lowest quartile of weight for age z-scores 1.28 [95% CI 1.08 to 1.51]). Poor growth in smaller than average infants was also associated with an increased risk of pneumonia (RR for those in the lowest quartile of growth in early infancy 1.31 [95%CI 1.02 to 1.68]). At a population level, we found that seasonal undernutrition preceded the seasonal increase in pneumonia and respiratory syncytial virus admissions by approximately 10 weeks (pairwise correlation at this lag was −0.41 [95%CI −0.53 to −0.27] for pneumonia admissions, and −0.63 [95%CI −0.72 to −0.51] for respiratory syncytial virus admissions). This lag appears biologically plausible. These results suggest that in addition to being an individual level risk factor for pneumonia, poor nutrition may act as a population level driver of seasonal pneumonia epidemics in the tropics. Further investigation of the seasonal level association, in particular the estimation of the expected lag between seasonal undernutrition and increased pneumonia incidence, is recommended.
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Affiliation(s)
- Stuart Paynter
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia.
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48
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Libraty DH, Capeding RZ, Obcena A, Brion JD, Tallo V. Breastfeeding During Early Infancy is Associated with a Lower Incidence of Febrile Illnesses. ACTA ACUST UNITED AC 2013; 7:40-41. [PMID: 24465289 PMCID: PMC3901055 DOI: 10.2174/1874309920130621002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Human breast milk is known to contain immunoprotective, antimicrobial, and anti-inflammatory agents. In a prospective clinical study of dengue virus infections during infancy, we examined the correlation between breastfeeding and the development of febrile illnesses in an infant population. We found that breastfeeding status and the frequency of breastfeeding during early infancy was associated with a lower incidence of febrile illnesses.
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Affiliation(s)
- Daniel H Libraty
- Division of Infectious Disease and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Rosario Z Capeding
- Department of Medicine, Research Institute for Tropical Medicine, Manila, Philippines ; Department of Microbiology, Research Institute for Tropical Medicine, Manila, Philippines
| | - Anamae Obcena
- Department of Medicine, Research Institute for Tropical Medicine, Manila, Philippines
| | - Job D Brion
- San Pablo City Health Office, San Pablo, Philippines
| | - Veronica Tallo
- Department of Epidemiology, Research Institute for Tropical Medicine, Manila, Philippines
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Murray CJL, Lopez AD, Black R, Ahuja R, Ali SM, Baqui A, Dandona L, Dantzer E, Das V, Dhingra U, Dutta A, Fawzi W, Flaxman AD, Gómez S, Hernández B, Joshi R, Kalter H, Kumar A, Kumar V, Lozano R, Lucero M, Mehta S, Neal B, Ohno SL, Prasad R, Praveen D, Premji Z, Ramírez-Villalobos D, Remolador H, Riley I, Romero M, Said M, Sanvictores D, Sazawal S, Tallo V. Population Health Metrics Research Consortium gold standard verbal autopsy validation study: design, implementation, and development of analysis datasets. Popul Health Metr 2011; 9:27. [PMID: 21816095 PMCID: PMC3160920 DOI: 10.1186/1478-7954-9-27] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 08/04/2011] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Verbal autopsy methods are critically important for evaluating the leading causes of death in populations without adequate vital registration systems. With a myriad of analytical and data collection approaches, it is essential to create a high quality validation dataset from different populations to evaluate comparative method performance and make recommendations for future verbal autopsy implementation. This study was undertaken to compile a set of strictly defined gold standard deaths for which verbal autopsies were collected to validate the accuracy of different methods of verbal autopsy cause of death assignment. METHODS Data collection was implemented in six sites in four countries: Andhra Pradesh, India; Bohol, Philippines; Dar es Salaam, Tanzania; Mexico City, Mexico; Pemba Island, Tanzania; and Uttar Pradesh, India. The Population Health Metrics Research Consortium (PHMRC) developed stringent diagnostic criteria including laboratory, pathology, and medical imaging findings to identify gold standard deaths in health facilities as well as an enhanced verbal autopsy instrument based on World Health Organization (WHO) standards. A cause list was constructed based on the WHO Global Burden of Disease estimates of the leading causes of death, potential to identify unique signs and symptoms, and the likely existence of sufficient medical technology to ascertain gold standard cases. Blinded verbal autopsies were collected on all gold standard deaths. RESULTS Over 12,000 verbal autopsies on deaths with gold standard diagnoses were collected (7,836 adults, 2,075 children, 1,629 neonates, and 1,002 stillbirths). Difficulties in finding sufficient cases to meet gold standard criteria as well as problems with misclassification for certain causes meant that the target list of causes for analysis was reduced to 34 for adults, 21 for children, and 10 for neonates, excluding stillbirths. To ensure strict independence for the validation of methods and assessment of comparative performance, 500 test-train datasets were created from the universe of cases, covering a range of cause-specific compositions. CONCLUSIONS This unique, robust validation dataset will allow scholars to evaluate the performance of different verbal autopsy analytic methods as well as instrument design. This dataset can be used to inform the implementation of verbal autopsies to more reliably ascertain cause of death in national health information systems.
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Affiliation(s)
- Christopher JL Murray
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave, Suite 600, Seattle, WA 98121, USA
| | - Alan D Lopez
- University of Queensland, School of Population Health, Brisbane, Australia
| | - Robert Black
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ramesh Ahuja
- Community Empowerment Lab, Shivgarh, India, and The INCLEN Trust International, New Delhi, India
| | | | - Abdullah Baqui
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lalit Dandona
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave, Suite 600, Seattle, WA 98121, USA
- Public Health Foundation of India, New Delhi, India
| | | | | | - Usha Dhingra
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Arup Dutta
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Wafaie Fawzi
- Harvard University, School of Public Health, Boston, MA, USA
| | - Abraham D Flaxman
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave, Suite 600, Seattle, WA 98121, USA
| | - Sara Gómez
- National Institute of Public Health, Cuernavaca, Mexico
| | | | - Rohina Joshi
- The George Institute for Global Health, Camperdown, Australia
| | - Henry Kalter
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Aarti Kumar
- Community Empowerment Lab, Shivgarh, India, and The INCLEN Trust International, New Delhi, India
| | - Vishwajeet Kumar
- Community Empowerment Lab, Shivgarh, India, and The INCLEN Trust International, New Delhi, India
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave, Suite 600, Seattle, WA 98121, USA
| | - Marilla Lucero
- Research Institute for Tropical Medicine, Manila, Philippines
| | - Saurabh Mehta
- Cornell University, Division of Nutritional Sciences, Ithaca, NY, USA
| | - Bruce Neal
- The George Institute for Global Health, Camperdown, Australia
| | - Summer Lockett Ohno
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave, Suite 600, Seattle, WA 98121, USA
| | | | | | - Zul Premji
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Hazel Remolador
- Research Institute for Tropical Medicine, Manila, Philippines
| | - Ian Riley
- University of Queensland, School of Population Health, Brisbane, Australia
| | | | - Mwanaidi Said
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Sunil Sazawal
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Veronica Tallo
- Research Institute for Tropical Medicine, Manila, Philippines
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50
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Carter K, Williams G, Tallo V, Sanvictores D, Madera H, Riley I. P1-106 Capture-recapture analysis of all-cause mortality data in Bohol, Philippines. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976c.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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