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    University - Scholar Department: School of Medicine Position: Postdoctoral Scholar

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  • Mapping development and health effects of cooking with solid fuels in low-income and middle-income countries, 2000-18: a geospatial modelling study. The Lancet. Global health 2022; 10 (10): e1395-e1411

    Abstract

    More than 3 billion people do not have access to clean energy and primarily use solid fuels to cook. Use of solid fuels generates household air pollution, which was associated with more than 2 million deaths in 2019. Although local patterns in cooking vary systematically, subnational trends in use of solid fuels have yet to be comprehensively analysed. We estimated the prevalence of solid-fuel use with high spatial resolution to explore subnational inequalities, assess local progress, and assess the effects on health in low-income and middle-income countries (LMICs) without universal access to clean fuels.We did a geospatial modelling study to map the prevalence of solid-fuel use for cooking at a 5 km × 5 km resolution in 98 LMICs based on 2·1 million household observations of the primary cooking fuel used from 663 population-based household surveys over the years 2000 to 2018. We use observed temporal patterns to forecast household air pollution in 2030 and to assess the probability of attaining the Sustainable Development Goal (SDG) target indicator for clean cooking. We aligned our estimates of household air pollution to geospatial estimates of ambient air pollution to establish the risk transition occurring in LMICs. Finally, we quantified the effect of residual primary solid-fuel use for cooking on child health by doing a counterfactual risk assessment to estimate the proportion of deaths from lower respiratory tract infections in children younger than 5 years that could be associated with household air pollution.Although primary reliance on solid-fuel use for cooking has declined globally, it remains widespread. 593 million people live in districts where the prevalence of solid-fuel use for cooking exceeds 95%. 66% of people in LMICs live in districts that are not on track to meet the SDG target for universal access to clean energy by 2030. Household air pollution continues to be a major contributor to particulate exposure in LMICs, and rising ambient air pollution is undermining potential gains from reductions in the prevalence of solid-fuel use for cooking in many countries. We estimated that, in 2018, 205 000 (95% uncertainty interval 147 000-257 000) children younger than 5 years died from lower respiratory tract infections that could be attributed to household air pollution.Efforts to accelerate the adoption of clean cooking fuels need to be substantially increased and recalibrated to account for subnational inequalities, because there are substantial opportunities to improve air quality and avert child mortality associated with household air pollution.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S2214-109X(22)00332-1

    View details for PubMedID 36113526

    View details for PubMedCentralID PMC9638039

  • Neglected Tropical Diseases Collaborators. The global distribution of lymphatic filariasis, 2000-18: a geospatial analysis (vol 8, pg e1186, 2020) LANCET GLOBAL HEALTH Abbas, K. 2021; 9 (10): E1371

    View details for DOI 10.1016/S2214-109X(21)00397-1

    View details for Web of Science ID 000755733400021

  • Subnational mapping of HIV incidence and mortality among individuals aged 15-49 years in sub-Saharan Africa, 2000-18: a modelling study. The lancet. HIV 2021; 8 (6): e363-e375

    Abstract

    High-resolution estimates of HIV burden across space and time provide an important tool for tracking and monitoring the progress of prevention and control efforts and assist with improving the precision and efficiency of targeting efforts. We aimed to assess HIV incidence and HIV mortality for all second-level administrative units across sub-Saharan Africa.In this modelling study, we developed a framework that used the geographically specific HIV prevalence data collected in seroprevalence surveys and antenatal care clinics to train a model that estimates HIV incidence and mortality among individuals aged 15-49 years. We used a model-based geostatistical framework to estimate HIV prevalence at the second administrative level in 44 countries in sub-Saharan Africa for 2000-18 and sought data on the number of individuals on antiretroviral therapy (ART) by second-level administrative unit. We then modified the Estimation and Projection Package (EPP) to use these HIV prevalence and treatment estimates to estimate HIV incidence and mortality by second-level administrative unit.The estimates suggest substantial variation in HIV incidence and mortality rates both between and within countries in sub-Saharan Africa, with 15 countries having a ten-times or greater difference in estimated HIV incidence between the second-level administrative units with the lowest and highest estimated incidence levels. Across all 44 countries in 2018, HIV incidence ranged from 2·8 (95% uncertainty interval 2·1-3·8) in Mauritania to 1585·9 (1369·4-1824·8) cases per 100 000 people in Lesotho and HIV mortality ranged from 0·8 (0·7-0·9) in Mauritania to 676·5 (513·6-888·0) deaths per 100 000 people in Lesotho. Variation in both incidence and mortality was substantially greater at the subnational level than at the national level and the highest estimated rates were accordingly higher. Among second-level administrative units, Guijá District, Gaza Province, Mozambique, had the highest estimated HIV incidence (4661·7 [2544·8-8120·3]) cases per 100 000 people in 2018 and Inhassunge District, Zambezia Province, Mozambique, had the highest estimated HIV mortality rate (1163·0 [679·0-1866·8]) deaths per 100 000 people. Further, the rate of reduction in HIV incidence and mortality from 2000 to 2018, as well as the ratio of new infections to the number of people living with HIV was highly variable. Although most second-level administrative units had declines in the number of new cases (3316 [81·1%] of 4087 units) and number of deaths (3325 [81·4%]), nearly all appeared well short of the targeted 75% reduction in new cases and deaths between 2010 and 2020.Our estimates suggest that most second-level administrative units in sub-Saharan Africa are falling short of the targeted 75% reduction in new cases and deaths by 2020, which is further compounded by substantial within-country variability. These estimates will help decision makers and programme implementers expand access to ART and better target health resources to higher burden subnational areas.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S2352-3018(21)00051-5

    View details for PubMedID 34087097

    View details for PubMedCentralID PMC8187986

  • Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems. BMC medicine 2021; 19 (1): 4

    Abstract

    Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico.We performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017.All countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries-apart from Ecuador-across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups-the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017.Our subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths.

    View details for DOI 10.1186/s12916-020-01876-4

    View details for PubMedID 33413343

    View details for PubMedCentralID PMC7791645

  • Mapping routine measles vaccination in low- and middle-income countries NATURE Graetz, N., Woyczynski, L., Wilson, K. F., Hall, J. B., Abate, K., Abd-Allah, F., Adebayo, O. M., Adekanmbi, V., Afshari, M., Ajumobi, O., Akinyemiju, T., Alahdab, F., Al-Aly, Z., Alcalde Rabanal, J., Alijanzadeh, M., Alipour, V., Altirkawi, K., Amiresmaili, M., Anber, N., Andrei, C., Anjomshoa, M., Antonio, C. T., Arabloo, J., Aremu, O., Aryal, K. K., Asadi-Aliabadi, M., Atique, S., Ausloos, M., Awasthi, A., Ayala Quintanilla, B., Azari, S., Badawi, A., Banoub, J., Barker-Collo, S., Barnett, A., Bedi, N., Bennett, D. A., Bhattacharjee, N. V., Bhattacharyya, K., Bhattarai, S., Bhutta, Z. A., Bijani, A., Bikbov, B., Britton, G., Burstein, R., Butt, Z. A., Cardenas, R., Carvalho, F., Castaneda-Orjuela, C. A., Castro, F., Cerin, E., Chang, J., Collison, M. L., Cooper, C., Cork, M. A., Daoud, F., Das Gupta, R., Weaver, N., De Neve, J., Deribe, K., Desalegn, B., Deshpande, A., Desta, M., Dhimal, M., Diaz, D., Dinberu, M., Djalalinia, S., Dubey, M., Dubljanin, E., Duraes, A. R., Dwyer-Lindgren, L., Earl, L., Kalan, M., El-Khatib, Z., Eshrati, B., Faramarzi, M., Fareed, M., Faro, A., Fereshtehnejad, S., Fernandes, E., Filip, I., Fischer, F., Fukumoto, T., Garcia, J. A., Gill, P., Gill, T. K., Gona, P. N., Gopalani, S., Grada, A., Guo, Y., Gupta, R., Gupta, V., Haj-Mirzaian, A., Haj-Mirzaian, A., Hamadeh, R. R., Hamidi, S., Hasan, M., Hassen, H., Hendrie, D., Henok, A., Henry, N. J., Hernandez Prado, B., Herteliu, C., Hole, M. K., Hossain, N., Hosseinzadeh, M., Hu, G., Ilesanmi, O., Irvani, S., Islam, S., Izadi, N., Jakovljevic, M., Jha, R., Ji, J. S., Jonas, J. B., Shushtari, Z., Jozwiak, J., Kanchan, T., Kasaeian, A., Karyani, A., Keiyoro, P., Kesavachandran, C., Khader, Y., Khafaie, M., Khan, E., Khater, M. M., Kiadaliri, A. A., Kiirithio, D. N., Kim, Y., Kimokoti, R. W., Kinyoki, D. K., Kisa, A., Kosen, S., Koyanagi, A., Krishan, K., Defo, B., Kumar, M., Kumar, P., Lami, F., Lee, P. H., Levine, A. J., Li, S., Liao, Y., Lim, L., Listl, S., Lopez, J. F., Majdan, M., Majdzadeh, R., Majeed, A., Malekzadeh, R., Mansournia, M., Martins-Melo, F., Masaka, A., Massenburg, B., Mayala, B. K., Mehta, K. M., Mendoza, W., Mensah, G. A., Meretoja, T. J., Mestrovic, T., Miller, T. R., Mini, G. K., Mirrakhimov, E. M., Moazen, B., Mohammad, D. K., Darwesh, A., Mohammed, S., Mohebi, F., Mokdad, A. H., Monasta, L., Moodley, Y., Moosazadeh, M., Moradi, G., Moradi-Lakeh, M., Moraga, P., Morawska, L., Morrison, S., Mosser, J. F., Mousavi, S., Murray, C. L., Mustafa, G., Nahvijou, A., Najafi, F., Nangia, V., Ndwandwe, D., Negoi, I., Negoi, R., Ngunjiri, J. W., Cuong Tat Nguyen, Long Hoang Nguyen, Ningrum, D., Noubiap, J., Shiadeh, M., Nyasulu, P. S., Ogbo, F., Olagunju, A. T., Olusanya, B., Olusanya, J., Onwujekwe, O. E., Ortega-Altamirano, D. V., Ortiz-Panozo, E., Overland, S., Mahesh, P. A., Pana, A., Panda-Jonas, S., Pati, S., Patton, G. C., Perico, N., Pigott, D. M., Pirsaheb, M., Postma, M. J., Pourshams, A., Prakash, S., Puri, P., Qorbani, M., Radfar, A., Rahim, F., Rahimi-Movaghar, V., Rahman, M., Rajati, F., Ranabhat, C., Rawaf, D., Rawaf, S., Reiner, R. C., Remuzzi, G., Renzaho, A. N., Rezaei, S., Rezapour, A., Rios-Gonzalez, C., Roever, L., Ronfani, L., Roshandel, G., Rostami, A., Rubagotti, E., Sadat, N., Sadeghi, E., Safari, Y., Sagar, R., Salam, N., Salamati, P., Salimi, Y., Salimzadeh, H., Samy, A. M., Sanabria, J., Milicevic, M., Sartorius, B., Sathian, B., Sawant, A. R., Schaeffer, L. E., Schipp, M. F., Schwebel, D. C., Senbeta, A., Sepanlou, S. G., Shaikh, M., Shams-Beyranvand, M., Shamsizadeh, M., Sharafi, K., Sharma, R., She, J., Sheikh, A., Shigematsu, M., Siabani, S., Silveira, D., Singh, J. A., Sinha, D., Skirbekk, V., Sligar, A., Sobaih, B., Soofi, M., Soriano, J. B., Soyiri, I. N., Sreeramareddy, C. T., Sudaryanto, A., Sufiyan, M., Sutradhar, I., Sylaja, P., Tabares-Seisdedos, R., Tadesse, B., Temsah, M., Terkawi, A., Tessema, B., Tessema, Z., Thankappan, K., Topor-Madry, R., Tovani-Palone, M., Tran, B., Car, L., Ullah, I., Uthman, O. A., Valdez, P. R., Veisani, Y., Violante, F. S., Vlassov, V., Vollmer, S., Vu, G., Waheed, Y., Wang, Y., Wilkinson, J. C., Winkler, A., Wolfe, C. A., Yamada, T., Yeshaneh, A., Yip, P., Yisma, E., Yonemoto, N., Younis, M. Z., Yousefifard, M., Yu, C., Bin Zaman, S., Zhang, J., Zhang, Y., Zodpey, S., Gakidou, E., Hay, S. I., Local Burden Dis Educ Attainment C 2020

    Abstract

    The safe, highly effective measles vaccine has been recommended globally since 1974, yet in 2017 there were more than 17 million cases of measles and 83,400 deaths in children under 5 years old, and more than 99% of both occurred in low- and middle-income countries (LMICs)1-4. Globally comparable, annual, local estimates of routine first-dose measles-containing vaccine (MCV1) coverage are critical for understanding geographically precise immunity patterns, progress towards the targets of the Global Vaccine Action Plan (GVAP), and high-risk areas amid disruptions to vaccination programmes caused by coronavirus disease 2019 (COVID-19)5-8. Here we generated annual estimates of routine childhood MCV1 coverage at 5 × 5-km2 pixel and second administrative levels from 2000 to 2019 in 101 LMICs, quantified geographical inequality and assessed vaccination status by geographical remoteness. After widespread MCV1 gains from 2000 to 2010, coverage regressed in more than half of the districts between 2010 and 2019, leaving many LMICs far from the GVAP goal of 80% coverage in all districts by 2019. MCV1 coverage was lower in rural than in urban locations, although a larger proportion of unvaccinated children overall lived in urban locations; strategies to provide essential vaccination services should address both geographical contexts. These results provide a tool for decision-makers to strengthen routine MCV1 immunization programmes and provide equitable disease protection for all children.

    View details for DOI 10.1038/s41586-020-03043-4

    View details for Web of Science ID 000599489600008

    View details for PubMedID 33328634

    View details for PubMedCentralID PMC7739806

  • Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000-17. The Lancet. Global health 2020; 8 (9): e1162-e1185

    Abstract

    Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities.We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs.Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4-40·7) to 50·3% (50·0-50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1-46·5) in 2017, compared with 28·7% (28·5-29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6% (95% UI 87·2-89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664-711) of the 1830 (1797-1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1% (95% UI 71·6-80·7) of countries from 2000 to 2017, and in 53·9% (50·6-59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017.Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S2214-109X(20)30278-3

    View details for PubMedID 32827479

    View details for PubMedCentralID PMC7443708

  • The global distribution of lymphatic filariasis, 2000-18: a geospatial analysis. The Lancet. Global health 2020; 8 (9): e1186-e1194

    Abstract

    Lymphatic filariasis is a neglected tropical disease that can cause permanent disability through disruption of the lymphatic system. This disease is caused by parasitic filarial worms that are transmitted by mosquitos. Mass drug administration (MDA) of antihelmintics is recommended by WHO to eliminate lymphatic filariasis as a public health problem. This study aims to produce the first geospatial estimates of the global prevalence of lymphatic filariasis infection over time, to quantify progress towards elimination, and to identify geographical variation in distribution of infection.A global dataset of georeferenced surveyed locations was used to model annual 2000-18 lymphatic filariasis prevalence for 73 current or previously endemic countries. We applied Bayesian model-based geostatistics and time series methods to generate spatially continuous estimates of global all-age 2000-18 prevalence of lymphatic filariasis infection mapped at a resolution of 5 km2 and aggregated to estimate total number of individuals infected.We used 14 927 datapoints to fit the geospatial models. An estimated 199 million total individuals (95% uncertainty interval 174-234 million) worldwide were infected with lymphatic filariasis in 2000, with totals for WHO regions ranging from 3·1 million (1·6-5·7 million) in the region of the Americas to 107 million (91-134 million) in the South-East Asia region. By 2018, an estimated 51 million individuals (43-63 million) were infected. Broad declines in prevalence are observed globally, but focal areas in Africa and southeast Asia remain less likely to have attained infection prevalence thresholds proposed to achieve local elimination.Although the prevalence of lymphatic filariasis infection has declined since 2000, MDA is still necessary across large populations in Africa and Asia. Our mapped estimates can be used to identify areas where the probability of meeting infection thresholds is low, and when coupled with large uncertainty in the predictions, indicate additional data collection or intervention might be warranted before MDA programmes cease.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S2214-109X(20)30286-2

    View details for PubMedID 32827480

    View details for PubMedCentralID PMC7443698

  • Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000-17. The Lancet. Global health 2020; 8 (8): e1038-e1060

    Abstract

    Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs.We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000-17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2·5th and 97·5th percentiles of those 250 draws.While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62·6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000-7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910-68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average.To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers' understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S2214-109X(20)30230-8

    View details for PubMedID 32710861

    View details for PubMedCentralID PMC7388204

  • Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017 NATURE MEDICINE Kinyoki, D. K., Ross, J. M., Lazzar-Atwood, A., Munro, S. B., Schaeffer, L. E., Bhattacharjee, N. V., Collison, M. L., Cork, M. A., Cormier, N., Weaver, N., Deshpande, A., Dharmaratne, S., Earl, L., Henry, N. J., Hollerich, G., Johnson, K. B., Kassebaum, N. J., Krohn, K. J., Letourneau, I. D., Marczak, L. B., Mayala, B. K., Mokdad, A. H., Mosser, J. F., Murray, C. L., Naghavi, M., Osgood-Zimmerman, A. E., Pickering, B. V., Pigott, D. M., Ray, S. E., Sbarra, A. N., Schipp, M. F., VanderHeide, J., Wang, H., Wiens, K. E., Afshin, A., Hay, S. I., Kinyoki, D. K., Mokdad, A. H., Murray, C. L., Naghavi, M., Pigott, D. M., Sartorius, B., Wang, H., Afshin, A., Hay, S. I., Ross, J. M., Khalil, I. A., Ross, J. M., Abbasalizad-Farhangi, M., Hasankhani, M., Abbasi, M., Farzam, H., Moradi, M., Rezaeian, S., Abbastabar, H., Abdelalim, A., El-Jaafary, S. I., Shehata, H., Abdoli, A., Abdollahi, M., Abdollahpour, I., Abdulkader, R., Abebe, N., Deribe, K., Abebe, N., Abebo, T., Abegaz, K., Abolhassani, H., Rezaei, N., Abreu, L., Abrigo, M. M., Abushouk, A. I., Accrombessi, M., Acharya, D., Adabi, M., Adebiyi, A., Ilesanmi, O., Adedeji, I., Adekanmbi, V., Adeoye, A., Adetokunboh, O. O., Mahasha, P., Ndwandwe, D., Nnaji, C. A., Sambala, E., Adham, D., Aduroja, P., Dipeolu, I., Ibitoye, S., John-Akinola, Y. O., Oluwasanu, M., Advani, S. M., Afarideh, M., Esteghamati, A., Ghajar, A., Heidari, B., Sayyah, M., Aghaali, M., Agrawal, A., Ahmad, T., Ahmadi, K., Ahmadi, S., Ahmed, M., Gebrehiwot, T., Gesesew, H., Ahmed, R., Das Gupta, R., Ajumobi, O., Akal, C., Demeke, F., Melese, A., Akalu, T., Baraki, A., Mekonnen, F., Sisay, M. M., Tamirat, K., Tessema, Z., Wolde, H., Yeshaw, Y., Akinyemiju, T., Akombi, B., Karki, S., Al-Aly, Z., Alam, S., Alamene, G., Alanzi, T. M., Alcalde Rabanal, J., Cahuana-Hurtado, L., Montero-Zamora, P. A., Alema, N., Araya, E., Kassaye, H., Ali, B., Mohammad, K., Ali, M., Alijanzadeh, M., Kalhor, R., Alinia, C., Yusefzadeh, H., Alipour, V., Arabloo, J., Azari, S., Rezapour, A., Sheikhtaheri, A., Moghadam, T., Alipour, V., Alizade, H., Aljunid, S., Almasi, A., Fattahi, N., Matin, B., Karyani, A., Moradi, M., Pirsaheb, M., Rajati, F., Sadeghi, E., Safari, Y., Sharafi, K., Vasseghian, Y., Almasi-Hashiani, A., Moradzadeh, R., Zamanian, M., Al-Mekhlafi, H. M., Al-Raddadi, R. M., Altirkawi, K., Alvis-Guzman, N., Alvis-Zakzuk, N. J., Amare, A. T., Gedefaw, G., Amegah, A., Amini, S., Rarani, M., Amiri, F., Amit, A., Anber, N., Andrei, C., Ansari, F., Ansari-Moghaddam, A., Anteneh, Z., Asrat, A. A., Bogale, K., Zewale, T., Antonio, C. T., Antriyandarti, E., Anvari, D., Anwer, R., Appiah, S., Arab-Zozani, M., Arefi, Z., Aremu, O., Arnlov, J., Fereshtehnejad, S., Arzani, A., Jahani, M., Mouodi, S., Asadi-Aliabadi, M., Babaee, E., Moradi-Lakeh, M., Asadi-Pooya, A. 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R., Varavikova, E., Varughese, S., Vasankari, T., Veisani, Y., Venkatesh, S., Venketasubramanian, N., Verma, M., Vidale, S., Violante, F. S., Vlassov, V., Vollmer, S., Vukovic, R., Waheed, Y., Wang, Y., Yu, C., Werdecker, A., Wiangkham, T., Wijeratne, T., Wondafrash, D., Wondmieneh, A., Wu, A., Xu, G., Yadollahpour, A., Jabbari, S., Yamada, T., Yano, Y., Yaya, S., Yazdi-Feyzabadi, V., Yeshaneh, A., Yip, P., Yonemoto, N., Yoon, S., Youm, Y., Younis, M. Z., Yousefi, Z., Yu, C., Moghadam, T., Zandian, H., Bin Zaman, S., Zamani, M., Zandian, H., Zarafshan, H., Zerfu, T., Zhang, Y., Zhang, Z., Zhao, X., LBD Double Burden Malnutr 2020; 26 (5): 750-+

    Abstract

    A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1-70.8) million) to 6.4% (58.3 (47.6-70.7) million), but is predicted to remain above the World Health Organization's Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8-38.5) million) in 2000 to 6.0% (55.5 (44.8-67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic.

    View details for DOI 10.1038/s41591-020-0807-6

    View details for Web of Science ID 000527507000001

    View details for PubMedID 32313249

    View details for PubMedCentralID PMC7220891

  • Mapping child growth failure across low- and middle-income countries NATURE Kinyoki, D. K., Osgood-Zimmerman, A. E., Pickering, B. V., Schaeffer, L. E., Marczak, L. B., Lazzar-Atwood, A., Collison, M. L., Henry, N. J., Abebe, Z., Adamu, A. A., Adekanmbi, V., Ahmadi, K., Ajumobi, O., Al-Eyadhy, A., Al-Raddadi, R. M., Alahdab, F., Alijanzadeh, M., Alipour, V., Altirkawi, K., Amini, S., Andrei, C., Antonio, C. T., Arabloo, J., Aremu, O., Asadi-Aliabadi, M., Atique, S., Ausloos, M., Avila, M., Awasthi, A., Ayala Quintanilla, B., Azari, S., Badawi, A., Baernighausen, T., Bassat, Q., Baye, K., Bedi, N., Bekele, B., Bell, M. L., Bhattacharjee, N. V., Bhattacharyya, K., Bhattarai, S., Bhutta, Z. A., Biadgo, B., Bikbov, B., Briko, A., Britton, G., Burstein, R., Butt, Z. A., Car, J., Castaneda-Orjuela, C. A., Castro, F., Cerin, E., Chipeta, M. G., Chu, D., Cork, M. A., Cromwell, E. A., Cuevas-Nasu, L., Dandona, L., Dandona, R., Daoud, F., Das Gupta, R., Weaver, N., De Leo, D., De Neve, J., Deribe, K., Desalegn, B., Deshpande, A., Desta, M., Diaz, D., Tadese Dinberu, M., Doku, D., Dubey, M., Duraes, A. R., Dwyer-Lindgren, L., Earl, L., Effiong, A., Zaki, M., El Tantawi, M., El-Khatib, Z., Eshrati, B., Fareed, M., Faro, A., Fereshtehnejad, S., Filip, I., Fischer, F., Foigt, N. A., Folayan, M., Fukumoto, T., Gebrehiwot, T., Gezae, K., Ghajar, A., Gill, P., Gona, P. N., Gopalani, S., Grada, A., Guo, Y., Haj-Mirzaian, A., Haj-Mirzaian, A., Hall, J. B., Hamidi, S., Henok, A., Prado, B., Herrero, M., Herteliu, C., Hoang, C., Hole, M. K., Hossain, N., Hosseinzadeh, M., Hu, G., Islam, S., Jakovljevic, M., Jha, R., Jonas, J. B., Jozwiak, J., Kahsay, A., Kanchan, T., Karami, M., Kasaeian, A., Khader, Y., Khan, E., Khater, M. M., Kim, Y., Kimokoti, R. W., Kisa, A., Kochhar, S., Kosen, S., Koyanagi, A., Krishan, K., Defo, B., Kumar, G., Kumar, M., Lad, S. D., Lami, F., Lee, P. H., Levine, A. J., Li, S., Linn, S., Lodha, R., Abd El Razek, H., Abd El Razek, M., Majdan, M., Majeed, A., Malekzadeh, R., Malta, D., Mamun, A. A., Mansournia, M., Martins-Melo, F., Masaka, A., Massenburg, B., Mayala, B. K., Mejia-Rodriguez, F., Melku, M., Mendoza, W., Mensah, G. A., Miazgowski, T., Miller, T. R., Mini, G. K., Mirrakhimov, E. M., Moazen, B., Darwesh, A., Mohammed, S., Mohebi, F., Mokdad, A. H., Moodley, Y., Moradi, G., Moradi-Lakeh, M., Moraga, P., Morrison, S., Mosser, J. F., Mousavi, S., Mueller, U., Murray, C. L., Mustafa, G., Naderi, M., Naghavi, M., Najafi, F., Nangia, V., Ndwandwe, D., Negoi, I., Ngunjiri, J. W., Huong Lan Thi Nguyen, Nguyen, L., Son Hoang Nguyen, Nie, J., Nnaji, C. A., Noubiap, J., Shiadeh, M., Nyasulu, P. S., Ogbo, F., Olagunju, A. T., Olusanya, B., Olusanya, J., Ortiz-Panozo, E., Otstavnov, S. S., Mahesh, P. A., Pana, A., Pandey, A., Pati, S., Patil, S. T., Patton, G. C., Perico, N., Pigott, D. M., Pirsaheb, M., Piwoz, E. G., Postma, M. J., Pourshams, A., Prakash, S., Quintana, H., Radfar, A., Rafiei, A., Rahimi-Movaghar, V., Rai, R., Rajati, F., Rawaf, D., Rawaf, S., Rawat, R., Remuzzi, G., Renzaho, A. N., Rios-Gonzalez, C., Roever, L., Ross, J. M., Rostami, A., Sadat, N., Safari, Y., Safdarian, M., Sahebkar, A., Salam, N., Salamati, P., Salimi, Y., Salimzadeh, H., Samy, A. M., Sartorius, B., Sathian, B., Schipp, M. F., Schwebel, D. C., Senbeta, A., Sepanlou, S. G., Shaikh, M., Levy, T., Shamsi, M., Sharafi, K., Sharma, R., Sheikh, A., Shil, A., Silva, D., Singh, J. A., Sinha, D., Soofi, M., Sudaryanto, A., Sufiyan, M., Tabares-Seisdedos, R., Tadesse, B., Temsah, M., Terkawi, A., Tessema, Z., Thorne-Lyman, A. L., Tovani-Palone, M., Tran, B., Tran, K., Ullah, I., Uthman, O. A., Vaezghasemi, M., Vaezi, A., Valdez, P. R., Vanderheide, J., Veisani, Y., Violante, F. S., Vlassov, V., Vu, G., Vu, L., Waheed, Y., Walson, J. L., Wang, Y., Wang, Y., Wangia, E. N., Werdecker, A., Xu, G., Yamada, T., Yisma, E., Yonemoto, N., Younis, M. Z., Yousefifard, M., Yu, C., Bin Zaman, S., Zamani, M., Zhang, Y., Kassebaum, N. J., Hay, S. I., Local Burden Dis Child Growth Fail 2020; 577 (7789): 231-+

    Abstract

    Childhood malnutrition is associated with high morbidity and mortality globally1. Undernourished children are more likely to experience cognitive, physical, and metabolic developmental impairments that can lead to later cardiovascular disease, reduced intellectual ability and school attainment, and reduced economic productivity in adulthood2. Child growth failure (CGF), expressed as stunting, wasting, and underweight in children under five years of age (0-59 months), is a specific subset of undernutrition characterized by insufficient height or weight against age-specific growth reference standards3-5. The prevalence of stunting, wasting, or underweight in children under five is the proportion of children with a height-for-age, weight-for-height, or weight-for-age z-score, respectively, that is more than two standard deviations below the World Health Organization's median growth reference standards for a healthy population6. Subnational estimates of CGF report substantial heterogeneity within countries, but are available primarily at the first administrative level (for example, states or provinces)7; the uneven geographical distribution of CGF has motivated further calls for assessments that can match the local scale of many public health programmes8. Building from our previous work mapping CGF in Africa9, here we provide the first, to our knowledge, mapped high-spatial-resolution estimates of CGF indicators from 2000 to 2017 across 105 low- and middle-income countries (LMICs), where 99% of affected children live1, aggregated to policy-relevant first and second (for example, districts or counties) administrative-level units and national levels. Despite remarkable declines over the study period, many LMICs remain far from the ambitious World Health Organization Global Nutrition Targets to reduce stunting by 40% and wasting to less than 5% by 2025. Large disparities in prevalence and progress exist across and within countries; our maps identify high-prevalence areas even within nations otherwise succeeding in reducing overall CGF prevalence. By highlighting where the highest-need populations reside, these geospatial estimates can support policy-makers in planning interventions that are adapted locally and in efficiently directing resources towards reducing CGF and its health implications.

    View details for DOI 10.1038/s41586-019-1878-8

    View details for Web of Science ID 000506682500041

    View details for PubMedID 31915393

  • Mapping HIV prevalence in sub-Saharan Africa between 2000 and 2017. Nature Dwyer-Lindgren, L., Cork, M. A., Sligar, A., Steuben, K. M., Wilson, K. F., Provost, N. R., Mayala, B. K., VanderHeide, J. D., Collison, M. L., Hall, J. B., Biehl, M. H., Carter, A., Frank, T., Douwes-Schultz, D., Burstein, R., Casey, D. C., Deshpande, A., Earl, L., El Bcheraoui, C., Farag, T. H., Henry, N. J., Kinyoki, D., Marczak, L. B., Nixon, M. R., Osgood-Zimmerman, A., Pigott, D., Reiner, R. C., Ross, J. M., Schaeffer, L. E., Smith, D. L., Davis Weaver, N., Wiens, K. E., Eaton, J. W., Justman, J. E., Opio, A., Sartorius, B., Tanser, F., Wabiri, N., Piot, P., Murray, C. J., Hay, S. I. 2019; 570 (7760): 189-193

    Abstract

    HIV/AIDS is a leading cause of disease burden in sub-Saharan Africa. Existing evidence has demonstrated that there is substantial local variation in the prevalence of HIV; however, subnational variation has not been investigated at a high spatial resolution across the continent. Here we explore within-country variation at a 5 × 5-km resolution in sub-Saharan Africa by estimating the prevalence of HIV among adults (aged 15-49 years) and the corresponding number of people living with HIV from 2000 to 2017. Our analysis reveals substantial within-country variation in the prevalence of HIV throughout sub-Saharan Africa and local differences in both the direction and rate of change in HIV prevalence between 2000 and 2017, highlighting the degree to which important local differences are masked when examining trends at the country level. These fine-scale estimates of HIV prevalence across space and time provide an important tool for precisely targeting the interventions that are necessary to bringing HIV infections under control in sub-Saharan Africa.

    View details for DOI 10.1038/s41586-019-1200-9

    View details for PubMedID 31092927

    View details for PubMedCentralID PMC6601349

  • Socio-epidemiological and land cover risk factors for melioidosis in Kedah, Northern Malaysia. PLoS neglected tropical diseases Abu Hassan, M. R., Aziz, N., Ismail, N., Shafie, Z., Mayala, B., Donohue, R. E., Pani, S. P., Michael, E. 2019; 13 (3): e0007243

    Abstract

    Melioidosis, a fatal infectious disease caused by Burkholderia pseudomallei, is increasingly diagnosed in tropical regions. However, data on risk factors and the geographic epidemiology of the disease are still limited. Previous studies have also largely been based on the analysis of case series data. Here, we undertook a more definitive hospital-based matched case-control study coupled with spatial analysis to identify demographic, socioeconomic and landscape risk factors for bacteremic melioidosis in the Kedah region of northern Malaysia.We obtained patient demographic and residential information and clinical presentation and medical history data from 254 confirmed melioidosis cases and 384 matched controls attending Hospital Sultanah Bahiyah (HSB), the main tertiary hospital of Alor Setar, the capital city of Kedah, during the period between 2005 and 2011. Crude and adjusted odds ratios employing conditional logistic regression analysis were used to assess if melioidosis in this region is related to risk factors connected with socio-demographics, various behavioural characteristics, and co-occurring diseases. Spatial clusters of cases were determined using a continuous Poisson model as deployed in SaTScan. A land cover map in conjunction with mapped case data was used to determine disease-land type associations using the Fisher's exact test deploying simulated p-values. Crude and adjusted odds ratios indicate that melioidosis in this region is related to gender (males), race, occupation (farming) and co-occurring chronic diseases, particularly diabetes. Spatial analyses of disease incidence, however, showed that disease risk and geographic clustering of cases are related strongly to land cover types, with risk of disease increasing non-linearly with the degree of human modification of the natural ecosystem.These findings indicate that melioidosis represents a complex socio-ecological public health problem in Kedah, and that its control requires an understanding and modification of the coupled human and natural variables that govern disease transmission in endemic communities.

    View details for DOI 10.1371/journal.pntd.0007243

    View details for PubMedID 30883550

    View details for PubMedCentralID PMC6438580

  • Mapping 123 million neonatal, infant and child deaths between 2000 and 2017. Nature Burstein, R. n., Henry, N. J., Collison, M. L., Marczak, L. B., Sligar, A. n., Watson, S. n., Marquez, N. n., Abbasalizad-Farhangi, M. n., Abbasi, M. n., Abd-Allah, F. n., Abdoli, A. n., Abdollahi, M. n., Abdollahpour, I. n., Abdulkader, R. S., Abrigo, M. R., Acharya, D. n., Adebayo, O. M., Adekanmbi, V. n., Adham, D. n., Afshari, M. n., Aghaali, M. n., Ahmadi, K. n., Ahmadi, M. n., Ahmadpour, E. n., Ahmed, R. n., Akal, C. G., Akinyemi, J. O., Alahdab, F. n., Alam, N. n., Alamene, G. M., Alene, K. A., Alijanzadeh, M. n., Alinia, C. n., Alipour, V. n., Aljunid, S. M., Almalki, M. J., Al-Mekhlafi, H. M., Altirkawi, K. n., Alvis-Guzman, N. n., Amegah, A. K., Amini, S. n., Amit, A. M., Anbari, Z. n., Androudi, S. n., Anjomshoa, M. n., Ansari, F. n., Antonio, C. A., Arabloo, J. n., Arefi, Z. n., Aremu, O. n., Armoon, B. n., Arora, A. n., Artaman, A. n., Asadi, A. n., Asadi-Aliabadi, M. n., Ashraf-Ganjouei, A. n., Assadi, R. n., Ataeinia, B. n., Atre, S. R., Quintanilla, B. P., Ayanore, M. A., Azari, S. n., Babaee, E. n., Babazadeh, A. n., Badawi, A. n., Bagheri, S. n., Bagherzadeh, M. n., Baheiraei, N. n., Balouchi, A. n., Barac, A. n., Bassat, Q. n., Baune, B. T., Bayati, M. n., Bedi, N. n., Beghi, E. n., Behzadifar, M. n., Behzadifar, M. n., Belay, Y. B., Bell, B. n., Bell, M. L., Berbada, D. A., Bernstein, R. S., Bhattacharjee, N. V., Bhattarai, S. n., Bhutta, Z. A., Bijani, A. n., Bohlouli, S. n., Breitborde, N. J., Britton, G. n., Browne, A. J., Nagaraja, S. B., Busse, R. n., Butt, Z. A., Car, J. n., Cárdenas, R. n., Castañeda-Orjuela, C. A., Cerin, E. n., Chanie, W. F., Chatterjee, P. n., Chu, D. T., Cooper, C. n., Costa, V. 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    Abstract

    Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.

    View details for DOI 10.1038/s41586-019-1545-0

    View details for PubMedID 31619795

  • Mapping local variation in educational attainment across Africa. Nature Graetz, N., Friedman, J., Osgood-Zimmerman, A., Burstein, R., Biehl, M. H., Shields, C., Mosser, J. F., Casey, D. C., Deshpande, A., Earl, L., Reiner, R. C., Ray, S. E., Fullman, N., Levine, A. J., Stubbs, R. W., Mayala, B. K., Longbottom, J., Browne, A. J., Bhatt, S., Weiss, D. J., Gething, P. W., Mokdad, A. H., Lim, S. S., Murray, C. J., Gakidou, E., Hay, S. I. 2018; 555 (7694): 48-53

    Abstract

    Educational attainment for women of reproductive age is linked to reduced child and maternal mortality, lower fertility and improved reproductive health. Comparable analyses of attainment exist only at the national level, potentially obscuring patterns in subnational inequality. Evidence suggests that wide disparities between urban and rural populations exist, raising questions about where the majority of progress towards the education targets of the Sustainable Development Goals is occurring in African countries. Here we explore within-country inequalities by predicting years of schooling across five by five kilometre grids, generating estimates of average educational attainment by age and sex at subnational levels. Despite marked progress in attainment from 2000 to 2015 across Africa, substantial differences persist between locations and sexes. These differences have widened in many countries, particularly across the Sahel. These high-resolution, comparable estimates improve the ability of decision-makers to plan the precisely targeted interventions that will be necessary to deliver progress during the era of the Sustainable Development Goals.

    View details for DOI 10.1038/nature25761

    View details for PubMedID 29493588

    View details for PubMedCentralID PMC6346272

  • Mapping child growth failure in Africa between 2000 and 2015. Nature Osgood-Zimmerman, A., Millear, A. I., Stubbs, R. W., Shields, C., Pickering, B. V., Earl, L., Graetz, N., Kinyoki, D. K., Ray, S. E., Bhatt, S., Browne, A. J., Burstein, R., Cameron, E., Casey, D. C., Deshpande, A., Fullman, N., Gething, P. W., Gibson, H. S., Henry, N. J., Herrero, M., Krause, L. K., Letourneau, I. D., Levine, A. J., Liu, P. Y., Longbottom, J., Mayala, B. K., Mosser, J. F., Noor, A. M., Pigott, D. M., Piwoz, E. G., Rao, P., Rawat, R., Reiner, R. C., Smith, D. L., Weiss, D. J., Wiens, K. E., Mokdad, A. H., Lim, S. S., Murray, C. J., Kassebaum, N. J., Hay, S. I. 2018; 555 (7694): 41-47

    Abstract

    Insufficient growth during childhood is associated with poor health outcomes and an increased risk of death. Between 2000 and 2015, nearly all African countries demonstrated improvements for children under 5 years old for stunting, wasting, and underweight, the core components of child growth failure. Here we show that striking subnational heterogeneity in levels and trends of child growth remains. If current rates of progress are sustained, many areas of Africa will meet the World Health Organization Global Targets 2025 to improve maternal, infant and young child nutrition, but high levels of growth failure will persist across the Sahel. At these rates, much, if not all of the continent will fail to meet the Sustainable Development Goal target-to end malnutrition by 2030. Geospatial estimates of child growth failure provide a baseline for measuring progress as well as a precision public health platform to target interventions to those populations with the greatest need, in order to reduce health disparities and accelerate progress.

    View details for DOI 10.1038/nature25760

    View details for PubMedID 29493591

    View details for PubMedCentralID PMC6346257

  • Continental-scale, data-driven predictive assessment of eliminating the vector-borne disease, lymphatic filariasis, in sub-Saharan Africa by 2020. BMC medicine Michael, E., Singh, B. K., Mayala, B. K., Smith, M. E., Hampton, S., Nabrzyski, J. 2017; 15 (1): 176

    Abstract

    There are growing demands for predicting the prospects of achieving the global elimination of neglected tropical diseases as a result of the institution of large-scale nation-wide intervention programs by the WHO-set target year of 2020. Such predictions will be uncertain due to the impacts that spatial heterogeneity and scaling effects will have on parasite transmission processes, which will introduce significant aggregation errors into any attempt aiming to predict the outcomes of interventions at the broader spatial levels relevant to policy making. We describe a modeling platform that addresses this problem of upscaling from local settings to facilitate predictions at regional levels by the discovery and use of locality-specific transmission models, and we illustrate the utility of using this approach to evaluate the prospects for eliminating the vector-borne disease, lymphatic filariasis (LF), in sub-Saharan Africa by the WHO target year of 2020 using currently applied or newly proposed intervention strategies. METHODS AND RESULTS: We show how a computational platform that couples site-specific data discovery with model fitting and calibration can allow both learning of local LF transmission models and simulations of the impact of interventions that take a fuller account of the fine-scale heterogeneous transmission of this parasitic disease within endemic countries. We highlight how such a spatially hierarchical modeling tool that incorporates actual data regarding the roll-out of national drug treatment programs and spatial variability in infection patterns into the modeling process can produce more realistic predictions of timelines to LF elimination at coarse spatial scales, ranging from district to country to continental levels. Our results show that when locally applicable extinction thresholds are used, only three countries are likely to meet the goal of LF elimination by 2020 using currently applied mass drug treatments, and that switching to more intensive drug regimens, increasing the frequency of treatments, or switching to new triple drug regimens will be required if LF elimination is to be accelerated in Africa. The proportion of countries that would meet the goal of eliminating LF by 2020 may, however, reach up to 24/36 if the WHO 1% microfilaremia prevalence threshold is used and sequential mass drug deliveries are applied in countries.We have developed and applied a data-driven spatially hierarchical computational platform that uses the discovery of locally applicable transmission models in order to predict the prospects for eliminating the macroparasitic disease, LF, at the coarser country level in sub-Saharan Africa. We show that fine-scale spatial heterogeneity in local parasite transmission and extinction dynamics, as well as the exact nature of intervention roll-outs in countries, will impact the timelines to achieving national LF elimination on this continent.

    View details for DOI 10.1186/s12916-017-0933-2

    View details for PubMedID 28950862

    View details for PubMedCentralID PMC5615442

  • Ecological Niche Modeling for the Prediction of the Geographic Distribution of Cutaneous Leishmaniasis in Tunisia. The American journal of tropical medicine and hygiene Chalghaf, B., Chlif, S., Mayala, B., Ghawar, W., Bettaieb, J., Harrabi, M., Benie, G. B., Michael, E., Salah, A. B. 2016; 94 (4): 844-851

    Abstract

    Cutaneous leishmaniasis is a very complex disease involving multiple factors that limit its emergence and spatial distribution. Prediction of cutaneous leishmaniasis epidemics in Tunisia remains difficult because most of the epidemiological tools used so far are descriptive in nature and mainly focus on a time dimension. The purpose of this work is to predict the potential geographic distribution of Phlebotomus papatasi and zoonotic cutaneous leishmaniasis caused by Leishmania major in Tunisia using Grinnellian ecological niche modeling. We attempted to assess the importance of environmental factors influencing the potential distribution of P. papatasi and cutaneous leishmaniasis caused by L. major. Vectors were trapped in central Tunisia during the transmission season using CDC light traps (John W. Hock Co., Gainesville, FL). A global positioning system was used to record the geographical coordinates of vector occurrence points and households tested positive for cutaneous leishmaniasis caused by L. major. Nine environmental layers were used as predictor variables to model the P. papatasi geographical distribution and five variables were used to model the L. major potential distribution. Ecological niche modeling was used to relate known species' occurrence points to values of environmental factors for these same points to predict the presence of the species in unsampled regions based on the value of the predictor variables. Rainfall and temperature contributed the most as predictors for sand flies and human case distributions. Ecological niche modeling anticipated the current distribution of P. papatasi with the highest suitability for species occurrence in the central and southeastern part of Tunisian. Furthermore, our study demonstrated that governorates of Gafsa, Sidi Bouzid, and Kairouan are at highest epidemic risk.

    View details for DOI 10.4269/ajtmh.15-0345

    View details for PubMedID 26856914

    View details for PubMedCentralID PMC4824228

  • Malaria, anaemia and nutritional status among schoolchildren in relation to ecosystems, livelihoods and health systems in Kilosa District in central Tanzania. BMC public health Mboera, L. E., Bwana, V. M., Rumisha, S. F., Malima, R. C., Mlozi, M. R., Mayala, B. K., Stanley, G., Mlacha, T. 2015; 15: 553

    Abstract

    Malaria prevalence and transmission intensity in Tanzania is heterogeneous with spatial and temporal variations between geographical areas and ecological systems. The objective of this study was to determine the prevalence of malaria, anaemia and nutritional status in relation to livelihoods, ecosystem and health systems in Kilosa District in central Tanzania.This study was conducted in four villages, two characterised by rice irrigation ecosystem and the other two by dry savannah ecosystem and pastoral livelihoods. In each ecosystem, one of the villages had a healthcare facility. Schoolchildren were screened for malaria infection using malaria rapid diagnostic test (mRDT) and microscopy and they were assessed for their anaemia and nutritional statuses.A total of 1,019 school children (age = 4-16 years) were screened for malaria infection. The overall prevalence of Plasmodium falciparum infection was 10.6% and 4.5% by mRDT and microscopy, respectively. Children from pastoral villages had lower (2.9%) prevalence of malaria than their counterparts (18.2%) in the rice irrigation villages. A significantly high risk of malaria was observed among children in rice irrigation than in the pastoral ecosystem (OR: 0.13; 95%CI 0.07, 0.23). Children living in areas with health care facilities had a low odd of malaria infection by 45% (OR: 0.55; 95% CI = 0.35, 0.86). Overall, the prevalence of anaemia in the district was 43.4% (n = 775); and 58.3% of those with severe anaemia were among children from the pastoral villages. Anaemia was significantly higher among children not using mosquito nets (p = 0.049); and among those with malaria infection (p <0.001). The majority (96%) of the children had Body Mass Index less than 18.5 kg/m(2) which indicate high proportion of underweight.There are significant variations in the risk of acquiring malaria infection between different ecosystems and livelihoods. These findings suggest that malaria control programmes must take into account ecosystems and livelihoods of the targeted population through an integrated management of malaria and nutrition approach.

    View details for DOI 10.1186/s12889-015-1932-x

    View details for PubMedID 26082157

    View details for PubMedCentralID PMC4469328

  • Knowledge, perception and practices about malaria, climate change, livelihoods and food security among rural communities of central Tanzania. Infectious diseases of poverty Mayala, B. K., Fahey, C. A., Wei, D., Zinga, M. M., Bwana, V. M., Mlacha, T., Rumisha, S. F., Stanley, G., Shayo, E. H., Mboera, L. E. 2015; 4: 21

    Abstract

    Understanding the interactions between malaria and agriculture in Tanzania is of particular significance when considering that they are the major sources of illness and livelihoods. The objective of this study was to determine knowledge, perceptions and practices as regards to malaria, climate change, livelihoods and food insecurity in a rural farming community in central Tanzania.Using a cross-sectional design, heads of households were interviewed on their knowledge and perceptions on malaria transmission, symptoms and prevention and knowledge and practices as regards to climate change and food security.A total of 399 individuals (mean age = 39.8 ± 15.5 years) were interviewed. Most (62.41%) of them had attained primary school education and majority (91.23%) were involved in crop farming activities. Nearly all (94.7%) knew that malaria is acquired through a mosquito bite. Three quarters (73%) reported that most people get sick from malaria during the rainy season. About 50% of the respondents felt that malaria had decreased during the last 10 years. The household coverage of insecticide treated mosquito nets (ITN) was high (95.5%). Ninety-six percent reported to have slept under a mosquito net the previous night. Only one in four understood the official Kiswahili term (Mabadiliko ya Tabia Nchi) for climate change. However, there was a general understanding that the rain patterns have changed in the past 10 years. Sixty-two percent believed that the temperature has increased during the same period. Three quarters of the respondents reported that they had no sufficient production from their own farms to guarantee food security in their household for the year. Three quarters (73.0%) reported to having food shortages in the past five years. About half said they most often experienced severe food shortage during the rainy season.Farming communities in Kilosa District have little knowledge on climate change and its impact on malaria burden. Food insecurity is common and community-based strategies to mitigate this need to be established. The findings call for an integrated control of malaria and food insecurity interventions.

    View details for DOI 10.1186/s40249-015-0052-2

    View details for PubMedID 25914808

    View details for PubMedCentralID PMC4408568

  • Spatio-temporal variation in malaria transmission intensity in five agro-ecosystems in Mvomero district, Tanzania. Geospatial health Mboera, L. E., Senkoro, K. P., Mayala, B. K., Rumisha, S. F., Rwegoshora, R. T., Mlozi, M. R., Shayo, E. H. 2010; 4 (2): 167-78

    Abstract

    In Africa, malaria is predominantly a rural disease where agriculture forms the backbone of the economy. Various agro-ecosystems and crop production systems have an impact on mosquito productivity, and hence malaria transmission intensity. This study was carried out to determine spatial and temporal variations in anopheline mosquito population and malaria transmission intensity in five villages, representing different agro-ecosystems in Mvomero district, Tanzania, so as to provide baseline information for malaria interventions. The agro-ecosystems consisted of irrigated sugarcane, flooding rice irrigation, non-flooding rice irrigation, wet savannah and dry savannah. In each setting, adult mosquitoes were sampled monthly using light traps recommended by the Centers for Disease Control and Prevention (CDC) from August 2004 to July 2005. A total of 35,702 female mosquitoes were collected. Anopheles gambiae sensu lato was the most abundant (58.9%) mosquito species. An. funestus accounted for 12.0% of the mosquitoes collected. There was a substantial village to village variation and seasonality in the density of Anopheles mosquito population, with peaks in May towards the end of the warm and rainy season. Significantly larger numbers of anophelines were collected from traditional flooding rice irrigation ecosystem (70.7%) than in non-flooding rice irrigation (8.6%), sugarcane (7.0%), wet savannah (7.3%) and dry savannah (6.4%). The overall sporozoite rates for An. gambiae and An. funestus were 3.4% and 2.3%, respectively. The combined overall sporozoite rate (An. gambiae+An. funestus) was 3.2%. The mean annual entomological inoculation rate (EIR) for An. gambiae s.l. was 728 infective bites per person per year and this was significantly higher in traditional flooding rice irrigation (1351) than in other agro-ecosystems. The highest EIRs for An. gambiae s.l. and An. funestus were observed during May 2005 (long rainy season) and December 2004 (short rainy season), respectively. The findings support the evidence that malaria transmission risk varies even between neighbouring villages and is influenced by agro-ecosystems. This study therefore, demonstrates the need to generate spatial and temporal data on transmission intensity on smaller scales taking into consideration agro-ecosystems that will identify area-specific transmission intensity to guide targeted control of malaria operations.

    View details for DOI 10.4081/gh.2010.198

    View details for PubMedID 20503186