All Publications

  • Gender-related data missingness, imbalance and bias in global health surveys. BMJ global health Weber, A. M., Gupta, R., Abdalla, S., Cislaghi, B., Meausoone, V., Darmstadt, G. L. 2021; 6 (11)

    Abstract

    Global surveys have built-in gender-related biases associated with data missingness across the gender dimensions of people's lives, imbalanced or incomplete representation of population groups, and biased ways in which gender information is elicited and used. While increasing focus is being placed on the integration of sex-disaggregated statistics into national programmes and on understanding effects of gender-based disparities on the health of all people, the data necessary for elucidating underlying causes of gender disparities and designing effective intervention programmes continue to be lacking. Approaches exist, however, that can reasonably address some shortcomings, such as separating questions of gender identification from biological sex. Qualitative research can elucidate ways to rephrase questions and translate gendered terms to avoid perpetuating historical gender biases and prompting biased responses. Non-health disciplines may offer lessons in collecting gender-related data. Ultimately, multidisciplinary global collaborations are needed to advance this evolving field and to set standards for how we measure gender in all its forms.

    View details for DOI 10.1136/bmjgh-2021-007405

    View details for PubMedID 34836912

  • COVID-19 antibody seroprevalence in Santa Clara County, California. International journal of epidemiology Bendavid, E., Mulaney, B., Sood, N., Shah, S., Bromley-Dulfano, R., Lai, C., Weissberg, Z., Saavedra-Walker, R., Tedrow, J., Bogan, A., Kupiec, T., Eichner, D., Gupta, R., Ioannidis, J. P., Bhattacharya, J. 2021

    Abstract

    BACKGROUND: Measuring the seroprevalence of antibodies to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is central to understanding infection risk and fatality rates. We studied Coronavirus Disease 2019 (COVID-19)-antibody seroprevalence in a community sample drawn from Santa Clara County.METHODS: On 3 and 4 April 2020, we tested 3328 county residents for immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies to SARS-CoV-2 using a rapid lateral-flow assay (Premier Biotech). Participants were recruited using advertisements that were targeted to reach county residents that matched the county population by gender, race/ethnicity and zip code of residence. We estimate weights to match our sample to the county by zip, age, sex and race/ethnicity. We report the weighted and unweighted prevalence of antibodies to SARS-CoV-2. We adjust for test-performance characteristics by combining data from 18 independent test-kit assessments: 14 for specificity and 4 for sensitivity.RESULTS: The raw prevalence of antibodies in our sample was 1.5% [exact binomial 95% confidence interval (CI) 1.1-2.0%]. Test-performance specificity in our data was 99.5% (95% CI 99.2-99.7%) and sensitivity was 82.8% (95% CI 76.0-88.4%). The unweighted prevalence adjusted for test-performance characteristics was 1.2% (95% CI 0.7-1.8%). After weighting for population demographics, the prevalence was 2.8% (95% CI 1.3-4.2%), using bootstrap to estimate confidence bounds. These prevalence point estimates imply that 53000 [95% CI 26000 to 82000 using weighted prevalence; 23000 (95% CI 14000-35000) using unweighted prevalence] people were infected in Santa Clara County by late March-many more than the 1200 confirmed cases at the time.CONCLUSION: The estimated prevalence of SARS-CoV-2 antibodies in Santa Clara County implies that COVID-19 was likely more widespread than indicated by the number of cases in late March, 2020. At the time, low-burden contexts such as Santa Clara County were far from herd-immunity thresholds.

    View details for DOI 10.1093/ije/dyab010

    View details for PubMedID 33615345

  • Comparison of World Health Organization and Demographic and Health Surveys data to estimate sub-national deworming coverage in pre-school aged children. PLoS neglected tropical diseases Lo, N. C., Gupta, R., Addiss, D. G., Bendavid, E., Heft-Neal, S., Mikhailov, A., Montresor, A., Mbabazi, P. S. 2020; 14 (8): e0008551

    Abstract

    BACKGROUND: The key metric for monitoring the progress of deworming programs in controlling soil-transmitted helminthiasis (STH) is national drug coverage reported to the World Health Organization (WHO). There is increased interest in utilizing geographically-disaggregated data to estimate sub-national deworming coverage and equity, as well as gender parity. The Demographic and Health Surveys (DHS) offer a potential source of sub-national data. This study aimed to compare deworming coverage routinely reported to WHO and estimated by DHS in pre-school aged children to inform global STH measurement and evaluation.METHODOLOGY: We compared sub-national deworming coverage in pre-school aged children reported to WHO and estimated by DHS aligned geospatially and temporally. We included data from Burundi (2016-2017), Myanmar (2015-2016), and the Philippines (2017) based on data availability. WHO provided data on the date and sub-national coverage per mass drug administration reported by Ministries of Health. DHS included maternally-reported deworming status within the past 6 months for each child surveyed. We estimated differences in sub-national deworming coverage using WHO and DHS data, and performed sensitivity analyses.PRINCIPAL FINDINGS: We compared data on pre-school aged children from 13 of 18 districts in Burundi (N = 6,835 in DHS), 11 of 15 districts in Myanmar (N = 1,462 in DHS) and 16 of 17 districts in the Philippines (N = 7,594 in DHS) following data exclusion. The national deworming coverages estimated by DHS in Burundi, Myanmar, and the Philippines were 75.5% (95% CI: 73.7%-77.7%), 47.0% (95% CI: 42.7%-51.3%), and 48.0% (95% CI: 46.0%-50.0%), respectively. The national deworming coverages reported by WHO in Burundi, Myanmar, and the Philippines were 80.1%, 93.6% and 75.7%, respectively. The mean absolute differences in district-level coverage reported to WHO and estimated by DHS in Burundi, Myanmar, and the Philippines were 9.5%, 41.5%, and 24.6%, respectively. Across countries, coverage reported to WHO was frequently higher than DHS estimates (32 of 40 districts). National deworming coverage from DHS estimates were similar by gender within countries.CONCLUSIONS AND SIGNIFICANCE: Agreement of deworming coverage reported to WHO and estimated by DHS data was heterogeneous across countries, varying from broadly compatible in Burundi to largely discrepant in Myanmar. DHS data could complement deworming data reported to WHO to improve data monitoring practices and serve as an independent sub-national source of coverage data.

    View details for DOI 10.1371/journal.pntd.0008551

    View details for PubMedID 32804925

  • Health and Economic Outcomes of Posterior Spinal Fusion for Children With Neuromuscular Scoliosis. Hospital pediatrics Lin, J. L., Tawfik, D. S., Gupta, R., Imrie, M., Bendavid, E., Owens, D. K. 2020

    Abstract

    OBJECTIVES: Neuromuscular scoliosis (NMS) can result in severe disability. Nonoperative management minimally slows scoliosis progression, but operative management with posterior spinal fusion (PSF) carries high risks of morbidity and mortality. In this study, we compare health and economic outcomes of PSF to nonoperative management for children with NMS to identify opportunities to improve care.METHODS: We performed a cost-effectiveness analysis. Our decision analytic model included patients aged 5 to 20 years with NMS and a Cobb angle ≥50°, with a base case of 15-year-old patients. We estimated costs, life expectancy, quality-adjusted life-years (QALYs), and incremental cost-effectiveness from published literature and conducted sensitivity analyses on all model inputs.RESULTS: We estimated that PSF resulted in modestly decreased discounted life expectancy (10.8 years) but longer quality-adjusted life expectancy (4.84 QALYs) than nonoperative management (11.2 years; 3.21 QALYs). PSF costs $75400 per patient. Under base-case assumptions, PSF costs $50100 per QALY gained. Our findings were sensitive to quality of life (QoL) and life expectancy, with PSF favored if it significantly increased QoL.CONCLUSIONS: In patients with NMS, whether PSF is cost-effective depends strongly on the degree to which QoL improved, with larger improvements when NMS is the primary cause of debility, but limited data on QoL and life expectancy preclude a definitive assessment. Improved patient-centered outcome assessments are essential to understanding the effectiveness of NMS treatment alternatives. Because the degree to which PSF influences QoL substantially impacts health outcomes and varies by patient, clinicians should consider shared decision-making during PSF-related consultations.

    View details for DOI 10.1542/hpeds.2019-0153

    View details for PubMedID 32079619

  • COMPARISON OF WORLD HEALTH ORGANIZATION AND DEMOGRAPHIC AND HEALTH SURVEY DATA TO ESTIMATE SUB-NATIONAL DEWORMING COVERAGE IN PRE-SCHOOL CHILDREN Lo, N. C., Gupta, R., Addiss, D. G., Bendavid, E., Heft-Neal, S., Mikhailov, A., Montresor, A., Mbabazi, P. AMER SOC TROP MED & HYGIENE. 2019: 616

    View details for Web of Science ID 000507364505117

  • Gender norms and health: insights from global survey data. Lancet (London, England) Weber, A. M., Cislaghi, B. n., Meausoone, V. n., Abdalla, S. n., Mejía-Guevara, I. n., Loftus, P. n., Hallgren, E. n., Seff, I. n., Stark, L. n., Victora, C. G., Buffarini, R. n., Barros, A. J., Domingue, B. W., Bhushan, D. n., Gupta, R. n., Nagata, J. M., Shakya, H. B., Richter, L. M., Norris, S. A., Ngo, T. D., Chae, S. n., Haberland, N. n., McCarthy, K. n., Cullen, M. R., Darmstadt, G. L. 2019

    Abstract

    Despite global commitments to achieving gender equality and improving health and wellbeing for all, quantitative data and methods to precisely estimate the effect of gender norms on health inequities are underdeveloped. Nonetheless, existing global, national, and subnational data provide some key opportunities for testing associations between gender norms and health. Using innovative approaches to analysing proxies for gender norms, we generated evidence that gender norms impact the health of women and men across life stages, health sectors, and world regions. Six case studies showed that: (1) gender norms are complex and can intersect with other social factors to impact health over the life course; (2) early gender-normative influences by parents and peers can have multiple and differing health consequences for girls and boys; (3) non-conformity with, and transgression of, gender norms can be harmful to health, particularly when they trigger negative sanctions; and (4) the impact of gender norms on health can be context-specific, demanding care when designing effective gender-transformative health policies and programmes. Limitations of survey-based data are described that resulted in missed opportunities for investigating certain populations and domains. Recommendations for optimising and advancing research on the health impacts of gender norms are made.

    View details for DOI 10.1016/S0140-6736(19)30765-2

    View details for PubMedID 31155273

  • Comparison of Strategies and Incidence Thresholds for Vi Conjugate Vaccines Against Typhoid Fever: A Cost-effectiveness Modeling Study JOURNAL OF INFECTIOUS DISEASES Lo, N. C., Gupta, R., Stanaway, J. D., Garrett, D. O., Bogoch, I. I., Luby, S. P., Andrews, J. R. 2018; 218: S232–S242

    View details for DOI 10.1093/infdis/jix598

    View details for Web of Science ID 000463874100008

  • Comparison of Strategies and Incidence Thresholds for Vi Conjugate Vaccines Against Typhoid Fever: A Cost-effectiveness Modeling Study. The Journal of infectious diseases Lo, N. C., Gupta, R. n., Stanaway, J. D., Garrett, D. O., Bogoch, I. I., Luby, S. P., Andrews, J. R. 2018

    Abstract

    Typhoid fever remains a major public health problem globally. While new Vi conjugate vaccines hold promise for averting disease, the optimal programmatic delivery remains unclear. We aimed to identify the strategies and associated epidemiologic conditions under which Vi conjugate vaccines would be cost-effective.We developed a dynamic, age-structured transmission and cost-effectiveness model that simulated multiple vaccination strategies with a typhoid Vi conjugate vaccine from a societal perspective. We simulated 10-year vaccination programs with (1) routine immunization of infants (aged <1 year) through the Expanded Program on Immunization (EPI) and (2) routine immunization of infants through the EPI plus a 1-time catch-up campaign in school-aged children (aged 5-14 years). In the base case analysis, we assumed a 0.5% case-fatality rate for all cases of clinically symptomatic typhoid fever and defined strategies as highly cost-effective by using the definition of a low-income country (defined as a country with a gross domestic product of $1045 per capita). We defined incidence as the true number of clinically symptomatic people in the population per year.Vi conjugate typhoid vaccines were highly cost-effective when administered by routine immunization activities through the EPI in settings with an annual incidence of >50 cases/100000 (95% uncertainty interval, 40-75 cases) and when administered through the EPI plus a catch-up campaign in settings with an annual incidence of >130 cases/100000 (95% uncertainty interval, 50-395 cases). The incidence threshold was sensitive to the typhoid-related case-fatality rate, carrier contribution to transmission, vaccine characteristics, and country-specific economic threshold for cost-effectiveness.Typhoid Vi conjugate vaccines would be highly cost-effective in low-income countries in settings of moderate typhoid incidence (50 cases/100000 annually). These results were sensitive to case-fatality rates, underscoring the need to consider factors contributing to typhoid mortality (eg, healthcare access and antimicrobial resistance) in the global vaccination strategy.

    View details for PubMedID 29444257

  • COMPARISON OF STRATEGIES AND THRESHOLDS FOR VI CONJUGATE VACCINES AGAINST TYPHOID FEVER: A COST-EFFECTIVENESS MODELING STUDY Lo, N. C., Gupta, R., Stanaway, J. D., Garrett, D. O., Bogoch, I. I., Luby, S. P., Andrews, J. R. AMER SOC TROP MED & HYGIENE. 2017: 617

    View details for Web of Science ID 000423215204697