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  • 1. AbouZahr, Carla
    et al.
    Boerma, Ties
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Univ Witwatersrand, Sch Publ Hlth, Johannesburg, South Africa ; Univ Aberdeen, Inst Appl Hlth Sci, Aberdeen, Scotland.
    Bridging the data gaps: do we have the right balance between country data and global estimates?2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, article id 1299978Article in journal (Refereed)
  • 2.
    Abraha, Atakelti
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Tigray Health Bureau, Tigray and Ethiopian Health Insurance Agency, Addis Ababa, Ethiopia.
    Myléus, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Institutes of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, United Kingdom; MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Kahsay, Asmelash
    Tigray Health Bureau, Tigray and Ethiopian Health Insurance Agency, Addis Ababa, Ethiopia.
    Kinsman, John
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institute, Stockholm, Sweden.
    Social determinants of under-5 child health: A qualitative study in Wolkayit Woreda, Tigray Region, Ethiopia2019In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 6, article id e0218101Article in journal (Refereed)
    Abstract [en]

    Despite the significant reductions seen in under-5 child mortality in Ethiopia over the last two decades, more than 10,000 children still die each year in Tigray Region alone, of whom 75% die from preventable diseases. Using an equity lens, this study aimed to investigate the social determinants of child health in one particularly vulnerable district as a means of informing the health policy decision-making process. An exploratory qualitative study design was adopted, combining focus group discussions and qualitative interviews. Seven Focus Group Discussions with mothers of young children, and 21 qualitative interviews with health workers were conducted in Wolkayit district in May-June 2015. Data were subjected to thematic analysis. Mothers’ knowledge regarding the major causes of child mortality appeared to be good, and they also knew about and trusted the available child health interventions. However, utilization and practice of these interventions was limited by a range of issues, including cultural factors, financial shortages, limited female autonomy on financial resources, seasonal mobility, and inaccessible or unaffordable health services. Our findings pointed to the importance of a multi-sectoral strategy to improve child health equity and reduce under-5 mortality in Wolkayit. Recommendations include further decentralizing child health services to local-level Health Posts, and increasing the number of Health Facilities based on local topography and living conditions.

  • 3. Alberts, Marianne
    et al.
    Dikotope, Sekgothe A
    Choma, Solomon R
    Masemola, Matshane L
    Modjadji, Sewela EP
    Mashinya, Felistas
    Burger, Sandra
    Cook, Ian
    Brits, Sanette J
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesberg, South Africa.
    Health & Demographic Surveillance System Profile: The Dikgale Health and Demographic Surveillance System.2015In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 44, no 5, p. 1565-1571Article in journal (Refereed)
  • 4. Ali, Mohammed
    et al.
    Asefaw, Teklehaimanot
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Beyene, Hagos
    Pedersen, F Karup
    Helping northern Ethiopian communities reduce childhood mortality: population-based intervention trial2005In: Bulletin of the World Health Organization, ISSN 0042-9686, E-ISSN 1564-0604, Vol. 83, no 1, p. 27-33Article in journal (Refereed)
  • 5. Alkema, Leontine
    et al.
    Chou, Doris
    Hogan, Daniel
    Zhang, Sanqian
    Moller, Ann-Beth
    Gemmill, Alison
    Fat, Doris Ma
    Boerma, Ties
    Temmerman, Marleen
    Mathers, Colin
    Say, Lale
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. University of the Witwatersrand, Johannesburg, South Africa.
    Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group2016In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 387, no 10017, p. 462-474Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Millennium Development Goal 5 calls for a 75% reduction in the maternal mortality ratio (MMR) between 1990 and 2015. We estimated levels and trends in maternal mortality for 183 countries to assess progress made. Based on MMR estimates for 2015, we constructed projections to show the requirements for the Sustainable Development Goal (SDG) of less than 70 maternal deaths per 100,000 livebirths globally by 2030.

    METHODS: We updated the UN Maternal Mortality Estimation Inter-Agency Group (MMEIG) database with more than 200 additional records (vital statistics from civil registration systems, surveys, studies, or reports). We generated estimates of maternal mortality and related indicators with 80% uncertainty intervals (UIs) using a Bayesian model. The model combines the rate of change implied by a multilevel regression model with a time-series model to capture data-driven changes in country-specific MMRs, and includes a data model to adjust for systematic and random errors associated with different data sources.

    RESULTS: We had data for 171 of 183 countries. The global MMR fell from 385 deaths per 100,000 livebirths (80% UI 359-427) in 1990, to 216 (207-249) in 2015, corresponding to a relative decline of 43·9% (34·0-48·7), with 303,000 (291,000-349,000) maternal deaths worldwide in 2015. Regional progress in reducing the MMR since 1990 ranged from an annual rate of reduction of 1·8% (0·0-3·1) in the Caribbean to 5·0% (4·0-6·0) in eastern Asia. Regional MMRs for 2015 ranged from 12 deaths per 100,000 livebirths (11-14) for high-income regions to 546 (511-652) for sub-Saharan Africa. Accelerated progress will be needed to achieve the SDG goal; countries will need to reduce their MMRs at an annual rate of reduction of at least 7·5%.

    INTERPRETATION: Despite global progress in reducing maternal mortality, immediate action is needed to meet the ambitious SDG 2030 target, and ultimately eliminate preventable maternal mortality. Although the rates of reduction that are needed to achieve country-specific SDG targets are ambitious for most high mortality countries, countries that made a concerted effort to reduce maternal mortality between 2000 and 2010 provide inspiration and guidance on how to accomplish the acceleration necessary to substantially reduce preventable maternal deaths.

    FUNDING: National University of Singapore, National Institute of Child Health and Human Development, USAID, and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction.

  • 6. Baiden, Frank
    et al.
    Bawah, Ayaga
    Biai, Sidu
    Binka, Fred
    Boerma, Ties
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Chandramohan, Daniel
    Chatterji, Somnath
    Engmann, Cyril
    Greet, Dieltiens
    Jakob, Robert
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Kunii, Osamu
    Lopez, Alan D
    Murray, Christopher JL
    Nahlen, Bernard
    Rao, Chalapati
    Sankoh, Osman
    Setel, Philip W
    Shibuya, Kenji
    Soleman, Nadia
    Wright, Linda
    Yang, Gonghuan
    Setting international standards for verbal autopsy2007In: Bulletin of the World Health Organization, ISSN 0042-9686, E-ISSN 1564-0604, Vol. 85, no 8, p. 570-571Article in journal (Refereed)
  • 7. Baschieri, Angela
    et al.
    Gordeev, Vladimir S
    Akuze, Joseph
    Kwesiga, Doris
    Blencowe, Hannah
    Cousens, Simon
    Waiswa, Peter
    Fisker, Ane B
    Thysen, Sanne M
    Rodrigues, Amabelia
    Biks, Gashaw A
    Abebe, Solomon M
    Gelaye, Kassahun A
    Mengistu, Mezgebu Y
    Geremew, Bisrat M
    Delele, Tadesse G
    Tesega, Adane K
    Yitayew, Temesgen A
    Kasasa, Simon
    Galiwango, Edward
    Natukwatsa, Davis
    Kajungu, Dan
    Enuameh, Yeetey Ak
    Nettey, Obed E
    Dzabeng, Francis
    Amenga-Etego, Seeba
    Newton, Sam K
    Manu, Alexander A
    Tawiah, Charlotte
    Asante, Kwaku P
    Owusu-Agyei, Seth
    Alam, Nurul
    Haider, M M
    Alam, Sayed S
    Arnold, Fred
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Croft, Trevor N
    Herbst, Kobus
    Kishor, Sunita
    Serbanescu, Florina
    Lawn, Joy E
    "Every Newborn-INDEPTH" (EN-INDEPTH) study protocol for a randomised comparison of household survey modules for measuring stillbirths and neonatal deaths in five Health and Demographic Surveillance sites2019In: Journal of Global Health, ISSN 2047-2978, E-ISSN 2047-2986, Vol. 9, no 1, p. 1-15, article id 010901Article in journal (Refereed)
    Abstract [en]

    Background: Under-five and maternal mortality were halved in the Millennium Development Goals (MDG) era, with slower reductions for 2.6 million neonatal deaths and 2.6 million stillbirths. The Every Newborn Action Plan aims to accelerate progress towards national targets, and includes an ambitious Measurement Improvement Roadmap. Population-based household surveys, notably Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys, are major sources of population-level data on child mortality in countries with weaker civil registration and vital statistics systems, where over two-thirds of global child deaths occur. To estimate neonatal/child mortality and pregnancy outcomes (stillbirths, miscarriages, birthweight, gestational age) the most common direct methods are: (1) the standard DHS-7 with Full Birth History with additional questions on pregnancy losses in the past 5 years (FBH+) or (2) a Full Pregnancy History (FPH). No direct comparison of these two methods has been undertaken, although descriptive analyses suggest that the FBH+ may underestimate mortality rates particularly for stillbirths.

    Methods: This is the protocol paper for the Every Newborn-INDEPTH study (INDEPTH Network, International Network for the Demographic Evaluation of Populations and their Health Every Newborn, Every Newborn Action Plan), aiming to undertake a randomised comparison of FBH+ and FPH to measure pregnancy outcomes in a household survey in five selected INDEPTH Network sites in Africa and South Asia (Bandim in urban and rural Guinea-Bissau; Dabat in Ethiopia; IgangaMayuge in Uganda; Kintampo in Ghana; Matlab in Bangladesh). The survey will reach >68 000 pregnancies to assess if there is ≥15% difference in stillbirth rates. Additional questions will capture birthweight, gestational age, birth/death certification, termination of pregnancy and fertility intentions. The World Bank's Survey Solutions platform will be tailored for data collection, including recording paradata to evaluate timing. A mixed methods assessment of barriers and enablers to reporting of pregnancy and adverse pregnancy outcomes will be undertaken.

    Conclusions: This large-scale study is the first randomised comparison of these two methods to capture pregnancy outcomes. Results are expected to inform the evidence base for survey methodology, especially in DHS, regarding capture of stillbirths and other outcomes, notably neonatal deaths, abortions (spontaneous and induced), birthweight and gestational age. In addition, this study will inform strategies to improve health and demographic surveillance capture of neonatal/child mortality and pregnancy outcomes.

  • 8. Bell, Jacqueline S
    et al.
    Ouédraogo, Moctar
    Ganaba, Rasmane
    Sombié, Issiaka
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Baggaley, Rebecca F
    Filippi, Véronique
    Fitzmaurice, Ann E
    Graham, Wendy J
    The epidemiology of pregnancy outcomes in rural Burkina Faso.2008In: Trop Med Int Health, ISSN 1365-3156, Vol. 13 Suppl 1, p. 31-43Article in journal (Refereed)
  • 9. Beran, David
    et al.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Gbakima, Aiah
    Kahn, Kathleen
    Sankoh, Osman
    Tollman, Stephen
    Witham, Miles
    Davies, Justine
    Bringing all together for research capacity building in LMICs2017In: The Lancet Global Health, E-ISSN 2214-109X, Vol. 5, no 9, p. E870-E870Article in journal (Other academic)
  • 10. Beran, David
    et al.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Gbakima, Aiah
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sankoh, Osman
    Tollman, Stephen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Witham, Miles
    Davies, Justine
    Research capacity building-obligations for global health partners2017In: The Lancet Global Health, E-ISSN 2214-109X, Vol. 5, no 6, p. E567-E568Article in journal (Refereed)
  • 11. Berhane, Yemane
    et al.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Fantahun, Mesganaw
    Emmelin, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Mekonnen, Wubegzier
    Högberg, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
    Worku, Alemayehu
    Tesfaye, Fikru
    Molla, Mitike
    Deyessa, Negussie
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
    Kumie, Abera
    Hailemariam, Damen
    Enqueselassie, Fikre
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    A rural Ethiopian population undergoing epidemiological transition over a generation: Butajira from 1987 to 20042008In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 36, no 4, p. 436-441Article in journal (Refereed)
  • 12. Bird, J.
    et al.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå Centre for Global Health Research, Umeå University, University of the Witwatersrand, South Africa and University College London, United Kingdom .
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå Centre for Global Health Research, Umeå University, University of the Witwatersrand, South Africa and University College London, United Kingdom .
    Mee, Paul
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå Centre for Global Health Research, Umeå University, University of the Witwatersrand, South Africa and University College London, United Kingdom .
    Fottrell, Edward
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. UCL Institute for Global Health, University College London, United Kingdom.
    A matter of life and death: practical and ethical constraints in the development of a mobile verbal autopsy tool2013In: CHI '13 Proceedings of the SIGCHI Conference on Human Factors in Computing SystemsPages 1489-1498, 2013, p. 1489-1498Conference paper (Refereed)
    Abstract [en]

    Verbal autopsy (VA) involves interviewing relatives of the deceased to identify the probable cause of death and is typically used in settings where there is no official system for recording deaths or their causes. Following the interview, physician assessment to determine probable cause can take several years to complete. The World Health Organization (WHO) recognizes that there is a pressing need for a mobile device that combines direct data capture and analysis if this technique is to become part of routine health surveillance. We conducted a field test in rural South Africa to evaluate a mobile system that we designed to meet WHO requirements (namely, simplicity, feasibility, adaptability to local contexts, cost-effectiveness and program relevance). If desired, this system can provide immediate feedback to respondents about the probable cause of death at the end of a VA interview. We assessed the ethical implications of this technological development by interviewing all the stakeholders in the VA process (respondents, fieldworkers, physicians, population scientists, data managers and community engagement managers) and highlight the issues that this community needs to debate and resolve.

  • 13. Bocquier, Philippe
    et al.
    Sankoh, Osman
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Are health and demographic surveillance system estimates sufficiently generalisable?2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, p. 1-3, article id 1356621Article in journal (Refereed)
    Abstract [en]

    Sampling rules do not apply in a Health and Demographic Surveillance System (HDSS) that covers exhaustively a district-level population and is not meant to be representative of a national population. We highlight the advantages of HDSS data for causal analysis and identify in the literature the principles of conditional generalisation that best apply to HDSS. A probabilistic view on HDSS data is still justified by the need to model complex causal inference. Accounting for contextual knowledge, reducing omitted-variable bias, detailing order of events, and high statistical power brings credence to HDSS data. Generalisation of causal mechanisms identified in HDSS data is consolidated through systematic comparison and triangulation with national or international data.

  • 14. Brooks, Chloe
    et al.
    D'Ambruoso, Lucia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen, Scotland, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Kazimierczak, Karolina
    Ngobeni, Sizzy
    Twine, Rhian
    Tollman, Stephen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH: An International Network for the Demographic Evaluation of Populations and Their Health, Accra, Ghana.
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH: An International Network for the Demographic Evaluation of Populations and Their Health, Accra, Ghana.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen, Scotland, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Introducing visual participatory methods to develop local knowledge on HIV in rural South Africa2017In: BMJ Global Health, E-ISSN 2059-7908, Vol. 2, no 3, article id e000231Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: South Africa is a country faced with complex health and social inequalities, in which HIV/AIDS has had devastating impacts. The study aimed to gain insights into the perspectives of rural communities on HIV-related mortality.

    METHODS: A participatory action research (PAR) process, inclusive of a visual participatory method (Photovoice), was initiated to elicit and organise local knowledge and to identify priorities for action in a rural subdistrict underpinned by the Agincourt Health and Socio-Demographic Surveillance System (HDSS). We convened three village-based discussion groups, presented HDSS data on HIV-related mortality, elicited subjective perspectives on HIV/AIDS, systematised these into collective accounts and identified priorities for action. Framework analysis was performed on narrative and visual data, and practice theory was used to interpret the findings.

    FINDINGS: A range of social and health systems factors were identified as causes and contributors of HIV mortality. These included alcohol use/abuse, gender inequalities, stigma around disclosure of HIV status, problems with informal care, poor sanitation, harmful traditional practices, delays in treatment, problems with medications and problematic staff-patient relationships. To address these issues, developing youth facilities in communities, improving employment opportunities, timely treatment and extending community outreach for health education and health promotion were identified.

    DISCUSSION: Addressing social practices of blame, stigma and mistrust around HIV-related mortality may be a useful focus for policy and planning. Research that engages communities and authorities to coproduce evidence can capture these practices, improve communication and build trust.

    CONCLUSION: Actions to reduce HIV should go beyond individual agency and structural forces to focus on how social practices embody these elements. Initiating PAR inclusive of visual methods can build shared understandings of disease burdens in social and health systems contexts. This can develop shared accountability and improve staff-patient relationships, which, over time, may address the issues identified, here related to stigma and blame.

  • 15.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    A transition towards a healthier global population?2015In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 386, no 10009, p. 2121-2122Article in journal (Refereed)
  • 16.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Achieving better global health policy, even when health metrics data are scanty2014In: The Handbook of Global Health Policy / [ed] Brown GW, Yamey G, Wamala S, Wiley-Blackwell, 2014, p. 119-132Chapter in book (Refereed)
  • 17.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Causes of child death estimates: making use of the InterVA model2015In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 386, no 9997, p. 953-953Article in journal (Refereed)
  • 18.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. edical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
    Cause-specific mortality findings from the Global Burden of Disease project and the INDEPTH Network2016In: The Lancet Global Health, E-ISSN 2214-109X, Vol. 4, no 11, p. e785-e786Article in journal (Refereed)
  • 19.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa.
    Child mortality is (estimated to be) falling2016In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 388, no 10063, p. 2965-2967Article in journal (Refereed)
  • 20.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Climate change and population health in Africa: where are the scientists?2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2, p. 173-176Article in journal (Refereed)
    Abstract [en]

    Despite a growing awareness of Africans' vulnerability to climate change, there is relatively little empirical evidence published about the effects of climate on population health in Africa. This review brings together some of the generalised predictions about the potential continent-wide effects of climate change with examples of the relatively few locally documented population studies in which climate change and health interact. Although ecologically determined diseases such as malaria are obvious candidates for susceptibility to climate change, wider health effects also need to be considered, particularly among populations where adequacy of food and water supplies may already be marginal.

  • 21.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Dr Tedros Adhanom Ghebreyesus is the best candidate for WHO DG2017In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 389, no 10084, p. E6-E7Article in journal (Refereed)
  • 22.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Epidemiology without borders: an anational view of global health2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Most analyses of global health use country as a unit of observation, not least because countries are intrinsic to health services and to many international organisations. However, this can mask geographical influences on population health, which do not respect political boundaries.

    METHODS: A global anational database was constructed with one degree cells of latitude and longitude, and used to calculate densities for population and key health indicators. These data were aggregated into 240 15 degrees ansectors, 171 of which were populated. Differences in ansector rank orders between population density and health outcomes (infant, maternal and HIV-related deaths and income) were calculated and mapped as quintiles.

    FINDINGS: Individual ansectors contained parts of 1-21 countries. Mapping by ansector showed that the four outcomes analysed were strongly geographically correlated. Sub-Saharan Africa was consistently disadvantaged in terms of health outcomes, while the Indian sub-continent was at an advantage in terms of HIV mortality, despite poverty.

    INTERPRETATION: Although in most cases it makes sense to analyse health on a national basis, these findings highlight the often unquestioned assumptions involved in doing so. Even if global patterns of health do not turn out so differently when analysed anationally, some major effects on health, such as climate change, are not nationally based, and should not necessarily be nationally analysed. Progress towards Millennium Development Goals must be evaluated on a population basis, rather than by counting countries achieving targets. Data files are available in Excel format and attached as separate files to this paper (see Supplementary files under Reading Tools online).

  • 23.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Global health estimated over two decades2017In: Nature, ISSN 0028-0836, E-ISSN 1476-4687, Vol. 545, no 7655, p. 421-422Article in journal (Refereed)
  • 24.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Integrated multisource estimates of mortality for Thailand in 20052010In: Population Health Metrics, ISSN 1478-7954, E-ISSN 1478-7954, Vol. 8, p. Article nr 10-Article in journal (Refereed)
    Abstract [en]

    Estimates of mortality in Thailand during 2005 have been published, integrating multiple data sources including national vital registration and a national follow-up cluster sample, covering both deaths in health facilities (approximately one-third) and elsewhere. The methodological challenge is to make the best use of the existing data, supplemented by additional data that are feasible to obtain, in order to arrive at the best possible overall estimates of mortality. In this case, information from the national vital registration database was supplemented by a verbal autopsy survey of approximately 2.5% of deaths, the latter being used to validate routine cause-of-death data and information from medical records. This led to a revised national cause-specific mortality envelope for Thailand in 2005, amounting to 447,104 deaths. However, difficulties over standardizing verbal autopsy interpretation may mean that there are still some uncertainties in these revised estimates.

  • 25.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Univ Witwatersrand, Fac Hlth Sci, Sch Publ Hlth, MRC Wits Rural Publ Hlth & Hlth Transit Res Unit, Johannesburg, South Africa.
    Interplay between childhood pneumonia and HIV infection2014In: Lancet. Infectious diseases (Print), ISSN 1473-3099, E-ISSN 1474-4457, Vol. 14, no 12, p. 1172-1173Article in journal (Refereed)
  • 26.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Is global health really global?2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 1-3Article in journal (Refereed)
    Abstract [en]

    This editorial is based on a keynote address given at the International Conference on Global Public Health, Colombo, Sri Lanka, in December 2012. It accompanies a set of papers which were also presented at the conference. So far, these papers describe a range of global health issues, from the health status of the United Arab Emirates through to social determinants of health in India. Two papers from Rwanda and India consider specific aspects of oral public health, which was a major sub-theme of the conference.

  • 27.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Making sense of long-term changes in malaria.2008In: Lancet, ISSN 1474-547X, Vol. 372, no 9649, p. 1523-5Article in journal (Refereed)
  • 28.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC-Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Minimally Invasive Autopsy: A New Paradigm for Understanding Global Health?2016In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 13, no 11, article id e1002173Article in journal (Refereed)
    Abstract [en]

    Peter Byass reflects on the potential niche for minimally invasive autopsies in determining cause-of-death in low- and middle-income countries.

  • 29.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    The democratic fallacy in matters of clinical opinion: implications for analysing cause-of-death data2011In: Emerging Themes in Epidemiology, ISSN 1742-7622, E-ISSN 1742-7622, Vol. 8, no 1Article in journal (Refereed)
    Abstract [en]

    Arriving at a consensus between multiple clinical opinions concerning a particular case is a complex issue - and may give rise to manifestations of the democratic fallacy, whereby a majority opinion is misconstrued to represent some kind of "truth" and minority opinions are somehow "wrong". Procedures for handling multiple clinical opinions in epidemiological research are not well established, and care is needed to avoid logical errors. How to handle physicians' opinions on cause of death is one important domain of concern in this respect. Whether multiple opinions are a legal requirement, for example ahead of cremating a body, or used for supposedly greater rigour, for example in verbal autopsy interpretation, it is important to have a clear understanding of what unanimity or disagreement in findings might imply, and of how to aggregate case data accordingly.In many settings where multiple physicians have interpreted verbal autopsy material, an over-riding goal of arriving at a single cause of death per case has been applied. In many instances this desire to constrain findings to a single cause per case has led to methodologically awkward devices such as "TB/AIDS" as a single cause. This has also usually meant that no sense of disagreements or uncertainties at the case level is taken forward into aggregated data analyses, and in many cases an "indeterminate" cause may be recorded which actually reflects a lack of agreement rather than a lack of data on possible cause(s).In preparing verbal autopsy material for epidemiological analyses and public health interpretations, the possibility of multiple causes of death per case, and some sense of any disagreement or uncertainty encountered in interpretation at the case level, need to be captured and incorporated into overall findings, if evidence is not to be lost along the way. Similar considerations may apply in other epidemiological domains.

  • 30.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ; Institute of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK.
    The global burden of liver disease: a challenge for methods and for public health2014In: BMC Medicine, ISSN 1741-7015, E-ISSN 1741-7015, Vol. 12, p. 159-Article in journal (Refereed)
    Abstract [en]

    New Global Burden of Disease estimates for liver cirrhosis, published in BMC Medicine, suggest that cirrhosis caused over a million deaths in 2010, with a further million due to liver cancer and acute hepatitis. Cause-specific mortality data were very sparse for some regions, particularly in Africa, with no relevant mortality data for 58/187 countries. Liver disease involves infectious, malignant and chronic aetiologies with overlapping symptoms. Where available mortality data come from verbal autopsies, separating different types of liver disease is challenging. Cirrhosis is a disease of rich and poor alike; key public health risk factors such as alcohol consumption play an important role. Risk-reduction strategies such as controlling the price of alcohol are being widely discussed. Since these estimates used alcohol consumption as a covariate, they cannot be used to explore relationships between alcohol consumption and cirrhosis mortality. There is hope: coming generations of adults will have been vaccinated against hepatitis B, and this is envisaged to reduce the burden of fatal liver disease. But more complete civil registration globally is needed to fully understand the burden of liver disease.

  • 31.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Immpact, University of Aberdeen, Aberdeen, United Kingdom.
    The imperfect world of global health estimates2010In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 7, no 11, p. e1001006-Article in journal (Refereed)
  • 32.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK, Scotland.
    The potential of community engagement to improve mother and child health in Ethiopia – what works and how should it be measured?2018In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 18, article id 366Article in journal (Refereed)
  • 33.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    The UN needs joined-up thinking on vital registration2012In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 380, no 9854, p. 1643-1643Article in journal (Other academic)
  • 34.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    The unequal world of health data2009In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 6, no 11, p. e1000155-Article in journal (Refereed)
  • 35.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Towards a global agenda on ageing2008In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 1Article in journal (Other academic)
  • 36.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Tuberculosis: a private and public health and data mix2016In: Lancet. Infectious diseases (Print), ISSN 1473-3099, E-ISSN 1474-4457, Vol. 16, no 11, p. 1206-1207Article in journal (Refereed)
  • 37.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Uncounted causes of death2016In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 387, no 10013, p. 26-27Article in journal (Refereed)
  • 38.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Medical Research Council-Wits Agincourt Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
    Universal health coverage is needed to deliver NCD control2018In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 391, no 10122, p. 738-738Article in journal (Refereed)
  • 39.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. WHO Collaborating Centre for Verbal Autopsy, Umeå Centre for Global Health Research, Umeå University and School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Usefulness of the Population Health Metrics Research Consortium gold standard verbal autopsy data for general verbal autopsy methods2014In: BMC Medicine, ISSN 1741-7015, E-ISSN 1741-7015, Vol. 12, no 1, p. 23-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Verbal Autopsy (VA) is widely viewed as the only immediate strategy for registering cause of death in much of Africa and Asia, where routine physician certification of deaths is not widely practiced. VA involves a lay interview with family or friends after a death, to record essential details of the circumstances. These data can then be processed automatically to arrive at standardized cause of death information.

    METHODS: The Population Health Metrics Research Consortium (PHMRC) undertook a study at six tertiary hospitals in low- and middle-income countries which documented over 12,000 deaths clinically and subsequently undertook VA interviews. This dataset, now in the public domain, was compared with the WHO 2012 VA standard and the InterVA-4 interpretative model.

    RESULTS: The PHMRC data covered 70% of the WHO 2012 VA input indicators, and categorized cause of death according to PHMRC definitions. After eliminating some problematic or incomplete records, 11,984 VAs were compared. Some of the PHMRC cause definitions, such as 'preterm delivery', differed substantially from the International Classification of Diseases, version 10 equivalent. There were some appreciable inconsistencies between the hospital and VA data, including 20% of the hospital maternal deaths being described as non-pregnant in the VA data. A high proportion of VA cases (66%) reported respiratory symptoms, but only 18% of assigned hospital causes were respiratory-related. Despite these issues, the concordance correlation coefficient between hospital and InterVA-4 cause of death categories was 0.61.

    CONCLUSIONS: The PHMRC dataset is a valuable reference source for VA methods, but has to be interpreted with care. Inherently inconsistent cases should not be included when using these data to build other VA models. Conversely, models built from these data should be independently evaluated. It is important to distinguish between the internal and external validity of VA models. The effects of using tertiary hospital data, rather than the more usual application of VA to all-community deaths, are hard to evaluate. However, it would still be of value for VA method development to have further studies of population-based post-mortem examinations.

  • 40.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Whither verbal autopsy?2011In: Population Health Metrics, ISSN 1478-7954, E-ISSN 1478-7954, Vol. 9, p. 23-Article in journal (Refereed)
  • 41.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Who needs cause-of-death data?2007In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 4, no 11, p. 1715-1716 (Article nr e333)Article in journal (Refereed)
  • 42.
    Byass, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Alberts, M
    Burger, S
    Motherhood, migration and mortality in Dikgale: modelling life events among women in a rural South African community2011In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 125, no 5, p. 318-323Article in journal (Refereed)
    Abstract [en]

    Objectives: Although particular types of life events in populations are often studied separately, this study investigated the joint effects of three major event types in South African women’s lives: motherhood, migration and mortality.

    Study design: Data were taken from a health and demographic surveillance site (HDSS) over an 11-year period, reflecting the entire population of a defined geographic area as an open cohort, in which individuals participated in regular longitudinal surveillance for health and demographic events. This HDSS is a member of the Indepth Network.

    Methods: Multivariate Poisson regression models were built for each of the three life event types, in which individual person-time observed out of the total possible 11-year period was used as a rate multiplier. These models were used to calculate adjusted incidence rate ratios for each factor.

    Results: In the 21,587 person–years observed for women aged 15–49 years, from 1996 to 2006, adjusted rate ratios for mortality and migration increased substantially over time, while motherhood remained fairly constant. Women who migrated were less likely to bear children; temporary migrants were at greater risk of dying, while permanent in-migrants had higher survival rates. Women who subsequently died were much less likely to bear children or migrate.

    Conclusions: The associations between motherhood, migration and mortality among these rural South African women were complex and dynamic. Extremely rapid increases in mortality over the period studied are presumed to reflect the effects of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic. Understanding these complex interactions between various life events at population level is crucial for effective public health planning and service delivery.

  • 43.
    Byass, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Berhane, Y
    Emmelin, Anders
    Kebede, D
    Andersson, T
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Högberg, Ulf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    The role of demographic surveillance systems (DSS) in assessing the health of communities: an example from rural Ethiopia2002In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 116, no 3, p. 145-150Article in journal (Refereed)
    Abstract [en]

    Longitudinal demographic surveillance systems (DSSs) in selected populations can provide important information in situations where routine health information is incomplete or absent, particularly in developing countries. The Butajira Rural Health Project is one such example, initiated in rural Ethiopia in 1987. DSSs rely on regular community-based surveillance as a means of vital event registration, among a sufficient population base to draw meaningful conclusions about rates and trends in relatively rare events such as maternal death. Enquiries into specific health problems can also then use this framework to quantify particular issues or evaluate interventions. Demographic characteristics and trends for a rural Ethiopian population over a 10-y period are presented as an illustration of the DSS approach, based on 336 000 person-years observed. Overall life expectancy at birth was 50 y. Demographic parameters generally showed modest trends towards improvement over the 10-y period. The DSS approach is useful in characterising populations at the community level over a period of time, providing important information for health planning and intervention. Methodological issues underlying this approach need further exploration and development.

  • 44.
    Byass, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Calvert, Clara
    Miiro-Nakiyingi, Jessica
    Lutalo, Tom
    Michael, Denna
    Crampin, Amelia
    Gregson, Simon
    Takaruza, Albert
    Robertson, Laura
    Herbst, Kobus
    Todd, Jim
    Zaba, Basia
    InterVA-4 as a public health tool for measuring HIV/AIDS mortality: a validation study from five African countries2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, no 1, article id 22448Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Reliable population-based data on HIV infection and AIDS mortality in sub-Saharan Africa are scanty, even though that is the region where most of the world's AIDS deaths occur. There is therefore a great need for reliable and valid public health tools for assessing AIDS mortality.

    OBJECTIVE: The aim of this article is to validate the InterVA-4 verbal autopsy (VA) interpretative model within African populations where HIV sero-status is recorded on a prospective basis, and examine the distribution of cause-specific mortality among HIV-positive and HIV-negative people.

    DESIGN: Data from six sites of the Alpha Network, including HIV sero-status and VA interviews, were pooled. VA data according to the 2012 WHO format were extracted, and processed using the InterVA-4 model into likely causes of death. The model was blinded to the sero-status data. Cases with known pre-mortem HIV infection status were used to determine the specificity with which InterVA-4 could attribute HIV/AIDS as a cause of death. Cause-specific mortality fractions by HIV infection status were calculated, and a person-time model was built to analyse adjusted cause-specific mortality rate ratios.

    RESULTS: The InterVA-4 model identified HIV/AIDS-related deaths with a specificity of 90.1% (95% CI 88.7-91.4%). Overall sensitivity could not be calculated, because HIV-positive people die from a range of causes. In a person-time model including 1,739 deaths in 1,161,688 HIV-negative person-years observed and 2,890 deaths in 75,110 HIV-positive person-years observed, the mortality ratio HIV-positive:negative was 29.0 (95% CI 27.1-31.0), after adjustment for age, sex, and study site. Cause-specific HIV-positive:negative mortality ratios for acute respiratory infections, HIV/AIDS-related deaths, meningitis, tuberculosis, and malnutrition were higher than the all-cause ratio; all causes had HIV-positive:negative mortality ratios significantly higher than unity.

    CONCLUSIONS: These results were generally consistent with relatively small post-mortem and hospital-based diagnosis studies in the literature. The high specificity in cause of death attribution achieved in relation to HIV status, and large differences between specific causes by HIV status, show that InterVA-4 is an effective and valid tool for assessing HIV-related mortality.

  • 45.
    Byass, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Chandramohan, Daniel
    Clark, Samuel J.
    D'Ambruoso, Lucia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Fottrell, Edward
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Graham, Wendy J.
    Herbst, Abraham J.
    Hodgson, Abraham
    Hounton, Sennen
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Krishnan, Anand
    Leitao, Jordana
    Odhiambo, Frank
    Sankoh, Osman A.
    Tollman, Stephen M.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Strengthening standardised interpretation of verbal autopsy data: the new InterVA-4 tool2012In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 5Article in journal (Refereed)
    Abstract [en]

    Background: Verbal autopsy (VA) is the only available approach for determining the cause of many deaths, where routine certification is not in place. Therefore, it is important to use standards and methods for VA that maximise efficiency, consistency and comparability. The World Health Organization (WHO) has led the development of the 2012 WHO VA instrument as a new standard, intended both as a research tool and for routine registration of deaths. Objective: A new public-domain probabilistic model for interpreting VA data, InterVA-4, is described, which builds on previous versions and is aligned with the 2012 WHO VA instrument. Design: The new model has been designed to use the VA input indicators defined in the 2012 WHO VA instrument and to deliver causes of death compatible with the International Classification of Diseases version 10 (ICD-10) categorised into 62 groups as defined in the 2012 WHO VA instrument. In addition, known shortcomings of previous InterVA models have been addressed in this revision, as well as integrating other work on maternal and perinatal deaths. Results: The InterVA-4 model is presented here to facilitate its widespread use and to enable further field evaluation to take place. Results from a demonstration dataset from Agincourt, South Africa, show continuity of interpretation between InterVA-3 and InterVA-4, as well as differences reflecting specific issues addressed in the design and development of InterVA-4. Conclusions: InterVA-4 is made freely available as a new standard model for interpreting VA data into causes of death. It can be used for determining cause of death both in research settings and for routine registration. Further validation opportunities will be explored. These developments in cause of death registration are likely to substantially increase the global coverage of cause-specific mortality data.

  • 46.
    Byass, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Collinson, M A
    Tollman, S M
    Kahn, K
    Malaria mortality in a hypoendemic area of North-Eastern South Africa: population-based surveillance from 1992 to 2013 reveals an increasing malaria burden2015In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, no Suppl. 1, p. 128-128Article in journal (Other academic)
    Abstract [en]

    Introduction: Most of South Africa is malaria-free, but hypoendemic levels of transmission persist in lowveld areas in the north-east of the country, adjacent to Mozambique. Many families have links to relatives in Mozambique, where malaria transmission remains much higher, and cross-border travel is commonplace, although the Kruger National Park provides something of a depopulated buffer zone along the border. Malaria diagnosis and treatment is relatively easily available at public and private facilities in the endemic area.

    Methods: The Agincourt Health and Socio-Demographic Surveillance Site has monitored population health in a defined area within Mpumulanga Province, around 24.7°S, 31.2°E, since 1992. A circumscribed semi-rural area with a population ranging from approximately 60 000 in 1992 to 90 000 in 2013 was covered. All households were visited regularly to consistently record demographic and health data, including the documentation of deaths and their causes using verbal autopsy.

    Results: From 1992 to 2013 a total of 13 251 deaths were documented over 1.58 million person-years observed. Of that total mortality burden, 1.2% of deaths were ascribed to malaria. Half of the malaria deaths were among children aged under 15 years, with most of the remainder among working-age adults. Malaria deaths were strongly correlated with temperature and rainfall. The malaria mortality rate was over 50% higher during the last 5 years of the surveillance period, compared with earlier years. A huge HIV/AIDS epidemic that developed and receded in this population during the period of observation had no apparent effect on malaria mortality.

    Conclusions: This detailed longitudinal examination of malaria mortality showed that although malaria is a relatively minor cause of death in this population, it has become more common in recent years, and shows no sign of retreating despite rapid socioeconomic development. In addition to local relevance, these findings are important for understanding potential population burdens of hypoendemic malaria in other areas of sub-Saharan Africa as progress towards malaria control and elimination targets is realised.

  • 47.
    Byass, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC-Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Collinson, Mark A.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC-Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Kabudula, C.
    Gómez-Olivé, F. X.
    Wagner, R.
    Ngobeni, S.
    Silaule, B.
    Mee, P.
    Coetzee, M.
    Twine, W.
    Tollman, Stephen M.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC-Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC-Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    The long road to elimination: malaria mortality in a South African population cohort over 21 years2017In: Global Health, Epidemiology and Genomics, E-ISSN 2054-4200, Vol. 2, article id e11Article in journal (Refereed)
    Abstract [en]

    Background: Malaria elimination is on global agendas following successful transmission reductions. Nevertheless moving from low to zero transmission is challenging. South Africa has an elimination target of 2018, which may or may not be realised in its hypoendemic areas.

    Methods: The Agincourt Health and Demographic Surveillance System has monitored population health in north-eastern South Africa since 1992. Malaria deaths were analysed against individual factors, socioeconomic status, labour migration and weather over a 21-year period, eliciting trends over time and associations with covariates.

    Results: Of 13 251 registered deaths over 1.58 million person-years, 1.2% were attributed to malaria. Malaria mortality rates increased from 1992 to 2013, while mean daily maximum temperature rose by 1.5 °C. Travel to endemic Mozambique became easier, and malaria mortality increased in higher socioeconomic groups. Overall, malaria mortality was significantly associated with age, socioeconomic status, labour migration and employment, yearly rainfall and higher rainfall/temperature shortly before death.

    Conclusions: Malaria persists as a small but important cause of death in this semi-rural South African population. Detailed longitudinal population data were crucial for these analyses. The findings highlight practical political, socioeconomic and environmental difficulties that may also be encountered elsewhere in moving from low-transmission scenarios to malaria elimination.

  • 48.
    Byass, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    D'Ambruoso, Lucia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Cellular telephone networks in developing countries2008In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 371, no 9613, p. 650-Article in journal (Refereed)
  • 49.
    Byass, Peter
    et al.
    Immpact, University of Aberdeen, Aberdeen, AB25 2ZD, UK .
    D'Ambruoso, Lucia
    Immpact, University of Aberdeen, Aberdeen, AB25 2ZD, UK .
    Ouédraogo, Moctar
    GREFSaD, Bobo-Dioulasso, Burkina Faso .
    Qomariyah, S Nurul
    Immpact, Center for Family Welfare, Faculty of Public Health, University of Indonesia, Jakarta, Indonesia .
    Assessing the repeatability of verbal autopsy for determining cause of death: two case studies among women of reproductive age in Burkina Faso and Indonesia2009In: Population Health Metrics, ISSN 1478-7954, E-ISSN 1478-7954, Vol. 7, no 1, p. 6-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Verbal autopsy (VA) is an established tool for assessing cause-specific mortality patterns in communities where deaths are not routinely medically certified, and is an important source of data on deaths among the poorer half of the world's population. However, the repeatability of the VA process has never been investigated, even though it is an important factor in its overall validity. This study analyses repeatability in terms of the overall VA process (from interview to cause-specific mortality fractions (CSMF)), as well as specifically for interview material and individual causes of death, using data from Burkina Faso and Indonesia.

    METHODS: Two series of repeated VA interviews relating to women of reproductive age in Burkina Faso (n = 91) and Indonesia (n = 116) were analysed for repeatability in terms of interview material, individual causes of death and CSMFs. All the VA data were interpreted using the InterVA-M model, which provides 100% intrinsic repeatability for interpretation, and thus eliminated the need to consider variations or repeatability in physician coding.

    RESULTS: The repeatability of the overall VA process from interview to CSMFs was good in both countries. Repeatability was moderate in the interview material, and lower in terms of individual causes of death. Burkinabé data were less repeatable than Indonesian, and repeatability also declined with longer recall periods between the death and interview, particularly after two years.

    CONCLUSION: While these analyses do not address the validity of the VA process in absolute terms, repeatability is a prerequisite for intrinsic validity. This study thus adds new understanding to the quest for reliable cause of death assessment in communities lacking routine medical certification of deaths, and confirms the status of VA as an important and reliable tool at the community level, but perhaps less so at the individual level.

  • 50.
    Byass, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    de Courten, Maximilian
    Graham, Wendy J
    Laflamme, Lucie
    McCaw-Binns, Affette
    Sankoh, Osman A
    Tollman, Stephen M
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Zaba, Basia
    Reflections on the global burden of disease 2010 estimates2013In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 10, no 7, p. e1001477-Article in journal (Refereed)
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