The Promise of Data for Transforming Global Health

I recently came back from a field visit and as my organization’s designated data person (among the many other hats I wear), I think constantly about the role of data in our work and more broadly, its role in global health.

We’ve always had a problem with data in our field, more specifically the dire lack thereof. Recent efforts to spotlight the lack of high quality data in global health has led to somewhat of a data renaissance. And you know it’s a big deal when Bill Gates throws his weight behind it. It seems like every global health innovation talk I go to nowadays portrays data (in all its forms, from big data, predictive analytics, and machine learning) as the ultimate game changer in global health. Data is so much easier to collect now with the various technologies and innovations available. Its potential is pretty obvious and I don’t disagree that data can and will create more positive changes in global health. But every time I attend one of these talks or I get an email alert about another new data innovation challenge, part of me gets really excited and the other part remains skeptical.

Anyone who has tried to implement a data collection initiative in the field, whether for research, monitoring and evaluation, or donor reporting, knows the many challenges faced when working in already resource-limited clinics and hospitals: the questionnaires are long and time consuming, we don’t have the resources to hire people to do just data collection (which is especially true in smaller facilities), data collection activities take away from clinical activities, data quality is poor, the staff spends a whole week every month doing reporting, every donor wants a report on different indicators, no one at the clinic knows how or has the time to analyze the data, the data is not in a format that is easy to use, etc. And the list goes on.

One huge barrier to accurate data collection involves the inordinate amount of burden placed on health care providers and/or clinic staff to collect and report data. Data collection is often a task that already busy doctors and nurses have to undertake in addition to their clinic duties. Hiring an extra data collection person is one solution, but may not always be sustainable outside of a research study setting. Reporting data to donors is not any less painful. It is too often a rote and uncoordinated endeavor. Donors ask for the same data, but sliced and diced in a slightly different way. Those asking for data haven’t exactly done a good job making data collection easy to do. Shorter questionnaires, standardizing indicators, simplifying and coordinating reporting are different approaches for addressing these issues. Getting providers and clinic staff to collect high quality data though is another beast. Some argue that doing regular data audits will fix the data quality problem. Others argue that mobile data collection has reduced data entry errors. Mobile data collection has certainly made it easier to collect data and scale-up data collection activities.

And while a lot of work is being undertaken by major development agencies and smaller NGOs alike to improve their data collection efforts in order to deliver on the promise that data has to offer, I’m not entirely convinced we’re there yet. A huge part of my skepticism in why data hasn’t yet reached its transformative power in global health is because even though I think we’ve spent lots of resources in building capacity to collect data, we haven’t spent equal amounts of efforts building capacity for local team members to use the data in a meaningful way.

If those who collect the data don’t understand why or how the indicators they collect impact patient care, then why do it? Although national level data is helpful in understanding what the different health needs are and how to allocate resources to address them, the interventions needed to dramatically move the needle when it comes to decreasing morbidity and mortality happen at the individual facility level, outside of the research setting. The frontline healthcare workers that help in the collection and reporting of data very rarely get the data back in a way that can help them understand how to improve care delivery and health outcomes for their patients.

I believe in the potential of data to transform global health but there are many obstacles to overcome before this happens. First things first, instead of thinking about data collection as an activity that providers and clinic staff have to do, it should be an activity they want to do. By having data available to providers that is easy to understand, timely, and meaningful, only then can the promise that data holds for transforming global health be fulfilled.

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The Importance of LGBT Cultural-Competency: A Discussion Towards an Inclusive Approach

The LGBT community is diverse. Although L, G, B, and T are often tied together as an acronym that suggests homogeneity, each letter represents a wide range of individuals of different races, ethnicities, ages, socioeconomic status and identities. Each letter deserves the same amount of care, attention and healthcare services. Sadly, what binds them together as social and gender minorities, especially in international countries, are the common experiences of stigma and discrimination that occur within healthcare, the struggle of living at the intersection of many cultural backgrounds and trying to be a part of each. With respect to healthcare, a long history of discrimination, overall lack of awareness, and simple education of health needs by health professionals. As a result, LGBT people face a common set of challenges in accessing culturally-competent health services and achieving the highest possible level of health. Continue reading “The Importance of LGBT Cultural-Competency: A Discussion Towards an Inclusive Approach”

Global News Round Up

Politics & Policies

A study shows a significant reduction in the India-Nepal drug trade due to the 2015-2016 Indian blockade and thus, potentially leading to shortage of medicines.

Since FY 2010, U.S. funding for global health has remained relatively flat. The FY 2018 President’s budget request proposes to reduce global health funding to $7.9 B, its lowest level since FY 2008.

Guided by the country’s oldest community-based health promotion project Nizwa Healthy Lifestyle Project (NHLP), businesses and communities in the Sultanate of Oman have joined forces to lead the charge against non-communicable diseases.

Yesterday, Global Health Council (GHC) applauded U.S. Senators Susan Collins (R-ME) and Chris Coons (D-DE) who led a bipartisan group of 10 Senators to reintroduce the Reach Every Mother and Child Act (S.1730).  This bipartisan legislation aims to accelerate the reduction of preventable child, newborn, and maternal deaths, putting us within reach of the global commitment to end these deaths within a generation

Programs, Grants & Awards

The WHO has launched the consultation of the draft global action plan to promote physical activity. The overarching goal is to get 100 million people more active by 2030.

Ethiopia will host an International Conference on Maternal and Child health on August 24th and 25th, the theme of which will be “Overcoming critical obstacles to maternal and child survival”.

Distance education graduate courses led by USC faculty are attracting students from around the world to virtual classrooms where they learn about global health leadership and ethics.

Hear from experts in the field, participate in collaborative exercises and network with colleagues at the 2018 UC Global Health Institute’s Women’s Health, Gender and Empowerment Center of Expertise annual retreat.

This year, five new trainees will join the Global Health Pathway for Residents and Fellows, administered by the Duke Hubert-Yeargan Center for Global Health, a part of the Duke Global Health Institute (DGHI).

Research

In this study in French Guiana involving 12 men with ZIKV (Zika Virus) infection for whom semen samples were available, we determined the prevalence of ZIKV RNA, the duration of ZIKV persistence and potential intermittent ZIKV excretion.

Results from a new study shows that people who do not eat a Western diet (such as the Hadza people in Tanzania) have greater diversity of microbes in their guts. Additionally, Western diet seems to lead to a loss of certain bacterial species.

Diseases & Disasters

A woman’s body was discovered as Harvey’s floodwaters started dropping, while Texas says more than 48,700 homes have been affected.

Crews in Texas have found the bodies of 21 victims of Harvey’s wrath, and warned on Wednesday that the number of dead would almost certainly rise as water levels across much of the Houston area start to recede.

City officials in Houston imposed an overnight curfew to guard against opportunistic crimes as Tropical Storm Harvey continued to deluge southeast Texas on Tuesday, breaking the record for the most extreme rainfall on the U.S. mainland.

Emergency workers rescued many more soaked and frightened people in southeast Texas on Tuesday as floodwaters continued to rise and officials counseled patience, warning that conditions would not improve soon.

Tropical Storm Harvey is causing catastrophic flooding along the Texas Gulf Coast as the storm lingers and continues to drop record-breaking rainfall.  Houston is experiencing unprecedented flooding, with shoulder-high water in some areas after a 20-plus-inch rainfall, and Houston Police Chief Art Acevedo calling it “a 500-year event.”

The cholera outbreak in Yemen is overwhelmingly affecting rebel-controlled areas due to Saudi-led air strikes and blockades, according to a letter by researchers from Queen Mary University of London, published in The Lancet Global Health.

Sierra Leone, a country that has been battered by Ebola, civil war and massive floods, suffered yet another tragedy this week,  Government and international aid workers are racing the clock to find survivors after a mudslide struck capital city Freetown early Monday morning.

Of the many steps governments can take to prevent people from getting sick, none can save more lives than reducing tobacco use.  Around the world, 1 in every 10 deaths is caused by tobacco.  In the 20th century, tobacco use killed 100 million people, far more than World War I and II—and most of the other major wars of the past century—combined. In the 21st century, unless we act, tobacco could kill a billion people.

The Cholera epidemic in Yemen is on track to claim more than 2500 lives in the coming months. At the current rate, this easily treatable disease could kill more people than the 2013-2015 Ebola epidemic in Guinea.

Technology

Using a walkie-talkie app called Zello, volunteers in Houston and beyond (including a woman in New Jersey) have established a parallel emergency response network to supplement overwhelmed government agencies, according to The New Yorker. Volunteer dispatchers field desperate calls for help and coordinate volunteer boaters trying to reach the stranded.

Royal Philips, a global leader in health technology, today announced an agreement with Lakeland Health to integrate the Philips IntelliVue Guardian Solution with automated Early Warning Scoring (FWS) at all three of the Lakeland Health’s hospitals. The IntelliVue Guardian Solution contains software and intelligent clinical decision algorithms allowing caregivers to accurately obtain vital signs and seamlessly integrate validated patient data directly to the EHR – reducing human errors and saving time.

Environmental Health

Bad news for humans about the spread of mosquito-borne disease as climate change continues to worsen. New research from the University of Notre Dame, recently published in PLOS Neglected Tropical Diseases, proposes a new way that climate change could contribute to mosquitos’ capacity to drive disease epidemics. As climate change continues to rise, so could the speed of epidemics of mosquito-borne diseases like dengue and Zika.

Equity & Disparities

Adolescent girls living in neighborhoods with wide salary gaps and low-income households showed increased thinning in the brain’s cortical thickness, which could indicate higher levels of stress.

Violence, preventable diseases and traffic accidents are to blame for a widening of the youth mortality gap between the developed and developing world, according to a new Guardian analysis of the most recent World Health Organisation (WHO) data.

Maternal, Neonatal & Children’s Health

Globally, nearly eight out of every 1,000 children in the general population Iis estimated to have Fetal Alcohol Spectrum Disorder (FASD), according to a new study by the Centre for Addiction and and Mental Health (CAMH).

Results from a large clinical trial of a specific combination of oral preparation of probiotics  in newborns in India showed a 40% reduction in sepsis and deaths in the first 2 months of infancy. The trial ended early because it proved to be so effective.

Results from the secondary data analysis from the Child Health Epidemiology Reference Group (CHERG) shows that one in five infants are born small for gestational age and one in four neonatal deaths occur among such infants.

A global study reveals that nearly 8 in every 1000 babies are born with fetal alcohol syndrome.

 

The Evaluation and Measurement of Health Literacy

This is a guest blog post by Dr. Heather F. de Vries McClintock PhD MSPH MSW, IH Section Member and Assistant Professor in the Department of Public Health, College of Health Sciences at Arcadia University. It is the third blog in a three-part series the IH Blog will feature this summer, Global health literacy: Conceptual basis, measurement and implications.

Part III. The Evaluation and Measurement of Health Literacy

While the IOM’s (now National Academy of Medicine) definition of health literacy (HL) is recognized and accepted, there is a lack of standardization in its conceptualization and operationalization within and between countries. Initially HL was perceived as a derivation of literacy with it’s primary purpose serving to as important tools to maximize comprehension during clinical encounters. In recent years the meaning and purpose of HL have broadened in scope to incorporate a health promotion perspective. This expanded and dynamic definition has resulted in increased utility in both clinical medicine and public health but has left this construct susceptible to conceptual drift.  A recent systematic review of the construct of HL found 17 varying definitions and 12 conceptual models that were employed in the literature.  

According to IOM’s report Health Literacy: Improving Health, Health Systems, and Health Policy Around the World: Workshop Summary, countries around the world have used a wide range of designs and approaches as well as purposes for examining HL.  These approaches have involved the usage of proxies such as education, income, or literacy to approximate HL. Other countries have relied on single items, often as a part of other measures (e.g. school attendance/enrollment, reading score), to evaluate HL. Thus, currently there is lack of comparability between estimates of HL within and between countries. Furthermore, the validity of many measures in assessing IOM’s definition of HL remains unclear. It is important to note that nearly all of the studies in this review were conducted in high income countries. Very little research has constructed a measure for use in LICs and LMICs. A robust measure of HL provides the foundation for comparison of HL across countries as well as its evaluation in relation to health outcomes.

My colleagues and I (see acknowledgements below) sought to develop a robust measure of HL using data from Demographic Health Surveys (DHS) conducted between 2006-2015 in 14 developing countries: Cameroon, Democratic Republic of the Congo, Ethiopia, Ghana, Guinea, Ivory Coast, Lesotho, Rwanda, Niger, Namibia, Sierra Leone, Swaziland, Toto, and Zambia. The same survey was administered in all countries, after translation into versions appropriate by language.  The DHS Program is administered by the United States Agency for International Development (USAID). Beginning in 1984, surveys have been administered in over 90 countries. The DHS survey includes items that represent domains of the IOM definition of HL. We identified eight survey questions that corresponded to elements of the four domains of health literacy as defined by the IOM: capacity to interpret, capacity to obtain, capacity to understand, and ability to make appropriate health decisions. We then applied factor analysis methods to extract a single factor – a measure of health literacy – and evaluate the results for reliability and validity.

In our work, a total of 259,684 individuals between the ages of 15 and 49 years were included.  The derived dichotomous measure of health literacy demonstrated internal consistency (Cronbach’s α = 0.72), good content validity, and importantly, was comprised of the elements described by the IOM.  The prevalence of high health literacy overall was 35.2%.  Health literacy varied by sex (females, 34.1% vs males, 39.2%) and education level (primary education or less, 8.9%, some secondary education, 69.4%, secondary education or higher, 84.4%). Health literacy varied considerably across nations, from 8.5% in Niger to 63.9% in Namibia.  

This was the first study to derive a robust indicator of health literacy following the IOM definition in a large number of national samples. In future work we plan to use this indicator with DHS datasets to measure health literacy in other countries, and ultimately test how health literacy relates to health behavior and outcomes, including for HIV/AIDS and domestic violence. An abstract of these findings was published in the Lancet Global Health, Volume 5, Special Issue, S18, April 2017.

Acknowledgements:

The following individuals contributed to the investigation of HL as discussed in this blog series:

Douglas J. Wiebe, Phd, Associate Professor, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania

Julia M. Alber, Phd, Postdoctoral Fellow, Center for Health Behavior Research, University of Pennsylvania

Sara M. Schrauben, MD, Renal Research Epidemiology Fellow, University of Pennsylvania

Carmella M. Mazzola, College of Health Sciences, Arcadia University

Ashley Andrews, MPH, Perelman School of Medicine, University of Pennsylvania

McClintock.Picture

Dr. Heather F. de Vries McClintockis currently Assistant Professor of Public Health at the College of Health Sciences at Arcadia University. Her research broadly focuses on the prevention, treatment, and management of chronic disease and disability globally. Recent research aims to understand and improve health literacy and the quality of care provision for persons in Sub-Saharan Africa.

 

 

CARPHA Conference 2018 – Call for Papers

63rd ANNUAL CARPHA (The Caribbean Public Health Agency) Health Research Conference
June 14th – 16th, 2018

CALL FOR PAPERS
DEADLINE FOR RECEIPT OF PAPERS
January 8th 2018

Theme:
‘Sustainable Health Systems for Economic Growth, Development and Wealth’

The 63rd Annual CARPHA Health Research Conference will be held from June 14th to June 16th, 2018.  The theme for 2018 is ‘Sustainable Health Systems for Economic Growth, Development and Wealth’ however, we will also accept quality research papers in all priority health areas (e.g. NCD, HIV, Health Systems, etc.) Sustainable Health Systems for Economic Growth, Development and Wealth comprises topics such as: Health Insurance systems, health financing in SIDS, health as a human right – the financial implementations, cost of prevention vs cure, cost of natural disasters on health and development, cost of poor health on economic development and cost of NCDs on development.

Selection of Papers
Papers are selected based on scientific merit and relevance to the health priorities areas of the Caribbean. As a guide, Poster presentations are preferable for papers that contain large amounts of data, deal with particular techniques, report highly specialized work, ‘research in progress’ and ‘programmes being implemented’. Authors whose papers are accepted, but who do not present will not have their papers considered for the next two years unless they have a good reason, such as:

  • acute illness
  • loss or bereavement
  • hardship or trauma

Prizes
The David Picou Young Researcher Prize is awarded for the best paper presented by a Caribbean investigator who is not yet an established researcher.

The criteria for being considered is as follows:

  • Age: 40 years or less
  • Qualifications: At least a 1st degree, including a medical degree
  • Work experience: Working in a health-related environment in a position considered junior; e.g. below senior lecturer/consultant grade
  • Nationality: must be a Caribbean national; may be based in an institution abroad (Persons who wish to be considered for the David Picou prize are to send
    a letter clearly answering the above questions.)

Student Prize will be awarded to the best paper presented by a student/student group.
(Persons who wish to be considered for the Student prizes should indicate such in the transmittal letter).

Poster Prize is awarded for the best poster.

For more information:
https://gallery.mailchimp.com/f93f457ff9c6f7046ff32bf20/files/e1e77763-fdab-4f16-bebb-0d3f54855e1e/CallForPapers2018_Final.pdf