Justin Fenty

London School of Hygiene and Tropical Medicine, Londinium, England, United Kingdom

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Publications (15)131.9 Total impact

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    ABSTRACT: Southern Africa has had an unprecedented increase in the burden of tuberculosis, driven by the HIV epidemic. The Zambia, South Africa Tuberculosis and AIDS Reduction (ZAMSTAR) trial examined two public health interventions that aimed to reduce the burden of tuberculosis by facilitating either rapid sputum diagnosis or integrating tuberculosis and HIV services within the community. ZAMSTAR was a community-randomised trial done in Zambia and the Western Cape province of South Africa. Two interventions, community-level enhanced tuberculosis case-finding (ECF) and household level tuberculosis-HIV care, were implemented between Aug 1, 2006, and July 31, 2009, and assessed in a 2×2 factorial design between Jan 9, 2010, and Dec 6, 2010. All communities had a strengthened tuberculosis-HIV programme implemented in participating health-care centres. 24 communities, selected according to population size and tuberculosis notification rate, were randomly allocated to one of four study groups using a randomisation schedule stratified by country and baseline prevalence of tuberculous infection: group 1 strengthened tuberculosis-HIV programme at the clinic alone; group 2, clinic plus ECF; group 3, clinic plus household intervention; and group 4, clinic plus ECF and household interventions. The primary outcome was the prevalence of culture-confirmed pulmonary tuberculosis in adults (≥18 years), defined as Mycobacterium tuberculosis isolated from one respiratory sample, measured 4 years after the start of interventions in a survey of 4000 randomly selected adults in each community in 2010. The secondary outcome was the incidence of tuberculous infection, measured using tuberculin skin testing in a cohort of schoolchildren, a median of 4 years after a baseline survey done before the start of interventions. This trial is registered, number ISRCTN36729271. Prevalence of tuberculosis was evaluated in 64 463 individuals randomly selected from the 24 communities; 894 individuals had active tuberculosis. Averaging over the 24 communities, the geometric mean of tuberculosis prevalence was 832 per 100 000 population. The adjusted prevalence ratio for the comparison of ECF versus non-ECF intervention groups was 1·09 (95% CI 0·86-1·40) and of household versus non-household intervention groups was 0·82 (0·64-1·04). The incidence of tuberculous infection was measured in a cohort of 8809 children, followed up for a median of 4 years; the adjusted rate ratio for ECF versus non-ECF groups was 1·36 (95% CI 0·59-3·14) and for household versus non-household groups was 0·45 (0·20-1·05). Although neither intervention led to a statistically significant reduction in tuberculosis, two independent indicators of burden provide some evidence of a reduction in tuberculosis among communities receiving the household intervention. By contrast the ECF intervention had no effect on either outcome. Bill & Melinda Gates Foundation.
    The Lancet 07/2013; 382(9899). DOI:10.1016/S0140-6736(13)61131-9 · 45.22 Impact Factor
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    ABSTRACT: To determine the effect of weekly low-dose vitamin A supplementation on cause-specific mortality in women of reproductive age in Ghana. A cluster-randomized, triple-blind, placebo-controlled trial was conducted in seven districts of the Brong Ahafo region of Ghana. Women aged 15-45 years who were capable of giving informed consent and intended to live in the trial area for at least 3 months were enrolled and randomly assigned, according to their cluster of residence, to receive oral vitamin A (7500 μg) or placebo once a week. Randomization was blocked, with two clusters in each fieldwork area allocated to vitamin A and two to placebo. Every 4 weeks, fieldworkers distributed capsules and collected data during home visits. Verbal autopsies were conducted by field supervisors and reviewed by physicians, who assigned a cause of death. Cause-specific mortality rates in both arms were compared by means of random-effects Poisson regression models to allow for the cluster randomization. Analysis was by intention-to-treat, based on cluster of residence, with women eligible for inclusion once they had consistently received the supplement or placebo capsules for 6 months. The analysis was based on 581 870 woman-years and 2624 deaths. Cause-specific mortality rates were found to be similar in the two study arms. Low-dose vitamin A supplements administered weekly are of no benefit in programmes to reduce mortality in women of childbearing age.
    Bulletin of the World Health Organisation 02/2013; 91(1):19-27. DOI:10.2471/BLT.11.100412 · 5.09 Impact Factor
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    ABSTRACT: This paper presents a method employed in building a semantically annotated corpus of 11,741 Verbal Autopsy documents, each annotated with Cause of Death, based on verbal records of deaths of mothers, stillbirths, and infants up to 1 year of age, captured for analysis in Ghana between December 2000 and July 2010. Verbal Autopsy is a technique which involves interviewing individu-als (such as relatives or caregivers) who were close to the deceased, and if pos-sible, who cared for the individual around the time of death, to document events that may have led to the individuals' death. The Verbal Autopsy technique is rec-ommended by the World Health Organisation as a pragmatic substitute for a clinical autopsy to establish cause of death in regions such as sub-Saharan Africa where death may occur well away from clinical services. An evaluation is carried out based on established criteria to demonstrate that the Verbal Autopsy corpus possesses the qualities of many referenced corpora. The experiences drawn from the methods employed, with alternative approaches, may lead to a more efficient and cost effective corpus development framework.
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    ABSTRACT: Background Many sub-Saharan countries, including Ghana, have introduced policies to provide free medical care to pregnant women. The impact of these policies, particularly on access to health services among the poor, has not been evaluated using rigorous methods, and so the empirical basis for defending these policies is weak. In Ghana, a recent report also cast doubt on the current mechanism of delivering free care – the National Health Insurance Scheme. Longitudinal surveillance data from two randomized controlled trials conducted in the Brong Ahafo Region provided a unique opportunity to assess the impact of Ghana’s policies. Methods We used time-series methods to assess the impact of Ghana’s 2005 policy on free delivery care and its 2008 policy on free national health insurance for pregnant women. We estimated their impacts on facility delivery and insurance coverage, and on socioeconomic differentials in these outcomes after controlling for temporal trends and seasonality. Results Facility delivery has been increasing significantly over time. The 2005 and 2008 policies were associated with significant jumps in coverage of 2.3% (p = 0.015) and 7.5% (p<0.001), respectively after the policies were introduced. Health insurance coverage also jumped significantly (17.5%, p<0.001) after the 2008 policy. The increases in facility delivery and insurance were greatest among the poorest, leading to a decline in socioeconomic inequality in both outcomes. Conclusion Providing free care, particularly through free health insurance, has been effective in increasing facility delivery overall in the Brong Ahafo Region, and especially among the poor. This finding should be considered when evaluating the impact of the National Health Insurance Scheme and in supporting the continuation and expansion of free delivery care.
    PLoS ONE 11/2012; 7(11):e49430. DOI:10.1371/journal.pone.0049430 · 3.23 Impact Factor
  • International Journal of Gynecology & Obstetrics 10/2012; 119:S332-S333. DOI:10.1016/S0020-7292(12)60636-5 · 1.54 Impact Factor
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    ABSTRACT: Objectives To assess the effect of vitamin A supplementation in women of reproductive age in Ghana on cause- and age-specific infant mortality. In addition, because of recently published studies from Guinea Bissau, effects on infant mortality by sex and season were assessed. Design Double-blind, cluster-randomised, placebo-controlled trial. Setting 7 contiguous districts in the Brong Ahafo region of Ghana. Participants All women of reproductive age (15-45 years) resident in the study area randomised by cluster of residence. All live born infants from 1 June 2003 to 30 September 2008 followed up through 4-weekly home visits. Intervention Weekly low-dose (25 000 IU) vitamin A. Main outcome measures Early infant mortality (1-5 months); late infant mortality (6-11 months); infection-specific infant mortality (0-11 months). Results 1086 clusters, 62 662 live births, 52 574 infant-years and 3268 deaths yielded HRs (95% CIs) comparing weekly vitamin A with placebo: 1.04 (0.88 to 1.05) early infant mortality; 0.99 (0.84 to 1.18) late infant mortality; 1.03 (0.92 to 1.16) infection-specific infant mortality. There was no evidence of modification of the effect of vitamin A supplementation on infant mortality by sex (Wald statistic =0.07, p=0.80) or season (Wald statistic =0.03, p=0.86). Conclusions This is the largest analysis of cause of infant deaths from Africa to date. Weekly vitamin A supplementation in women of reproductive age has no beneficial or deleterious effect on the causes of infant death to age 6 or 12 months in rural Ghana. Trial registration number http://ClinicalTrials.gov: NCT00211341.
    BMJ Open 01/2012; 2(1):e000658. DOI:10.1136/bmjopen-2011-000658 · 2.27 Impact Factor
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    ABSTRACT: Clean delivery of newborns is a key intervention for reducing infection-related neonatal mortality. Understanding local practices and beliefs is important for designing appropriate interventions. There are few data from Africa. This study explored delivery practices in Ghana to identify behaviors for intervention and to determine behavioral influencers. Data on the prevalence of clean delivery behaviors, collected through a demographic surveillance system, were analyzed for 2631 women who delivered at home within a 1-year period. Qualitative data on delivery practices were collected through birth narratives, in-depth interviews, and focus groups with recently delivered/pregnant women, traditional birth attendants, grandmothers, and husbands. Most women delivered on a covered surface (79%), had birth attendants who washed their hands (79%), cut the cord with a new blade (98%), and tied it with a new thread (90%). Eight percent of families practiced dry cord care. Families understood the importance of a clean delivery surface and many birth attendants knew the importance of hand-washing. Delivering on an uncovered surface was linked to impromptu deliveries and a belief that a swept floor is clean. Not washing hands was linked to rushing to help the woman, not being provided with soap, forgetfulness, and a belief among some that the babies are born dirty. The frequent application of products to the cord was nearly universal and respondents believed that applying nothing to the cord would have serious negative consequences. Delivery surfaces, hand-washing, and cord cutting and tying appear appropriate for the majority of women. Changing cord care practices is likely to be difficult unless replacement products are provided.
    The Pediatric Infectious Disease Journal 11/2010; 29(11):1004-8. DOI:10.1097/INF.0b013e3181f5ddb1 · 2.72 Impact Factor
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    ABSTRACT: A previous trial in Nepal showed that supplementation with vitamin A or its precursor (betacarotene) in women of reproductive age reduced pregnancy-related mortality by 44% (95% CI 16-63). We assessed the effect of vitamin A supplementation in women in Ghana. ObaapaVitA was a cluster-randomised, double-blind, placebo-controlled trial undertaken in seven districts in Brong Ahafo Region in Ghana. The trial area was divided into 1086 small geographical clusters of compounds with fieldwork areas consisting of four contiguous clusters. All women of reproductive age (15-45 years) who gave informed consent and who planned to remain in the area for at least 3 months were recruited. Participants were randomly assigned by cluster of residence to receive a vitamin A supplement (25 000 IU retinol equivalents) or placebo capsule orally once every week. Randomisation was blocked and based on an independent, computer-generated list of numbers, with two clusters in each fieldwork area allocated to vitamin A supplementation and two to placebo. Capsules were distributed during home visits undertaken every 4 weeks, when data were gathered on pregnancies, births, and deaths. Primary outcomes were pregnancy-related mortality and all-cause female mortality. Cause of death was established by verbal post mortems. Analysis was by intention to treat (ITT) with random-effects regression to account for the cluster-randomised design. Adverse events were synonymous with the trial outcomes. This trial is registered with ClinicalTrials.gov, number NCT00211341. 544 clusters (104 484 women) were randomly assigned to vitamin A supplementation and 542 clusters (103 297 women) were assigned to placebo. The main reason for participant drop out was migration out of the study area. In the ITT analysis, there were 39 601 pregnancies and 138 pregnancy-related deaths in the vitamin A supplementation group (348 deaths per 100 000 pregnancies) compared with 39 234 pregnancies and 148 pregnancy-related deaths in the placebo group (377 per 100 000 pregnancies); adjusted odds ratio 0.92, 95% CI 0.73-1.17; p=0.51. 1326 women died in 292 560 woman-years in the vitamin A supplementation group (453 deaths per 100 000 years) compared with 1298 deaths in 289 310 woman-years in the placebo group (449 per 100 000 years); adjusted rate ratio 1.01, 0.93-1.09; p=0.85. The body of evidence, although limited, does not support inclusion of vitamin A supplementation for women in either safe motherhood or child survival strategies. UK Department for International Development, and USAID.
    The Lancet 05/2010; 375(9726):1640-9. DOI:10.1016/S0140-6736(10)60311-X · 45.22 Impact Factor
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    ABSTRACT: The potential health effects of the manufacture and use of crop protection chemicals were investigated through systematic review and meta-analysis of studies of cohorts of workers in the crop protection product manufacturing industry. Several computerised literature databases were searched from inception until December 2003, with references listed in identified articles checked for further relevant articles. Random effects meta-analyses of log standardised mortality ratios (SMRs) were carried out. Heterogeneity was explored through subgroup analyses and meta-regression; sensitivity analyses of different approaches for zero events were performed. 21 references reporting information on 37 separate cohorts for mortality were identified. The meta-SMR for all cause mortality was 0.94 (95% CI 0.88 to 1.00) (37 cohorts). Significantly raised mortality was found for cancers of the buccal cavity and pharynx, oesophagus, rectum, larynx, lung, and lymphatic and haematopoietic system with little heterogeneity being observed. Excluding studies with zero events identified additional excesses. Evidence of multiple excesses, particularly in subgroups exposed to phenoxy herbicides contaminated with dioxins, substantiates previous findings. The importance of careful treatment of zero cases was highlighted. Future systematic reviews and meta-analyses would benefit from availability of results for a standard list of causes of disease.
    Occupational and environmental medicine 02/2009; 66(1):7-15. DOI:10.1136/oem.2007.035733 · 3.27 Impact Factor
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    ABSTRACT: Production of synthetic rubber involves exposure to several potentially harmful chemicals. The authors carried out a systematic review and meta-analysis of cohort studies of workers in the rubber-producing industry. Data were obtained from computerized literature searches of several databases from their inception through December 2003. The reference lists of identified articles were inspected for further relevant articles. The authors conducted random-effects meta-analyses of log standardized mortality ratios (SMRs)/standardized incidence ratios. Heterogeneity between study results was explored through subgroup analyses and meta-regression on cohort demographic factors and study quality indicators. The authors identified 36 published articles reporting information on 31 different cohort groups. The meta-SMR was 0.86 (95% confidence interval (CI): 0.82, 0.91) for all-cause mortality (28 cohorts) and 0.94 (95% CI: 0.89, 1.01) for all malignant neoplasms (27 cohorts). Heterogeneity was observed for these endpoints and for the majority of disease-specific outcomes. Statistically significant excesses were observed for diabetes (meta-SMR=1.36, 95% CI: 1.17, 1.59) (five cohorts) and leukemia (meta-SMR=1.21, 95% CI: 1.03, 1.43) (16 cohorts), the latter particularly for persons working exclusively in nontire manufacturing (meta-SMR=1.70, 95% CI: 1.14, 2.54) (four cohorts). Excesses highlighted in previous narrative reviews were not substantiated. Interpretation of these results is complicated by substantial unexplainable heterogeneity; small excesses in specific mortality outcomes may have been disguised by the healthy worker effect.
    American Journal of Epidemiology 10/2006; 164(5):405-20. DOI:10.1093/aje/kwj252 · 5.23 Impact Factor
  • Eurosurveillance: bulletin europeen sur les maladies transmissibles = European communicable disease bulletin 02/2006; 11(6):E060622.4. · 5.72 Impact Factor
  • Epidemiology 09/2005; 16(5). DOI:10.1097/00001648-200509000-00227 · 6.20 Impact Factor
  • Epidemiology 07/2004; 15(4). DOI:10.1097/00001648-200407000-00331 · 6.20 Impact Factor
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    ABSTRACT: Unregistered deaths account for over 67 percent of global annual deaths. These deaths occur in poor resource countries where no or weak death registration system exists. Verbal Autopsy is a technique recommended by the World Health Organization (WHO) to determine the causes of deaths in countries with poor death registration systems. Traditional approaches to the analysis and prediction of causes of death from verbal autopsies have several limitations, and computational approaches are being developed to address. Ongoing research aims to extend the current computational approaches by employing corpus linguistics and natural language processing with machine learning approaches to predict causes of death from Verbal Autopsies. In this paper, we present the corpus to be used for this research. We demonstrate that the Verbal Autopsy corpus has properties of human language and similarities to other corpora. Apart from the primary objective of predicting causes of death, this corpus has potential, to be of interest for other linguistic research.

Publication Stats

166 Citations
131.90 Total Impact Points


  • 2010–2013
    • London School of Hygiene and Tropical Medicine
      • • Faculty of Public Health and Policy
      • • Faculty of Epidemiology and Population Health
      Londinium, England, United Kingdom
  • 2012
    • University of Nottingham
      • University of Nottingham Clinical Trials Unit
      Nottigham, England, United Kingdom
  • 2009
    • University of Leicester
      • Department of Health Sciences
      Leiscester, England, United Kingdom