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Introduction
Current institution
Additional affiliations
February 2017 - May 2017
Publications
Publications (89)
Background: Inappropriate antibiotic use drives antimicrobial resistance and remains a global concern. Evidence suggests antibiotic use may be higher among malaria-negative patients compared to malaria-positive ones, but uncertainty persists, particularly in regions with varying malaria prevalence. This study measured antibiotic residuals in three...
Purpose
Maternal mortality in Malawi is high, with low coverage of maternity care being a contributing factor. To improve maternal health coverage, an Android-based, integrated mobile health (mHealth) app called YendaNafe was introduced to community health workers (CHWs) in the Neno district, rural Malawi. This study evaluates the impact of this ap...
Digital clinical decision support algorithms (CDSAs) that guide healthcare workers during consultations can enhance adherence to guidelines and the resulting quality of care. However, this improvement depends on the accuracy of inputs (symptoms and signs) entered by healthcare workers into the digital tool, which relies mainly on their clinical ski...
Digital clinical decision support tools have contributed to improved quality of care at primary care level health facilities. However, data from real-world randomized trials are lacking. We conducted a cluster randomized, open-label trial in Tanzania evaluating the use of a digital clinical decision support algorithm (CDSA), enhanced by point-of-ca...
Background
The use of mobile health technology (mHealth) by community health workers (CHWs) can strengthen community-based service delivery and improve access to and quality of healthcare.
Objective
This qualitative study sought to explore experiences and identify factors influencing the use of an integrated smartphone-based mHealth called YendaNa...
Digital clinical decision support tools have contributed to improved quality of care at primary care level health facilities. However, data from real-world randomized trials are lacking.
We conducted a cluster randomized, open-label trial in Tanzania evaluating the use of a digital clinical decision support algorithm (CDSA), enhanced by point-of-ca...
Objective
To retrospectively analyse routinely collected data on the drivers and barriers to retention in chronic care for patients with hypertension in the Kono District of Sierra Leone.
Design
Convergent mixed-methods study.
Setting
Koidu Government Hospital, a secondary-level hospital in Kono District.
Participants
We conducted a descriptive...
BACKGROUND
Limited information exists on the impact of mobile health (mHealth) use by community health workers (CHWs) on improving maternal health services in sub-Saharan Africa (SSA).
OBJECTIVE
This mixed method systematic review addresses two objectives: 1) The impact of mHealth use by CHWs on antenatal care (ANC), facility-based births, and pos...
Background
Limited information exists on the impact of mobile health (mHealth) use by community health workers (CHWs) on improving the use of maternal health services in sub-Saharan Africa (SSA).
Objective
This systematic review addresses 2 objectives: evaluating the impact of mHealth use by CHWs on antenatal care (ANC) use, facility-based births,...
Excessive antibiotic use and antimicrobial resistance are major global public health threats. We developed ePOCT+, a digital clinical decision support algorithm in combination with C-reactive protein test, hemoglobin test, pulse oximeter and mentorship, to guide health-care providers in managing acutely sick children under 15 years old. To evaluate...
Introduction
Children account for a significant proportion of antibiotic consumption in low- and middle-income countries, with the overuse of antibiotics occurring in both formal and informal health sectors. This study assessed the prevalence and predictors of residual antibiotics in children’s blood in Mbeya and Morogoro regions of Tanzania.
Meth...
Objective:
To compare the impact of a teen club model to the standard care model on HIV treatment outcomes among adolescents (10-19 years of age).
Design:
Retrospective cohort study.
Setting:
HIV clinics in Neno district, Malawi.
Participants:
Adolescents living with HIV enrolled in teen clubs (n=235) and matched participants in standard HIV...
Clinical Decision Support Systems (CDSS) have the potential to improve and standardise care with probabilistic guidance. However, many CDSS deploy static, generic rule-based logic, resulting in inequitably distributed accuracy and inconsistent performance in evolving clinical environments. Data-driven models could resolve this issue by updating pre...
Excessive antibiotic use and antimicrobial resistance are major global public health threats. We developed ePOCT+, a digital Clinical Decision Support Algorithm in combination with C-reactive protein test, haemoglobin test, pulse oximeter and mentorship, to guide healthcare providers in managing acutely sick children under 15 years old. To evaluate...
Background
Schistosomiasis and soil-transmitted helminth infections are among the neglected tropical diseases (NTDs) affecting primarily marginalized communities in low- and middle-income countries. Surveillance data for NTDs are typically sparse, and hence, geospatial predictive modeling based on remotely sensed (RS) environmental data is widely u...
High quality health data as collected by health management information systems (HMIS) is an important building block of national health systems. District Health Information System 2 (DHIS2) software is an innovation in data management and monitoring for strengthening HMIS that has been widely implemented in low and middle-income countries in the la...
Electronic clinical decision support algorithms (CDSAs) have been developed to address high childhood mortality and inappropriate antibiotic prescription by helping clinicians adhere to guidelines. Previously identified challenges of CDSAs include their limited scope, usability, and outdated clinical content. To address these challenges we develope...
Objective
In sub-Saharan Africa, 45% of the rural population uses boreholes (BHs). Despite recent gains in improved water access and coverage, parallel use of unimproved sources persists. Periodic infrastructure disrepair contributes to non-exclusive use of BHs. Our study describes functionality of BHs in 2014, 2015, and 2016 in 15 rural towns in t...
BACKGROUND
Studies have shown that mobile health (mHealth) technologies enhance utilization of maternal health services. However, there is limited evidence describing mHealth technology use for maternal health service delivery in sub Saharan Africa where utilization is limited and maternal morbidity and mortality are high.
OBJECTIVE
This systemati...
Background:
Studies have shown that mobile health technologies (mHealth) enhance the use of maternal health services. However, there is limited evidence of the impact of mHealth use by community health workers (CHWs) on the use of maternal health services in sub-Saharan Africa.
Objective:
This mixed method systematic review will explore the impa...
Electronic clinical decision support algorithms (CDSAs) have been developed to address high childhood mortality and inappropriate antibiotic prescription by helping clinicians adhere to guidelines. Previously identified challenges of CDSAs include its limited scope, usability, and outdated clinical algorithms. To address these challenges we develop...
Few studies have developed data-driven indices to describe and compare disease outbreak severity with respect to health burdens. We created a severity index using the National Outbreak Reporting System (NORS) database from 01 January 2009 through 31 December 2019. We identified 11 metrics related to case morbidity/mortality, outbreak duration, and...
Foodborne and waterborne gastrointestinal infections and their associated outbreaks are preventable, yet still result in significant morbidity, mortality and revenue loss. Many enteric infections demonstrate seasonality, or annual systematic periodic fluctuations in incidence, associated with climatic and environmental factors. Public health profes...
Objective: In sub-Saharan Africa, 45% of the rural population uses boreholes (BHs). Despite recent gains in improved water access and coverage, parallel use of unimproved sources persists. Periodic infrastructure disrepair contributes to non-exclusive use of BHs. Our study describes functionality of BHs in 2014, 2015, and 2016 in 15 rural towns in...
This study is an evaluation of the first cohort of patients enrolled in an outpatient non-communicable disease clinic in Kono, Sierra Leone. In the first year, the clinic enrolled 916 patients. Eight months after the enrollment of the last patient, 53% were still active in care, 43% had been lost to follow-up (LTFU) and 4% had defaulted. Of the LTF...
Background
Community health worker (CHW) programmes are a valuable component of primary care in resource-poor settings. The evidence supporting their effectiveness generally shows improvements in disease-specific outcomes relative to the absence of a CHW programme. In this study, we evaluated expanding an existing HIV and tuberculosis (TB) disease-...
Sustainable Development Goal (SDG) 6 aims to achieve universal access to safe drinking water sources. However, the health benefits of meeting this goal will only be fully realized if improved sources are used to the exclusion of unimproved sources. Very little is known about how rural African households balance the use of improved and unimproved wa...
Children's health is affected by the quality of indoor and outdoor environments. In order to prevent environmentally mediated diseases among children, the Member States of the World Health Organization (WHO) European Region adopted the Parma Declaration on Environment and Health in 2010, which includes commitments to provide children with access to...
Soil-transmitted helminth (STH) infections propagate poverty and slow economic growth in low-income countries. As with many other neglected tropical diseases, environmental conditions are important determinants of STH transmission. Hence, remotely sensed (RS) data are commonly utilized in spatial risk models intended to inform control strategies. I...
Schistosomiasis control in sub-Saharan Africa is enacted primarily through preventive chemotherapy. Predictive models can play an important role in filling knowledge gaps in the distribution of the disease and help guide the allocation of limited resources. Previous modeling approaches have used localized cross-sectional survey data and environment...
Background
Knowledge of urogenital schistosomiasis can empower individuals to limit surface water contact and participate in mass drug administration campaigns, but nothing is currently known about the schistosomiasis knowledge that schoolchildren have in Ghana. We developed and implemented a survey tool aiming to assess the knowledge of urogenital...
Background
Schistosomiasis is a water-related neglected tropical disease. In many endemic low- and middle-income countries, insufficient surveillance and reporting lead to poor characterization of the demographic and geographic distribution of schistosomiasis cases. Hence, modeling is relied upon to predict areas of high transmission and to inform...
Sentinel-2 blue band reflectance values.
(TIF)
Sentinel-2 green band reflectance values.
(TIF)
Sentinel-2 NDWI values.
(TIF)
Sentinel-2 short wavelength infrared band reflectance values.
(TIF)
Landsat 8 land surface temperature values.
(TIF)
Sentinel-2 NDVI values.
(TIF)
Sentinel-2 EVI values.
(TIF)
Sentinel-2 SAVI values.
(TIF)
Sentinel-2 MSAVI values.
(TIF)
Interpolated total dissolved solids (TDS) concentration values (in mg/L) derived in ArcGIS from field data.
(TIF)
Interpolated iron concentration values (in mg/l) derived in ArcGIS from field data.
(TIF)
Scatter plots of model predicted (x-axis) vs. observed (y-axis) prevalence values as compared to the line of equality [left]; variable importance values [right] for random forest models conducted with environmental variables from Landsat 8 and topographic variables from GDEM.
(TIF)
Scatter plots of model predicted (x-axis) vs. observed (y-axis) prevalence values as compared to the line of equality [left]; variable importance values [right] for random forest models conducted with environmental variables from Sentinel-2 and topographic variables from GDEM.
(TIF)
Predicted prevalence values using Landsat 8 data (mask 1).
(TIF)
Spearman’s rank correlations among six environmental indices (all are statistically significant; p < 0.05); Sentinel-2 values are shown in top and Landsat 8 in bottom of the matrix.
(XLSX)
Sentinel-2 red band reflectance values.
(TIF)
Sentinel-2 MNDWI values.
(TIF)
Slope values (in degrees) derived from GDEM.
(TIF)
Functional improved water source (FIWS) access values derived in ArcGIS from field data.
(TIF)
Perennial surface water source (SWAP) access values derived in ArcGIS from field data.
(TIF)
Predicted prevalence values using Sentinel-2 data (mask 1).
(TIF)
Predicted prevalence values using Landsat 8 data (mask 2).
(TIF)
Predicted prevalence values using Landsat 8 data (mask 6).
(TIF)
Microhematuria prevalence survey results.
(XLSX)
Sentinel-2 near infrared band reflectance values.
(TIF)
Elevation values (in meters) derived from GDEM.
(TIF)
Slope values derived from GDEM.
(TIF)
Predicted prevalence values using Sentinel-2 data (mask 2).
(TIF)
Predicted prevalence values using Landsat 8 data (mask 4).
(TIF)
Predicted prevalence values using Sentinel-2 data (mask 4).
(TIF)
Predicted prevalence values using Sentinel-2 data (mask 6).
(TIF)
Predicted prevalence values using Landsat 8 data (mask 5).
(TIF)
Predicted prevalence values using Sentinel-2 data (mask 5).
(TIF)
Poor ventilation in schools is associated with accumulation of indoor-generated pollutants, which is associated with “stuffy” air, elevated risk of infectious diseases and impaired learning outcomes. This survey in Albania was conducted as part of WHO’s efforts to facilitate assessments of indoor air quality and other environmental factors in schoo...
Rural Ghanaian communities continue using microbiologically contaminated surface water sources due in part to undesirable organoleptic characteristics of groundwater from boreholes. Our objective was to identify thresholds of physical and chemical parameters associated with consumer complaints related to groundwater. Water samples from 94 boreholes...
Continuous access to adequate quantities of safe water is essential for human health and socioeconomic development. Piped water systems (PWSs) are an increasingly common type of water supply in rural African small towns. We assessed temporal and spatial patterns in water consumption from public standpipes of four PWSs in Ghana in order to assess cl...
90% of the worldwide schistosomiasis burden falls on sub-Saharan Africa. Control efforts are often based on infrequent, small-scale health surveys, which are expensive and logistically difficult to conduct. Use of satellite imagery to predictively model infectious disease transmission has great potential for public health applications. Transmission...
Schistosoma haematobium transmission is influenced by environmental conditions that determine the suitability of the parasite and
intermediate host snail habitats, as well as by socioeconomic conditions, access to water and sanitation infrastructure, and human
behaviors. Remote sensing is a demonstrated valuable tool to characterize environmental c...
Background
Surface water contaminated with human waste may transmit urogenital schistosomiasis (UGS). Water-related activities that allow skin exposure place people at risk, but public health practitioners know little about why some communities with access to improved water infrastructure have substantial surface water contact with infectious water...
The study examined relationships among meteorological parameters, water quality and diarrheal
disease counts in two urban and three rural sites in Tamil Nadu, India. Disease surveillance was
conducted between August 2010 and March 2012; concurrently water samples from street-level taps
in piped distribution systems and from household storage contai...
Few studies assess agreement among Schistosoma haematobium eggs, measured hematuria, and self-reported metrics. We assessed agreement among four metrics at a single time point and analyzed the stability of infection across two time points with a single metric. We used data from the Eastern Region of Ghana and constructed logistic regression models....
Aims:
In this study, the aim was to develop and test an urban green space indicator for public health, as proposed by the World Health Organisation (WHO) Regional Office for Europe, in order to support health and environmental policies.
Methods:
We defined the indicator of green space accessibility as a proportion of an urban population living w...
The Fifth Ministerial Conference on Environment and Health (Parma, Italy, 2010) adopted the Declaration and the Commitment to Act containing the set of targets for the environment and health process. The aim of Declaration was to reduce the harm to children’s health from specific environmental factors. One of the commitments is to provide each chil...
SUMMARY Diarrhoeal diseases are major causes of morbidity and mortality in developing countries. This longitudinal study aimed to identify controllable environmental drivers of intestinal infections amidst a highly contaminated drinking water supply in urban slums and villages of Vellore, Tamil Nadu in southern India. Three hundred households with...
There is growing evidence confirming the utility of meteorological parameters to enhance forecasting and characterize the risk of enteric infections. This research conducted in partnership with the Christian Medical College (CMC) in Vellore, India aims to determine environmental parameters influencing the rate of enteric infections in three rural v...
