Betty Rosamund Kirkwood

Betty Rosamund Kirkwood
London School of Hygiene and Tropical Medicine | LSHTM · Faculty of Epidemiology and Population Health

MA MSc FFPH FMedSci

About

333
Publications
87,482
Reads
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23,212
Citations
Citations since 2017
69 Research Items
9103 Citations
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201720182019202020212022202305001,0001,500
201720182019202020212022202305001,0001,500
Additional affiliations
October 1979 - present
London School of Hygiene and Tropical Medicine
Position
  • Professor (Full)

Publications

Publications (333)
Article
Full-text available
Low and middle-income countries continue to use Verbal autopsies (VAs) as a World Health Organisation-recommended method to ascertain causes of death in settings where coverage of vital registration systems is not yet comprehensive. Whilst the adoption of VA has resulted in major improvements in estimating cause-specific mortality in many settings,...
Preprint
Full-text available
Introduction The Covid-19 pandemic, and societal attempts to control it, have touched almost every aspect of people’s lives around the world, albeit in unequal ways. In particular, there is considerable concern about the way that stringent ‘lockdowns’, as implemented in Kenya and many other countries, affected young children, especially those livin...
Article
Background: Early adversities negatively impact children’s growth and development, putatively mediated by chronic physiological stress resulting from these adverse experiences. We aimed to estimate the associations between prospectively measured cumulative early adversities with growth and cognition outcomes in rural Indian preschool children and t...
Preprint
Background The majority of post-neonatal deaths in children under 5 are due to malaria, diarrhoea and pneumonia (MDP). The WHO recommends integrated community case management (iCCM) of these conditions using community-based health workers. However iCCM programmes have suffered from poor implementation and mixed outcomes. We designed and evaluated a...
Article
Full-text available
Conducting qualitative research within public health trials requires balancing timely data collection with the need to maintain data quality. Verbatim transcription of interviews is the conventional way of recording qualitative data, but is time consuming and can severely delay the availability of research findings. Expanding field notes into fair...
Article
Full-text available
Background Vaccines may induce non-specific effects on survival and health outcomes, in addition to protection against targeted pathogens or disease. Observational evidence suggests that infant Baccillus Calmette-Guérin (BCG) vaccination may provide non-specific survival benefits, while diphtheria-tetanus-pertussis (DTP) vaccination may increase th...
Article
Full-text available
Background: Early adversities negatively impact children’s growth and development, putatively mediated by chronic physiological stress resulting from these adverse experiences. We aimed to estimate the associations between prospectively measured cumulative early adversities with growth and cognition outcomes in rural Indian preschool children and t...
Article
Full-text available
Background Preterm birth is the leading cause of neonatal deaths in low middle-income countries (LMICs), yet there exists a paucity of high-quality data from these countries. Most modelling estimates are based on studies using inaccurate methods of gestational age assessment. We aimed to fill this gap by measuring the population-based burden of pre...
Article
Background: The World Health Organization and others promote responsive caregiving to support all children to thrive, particularly in low- and middle-income countries. The 14-item Mother’s Object Relations Scales – Short Form (MORS-SF) may be of use in research and public health programmes because of its basis in attachment theory and ability to ca...
Article
Full-text available
Background Globally adopted health and development milestones have not only encouraged improvements in the health and wellbeing of women and infants worldwide, but also a better understanding of the epidemiology of key outcomes and the development of effective interventions in these vulnerable groups. Monitoring of maternal and child health outcome...
Article
Full-text available
The World Health Organization (WHO) has a mandate to promote maternal and child health and welfare through support to governments in the form of technical assistance, standards, epidemiological and statistical services, promoting teaching and training of healthcare professionals and providing direct aid in emergencies. The Strategic and Technical A...
Article
Full-text available
Background Successful implementation of community-based research is dominantly influenced by participation and engagement from the local community without which community members will not want to participate in research and important knowledge and potential health benefits will be missed. Therefore, maximising community participation and engagement...
Conference Paper
Full-text available
Background The period through pregnancy and the early years is crucial for optimising child growth, development and lifelong well-being. Son-preference (family desire for male over female children) disadvantages girls through mechanisms including unequal distribution of resources (e.g. food or medicine) and parental-time, abuse, short birth interva...
Article
Full-text available
Preterm birth is the leading cause of child mortality. This study aimed to develop and validate programmatically feasible and accurate approaches to estimate newborn gestational age (GA) in low resource settings. The WHO Alliance for Maternal and Newborn Health Improvement (AMANHI) study recruited pregnant women from population- based cohorts in f...
Article
Full-text available
Objective: To evaluate the associations of depressive symptoms and antidepressant use during pregnancy with the risks of preterm birth, low birth weight, small for gestational age (SGA), and low Apgar scores. Data sources: MEDLINE, EMBASE, ClinicalTrials.gov, and PsycINFO up to June 2016. Methods of study selection: Data were sought from studi...
Article
Full-text available
Background There is an urgent need to fill the gap of scalable cognitive assessment tools for preschool children to enable identification of children at-risk of sub-optimal development and to support their timely referral into interventions. We present the associations between growth in early childhood, a well-established marker of cognitive develo...
Article
Full-text available
Background Maternal morbidity occurs several times more frequently than mortality, yet data on morbidity burden and its effect on maternal, foetal, and newborn outcomes are limited in low- and middle-income countries. We aimed to generate prospective, reliable population-based data on the burden of major direct maternal morbidities in the antenatal...
Article
Full-text available
The early years are critical and inform the developmental trajectory of children. This is justifiably attracting growing policy attention. Much of this attention is focused on interventions and policies directed at parents, especially mothers. Yet emerging evidence suggests that increasing numbers of children in rapidly urbanizing low- and middle-i...
Article
Full-text available
Background: The World Health Organization and others promote responsive caregiving to support all children to thrive, particularly in low- and middle-income countries. The 14-item Mother’s Object Relations Scales – Short Form (MORS-SF) may be of use in research and public health programmes because of its basis in attachment theory and ability to ca...
Article
Full-text available
Introduction The early years are critical. Early nurturing care can lay the foundation for human capital accumulation with lifelong benefits. Conversely, early adversity undermines brain development, learning and future earning. Slums are among the most challenging places to spend those early years and are difficult places to care for a child. Shif...
Article
Full-text available
Background Child undernutrition results in poor growth in early childhood, undermines optimal development and increases the risk of mortality. Responsive feeding has been promoted as a key intervention for improving nutritional status, however measurement of this remains difficult and has rarely considered child behaviour. We therefore developed a...
Article
Full-text available
Background: The Unmet Obstetric Need (UON) indicator has been widely used to estimate unmet need for life-saving surgery at birth; however, its assumptions have not been verified. The objective of this study was to test two UON assumptions: (a) Absolute maternal indications (AMIs) require surgery for survival and (b) 1%-2% of deliveries develop AM...
Article
Full-text available
Background: Maternal and perinatal mortality are still unacceptably high in many countries despite steep increases in facility birth. The evidence that childbirth in facilities reduces mortality is weak, mainly because of the scarcity of robust study designs and data. We aimed to assess this link by quantifying the influence of major determinants...
Article
Full-text available
Background: The majority of the world's children live in low- and middle-income countries and face multiple obstacles to optimal wellbeing. The mechanisms by which adversities - social, cultural, psychological, environmental, economic - get 'under the skin' in the early days of life and become biologically embedded remain an important line of enqu...
Conference Paper
Full-text available
Background and aims Improving early childhood development globally will lead to improved health and wellbeing for all and is key to achieving the ambitious Sustainable Development Goals. Exposure to a cumulative burden of adversity is detrimental to child health and wellbeing across the lifecourse, but the relative importance of the very early year...
Article
Full-text available
Translating the Nurturing Care Framework and unprecedented global policy support for early child development (ECD) into action requires evidence-informed guidance about how to implement ECD programmes at national and regional scale. We completed a literature review and participatory mixed-method evaluation of projects in Saving Brains®, Grand Chall...
Article
Full-text available
Introduction Early childhood development is key to achieving the Sustainable Development Goals and can be negatively influenced by many different adversities including violence in the home, neglect, abuse and parental ill-health. We set out to quantify the extent to which multiple adversities are associated with impaired early childhood growth & de...
Article
Full-text available
Background Exposure to a range of biological and psychosocial adversities in early childhood is of negative consequence through the lifecourse. This is particularly important for children in low- and middle-income countries where at least 250 million children are at high-risk of not meeting their developmental potential. Minimal evidence describes...
Article
Full-text available
Background: A key barrier to appropriate treatment for malaria, diarrhoea, and pneumonia (MDP) in children under 5 years of age in low income rural settings is the lack of access to quality health care. The WHO and UNICEF have therefore called for the scale-up of integrated community case management (iCCM) using community health workers (CHWs). Th...
Article
Full-text available
Background Biannual vitamin A supplementation is a well-established survival tool for preschool children 6 months and older in vitamin A deficient populations but this schedule misses the opportunity to intervene on most young infant deaths. Randomised trials of neonatal vitamin A supplementation (NVAS) in the first few days of life to assess its i...
Article
Full-text available
Background: Modelled mortality estimates have been useful for health programmes in low-income and middle-income countries. However, these estimates are often based on sparse and low-quality data. We aimed to generate high quality data about the burden, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in south Asia and sub-Sa...
Article
Full-text available
Objective The objective of the Alliance for Maternal and Newborn Health Improvement (AMANHI) gestational age study is to develop and validate a programmatically feasible and simple approach to accurately assess gestational age of babies after they are born. The study will provide accurate, population–based rates of preterm birth in different settin...
Article
Full-text available
Background The Healthy Activity Programme (HAP), a brief behavioural intervention delivered by lay counsellors, enhanced remission over 3 months among primary care attendees with depression in peri-urban and rural settings in India. We evaluated the sustainability of the effects after treatment termination, the cost-effectiveness of HAP over 12 mon...
Article
Full-text available
Background Counselling for Alcohol Problems (CAP), a brief intervention delivered by lay counsellors, enhanced remission and abstinence over 3 months among male primary care attendees with harmful drinking in a setting in India. We evaluated the sustainability of the effects after treatment termination, the cost-effectiveness of CAP over 12 months,...
Data
Cost-effectiveness acceptability curve: Willingness to pay per remission achieved via counselling for alcohol problems from a health system perspective. (DOCX)
Data
Description of serious adverse events over 12 months by arm. (DOCX)
Data
Mediation results examining patient-reported readiness to change at 3 months on mean standard ethanol consumption at 12 months (n = 151). Beta estimates (β) are unstandardised. Multiple linear regression models controlled for baseline AUDIT score, baseline PHQ-9 score, where the intervention was delivered (primary health centre) and who delivered i...
Data
Interaction effect of readiness to change, expectations of treatment, and drinking severity (AUDIT score) at baseline on the effect of CAP on primary outcomes. (DOCX)
Data
Intervention effect on outcomes at 12 months (complete case analysis and random effects). 1Among those with observed data at 12 months. 2Number of participants for whom AUDIT and Alcohol Timeline Followback were available. 3Including imputed outcome data for those with missing data. 4Analysed with a zero-inflated negative binomial model that fits 2...
Data
Means and 95% CIs for key variables used in mediation analyses. (DOCX)
Data
Study protocol. The effectiveness and cost-effectiveness of lay-counsellor-delivered psychological treatments for harmful and dependent drinking and moderate to severe depression in primary care in India: PREMIUM study protocol for randomised controlled trials. (PDF)
Data
Cost-effectiveness planes: CAP plus EUC compared to EUC alone per recovery achieved. (DOCX)
Data
Secondary outcomes at 12 months. (DOCX)
Data
Baseline characteristics of completers of outcome evaluation and those lost to follow-up. 1Includes those who completed the 3- and 12-month evaluations (n = 305) and those who completed only the 12-month evaluation (n = 11). 2Includes those who completed only the 3-month evaluation (n = 31) and those who dropped out before the 3-month evaluation (n...
Data
Mean costs (2015 international dollars) and QALYs gained per person over 12 months. (DOCX)
Data
Counselling for Alcohol Problems (CAP) manual. (PDF)
Data
Statistical analysis plan for the PREMIUM randomised controlled trials of the effectiveness and cost-effectiveness of lay-counsellor-delivered psychological treatments for harmful and dependent drinking and moderate to severe depression in primary care in India. (DOC)
Data
Cost-effectiveness acceptability curve: Willingness to pay per QALY gained from HAP from a health system perspective. (TIF)
Data
Cost-effectiveness planes: HAP plus EUC compared to EUC per remission achieved. (A) Health system perspective; (B) societal perspective. (TIF)
Data
Comparison of participants who were followed up and those lost to follow-up at 3 and 12 months. (DOCX)
Data
Results of t test and descriptive statistics for change in mean primary outcome score between the 3- and 12-month endpoints by trial arm (complete case n = 438). (DOCX)
Data
Interaction effect of baseline depression severity, sex, length of depression, and expectations of treatment on the effect of HAP plus EUC on scores for depression symptoms (BDI-II outcome). 1Adjusted for PHC as a fixed effect and PHQ-9 baseline score. (DOCX)
Data
Secondary outcomes at 12 months. (DOCX)
Data
Effect of HAP plus EUC on scores for depression symptoms, disability, suicide behaviour, and intimate partner violence over 9 months, based on complete case and random effects. 1Adjusted for PHC as a fixed effect and PHQ-9 baseline score. ***Not previously specified in trials protocol but specified in published analysis plan. #Suicidal thoughts ove...
Data
Statistical analysis plan. (DOC)
Data
Serious adverse events and medication use by arm in the last 3 months. (DOCX)
Data
Mediation results examining the effect of patient-reported activation levels at 3 months on 12-month depression outcomes. *Beta estimates are unstandardised. Multiple linear regression models controlled for baseline PHQ-9 score, participant age, and PHC. *p < 0.05. **p < 0.01. ***p < 0.001. c′, total effect; a × b, indirect effect. (DOCX)
Data
Mean costs (2015 international dollars) and QALYs gained per person over 12 months. (DOCX)
Article
Full-text available
Background The contributions that community–based primary health care (CBPHC) and engaging with communities as valued partners can make to the improvement of maternal, neonatal and child health (MNCH) is not widely appreciated. This unfortunate reality is one of the reasons why so few priority countries failed to achieve the health–related Millenni...
Conference Paper
Full-text available
Background SPRING-ELS (Early Life Stress) is a substudy of the SPRING cluster randomised controlled trial that is assessing a home visits programme in rural India promoting early child development and growth. Early life stress interferes with healthy child development so our aim was to evaluate its role in the SPRING causal pathway. We report find...
Article
Background SPRING-ELS (Early Life Stress) is a substudy of the SPRING cluster randomised controlled trial that is assessing a home visits programme in rural India promoting early child development and growth. Early life stress interferes with healthy child development so our aim was to evaluate its role in the SPRING causal pathway. We report findi...
Article
Objective: Male circumcision services have expanded throughout Africa as part of a long-term HIV prevention strategy. We assessed the effect of type of service provider (formal and informal) and hygiene practices on circumcision-related morbidities in rural Ghana. Methods: Population-based, cross-sectional study conducted between May and Decembe...
Article
: Although structured psychological treatments are recommended as first-line interventions for harmful drinking, only a small fraction of people globally receive these treatments because of poor access in routine primary care. We assessed the effectiveness and cost-effectiveness of Counselling for Alcohol Problems (CAP), a brief psychological treat...
Article
Full-text available
Background: Although structured psychological treatments are recommended as first-line interventions for harmful drinking, only a small fraction of people globally receive these treatments because of poor access in routine primary care. We assessed the effectiveness and cost-effectiveness of Counselling for Alcohol Problems (CAP), a brief psycholo...
Article
Full-text available
: Although structured psychological treatments are recommended as first-line interventions for depression, only a small fraction of people globally receive these treatments because of poor access in routine primary care. We assessed the effectiveness and cost-effectiveness of a brief psychological treatment (Healthy Activity Program [HAP]) for deli...
Article
Objectives Global vaccination policy advocates for identifying and targeting groups who are underserved by vaccination to increase equity and uptake. We investigated whether birth weight and other factors are determinants of neonatal BCG vaccination in order to identify infants underserved by vaccination. Methods We used logistic regression to cal...
Article
Full-text available
Objective To estimate neonatal mortality, particularly within 24 hours of birth, in six low- and lower-middle-income countries. Methods We analysed epidemiological data on a total of 149 570 live births collected between 2007 and 2013 in six prospective randomized trials and a cohort study from predominantly rural areas of Bangladesh, Ghana, India...