Till Bärnighausen

Till Bärnighausen
Universität Heidelberg · Heidelberg Institute of Global Health

About

948
Publications
284,158
Reads
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66,350
Citations
Citations since 2016
714 Research Items
60885 Citations
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Introduction
I work on improving population health through research. My research quantifies unmet need for healthcare, designs novel interventions, and tests the causal impacts of population health interventions on health, economic, and social outcomes. I use both quasi-experimental and experimental approaches in my research. I also use both qualitative and quantitative methods in integrated approaches to generative and evaluative research. Currently, I am working on measuring the causal impacts of (i) novel screening and early detection programs, (ii) digital approaches to healthcare, and (ii) community health worker approaches for healthcare delivery in resource-poor communities.

Publications

Publications (948)
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Food systems in Europe are largely unjust and not sustainable. Despite substantial negative consequences for individual health, the environment and public sector health and care services, large multi-national corporations continue to benefit from the way food systems are designed—perpetuating “Lose–Lose–Lose–Win” food systems that see these large c...
Article
The provision of high-quality antenatal care (ANC) is important for preventing maternal and newborn mortality and morbidity, but only around half of pregnant women in Tanzania attended four or more ANC visits in 2019. Although there is emerging evidence on the benefit of community health worker (CHW) interventions on ANC uptake, few large-scale pra...
Preprint
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BACKGROUND Even though climate change is one of the most significant global health challenges, empirical population-based data on its impacts and adaptation measures to protect population health are still limited. The 56 long-term health cohorts in Africa and Asia, called Health and Demographic Surveillance Systems (HDSSs) are excellent for monitor...
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Background Continuous monitoring of the pandemic’s impact on health service provision and mental health, COVID-19 perceptions, and compliance with prevention measures among health care providers (HCPs) can help with mitigating the pandemic’s negative effects. Methods A computer-assisted telephone interviewing (CATI) survey was conducted among 1499...
Article
Data resource basics The World Health Organization (WHO) and the Centres for Disease Control and Prevention (CDC) developed the Global School-based Student Health Survey (GSHS) in collaboration with United Nations Children’s Fund (UNICEF), United Nations Educational, Scientific and Cultural Organization (UNESCO) and Joint United Nations Programme o...
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Vertical global health programs often evaluate success with a narrow focus on programmatic outcomes. However, evaluation of broader patient-centred and unintended outcomes is critical to assess impacts on patient choice and autonomy. Here, we evaluate the effects of a postpartum IUD (PPIUD) intervention on outcomes related to contraceptive method c...
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Background The global expansion of HIV pre-exposure prophylaxis (PrEP) includes health systems that face a shortage of skilled health care workers (HCWs). We estimated the human resource needs and costs for providing PrEP in nurse-led primary care clinics in Eswatini. Furthermore, we assessed potential cost savings from task sharing between nurses...
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German (English below): Hintergrund: Seit einigen Jahren wird in Deutschland vielerorts ein Mangel an Hebammen diskutiert. In dieser Studie befragten wir freiberufliche und angestellte Hebammen in Baden-Württemberg zu ihrer Gesundheit sowie beruflichen Zufriedenheit. Methode: In Zusammenarbeit mit dem Hebammenverband Baden-Württemberg wurde vom 16...
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User costs constitute a barrier to the uptake of HIV pre-exposure prophylaxis (PrEP), but their magnitude appears rarely assessed. In this prospective observational study, we assessed self-reported out-of-pocket expenses (OOPE) and time spent on clinic visits during a PrEP demonstration project in Eswatini. At six public primary care clinics, 240 P...
Preprint
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The African continent has some of the world’s lowest COVID-19 vaccination rates. While the limited availability of vaccines is a contributing factor, COVID-19 vaccine hesitancy among health care providers (HCP) is another factor that could adversely affect efforts to control infections on the continent. We sought to understand the extent of COVID-1...
Preprint
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Background Historically, the international development community has often held the view that those living in extreme poverty (at less than $1.90/day) are likely to have a low prevalence of cardiovascular disease (CVD) risk factors due to calorie scarcity, a largely plant-based diet, and physical labor. Evidence on CVD risk factor prevalence among...
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COVID-19 vaccine hesitancy among adolescents poses a challenge to the global effort to control the pandemic. This multi-country survey aimed to assess the prevalence and determinants of COVID-19 vaccine hesitancy among adolescents in sub-Saharan Africa between July and December 2021. The survey was conducted using computer-assisted telephone interv...
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Studies on knowledge and attitudes about HIV pre-exposure prophylaxis (PrEP) have mostly focused on key populations in North America and Europe. To inform Lesotho’s national rollout of PrEP to the general population, this study aimed to characterize knowledge and attitudes about PrEP among policy makers, implementing partners, healthcare providers,...
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Background: Wearable devices may generate valuable data for global health research for low- and middle-income countries (LMICs). However, wearable studies in LMICs are scarce. This study aims to investigate the use of consumer-grade wearables to generate individual-level data in vulnerable populations in LMICs, focusing on the acceptability (qualit...
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Background: There has been a large influx of COVID-19 seroprevalence studies, but comparability between the seroprevalence estimates has been an issue because of heterogeneities in testing platforms and study methodology. One potential source of heterogeneity is the response or participation rate. Methods: We conducted a review of participation...
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Background Although climate change is one of the biggest global health threats, individual-level and short-term data on direct exposure and health impacts are still scarce. Wearable electronic devices (wearables) present a potential solution to this research gap. Wearables have become widely accepted in various areas of health research for ecologic...
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Background: An absence of gender-sensitive sanitation facilities in schools and the negative effects this has on girls has been widely discussed among advocacy groups, though less examined in academic spheres. Drawing on triangulated data, we outline current challenges and respondent-driven solutions to enhance the female-friendly nature of toilet...
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Background Alcohol is a leading risk factor for over 200 conditions and an important contributor to socioeconomic health inequalities. However, little is known about the associations between individuals’ socioeconomic circumstances and alcohol consumption, especially heavy episodic drinking (HED; ≥5 drinks on one occasion) in low-income or middle-i...
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Cardiovascular diseases (CVD) are the leading cause of death in Cambodia. However, it is unknown whether clinicians in Cambodia provide evidence-based CVD preventive care actions. We address this important gap and provide one of the first assessments of clinical care for CVD prevention in an LMIC context. We determined the proportion of primary car...
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In sub-Saharan Africa, home-based HIV testing interventions are designed to reach sub-populations with low access to HIV testing such as men, younger or less educated people. Combining these interventions with conditional financial incentives (CFI) has been shown to be effective to increase testing uptake. CFI are effective for one-off health behav...
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Intimate Partner Violence (IPV) has severe health consequences, though may be underreported due to stigma. In Tanzania, estimates of IPV prevalence range from 12 to >60%. List experiments, a technique of indirectly asking survey questions, may allow for more accurate prevalence estimates of sensitive topics. We examined list experiment and direct q...
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Objectives To determine the prevalence and frequency of using any tobacco product and each of a detailed set of tobacco products, how tobacco use and frequency of use vary across countries, world regions, and World Bank country income groups, and the socioeconomic and demographic gradients of tobacco use and frequency of use within countries. Desi...
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Introduction: Exposure to a high volume of vaccine misinformation on social media can have a negative effect on vaccine confidence and rates. To counteract misinformation, we designed a collage of three short, animated story-based (SAS) videos to convey scientifically informed and accessible information about COVID-19 vaccine applicable to a social...
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Background: The school presents an ideal environment to positively impact the long-term health and nutrition outcomes of early adolescents, who are at risk of obesity and anemia. Methods: In this cross-sectional survey, we described differences in weight and anemia by sociodemographic, diet and physical activity indicators among 1059 students ag...
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There is a dearth of evidence on the epidemiology of multimorbidity in low- and middle-income countries. This study aimed to determine the prevalence of multimorbidity in India and its variation among states and population groups. We analyzed data from a nationally representative household survey conducted in 2015–2016 among individuals aged 15 to...
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Background: Fear over side-effects is one of the main drivers of COVID-19 vaccine hesitancy. A large literature in the behavioral and communication sciences finds that how risks are framed and presented to individuals affects their judgments of its severity. However, it remains unknown whether such framing changes can affect COVID-19 vaccine behav...
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This study aimed to determine levels of health insurance coverage in low- and middle-income countries and how coverage varies by people's sociodemographic characteristics. We conducted a population size-weighted, one-stage individual participant data meta-analysis of health insurance coverage, using a population-based sample of 2,035,401 participan...
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Introduction: Population-based biomarker surveys are the gold standard for estimating HIV prevalence but are susceptible to substantial non-participation (up to 30%). Analytical missing data methods, including inverse-probability weighting (IPW) and multiple imputation (MI), are biased when data are missing-not-at-random, for example when people l...
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Background Effective equity-focused health policy for hypertension in low- and middle-income countries (LMICs) requires an understanding of the condition’s current socioeconomic gradients and how these are likely to change in the future as countries develop economically. Objectives This cross-sectional study aimed to determine how hypertension pre...
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Introduction: Midwifery services are a cornerstone of maternal care, but the mental health of midwives is at risk in many work settings. The aim of this study was to assess burnout and attitudes toward midwifery among midwives in Baden-Württemberg, Germany. Methods: A cross-sectional online survey among midwives was conducted from 16 October to 1...
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Background Continuing progress in the global pediatric human immunodeficiency virus (HIV) response depends on timely identification and care of infants with HIV. As countries scale-out improvements to HIV early infant diagnosis (EID), economic evaluations are needed to inform program design and implementation. This scoping review aimed to summarize...
Preprint
Studies on PrEP knowledge and attitudes have mostly focused on key populations in North America and Europe. To inform Lesotho’s national rollout of PrEP to the general population, this research aimed to characterize knowledge and attitudes towards PrEP among policy makers, implementing partners, healthcare providers, and PrEP end-users in Lesotho....
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Background Maternal knowledge that motivates improvements in critical perinatal health behaviors has the potential to significantly reduce maternal and neonatal mortality. However, evidence-based health information often fails to reach mothers and their partners. mHealth video micro-messages, which disseminate evidence-based perinatal health messag...
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Ensuring responsive healthcare which meets patient expectations and generates trust is important to increase rates of access and retention. This need is important for aging populations where non-communicable diseases (NCDs) are a growing cause of morbidity and mortality. We performed a cross-sectional household survey including socio-demographic; m...
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Mobile health (mHealth) interventions are increasingly used to support community health workers (CHWs) in low-and middle-income countries. As near-peers within their communities, the credibility of CHWs is sometimes questioned—a recognized barrier to their efficacy. Nested within a large, randomized-controlled trial, this qualitative study captured...
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Widespread vaccine uptake is critical for ending the COVID-19 pandemic. As public health officials focus on overcoming vaccine hesitancy, simultaneously boosting hope may be equally important in the US. We analyzed data from an online cross-sectional survey conducted in June 2021. Participants were 11,955 US adults (ages 18-83) of various ethniciti...
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Objectives: Cervical cancer still poses a considerable threat to women in low- and middle-income countries, particularly on the African continent. Self-collection of a vaginal sample promises advantages over the established sampling by clinicians. We aimed to assess the accuracy of self-sampling compared to clinician sampling in order to inform it...
Preprint
Full-text available
COVID-19 vaccine hesitancy among adolescents poses a challenge to the global effort to control the pandemic. This multi-country survey aimed to assess the levels and determinants of COVID-19 vaccine hesitancy among adolescents in sub-Saharan Africa between July and December 2021. The survey was conducted using computer-assisted telephone interviewi...
Article
Full-text available
Background: Climate change is projected to induce extreme and irregular rainfall patterns in the West African Sahel region, affecting household food security and income. Children are among the worst affected population groups. Previous studies focusing on rainfall irregularities in specified periods have revealed how child health and nutritional st...
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Home gardening is promoted as an adaptation strategy to ameliorate the increasing food insecurity from climate change impacts among subsistence farming families in rural sub‐Saharan Africa. Yet, the geographic distribution of home gardens, their setup, management, and the effects on nutrition outcomes have not been fully described. This scoping rev...
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Background Previous studies suggest that retirement, a major life event, affects overall healthcare utilization. We examine, the effects of retirement on inpatient healthcare utilization, including effect heterogeneity by gender, disease category, and type of health service. Methods We used routine health insurance claims data (N = 87,087) spannin...
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Objectives: We aimed to determine the rate of catastrophic health expenditure incurred by women using maternal healthcare services at faith-based hospitals in Madagascar. Design: This was a secondary analysis of programmatic data obtained from a non-governmental organisation. Setting: Two faith-based, secondary-level hospitals located in rural...
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Due to the high HIV incidence among the general population of Eswatini, pre-exposure prophylaxis (PrEP) for HIV-exposed individuals is recommended. However, little is known about PrEP uptake and preferences in PrEP delivery healthcare setting among the general population. We conducted a secondary analysis of a randomized trial that aimed to increas...
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Background World-wide, there is growing universal health coverage (UHC) enthusiasm. The South African government began piloting policies aimed at achieving UHC in 2012. These UHC policies have been and are being rolled out in the ten selected pilot districts. Our study explored policy implementation experiences of 71 actors involved in UHC policy i...
Preprint
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Background The COVID-19 pandemic has led many individuals to miss essential care. Machine-learning models that predict which patients are at greatest risk of missing care visits can help health administrators prioritize retentions efforts towards patients with the most need. Such approaches may be especially useful for efficiently targeting interve...
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Although a majority of SARS-COV-2 diagnosis are asymptomatic, presymptimatic or minimally symptomatic, little has been described and understood about the illness careers of these individuals. This study explored the lived experience of a SARS-COV-2 diagnosis and subsequent quarantine among individuals in Germany who were diagnosed with SARS-COV-2 d...
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In this study, we hypothesize that HIV geographical clusters (geospatial areas with significantly higher numbers of HIV positive individuals) can behave as the highly connected nodes in the transmission network. Using data come from one of the most comprehensive demographic surveillance systems in Africa, we found that more than 70% of the HIV tran...
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Individual informed consent is a central requirement for clinical research on human subjects, yet whether and how consent requirements should apply to health policy experiments (HPEs) remains unclear. HPEs test and evaluate public health policies prior to implementation. We interviewed 58 health experts in Tanzania, Bangladesh and Germany on inform...
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Objectives: We aimed to determine i) the prevalence of depression during the COVID-19 pandemic among Chinese adults, and ii) how depression prevalence varied by province and sociodemographic characteristics. Design: Cross-sectional study. Setting: National online survey in China. Participants: We conducted a cross-sectional online survey among adu...
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Background Multimorbidity poses an increasing challenge to health care systems in Sub-Saharan Africa. We studied the extent of multimorbidity and patterns of comorbidity among women aged 40 years or older in a peri-urban area of Dar es Salaam, Tanzania. Methods We assessed 15 chronic conditions in 1528 women who participated in a cross-sectional s...
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Background: The prevalence of multimorbidity in low- and middle-income countries (LMICs) is thought to be rising rapidly. Research on the state of healthcare for multimorbidity in LMICs is needed to provide an impetus for integration of care across conditions, a baseline to monitor progress, and information for targeting of interventions to those...
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Background Wearable devices hold great promise, particularly for data generation for cutting-edge health research, and their demand has risen substantially in recent years. However, there is a shortage of aggregated insights into how wearables have been used in health research. Objective In this review, we aim to broadly overview and categorize th...
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Objectives Among ID studies seeking to make causal inferences and pooling individual-level longitudinal data from multiple infectious disease cohorts, we sought to assess what methods are being used, how those methods are being reported, and whether these factors have changed over time. Study Design and Setting Systematic review of longitudinal ob...