Institute for Health Metrics and Evaluation (IHME)

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THE GRANT

Grand Challenges in Global Health is a family of grants programs focused on one unifying purpose: To overcome persistent bottlenecks in creating new tools that can radically improve health in the developing world.

The Bill & Melinda Gates Foundation

Principal Investigator:

Christopher J.L. Murray

Population Health Metrics Research Consortium Project

Critical information on population health is needed to inform planning, resource allocation, program implementation, monitoring and evaluation. Currently, there are major gaps in the available measurement methods and technologies to yield this information, making it difficult to address health inequities through effective policy.

The Population Health Metrics Research Consortium Project is funded by the Bill and Melinda Gates Foundation as part of its Grand Challenges in Global Health program. This project aims to address Grand Challenge #13: Develop technologies that permit quantitative assessment of population health. The PHMRC project pursues a creative and bold approach by wedding epidemiology, biomedical research, and population health assessment to:

• Improve strategies for population health measurement and produce instruments that are science-based, standardized, and widely-applicable across different resource-poor settings.
• Provide data and resources that will be the basis for rapid and effective field assessment of population prevalence of specific diseases and causes of death.
• Enable policymakers and researchers to help address persistent inequities in health outcomes in both the developed and the developing world.

Collaborators

The PHMRC project team represents a wide array of research interests and areas of expertise. Collaborating scientists include physicians, epidemiologists, health economists, demographers, mathematicians, biologists, and social scientists from the following institutions.

• Broad Institute of MIT and Harvard (United States)
• Harvard University (United States)
• Institute for Health Metrics and Evaluation, University of Washington (United States)
• Johns Hopkins University (United States)
• King George Medical College (India)
• Muhimbili University of Health and Sciences (Tanzania)
• Public Health Laboratory – Ivo de Carneri (Tanzania)
• Research Institute for Tropical Medicine (The Philippines)
• University of Queensland (Australia)

Project Highlights

Objective 1: Develop methods to measure mortality where vital registration systems are incomplete.

Survey Analysis Methods: The PHMRC project is developing household surveys that incorporate new and innovative ways of gathering accurate information on mortality. It has previously completed a census at research sites in Tanzania, India, and the Philippines to establish mortality rates against which the results of the household survey will be measured.  New methods to analyze existing census data have also been developed.  Most notably, we have developed better methods to gauge mortality based upon sibling survival questions. 

Objective 2: Develop methods to measure cause-specific mortality in populations with incomplete or inadequate cause-of-death coding.

Verbal Autopsy instruments: The principle of verbal autopsies (VA) is that signs and symptoms associated with major causes of death can be reliably recalled by relatives after the fact of death. In this method, field interviewers speak with the next of kin, using a VA questionnaire that seeks information about the symptoms of the deceased, some demographic characteristics, and some questions about possible risk factors (such as tobacco use). The data is then aggregated to estimate population level patterns of the major causes of death using the newly developed Symptom Pattern Method. Currently, the PHMRC project team is collecting data in hospital and clinical environments where the causes of death are known. By doing so, it allows the new methods to be validated against gold standard data. Ultimately, this method can be used to assess verbal autopsy results from community datasets where causes of death are unknown, to allow for estimation of cause-specific mortality in areas that lack complete vital registration systems. The PHMRC goals include developing a standardized and concise VA instrument that can be easily used in resource-poor settings and developing straightforward and cost-effective methods to analyze them.  

Statistical methods to correct for selection bias in hospital deaths: Deaths recorded in hospitals are not a random sub-sample of all deaths in the community, but are still a valuable source of population health information. The PHMRC project team has developed a statistical method that estimates population level cause-of-death profiles using regional vital registration data to overcome the selection bias of hospital death data. The PHMRC is currently applying and advancing this new method using datasets from both the developed and developing world. 

Objective 3: Develop methods to measure the prevalence and incidence of major diseases

Proteomics research: The PHMRC Project team is working to develop methods that will allow for effective population screening for diseases based on complementary sets of biomarkers, or molecular barcodes, found in human blood samples. The diseases being investigated include tuberculosis, HIV, malaria, diabetes, and COPD. The PHMRC project team collects plasma samples from three research sites in Tanzania and the Philippines and sends them to the Broad Institute for processing, analysis, and biomarker discovery. If this approach is found to be effective, it could be used in conjunction with population censuses to better understand the prevalence of key conditions.

Serum Immunoglobulins for Enteric Pathogens: The PHMRC project team is endeavoring to validate serological assays for representative bacterial, viral and parasitic causes of diarrhea in developing countries and then prospectively evaluate these serological assays in field areas.

Developing a Comprehensive Household Survey

The PHMRC is bringing together several of the different research objectives to devise a comprehensive household survey that can be implemented in a variety of cultural and linguistic settings. The survey will be implemented in 6,000 households in each of several sites – Bohol, the Philippines; Hyderabad, India; Lucknow, India; and Pemba Island, Tanzania. The surveys will have several modules – demographic, mortality, verbal autopsy (where a death has occurred in the past 5 years), maternal and child health, and a coverage module. For a subset of individuals, some basic functional health tests will be administered along with a dried blood spot to use as a measurement of prevalence of certain conditions. This data collection activity and the accompanying analysis will provide insights into how a number of different population health characteristics might be easily attained in a variety of settings where formal reporting systems do not exist.

For more information, please contact: gc13@healthmetricsandevaluation.org

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