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:

Rafael Lozano

Mexico Study

A part of the Population Health Metrics Research Consortium (PHMRC) Project

The Population Health Metrics Research Consortium (PHMRC) Mexico Study strives to develop better instruments and methods for measuring population health, particularly in resource-poor settings. As part of the Gates Foundation’s Grand Challenges in Global Health, this study will collect mortality and disease prevalence information to help improve strategies for population health measurement and produce instruments that are science-based, standardized, and widely applicable. It will also enable policymakers and researchers to help address persistent inequities in health outcomes in both the developed and the developing worlds.

The PHMRC Mexico Study focuses on two key areas of population health:

• Adult and child causes of death in populations where cause-of-death coding is incomplete or inadequate.
• Prevalence and incidence of major diseases.

Collaborators

IHME’s Dr. Rafael Lozano is working with the National Institute of Public Health of Mexico, which is supported by Mexico’s Ministry of Health, gathering cases from the General Hospital of Mexico, the Mexico City Government, the National Institute of Psychiatry, and the Institute for Social Security and Services for State Workers.

Project Highlights

Verbal Autopsy

In countries with an incomplete or nonexistent vital registration system, researchers conduct verbal autopsies (VA) by asking a deceased person’s relatives about signs or symptoms there were of specific illnesses which the deceased may have experienced prior to death. IHME is currently leading a VA study in Mexico City and the state of Hidalgo with the aim of finding new ways to collect accurate cause-of-death information in low-resource settings. This project builds on the success of verbal autopsy research in other PHMRC field sites and will validate the VA instrument in Spanish. The materials produced can then be used throughout Latin America.

In Mexico City, researchers are interviewing approximately 3,500 households in cases where the underlying causes of death already have been well documented using a combination of death certificates, autopsy records, and medical records.

In Hidalgo, north of Mexico City, researchers are conducting approximately 1,200 VA interviews from a random community sample based solely on death certificates, which may be vague or inaccurate. This is the first attempt to collect VAs in a community where the true cause of mortality is not known.

The researchers’ notes about the deaths and their conclusions will help IHME create a computer algorithm to determine the most accurate assessment of the cause of death. The computer analysis will be based on the new Symptom Pattern Method pioneered by Institute Director Dr. Christopher J.L. Murray and Dr. Alan Lopez, an IHME Affiliate Professor, along with other researchers involved in a 2007 study published in the journal PLoS Medicine.

Symptomatic Diagnosis

IHME also is trying to gauge the prevalence of major diseases in Mexico City by testing a new survey method called Symptomatic Diagnosis (SD).

For many chronic diseases, it is extremely difficult to measure prevalence in resource-poor areas. The SD method aims to solve that problem by utilizing a survey about self-reported signs, symptoms, and indicators of chronic diseases.

Researchers will analyze questionnaire responses with a statistical algorithm, analogous to that used in the VA study, to estimate the probability that the respondent suffers from a certain condition. The project will focus on 10 specific diseases and conditions that do not have simple tests to determine illness, but can be diagnosed based on a specific set of signs and symptoms.

The project aims to produce a validated SD instrument and a disease list that can serve as a gold standard in English and Spanish and apply to many other settings in Latin America. The Mexico team will conduct approximately 1,000 SD interviews with individuals who suffer from the conditions studied, and conduct approximately 200 SD interviews with healthy individuals as a control. Ultimately, the study will produce baseline population prevalence for each of the conditions separately, as well as estimates of the probability that each individual suffers from each of the conditions studied. With these results, the study also will provide an opportunity to test and better understand the methods necessary to analyze SD data. Eventually, this type of instrument could be used to gather useful information to inform decisions on policy and health interventions that address chronic diseases in resource-poor areas.

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

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