Population Health Metrics Research Consortium (PHMRC) Project

The project is part of the response to Gates Grand Challenge 13 which seeks to "develop new technologies that permit better quantitative assessment of population health".

The project pursues a creative and bold approach by pooling epidemiology, biomedical research, and population health assessment to:

  • Improve strategies for population health measurement and produce instruments that are science-based, standardised, and widely-applicable across different resource-poor settings
  • Provide 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

This is a collaborative multi-country project including India, Tanzania and the Philippines. The investigators and partner institutions for this study in Andhra Pradesh are the Department of Community Medicine at the Gandhi Medical College, Secunderabad, Department of Community Medicine at the Osmania Medical College, Hyderabad and the George Institute India in Hyderabad.

There are three main components to this study.

1. The evaluation of different strategies for the assessment of population mortality rates in communities without vital registration processes

  • Aim:  To define optimal strategies for the assessment of population mortality rates
  • Method: This goal is addressed by conducting a large-scale household survey and maintaining a vital registration system.  The household survey utilises a range of different strategies to collect and analyse reported information about births, deaths and migration.  The results are compared against the gold standard information collected by the vital registration system in an effort to identify which survey processes and analysis procedures provide the best estimates of population mortality rates.  The intent is that the comparison of different methods will allow the development of an optimal questioning and analysis strategy.  Likewise, comparison of the findings from the Andhra Pradesh site with results from other collaborating sites in India and overseas will enable the research team to define the broader generalisablity of the conclusions drawn.
  • Status: Data collection is complete and analysis is ongoing

2. To define robust methods to measure causes of death in populations lacking robust cause-of-death assignment systems

  • Aim: To develop a standard, valid and reliable verbal autopsy instrument and associated data analysis method that will provide reliable estimates of the causes of death in resource poor communities lacking cause-of-death registration systems.
  • Method: This aim is achieved by identifying gold standard cases for which the cause of death is known and then conducting verbal autopsies with the individual that cared for the deceased during the period leading up to their death. The gold standard cases are identified from hospitals using established gold standard criteria. The address of the deceased is obtained from the notes and a trained fieldworker blinded to the cause of death then visits the family and completes the verbal autopsy. Verbal autopsies are done within four - 14 weeks of the death. Different analytic methods are applied to identify the optimal format of the verbal autopsy questionnaire and to define the capacity of the verbal autopsy process to discriminate between different causes of death.
  • Status: Data collection is complete and analysis is going on.

3. The development of new methods to estimate disease prevalence and the coverage of preventative therapies

  • Aim: To determine the capacity of different survey techniques to define the prevalence of different diseases and the coverage of key prevention programs in poor communities in developing country settings.
  • Method: A household survey will be done comprising questionnaires, physical assessments and blood tests. The survey will utilize different techniques in different households to test the findings that derive from a range of different approaches to survey conduct.
  • Status: Data collection is complete and analysis is going on.

Status

Analysis and publications are underway.