D-SINE Africa Research Projects
Research Project 1: Health Equity Surveillance
A novel cluster-based algorithm to estimate socioeconomic status for health equity surveillance in sub-Saharan Africa
Principal Investigators:
Georges Nguefack-Tsague, PhD, Associate Professor of Statistics at the University of Yaoundé I in Cameroon, with affiliate faculty positions at AIMS-Cameroon and Buea
Alan Hubbard, PhD, Professor of Biostatistics at the University of California, Berkeley
Co-Investigators:
Catherine Juillard MD, MPH, trauma surgeon, Associate Professor of Surgery at University of California, Los Angeles and co-director of UCLA Department of Surgery’s Program for the Advancement of Surgical Equity (PASE)
Salome Maswime, MD, PhD, obstetrician/gynecologist and Associate Professor and the Head of the Global Surgery Division at the University of Cape Town
Fanny Dissak-Delon, MD, PhD, MPH, Public Health Officer, Cameroon Ministry of Public Health Littoral Regional Delegation
Our long-term goal is to improve health equity. As health disparities widen globally, achieving improvements in health equity between and within regions is an urgent priority. Currently, in sub-Saharan Africa (SSA), health equity surveillance is not regularly implemented, in large part due to the difficulty in measuring socioeconomic status (SES). The lack of a quick, reliable metric of SES severely hinders researchers’ ability to study and reduce health disparities.
Our overall objective is to apply a novel, cluster-based algorithm to estimate socioeconomic status for health equity surveillance in sub-Saharan Africa. We have developed a k-medoids clustering-based algorithm that generates simple, population-specific models of economic status using only four or five of the 29 to 36 Demographic and Health Survey (DHS) assets variables in Cameroon and Ghana. Each cluster’s population wealth is objectively ranked based on variables known to be associated with poverty: mean cluster child height-for-age Z-score (HAZ) and child mortality. In both countries, the efficient EconomicClusters model accounted for a similar proportion of the variance in child HAZ and child mortality as the >25 variable DHS Wealth Index model. This data-adaptive SES metric derived from publicly available DHS surveys selects the most appropriate variables for each country, minimizing resources needed for longitudinal health equity surveillance.
Our overall objective will be met through the following Specific Aims: Aim 1. Develop EconomicClusters models for 37 sub-Saharan African countries with Demographic and Health Survey (DHS) data since 2010
Aim 2: Validate the EconomicClusters models for each country using established DHS metrics known to be consistently correlated with socioeconomic status: proportion of a woman’s children who are deceased, whether healthcare is sought at public or private facilities, and educational attainment.
Aim 3: Characterize inequity in trauma care access and outcomes in Cameroon, South Africa, and Uganda by implementing the EconomicClusters strategy in trauma registry data collection.
Aim 4: Develop a free, publicly available toolkit to support researchers to use EconomicClusters models strategy in their own research.
Research Project 2: Trauma Outcomes Prediction
Using data-adaptive methods to optimize follow up of injured patients after hospital discharge in Cameroon
Principal Investigators:
Alain Chichom-Mefire, MD, Professor of General Surgery, University of Buea
Catherine Juillard MD, MPH, trauma surgeon, Associate Professor of Surgery at University of California, Los Angeles and co-director of UCLA Department of Surgery’s Program for the Advancement of Surgical Equity (PASE)
Co-Investigators:
Nicholas Tendongfor, PhD, Associate Professor of Medical Microbiology and Biostatistician and head of Department of Public Health and Hygiene, Associate Professor in Residence in the Division of Epidemiology and Biostatistics, University of California, Berkeley Alan Hubbard, PhD, Professor of Biostatistics at the University of California, Berkely
Sithombo Maqungo, MBChB, Associate Professor of Orthopaedic Surgery, University of Cape Town
Fanny Dissak-Delon, MD, PhD, MPH, Public Health Officer, Cameroon Ministry of Public Health Littoral Regional Delegation
Our long-term goal is to significantly improve health in sub-Saharan Africa (SSA) Approximately 9% of the world’s deaths, more than 5 million deaths annually, are due to injury. The research and funding investment in the study of injury is not commensurate to the magnitude of the problem. The people of sub-Saharan Africa (SSA) are disproportionately affected by injury. To significantly improve the health in SSA, there is an urgent need for effective, innovative and scalable approaches to reduce morbidity and mortality from injury.
Our overall objective is to improve health in SSA by identifying and retaining injury patients who would benefit from further care after initial treatment. In SSA countries like Cameroon, injured people face multiple obstacles to trauma care, including potentially lifesaving follow-up care after hospital discharge. Our community-based survey of 8,065 patients in Southwest Cameroon found that 34.6% of injured respondents did not seek immediate formal care after injury, and another 9.9% only sought formal care after alternative means, such as traditional medicine practitioners. However, initial receipt of formal care is only the first of several necessary steps in recovery. In Cameroon, for the 65.4% of injured people who seek formal care after injury, therapeutic itineraries can be complex, often involving poorly supported referrals to other facilities or transitions away from formal care. As a result, formal systems of care fail to retain trauma patients for follow-up care, a missed opportunity as these patients have already overcome significant financial and personal challenges to seek initial care for their injuries. Consequently, discharged trauma patients who may benefit from follow-up care often delay care until advanced complications develop. Exacerbating this supply-side issue are patient- and household-level factors that impede care-seeking, such as dissatisfaction with the length or progress of treatment or poverty. Trauma patients in Cameroon of lower socioeconomic status (SES) are less likely to receive follow-up care after discharge. Together, these data suggest a critical yet untapped opportunity to significantly improve health in SSA by identifying and retaining injury patients who would benefit from further care.
Our overall objective will be met through the following Specific Aims:
- Aim 1. Scale-up an mHealth, phone-based screening tool to identify trauma patients in Cameroon who would benefit from further formal medical care.
- Aim 2. Evaluate a machine-learning, optimized, phone-based screening tool that predicts which trauma patients are most likely to benefit from follow-up care.
- Aim 3. Determine factors associated with compliance with recommendations for post-discharge follow-up care after injury.
Expected Outcome: Improved trauma morbidity through an effective, optimized, targeted follow-up tool and methodology that can be adapted to other patient settings and conditions.