The Institute for Global Health and Development
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Item Multimorbidity latent classes in relation to 11-year mortality, risk factors and health-related quality of life in Malaysia: a prospective health and demographic surveillance system study(BioMed Central, 2025-01-06) Tan, Michelle M. C.; Hanlon, Charlotte; Muniz-Terrera, Graciela; Benaglia, Tatiana; Ismail, Roshidi; Mohan, Devi; Konkoth, Ann Breeze Joseph; Reidpath, Daniel; Pinho, Pedro José M. Rebello; Allotey, Pascale; Kassim, Zaid; Prina, Matthew; Su, Tin TinBackground: We aimed to identify specific multimorbidity latent classes among multi-ethnic community-dwelling adults aged ≥ 18 years in Malaysia. We further explored the risk factors associated with these patterns and examined the relationships between the multimorbidity patterns and 11-year all-cause mortality risk, as well as health-related quality of life (HRQoL). Methods: Using data from 18,101 individuals (aged 18–97 years) from the baseline Census 2012, Health Round 2013, and Verbal Autopsies 2012–2023 of the South East Asia Community Observatory (SEACO) health and demographic surveillance system, latent class analysis was performed on 13 chronic health conditions to identify statistically and clinically meaningful groups. Multinomial logistic regression and Cox proportional hazards regression models were conducted to investigate the adjusted association of multimorbidity patterns with the risk factors and mortality, respectively. HRQoL was analyzed by linear contrasts in conjunction with ANCOVA adjusted for baseline confounders. Results: Four distinct multimorbidity latent classes were identified: (1) relatively healthy (n = 10,640); (2) cardiometabolic diseases (n = 2428); (3) musculoskeletal, mobility and sensory disorders (n = 2391); and (4) complex multimorbidity (a group with more severe multimorbidity with combined profiles of classes 2 and 3) (n = 699). Significant variations in associations between socio-demographic characteristics and multimorbidity patterns were discovered, including age, sex, ethnicity, education level, marital status, household monthly income and employment status. The complex multimorbidity group had the lowest HRQoL across all domains compared to other groups (p < 0.001), including physical health, psychological, social relationships and environment. This group also exhibited the highest mortality risk over 11 years even after adjustment of confounders (age, sex, ethnicity, education and employment status), with a hazard of death of 1.83 (95% CI 1.44–2.33), followed by the cardiometabolic group (HR 1.42, 95% CI 1.18–1.70) and the musculoskeletal, mobility and sensory disorders group (HR 1.29, 95% CI 1.04–1.59). Conclusions: Our study advances the understanding of the complexity of multimorbidity and its implications for health outcomes and healthcare delivery. The findings suggest the need for integrated healthcare approaches that account for the clusters of multiple conditions and prioritize the complex multimorbidity cohort. Further longitudinal studies are warranted to explore the underlying mechanisms and evolution of multimorbidity patterns.Item Equity in decline: illustrating fairness in a worse-off world. [Commentary](2023-10-30) Reidpath, Daniel; Khosla, Rajat; Gruskin, Sofia; Dakessian, Arek; Allotey, PascaleItem Equity in decline: fair distribution in a worse-off world.(2023-06-28) Reidpath, Daniel; Gruskin, Sofia; Khosla, Rajat; Dakessian, Arek; Allotey, PascaleItem Multicultural issues in general practice(Australian Drug Information Service, 1999-12) Reidpath, Daniel; Allotey, PascalePeople's experiences of health and illness vary widely and are affected by factors such as age, gender, education, socioeconomic status and culture. Additional factors such as language, culture and pre- and post-migration experience affect people from culturally diverse backgrounds. Individual patients are their own cultural expert; no resource can be comprehensive enough to give the health practitioner better information than asking the patient.Item Information quality in a remote rural maternity unit in Ghana(Oxford University Press, 2000-06-01) Allotey, Pascale; Reidpath, DanielThe collection of accurate maternal outcome data enables causes of morbidity and mortality to be identified, which in turn permits interventions to be targeted appropriately. It also allows estimates to be made about the importance of various indicators in predicting birth outcome. These indicators can then be compared between health services, across time and against programme objectives, thus ensuring a management information system that informs policy and provides for real change. A review was done of data collection at the antenatal clinic and maternity ward in a remote rural hospital in northern Ghana. The data collected came from maternity ward records and participant observation, and they highlight deficiencies in the record management procedures. It is argued that exhorting staff to greater accuracy, although obvious, may not be the only solution, because of the structural impediments that often give an illusion of accuracy. The best data need to be collected within the constraints of the equipment and the people. Furthermore, to make the task more meaningful, regular feedback needs to be provided so that the process of record keeping is relevant to those who do it. Ministries of health need to conduct regular audits, like this microanalysis, so that policies are not based on data that are analyzed under a presumption of accuracy.Item Social, cultural and environmental contexts and the measurement of burden of disease : an exploratory comparison of the developed and developing world(University of Melbourne, 2001) Reidpath, Daniel; Allotey, Pascale; Kouamé, Aka; Cummins, RobertThe Disability Adjusted Life Year (DALY) is a measure of population health that was developed, as part of a World Bank initiated study, to inform health strategy development, priority setting, resource allocation and research, and to measure the global burden of disease. The innovative feature of the DALY was the combination of information on morbidity and mortality within a single index. Since its development in 1992, the rate at which it has been adopted by governments, multilateral agencies and researchers has been staggering. The enthusiasm with which the measure has been taken-up perhaps reflects a desire on the part of health policy makers to embrace an “evidence-based” approach to health policy. Although the DALY has been heavily criticised in some quarters, it has survived. There are a number of reasons why this may be: • It is a good measure of population health; • The enormous political will to see it succeed; and • The lack of empirical data to challenge the validity of the DALY; • In addition, many of the criticisms of the DALY have been about the implicit and explicit social values, which are hard to argue on technical grounds. This report details the findings of an empirical investigation of some of the technical and social assumptions on which the DALY is based.Item Establishing the causes of childhood mortality in Ghana: the ‘spirit child’(Elsevier, 2001-04) Allotey, Pascale; Reidpath, DanielCommunities in remote regions of northeast Ghana record some of the highest rates of under five mortality in West Africa (23.9 per 1000 children/year (Binka, Maude et al. (1995). International Journal of Epidemiology, 24(1), 127–135). The communities, isolated geographically and culturally from the main tribal groups in Ghana continue to adhere very strongly to traditional beliefs and practices. A qualitative study of both traditional and modern maternal and child health care systems in the area, demonstrated that almost 15% of deaths of infants under 3 months of age were due to a belief in chichuru or spirit children, resulting in infanticide. It is therefore a significant public health problem, which has to be addressed in programs for the control of child mortality. A modification of the verbal autopsy method is proposed to assist in the identification of non-biomedical causes of death.Item Data Sharing in Medical Research: An Empirical Investigation(Wiley, 2001-04) Reidpath, Daniel; Allotey, PascaleBackground: Scientific research entails systematic investigation. Publishing the findings of research in peer reviewed journals implies a high level of confidence by the authors in the veracity of their interpretation. Therefore it stands to reason that researchers should be prepared to share their raw data with other researchers, so that others may enjoy the same level of confidence in the findings. Method: In a prospective study, 29 corresponding authors of original research articles in a medical journal (the British Medical Journal) were contacted to ascertain their preparedness to share the data from their research. The email contact was in one of two forms, a general request and a specific request. The type of request a researcher received was randomly allocated. Findings: Researchers receiving specific requests for data were less likely, and slower, to respond than researchers receiving general requests. Only one researcher released data. Most researchers were reluctant to release their data. Some required further information, clarification, or authorship. Interpretation: The general reluctance of researchers to consider requests for their data is of concern. It raises questions about the level of confidence that should be placed on their interpretations of the data. It also highlights an unfortunate situation where researchers are more concerned with losing an advantage than advancing science.Item Addressing cultural diversity in Australian health services(2002-08-01) Allotey, Pascale; Reidpath, Daniel; Manderson, LIssue addressed: Recent changes in the model of health service delivery in Australia have resulted in the attrition of ethnic specific health services and the expectation that patients from culturally and linguistically diverse backgrounds will present to mainstream health services for all health problems. Providers are often ill equipped to provide appropriate care and have expressed concerns with addressing the needs of people from increasingly diverse communities. Meanwhile, community groups and anthropologists have expressed their frustration with the stereotypic and essentialising tone of many of the guides and fact-files developed for use in clinical settings. Methods: Applied anthropological approaches were used to negotiate the style and content of a set of resource materials for health providers in community health and hospital settings. Results: Extensive consultation ensured that the resources met providers' needs and were acceptable to communities. Conclusion: The result provides a guide to best practice of clinical care, regardless of cultural or linguistic background. So what: Health services would be assisted by materials on ethnic cultural factors that avoided stereotyping and emphasised asking questions.Item Objectivity in Priority Setting Tools in Reproductive Health: Context and the DALY(Taylor and Francis Group, 2002-11-09) Allotey, Pascale; Reidpath, DanielThe Disability Adjusted Life-Year (DALY) heralded a new age in the development of an evidence base for priority setting and resource allocation. The DALY was intended to represent sound measurement of the incidence and prevalence of conditions in a process by which burden of disease would be determined, health conditions prioritised and interventions evaluated. However, in the reification of objectivity, sight was lost of critical aspects of health and disease, namely that they are not independent of the context in which they occur. This is powerfully illustrated by many reproductive health conditions. Priority setting and resource allocation exercises need to take into account both objective measures and contextually relevant factors. Based on comparative data that highlights the effect of the development gradient on the burden of disease, this paper discusses the implications of context in the assessment of population health and priority setting, with a focus on reproductive health.