The Adult Morbidity and Mortality Project, Phases 1 and 2, helped to raise awareness in Tanzania of the importance of community-based data on cause-specific mortality for health policy and planning. AMMP-2 intended to help the Ministry of Health and local councils to establish, manage, and use a permanent information system for the continued production of reliable information on disease burdens, mortality, and poverty. AMMP-2 aimed to enhance capacity for data collection, management, analysis, and use at the district and ministry levels; disseminate information and tools to key users; and deliver to the Ministry of Health and district partners validated and consolidated tools for establishing and operating sentinel demographic and mortality surveillance.
Contact for further information: david.whiting@ncl.ac.uk
CHD modeling
Developing and refining a coronary heart disease mortality model for use in different populations,
include middle income settings (Beijing). This combines data on patient numbers, treatment effectiveness and uptake, and
risk factor trends to estimate the deaths prevented or postponed, and life years gained over a specified time period.
The model has been used in policy analyses e.g. assessing the potential for further risk factor reductions or increases
in treatment uptake to reduce mortality. Planned work includes incorporating other measures of morbidity, quality of life,
further risk factors, and adapting the model for stroke incidence and mortality (collaborator on MRC funded project).
Illustrative references:
- Critchley JA, Liu J, Dong Z, Wei W, Capewell S. Explaining the increase in coronary heart disease mortality in Beijing
between 1984 and 1999. Circulation 2004 110: 1236 - 1244
- Unal B, Critchley JA, Capewell, S. Explaining mortality trends from CHD in England and Wales, 1980-2000.
Circulation 2004; 109: 1101-1107
Contact for further information: julia.critchley@ncl.ac.uk
Smoking, ill health and poverty in China
Using data from a large, nationally representative cross-sectional household survey in China we are
examining recent trends in active and passive smoking from 1993-2003, factors influencing smoking
uptake, quitting and attitudes towards quitting smoking by age, sex, and geography. We are estimating
the financial burden of cigarette consumption on poor households, and the burden of ill-health
associated with smoking at household level (including general health status, specific acute and chronic disease episodes,
and health service use). We will describe exposure to environmental tobacco smoke (ETS) in the home, and estimate the
number of non-smokers exposed to ETS, and the influence of age and sex on exposure.
Illustrative references: In progress
Contact for further information: julia.critchley@ncl.ac.uk
The epidemiology, treatment and prevention of noncommunicable diseases in sub-Saharan Africa represents a large body of work linking together several projects funded mainly by the Department for International Development and the European Union. This work has help to provide a basis for assessing the public health importance of these conditions in Africa and has lead on to a series of new projects.
Illustrative references:
- Aspray TJ, Mugusi F, Rashid S, Whiting D, Edwards R, Alberti KG, Unwin NC, Essential Non-Communicable Disease Health
Intervention Project. Rural and urban differences in diabetes prevalence in Tanzania: the role of obesity, physical
inactivity and urban living. Transactions of the Royal Society of Tropical Medicine & Hygiene 2000,
94(6):637-644
- Unwin N, Setel P, Rashid S, Mugusi F, Mbanya JC, Kitange H, Hayes L, Edwards R, Aspray T, Alberti KG: Noncommunicable
diseases in sub-Saharan Africa: where do they feature in the health research agenda? Bulletin of the World Health
Organization 2001, 79(10):947-953.
Contact for further information: n.c.unwin@ncl.ac.uk
The Tanzanian Stroke Incidence Study (TSIP) is funded by the Wellcome Trust. It is the first population based study of stroke incidence in sub-Saharan Africa and grew out of observed high stroke mortality (see reference). It includes a case control component to identify risk factors, and work linked to it includes an examination of the economic burden of stroke and lay health beliefs.
Illustrative references:
- Walker RW, McLarty DG, Kitange HM, Whiting D, Masuki G, Mtasiwa DM, Machibya H, Unwin N, Alberti KG: Stroke mortality
in urban and rural Tanzania. Adult Morbidity and Mortality Project. Lancet 2000, 355(9216):1684-1687
Contact for further information: Richard.walker@northumbria-healthcare.nhs.uk
Sample Vital Registration with Verbal Autopsy (SAVVY) aims to provide robust national estimates of cause-specific mortality in countries that do not have functioning vital registration systems. The foundation of SAVVY is demographic surveillance. Following an initial census of SAVVY sites to determine resident populations, a network of supervised lay reporters continues to enumerate all births, deaths, and migrations through annual or semi-annual update rounds. Deaths are reported by a separate system and are followed up at the household with a verbal autopsy interview implemented by trained staff. Medically trained coders review the interview forms and determine the probable cause of death.
Contact for further information: psetel@unc.edu