A major objective of many health systems worldwide is to ensure that all people obtain the high-quality health services they need without risk of financial hardship. Achieving this universal health coverage (UHC) requires reducing inequalities within countries as well as between countries. Within-country inequalities, particularly in low- and middle-income countries, has therefore become the focus of research. In a recent study published in BMC Medicine, Emmanuela Gakidou from the University of Washington, USA, and colleagues focus on maternal, neonatal, and child health (MNCH) interventions across 72 districts in Zambia. Using data collected over 20 years, they produce the first systematic assessment of trends in this area. Here Gakidou explains their findings and what the implications are, not only for Zambia but also for other sub-Saharan African countries.
Biography
Emmanuela Gakidou, MSc, PhD, is Professor of Global Health and Senior Director of Organizational Development and Training at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. She is also a Faculty Affiliate for the Center for Statistics and the Social Sciences at the University of Washington.
Dr. Gakidou’s research interests focus on impact evaluation, methods, and tools development for analytical challenges in global health. Examples of current research projects include the evaluation of community-based interventions to improve non-communicable disease management in underserved populations, the assessment of facility efficiency in the provision of health services, and the measurement of poverty and educational attainment at the small area level.
A founding member of IHME, Dr. Gakidou oversees the Organizational Development and Training team as they strengthen and support our high-achieving, diverse, and ambitious staff. She is passionate about training the next generation of leaders in the field of health metrics and evaluation both at the University of Washington and around the world, and enjoys mentoring and teaching.
Before joining IHME, Dr. Gakidou was a research associate at the Harvard Initiative for Global Health and the Institute for Quantitative Social Science. Prior to moving to Harvard University, Dr. Gakidou worked as a health economist at the World Health Organization (WHO), where she led work on the measurement of health inequalities.
Originally from Greece, Dr. Gakidou moved to the US for higher education and received her degrees – a BA, a Master of International Health Economics, and a PhD in Health Policy – from Harvard University.
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Wollum A, Burstein R, Fullman N, Dwyer-Lindgren L, Gakidou E. Benchmarking health system performance across states in Nigeria: a systematic analysis of levels and trends in key maternal and child health interventions and outcomes, 2000–2013. BMC Medicine. 2015 2 September.
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Duber HC, Dansereau E, Masters SH, Achan J, Burstein R, DeCenso B, Gasasira A, Ikilezi G, Kisia C, Masiye F, Njuguna P, Odeny T, Okiro E, Roberts DA, Gakidou E. Uptake of WHO recommendations for first-line antiretroviral therapy in Kenya, Uganda, and Zambia. PLOS One. 2015 March 25. doi: 10.1371/journal.pone.0120350.
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James SL, Romero M, Ramírez-Villalobos D, Gómez S, Pierce K, Flaxman A, Serina P, Stewart A, Murray CJL, Gakidou E, Lozano R, Hernandez B. Validating estimates of prevalence of non-communicable diseases based on household surveys: the symptomatic diagnosis study. BMC Medicine. 2015 Jan 26; 13:15. doi:10.1186/s12916-014-0245-8.
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‡Corresponding author
Ng M, Freeman MK, Fleming TD, Robinson M, Dwyer-Lindgren L, Thomson B, Wollum A, Sanman E, Wulf S, Lopez AD, Murray CJL, Gakidou E. Smoking prevalence and cigarette consumption in 187 countries, 1980-2012. Journal of the American Medical Association. 2014; 311(2):183-192. Doi:10.1001/jama.2013.284692.
Darney BG, Weaver MR, Sosa-Rubi SG, Walker D, Servan-Mori E, Prager S, Gakidou E. The Oportunidades Conditional Cash Transfer Program: effects on pregnancy and contraceptive use among young rural women in Mexico. International Perspectives on Sexual and Reproductive Health. 2013 Dec; 39(4).
Dwyer-Lindgren L, Gakidou E, Flaxman A, Wang H. Error and bias in under-5 mortality estimates derived from birth histories with small sample sizes. Population Health Metrics. 2013; 11:13.
Ng M, Gakidou E, Murray CJL, Lim SS. A comparison of missing data procedures for addressing selection bias in HIV sentinel surveillance data. Population Health Metrics. 2013; 11:12.
Murray CJL, Abraham J, Ali MK, Alvarado M, Atkinson C, Baddour LM, Bartels DH, Benjamin EJ, Bhalla K, Birbeck G, Bolliger I, Burstein R, Carnahan E, Chen H, Chou D, Chugh SS, Cohen A, Colson KE, Cooper LT, Couser W, Criqui MH, Dabhadkar KC, Dahodwala N, Danaei G, Dellavalle RP, Des Jarlais DC, Dicker D, Ding EL, Dorsey ER, Duber H, Ebel BE, Engell RE, Ezzati M, Fahimi S, Felson DT, Finucane MM, Flaxman S, Flaxman AD, Fleming T, Foreman KJ, Forouzanfar MH, Freedman G, Freeman MK, Gabriel SE, Gakidou E, Gillum RF, Gonzalez-Medina D, Gosselin R, Grant B, Gutierrez HR, Hagan H, Havmoeller R, Hoffman H, Jacobsen KH, James SL, Jasrasaria R, Jayaraman S, Johns N, Kassebaum N, Khatibzadeh S, Knowlton LM, Lan Q, Leasher JL, Lim S, Lin JK, Lipshultz SE, London S, Lozano R, Lu Y, MacIntyre MF, Mallinger L, McDermott MM, Meltzer M, Mensah GA, Micha R, Michaud C, Miller TR, Mock C, Terrie E. Moffitt TE, Mokdad AA, Mokdad AH, Moran AE, Mozaffarian D, Murphy T, Naghavi M, Narayan KMV, Nelson RG, Olives C, Omer SB, Ortblad K, Ostro B, Pelizzari PM, Phillips D, Pope CA, Raju M, Ranganathan D, Razavi H, Ritz B, Rivara FP, Roberts T, Sacco RL, Salomon JA, Sampson U, Sanman E, Sapkota A, Schwebel DC, Shahraz S, Shibuya K, Shivakoti R, Silberberg D, Singh GM, Singh D, Singh JA, Sleet DA, Steenland K, Tavakkoli M, Taylor JA, Thurston GD, Towbin JA, Vavilala MS, Vos T, Wagner GR, Weinstock MA, Weisskopf MG, Wilkinson JD, Wulf S, Zabetian A, Lopez AD. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors [published online July 10, 2013]. Journal of the American Medical Association. DOI: 10.1001/jama.2013.13805.
Fullman N, Burstein R, Lim S, Medlin C, Gakidou E. Nets, spray or both? The effectiveness of insecticide-treated nets and indoor residual spraying in reducing malaria morbidity and child mortality in sub-Saharan Africa. Malaria Journal. 2013; 12:62. doi:1
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‡ Corresponding author
Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V*, Abraham J*, Adair T*, Aggarwal R*, Ahn SY*, Alvarado M*, Anderson HR*, Anderson LM*, Andrews KG*, Atkinson C*, Baddour LM*, Barker‐Collo* S, Bartelsn DH*, Bell M*, Benjamin EJ*, Bennett D*, Bhalla K*, Bikbov B*, Abdulhak AB*, Birbeck G*, Blyth F*, Bolliger I*, Boufous S*, Bucello C*, Burch M*, Burney P*, Carapetis J*, Chen H*, Chou D*, Chugh SS*, Coffeng LE*, Colan SD*, Colquhoun S*, Colson KE*, Condon J*, Connor MD*, Cooper LT*, Corriere M*, Cortinovis M*, Courville de Vaccaro *, Couser W*, Cowie BC*, Criqui MH*, Cross M*, Dabhadkar KC*, Dahodwala N*, De Leo D*, Degenhardt L*, Delossantos A*, Denenberg J*, Des Jarlais DC*, Dharmaratne SD*, Dorsey EJ*, Driscoll T*, Duber H*, Ebel B*, Erwin PJ*, Espindola P*, Ezzati M*, Feigin V*, Flaxman A*, Forouzanfar MH*, Fowkes FGR*, Franklin R*, Fransen M*, Freeman MK*, Gabriel SE*, Gakidou E*, Gaspari F*, Gillum RJ*, Gonzalez‐Medina D*, Halasa YA*, Haring D*, Harrison JE*, Havmoeller R*, Hay RJ*, Hoen B*, Hotez PJ*, Hoy D*, Jacobsen KH*, James SL*, Jasrasaria R*, Jayaraman S*, Johns N*, Karthikeyan G*, Kassebaum N*, Keren A*, Khoo J-P*, Knowlton LM*, Kobusingye O*, Koranteng A*, Krishnamurthi R*, Lipnick M*, Lipshultz SE*, Ohno SL*, Mabweijano J*, MacIntyre MF*, Mallinger L*, March L*, Marks GM*, Marks R*, Matsumori A*, Matzopoulos R*, Mayosi BM*, McAnulty JH*, McDermott MM*, McGrath J*, Mensah GA*, Merriman TR*, Michaud C*, Miller M*, Miller TR*, Mock C*, Mocumbi AO*, Mokdad AA*, Moran A*, Mulholland K*, Nair MN*, Naldi L*, Narayan KMV*, Nasseri K*, Norman P*, O’Donnell M*, Omer SB*, Ortblad K*, Osborne R*, Ozgediz D*, Pahari B*, Pandian JD*, Panozo Rivero A*, Perez Padilla R*, Perez‐Ruiz F*, Perico N*, Phillips D*, Pierce K*, Pope CA III*, Porrini E*, Pourmalek F*, Raju M*, Ranganathan D*, Rehm JT*, Rein DB*, Remuzzi G*, Rivara FP*, Roberts T*, Rodriguez De León F*, Rosenfeld LC*, Rushton L*, Sacco RL*, Salomon JA*, Sampson U*, Sanman E*, Schwebel DC*, Segui‐Gomez M*, Shepard DS*, Singh D*, Singleton J*, Sliwa K*, Smith D*, Steer A*, Taylor JA*, Thomas B*, Tleyjeh IM*, Towbin JA*, Truelsen T*, Undurraga EA*, Venketasubramanian N*, Vijayakumar L*, Vos T*, Wagner GR*, Wang M*, Wang W*, Watt K*, Weinstock MA*, Weintraub R*, Wilkinson JA*, Woolf AD*, Wulf S*, Yeh P-H*, Yip P*, Zabetian A*, Zheng J-J*, Lopez AD†, Murray CJL.†‡ Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet. 2012 Dec 13; 380: 2095–2128.
* Authors listed alphabetically
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† Joint senior authors
‡ Corresponding author
Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S*, Aboyans V*, Abraham J*, Ackerman I*, Aggarwal R*, Ahn SY*, Ali MK*, Alvarado M*, Anderson HR*, Anderson LM*, Andrews KG*, Atkinson C*, Baddour LM*, Bahalim AN*, Barker-Collo S*, Barrero LH*, Bartels DH*, Basáñez MG*, Baxter A*, Bell ML*, Benjamin EJ*, Bennett D*, Bernabé E*, Bhalla K*, Bhandari B*, Bikbov B*, Bin Abdulhak A*, Birbeck G*, Black JA*, Blencowe H*, Blore JD*, Blyth F*, Bolliger I*, Bonaventure A*, Boufous S*, Bourne R*, Boussinesq M*, Braithwaite T*, Brayne C*, Bridgett L*, Brooker S*, Brooks P*, Brugha TS*, Bryan-Hancock C*, Bucello C*, Buchbinder R*, Buckle G*, Budke CM*, Burch M*, Burney P*, Burstein R*, Calabria B*, Campbell B*, Canter CE*, Carabin H*, Carapetis J*, Carmona L*, Cella C*, Charlson F*, Chen H*, Cheng ATA*, Chou D*, Chugh SS*, Coffeng LE*, Colan SD*, Colquhoun S*, Colson KE*, Condon J*, Connor MD*, Cooper LT*, Corriere M*, Cortinovis M*, Courville de Vaccaro K*, Couser W*, Cowie BC*, Criqui MH*, Cross M*, Dabhadkar KC*, Dahiya M*, Dahodwala N*, Damsere-Derry J*, Danaei G*, Davis A*, De Leo D*, Degenhardt L*, Dellavalle R*, Delossantos A*, Denenberg J*, Derrett S*, Des Jarlais DC*, Dharmaratne SD*, Dherani M*, Diaz-Torne C*, Dolk H*, Dorsey ER*, Driscoll T*, Duber H*, Ebel B*, Edmond K*, Elbaz A*, Eltahir Ali S*, Erskine H*, Erwin PJ*, Espindola P*, Ewoigbokhan SE*, Farzadfar F*, Feigin V*, Felson DT*, Ferrari A*, Ferri CP*, Fèvre EM*, Finucane MM*, Flaxman S*, Flood L*, Foreman K*, Forouzanfar MH*, Fowkes FGR*, Franklin R*, Fransen M*, Freeman MK*, Gabbe BJ*, Gabriel SE*, Gakidou E*, Ganatra HA*, Garcia B*, Gaspari F*, Gillum RF*, Gmel G*, Gosselin R*, Grainger R*, Groeger J*, Guillemin F*, Gunnell D*, Gupta R*, Haagsma J*, Hagan H*, Halasa YA*, Hall W*, Haring D*, Haro JM*, Harrison JE*, Havmoeller R*, Hay RJ*, Higashi H*, Hill C*, Hoen B*, Hoffman H*, Hotez PJ*, Hoy D*, Huang JJ*, Ibeanusi SE*, Jacobsen KH*, James SL*, Jarvis D*, Jasrasaria R*, Jayaraman S*, Johns N*, Jonas JB*, Karthikeyan G*, Kassebaum N*, Kawakami N*, Keren A*, Khoo J-P*, King CH*, Knowlton LM*, Kobusingye O*, Koranteng A*, Krishnamurthi R*, Lalloo R*, Laslett LL*, Lathlean T*, Leasher JL*, Lee YY*, Leigh J*, Lim SS*, Limb E*, Lin JK*, Lipnick M*, Lipshultz SE*, Liu W*, Loane M*, Lockett Ohno S*, Lyons R*, Ma J*, Mabweijano J*, MacIntyre MF*, Malekzadeh R*, Mallinger L*, Manivannan S*, Marcenes W*, March L*, Margolis DJ*, Marks GB*, Marks R*, Matsumori A*, Matzopoulos R*, Mayosi BM*, McAnulty JH*, McDermott MM*, McGill N*, McGrath J*, Medina-Mora ME*, Meltzer M*, Mensah GA*, Merriman TR*, Meyer AC*, Miglioli V*, Miller M*, Miller TR*, Mitchell PB*, Mocumbi AO*, Moffitt TE*, Mokdad AA*, Monasta L*, Montico M*, Moradi-Lakeh M*, Moran A*, Morawska L*, Mori R*, Murdoch ME*, Mwaniki MK*, Naidoo K*, Nair MN*, Naldi L*, Narayan KMV*, Nelson PK*, Nelson RG*, Nevitt MC*, Newton CR*, Nolte S*, Norman P*, Norman R*, O’Donnell M*, O’Hanlon S*, Olives C*, Omer SB*, Ortblad K*, Osborne R*, Ozgediz D*, Page A*, Pahari B*, Pandian JD*, Rivero AP*, Patten SB*, Pearce N*, Perez Padilla R*, Perez-Ruiz F*, Perico N*, Pesudovs K*, Phillips D*, Phillips MR*, Pierce K*, Pion S*, Polanczyk GV*, Polinder S*, Pope III CA*, Popova S*, Porrini E*, Pourmalek F*, Prince M*, Pullan RL*, Ramaiah KD*, Ranganathan D*, Razavi H*, Regan M*, Rehm JT*, Rein DB*, Remuzzi G*, Richardson K*, Rivara FP*, Roberts T*, Robinson C*, Rodriguez De Leòn F*, Ronfani L*, Room R*, Rosenfeld LC*, Rushton L*, Sacco RL*, Saha S*, Sampson U*, Sanchez-Riera L*, Sanman E*, Schwebel DC*, Scott JG*, Segui-Gomez M*, Shahraz S*, Shepard DS*, Shin H*, Shivakoti R*, Singh D*, Singh GM*, Singh JA*, Singleton J*, Sleet DA*, Sliwa K*, Smith E*, Smith JL*, Stapelberg NJC*, Steer A*, Steiner T*, Stolk WA*, Stovner LJ*, Sudfeld C*, Syed S*, Tamburlini G*, Tavakkoli M*, Taylor HR*, Taylor JA*, Taylor WJ*, Thomas B*, Thomson WM*, Thurston GD*, Tleyjeh IM*, Tonelli M*, Towbin JA*, Truelsen T*, Tsilimbaris MK*, Ubeda C*, Undurraga EA*, van der Werf MJ*, van Os J*, Vavilala MS*, Venketasubramanian N*, Wang M*, Wang W*, Watt K*, Weatherall DJ*, Weinstock MA*, Weintraub R*, Weisskopf MG*, Weissman MM*, White RA*, Whiteford H*, Wiersma ST*, Wilkinson JD*, Williams HC*, Williams SRM*, Witt E*, Wolfe F*, Woolf AD*, Wulf S*, Yeh PH*, Zaidi AKM*, Zheng ZJ*, Zonies D*, Lopez AD†, Murray CJL†‡. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet. 2012 Dec 13; 380: 2163–2196.
* Authors listed alphabetically
† Joint senior authors
‡ Corresponding author
Gakidou E, Fullman N. Monitoring health inequalities: measurement considerations and implications. University of Queensland: Health Information Systems Knowledge Hub. 2012 Oct; 20. http://www.uq.edu.au/hishub/docs/WP20/HISHUB-20-WP-WEB-22Oct12.pdf.
James SL, Gubbins P, Murray CJL, Gakidou E. Developing a comprehensive time series of GDP per capita for 210 countries from 1950 to 2015. Population Health Metrics. 2012; 10:12.
Farzadfar F, Murray CJL, Gakidou E , Bossert T, Namdaritabar H, Alikhani S, Moradi G, Delavari A, Jamshidi H, Ezzati M. Effectiveness of diabetes and hypertension management by rural primary health-care workers (Behvarz workers) in Iran: a nationally representative observational study. The Lancet. 2011; DOI:10.1016/S0140-6736(08)61345-8.
Ng M, Gakidou E, Levin-Rector A, Khera A, Murray CJL, Dandona L. Assessment of population-level effect of Avahan, an HIV-prevention initiative in India. The Lancet. 2011; DOI:10.1016/S0140-6736(11)61390-1.
Lim SS, Fullman N, Stokes A, Ravishankar N, Masiye F, Murray CJL, Gakidou E. Net benefits: a multicountry analysis of observational data examining associations between insecticide-treated mosquito nets and health outcomes. PLoS Medicine. September 2011; 8(9): e1001.
Ahern RM, Lozano R, Naghavi M, Foreman K, Gakidou E, Murray CJL. Improving the public health utility of global cardiovascular mortality data: the rise of ischemic heart disease. Population Health Metrics. 2011; 9:8.
Gakidou E, Mallinger L, Abbott-Klafter J, Guerrero R, Villalpando S, Ridaura RL, Aekplakorn W, Naghavi M, Lim S, Lozano R, Murray CJL. Management of diabetes and associated cardiovascular risk factors in seven countries: a comparison of data from national health examination surveys. Bulletin of the World Health Organization. 2011; 89:172-183.
Gakidou E, Cowling K, Lozano R, Murray CJL. Increased educational attainment and its effect on child mortality in 175 countries between 1970 and 2009: a systematic analysis. The Lancet. 2010 Sept 18; 376(9745):959-974. doi: 10.1016/S0140-6736(10)61257-3.
Lim SS, Dandona L, Hoisington JA, James SL, Hogan MC, Gakidou E. India's Janani Suraksha Yojana, a conditional cash transfer programme to increase births in health facilities: an impact evaluation. The Lancet. 2010 Jun 4; 375:2009–2023.
Obermeyer Z, Rajaratnam JK, Park CH, Gakidou E, Hogan MC, Lopez AD, Murray CJL. Measuring adult mortality using sibling survival: a new analytical method and new results for 44 countries, 1974–2006. PLoS Medicine. 2010 Apr 13; 7(4):e1000260.
King G, Gakidou E, Imai K, Lakin J, Moore RT, Nall C, Ravishankar N, Vargas M, Téllez-Rojo MM, Hernández Ávila JE, Hernández Ávila M, Hernández Llamas H. Public Policy for the poor? A randomised assessment of the Mexican universal health insurance programme. The Lancet. 2009 Apr 9; 373:1447–1454.
Liu Y, Rao K, Wu J, Gakidou E. China's health system performance. The Lancet. 2008; 372(9653):1914-23.
Ikeda N, Gakidou E, Hasegawa T, Murray CJL. Understanding the decline of mean systolic blood pressure in Japan: an analysis of pooled data from the National Nutrition Survey, 1986–2002. Bulletin of the World Health Organization. 2008; 86:978–988.
Obermeyer Z, Murray CJL, Gakidou E. A half-century of war mortality from Vietnam to Bosnia: New estimates from the World Health Survey Program. British Medical Journal. 2008 Jun 28; 336(7659):1482-6.
Obermeyer Z, Murray CJL, Gakidou E. Fifty years of violent war deaths from Vietnam to Bosnia: Analysis of data from the World Health Survey programme. British Medical Journal. 2008; 336:1482.
Gakidou E, Nordhagen S, Obermeyer Z. Coverage of cervical cancer screening in 57 countries: Low average levels and large inequalities. PLoS Medicine. 2008 Jun 17; 5(4):e132.
Lim SS, Gaziano TA, Gakidou E, Reddy KS, Farzadfar F, Lozano R, Rodgers A. Prevention of cardiovascular disease in high-risk individuals in low-income and middle-income countries: health effects and costs. The Lancet. 2007 Dec 15; 370:2054–2062.
King G, Gakidou E, Ravishankar N, Moore RT, Lakin J, Vargas M, Tellez-Rojo MM, Hernandez-Avila JE, Hernandez-Avila M, Hernandez-Llamas H. A ‘politically robust’ experimental design for public policy evaluation, with application to the Mexican universal health insurance program. Journal of Policy Analysis and Management. 2007; 26(3):479-506.
Vapattanawong P, Hogan MC, Hanvoravongchai P, Gakidou E, Vos T, Lopez AD, et al. Reductions in child mortality levels and inequalities in Thailand: analysis of two censuses. The Lancet. 2007 Mar 10; 369(9564):850-5.
Gakidou E, Lozano R, Gonzalez-Pier E, Abbott-Klafter J, Barofsky JT, Bryson-Cahn C, Feehan DM, Lee DK, Hernandez-Llamas H, Murray CJL. Assessing the effect of the 2001-06 Mexican health reform: an interim report card. The Lancet. 2006 Nov 25; 368(9550):1920-35.
Lozano R, Soliz P, Gakidou E, Abbott-Klafter J, Feehan D, Vidal C, Ortiz JP, Murray CJL. Benchmarking of performance of Mexican states with effective coverage. The Lancet. 2006; 368(9548):1729-41.
Lu C, Michaud C, Gakidou E, Khan K, Murray CJL. Independent evaluation of the impact of GAVI Alliance on DTP3 coverage. The Lancet. 2006; 368(9541):1088-95.
Gakidou E, King G. Death by survey: estimating adult mortality without selection bias from sibling survival data. Demography. 2006; 43(3):569-85.
Gakidou E, Murray CJL, Frenk J. Health inequalities and social group differences: what should we measure? Bulletin of the World Health Organization. 1999; 77(7):537-43.
April 2, 2015
April 2, 2015
BioMed Central
Interventions for improving maternal and child health have resulted in significant national health gains in Zambia since 1990. However, these national gains mask substantial variations across districts and interventions. Emmanuela Gakidou discusses the findings of her study on this area published today in BMC Medicine.