Accurate, comprehensive information on population health is needed to inform planning, resource allocation, program implementation, monitoring, and evaluation. Currently, there are major gaps in the available measurement methods and technologies to yield this information, making it difficult to address health inequities through effective policy.

The Population Health Metrics Research Consortium (PHMRC) was developed to wed survey design, primary data collection, analysis development, and novel diagnostic proteomics to provide tools for quantifying population health.

The PHMRC project collected data in the following five study sites: Bohol, Philippines; Andhra Pradesh, India; Uttar Pradesh, India; Dar es Salaam, Tanzania; and Pemba Island, Tanzania.

Collaborators

The PHMRC project team represents a wide array of research interests and areas of expertise. Collaborating scientists include physicians, epidemiologists, health economists, demographers, mathematicians, biologists, and social scientists from the following institutions:

Impact

Results of the research activities carried out by the Population Health Metrics Research Consortium:
  • Improved strategies for population health measurement and produced instruments that are science-based, standardized, and widely applicable across different settings. These instruments, paired with novel methods for easy-to-use analysis, provide the tools needed to create a population health profile of an area in terms of mortality rates, causes of death, coverage of key interventions, and various health behaviors.
  • Provided data and resources that allow rapid and effective field assessment of population prevalence of specific diseases and causes of death.
  • Produced data and tools that enable policymakers and researchers to address persistent inequities in health outcomes in both the developed and the developing world.

Key Activities

1. Developed methods to measure effective delivery of priority health interventions and mortality where vital registration systems are incomplete

The PHMRC project has implemented a household survey that incorporates innovative methods for gathering accurate information on mortality, effective coverage of key interventions, and causes of death from five international sites. It relied on innovative electronic data capture using netbooks in the field to markedly increase the quality of data and speed of transmission.
 
The survey was developed as a cost-effective and easy-to-use tool to utilize in a broad range of areas with poor or missing data.
 
In addition, a full census was implemented in four of the five study sites: Bohol, Andhra Pradesh, Uttar Pradesh, and Pemba Island. The census aimed to contact every household and every person 15 years or older. The instrument was designed to provide baseline information on child and adult mortality against which estimates from subsequent sample surveys can be compared. The census also tested some simple alternative formulations of certain questions to explore which formulations give the best results.

2. Developed methods to measure cause-specific mortality in populations with incomplete or inadequate cause of death coding

The principle of verbal autopsies (VAs) is that key conditions relating to major causes of death can be reliably recalled by relatives after a family member’s death. In this method, field interviewers speak with the next of kin, using a VA questionnaire to collect information about the symptoms of the deceased, demographic characteristics, possible risk factors (such as tobacco use), and other potentially contributing characteristics. The data are then aggregated to estimate population-level patterns of the major causes of death using multiple automated analytic methods including Tariff 2.0, which is now publicly available.
 
The study sites collected data in hospital and clinical environments for decedents with known causes of death. The Consortium developed a list of stringent, gold standard definitions for each cause of death, detailing the diagnostic criteria required to qualify for the study. Cases that met the gold standard criteria were followed up with blinded VA interviews with a relative of the deceased. The data were then aggregated to estimate population-level patterns of the major causes of death using the recently developed analysis models.
 
Statistical algorithms have been developed to analyze VA data. These methods provide a valuable alternative to the current standard in the field, the use of physicians to manually code each questionnaire. The physician review process is time-intensive and costly. By utilizing new methods of analysis, the VA survey tool becomes more widely accessible to users.

3. Develop methods to measure the prevalence and incidence of major diseases

The PHMRC project team is developing methods that will allow for effective population screening for diseases based on complementary sets of biomarkers, or molecular barcodes, found in human blood samples.

The diseases being investigated include tuberculosis, HIV, malaria, and diabetes. The PHMRC project team collected plasma samples from a research site in the Philippines and blood and sputum samples from the Dar es Salaam, Tanzania site, and is currently collecting plasma and sputum samples in Pemba Island, Tanzania. The samples are processed and analyzed by the Broad Institute for potential biomarker patterns. If this approach is found to be effective, it could be used in conjunction with population censuses to better understand the prevalence of key conditions.

In addition, the PHMRC project team is working to validate serological assays for representative bacterial, viral, and parasitic causes of diarrhea in developing countries and then prospectively evaluate these serological assays in field areas.