TY - JOUR
T1 - Using evidence, expert opinion and epidemiological model to understand pathways to survival and mortality
T2 - The Pathways to Survival (PATHS) Tool
AU - Rudan, Igor
AU - Theodoratou, Evropi
AU - Chan, Kit Yee
AU - Adeloye, Davies
AU - Polašek, Ozren
AU - Campbell, Harry
AU - Chopra, Mickey
N1 - Funding Information:
In order to develop the model, we held three expert group meetings ? in Dubrovnik, Croatia, in September 2010; in Seattle, USA, in March 2011; and in Edinburgh, UK, in September 2011. We invited some of the most respected international researchers in the field of neonatal infections to the meetings, and we thank them for their contribution to the development of our model (see full list in the Acknowledgment section). The model has been developed and refined iteratively between September 2010 and September 2011, over the course of three expert meetings. At the beginning of each meeting, our expert panels were introduced to the aims of our project and expectations from the model. We acknowledge the support from the following international experts in neonatal infections to the development of the proposed epidemiological model (listed in alphabetical order): Abdullah Baqui, Helen Brotherton, Debbie Burgess, Aruna Chandran, Mike English, Rachel Falconer, Hadley Herbert, Bernardo L. Horta, Issrah Jawad, Ivana Kolcic, Emmanouil Korakakis, Anne C.C. Lee, Ivana Luksic, Shabir Madhi, Smruti Patel, Ozren Polasek, Zeshan Qureshi, Dalibora Rako, Craig Rubens, Donald Waters, Martin Weber, Anita Zaidi and Lina Zgaga.
Publisher Copyright:
© 2021 The Author(s)
PY - 2021/9/8
Y1 - 2021/9/8
N2 - Background The reasons why episodes of illness can lead to fatal outcomes in affected persons in low resource settings are numerous and complex. A tool that allows policy makers to better understand those complexities could be useful to improve success of programmes that are implemented globally to reduce mortality. Methods We developed a “Pathways to Survival” (PATHS) tool: an epidemiological model using decision trees, available evidence and expert opinion. PATHS visualises the “architecture” of mortality in the population by following the entire population cohort over a certain period of time. It explains how initially healthy persons progress through health systems to lethal outcomes at the end of the specified time period. We developed an illustrative example based on the 136 million newborns and an estimated 907 000 deaths from newborn sepsis in the year 2008. This allowed us to develop an epidemiological model that described pathways to deaths from neonatal sepsis globally in 2010. Results The model described the “status quo’ situation in 2010 with 907 000 deaths to allow an assessment of the potential impact and feasibility of different interventions and programmes at various level of health systems in reducing this cause of mortality. A useful model should incorporate both a ‘horizontal’ and a ‘vertical’ component. The ‘horizontal’ would track the progress of all neonates globally through time, ie, their first 28 days of life, and separate them into different ‘pathways’ every time a change in their risk of dying from neonatal infection occurs because of their specific contextual circumstances. The ‘vertical’ would track their position within the health systems of their countries and separate them into different categories based on the ability of health system to intervene and reduce their risk of dying. Based on those requirements, PATHS tool was developed which is based on decision trees where different “branches” of the trees are associated with varying case-fatality rates. Conclusions The application of the PATHS tool on the example of newborn sepsis revealed that novel diagnostic tests could save many lives, so we should continue to invest in them to improve their validity, deliverability and affordability. However, PATHS showed that investments in better diagnostics have limited impact unless they are coupled with improvements of the context. Programs for parental education improve compliance and care seeking. Promoting legislation change to empower community health workers (CHWs) to actively engage in prevention, diagnosis and care also makes a difference, as well as programs for training CHWs to use diagnostic tests and administer treatments correctly. Care-seeking behaviour can also be improved through programs of conditional cash transfers. Finally, PATHS demonstrated that improving access to primary and secondary health care for everyone is the most powerful contextual change. Funding: Bill and Melinda Gates Foundation.
AB - Background The reasons why episodes of illness can lead to fatal outcomes in affected persons in low resource settings are numerous and complex. A tool that allows policy makers to better understand those complexities could be useful to improve success of programmes that are implemented globally to reduce mortality. Methods We developed a “Pathways to Survival” (PATHS) tool: an epidemiological model using decision trees, available evidence and expert opinion. PATHS visualises the “architecture” of mortality in the population by following the entire population cohort over a certain period of time. It explains how initially healthy persons progress through health systems to lethal outcomes at the end of the specified time period. We developed an illustrative example based on the 136 million newborns and an estimated 907 000 deaths from newborn sepsis in the year 2008. This allowed us to develop an epidemiological model that described pathways to deaths from neonatal sepsis globally in 2010. Results The model described the “status quo’ situation in 2010 with 907 000 deaths to allow an assessment of the potential impact and feasibility of different interventions and programmes at various level of health systems in reducing this cause of mortality. A useful model should incorporate both a ‘horizontal’ and a ‘vertical’ component. The ‘horizontal’ would track the progress of all neonates globally through time, ie, their first 28 days of life, and separate them into different ‘pathways’ every time a change in their risk of dying from neonatal infection occurs because of their specific contextual circumstances. The ‘vertical’ would track their position within the health systems of their countries and separate them into different categories based on the ability of health system to intervene and reduce their risk of dying. Based on those requirements, PATHS tool was developed which is based on decision trees where different “branches” of the trees are associated with varying case-fatality rates. Conclusions The application of the PATHS tool on the example of newborn sepsis revealed that novel diagnostic tests could save many lives, so we should continue to invest in them to improve their validity, deliverability and affordability. However, PATHS showed that investments in better diagnostics have limited impact unless they are coupled with improvements of the context. Programs for parental education improve compliance and care seeking. Promoting legislation change to empower community health workers (CHWs) to actively engage in prevention, diagnosis and care also makes a difference, as well as programs for training CHWs to use diagnostic tests and administer treatments correctly. Care-seeking behaviour can also be improved through programs of conditional cash transfers. Finally, PATHS demonstrated that improving access to primary and secondary health care for everyone is the most powerful contextual change. Funding: Bill and Melinda Gates Foundation.
UR - http://www.scopus.com/inward/record.url?scp=85109136776&partnerID=8YFLogxK
U2 - 10.7189/JOGH.11.15001
DO - 10.7189/JOGH.11.15001
M3 - Article
AN - SCOPUS:85109136776
SN - 2047-2978
VL - 11
SP - 1
EP - 19
JO - Journal of Global Health
JF - Journal of Global Health
ER -