Study Investigates Joint Spatial-Temporal Modelling of Adverse Pregnancy Outcomes
Dr Julius Nyerere Odhiambo was awarded a PhD in Public Health for his study titled titled: Joint Spatial-Temporal Modelling of Adverse Pregnancy Outcomes and Related Risk Factors in Kenya.
Supervised by Professor Benn Sartorius, Nyerere sought to unmask the joint burden of adverse outcomes in pregnancy and related risk factors using advanced Bayesian space-time methods. The study supports the growing evidence-base for precision public health using routine health metrics, and the need for integrated suites of interventions at policy-relevant thresholds to reduce missed opportunities and simultaneously address the healthcare needs of women of child-bearing age.
‘Amidst Kenya’s diverse and growing population of women of childbearing age, the precise burden of adverse pregnancy outcomes has remained elusive in recent decades with Kenya falling short in its attempt to achieve Millennium Development Goal (MDG) 4 targets for both maternal and child health,’ said Nyerere.
He said the joint spatio-temporal model highlighted a non-uniform risk across all adverse pregnancy outcomes that may have been driven by demand side barriers and supply side challenges, with low-resource and malaria prone sub-counties being disproportionately more vulnerable to adverse pregnancy outcomes.
According to Nyerere, this study presents the first comprehensive sub-national estimates of adverse pregnancy outcomes in Kenya, often concealed by national and county estimates.
‘I advance both methodology and practice by reviewing and demonstrating the applicability of Bayesian hierarchical models in an environment of sparse/incomplete routinely collected data. By identifying areas with elevated risks and data gaps, our estimates not only assert the need to bolster maternal health programmes in the identified high-risk sub-counties, but also provide a baseline against which to assess progress towards the attainment of Sustainable Development Goals. Furthermore, our joint spatio-temporal model found evidence of shared risk factors that may contribute to adverse pregnancy outcomes.’
Nyerere is currently a postdoctoral research fellow at the Technical University of Kenya and a collaborator with the Global Burden of Disease Network at the Institute for Health Metric and Evaluation, at the University of Washington.
‘I would like to develop spatial and spatio-temporal statistical methods to understand the burden of disease/health outcomes and associated determinants at finer spatial and temporal scales. I also seek to explore interactive visualisation applications for reproducible research and communication. This will contribute to building resilient health systems that are responsive to population health needs, particularly in resource constrained settings,’ he added.
Nyerere was born and raised in the mountainous “Muksero-Kalando” village in western Kenya. He said he is deeply indebted to his supervisor: ‘I was primarily inspired by his research prowess and our converging interest in spatial epidemiology cemented my quest to join UKZN. The incredible support and research ecosystem at the College of Health Sciences made my study enjoyable and interesting.’
Words: Nombuso Dlamini