I am a demographer with interests (1) in the measurement of the global burden of disease and associated risk factors, and (2) in the design/evaluation of programs addressing health issues across the lifecourse in low and middle-income countries (LMICs). One main area of research has focused on testing new ways to improve measures of adult mortality in countries with limited vital registration (VR). In such countries, adult mortality is typically measured using survey data, but there are strong concerns that these data are prone to large biases. In a randomized trial in Senegal, I showed that a new questionnaire improved the coverage of survey data on adult mortality by more than 65%. I am now developing new tools to measure mortality and morbidity above age 50 in countries with limited VR. In a second main area of work, I have investigated the role of sexual networks in HIV prevention programs. I have conducted a unique study of sexual networks on a small island of Lake Malawi affected by a generalized HIV epidemic (the Likoma Network Study, LNS). This work has provided the first dynamic â€œmapâ€ of a sexual network through which HIV has spread extensively. I am now testing a new theoretical framework for sexual network research. It will permit a better targeting of treatment-as-prevention programs, as well as a better evaluation of their indirect effects. My research has been funded by the National Institutes of Health, the World Bank and the United Nations Childrenâ€™s Fund.
Areas of Expertise
Select Global Activities
Improving adult mortality data in countries with limited vital registration, Senegal: The project is a randomized controlled trial of a new survey instrument (the siblings enhanced life calendar, SELC) used to collect retrospective data on adolescent and adult mortality during household based surveys in developing countries. We hypothesize that by using recall cues and a life history calendar approach, the SELC will limit forgetting of siblings and foster more accurate reporting of these siblings' ages during interviews. As a result, it will help reduce current biases in estimates of adult mortality in developing countries. If effective, the new instrument will permit 1) better describing the burden of disease borne by adults in developing countries, and 2) evaluating the mortality impact of large public health programs targeting adult health including AIDS treatment programs or maternal health interventions.
The Likoma Network Study, Malawi: The Likoma network study (LNS) investigates the sexual networks connecting the inhabitants of Likoma, a small island of Lake Malawi with high HIV prevalence. Whereas previous studies of sexual networks and HIV/AIDS in sub-Saharan countries have focused solely on the personal networks of a small number of respondents, the LNS attempts to document the sexual networks of the entire adult population of Likoma. To do so, it uses a unique sociocentric study design, in which all members of the local population are contacted for a survey interview and are asked to nominate their five most recent sexual partners. Using these data, quasi-complete 'maps' of the sexual networks connecting inhabitants of the island can be constructed. These maps allow investigation of the impact of networks on HIV epidemiology and can inform mathematical models of HIV prevention.