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Spatial distribution of contraceptive usage by district in Pakistan: Percent change in couple years of protection in 2015-16 compared to 2014-15.
JPMA. Journal of the Pakistan Medical Association. 2018 Jul; 68(7):1090-1094.Pakistan's population will cross the 200 million-mark in 2017. 'Couple Years of Protection' (CYP) is a proxy indicator for various contraceptive methods used. The Pakistan 'Contraceptive Performance Report 2015-2016' (CPR) in Pakistan, provides comparison with the previous year i.e. 2014-2015 in terms of CYP percent change at the district level in the country. In this study, CPR percent change data were mapped and cluster analysis was conducted, using GIS programmes to visualize spatial distribution in the country by district. No statistical evidence of clustering at the global/country level was found. The percent change in CYP 2015-16, compared to 2014-15 at the district level ranged from -90.4% to 316.9% in the 113 districts for which data was available. Sixty-five districts reported negative CYP percent change, while 48 reported positive CYP change. With the exception of Balochistan province, all provinces and FATA had districts with percent change in CYP ranging from -90.4% to -50.0%.
HIV prevention where it is needed most: comparison of strategies for the geographical allocation of interventions.
Journal of the International AIDS Society. 2017 Dec; 20(4)INTRODUCTION: A strategic approach to the application of HIV prevention interventions is a core component of the UNAIDS Fast Track strategy to end the HIV epidemic by 2030. Central to these plans is a focus on high-prevalence geographies, in a bid to target resources to those in greatest need and maximize the reduction in new infections. Whilst this idea of geographical prioritization has the potential to improve efficiency, it is unclear how it should be implemented in practice. There are a range of prevention interventions which can be applied differentially across risk groups and locations, making allocation decisions complex. Here, we use mathematical modelling to compare the impact (infections averted) of a number of different approaches to the implementation of geographical prioritization of prevention interventions, similar to those emerging in policy and practice, across a range of prevention budgets. METHODS: We use geographically specific mathematical models of the epidemic and response in 48 counties and major cities of Kenya to project the impact of the different geographical prioritization approaches. We compare the geographical allocation strategies with a nationally uniform approach under which the same interventions must be applied across all modelled locations. RESULTS: We find that the most extreme geographical prioritization strategy, which focuses resources exclusively to high-prevalence locations, may substantially restrict impact (41% fewer infections averted) compared to a nationally uniform approach, as opportunities for highly effective interventions for high-risk populations in lower-prevalence areas are missed. Other geographical allocation approaches, which intensify efforts in higher-prevalence areas whilst maintaining a minimum package of cost-effective interventions everywhere, consistently improve impact at all budget levels. Such strategies balance the need for greater investment in locations with the largest epidemics whilst ensuring higher-risk groups in lower-priority locations are provided with cost-effective interventions. CONCLUSIONS: Our findings serve as a warning to not be too selective in the application of prevention strategies. Further research is needed to understand how decision-makers can find the right balance between the choice of interventions, focus on high-risk populations, and geographical targeting to ensure the greatest impact of HIV prevention. (c) 2017 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.
Jornal De Pediatria. 2016 Nov - Dec; 92(6):567-573.OBJECTIVE: Maternal and neonatal mortality are important public health issues in low-income countries. This study evaluated spatial and temporal maternal and neonatal mortality trends in Brazil between 1997 and 2012. METHODS: This study employed spatial analysis techniques using death records from the mortality information system. Maternal mortality rates per 100,000 and neonatal mortality rates (early and late) per 1000 live births were calculated by state, region, and period (1997-2000, 2001-2004, 2005-2008, and 2009-2012). Multivariate negative binomial models were used to explain the risk of death. RESULTS: The mean Brazilian maternal mortality rate was 55.63/100,000 for the entire 1997-2012 period. The rate fell 10% from 1997-2000 (58.92/100,000) to 2001-2004 (52.77/100,000), but later increased 11% during 2009-2012 (58.69/100,000). Early and late neonatal mortality rates fell 33% (to 7.36/1000) and 21% (to 2.29/1000), respectively, during the 1997-2012 period. Every Brazilian region witnessed a drop in neonatal mortality rates. However, maternal mortality increased in the Northeast, North, and Southeast regions. CONCLUSION: Brazil's neonatal mortality rate has improved in recent times, but maternal mortality rates have stagnated, failing to meet the Millennium Development Goals. Public policies and intersectoral efforts may contribute to improvements in these health indicators.
Community context and sub-neighborhood scale detail to explain dengue, chikungunya and Zika patterns in Cali, Colombia.
PloS One. 2017; 12(8):e0181208.BACKGROUND: Cali, Colombia has experienced chikungunya and Zika outbreaks and hypoendemic dengue. Studies have explained Cali's dengue patterns but lack the sub-neighborhood-scale detail investigated here. METHODS: Spatial-video geonarratives (SVG) with Ministry of Health officials and Community Health Workers were collected in hotspots, providing perspective on perceptions of why dengue, chikungunya and Zika hotspots exist, impediments to control, and social outcomes. Using spatial video and Google Street View, sub-neighborhood features possibly contributing to incidence were mapped to create risk surfaces, later compared with dengue, chikungunya and Zika case data. RESULTS: SVG captured insights in 24 neighborhoods. Trash and water risks in Calipso were mapped using SVG results. Perceived risk factors included proximity to standing water, canals, poverty, invasions, localized violence and military migration. These risks overlapped case density maps and identified areas that are suitable for transmission but are possibly underreporting to the surveillance system. CONCLUSION: Resulting risk maps with local context could be leveraged to increase vector-control efficiency- targeting key areas of environmental risk.
Visual analysis of geospatial habitat suitability model based on inverse distance weighting with paired comparison analysis.
Multimedia Tools and Applications. 2017 Jun 3; 1-21.Geospatial data analytical model is developed in this paper to model the spatial suitability of malaria outbreak in Vellore, Tamil Nadu, India. In general, Disease control strategies are only the spatial information like landscape, weather and climate, but also spatially explicit information like socioeconomic variable, population density, behavior and natural habits of the people. The spatial multi-criteria decision analysis approach combines the multi-criteria decision analysis and geographic information system (GIS) to model the spatially explicit and implicit information and to make a practical decision under different scenarios and different environment. Malaria is one of the emerging diseases worldwide; the cause of malaria is weather & climate condition of the study area. The climate condition is often called as spatially implicit information, traditional decision-making models do not use the spatially implicit information it most often uses spatially explicit information such as socio-economic, natural habits of the people. There is need to develop an integrated approach that consists of spatially implicit and explicit information. The proposed approach is used to identity an effective control strategy that prevents and control of malaria. Inverse Distance Weighting (IDW) is a type of deterministic method used in this paper to assign the weight values based on the neighborhood locations. ArcGIS software is used to develop the geospatial habitat suitability model.
Scientific Reports. 2016 Oct 05; 5:34541.In low-income settings, vaccination campaigns supplement routine immunization but often fail to achieve coverage goals due to uncertainty about target population size and distribution. Accurate, updated estimates of target populations are rare but critical; short-term fluctuations can greatly impact population size and susceptibility. We use satellite imagery to quantify population fluctuations and the coverage achieved by a measles outbreak response vaccination campaign in urban Niger and compare campaign estimates to measurements from a post-campaign survey. Vaccine coverage was overestimated because the campaign underestimated resident numbers and seasonal migration further increased the target population. We combine satellite-derived measurements of fluctuations in population distribution with high-resolution measles case reports to develop a dynamic model that illustrates the potential improvement in vaccination campaign coverage if planners account for predictable population fluctuations. Satellite imagery can improve retrospective estimates of vaccination campaign impact and future campaign planning by synchronizing interventions with predictable population fluxes.
Mapping adolescent first births within three east African countries using data from Demographic and Health Surveys: exploring geospatial methods to inform policy.
Reproductive Health. 2016 Aug 23; 13(98):1-29.Background Early adolescent pregnancy presents a major barrier to the health and wellbeing of young women and their children. Previous studies suggest geographic heterogeneity in adolescent births, with clear “hot spots” experiencing very high prevalence of teenage pregnancy. As the reduction of adolescent pregnancy is a priority in many countries, further detailed information of the geographical areas where they most commonly occur is of value to national and district level policy makers. The aim of this study is to develop a comprehensive assessment of the geographical distribution of adolescent first births in Uganda, Kenya and Tanzania using Demographic and Household (DHS) data using descriptive, spatial analysis and spatial modelling methods. Methods The most recent Demographic and Health Surveys (DHS) among women aged 20 to 29 in Tanzania, Kenya, and Uganda were utilized. Analyses were carried out on first births occurring before the age of 20 years, but were disaggregated in to three age groups: <16, 16/17 and 18/19 years. In addition to basic descriptive choropleths, prevalence maps were created from the GPS-located cluster data utilizing adaptive bandwidth kernel density estimates. To map adolescent first birth at district level with estimates of uncertainty, a Bayesian hierarchical regression modelling approach was used, employing the Integrated Nested Laplace Approximation (INLA) technique. Results The findings show marked geographic heterogeneity among adolescent first births, particularly among those under 16 years. Disparities are greater in Kenya and Uganda than Tanzania. The INLA analysis which produces estimates from smaller areas suggest “pockets” of high prevalence of first births, with marked differences between neighboring districts. Many of these high prevalence areas can be linked with underlying poverty. Conclusions There is marked geographic heterogeneity in the prevalence of adolescent first births in East Africa, particularly in the youngest age groups. Geospatial techniques can identify these inequalities and provide policy-makers with the information needed to target areas of high prevalence and focus scarce resources where they are most needed.
Data visualization that works. Facilitating HIV program targeting: Case examples and considerations.
Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, Carolina Population Center, MEASURE Evaluation, 2016 Apr.  p. (Working Paper WP-16-162; USAID Cooperative Agreement No. AID-OAA-L-14-00004)Electronic health information systems offer health data in digital formats that are more complete, timelier, and more robust. These technologies offer a promise that health systems -- and therefore health -- can be improved with an increasing in evidence-informed decision making. Access to data, however, is not sufficient. Data must be processed, analyzed, and presented to decision makers in usable formats. Data visualization can help would-be data users to see patterns, trends, and correlations that might go undetected in text-based or numerically-based data. MEASURE Evaluation sought to understand how data visualization tools are being used in the field to improve HIV programs and to see what kind of impact they have on decision making. Multiple software platforms, either open-source or proprietary, are available to facilitate data visualization and often are interactive, providing tools to develop charts, maps, infographics, timelines, and other visuals. Our interviews with respondents uncovered important facilitators and barriers to the development of data visualization and its successful use in decision making. This paper presents six fundamentals for data visualization and four case studies to illustrate their application in various program settings.
Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, Carolina Population Center, MEASURE Evaluation, 2015 Dec.  p. (SR-15-126; USAID Cooperative Agreement No. AID-OAA-L-14-00004)Recent years have seen tremendous growth in interest in geographic information system (GIS) technology. These systems manage data, facilitate analysis, and generate effective information products that can support decision making. Considerable investment in health systems has increased the availability of reliable data, making GIS well suited to support global health and development activities. At its most effective, GIS is a tool employed in pursuit of a larger objective, such as improving response to disease outbreaks, increasing access to treatment, or reducing maternal mortality. It enhances the ability of program managers to distribute services efficiently and equitably. As a supporting tool, its value may be overlooked if attention is limited to service delivery and health outcomes. This document presents specific examples of how GIS has served programs associated with key global health and development priorities. It is intended for program managers, technical specialists, and decision makers.
Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, Carolina Population Center, MEASURE Evaluation, 2016 Feb.  p. (FS-15-161; USAID Cooperative Agreement No. AID-OAA-L-14-00004)An explosion in the quantity of data has prompted an increasing emphasis on how this information can advance global health. Within this burgeoning data “tsunami,” as some have termed it, are rich streams of data on the populations at risk and in need of HIV treatment, the services being provided, and the context in which these both exist. Many of these data streams have a geographic component. Geographic information systems (GIS) can make use of the geographic data to produce analysis that can better locate services and ensure they reach populations in need. GIS synthesizes data from many sources, such as health surveys, routine health information systems (RHIS), or census data, and links them using a common geography. It offers the opportunity to combine data sources that previously may not have been used together, resulting in a richer picture of the context in which HIV programs operate. MEASURE Evaluation -- a project funded by USAID and PEPFAR -- believes GIS has a big role to play in strengthening health information systems (HIS) and improving monitoring and evaluation (M&E). We are breaking new ground with research on the uses of GIS in these areas to guide decision making on health policy, resource allocation, priorities, and programs.
Health Policy and Planning. 2016 Oct 1; 31(8):1058-1068.While geographic information systems (GIS) are frequently used to research accessibility issues for healthcare services around the world, sophisticated spatial analysis protocols and outputs often prove inappropriate and unsustainable to support evidence-based programme strategies in resource-constrained environments. This article examines how simple, open-source and interactive GIS tools have been used to locate family planning (FP) services delivery points in Kinshasa (Democratic Republic of Congo) and to identify underserved areas, determining the potential location of new service points, and to support advocacy for FP programmes. Using smartphone-based data collection applications (OpenDataKit), we conducted two surveys of FP facilities supported by partner organizations in 2012 and 2013 and used the results to assess gaps in FP services coverage, using both ratio of facilities per population and distance-based accessibility criteria. The cartographic outputs included both static analysis maps and interactive Google Earth displays, and sought to support advocacy and evidence-based planning for the placement of new service points. These maps, at the scale of Kinshasa or for each of the 35 health zones that cover the city, garnered a wide interest from the operational level of the health zones' Chief Medical Officers, who were consulted to contribute field knowledge on potential new service delivery points, to the FP programmes officers at the Ministry of Health, who could use the map to inform resources allocation decisions throughout the city.
Cadernos De Saude Publica. 2015 Aug; 31(8):1721-31.The dynamics of the spread of the AIDS epidemic ranges according to the characteristics of each geographical region in different population groups. The aim of this study was to evaluate spatial and temporal trends of the AIDS epidemic among the elderly in the State of Rio de Janeiro, Brazil. A retrospective study using spatial analysis techniques was conducted among AIDS cases (>/= 60 years) diagnosed from 1997-2011. The Poisson regression model was used to assess the relationship between year of diagnosis and incidence of AIDS, adjusted by sex. The AIDS epidemic began in the south coast of the state and gradually reached neighboring cities. The highest rates were found in regions around Rio de Janeiro and Niteroi cities. The highest smoothed rates of the period were observed in Niteroi in 2002-2006: 11.87/100,000 (men) and 8,5/100,000 (women). AIDS incidence rates among the elderly have stabilized in recent decades. To prevent HIV from spreading further among the general population, greater attention should be given to the older population.
Revista De Saude Publica. 2015; 49OBJECTIVE: To analyze if the distribution of specialized care services for HIV/AIDS is associated with AIDS rates. METHODS: Ecological study, for which the distribution of 10 specialized care services in the Ceara state, Northeastern Brazil, was obtained, and the mean rates of the disease were estimated per mesoregion. We evaluated 7,896 individuals who had been diagnosed with AIDS, were aged 13 years or older, lived in Ceara, and had been informed of their condition between 2001 and 2011. Maps were constructed to verify the relationship between the distribution of AIDS cases and institutionalized support networks in the 2001-2006 and 2007-2011 periods. BoxMap and LisaMap were used for data analysis. The Voronoi diagram was applied for the distribution of the studied services. RESULTS: Specialized care services concentrated in AIDS clusters in the metropolitan area. The Noroeste Cearense and west of the Sertoes Cearenseshad high AIDS rates, but a low number of specialized care services over time. Two of these services were implemented where clusters of the disease exist in the second period. The application of the Voronoi diagram showed that the specialized care services located outside the metropolitan area covered a large territory. We identified one polygon that had no services. CONCLUSIONS: The scenario of AIDS cases spread away from major urban areas demands the creation of social support services in areas other than the capital and the metropolitan area of the state; this can reduce access barriers to these institutions. It is necessary to create specialized care services for HIV/AIDS in the Noroeste Cearense and north of Jaguaribe.
How Can Childbirth Care for the Rural Poor Be Improved? A Contribution from Spatial Modelling in Rural Tanzania.
PloS One. 2015; 10(9):e0139460.INTRODUCTION: Maternal and perinatal mortality remain a challenge in resource-limited countries, particularly among the rural poor. To save lives at birth health facility delivery is recommended. However, increasing coverage of institutional deliveries may not translate into mortality reduction if shortage of qualified staff and lack of enabling working conditions affect quality of services. In Tanzania childbirth care is available in all facilities; yet maternal and newborn mortality are high. The study aimed to assess in a high facility density rural context whether a health system organization with fewer delivery sites is feasible in terms of population access. METHODS: Data on health facilities' location, staffing and delivery caseload were examined in Ludewa and Iringa Districts, Southern Tanzania. Geospatial raster and network analysis were performed to estimate access to obstetric services in walking time. The present geographical accessibility was compared to a theoretical scenario with a 40% reduction of delivery sites. RESULTS: About half of first-line health facilities had insufficient staff to offer full-time obstetric services (45.7% in Iringa and 78.8% in Ludewa District). Yearly delivery caseload at first-line health facilities was low, with less than 100 deliveries in 48/70 and 43/52 facilities in Iringa and Ludewa District respectively. Wide geographical overlaps of facility catchment areas were observed. In Iringa 54% of the population was within 1-hour walking distance from the nearest facility and 87.8% within 2 hours, in Ludewa, the percentages were 39.9% and 82.3%. With a 40% reduction of delivery sites, approximately 80% of population will still be within 2 hours' walking time. CONCLUSIONS: Our findings from spatial modelling in a high facility density context indicate that reducing delivery sites by 40% will decrease population access within 2 hours by 7%. Focused efforts on fewer delivery sites might assist strengthening delivery services in resource-limited settings.
PloS One. 2015; 10(3):e0119944.HIV prevalence is rising and has been consistently higher among women in Rwanda whereas a decreasing national HIV prevalence rate in the adult population has stabilised since 2005. Factors explaining the increased vulnerability of women to HIV infection are not currently well understood. A statistical mapping at smaller geographic units and the identification of key HIV risk factors are crucial for pragmatic and more efficient interventions. The data used in this study were extracted from the 2010 Rwanda Demographic and Health Survey data for 6952 women. A full Bayesian geo-additive logistic regression model was fitted to data in order to assess the effect of key risk factors and map district-level spatial effects on the risk of HIV infection. The results showed that women who had STIs, concurrent sexual partners in the 12 months prior to the survey, a sex debut at earlier age than 19 years, were living in a woman-headed or high-economic status household were significantly associated with a higher risk of HIV infection. There was a protective effect of high HIV knowledge and perception. Women occupied in agriculture, and those residing in rural areas were also associated with lower risk of being infected. This study provides district-level maps of the variation of HIV infection among women of child-bearing age in Rwanda. The maps highlight areas where women are at a higher risk of infection; the aspect that proximate and distal factors alone could not uncover. There are distinctive geographic patterns, although statistically insignificant, of the risk of HIV infection suggesting potential effectiveness of district specific interventions. The results also suggest that changes in sexual behaviour can yield significant results in controlling HIV infection in Rwanda.
Finding HIV in hard to reach populations: mobile HIV testing and geospatial mapping in Umlazi township, Durban, South Africa.
AIDS and Behavior. 2015 Oct; 19(10):1888-95.Mobile, community-based HIV testing may help achieve universal HIV testing in South Africa. We compared the yield, geographic distribution, and demographic characteristics of populations tested by mobile- and clinic-based HIV testing programs deployed by iThembalabantu Clinic in Durban, South Africa. From July to November 2011, 4,701 subjects were tested; HIV prevalence was 35 % among IPHC testers and 10 % among mobile testers (p < 0.001). Mobile testers varied in mean age (22-37 years) and % males (26-67 %). HIV prevalence at mobile sites ranged from 0 to 26 %. Testers traveled further than the clinic closest to their home; mobile testers were more likely to test >/=5 km away from home. Mobile HIV testing can improve testing access and identify testing sites with high HIV prevalence. Individuals often access mobile testing sites farther from home than their nearest clinic. Geospatial techniques can help optimize deployment of mobile units to maximize yield in hard-to-reach populations.
Using geographic information systems and spatial analysis methods to assess household water access and sanitation coverage in the SHINE trial.
Clinical Infectious Diseases. 2015; 61 Suppl 7:S716–S725.Access to water and sanitation are important determinants of behavioral responses to hygiene and sanitation interventions. We estimated cluster-specific water access and sanitation coverage to inform a constrained randomization technique in the SHINE trial. Technicians and engineers inspected all public access water sources to ascertain seasonality, function, and geospatial coordinates. Households and water sources were mapped using open-source geospatial software. The distance from each household to the nearest perennial, functional, protected water source was calculated, and for each cluster, the median distance and the proportion of households within <500 m and >1500 m of such a water source. Cluster-specific sanitation coverage was ascertained using a random sample of 13 households per cluster. These parameters were included as covariates in randomization to optimize balance in water and sanitation access across treatment arms at the start of the trial. The observed high variability between clusters in both parameters suggests that constraining on these factors was needed to reduce risk of bias. © The Author 2015. Open Access.
Social Science and Medicine. 2015 May; 133:296-303.In Senegal, recent data indicates that the HIV epidemic is increasingly driven by concurrent sexual partners among men and women in stable relationships. In order to respond to this changing epidemiological profile in Senegal, multi-lateral and national AIDS actors require information about these emerging trends in unstudied populations. To that end, this study has several objectives, first, to assess local dynamics of sexual behaviors among individuals at popular socializing venues in areas at increased risk of HIV transmission; and then to examine how particular venues may influence risks of HIV transmission. In 2013 we collected data at 314 venues in 10 cities in Senegal using PLACE methodology. These venues were listed with collaboration of 374 community informants. They are places where commercial sex workers, MSM, and individuals who are not part of any identified risk group socialize and meet new sexual partners. We conducted 2600 interviews at the 96 most popular venues. A significant portion of the sample reports buying or selling sex and the majority engaged in behavior considered high-risk for transmitting sexual infections. Almost a quarter of patrons interviewed in venues were young people aged 15-24 years. Types of venues described were very diverse. Half of them were venues (n = 156) where sex workers could be solicited and almost a third were venues where MSM could meet male partners (n = 90). The study showed existing pockets of vulnerability to HIV in Thies, Bignona or Saly that are not evident from aggregate HIV data. These early findings suggest links between risky behaviors and type of venue on the one hand and type of city on the other hand. Finally, these findings offer complementary insight to existing studies of HIV vulnerability in Senegal and support a case for venue-based interventions.
Global Health: Science and Practice. 2015 Dec 1; 3(4):646-659.Challenges in data availability and quality have contributed to the longest and deadliest Ebola epidemic in history that began in December 2013. Accurate surveillance data, in particular, has been difficult to access, as it is often collected in remote communities. We describe the design, implementation, and challenges of implementing a smartphone-based contact tracing system that is linked to analytics and data visualization software as part of the Ebola response in Guinea. The system, built on the mobile application CommCare and business intelligence software Tableau, allows for real-time identification of contacts who have not been visited and strong accountability of contact tracers through timestamps and collection of GPS points with their surveillance data. Deployment of this system began in November 2014 in Conakry, Guinea, and was expanded to a total of 5 prefectures by April 2015. To date, the mobile system has not replaced the paper-based system in the 5 prefectures where the program is active. However, as of April 30, 2015, 210 contact tracers in the 5 prefectures were actively using the mobile system to collectively monitor 9,162 contacts. With proper training, some investment in technical hardware, and adequate managerial oversight, there is opportunity to improve access to surveillance data from difficult-to-reach communities in order to inform epidemic control strategies while strengthening health systems to reduce risk of future disease outbreaks.
Defining electronic health technologies and their benefits for global health program managers. Geospatial analysis.
Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, Carolina Population Center, MEASURE Evaluation, .  p. (e-Health Glossary; FS-15-165d; USAID Cooperative Agreement No. AID-OAA-L-14-00004)Geospatial analysis can be described as the use of geographic data (such as GPS coordinates, street names, or other geographic identifiers) to identify spatial relationships, patterns, and trends in data. This can include statistical methods, spatial statistics techniques (such as interpolation or network analysis), or the layering of different geographically coded data sets in order to discover geographic patterns in data using a geographic information system, or GIS. Geographic information systems enable the linking of data sets with geographic data to spatially assess relationships and trends. In health, geospatial analysis software is used to discover patterns of disease outbreaks and their response to interventions; identify catchment areas for health facilities; and identify areas of high priority for investment and interventions. Spatial analysis and metrics can also be calculated to go beyond simply displaying data on a map. For instance, network analysis allows you to estimate time for travel based on the road network, rather than just straight-line estimates of distance. All of these analyses can be pivotal for better health program management and program targeting.
Lancet. Global Health. 2013 Nov; 1(5):e251-3.Add to my documents.
Security Dialogue. 2015 Aug 12; 46(4):345-364.In December 2010, HarassMap was launched as a Cairo-based interactive online mapping interface for reporting and mapping incidents of sexual harassment anonymously and in real time, in Egypt. The project’s use of spatial information technologies for crowdmapping sexual harassment raises important questions about the use of crowdsourced mapping as a technique of global human security governance, as well as the techno-politics of interpreting and representing spaces of gendered security and insecurity in Egypt’s urban streetscape. By recoding Egypt’s urban landscape into spaces subordinated to the visual cartography of the project’s crowdsourced data, HarassMap obscures the complex assemblage that it draws together as the differentially open space of the Egyptian street – spaces that are territorialized and deterritorialized for authoritarian control, state violence, revolt, rape, new solidarities, gender reversals, sectarian tensions, and class-based mobilization. What is at stake in my analysis is the plasticity of victimage: to what extent can attempts to ‘empower’ women be pursued at the microlevel without amplifying the similarly imperial techniques of objectifying them as resources used to justify other forms of state violence? The question requires taking seriously the practices of mapping and targeting as an interface for securing public space.
Covering the last kilometer: using GIS to scale-up voluntary medical male circumcision services in Iringa and Njombe Regions, Tanzania.
Global Health: Science and Practice. 2015 Sep 10; 3(3):503-515.Background: Based on the established protective effect of voluntary medical male circumcision (VMMC) in reducing female-to-male HIV transmission, Tanzania's Ministry of Health and Social Welfare (MOHSW) embarked on the scale-up of VMMC services in 2009. The Maternal and Child Health Integrated Project (MCHIP) supported the MOHSW to roll out VMMC services in Iringa and Njombe, 2 regions of Tanzania with among the highest HIV and lowest circumcision prevalence. With ambitious targets of reaching 264,990 males aged 10-34 years with VMMC in 5 years, efficient and innovative program approaches were necessary. Program Description: Outreach campaigns, in which mobile teams set up temporary services in facilities or non-facility settings, are used to reach lesser-served areas with VMMC. In 2012, MCHIP began using geographic information systems (GIS) to strategically plan the location of outreach campaigns. MCHIP gathered geocoded data on variables such as roads, road conditions, catchment population, staffing, and infrastructure for every health facility in Iringa and Njombe. These data were uploaded to a central database and overlaid with various demographic and service delivery data in order to identify the VMMC needs of the 2 regions. Findings: MCHIP used the interactive digital maps as decision-making tools to extend mobile VMMC outreach to “the last kilometer.” As of September 2014, the MOHSW with MCHIP support provided VMMC to 267,917 men, 259,144 of whom were men were aged 10-34 years, an achievement of 98% of the target of eligible males in Iringa and Njombe. The project reached substantially more men through rural dispensaries and non-health care facilities each successive year after GIS was introduced in 2012, jumping from 48% of VMMCs performed in rural areas in fiscal year 2011 to 88% in fiscal year 2012 and to 93% by the end of the project in 2014. Conclusion: GIS was an effective tool for making strategic decisions about where to prioritize VMMC service delivery, particularly for mobile and outreach services. Donors may want to consider funding mapping initiatives that support numerous interventions across implementing partners to spread initial start-up costs.
International Journal of Public Health. 2014 Oct; 59(5):841-9.OBJECTIVES: To investigate the possibility of using HIV- and syphilis-related web queries to predict incident diagnosis rates of sexually transmitted infections in Russia. METHODS: The regional volume of HIV/syphilis queries, normalized to the total number of queries submitted to the most popular search engine, was used to predict the notification rates of HIV/syphilis in each region by applying both global non-spatial and spatial statistics. RESULTS: Nationwide, both search volumes and regional HIV/syphilis diagnosis rates were positively spatially auto-correlated, indicating a clustered pattern of spatial distribution. A high positive correlation between notification rates and search volume was observed. Compared with linear models, spatially explicit geographically weighted models adjusted for broadband Internet diffusion proved superior in predicting the regional level of the HIV/syphilis epidemic on the basis of their search volume. CONCLUSIONS: Timeliness, easy availability, low cost, and transparency make HIV- and syphilis-related web queries a promising addition to traditional methods of disease surveillance in Russia. Geographically weighted regression provides useful insights, as it is able to capture the spatial heterogeneity of the relationship between search volume and disease incidence.
Geospatial analysis in global health M&E: a process guide to monitoring and evaluation for informed decision making.
Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, Carolina Population Center, MEASURE Evaluation, 2015 Jan.  p. (MS-14-98; USAID Cooperative Agreement No. GHA-A-00-08-00003-00)This guide provides monitoring and evaluation (M&E) practitioners an overview of geospatial analysis techniques applicable to their work. This guide shows how geospatial analysis can be used to support public health program decision-making along with routine planning and M&E. The use of geographic information systems (GIS) for M&E of health programs is expanding. As a result of this expansion, a growing number of users are seeking to move beyond basic GIS techniques (such as facility mapping), into more advanced GIS applications that combine various GIS techniques, outputs, and routine M&E datasets to conduct geospatial analysis. However, knowing which advanced analysis approaches are most relevant for M&E can be challenging for M&E professionals with limited formal GIS training. To identify the most appropriate spatial analysis techniques and help M&E professionals understand how to incorporate them into M&E, MEASURE Evaluation convened an experts meeting on Spatial Analytical Methods for M&E in December 2013 in Rosslyn, Virginia. Participating in the meeting were 18 GIS and global health experts with experience in either spatial analysis or M&E. The meeting’s objective was to identify key decision points where M&E practitioners might include spatial analysis techniques in their work. The participants identified several key challenges that M&E practitioners faced when including geospatial analysis in their work: Mixed skill levels -- basic to advanced-among GIS practitioners in many settings; Limited knowledge of GIS among public health decision makers; Limited understanding among M&E practitioners about how to use GIS in M&E; Limitations and incompleteness exist in many of the commonly available routine public health and programmatic datasets. To address these challenges, meeting participants recommended the development of a guide to give M&E and GIS practitioners an overview of how to select appropriate geospatial analysis techniques to help overcome the drawbacks of commonly used M&E data. This guide provides examples of ways to apply geospatial analysis within the context of M&E, along with resources for additional information if needed.