![]() This concept could be called systems epidemiology : analysis of the whole system of humans in their total environment within which disease occurs. Systems epidemiologyĭeveloping effective interventions requires evidence not only on how individual causal mechanisms influence ALRI risk but also on how these jointly determine disease. This implies that interventions to improve living conditions play a critical role in reducing ALRI morbidity and mortality. Interestingly, childhood ALRI deaths in the United States fell by two thirds during the first three decades of the 20th century, prior to the introduction of antibiotics or vaccines. Even with successful cure, children return to a home with high risk of re-infection. Fewer than 20% of children with ALRI receive appropriate treatment. improved nutrition, promotion of breastfeeding, reduced exposure to indoor air pollution), or at instigating longer-term socio-economic changes to create healthier societies. access to healthcare, timely treatment with antibiotics), at reducing the risk of infection (e.g. Interventions can thus be directed at curbing mortality (e.g. Instead, national and international decision-making heavily relies on nationally representative household surveys that generate cross-sectional datasets that are largely comparable across countries.Ĭhildhood ALRI is the outcome of a web of interacting socio-economic, environmental, behavioral and healthcare factors. In most African countries, vital registration systems are either non-existent or do not reach the whole population, and health surveillance is limited. One of the reasons for this lack of attention is the difficulty of obtaining high-quality health information. Childhood ALRI is one of several enormous public health problems in developing countries that fail to attract the necessary research to elucidate more of their epidemiology, and how this relates to the environmental and social context. They were responsible for 6.8% of 2.8 million neonatal deaths, 20.1% of 2.0 million infant deaths and 12.4% of 2.0 million deaths among children aged 1 to 4 years respectively in 2010, with sub-Saharan Africa being the most affected world region. This approach is well-suited to dealing with complex systems, in particular where data are scarce.Ĭhildhood acute lower respiratory infections in sub-Saharan AfricaĪcute lower respiratory infections (ALRI) represent a permanent global emergency. This partly a priori approach is explicit about causal assumptions guiding the analysis and about researcher judgment, and wrong assumptions can be reversed following empirical testing. Conclusionsĭiagram-based Analysis of Causal Systems is a means of organizing the current state of knowledge about a specific area of research, and a framework for integrating statistical analyses across a whole system. Notably, solid fuel use is structured by socio-economic factors and increases the risk of childhood ALRI mortality. Explicit strategies are employed to make decisions transparent about the inclusion/omission of arrows, the sign and strength of the relationships and homogeneity/heterogeneity across settings.įindings about the current state of evidence on the complex web of socio-economic, environmental, behavioral and healthcare factors influencing childhood ALRI, based on DHS and WHS data, are summarized in an integrated causal diagram. In our application, we apply different regression techniques to Demographic and Health Survey (DHS) datasets for Benin, Ethiopia, Kenya and Namibia and a pooled World Health Survey (WHS) dataset for sixteen African countries. ![]() In a step-by-step process, the causal diagram evolves from conceptual based on a priori knowledge and assumptions, through operational informed by data availability which then undergoes empirical testing, to integrated which synthesizes information from multiple datasets. ![]() Resultsĭiagram-based Analysis of Causal Systems combines the use of causal diagrams with multiple routinely available data sources, using a variety of statistical techniques. Based on the concept of systems epidemiology, this paper develops Diagram-based Analysis of Causal Systems (DACS) as an approach to analyze complex systems, and applies it by examining the contributions of proximal and distal determinants of childhood acute lower respiratory infections (ALRI) in sub-Saharan Africa. ![]() Effective interventions require evidence on how individual causal pathways jointly determine disease. ![]()
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