Saba Moussavi - Academia.edu (original) (raw)

Papers by Saba Moussavi

Monitoring and assessment of coverage rates in national health programmes is becoming increasingl... more Monitoring and assessment of coverage rates in national health programmes is becoming increasingly important. We aimed to assess the accuracy of officially reported coverage rates of vaccination with diphtheria-tetanus-pertussis vaccine (DTP3), which is commonly used to monitor child health interventions. We compared officially reported national data for DTP3 coverage with those from the household Demographic and Health Surveys (DHS) in 45 countries between 1990 and 2000. We adjusted survey data to reflect the number of valid vaccinations (ie, those administered in accordance with the schedule recommended by WHO) using a probit model with sample selection. The model predicted the probability of valid vaccinations for children, including those without documented vaccinations, after correcting for bias from differences between the children with and without documented information on vaccination. We then assessed the extent of survey bias and differences between officially reported data and those from DHS estimates. Our results suggest that officially reported DTP3 coverage is higher than that reported from household surveys. This size of the difference increases with the rate of reported coverage of DTP3. Results of time-trend analysis show that changes in reported coverage are not correlated with changes reported from household surveys. Although reported data might be the most widely available information for assessment of vaccination coverage, their validity for measuring changes in coverage over time is highly questionable. Household surveys can be used to validate data collected by service providers. Strategies for measurement of the coverage of all health interventions should be grounded in careful assessments of the validity of data derived from various sources.

Background Depression is an important public-health problem, and one of the leading causes of dis... more Background Depression is an important public-health problem, and one of the leading causes of disease burden worldwide. Depression is often comorbid with other chronic diseases and can worsen their associated health outcomes. Few studies have explored the eff ect of depression, alone or as a comorbidity, on overall health status. Methods The WHO World Health Survey (WHS) studied adults aged 18 years and older to obtain data for health, health-related outcomes, and their determinants. Prevalence of depression in respondents based on ICD-10 criteria was estimated. Prevalence values for four chronic physical diseases-angina, arthritis, asthma, and diabetes-were also estimated using algorithms derived via a Diagnostic Item Probability Study. Mean health scores were constructed using factor analysis and compared across diff erent disease states and demographic variables. The relation of these disease states to mean health scores was determined through regression modelling. Findings Observations were available for 245 404 participants from 60 countries in all regions of the world. Overall, 1-year prevalence for ICD-10 depressive episode alone was 3•2% (95% CI 3•0-3•5); for angina 4•5% (4•3-4•8); for arthritis 4•1% (3•8-4•3); for asthma 3•3% (2•9-3•6); and for diabetes 2•0% (1•8-2•2). An average of between 9•3% and 23•0% of participants with one or more chronic physical disease had comorbid depression. This result was signifi cantly higher than the likelihood of having depression in the absence of a chronic physical disease (p<0•0001). After adjustment for socioeconomic factors and health conditions, depression had the largest eff ect on worsening mean health scores compared with the other chronic conditions. Consistently across countries and diff erent demographic characteristics, respondents with depression comorbid with one or more chronic diseases had the worst health scores of all the disease states. Interpretation Depression produces the greatest decrement in health compared with the chronic diseases angina, arthritis, asthma, and diabetes. The comorbid state of depression incrementally worsens health compared with depression alone, with any of the chronic diseases alone, and with any combination of chronic diseases without depression. These results indicate the urgency of addressing depression as a public-health priority to reduce disease burden and disability, and to improve the overall health of populations.

The Lancet Global Health, 2017

Background Although childhood trauma and violence against women are global public health issues, ... more Background Although childhood trauma and violence against women are global public health issues, few populationbased data from low-income and middle-income countries exist about the links between them. We present data from the UN Multi-country Study on Men and Violence in Asia and the Pacific, exploring the pathways between different forms of childhood trauma and violence against women. Methods In this multicountry study, we interviewed multistage representative samples of men and women, aged 18-49 years, in Asia and the Pacific, using standardised population-based household surveys. Men were interviewed in six countries, and women in four. Respondents were asked questions about their perpetration or experience of intimate partner violence or non-partner sexual violence, childhood trauma, and harsh parenting (smacking their children as a form of discipline). We used maximum likelihood multivariate logit models to explore associations between childhood trauma and violence against women, and fitted path models to explore associations between experience and perpetration of child maltreatment.

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2009

This article describes the development of the international reporting system to monitor the imple... more This article describes the development of the international reporting system to monitor the implementation of the Declaration of Commitment on HIV/AIDS that resulted from the 2001 United Nations General Assembly Special Session on HIV/AIDS (UNGASS). The UNGASS reporting system is based on the biennial submission of Country Progress Reports. These include data on a set of core indicators and are prepared and submitted by Member States using a transparent collaborative process. This article reviews the evolution of the system and analyzes the quality and completeness of data from the most recent 2008 reporting round. Over the course of 3 rounds of reporting response rates increased from 54% to 77%. This increase occurred alongside an increase in the completeness of the reported data. Increases in reporting are consistent across countries regardless of the severity of the HIV epidemic. UNGASS reporting has resulted in an unparalleled body of evidence on the response to HIV. Data from 147 countries are now available on the patterns of HIV epidemics, the behaviors related to them, and the programmatic responses that have been mounted by countries. The ultimate goal is for national governments and their civil society partners to achieve ownership of the reporting process. The reporting system has provided a catalyst for the development of national systems for monitoring and evaluating HIV programs and for guiding more effective, efficient, and sustainable responses to the HIV epidemic.

Monitoring and assessment of coverage rates in national health programmes is becoming increasingl... more Monitoring and assessment of coverage rates in national health programmes is becoming increasingly important. We aimed to assess the accuracy of officially reported coverage rates of vaccination with diphtheria-tetanus-pertussis vaccine (DTP3), which is commonly used to monitor child health interventions. We compared officially reported national data for DTP3 coverage with those from the household Demographic and Health Surveys (DHS) in 45 countries between 1990 and 2000. We adjusted survey data to reflect the number of valid vaccinations (ie, those administered in accordance with the schedule recommended by WHO) using a probit model with sample selection. The model predicted the probability of valid vaccinations for children, including those without documented vaccinations, after correcting for bias from differences between the children with and without documented information on vaccination. We then assessed the extent of survey bias and differences between officially reported data and those from DHS estimates. Our results suggest that officially reported DTP3 coverage is higher than that reported from household surveys. This size of the difference increases with the rate of reported coverage of DTP3. Results of time-trend analysis show that changes in reported coverage are not correlated with changes reported from household surveys. Although reported data might be the most widely available information for assessment of vaccination coverage, their validity for measuring changes in coverage over time is highly questionable. Household surveys can be used to validate data collected by service providers. Strategies for measurement of the coverage of all health interventions should be grounded in careful assessments of the validity of data derived from various sources.

Background Depression is an important public-health problem, and one of the leading causes of dis... more Background Depression is an important public-health problem, and one of the leading causes of disease burden worldwide. Depression is often comorbid with other chronic diseases and can worsen their associated health outcomes. Few studies have explored the eff ect of depression, alone or as a comorbidity, on overall health status. Methods The WHO World Health Survey (WHS) studied adults aged 18 years and older to obtain data for health, health-related outcomes, and their determinants. Prevalence of depression in respondents based on ICD-10 criteria was estimated. Prevalence values for four chronic physical diseases-angina, arthritis, asthma, and diabetes-were also estimated using algorithms derived via a Diagnostic Item Probability Study. Mean health scores were constructed using factor analysis and compared across diff erent disease states and demographic variables. The relation of these disease states to mean health scores was determined through regression modelling. Findings Observations were available for 245 404 participants from 60 countries in all regions of the world. Overall, 1-year prevalence for ICD-10 depressive episode alone was 3•2% (95% CI 3•0-3•5); for angina 4•5% (4•3-4•8); for arthritis 4•1% (3•8-4•3); for asthma 3•3% (2•9-3•6); and for diabetes 2•0% (1•8-2•2). An average of between 9•3% and 23•0% of participants with one or more chronic physical disease had comorbid depression. This result was signifi cantly higher than the likelihood of having depression in the absence of a chronic physical disease (p<0•0001). After adjustment for socioeconomic factors and health conditions, depression had the largest eff ect on worsening mean health scores compared with the other chronic conditions. Consistently across countries and diff erent demographic characteristics, respondents with depression comorbid with one or more chronic diseases had the worst health scores of all the disease states. Interpretation Depression produces the greatest decrement in health compared with the chronic diseases angina, arthritis, asthma, and diabetes. The comorbid state of depression incrementally worsens health compared with depression alone, with any of the chronic diseases alone, and with any combination of chronic diseases without depression. These results indicate the urgency of addressing depression as a public-health priority to reduce disease burden and disability, and to improve the overall health of populations.

The Lancet Global Health, 2017

Background Although childhood trauma and violence against women are global public health issues, ... more Background Although childhood trauma and violence against women are global public health issues, few populationbased data from low-income and middle-income countries exist about the links between them. We present data from the UN Multi-country Study on Men and Violence in Asia and the Pacific, exploring the pathways between different forms of childhood trauma and violence against women. Methods In this multicountry study, we interviewed multistage representative samples of men and women, aged 18-49 years, in Asia and the Pacific, using standardised population-based household surveys. Men were interviewed in six countries, and women in four. Respondents were asked questions about their perpetration or experience of intimate partner violence or non-partner sexual violence, childhood trauma, and harsh parenting (smacking their children as a form of discipline). We used maximum likelihood multivariate logit models to explore associations between childhood trauma and violence against women, and fitted path models to explore associations between experience and perpetration of child maltreatment.

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2009

This article describes the development of the international reporting system to monitor the imple... more This article describes the development of the international reporting system to monitor the implementation of the Declaration of Commitment on HIV/AIDS that resulted from the 2001 United Nations General Assembly Special Session on HIV/AIDS (UNGASS). The UNGASS reporting system is based on the biennial submission of Country Progress Reports. These include data on a set of core indicators and are prepared and submitted by Member States using a transparent collaborative process. This article reviews the evolution of the system and analyzes the quality and completeness of data from the most recent 2008 reporting round. Over the course of 3 rounds of reporting response rates increased from 54% to 77%. This increase occurred alongside an increase in the completeness of the reported data. Increases in reporting are consistent across countries regardless of the severity of the HIV epidemic. UNGASS reporting has resulted in an unparalleled body of evidence on the response to HIV. Data from 147 countries are now available on the patterns of HIV epidemics, the behaviors related to them, and the programmatic responses that have been mounted by countries. The ultimate goal is for national governments and their civil society partners to achieve ownership of the reporting process. The reporting system has provided a catalyst for the development of national systems for monitoring and evaluating HIV programs and for guiding more effective, efficient, and sustainable responses to the HIV epidemic.