Emmanuel Peprah
Emmanuel Peprah
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Associate Professor of Global and Environmental Health
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Professional overview
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Dr. Emmanuel Peprah’s research interests lie at the confluence of understanding what, why, and how some evidence-based interventions work in some populations and not others. The programattic focus of his research is understanding the contextual factors that influence the burden of co-morbidity in people living with HIV/AIDS (PLWH), with a particular focus on cardiovascular disease risk factors and mental health. As the burden of non-communicable diseases (NCDs) continues to increase, there is an opportunity to integrate NCD management into HIV care with implemention strategies that leverage the global infrasturcture designed to improve care delivery for PLWH. Dr. Peprah has built collaborations with multidisciplinary teams of investigators, both nationally and internationally, to address the high burden of comorbidity in PLWH globally. He is also the founder of the Baakoye Foundation, a nonprofit philanthropic organization dedicated to serving people in sub-Saharan Africa, and co-founder of the Washington Leaders Index (WLI), which aims to empower the next generation of emerging leaders through active, innovative, and inclusive leadership programs. Both nonprofit organizations serve the needs of children and people globally within the domains of education and health.
Before joining GPH, Dr. Peprah was a senior program official at the National Institutes of Health (NIH), where he worked with senior leadership to oversee strategic planning, initiative development, and implementation of research priorities in the areas of translational research, implementation science, and global health. He led and managed HIV/AIDS programs and a $10 million portfolio as part of the National Heart, Lung, and Blood Institute’s Trans-Omics for Precision Medicine Program. He was instrumental in launching the Human, Heredity, and Health in Africa (H3Africa) Initiative, a multimillion trans-NIH program, and served on its executive board. Dr. Peprah has received several awards for strategic planning, management, and implementation of large-scale NIH programs.
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Education
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BS, Biology, Texas A&M University, Commerce, TXPhD, Molecular Biology & Biomedical Science, Meharry Medical College, Nashville, TN
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Honors and awards
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NIH Director’s Award for Leadership H3Africa Stage II Team: For exceptional leadership and dedication in implementing Stage II of the Human Heredity and Health in Africa program (2018)NHLBI’s Director's for Outstanding Service (2018)NHLBI’s Director's for Outstanding Service Partnership/Collaboration Award for bringing multiple disciplines together to understand HIV-related co-morbidities and prepare for the challenges presented by the complex conditions of the new HIV era (2018)NHLBI’s Director's for Outstanding Translational Science Award for demonstrating exemplary leadership and service in advancing translation research (2017)Federal Service Career Promotion (2016)NHLBI’s Director's for Outstanding Translational Science Award as part of the Center for Translational Research and Implementation Science (CTRIS) Leadership Team for demonstrating exemplary leadership and service in advancing CTRIS’s translation (2016)NHLBI’s Director's for Breath of Fresh Air (Innovation) award for exemplary work evaluating NHLBI’s support for multi-project research grants and proposing creative and innovative enhancements to the NHLBI’s program project grants (PPG) (2016)NHLBI’s Director's for Learning Environment Award for fostering a learning environment through effective administration, knowledge sharing, and thoughtful implementation of the NHLBI R35 Program (2016)NHLBI’s Director's for Partnership/Collaboration in recognition of outstanding collaborative efforts in developing a conceptual framework for the NHLBI R35 program to provide greater funding stability and flexibility to investigators (2015)NIH Director's Common Fund Leadership Award for the NIH Common Fund Early Independence Award Program (2013)NIH Director's Award as a member of the Common Fund Global Health Leadership Team for outstanding service in the coordination of the Common Fund Global Health Initiatives (2012)Certificate of Appreciation for Invited Presenter, NIH Seminar Series, STEM Careers (2012)Certificate of Appreciation for Invited Presenter, Washington Mathematics Science Technology Public Charter High School, Washington, DC (2012)Leadership Award, Postdoctoral Fellows Research Symposium Committee, Emory University, Atlanta, GA (2008)
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Areas of research and study
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Dissemination and Implementation of Evidence-based ProgramsHIV/AIDSImplementation scienceInter-organizational NetworksTranslational science
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Publications
Publications
Mapping age- and sex-specific HIV prevalence in adults in sub-Saharan Africa, 2000-2018
AbstractLocal Burden Dis Sub-Saharan Afric, A., Haeuser, E., Serfes, A., Cork, M., Yang, M., Abbastabar, H., Abhilash, E., Adabi, M., Adebayo, O., Adekanmbi, V., Adeyinka, D., Afzal, S., Ahinkorah, B., Ahmadi, K., Ahmed, M., Akalu, Y., Akinyemi, R., Akunna, C., Alahdab, F., … Peprah, E. (n.d.).Publication year
2022Journal title
BMC MedicineVolume
20Issue
1Abstract~Mapping age- and sex-specific HIV prevalence in adults in sub-Saharan Africa, 2000-2018
Failed generating bibliography.AbstractPublication year
2022Journal title
BMC medicineVolume
20Issue
1Page(s)
488AbstractHuman immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) is still among the leading causes of disease burden and mortality in sub-Saharan Africa (SSA), and the world is not on track to meet targets set for ending the epidemic by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Sustainable Development Goals (SDGs). Precise HIV burden information is critical for effective geographic and epidemiological targeting of prevention and treatment interventions. Age- and sex-specific HIV prevalence estimates are widely available at the national level, and region-wide local estimates were recently published for adults overall. We add further dimensionality to previous analyses by estimating HIV prevalence at local scales, stratified into sex-specific 5-year age groups for adults ages 15-59 years across SSA.Mapping age- and sex-specific HIV prevalence in adults in sub-Saharan Africa, 2000–2018
AbstractPeprah, E. (n.d.).Publication year
2022Journal title
BMC MedicineVolume
20Issue
1AbstractBackground: Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) is still among the leading causes of disease burden and mortality in sub-Saharan Africa (SSA), and the world is not on track to meet targets set for ending the epidemic by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Sustainable Development Goals (SDGs). Precise HIV burden information is critical for effective geographic and epidemiological targeting of prevention and treatment interventions. Age- and sex-specific HIV prevalence estimates are widely available at the national level, and region-wide local estimates were recently published for adults overall. We add further dimensionality to previous analyses by estimating HIV prevalence at local scales, stratified into sex-specific 5-year age groups for adults ages 15–59 years across SSA. Methods: We analyzed data from 91 seroprevalence surveys and sentinel surveillance among antenatal care clinic (ANC) attendees using model-based geostatistical methods to produce estimates of HIV prevalence across 43 countries in SSA, from years 2000 to 2018, at a 5 × 5-km resolution and presented among second administrative level (typically districts or counties) units. Results: We found substantial variation in HIV prevalence across localities, ages, and sexes that have been masked in earlier analyses. Within-country variation in prevalence in 2018 was a median 3.5 times greater across ages and sexes, compared to for all adults combined. We note large within-district prevalence differences between age groups: for men, 50% of districts displayed at least a 14-fold difference between age groups with the highest and lowest prevalence, and at least a 9-fold difference for women. Prevalence trends also varied over time; between 2000 and 2018, 70% of all districts saw a reduction in prevalence greater than five percentage points in at least one sex and age group. Meanwhile, over 30% of all districts saw at least a five percentage point prevalence increase in one or more sex and age group. Conclusions: As the HIV epidemic persists and evolves in SSA, geographic and demographic shifts in prevention and treatment efforts are necessary. These estimates offer epidemiologically informative detail to better guide more targeted interventions, vital for combating HIV in SSA.Temitope Ojo, Joyce Gyamfi, Nessa Ryan, Emmanuel Peprah. Development of the Contextual Index of Feasibility for Early-Stage Implementation in Low- and Middle-Income Countries (CATALYTIC Tool). 15th Annual Conference on the Science of Dissemination and Implementation in Health. December 11-14, 2022. (Poster)
AbstractPeprah, E. (n.d.).Publication year
2022Abstract~The overlapping burden of the three leading causes of disability and death in sub-Saharan African children
AbstractPeprah, E. (n.d.).Publication year
2022Journal title
Nature communicationsVolume
13Issue
1AbstractDespite substantial declines since 2000, lower respiratory infections (LRIs), diarrhoeal diseases, and malaria remain among the leading causes of nonfatal and fatal disease burden for children under 5 years of age (under 5), primarily in sub-Saharan Africa (SSA). The spatial burden of each of these diseases has been estimated subnationally across SSA, yet no prior analyses have examined the pattern of their combined burden. Here we synthesise subnational estimates of the burden of LRIs, diarrhoea, and malaria in children under-5 from 2000 to 2017 for 43 sub-Saharan countries. Some units faced a relatively equal burden from each of the three diseases, while others had one or two dominant sources of unit-level burden, with no consistent pattern geographically across the entire subcontinent. Using a subnational counterfactual analysis, we show that nearly 300 million DALYs could have been averted since 2000 by raising all units to their national average. Our findings are directly relevant for decision-makers in determining which and targeting where the most appropriate interventions are for increasing child survival.Toward a Theory of the Underpinnings and Vulnerabilities of Structural Racism : Looking Upstream from Disease Inequities among People Who Use Drugs
AbstractFriedman, S. R., Williams, L. D., Jordan, A. E., Walters, S., Perlman, D. C., Mateu-Gelabert, P., Nikolopoulos, G. K., Khan, M. R., Peprah, E., & Ezell, J. (n.d.).Publication year
2022Journal title
International journal of environmental research and public healthVolume
19Issue
12AbstractStructural racism is increasingly recognized as a key driver of health inequities and other adverse outcomes. This paper focuses on structural racism as an “upstream” institutionalized process, how it creates health inequities and how structural racism persists in spite of generations of efforts to end it. So far, “downstream” efforts to reduce these health inequities have had little success in eliminating them. Here, we attempt to increase public health awareness of structural racism and its institutionalization and sociopolitical supports so that research and action can address them. This paper presents both a theoretic and an analytic approach to how structural racism contributes to disproportionate rates of HIV/AIDS and related diseases among oppressed populations. We first discuss differences in disease and health outcomes among people who use drugs (PWUD) and other groups at risk for HIV from different racial and ethnic populations. The paper then briefly analyzes the history of racism; how racial oppression, class, gender and other intersectional divisions interact to create health inequities; and how structural racism is institutionalized in ways that contribute to disease disparities among people who use drugs and other people. It examines the processes, institutions and other structures that reinforce structural racism, and how these, combined with processes that normalize racism, serve as barriers to efforts to counter and dismantle the structural racism that Black, indigenous and Latinx people have confronted for centuries. Finally, we discuss the implications of this analysis for public health research and action to undo racism and to enhance the health of populations who have suffered lifetimes of racial/ethnic oppression, with a focus on HIV/AIDS outcomes.Using a Syndemics Framework to Understand How Substance Use Contributes to Morbidity and Mortality among People Living with HIV in Africa : A Call to Action
AbstractPeprah, E., Myers, B., Kengne, A. P., Peer, N., El-Shahawy, O., Ojo, T., Mukasa, B., Ezechi, O., Iwelunmor, J., Ryan, N., Sakho, F., Patena, J., & Gyamfi, J. (n.d.).Publication year
2022Journal title
International journal of environmental research and public healthVolume
19Issue
3AbstractSubstance use is increasing throughout Africa, with the prevalence of alcohol, tobacco, cannabis, and other substance use varying regionally. Concurrently, sub-Saharan Africa bears the world’s largest HIV burden, with 71% of people living with HIV (PWH) living in Africa. Problematic alcohol, tobacco, and other substance use among PWH is associated with multiple vulnerabilities comprising complex behavioral, physiological, and psychological pathways that include high-risk behaviors (e.g., sexual risk-taking), HIV disease progression, and mental health problems, all of which contribute to nonadherence to antiretroviral therapy. Physiologically, severe substance use disorders are associated with increased levels of biological markers of inflammation; these, in turn, are linked to increased mortality among PWH. The biological mechanisms that underlie the increased risk of substance use among PWH remain unclear. Moreover, the biobehavioral mechanisms by which substance use contributes to adverse health outcomes are understudied in low-and middle-income countries (LMIC). Syndemic approaches to understanding the co-occurrence of substance use and HIV have largely been limited to high-income countries. We propose a syndemic coupling conceptual model to disentangle substance use from vulnerabilities to elucidate underlying disease risk for PWH. This interventionist perspective enables assessment of biobehavioral mechanisms and identifies malleable targets of intervention.2021 APHA Conference
• APHA Conference Moderator - HIV and Gender Oct 24, 2021
• Moderated guest presenters on HIV, gender and syndemicsAbstractPeprah, E. (n.d.).Publication year
2021Abstract~An emerging syndemic of smoking and cardiopulmonary diseases in people living with HIV in Africa
AbstractPeprah, E., Armstrong-Hough, M., Cook, S. H., Mukasa, B., Taylor, J. Y., Xu, H., Chang, L., Gyamfi, J., Ryan, N., Ojo, T., Snyder, A., Iwelunmor, J., Ezechi, O., Iyegbe, C., O’reilly, P., & Kengne, A. P. (n.d.).Publication year
2021Journal title
International journal of environmental research and public healthVolume
18Issue
6Page(s)
1-12AbstractBackground: African countries have the highest number of people living with HIV (PWH). The continent is home to 12% of the global population, but accounts for 71% of PWH globally. Antiretroviral therapy has played an important role in the reduction of the morbidity and mortality rates for HIV, which necessitates increased surveillance of the threats from pernicious risks to which PWH who live longer remain exposed. This includes cardiopulmonary comorbidities, which pose significant public health and economic challenges. A significant contributor to the cardiopulmonary comorbidities is tobacco smoking. Indeed, globally, PWH have a 2–4-fold higher utilization of tobacco compared to the general population, leading to endothelial dysfunction and atherogenesis that result in cardiopulmonary diseases, such as chronic obstructive pulmonary disease and coronary artery disease. In the context of PWH, we discuss (1) the current trends in cigarette smoking and (2) the lack of geographically relevant data on the cardiopulmonary conditions associated with smoking; we then review (3) the current evidence on chronic inflammation induced by smoking and the potential pathways for cardiopulmonary disease and (4) the multifactorial nature of the syndemic of smoking, HIV, and cardiopulmonary diseases. This commentary calls for a major, multi-setting cohort study using a syndemics framework to assess cardiopulmonary disease outcomes among PWH who smoke. Conclusion: We call for a parallel program of implementation research to promote the adoption of evidence-based interventions, which could improve health outcomes for PWH with cardiopulmonary diseases and address the health inequities experienced by PWH in African countries.Applying the WHO ICD-MM classification system to maternal deaths in a tertiary hospital in Nigeria : A retrospective analysis from 2014–2018
AbstractAkaba, G. O., Nnodu, O. E., Ryan, N., Peprah, E., Agida, T. E., Anumba, D. O., & Ekele, B. A. (n.d.).Publication year
2021Journal title
PloS oneVolume
16Issue
1AbstractBackground Addressing the problem of maternal mortality in Nigeria requires proper identification of maternal deaths and their underlying causes in order to focus evidence-based interventions to decrease mortality and avert morbidity. Objectives The objective of the study was to classify maternal deaths that occurred at a Nigerian teaching hospital using the WHO International Classification of Diseases Maternal mortality (ICD-MM) tool. Methods This was a retrospective observational study of all maternal deaths that occurred in a tertiary Nigerian hospital from 1st January 2014 to 31st December,2018. The WHO ICD-MM classification system for maternal deaths was used to classify the type, group, and specific underlying cause of identified maternal deaths. Descriptive analysis was performed using Statistical Package for Social Sciences (SPSS). Categorical and continuous variables were summarized respectively as proportions and means (standard deviations). Results The institutional maternal mortality ratio was 831/100,000 live births. Maternal deaths occurred mainly amongst women aged 25–34 years;30(57.7%), without formal education; 22(42.3%), married;47(90.4%), unbooked;24(46.2%) and have delivered at least twice;34 (65.4%). The leading causes of maternal death were hypertensive disorders in pregnancy, childbirth, and the puerperium (36.5%), obstetric haemorrhage (30.8%), and pregnancy related infections (17.3%). Application of the WHO ICD-MM resulted in reclassification of underlying cause for 3.8% of maternal deaths. Postpartum renal failure (25.0%), postpartum coagulation defects (17.3%) and puerperal sepsis (15.4%) were the leading final causes of death. Among maternal deaths, type 1, 2, and 3 delays were seen in 30(66.7%), 22(48.9%), and 6(13.3%), respectively. Conclusion Our institutional maternal mortality ratio remains high. Hypertensive disorders during pregnancy, childbirth, and the puerperium and obstetric haemorrhage are the leading causes of maternal deaths. Implementation of evidence-based interventions both at the hospital and community levels may help in tackling the identified underlying causes of maternal mortality in Nigeria.Assess : A comprehensive tool to support reporting and critical appraisal of qualitative, quantitative, and/or mixed methods implementation research outcomes
AbstractRyan, N., Vieira, D., Gyamfi, J., Ojo, T., Peprah, E., & Peprah, E. (n.d.).Publication year
2021Journal title
Implementation ScienceVolume
16Issue
SUPPL 1Abstract~Characterization of Medical Conditions of Children with Sickle Cell Disease in the United States : Findings from the 2007-2018 National Health Interview Surveys (NHIS)
AbstractGyamfi, J., Tampubolon, S., Lee, J., Islam, F., Ojo, T., Opeyemi, J., Qiao, Y., Mai, A., Vieira, D., Peprah, E., & Peprah, E. (n.d.).Publication year
2021Journal title
BloodVolume
138Page(s)
1908-+Abstract~Characterization of Neurological Complications Among Children with Sickle Cell Disease in the United States : Findings from the 2007-2018 National Health Interview Survey (NHIS)
AbstractGyamfi, J., Lee, J., Islam, F., Opeyemi, J., Tampubolon, S., Ojo, T., Qiao, Y., Mai, A., Vieira, D., Peprah, E., & Peprah, E. (n.d.).Publication year
2021Journal title
BloodVolume
138Page(s)
1909-+Abstract~Evidence-based interventions implemented in low-and middle-income countries for sickle cell disease management : A systematic review of randomized controlled trials
AbstractGyamfi, J., Ojo, T., Epou, S., Diawara, A., Dike, L., Adenikinju, D., Enechukwu, S., Vieira, D., Nnodu, O., Ogedegbe, G., & Peprah, E. (n.d.).Publication year
2021Journal title
PloS oneVolume
16Issue
2AbstractBACKGROUND: Despite ~90% of sickle cell disease (SCD) occurring in low-and middle-income countries (LMICs), the vast majority of people are not receiving evidence-based interventions (EBIs) to reduce SCD-related adverse outcomes and mortality, and data on implementation research outcomes (IROs) and SCD is limited. This study aims to synthesize available data on EBIs for SCD and assess IROs.METHODS: We conducted a systematic review of RCTs reporting on EBIs for SCD management implemented in LMICs. We identified articles from PubMed/Medline, Global Health, PubMed Central, Embase, Web of Science medical subject heading (MeSH and Emtree) and keywords, published from inception through February 23, 2020, and conducted an updated search through December 24, 2020. We provide intervention characteristics for each study, EBI impact on SCD, and evidence of reporting on IROs.MAIN RESULTS: 29 RCTs were analyzed. EBIs identified included disease modifying agents, supportive care agents/analgesics, anti-malarials, systemic treatments, patient/ provider education, and nutritional supplements. Studies using disease modifying agents, nutritional supplements, and anti-malarials reported improvements in pain crisis, hospitalization, children's growth and reduction in severity and prevalence of malaria. Two studies reported on the sustainability of supplementary arginine, citrulline, and daily chloroquine and hydroxyurea for SCD patients. Only 13 studies (44.8%) provided descriptions that captured at least three of the eight IROs. There was limited reporting of acceptability, feasibility, fidelity, cost and sustainability.CONCLUSION: EBIs are effective for SCD management in LMICs; however, measurement of IROs is scarce. Future research should focus on penetration of EBIs to inform evidence-based practice and sustainability in the context of LMICs.CLINICAL TRIAL REGISTRATION: This review is registered in PROSPERO #CRD42020167289.Global, regional, and national mortality among young people aged 10–24 years, 1950–2019 : a systematic analysis for the Global Burden of Disease Study 2019
AbstractPeprah, E. (n.d.).Publication year
2021Journal title
The LancetVolume
398Issue
10311Page(s)
1593-1618AbstractBackground: Documentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10–24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods: We report trends in estimated total numbers of deaths and mortality rate per 100 000 population in young people aged 10–24 years by age group (10–14 years, 15–19 years, and 20–24 years) and sex in 204 countries and territories between 1950 and 2019 for all causes, and between 1980 and 2019 by cause of death. We analyse variation in outcomes by region, age group, and sex, and compare annual rate of change in mortality in young people aged 10–24 years with that in children aged 0–9 years from 1990 to 2019. We then analyse the association between mortality in people aged 10–24 years and socioeconomic development using the GBD Socio-demographic Index (SDI), a composite measure based on average national educational attainment in people older than 15 years, total fertility rate in people younger than 25 years, and income per capita. We assess the association between SDI and all-cause mortality in 2019, and analyse the ratio of observed to expected mortality by SDI using the most recent available data release (2017). Findings: In 2019 there were 1·49 million deaths (95% uncertainty interval 1·39–1·59) worldwide in people aged 10–24 years, of which 61% occurred in males. 32·7% of all adolescent deaths were due to transport injuries, unintentional injuries, or interpersonal violence and conflict; 32·1% were due to communicable, nutritional, or maternal causes; 27·0% were due to non-communicable diseases; and 8·2% were due to self-harm. Since 1950, deaths in this age group decreased by 30·0% in females and 15·3% in males, and sex-based differences in mortality rate have widened in most regions of the world. Geographical variation has also increased, particularly in people aged 10–14 years. Since 1980, communicable and maternal causes of death have decreased sharply as a proportion of total deaths in most GBD super-regions, but remain some of the most common causes in sub-Saharan Africa and south Asia, where more than half of all adolescent deaths occur. Annual percentage decrease in all-cause mortality rate since 1990 in adolescents aged 15–19 years was 1·3% in males and 1·6% in females, almost half that of males aged 1–4 years (2·4%), and around a third less than in females aged 1–4 years (2·5%). The proportion of global deaths in people aged 0–24 years that occurred in people aged 10–24 years more than doubled between 1950 and 2019, from 9·5% to 21·6%. Interpretation: Variation in adolescent mortality between countries and by sex is widening, driven by poor progress in reducing deaths in males and older adolescents. Improving global adolescent mortality will require action to address the specific vulnerabilities of this age group, which are being overlooked. Furthermore, indirect effects of the COVID-19 pandemic are likely to jeopardise efforts to improve health outcomes including mortality in young people aged 10–24 years. There is an urgent need to respond to the changing global burden of adolescent mortality, address inequities where they occur, and improve the availability and quality of primary mortality data in this age group. Funding: Bill & Melinda Gates Foundation.Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health : all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019
AbstractPaulson, K. R., Kamath, A. M., Alam, T., Bienhoff, K., Abady, G. G., Abbas, J., Abbasi-Kangevari, M., Abbastabar, H., Abd-Allah, F., Abd-Elsalam, S. M., Abdoli, A., Abedi, A., Abolhassani, H., Abreu, L. G., Abu-Gharbieh, E., Abu-Rmeileh, N. M., Abushouk, A. I., Adamu, A. L., Adebayo, O. M., … Peprah, E. (n.d.).Publication year
2021Journal title
The LancetVolume
398Issue
10303Page(s)
870-905AbstractBackground: Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. Methods: We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (U5MR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. Findings: Global U5MR decreased from 71·2 deaths per 1000 livebirths (95% uncertainty interval [UI] 68·3–74·0) in 2000 to 37·1 (33·2–41·7) in 2019 while global NMR correspondingly declined more slowly from 28·0 deaths per 1000 live births (26·8–29·5) in 2000 to 17·9 (16·3–19·8) in 2019. In 2019, 136 (67%) of 204 countries had a U5MR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030, 154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9·65 million (95% UI 9·05–10·30) in 2000 and 5·05 million (4·27–6·02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3·76 million [95% UI 3·53–4·02]) in 2000 to 48% (2·42 million; 2·06–2·86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0·80 (95% UI 0·71–0·86) deaths per 1000 livebirths and U5MR to 1·44 (95% UI 1·27–1·58) deaths per 1000 livebirths, and in 2019, there were as many as 1·87 million (95% UI 1·35–2·58; 37% [95% UI 32–43]) of 5·05 million more deaths of children younger than 5 years than the survival potential frontier. Interpretation: Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve U5MR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. Funding: Bill & Melinda Gates Foundation.Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990–2019, for 204 countries and territories : the Global Burden of Diseases Study 2019
AbstractPeprah, E. (n.d.).Publication year
2021Journal title
The Lancet HIVVolume
8Issue
10Page(s)
e633-e651AbstractBackground: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio thresholdImplementation science research for the scale-up of evidence-based interventions for sickle cell disease in africa : a commentary
AbstractGyamfi, J., Ojo, T., Iwelunmor, J., Ogedegbe, G., Ryan, N., Diawara, A., Nnodu, O., Wonkam, A., Royal, C., & Peprah, E. (n.d.).Publication year
2021Journal title
Globalization and HealthVolume
17Issue
1AbstractBackground: The burden of sickle cell disease (SCD) is greatest among African nations. Effective scalability of evidence-based interventions (e.g., newborn screening, health education, prophylaxis for infection, optimal nutrition and hydration, hydroxyurea therapy, blood transfusions, and transcranial Doppler (TCD) screening) is urgently needed particularly in these settings for disease management. However, Africa is constrained by limited resources and the lack of capacity to conduct implementation science research for proper understanding of context, and assessment of barriers and facilitators to the uptake and scalability of evidence-based interventions (EBI) for SCD management. Main Body: We outline implementation science approaches to embed EBI for SCD within the African context and highlight key implementation research programs for SCD management. Building implementation research capacity will meet the major need of developing effective life-long and accessible locally-tailored interventions for patients with SCD in Africa. Conclusion: This commentary communicates the importance of the application of implementation science methodology to scale-up evidence-based interventions for the management of SCD in order to reduce pain, prevent other morbidities and premature death experienced by people with SCD in Africa, and improve their overall quality of life.Joyce Gyamfi, Emmanuel Peprah, Gbenga Ogedegbe. Mapping implementation strategies for delivering evidence-based hypertension interventions in low-middle income countries: Evidence from a multi-country consortium for hypertension control. American Public Health Association (APHA) – Annual Meeting. October 24-27, 2021. (Poster)
AbstractPeprah, E. (n.d.).Publication year
2021Abstract~Joyce Gyamfi, Siphra Tampubolon, Justin Lee, Farha Islam, Temitope Ojo, Jumoke Opeyemi, Yuki Qiao, Andi Mai, Dorice Vieira, Emmanuel Peprah. Characterization of Medical Conditions of Children with Sickle Cell Disease in the United States: Findings from the 2007-2018 National Health Interview Surveys (NHIS). American Society of Hematology 63rd ASH Annual Meeting 2021. GA, United States; Dec 11-14, 2021.(Poster & Oral Presentation)
AbstractPeprah, E. (n.d.).Publication year
2021Abstract~Joyce Gyamfi, Siphra Tampubolon, Justin Lee, Farha Islam, Temitope Ojo, Jumoke Opeyemi, Yuki Qiao, Andi Mai, Dorice Vieira, Emmanuel Peprah. Characterization of Neurological Conditions of Children with Sickle Cell Disease in the United States: Findings from the 2007-2018 National Health Interview Surveys (NHIS). American Society of Hematology 63rd ASH Annual Meeting. GA, United States; Dec 11-14, 2021.(Poster)
AbstractPeprah, E. (n.d.).Publication year
2021Abstract~Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems
AbstractCork, M. A., Henry, N. J., Watson, S., Croneberger, A. J., Baumann, M., Letourneau, I. D., Yang, M., Serfes, A. L., Abbas, J., Abbasi, N., Abbastabar, H., Abreu, L. G., Abu-Gharbieh, E., Achappa, B., Adabi, M., Adal, T. G., Adegbosin, A. E., Adekanmbi, V., Adetokunboh, O. O., … Dwyer-Lindgren, L. (n.d.).Publication year
2021Journal title
BMC MedicineVolume
19Issue
1AbstractBackground: Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico. Methods: We performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017. Results: All countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries—apart from Ecuador—across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups—the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017. Conclusions: Our subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths.Nessa Ryan, Anya Snyder, Siphra Tampubolon, Emmanuel Peprah. Successes and challenges of intervention and implementation strategies addressing maternal health and racism in the US: A scoping review. International Federation of Gynaecology and Obstetrics (FIGO) – XXIII World Congress on Gynecology and Obstetrics. October 24-28, 2021. (Poster)
AbstractPeprah, E. (n.d.).Publication year
2021Abstract~Nessa Ryan, Dorice Vieira, Dena Goffman, Evan Chioma Egekeze, Anya Snyder, Magdalena Lyimo, Obiageli Nnodu, Emmanuel Peprah. Successes and challenges of intervention and implementation strategies addressing maternal health and racism in the US: A scoping review. International Federation of Gynecology and Obstetrics (FIGO) XXIII World Congress on Gynecology and Obstetrics. October 24-28, 2021. (Poster)
AbstractPeprah, E. (n.d.).Publication year
2021Abstract~Nessa Ryan, Dorice Vieira, Temitope Ojo, Joyce Gyamfi, Emmanuel Peprah. Validating ASSESS: A comprehenSive tool to Support rEporting and critical appraiSal of qualitative, quantitative, and mixed methods implementation reSearch outcomes. American Public Health Association (APHA) – Annual Meeting; October 24-27, 2021. (Poster)
AbstractPeprah, E. (n.d.).Publication year
2021Abstract~