Yesim Tozan
Yesim Tozan
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Associate Professor of Global and Environmental Health
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Professional overview
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Dr. Yesim Tozan’s research centers on health decision science and priority setting, and explores the costs and cost-effectiveness of health care interventions using decision analytic models and the issues of health care resource allocation in low- and middle-income countries. Her main focus has been infectious disease prevention and control with an emphasis on dengue and malaria. Dr. Tozan is currently leading a health economics work package in a European Union-funded research project on dengue surveillance and control with field sites in Sri Lanka and Thailand. She is also leading a prospective multi-center study on the cost of dengue illness in international travelers utilizing a network of travel clinics in Europe, the US, the Middle East and Australia. Most recently, she has been working on economic evaluation of artemisinin-based combination therapies for the treatment of uncomplicated childhood malaria using data from multi-site randomized clinical trials in Africa and Asia. Dr. Tozan was a task force associate for the UN Millennium Project’s Task Force on HIV/AIDS, Malaria, Tuberculosis and Access to Essential Medicines and was lead author of the malaria task force report entitled “Coming to grips with malaria in the new millennium.”
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Education
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BS, Environmental Engineering, Istanbul Technical University, TurkeyMS, Environmental Technology, Bogazici University, TurkeyMA, Public Affairs, Princeton University, Princeton, NJPhD, Public Affairs, Princeton University, Princeton, NJ
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Areas of research and study
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Cost EffectivenessCost-effective Health Programs and PoliciesEconomic EvaluationHealth EconomicsInfectious DiseasesPrevention Interventions
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Publications
Publications
Climate-driven malaria mortality highest among children in malaria-endemic areas of Uganda
AbstractTozan, Y. (n.d.).Publication year
2025Journal title
BMC Public HealthAbstract~Cost-Effectiveness of an Economic Empowerment and Family Intervention for School-going Adolescent Girls in Uganda
AbstractTozan, Y. (n.d.).Publication year
2025Journal title
AJPHAbstract~Countries' progress towards Global Health Security (GHS) increased health systems resilience during the Coronavirus Disease-19 (COVID-19) pandemic: A difference-in-difference study of 191 countries
AbstractTozan, Y., Headley, T. Y., Kim, S., & Tozan, Y. (n.d.).Publication year
2025Journal title
PLOS global public healthVolume
5Issue
1Page(s)
e0004051AbstractResearch on health systems resilience during the Coronavirus Disease-2019 pandemic frequently used the Global Health Security Index (GHSI), a composite index scoring countries' health security and related capabilities. Conflicting results raised questions regarding the validity of the GHSI as a reliable index. This study attempted to better characterize when and to what extent countries' progress towards Global Health Security (GHS) augments health systems resilience. We used longitudinal data from 191 countries and a difference-in-difference (DiD) causal inference strategy to quantify the effect of countries' GHS capacity as measured by the GHSI on their coverage rates for essential childhood immunizations, a previously established proxy for health systems resilience. Using a sliding scale of cutoff values with step increments of one, we divided countries into treatment and control groups and determined the lowest GHSI score at which a safeguarding effect was observed. All analyses were adjusted for potential confounders. World Bank governance indicators were employed for robustness tests. While countries with overall GHSI scores of 57 and above prevented declines in childhood immunization coverage rates from 2020-2022 (coef: 0.91; 95% CI: 0.41-1.41), this safeguarding effect was strongest in 2021 (coef: 1.23; 95% CI: 0.05-2.41). Coefficient sizes for overall GHSI scores were smaller compared to several GHSI sub-components, including countries' environmental risks (coef: 4.28; 95% CI: 2.56-5.99) and emergency preparedness and response planning (coef: 1.82; 95% CI: 0.54-3.11). Our findings indicate that GHS was positively associated with health systems resilience during the pandemic (2020) and the following two years (2021-2022), that GHS may have had the most significant protective effects in 2021 as compared with 2020 and 2022, and that countries' underlying characteristics, including governance quality, bolstered health systems resilience during the pandemic.Countries’ progress towards Global Health Security (GHS) increased health systems resilience during the Coronavirus Disease-19 (COVID-19) pandemic : A difference-indifference study of 191 countries
AbstractHeadley, T. Y., Kim, S., & Tozan, Y. (n.d.).Publication year
2025Journal title
PLOS Global Public HealthVolume
5Issue
1AbstractResearch on health systems resilience during the Coronavirus Disease-2019 pandemic frequently used the Global Health Security Index (GHSI), a composite index scoring countries’ health security and related capabilities. Conflicting results raised questions regarding the validity of the GHSI as a reliable index. This study attempted to better characterize when and to what extent countries’ progress towards Global Health Security (GHS) augments health systems resilience. We used longitudinal data from 191 countries and a difference-in-difference (DiD) causal inference strategy to quantify the effect of countries’ GHS capacity as measured by the GHSI on their coverage rates for essential childhood immunizations, a previously established proxy for health systems resilience. Using a sliding scale of cutoff values with step increments of one, we divided countries into treatment and control groups and determined the lowest GHSI score at which a safeguarding effect was observed. All analyses were adjusted for potential confounders. World Bank governance indicators were employed for robustness tests. While countries with overall GHSI scores of 57 and above prevented declines in childhood immunization coverage rates from 2020–2022 (coef: 0.91; 95% CI: 0.41–1.41), this safeguarding effect was strongest in 2021 (coef: 1.23; 95% CI: 0.05–2.41). Coefficient sizes for overall GHSI scores were smaller compared to several GHSI sub-components, including countries’ environmental risks (coef: 4.28; 95% CI: 2.56–5.99) and emergency preparedness and response planning (coef: 1.82; 95% CI: 0.54–3.11). Our findings indicate that GHS was positively associated with health systems resilience during the pandemic (2020) and the following two years (2021–2022), that GHS may have had the most significant protective effects in 2021 as compared with 2020 and 2022, and that countries’ underlying characteristics, including governance quality, bolstered health systems resilience during the pandemic.Cultural adaptation of clinic-based pediatric hiv status disclosure intervention with task shifting in Eastern Uganda
AbstractKirabira, J., Nakigudde, J., Huang, K.-Y., Ashaba, S., Nambuya, H., Tozan, Y., & Yang, L. (n.d.).Publication year
2025Journal title
AIDS Research and TherapyVolume
22Issue
1AbstractBackground: HIV status disclosure remains a major challenge among children living with perinatally acquired HIV with many taking treatment up to adolescence without knowing their serostatus. This non-disclosure is influenced by factors like fear of the negative consequences of disclosure. Since HIV status disclosure has been found to have good effects including improving treatment adherence and better mental health outcomes, there is a need to design interventions aimed at improving disclosure rates among children living with HIV. This study aims at adapting a clinic-based pediatric HIV status disclosure intervention and tasking shifting from healthcare workers to caregiver peer supporters in Eastern Uganda. Methods: The adaptation process involved consultations with caregivers, healthcare workers involved in the care of children living with HIV, researchers in this field, intervention developers, and other experts and stakeholders. This was done through conducting FGDs with HCWs, caregivers, and peer supporters and consultations with researchers in the field of HIV. The original intervention manual was translated to Lusoga which is the commonly spoken dialect in this region. Collected qualitative data were analyzed using an inductive approach to develop themes and subthemes. Written informed consent will be obtained from all participants before participation in the study. Results: A total of 28 participants were involved in the FGDs, while two pediatricians and two HIV researchers/specialists were consulted. Six themes were generated in relation to all suggested changes to the original manual which were related to: (1) sociocultural beliefs/norms/perceptions (5 FGDs), (2) boosting caregiver’s confidence for disclosure (5FGDs), (3) disclosure mode, environment, and person (4 FGDs), (4) health facility/system related changes (3 FGDs), (5) reorganization/paraphrasing (3FGDs) and (6) age appropriateness (2FGDs). Conclusion: This study emphasized that whereas some aspects of intervention can apply to various contexts, there is a need for cross-cultural adaptation of interventions before being implemented in settings where they were not developed.Cultural adaptation of clinic-based pediatric hiv status disclosure intervention with task shifting in Eastern Uganda
AbstractTozan, Y., Kirabira, J., Nakigudde, J., Huang, K.-Y. Y., Ashaba, S., Nambuya, H., Tozan, Y., & Yang, L. H. (n.d.).Publication year
2025Journal title
AIDS research and therapyVolume
22Issue
1Page(s)
48AbstractHIV status disclosure remains a major challenge among children living with perinatally acquired HIV with many taking treatment up to adolescence without knowing their serostatus. This non-disclosure is influenced by factors like fear of the negative consequences of disclosure. Since HIV status disclosure has been found to have good effects including improving treatment adherence and better mental health outcomes, there is a need to design interventions aimed at improving disclosure rates among children living with HIV. This study aims at adapting a clinic-based pediatric HIV status disclosure intervention and tasking shifting from healthcare workers to caregiver peer supporters in Eastern Uganda.Evaluating the effect heterogeneity of malaria camp interventions in hard-to-reach areas of Odisha state, India
AbstractTozan, Y. (n.d.).Publication year
2025Journal title
PLOS OneAbstract~Quantifying the lagged effects of climate variables on malaria risk in Eastern Uganda: A case study in Iganga-Mayuge population cohort (an HDSS)
AbstractTozan, Y. (n.d.).Publication year
2025Journal title
Am J Trop Med HygAbstract~Social and Psychological Mediators of Sexual and Physical Male-Perpetrated Intimate Partner Violence Against Young African American Women : The Role of Alcohol Use and Drinking Context
AbstractCapasso, A., Pahl, K., Tozan, Y., & DiClemente, R. J. (n.d.).Publication year
2025Journal title
Journal of Interpersonal ViolenceAbstractProblem alcohol use is prevalent among women who experience male-perpetrated intimate partner violence (IPV). However, the pathways by which this occurs remain poorly understood and understudied among African American women. This study sought to examine context-specific social and psychological mediators of this association. Using structural equation modeling (SEM), we tested a conceptual framework predicting problem alcohol use within 3 months of experiencing physical and/or sexual IPV. The sample included 508 young African American women (median age 21, interquartile range 19–22 years). A modified SEM met prespecified global and local fit index criteria. The model identified four indirect paths from IPV to problem alcohol use. Three of the paths were through the endorsement of drinking contexts: negative coping, social drinking, and intimate drinking. Negative coping and social drinking emerged as the most salient pathways (β =.431, 95% CI [0.107, 0.754]; β =.472 [0.103, 0.841], respectively). A fourth path operated via depressive symptomatology and negative coping. The model predictors explained 35% of the variance in problem alcohol use; findings were consistent with full mediation of IPV and problem drinking. These findings increase the understanding of problem alcohol use among African American women who experience IPV and identify modifiable context-specific risk factors for problem alcohol use. Interventions to reduce problem drinking could incorporate trauma-informed counseling, as part of integrated IPV and substance use care, to reduce depressive symptomatology and enhance drinking refusal skills in response to situational drinking.Social and psychological mediators of sexual and physical male-perpetrated intimate partner violence against young African American women and problem alcohol use: the role of intimate and social drinking context
AbstractTozan, Y. (n.d.).Publication year
2025Journal title
J Interpers ViolenceAbstract~Spatio-temporal modelling and prediction of malaria incidence in Mozambique using climatic indicators from 2001 to 2018
AbstractArmando, C. J., Rocklöv, J., Sidat, M., Tozan, Y., Mavume, A. F., & Sewe, M. O. (n.d.).Publication year
2025Journal title
Scientific reportsVolume
15Issue
1AbstractAccurate malaria predictions are essential for implementing timely interventions, particularly in Mozambique, where climate factors strongly influence transmission. This study aims to develop and evaluate a spatial–temporal prediction model for malaria incidence in Mozambique for potential use in a malaria early warning system (MEWS). We used monthly data on malaria cases from 2001 to 2018 in Mozambique, the model incorporated lagged climate variables selected through Deviance Information Criterion (DIC), including mean temperature and precipitation (1–2 months), relative humidity (5–6 months), and Normalized Different Vegetation Index (NDVI) (3–4 months). Predictive distributions from monthly cross-validations were employed to calculate threshold exceedance probabilities, with district-specific thresholds set at the 75th percentile of historical monthly malaria incidence. The model’s ability to predict high and low malaria seasons was evaluated using receiver operating characteristic (ROC) analysis. Results indicated that malaria incidence in Mozambique peaks from November to April, offering a predictive lead time of up to 4 months. The model demonstrated high predictive power with an area under the curve (AUC) of 0.897 (0.893–0.901), sensitivity of 0.835 (0.827–0.843), and specificity of 0.793 (0.787–0.798), underscoring its suitability for integration into a MEWS. Thus, incorporating climate information within a multisectoral approach is essential for enhancing malaria prevention interventions effectiveness.Spatio-temporal modelling and prediction of malaria incidence in Mozambique using climatic indicators from 2001 to 2018
AbstractTozan, Y., Armando, C. J. J., Rocklöv, J., Sidat, M., Tozan, Y., Mavume, A. F. F., & Sewe, M. O. O. (n.d.).Publication year
2025Journal title
Scientific reportsVolume
15Issue
1Page(s)
11971AbstractAccurate malaria predictions are essential for implementing timely interventions, particularly in Mozambique, where climate factors strongly influence transmission. This study aims to develop and evaluate a spatial-temporal prediction model for malaria incidence in Mozambique for potential use in a malaria early warning system (MEWS). We used monthly data on malaria cases from 2001 to 2018 in Mozambique, the model incorporated lagged climate variables selected through Deviance Information Criterion (DIC), including mean temperature and precipitation (1-2 months), relative humidity (5-6 months), and Normalized Different Vegetation Index (NDVI) (3-4 months). Predictive distributions from monthly cross-validations were employed to calculate threshold exceedance probabilities, with district-specific thresholds set at the 75th percentile of historical monthly malaria incidence. The model's ability to predict high and low malaria seasons was evaluated using receiver operating characteristic (ROC) analysis. Results indicated that malaria incidence in Mozambique peaks from November to April, offering a predictive lead time of up to 4 months. The model demonstrated high predictive power with an area under the curve (AUC) of 0.897 (0.893-0.901), sensitivity of 0.835 (0.827-0.843), and specificity of 0.793 (0.787-0.798), underscoring its suitability for integration into a MEWS. Thus, incorporating climate information within a multisectoral approach is essential for enhancing malaria prevention interventions effectiveness.Trajectories of Physical Violence Against Latinas and Black Women : The Protective Role of Parents, Neighborhoods, and Schools
AbstractCapasso, A., Tozan, Y., DiClemente, R. J., & Pahl, K. (n.d.).Publication year
2025Journal title
Violence Against WomenAbstractUnderstanding the heterogeneous experiences of violence experienced by Black and Latina women over the life course is critical to prevention. We identified four physical violence trajectories experienced by 361 Black and Latina women followed from ages 14 to 39: low/none (44.0%), persistent-moderate (36.8%), peak in the 20s (11.9%), and persistent-high (7.2%) violence exposure. Childhood abuse predicted membership in the three violence-exposed groups, whereas parental closeness, school academic orientation, and neighborhood safety were protective factors. Public health interventions aimed at preventing childhood trauma and ensuring safe interpersonal relationships and environments for girls to thrive are urgently needed.Trajectories of Physical Violence Against Latinas and Black Women: The Protective Role of Parents, Neighborhoods, and Schools
AbstractTozan, Y., Capasso, A., Tozan, Y., DiClemente, R. J., & Pahl, K. (n.d.).Publication year
2025Journal title
Violence against womenPage(s)
10778012251319752AbstractUnderstanding the heterogeneous experiences of violence experienced by Black and Latina women over the life course is critical to prevention. We identified four physical violence trajectories experienced by 361 Black and Latina women followed from ages 14 to 39: low/none (44.0%), persistent-moderate (36.8%), peak in the 20s (11.9%), and persistent-high (7.2%) violence exposure. Childhood abuse predicted membership in the three violence-exposed groups, whereas parental closeness, school academic orientation, and neighborhood safety were protective factors. Public health interventions aimed at preventing childhood trauma and ensuring safe interpersonal relationships and environments for girls to thrive are urgently needed.A pre-post evaluation study of a social media-based COVID-19 communication campaign to improve attitudes and behaviors toward COVID-19 vaccination in Tanzania
AbstractKim, S., Lilani, A., Redemptus, C., Campana, K., & Tozan, Y. (n.d.).Publication year
2024Journal title
PloS oneVolume
19Issue
5 MayAbstractIn Tanzania, the One by One: Target COVID-19 campaign was launched nationally in July 2022 to address the prevalent vaccine hesitancy and lack of confidence in COVID-19 vaccines. The campaign mobilized social media influencers and viral content with the ultimate goal of increasing COVID-19 vaccine uptake in the country. The objective of this study was to empirically assess the impact of the campaign on three outcomes: vaccine confidence, vaccine hesitancy, and vaccination status. Using programmatic data collected through an online survey before and after the campaign, we conducted a difference-in-difference (DiD) analysis and performed a crude, adjusted, and propensity score-matched analysis for each study outcome. Lastly, to observe whether there was any differential impact of the campaign across age groups, we repeated the analyses on age-stratified subgroups. Data included 5,804 survey responses, with 3,442 and 2,362 responses collected before and after the campaign, respectively. Although there was only weak evidence of increased COVID-19 vaccine confidence in the campaign-exposed group compared to the control group across all age groups, we observed a differential impact among different age groups. While no significant change was observed among young adults aged 18–24 years, the campaign exposure led to a statistically significant increase in vaccine confidence (weighted/adjusted DiD coefficient = 0.76; 95% CI: 0.06, 1.5; p-value = 0.034) and vaccination uptake (weighted/adjusted DiD coefficient = 1.69.; 95% CI: 1.02, 2.81; p-value = 0.023) among young adults aged 25–34 years. Among adults aged 35 years and above, the campaign exposure led to a significant decrease in vaccine hesitancy (weighted/adjusted DiD coefficient = -15; 95% CI: -21, -8.3; p-valueA pre-post evaluation study of a social media-based COVID-19 communication campaign to improve attitudes and behaviors toward COVID-19 vaccination in Tanzania
AbstractTozan, Y., Kim, S., Lilani, A., Redemptus, C., Campana, K., & Tozan, Y. (n.d.).Publication year
2024Journal title
PloS oneVolume
19Issue
5Page(s)
e0300206AbstractIn Tanzania, the One by One: Target COVID-19 campaign was launched nationally in July 2022 to address the prevalent vaccine hesitancy and lack of confidence in COVID-19 vaccines. The campaign mobilized social media influencers and viral content with the ultimate goal of increasing COVID-19 vaccine uptake in the country. The objective of this study was to empirically assess the impact of the campaign on three outcomes: vaccine confidence, vaccine hesitancy, and vaccination status. Using programmatic data collected through an online survey before and after the campaign, we conducted a difference-in-difference (DiD) analysis and performed a crude, adjusted, and propensity score-matched analysis for each study outcome. Lastly, to observe whether there was any differential impact of the campaign across age groups, we repeated the analyses on age-stratified subgroups. Data included 5,804 survey responses, with 3,442 and 2,362 responses collected before and after the campaign, respectively. Although there was only weak evidence of increased COVID-19 vaccine confidence in the campaign-exposed group compared to the control group across all age groups, we observed a differential impact among different age groups. While no significant change was observed among young adults aged 18-24 years, the campaign exposure led to a statistically significant increase in vaccine confidence (weighted/adjusted DiD coefficient = 0.76; 95% CI: 0.06, 1.5; p-value = 0.034) and vaccination uptake (weighted/adjusted DiD coefficient = 1.69.; 95% CI: 1.02, 2.81; p-value = 0.023) among young adults aged 25-34 years. Among adults aged 35 years and above, the campaign exposure led to a significant decrease in vaccine hesitancy (weighted/adjusted DiD coefficient = -15; 95% CI: -21, -8.3; p-valueChildhood Violence, High School Academic Environment, and Adult Alcohol Use Among Latinas and Black Women : A Structural Equation Modeling Study
AbstractCapasso, A., Tozan, Y., DiClemente, R. J., & Pahl, K. (n.d.).Publication year
2024Journal title
Journal of Interpersonal ViolenceAbstractObjective: Young Latinas and Black women drink less than women of other racial/ethnic groups but experience more alcohol-related problems in midlife. This study aims to identify modifiable factors to prevent adult onset of alcohol use disorder (AUD) in this population. Methods: Data were collected at six time points as part of the Harlem Longitudinal Development Study from 365 Latinas (47%) and Black (53%) women (mean age at time 1 = 14, standard deviation 1.3). Structural equation modeling was used to test hypothesized pathways from childhood physical and sexual abuse to AUD via depressive mood, anxiety disorders, and somatic complaints in the 20s. We also tested the moderation effect of the high school academic environment by including in the structural equation model two latent variable interaction terms between the school environment and each of the abuse variables. Results: Childhood physical and sexual abuse was positively associated with depressive mood, anxiety disorders, and somatic complaints when participants were in the 20s. Depressive mood mediated childhood abuse and AUD when women were in the 30s. The high school academic environment attenuated the effect of physical, but not sexual abuse, on depressive mood (β = −0.59, B = −9.38, 95% CI [−14.00, −4.76]), anxiety symptoms (β = −0.61, B = −14.19, 95% CI [−21.76, −6.61]), appetite loss (β = −0.41, B = −10.52, 95% CI [−15.61, −5.42]), and sleeplessness (β = −0.50, B = −9.56, 95% CI [−13.95, −5.17]) in the early 20s. Conclusions: Our findings underscore the need to invest in early violence prevention interventions and in education to ensure equitable access to quality, academically oriented, and safe schools.Childhood Violence, High School Academic Environment, and Adult Alcohol Use Among Latinas and Black Women: A Structural Equation Modeling Study
AbstractTozan, Y., Capasso, A., Tozan, Y., DiClemente, R. J., & Pahl, K. (n.d.).Publication year
2024Journal title
Journal of interpersonal violenceVolume
39Issue
23-24Page(s)
4924-4953AbstractYoung Latinas and Black women drink less than women of other racial/ethnic groups but experience more alcohol-related problems in midlife. This study aims to identify modifiable factors to prevent adult onset of alcohol use disorder (AUD) in this population.Costing of a Combination Intervention (Kyaterekera) Addressing Sexual Risk-Taking Behaviors among Vulnerable Women in Southern Uganda
AbstractTozan, Y., Kiyingi, J., Kim, S., Nabayinda, J., Namuwonge, F., Nsubuga, E., Nakabuye, F., Sensoy, O. B., Nabunya, P., Mayo-Wilson, L. J., McKay, M. M., Witte, S. S., & Ssewamala, F. M. (n.d.).Publication year
2024Journal title
American Journal of Tropical Medicine and HygieneVolume
110Issue
5Page(s)
1046-1056AbstractIn Uganda, women engaged in sex work (WESW) are a marginalized population at the intersection of multiple vulnerabilities. The Kyaterekera intervention is targeted at WESW in Rakai and the greater Masaka regions in Uganda and combines a traditional HIV risk-reduction approach with a savings-led economic empowerment intervention and financial literacy training. We estimated the economic costs of the Kyaterekera intervention from a program provider perspective using a prospective activity-based micro-costing method. All program activities and resource uses were measured and valued across the control arm receiving a traditional HIV risk-reduction intervention and the treatment arm receiving a matched individual development savings account and financial literacy training on top of HIV risk reduction. The total per-participant cost by arm was adjusted for inflation and discounted at an annual rate of 3% and presented in 2019 US dollars. The total per-participant costs of the control and intervention arms were estimated at $323 and $1,435, respectively, using the per-protocol sample. When calculated based on the intent-to-treat sample, the per-participant costs were reduced to $183 and $588, respectively. The key cost drivers were the capital invested in individual development accounts and personnel and transportation costs for program operations, linked to WESW's higher mobility and the dispersed pattern of hot spot locations. The findings provide evidence of the economic costs of implementing a targeted intervention for this marginalized population in resource-constrained settings and shed light on the scale of potential investment needed to better achieve the health equity goal of HIV prevention strategies.Opportunities and challenges for innovative and equitable healthcare
AbstractEcker, D. J., Aiello, C. D., Arron, J. R., Bennett, C. F., Bernard, A., Breakefield, X. O., Broderick, T. J., Callier, S. L., Canton, B., Chen, J. S., Fishburn, C. S., Garrett, B., Hecht, S. M., Janowitz, T., Kliegman, M., Krainer, A., Louis, C. U., Lowe, C., Sehgal, A., … Hayden, M. R. (n.d.).Publication year
2024Journal title
Nature Reviews Drug DiscoveryVolume
23Issue
5Page(s)
321-322AbstractAn unprecedented number of potentially disruptive therapeutic technologies are under development. Forward-looking policies, incentives and infrastructure are needed to harness these advances to provide effective and globally equitable healthcare.Opportunities and challenges for innovative and equitable healthcare
AbstractTozan, Y., Ecker, D. J., Aiello, C. D., Arron, J. R., Bennett, C. F., Bernard, A., Breakefield, X. O., Broderick, T. J., Callier, S. L., Canton, B., Chen, J. S., Fishburn, C. S., Garrett, B., Hecht, S. M., Janowitz, T., Kliegman, M., Krainer, A., Louis, C. U., Lowe, C., … Hayden, M. R. (n.d.).Publication year
2024Journal title
Nature reviews. Drug discoveryAbstract~Spatial-temporal analysis of climate and socioeconomic conditions on cholera incidence in Mozambique from 2000 to 2018 : an ecological longitudinal retrospective study
AbstractArmando, C. J., Rocklöv, J., Sidat, M., Tozan, Y., Mavume, A. F., Bunker, A., & Sewe, M. O. (n.d.).Publication year
2024Journal title
BMJ openVolume
14Issue
8AbstractObjectives This study aims to assess both socioeconomic and climatic factors of cholera morbidity in Mozambique considering both spatial and temporal dimensions. Design An ecological longitudinal retrospective study using monthly provincial cholera cases from Mozambican Ministry of Health between 2000 and 2018. The cholera cases were linked to socioeconomic data from Mozambique Demographic and Health Surveys conducted in the period 2000-2018 and climatic data; relative humidity (RH), mean temperature, precipitation and Normalised Difference Vegetation Index (NDVI). A negative binomial regression model in a Bayesian framework was used to model cholera incidence while adjusting for the spatiotemporal covariance, lagged effect of environmental factors and the socioeconomic indicators. Setting Eleven provinces in Mozambique. Results Over the 19-year period, a total of 153 941 cholera cases were notified to the surveillance system in Mozambique. Risk of cholera increased with higher monthly mean temperatures above 24°C in comparison to the reference mean temperature of 23°C. At mean temperature of 19°C, cholera risk was higher at a lag of 5-6 months. At a shorter lag of 1 month, precipitation of 223.3 mm resulted in an 57% increase in cholera risk (relative risk, RR 1.57 (95% CI 1.06 to 2.31)). Cholera risk was greatest at 3 lag months with monthly NDVI of 0.137 (RR 1.220 (95% CI 1.042 to 1.430)), compared with the reference value of 0.2. At an RH of 54%, cholera RR was increased by 62% (RR 1.620 (95% CI 1.124 to 2.342)) at a lag of 4 months. We found that ownership of radio RR 0.29, (95% CI 0.109 to 0.776) and mobile phones RR 0.262 (95% CI 0.097 to 0.711) were significantly associated with low cholera risk. Conclusion The derived lagged patterns can provide appropriate lead times in a climate-driven cholera early warning system that could contribute to the prevention and management of outbreaks.Spatial-temporal analysis of climate and socioeconomic conditions on cholera incidence in Mozambique from 2000 to 2018: an ecological longitudinal retrospective study
AbstractTozan, Y., Armando, C. J. J., Rocklöv, J., Sidat, M., Tozan, Y., Mavume, A. F. F., Bunker, A., & Sewe, M. O. O. (n.d.).Publication year
2024Journal title
BMJ openVolume
14Issue
8Page(s)
e082503AbstractThis study aims to assess both socioeconomic and climatic factors of cholera morbidity in Mozambique considering both spatial and temporal dimensions.The synergistic impact of Universal Health Coverage and Global Health Security on health service delivery during the Coronavirus Disease-19 pandemic : A difference-indifference study of childhood immunization coverage from 192 countries
AbstractKim, S., Headley, T. Y., & Tozan, Y. (n.d.).Publication year
2024Journal title
PLOS global public healthVolume
4Issue
5 MayAbstractUniversal Health Coverage (UHC) and Global Health Security (GHS) are two high-priority global health agendas that seek to foster health system resilience against health emergencies. Many countries have had to prioritize one agenda over the other due to scarce resources and political pressures. To aid policymakers’ decision-making, this study investigated the individual and synergistic effects of countries’ UHC and GHS capacities in safeguarding essential health service delivery during the COVID-19 pandemic. We used a quasi-experimental difference-in-difference methodology to quantify the relationship between 192 countries’ progress towards UHC and GHS and those countries’ abilities to provide 12 essential childhood immunization services between 2015 and 2021. We used the 2019 UHC Service Coverage Index (SCI) to divide countries into a “high UHC group” (UHC SCI≥75) and the rest (UHC SCI 75), and similarly used the 2019 GHS Index (GHSI) to divide countries into a “high GHS group” (GHSI≥65) and the rest (GHSIThe synergistic impact of Universal Health Coverage and Global Health Security on health service delivery during the Coronavirus Disease-19 pandemic: A difference-in-difference study of childhood immunization coverage from 192 countries
AbstractTozan, Y., Kim, S., Headley, T. Y., & Tozan, Y. (n.d.).Publication year
2024Journal title
PLOS global public healthVolume
4Issue
5Page(s)
e0003205AbstractUniversal Health Coverage (UHC) and Global Health Security (GHS) are two high-priority global health agendas that seek to foster health system resilience against health emergencies. Many countries have had to prioritize one agenda over the other due to scarce resources and political pressures. To aid policymakers' decision-making, this study investigated the individual and synergistic effects of countries' UHC and GHS capacities in safeguarding essential health service delivery during the COVID-19 pandemic. We used a quasi-experimental difference-in-difference methodology to quantify the relationship between 192 countries' progress towards UHC and GHS and those countries' abilities to provide 12 essential childhood immunization services between 2015 and 2021. We used the 2019 UHC Service Coverage Index (SCI) to divide countries into a "high UHC group" (UHC SCI≥75) and the rest (UHC SCI 75), and similarly used the 2019 GHS Index (GHSI) to divide countries into a "high GHS group" (GHSI≥65) and the rest (GHSI