Precision global health and comorbidity: a population-based study of 16 357 people in rural Uganda.
Precision global health and comorbidity: a population-based study of 16 357 people in rural Uganda.
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DOI：
10.1098/rsif.2018.0248
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发表时间：
2018-10-31
期刊：
影响因子：
--
通讯作者：
Dunne DW
中科院分区：
文献类型：
--
作者：
Chami GF;Kabatereine NB;Tukahebwa EM;Dunne DW
在低收入国家，复杂的合并症和薄弱的卫生系统混淆了疾病的诊断和治疗。然而，数据驱动的方法尚未被应用于制定更好的诊断战略或为农村贫困社区内的个人量身定做治疗提供。我们观察了乌干达Mayuge区17个村庄1岁以上的16357人在三个月内报告的症状/疾病。症状被映射到人类表型本体论。建立共病网络。如果相对风险大于1，ϕ相关性大于0，局部错误发现率小于0.05时，则产生两个症状/疾病之间的边缘。我们研究了网络结构和旗舰症状特征如何随着生物社会因素的变化而变化。88.05%的人(14402/16357)至少报告一种症状/疾病。较贫困家庭的幼儿和个人--社会经济地位低、水、环境卫生和个人卫生条件差、医疗保健差--具有密集的网络结构，具有最高的共病负担和/或有助于从发烧等现有主要症状中出现新的共病。发烧的主要症状描述显示，自己将发烧误诊为疟疾和性传播感染，认为这可能是育龄个人发烧的潜在遗漏原因。网络分析可能有助于制定新的旗舰症状诊断和治疗战略，用于确定全球关注的症状/疾病的特征。
In low-income countries, complex comorbidities and weak health systems confound disease diagnosis and treatment. Yet, data-driven approaches have not been applied to develop better diagnostic strategies or to tailor treatment delivery for individuals within rural poor communities. We observed symptoms/diseases reported within three months by 16 357 individuals aged 1+ years in 17 villages of Mayuge District, Uganda. Symptoms were mapped to the Human Phenotype Ontology. Comorbidity networks were constructed. An edge between two symptoms/diseases was generated if the relative risk greater than 1, ϕ correlation greater than 0, and local false discovery rate less than 0.05. We studied how network structure and flagship symptom profiles varied against biosocial factors. 88.05% of individuals (14 402/16 357) reported at least one symptom/disease. Young children and individuals in worse-off households—low socioeconomic status, poor water, sanitation, and hygiene, and poor medical care—had dense network structures with the highest comorbidity burden and/or were conducive to the onset of new comorbidities from existing flagship symptoms, such as fever. Flagship symptom profiles for fever revealed self-misdiagnoses of fever as malaria and sexually transmitted infections as a potentially missed cause of fever in individuals of reproductive age. Network analysis may inform the development of new diagnostic and treatment strategies for flagship symptoms used to characterize syndromes/diseases of global concern.
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DOI：
10.1056/nejmoa1411100
发表时间：
2014-10-16
期刊：
The New England journal of medicine
影响因子：
--
作者：
WHO Ebola Response Team;Aylward B;Barboza P;Bawo L;Bertherat E;Bilivogui P;Blake I;Brennan R;Briand S;Chakauya JM;Chitala K;Conteh RM;Cori A;Croisier A;Dangou JM;Diallo B;Donnelly CA;Dye C;Eckmanns T;Ferguson NM;Formenty P;Fuhrer C;Fukuda K;Garske T;Gasasira A;Gbanyan S;Graaff P;Heleze E;Jambai A;Jombart T;Kasolo F;Kadiobo AM;Keita S;Kertesz D;Koné M;Lane C;Markoff J;Massaquoi M;Mills H;Mulba JM;Musa E;Myhre J;Nasidi A;Nilles E;Nouvellet P;Nshimirimana D;Nuttall I;Nyenswah T;Olu O;Pendergast S;Perea W;Polonsky J;Riley S;Ronveaux O;Sakoba K;Santhana Gopala Krishnan R;Senga M;Shuaib F;Van Kerkhove MD;Vaz R;Wijekoon Kannangarage N;Yoti Z
通讯作者：
Yoti Z
影响因子：
5.5
作者：
Khoury MJ;Iademarco MF;Riley WT
通讯作者：
Riley WT
影响因子：
3.8
作者：
Bwire, Godfrey;Munier, Aline;Mengel, Martin A.
通讯作者：
Mengel, Martin A.
影响因子：
56.9
作者：
Campillos, Monica;Kuhn, Michael;Bork, Peer
通讯作者：
Bork, Peer
影响因子：
64.5
作者：
Huttlin EL;Ting L;Bruckner RJ;Gebreab F;Gygi MP;Szpyt J;Tam S;Zarraga G;Colby G;Baltier K;Dong R;Guarani V;Vaites LP;Ordureau A;Rad R;Erickson BK;Wühr M;Chick J;Zhai B;Kolippakkam D;Mintseris J;Obar RA;Harris T;Artavanis-Tsakonas S;Sowa ME;De Camilli P;Paulo JA;Harper JW;Gygi SP
通讯作者：
Gygi SP