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Santosa, A. & Byass, P. (2016). Diverse empirical evidence on epidemiological transition in low- and middle-income countries: population-based findings from INDEPTH Network data. PLoS ONE, 11(5), Article ID e0155753.
Open this publication in new window or tab >>Diverse empirical evidence on epidemiological transition in low- and middle-income countries: population-based findings from INDEPTH Network data
2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 5, article id e0155753Article in journal (Refereed) Published
Abstract [en]

Background Low-and middle-income countries are often described as being at intermediate stages of epidemiological transition, but there is little population-based data with reliable cause of death assignment to examine the situation in more detail. Non-communicable diseases are widely seen as a coming threat to population health, alongside receding burdens of infection. The INDEPTH Network has collected empirical population data in a number of health and demographic surveillance sites in low-and middle-income countries which permit more detailed examination of mortality trends over time.

Objective To examine cause-specific mortality trends across all ages at INDEPTH Network sites in Africa and Asia during the period 1992-2012. Emphasis is given to the 15-64 year age group, which is the main focus of concern around the impact of the HIV pandemic and emerging non-communicable disease threats.

Methods INDEPTH Network public domain data from 12 sites that each reported at least five years of cause-specific mortality data were used. Causes of death were attributed using standardised WHO verbal autopsy methods, and mortality rates were standardised for comparison using the INDEPTH standard population. Annual changes in mortality rates were calculated for each site.

Results A total of 96,255 deaths were observed during 9,487,418 person years at the 12 sites. Verbal autopsies were completed for 86,039 deaths (89.4%). There were substantial variations in mortality rates between sites and over time. HIV-related mortality played a major part at sites in eastern and southern Africa. Deaths in the age group 15-64 years accounted for 43% of overall mortality. Trends in mortality were generally downwards, in some cases quite rapidly so. The Bangladeshi sites reflected populations at later stages of transition than in Africa, and were largely free of the effects of HIV/AIDS.

Conclusions To some extent the patterns of epidemiological transition observed followed theoretical expectations, despite the impact of the HIV pandemic having a major effect in some locations. Trends towards lower overall mortality, driven by decreasing infections, were the general pattern. Low-and middle-income country populations appear to be in an era of rapid transition.

Keyword
mortality transition, premature mortality, non-communicable disease, low- and middle incom countries, INDEPTH Network
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-103276 (URN)10.1371/journal.pone.0155753 (DOI)000376282300065 ()
Available from: 2015-05-19 Created: 2015-05-19 Last updated: 2017-12-04Bibliographically approved
Santosa, A., Rocklöv, J., Högberg, U. & Byass, P. (2015). Achieving a 25% reduction in premature non-communicable disease mortality: the Swedish population as a cohort study. BMC Medicine, 13(65)
Open this publication in new window or tab >>Achieving a 25% reduction in premature non-communicable disease mortality: the Swedish population as a cohort study
2015 (English)In: BMC Medicine, ISSN 1741-7015, E-ISSN 1741-7015, Vol. 13, no 65Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The 2012 World Health Assembly set a target for Member States to reduce premature non-communicable disease (NCD) mortality by 25% over the period 2010 to 2025. This reflected concerns about increasing NCD mortality burdens among productive adults globally.

OBJECTIVES: We firstly considered whether the WHO target of a 25% reduction in the unconditional probability of dying between ages of 30 and 70 from NCDs (cardiovascular diseases, cancer, diabetes or chronic respiratory diseases) had already taken place in Sweden during an equivalent 15-year period. Secondly, we assessed which population sub-groups had been more or less successful in contributing to overall changes in premature NCD mortality in Sweden.

METHODS: A retrospective dynamic cohort database was constructed from Swedish population registers in the Linnaeus database, covering the entire population in the age range 30-69 years for the period 1991 to 2006, which was used directly to measure reductions in premature NCD mortality. Multivariate Poisson regression models were used to assess the contributions of individual background factors to decreases in premature NCD mortality.

RESULTS: A total of 292,320 deaths occurred in the 30-69 year age group during the period 1991 to 2006, against 70,768,848 person-years registered. The crude all-cause mortality rate declined from 5.03 to 3.72 per 1,000 person-years, a 26% reduction. Within this, the unconditional probability of dying between the ages of 30 and 70 from NCD causes as defined by WHO fell by 30.0%. Age was consistently the strongest determinant of NCD mortality. Background determinants of NCD mortality changed significantly over the four time periods 1991-1994, 1995-1998, 1999-2002 and 2003-2006.

CONCLUSIONS: Sweden, now at a late stage of epidemiological transition, has already exceeded the 25% premature NCD mortality reduction target during an earlier 15-year period. This should be encouraging news for countries currently implementing premature NCD mortality reduction programmes. Our findings suggest, however, that it may be difficult for Sweden and other late-transition countries to reach the current 25x25 target, particularly where substantial premature mortality reductions have already been achieved.

Keyword
non-communicable disease, mortality, Sweden, World Health Organization, 25x25 target
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-103028 (URN)10.1186/s12916-015-0313-8 (DOI)000352599700001 ()25889300 (PubMedID)
Available from: 2015-05-15 Created: 2015-05-15 Last updated: 2017-12-04Bibliographically approved
Hussain-Alkhateeb, L., Fottrell, E., Petzold, M., Kahn, K. & Byass, P. (2015). Local perceptions of causes of death in rural South Africa: a comparison of perceived and verbal autopsy causes of death. Global Health Action, 8, 1-9, Article ID 28302.
Open this publication in new window or tab >>Local perceptions of causes of death in rural South Africa: a comparison of perceived and verbal autopsy causes of death
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2015 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, p. 1-9, article id 28302Article in journal (Refereed) Published
Abstract [en]

Background: Understanding how lay people perceive the causes of mortality and their associated risk factors is important for public health. In resource-limited settings, where verbal autopsy (VA) is used as the most expedient method of determining cause of death, it is important to understand how pre-existing concepts of cause of death among VA-informants may influence their VA-responses and the consequential impact on cause of death assessment. This study describes the agreement between VA-derived causes of death and informant-perceived causes and associated influential factors, which also reflects lay health literacy in this setting. Method: Using 20 years of VA data (n = 11,228) from the Agincourt Health and Demographic Surveillance System (HDSS) site in rural South Africa, we explored the agreement between the causes of death perceived by the VA-informants and those assigned by the automated Inter-VA tool. Kappa statistics and concordance correlation coefficients were applied to measure agreement at individual and population levels, respectively. Multivariable regression models were used to explore factors associated with recognised lay perceptions of causes of mortality. Results: Agreement between informant-perceived and VA-derived causes of death at the individual level was limited, but varied substantially by cause of death. However, agreement at the population level, comparing cause-specific mortality fractions was higher, with the notable exception of bewitchment as a cause. More recent deaths, those in adults aged 15-49 years, deaths outside the home, and those associated with external causes showed higher concordance with InterVA. Conclusion: Overall, informant perception of causes of death was limited, but depended on informant characteristics and causes of death, and to some extent involved non-biomedical constructs. Understanding discordance between perceived and recognised causes of death is important for public health planning; low community understanding of causes of death may be detrimental to public health. These findings also illustrate the importance of using rigorous and standardised VA methods rather than relying on informants' reported causes of death.

Keyword
community perception, causes of death, verbal autopsy
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-107183 (URN)10.3402/gha.v8.28302 (DOI)000358180600001 ()26193897 (PubMedID)
Available from: 2015-09-01 Created: 2015-08-19 Last updated: 2017-12-04Bibliographically approved
Fottrell, E., Högberg, U., Ronsmans, C., Osrin, D., Azad, K., Nair, N., . . . Filippi, V. (2014). A probabilistic method to estimate the burden of maternal morbidity in resource-poor settings: preliminary development and evaluation. Emerging Themes in Epidemiology, 11(1), 3
Open this publication in new window or tab >>A probabilistic method to estimate the burden of maternal morbidity in resource-poor settings: preliminary development and evaluation
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2014 (English)In: Emerging Themes in Epidemiology, ISSN 1742-7622, E-ISSN 1742-7622, Vol. 11, no 1, p. 3-Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Maternal morbidity is more common than maternal death, and population-based estimates of the burden of maternal morbidity could provide important indicators for monitoring trends, priority setting and evaluating the health impact of interventions. Methods based on lay reporting of obstetric events have been shown to lack specificity and there is a need for new approaches to measure the population burden of maternal morbidity. A computer-based probabilistic tool was developed to estimate the likelihood of maternal morbidity and its causes based on self-reported symptoms and pregnancy/delivery experiences. Development involved the use of training datasets of signs, symptoms and causes of morbidity from 1734 facility-based deliveries in Benin and Burkina Faso, as well as expert review. Preliminary evaluation of the method compared the burden of maternal morbidity and specific causes from the probabilistic tool with clinical classifications of 489 recently-delivered women from Benin, Bangladesh and India.

RESULTS: Using training datasets, it was possible to create a probabilistic tool that handled uncertainty of women's self reports of pregnancy and delivery experiences in a unique way to estimate population-level burdens of maternal morbidity and specific causes that compared well with clinical classifications of the same data. When applied to test datasets, the method overestimated the burden of morbidity compared with clinical review, although possible conceptual and methodological reasons for this were identified.

CONCLUSION: The probabilistic method shows promise and may offer opportunities for standardised measurement of maternal morbidity that allows for the uncertainty of women's self-reported symptoms in retrospective interviews. However, important discrepancies with clinical classifications were observed and the method requires further development, refinement and evaluation in a range of settings.

Place, publisher, year, edition, pages
BioMed Central, 2014
Keyword
Maternal health, Morbidity, Developing countries, Pregnancy, Childbirth, Bayesian analysis, Africa, Asia
National Category
Public Health, Global Health, Social Medicine and Epidemiology Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-90534 (URN)10.1186/1742-7622-11-3 (DOI)24620784 (PubMedID)
Available from: 2014-06-24 Created: 2014-06-24 Last updated: 2017-12-05Bibliographically approved
Byass, P. (2014). Achieving better global health policy, even when health metrics data are scanty. In: Brown GW, Yamey G, Wamala S (Ed.), The Handbook of Global Health Policy: (pp. 119-132). Wiley-Blackwell
Open this publication in new window or tab >>Achieving better global health policy, even when health metrics data are scanty
2014 (English)In: The Handbook of Global Health Policy / [ed] Brown GW, Yamey G, Wamala S, Wiley-Blackwell, 2014, p. 119-132Chapter in book (Refereed)
Place, publisher, year, edition, pages
Wiley-Blackwell, 2014
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-97438 (URN)978-0-470-67419-2 (ISBN)
Available from: 2014-12-17 Created: 2014-12-17 Last updated: 2015-05-12Bibliographically approved
Streatfield, P. K., Khan, W. A., Bhuiya, A., Hanifi, S. M. A., Alam, N., Bagagnan, C. H., . . . Byass, P. (2014). Adult non-communicable disease mortality in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System sites. Global Health Action, 7, Article ID 25365.
Open this publication in new window or tab >>Adult non-communicable disease mortality in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System sites
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2014 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 25365Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Mortality from non-communicable diseases (NCDs) is a major global issue, as other categories of mortality have diminished and life expectancy has increased. The World Health Organization's Member States have called for a 25% reduction in premature NCD mortality by 2025, which can only be achieved by substantial reductions in risk factors and improvements in the management of chronic conditions. A high burden of NCD mortality among much older people, who have survived other hazards, is inevitable. The INDEPTH Network collects detailed individual data within defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available.

OBJECTIVE: To describe patterns of adult NCD mortality from INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories, with separate consideration of premature (15-64 years) and older (65+ years) NCD mortality.

DESIGN: All adult deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates.

RESULTS: A total of 80,726 adult (over 15 years) deaths were documented over 7,423,497 person-years of observation. NCDs were attributed as the cause for 35.6% of these deaths. Slightly less than half of adult NCD deaths occurred in the 15-64 age group. Detailed results are presented by age and sex for leading causes of NCD mortality. Per-site rates of NCD mortality were significantly correlated with rates of HIV/AIDS-related mortality.

CONCLUSIONS: These findings present important evidence on the distribution of NCD mortality across a wide range of African and Asian settings. This comes against a background of global concern about the burden of NCD mortality, especially among adults aged under 70, and provides an important baseline for future work.

Place, publisher, year, edition, pages
CoAction Publishing, 2014
Keyword
adults, non-communicable disease, Africa, Asia, mortality, INDEPTH Network, verbal autopsy, InterVA
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-97425 (URN)10.3402/gha.v7.25365 (DOI)000209734900001 ()25377326 (PubMedID)
Funder
Wellcome trust, 058893/Z/99/AWellcome trust, 069683/Z/02/ZWellcome trust, 084538Wellcome trust, 085477/Z/08/ZWellcome trust, 091758Wellcome trust, WT081993MA
Available from: 2014-12-17 Created: 2014-12-17 Last updated: 2018-02-12Bibliographically approved
Desai, M., Buff, A. M., Khagayi, S., Byass, P., Amek, N., van Eijk, A., . . . Hamel, M. J. (2014). Age-specific malaria mortality rates in the KEMRI/CDC health and demographic surveillance system in western Kenya, 2003-2010. PLoS ONE, 9(9), Article ID e106197.
Open this publication in new window or tab >>Age-specific malaria mortality rates in the KEMRI/CDC health and demographic surveillance system in western Kenya, 2003-2010
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2014 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 9, article id e106197Article in journal (Refereed) Published
Abstract [en]

Recent global malaria burden modeling efforts have produced significantly different estimates, particularly in adult malaria mortality. To measure malaria control progress, accurate malaria burden estimates across age groups are necessary. We determined age-specific malaria mortality rates in western Kenya to compare with recent global estimates. We collected data from 148,000 persons in a health and demographic surveillance system from 2003-2010. Standardized verbal autopsies were conducted for all deaths; probable cause of death was assigned using the InterVA-4 model. Annual malaria mortality rates per 1,000 person-years were generated by age group. Trends were analyzed using Poisson regression. From 2003-2010, in children <5 years the malaria mortality rate decreased from 13.2 to 3.7 per 1,000 person-years; the declines were greatest in the first three years of life. In children 5-14 years, the malaria mortality rate remained stable at 0.5 per 1,000 person-years. In persons ≥15 years, the malaria mortality rate decreased from 1.5 to 0.4 per 1,000 person-years. The malaria mortality rates in young children and persons aged ≥15 years decreased dramatically from 2003-2010 in western Kenya, but rates in older children have not declined. Sharp declines in some age groups likely reflect the national scale up of malaria control interventions and rapid expansion of HIV prevention services. These data highlight the importance of age-specific malaria mortality ascertainment and support current strategies to include all age groups in malaria control interventions.

Place, publisher, year, edition, pages
Plos, 2014
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-95822 (URN)10.1371/journal.pone.0106197 (DOI)000341231500058 ()25180495 (PubMedID)
Available from: 2014-11-05 Created: 2014-11-05 Last updated: 2017-12-05Bibliographically approved
Hall, C. S., Fottrell, E., Wilkinson, S. & Byass, P. (2014). Assessing the impact of mHealth interventions in low- and middle-income countries: what has been shown to work?. Global Health Action, 7, 1-12, Article ID 25606.
Open this publication in new window or tab >>Assessing the impact of mHealth interventions in low- and middle-income countries: what has been shown to work?
2014 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, p. 1-12, article id 25606Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: Low-cost mobile devices, such as mobile phones, tablets, and personal digital assistants, which can access voice and data services, have revolutionised access to information and communication technology worldwide. These devices have a major impact on many aspects of people's lives, from business and education to health. This paper reviews the current evidence on the specific impacts of mobile technologies on tangible health outcomes (mHealth) in low- and middle-income countries (LMICs), from the perspectives of various stakeholders.

DESIGN: Comprehensive literature searches were undertaken using key medical subject heading search terms on PubMed, Google Scholar, and grey literature sources. Analysis of 676 publications retrieved from the search was undertaken based on key inclusion criteria, resulting in a set of 76 papers for detailed review. The impacts of mHealth interventions reported in these papers were categorised into common mHealth applications.

RESULTS: There is a growing evidence base for the efficacy of mHealth interventions in LMICs, particularly in improving treatment adherence, appointment compliance, data gathering, and developing support networks for health workers. However, the quantity and quality of the evidence is still limited in many respects.

CONCLUSIONS: Over all application areas, there remains a need to take small pilot studies to full scale, enabling more rigorous experimental and quasi-experimental studies to be undertaken in order to strengthen the evidence base.

Place, publisher, year, edition, pages
Rockville Pike, Bethesda MD, USA: National Center for Biotechnology Information,U.S. National Library of Medicine, 2014
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-95820 (URN)10.3402/gha.v7.25606 (DOI)000344630100001 ()25361730 (PubMedID)
Available from: 2014-11-05 Created: 2014-11-05 Last updated: 2017-12-05Bibliographically approved
Ndila, C., Bauni, E., Mochamah, G., Nyirongo, V., Makazi, A., Kosgei, P., . . . Williams, T. N. (2014). Causes of death among persons of all ages within the Kilifi Health and Demographic Surveillance System, Kenya, determined from verbal autopsies interpreted using the InterVA-4 model. Global Health Action, 7, Article ID 25593.
Open this publication in new window or tab >>Causes of death among persons of all ages within the Kilifi Health and Demographic Surveillance System, Kenya, determined from verbal autopsies interpreted using the InterVA-4 model
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2014 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 25593Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The vast majority of deaths in the Kilifi study area are not recorded through official systems of vital registration. As a result, few data are available regarding causes of death in this population.

OBJECTIVE: To describe the causes of death (CODs) among residents of all ages within the Kilifi Health and Demographic Surveillance System (KHDSS) on the coast of Kenya.

DESIGN: Verbal autopsies (VAs) were conducted using the 2007 World Health Organization (WHO) standard VA questionnaires, and VA data further transformed to align with the 2012 WHO VA instrument. CODs were then determined using the InterVA-4 computer-based probabilistic model.

RESULTS: Five thousand one hundred and eighty seven deaths were recorded between January 2008 and December 2011. VA interviews were completed for 4,460 (86%) deaths. Neonatal pneumonia and birth asphyxia were the main CODs in neonates; pneumonia and malaria were the main CODs among infants and children aged 1-4, respectively, while HIV/AIDS was the main COD for adult women of reproductive age. Road traffic accidents were more commonly observed among men than women. Stroke and neoplasms were common CODs among the elderly over the age of 65.

CONCLUSIONS: We have established the main CODs among people of all ages within the area served by the KHDSS on the coast of Kenya using the 2007 WHO VA questionnaire coded using InterVA-4. We hope that our data will allow local health planners to estimate the burden of various diseases and to allocate their limited resources more appropriately.

Keyword
verbal autopsy, InterVA-4, cause-specific mortality fraction, Kenya
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-97431 (URN)10.3402/gha.v7.25593 (DOI)000209736500001 ()25377342 (PubMedID)
Funder
Wellcome trust, 091758
Available from: 2014-12-17 Created: 2014-12-17 Last updated: 2018-02-12Bibliographically approved
Streatfield, P. K., Khan, W. A., Bhuiya, A., Hanifi, S. M. A., Alam, N., Ouattara, M., . . . Byass, P. (2014). Cause-specific childhood mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites. Global Health Action, 7, Article ID 25363.
Open this publication in new window or tab >>Cause-specific childhood mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites
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2014 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 25363Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Childhood mortality, particularly in the first 5 years of life, is a major global concern and the target of Millennium Development Goal 4. Although the majority of childhood deaths occur in Africa and Asia, these are also the regions where such deaths are least likely to be registered. The INDEPTH Network works to alleviate this problem by collating detailed individual data from defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available.

OBJECTIVE: To present a description of cause-specific mortality rates and fractions over the first 15 years of life as documented by INDEPTH Network sites in sub-Saharan Africa and south-east Asia.

DESIGN: All childhood deaths at INDEPTH sites are routinely registered and followed up with verbal autopsy (VA) interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provided person-time denominators for mortality rates. Cause-specific mortality rates and cause-specific mortality fractions are presented according to WHO 2012 VA cause groups for neonatal, infant, 1-4 year and 5-14 year age groups.

RESULTS: A total of 28,751 childhood deaths were documented during 4,387,824 person-years over 18 sites. Infant mortality ranged from 11 to 78 per 1,000 live births, with under-5 mortality from 15 to 152 per 1,000 live births. Sites in Vietnam and Kenya accounted for the lowest and highest mortality rates reported.

CONCLUSIONS: Many children continue to die from relatively preventable causes, particularly in areas with high rates of malaria and HIV/AIDS. Neonatal mortality persists at relatively high, and perhaps sometimes under-documented, rates. External causes of death are a significant childhood problem in some settings.

Keyword
Childhood, Africa, Asia, mortality, INDEPTH Network, verbal autopsy, InterVA
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-97423 (URN)10.3402/gha.v7.25363 (DOI)000209734800001 ()25377325 (PubMedID)
Funder
Wellcome trust, 058893/Z/99/AWellcome trust, 069683/Z/02/ZWellcome trust, 084538Wellcome trust, 085477/Z/08/ZWellcome trust, 091758Wellcome trust, WT081993MA
Available from: 2014-12-17 Created: 2014-12-17 Last updated: 2018-02-12Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-5474-4361

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