Statistical Methods in the Global Enteric Multicenter Study (GEMS)

Overview

Journal Clin Infect Dis

Publisher Oxford University Press

Specialty Infectious Diseases

Date 2012 Nov 22

PMID 23169937

Citations 55

Authors

William C Blackwelder

Kousick Biswas

Yukun Wu

Karen L Kotloff

Tamer H Farag

Dilruba Nasrin

Barry I Graubard

Halvor Sommerfelt

Myron M Levine

Affiliations

Soon will be listed here.

Abstract

The Global Enteric Multicenter Study (GEMS) is an investigation of the burden (number of cases and incidence) of moderate-to-severe diarrhea (MSD) in children <60 months of age at 7 sites in sub-Saharan Africa and South Asia. The population attributable fraction for a putative pathogen, either unadjusted or adjusted for other pathogens, is estimated using the proportion of MSD cases from whom the pathogen was isolated and the odds ratio for MSD and the pathogen from conditional logistic regression modeling. The adjusted attributable fraction, proportion of MSD cases taken to a sentinel health center (SHC), number of cases presenting to an SHC, and the site's population are used to estimate the annual number of MSD cases and MSD incidence rate attributable to a pathogen or group of pathogens. Associations with death and nutritional outcomes, ascertained at follow-up visits to case and control households, are evaluated both in MSD cases and in the population.

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References

Black R, Cousens S, Johnson H, Lawn J, Rudan I, Bassani D . Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet. 2010; 375(9730):1969-87. DOI: 10.1016/S0140-6736(10)60549-1. View

Curtis V, Cairncross S . Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. Lancet Infect Dis. 2003; 3(5):275-81. DOI: 10.1016/s1473-3099(03)00606-6. View

Rockhill B, Newman B, WEINBERG C . Use and misuse of population attributable fractions. Am J Public Health. 1998; 88(1):15-9. PMC: 1508384. DOI: 10.2105/ajph.88.1.15. View

Kotloff K, Blackwelder W, Nasrin D, Nataro J, Farag T, van Eijk A . The Global Enteric Multicenter Study (GEMS) of diarrheal disease in infants and young children in developing countries: epidemiologic and clinical methods of the case/control study. Clin Infect Dis. 2012; 55 Suppl 4:S232-45. PMC: 3502307. DOI: 10.1093/cid/cis753. View

Clasen T, Bostoen K, Schmidt W, Boisson S, Fung I, Jenkins M . Interventions to improve disposal of human excreta for preventing diarrhoea. Cochrane Database Syst Rev. 2010; (6):CD007180. PMC: 6532559. DOI: 10.1002/14651858.CD007180.pub2. View

Hanley J . A heuristic approach to the formulas for population attributable fraction. J Epidemiol Community Health. 2001; 55(7):508-14. PMC: 1731931. DOI: 10.1136/jech.55.7.508. View

Benichou J . A review of adjusted estimators of attributable risk. Stat Methods Med Res. 2001; 10(3):195-216. DOI: 10.1177/096228020101000303. View

Levin M . The occurrence of lung cancer in man. Acta Unio Int Contra Cancrum. 1953; 9(3):531-41. View

Levine M, Kotloff K, Nataro J, Muhsen K . The Global Enteric Multicenter Study (GEMS): impetus, rationale, and genesis. Clin Infect Dis. 2012; 55 Suppl 4:S215-24. PMC: 3502311. DOI: 10.1093/cid/cis761. View

10.

Clasen T, Schmidt W, Rabie T, Roberts I, Cairncross S . Interventions to improve water quality for preventing diarrhoea: systematic review and meta-analysis. BMJ. 2007; 334(7597):782. PMC: 1851994. DOI: 10.1136/bmj.39118.489931.BE. View

11.

Levine M . Enteric infections and the vaccines to counter them: future directions. Vaccine. 2006; 24(18):3865-73. DOI: 10.1016/j.vaccine.2006.03.039. View

12.

Albert M, Faruque A, Faruque S, Sack R, Mahalanabis D . Case-control study of enteropathogens associated with childhood diarrhea in Dhaka, Bangladesh. J Clin Microbiol. 1999; 37(11):3458-64. PMC: 85667. DOI: 10.1128/JCM.37.11.3458-3464.1999. View

13.

Breslow N, Day N . Statistical methods in cancer research. Volume I - The analysis of case-control studies. IARC Sci Publ. 1980; (32):5-338. View

14.

Valentiner-Branth P, Steinsland H, Fischer T, Perch M, Scheutz F, Dias F . Cohort study of Guinean children: incidence, pathogenicity, conferred protection, and attributable risk for enteropathogens during the first 2 years of life. J Clin Microbiol. 2003; 41(9):4238-45. PMC: 193811. DOI: 10.1128/JCM.41.9.4238-4245.2003. View

15.

Bruzzi P, Green S, Byar D, Brinton L, Schairer C . Estimating the population attributable risk for multiple risk factors using case-control data. Am J Epidemiol. 1985; 122(5):904-14. DOI: 10.1093/oxfordjournals.aje.a114174. View

16.

Sobel J, Gomes T, Ramos R, Hoekstra M, Rodrigue D, Rassi V . Pathogen-specific risk factors and protective factors for acute diarrheal illness in children aged 12-59 months in São Paulo, Brazil. Clin Infect Dis. 2004; 38(11):1545-51. DOI: 10.1086/420822. View

17.

Huilan S, Zhen L, Mathan M, Mathew M, Olarte J, Espejo R . Etiology of acute diarrhoea among children in developing countries: a multicentre study in five countries. Bull World Health Organ. 1991; 69(5):549-55. PMC: 2393250. View

18.

Echeverria P, Taylor D, Lexsomboon U, BHAIBULAYA M, Blacklow N, Tamura K . Case-control study of endemic diarrheal disease in Thai children. J Infect Dis. 1989; 159(3):543-8. DOI: 10.1093/infdis/159.3.543. View

19.

Myo-Khin , Hayashi H . Epidemiology and aetiology of acute childhood diarrhoea in Burma: a rural community survey. Trans R Soc Trop Med Hyg. 1989; 83(6):827-30. DOI: 10.1016/0035-9203(89)90344-1. View

20.

Sommerfelt H, Steinsland H, van der Merwe L, Blackwelder W, Nasrin D, Farag T . Case/control studies with follow-up: Constructing the source population to estimate effects of risk factors on development, disease, and survival. Clin Infect Dis. 2012; 55 Suppl 4:S262-70. PMC: 3502318. DOI: 10.1093/cid/cis802. View