Tiwari, Neha

School of Public Health


Bangladesh, Uganda

Improving adolescent and adult mortality metrics in low- and middle-income countries

With child mortality rapidly declining, an increasing proportion of all deaths in low and middle-income countries (LMICs) will occur at adolescent and adult ages in the next decades. Key global health objectives thus focus on reducing deaths from causes that affect primarily those age groups (e.g., non-communicable diseases, maternal mortality, road traffic accidents, suicides). The number of lives saved by global health programs focused on the health of adolescents and adults may however remain unknown because few LMICs have vital registration systems that allow measuring mortality precisely. In this project, we will test new survey methods to improve the quantity and quality of data on adolescent and adult mortality. These methods mobilize new mobile platforms, as well as innovative interviewing strategies. The project will be conducted in two sites: Matlab in Bangladesh, and Rakai in Uganda, with an emphasis on accidental deaths and injuries in Bangladesh, and on HIV and reproductive health in Uganda. Results from this study will help develop and target adolescent and adult health interventions in LMICs, and evaluate the effectiveness of global health initiatives.

PI Mentor: Stephane Helleringer

My practicum working at the Rakai Health Sciences Program in Kalisizo Uganda was one of the most enriching experiences of my graduate education at Hopkins. This was my first time in the country as well as in East Africa. I did some research before I arrived and asked those who had been there before about their experiences, but no amount of anecdotes or articles could have prepared me for the beauty of Uganda. The countryside is vibrant and unique in each district and no village is quite the same as the one before it. The people there are warm, friendly, and welcoming. While most people at the research center and surrounding tourist areas spoke some English, the local language in that area is Luganda and they appreciate the effort taken to learn it. Uganda has a vibrant and rich history, one that the local team I was working with liked to share with me and I felt that I got to see their home through their eyes.

There wasn’t necessarily a sense of culture shock when I first arrived in Uganda. I was, of course, apprehensive as I always am when traveling to a new place, but when I landed there early morning, I didn't feel as nervous as I thought I would. Driving to the research site the next morning with the other interns, I observed the landscape and while it wasn’t familiar in any real sense, it did remind me of the rural countryside of India. It also helped that there was a large Indian community in Uganda and that much of the infrastructure was similar to the infrastructure in India. These details helped combat the initial culture shock and allowed me to acclimate quicker to my surroundings.

My project entailed helping coordinate the setup and launch of a survey-based study that was validating a new tool intended to collect data related to demographic health surveillance and mortality in the Rakai Community Cohort. The specific aims of this study are to evaluate the accuracy of survey data on adolescent and adult mortality collected retrospectively through siblings’ survival histories (SSH), compared to the reference mortality data collected prospectively. My role as a student researcher was to assist the in-country team with finalizing the protocol and data management of the parent study. I was also in charge of designing a tool for the sub-study – a survey instrument that would help capture mortality data and subsequent risk factors associated with mortality for a mobile phone survey platform. I would also pilot it and ensure that the logistics of setting up the sub-study was complete.

I cultivated a lot of close relationships during my time in Rakai, Uganda. My colleagues at work were warm and welcoming and we exchanged stories of our respective hometowns. I became particularly close to our host Grace at the guesthouse. She was our most steadfast point of contact while in-country, assisting us from things like cooking, cleaning, and laundry, to helping us navigate the language and local markets. She took us around Kalisizo and introduced us to her friends as well as her family. Grace was an excellent cook and would show us how to make local dishes such as Kabalagala (cassava dough-based pancake), chappti (bread), and matoke (plantain dish with peanut sauce) – staples of that region’s local cuisine. I still keep in contact with Grace and I know I’ve made a lifelong friend in her. This practicum experience has helped me in so many ways – I’ve learned new skills in the field of public health and survey methodology as well as gotten to better understand the culture and public health ecosystem in Rakai. The three months spent working at RHSP have shaped my future career goals and I hope to one day return to Uganda to work and explore more of the country.



October 2022



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