Center for Global Health Faculty
Amnesty E. LeFevre
Assistant Scientist
Departmental Address
Wolfe St. Building E8139
Research and Professional Experience
My research interests remains focused on health systems and the design and evaluation of potential interventions/ strategies for addressing the leading causes of mortality in mothers, newborns, and children. To this end, I have broad expertise in the design and evaluation of MNCH health care programs, as well as concrete skills in impact evaluation (including morbidity and mortality measurement), economic evaluation, financing, and equity. Present research has sought to explore factors related to the integration of health services -- and thus moving research from efficacy, effectiveness, to large-scale health service provision. Globally, I have worked extensively throughout South Asia, Africa, and in parts of Latin America, on over a dozen large-scale maternal, newborn, and child health programs. Details of these are contained below.
Maternal, Newborn, Children Health (MNCH) Packages: In collaboration with JHU colleagues and with support from Save the Children's Saving Newborn Lives Initiative and other partners, I have carried out economic analyses of large-scale community-based MNCH packages in Bangladesh (Projahnmo; Dr. Abdullah Baqui PI), India (Shivgarh trial with Drs. Vishwajeet Kumar and Gary Darmstadt), Pakistan (Hala trial in Sindh led by Dr. Zulfi Bhutta and Aga Khan University). Presently, I am working with Dr. Abdullah Baqui and colleagues to evaluate the feasibility and effectiveness of integrating postpartum family planning services into a platform of MNCH services in Bangladesh.
Maternal Health: In collaboration with JHPIEGO and Dr. Linda Bartlett, I have worked to evaluate Afghanistan's national pre-service midwifery program. With funding from USAID, we are additionally in the process of carrying out a second RAMOS study to determine national mortality rates for Afghanistan -- cited in 2005 as having the highest maternal mortality rate in the world. Data collection was initiated in September 2010 and project activities will span through July 2012.
Beyond these evaluations, I am initiating work to test new technologies (with Catie Bereznay) for the enhanced recognition and diagnosis and postpartum hemorrhage; the single leading cause of maternal mortality globally.
Newborn Specific: In addition packages of MNCH services, I have carried out research to determine the cost-effectiveness of new technologies aimed at improving newborn health outcomes. This includes topical emollients for the prevention and reduction of infection, and most recently the use of chlorhexidine for cord cleansing in Bangladesh.
Child health specific: In collaboration with Drs. Robert Black and Peter Winch and with support from colleagues in India, Mali, and Pakistan, I have conducted large-scale economic analyses of the therapeutic distribution of zinc and reduced osmolarity ORS for the treatment of diarrhea in children under-5 (the second leading cause of child mortality). In 2011, we began a large scale evaluation of zinc delivery at scale through public and private sector cadres in two large Indian states -- UP and Gujarat-- with support from the Bill and Melinda Gate's Foundation.
Beyond diarrhea treatment, with support from the World Health Organization, I have also worked with Dr. David Bishai to carryout a cost-effectiveness analysis of measles eradication in Ethiopia and as well contribute to global modeling efforts in this regard.
Optimizing service delivery: In late 2011, Dr. David Bishai (PI) and I began working with UCSF to provide recommendations to PSI-Burma on the optimal components for services for private providers in Yangon. We have additionally been contracted by DFID to design an optimal package of MNCH services for delivery at scale with support from a $250 million donor consortium project “The 3 Millennium Diseases Fund”. Our work has focused on providing recommendations on the optimal design, including priority interventions and delivery strategies, and evidence on the cost-effectiveness of individual component and overall services.
Keywords
International Health; maternal, newborn, and child health; evaluation of community based interventions; costing and cost-effectiveness; equity; financial barriers to care; micronutrients
Selected Publications
PEER-REVIEW PUBLICATIONS
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1.
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Winch PJ, Swedberg E, Doumbia S, Kanté M, Cheick K, Sissoko T, LeFevre AE, Gilroy KE, Black RE, Fontaine O, and the Mali Zinc Introduction Study Group. Cluster-randomized programme effectiveness study of community case management with zinc for childhood diarrhoea in southern Mali. (Bulletin of the World Health Organization in press)
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2.
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LeFevre AE, Shillcutt S, Saha S, Chowdhury MAK, Law PA, Black RE, Santosham M, and Darmstadt G. Cost effectiveness of skin barrier enhancing emollients to prevent infection and death among preterm neonates in Bangladesh. Bulletin of the World Health Organization. February 2010.
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3.
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Baqui AH, El-Arifeen S, Darmstadt GL, Ahmed S, Williams EK, Seraji HR, Mannan I, Rahman SM, Shah R, Saha SK, Syed U, Winch PJ, LeFevre AE, Santosham M, Black RE; Projahnmo Study Group. Impact of a package of community-based newborn care interventions implemented through two service delivery strategies in Sylhet district, Bangladesh: a cluster-randomised controlled trial. Lancet. 2008 Jun 7;371(9628):1936-44.
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SUBMITTED MANUSCRIPTS
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4.
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Bishai D, Johns BJ, LeFevre AE, et al Measles eradication versus measles control: an economic analysis (Submitted to Journal of Vaccines and Vaccinations)
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5.
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Shillcutt S, LeFevre AE, et al. Modeling the years lost to disability (YLD) burden resulting from neonatal conditions: An application to the Prohanmo I trial, Sylhet Bangladesh (Submitted to Health Policy and Planning)
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6.
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LeFevre A, Waters H, Shillcutt S, Haider S, Darmstadt G, El Arifeen S, Mannan I, Wall S, Syed U, and Baqui AH. Cost effectiveness of a community-based package of maternal and newborn services in Sylhet, Bangladesh. (Submitted to BMJ)
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7.
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LeFevre A, Shillcutt S, Mirani M, Soofi S, Black RE, and Bhutta Z. Cost effectiveness of a community-based package of maternal and newborn services in Sindh, Pakistan
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8.
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LeFevre AE, Mazumder S, Dube B, Bhandari N, Taneja S, Mahalanabis D, Fontaine O, Black RE. Cost Effectiveness of Zinc Supplementation Plus Oral Rehydration Salts Compared With Oral Rehydration Salts Alone as a Treatment for Acute Diarrhea in a Primary Care Setting in Haryana, India (Submitted to WHO Bull)
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9.
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Ahmed S, William E, LeFevre AE, et al Design and evaluation of a study to integrate postpartum birth spacing promotion with community-based maternal and neonatal care in rural northeastern Bangladesh
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FORTHCOMING MANUSCRIPTS 2011
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MNCH Continuum of care
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10.
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LeFevre AE, Bishai D, et al The 3 Millennium Development Fund for Myanmar: designing a cost-effective continuum of care for maternal, newborn and child health at scale (target journal Lancet)
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11.
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LeFevre AE, Darmstadt GL; Kumar V, Mohanty S, Kumar A, Misra RP, Santosham M, Awasthi S, Baqui AH, Singh P, Singh V, Ahuja RC, Singh JV, Malik GK, Ahmed S, Bhandari M, Black RE, Saksham Study Group. Cost effectiveness of community-based behavior change management in reducing neonatal mortality in Shivgarh, Uttar Pradesh
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12.
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Baqui AH, LeFevre AE, et al Impact of integrating family planning into a comprehensive package of MNCH services in Sylhet, Bangladesh (target journal Lancet)
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13.
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Ahmed S, LeFevre AE et al Designing an enhanced MNCH platform through the introduction of postpartum family planning in Sylhet Bangladesh
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14.
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Okebukola P, LeFevre AE et al Cost Effectiveness of providing a continuum of MNCH services in Ethiopia
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Maternal Health
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15.
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Mckaig C, Ahmed S, Ahmed S, LeFevre AE et al Promoting LAM as an effective form of contraception within integrated MNCH platform of care: impact on exclusive breastfeeding and other child health outcomes in Sylhet Bangladesh
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Child Health
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16.
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Soofi S, Zaidi S, Sunil Hotwani S, Suhag Z, LeFevre AE et al Effectiveness of Zinc Treatment in Acute Childhood Diarrhoea: A Cluster Randomized Trial in Rural Pakistan (Target Journal JAMA)
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17.
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LeFevre AE, Mazumder S, et al The effect of zinc supplementation on diarrhea morbidity and health care utilization among children under 5 in rural India: Changes in Equity
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18.
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LeFevre AE, et al Resource implications of community-based zinc introduction in Mali for the treatment of acute diarrhea in children under 5 (target journal, Health Policy and Planning)
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19.
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LeFevre AE, et al Bhutta ZA, et al Cost Effectiveness of therapeutic delivery of Zinc for the treatment of acute diarrhea in children 1 to 59 months in Sindh, Pakistan: the importance of ensuring optimal coverage (target journal, BMJ)
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Newborn Health
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20.
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LeFevre AE, Shah R, et al Cost effectiveness of community based application of chlorxhedine for the prevention of newborn infections and mortality in Sylhet, Bangladesh
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Operations research/ service delivery
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21.
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Bishai D, LeFevre AE, et al. How donors add value to private sector health care in Myanmar: Tracking the flow of funds in a social franchise
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