Peter Macharia, using geospatial modelling to reduce child mortality

Peter Macharia is a PhD candidate of spatial epidemiology at The Open University UK, supported by the Initiative to Develop Research Leaders (IDeAL), based at the Kenya Medical Research Institute-Wellcome Trust Research Programme (KWTRP).  To better understand his work and his involvement in the geospatial industry we asked him some thought-provoking questions.

Peter, kindly share some of your biodata to introduce yourself.

I am Peter Macharia born in the late eighties in Nakuru county where I undertook my Primary school and Secondary School education. I have a background in Geomatic Engineering and GIS for both my undergraduate and masters from Jomo Kenyatta University of Agriculture and Technology (JKUAT). I have augmented these domains with a post-graduate diploma in health research methods offered by Pwani University and KEMRI Wellcome Trust Research Programme (KWTRP). In the last years, I have been involved in geospatial modelling of spatial health metrics applicable in the SDG and UHC era. Currently, I am a PhD student with KWTRP, Kenya and The Open University, UK.

What are the early life experiences that have made you who you are today?

I can attribute this to my background in the early years. I was a victim of the post-election violence and tribal clashes in 1992, and literally all the other skirmishes that followed. This disrupted my family immensely and I ended up in a Children’s home (Nakuru county) where educational values and giving back to society were cultivated in me. All the different stages of my education have been sponsored by well-wishers and this has taught me to be involved in research and other activities for the prosperity of current and future generations.

You are currently pursuing a PhD in spatial epidemiology at The Open University UK. What can you tell us about it?

Yes, I am currently in my third year and looking forward to submitting my thesis before the year ends. My PhD work is threefold:

  • First, I estimated the levels, trends, inequities, and progress towards achieving internationally set goals of child mortality by each county and year in Kenya since independence up to 2015. This work has shown that there are huge disparities and inequities across counties despite substantial declines over the last 5 decades. There is more that needs to be done to lower child mortality in Kenya. This work was published in 2019 in BMC public health and summarized by the Conversation. In addition, there is also a short video done at my university explaining about my PhD.
Fig. 3
County-level under-five mortality in Kenya between 1965 and 2013 [Macharia et al 2019]

  • Secondly, I have estimated the coverage and/or the prevalence of determinants of child survival at the same spatial and temporal resolution as child mortality. This is because the changes and variations that we observe in child mortality are likely to be driven by factors like immunization, malnutrition, malaria, HIV, water & sanitation among others. The findings show inequities and systematic disadvantage among counties in Northern Kenya while those around Central have higher coverages of most interventions. An example of the determinant that I have mapped is malaria risk
Fig. 2
Malaria risk in Kenya at 1 × 1 km spatial resolution from 1990 to 2015 [ Macharia et al 2018]

  • Finally, the policymakers are really interested in the impact/role of these determinants on child survival to know what to prioritize due to limited funding and competing needs. I am currently estimating the impact of these determinants for this purpose. I can keep talking about my work since I am passionate about it, I will leave it here

Could you explain the differences between epidemiology, public health, and medical services and how they are related?

Medical doctors would be in a better position to answer this, but all these terms are interrelated. I am inclined to epidemiology and more specifically spatial epidemiology. Epidemiology entails the study of distribution and determinants of different health states and the applications of these findings to control the diseases/ health state. Public health is commonly defined as the art and science of preventing disease, prolonging life and promoting health through the organized efforts of society while medical services are the medical care and health-related services offered to a person by a health professional to prevent, diagnose, treat, or correct a medical problem. The work I am part of on spatial epidemiology forms a useful input in public health for policymakers to prevent disease and promote health.

What are the main geospatial applications in health, specifically in Kenya?

I tend to think this is limited by the power of our minds and imagination. There are many applications, but biased towards Kenya and thinking of two main applications.

  • Spatial statistics is key in mapping the trends, coverage and prevalence/incidence of health outcomes/states (diseases), and the determinants of these outcomes at high spatial and temporal resolution. This could help us to identify areas with high disease prevalence (hotspots) for resource prioritization, allocation of funds, and policy changes. We also need early warning systems powered by spatial statistics to avert disasters in locations where they are most likely to occur.
  • Bringing health services closer to the people is important in the current era of UHC in Kenya. We need to map the location of all specific health services, model/estimate how far they are to the needy people in terms of distance, affordability, quality, accessibility and how can we optimally position additional service centers to reduce inequities.

I have seen you publishing papers on geo-statistics. Is this an academic pastime, or does geo-statistics have relevance in real-world applications?

If not sought-after this skill will definitely be in demand in the near future. It has real-world applications that have the potential to improve health substantially. For example, we used model-based geostatistics to advise national malaria control programs across ministries of health in Sub Saharan Africa including Kenya. We mapped malaria risk, coverage of malaria control interventions (bednets, antimalarials, IRS) and treatment-seeking behaviors for fever. The control programs would use these maps to inform decisions and as a basis for monitoring and evaluation. We regularly updated the maps after consultations with the ministries and even trained them on how to undertake modelling using customized open source applications.

What’s your take on emerging technologies like AI, Big Data, IoT and Blockchain ?

Many new modelling approaches are emerging and new terms are coined by the day; this development is likely to continue. They present new opportunities to explore more and compliment geospatial technology. Going back to the basics, we need good quality data that we can use to solve problems. No matter how much we model without good data we are flying blind. Rather than take that trajectory we need more resources and funding directed to have better systems of data collection while ensuring quality. For example, we have a health information system based on DHIS2 in Kenya, but I look forward to when all facilities will be reporting on time and report all indicators while ensuring quality and correctness. This would improve health metrics at all levels of administrations and enable us to make better decisions for the health of our people.

How are you involved in the geospatial community in Kenya and the world at large?

My interest started while I was pursuing my undergraduate at JKUAT where I co-founded The Association of Geomatic Engineering Students and after seeing a gap organized events to bring the industry closer to the students. On graduating in 2014 I formed a WhatsApp group to facilitate sharing of ideas across the geospatial community which is still active to date. Currently, I am an active member of the Institutions of Surveyors of Kenya and participate in geospatial events organized in Kenya. I regularly go back to the universities to talk about the work we do and the role of geospatial technologies.

Across the globe, I also subscribe to several professional groups. I am an active member of AAG (American Association of Geographers), International Society of Geospatial Health, American Society of Tropical Medicine and Hygiene (ASTMH) and Population Association of America (PAA). I am currently a student ambassador of the RSTMH (Royal Society of Tropical Medicine and Hygiene) in Kenya

How can the different geospatial industry sectors (government, academia, NGOs, businesses) work together for the common good?

I could share the following practical thoughts:

  • Universities need to engage all stakeholders when coming up with courses and course content for relevance in solving problems in society.
  • The industry should take an active role in training students by offering internships and industrial attachments.
  • Such opportunities should be meaningful for students to get better accustomed and relate school work and applications outside the lecture halls.
  • The universities’ dons and academia should always start at the community level and other relevant stakeholders to understand the problems before formulating research questions.
  • The universities should enhance the co-supervision of students by professionals from academia, industry and research institutes to give the student the full view of the problems and provide realistic solutions that accommodate all domains.

Many people in Kenya’s geospatial community see you as a role model. What advice can you give them?

This is humbling to know. I have always been able to see far by standing on the shoulders of giants and would like to thank Dr. Emelda Okiro (Population Health Unit, KWTRP), Dr. Emanuele Giorgi (Lancaster Medical School, Lancaster University, UK), Prof. Abdisalan Noor (Global Malaria Programme World Health Organization), Prof. Benn Sartorius (The London Applied & Spatial Epidemiology Research Group (LASER), London School of Hygiene and Tropical Medicine) and Prof. Robert Snow (Population Health Unit, KWTRP and Nuffield Department of Clinical Medicine, University of Oxford, UK). Identifying mentors who believe in you and support you is important. In addition, always offer your full energy and dedication to whatever you are doing for the bigger good of society, you never know who is watching.

1 Comment

  1. George machariaJanuary 31, 2020

    Very educative and informative good work


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