Melbourne School of Population and Global Health - Theses

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    Beliefs, understanding and access to male family planning methods in Timor-Leste - a participatory and operational qualitative study
    Henderson, Helen Lucy ( 2023-12)
    Abstract Background The engagement of men is essential to improving the sexual and reproductive health and rights for everyone. Effective male engagement includes increasing the availability and uptake of male family planning methods (vasectomy, male condoms and some natural family planning). The Democratic Republic of Timor-Leste (Timor-Leste) has some of the most critical sexual and reproductive health challenges in the Asia-Pacific region, including low uptake of male family planning methods. While previous studies have explored understanding of and influences upon women’s uptake of family planning methods in Timor-Leste, limited evidence exists about access to and uptake of male methods of family planning. Methods Participatory and operational qualitative research was designed and implemented to explore beliefs, understanding and access to male family planning methods in Timor-Leste from both a community and healthcare provider perspective. Fourteen participatory group discussions were held with 175 community members (84 men, 91 women; aged 18 to 72) across seven municipalities in Timor-Leste (Ainaro, Baucau, Bobonaro, Dili, Lautem, Manufahi, and Oecusse) between August - December 2019. In-depth interviews were held with 24 healthcare providers (16 women, 8 men; aged 25 to 56 years) working in the same location as the participatory group discussions. Data were analysed using reflexive thematic analysis. The ethics of reflexivity and solidarity were practiced throughout the research process. Results Community members and healthcare providers had overall low awareness and knowledge about male family planning methods and male sexual and reproductive health. Misinformation was widespread, contributing to negative attitudes about male family planning methods. Healthcare providers had limited training and experience about male sexual and reproductive health services, including male family planning services. Further, while some healthcare providers reported providing universal access to family planning, others reported restricting access based on gender, age, civil status, or number of children. Reasons for restricting access included: personal belief; misunderstandings about national health policies and laws; pressure or direction from senior health staff or colleagues; and harmful social norms regarding sexual and reproductive health and rights. Men were identified as playing a leading role in the decision to have children and a woman’s ability to access contraception by all participants. However, men were also identified as having limited interaction with healthcare services and healthcare providers. Instead, family planning services were framed as being almost exclusively about healthy birth spacing for pregnant women and mothers, delivered through maternal health services. Participants expressed interest to learn more about male family planning services, and a desire for improved access to sexual and reproductive health services more generally. Conclusion Access to male family planning services in Timor-Leste is complex and influenced by many personal, historical, socio-cultural, geographical, political, and financial factors. This study identified numerous barriers and enablers to increasing access to and uptake of male family planning methods, at the client, provider, health system and society levels. While focused on male methods of family planning, study findings are also relevant and insightful to other population groups, including young and unmarried people, and people with diverse gender and/or sexual identities. Findings indicate that Timor-Leste has a unique opportunity to design and invest in new evidence-based family planning initiatives that can better engage men, are gender transformative and are complementary to existing programs. Research findings were translated into public health practices as the study was implemented, including guiding health promotion initiatives, and informing healthcare provider training. Others working within Timor-Leste and globally can use insights from the research process and findings to inform future research, policy, and program initiatives.
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    Individual and environmental determinants of fast food purchasing
    Thornton, Lukar Ezra. (University of Melbourne, 2008)
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    Diasporas of medical beliefs : a multi-ethnic clinic and the experience of tuberculosis in a low incidence country
    Johnson, Penelope Lynn. (University of Melbourne, 2006)
    This thesis reports on a qualitative, ethnographic study of a multicultural migrant population in a tuberculosis clinic in Melbourne, Australia. The thesis focuses on two groups of people and their interaction � health professionals who work with tuberculosis, and patients who have, or have had, the disease. My focus in interviewing the health professionals is on their management of disease in the face of widely different patient beliefs. In analysing interviews with patients and their families, I focus on narrative and conceptual syncretisms, where a partially assimilated explanatory framework of western medicine coexists with other traditional or personal models about tuberculosis. For none of the patients interviewed, was is it the case that these alternative models blended together without friction, nor was there evidence of one idea or component over-riding or replacing another. Rather, it was repeatedly found that ideas or models, which outwardly appear inconsistent and contradictory, appeared to fit together quite comfortably. While nearly everyone who goes through the clinic already has (or has recently acquired) a good understanding of their infection, disease and treatment from a biomedical perspective, this does not lead to a rejection of preexisting models. For example, the two apparently contradictory statements that "TB is caused by a pathogen" and that "TB is caused by the supernatural" regularly co-occur within the narratives I collected. A deeper analysis of what is being said indicates that in cases of this type, people are presenting information on different, though parallel, levels. This results in a multitude of discrepant assessments that are somehow commensurate, resulting in a functioning clinic where treatment is extremely successful despite the great diversity surrounding the two groups and health models. The individual's comfort with incommensurable models is thus a central interest in the thesis. Importantly for health professionals, this research shows that the impact of non-western models of disease aetiology on TB treatment regimes may be far less than it appears at first sight. Contrary to expectations, even seemingly incompatible propositions held by patients rarely cause problems of compliance, or otherwise hinder the patient's integration into the biomedical treatment regime presented to them in the course of their dealings with the clinic.
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    The spirit of emancipation and the struggle with modernity : land, art, ritual and a digital knowledge documentation project in a Yolnu community, Galiwin'ku, Northern Territory of Australia
    De Largy Healy, Jessica. (University of Melbourne, 2008)
    This thesis concerns Indigenous knowledge systems, agency, technology and modernity. It presents an ethnographic study of a contemporary Yolrp documentation project devised in a remote township in north-eastern Arnhem Land, in the Northern Territory of Australia, in order to produce meaningful representations of modernity for the young generations. The study sets out the possibility to rethink the implications of the digitisation of Aboriginal knowledge within the broader theoretical frame of cultural transmission. It draws on the dynamic tension between structure, performance and agency to transcend common views of what culture is in order to investigate the performative aspects of knowledge production. In other words, the ethnography tracks the social life of Yolnu culture, from the field to the archive (ethnographic, digital) and back again and describes how these trajectories are inscribed in multi-sited knowledge systems which in turn inform contemporary meaning making practices and strategics of representation and becoming. Research questions were originally framed around the changing status of images in Yolrju society, a people who have a long tradition of anthropological dealings and whose material collections can be found in numerous archival institutions. In these times of rapid change, I was and am particularly interested in examining the use Yolnu made of Information and Communication Technologies (ICT) in cultural resource management projects and the ways in which these experiments influenced contemporary approaches to knowledge transmission. For this purpose, fieldwork undertaken on Elcho Island between February 2003 and December 2004, revolved around the Caliwin'ku Indigenous Knowledge Centre, a community organisation which, as part of a state wide strategy to support "sustainable" communities, had just received seed funding from the Northern Territory Libraries to build a digital cultural archive. In this thesis, I document how this digital experiment evolved in the community, further departing from the original project-plan as it was gradually being appropriated by the local actors and fitted into Yolgu reality of being in the modern world. While the "knowledge centre" concept itself became increasingly entangled in a web of controversies and strategically reconfigured at the local level, the organisation was taken over by a group of senior Yolnu men whose primary concern lay with the recognition of their ancestral law and historical agency, the transmission of knowledge to the young generations and the projection of meaningful representations into the future.
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    Science Communication for Public Health: Public Consultations, News Media Representations and Public Experts
    Dempster, Georgia ( 2023-09)
    This thesis is focused on the intersection of science communication and public health. The COVID-19 pandemic (which was declared a pandemic by the World Health Organization (WHO) in 2020 and as of writing this thesis in 2023, it is ongoing) has highlighted how crucial effective science communication is during a public health crisis. Natural sciences have been heavily influenced by the school of thought known as positivism, which involves the methodological pursuit of knowledge through empirical observations and the quest for universally applicable scientific laws. Many public health disciplines follow the principles of positivist natural science. However, the concept of positivism is subject to debate, as critics suggest its focus on objective truths disregards the influence of social, cultural, and historical factors on knowledge generation. Furthermore, social scientists view the media, and other information dissemination activities, as socially constructed rather than purely objective. The task of communicating natural science to the public via media and engagement activities such as public consultations involves translating intricate scientific information into narratives that resonate with the public. This translation process involves professionals such as scientific experts, science communicators and journalists who must balance understandability, relevance to the audience, and factual correctness. Key theoretical frameworks used in the science communication literature include the ‘public understanding of science’ (PUS) framework and ‘public engagement with science and technology’ (PEST) framework. The PUS framework assumes that the public's doubt or scepticism about science is linked to a deficiency in their understanding of science. The PEST framework has a focus on conveying diverse perspectives and critical reflections about science and involving the public in scientific dialogues and active participation. Whilst some science communication scholars have argued that there should be a shift from the PUS to PEST frameworks, there is acknowledgement that the PUS framework is still widely in use. Related to the PUS and PEST frameworks is medialisation theory, which describes the relationship between science and the media. This involves the mutually beneficial relationship between scientists and journalists and the overall orientation of science toward the media. Medialisation can result in increased media coverage of science but can also lead to the distortion of scientific reporting which can be a threat to scientific integrity. My thesis aimed to address the gap in knowledge regarding the stakeholders of science communication in socially constructed public health contexts and the applicability of science communication theoretical frameworks. Therefore, the overarching aim of this thesis was to explore the roles, tensions and experiences of the stakeholders involved in the communication of public health science in socially constructed environments. To achieve this, I conducted three separate case studies of public health-related science communication in socially constructed contexts in Australia. The first case study used qualitative content and thematic analysis to examine the written submissions to an Australian government-led public consultation run by the Therapeutic Goods Administration covering the regulation of autologous stem cell therapy. The findings showed that there was a divergence of opinion among stakeholders, with some advocating for unregulated ASCT (patients and providers) while others pushed for greater regulation (scientist and scientific organisations). This public consultation had the potential to strengthen prevailing power relationships and exacerbate social inequalities. The PUS framework appeared to underpin the approach to this Australian government-led public consultation, with disproportionate influence of scientists and scientific institutions over patients and providers. The second case study used qualitative content and thematic analysis to examine the translation of journal article to press release and the subsequent news media reporting of an Australian study on vitamin supplementation and risk of birth defects. The findings showed that, replicated from the press release to the news media reporting were issues such as sensationalism, misrepresentation, inappropriate clinical recommendations, and subjectivity. Additionally, pressures faced by journalists, scientists, and their institutions created a mutually beneficial relationship that prioritised newsworthiness over scientific integrity, with the potential to harm public health. The PUS framework and medialisation theory can help to explain the distortion of information about this Australian scientific study, including misrepresentation within the institution press release and whether independent views were sought by journalists. The third case study used a thematic analysis of in-depth qualitative interviews with public experts acting as science communicators during the COVID-19 pandemic to understand their motivations, responsibilities, impacts, and experiences. Findings showed that public experts received negative feedback from the public. However, difficult interactions for public experts extended beyond members of the public and involved journalists. Additionally, public experts had positive experiences, such as making a tangible impact on public health, alleviating community anxiety, and democratising research by making it accessible beyond academic audiences. Furthermore, public experts were not talking about their own research but were talking about the work of other scientists and how this related to society in general. From a theoretical perspective, the motivations, responsibilities, impacts and experiences of public experts who spoke in the media during the COVID-19 pandemic were explained by aspects of both the PUS and PEST frameworks. Additionally, medialisation may have equipped scientists to serve as public experts during the COVID-19 crisis, ultimately benefiting society. In conclusion, this thesis explored the roles, tensions and experiences of the stakeholders involved in the communication of public health science in socially constructed environments in Australia via three separate case studies. The findings revealed that the public consultation had the potential to strengthen prevailing power relationships and exacerbate social inequalities. Pressures faced by journalists, scientists, and their institutions created a mutually beneficial relationship that prioritised newsworthiness over scientific integrity. Public experts had negative but also notable positive experiences from engaging with the media including having a translatable impact on public health. Additionally, my three case studies demonstrated the value of the theoretical frameworks in understanding the relationships between science and society, and science and the media.
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    Re-storying place, connection and belonging: Aboriginal and Torres Strait Islander young people making space and creating futures in Narrm
    Munro-Harrison, Emily Jane ( 2023-10)
    Constructs of Indigeneity have been the locus of settler colonial interest and control since colonisation in Australia. Through historical policies of displacement, and contemporary normative processes that question the authenticity and belonging of Aboriginal and Torres Strait Islander people, urban places continue to be sites of erasure and non-belonging. However, cities will always be Aboriginal land, and places of cultural resurgence, renewal and regeneration. Internationally, a growing body of literature investigates experiences of First Nations young people in urban places, but in Australia this is lacking. This thesis explores how Aboriginal and Torres Strait Islander young urban people in Narrm (Melbourne) practise and connect to their Indigeneity, as they come into relation with place, community, and their engagement with institutional regimes. This thesis makes an original contribution to knowledge by articulating how Aboriginal and Torres Strait Islander young people in Narrm engage in processes of re-storying place, cultural resurgence and presencing as assertions of belonging, and enacting responsibilities of relationality in generating desire-based futures. Indigenous women’s standpoint theory, and a desire-based framework guide the methodological approach. Yarning methodology was used to develop partnerships with collaborating organisations, to guide the direction and methods of engagement with participants. Theories of relationality, youth refusal, resistance, counterstory, and cultural resurgence are used to understand the key formulations of Indigeneity for young people. To investigate the research question, Aboriginal and Torres Strait Islander young people (aged 16-30) living in Narrm were engaged across four sites. These sites included – an Aboriginal youth drop-in program; an arts mentoring program; a cultural support program for incarcerated First Nations men staffed by First Nations and non-Indigenous volunteers; and an Indigenous student centre at a university. Resistance and refusal are theorised as engagements of power by young people in their interactions with service systems that problematise and imagine their limited potential and future possibilities. Building on this, counterstory is a way to understand these acts of resistance and refusal by participants. The theory of re-storying is offered, to interpret how young people connect and engage with place in ways that are not a counter to colonisation, but a re-storying and continuation of Aboriginal and Torres Strait Islander presence. Presencing is in the everyday acts of resurgence, it resists colonial erasure and is a reminder of the ongoing relationships and connections of Aboriginal and Torres Strait Islander communities to place. Acts of cultural resurgence and renewal engage young people in intergenerational practises of relationality – a responsibility of ongoing learning and connection to claiming Indigeneity. Culture, belonging, identity and self-determining futures are protective factors for the health and wellbeing of Aboriginal and Torres Strait Islander people and communities. This thesis shows the ways that participants are engaging and practising their identities in Narrm and navigating paths for desire-based futures.
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    The determinants of evidence use by Australian clinical networks as safety and quality stewards
    Hart, Jade Marie ( 2023-05)
    Contemporary expectations for health services to be safe and of high quality reflect the longstanding principle of “first do no harm” and the altruistic intentions of medicine that form the essence of the Hippocratic Oath. Central to assuring safety and quality of health services is the use of appropriate evidence at the point of clinical care. Yet practitioners, institutions, and government departments still grapple with understanding what evidence-based care is and what strategies can be used to best influence evidence use across service provision. In Australia, the unique degree of system complexity and fragmentation further challenges the development of these strategies. There exists a need for diverse models of safety and quality stewardship to evaluate the evidence, deliver oversight, and achieve influence over the range of factors that ultimately shape clinical practice. This thesis examines the determinants of evidence use by clinical networks in Australia. Established across all Australian states, clinical networks rely on clinical leadership and engagement to execute safety and quality stewardship. Australian clinical networks traverse across traditional boundaries to define care expectations and facilitate improvement, with activities to be based on evidence. This thesis investigates the link between safety and quality stewardship, clinical networks, and evidence use. This research was qualitative in nature. A mixed methods study was conducted involving interviews at the national level and within the state of Victoria, including the comparative case study of three clinical networks, documentary analysis, and the use of Q-methodology. This research contributes three main empirical findings. Firstly, it demonstrates the necessity of networked stewardship models to deliver health system oversight. Secondly, because these networks are clinician-led and examine multifaceted issues, there are differences in individual capability to transmute prior understandings, predominately drawn upon for clinical practice decision-making, to matters of management and policy decision-making. This research identifies the application of positivist, pragmatic, and strategic framing of problems and problem-solving approaches. Thirdly, the underlying model of safety and quality coordination and governance shapes the way in which use of evidence occurs to exert trust-based and control-based strategies to influence practitioners and institutions. Empirical contributions strengthen the link between theories of stewardship and evidence use. It contributes new knowledge to the area of safety and quality stewardship to strengthen research, practice, and evaluation. A theoretical contribution of this research is the development of the Clinical Network Safety and Quality Stewardship Conceptual Framework. Ultimately, these scholarly contributions are positioned to stimulate new ways in which practitioners, institutions, and the bureaucracy are organised to steer the health system to be responsive to the needs and preferences of consumers served.
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    Lifetime asthma and the development of fixed airflow obstruction
    Tan, Daniel Jonathan ( 2023-05)
    Asthma is a major public health problem worldwide and its prevalence has risen considerably over recent decades. Asthma prevalence in Australia is among the highest in the world and thus has been recognised as an Australian National Health Priority Area since 1999. There is now established evidence that asthma has adverse effects on lung health over the life course and strategies aimed at improving long-term outcomes are urgently needed. The natural history of asthma is influenced by complex interactions between genetic and environmental factors. Despite extensive research in this area over recent decades, many uncertainties remain. An important limiting factor has been the lack of suitable prospective studies with follow-up from childhood (when asthma is most prevalent) into middle-age (when respiratory complications manifest clinically). To address these knowledge gaps, my doctoral work utilises data from the Tasmanian Longitudinal Health Study (TAHS), the world’s largest and longest-running population-based study of respiratory disease. The primary aim within my thesis is to characterise the natural history of asthma and its cumulative effects on lung health over the life course, focusing on a complication known as fixed airflow obstruction. I also aim to evaluate strategies which might improve these outcomes in asthma, and to validate novel methods of detecting these complications earlier in the disease process. The findings of this work will have important clinical and public health implications, with the overall objective of improving asthma outcomes in Australia and worldwide. In chapter 4, I present a study on the diagnostic utility of bronchodilator responsiveness (BDR) as a test for adult asthma, both with and without fixed airflow obstruction (FAO). I provide specific data on the sensitivity and specificity of commonly-used BDR cut-offs, and additional normative data on BDR ranges in a general population cohort. In chapter 5, I present my findings that asthma follows five longitudinal pathways (phenotypes) from childhood to middle-age, each associated with different risks of developing FAO. Importantly, I found that even apparently remitted asthma was associated with FAO in middle-age, despite an absence of symptoms. In chapter 6, I present my findings of several biomarkers which hold prognostic value in adults in spontaneous asthma remission. I showed that abnormal serum cytokine profiles (Th2-high and Th2-low) were associated with accelerated lung function decline in these individuals. In chapter 7, I present the findings of a systematic review and meta-analysis showing that long-term use of inhaled corticosteroids (ICS) are associated with modest, age-dependent improvements in lung function children and adults with asthma. In chapter 8, I present my findings that lung function thresholds can accurately identify individuals at high-risk of developing FAO in the future. I describe a particular threshold of pre-BD FEV1/FVC < 10th percentile as accurately identifying 88% of individuals who developed COPD over an 8-year follow-up period, while excluding 87% of individuals who did not. Collectively these findings provide new insight into the complex relationship between asthma and lung function over the life-course, with a particular focus on the development of FAO. My work highlights lifetime asthma as a potentially-modifiable risk factor for FAO, and describes the high-risk subgroups in whom early detection and prevention strategies might be beneficial.
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    Exploration of sex differences in genetic susceptibility to glioma
    Alpen, Karen ( 2023-08)
    Glioma comprises around 80% of all malignant primary adult brain tumours. It consists of a heterogenous group of tumours with the most common types being glioblastoma (GBM), astrocytoma and oligodendroglioma, each having a distinct molecular characteristic and varying rates of survival. GBM has one of the worst median survival times among cancers, less than 15 months. Glioma incidence is around 6.0 per 100,000 people in the USA and Australia with a higher incidence in men than women. This sex difference in incidence exists across all adult age groups and across ethnicities. The only consistently validated environmental risk factor for glioma is high level ionising radiation and a protective association with asthma and eczema. First-degree relatives of an affected individual have a two-fold increase in glioma risk and there are several rare inherited cancer syndromes which increase glioma risk but these account for only 1-2% of adult glioma cases. Previous genome-wide association studies (GWAS) have identified 50 common risk variants in 34 genomic risk regions with some of these risk variants being glioma type-specific, according to current evidence. These known glioma risk variants explain less than 40% of the familial risk leaving much of glioma’s familial risk to be discovered. This thesis examines whether biological sex (having XX versus XY sex chromosomes) influences an individual’s genetic risk of glioma. Sex differences in the incidence and survival of many cancers is well documented with many cancer-related pathways such as DNA repair, cellular metabolism, tumour suppressor activity, cell cycle regulation and immunity having known sex differences. The brain is also noted for sex differences in its structure and function. Many neurological and psychiatric disorders have sex differences in risk, prevalence, and symptoms. Glioma shows sex differences in incidence, survival, therapy responses and tumour molecular characteristics. Gene expression in the brain is known to vary between the sexes, across brain regions and across time, therefore it is possible that some of glioma’s missing heritability may be accounted for by sex-specific or sex-different risk variants. This thesis uses sex-stratified GWAS to identify novel genetic risk variants/regions of glioma. The major contributions of this thesis are: 1) validation of the sex difference in oligodendroglioma risk of the CCDC26 long non-coding RNA region using an Australian glioma case-control study. This GWAS was the first to validate a previous sex-specific study that found women are at higher risk than men for variants within the CCDC26 region (see Chapter 4). 2) Identification of 11 potential novel risk regions of glioma using region-based GWAS methods which analyse genomic regions rather than individual genetic variants. Four of these regions were consistently associated with one sex across multiple studies. Seven of the 11 regions contain genes previously reported as potential regulators of glioma tumour cell proliferation. This study highlights the importance of region-based GWAS analyses for detecting risk regions in existing datasets that are missed by conventional SNP-based analyses and suggests that sex may be an important influence on genetic susceptibility to glioma (see Chapter 5). 3) Identification of ten potential novel risk regions of glioma that are specific to certain brain locations (frontal, temporal or parietal lobes). To the best of my knowledge this is the first glioma GWAS stratified by tumour location. Nine of the ten potential risk regions were identified in sex-specific data. The known glioma risk regions including TERT, EGFR, CCDC26, CDKN2BAS, TP53 and RTEL1 do not appear to be strong drivers of tumour location (see Chapter 6). 4) Identification of candidate gene families and biological pathways that warrant future investigation for their potential association with glioma risk. These include the synapse-related genes, olfactory receptor genes and genes involved in the heparan sulphate/fibroblast growth factor (FGF) biological pathway (see Chapter 8). The validation of CCDC26 as a higher female risk region for oligodendroglioma (Chapter 4), and the discovery of novel glioma risk regions using sex-specific data (Chapter 5 and 6) infers that an individual’s biological sex (XX or XY chromosome) plays a role in their genetic susceptibility to glioma. An individual with glioma has their own unique combination of hundreds, possibly thousands of known and undiscovered glioma genetic risk variants. Some of these variants may place that individual at risk of developing any cancer, other variants may influence the risk of developing a particular glioma type anywhere in the brain (e.g., GBM, astrocytoma or oligodendroglioma) and some may be risk factors for developing a tumour in a particular brain location. Many of these risk variants will be mutual to both sexes, but some may have sex-differences in their effect or be specific for one sex. Acknowledging that sex may influence the assortment of genetic variants that increase an individual’s glioma risk may guide future clinical trials and the development of more effective personalised treatments.
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    Anopheles salivary antibodies as biomarkers of vector exposure and malaria transmission in the Greater Mekong Subregion
    Kearney, Ellen Atess ( 2023-06)
    Measurement of human antibodies against Anopheles salivary antigens has been suggested as a sensitive and feasible alternative to measure human biting rates (HBR), improving on logistically challenging gold-standard entomological approaches that provide crude measures of total exposure to vector bites. To understand how this approach could be used to advance the Greater Mekong Subregion’s (GMS) malaria elimination agenda, in this thesis I sought to formally quantify the association between anti-Anopheles salivary antibodies and HBR, and investigate the programmatic application of these antibodies for serosurveillance of malaria transmission and as outcomes in vector control intervention effectiveness trials. Firstly, I performed a systematic review with multilevel modelling and quantified a positive non-linear association between antibodies against gSG6 (from the dominant African vector An. gambiae) and HBR, as well as metrics of malaria transmission. However, I identified that this association was weaker outside Africa where An. gambiae is absent. These findings provide evidence that anti-Anopheles salivary antibodies could serve as biomarkers of Anopheles biting exposure, but novel species-specific antigens may be needed to estimate HBR in the GMS. Secondly, I measured the seroprevalence of antibodies against Anopheles salivary antigen gSG6 in 104 villages in Southeast Myanmar and employed Bayesian geostatistical modelling to quantify the micro-heterogeneity in Anopheles biting exposure, which was found to be high (mean: 66%) yet heterogeneous (range: 9-99%). I combined vector (gSG6) and transmission-stage malaria parasite (CSP) antibody biomarkers with PCR-detectable infections in a novel joint modelling framework to predict malaria transmission across Southeast Myanmar. These maps identify several foci of ongoing transmission and could be used to micro-stratify malaria risk for targeting interventions. Thirdly, I quantified the effect of topical insect repellent on the levels of antibodies against Anopheles salivary antigen gSG6. By estimating a series of lagged effects of repellent distribution (to model gradual antibody decay from prolonged use), I observed reduced antibody levels after 6-months of repellent use, particularly for high-risk participants (migrants and forest-goers). These findings suggest anti-Anopheles salivary antibodies could be an informative trial outcome measure and provide important parameters on antibody decay dynamics to inform the design of future vector control interventions effectiveness trials. Finally, I directly quantified the boosting and decay of IgG and IgM antibodies against a series of Anopheles species-specific salivary antigens in response to controlled biting exposure from dominant vectors of the GMS. I found that antibody levels decayed overall, but were boosted with and following mosquito biting. These associations were similar across Anopheles species-specific salivary antigens and antibody isotypes, and species-specific antibodies levels were all highly correlated (spearman’s rho>0.8). These findings provide evidence that anti-Anopheles species-specific salivary antibodies could be sensitive biomarkers of exposure to Anopheles bites in the GMS. Collectively, the findings of this thesis provide a comprehensive investigation of anti-Anopheles salivary antibodies as biomarkers of exposure to Anopheles bites in the GMS. These findings directly quantify (previously-assumed) associations with entomological and malariometric measures of exposure and transmission, and support the application of these antibodies as endpoints in surveillance programs and vector control intervention effectiveness trials.