Joseph Akuze1, Hannah Blencowe2, Peter Waiswa3, Angela Baschieri2, Vladimir S Gordeev4, Doris Kwesiga5, Ane B Fisker6, Sanne M Thysen7, Amabelia Rodrigues8, Gashaw A Biks9, Solomon M Abebe9, Kassahun A Gelaye9, Mezgebu Y Mengistu9, Bisrat M Geremew9, Tadesse G Delele9, Adane K Tesega9, Temesgen A Yitayew9, Simon Kasasa10, Edward Galiwango11, Davis Natukwatsa11, Dan Kajungu11, Yeetey Ak Enuameh12, Obed E Nettey13, Francis Dzabeng13, Seeba Amenga-Etego13, Sam K Newton12, Charlotte Tawiah13, Kwaku P Asante13, Seth Owusu-Agyei14, Nurul Alam15, Moinuddin M Haider15, Ali Imam15, Kaiser Mahmud15, Simon Cousens2, Joy E Lawn2. 1. Maternal, Adolescent, Reproductive, and Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK; Center of Excellence for Maternal Newborn and Child Health Research, School of Public Health, Makerere University, Kampala, Uganda. Electronic address: jakuze@musph.ac.ug. 2. Maternal, Adolescent, Reproductive, and Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK. 3. Center of Excellence for Maternal Newborn and Child Health Research, School of Public Health, Makerere University, Kampala, Uganda; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden. 4. Maternal, Adolescent, Reproductive, and Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK; The Institute of Population Health Sciences, Queen Mary University of London, London, UK. 5. Center of Excellence for Maternal Newborn and Child Health Research, School of Public Health, Makerere University, Kampala, Uganda. 6. Bandim Health Project, Bissau, Guinea-Bissau; Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark; Odense Patient data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark. 7. Bandim Health Project, Bissau, Guinea-Bissau; Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark; Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark. 8. Bandim Health Project, Bissau, Guinea-Bissau. 9. Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. 10. Center of Excellence for Maternal Newborn and Child Health Research, School of Public Health, Makerere University, Kampala, Uganda; IgangaMayuge Health and Demographic Surveillance System, Iganga, Uganda. 11. IgangaMayuge Health and Demographic Surveillance System, Iganga, Uganda. 12. Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana; Kintampo Health Research Centre, Kintampo, Ghana. 13. Kintampo Health Research Centre, Kintampo, Ghana. 14. Malaria Centre, London School of Hygiene & Tropical Medicine, London, UK; Kintampo Health Research Centre, Kintampo, Ghana; University of Health and Allied Sciences, Kintampo Health Research Centre, Kintampo, Ghana. 15. Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh.
Abstract
BACKGROUND: An estimated 5·1 million stillbirths and neonatal deaths occur annually. Household surveys, most notably the Demographic and Health Survey (DHS), run in more than 90 countries and are the main data source from the highest burden regions, but data-quality concerns remain. We aimed to compare two questionnaires: a full birth history module with additional questions on pregnancy losses (FBH+; the current DHS standard) and a full pregnancy history module (FPH), which collects information on all livebirths, stillbirths, miscarriages, and neonatal deaths. METHODS:Women residing in five Health and Demographic Surveillance System sites within the INDEPTH Network (Bandim in Guinea-Bissau, Dabat in Ethiopia, IgangaMayuge in Uganda, Matlab in Bangladesh, and Kintampo in Ghana) were randomly assigned (individually) to be interviewed using either FBH+ or FPH between July 28, 2017, and Aug 13, 2018. The primary outcomes were stillbirths and neonatal deaths in the 5 years before the survey interview (measured by stillbirth rate [SBR] and neonatal mortality rate [NMR]) and mean time taken to complete the maternity history section of the questionnaire. We also assessed between-site heterogeneity. This study is registered with the Research Registry, 4720. FINDINGS:69 176 women were allocated to be interviewed by either FBH+ (n=34 805) or FPH (n=34 371). The mean time taken to complete FPH (10·5 min) was longer than for FBH+ (9·1 min; p<0·0001). Using FPH, the estimated SBR was 17·4 per 1000 total births, 21% (95% CI -10 to 62) higher than with FBH+ (15·2 per 1000 total births; p=0·20) in the 5 years preceding the survey interview. There was strong evidence of between-site heterogeneity (I2=80·9%; p<0·0001), with SBR higher for FPH than for FBH+ in four of five sites. The estimated NMR did not differ between modules (FPH 25·1 per 1000 livebirths vs FBH+ 25·4 per 1000 livebirths), with no evidence of between-site heterogeneity (I2=0·7%; p=0·40). INTERPRETATION: FPH takes an average of 1·4 min longer to complete than does FBH+, but has the potential to increase reporting of stillbirths in high burden contexts. The between-site heterogeneity we found might reflect variations in interviewer training and survey implementation, emphasising the importance of interviewer skills, training, and consistent implementation in data quality. FUNDING: Children's Investment Fund Foundation.
RCT Entities:
BACKGROUND: An estimated 5·1 million stillbirths and neonatal deaths occur annually. Household surveys, most notably the Demographic and Health Survey (DHS), run in more than 90 countries and are the main data source from the highest burden regions, but data-quality concerns remain. We aimed to compare two questionnaires: a full birth history module with additional questions on pregnancy losses (FBH+; the current DHS standard) and a full pregnancy history module (FPH), which collects information on all livebirths, stillbirths, miscarriages, and neonatal deaths. METHODS:Women residing in five Health and Demographic Surveillance System sites within the INDEPTH Network (Bandim in Guinea-Bissau, Dabat in Ethiopia, IgangaMayuge in Uganda, Matlab in Bangladesh, and Kintampo in Ghana) were randomly assigned (individually) to be interviewed using either FBH+ or FPH between July 28, 2017, and Aug 13, 2018. The primary outcomes were stillbirths and neonatal deaths in the 5 years before the survey interview (measured by stillbirth rate [SBR] and neonatal mortality rate [NMR]) and mean time taken to complete the maternity history section of the questionnaire. We also assessed between-site heterogeneity. This study is registered with the Research Registry, 4720. FINDINGS: 69 176 women were allocated to be interviewed by either FBH+ (n=34 805) or FPH (n=34 371). The mean time taken to complete FPH (10·5 min) was longer than for FBH+ (9·1 min; p<0·0001). Using FPH, the estimated SBR was 17·4 per 1000 total births, 21% (95% CI -10 to 62) higher than with FBH+ (15·2 per 1000 total births; p=0·20) in the 5 years preceding the survey interview. There was strong evidence of between-site heterogeneity (I2=80·9%; p<0·0001), with SBR higher for FPH than for FBH+ in four of five sites. The estimated NMR did not differ between modules (FPH 25·1 per 1000 livebirths vs FBH+ 25·4 per 1000 livebirths), with no evidence of between-site heterogeneity (I2=0·7%; p=0·40). INTERPRETATION: FPH takes an average of 1·4 min longer to complete than does FBH+, but has the potential to increase reporting of stillbirths in high burden contexts. The between-site heterogeneity we found might reflect variations in interviewer training and survey implementation, emphasising the importance of interviewer skills, training, and consistent implementation in data quality. FUNDING: Children's Investment Fund Foundation.
Authors: Joy E Lawn; Hannah Blencowe; Vladimir Sergeevich Gordeev; Joseph Akuze; Angela Baschieri; Sanne M Thysen; Francis Dzabeng; M Moinuddin Haider; Melanie Smuk; Michael Wild; Michael M Lokshin; Temesgen Azemeraw Yitayew; Solomon Mokonnen Abebe; Davis Natukwatsa; Collins Gyezaho; Seeba Amenga-Etego Journal: Popul Health Metr Date: 2021-02-08
Authors: Joseph Akuze; Hannah Blencowe; Simon Cousens; Joy E Lawn; Peter Waiswa; Vladimir Sergeevich Gordeev; Fred Arnold; Trevor Croft; Angela Baschieri Journal: Popul Health Metr Date: 2021-02-08
Authors: Judith Yargawa; Kazuyo Machiyama; Victoria Ponce Hardy; John Cleland; Yeetey Enuameh; Edward Galiwango; Kassahun Gelaye; Kaiser Mahmud; Sanne M Thysen; Damazo T Kadengye; Vladimir Sergeevich Gordeev; Hannah Blencowe; Joy E Lawn; Angela Baschieri Journal: Popul Health Metr Date: 2021-02-08
Authors: Lucia Hug; Danzhen You; Hannah Blencowe; Anu Mishra; Zhengfan Wang; Miranda J Fix; Jon Wakefield; Allisyn C Moran; Victor Gaigbe-Togbe; Emi Suzuki; Dianna M Blau; Simon Cousens; Andreea Creanga; Trevor Croft; Kenneth Hill; K S Joseph; Salome Maswime; Elizabeth M McClure; Robert Pattinson; Jon Pedersen; Lucy K Smith; Jennifer Zeitlin; Leontine Alkema Journal: Lancet Date: 2021-08-28 Impact factor: 79.321