Nurul Alam1, Joy E Lawn2, M Moinuddin Haider3, Kaiser Mahmud1, Hannah Blencowe2, Tahmeed Ahmed4, Joseph Akuze2,5,6, Simon Cousens2,7, Nafisa Delwar1, Ane B Fisker8,9,10, Victoria Ponce Hardy2, S M Tafsir Hasan4, Md Ali Imam1, Dan Kajungu11, Md Alfazal Khan12, Justiniano S D Martins8, Quamrun Nahar1, Obed Ernest A Nettey13, Adane Kebede Tesega14,15, Judith Yargawa2. 1. Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh. 2. Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK. 3. Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh. moin@icddrb.org. 4. Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh. 5. Centre of Excellence for Maternal Newborn and Child Health Research, Makerere University, Kampala, Uganda. 6. Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda. 7. Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK. 8. Bandim Health Project, Bissau, Guinea-Bissau. 9. Research Centre for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark. 10. Open Patient Data Explorative Network (OPEN), University of Southern Denmark, Odense, Denmark. 11. IgangaMayuge Health and Demographic Surveillance System, Makerere University Centre for Health and Population Research, Makerere, Uganda. 12. Matlab Health Research Centre, icddr,b, Dhaka, Bangladesh. 13. Kintampo Health Research Centre, Kintampo, Ghana. 14. Dabat Research Centre Health and Demographic Surveillance System, Dabat, Ethiopia. 15. Department of Health Systems and Policy, University of Gondar Institute of Public Health, Gondar, Ethiopia.
Abstract
BACKGROUND: Preterm birth (gestational age (GA) <37 weeks) is the leading cause of child mortality worldwide. However, GA is rarely assessed in population-based surveys, the major data source in low/middle-income countries. We examined the performance of new questions to measure GA in household surveys, a subset of which had linked early pregnancy ultrasound GA data. METHODS: The EN-INDEPTH population-based survey of 69,176 women was undertaken (2017-2018) in five Health and Demographic Surveillance System sites in Bangladesh, Ethiopia, Ghana, Guinea-Bissau and Uganda. We included questions regarding GA in months (GAm) for all women and GA in weeks (GAw) for a subset; we also asked if the baby was 'born before expected' to estimate preterm birth rates. Survey data were linked to surveillance data in two sites, and to ultrasound pregnancy dating at <24 weeks in one site. We assessed completeness and quality of reported GA. We examined the validity of estimated preterm birth rates by sensitivity and specificity, over/under-reporting of GAw in survey compared to ultrasound by multinomial logistic regression, and explored perceptions about GA and barriers and enablers to its reporting using focus group discussions (n = 29). RESULTS: GAm questions were almost universally answered, but heaping on 9 months resulted in underestimation of preterm birth rates. Preference for reporting GAw in even numbers was evident, resulting in heaping at 36 weeks; hence, over-estimating preterm birth rates, except in Matlab where the peak was at 38 weeks. Questions regarding 'born before expected' were answered but gave implausibly low preterm birth rates in most sites. Applying ultrasound as the gold standard in Matlab site, sensitivity of survey-GAw for detecting preterm birth (GAw <37) was 60% and specificity was 93%. Focus group findings suggest that women perceive GA to be important, but usually counted in months. Antenatal care attendance, women's education and health cards may improve reporting. CONCLUSIONS: This is the first published study assessing GA reporting in surveys, compared with the gold standard of ultrasound. Reporting GAw within 5 years' recall is feasible with high completeness, but accuracy is affected by heaping. Compared to ultrasound-GAw, results are reasonably specific, but sensitivity needs to be improved. We propose revised questions based on the study findings for further testing and validation in settings where pregnancy ultrasound data and/or last menstrual period dates/GA recorded in pregnancy are available. Specific training of interviewers is recommended.
BACKGROUND: Preterm birth (gestational age (GA) <37 weeks) is the leading cause of childmortality worldwide. However, GA is rarely assessed in population-based surveys, the major data source in low/middle-income countries. We examined the performance of new questions to measure GA in household surveys, a subset of which had linked early pregnancy ultrasound GA data. METHODS: The EN-INDEPTH population-based survey of 69,176 women was undertaken (2017-2018) in five Health and Demographic Surveillance System sites in Bangladesh, Ethiopia, Ghana, Guinea-Bissau and Uganda. We included questions regarding GA in months (GAm) for all women and GA in weeks (GAw) for a subset; we also asked if the baby was 'born before expected' to estimate preterm birth rates. Survey data were linked to surveillance data in two sites, and to ultrasound pregnancy dating at <24 weeks in one site. We assessed completeness and quality of reported GA. We examined the validity of estimated preterm birth rates by sensitivity and specificity, over/under-reporting of GAw in survey compared to ultrasound by multinomial logistic regression, and explored perceptions about GA and barriers and enablers to its reporting using focus group discussions (n = 29). RESULTS:GAm questions were almost universally answered, but heaping on 9 months resulted in underestimation of preterm birth rates. Preference for reporting GAw in even numbers was evident, resulting in heaping at 36 weeks; hence, over-estimating preterm birth rates, except in Matlab where the peak was at 38 weeks. Questions regarding 'born before expected' were answered but gave implausibly low preterm birth rates in most sites. Applying ultrasound as the gold standard in Matlab site, sensitivity of survey-GAw for detecting preterm birth (GAw <37) was 60% and specificity was 93%. Focus group findings suggest that women perceive GA to be important, but usually counted in months. Antenatal care attendance, women's education and health cards may improve reporting. CONCLUSIONS: This is the first published study assessing GA reporting in surveys, compared with the gold standard of ultrasound. Reporting GAw within 5 years' recall is feasible with high completeness, but accuracy is affected by heaping. Compared to ultrasound-GAw, results are reasonably specific, but sensitivity needs to be improved. We propose revised questions based on the study findings for further testing and validation in settings where pregnancy ultrasound data and/or last menstrual period dates/GA recorded in pregnancy are available. Specific training of interviewers is recommended.
Authors: Rebecca E Rosenberg; A S M Nawshad U Ahmed; Saifuddin Ahmed; Samir K Saha; M A K Azad Chowdhury; Robert E Black; Mathuram Santosham; Gary L Darmstadt Journal: J Health Popul Nutr Date: 2009-06 Impact factor: 2.000
Authors: Proma Paul; Jaya Chandna; Simon R Procter; Ziyaad Dangor; Shannon Leahy; Sridhar Santhanam; Hima B John; Quique Bassat; Justina Bramugy; Azucena Bardají; Amina Abubakar; Carophine Nasambu; Romina Libster; Clara Sánchez Yanotti; Farah Seedat; Erzsébet Horváth-Puhó; A K M Tanvir Hossain; Qazi Sadeq-Ur Rahman; Mark Jit; Charles R Newton; Kate Milner; Bronner P Gonçalves; Joy E Lawn Journal: EClinicalMedicine Date: 2022-04-28