Tryphena Nareeba1, Francis Dzabeng2, Nurul Alam3, Gashaw A Biks4,5, Sanne M Thysen6,7,8, Joseph Akuze9,10,11, Hannah Blencowe9, Stephane Helleringer12, Joy E Lawn9, Kaiser Mahmud3, Temesgen Azemeraw Yitayew4, Ane B Fisker13,14,15. 1. IgangaMayuge Health and Demographic Surveillance System, Makerere University Centre for Health and Population Research, Iganga, Uganda. 2. Kintampo Health Research Centre, Kintampo, Ghana. 3. Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh. 4. Dabat Research Centre Health and Demographic Surveillance System, Dabat, Ethiopia. 5. Department of Health Services Management and Health Economics, Institute of Public Health College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. 6. Bandim Health Project, Bissau, Guinea-Bissau. 7. Research Centre for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark. 8. Bandim Health Project, OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark. 9. Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK. 10. Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda. 11. Centre of Excellence for Maternal Newborn and Child Health Research, Makerere University, Kampala, Uganda. 12. Division of Social Science, New York University-Abu Dhabi, Abu Dhabi, United Arab Emirates. 13. Bandim Health Project, Bissau, Guinea-Bissau. a.fisker@bandim.org. 14. Research Centre for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark. a.fisker@bandim.org. 15. Bandim Health Project, OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark. a.fisker@bandim.org.
Abstract
BACKGROUND: Global mortality estimates remain heavily dependent on household surveys in low- and middle-income countries, where most under-five deaths occur. Few studies have assessed the accuracy of mortality data or determinants of capturing births in surveys. METHODS: The Every Newborn-INDEPTH study (EN-INDEPTH) included a large, multi-country survey of women aged 15-49 interviewed about livebirths and their survival status in five Health and Demographic Surveillance Systems (HDSSs). The HDSSs undertake regular household visits to register births and deaths for a given population. We analysed EN-INDEPTH survey data to assess background factors associated with not recalling a complete date-of-birth. We calculated Kaplan-Meier survival estimates for both survey and HDSS data and describe age-at-death distributions during the past 5 years for children born to the same women. We assessed the proportion of HDSS-births that could be matched on month-of-birth to survey-births and used regression models to identify factors associated with matching. RESULTS: 69,176 women interviewed in the survey reported 109,817 births and 3064 deaths in children under 5 years in the 5 years prior to the survey. In the HDSS data, the same women had 83,768 registered births and 2335 under-five deaths in the same period. A complete date-of-birth was not reported for 1-7% of survey-births. Birthdates were less likely to be complete for dead children and children born to women of higher parity or with little/no education. Distributions of reported age-at-death indicated heaping at full weeks (neonatal period) and at 12 months. Heaping was more pronounced in the survey data. Survey estimates of under-five mortality rates were similar to HDSS estimates of under-five mortality in two of five sites, higher in the survey in two sites (15%, 41%) and lower (24%) in one site. The proportion of HDSS-births matched to survey-births ranged from 51 to 89% across HDSSs and births of children who had died were less likely to be matched. CONCLUSIONS: Mortality estimates in the survey and HDSS were not markedly different for most sites. However, neither source is a "gold standard" and both sources miss some events. Research is required to improve capture and accuracy to better track newborn and child survival targets.
BACKGROUND: Global mortality estimates remain heavily dependent on household surveys in low- and middle-income countries, where most under-five deaths occur. Few studies have assessed the accuracy of mortality data or determinants of capturing births in surveys. METHODS: The Every Newborn-INDEPTH study (EN-INDEPTH) included a large, multi-country survey of women aged 15-49 interviewed about livebirths and their survival status in five Health and Demographic Surveillance Systems (HDSSs). The HDSSs undertake regular household visits to register births and deaths for a given population. We analysed EN-INDEPTH survey data to assess background factors associated with not recalling a complete date-of-birth. We calculated Kaplan-Meier survival estimates for both survey and HDSS data and describe age-at-death distributions during the past 5 years for children born to the same women. We assessed the proportion of HDSS-births that could be matched on month-of-birth to survey-births and used regression models to identify factors associated with matching. RESULTS: 69,176 women interviewed in the survey reported 109,817 births and 3064 deaths in children under 5 years in the 5 years prior to the survey. In the HDSS data, the same women had 83,768 registered births and 2335 under-five deaths in the same period. A complete date-of-birth was not reported for 1-7% of survey-births. Birthdates were less likely to be complete for dead children and children born to women of higher parity or with little/no education. Distributions of reported age-at-death indicated heaping at full weeks (neonatal period) and at 12 months. Heaping was more pronounced in the survey data. Survey estimates of under-five mortality rates were similar to HDSS estimates of under-five mortality in two of five sites, higher in the survey in two sites (15%, 41%) and lower (24%) in one site. The proportion of HDSS-births matched to survey-births ranged from 51 to 89% across HDSSs and births of children who had died were less likely to be matched. CONCLUSIONS:Mortality estimates in the survey and HDSS were not markedly different for most sites. However, neither source is a "gold standard" and both sources miss some events. Research is required to improve capture and accuracy to better track newborn and child survival targets.