Measurement of stillbirths and neonatal deaths in standardised population-based surveys - PhDData

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Measurement of stillbirths and neonatal deaths in standardised population-based surveys

The thesis was published by Akuze Waiswa, J, in October 2022, London School of Hygiene and Tropical Medicine.

Abstract:

BACKGROUND: Worldwide, 4.4 million stillbirths and neonatal deaths (SB&NND) are estimated to occur annually. Household surveys, notably the Demographic and Health Surveys (DHS), are an important source of SB&NND data. This PhD aimed to review the DHS’s evolution for SB&NND data capture and compare the full birth history with additional questions on pregnancy losses (FBH+) and full pregnancy history (FPH) approaches in terms of data quality and potential measurement errors. METHODS: A literature and programmatic review of the DHS programme and HDSS pregnancy surveillance system was conducted. A randomised comparison of FBH+ versus FPH modules (the EveryNewborn-INDEPTH (EN-INDEPTH) survey) was undertaken in five health and demographic surveillance sites (HDSS). Reported stillbirth rates (SBR) and neonatal mortality rates (NMR); time for completion of survey modules; evidence for heterogeneity between sites; patterns of corrections between question types and structures, and modules were assessed. Survey data were compared to and HDSS data in four sites. RESULTS: Both FPH and FBH+ modules have been used within the DHS programme, but there is limited evidence concerning their accuracy for SB&NND. The FBH+ was the core model questionnaire between DHS-phases I-VII. A total of 69,176 women consented. 34,805 (50·3%) were randomised to FBH+ and 34,371 (49·7%) to FPH. There was little difference between the average time to administer questions in FBH+ (9.1 minutes) and FPH (10.5 minutes). The SBR was 15.2/1000 and 17.4/1000 total births for FBH+ and FPH, respectively. SBR was 21% (95% CI (-10% – 62%)) higher in FPH than in FBH+ with strong evidence of heterogeneity across the sites (I-squared=80·9% (p



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