Variance estimation for effective coverage measures: A simulation study

Methodological considerations for linking household and healthcare provider data for estimating effective coverage: a systematic review

OBJECTIVE

To assess existing knowledge related to methodological considerations for linking population-based surveys and health facility data to generate effective coverage estimates. Effective coverage estimates the proportion of individuals in need of an intervention who receive it with sufficient quality to achieve health benefit.

DESIGN

Systematic review of available literature.

DATA SOURCES

Medline, Carolina Population Health Center and Demographic and Health Survey publications and handsearch of related or referenced works of all articles included in full text review. The search included publications from 1 January 2000 to 29 March 2021.

ELIGIBILITY CRITERIA

Publications explicitly evaluating (1) the suitability of data, (2) the implications of the design of existing data sources and (3) the impact of choice of method for combining datasets to obtain linked coverage estimates.

RESULTS

Of 3805 papers reviewed, 70 publications addressed relevant issues. Limited data suggest household surveys can be used to identify sources of care, but their validity in estimating intervention need was variable. Methods for collecting provider data and constructing quality indices were diverse and presented limitations. There was little empirical data supporting an association between structural, process and outcome quality. Few studies addressed the influence of the design of common data sources on linking analyses, including imprecise household geographical information system data, provider sampling design and estimate stability. The most consistent evidence suggested under certain conditions, combining data based on geographical proximity or administrative catchment (ecological linking) produced similar estimates to linking based on the specific provider utilised (exact match linking).

CONCLUSIONS

Linking household and healthcare provider data can leverage existing data sources to generate more informative estimates of intervention coverage and care. However, existing evidence on methods for linking data for effective coverage estimation are variable and numerous methodological questions remain. There is need for additional research to develop evidence-based, standardised best practices for these analyses.

Effective coverage of nutrition interventions across the continuum of care in Bangladesh: insights from nationwide cross-sectional household and health facility surveys

INTRODUCTION

Improving the impact of nutrition interventions requires adequate measurement of both reach and quality of interventions, but limited evidence exists on advancing coverage measurement. We adjusted contact-based coverage estimates, taking into consideration the inputs required to deliver quality nutrition services, to calculate input-adjusted coverage of nutrition interventions across the continuum of care from pregnancy through early childhood in Bangladesh.

METHODS

We used data from the 2014 Bangladesh Demographic and Health Surveys to assess use of maternal and child health services and the 2014 Service Provision Assessment to determine facility readiness to deliver nutrition interventions. Service readiness captured availability of nutrition-specific inputs (including human resources and training, equipment, diagnostics and medicines). Contact coverage was combined with service readiness to create a measure of input-adjusted coverage at the national and regional levels, across place of residence, and by maternal education and household socioeconomic quintiles.

RESULTS

Contact coverage varied from 28% for attending at least four ANC visits to 38% for institutional delivery, 35% for child growth monitoring and 81% for sick child care. Facilities demonstrated incomplete readiness for nutrition interventions, ranging from 48% to 51% across services. Nutrition input-adjusted coverage was suboptimal (18% for ANC, 23% for institutional delivery, 20% for child growth monitoring and 52% for sick child care) and varied between regions within the country. Inequalities in input-adjusted coverage were large during ANC and institutional delivery (14-17 percentage points (pp) between urban and rural areas, 15 pp between low and high education, and 28-34 pp between highest and lowest wealth quintiles) and less variable for sick child care (<2 pp).

CONCLUSION

Nutrition input-adjusted coverage was suboptimal and varied subnationally and across the continuum of care in Bangladesh. Special efforts are needed to improve the reach as well as the quality of health and nutrition services to achieve the Sustainable Development Goals.