Why some mothers overestimate birth size and length of pregnancy in rural Nepal

Birthweight data completeness and quality in population-based surveys: EN-INDEPTH study

BACKGROUND

Low birthweight (< 2500 g) is an important marker of maternal health and is associated with neonatal mortality, long-term development and chronic diseases. Household surveys remain an important source of population-based birthweight information, notably Demographic and Health Surveys (DHS) and UNICEF's Multiple Indicator Cluster Surveys (MICS); however, data quality concerns remain. Few studies have addressed how to close these gaps in surveys.

METHODS

The EN-INDEPTH population-based survey of 69,176 women was undertaken in five Health and Demographic Surveillance System sites (Matlab-Bangladesh, Dabat-Ethiopia, Kintampo-Ghana, Bandim-Guinea-Bissau, IgangaMayuge-Uganda). Responses to existing DHS/MICS birthweight questions on 14,411 livebirths were analysed and estimated adjusted odds ratios (aORs) associated with reporting weighing, birthweight and heaping reported. Twenty-eight focus group discussions with women and interviewers explored barriers and enablers to reporting birthweight.

RESULTS

Almost all women provided responses to birthweight survey questions, taking on average 0.2 min to answer. Of all babies, 62.4% were weighed at birth, 53.8% reported birthweight and 21.1% provided health cards with recorded birthweight. High levels of heterogeneity were observed between sites. Home births and neonatal deaths were less likely to be weighed at birth (home births aOR 0.03(95%CI 0.02-0.03), neonatal deaths (aOR 0.19(95%CI 0.16-0.24)), and when weighed, actual birthweight was less likely to be known (aOR 0.44(95%CI 0.33-0.58), aOR 0.30(95%CI 0.22-0.41)) compared to facility births and post-neonatal survivors. Increased levels of maternal education were associated with increases in reporting weighing and knowing birthweight. Half of recorded birthweights were heaped on multiples of 500 g. Heaping was more common in IgangaMayuge (aOR 14.91(95%CI 11.37-19.55) and Dabat (aOR 14.25(95%CI 10.13-20.3) compared to Bandim. Recalled birthweights were more heaped than those recorded by card (aOR 2.59(95%CI 2.11-3.19)). A gap analysis showed large missed opportunity between facility birth and known birthweight, especially for neonatal deaths. Qualitative data suggested that knowing their baby's weight was perceived as valuable by women in all sites, but lack of measurement and poor communication, alongside social perceptions and spiritual beliefs surrounding birthweight, impacted women's ability to report birthweight.

CONCLUSIONS

Substantial data gaps remain for birthweight data in household surveys, even amongst facility births. Improving the accuracy and recording of birthweights, and better communication with women, for example using health cards, could improve survey birthweight data availability and quality.

What caused neonatal deaths in Senegal in 2017? a secondary analysis of 2017 DHS

Introduction

in Senegal, the fight for newborn and child survival is a public health priority. The aim of this study is to analyze the factors associated with neonatal deaths in Senegal in 2017.

Methods

this article used data from the Senegal Demographic and Health Survey 2017. It covered 6073 children under the age of 5. The sample from the 2017 Continuous DHS is nationally representative. A bivariate analysis was conducted. The multivariate analysis was performed using STATA 15 software. Adjusted odds ratios had been calculated for variables with significant p values. The dependent variable was neonatal death.

Results

a total of 6,073 children had been investigated. The neonatal death rate is 2.12%. Neonatal deaths account for 50.97% of all infant and child deaths. Newborns with a low birth weight < 2500 g are 2.3 times more likely to die with an ORaj of 2.3 [1.01-5.28]. Newborns who are considered “very small” by their mother at birth are 2.5 times more likely to die in the neonatal period ORaj=2.5 [1.04-6.04]. The last risk factor identified is birth by caesarean section (ORaj=3.97 [1.68-9.39]).

Conclusion

this study concludes that low birth weight is an important risk factor for neonatal deaths in Senegal. These results suggest better management of antenatal care. However, this study showed that there was a deficit in the provision of perinatal services in Senegal. A qualitative analysis of caesarean section in the context of universal coverage could be a perspective for further reflection on improving newborn survival in Senegal.

What is meant by validity in maternal and newborn health measurement? A conceptual framework for understanding indicator validation

BACKGROUND

Rigorous monitoring supports progress in achieving maternal and newborn mortality and morbidity reductions. Recent work to strengthen measurement for maternal and newborn health highlights the existence of a large number of indicators being used for this purpose. The definitions and data sources used to produce indicator estimates vary and challenges exist with completeness, accuracy, transparency, and timeliness of data. The objective of this study is to create a conceptual overview of how indicator validity is defined and understood by those who develop and use maternal and newborn health indicators.

METHODS

A conceptual framework of validity was developed using mixed methods. We were guided by principles for conceptual frameworks and by a review of the literature and key maternal and newborn health indicator guidance documents. We also conducted qualitative semi-structured interviews with 32 key informants chosen through purposive sampling.

RESULTS

We categorised indicator validity into three main types: criterion, convergent, and construct. Criterion or diagnostic validity, comparing a measure with a gold standard, has predominantly been used to assess indicators of care coverage and content. Studies assessing convergent validity quantify the extent to which two or more indicator measurement approaches, none of which is a gold-standard, relate. Key informants considered construct validity, or the accuracy of the operationalisation of a concept or phenomenon, a critical part of the overall assessment of indicator validity.

CONCLUSION

Given concerns about the large number of maternal and newborn health indicators currently in use, a more consistent understanding of validity can help guide prioritization of key indicators and inform development of new indicators. All three types of validity are relevant for evaluating the performance of maternal and newborn health indicators. We highlight the need to establish a common language and understanding of indicator validity among the various global and local stakeholders working within maternal and newborn health.