HIV and Fertility in Africa: First Evidence from Population Based Surveys

The historical pattern of the demographic transition suggests that fertility declines follow mortality declines, followed by a rise in human capital accumulation and economic growth. The HIV/AIDS epidemic threatens to reverse this path. A recent paper by Young (2005), however, suggests that similar to the "Black Death" episode in Europe, HIV/AIDS will actually lead to higher growth per capita among the a affected African countries. Not only will population decline, behavioral responses in fertility will reinforce this decline by reducing the willingness to engage in unprotected sex. We utilize recent rounds of the Demographic and Health Surveys that link an individual woman’s fertility outcomes to her HIV status based on testing. The data allows us to distinguish the effect of own positive HIV status on fertility (which may be due to lower fecundity and other physiological reasons) from the behavioral response to higher mortality risk, as measured by the local community HIV prevalence. We show that HIV-infected women have significantly lower fertility. In contrast to Young (2005), however, we find that local community HIV prevalence has no significant effect on non-infected women's fertility.HIV/AIDS, fertility, economic development

Comparison of estimates of population-based surveys

OBJECTIVE: To compare estimates obtained through household and telephone surveys for monitoring, intervention and development of health policies. METHODS: The study analyzed data from 2,526 and 1,900 individuals aged 18 and over, living in Campinas, SP, interviewed by the household survey (ISACamp) and by the telephone survey (Vigitel), respectively. Sex, age and schooling were used to characterize the studied population. Prevalence estimates and 95% confidence intervals were utilized in the analysis. The estimates of the sociodemographic characteristics of the population were compared by t-test for two independent samples and the comparison of the other estimates, according to the type of survey, was performed using Poisson regression. RESULTS: No statistically significant differences were found between the estimates obtained by the two surveys analyzed for overall prevalence of: overweight/obesity, smoking status, mammography in the prior year and Pap smear at least once in life. However, for the estimates of worse perceived health status, health plan affiliation, mammography at least once in life and Pap smear in the prior year, significant differences were found, with a tendency to overestimate data from the telephone survey, except in the case of worse perceived health status. CONCLUSIONS: These findings point to the need for further studies, which may contribute to a better understanding of the differences, given that telephone surveys can provide quick and essential information for monitoring modifiable risk factors for the assessment of interventions and to develop policies promoting health in Brazil.OBJETIVO: Comparar estimativas obtidas de inquéritos domiciliar e telefônico para monitoramento, intervenção e desenvolvimento de políticas de saúde. MÉTODOS: Foram utilizados dados de 2.526 e 1.900 indivíduos de 18 anos e mais, residentes em Campinas, entrevistados pelo inquérito domiciliar e pelo telefônico, respectivamente. As variáveis sexo, faixa etária e escolaridade foram utilizadas para caracterizar a população estudada. Foram calculadas as prevalências e seus respectivos intervalos de confiança de 95%. As estimativas das características sociodemográficas da população foram comparadas pelo teste t. A comparação das estimativas das demais variáveis, segundo o tipo de inquérito, foi feita pela regressão de Poisson. RESULTADOS: Não foram encontradas diferenças estatisticamente significantes entre as estimativas obtidas pelos dois inquéritos para as prevalências globais de: sobrepeso/obesidade, tabagismo, realização de mamografia no ano prévio e de Papanicolaou alguma vez na vida. Para pior saúde percebida, filiação a plano médico de saúde, realização do exame de mamografia alguma vez e de Papanicolaou no ano prévio, observaram-se diferenças significantes, com tendência de superestimação pelos dados do inquérito telefônico, exceto para pior saúde percebida. CONCLUSÕES: Para melhor compreensão das diferenças observadas, outros estudos serão necessários, pois as pesquisas telefônicas podem fornecer informações rápidas e essenciais para o monitoramento de fatores de risco modificáveis, para a avaliação de intervenções e para o desenvolvimento de políticas de promoção à saúde no País.OBJETIVO: Comparar estimativas obtenidas de pesquisas domiciliar y telefónica para monitoreo, intervención y desarrollo de políticas de salud. MÉTODOS: Se utilizaron datos de 2.526 y 1.900 individuos de 18 años y más residentes en Campinas, Brasil, entrevistados por pesquisa domiciliar y telefónica, respectivamente. Las variables sexo, grupo etario y escolaridad se utilizaron para caracterizar la población estudiada. Se calcularon las prevalencias y sus respectivos intervalos de confianza de 95%. Las estimativas de las características sociodemográficas de la población se compararon usando el teste t de Student. La comparación de las estimativas de las variables restantes, según el tipo de pesquisa, se hizo a través de la regresión de Poisson. RESULTADOS: No se encontraron diferencias estadísticamente significativas entre las estimativas obtenidas por las dos pesquisas para las prevalencias globales de: sobrepeso/obesidad, tabaquismo, realización de mamografía en el año anterior y de Papanicolaou alguna vez en la vida. Para peor salud percibida, afiliación a plano medico de salud, realización del examen de mamografía alguna vez y de Papanicolaou en el año previo, se observaron diferencias significativas, con tendencia de sobrestimación por los datos de la pesquisa telefónica, excepto para peor salud percibida. CONCLUSIONES: Para mejor comprensión de las diferencias observadas, otros estudios serán necesarios, ya que las pesquisas telefónicas pueden suministrar informaciones rápidas y esenciales para el monitoreo de factores de riesgo modificables, para la evaluación de intervenciones y para el desarrollo de políticas de promoción de la salud en el país.606

Comparison Of Estimates Of Population-based Surveys.

To compare estimates obtained through household and telephone surveys for monitoring, intervention and development of health policies. The study analyzed data from 2,526 and 1,900 individuals aged 18 and over, living in Campinas, SP, interviewed by the household survey (ISACamp) and by the telephone survey (Vigitel), respectively. Sex, age and schooling were used to characterize the studied population. Prevalence estimates and 95% confidence intervals were utilized in the analysis. The estimates of the sociodemographic characteristics of the population were compared by t-test for two independent samples and the comparison of the other estimates, according to the type of survey, was performed using Poisson regression. No statistically significant differences were found between the estimates obtained by the two surveys analyzed for overall prevalence of: overweight/obesity, smoking status, mammography in the prior year and Pap smear at least once in life. However, for the estimates of worse perceived health status, health plan affiliation, mammography at least once in life and Pap smear in the prior year, significant differences were found, with a tendency to overestimate data from the telephone survey, except in the case of worse perceived health status. These findings point to the need for further studies, which may contribute to a better understanding of the differences, given that telephone surveys can provide quick and essential information for monitoring modifiable risk factors for the assessment of interventions and to develop policies promoting health in Brazil.4760-

Who should be undertaking population-based surveys in humanitarian emergencies?

<p>Abstract</p> <p>Background</p> <p>Timely and accurate data are necessary to prioritise and effectively respond to humanitarian emergencies. 30-by-30 cluster surveys are commonly used in humanitarian emergencies because of their purported simplicity and reasonable validity and precision. Agencies have increasingly used 30-by-30 cluster surveys to undertake measurements beyond immunisation coverage and nutritional status. Methodological errors in cluster surveys have likely occurred for decades in humanitarian emergencies, often with unknown or unevaluated consequences.</p> <p>Discussion</p> <p>Most surveys in humanitarian emergencies are done by non-governmental organisations (NGOs). Some undertake good quality surveys while others have an already overburdened staff with limited epidemiological skills. Manuals explaining cluster survey methodology are available and in use. However, it is debatable as to whether using standardised, 'cookbook' survey methodologies are appropriate. Coordination of surveys is often lacking. If a coordinating body is established, as recommended, it is questionable whether it should have sole authority to release surveys due to insufficient independence. Donors should provide sufficient funding for personnel, training, and survey implementation, and not solely for direct programme implementation.</p> <p>Summary</p> <p>A dedicated corps of trained epidemiologists needs to be identified and made available to undertake surveys in humanitarian emergencies. NGOs in the field may need to form an alliance with certain specialised agencies or pool technically capable personnel. If NGOs continue to do surveys by themselves, a simple training manual with sample survey questionnaires, methodology, standardised files for data entry and analysis, and manual for interpretation should be developed and modified locally for each situation. At the beginning of an emergency, a central coordinating body should be established that has sufficient authority to set survey standards, coordinate when and where surveys should be undertaken and act as a survey repository. Technical expertise is expensive and donors must pay for it. As donors increasingly demand evidence-based programming, they have an obligation to ensure that sufficient funds are provided so organisations have adequate technical staff.</p

Recommended core items to assess e-cigarette use in population-based surveys

A consistent approach using standardised items to assess e-cigarette use in both youth and adult populations will aid cross-survey and cross-national comparisons of the effect of e-cigarette (and tobacco) policies and improve our understanding of the population health impact of e-cigarette use. Focusing on adult behaviour, we propose a set of e-cigarette use items, discuss their utility and potential adaptation, and highlight e-cigarette constructs that researchers should avoid without further item development. Reliable and valid items will strengthen the emerging science and inform knowledge synthesis for policy-making. Building on informal discussions at a series of international meetings of 65 experts from 15 countries, the authors provide recommendations for assessing e-cigarette use behaviour, relative perceived harm, device type, presence of nicotine, flavours and reasons for use. We recommend items assessing eight core constructs: e-cigarette ever use, frequency of use and former daily use; relative perceived harm; device type; primary flavour preference; presence of nicotine; and primary reason for use. These items should be standardised or minimally adapted for the policy context and target population. Researchers should be prepared to update items as e-cigarette device characteristics change. A minimum set of e-cigarette items is proposed to encourage consensus around items to allow for cross-survey and cross-jurisdictional comparisons of e-cigarette use behaviour. These proposed items are a starting point. We recognise room for continued improvement, and welcome input from e-cigarette users and scientific colleagues

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

Stillbirth outcome capture and classification in population-based surveys: EN-INDEPTH study.

BACKGROUND: Household surveys remain important sources of stillbirth data, but omission and misclassification are common. Classifying adverse pregnancy outcomes as stillbirths requires accurate reporting of vital status at birth and gestational age or birthweight for every pregnancy. Further categorisation, e.g. by sex, or timing (intrapartum/antepartum) improves data to understand and prevent stillbirth. METHODS: We undertook a cross-sectional population-based survey of women of reproductive age in five health and demographic surveillance system sites in Bangladesh, Ethiopia, Ghana, Guinea-Bissau and Uganda (2017-2018). All women answered a full birth history with pregnancy loss questions (FBH+) or a full pregnancy history (FPH). A sub-sample across both groups were asked additional stillbirth questions. Questions were evaluated using descriptive measures. Using an interpretative paradigm and phenomenology methodology, focus group discussions with women exploring barriers to reporting birthweight for stillbirths were conducted. Thematic analysis was guided by an a priori codebook. RESULTS: Overall 69,176 women reported 98,483 livebirths (FBH+) and 102,873 pregnancies (FPH). Additional questions were asked for 1453 stillbirths, 1528 neonatal deaths and 12,620 surviving children born in the 5 years prior to the survey. Completeness was high (> 99%) for existing FBH+/FPH questions on signs of life at birth and gestational age (months). Discordant responses in signs of life at birth between different questions were common; nearly one-quarter classified as stillbirths on FBH+/FPH were reported born alive on additional questions. Availability of information on gestational age (weeks) (58.1%) and birthweight (13.2%) was low amongst stillbirths, and heaping was common. Most women (93.9%) were able to report the sex of their stillborn baby. Response completeness for stillbirth timing (18.3-95.1%) and estimated proportion intrapartum (15.6-90.0%) varied by question and site. Congenital malformations were reported in 3.1% stillbirths. Perceived value in weighing a stillborn baby varied and barriers to weighing at birth a nd knowing birthweight were common. CONCLUSIONS: Improving stillbirth data in surveys will require investment in improving the measurement of vital status, gestational age and birthweight by healthcare providers, communication of these with women, and overcoming reporting barriers. Given the large burden and effect on families, improved data must be made available to end preventable stillbirths

Overestimation of Vitamin a Supplementation Coverage from District Tally Sheets Demonstrates Importance of Population-Based Surveys for Program Improvement: Lessons from Tanzania.

Tanzania has conducted a national twice-yearly Vitamin A supplementation (VAS) campaign since 2001. Administrative coverage rates based on tally sheets consistently report >90% coverage; however the accuracy of these rates are uncertain due to potential errors in tally sheets and their aggregation, incomplete or inaccurate reporting from distribution sites, and underestimating the target population. The post event coverage survey in Mainland Tanzania sought to validate tally-sheet based national coverage estimates of VAS and deworming for the June 2010 mass distribution round, and to characterize children missed by the national campaign. WHO/EPI randomized cross-sectional cluster sampling methodology was adapted for this study, using 30 clusters by 40 individuals (n = 1200), in addition to key informant interviews. Households with children 6-59 months of age were included in the study (12-59 months for deworming analysis). Chi-squared tests and logistic regression analysis were used to test differences between children reached and not reached by VAS. Data was collected within six weeks of the June 2010 round. A total of 1203 children, 58 health workers, 30 village leaders and 45 community health workers were sampled. Preschool VAS coverage was 65% (95% CI: 62.7-68.1), approximately 30% lower than tally-sheet coverage estimates. Factors associated with not receiving VAS were urban residence [OR = 3.31; p = 0.01], caretakers who did not hear about the campaign [OR = 48.7; p<0.001], and Muslim households [OR<3.25; p<0.01]. There were no significant differences in VAS coverage by child sex or age, or maternal age or education. Coverage estimation for vitamin A supplementation programs is one of most powerful indicators of program success. National VAS coverage based on a tally-sheet system overestimated VAS coverage by ∼30%. There is a need for representative population-based coverage surveys to complement and validate tally-sheet estimates

HIV and Fertility in Africa: First Evidence from Population Based Surveys

The historical pattern of the demographic transition suggests that fertility declines follow mortality declines, followed by a rise in human capital accumulation and economic growth. The HIV/AIDS epidemic threatens to reverse this path. A recent paper by Young (2005), however, suggests that similar to the "Black Death" episode in Europe, HIV/AIDS will actually lead to higher growth per capita among the affected African countries. Not only will population decline, behavioral responses in fertility will reinforce this decline by reducing the willingness to engage in unprotected sex. We utilize recent rounds of the Demographic and Health Surveys which link an individual woman's fertility outcomes to her HIV status based on testing. The data allows us to distinguish the effect of own positive HIV status on fertility (which may be due to lower fecundity and other physiological reasons) from the behavioral response to higher mortality risk, as measured by the local community HIV prevalence. We show that HIV-infected women have significantly lower fertility. In contrast to Young (2005), however, we find that local community HIV prevalence has no significant effect on non-infected women's fertility.

Comparison of estimates of population-based surveys

OBJETIVO: Comparar estimativas obtidas de inquéritos domiciliar e telefônico para monitoramento, intervenção e desenvolvimento de políticas de saúde. MÉTODOS: Foram utilizados dados de 2.526 e 1.900 indivíduos de 18 anos e mais, residentes em Campinas, entrevistados pelo inquérito domiciliar e pelo telefônico, respectivamente. As variáveis sexo, faixa etária e escolaridade foram utilizadas para caracterizar a população estudada. Foram calculadas as prevalências e seus respectivos intervalos de confiança de 95%. As estimativas das características sociodemográficas da população foram comparadas pelo teste t. A comparação das estimativas das demais variáveis, segundo o tipo de inquérito, foi feita pela regressão de Poisson. RESULTADOS: Não foram encontradas diferenças estatisticamente significantes entre as estimativas obtidas pelos dois inquéritos para as prevalências globais de: sobrepeso/obesidade, tabagismo, realização de mamografia no ano prévio e de Papanicolaou alguma vez na vida. Para pior saúde percebida, filiação a plano médico de saúde, realização do exame de mamografia alguma vez e de Papanicolaou no ano prévio, observaram-se diferenças significantes, com tendência de superestimação pelos dados do inquérito telefônico, exceto para pior saúde percebida. CONCLUSÕES: Para melhor compreensão das diferenças observadas, outros estudos serão necessários, pois as pesquisas telefônicas podem fornecer informações rápidas e essenciais para o monitoramento de fatores de risco modificáveis, para a avaliação de intervenções e para o desenvolvimento de políticas de promoção à saúde no País.OBJETIVO: Comparar estimativas obtenidas de pesquisas domiciliar y telefónica para monitoreo, intervención y desarrollo de políticas de salud. MÉTODOS: Se utilizaron datos de 2.526 y 1.900 individuos de 18 años y más residentes en Campinas, Brasil, entrevistados por pesquisa domiciliar y telefónica, respectivamente. Las variables sexo, grupo etario y escolaridad se utilizaron para caracterizar la población estudiada. Se calcularon las prevalencias y sus respectivos intervalos de confianza de 95%. Las estimativas de las características sociodemográficas de la población se compararon usando el teste t de Student. La comparación de las estimativas de las variables restantes, según el tipo de pesquisa, se hizo a través de la regresión de Poisson. RESULTADOS: No se encontraron diferencias estadísticamente significativas entre las estimativas obtenidas por las dos pesquisas para las prevalencias globales de: sobrepeso/obesidad, tabaquismo, realización de mamografía en el año anterior y de Papanicolaou alguna vez en la vida. Para peor salud percibida, afiliación a plano medico de salud, realización del examen de mamografía alguna vez y de Papanicolaou en el año previo, se observaron diferencias significativas, con tendencia de sobrestimación por los datos de la pesquisa telefónica, excepto para peor salud percibida. CONCLUSIONES: Para mejor comprensión de las diferencias observadas, otros estudios serán necesarios, ya que las pesquisas telefónicas pueden suministrar informaciones rápidas y esenciales para el monitoreo de factores de riesgo modificables, para la evaluación de intervenciones y para el desarrollo de políticas de promoción de la salud en el país.OBJECTIVE: To compare estimates obtained through household and telephone surveys for monitoring, intervention and development of health policies. METHODS: The study analyzed data from 2,526 and 1,900 individuals aged 18 and over, living in Campinas, SP, interviewed by the household survey (ISACamp) and by the telephone survey (Vigitel), respectively. Sex, age and schooling were used to characterize the studied population. Prevalence estimates and 95% confidence intervals were utilized in the analysis. The estimates of the sociodemographic characteristics of the population were compared by t-test for two independent samples and the comparison of the other estimates, according to the type of survey, was performed using Poisson regression. RESULTS: No statistically significant differences were found between the estimates obtained by the two surveys analyzed for overall prevalence of: overweight/obesity, smoking status, mammography in the prior year and Pap smear at least once in life. However, for the estimates of worse perceived health status, health plan affiliation, mammography at least once in life and Pap smear in the prior year, significant differences were found, with a tendency to overestimate data from the telephone survey, except in the case of worse perceived health status. CONCLUSIONS: These findings point to the need for further studies, which may contribute to a better understanding of the differences, given that telephone surveys can provide quick and essential information for monitoring modifiable risk factors for the assessment of interventions and to develop policies promoting health in Brazil