Addressing unintentional exclusion of vulnerable and mobile households in traditional surveys in Kathmandu, Dhaka and Hanoi : a mixed methods feasibility study

The methods used in low- and middle-income countries’ (LMICs) household surveys have not changed in four decades; however, LMIC societies have changed substantially and now face unprecedented rates of urbanization and urbanization of poverty. This mismatch may result in unintentional exclusion of vulnerable and mobile urban populations. We compare three survey method innovations with standard survey methods in Kathmandu, Dhaka, and Hanoi and summarize feasibility of our innovative methods in terms of time, cost, skill requirements, and experiences. We used descriptive statistics and regression techniques to compare respondent characteristics in samples drawn with innovative versus standard survey designs and household definitions, adjusting for sample probability weights and clustering. Feasibility of innovative methods was evaluated using a thematic framework analysis of focus group discussions with survey field staff, and via survey planner budgets. We found that a common household definition excluded single adults (46.9%) and migrant-headed households (6.7%), as well as non-married (8.5%), unemployed (10.5%), disabled (9.3%), and studying adults (14.3%). Further, standard two-stage sampling resulted in fewer single adult and non-family households than an innovative area-microcensus design; however, two-stage sampling resulted in more tent and shack dwellers. Our survey innovations provided good value for money, and field staff experiences were neutral or positive. Staff recommended streamlining field tools and pairing technical and survey content experts during fieldwork. This evidence of exclusion of vulnerable and mobile urban populations in LMIC household surveys is deeply concerning and underscores the need to modernize survey methods and practices

Surveys for Urban Equity

This dataset contains results and documentation from three cross-sectional urban household surveys done in Kathmandu (Nepal), Dhaka (Bangladesh) and Hanoi (Vietnam) in 2017 and 2018. The surveys primarily aimed to test the feasibility of using new urban household survey methods that try to better cover/capture informal/slum settlements using sampling frame data generated from random forest models that incorporate census data (which is often outdated and inaccurate) with multiple remotely-sensed covariates, such as urbanisation and infrastructure data. Additionally, the surveys also aimed to gather data on a range of topics including many that are not commonly collected in household surveys, particularly of urban areas: A) basic socio-demographic details of household members, B) household characteristics, assets, income and expenses, C) household migration and social capital, D) household member injury and injury related death, and, for one individual per household, E) migration, social capital and depression/mental health. See the "Readme - dataset file descriptions.docx” file for a description of all files and datasets available, plus additional relevant references

Usability and acceptability of an automated respiratory rate counter to assess childhood pneumonia in Nepal

AIM: Pneumonia is the leading cause of child death after the neonatal period, resulting from late care seeking and inappropriate treatment. Diagnosis involves counting respiratory rate (RR); however, RR counting remains challenging for health workers and miscounting, and misclassification of RR is common. We evaluated the usability of a new automated RR counter, the Philips Children's Respiratory Monitor (ChARM), to Female Community Health Volunteers (FCHVs), and its acceptability to FCHVs and caregivers in Nepal. METHODS: A cross-sectional study was conducted in Jumla district, Nepal. About 133 FCHVs were observed between September and December 2018 when using ChARM during 517 sick child consultations, 264 after training and 253 after 2 months of routine use of ChARM. Acceptability of the ChARM was explored using semi-structured interviews. RESULTS: FCHV adherence to guidelines after 2 months of using ChARM routinely was 52.8% (95% CI 46.6-58.9). The qualitative findings suggest that ChARM is acceptable to FCHVs and caregivers; however, capacity constraints such as older age and low literacy and impacted device usability were mentioned. CONCLUSION: Further research on the performance, cost-effectiveness and implementation feasibility of this device is recommended, especially among low-literate CHWs