From Design to Practice: How can large-scale household surveys better represent the complexities of the social units under investigation?

The way in which ‘the household’ is defined and operationalised in surveys and census data collection has long been criticised as unable to adequately capture the complexities of the social units within which people live. In a South African national survey on household wealth (HWS) a definition of the household was used to rep-resent the ways in which South African households arrange themselves financially. Here we report on a qualitative study in which 36 households originally included in the HWS were re-interviewed to collect detailed data on household financial links and dependencies. Households with more complex structures, which represent the majority of household types in South Africa, were very poorly represented, and possible reasons for this are explored. We analyse and discuss the HWS research process in the light of the findings of this study, and propose ways to improve large-scale survey design and data collection, drawing on perspectives from multiple disciplines.

Prospective antimicrobial stewardship interventions by multidisciplinary teams to reduce neonatal antibiotic use in South Africa : the neonatal antimicrobial stewardship (NeoAMS) study

DATA SHARING : De-identified participant data, the study protocol, and data dictionary are available from the corresponding author on reasonable request following publication, with completion of a signed data sharing agreement.BACKGROUND : Hospitalized neonates are vulnerable to infection and have high rates of antibiotic utilization. METHODS : Fourteen South African neonatal units (seven public, seven private sector) assembled multidisciplinary teams involving neonatologists, microbiologists, pharmacists, and nurses to implement prospective audit and feedback neonatal antimicrobial stewardship (NeoAMS) interventions. The teams attended seven online training sessions. Pharmacists conducted weekday antibiotic prescription reviews in the neonatal intensive care unit and/or neonatal wards providing feedback to the clinical teams. Anonymized demographic and NeoAMS interventions data were aggregated for descriptive purposes and statistical analysis. FINDINGS : During the 20-week NeoAMS intervention in 2022, 565 neonates were enrolled. Pharmacists evaluated seven hundred antibiotic prescription episodes; rule-out sepsis (180; 26%) and culture-negative sepsis (138; 20%) were the most frequent indications for antibiotic prescription. For infection episodes with an identified pathogen, only 51% (116/229) of empiric treatments provided adequate antimicrobial coverage. Pharmacists recommended 437 NeoAMS interventions (0·6 per antibiotic prescription episode), with antibiotic discontinuation (42%), therapeutic drug monitoring (17%), and dosing (15%) recommendations most frequent. Neonatal clinicians’ acceptance rates for AMS recommendations were high (338; 77%). Mean antibiotic length of therapy decreased by 24% from 9·1 to 6·9 days (0·1 day decrease per intervention week; P = 0·001), with the greatest decline in length of therapy for culture-negative sepsis (8·2 days (95% CI 5·7-11·7) to 5·9 days (95% CI 4·6-7·5); P = 0·032). INTERPRETATION : This neonatal AMS programme was successfully implemented in heterogenous and resource-limited settings. Pharmacist-recommended AMS interventions had high rates of clinician acceptance. The NeoAMS intervention significantly reduced neonatal antibiotic use, particularly for culture-negative sepsis.A grant from Merck provided partial support.http://www.elsevier.com/locate/ijidhj2024PharmacologySDG-03:Good heatlh and well-bein

From design to practice: how can large-scale household surveys better represent the complexities of the social units under investigation?

‘The household’ is most commonly used as unit of analysis in household surveys and as enumeration unit during census data collection. Relationships are mostly indicated with regards to ‘household head’ or ‘acting household head’. The way in which ‘the household’ is defined in these surveys has long been criticised by anthropologists and sociologists as unable to adequately capture the complexities of the social units within which people arrange themselves. However the problem often doesn’t simply lie with the definition but the assumptions made when designing a questionnaire and taking the survey from the design phase into the implementation phase. The aim of this paper is to reflect on lessons learnt from a household financial well-being survey with regards to defining ‘the household’ and operationalising the definition in a heterogeneous, complex society such as South Africa. In a follow-up study group interviews were conducted with fieldworkers who administered the survey, and willing respondents were re-interviewed, collecting qualitative information about those with familial and/or financial links. It was found that: 1. There was already confusion at the survey design stage as to exactly what the unit of analysis is. 2. This confusion translated into lack of clarity in terms of operationalising the working definition given to fieldworkers. 3. Fieldworkers therefore reverted back to what they know, namely ‘family’ or simply ‘who is there’. 4. The design and layout of the questionnaire did not easily allow for the capturing of more complex units and understanding the relationships between the individual members. 5. This affected not only the accuracy and reliability of the demographic data collected but may also have an impact on the financial well-being data collected. Considering the type of definition to be used for the household as unit of analysis is simply the starting point. Much more consideration needs to be given by survey designers to the implementation of concepts in the field instead of trying to find ‘the perfect’ definition