The power of the interviewer: A qualitative perspective on African survey data collection

BACKGROUND African censuses and surveys remain dependent on interviewers for data collection. Data quality is assured through training and supervision. Many survey concepts are difficult to translate into African languages and some, such as "household", may have multiple criteria which are not fulfilled by everyone, leading interviewers to prioritise different criteria. Some questions introduce unfamiliar ideas which require considerable negotiation by interviewers to obtain acceptable answers. OBJECTIVE To identify key stages in the data collection process and domains where interviewer judgement and interviewer-respondent social dynamics play a substantial role in determining who is included in household surveys, and in shaping responses to questions. METHODS We analyse published definitions, enumerator manuals and qualitative interview data with households, interviewers, supervisors, trainers, survey organisers and analysts along the chain of data production and use in Tanzania, Uganda, Senegal and Burkina Faso. RESULTS Despite comprehensive training manuals and definitions, interviewers influence who is included in, and excluded from surveys. Interviewer versatility needs to include both persuasive social skills and an ability to follow precise wording. In Africa, where survey concepts are often different from local concepts and where interviewers are socio-economically distant from respondents, these persuasive social skills are required throughout the interview process with unknown impact on the data produced. Language diversity is a major barrier to harmonisation. CONCLUSIONS To improve survey data validity more effort should be made to understand the influence of interviewers on data in low-income settings. COMMENTS This submission covers important issues for demographers undertaking secondary analysis of African surveys, especially those without fieldwork experience

The power of the interviewer: a qualitative perspective on African survey data collection

BACKGROUND African censuses and surveys remain dependent on interviewers for data collection. Data quality is assured through training and supervision. Many survey concepts are difficult to translate into African languages and some, such as “household”, may have multiple criteria which are not fulfilled by everyone, leading interviewers to prioritise different criteria. Some questions introduce unfamiliar ideas which require considerable negotiation by interviewers to obtain acceptable answers. OBJECTIVE To identify key stages in the data collection process and domains where interviewer judgement and interviewer-respondent social dynamics play a substantial role in determining who is included in household surveys, and in shaping responses to questions. METHODS We analyse published definitions, enumerator manuals and qualitative interview data with households, interviewers, supervisors, trainers, survey organisers and analysts along the chain of data production and use in Tanzania, Uganda, Senegal and Burkina Faso. RESULTS Despite comprehensive training manuals and definitions, interviewers influence who is included and excluded from surveys. Interviewer versatility needs to include both persuasive social skills and an ability to follow precise wording. In Africa, where survey concepts are often different from local concepts and where interviewers are socio-economically distant from respondents, these persuasive social skills are required throughout the interview process with unknown impact on the data produced. Language diversity is a major barrier to harmonisation. CONCLUSIONS To improve survey data validity more effort should be made to understand the influence of interviewers on data in low income settings

The dynamic role of household structure on child mortality in southern and eastern sub-Saharan Africa

Households are where children are born and grow up, where they receive essential care, including time, socio-psychological support and economic resources. Households can also change over a child’s life. We consider the dynamic role of household structure in child mortality in South and Eastern Africa using longitudinal data from 16 Health and Demographic Surveillance Systems between 1990 and 2016, covering ~625,000 under-five year olds. We account for household structure as time-varying, using the number of household members by age and sex, and a typology of households, in semi-parametric Cox models estimating the risk of death among under-five year olds. We find that under-five year old children experience on average six changes in household structure. In contrast to expectations, more working aged adults in the household does not reduce the risk of child death. The presence of over 65 year olds in the household adversely affects child survival, likely because they are also dependents, competing for resources. Our findings suggest that (in)stability of households is important to consider in evaluating child survival

The Crucial Role of Mothers and Siblings in Child Survival: Evidence from 29 Health and Demographic Surveillance Systems in Sub-Saharan Africa

There is a considerable body of research on the effects of siblings on child mortality through birth intervals. This research commonly focuses on older siblings. We argue that birth intervals with younger siblings may have equal or stronger effects on child mortality, even during a mother’s pregnancy. Moreover, we contend that birth interval effects need to be considered only when siblings are co-resident. Using longitudinal data from 29 Health and Demographic Surveillance Systems across sub-Saharan Africa, covering over 560,000 children, we examine the proximate role of siblings and mothers in child mortality. We find that a minimum 24-month birth interval is advantageous between both older and younger siblings. The effect of a younger sibling on child mortality is more pronounced and is present in addition to that of an older sibling. Moreover, child mortality is further found to be particularly low during a mother’s subsequent pregnancy, contrasting the shock resulting from a younger sibling’s birth. Further, we find that when a mother or sibling is absent from the household there is a higher risk of mortality, and the death of either reduces child survival up to six months before the death

Performance-based financing to increase utilization of maternal health services: Evidence from Burkina Faso

Performance-based financing (PBF) programs are increasingly implemented in low and middle-income countries to improve health service quality and utilization. In April 2011, a PBF pilot program was launched in Boulsa, Leo and Titao districts in Burkina Faso with the objective of increasing the provision and quality of maternal health services. We evaluate the impact of this program using facility-level administrative data from the national health management information system (HMIS). Primary outcomes were the number of antenatal care visits, the proportion of antenatal care visits that occurred during the first trimester of pregnancy, the number of institutional deliveries and the number of postnatal care visits. To assess program impact we use a difference-in-differences approach, comparing changes in health service provision post-introduction with changes in matched comparison areas. All models were estimated using ordinary least squares (OLS) regression models with standard errors clustered at the facility level. On average, PBF facilities had 2.3 more antenatal care visits (95% CI [0.446–4.225]), 2.1 more deliveries (95% CI [0.034–4.069]) and 9.5 more postnatal care visits (95% CI [6.099, 12.903]) each month after the introduction of PBF. Compared to the service provision levels prior to the interventions, this implies a relative increase of 27.7 percent for ANC, of 9.2 percent for deliveries, and of 118.7 percent for postnatal care. Given the positive results observed during the pre-pilot period and the limited resources available in the health sector, the PBF program in Burkina Faso may be a low-cost, high impact intervention to improve maternal and child health