Objectives and methods of a world health survey

Many developing countries are trying to improve the routine collection of health information by strengthening surveys, censuses, and registration systems. At the international level, too, efforts are underway to provide information on health and health interventions, including statistical reporting programs of the U.N. and the World Bank. In view of the limited financial resources in the developing countries, would a world health survey complement these health information systems and contribute to long-term health care? This paper finds that although a series of coordinated country health studies could be valuable, there are many tradeoffs. Considering the variety of health problems and priorities in developing countries, it is probably more important to develop the expertise to conduct and analyze health studies than to devise a standard questionnaire to collect health data. As for the cost effectiveness of health programs, a world health survey is not the appropriate vehicle for such evaluations, but it could address such concerns as access, coverage, patient costs, and financing systems.Health Monitoring&Evaluation,Health Systems Development&Reform,Agricultural Knowledge&Information Systems,Housing&Human Habitats,Gender and Health

Measuring adult mortality in developing countries : a review and assessment of methods

In most developing countries, data collection methods in the civil registration system and health services are woefully inadequate and methods for adjusting them apply only at the national level. The authors argue that the best way to collect data on adult mortality is probably to combine sample community based health reporting systems and singleround surveys in which respondents are asked about the survival of various relatives. The method's main limitation is that it provides rather broad, nonspecific measures of mortality - but these are adequate for allocation of resources, which is likely to be affected only by large differences.Health Monitoring&Evaluation,Demographics,Health Systems Development&Reform,Health Economics&Finance,Adolescent Health

Contraceptive use and lengthening birth intervals in rural and urban Eastern Africa

BACKGROUND The transition towards low fertility has been slow in sub-Saharan Africa. Although increasing numbers of women are now using contraception, levels of unmet need for contraception remain high. And yet the dynamics of fertility are changing: national estimates have documented significant lengthening of birth intervals across the region. OBJECTIVE The aim of this paper is to explore trends in birth interval length by residence in Ethiopia, Kenya, Tanzania, and Zimbabwe, and the role of contraception in these changes. METHODS We conducted a birth interval analysis of fertility using up to six Demographic and Health Surveys from each country. We modelled age-order duration-specific period fertility using Poisson regression and calculated median birth interval lengths from the fitted rates using life-table techniques. RESULTS Birth intervals have lengthened in all four countries, most notably Zimbabwe. Urban populations now have median intervals that exceed 35 months in all four countries. The lengthening of birth intervals is associated with, although not limited to, the use of contraception. In urban areas the median birth interval among ever-users of contraception ranges between 52 and 86 months. CONCLUSIONS The increase in the length of birth intervals in Eastern Africa has been concentrated in urban areas. The trend is most pronounced among contraceptive users, but also results from unreported forms of birth control. It might become even more pronounced if access to contraception were improved. CONTRIBUTION We show that lengthening of birth intervals in Eastern Africa has resulted largely from dramatic increases among urban women and women who have ever used contraception

Intra-urban differentials in child health

This paper uses DHS data on the urban populations of Ghana, Egypt, Brazil and Thailand to investigate the effect of poverty and environmental conditions on diarrhoeal disease, nutritional status and survival among children. Differentials in health are moderate in urban Ghana, whereas in Egypt and Brazil reductions in morbidity and, above all, mortality have accrued largely to the better off. In Thailand, the poor fare better and inequalities in mortality are no larger than those in morbidity. Children’s health is affected by environmental conditions as well as by their family’s socio-economic status

Measurement of adult mortality in populations affected by AIDS: an assessment of the orphanhood method

This paper demonstrates that orphanhood data can be used to estimate adult women’s mortality in populations experiencing an epidemic of AIDS. It develops both a correction for selection bias in reports of orphanhood and a revised procedure for estimating life table survivorship for use in populations with significant AIDS mortality. These new methods yield mortality estimates for a Ugandan population that are consistent with those obtained by prospective surveillance. Countries that lack effective death registration systems should ask about the survival of mothers in the census and surveys in order to monitor the effect of the AIDS epidemic on mortality

The Own-Children Method of fertility estimation: The devil is in the detail

BACKGROUND The Own-Children Method is a widely used procedure for estimating levels, trends, and differentials in age-specific and total fertility from the age distribution. OBJECTIVES This article demonstrates that the procedure used in most applications of the Own- Children Method produces systematically biased estimates of the age pattern of fertility and describes a new estimator that avoids this bias. METHODS The Own-Children Method incorporates an adjustment for the proportion of children by age who are not living with their mothers. Because these children include orphans and because women’s mortality accelerates with age, this adjustment overestimates births to young women and underestimates births to older women relative to the number of women in the denominators of the fertility rates. By explicitly estimating the prevalence of maternal orphanhood by age, age-specific fertility can instead be calculated using a formula that avoids this bias. RESULTS The bias in the estimated age pattern of fertility is trivial for rates calculated from children born in the few years before an inquiry, but increases with the age of the children and with the population’s mortality. Its overall impact is to shift the fertility distribution toward younger ages at childbearing. Because the errors for women of different ages more or less cancel each other out, the bias in estimates of total fertility is smaller. CONTRIBUTION The new Own-Children Method estimator of age-specific fertility proposed here eliminates a small but systematic bias in the results produced by the existing procedure. It should enable analysts using the Own-Children Method to measure fertility more accurately in the future

Teenage Childbearing and Educational Attainment in South Africa.

The relationship between teenage childbearing and school attainment is investigated using nationally representative longitudinal data drawn from South Africa's National Income Dynamics Study. The analysis focuses on the outcomes by 2010 of a panel of 673 young women who were aged 15-18 and childless in 2008. Controlling for other factors, girls who went on to give birth had twice the odds of dropping out of school by 2010 and nearly five times the odds of failing to matriculate. Few girls from households in the highest-income quintile gave birth. Girls who attended schools in higher-income areas and were behind at school were much more likely to give birth than those who were in the appropriate grade for their age or were in no-fee schools. New mothers were much more likely to have re-enrolled in school by 2010 if they were rural residents, they belonged to relatively well-off households, or their own mother had attended secondary school. These findings suggest that, in South Africa, interventions that address poor school attainment would also reduce teenage childbearing

The impact of adult mortality on household dissolution and migration in rural South Africa.

OBJECTIVE: To investigate the effect of adult death on household dissolution and migration. DESIGN: Demographic surveillance of the population in a rural area of northern KwaZulu Natal, South Africa. METHODS: Data on households resident in the surveillance area on 1 January 2000 were used to examine the effect of adult mortality and household risk factors on household dissolution and mobility between January 2000 and October 2002. Cox regression models were used to assess the risk of household dissolution and migration, controlling for multiple risk factors including causes of death, household composition and household assets. RESULTS: By October 2002, 238 households (2%) had dissolved and 874 (8%) migrated out of the area; 21% (2179) of all households had at least one adult death (18 years and older). Households where one or more adult members died during the follow-up period were four times more likely to dissolve, after controlling for household and community level risk factors [4.3; 95% confidence interval, (CI), 3.3-5.7]. The risk of dissolution was significantly higher in households with multiple deaths (2.3; 95% CI, 1.3-4.3). There were no significant differential risks associated with cause of death, age or sex of the deceased. Adult mortality in the household was not associated with migration. CONCLUSIONS: Poorer households, as measured by asset ownership, and households trying to cope with adult deaths are vulnerable to dissolution. The dramatic increase in adult mortality attributable to AIDS will increase the number of households that do not survive as a functional and cohesive social group

Unabated rise in number of adult deaths in South Africa

Mortality statistics are a fundamental cornerstone of the health status data needed for planning and monitoring the impact of health programmes. In developed countries, such data are generated through the death registration system, dating back to the 19th century in the case of the UK and Sweden. Until recently, South Africa’s death registration system was recognised as inadequate to provide such statistics for the majority of the population,1 but the postApartheid government has prioritised the collection of such statistics, as evidenced by a new-found collaboration between the Departments of Health and Home Affairs and Statistics South Africa.2 Registration of adult deaths improved from about 50% in 1990 to over 90% in 20003 as a result of the incorporation of the former homelands as well as national efforts to improve coverage. However, the production of timely cause of death statistics remains a challenge; the most recent year with full officially published statistics is 1996