Randomised comparison of two household survey modules for measuring stillbirths and neonatal deaths in five countries: the Every Newborn-INDEPTH study

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  • Joseph Akuze, London School of Hygiene and Tropical Medicine, Makerere University
  • ,
  • Hannah Blencowe, London School of Hygiene and Tropical Medicine
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  • Peter Waiswa, Makerere University, Karolinska Institutet
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  • Angela Baschieri, London School of Hygiene and Tropical Medicine
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  • Vladimir S. Gordeev, London School of Hygiene and Tropical Medicine, Queen Mary University of London
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  • Doris Kwesiga, Makerere University
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  • Ane B. Fisker, Bandim Health Project, Statens Serum Institut, Odense Patient Data Explorative Network, University of Southern Denmark
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  • Sanne M. Thysen, Bandim Health Project, Guinea-Bissau, Statens Seruminstitut
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  • Amabelia Rodrigues, Bandim Health Project
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  • Gashaw A. Biks, Gondar University
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  • Solomon M. Abebe, Gondar University
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  • Kassahun A. Gelaye, Gondar University
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  • Mezgebu Y. Mengistu, Gondar University
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  • Bisrat M. Geremew, Gondar University
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  • Tadesse G. Delele, Gondar University
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  • Adane K. Tesega, Gondar University
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  • Temesgen A. Yitayew, Gondar University
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  • Simon Kasasa, Makerere University, IgangaMayuge Health and Demographic Surveillance System
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  • Edward Galiwango, IgangaMayuge Health and Demographic Surveillance System
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  • Davis Natukwatsa, IgangaMayuge Health and Demographic Surveillance System
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  • Dan Kajungu, IgangaMayuge Health and Demographic Surveillance System
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  • Yeetey AK Enuameh, Kwame Nkrumah University of Science and Technology, Kintampo Health Research Centre
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  • Obed E. Nettey, Kintampo Health Research Centre
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  • Francis Dzabeng, Kintampo Health Research Centre
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  • Seeba Amenga-Etego, Kintampo Health Research Centre
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  • Sam K. Newton, Kwame Nkrumah University of Science and Technology, Kintampo Health Research Centre
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  • Charlotte Tawiah, Kintampo Health Research Centre
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  • Kwaku P. Asante, Kintampo Health Research Centre
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  • Seth Owusu-Agyei, London School of Hygiene and Tropical Medicine, Kintampo Health Research Centre, University of Health and Allied Sciences
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  • Nurul Alam, Health Systems and Population Studies Division
  • ,
  • Moinuddin M. Haider, Health Systems and Population Studies Division
  • ,
  • Ali Imam, Health Systems and Population Studies Division
  • ,
  • Kaiser Mahmud, Health Systems and Population Studies Division
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  • Simon Cousens, London School of Hygiene and Tropical Medicine
  • ,
  • Joy E. Lawn, London School of Hygiene and Tropical Medicine
  • ,
  • The Every Newborn-INDEPTH Study Collaborative Group

Background: An estimated 5·1 million stillbirths and neonatal deaths occur annually. Household surveys, most notably the Demographic and Health Survey (DHS), run in more than 90 countries and are the main data source from the highest burden regions, but data-quality concerns remain. We aimed to compare two questionnaires: a full birth history module with additional questions on pregnancy losses (FBH+; the current DHS standard) and a full pregnancy history module (FPH), which collects information on all livebirths, stillbirths, miscarriages, and neonatal deaths. Methods: Women residing in five Health and Demographic Surveillance System sites within the INDEPTH Network (Bandim in Guinea-Bissau, Dabat in Ethiopia, IgangaMayuge in Uganda, Matlab in Bangladesh, and Kintampo in Ghana) were randomly assigned (individually) to be interviewed using either FBH+ or FPH between July 28, 2017, and Aug 13, 2018. The primary outcomes were stillbirths and neonatal deaths in the 5 years before the survey interview (measured by stillbirth rate [SBR] and neonatal mortality rate [NMR]) and mean time taken to complete the maternity history section of the questionnaire. We also assessed between-site heterogeneity. This study is registered with the Research Registry, 4720. Findings: 69 176 women were allocated to be interviewed by either FBH+ (n=34 805) or FPH (n=34 371). The mean time taken to complete FPH (10·5 min) was longer than for FBH+ (9·1 min; p<0·0001). Using FPH, the estimated SBR was 17·4 per 1000 total births, 21% (95% CI −10 to 62) higher than with FBH+ (15·2 per 1000 total births; p=0·20) in the 5 years preceding the survey interview. There was strong evidence of between-site heterogeneity (I2=80·9%; p<0·0001), with SBR higher for FPH than for FBH+ in four of five sites. The estimated NMR did not differ between modules (FPH 25·1 per 1000 livebirths vs FBH+ 25·4 per 1000 livebirths), with no evidence of between-site heterogeneity (I2=0·7%; p=0·40). Interpretation: FPH takes an average of 1·4 min longer to complete than does FBH+, but has the potential to increase reporting of stillbirths in high burden contexts. The between-site heterogeneity we found might reflect variations in interviewer training and survey implementation, emphasising the importance of interviewer skills, training, and consistent implementation in data quality. Funding: Children's Investment Fund Foundation.

OriginalsprogEngelsk
TidsskriftThe Lancet Global Health
Vol/bind8
Nummer4
Sider (fra-til)e555-e566
ISSN2214-109X
DOI
StatusUdgivet - apr. 2020

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