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Comparative Study
. 2019 Jun;9(1):010901.
doi: 10.7189/jogh.09.010901.

"Every Newborn-INDEPTH" (EN-INDEPTH) study protocol for a randomised comparison of household survey modules for measuring stillbirths and neonatal deaths in five Health and Demographic Surveillance sites

Angela Baschieri  1 , Vladimir S Gordeev  1 , Joseph Akuze  1   2   3 , Doris Kwesiga  2   3 , Hannah Blencowe  1 , Simon Cousens  1 , Peter Waiswa  2   3 , Ane B Fisker  4   5   6 , Sanne M Thysen  4   5   7 , Amabelia Rodrigues  4 , Gashaw A Biks  8 , Solomon M Abebe  8 , Kassahun A Gelaye  8 , Mezgebu Y Mengistu  8 , Bisrat M Geremew  8 , Tadesse G Delele  8 , Adane K Tesega  8 , Temesgen A Yitayew  8 , Simon Kasasa  2   9 , Edward Galiwango  2   9 , Davis Natukwatsa  2   9 , Dan Kajungu  2   9 , Yeetey Ak Enuameh  10   11 , Obed E Nettey  11 , Francis Dzabeng  11 , Seeba Amenga-Etego  11 , Sam K Newton  10   11 , Alexander A Manu  11 , Charlotte Tawiah  11 , Kwaku P Asante  11 , Seth Owusu-Agyei  1   12   13 , Nurul Alam  14 , M M Haider  14 , Sayed S Alam  14 , Fred Arnold  15 , Peter Byass  16 , Trevor N Croft  15 , Kobus Herbst  17 , Sunita Kishor  18 , Florina Serbanescu  19 , Joy E Lawn  1
Affiliations
Comparative Study

"Every Newborn-INDEPTH" (EN-INDEPTH) study protocol for a randomised comparison of household survey modules for measuring stillbirths and neonatal deaths in five Health and Demographic Surveillance sites

Angela Baschieri et al. J Glob Health. 2019 Jun.

Abstract

Background: Under-five and maternal mortality were halved in the Millennium Development Goals (MDG) era, with slower reductions for 2.6 million neonatal deaths and 2.6 million stillbirths. The Every Newborn Action Plan aims to accelerate progress towards national targets, and includes an ambitious Measurement Improvement Roadmap. Population-based household surveys, notably Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys, are major sources of population-level data on child mortality in countries with weaker civil registration and vital statistics systems, where over two-thirds of global child deaths occur. To estimate neonatal/child mortality and pregnancy outcomes (stillbirths, miscarriages, birthweight, gestational age) the most common direct methods are: (1) the standard DHS-7 with Full Birth History with additional questions on pregnancy losses in the past 5 years (FBH+) or (2) a Full Pregnancy History (FPH). No direct comparison of these two methods has been undertaken, although descriptive analyses suggest that the FBH+ may underestimate mortality rates particularly for stillbirths.

Methods: This is the protocol paper for the Every Newborn-INDEPTH study (INDEPTH Network, International Network for the Demographic Evaluation of Populations and their Health Every Newborn, Every Newborn Action Plan), aiming to undertake a randomised comparison of FBH+ and FPH to measure pregnancy outcomes in a household survey in five selected INDEPTH Network sites in Africa and South Asia (Bandim in urban and rural Guinea-Bissau; Dabat in Ethiopia; IgangaMayuge in Uganda; Kintampo in Ghana; Matlab in Bangladesh). The survey will reach >68 000 pregnancies to assess if there is ≥15% difference in stillbirth rates. Additional questions will capture birthweight, gestational age, birth/death certification, termination of pregnancy and fertility intentions. The World Bank's Survey Solutions platform will be tailored for data collection, including recording paradata to evaluate timing. A mixed methods assessment of barriers and enablers to reporting of pregnancy and adverse pregnancy outcomes will be undertaken.

Conclusions: This large-scale study is the first randomised comparison of these two methods to capture pregnancy outcomes. Results are expected to inform the evidence base for survey methodology, especially in DHS, regarding capture of stillbirths and other outcomes, notably neonatal deaths, abortions (spontaneous and induced), birthweight and gestational age. In addition, this study will inform strategies to improve health and demographic surveillance capture of neonatal/child mortality and pregnancy outcomes.

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Conflict of interest statement

Competing interests: The authors completed the Unified Competing Interest form at www.icjme.org/coi_disclosure.pdf (available upon request from the corresponding author), and declare no conflicts of interest.

Figures

Figure 1
Figure 1
Pregnancy outcomes and neonatal deaths with definitions for international comparison. From [11]. Pregnancy outcomes include miscarriage, stillbirth, termination of pregnancy, gestational age at birth and birthweight. This figure does not include induced termination of pregnancy which are defined as an induced termination of pregnancy by medical or surgical means and this definition be different in countries depending on their law and regulations.
Figure 2
Figure 2
Two DHS alternative approaches to estimate neonatal mortality rates and stillbirth rates. Panel A. Full Birth History (FBH+) and Full Pregnancy History (FPH) approaches used to collect pregnancy outcomes including stillbirth and neonatal death. DHS-6 and DHS-5 also collected similar information with a Full Birth History, but information on pregnancies not resulting in a live birth were collected in the reproductive calendar only. The new design of DHS-7 questionnaire has additional questions inserted in the questionnaire after the Full Birth History to capture this information. Panel B. Data capture by FBH+ and FPH methodologies.
Figure 3
Figure 3
Map showing the location of the EN-INDEPTH study HDSS sites. Total fertility rate (TFR) for women ages 15-49; neonatal mortality rate (NMR) per 1000 live births; stillbirth rate (SBR) per 1000 live births. More detailed information on study HDSS sites: Bandim (http://www.indepth-network.org/member-centres/bandim-hdss); Dabat (http://www.indepth-network.org/member-centres/dabat-hdss); Iganga-Mayuge (http://www.indepth-network.org/member-centres/igangamayuge); Kintampo (http://www.indepth-network.org/member-centres/kintampo-hdss); Matlab (http://www.indepth-network.org/member-centres/matlab-hdss). Asterisk: Bandim – children/pregnancies only followed prospectively; TFR estimated by cumulative birth hazards (Nelson Ahlen) as observed for specific age bands between 2012-16 extrapolated to age span 15-50 years; SBR, NMR estimated among registered pregnancies ending in 2012-16.
Figure 4
Figure 4
EN-INDEPTH Data Collection and Flow.
See this image and copyright information in PMC

References

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