Barriers and enablers to reporting pregnancy and adverse pregnancy outcomes in population-based surveys: EN-INDEPTH study

Kwesiga, Doris; Tawiah, Charlotte; Imam, Md. Ali; Tesega, Adane K; Nareeba, Tryphena; Enuameh, Yeetey; Biks, Gashaw Andargie; Manu, Grace; Beedle, Alexandra; Delwar, Nafisa; Fisker, Ane Bærent; Waiswa, Peter; Lawn, Joy E; Blencowe, Hannah

doi:10.1186/s12963-020-00228-x

Cited by 29 publications

(29 citation statements)

References 43 publications

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“…Additionally, persistent stigma associated with neonatal deaths and, in particular, stillbirths across many LMIC and HIC settings can undermine collection and analysis of survey data [47]. Detailed qualitative analysis of barriers to reporting stillbirths and neonatal deaths within household surveys are reported elsewhere in this series [48], and we highlight this here again as an important gap in data collection for maternal and newborn health.…”

Section: Completeness and Data Quality Of Questions In Measuring Pregmentioning

confidence: 93%

Pregnancy intention data completeness, quality and utility in population-based surveys: EN-INDEPTH study

Yargawa

Machiyama

Hardy

et al. 2021

Popul Health Metrics

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Background An estimated 40% of pregnancies globally are unintended. Measurement of pregnancy intention in low- and middle-income countries relies heavily on surveys, notably Demographic and Health Surveys (DHS), yet few studies have evaluated survey questions. We examined questions for measuring pregnancy intention, which are already in the DHS, and additional questions and investigated associations with maternity care utilisation and adverse pregnancy outcomes. Methods The EN-INDEPTH study surveyed 69,176 women of reproductive age in five Health and Demographic Surveillance System sites in Ghana, Guinea-Bissau, Ethiopia, Uganda and Bangladesh (2017–2018). We investigated responses to survey questions regarding pregnancy intention in two ways: (i) pregnancy-specific intention and (ii) desired-versus-actual family size. We assessed data completeness for each and level of agreement between the two questions, and with future fertility desire. We analysed associations between pregnancy intention and number and timing of antenatal care visits, place of delivery, and stillbirth, neonatal death and low birthweight. Results Missing data were <2% in all questions. Responses to pregnancy-specific questions were more consistent with future fertility desire than desired-versus-actual family size responses. Using the pregnancy-specific questions, 7.4% of women who reported their last pregnancy as unwanted reported wanting more children in the future, compared with 45.1% of women in the corresponding desired family size category. Women reporting unintended pregnancies were less likely to attend 4+ antenatal care visits (aOR 0.73, 95% CI 0.64–0.83), have their first visit during the first trimester (aOR 0.71, 95% CI 0.63–0.79), and report stillbirths (aOR 0.57, 95% CI 0.44–0.73) or neonatal deaths (aOR 0.79, 95% CI 0.64–0.96), compared with women reporting intended pregnancies. We found no associations for desired-versus-actual family size intention. Conclusions We found the pregnancy-specific intention questions to be a much more reliable assessment of pregnancy intention than the desired-versus-actual family size questions, despite a reluctance to report pregnancies as unwanted rather than mistimed. The additional questions were useful and may complement current DHS questions, although these are not the only possibilities. As women with unintended pregnancies were more likely to miss timely and frequent antenatal care, implementation research is required to improve coverage and quality of care for those women.

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Section: Completeness and Data Quality Of Questions In Measuring Pregmentioning

confidence: 93%

Pregnancy intention data completeness, quality and utility in population-based surveys: EN-INDEPTH study

Yargawa

Machiyama

Hardy

et al. 2021

Popul Health Metrics

Self Cite

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“…This is due to the sensitive nature of pregnancy information. Unmarried women may be more vulnerable to stigma or not ready to disclose an out-of-wedlock pregnancy 53 .…”

Section: Discussionmentioning

confidence: 99%

“…Unmarried women may be more vulnerable to stigma or not ready to disclose an out-of-wedlock pregnancy 53 . There may be shame around having an unplanned pregnancy; for women who are at risk of pregnancy loss due to their age, they may want to avoid the shame that can accompany pregnancy loss, or being suspected of having terminated the pregnancy 53 . Unmarried women are likely to be young and at higher risk of adverse pregnancy outcomes 54 .…”

Section: Discussionmentioning

confidence: 99%

Pregnancy Surveillance Methods within Health and Demographic Surveillance Systems

et al. 2021

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Background: Pregnancy identification and follow-up surveillance can enhance the reporting of pregnancy outcomes, including stillbirths and perinatal and early postnatal mortality. This paper reviews pregnancy surveillance methods used in Health and Demographic Surveillance Systems (HDSSs) in low- and middle-income countries. Methods: We searched articles containing information about pregnancy identification methods used in HDSSs published between January 2002 and October 2019 using PubMed and Google Scholar. A total of 37 articles were included through literature review and 22 additional articles were identified via manual search of references. We reviewed the gray literature, including websites, online reports, data collection instruments, and HDSS protocols from the Child Health and Mortality Prevention Study (CHAMPS) Network and the International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH). In total, we reviewed information from 52 HDSSs described in 67 sources. Results: Substantial variability exists in pregnancy surveillance approaches across the 52 HDSSs, and surveillance methods are not always clearly documented. 42% of HDSSs applied restrictions based on residency duration to identify who should be included in surveillance. Most commonly, eligible individuals resided in the demographic surveillance area (DSA) for at least three months. 44% of the HDSSs restricted eligibility for pregnancy surveillance based on a woman’s age, with most only monitoring women 15-49 years. 10% had eligibility criteria based on marital status, while 11% explicitly included unmarried women in pregnancy surveillance. 38% allowed proxy respondents to answer questions about a woman’s pregnancy status in her absence. 20% of HDSSs supplemented pregnancy surveillance with investigations by community health workers or key informants and by linking HDSS data with data from antenatal clinics. Conclusions: Methodological guidelines for conducting pregnancy surveillance should be clearly documented and meticulously implemented, as they can have implications for data quality and accurately informing maternal and child health programs.

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“…Focus group discussions (FGDs) with survey respondents and interviewers, and a survey of interviewers were performed in March-August 2018 [33]. Information on perceptions, practices, and barriers relating to knowledge and reporting of GA was collected.…”

Section: Measuring Gestational Age After Birthmentioning

confidence: 99%

“…To understand community perceptions and barriers related to GA reporting in household surveys, 29 focus group discussions (FGDs) were undertaken with 172 survey respondents and 82 survey interviewers and supervisors (Additional file 6) [33]. Thematic analysis to identify community perceptions, practices and barriers to reporting GA was conducted in NViVo 12 using an iterative process guided by an a priori codebook and addition of new codes that emerged during analysis.…”

Section: Data Analysesmentioning

confidence: 99%

Gestational age data completeness, quality and validity in population-based surveys: EN-INDEPTH study

Haider

Mahmud

Blencowe

et al. 2021

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Background Preterm birth (gestational age (GA) <37 weeks) is the leading cause of child mortality worldwide. However, GA is rarely assessed in population-based surveys, the major data source in low/middle-income countries. We examined the performance of new questions to measure GA in household surveys, a subset of which had linked early pregnancy ultrasound GA data. Methods The EN-INDEPTH population-based survey of 69,176 women was undertaken (2017-2018) in five Health and Demographic Surveillance System sites in Bangladesh, Ethiopia, Ghana, Guinea-Bissau and Uganda. We included questions regarding GA in months (GAm) for all women and GA in weeks (GAw) for a subset; we also asked if the baby was ‘born before expected’ to estimate preterm birth rates. Survey data were linked to surveillance data in two sites, and to ultrasound pregnancy dating at <24 weeks in one site. We assessed completeness and quality of reported GA. We examined the validity of estimated preterm birth rates by sensitivity and specificity, over/under-reporting of GAw in survey compared to ultrasound by multinomial logistic regression, and explored perceptions about GA and barriers and enablers to its reporting using focus group discussions (n = 29). Results GAm questions were almost universally answered, but heaping on 9 months resulted in underestimation of preterm birth rates. Preference for reporting GAw in even numbers was evident, resulting in heaping at 36 weeks; hence, over-estimating preterm birth rates, except in Matlab where the peak was at 38 weeks. Questions regarding ‘born before expected’ were answered but gave implausibly low preterm birth rates in most sites. Applying ultrasound as the gold standard in Matlab site, sensitivity of survey-GAw for detecting preterm birth (GAw <37) was 60% and specificity was 93%. Focus group findings suggest that women perceive GA to be important, but usually counted in months. Antenatal care attendance, women’s education and health cards may improve reporting. Conclusions This is the first published study assessing GA reporting in surveys, compared with the gold standard of ultrasound. Reporting GAw within 5 years’ recall is feasible with high completeness, but accuracy is affected by heaping. Compared to ultrasound-GAw, results are reasonably specific, but sensitivity needs to be improved. We propose revised questions based on the study findings for further testing and validation in settings where pregnancy ultrasound data and/or last menstrual period dates/GA recorded in pregnancy are available. Specific training of interviewers is recommended.

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Barriers and enablers to reporting pregnancy and adverse pregnancy outcomes in population-based surveys: EN-INDEPTH study

Cited by 29 publications

References 43 publications

Pregnancy intention data completeness, quality and utility in population-based surveys: EN-INDEPTH study

Pregnancy intention data completeness, quality and utility in population-based surveys: EN-INDEPTH study

Pregnancy Surveillance Methods within Health and Demographic Surveillance Systems

Gestational age data completeness, quality and validity in population-based surveys: EN-INDEPTH study

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