Characteristics of non-response in the Danish Health Interview Surveys, 1987-1994

BACKGROUND: The types and quantity of non-response in surveys influence the extent to which the results may be generalized. This study analysed trends in non-response in the Danish Health Interview Surveys from 1987 to 1994 and used the National Patient Registry to assess whether non-response biased the estimated population prevalence of morbidity when solely based on responders. METHODS: The data were for the 23,096 adults sampled for the Danish Health Interview Surveys in 1987, 1991 and 1994. All were followed using the National Patient Registry to obtain such information as hospital admissions. RESULTS: Non-response increased from 20.0% in 1987 to 22.6% in 1994. Four combinations of background variables characterized the non-response: gender and age; gender and civil status; county of residence and age; survey year and age. Non-respondents and respondents had identical gender- and age-standardized hospital admission rates for approximately 5 years before and 2 years after data collection, but non-respondents had a significantly higher rate immediately before and during data collection. Admissions rates were analysed according to reasons for non-response. Refusers had a lower admission rate than respondents before data collection but similar during and after data collection. The rate was higher during the whole period among ill or disabled non-respondents. Among people who could not be contacted during the data collection period a higher admission rate was only found immediately before and during data collection. CONCLUSIONS: Although admission rates differed between respondents and non-respondents these differences were too small to bias the estimated population prevalence of morbidity when solely based on respondents.     

Utilization of village midwives and other trained delivery attendants for home deliveries in Indonesia: results of Indonesia Demographic and Health Survey 2002/2003 and 2007

This study aimed to examine factors associated with utilization of village midwife and other trained delivery attendants for home deliveries. Information from 14,672 cases of the most recent home deliveries of mothers in the 5 year-period prior to the Indonesia Demographic and Health Survey 2002/2003 and 2007 were analysed. Multinomial logistic regression analysis was performed. The association between 26 factors categorised into external environment, predisposing, enabling, need and previous utilization of maternal health services, and utilization of village midwife and other trained delivery attendants, such as nurses, other midwives and doctors, for home deliveries was examined. The population attributable risk of selected significant predictors was calculated. The odds of using village midwives and other trained delivery attendants at childbirth for home deliveries increased with increasing household wealth index and levels of parental education. The odds increased among first birth, mothers who were exposed to mass media, mothers with knowledge of delivery complications, and mothers who had any delivery complications. However, mothers who attended less than four antenatal care visits, who had high parity, or who reported distance and transportation to health facilities was a major problem, had significantly reduced odds for utilizing any trained delivery attendants. Health promotion strategies to raise community awareness about the importance of safe delivery should target low educated parents, mothers from low household economic status, as well as high parity mothers. Efforts to promote antenatal care visits are likely to increase utilization of trained delivery attendants for home deliveries in Indonesia.     

Factors associated with underutilization of antenatal care services in Indonesia: results of Indonesia Demographic and Health Survey 2002/2003 and 2007

Background  

Antenatal care aims to prevent maternal and perinatal mortality and morbidity. In Indonesia, at least four antenatal visits are recommended during pregnancy. However, this service has been underutilized. This study aimed to examine factors associated with underutilization of antenatal care services in Indonesia.     

Maternal characteristics associated with place of delivery and neonatal mortality rates among very-low-birthweight infants,Georgia

To determine whether the Healthy People 2000 objective to deliver very-low-birthweight (VLBW) infants at subspecialty perinatal care centres was met, and if improvements in the regional perinatal care system could reduce neonatal mortality further for 2010, we examined place of delivery for VLBW infants, associated maternal characteristics and the potential impact on neonatal mortality. We used linked birth and death records for the 1994-96 Georgia VLBW (i.e. 500-1499 g) birth cohorts. Among 4770 VLBW infants, 77% were delivered at hospitals providing subspecialty perinatal care. The strongest predictor of birth hospital level was the mother's county of residence, defined using three levels: residence in a county with a subspecialty hospital, residence in a county adjacent to one with such a hospital or residence in a non-adjacent county. Eighty-nine per cent of infants born to women who resided in counties with subspecialty care hospitals delivered at such hospitals, compared with 53% of infants born to women who resided in a non-adjacent county. Women were also more likely to deliver outside subspecialty care if they had less than adequate prenatal care [adjusted odds ratio (AOR) 1.5, P-value = 0.0001]. The neonatal mortality rate varied by level of perinatal care at the birth hospital from 132.1/1000 to 283/1000 live births, with the highest death rate for infants born at hospitals offering the lowest level of care. Assuming that the differences in mortality were due to care level of the birth hospital, potentially 16-23% of neonatal deaths among VLBW infants could have been prevented if 90% of infants born outside subspecialty care were delivered at the recommended level. These findings suggest that a state's support of strong, collaborative, regional perinatal care networks is required to ensure that high-risk women and infants receive optimal health care. Improved access to recommended care levels should further reduce neonatal mortality until interventions are identified to prevent VLBW births.     

Determinants of Optimal Breastfeeding Practices in Indonesia: Findings From the 2017 Indonesia Demographic Health Survey

ObjectivesUnderstanding the factors influencing mothers’ decision to breastfeed their infants is essential to formulate effective breastfeeding interventions. This study explored the determinants of optimal breastfeeding indicators in Indonesia.MethodsWe used the 2017 Indonesia Demographic and Health Survey to analyze factors associated with early initiation of breastfeeding, exclusive breastfeeding (EBF), and continued breastfeeding at 1 year (CBF-1) and 2 years (CBF-2). Multivariate logistic regression models were used to examine bio-demographic, socio-cultural, and behavioral characteristics associated with breastfeeding after considering the survey design effect.ResultsThe risk of delayed breastfeeding initiation was higher among infants who were born smaller, first-born children, were delivered via cesarean delivery, and did not have immediate skin-to-skin contact (p<0.01). Infant’s age, birth pattern, household wealth index, and the mother’s occupation and smoking status were predictors of EBF (p<0.05). CBF-1 was less common among first-time mothers and those working in the non-agricultural sector, mothers from wealthier families, and mothers who had cesarean deliveries (p<0.01). Infant’s age was negatively associated with CBF-2 (adjusted odds ratio [aOR], 0.85; 95% confidence interval [CI], 0.74 to 0.99). Mothers attending college were less likely to practice CBF-2 than those with no education or primary education (aOR, 0.45; 95% CI, 0.26 to 0.77). The absence of postnatal visits was a risk factor for CBF-1 and CBF-2 (p<0.05).ConclusionsBreastfeeding interventions in Indonesia should pay particular attention to at-risk groups such as women from wealthier families, working outside the agricultural sector, and with a higher education level. Nutrition-sensitive programs (e.g., postnatal care and smoking cessation) should also be encouraged.     

HIV testing in national population-based surveys: experience from the Demographic and Health Surveys

OBJECTIVES: To describe the methods used in the Demographic and Health Surveys (DHS) to collect nationally representative data on the prevalence of human immunodeficiency virus (HIV) and assess the value of such data to country HIV surveillance systems. METHODS: During 2001-04, national samples of adult women and men in Burkina Faso, Cameroon, Dominican Republic, Ghana, Mali, Kenya, United Republic of Tanzania and Zambia were tested for HIV. Dried blood spot samples were collected for HIV testing, following internationally accepted ethical standards. The results for each country are presented by age, sex, and urban versus rural residence. To estimate the effects of non-response, HIV prevalence among non-responding males and females was predicted using multivariate statistical models for those who were tested, with a common set of predictor variables. RESULTS: Rates of HIV testing varied from 70% among Kenyan men to 92% among women in Burkina Faso and Cameroon. Despite large differences in HIV prevalence between the surveys (1-16%), fairly consistent patterns of HIV infection were observed by age, sex and urban versus rural residence, with considerably higher rates in urban areas and in women, especially at younger ages. Analysis of non-response bias indicates that although predicted HIV prevalence tended to be higher in non-tested males and females than in those tested, the overall effects of non-response on the observed national estimates of HIV prevalence are insignificant. CONCLUSIONS: Population-based surveys can provide reliable, direct estimates of national and regional HIV seroprevalence among men and women irrespective of pregnancy status. Survey data greatly enhance surveillance systems and the accuracy of national estimates in generalized epidemics.     

Assessing the quality of cesarean birth data in the Demographic and Health Surveys

Cesarean section surgery is the clinical response used to prevent several of the leading causes of maternal and perinatal mortality and morbidity. Given the deficient state of health-information systems in most developing countries, nationally representative surveys are currently the most widely available source of population-based cesarean birth data. The purpose of this study is to assess the quality and internal consistency of Demographic and Health Survey cesarean birth data across countries and time periods. Although these surveys are highly standardized, the formulation of the question on cesarean birth and the categories of women who are asked the question often differ across surveys. A skip pattern that restricts the cesarean question to women who delivered in a health-care facility improves the internal consistency of the data, although in some countries cesarean deliveries are still reported at low-level, presumably nonsurgical facilities. Recommendations are made for improving data analysis and the future collection of population-based cesarean birth data.     

Availability and quality of global disability data: A commentary on the Demographic and Health Surveys

In the field of global health, there are very little data available regarding disability. Global health datasets including disability indicators operationalize the term disability in a variety of ways, making calculating global trends and cross-country comparisons by researchers difficult. The Washington Group on Disability Statistics has developed easily implemented questionnaires regarding disability to increase the availability of disability data. In 2014, the Demographic and Health Surveys program developed a disability data collection module based on the Washington Group Short Set of Questions. It is an optional module and has been implemented in fewer than 20 countries. Some countries had made adjustments to the questions while other countries have included disability using completely different questionnaires. This doesn’t solve the problem of data consistency and cross-country comparison. Based on the data collected, there are also concerns regarding the quality of the available data and how the data is being collected.     

An atlas of suicide mortality: England and Wales, 1988-1994

The incidence of suicide exhibits marked geographic variability; however, documentation of features in its spatial distribution, or the magnitude of differences, is limited. Standardised mortality ratios, commonly presented in maps, are calculated in each area independently and incorporate no information about heterogeneity or clustering. Bayesian hierarchical models with random effects for between-area and local variability in neighbouring areas were used to map age- and sex-specific estimates of rate ratios of suicide across wards in England and Wales. Differences were greater than expected due to random variation alone. Although the geography of suicide differed across age/sex groups, some common patterns emerged e.g. high rates in (a) central parts of cities and (b) remote and coastal areas. Some features were common to all, while others appeared male specific or specific to the younger age group. Suicide prevention strategies can be informed by an understanding and addressing the geography of suicide.     

Indigenous round houses versus 'healthy houses': Health, place and identity among the Dawan of West Timor, Indonesia

Qualitative research was undertaken among Dawan people living in Fatumnasi, West Timor, to investigate the reasons for the Dawan's retention of traditional houses, ume kbubu, in the face of a national development campaign to introduce modern, "healthy" homes (rumah sehat). Indoor smoke pollution from internal fires and poor ventilation is believed to contribute to poor respiratory health among this population. The study explored Dawan cultural constructions of health to find that ume kbubu are fundamental to the Dawan's sense of psychosocial well-being and ethnic identity. While rumah sehat are associated with prosperity, public image and social status they do not provide the warmth, security and emotional nurturance that the Dawan perceive as necessary for optimum health and to protect them from disease.