scholarly journals Beyond national indicators: adapting the Demographic and Health Surveys’ sampling strategies and questions to better inform subnational malaria intervention policy

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Ifeoma D. Ozodiegwu ◽  
Monique Ambrose ◽  
Katherine E. Battle ◽  
Caitlin Bever ◽  
Ousmane Diallo ◽  
...  

AbstractIn malaria-endemic countries, prioritizing intervention deployment to areas that need the most attention is crucial to ensure continued progress. Global and national policy makers increasingly rely on epidemiological data and mathematical modelling to help optimize health decisions at the sub-national level. The Demographic and Health Surveys (DHS) Program is a critical data source for understanding subnational malaria prevalence and intervention coverage, which are used for parameterizing country-specific models of malaria transmission. However, data to estimate indicators at finer resolutions are limited, and surveys questions have a narrow scope. Examples from the Nigeria DHS are used to highlight gaps in the current survey design. Proposals are then made for additional questions and expansions to the DHS and Malaria Indicator Survey sampling strategy that would advance the data analyses and modelled estimates that inform national policy recommendations. Collaboration between the DHS Program, national malaria control programmes, the malaria modelling community, and funders is needed to address the highlighted data challenges.

2021 ◽  
Author(s):  
Ndeye Mareme Sougou ◽  
Adama Faye ◽  
Mamadou Makhtar Mbacké Leye ◽  
Oumar Bassoum ◽  
Ibrahima Seck

Abstract Introduction Analysis of the evolution of malaria will help address the determinants of malaria elimination in this country. The aim of this study is to analyze the evolution of malaria in Senegal from 2010 to 2016.MethodsThis article uses data from the Senegalese Demographic and Health Surveys (for 2010-2011, 2012-2013, 2014, 2015 and 2016. To assess the factors associated with the positivity of the RDT, a multivariate logistic analysis was conducted to account for the effect of confounding factors. Adjusted odds ratios were calculated with their 95% confidence intervals. The dependent variable was the result of the Malaria rapid diagnostic test. ResultsThe malaria prevalence rate varies from 3.01% in 2010 to 0.87% in 2016. The risk factors associated with the evolution of malaria were the age of the child (4 years (aOR=1.82 [1.14-2.89]) and 5 years (aOR=1.98 [1.21-3.25]). The richest wealth quintile was a protective factor against malaria with aOR=0.02 [0-0.18]. Other protective factors against malaria were the construction characteristics of the houses. These are houses with improved wall and roof materials with aOR 0.45 [0.24-0.85] and 0.48 [0.25-0.93] respectively.Conclusion Factors associated with the evolution of malaria in Senegal are children’s age, level of wealth of the household and type of dwelling in the house. It should be noted that the level of development of countries, by influencing better living conditions for communities, remains an important prerequisite for the elimination of malaria in the African sub region and in Senegal in particular.


2019 ◽  
Vol 11 (21) ◽  
pp. 2543 ◽  
Author(s):  
Stefanos Georganos ◽  
Assane Niang Gadiaga ◽  
Catherine Linard ◽  
Tais Grippa ◽  
Sabine Vanhuysse ◽  
...  

A systematic and precise understanding of urban socio-economic spatial inequalities in developing regions is needed to address global sustainability goals. At the intra-urban scale, access to detailed databases (i.e., a census) is often a difficult exercise. Geolocated surveys such as the Demographic and Health Surveys (DHS) are a rich alternative source of such information but can be challenging to interpolate at such a fine scale due to their spatial displacement, survey design and the lack of very high-resolution (VHR) predictor variables in these regions. In this paper, we employ satellite-derived VHR land-use/land-cover (LULC) datasets and couple them with the DHS Wealth Index (WI), a robust household wealth indicator, in order to provide city-scale wealth maps. We undertake several modelling approaches using a random forest regressor as the underlying algorithm and predict in several geographic administrative scales. We validate against an exhaustive census database available for the city of Dakar, Senegal. Our results show that the WI was modelled to a satisfactory degree when compared against census data even at very fine resolutions. These findings might assist local authorities and stakeholders in rigorous evidence-based decision making and facilitate the allocation of resources towards the most disadvantaged populations. Good practices for further developments are discussed with the aim of upscaling these findings at the global scale.


2018 ◽  
Vol 15 (1) ◽  
pp. 16-29
Author(s):  
Stella Babalola ◽  
Joshua O. Akinyemi ◽  
Clifford O. Odimegwu

Abstract Nigeria has one of the highest fertility rates in Africa. Data from 2013 Demographic and Health Surveys indicate a virtual stagnation of fertility rate since 2003. Low contraceptive use and pronatalist attitudes are among the factors contributing to the high fertility rate in Nigeria. In this manuscript, we pooled data from three most recent waves of Demographic and Health Surveys to examine trends in demand for children over time and identify the factors associated with change in demand for children. The data show that demand for children has declined since 2003 although not monotonically so. Variables that were positively associated with increased likelihood of desiring no additional children were residence in the South-West (as opposed to residence in the North-Central), exposure to family planning (FP) messages on the mass media, number of children ever born, educational level, and urban residence. In contrast, uncertainty about fertility desire was more widespread in 2008 compared to 2013 although less widespread in 2003 than in 2013. The likelihood of being undecided about fertility desire was positively associated with discrepancies in family size desires between husband and wife, parity and Islamic religious affiliation. Programs should aim to increase access to effective contraceptive methods and promote demand for contraceptives as a way of fostering a sustainable reduction in demand for children. Furthermore, strategies that address uncertainty by fostering women’s understanding of the social and health implications of large family sizes are relevant.


Author(s):  
Nidhi Wali ◽  
Kingsley E. E. Agho ◽  
Andre M. N. Renzaho

Child wasting continues to be a major public health concern in South Asia, having a prevalence above the emergency threshold. This paper aimed to identify factors associated with wasting among children aged 0–23 months, 24–59 months, and 0–59 months in South Asia. A weighted sample of 564,518 children aged 0–59 months from the most recent demographic and health surveys (2014–2018) of five countries in South Asia was combined. Multiple logistic regression analyses that adjusted for clustering and sampling weights were used to examine associated factors. Wasting prevalence was higher for children aged 0–23 months (25%) as compared to 24–59 months (18%), with variations in prevalence across the South Asian countries. The most common factor associated with child wasting was maternal BMI [adjusted odds ratio (AOR) for 0–23 months = 2.02; 95% CI: (1.52, 2.68); AOR for 24–59 months = 2.54; 95% CI: (1.83, 3.54); AOR for 0–59 months = 2.18; 95% CI: (1.72, 2.77)]. Other factors included maternal height and age, household wealth index, birth interval and order, children born at home, and access to antenatal visits. Study findings suggest need for nutrition specific and sensitive interventions focused on women, as well as adolescents and children under 2 years of age.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Betregiorgis Zegeye ◽  
Gebretsadik Shibre ◽  
Gashaw Garedew Woldeamanuel

Abstract Background The growing rates of obesity in developing countries are alarming. There is a paucity of evidence about disparities of obesity in Lesotho. This study examined socioeconomic and area-based inequalities in obesity among non-pregnant women in Lesotho. Methods Data were extracted from the 2004, 2009 and 2014 Lesotho Demographic and Health Surveys (LDHS) and analyzed through the recently updated Health Equity Assessment Toolkit (HEAT) of the World Health Organization. Obesity prevalence was disaggregated by four equity stratifiers, namely education, wealth, residence and sub-national region. For each equity stratifier, simple and complex as well as relative and absolute summary measures were calculated. A 95% confidence interval was used to measure statistical significance of findings. Results We noticed substantial wealth-driven (D = -21.10, 95% CI; − 25.94, − 16.26), subnational region (PAR = -11.82, 95%CI; − 16.09, − 7.55) and urban-rural (− 9.82, 95% CI; − 13.65, − 5.99) inequalities in obesity prevalence without the inequalities improved over time in all the studied years. However, we did not identify educational inequality in obesity. Conclusions Wealth-driven and geographical inequalities was identified in Lesotho in all the studied time periods while education related inequalities did not appear during the same time period. All population groups in the country need to be reached with interventions to reduce the burden of obesity in the country.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gebretsadik Shibre ◽  
Betregiorgis Zegeye ◽  
Dina Idriss-Wheeler ◽  
Sanni Yaya

Abstract Background Pneumonia is a leading public health problem in under-five children worldwide and particularly in Africa. Unfortunately, progress in reducing pneumonia related mortality has been slow. The number of children with symptoms of pneumonia taken to health facilities for treatment is low in Ethiopia, and disparities among sub-groups regarding health seeking behavior for pneumonia have not been well explored in the region. This study assessed the trends of inequalities in care seeking behavior for children under five years of age with suspected pneumonia in Ethiopia. Methods Using cross-sectional data from the 2005, 2011 and 2016 Ethiopia Demographic and Health Surveys (DHS) and the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT), this study investigated the inequalities in health seeking behavior for children with suspected pneumonia. Four measures of inequality were calculated: Difference, Ratio, Slope Index of Inequality and Relative Index of Inequality. Results were disaggregated by wealth, education, residence, and sex with computed 95% Uncertainty Intervals for each point estimate to determine significance. Results The percentage of under-five children with symptoms of pneumonia who were taken to a health facility was significantly lower for children in the poorest families, 15.48% (95% UI; 9.77, 23.64) as compared to children in the richest families, 61.72% (95% UI; 45.06, 76.02) in 2011. Substantial absolute (SII = 35.61; 95% UI: 25.31, 45.92) and relative (RII = 4.04%; 95% UI: 2.25, 5.84) economic inequalities were also observed. Both educational and geographic inequalities were observed; (RII = 2.07; 95% UI: 1.08, 3.06) and (D = 28.26; 95% UI: 7.14, 49.37), respectively. Economic inequality decreased from 2011 to 2016. There was no statistically significant difference between male and female under-five children with pneumonia symptoms taken to health facility, in all the studied years. Conclusions Health care seeking behavior for children with pneumonia was lower among the poorest and non-educated families as well as children in rural regions. Policies and strategies need to target subpopulations lagging behind in seeking care for pneumonia treatment as it impedes achievement of key UN sustainable development goals (SDGs).


2021 ◽  
Vol 6 (4) ◽  
pp. e004230
Author(s):  
Teesta Dey ◽  
Sam Ononge ◽  
Andrew Weeks ◽  
Lenka Benova

IntroductionProgress in reducing maternal and neonatal mortality, particularly in sub-Saharan Africa, is insufficient to achieve the Sustainable Developmental Goals by 2030. The first 24 hours following childbirth (immediate postnatal period), where the majority of morbidity and mortality occurs, is critical for mothers and babies. In Uganda,<50% of women reported receiving such care. This paper describes the coverage, changes over time and determinants of immediate postnatal care in Uganda after facility births between 2001 and 2016.MethodsWe analysed the 2006, 2011 and 2016 Ugandan Demographic and Health Surveys, including women 15–49 years with most recent live birth in a healthcare facility during the survey 5-year recall period. Immediate postnatal care coverage and changes over time were presented descriptively. Multivariable logistic regression was used to examine determinants of immediate postnatal care.ResultsData from 12 872 mothers were analysed. Between 2006 and 2016, births in healthcare facilities increased from 44.6% (95% CI: 41.9% to 47.3%) to 75.2% (95% CI: 73.4% to 77.0%) and coverage of immediate maternal postnatal care from 35.7% (95% CI 33.4% to 38.1%) to 65.0% (95% CI: 63.2% to 66.7%). The majority of first checks occurred between 1 and 4 hours post partum; the median time reduced from 4 hours to 1 hour. The most important factor associated with receipt of immediate postnatal care was women having a caesarean section birth adjusted OR (aOR) 2.93 (95% CI: 2.28 to 3.75). Other significant factors included exposure to mass media aOR 1.38 (95% CI: 1.15 to 1.65), baby being weighed at birth aOR 1.84 (95% CI: 1.58 to 2.14) and receipt of antenatal care with 4+Antenatal visits aOR 2.34 (95% CI: 1.50 to 3.64).ConclusionIn Uganda, a large gap in coverage remains and universal immediate postnatal care has not materialised through increasing facility-based births or longer length of stay. To ensure universal coverage of high-quality care during this critical time, we recommend that maternal and newborn services should be integrated and actively involve mothers and their partners.


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