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Randomised comparison of two household survey modules for measuring stillbirths and neonatal deaths in five countries: the Every Newborn-INDEPTH study
Open accessAbstract
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 ( I 2 =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 ( I 2 =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.
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“It is characterized by an unexpected loss through miscarriage, stillbirth, or neonatal death.2”
From Bereavement care guidelines used in health care facilities immediately following perinatal loss: a scoping review (2024) · cites this paper as [2]
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Every Newborn INDEPTH (EN-INDEPTH) Study - Additional Materials
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Metadata
- Authors
- Akuze, J., Blencowe, H., Waiswa, P., Baschieri, A., Gordeev, V. S., Kwesiga, D., Fisker, A. B., Thysen, S. M., Rodrigues, A., Biks, G. A., Abebe, S. M., Gelaye, K. A., Mengistu, M. Y., Geremew, B. M., Delele, T. G., Tesega, A. K., Yitayew, T. A., Kasasa, S., Galiwango, E., Natukwatsa, D., Kajungu, D., Enuameh, Y. A., Nettey, O. E., Dzabeng, F., Amenga-Etego, S., Newton, S. K., Tawiah, C., Asante, K. P., Owusu-Agyei, S., Alam, N., Haider, M. M., Imam, A., Mahmud, K., Cousens, S., Lawn, J. E., Ayele, T. A., Bisetegn, T. B., Delwar, N., Gezie, L. D., Gyezaho, C., Kaija, J., Machiyama, K., Manu, G., Manu, A. A., Martins, J. S., Melese, T., Alam, S. S., Nareeba, T., Hardy, V. P., Zandoh, C., Arnold, F., Byass, P., Croft, T., Herbst, K., Kishor, S. K., & Serbanescu, F.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- Karolinska Institutet (SE)
- Queen Mary University of London (GB)
- Makerere University (UG)
- Statens Serum Institut (DK)
- University of Gondar (ET)
- Kwame Nkrumah University of Science and Technology (GH)
- Kintampo Health Research Centre (GH)
- International Centre for Diarrhoeal Disease Research (BD)
- Corresponding author
- Akuze, Joseph
- ORCID
- Blencowe, Hannah
- Waiswa, Peter
- Baschieri, Angela
- Gordeev, Vladimir S
- Kwesiga, Doris
- Fisker, Ane B
- Thysen, Sanne M
- Biks, Gashaw A
- Gelaye, Kassahun A
- Geremew, Bisrat M
- Delele, Tadesse G
- Kasasa, Simon
- Galiwango, Edward
- Natukwatsa, Davis
- Kajungu, Dan
- Enuameh, Yeetey AK
- Dzabeng, Francis
- Newton, Sam K
- Tawiah, Charlotte
- Asante, Kwaku P
- Alam, Nurul
- Haider, Moinuddin M
- Cousens, Simon
- Lawn, Joy E
- Ayele, Tadesse Awoke
- Gezie, Lemma Derseh
- Gyezaho, Collins
- Machiyama, Kazuyo
- Manu, Alexander A
- Nareeba, Tryphena
- Hardy, Victoria Ponce
- Byass, Peter
- Herbst, Kobus
- Serbanescu, Florina
- Venue
- The Lancet Global Health
- Publisher
- Elsevier BV
- Published
- 2020-04
- Volume
- 8
- Issue
- 4
- Pages
- e555-e566
- ISSN
- 2214-109X (ISSN-L)
- OpenAlex
- W3012086947
- Cited by
- 121
- References
- 21
- Citations by year
- 2026: 3 · 2025: 11 · 2024: 7 · 2023: 10 · 2022: 9 · 2021: 79 · 2020: 2
- FWCI
- 24.02
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Global Health (publishedVersion, cc-by)
- PubMed (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion, cc-by)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion, cc-by)
- Greater South Information System
- Funders
- Children's Investment Fund Foundation
- London School of Hygiene and Tropical Medicine
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and Neonatal Healthcare
- Social Sciences › Sociology and Political Science › Survey Methodology and Nonresponse
- Keywords
- stillbirth, neonatal mortality, questionnaire comparison, Demographic and Health Surveys, miscarriage, survey data quality, questionnaire length, health and demographic surveillance system, maternal mortality surveillance, MATLAB, Kintampo
- MeSH terms
- Adolescent, Adult, Bangladesh, Ethiopia, Female, Ghana, Guinea-Bissau, Humans, Infant, Infant Mortality, Infant, Newborn, Middle Aged, Surveys and Questionnaires, Uganda, Reproducibility of Results, Stillbirth, Young Adult
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