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Biases in Survey Estimates of Neonatal Mortality: Results From a Validation Study in Urban Areas of Guinea-Bissau

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Demography

Abstract

Neonatal deaths (occurring within 28 days of birth) account for close to one-half of all deaths among children under age 5 worldwide. In most low- and middle-income countries, data on neonatal deaths come primarily from household surveys. We conducted a validation study of survey data on neonatal mortality in Guinea-Bissau (West Africa). We used records from an urban health and demographic surveillance system (HDSS) that monitors child survival prospectively as our reference data set. We selected a stratified sample of 599 women aged 15–49 among residents of the HDSS and collected the birth histories of 422 participants. We cross-tabulated survey and HDSS data. We used a mathematical model to investigate biases in survey estimates of neonatal mortality. Reporting errors in survey data might lead to estimates of the neonatal mortality rate that are too high, which may limit our ability to track progress toward global health objectives.

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Data Availability

All study data are available from the authors upon request.

Notes

  1. Two interviews required a translator and were conducted in French (among Fulani migrants recently arrived from the neighboring Republic of Guinea).

  2. In its eighth wave of data collection, the DHS program will begin collecting full pregnancy histories instead of full birth histories in the LMICs where it is implemented (https://www.dhsprogram.com/pubs/pdf/DHSM11/DHSM11.pdf).

  3. For example, our study yielded an estimate of the sensitivity of FBH data in recording neonatal deaths that was comparable to the estimate obtained in Bangladesh by Espeut and Becker (2015): .79 versus .82, respectively. However, our study yielded an estimate of the sensitivity of FBH in recording postneonatal deaths that was much lower than the estimate obtained in Bangladesh: .69 versus .87, respectively.

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Acknowledgments

This work was supported by grants R21HD087811 and R01HD088516 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (PI: Helleringer). We thank Stan Becker and Tom Pullum for comments on a previous version of this manuscript.

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Authors and Affiliations

  1. Division of Social Science Program on Social Research and Public Policy, New York University - Abu Dhabi, P.O. Box 129188, Abu Dhabi, United Arab Emirates

    Stéphane Helleringer

  2. Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA

    Li Liu

  3. Department of Sociology, The Ohio State University, Columbus, OH, USA

    Yue Chu

  4. Bandim Health Project, Bissau, Guinea-Bissau

    Amabelia Rodrigues & Ane Barent Fisker

  5. University of Southern Denmark, Odense, Denmark

    Ane Barent Fisker

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  1. Stéphane Helleringer
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  2. Li Liu
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  4. Amabelia Rodrigues
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  5. Ane Barent Fisker
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Contributions

SH and LL are joint first authors. SH, AR and ABF designed the study; ABF, SH and AR oversaw data collection; SH, LL, YC, and ABF analyzed data; LL and SH drafted the paper; all authors reviewed and revised the manuscript.

Corresponding author

Correspondence to Stéphane Helleringer.

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This protocol was reviewed and approved by institutional review boards at Johns Hopkins University and at the Comité de Ética na Saúde in Guinea- Bissau. We obtained written informed consent from participants prior to interviews.

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Helleringer, S., Liu, L., Chu, Y. et al. Biases in Survey Estimates of Neonatal Mortality: Results From a Validation Study in Urban Areas of Guinea-Bissau. Demography 57, 1705–1726 (2020). https://doi.org/10.1007/s13524-020-00911-6

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