Dataset Information

Evaluation of methods for linking household and health care provider data to estimate effective coverage of management of child illness: results of a pilot study in Southern Province, Zambia.

ABSTRACT:

Background

Existing population-based surveys have limited accuracy for estimating the coverage and quality of management of child illness. Linking household survey data with health care provider assessments has been proposed as a means of generating more informative population-level estimates of effective coverage, but methodological issues need to be addressed.

Methods

A 2016 survey estimated effective coverage of management of child illness in Southern Province, Zambia, using multiple methods for linking temporally and geographically proximate household and health care provider data. Mothers of children <5 years were surveyed about seeking care for child illness. Information on health care providers' capacity to manage child illness, or structural quality, was assessed using case scenarios and a tool modeled on the WHO Service Availability and Readiness Assessment (SARA). Each sick child was assigned the structural quality score of their stated (exact-match) source of care. Effective coverage was calculated as the average structural quality experienced by all sick children. Children were also ecologically linked to providers using measures of geographic proximity, with and without data on non-facility providers, to assess the effects of these linking methods on effective coverage estimates.

Results

Data were collected on 83 providers and 385 children with fever, diarrhea, and/or symptoms of ARI in the preceding 2 weeks. Most children sought care from government facilities or community-based agents (CBAs). Effective coverage of management of child illness estimated through exact-match linking was approximately 15-points lower in each stratum than coverage of seeking skilled care due to providers' limited structural quality. Estimates generated using most measures of geographic proximity were similar to the exact-match estimate, with the exception of the kernel density estimation method in the urban area. Estimates of coverage in rural areas were greatly reduced across all methods using facility-only data if seeking care from CBAs was treated as unskilled care.

Conclusions

Linking household and provider data may generate more informative estimates of effective coverage of management of child illness. Ecological linking with provider data on a sample of all skilled providers may be as effective as exact-match linking in areas with low variation in structural quality within a provider category or minimal provider bypassing.

SUBMITTER: Carter ED

PROVIDER: S-EPMC6013179 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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Publications

Evaluation of methods for linking household and health care provider data to estimate effective coverage of management of child illness: results of a pilot study in Southern Province, Zambia.

Carter Emily D ED Ndhlovu Micky M Eisele Thomas P TP Nkhama Emmy E Katz Joanne J Munos Melinda M

Journal of global health 20180601 1

<h4>Background</h4>Existing population-based surveys have limited accuracy for estimating the coverage and quality of management of child illness. Linking household survey data with health care provider assessments has been proposed as a means of generating more informative population-level estimates of effective coverage, but methodological issues need to be addressed.<h4>Methods</h4>A 2016 survey estimated effective coverage of management of child illness in Southern Province, Zambia, using mu ...[more]

PMID: 29983929

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Project description:ObjectiveTo assess existing knowledge related to methodological considerations for linking population-based surveys and health facility data to generate effective coverage estimates. Effective coverage estimates the proportion of individuals in need of an intervention who receive it with sufficient quality to achieve health benefit.DesignSystematic review of available literature.Data sourcesMedline, Carolina Population Health Center and Demographic and Health Survey publications and handsearch of related or referenced works of all articles included in full text review. The search included publications from 1 January 2000 to 29 March 2021.Eligibility criteriaPublications explicitly evaluating (1) the suitability of data, (2) the implications of the design of existing data sources and (3) the impact of choice of method for combining datasets to obtain linked coverage estimates.ResultsOf 3805 papers reviewed, 70 publications addressed relevant issues. Limited data suggest household surveys can be used to identify sources of care, but their validity in estimating intervention need was variable. Methods for collecting provider data and constructing quality indices were diverse and presented limitations. There was little empirical data supporting an association between structural, process and outcome quality. Few studies addressed the influence of the design of common data sources on linking analyses, including imprecise household geographical information system data, provider sampling design and estimate stability. The most consistent evidence suggested under certain conditions, combining data based on geographical proximity or administrative catchment (ecological linking) produced similar estimates to linking based on the specific provider utilised (exact match linking).ConclusionsLinking household and healthcare provider data can leverage existing data sources to generate more informative estimates of intervention coverage and care. However, existing evidence on methods for linking data for effective coverage estimation are variable and numerous methodological questions remain. There is need for additional research to develop evidence-based, standardised best practices for these analyses.

Project description:Calls have been made for improved measurement of coverage for maternal, newborn and child health interventions. Recently, methods linking household and health facility surveys have been used to improve estimation of intervention coverage. However, linking methods rely the availability of household and health facility surveys which are temporally matched. Because nationally representative health facility assessments are not yet routinely conducted in many low and middle income countries, estimates of intervention coverage based on linking methods can be produced for only a subset of countries. Estimates of intervention coverage are a critical input for modelling the health impact of intervention scale-up in the Lives Saved Tool (LiST). The purpose of this study was to develop a data-driven approach to estimate coverage for a subset of antenatal care interventions modeled in LiST.Using a five-step process, estimates of population level coverage for syphilis detection and treatment, case management of diabetes, malaria infection, hypertensive disorders, and pre-eclampsia, were computed by linking household and health facility surveys. Based on data characterizing antenatal care and estimates of coverage derived from the linking approach, predictive models for intervention coverage were developed. Updated estimates of coverage based on the predictive models were compared, first with current default proxies, then with estimates based on the linking approach. Model fit and accuracy were assessed using three measures: the coefficient of determination, Pearson's correlation coefficient, and the root mean square error (RMSE).The ability to predict intervention coverage was fairly accurate across all interventions considered. Predictive models accounted for 20-63% of the variance in intervention coverages, and correlation coefficients ranged from 0.5 to 0.83. The predictive model used to estimate coverage of management of pre-eclampsia performed relatively better (RMSE = 0.11) than the model estimating coverage of diabetes case management (RMSE = 0.19).The new approach to estimate coverage represents an improvement over current default proxies in LiST. As the availability of reliable coverage data improves, impact estimates generated by LiST will improve. This study underscores the need for continued efforts to improve coverage measurement, while bringing to the fore the importance of health facility assessments as complementary data sources.

Project description:BackgroundCurrently many measures of intervention coverage obtained from household surveys do not measure actual health intervention/service delivery, resulting in a need for linking reports of care-seeking with assessments of the service environment in order to improve measurements. This systematic review aims to identify evidence of different methods used to link household surveys and service provision assessments, with a focus on reproductive, maternal, newborn and child health care, in low- and middle-income countries.MethodsUsing pre-defined search terms, articles published in peer-reviewed journals and the grey literature after 1990 were identified, their reference lists scanned and linking methods synthesized.FindingsA total of 59 articles and conference presentations were carefully reviewed and categorized into two groups based on the linking method used: 1) indirect/ecological linking that included studies in which health care-seeking behavior was linked to all or the nearest facilities or providers of certain types within a geographical area, and 2) direct linking/exact matching where individuals were linked with the exact provider or facility where they sought care. The former approach was employed in 51 of 59 included studies, and was particularly common among studies that were based on independent sources of household and facility data that were nationally representative. Only eight of the 59 reviewed studies employed direct linking methods, which were typically done at the sub-national level (eg, district level) and often in rural areas, where the number of providers was more limited compared to urban areas.ConclusionsDifferent linking methods have been reported in the literature, each category has its own set of advantages and limitations, in terms of both methodology and practicality for scale-up. Future studies that link household and provider/facility data should also take into account factors such as sources of data, the timing of surveys, the temporality of data points, the type of services and interventions, and the scale of the study in order to produce valid and reliable results.

Project description:The purpose of this study was to establish best ways of improving household soybean processing and utilization in selected districts in the Eastern Province of Zambia. This was a concurrent triangulation study design, nested with a cross sectional survey and barrier analysis. Up to 1,237 households and 42 key informants participated in the quantitative and qualitative studies respectively. Quantitative data was analysed using Stata MP 15 software (StataCorp, College Station, TX, USA). NVIVO QSR10 software (QSRInt, Melbourne Australia) was used to organize qualitative data which was later analysed thematically. In this study whole soybean processing and utilization in eastern province was at 48%. However, accessibility to soybean for household consumption throughout the year was negligible (0.29%). Based on the food systems an interplay of factors influenced soybean processing and utilization. In the food environment, a ready-made Textured Soya Protein mainly imported [1,030/1237(83%)] and a milled whole soybean-maize blend AOR 816.37; 95%CI 110.83 to 6013.31 were preferred. Reports of labour intensity, hard to cook properties, coarse milling and beany flavour with associated anti-nutrients negatively influenced whole soybean utilization. In the enabling environment, soybean production AOR 4.47; 95%CI 2.82 to 7.08 increased the chances of utilization. Lack of inputs, poor access to affordable credit and lack of ingredients were deleterious to utilization. Low coverage of existing projects and poor access to technologies were other adverse factors. Among the Socioeconomic factors, a higher social hierarchy shown by owning a bed AOR 1.75; 95%CI 1.22 to 2.49, belonging to the Chewa community AOR 1.16; 95%CI 1.08 to 0 1.25, gender of household head particularly male AOR 1.94; 95%CI 1.21 to 3.13, off farm income and livestock ownership were supportive to soybean utilization. Unfavourable factors were; belonging to any of the districts under study AOR 0.76; 95%CI 0.58 to 0.98, lack of knowledge (55.65%), low involvement of the male folks AOR 0.47; 95%CI 0.30 to 0.73 and belonging to a female headed household AOR 1.94; 95%CI 1.21 to 3.13. Age, time and household size constraints as well as unreliable soybean output markets, lack of land, poor soils in some wards and poor soybean value chain governance were other negative factors. Immediately in the food environment there is need to boost milling of whole soybean while strengthening cooking demonstrations, correct processing, incorporation of soybean in the local dishes and conducting acceptability tests. In the enabling environment, there should be access to inputs, affordable credit facilities and subsidized mineral fertilisers. Post-harvest storage, collective action with full scale community involvement and ownership should be heightened. Socioeconomic approaches should target promotion of soybean processing and utilization among all ethnic groups, participation of male folks and female headed households as well as advocating for increased nutrition sensitive social protection. In the medium or long term, capacity building, market development, import substitution agreements, creation of new products, development of cottage industries, information exchange and inter district trade as well as more public-private partnerships and more local private sector players should be bolstered. Lastly farm diversification should be supported.

Dataset Information

Evaluation of methods for linking household and health care provider data to estimate effective coverage of management of child illness: results of a pilot study in Southern Province, Zambia.

Background

Methods

Results

Conclusions

Publications

Evaluation of methods for linking household and health care provider data to estimate effective coverage of management of child illness: results of a pilot study in Southern Province, Zambia.

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