Collaborators: Byass P, Lawn J, Waiswa P, Blencowe H, Yargawa J, Akuze J, Fisker AB, Martins JSD, Rodrigues A, Thysen SM, Biks GA, Abebe SM, Ayele TA, Bisetegn TA, Delele TG, Gelaye KA, Geremew BM, Gezie LD, Melese T, Mengistu MY, Tesega AK, Yitayew TA, Kasasa S, Galigawango E, Gyezaho C, Kaija J, Kajungu D, Nareeba T, Natukwatsa D, Tusubira V, Enuameh YAK, Asante KP, Dzabeng F, Etego SA, Manu G, Manu AA, Nettey OE, Newton SK, Owusu-Agyei S, Tawiah C, Zandoh C, Alam N, Delwar N, Haider MM, Imam MA, Mahmud K, Baschieri A, Cousens S, Gordeev VS, Hardy VP, Kwesiga D, Machiyama K. Author information:
(1)Dabat Research Centre Health and Demographic Surveillance System, Dabat,
(2)Department of Health Systems and Policy, Institute of Public Health,
University of Gondar, Gondar, Ethiopia.
(3)Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London
School of Hygiene & Tropical Medicine, London, UK. [Email]
(4)Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London
School of Hygiene & Tropical Medicine, London, UK.
(5)Department of Epidemiology and Biostatistics, Institute of Public Health,
University of Gondar, Gondar, Ethiopia.
(6)Department of Human Nutrition, Institute of Public Health, University of
Gondar, Gondar, Ethiopia.
(7)Department of Environmental and Occupational Health and Safety, Institute of
Public Health, University of Gondar, Gondar, Ethiopia.
(8)Bandim Health Project, Bissau, Guinea-Bissau.
(9)Research Centre for Vitamins and Vaccines, Statens Serum Institut,
(10)Department of Clinical Research Open Patient data Explorative Network
(OPEN), University of Southern Denmark, Odense, Denmark.
(11)Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh.
(12)Kintampo Health Research Centre, Kintampo, Ghana.
(13)IgangaMayuge Health and Demographic Surveillance System, Iganga, Uganda.
(14)Makerere University Centre for Health and Population Research, Makerere,
(15)Department of Epidemiology and Biostatistics, Makerere University School of
Public Health, Kampala, Uganda.
(16)Faculty of Medicine, Nursing and Health Sciences, Monash University,
(17)Dept. of Health Policy, Planning and Management, Makerere University School
of Public Health, Kampala, Uganda.
(18)Centre of Excellence for Maternal Newborn and Child Health Research,
Makerere University, Kampala, Uganda.
(19)Department of Women and Children's Health, Uppsala University, Uppsala,
BACKGROUND: Low birthweight (< 2500 g) is an important marker of maternal health and is associated with neonatal mortality, long-term development and chronic diseases. Household surveys remain an important source of population-based birthweight information, notably Demographic and Health Surveys (DHS) and UNICEF's Multiple Indicator Cluster Surveys (MICS); however, data quality concerns remain. Few studies have addressed how to close these gaps in surveys. METHODS: The EN-INDEPTH population-based survey of 69,176 women was undertaken in five Health and Demographic Surveillance System sites (Matlab-Bangladesh, Dabat-Ethiopia, Kintampo-Ghana, Bandim-Guinea-Bissau, IgangaMayuge-Uganda). Responses to existing DHS/MICS birthweight questions on 14,411 livebirths were analysed and estimated adjusted odds ratios (aORs) associated with reporting weighing, birthweight and heaping reported. Twenty-eight focus group discussions with women and interviewers explored barriers and enablers to reporting birthweight. RESULTS: Almost all women provided responses to birthweight survey questions, taking on average 0.2 min to answer. Of all babies, 62.4% were weighed at birth, 53.8% reported birthweight and 21.1% provided health cards with recorded birthweight. High levels of heterogeneity were observed between sites. Home births and neonatal deaths were less likely to be weighed at birth (home births aOR 0.03(95%CI 0.02-0.03), neonatal deaths (aOR 0.19(95%CI 0.16-0.24)), and when weighed, actual birthweight was less likely to be known (aOR 0.44(95%CI 0.33-0.58), aOR 0.30(95%CI 0.22-0.41)) compared to facility births and post-neonatal survivors. Increased levels of maternal education were associated with increases in reporting weighing and knowing birthweight. Half of recorded birthweights were heaped on multiples of 500 g. Heaping was more common in IgangaMayuge (aOR 14.91(95%CI 11.37-19.55) and Dabat (aOR 14.25(95%CI 10.13-20.3) compared to Bandim. Recalled birthweights were more heaped than those recorded by card (aOR 2.59(95%CI 2.11-3.19)). A gap analysis showed large missed opportunity between facility birth and known birthweight, especially for neonatal deaths. Qualitative data suggested that knowing their baby's weight was perceived as valuable by women in all sites, but lack of measurement and poor communication, alongside social perceptions and spiritual beliefs surrounding birthweight, impacted women's ability to report birthweight. CONCLUSIONS: Substantial data gaps remain for birthweight data in household surveys, even amongst facility births. Improving the accuracy and recording of birthweights, and better communication with women, for example using health cards, could improve survey birthweight data availability and quality.
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