1
|
Susmann H, Alexander M, Alkema L. Temporal Models for Demographic and Global Health Outcomes in Multiple Populations: Introducing a New Framework to Review and Standardise Documentation of Model Assumptions and Facilitate Model Comparison. Int Stat Rev 2022; 90:437-467. [PMID: 36590075 PMCID: PMC9790657 DOI: 10.1111/insr.12491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 12/17/2021] [Accepted: 01/28/2022] [Indexed: 01/04/2023]
Abstract
There is growing interest in producing estimates of demographic and global health indicators in populations with limited data. Statistical models are needed to combine data from multiple data sources into estimates and projections with uncertainty. Diverse modelling approaches have been applied to this problem, making comparisons between models difficult. We propose a model class, Temporal Models for Multiple Populations (TMMPs), to facilitate both documentation of model assumptions in a standardised way and comparison across models. The class makes a distinction between the process model, which describes latent trends in the indicator interest, and the data model, which describes the data generating process of the observed data. We provide a general notation for the process model that encompasses many popular temporal modelling techniques, and we show how existing models for a variety of indicators can be written using this notation. We end with a discussion of outstanding questions and future directions.
Collapse
Affiliation(s)
- Herbert Susmann
- Department of Biostatistics and EpidemiologyUniversity of Massachusetts Amherst715 North Pleasant StreetAmherstMA01003USA
| | - Monica Alexander
- Departments of Statistical Sciences and SociologyUniversity of Toronto700 University AvenueTorontoON M5G 1Z5Canada
| | - Leontine Alkema
- Department of Biostatistics and EpidemiologyUniversity of Massachusetts Amherst715 North Pleasant StreetAmherstMA01003USA
| |
Collapse
|
2
|
Wang Z, Fix MJ, Hug L, Mishra A, You D, Blencowe H, Wakefield J, Alkema L. Estimating the stillbirth rate for 195 countries using a Bayesian sparse regression model with temporal smoothing. Ann Appl Stat 2022. [DOI: 10.1214/21-aoas1571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Zhengfan Wang
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst
| | | | - Lucia Hug
- Division of Data, Analytics, Planning and Monitoring, UNICEF
| | - Anu Mishra
- Division of Data, Analytics, Planning and Monitoring, UNICEF
| | - Danzhen You
- Division of Data, Analytics, Planning and Monitoring, UNICEF
| | - Hannah Blencowe
- London School of Hygiene and Tropical Medicine, University of London
| | - Jon Wakefield
- Department of Biostatistics, University of Washington
| | - Leontine Alkema
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst
| |
Collapse
|
3
|
Sserwanja Q, Mutisya LM, Nuwabaine L, Kamara K, Mutebi RK, Musaba MW. Continuum of maternal and newborn health in Sierra Leone: a 2019 national survey. Arch Public Health 2022; 80:186. [PMID: 35945622 PMCID: PMC9364565 DOI: 10.1186/s13690-022-00946-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/27/2022] [Indexed: 12/26/2022]
Abstract
Introduction Globally, Sierra Leone has some of the worst maternal and child health indicators. The situation is worsened by a dearth of evidence about the level of continuum of care, an evidence-based intervention aimed at reducing maternal and perinatal morbidity and mortality. Hence this study aimed to assess the level of and factors associated with continuum of maternal and newborn care in Sierra Leone. Method This study analyzed secondary data from the 2019 Sierra Leone Demographic Health Survey. Analysis was restricted to women who had a live birth in the 5 years preceding the survey (n = 7326). Complete continuum of care was considered when a woman reported having had at least eight antenatal care contacts, skilled birth attendance and mother and baby had at least one postnatal check-up. Bi-variable and multivariable logistic regression were performed using the statistical package for the social sciences software version 25. Results Only 17.9% (95% CI: 17.4–19.1) of the women utilized complete continuum of care for maternal and newborn health services in Sierra Leone. About 22% (95% CI: 21.3–23.1) utilized 8 or more antenatal care contacts, 88% (95% CI: 87.9–89.4) had skilled birth attendance while 90.7% (95% CI: 90.2–91.5) and 90.4% (95% CI: 89.9–91.2) of mothers and neonates utilized postnatal care respectively. Having started antenatal care within the first trimester (aOR 1.71, 95% CI: 1.46–2.00), being resident in the Southern region (aOR 1.85, 95% CI: 1.23–2.80), belonging to richer wealth quintile (aOR 1.76, 95% CI: 1.27–2.44), using internet (aOR 1.49, 95% CI: 1.12–1.98) and having no big problems seeking permission to access healthcare (aOR 1.34, 95% CI: 1.06–1.69) were significantly associated with utilization of continuum of care. Conclusion The overall completion of continuum of maternal care is low, with ANC being the lowest utilized component of continuum of care. These findings call for urgent attention for maternal health stakeholders to develop and implement tailored interventions prioritizing women empowerment, access to affordable internet services, timely initiation of ANC contacts, women in developed regions such as the Western and those from poor households.
Collapse
Affiliation(s)
- Quraish Sserwanja
- Programmes Department, GOAL Global, Arkaweet Block 65 House No. 227, Khartoum, Sudan.
| | - Linet M Mutisya
- Maternal and Child Health Project, Swedish Organization for Global Health, Mayuge, Uganda
| | - Lilian Nuwabaine
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda
| | - Kassim Kamara
- National Disease Surveillance Programme, Ministry of Health and Sanitation, Free town, Sierra Leone
| | - Ronald K Mutebi
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda.,Department of Internal Medicine, Mengo Hospital, Kampala, Uganda
| | - Milton W Musaba
- Department of Obstetrics and Gynaecology, Mbale Regional Referral and Teaching Hospital, Mbale, Uganda.,Department of Obstetrics and Gynaecology, Busitema University, Mbale, Uganda
| |
Collapse
|
4
|
Musarandega R, Cresswell J, Magwali T, Makosa D, Machekano R, Ngwenya S, Nystrom L, Pattinson R, Munjanja S. Maternal mortality decline in Zimbabwe, 2007/2008 to 2018/2019: findings from mortality surveys using civil registration, vital statistics and health system data. BMJ Glob Health 2022; 7:bmjgh-2022-009465. [PMID: 35926916 PMCID: PMC9358939 DOI: 10.1136/bmjgh-2022-009465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/24/2022] [Indexed: 11/07/2022] Open
Abstract
Background Sustainable Development Goal (SDG) 3.1 target is to reduce the global maternal mortality ratio (MMR) to less than 70 maternal deaths per 100 000 live births by 2030. In the Ending Preventable Maternal Mortality strategy, a supplementary target was added, that no country has an MMR above 140 by 2030. We conducted two cross-sectional reproductive age mortality surveys to analyse changes in Zimbabwe’s MMR between 2007–2008 and 2018–2019 towards the SDG target. Methods We collected data from civil registration, vital statistics and medical records on deaths of women of reproductive ages (WRAs), including maternal deaths from 11 districts, randomly selected from each province (n=10) using cluster sampling. We calculated weighted mortality rates and MMRs using negative binomial models, with 95% CIs, performed a one-way analysis of variance of the MMRs and calculated the annual average reduction rate (ARR) for the MMR. Results In 2007–2008 we identified 6188 deaths of WRAs, 325 pregnancy-related deaths and 296 maternal deaths, and in 2018–2019, 1856, 137 and 130, respectively. The reproductive age mortality rate, weighted by district, declined from 11 to 3 deaths per 1000 women. The MMR (95% CI) declined from 657 (485 to 829) to 217 (164 to 269) deaths per 100 000 live births at an annual ARR of 10.1%. Conclusions Zimbabwe’s MMR declined by an annual ARR of 10.1%, against a target of 10.2%, alongside declining reproductive age mortality. Zimbabwe should continue scaling up interventions against direct maternal mortality causes to achieve the SDG 3.1 target by 2030.
Collapse
Affiliation(s)
- Reuben Musarandega
- School of Health Systems and Public Health, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa .,Unit of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Jenny Cresswell
- Department of Sexual and Reproductive Health and Research, WHO, Geneve, Switzerland
| | - Thulani Magwali
- Unit of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Davidzoyashe Makosa
- Department of Reproductive Health (fomerly), Ministry of Health and Child Care, Harare, Zimbabwe
| | - Rhoderick Machekano
- Department of Biostatistics and Epidemiology, Stellenbosch University, Cape Town, South Africa
| | - Solwayo Ngwenya
- Department of Obstetrics and Gynaecology, National University of Science and Technology, Bulawayo, Zimbabwe
| | - Lennarth Nystrom
- Department of Epidemiology and Global Health, Umea University, Umea, Sweden
| | - Robert Pattinson
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
| | - Stephen Munjanja
- Unit of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | |
Collapse
|
5
|
Peterson E, Chou D, Moller A, Gemmill A, Say L, Alkema L. Estimating misclassification errors in the reporting of maternal mortality in national civil registration vital statistics systems: A Bayesian hierarchical bivariate random walk model to estimate sensitivity and specificity for multiple countries and years with missing data. Stat Med 2022; 41:2483-2496. [PMID: 35165916 PMCID: PMC9303473 DOI: 10.1002/sim.9335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/11/2021] [Accepted: 12/09/2021] [Indexed: 12/13/2022]
Abstract
Civil registration vital statistics (CRVS) systems provide data on maternal mortality that can be used for monitoring trends and to inform policies and programs. However, CRVS maternal mortality data may be subject to substantial reporting errors due to misclassification of maternal deaths. Information on misclassification is available for selected countries and periods only. We developed a Bayesian hierarchical bivariate random walk model to estimate sensitivity and specificity for multiple populations and years and used the model to estimate misclassification errors in the reporting of maternal mortality in CRVS systems. The proposed Bayesian misclassification (BMis) model captures differences in sensitivity and specificity across populations and over time, allows for extrapolations to periods with missing data, and includes an exact likelihood function for data provided in aggregated form. Validation exercises using maternal mortality data suggest that BMis is reasonably well calibrated and improves upon the CRVS-adjustment approach used until 2018 by the UN Maternal Mortality Inter-Agency Group (UN-MMEIG) to account for bias in CRVS data resulting from misclassification error. Since 2019, BMis is used by the UN-MMEIG to account for misclassification errors when estimating maternal mortality using CRVS data.
Collapse
Affiliation(s)
- Emily Peterson
- Department of Biostatistics and BioinformaticsEmory UniversityAtlantaGeorgia
| | - Doris Chou
- Department of Sexual and Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
| | - Ann‐Beth Moller
- Department of Sexual and Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
| | - Alison Gemmill
- Department of Population, Family, and Reproductive HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Lale Say
- Department of Sexual and Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
| | - Leontine Alkema
- Department of Biostatistics and EpidemiologyUniversity of Massachusetts AmherstAmherstMassachusettsUSA
| |
Collapse
|
6
|
Chao F, KC S, Ombao H. Estimation and probabilistic projection of levels and trends in the sex ratio at birth in seven provinces of Nepal from 1980 to 2050: a Bayesian modeling approach. BMC Public Health 2022; 22:358. [PMID: 35183138 PMCID: PMC8858562 DOI: 10.1186/s12889-022-12693-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 02/02/2022] [Indexed: 11/23/2022] Open
Abstract
Background The sex ratio at birth (SRB; ratio of male to female births) in Nepal has been reported around the normal level on the national level. However, the national SRB could mask the disparity within the country. Given the demographic and cultural heterogeneities in Nepal, it is crucial to model Nepal SRB on the subnational level. Prior studies on subnational SRB in Nepal are mostly based on reporting observed values from surveys and census, and no study has provided probabilistic projections. We aim to estimate and project SRB for the seven provinces of Nepal from 1980 to 2050 using a Bayesian modeling approach. Methods We compiled an extensive database on provincial SRB of Nepal, consisting 2001, 2006, 2011, and 2016 Nepal Demographic and Health Surveys and 2011 Census. We adopted a Bayesian hierarchical time series model to estimate and project the provincial SRB, with a focus on modelling the potential SRB imbalance. Results In 2016, the highest SRB is estimated in Province 5 (Lumbini Pradesh) at 1.102, corresponding to 110.2 male births per 100 female births, with a 95% credible interval (1.044, 1.127) and the lowest SRB is in Province 2 at 1.053 (1.035, 1.109). The SRB imbalance probabilities in all provinces are generally low and vary from 16% in Province 2 to 81% in Province 5 (Lumbini Pradesh). SRB imbalances are estimated to have begun at the earliest in 2001 in Province 5 (Lumbini Pradesh) with a 95% credible interval (1992, 2022) and the latest in 2017 (1998, 2040) in Province 2. We project SRB in all provinces to begin converging back to the national baseline in the mid-2030s. By 2050, the SRBs in all provinces are projected to be around the SRB baseline level. Conclusions Our findings imply that the majority of provinces in Nepal have low risks of SRB imbalance for the period 1980–2016. However, we identify a few provinces with higher probabilities of having SRB inflation. The projected SRB is an important illustration of potential future prenatal sex discrimination and shows the need to monitor SRB in provinces with higher possibilities of SRB imbalance. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12693-0.
Collapse
|
7
|
Melaku MS, Aemro A, Aychiluhm SB, Muche A, Bizuneh GK, Kebede SD. Geographical variation and predictors of zero utilization for a standard maternal continuum of care among women in Ethiopia: a spatial and geographically weighted regression analysis. BMC Pregnancy Childbirth 2022; 22:76. [PMID: 35090405 PMCID: PMC8796399 DOI: 10.1186/s12884-021-04364-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Maintaining and effectively utilizing maternal continuum of care could save an estimated 860,000 additional mothers and newborn lives each year. In Ethiopia, the number of maternal and neonatal deaths occurred during pregnancy, childbirth, and the postpartum period was very high. It is indisputable that area-based heterogeneity of zero utilization for a standard maternal continuum of care is critical to improve maternal and child health interventions. However, none of the previous studies explored the spatial distribution of zero utilization for maternal continuum of care. Hence, this study was aimed to explore geographical variation and predictors of zero utilization for a standard maternal continuum of care among women in Ethiopia. METHODS A total of 4178 women who gave birth five years preceding the 2016 Ethiopian demographic and health survey were included. ArcGIS version 10.7, SaT Scan version 9.6, and GWR version 4.0 Software was used to handle mapping, hotspot, ordinary least square, Bernoulli model analysis, and to model spatial relationships. Finally, a statistical decision was made at a p-value< 0.05 and at 95% confidence interval. MAIN FINDINGS The proportion of mothers who had zero utilization of a standard maternal continuum of care was 48.8% (95% CI: 47.3-50.4). Hot spot (high risk) regions for zero utilization of maternal continuum of care was detected in Afder, Warder, Korahe and Gode Zones of Somali region and West Arsi Zone of Oromia region. Respondents who had poor wealth index, uneducated mothers, and mothers who declared distance as a big problem could increase zero utilization of maternal continuum of care by 0.24, 0.27, and 0.1 times. CONCLUSION Five women out of ten could not utilize any components of a standard maternal continuum of care. Hot spot (high risk) areas was detected in Afder, Warder, Korahe and Gode Zones of Somali region and West Arsi Zone of Oromia region. Poor wealth index, uneducated mothers, and mothers who declare distance as a big problem were factors significantly associated with zero utilization of maternal continuum of care. Thus, geographical based intervention could be held to curve the high prevalence of zero utilization of maternal continuum of care.
Collapse
Affiliation(s)
- Mequannent Sharew Melaku
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Agazhe Aemro
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Setognal Birara Aychiluhm
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Amare Muche
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Gizachew Kassahun Bizuneh
- Department of Pharmacognosy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Shimels Derso Kebede
- Department of Health Informatics, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| |
Collapse
|
8
|
Atnafu A, Kebede A, Misganaw B, Teshome DF, Biks GA, Demissie GD, Wolde HF, Gelaye KA, Yitayal M, Ayele TA, Azale T, Derso T, Gebremedhin T, Dellie E. Determinants of the Continuum of Maternal Healthcare Services in Northwest Ethiopia: Findings from the Primary Health Care Project. J Pregnancy 2020; 2020:4318197. [PMID: 32908704 DOI: 10.1155/2020/4318197] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 06/29/2020] [Indexed: 11/17/2022] Open
Abstract
Background The maternity continuum of care is the continuity of maternal healthcare services that a woman uses, which includes antenatal care (ANC 4+), skill birth attendant (SBA), and postnatal care (PNC) within 48 hours of delivery. It is one of the essential strategies for reducing maternal and newborn mortality. This study aimed to assess the factors associated with the completion of a continuum of maternal healthcare services among mothers who gave birth in the past five years. Methods A community-based cross-sectional study was conducted from May 01 to June 29, 2019, among 565 randomly selected mothers who gave birth in five years before the study in primary healthcare project implementation districts of north Gondar zone, Amhara National Regional State, Ethiopia. Bivariable and multivariable logistic regression analysis were computed, and in the multivariable logistic regression analysis, adjusted odds ratio (AOR) with 95% confidence interval (CI) and a p value of less than 0.05 were used to identify the associated factors with completion of the continuum of maternal healthcare services. Results The study revealed that the overall completion of the continuum of maternal healthcare services was 21.60% (95% CI: 18.20, 24.90). Women who were able to read and write (AOR: 2.70, 95% CI: 1.22, 6.04), using car/motorcycle as a means of transportation to get the health facility (AOR: 5.59, 95% CI: 2.29, 9.50), travel time less than an hour to get the health facility (AOR: 4.98, 95% CI: 2.97, 8.38), being satisfied with the service delivery (AOR: 1.89, 95% CI: 1.15, 3.11), and getting health education on maternal healthcare services in the last 6 months (AOR: 2.77, 95% CI: 1.52, 5.05) were factors associated with the completion of the continuum of maternal healthcare services. Conclusions The completion of the continuum of maternal healthcare services was relatively low, indicating that women were not getting the likely health benefit from the present health services. Therefore, interventions should focus on increasing women's awareness, improving the availability of services at nearby health facilities, and improving service delivery by considering women's preferences and needs to increase their satisfaction are essential to increase the completion of maternal healthcare services.
Collapse
|