Maternal, Adolescent, Reproductive, and Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK; Center of Excellence for Maternal Newborn and Child Health Research, School of Public Health, Makerere University, Kampala, Uganda.
Maternal, Adolescent, Reproductive, and Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK.
Lancet Glob Health. 2020 Apr;8(4):e555-e566. doi: 10.1016/S2214-109X(20)30044-9.
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=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=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.
背景：每年约有 510 万死产和新生儿死亡。家庭调查，尤其是人口与健康调查（ DHS），在 90 多个国家进行，是来自负担最重地区的主要数据来源，但数据质量仍存在问题。我们旨在比较两种问卷：一个完整的生育史模块，其中包含额外的妊娠丢失问题（FBH+；目前 DHS 的标准）和一个完整的妊娠史模块（FPH），它收集了所有活产、死产、流产和新生儿死亡的信息。
方法：居住在 INDEPTH 网络内的五个健康和人口监测系统站点（几内亚比绍的班迪姆、埃塞俄比亚的达巴特、乌干达的伊甘加-马尤盖、孟加拉国的马塔巴和加纳的金塔波）的妇女在 2017 年 7 月 28 日至 2018 年 8 月 13 日期间被随机分配（单独）接受 FBH+或 FPH 访谈。主要结局是调查访谈前 5 年的死产和新生儿死亡（通过死产率[SBR]和新生儿死亡率[NMR]衡量）以及完成产妇病史部分问卷所需的平均时间。我们还评估了不同地点的异质性。本研究在研究登记处注册，编号为 4720。
结果：69176 名妇女被分配接受 FBH+（n=34805）或 FPH（n=34371）访谈。完成 FPH 的平均时间（10.5 分钟）长于 FBH+（9.1 分钟；p<0.0001）。使用 FPH，在调查访谈前的 5 年内，估计的 SBR 为每 1000 例总分娩中有 17.4 例，比 FBH+（每 1000 例总分娩中有 15.2 例；p=0.20）高 21%（95%CI-10 至 62）。有很强的证据表明存在站点间异质性（I=80.9%；p<0.0001），在五个站点中的四个站点中，FPH 比 FBH+报告的 SBR 更高。两个模块估计的 NMR 没有差异（FPH 为每 1000 例活产中有 25.1 例，FBH+为每 1000 例活产中有 25.4 例），且没有站点间异质性的证据（I=0.7%；p=0.40）。
解释：FPH 完成平均需要多 1.4 分钟，但有可能增加高负担地区的死产报告。我们发现的站点间异质性可能反映了访谈员培训和调查实施的差异，强调了访谈员技能、培训和一致执行在数据质量方面的重要性。
资金来源：儿童投资基金会。
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