International Journal of Epidemiology, Vol 18, S20-S32, Copyright © 1989 by International Epidemiological Association
G Bicego, A Augustin, S Musgrave, J Allman and P Kelly
The provision of simple health technologies in less developed countries has
far outpaced the capabilities to evaluate their impact on health in
general, and early childhood survival in particular. In rural Haiti,
attempts to monitor the impact of health care delivery programmes have been
frustrated by some of the same problems encountered elsewhere; ie lack of
practicable yet scientifically sound methodologies that interface well with
ongoing service delivery programmes. The 'preceding birth' technique,
originally advanced by Brass and Macrae, holds promise as just such a
method. Its practical appeal derives largely from simple data requirements.
In its simplest form, the method requires only responses to a single
question put to mothers at delivery regarding the survival status of her
previous child. They have shown that the proportion of immediately
preceding births dying before the 'index' birth date provides a good
approximation of the standard life table probability of death before the
second birthday. Given that in rural Haiti, as in much of the less
developed world, few women deliver in clinic or hospital where such data
could be systematically obtained, exploitation of the preceding birth
method would require identification of a convenient and unobtrusive point
of contact between questioner and mothers who have recently delivered. In
Haiti, two options arose: (1) interview women at home after childbirth, and
(2) interview women when they bring the 'index' child seeking vaccination
or some other child survival intervention. Both of these deviate from the
original technique of Brass and Macrae with respect to the timing and
method of data collection, and could therefore introduce serious
complications to the interpretation of trends in child mortality. To study
this, we examined the effects of adapting the preceding birth method to a
rural less developed country setting in Mirebalais, where since 1983
primary health care activities have been administered by MARCH (Management
and Resources for Community Health), a private voluntary health
organization. The Mirebalais study used a pregnancy register, originally
developed for targeting of services, to identify women who were expected to
have given birth during the 12-month period before each of two survey
rounds. Brief interviews with these women would provide direct life table
estimates of child mortality level and trend with which to compare
estimates produced from use of the preceding birth method in modified form.
Direct estimates of the probability of dying before the second birthday
were 138/1000 from first round data and 134/1000 from second round data,
indicating a 3% decline.(ABSTRACT TRUNCATED AT 400 WORDS)
ARTICLES
Evaluation of a simplified method for estimation of early childhood mortality in small populations
Johns Hopkins University at L'Institut Haitien de L'Enfance, Port-au- Prince, Haiti.
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