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IJE Advance Access originally published online on October 2, 2007
International Journal of Epidemiology 2008 37(1):194-200; doi:10.1093/ije/dym202
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2007; all rights reserved.

Accuracy of child morbidity data in demographic and health surveys

Alireza Olyaee Manesh1, Trevor A Sheldon1, Kate E Pickett1,* and Roy Carr-Hill2

1Department of Health Sciences, University of York, UK.
2Centre for Health Economics, University of York, UK.

* Corresponding author. Department of Health Sciences, Seebohm Rowntree Building, A/TB/165, University of York, Heslington, York, YO10 5DD, UK. E-mail: kp6{at}york.ac.uk


  Abstract

Background: The Demographic and Health Surveys (DHSs) have been used throughout the developing world for the last 20 years to provide data on the distribution of disease in order to inform planning. Data on child illness and death are reported by mothers and are susceptible to error.

Methods: We conducted an in-depth study of the Iranian DHS carried out in 2000–2001 and reviewed 110 DHS carried out around the world to check for bias by assessing the social gradient in reported child morbidity and mortality.

Results: We found that the reported under-5 child morbidity and mortality rates for the 28 Iranian provinces were inversely correlated (r = –0.592, P < 0.001) and that the adjusted social gradient of child morbidity implied increased illness in those who had literate vs illiterate mothers (OR = 1.26, 95% CI 1.20–1.32) compared with a decrease in mortality with increased literacy (OR = 0.52, 95% CI 0.46–0.59). Many of the other DHSs also show increased rates of reported child diarrhoea in households with higher levels of maternal education, access to piped water and urban (vs rural) dwellings, the reverse of what is found with mortality rates.

Conclusions: This suggests that there may be significant recall and reporting bias in under-5 childhood morbidity in DHSs. Caution should be used in the interpretation and use of data from DHSs and the survey methods should be reviewed.

Keywords Demographic and Health Surveys, child mortality, morbidity, bias (epidemiology), error sources

Accepted 30 August 2007


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