On September 7, this year, the Uganda Bureau of Statistics released the key findings of the Uganda Demographic and Health Survey (UDHS) 2022.
The UDHS is an important study that shows the status of the population countrywide, looking at certain health and other indicators, usually focusing on the previous five years. These include family planning, maternal and child mortality (death), nutrition, HIV/AIDS, domestic violence and others.
This information is critical. For instance, it provides data on how many people may be suffering from a disease or condition and whether people are using key health services. It is also a basis for planning services needed by the community. The 2022 UDHS shows a decline in the number of babies born alive, who die in the first 28 days of life; from 27 deaths per 1,000 live births in the 2016 UDHS to 22 deaths per 1,000 live births. This is good news and possibly indicates that interventions put in place before 2022 to reduce deaths of babies are working. However, it is known that there are challenges with collecting accurate information in surveys, such as the UDHS about deaths of new-born babies, or even stillbirths. In this article I share three aspects we learned during studies we conducted in Uganda, Guinea Bissau, Ethiopia, Bangladesh and Ghana, within the EN-INDEPTH survey and as part of my PhD work, from 2018-2021.
One of these key aspects is the social and cultural barriers surrounding reporting of these deaths. We found that where a baby was not considered as a human being, for example because it was not fully developed yet, then the death was not reported. In fact, these babies usually were not buried publically like adults.
In other cases, women feared to reveal what happened because of fear of judgement and blame from the community, especially where the same woman repeatedly lost babies or pregnancies. In some instances, it was believed that talking about pregnancy loss or a baby's death would cause the same problem to happen again.
The communities we interviewed said as a result of such beliefs, people avoided telling interviewers the truth and instead said they had never lost a baby.
The second barrier I highlight here is the negative effects of losing a baby or pregnancy. Women and men suffer grief, depression, anger, shock, thoughts of suicide and many other emotions after loss. Many of these psychosocial effects last for years.
The grief never really ends. Therefore, when interviewers come to ask them about whether they have ever lost a baby and to share certain information around that loss, sometimes to avoid discussing a painful topic, women confessed that they may say they have never had such a loss, so the interviewer can go away. Others provide scanty information or are too distraught to complete the interview.
Thirdly, people often do not understand the purpose of questions about new-born deaths or other pregnancy loss. They do not see the relevance because the questions will not resurrect the baby and some find them intrusive and almost a violation of their private life.
Therefore, while the new-born deaths may have declined as shown by the UDHS 2022, it is likely that a number of new-born deaths still remain unreported and invisible. This means that the true number is probably higher and the associated causes will persist.
How then can population-based surveys like the UDHS strengthen data collection and the quality of their data? Some solutions proposed by our studies include improved training of the survey interviewers, who are a focal point of this process.
Interviewers need to be able to probe or investigate more deeply to get accurate information. They should also be trained to be sensitive to the emotional and psychological state of the person they are interviewing, especially in cases of bereavement. By starting the interview with a friendly approach and giving the respondent time to recollect herself if she gets sad, then they are more likely to collect accurate information. Furthermore, by ensuring that interviewers are clear on the purpose of the survey, they can in tum explain to respondents why the interview is being done and of what use the information will be to the community and the country. This clarity helps to spike people's interest and eagerness to respond. I suggest that as more of the UDHS 2022 data is availed, follow up studies are done to understand certain results.
Read the full version at www.newvision.co.ug
Doris K. Kwesiga | The writer is a research Fellow and PhD student; School of Public Health, Makerere University
Child loss: Why and when people do not report
On September 7, this year, the Uganda Bureau of Statistics released the key findings of the Uganda Demographic and Health Survey (UDHS) 2022.
The UDHS is an important study that shows the status of the population countrywide, looking at certain health and other indicators, usually focusing on the previous five years. These include family planning, maternal and child mortality (death), nutrition, HIV/AIDS, domestic violence and others.
This information is critical. For instance, it provides data on how many people may be suffering from a disease or condition and whether people are using key health services. It is also a basis for planning services needed by the community. The 2022 UDHS shows a decline in the number of babies born alive, who die in the first 28 days of life; from 27 deaths per 1,000 live births in the 2016 UDHS to 22 deaths per 1,000 live births. This is good news and possibly indicates that interventions put in place before 2022 to reduce deaths of babies are working. However, it is known that there are challenges with collecting accurate information in surveys, such as the UDHS about deaths of new-born babies, or even stillbirths. In this article I share three aspects we learned during studies we conducted in Uganda, Guinea Bissau, Ethiopia, Bangladesh and Ghana, within the EN-INDEPTH survey and as part of my PhD work, from 2018-2021.
One of these key aspects is the social and cultural barriers surrounding reporting of these deaths. We found that where a baby was not considered as a human being, for example because it was not fully developed yet, then the death was not reported. In fact, these babies usually were not buried publically like adults.
In other cases, women feared to reveal what happened because of fear of judgement and blame from the community, especially where the same woman repeatedly lost babies or pregnancies. In some instances, it was believed that talking about pregnancy loss or a baby's death would cause the same problem to happen again.
The communities we interviewed said as a result of such beliefs, people avoided telling interviewers the truth and instead said they had never lost a baby.
The second barrier I highlight here is the negative effects of losing a baby or pregnancy. Women and men suffer grief, depression, anger, shock, thoughts of suicide and many other emotions after loss. Many of these psychosocial effects last for years.
The grief never really ends. Therefore, when interviewers come to ask them about whether they have ever lost a baby and to share certain information around that loss, sometimes to avoid discussing a painful topic, women confessed that they may say they have never had such a loss, so the interviewer can go away. Others provide scanty information or are too distraught to complete the interview.
Thirdly, people often do not understand the purpose of questions about new-born deaths or other pregnancy loss. They do not see the relevance because the questions will not resurrect the baby and some find them intrusive and almost a violation of their private life.
Therefore, while the new-born deaths may have declined as shown by the UDHS 2022, it is likely that a number of new-born deaths still remain unreported and invisible. This means that the true number is probably higher and the associated causes will persist.
How then can population-based surveys like the UDHS strengthen data collection and the quality of their data? Some solutions proposed by our studies include improved training of the survey interviewers, who are a focal point of this process.
Interviewers need to be able to probe or investigate more deeply to get accurate information. They should also be trained to be sensitive to the emotional and psychological state of the person they are interviewing, especially in cases of bereavement. By starting the interview with a friendly approach and giving the respondent time to recollect herself if she gets sad, then they are more likely to collect accurate information. Furthermore, by ensuring that interviewers are clear on the purpose of the survey, they can in tum explain to respondents why the interview is being done and of what use the information will be to the community and the country. This clarity helps to spike people's interest and eagerness to respond. I suggest that as more of the UDHS 2022 data is availed, follow up studies are done to understand certain results.
Read the full version at www.newvision.co.ug
Doris K. Kwesiga | The writer is a research Fellow and PhD student; School of Public Health, Makerere University
