Perspectives on the INDEPTH Network-ENAP metrics design workshop
The INDEPTH Network ENAP (Every Newborn Action Plan) metrics design workshop that took place in Kampala, Uganda, in June  was an awesome experience. It was held to discuss a collaborative study that involves concurrent data collection in five Health and Demographic Surveillance Sites (HDSS) in Africa and Asia, as well as shared authorship. These are Bandim (Guinea Bissau), Dabat (Ethiopia), Kintampo (Ghana), Iganga-Mayuge (Uganda), and Matlab (Bangladesh).
The objectives of the work are to 1) Improve household survey capture of stillbirths and neonatal deaths in terms of assessing pregnancy history compared to live birth history modules; 2) Improve household survey capture of birth weight and gestational age; and 3) to optimise the HDSS data capture of pregnancy outcomes. The focus of the workshop was to bring the site teams together to review the objectives of the ENAP work and refine a generic protocol and relevant tools in order to meet these objectives.
Over three days, a group of 27 participants from Africa, Asia, and Europe were able to successfully share ideas to discuss the methods to achieve each objective. Together, the group worked through the draft generic protocol that was written by the core team from INDEPTH Network Maternal and Newborn Working Group and London School of Hygiene & Tropical Medicine. They deliberated the survey design, the survey questionnaire content, and the data collection modalities. For instance, it was agreed that randomization in the survey would be done at the individual woman level, rather than through the use of clusters or villages.
The site representatives were also in agreement that the enumerator should not be somebody who knows the family well and should be someone different from the routine HDSS team that collected data from that particular woman. Other deliberations were held on sample size (total estimated sample size was 68,000), data linkages with health facility data, culturally sensitive issues during data collection, the ethnographic study and other qualitative data collection, and much more.
Generation of ideas on how to improve gestational age data and birth weight data in surveys was also a focal point of the workshop. The sites gave some examples of what they are currently doing, including collection of data on last menstrual period and expected date of delivery from the mothersâ€™ antenatal cards or maternal passports, while some asked the mothers about perceived birth weight. Finally, the participants were separated by sites, to discuss which pregnancies they think their HDSS is missing, if any; specific local barriers around pregnancy loss; possible enhancements to the surveillance system and reporting (with limited cost implications and with higher costs).
Participants also worked through possible ways in which this work can be done without destabilizing the routine surveillance. Throughout the workshop, the sites were able to learn from each other and identify good practices that could be replicated in sites that were not doing them, for instance the in-migration form in Kintampo that tracks pregnancies, conducting urine tests to confirm pregnancy in Matlab, placing somebody at a health facility to collect data in Bandim, incentives given to local guides in Dabat, and use of the village health team in Iganga-Mayuge.
The next phase is for the core team to complete the generic protocol. Each HDSS will then adapt this and develop a protocol to suit their site-specific needs and submit it for ethical review and approval in January 2017, after which data collection can start. Analysis of data will be done jointly through sharing specific data, rather than pooled datasets. A data sharing agreement is also going to be drafted, led by INDEPTH Network. The participants identified two further multi-site grants that they are going to collaborate on to get further funding for this and future work. The next face-to-face meeting will be held in April 2017, to discuss progress and other issues like verbal autopsy.
Our special thanks goes to the Childrenâ€™s Investment Fund Foundation for the financial support to the INDEPTH Network-ENAP work!
*Blog by Doris Kwesiga, a research fellow with the INDEPTH Network Maternal and Newborn Working Group.