20 Jul

Spotlight on New Staff: Trinadh Dontamsetti

Name: Trinadh Dontamsetti

Position title: Health Geographic Analyst

Languages spoken: English, Spanish, Telugu

When not working, favorite place to visit:  You mean other than grandma’s house to get some home-cooked food? I have a definite soft spot for my hometown of Tampa, Florida and its perpetually great weather (and mom’s home-cooked food).

Favorite type of cuisine: I can’t say I’ve got a favorite, if only because I’ll eat anything and everything that looks good.  I most often catch myself cooking Italian or Chinese food, however.

Last good book you read: “Man’s Search for Meaning” by Viktor Frankl.  While really heavy, it’s one of the most inspiring books I’ve ever read.

Where would we find you on a Saturday?  Any number of places, depending on the time! A typical Saturday includes a long workout at the gym, a longer drive on winding roads (it’s my go-to stress relief), and a trip into DC to undo my workout by eating far too much.

First time you worked with DHS survey data: During my Master’s program at the University of South Florida, using 2013 Nigeria DHS GPS data as part of a study on schistosomiasis transmission.

What is on your desk (or bulletin board/wall) right now?  I’m a minimalist, so not much (that’s a better way of saying I’m too lazy to decorate).  I do have a tiny, magnetic alpaca that a friend brought me from Peru, and I plan to surround him with souvenirs once I get back from my first DHS trip to Ghana!

What is your favorite survey final report cover?   2010-11 Senegal DHS.  I’m a huge fan of geometric art.

Favorite chapter or indicator, and why? One of my major focuses during my Master’s program was vector-borne disease (specifically Integrated Vector Management as an alternative way of combating these diseases), so the indoor residual spraying indicator is of particular interest to me.

What’s your favorite way to access The DHS Program’s data?  You can’t go wrong with the Spatial Data Repository (SDR) and STATCompiler!

What population or health issue are you most passionate about?  Why?  I’ve been most fascinated and passionate about studying tuberculosis (TB), given that it’s been around for so long and yet continues to be such a burden all over the world.  With few exceptions, I focused almost all of my projects during grad school (including my final thesis) on studying some aspect of TB.  Since there’s so much overlap between TB and other diseases (most notably HIV/AIDS), I’ve been trying to familiarize myself further with the HIV/AIDS work done by DHS so that I can get a better understanding of the interplay between these two diseases.

What are you most looking forward to about your new position?  I’m extremely excited that I’ll be working on analytical projects and conducting research as part of my work here, which makes all those late nights in the computer lab during grad school doing analytical projects and conducting research seem just a little bit more worth it in the long run.

What has been your biggest surprise so far?  The incredible amount of support I so routinely receive from everyone in the office as I settle into my position, and the continued opportunities I’m being given to learn new things but also contribute to ongoing projects by applying the skills I’ve brought in.

What do you look forward to bringing to The DHS Program (job-related or not!)? A public health-centric GIS perspective, an unhealthy obsession with food (did I mention it at least three times already in this post?), an even less healthy obsession with superheroes and cars, and a nearly endless supply of optimism and sarcasm (could this be any more cliché?).

13 Jul

Spotlight on Implementing Agencies: Tchad

De gauche à droite: BOYALNGAR MBATINA, YODIT BEKELE , NOUBADIGNIM RONELYAMBAYE and RIGUIDE MBAISSANADJ

In April 2016, The DHS Program welcomed visitors from Tchad. This post is one in a series of interviews with visitors to DHS headquarters. Don’t read French? You can use the translate feature at the top of the page!

Nom : Riguide Mbaissanadje (Point Focal du Ministère de la Sante Publique), Noubadignim Ronelyanbaye (Chef de Service des Etudes de Population et Perspectives Démographiques de e’INSEED), et Boyalngar Mbatina (Chef de Département des Etudes Démographiques  et de la Cartographie à l’Institut National de la Statistique)

Pays d’origine : Tchad

Racontez un peu la première fois que vous avez travaillé sur des données de « The DHS Program »:

Noubadignim Ronelyanbaye: Je me suis retrouvé dans une situation semblable aux autres occasions où j’en ai travaillé sur la relecture et finalisation d’un rapport d’enquête nationale du Tchad

Boyalngar Mbatina : Préparation du mémoire de fin d’études pour l’obtention du Diplôme D’Études Supérieures Spécialisées en Démographie (DESSD)

Qu’est-ce que vous avez trouvé comme surprise  agréable lors de votre séjour  à « The DHS Program »?

Riguide Mbaissanadje : La sympathie.

Noubadignim Ronelyanbaye : Le temps passe plus vite que je ne m’attendais.

Boyalngar Mbatina : L’organisation du travail ainsi que la spécialité de chaque agent.

Qu’est-ce que vous manque le plus de chez vous quand vous êtes ici ?

Riguide Mbaissanadje: Les chaînes de télévision en Français

Noubadignim Ronelyanbaye: L’ambiance en famille

Quelle est la plus grande différence entre le bureau de «The DHS Program » et votre bureau dans votre pays ?

Riguide Mbaissanadje : La salle de café.

Noubadignim Ronelyanbaye et Boyalngar Mbatina : Le bureau DHS est bien équipé avec le minimum requis et les cadres disposent de moyens matériels pour effectuer les travaux et les tâches sont réparties d’avance.  Ce n’est pas comme chez nous où une personne ne peut pas faire beaucoup de tâches en même temps.

Quelle est votre  page de couverture préférée ?

Tout : EDST-2 du Tchad de 2004

Quel est votre chapitre ou indicateur préféré, et pourquoi ? 

Riguide Mbaissanadje : Chapitre 12, Mortalité des enfants de moins de 5 ans parce qu’il montre que la mortalité infantile est faible dans le Barh, El Grazal et le LAC.  Il y a lieu de faire une recherche sur la corrélation qui existe entre la mortalité et les indicateurs sanitaires (soins prénatals, vaccination des enfants et accouchement assisté).

Noubadignim Ronelyanbaye : Le paludisme.  Il y a 8 ménages sur 10 qui possèdent une MII (EDS-MICS 2014-15) bien qu’au Nord il n’y a pratiquement pas de paludisme.

Boyalngar Mbatina : Le chapitre sur la fécondité et l’ISF car il permet de bien comprendre les enjeux réels des problèmes et questions de population dans un pays en développement.

Quel est le thème de population ou de santé qui vous intéresse le plus, et pourquoi ?

Riguide Mbaissanadje : Le VIH/SIDA. Parce que pendant la collecte, avant la collecte, j’étais le responsable de tous les matériels… On a eu beaucoup de difficultés pendant la collecte et l’analyse au laboratoire mais les résultats nous réconfortent.

Noubadignim Ronelyanbaye : La consommation d’alcool et de tabac, les maladies nontransmissibles constituent des pathologies émergentes faisant sournoisement de savage au sein de la population et il est intéressant d’étudier les causes les plus communes qui sont le tabagisme, l’abus d’alcool, un régime alimentaire  malsain et l’inactivité physique.

Boyalngar Mbatina : Malnutrition des enfants de moins de 5 ans, car un enfant qui a un problème de croissance après deux dans, il y a peu de chance pour qu’une intervention, quoiqu’elle soit, puisse améliorer la situation.

Comment espérez-vous que les données de l’EDS sur votre pays seront utilisées ?

Riguide Mbaissanadje : Les données seront utilisées pour l’élaboration des documents politiques et stratégiques des Ministères de la Santé Publique, de l’Education Nationale et de la Femme et de l’Action Sociale

Noubadignim Ronelyanbaye : Restitution des principaux résultats aux institutions clés et personnes enquêtées; valorisation des données ; enseignements méthodologiques tirés ; concrétisation des objectifs et usages de données colletées

Boyalngar Mbatina : Pour la planification du développement et pour l’amélioration des conditions sanitaires et de vie de la population

Qu’avez–vous appris en travaillant avec «The DHS Program »?

Riguide Mbaissanadje : La collecte de sang à travers le DBS, conservation sur le terrain et la transmission au laboratoire.

Noubadignim Ronelyanbaye : La répartition équilibrée des tâches et la rigueur scientifique dans la rédaction des commentaires concernant les niveaux d’indicateurs qui ne sont pas attendues.

Boyalngar Mbatina : Le sens de responsabilité dans le travail, la rigueur dans le travail, le désir d’en savoir plus, et l’esprit d’équipe et de collaboration.

The 2014-15 Tchad EDS-MICS was released on July 11, 2016. Download the final report here.

 

 

 

 

 

29 Jun

Strengthening Afghanistan’s Health Sector: Evidence from the 2015 Afghanistan DHS

Dr. Ferozuddin Feroz (left), Sayed Alam Shinwari, Micheal Kugelman, and Larry Sample at The Wilson Center's Event, "A Good Diagnosis for Afghanistan: Strengthening the Health Sector"

Dr. Ferozuddin Feroz (left), Sayed Alam Shinwari, Michael Kugelman, and Larry Sampler at The Wilson Center’s Event, “A Good Diagnosis for Afghanistan: Strengthening the Health Sector”

Working in collaboration, two Afghan government organizations– the Central Statistics Organization and the Ministry of Public Health (MOPH) – conducted Afghanistan’s first Demographic and Health Survey (AfDHS). “This in itself is an enormous milestone,” said Larry Sampler, Assistant to the Administrator for the Office of Afghanistan and Pakistan Affairs at USAID during a panel discussion at the Wilson Center, “A Good Diagnosis for Afghanistan: Strengthening the Health Sector.” Sampler, joined by the Afghanistan Minister of Public Health, Dr. Ferozuddin Feroz; Sayed Alam Shinwari, President of the Afghan Medical Professionals Association of America; and Michael Kugelman, Senior Associate for South Asia at The Wilson Center highlighted the implications of the Afghan government’s efforts to improve maternal and child health as demonstrated in the newly released 2015 AfDHS Key Indicators Report (KIR).

AfDHS-KIROf particular interest to both the MOPH and USAID, AfDHS results show progress in reducing childhood mortalityCurrently, about 1 in 20 children does not survive until their 5th birthday in Afghanistan. The majority of these childhood deaths occur during the first year of life. Compared to earlier time periods, both infant and under-five mortality have declined, suggesting that child health interventions are making a difference. Dr. Feroz explains, “The DHS survey shows that there is substantial improvement in maternal health and child health. This progress has been made through high-level commitments, a productive work environment with development partners as well as non-governmental organizations (NGOs) and local NGOs, scaling up of cost effective and lifesaving interventions across the country, training of midwives, as well as attention to equity and those living in remote areas.”

“The DHS survey demonstrates how far the Afghan public health sector has come and also how far it has to go,” stated Larry Sampler. What are the challenges of Afghanistan’s health sector? “Afghanistan still faces instability and insecurity, poverty, unemployment, the few number of midwives or health staff across the country,” explains Dr. Feroz. But in spite of these challenges, the Afghan MOPH is developing a national strategy for the next five years. “We will use this recent survey as a baseline to measure progress – to increase access to remote areas, improve the quality of services, introduce cost-effective interventions, and focus on equity issues.”

Dr. Fred Arnold of The DHS Program with Dr. Ferozuddin Feroz, Afghanistan Minister of Public Health

Dr. Fred Arnold (left)  of The DHS Program with Dr. Ferozuddin Feroz, Afghanistan Minister of Public Health

The survey covered topics including fertility and family planning, maternal and child health, childhood and maternal mortality, nutrition, malaria, HIV knowledge, and other health issues. The KIR is a short report of key indicators from the 2015 AfDHS that is meant to provide important data in a timely fashion to program managers and policy makers. Additional indicators such as the maternal mortality ratio will be included in the AfDHS Final Report, scheduled for release in late 2016.

To learn more about the Woodrow Wilson Center’s event, watch “A Good Diagnosis for Afghanistan: Strengthening the Health Sector” or visit the Wilson Center’s website.

The 2015 Afghanistan Demographic and Health Survey (2015 AfDHS) was implemented by the Central Statistics Organization and the Ministry of Public Health from June 15, 2015, to February 23, 2016. The funding for the AfDHS was provided by the United States Agency for International Development (USAID). ICF International provided technical assistance through The DHS Program, a USAID-funded project providing support and technical assistance in the implementation of population and health surveys in countries worldwide.

16 Jun

Spotlight on Implementing Agencies: Lesotho

From left to right: Joanna Lowell of The DHS Program, Mr. Leutsoa Matsoso and Motsoanku Grace ‘Mefane of the Ministry of Health, Michelle Surdyk of USAID, Anna Masheane-Moseneke and Mahlape Ramoseme of the Ministry of Health

Name(s): Mrs. Anna Malefa Masheane/Moseneke (HIV/TB Clinical Officer), Miss Motsoanku Grace ‘Mefane (Sexual and Reproductive Health Manager), Miss Mahlape Ramoseme (Chief Statistician), and Mr. Leutsoa Matsoso (Head M&E Officer) of the Ministry of Health.

Country of origin:  Lesotho

When not working, favorite place to visit:

Anna: At the stadium watching football.

Motsoanku Grace: Public places to meet people, like hotels and parks, usually in the afternoon.

What has been the nicest surprise visiting The DHS Program headquarters?

Anna: Everybody seem to be busy doing their work.

Motsoanku Grace: The lack of noise.

Mahlape: Your team spirit towards your visitors.

What do you miss most about home when you are here?

Anna: Family members.

Motsoanku Grace: Braai and Papa.

Mahlape: Friends.

Leutsoa: Colleagues.

What is the biggest difference between The DHS Program headquarters office and your office at home?

Anna: Security here is very tight.

Motsoanku Grace: Staff here can work from home while in Lesotho we are always expected to come on duty for work.

What is your favorite DHS final report cover?

All: The 2009 Lesotho DHS.

Favorite DHS chapter or indicator?

Anna: Maternal Health.

Motsoanku Grace: Child Health.

Mahlape: HIV/AIDS.

What population or health issue are you most passionate about? 

Anna: Children under five.

Motsoanku Grace: Women of childbearing age.

How do you hope the DHS data from your country will be used?

Anna: For advocating for support from partners.

Motsoanku Grace: Prioritizing funding.

Mahlape: Decision making.

What have you learned from the DHS experience?

Anna: I find it easy to read and understand the tables now.

Motsoanku Grace: How to interpret surveys and write what results from them.

The 2014 Lesotho DHS was released on June 15, 2016. Download the final report here: http://bit.ly/LDHS14

18 May

Building Awareness of the Link between Fistula and Gender-Based Violence

Genital fistula, an abnormal hole between the vagina and rectum or bladder that causes urinary or fecal incontinence, is a devastating, preventable condition that no woman should have to endure. It usually results from inadequately managed, prolonged or obstructed labor, surgical error, or trauma [1, 2].  Although rare, it can be completely debilitating—physically, socially, and economically—particularly to women who live in remote areas without access to treatment; women with fistula are often shunned from the household or society, which can cause immense suffering  [3].

While sexual violence can cause traumatic fistula, the vulnerable state of women with fistula gives reason to suspect that the risk of violence could also increase after the onset of fistula [4, 5, 6], though no studies have attempted to evaluate this to date.  Moreover, because it is so rare, it is difficult to capture statistically significant associations with the condition.

The DHS Program provides an opportunity to study such rare events because of the inclusion of standardized questions in numerous, nationally-representative  surveys with large sample sizes. In a study conducted to further examine the relationship between fistula and violence, data were pooled from 12 DHS surveys, 11 conducted in Sub-Saharan African countries and one in Haiti, where standardized modules (sets of questions) on the two topics were included.

In total, 90,276 women were included in the analysis.  Among these women, the prevalence of self-reported symptoms of fistula ranged from 0.4% to 2.0%.  Regression analyses confirmed an association with sexual violence: women who have experienced sexual violence, both ever as well as within the 12 months preceding the survey, have almost twice the odds of reporting symptoms of fistula. Although there are no questions posed on timing of onset of symptoms of fistula in the DHS, the association with lifetime as well as recent experience of sexual violence suggests that violence could occur both before as well as after fistula’s onset.

One other finding of interest was that women whose first experience of sexual violence was committed by a non-partner had over four times the odds of reporting symptoms of fistula than women who did not report sexual violence.  Although inferences from these findings can only be made with caution, the temporality relationship between fistula and sexual violence deserves further investigation.

In light of International Day to End Fistula on May 23, it is imperative to continue to work towards minimizing occurrence of fistula by building awareness around conditions that contribute to and result from this morbidity. This study shows yet another disheartening correlation between gender-based violence and poor health outcomes for women. It provides even more impetus for training and sensitivity for women’s health care providers in this area.

full studyA poster presentation of the study was exhibited at the 2016 Annual Meeting of the Population Association of America (PAA) in Washington DC. More information can be found in this poster.

 

 

 


  1. Longombe AO, Claude KM, Ruminjo J. Fistula and traumatic genital injury from sexual violence in a conflict setting in Eastern Congo: case studies. Reprod Health Matters. 2008 May;16(31):132-41
  2. Raassen TJ, Ngongo CJ, Mahendeka MM. Iatrogenic genitourinary fistula: an 18-year retrospective review of 805 injuries. Int Urogynecol J. 2014 Dec;25(12):1699-706.
  3. Baloch, B.A., A. Salam, D. ZaibUnnisa, and H. Nawaz. 2014. Vesico-Vaginal Fistulae. The Professional Medical Journal, 21(5), 851-855.
  4. ACQUIRE. 2006. Traumatic gynecologic fistula: A Consequence of Sexual Violence in Conflict Settings. A report of a meeting held in Addis Ababa, Ethiopia, September 6-8, 2005. New York, The ACQUIRE Project/EngenderHealth.
  5. Peterman A, Johnson K. Incontinence and trauma: sexual violence, female genital cutting and proxy measures of gynecological fistula. Soc Sci Med. 2009 Mar;68(5):971-9.
  6. Naved RT, Blum LS, Chowdhury S, Khan R, Bilkis S, Koblinsky M. Violence against women with chronic maternal disabilities in rural Bangladesh. J Health Popul Nutr. 2012 Jun;30(2):181-92.

 

11 May

Spotlight on New Staff: Lindsay Mallick

lindsayandaviName: Lindsay Mallick

Position title:  Research Associate/Data Analyst

Languages spoken: English, French

When not working, favorite place to visit: Target. Just kidding.  But I’d love to vacation somewhere, anywhere, again one day.  Can someone spot me some leave? I can’t seem to save any since I came back from maternity leave!

Favorite type of cuisine: Anything I don’t have to cook or can’t cook myself, like Indian and sushi. Yum!

Last good book you read: “Expecting Better” by Emily Oster. She’s an economist who debunks a lot of the overly-prudent pregnancy restrictions with sound research and presents statistics on common pregnancy fears, myths, and the nitty gritty of labor and delivery.

Where would we find you on a Saturday?   At home, spending quality time with my family.  AKA, dancing to toddler radio, finding new places to hide the TV remote controls, narrowly avoiding lego foot injuries, and passing out early after a blissful 30 minutes of TV and cuddling with my husband.

First time you worked with DHS survey data: At Tulane for my MPH program, using the 2006 Mali DHS dataset to look at genital cutting for a research project in a class.

What is on your desk (or bulletin board/wall) right now?  Pictures of my son and husband; trinkets from around the world, kindly brought to me from my traveling coworkers.

What is your favorite survey final report cover?   2000-01 Mauritania DHS because that’s where I served in the Peace Corps!

Favorite chapter or indicator, and why? Family planning—I’m always interested to learn what the latest contraceptive prevalence rate and method mix is in a new survey, and see how that has changed over time.

What’s your favorite way to access The DHS Program’s data? From my hard drive, where I have many datasets stored for everyday use.

What population or health issue are you most passionate about?  Why?  It’s hard to choose just one.  They are all so important and intricately linked.  In the Peace Corps, I focused on water and sanitation, because they’re so fundamental to health.

What are you most looking forward to about your new position?  There is so much to learn working here, from new survey findings to working with DHS data.

What has been your biggest surprise so far?  The kind and supportive work environment—I really lucked out with this job.  My colleagues and supervisors are truly amazing people!

What do you look forward to bringing to The DHS Program (job-related or not!)? Funny stories, pictures and videos of life with a toddler.

27 Apr

The Vaccination Landscape: Changes and Challenges

What was the last vaccination you received? The one before that? When did you receive them?  Where was the vaccine administered – your arm? Your thigh? The right or the left? For most of us, this is not easy information to remember. And yet it’s what we ask many women to recall for their children in DHS interviews.

A child in Lhoksemawe, Aceh, Indonesia, receives a vaccine injection.

© 2012 Armin Hari/INSIST, Courtesy of Photoshare

Since 1984, The DHS Program has collected data on vaccinations in over 80 countries.  During this time, the vaccination landscape has changed dramatically. Initially, BCG, DPT (Diphtheria; Pertussis, or whooping cough; and Tetanus), Polio, and Measles were the only childhood vaccines most countries administered. These data were collected only from vaccination cards.

As time went on, our methodology expanded to include data collection from mother’s recall to clarify incomplete vaccination cards. In cases where there is no vaccination card, mothers are asked whether or not her child received each type of vaccine and the number of doses.

Today, the number of vaccines standardly administered is much higher. This is good news — it means millions more lives saved — but it introduces data collection challenges.

The vaccination data collected in a standard DHS questionnaire are far more elaborate than any time in our history: BCG remains; for Polio a birth dose is added; DPT is now combined into a pentavalent vaccine with Hepatitis B and Haemophilus influenza type B (Hib); 3 doses of a pneumococcal vaccine and 3 doses of a rotavirus vaccine are now included; and the measles vaccine has been replaced with a measles combination vaccine. For countries that are transitioning between vaccination schedules or have more complicated schedules, the landscape becomes more challenging to navigate.

Data collection is relatively straightforward when a child has an up-to-date and complete vaccination card.  But in many cases, changing vaccine schedules and inconsistent record-keeping render the cards incomplete or unclear. Worse, vaccination cards are often missing or otherwise unavailable.

Indeed, a recent study revealed that in 4 of the 10 countries with the largest birth cohorts that had carried out either a DHS or MICS survey in 2010-2013, less than 50% of children had home-based vaccination records.

A happy mother shows her child's vaccination card in New Delhi, India.

© 2012 Bhupendra/MCHIP, Courtesy of Photoshare

When a vaccination card is unavailable, it is the mother who is expected to fill in the gaps.  But a mother’s recall is not 100% reliable. Keeping track of vaccines for multiple children and for combination vaccines is challenging enough, but even more so if the mother isn’t present for every vaccination event.

Knowing whether newer and existing vaccines are reaching their target population and doing so on schedule is valuable information to many. What can be done to maintain and even improve data quality when the complexity of the data needs on vaccine coverage continue to grow?

The DHS Program, in collaboration with the World Health Organization (WHO), United Nations Children’s Fund (UNICEF) and other experts in the field, are pursuing several options. One involves visiting health facilities to compare the information collected during the interview to the vaccination information recorded at the health facility.

This process has been used previously in Central Asian countries and in Albania, where facility-based documentation is strong. It is now being pilot-tested in Ethiopia; however, the method of record-keeping varies by location and includes instances where records are kept based on the date of visit and not based on the child’s name or date of birth. Country-specific challenges such as these require additional flexibility and coordination between survey implementers, Ministries of Health, and health facilities.

There is unlikely a one-size-fits-all solution to the challenge of accurately measuring vaccination coverage.  But from the perspective of global health, this is a good problem to have.  More children worldwide are being protected from a host of illnesses.  We are proud to be sharing data to help track progress towards closing the gap as our implementing partners reach more children with a larger variety of vaccines.

20 Apr

From the Field: 2014-15 Uganda Malaria Indicator Survey (UMIS) Team

From left to right: Patrick, Aziza, Irene N., Doreen, Persis, Irene B. with Uganda Bureau of Statistics (UBOS) survey vehicle

During fieldwork for a household survey, survey teams visit households that are selected to represent an entire country. Respondents to the survey are as diverse as the country and live within mountains, valleys, deep in forests, and busy urban centers. These respondents allow survey teams into their homes to answer questions about themselves, their families, and their lives. While I consider myself lucky to have the opportunity to meet and talk to so many people during survey fieldwork, there are certainly many challenges.

For the fieldwork phase of the 2014-15 Uganda Malaria Indicator Survey (UMIS), I spent a day with Patrick, Aziza, Irene N., Doreen, and Persis as they conducted interviews and tested children under 5 for anemia and malaria. Despite the challenges and even some homesickness, the team worked hard to collect data important to Uganda while enjoying the chance to travel throughout their country, make friends, treat children for malaria, and engage with different communities.

Patrick, Lab Technician

“When you test a person’s child and actually find he has malaria, at the end of the day you give them treatment and the guardians are usually grateful. You feel like you’ve helped out.”


 

AzizaAziza, Interviewer

“It has been hectic. It hasn’t been easy. But at the end of the day we get data, even when you are very tired!”

“I’ve gotten the chance to educate women in the village… This is a way we connect with people in the village.”

 

Irene-NIrene N., Interviewer

“Most times, we wake up at 6 so we can be on the road by 7 after breakfast. Then, we get in the field by 8, so each interviewer does 5 to 7 households and then test about 16 children in a day.”

 

Doreen, Nurse/Interviewer

“We realized that malaria is still a major problem. People are suffering. Young children under five are really suffering from malaria and also anemia.”

“It has actually given us an opportunity to appreciate and learn more about our communities, because you would not have ever imagined that malaria really exists and is killing so many people until you are there, testing and seeing positive rapid diagnostic tests (RDTs).”

Persis, Supervisor

“My motto is, ‘I don’t give up’ … when it comes to work I do it with all my heart. I don’t compromise work, I am really mindful of the quality at the end of the day.”

“I really wanted to work on the malaria survey because health is the first and foremost priority… I believe our work is good.”

The 2014-15 Uganda Malaria Indicator Survey (UMIS) was released on November 6th, 2015, and is the 2nd UMIS as part of The DHS Program. Fieldwork took place from early December 2014 to late January 2015. There were 17 teams for field data collection; each field team included 1 field supervisor, 3 interviewers (1 of whom was a nurse), 2 health technicians, and 1 driver. A total of 5,345 households were interviewed. The 2014-15 UMIS was implemented by the Uganda Bureau of Statistics (UBOS) and the National Malaria Control Programme (NMCP) of the Uganda Ministry of Health.

13 Apr

How Many Demographers Does It Take to Make a Great Visualization?

How much time do you budget to create a data visualization?  The best visualizations, though they appear to be simple and clear, are often the result of dozens of attempts.

Demographers spend countless hours crunching data and preparing journal submissions, but not all take full advantage of data visualization, either in their exploratory analysis, or in communication of their findings.  Last month, data visualization enthusiasts met at the Population Reference Bureau for a hands-on workshop as part of the Population Association of America (PAA) Conference.  The 4 hour interactive workshop featured presentations from DC-based data viz expert Jon Schwabish, Dr. Tim Riffe, demographer at the Max Planck Institute for Demographic Research (MPIDR), Jonas Schoeley (MPIDR), and Dr. Audrey Dorelien of the Minnesota Population Center.  While each presenter had a unique focus, a common theme was clear:  your first draft visualization should never be your final visualization.  This lesson was put into practice as participants shared works-in-progress, received constructive feedback, and prepared “makeovers”.


Clara Burgert and I have been working on a visualization project for over a year.  The original was published last summer but we’ve been reworking it for a journal submission. Our colleagues at the data viz workshop provided constructive feedback, and we have made yet another round of changes. Some of the many stages of our chart “makeover” are presented below.

SAR12

Clara’s recently published analysis looks at 27 countries and 6 child health indicators. The goals of our visualization were to compare countries across these 6 indicators and to illustrate the inequity within countries, by highlighting the worst and best performing sub-national regions. While some countries have a very high measles vaccination prevalence, such as Tanzania, there are regions in Tanzania that are performing very poorly. Meanwhile, other countries have moderately good vaccination rates with very little variation among regions (like Rwanda). Our first real attempt at a publishable graphic looked like this:

indicators for journal

One of the challenges with this first graphic was that it didn’t use color very well. Clara needed to use color to distinguish between the 6 indicators in other places in the report, so we wanted to integrate that color scheme here for consistency. Simultaneously we realized that we could also simplify our use of color in this first draft: while we had originally plotted the red circle as the lowest region, the reader doesn’t need that color to know that that plot is the lowest- it’s obvious based on the axis and the left-to-right understanding of a numerical timeline. So we tried this:

indicators for journal with color coding

This color scheme worked better to unify the other graphics in the report, and we were feeling pretty good about it. But we still had a few concerns and questions:

  • Was it okay to have the axis for the stunting indicator and under-five mortality the same size as the others even though they aren’t at the same scale?
  • Was it okay that we were sorting lowest to highest, instead of ordering countries in a consistent way?
  • How should we handle ordering of the data when for 4 of our indicators, a high data value is “good”, like vaccination coverage, while for 2 of our indicators, a high data value is bad, like mortality?
  • Were there any formatting tweaks we could make to improve readability?

It was this version that was shared at the PAA data visualization workshop. Through the feedback of experts and colleagues, we made some final decisions:

  1. Change the axis of the stunting indicator to go to 100% so that it is consistent with the other percentages in the graphic. Some suggested that we move stunting and under-five mortality to a separate page to visually remind readers that the interpretation of these indicators is different (i.e., high values are bad). Ultimately, we decided that the layout of the 6 indicators was better for us in terms of publication, but agree that this is a trade-off and may confuse some less technical audiences.
  2. We decided to keep our sorting from low to high, as the main audience for this paper is looking at general trends, not for data for a specific country. However, reports by The DHS Program often have many audiences, and with that in mind, we created an additional graphic (not shown) that summarizes each of the indicators by country so that a stakeholder in Ghana can see his or her relevant data in one view, without searching for Ghana in each of the above graphics.
  3. Jon Schwabish had some quick and practical suggestions for making this graphic easier to read. His critique that it felt “heavy” resonated with us as the creators. He suggested thinning out the lines and substituting the big “X” marking the national average with a smaller circle.

6 indicators for journal April 4

There is a science to data visualization, but there is also a lot of subjectivity. Many solutions can be found only through trial and error. Often it takes time, several new sets of eyes, and dozens of drafts to settle on the best possible visualization for your data. While this is a big investment, there is growing evidence that it’s worth it. We are competing for just 1 or 2 minutes of our audience’s attention in a world filled with data and information. We hope to create a few visualizations that are worth stopping to explore.

 

07 Apr

Measuring health care: The Service Provision Assessment Survey

http://dhsprogram.com/publications/publication-SPA22-SPA-Final-Reports.cfm

When DHS and other population-based surveys indicate potential problems with a country’s health care systems, such questions are raised:

“Are certain services available in health facilities?”
“What is the quality of those services?”
“Are there factors at the service delivery level that could be contributing to the problems?”

The Service Provision Assessment (or SPA) survey attempts to bridge this gap while fulfilling the need to monitor health systems strengthening in surveyed countries.

Let’s say a national strategy is initiated to address a growing obesity problem and its associated issues, diabetes and hypertension. A component of the strategy may focus on improving a country’s health facilities by increasing the number that have diabetes services available.

2014-15 Tanzania SPA Key Findings

2014-15 Tanzania SPA Key Findings

It may also strengthen readiness of those facilities to provide quality services – more staff who are up-to-date on trainings for provision of diabetes services, more equipment (such as blood pressure apparatuses, adult weighing scales, and height boards), improved diagnostic capacity (the ability to conduct blood glucose and urine protein tests), and increased availability of medicines to manage diabetes. These are all indicators a SPA survey provides.

The improvements in service availability and readiness may lead to early identification of risk factors, early diagnosis and initiation of management, and, perhaps, a gradual decline in unmanaged diabetes.

2014-15 Tanzania SPA Key Findings video series
The SPA survey is designed to collect information from a sample of functioning health facilities in a country on the availability of services, readiness of facilities to provide health services in many areas, and measures of quality of care. Four different questionnaires are used to collect data at the facility, provider, and client levels. Survey data collection is done by teams of health workers.

If the DHS is a snapshot of a population’s health, the SPA is a snapshot of the service environment and those who provide and receive services, which drives population health. Though it can be challenging to directly link health facility data with population data, the SPA is useful in providing support and context to the DHS.

The first SPA surveys took place in Guatemala, Kenya, and Bangladesh in the late 1990’s, and continue to be implemented today. To date, 22 SPA surveys have been conducted, the latest being the 2014 Bangladesh Health Facilities Survey and 2014-15 Tanzania SPA. Ongoing surveys include the 2015 Nepal SPA and Senegal Continuous SPA. Be the first to know when those will be available (along with all other surveys) by signing up for email alerts, or by following us on Facebook and Twitter

The information provided on this Web site is not official U.S. Government information and does not represent the views or positions of the U.S. Agency for International Development or the U.S. Government.

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