19 Mar 2015

Getting data to you faster: The Key Indicators Report

In 2006 I was in Addis Ababa, Ethiopia, preparing for the release of the 2005 Ethiopia Demographic and Health Survey (EDHS). In the days leading up to the national seminar and launch of the EDHS report, two separate individuals approached me at my hotel, both looking for an “advance copy” of the report. One was writing a grant proposal for child health services and wanted to see how child health indicators had changed since 2000.  Another needed to know how to budget for family planning activities before his annual work plan was due, just days before the launch of the report. This is not a unique story, but rather an illustration of how much people rely on DHS survey data, how well they are used, and how much impact can be made by providing quality data in a timely fashion.

2014 Lesotho DHS Key Indicators Report

2014 Lesotho DHS Key Indicators Report

There is no survey manager at The DHS Program who has not been asked if data can be released in advance. We are always asking ourselves, “how can we get people the DHS survey data faster?” This month, we release the first Key Indicators Report:  a report of the most essential results from the DHS, published just three months after the completion of fieldwork. In this case, the lucky country is Lesotho.*

While The DHS Program has always published a “Preliminary Report”, the Key Indicators Report is more complete, including additional indicators, more background characteristics such as wealth quintile, and many more figures, primarily to highlight trends. In Lesotho, for example, the Key Indicators Report highlights progress towards reducing childhood mortality.

The full DHS final report will continue to be published on schedule. For Lesotho, this will likely be in late 2015. But for now, it is our hope that these key indicators provide the much needed data that policy makers and program managers need to plan, monitor, and evaluate their efforts.

Trends in Childhood Mortality in Lesotho

Trends in Childhood Mortality from the 2014 LDHS Key Indicators Report

 

*Lesotho is the first country to produce a KIR with the newly designed standard DHS KIR tabplan and cover.  Cambodia released a country-specific KIR in February 2015.  

10 Mar 2015

Training the Next Generation of DHS Program Biomarker Consultants

In January, 2015, 11 biomarker specialists from 8 countries met in Uganda to participate in the first-ever South-to-South DHS Program Biomarker Workshop. Participants all had previous experience with DHS surveys, either as consultants or as in-country staff. The objectives of the training were to emphasize mastery of technical biomarker content and training materials, strengthen consultants training and facilitation skills, and to pilot test the newly designed DHS Program Biomarker Curriculum. Ultimately, it is hoped that many of the participants from this workshop will be able to serve as DHS Program biomarker consultants for future surveys.

There were many lessons learned from the training. For example, while DHS Program staff have been training biomarker specialists in survey countries for decades, their training has been limited to their specific role in one country. The new biomarker curriculum is broader, allowing biomarker consultants to see how biomarker data collection fits into the larger survey process, and which aspects of the standard methodologies are applied in all survey settings.

CS blog biomarkers 2

Biomarker specialists visit a Ugandan laboratory as an experiential activity.

Bakunda Kamaranzi, a Laboratory Training Coordinator from the Uganda Ministry of Health, elaborates: “I was invited from Uganda, and had a fair understanding of the DHS Program, having participated in more than one DHS survey. In as much as I thought I knew quite a bit about the program, by the end of the first day, I knew and agreed with my colleagues that there was a lot to learn, a lot more that we did not know.”

One of the challenges of training a group of future consultants is that the participants must not just be able to implement data collection protocols and practices, but they must also be able to explain them to dozens of future trainees. This requires that these consultants understand the “why” of the way we do things. Why must the blood drops be totally dry before packing? Why do we wipe away the first drop of blood during a finger prick? Why do we measure younger children lying down? The South-to-South training allowed for a discussion of all this important background information.

Zoulkarneiri Issa (Togo), Jean de Dieu Butura (Rwanda) and Tharcisse Munyaneza (Rwanda) wrote: “En effet, ils nous rappelaient à chaque moment sur notre rôle de consultant et par conséquent, nous devons maitriser tous les contours scientifiques et même épidémiologiques des thématiques à enseigner. Ce qui nous permettra de faire face aux éventuelles questions et préoccupations des autorités sanitaires et administratives des pays où nous serons appelés à consulter.”

English: “In fact, [the facilitators] reminded us every moment of our consulting role and that we were expected to master all the scientific and epidemiological concepts and the teaching thematic concepts. This will enable us to deal with any issues and concerns of health and administrative authorities of the countries where we are called to provide technical assistance.”

Lastly, most biomarker specialists had no previous experience with adult learning techniques; few had been trained in training or facilitation. If The DHS Program hopes to use these participants as future biomarker consultants, they will, in turn, be expected to train all of the in-country biomarker survey staff on biomarker data collection. Simply knowing the technical material is not enough. They will need to know how to train people to do this correctly.

Jean de Dieu Butura, Kamarazni Bakunda, and Mike Amakyi practice storing blood samples.

For the teach back exercise, Jean de Dieu Butura, Kamarazni Bakunda, and Mike Amakyi practice proper storage of blood samples.

Bakunda Kamaranzi explains: Then came the training-of trainers. At the beginning we were introduced to new theories and names; Bloom’s taxonomy, Edgar Dale’s cone of learning, David Kolb’s experiential learning cycle, all which some of us were seeing for the very first time. By the end of the day, we were able to relate the theories to training and it all made a lot of sense.  The teaching methods learned in the TOT session were used during the teach-back sessions and, we are better trainers than we were on the 19th of January when we reported to the workshop. The trainers guide will definitely improve the way we deliver Biomarker training for DHS surveys.”

The January 2015 South-to-South Biomarker Training is one of many activities The DHS Program is undertaking to formalize our capacity strengthening efforts, and empower a wider group of experts to assist in the implementation of DHS surveys globally. The reach of these trainings is limitless:  as we train our colleagues to be trainers, they can train hundreds more. Ultimately, these South-to-South consultants will be leaders in DHS survey management, and, more broadly, will contribute to improved quality of data collection of other surveys in their region.

Biomarker specialists learning proper DBS collection.

Biomarker specialists learning proper DBS collection.

Michel Toukam, Lecturer at the Faculty of Medicine and Biomedical Sciences, University of Yaounde, Cameroon, summarizes: With this workshop, the consultants have acquired more knowledge on adult’s training methodology and techniques (Andragogy), on the DHS gold standards, protocols and procedures. They will form a network of DHS Program consultants in which experiences in learning techniques and follow up of DHS survey biomarker procedures will be shared. They will be more confident when they are leading training sessions in surveys.”

Nsobya Samuel Lubwama, Senior Lecturer at the Department of Pathology, School of Biomedical Science, Makerere University College of Health Sciences in Uganda, adds: “With my laboratory background experience of over 20 years, this workshop was timely to enrich me with new skills by expert facilitators…I am now able to train health laboratory technicians worldwide with very minimum supervision on other biomarkers namely:  anthropometry, DBS collection, measuring pressure, blood glucose, Hemoglobin, HIV. I have also been empowered with new knowledge how to plan for survey in advance such as advising the country policy makers on what is needed to collect biomarkers of interest in relation to country specific needs.”

 

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Anthropometry measurement (height and weight) is a core component of DHS surveys that is used to generate indicators on nutritional status. The Biomarker Questionnaire now includes questions on clothing and hairstyle interference on measurements for both women and children for improved interpretation.