Methods for health surveys in difficult settings: charting progress, moving forward

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Abstract

Health surveys are a very important component of the epidemiology toolbox, and play a critical role in gauging population health, especially in developing countries. Research on health survey methods, however, is sparse. In particular, current sampling methods are not well adapted for certain 'difficult' settings, such as emergencies, remote regions without easily available sampling frames, hidden and vulnerable population groups, urban slums and populations living under strong political pressure. This special issue of Emerging Themes in Epidemiology is entirely devoted to survey methods in such settings, and builds upon a successful conference in London highlighting problems with current approaches and possible ways forward. Greater investment in research on health survey methods is needed and will have beneficial effects for populations in need.

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Most cited references 13

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Cluster sampling to assess immunization coverage: a review of experience with a simplified sampling method.

T Sundaresan, R. C. W. Henderson (1981)

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Health statistics now: are we making the right investments?

Egge J. Boerma, Brian K Stansfield (2007)

Increases in international funding for health have been accompanied by accelerating demand for more and better statistics, which are needed to track performance and ensure accountability. Worldwide interest in the monitoring of development, as exemplified in the Millennium Development Goals (MDGs), generates pressure for high-quality and timely data for reporting on country progress. This rapid escalation of demand has exposed major gaps in the supply of health statistics for developing countries but also provides major opportunities to increase the supply and use of sound health statistics. First, the emphasis on monitoring and evaluation is leading to proliferation of indicators and excessive reporting requirements, and needs to be refocused on systematic investments in data generation and analysis. Second, the risk of inadequate or poorly targeted investments can be kept to a minimum by understanding the causes of poor availability of health statistics, including lack of accurate measurement instruments, application of suboptimum methods of data collection, and inadequate use of methods and analyses to produce comparable estimates. Third, the preoccupation with MDGs does not take into account the rapid health transition, which implies that health statistics should systematically include a much wider array of health issues from acute infectious diseases to chronic non-communicable diseases and injuries, disaggregated by socioeconomic position. Fourth, the growing number of national household surveys, which are the main source of most population health statistics, need to be streamlined into cohesive and comprehensive country health survey programmes. Now is the time to accelerate the production and use of accurate, complete, and timely health statistics for decision-making by investing in country health information systems that should be based on an efficient and effective mix of standardised methods of data collection and analysis that meet country and international needs.

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Don't spin the pen: two alternative methods for second-stage sampling in urban cluster surveys

Rebecca F. Grais, Angela MC Rose, Jean-Paul Guthmann (2007)

In two-stage cluster surveys, the traditional method used in second-stage sampling (in which the first household in a cluster is selected) is time-consuming and may result in biased estimates of the indicator of interest. Firstly, a random direction from the center of the cluster is selected, usually by spinning a pen. The houses along that direction are then counted out to the boundary of the cluster, and one is then selected at random to be the first household surveyed. This process favors households towards the center of the cluster, but it could easily be improved. During a recent meningitis vaccination coverage survey in Maradi, Niger, we compared this method of first household selection to two alternatives in urban zones: 1) using a superimposed grid on the map of the cluster area and randomly selecting an intersection; and 2) drawing the perimeter of the cluster area using a Global Positioning System (GPS) and randomly selecting one point within the perimeter. Although we only compared a limited number of clusters using each method, we found the sampling grid method to be the fastest and easiest for field survey teams, although it does require a map of the area. Selecting a random GPS point was also found to be a good method, once adequate training can be provided. Spinning the pen and counting households to the boundary was the most complicated and time-consuming. The two methods tested here represent simpler, quicker and potentially more robust alternatives to spinning the pen for cluster surveys in urban areas. However, in rural areas, these alternatives would favor initial household selection from lower density (or even potentially empty) areas. Bearing in mind these limitations, as well as available resources and feasibility, investigators should choose the most appropriate method for their particular survey context.

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Journal ID (nlm-ta): Emerg Themes Epidemiol

Title: Emerging Themes in Epidemiology

Publisher: BioMed Central (London )

ISSN (Electronic): 1742-7622

Publication date Collection: 2007

Publication date (Electronic): 1 June 2007

Volume: 4

Page: 13

Affiliations

[1 ]Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK

[2 ]International Emergency and Refugee Health Branch, Division of Emergency and Environmental Health Services, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

[3 ]Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK

[4 ]East of England Regional Epidemiology Unit, Health Protection Agency, UK

[5 ]Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK

Article

Publisher ID: 1742-7622-4-13

DOI: 10.1186/1742-7622-4-13

PMC ID: 1892016

SO-VID: 2ca20106-9323-4c98-a6d5-7cc493c52934

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Methods for health surveys in difficult settings: charting progress, moving forward

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Most cited references 13

Cluster sampling to assess immunization coverage: a review of experience with a simplified sampling method.

Health statistics now: are we making the right investments?

Don't spin the pen: two alternative methods for second-stage sampling in urban cluster surveys

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