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Barriers and enablers to reporting pregnancy and adverse pregnancy outcomes in population-based surveys: EN-INDEPTH study

BACKGROUND: Risks of neonatal death, stillbirth and miscarriage are highest in low- and middle-income countries (LMICs), where data has most gaps and estimates rely on household surveys, dependent on women reporting these events. Underreporting of pregnancy and adverse pregnancy outcomes (APOs) is c...

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Autores principales: Kwesiga, Doris, Tawiah, Charlotte, Imam, Md Ali, Tesega, Adane Kebede, Nareeba, Tryphena, Enuameh, Yeetey A K, Biks, Gashaw A., Manu, Grace, Beedle, Alexandra, Delwar, Nafisa, Fisker, Ane B., Waiswa, Peter, Lawn, Joy E., Blencowe, Hannah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869448/
https://www.ncbi.nlm.nih.gov/pubmed/33557858
http://dx.doi.org/10.1186/s12963-020-00228-x
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author Kwesiga, Doris
Tawiah, Charlotte
Imam, Md Ali
Tesega, Adane Kebede
Nareeba, Tryphena
Enuameh, Yeetey A K
Biks, Gashaw A.
Manu, Grace
Beedle, Alexandra
Delwar, Nafisa
Fisker, Ane B.
Waiswa, Peter
Lawn, Joy E.
Blencowe, Hannah
author_facet Kwesiga, Doris
Tawiah, Charlotte
Imam, Md Ali
Tesega, Adane Kebede
Nareeba, Tryphena
Enuameh, Yeetey A K
Biks, Gashaw A.
Manu, Grace
Beedle, Alexandra
Delwar, Nafisa
Fisker, Ane B.
Waiswa, Peter
Lawn, Joy E.
Blencowe, Hannah
author_sort Kwesiga, Doris
collection PubMed
description BACKGROUND: Risks of neonatal death, stillbirth and miscarriage are highest in low- and middle-income countries (LMICs), where data has most gaps and estimates rely on household surveys, dependent on women reporting these events. Underreporting of pregnancy and adverse pregnancy outcomes (APOs) is common, but few studies have investigated barriers to reporting these in LMICs. The EN-INDEPTH multi-country study applied qualitative approaches to explore barriers and enablers to reporting pregnancy and APOs in surveys, including individual, community, cultural and interview level factors. METHODS: The study was conducted in five Health and Demographic Surveillance System sites in Guinea-Bissau, Ethiopia, Uganda, Bangladesh and Ghana. Using an interpretative paradigm and phenomenology methodology, 28 focus group discussions were conducted with 82 EN-INDEPTH survey interviewers and supervisors and 172 women between February and August 2018. Thematic analysis was guided by an a priori codebook. RESULTS: Survey interview processes influenced reporting of pregnancy and APOs. Women found questions about APOs intrusive and of unclear relevance. Across all sites, sociocultural and spiritual beliefs were major barriers to women reporting pregnancy, due to fear that harm would come to their baby. We identified several factors affecting reporting of APOs including reluctance to speak about sad memories and variation in recognition of the baby’s value, especially for APOs at earlier gestation. Overlaps in local understanding and terminology for APOs may also contribute to misreporting, for example between miscarriages and stillbirths. Interviewers’ skills and training were the keys to enabling respondents to open up, as was privacy during interviews. CONCLUSION: Sociocultural beliefs and psycho-social impacts of APOs play a large part in underreporting these events. Interviewers’ skills, careful tool development and translation are the keys to obtaining accurate information. Reporting could be improved with clearer explanations of survey purpose and benefits to respondents and enhanced interviewer training on probing, building rapport and empathy.
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spelling pubmed-78694482021-02-08 Barriers and enablers to reporting pregnancy and adverse pregnancy outcomes in population-based surveys: EN-INDEPTH study Kwesiga, Doris Tawiah, Charlotte Imam, Md Ali Tesega, Adane Kebede Nareeba, Tryphena Enuameh, Yeetey A K Biks, Gashaw A. Manu, Grace Beedle, Alexandra Delwar, Nafisa Fisker, Ane B. Waiswa, Peter Lawn, Joy E. Blencowe, Hannah Popul Health Metr Research BACKGROUND: Risks of neonatal death, stillbirth and miscarriage are highest in low- and middle-income countries (LMICs), where data has most gaps and estimates rely on household surveys, dependent on women reporting these events. Underreporting of pregnancy and adverse pregnancy outcomes (APOs) is common, but few studies have investigated barriers to reporting these in LMICs. The EN-INDEPTH multi-country study applied qualitative approaches to explore barriers and enablers to reporting pregnancy and APOs in surveys, including individual, community, cultural and interview level factors. METHODS: The study was conducted in five Health and Demographic Surveillance System sites in Guinea-Bissau, Ethiopia, Uganda, Bangladesh and Ghana. Using an interpretative paradigm and phenomenology methodology, 28 focus group discussions were conducted with 82 EN-INDEPTH survey interviewers and supervisors and 172 women between February and August 2018. Thematic analysis was guided by an a priori codebook. RESULTS: Survey interview processes influenced reporting of pregnancy and APOs. Women found questions about APOs intrusive and of unclear relevance. Across all sites, sociocultural and spiritual beliefs were major barriers to women reporting pregnancy, due to fear that harm would come to their baby. We identified several factors affecting reporting of APOs including reluctance to speak about sad memories and variation in recognition of the baby’s value, especially for APOs at earlier gestation. Overlaps in local understanding and terminology for APOs may also contribute to misreporting, for example between miscarriages and stillbirths. Interviewers’ skills and training were the keys to enabling respondents to open up, as was privacy during interviews. CONCLUSION: Sociocultural beliefs and psycho-social impacts of APOs play a large part in underreporting these events. Interviewers’ skills, careful tool development and translation are the keys to obtaining accurate information. Reporting could be improved with clearer explanations of survey purpose and benefits to respondents and enhanced interviewer training on probing, building rapport and empathy. BioMed Central 2021-02-08 /pmc/articles/PMC7869448/ /pubmed/33557858 http://dx.doi.org/10.1186/s12963-020-00228-x Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Kwesiga, Doris
Tawiah, Charlotte
Imam, Md Ali
Tesega, Adane Kebede
Nareeba, Tryphena
Enuameh, Yeetey A K
Biks, Gashaw A.
Manu, Grace
Beedle, Alexandra
Delwar, Nafisa
Fisker, Ane B.
Waiswa, Peter
Lawn, Joy E.
Blencowe, Hannah
Barriers and enablers to reporting pregnancy and adverse pregnancy outcomes in population-based surveys: EN-INDEPTH study
title Barriers and enablers to reporting pregnancy and adverse pregnancy outcomes in population-based surveys: EN-INDEPTH study
title_full Barriers and enablers to reporting pregnancy and adverse pregnancy outcomes in population-based surveys: EN-INDEPTH study
title_fullStr Barriers and enablers to reporting pregnancy and adverse pregnancy outcomes in population-based surveys: EN-INDEPTH study
title_full_unstemmed Barriers and enablers to reporting pregnancy and adverse pregnancy outcomes in population-based surveys: EN-INDEPTH study
title_short Barriers and enablers to reporting pregnancy and adverse pregnancy outcomes in population-based surveys: EN-INDEPTH study
title_sort barriers and enablers to reporting pregnancy and adverse pregnancy outcomes in population-based surveys: en-indepth study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869448/
https://www.ncbi.nlm.nih.gov/pubmed/33557858
http://dx.doi.org/10.1186/s12963-020-00228-x
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