TY - JOUR
T1 - Validation of maternal reports for low birthweight and preterm birth indicators in rural Nepal
AU - Chang, Karen T.
AU - Mullany, Luke C.
AU - Khatry, Subarna K.
AU - Le-Clerq, Steven C.
AU - Munos, Melinda K.
AU - Katz, Joanne
N1 - Funding Information:
The authors thank the study team at the Nepal Nutrition Intervention Project-Sarlahi, who conducted the household data collection. This work was supported by the Improving Coverage Measurement grant (OPP1084442) from the Bill & Melinda Gates Foundation and the Nepal Oil Massage Study grant (OPP1084399) from the Bill & Melinda Gates Foundation and (R01HD060712) from the National Institutes of Health.
Publisher Copyright:
© 2018 Journal of Global Health.
PY - 2018
Y1 - 2018
N2 - Background Tracking progress towards global newborn health targets depends largely on maternal reported data collected through large, nationally representative surveys. We evaluated the validity, across a range of recall period lengths (1 to 24 months post-delivery), of maternal report of birthweight, birth size and length of pregnancy. Methods We compared maternal reports to reference standards of birthweights measured within 72 hours of delivery and gestational age generated from reported first day of the last menstrual period (LMP) prospectively collected as part of a population-based study (n = 1502). We calculated sensitivity, specificity, area the under the receiver operating curve (AUC) as a measure of individual-level accuracy, and the inflation factor (IF) to quantify population-level bias for each indicator. We assessed if length of recall period modified accuracy by stratifying measurements across time bins and using a modified Poisson regression with robust error variance to estimate the relative risk (RR) of correctly classifying newborns as low birthweight (LBW) or preterm, adjusting for child sex, place of delivery, maternal age, maternal education, parity, and ethnicity. Results The LBW indicator using maternally reported birthweight in grams had low individual-level accuracy (AUC = 0.69) and high population- level bias (inflation factor IF = 0.62). LBW using maternally reported birth size and the preterm birth indicator had lower individual- level accuracy (AUC = 0.58 and 0.56, respectively) and higher population- level bias (IF = 0.28 and 0.35, respectively) up to 24 months following birth. Length of recall time did not affect accuracy of LBW indicators. For the preterm birth indicator, accuracy did not change with length of recall up to 20 months after birth and improved slightly beyond 20 months. Conclusions The use of maternal reports may underestimate and bias indicators for LBW and preterm birth. In settings with high prevalence of LBW and preterm births, these indicators generated from maternal reports may be more vulnerable to misclassification. In populations where an important proportion of births occur at home or where weight is not routinely measured, mothers perhaps place less importance on remembering size at birth. Further work is needed to explore whether these conclusions on the validity of maternal reports hold in similar rural and low-income settings.
AB - Background Tracking progress towards global newborn health targets depends largely on maternal reported data collected through large, nationally representative surveys. We evaluated the validity, across a range of recall period lengths (1 to 24 months post-delivery), of maternal report of birthweight, birth size and length of pregnancy. Methods We compared maternal reports to reference standards of birthweights measured within 72 hours of delivery and gestational age generated from reported first day of the last menstrual period (LMP) prospectively collected as part of a population-based study (n = 1502). We calculated sensitivity, specificity, area the under the receiver operating curve (AUC) as a measure of individual-level accuracy, and the inflation factor (IF) to quantify population-level bias for each indicator. We assessed if length of recall period modified accuracy by stratifying measurements across time bins and using a modified Poisson regression with robust error variance to estimate the relative risk (RR) of correctly classifying newborns as low birthweight (LBW) or preterm, adjusting for child sex, place of delivery, maternal age, maternal education, parity, and ethnicity. Results The LBW indicator using maternally reported birthweight in grams had low individual-level accuracy (AUC = 0.69) and high population- level bias (inflation factor IF = 0.62). LBW using maternally reported birth size and the preterm birth indicator had lower individual- level accuracy (AUC = 0.58 and 0.56, respectively) and higher population- level bias (IF = 0.28 and 0.35, respectively) up to 24 months following birth. Length of recall time did not affect accuracy of LBW indicators. For the preterm birth indicator, accuracy did not change with length of recall up to 20 months after birth and improved slightly beyond 20 months. Conclusions The use of maternal reports may underestimate and bias indicators for LBW and preterm birth. In settings with high prevalence of LBW and preterm births, these indicators generated from maternal reports may be more vulnerable to misclassification. In populations where an important proportion of births occur at home or where weight is not routinely measured, mothers perhaps place less importance on remembering size at birth. Further work is needed to explore whether these conclusions on the validity of maternal reports hold in similar rural and low-income settings.
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U2 - 10.7189/jogh.08.010604
DO - 10.7189/jogh.08.010604
M3 - Article
C2 - 29899981
AN - SCOPUS:85048938174
SN - 2047-2978
VL - 8
JO - Journal of global health
JF - Journal of global health
IS - 1
M1 - 010604
ER -