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The Continuing Epidemiological Transition in Sub-Saharan Africa: A Workshop Summary (2012)

Chapter: 7 Data Collection and Validation in Resource-Poor Settings

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Suggested Citation:"7 Data Collection and Validation in Resource-Poor Settings." National Research Council. 2012. The Continuing Epidemiological Transition in Sub-Saharan Africa: A Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13533.
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7

Data Collection and Validation in Resource-Poor Settings

Much of the input to the workshop emphasized the point that patterns of morbidity and mortality are shifting both in terms of cause and in terms of age distribution. The workshop paper by Byass, de Savigny, and Lopez notes that changing therapeutic options tend to increase prevalence as compared with incidence for some key diseases; perhaps the most obvious example of this phenomenon in sub-Saharan Africa can be found in the use of antiretroviral therapy against HIV/AIDS, which keep AIDS patients alive for longer periods of time, thus increasing rates of prevalence. Changing patterns of risk factors—such as the prevalence of mosquito breeding sites in the case of infectious diseases, or factors such as tobacco and alcohol consumption in the case of noncommunicable diseases—constitute a further critical factor in the changing patterns of mortality and morbidity (Dalal et al., 2011; Danaei et al., 2011). All of these factors are changing rapidly against a background of sparse and sometimes dubious detailed information about what is actually happening, which makes it even more vital to proactively consider changes in health data systems in sub-Saharan Africa in order to increase the visibility of the continent’s long-term trends and needs in population health (Byass, 2009).

Nevertheless, it is unrealistic to suppose that over the next 10 to 20 years all the countries of sub-Saharan Africa will develop national health information systems that have sufficiently high coverage and achieve global standards of timeliness, completeness, and quality. Thus it is necessary to consider a transitional approach to improving the supply of health information in the short term in ways that are relevant to the essential policy actions that sub-Saharan African countries will need to take as the epidemiological transition unfolds.

In his presentation for the session on data collection and validation, Peter Byass identified several key questions that countries and international agencies should consider:

•  What mix of national and local-area data sources are needed for monitoring epidemiological transition, and with what sampling approaches?

•  How can continuous longitudinal, repeated cross-sectional, and one-time survey data be effectively integrated within a national information system to reveal epidemiological transitions?

•  What are the economic and human resource implications for upgrading national health information systems in order to measure epidemiological transitions?

•  What are the ethical and political issues related to long-term improvements in national health information systems?

Suggested Citation:"7 Data Collection and Validation in Resource-Poor Settings." National Research Council. 2012. The Continuing Epidemiological Transition in Sub-Saharan Africa: A Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13533.
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Byass, de Savigny, and Lopez also described a typology of data sources that can potentially contribute to national health information (see Table 7-1).

TABLE 7-1 Typology of Data Sources That Potentially Contribute to National Health Information

Level Model Sample Approach Examples
National National census All Complete cross-section Most countries
Ongoing registration All Complete longitudinal Industrialised countries
Sentinel districts 1-2% of population Longitudinal sample China
Cluster surveys Cluster sample size Repeatable cross-section DHS surveys, WHO-SAGE
Fixed panel surveys Cohort sample size Longitudinal cohort Millennium Cohort Study
At health facilities All or sample of facilities Self-selected group Annual health reports
Provincial Complete population All Complete longitudinal In registered countries
Cluster surveys Cluster sample size Cross-section Vaccine coverage
At health facilities All or sample of facilities Self-selected group Annual health reports
Local area Individual surveillance Defined area population Complete in defined area INDEPTH centers
One-time surveys Survey sample size Cross-sectional  
Specific research Context- dependent Specific issues of interest  

SOURCE: Byass, de Savigny, and Lopez (2011).

This session also included a discussion of how lessons learned to date from HIV surveillance efforts might be applied. Thomas Rehle described the key features of

Suggested Citation:"7 Data Collection and Validation in Resource-Poor Settings." National Research Council. 2012. The Continuing Epidemiological Transition in Sub-Saharan Africa: A Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13533.
×

second-generation HIV surveillance, which include (1) combining survey methods for greater explanatory power; (2) developing strategic partnership between surveillance and program evaluation; (3) a shift in emphasis toward measuring incidence rather than focusing mainly on prevalence; and (4) recognition of biological (HIV, AIDS, sexually transmitted infections) and behavioral surveillance as integral components adapted to the stage and type of the epidemic. These features imply a surveillance that is more focused on subpopulations at high risk of infection and that has an emphasis on trends over time.

Rehle further described the new South African National Health and Nutrition Examination Survey (SANHANES). It combines questionnaires with physical examinations and biomarker testing, combines longitudinal and cross-sectional design elements, and is designed to make it possible for health and nutritional status to be explored in much greater detail than was previously possible.

Suggested Citation:"7 Data Collection and Validation in Resource-Poor Settings." National Research Council. 2012. The Continuing Epidemiological Transition in Sub-Saharan Africa: A Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13533.
×
Page 14
Suggested Citation:"7 Data Collection and Validation in Resource-Poor Settings." National Research Council. 2012. The Continuing Epidemiological Transition in Sub-Saharan Africa: A Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13533.
×
Page 15
Suggested Citation:"7 Data Collection and Validation in Resource-Poor Settings." National Research Council. 2012. The Continuing Epidemiological Transition in Sub-Saharan Africa: A Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13533.
×
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Among the poorest and least developed regions in the world, sub-Saharan Africa has long faced a heavy burden of disease, with malaria, tuberculosis, and, more recently, HIV being among the most prominent contributors to that burden. Yet in most parts of Africa-and especially in those areas with the greatest health care needs-the data available to health planners to better understand and address these problems are extremely limited. The vast majority of Africans are born and will die without being recorded in any document or spearing in official statistics. With few exceptions, African countries have no civil registration systems in place and hence are unable to continuously generate vital statistics or to provide systematic information on patterns of cause of death, relying instead on periodic household-level surveys or intense and continuous monitoring of small demographic surveillance sites to provide a partial epidemiological and demographic profile of the population.

In 1991 the Committee on Population of the National Academy of Sciences organized a workshop on the epidemiological transition in developing countries. The workshop brought together medical experts, epidemiologists, demographers, and other social scientists involved in research on the epidemiological transition in developing countries to discuss the nature of the ongoing transition, identify the most important contributors to the overall burden of disease, and discuss how such information could be used to assist policy makers in those countries to establish priorities with respect to the prevention and management of the main causes of ill health.

This report summarizes the presentations and discussions from a workshop convened in October 2011 that featured invited speakers on the topic of epidemiological transition in sub-Saharan Africa. The workshop was organized by a National Research Council panel of experts in various aspects of the study of epidemiological transition and of sub-Saharan data sources. The Continuing Epidemiological Transition in Sub-Saharan Africa serves as a factual summary of what occurred at the workshop in October 2011.

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