Limits...
Observational bias during nutrition surveillance: results of a mixed longitudinal and cross-sectional data collection system in Northern Nigeria.

Grellety E, Luquero FJ, Mambula C, Adamu HH, Elder G, Porten K - PLoS ONE (2013)

Bottom Line: The effect of repeated visits to the same cluster was examined using general linear mixed effects models adjusted for the seasonal change.With each repeat survey of a cluster, the prevalence of GAM decreased by 1.6% (95% CI: 0.4 to 2.7; p = 0.012) relative to the prevalence observed during the previous visit after adjusting for seasonal change.Repeated surveys in the same cluster-village, even if different children are selected, lead to a progressive improvement of the nutritional status of that village.

View Article: PubMed Central - PubMed

Affiliation: Epicentre, Paris, France. Emmanuel.GRELLETY@epicentre.msf.org

ABSTRACT

Background: The Sahel is subject to seasonal hungry periods with increasing rates of malnutrition. In Northern Nigeria, there is no surveillance system and surveys are rare. The objectives were to analyse possible observational bias in a sentinel surveillance system using repeated mixed longitudinal/cross-sectional data and estimate the extent of seasonal variation.

Methods: Thirty clusters were randomly selected using probability proportional to size (PPS) sampling from Kazaure Local Government Area, Jigawa State. In each cluster, all the children aged 6-59 months within 20 randomly selected households had their mid-upper arm circumference measured and were tested for oedema. The surveys were repeated every 2 or 4 weeks. At each survey round, three of the clusters were randomly selected to be replaced by three new clusters chosen at random by PPS. The seasonal variation of acute malnutrition was assessed using cyclical regression. The effect of repeated visits to the same cluster was examined using general linear mixed effects models adjusted for the seasonal change.

Results: There was a significant seasonal fluctuation of Global Acute Malnutrition (GAM) with a peak in October. With each repeat survey of a cluster, the prevalence of GAM decreased by 1.6% (95% CI: 0.4 to 2.7; p = 0.012) relative to the prevalence observed during the previous visit after adjusting for seasonal change.

Conclusions: Northern Nigeria has a seasonal variation in the prevalence of acute malnutrition. Repeated surveys in the same cluster-village, even if different children are selected, lead to a progressive improvement of the nutritional status of that village. Sentinel site surveillance of nutritional status is prone to observational bias, with the sentinel site progressively deviating from that of the community it is presumed to represent.

Show MeSH

Related in: MedlinePlus

GAM and SAM prevalence based on MUAC and/or bilateral oedema for children aged from 6 to 59 months between June 2010 and February 2012, Kazaure LGA, Jigawa State, Nigeria.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3643959&req=5

pone-0062767-g002: GAM and SAM prevalence based on MUAC and/or bilateral oedema for children aged from 6 to 59 months between June 2010 and February 2012, Kazaure LGA, Jigawa State, Nigeria.

Mentions: A total of 31 cross sectional surveys were performed; 21 fortnightly from June 2010 to April 2011 and then 10 monthly until February 2012. A total of 108 different clusters were surveyed; 19 were re-selected more than once and the data from second and subsequent surveys of the same cluster excluded from the analysis. Figure 1 shows the mean absolute MUAC and Figure 2 the prevalence of GAM and SAM during this period.


Observational bias during nutrition surveillance: results of a mixed longitudinal and cross-sectional data collection system in Northern Nigeria.

Grellety E, Luquero FJ, Mambula C, Adamu HH, Elder G, Porten K - PLoS ONE (2013)

GAM and SAM prevalence based on MUAC and/or bilateral oedema for children aged from 6 to 59 months between June 2010 and February 2012, Kazaure LGA, Jigawa State, Nigeria.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3643959&req=5

pone-0062767-g002: GAM and SAM prevalence based on MUAC and/or bilateral oedema for children aged from 6 to 59 months between June 2010 and February 2012, Kazaure LGA, Jigawa State, Nigeria.
Mentions: A total of 31 cross sectional surveys were performed; 21 fortnightly from June 2010 to April 2011 and then 10 monthly until February 2012. A total of 108 different clusters were surveyed; 19 were re-selected more than once and the data from second and subsequent surveys of the same cluster excluded from the analysis. Figure 1 shows the mean absolute MUAC and Figure 2 the prevalence of GAM and SAM during this period.

Bottom Line: The effect of repeated visits to the same cluster was examined using general linear mixed effects models adjusted for the seasonal change.With each repeat survey of a cluster, the prevalence of GAM decreased by 1.6% (95% CI: 0.4 to 2.7; p = 0.012) relative to the prevalence observed during the previous visit after adjusting for seasonal change.Repeated surveys in the same cluster-village, even if different children are selected, lead to a progressive improvement of the nutritional status of that village.

View Article: PubMed Central - PubMed

Affiliation: Epicentre, Paris, France. Emmanuel.GRELLETY@epicentre.msf.org

ABSTRACT

Background: The Sahel is subject to seasonal hungry periods with increasing rates of malnutrition. In Northern Nigeria, there is no surveillance system and surveys are rare. The objectives were to analyse possible observational bias in a sentinel surveillance system using repeated mixed longitudinal/cross-sectional data and estimate the extent of seasonal variation.

Methods: Thirty clusters were randomly selected using probability proportional to size (PPS) sampling from Kazaure Local Government Area, Jigawa State. In each cluster, all the children aged 6-59 months within 20 randomly selected households had their mid-upper arm circumference measured and were tested for oedema. The surveys were repeated every 2 or 4 weeks. At each survey round, three of the clusters were randomly selected to be replaced by three new clusters chosen at random by PPS. The seasonal variation of acute malnutrition was assessed using cyclical regression. The effect of repeated visits to the same cluster was examined using general linear mixed effects models adjusted for the seasonal change.

Results: There was a significant seasonal fluctuation of Global Acute Malnutrition (GAM) with a peak in October. With each repeat survey of a cluster, the prevalence of GAM decreased by 1.6% (95% CI: 0.4 to 2.7; p = 0.012) relative to the prevalence observed during the previous visit after adjusting for seasonal change.

Conclusions: Northern Nigeria has a seasonal variation in the prevalence of acute malnutrition. Repeated surveys in the same cluster-village, even if different children are selected, lead to a progressive improvement of the nutritional status of that village. Sentinel site surveillance of nutritional status is prone to observational bias, with the sentinel site progressively deviating from that of the community it is presumed to represent.

Show MeSH
Related in: MedlinePlus