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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.

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Related in: MedlinePlus

Spatial clusters representation of SAM week 35 at the peak period, Kazaure LGA, Jigawa State, Nigeria.
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Related In: Results  -  Collection


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pone-0062767-g007: Spatial clusters representation of SAM week 35 at the peak period, Kazaure LGA, Jigawa State, Nigeria.

Mentions: Figures 6 and 7, shows the computed spatial prevalence contours of GAM and SAM at peak prevalence (week 40 and 35). The prevalence appears to be highest in eastern Kazaure LGA with a steep gradient from very low to “emergency” levels.


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)

Spatial clusters representation of SAM week 35 at the peak period, Kazaure LGA, Jigawa State, Nigeria.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0062767-g007: Spatial clusters representation of SAM week 35 at the peak period, Kazaure LGA, Jigawa State, Nigeria.
Mentions: Figures 6 and 7, shows the computed spatial prevalence contours of GAM and SAM at peak prevalence (week 40 and 35). The prevalence appears to be highest in eastern Kazaure LGA with a steep gradient from very low to “emergency” levels.

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