Measuring coverage in MNCH: total survey error and the interpretation of intervention coverage estimates from household surveys

PLoS Med. 2013;10(5):e1001386. doi: 10.1371/journal.pmed.1001386. Epub 2013 May 7.

Abstract

Nationally representative household surveys are increasingly relied upon to measure maternal, newborn, and child health (MNCH) intervention coverage at the population level in low- and middle-income countries. Surveys are the best tool we have for this purpose and are central to national and global decision making. However, all survey point estimates have a certain level of error (total survey error) comprising sampling and non-sampling error, both of which must be considered when interpreting survey results for decision making. In this review, we discuss the importance of considering these errors when interpreting MNCH intervention coverage estimates derived from household surveys, using relevant examples from national surveys to provide context. Sampling error is usually thought of as the precision of a point estimate and is represented by 95% confidence intervals, which are measurable. Confidence intervals can inform judgments about whether estimated parameters are likely to be different from the real value of a parameter. We recommend, therefore, that confidence intervals for key coverage indicators should always be provided in survey reports. By contrast, the direction and magnitude of non-sampling error is almost always unmeasurable, and therefore unknown. Information error and bias are the most common sources of non-sampling error in household survey estimates and we recommend that they should always be carefully considered when interpreting MNCH intervention coverage based on survey data. Overall, we recommend that future research on measuring MNCH intervention coverage should focus on refining and improving survey-based coverage estimates to develop a better understanding of how results should be interpreted and used.

Publication types

  • Review

MeSH terms

  • Adult
  • Child
  • Child Health Services* / standards
  • Child Health Services* / statistics & numerical data
  • Child, Preschool
  • Confidence Intervals
  • Data Interpretation, Statistical
  • Developing Countries* / statistics & numerical data
  • Family Characteristics
  • Female
  • Global Health
  • Health Care Surveys* / standards
  • Health Care Surveys* / statistics & numerical data
  • Health Services Research / methods*
  • Health Services Research / standards
  • Health Services Research / statistics & numerical data
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Maternal Health Services* / standards
  • Maternal Health Services* / statistics & numerical data
  • Program Evaluation
  • Reproducibility of Results
  • Research Design
  • Selection Bias
  • Surveys and Questionnaires

Grants and funding

No specific funding was received for the writing of this paper. TPE and JK were funded by the Malaria Control and Evaluation Partnership in Africa (MACEPA), a PATH project, from funding from the Bill & Melinda Gates Foundation. This work was conducted under the auspices of the Child Health Epidemiology Reference Group (CHERG) for WHO and UNICEF. CHERG receives financial support from the Bill & Melinda Gates Foundation through their grant to the US Fund for UNICEF. No funders were involved in in study design, data collection and analysis, decision to publish, or preparation of the manuscript.