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Monitoring and assessing the impact of vaccinations and other childhood interventions for both boys and girls

KENYA, 2011 - 2014
Health and Well-Being (HaW)
African Population and Health Research Center
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Identification

IDNO
APHRC-IVP-2010-v1.01
Title
Monitoring and assessing the impact of vaccinations and other childhood interventions for both boys and girls
Country
Name Country code
KENYA KEN
Abstract
OBJECTIVE

The overall objective is to assure evidence-based policies for vaccine and preventive drug delivery in low-income countries (LIC) in order to reduce child morbidity and mortality.

Hypotheses: Current practice is to consider health issues as independent problems - e.g. TB, malaria, HIV, measles, rotavirus diarrhoea, vitamin A or iron deficiency - that can be solved with specific interventions which have separate and additive effects. However, our interventions in childhood may have a more general impact on the immune system with far-reaching consequences for survival - the so-called non-specific effects (NSE)1,2. These NSE often differ for boys and girls. Taking the non-specific and sex-differential effects of vaccines and micronutrients into consideration in the planning of health intervention policies could contribute importantly to better child health.



BACKGROUND

Both observational studies and randomised clinical trials (RCT) conducted by the Bandim Health Project (BHP) group in West Africa have shown consistently that the main childhood interventions with vaccines and micronutrients used by the international health community have NSE, i.e. effects which are not explained by the prevention of the targeted infection or deficiency. These effects are often sex-differential2-7. The effects can be major; high-titre measles vaccine (HTMV) was associated with 2-fold higher mortality for girls2, and providing BCG at birth halved neonatal mortality among low-birth-weight (LBW) children. WHO recommends schedules for delivery of vaccines and micronutrients. These schedules are often not followed. Many children receive vaccines out-of-sequence; e.g. BCG simultaneously with diphtheria-tetanus-pertussis vaccine (DTP), DTP with measles vaccine (MV), or DTP after MV. Such variations have very different NSE on overall mortality8-11 though it has not yet been recognised.



RELEVANCE

The implication of NSE is that interventions ought to be monitored or tested for their overall effect on mortality in different environments. Hence, more data on NSE in other environments are needed. For this to happen, we need more study sites and researchers involved in such research. The present proposal will train a small network of young scientists in monitoring and assessing the NSE of vaccines and other interventions. In the initial phase, monitoring systems will be set up at six Health and Demographic Surveillance System (HDSS) sites within the INDEPTH Network. Risk factors for delay in uptake of childhood interventions will be examined with emphasis on possible differences between boys and girls. We will examine the causes of out-of-sequence vaccinations. The impact of major variations in implementation will be examined. If NSE are similar in other LICs, the effect on child survival is expected to be very large. In a longer perspective, we will therefore train the sites in implementing trials assessing potential variations in policy. In conclusion, the proposal will establish a research training network in order to provide better evidence-based policies for delivery of vaccines and other health interventions in LIC.



METHODS

• The project follows up all children born in the DSS area since September 2010 and their mothers, for a period of 3 years (Jan 2011 - Dec 2013)

• We administer structured questionnaires to the eligible children's mothers or their guardians to collect information on morbidity, health seeking behavior, cause of death (for those who have died)

• We collect anthropometric measurements from all children every round to monitor nutritional status and growth

• Through the NUHDSS, we collect socioeconomic, demographic, migration and pregnancy outcome data for all the mothers and their households



DATA COLLECTED

• Background characteristics

• Antenatal care, delivery and post natal care

• Birth histories for the mothers

• Child's vital health Status

• Breastfeeding and child feeding practices

• Anthropometric measurements for children

• Detailed Vaccination history of the child

• Child morbidity and health seeking practices
Kind of Data
Sample survey data [ssd]

Version

Version Date
2014-12-19
Version Notes
Version 1.0: Edited, anonymous dataset for Data Documentation Working Group



Version 1.1 (February 2015): This version has additional surveys conducted in 2014. Datasets edidted, anonymised and study materials added.

Scope

Keywords
Keyword
Maternal Health
Child Health
Routine Vaccination
Childhood intervention

Coverage

Geographic Coverage
Two urban informal settlements, Korogocho and Viwandani, in Nairobi City (the capital city) of Kenya.
Unit of Analysis
The unit of analysis is the Child
Universe
The survey covered all mothers who gave birth from september 2010 in the Demographic Surveillance Area

Producers and sponsors

Authoring entity/Primary investigators
Agency Name Affiliation
African Population and Health Research Center APHRC
Producers
Name Affiliation Role
Dr Peter Aaby Bandim Health Project Primary Investigator
Dr Catherine Kyobutungi APHRC Co-Investigator
Dr Elizabeth Kimani APHRC Co-Investigator
Funding Agency/Sponsor
Name Abbreviation Role
DANISH INTERNATIONAL DEVELOPMENT AGENCY DANIDA Funder
Other Identifications/Acknowledgments
Name Affiliation Role
Residents of Korogocho and Viwandani Slums Study Subjects
Bandim Health Project Collaborator
Peter Aaby Bandim Health Project PI

Sampling

Sampling Procedure
All NUHDSS female members who gave birth since September 2010 and their children were enrolled in the study. No samples were drawn.
Weighting
Sample weights were not used.

Data Collection

Dates of Data Collection (YYYY/MM/DD)
Start date End date Cycle
2011-03-01 2014-07-31 1
2011-08-19 2012-01-31 2
2012-02-01 2012-05-12 3
2012-05-14 2012-10-15 4
2012-10-15 2013-01-30 5
2013-04-24 2013-08-31 6
2013-09-02 2013-12-03 7
2013-12-04 2014-04-30 8
Mode of data collection
Face-to-face [f2f]
Type of Research Instrument
DATA COLLECTION



Once recruited into the study, the mother and child are followed up approximately every 4 months



QUESTIONNAIRES



A recruitment questionnaire is administered during the first visit, an update 1 questionnaire is administered during the first follow up visit, update 2 during the second follow up visit and so on. the content of the questionnaires keep changing from recruitment questionnaire to the subsequent follow up visits. but from update 3 onward the questionnaires are the same as documented below;



RECRUITMENT (First Visit)



Data Collected



• Consent

• Background characteristics

• Antenatal care, delivery and post natal care

• Birth histories for the mothers

• Child's vital health Status

• Breastfeeding and child feeding practices

• Anthropometric measurements for mother and child

• Vaccination history

• Child morbidity and health seeking practices

• Post partum sexual activity

• Postpartum contraceptive use

• Future intentions

• Perception of HIV risk and condom use

• Migration and poverty

• Exposure calendar



UPDATE 1 (Second Visit)



Data Collected (comparing update 1 to recruitment questionnaires)



• Consent (same)

• Background characteristics (same)

• OBA voucher questions (new questions added)

• Child's vital health Status (question 4.10 dropped)

• Breastfeeding and child feeding practices

• Anthropometric measurements for mother and child (same)

• Vaccination history (same)

• Child morbidity and health seeking practices (same)

• Post partum sexual activity (question 8.1p added, questions 8.2 dropped)

• Postpartum contraceptive use (questions 9.1, 9.2, 9.3, 9.7p, 9.8, 9.9, 9.10 dropped)

• Future intentions (only question 10.6 remained)

• Perception of HIV risk and condom use (only questions 11.8, 11.9 remains)

• Exposure calendar (same)

• Migration and poverty (questions 15.1, 15.2, 15.3 dropped)





UPDATE 2 (Third Visit)



Data Collected (comparing update 2 to update 1 questionnaires)



• Consent (same)

• Background characteristics (same)

• OBA voucher questions (dropped)

• Child's vital health Status (same)

• Breastfeeding and child feeding practices (questions 5.18, 5.19 dropped)

• Anthropometric measurements for mother and child (same)

• Vaccination history (same)

• Child morbidity and health seeking practices (same)

• Post partum sexual activity (same)

• Postpartum contraceptive use (same)

• Future intentions (same)

• Perception of HIV risk and condom use (same)

• Exposure calendar (same)

• Migration and poverty (same)





UPDATE 3 (Fourth Visit)



Data Collected (comparing update 3 to update 2 questionnaires)



• Consent (same)

• Background characteristics (same)

• Child's vital health Status (same)

• Anthropometric measurements for mother and child (same)

• Child morbidity and health seeking practices (same)

• Post partum sexual activity (same)

• Postpartum contraceptive use (same)

• Future intentions (same)

• Perception of HIV risk and condom use (same)

• Exposure calendar (same)

• Migration and poverty (same)





UPDATE 4 (Fifth Visit)



Data Collected (comparing update 4 to update 3 questionnaires)



• Consent (same)

• Background characteristics (same)

• Child's vital health Status (same)

• Anthropometric measurements for mother and child (same)

• Child morbidity and health seeking practices (same)

• Post partum sexual activity (same)

• Postpartum contraceptive use (same)

• Future intentions (same)

• Perception of HIV risk and condom use (same)

• Exposure calendar (same)

• Migration and poverty (same)





UPDATE 5 (Sixth Visit)



Data Collected (comparing update 5 to update 4 questionnaires)



• Consent (same)

• Background characteristics (same)

• Child's vital health Status (same)

• Anthropometric measurements for mother and child (same)

• Child morbidity and health seeking practices (same)

• Post partum sexual activity (same)

• Postpartum contraceptive use (same)

• Future intentions (same)

• Perception of HIV risk and condom use (same)

• Exposure calendar (same)

• Migration and poverty (same)







UPDATE 6 (Seventh Visit)



Data Collected (comparing update 6 to update 5 questionnaires)



SAME





UPDATE 7 (Eight Visit)



Data Collected (comparing update 7 to update 6 questionnaires)



SAME





UPDATE 8 (Nineth Visit)



Data Collected (comparing update 8 to update 7 questionnaires)



SAME





UPDATE 9 (Tenth Visit)



Data Collected (comparing update 9 to update 8 questionnaires)



SAME
Data Collectors
Name Abbreviation
African Population & Health Research Center APHRC

Data Processing

Cleaning Operations
Data editing took place at a number of stages throughout the processing, including:

a) Office editing and coding

b) During data entry

c) Structure checking and completeness

d) Secondary editing



Detailed documentation of the editing of data can be found in the "Standard Procedures Manual" document provided as an external resource.



Some corrections are made automatically by the program (80%) and the rest by visual control of the questionnaire (20%).
Other Processing
Data entry for the first five rounds of data collection was performed manually at APHRC's headquarters on desktop computers using an in-house built system with a Visual Basic.Net front-end and a Microsoft SQL Server back-end. For the last 3 rounds data collection was done using netbooks. Double data entry was carried out on 10% of the questionnaires.



Data were processed in clusters (cohort and updates), with each cluster being processed as a complete unit through each stage of data processing. Each cluster goes through the following steps:

1) Questionnaire reception

2) Office editing and coding

3) Data entry

4) Structure and completeness checking

5) Verification entry

6) Comparison of verification data

7) Back up of raw data

8) Secondary editing

9) Edited data back up



After all clusters are processed, all data is concatenated together and then the following steps are completed for all data files:

10) Exported to STATA

11) Recoding of variables needed for analysis

13) Structural checking of STATA files

14) Data quality tabulations

15) Production of analysis tabulations



Details of each of these steps can be found in the Standard Procedures Manual.

Data Appraisal

Estimates of Sampling Error
No estimation of sampling error was done.

Data access

Contact
Name Affiliation Email URI
Head Statistics and Surveys Unit APHRC info@aphrc.org www.aphrc.org
Confidentiality Declaration
Details are included in the document: Data Use Agreement Guidelines for Internal/External Users (External Resources)
Conditions
All non-APHRC staff seeking to use data generated at the Center must obtain written approval to use the data from the Director of Research. This form is developed to assess applications for data use and facilitate responsible sharing of data with external partners/collaborators/researchers. By entering into this agreement, the undersigned agrees to use these data only for the purpose for which they were obtained (as outlined on this form) and to abide by the conditions outlined below:

1. Data Ownership: The data remain the property of APHRC; any unauthorized reproduction and sharing of the data is strictly prohibited. The user will, therefore, not release nor permit others to use or release the data to any other person without the written authorization from the Center.

2. Purpose: The provided data must be used for the purpose specified in the Data Request Form; any other use not specified in the form must receive additional or separate authorization.

3. Respondent Identifiers: The Center is committed to protecting the identity of the respondents who provide information in its research. All analytical data sets (both qualitative and quantitative) released by the Data Unit MUST are stripped of respondent identifiers to protect the identity of the respondents. By accepting to use APHRC data, the user is pledging that he/she will not, under any circumstance, regenerate the identifiers or permit others to use the data to learn the identity of any individual, household or community included in any data set.

4. Confidentiality pledge: The user will not use nor permit others to use the data to report any information in the data sets that could identify, directly or by inference, individuals or households.

5. Reporting of errors or inconsistencies: The user will promptly notify the Head of the Statistics and Survey Unit any errors discovered in the data as soon as the errors are discovered.

6. Publications resulting from APHRC data: The Center requires external collaborators to work with APHRC staff on all publications resulting from its data. In order to facilitate this, lead authors should send a detailed concept note of the paper (including the background, rationale, data, analytical methods, and preliminary findings) to the Principle Investigator (or Theme Leader) for the project (with a copy to the Director of Research), who will circulate the abstract to concerned researchers for possible expression of interest in participating in the publication as co-authors. Any exception to the involvement of APHRC staff should be approved by the Director of Research, APHRC.

7. Security: The user will take responsibility for the security of the data by ensuring that the data are used and stored in a secure environment where access is password protected. This will ensure that non-authorized people should not have access to the data.

8. Loss of privilege to use data: In the event that APHRC determines that the data user is in violation of the conditions for using the data, or if the user wishes to cancel this agreement, the user will destroy the data files provided to him/her. APHRC retains the right to revoke this agreement or informs publishers to withhold publication of any work based wholly or in part on its data if the conditions for using the data are violated.

9. Acknowledgement: Any work/reports from this data must acknowledge APHRC as the source of these data. For example, the suggested acknowledgement for NUHDSS data is:

"This research uses livelihoods data collected under the longitudinal Nairobi Urban Health and Demographic Surveillance System (NUHDSS) since 2006. The NUHDSS is carried out by the African Population and Health Research Center in two slums settlements (Korogocho and Viwandani) in Nairobi City."

Additionally all funders, the study communities that provided the data, and staff who collected and analyzed or processed the data should be acknowledged.

10. Deposit of Reports/Papers: The user should submit electronic and paper copies of all publications generated using APHRC data to the Policy Engagement and Communications Department, with copies to the Director of Research.

11. Change of contact details: The user will promptly inform the Director of Research of any change in your personal details as contained on this data request form.
Citation requirement
African Population & Health Research Center, Monitoring and assessing the impact of vaccinations and other childhood interventions for both boys and girls, February 2015. APHRC, Nairobi, Kenya. doi:11239/176-2014-028-1.1

Contacts

Contact
Name Affiliation Email URI
Head, Data Unit African Population & Health Research Center info@aphrc.org www.aphrc.org

Metadata production

Document ID
APHRC-IVP-2010-v1.01
Producers
Name Abbreviation Affiliation Role
African Population and Health Research Center APHRC APHRC Metadata Producer
Date of Production
2014-12-19
Document version
Version 1.1 (February 2015).