In countries with limited vital registration, adult mortality rates are frequently estimated using siblings’ survival histories (SSH) collected during nationally representative surveys such as the Demographic and Health Surveys. Such data may underestimate adult mortality because of reporting errors and omissions of deceased siblings. Dr. Helleringer and fellow researchers developed a new SSH questionnaire, the siblings’ life calendar (SLC), which incorporates recall cues designed to limit omissions of siblings and uses a life calendar approach to improve the reporting of dates and ages. They tested whether the SLC improved the quality and completeness of death reports in SSH during a randomized controlled trial in Niakhar (Senegal). The SSH data collected in each RCT arm were compared to prospective data on adult mortality collected through demographic surveillance since 1963. Researchers interviewed 575 respondents with the SLC and 614 respondents with a standard SSH questionnaire. They found that the SLC reduced the extent of missing data and age/date heaping compared to the standard SSH questionnaire. It also yielded estimates of the sex ratio at birth much closer to 1.05 and comparable to those observed through demographic surveillance. Among respondents with (at least) one adult sister who had died within 15 years of the survey, 75% of those interviewed with the standard SSH questionnaire reported a death among their adult sisters versus 90% among those interviewed with the SLC (P=0.01). The greatest improvements in data quality were seen among the least educated respondents. The SLC has the potential to collect more complete SSH data than instruments currently used in the Demographic and Health Surveys. Similar trials should be conducted in different social and epidemiological settings to confirm this finding.
Stéphane Helleringer is Assistant Professor of Public health at the Mailman School of Public Health, Columbia University. His research has covered a wide range of topics related to global health, with particular focus on 1) the measurement of the global burden of disease and associated risk factors on one side, and 2) the design/evaluation of programs addressing health issues across the lifecourse in low and middle-income countries on the other. He has just completed a randomized trial of a new questionnaire to collect adult mortality data during surveys in Senegal. He has also been working on a longitudinal study of the sexual networks that transmit HIV on a small island of Lake Malawi and on an evaluation of the impact of polio vaccination campaigns on health behaviors and health systems in sub-Saharan countries.