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Estimating Numbers of Orphans and Vulnerable Children – A Test of Regression Modeling

Cover_tr-17-154-enAn earlier study reported a tight linear fit between national adult HIV prevalence and the percentage of children living in a household with at least one HIV-positive adult. MEASURE Evaluation extended this analysis to all existing DHS data sets with HIV testing, to determine the feasibility of using regression modeling to estimate the size of two priority groups: (1) children living with at least one adult who is HIV-positive, and (2) orphans and coresident children living with at least one adult who is HIV-positive.

At the national level, we found reasonably tight linear relationships between HIV prevalence among adults and the proportion of children living with at least one HIV-positive adult and between adult HIV prevalence and the proportion of orphans and coresident children living with at least one HIV-positive adult. However, at the subnational level, owing to small sample sizes, we found greater variation at the same level of HIV prevalence in the proportion of children living with an HIV-positive adult. Although the slopes and intercepts of the national and subnational regression lines are almost the same, the confidence intervals for the subnational level estimates are very wide and many data points fall outside the prediction.

PEPFAR has given priority for OVC programs to 21 countries. Of these, 17 have a recent biomarker survey: Burundi, Cameroon, Cote d’Ivoire, Democratic Republic of Congo, Ethiopia, Haiti, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe. For these countries, we recommend using the results of our secondary DHS analyses for programmatic estimates. Our Excel workbook (OVC estimates from DHS, available here) includes point estimates and 95-percent confidence intervals at both the national and subnational levels of the proportions of children who live in a household with an HIV-positive adult and the proportion of children who are orphans or coresident children living in a household with an HIV-positive adult, and extrapolates the observed proportions to numbers of children.

At present, four countries in the PEPFAR OVC portfolio do not have a recent DHS survey with HIV testing: Botswana, Nigeria, South Africa, and South Sudan. For these countries, the linear regression is a reasonable way to estimate at the national level the proportion of children who live in a household with an HIV-positive adult and the proportion of children who are orphans or coresident children living in a household with an HIV-positive adult. We have created an Excel workbook to predict these two indicators at the national level and to extrapolate the predicted proportions to numbers of children (OVC estimation calculator, available here.)

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Learning What Drives Data Use in Health Systems

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Health data begins at the health facility, where service providers collect information and clinical data about their clients. However, these health workers are less likely to use data they collect because their focus is to serve clients, which means there is less time to analyze data. A recent qualitative study conducted in Kenya and Tanzania suggests ways that data can be compiled into useful and intuitive information products that can encourage data use throughout the health system—even among health facility workers.

Learn more about data use through information products, read this report by Eric Geers, data use specialist with the USAID-funded MEASURE Evaluation project.


A Review of Family Planning Outcomes in Integrated Health Programs and Research Recommendations

A Review of Family  Planning Outcomes in Integrated Health Programs and Research  Recommendations Research on the integration of health services is abundant and has been undertaken to investigate the many assumptions related to service integration: namely, that integrated services are cost-effective, efficient, and lead to improved health outcomes. Most research on integration outcomes has focused on short-term outcomes; less is known about longer-term outcomes, particularly the health benefits of integration. Additionally, family planning (FP) outcomes are not always a focus of research and evaluations and are not routinely measured by programs. As a result, many questions on the specific outcomes and impacts of integration on FP programming remain.

The main objectives of this review are to assess the recent evidence base on the effects of integrated programming on FP services and outcomes, gather lessons learned for FP services in integrated programs, and provide recommendations for future research. Although the review builds on the evidence base on FP- integrated programs, the paper differs from previous reviews by focusing on questions relevant to FP program stakeholders.

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Brief on the Routine Health Information System Curriculum

fs-17-204coverThe USAID-funded MEASURE Evaluation project developed a new online curriculum on routine health information systems (RHIS), working with other leaders in the field of RHIS—the World Health Organization; the Free University of Brussels/European Agency for Development and Health (AEDES); the University of Oslo, in Norway; the National Institute of Public Health (INSP), in Mexico; the University of Queensland, in Australia; and the Public Health Foundation of India.

RHIS (also called health facility and community information systems) regularly generate data that have been collected at public and private health facilities and institutions, as well as at community-level healthcare posts and clinics. The purpose of this curriculum is to enhance participants’ capacity to conceptualize, design, develop, govern, and manage an RHIS, and use the information the system generates to improve public health practice and service delivery.

One one-page flier describes the curriculum and provides links to its various components.

Effects of individual, household and community characteristics on child nutritional status in the slums of urban Bangladesh

Effects of individual, household and community characteristics on child nutritional status in the slums of urban BangladeshBackground
Bangladesh urban population is expected to overtake rural population by 2040, and a significant part of the increase will be in slums. Wide disparities between urban slums and the rest of the country can potentially push country indicators off track unless the specific health and nutrition needs of the expanding slum communities are addressed. The study aims at describing the individual, household and community determinants of undernutrition status among children living in major urban strata, viz. City Corporation slums and non-slums, in order to understand the major drivers of childhood undernutrition in urban slum settings.

Data are derived from Bangladesh Urban Health Survey conducted in 2013. This survey is a large-scale, nationally representative of urban areas, household survey designed specifically to provide health and nutrition status of women and children in urban Bangladesh.

Data showed that 50% of under-5 children in slums are stunted and 43% are underweight, whereas for non-slums these rates are 33 and 26% respectively. In terms of severity, proportion of under-5 children living in slums severely underweight or stunted are nearly double than the children living in non-slums. Logistic analyses indicate that mother’s education, child’s age, and household’s socio-economic status significantly affects stunting and underweight levels among children living in the urban slums. Logistic models also indicate that all individual-level characteristics, except exposure to mass media and mother’s working outside home, significantly affect undernutrition levels among children living on non-slums. Among the household- and community-level characteristics, only household’s socioeconomic status remains significant for the non-slums.

Poor nutritional status is a major concern in slum areas, particularly as this group is expected to grow rapidly in the next few years. The situation calls for specially designed and well targeted interventions that take into account that many of the mothers are poorer and less educated, which affects their ability to provide care to their children.

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Availability and Use of Sex-Disaggregated Data in Tanzania: An Assessment

tr-16-132-coverMEASURE Evaluation has been working to support the Government of Tanzania at national and subnational levels to ensure data quality for sex-disaggregated and gender-sensitive data, and to better use data from routine health information systems (RHIS) for health and social service program and policy decision making.

In support of these efforts, MEASURE Evaluation-Tanzania conducted a data and gender assessment of the national and subnational RHIS to understand the current availability and use of sex-disaggregated and gender-sensitive indicators.

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Evaluation Research on Results-Based Financing

An Annotated Bibliography of Health Science Literature on RBF Indicators for Reproductive, Maternal, Newborn, Child, and Adolescent Health

Evaluation Research on Results-Based Financing: An Annotated Bibliography of Health Science Literature on RBF Indicators for Reproductive, Maternal, Newborn, Child, and Adolescent HealthThis annotated bibliography offers a critical review of peer-reviewed and gray literature, published between 2002 and 2016, and relevant to indicators for the monitoring and evaluation of results-based financing (RBF) initiatives for reproductive, maternal, neonatal, child, and adolescent health (RMNCAH). Unlike a systematic review, this annotated bibliography does not aim to be a comprehensive assessment of the research on RBF for health. Rather, it seeks to describe the conceptual contribution and practical experiences of experts in using indicators to assess performance and quality throughout RMNCAH-focused RBF schemes.

The review includes peer-reviewed articles, toolkits, technical briefs, case studies, and evaluation reports. Microsoft PowerPoint presentations, posters, and books are not included. Articles were identified via key informant interviews, online database searches, and website reviews. For Google Scholar and the PubMed databases, search terms were indicators, results based financing, performance based financing, performance based funding, quality, reproductive, maternal, neonatal, child, and adolescent health. Gray literature was identified through searches of the following regional, multilateral, and donor websites: RBFHealth, World Bank, World Health Organization, BlueSquare, United States Agency for International Development (USAID), USAID TRAction Project, Salud Mesoamerica Initiative, Pan American Health Organization, the United Nations Children’s Fund, and the USAID-funded MEASURE Evaluation. Review of the listed references of pertinent articles yielded additional resources.

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