Every year, large amounts of resources are invested by federal institutions in preventing premature deaths during adulthood worldwide. Unfortunately, the mortality impact of such interventions in a large number of target countries remains unclear because very few developing countries have complete vital registration systems to monitor adult mortality accurately. Instead, adult mortality rates are commonly estimated from retrospective data collected during household-based surveys, by asking respondents about the survival of their maternal siblings. These siblings'survival histories (SSH) are inexpensive to collect but are potentially affected by large biases, including sample selection, recall and interviewer behavior biases. As a result, estimates of the level of adult mortality in developing countries are frequently contested. Sophisticated statistical adjustment techniques have been proposed to correct for sample selection biases, but respondent errors (i.e., forgetting of siblings) affecting retrospective mortality data are considered inevitable. In this project, we will test whether a new survey instrument helps improve the quality of data on siblings'survival collected during surveys. This instrument - the siblings enhanced life calendar (SELC) - is based on recall cues and life calendars. These are simple tools that have been widely and successfully used in other areas of survey research. They have however never been used to improve the recall of adult mortality data in developing countries. We will conduct a randomized controlled trial of the new SELC, which will determine whether this new instrument improves mortality data relative to standard instruments currently in use. We will evaluate this improvement by comparing reports of mortality in each arm to a gold standard obtained from demographic surveillance. We expect that close to 400 respondents in three rural populations of Senegal will participate in this trial. If successful, the proposed SELC will constitute a new approach to eliciting retrospective mortality data that can be tested on a larger scale and possibly incorporated in national surveys of adult mortality (e.g., DHS).

Public Health Relevance

The project is a randomized controlled trial of a new survey instrument (the siblings enhanced life calendar, SELC) used to collect retrospective data on adolescent and adult mortality during household based surveys in developing countries. We hypothesize that by using recall cues and a life history calendar approach, the SELC will limit forgetting of siblings and foster more accurate reporting of these siblings'ages during interviews. As a result, it will help reduce current biases in estimates of adult mortality in developing countries. If effective, the new instrument will permit 1) better describing the burden of disease borne by adults in developing countries, and 2) evaluating the mortality impact of large public health programs targeting adult health including AIDS treatment programs or maternal health interventions.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Small Research Grants (R03)
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Pediatrics Subcommittee (CHHD)
Program Officer
King, Rosalind B
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Columbia University (N.Y.)
Public Health & Prev Medicine
Schools of Public Health
New York
United States
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Helleringer, Stéphane; Pison, Gilles; Masquelier, Bruno et al. (2014) Improving the quality of adult mortality data collected in demographic surveys: validation study of a new siblings' survival questionnaire in Niakhar, Senegal. PLoS Med 11:e1001652
Helleringer, Stéphane; Pison, Gilles; Kanté, Almamy M et al. (2014) Reporting errors in siblings' survival histories and their impact on adult mortality estimates: results from a record linkage study in Senegal. Demography 51:387-411
Delaunay, Valerie; Douillot, Laetitia; Diallo, Aldiouma et al. (2013) Profile: the Niakhar Health and Demographic Surveillance System. Int J Epidemiol 42:1002-11
Helleringer, Stéphane; Duthé, Géraldine; Kanté, Almamy Malick et al. (2013) Misclassification of pregnancy-related deaths in adult mortality surveys: case study in Senegal. Trop Med Int Health 18:27-34