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Using HDSS data to drive newborn programs & policy

This is a one year study that is using multi-country data from Health and Demographic Surveillance System (HDSS) sites for newborn and maternal advocacy in Africa. It is coordinated by the technical secretariat of the INDEPTH Network Maternal, Newborn, and Child Health (MNCH) working group, based at Makerere University School of Public Health, Uganda.

The primary goal is to use data to advocate for newborn policy and funding for Africa’s mothers, newborns and stillbirths in order to facilitate achievement of the Sustainable Development Goals (SDGs). The secondary goals include building HDSS capacity to regularly produce and disseminate such high quality data; and to increase on the number of African newborn and maternal health experts.

Activities undertaken

The following progress has been made so far, from inception to September 2018.

Development of templates for data collection
The MNCH working group technical secretariat designed draft templates for collecting data on different pregnancy outcomes (live births, neonatal deaths, stillbirths and abortions) in HDSS sites between 2012 and 2016. The templates focused on trends in different key indicators, as well as some background socio-demographics. This process involved analysis of data collection tools used in different sites in order to identify the data that most HDSS sites commonly collect during their rounds.

Set up of collaboration with HDSS sites
The technical secretariat contacted 25 HDSS sites that are members of the working group, explained the study and shared the draft templates. 11 sites expressed their interest in the work. This was dependent on whether they had the required data available, amidst other considerations. We engaged in multiple skype meetings and email conversations with each of the site leaders and their key data analysts and statisticians to discuss the study idea, templates, and possible analysis.

Data analysis
This is taking part in phases and is still ongoing. The first phase involved the participating sites analysing and compiling their own data and filling in the templates with secondary data. The second phase is the analysis of the data submitted, to check for quality, missingness and how much of it can actually be used. The third phase is the analysis of data that is going to be included in the final scientific paper and study report. A data sharing agreement has been developed and is being shared with sites for approval.

Cross-Site analysis workshop
Conducting data analysis across countries is a fairly slow process. It was realized that sites and the coordinators had to meet face to face as a group, in order to have a shared understanding of the study and the required analysis. Furthermore, sites collect some of the data using different definitions of indicators, so a group discussion was necessary to harmonize these as much as possible. Therefore, a workshop was held in Nairobi, Kenya, between 28th and 31st May 2018. It brought together 11 HDSS sites, each of which was represented by one or two people. It was also a strategic partnership and start of a longer collaboration with the African Population and Health Research Center (APHRC), Nairobi, who were the co-hosts of the workshop.

The objectives of the workshop were to present draft findings from the analyses done so far, agree on the key indicators that data is being collected on, harmonize definitions of the key indicators, among other goals.

Capacity building
To-date, the study has built and will continue to build capacity in the following ways: 1) Building the analysis capability of site representatives who attended the workshop in Nairobi. This is through the various presentations made on how HDSS sites can analyse data, practical analysis tips from other people at the workshop and much more. 2) Feedback on the templates submitted, including identification of data quality challenges and possible areas for improvement. 3) The technical secreatriat has drafted a concept on how to strengthen data collected in HDSS sites. This is going to be shared with the sites for their input and also use where they see fit. 4) Sites members are encouraged to participate in the writing of papers from this study and to initiate their own, either as individuals but more importantly as cross-site or cross-country collaborations.

Partnerships and networking
So far, a number of partnerships have already been built. These are with the HDSS sites, between the HDSS sites themselves, as well as with APHRC.

Activities for the next few months (until March 2019)

Manuscript writing: A paper on pregnancy outcomes across the participating sites will be written and submitted for publication to a peer reviewed journal. Other papers will also be written as per availability of HDSS sites data and areas of interest.

Dissemination and advocacy: Part of this sudy involves dissemination of the results and indeed other HDSS input to national and global audiences, as well as advocacy around MNCH issues. This will include HDSS sites holding a meeting in their country to disseminate to key people at national level. In Uganda, we plan to partner with a Countdown 2030 meeting that will take place in 2019. It is targeting top Government officials and we shall invite more people who are beneficial to our cause. We are also planning a joint analysis and dissemination workshop for HDSS sites in Ethiopia in December 2018 and January 2019.

Writing and circulating country specific policy briefs by each participating site.

A study report that will be shared on different websites and platforms

Principal Investigator: Assoc. Prof. Peter Waiswa

Coordinator: Ms. Doris Kwesiga

Data analysis: Mr. Rornald Kananura

Funding: New Venture Fund

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