Rushton, Simon
(2021).
Community Based Integrated Management of Neonatal and Childhood Illness Records of Under-5 Patients at 23 Health Centres in Rural Nepal, 2013-2018.
[Data Collection]. Colchester, Essex:
UK Data Service.
10.5255/UKDA-SN-854820
This project aims to increase academic understanding, and develop appropriate options for responding to, inequalities in health and healthcare amongst under-5 children in remote rural areas of Nepal. These continuing inequalities represent a significant challenge for Nepal's efforts to promote social and economic development and meet the SDG targets. Whilst it is widely known that a variety of social and geographic factors contribute to determining health outcomes (including gender, caste/ethnicity and region), the currently available data lacks the degree of granularity to enable a robust exploration of the relationships between these various forms of inequality and i) health status; ii) utilisation of health services; and iii) quality/appropriateness of treatment received.
Whilst the existing data published by the Government of Nepal is available only in an aggregated format, PHASE Nepal - a high-profile and highly-respected NGO that supports government health facilities in some of the most remote areas of the country - has circa 50,000 records of health facility visits by under-5s that have not previously been analysed as they currently exist only in paper format. The project proposed here will allow, for the first time, for the digitisation and rigorous analysis of this individual patient-level data to further understand inequalities and to address a series of Research Questions related to the country's social and geographic inequalities:
RQ1: How do geography, age, gender, ethnicity and caste affect the nutrition status of under-5 children presenting in remote health facilities of Nepal?
RQ2: Is diagnosis and treatment for malnutrition affected by geography, and child's age, gender, ethnicity and caste?
RQ3: How do geography, and child's age, gender, ethnicity and caste affect health-seeking behaviours and utilisation of health services?
RQ4: How do geography, and child's age, gender, ethnicity and caste affect the treatment that under-5s receive at health centres?
Data description (abstract)
Data (in the form of paper records) was collected from 23 health centres in rural areas of Nepal, totalling 33,860 records of individual patient contacts for children under 5 years of age. The format of the record books follows the WHO (Nepal) guidance on Community Based - Integrated Management of Neonatal and Childhood Illness (IMNCI).
The data included on the forms includes the following information on all children under 5: unique identifier, date of visit, child’s sex, age, ethnicity/caste, weight, temperature, symptoms of general danger signs, symptoms of acute respiratory infection (including respiratory rate), diarrhoea and dehydration symptoms, symptoms for fever and ear infections, mid upper arm circumference (MUAC) measurements, assessment of nutritional status, classification for one major diagnosis, medicine prescribed (name of medicine), follow up plan, and condition of child on the date of follow up.
| Data creators: |
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| Sponsors: |
Economic and Social Research Council
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| Grant reference: |
ES/T010436/1
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| Topic classification: |
Social welfare policy and systems
Health
Social stratification and groupings
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| Keywords: |
CHILD HEALTH, ILL HEALTH, COMMUNITY HEALTH CARE, HEALTH CONSULTATIONS, HEALTH CARE PROVISION, VISITS TO HEALTH CENTRES
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| Project title: |
Determinants of health in rural Nepal: Utilising PHASE Nepal data to investigate social inequalities in health and healthcare amongst under-5s
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| Alternative title: |
IMNCI
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| Grant holders: |
Simon Rushton, Manish Baidya, Timothy Chater, Dan Green, Jiban Karki, Andrew Lee, Gerda Pohl
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| Project dates: |
| From | To |
|---|
| November 2019 | March 2021 |
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| Date published: |
13 May 2021 09:22
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| Last modified: |
13 May 2021 09:23
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| Temporal coverage: |
| From | To |
|---|
| 16 July 2013 | 16 July 2018 |
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| Collection period: |
| Date from: | Date to: |
|---|
| 1 November 2019 | 28 February 2021 |
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| Geographical area: |
Sindhupalchowk District; Gorkha District; Bajura District; Mugu District; Humla District |
| Country: |
Nepal |
| Spatial unit: |
Administrative > District Council Areas |
| Data collection method: |
Data (in the form of paper records) was collected from 23 health centres, totalling 33,860 records of individual patient contacts for children under 5 years of age. The format of the record books follows the WHO (Nepal) guidance on Community Based - Integrated Management of Neonatal and Childhood Illness (IMNCI).
The data included on the forms includes the following information on all children under 5: unique identifier, date of visit, child’s sex, age, ethnicity/caste, weight, temperature, symptoms of general danger signs, symptoms of acute respiratory infection (including respiratory rate), diarrhoea and dehydration symptoms, symptoms for fever and ear infections, mid upper arm circumference (MUAC) measurements, assessment of nutritional status, classification for one major diagnosis, medicine prescribed (name of medicine), follow up plan, and condition of child on the date of follow up.
Research Assistants visited each of these centres to collect the data. The paper records were either digitally photographed and transported on secure electronic media to the PHASE Nepal office in the Kathmandu valley, or the books themselves were taken to the PHASE Nepal office, photocopied, and later returned to the health centres.
Sampling procedure:
This project was funded by the GCRF NGO Secondary Data Initiative, with the aim of making available data held by NGOs. The research was carried out with the project partner PHASE Nepal (https://phasenepal.org), a Nepali NGO specialising in health, education and livelihoods.
The data digitised and archived in this collection (c.34,000 IMNCI records) is from the health posts run or supported by PHASE Nepal: a total of 23 health posts spread across 5 Districts. The sampling method was therefore based on the presence of PHASE Nepal in these particular health posts, rather than a nationally representative sample.
The health posts themselves are in rural areas, given that PHASE specialises in providing community-level services in places where government services are either absent or weak. They are all in the Hill and Mountain areas of Nepal (not the Terai). |
| Observation unit: |
Individual, Organization |
| Kind of data: |
Numeric, Text |
| Type of data: |
Other surveys |
| Resource language: |
English |
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| Data sourcing, processing and preparation: |
Research Assistants visited each of these centres to collect the data. The paper records were either digitally photographed and transported on secure electronic media to the PHASE Nepal office in the Kathmandu valley, or the books themselves were taken to the PHASE Nepal office, photocopied, and later returned to the health centres.
Data management: Each of the collected registers, xerox and photographs of registers, were coded for identification. The code included the first letters of name of the district, followed by the first letters of the name of health post, and finally the year of the register (according to the Nepali calendar), all separated by “-”. Hard copy record books had the code marked on the cover. For example, the Kolti Health Post (Bajura district) record book for Nepali year 2072 (April 2015-April 2016 in the Western calendar) was coded as BAJ-KOL-72-1. If the Health Post had two registers in the same year, it was coded as BAJ-KOL-71-1A and BAJ-KOL-71-1B. Detail is shown in Table 2.
Register types: There were two major versions of the register books: IMCI and IMNCI. Within each of these two main versions there was some variation in the precise format of the forms (e.g. slight differences in the questions /or slight differences in the answer options in different registers). There were also separate forms for children from 2 to 59 months, and children below 2 months.
Data entry: Data entry was carried out in the desktop version of KoBoToolbox by a team of 12 Data Entry Assistants. The IMCI/IMNCI questionnaire was created in KoBoToolbox, pretested, and any issues identified were updated in the data entry questionnaire. Written Data Entry Guidelines were prepared for data entry personnel in order to minimize possible data entry errors and to ensure data uniformity.
Special codes were formulated for missing values (-999), unreadable/illegible values (-888), where the health worker had written “normal” instead of entering a value (-777), other marks (-666) and where the health worker had written “0” (0).
A detailed guide to the IMNCI classification of diseases and their management according to CB-IMNCI guidelines was also developed. Additionally, a list of essential medicines at health posts and abbreviations used by health personnel for medicines, diagnosis, and other recording inputs as created for use in data processing and analysis.
Data Review and Processing: In order to minimize entry error, five percent of data entered by each data entry assistant was randomly selected and checked for error, including accuracy of input and whether they followed the entry guidelines correctly. Any mismatch between entered data and register were recorded as well as corrected. This data reviewing was performed simultaneously during the data entry period and was done on a regular basis. If any errors were identified, they were corrected and feedback was provided to each data entry assistant.
Data cleaning was carried out simultaneously with data entry. Data was downloaded from KoBoTookbox,and converted to and cleaned using STATA v15.0 statistical tool. The following steps were carried out in the process of data cleaning: 1) Frequency distribution of each variable was explored to identify any extreme or out of range values. 2) Any variables with out of range values were listed in an excel file along with related information to locate the case in the register to verify the entered data for any error. 3) All variables which data entry personnel entered as unreadable (entered as -888) were also listed in Excel to allow for verification with the register.
Recording errors in the register by health workers and entries that were hard to understand were discussed with team members and decisions were made on case by case basis. In many cases it was possible for PHASE Nepal staff with experience of working in Health Posts to decipher unclear entries. Once all identified data entry errors were updated in the database, a final dataset was created for the purposes of analysis and deposit.
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| Rights owners: |
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| Contact: |
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| Notes on access: |
The Data Collection is available for download to users registered with the UK Data Service.
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| Publisher: |
UK Data Service
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| Last modified: |
13 May 2021 09:23
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