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J T Boerma

Publications and source records attributed to J T Boerma.

35 records · Page 2Linked to original sources
PubMed1996

Validation study of a verbal autopsy method for causes of childhood mortality in Namibia.

Verbal autopsy uses a caretaker interview to determine the cause of death. We conducted a study of the major causes of child death in Namibia to determine the validity of this method. A questionnaire, including signs and symptoms of the diagnoses of interest was administered to the caretaker in 135 deaths of children < 5 years old who were identified from hospital records. The 243 diagnoses included malnutrition (77), diarrhoea (73), pneumonia (36), malaria (33), and measles (24). Sensitivity and specificity of various algorithms of reported signs and symptoms were compared to the medical diagnoses. An algorithm for malnutrition (very thin or swelling) had 73 per cent sensitivity and 76 per cent specificity. An algorithm for cerebral malaria (fever, loss of consciousness or convulsion) had 72 per cent sensitivity and 85 per cent specificity, while for all malaria deaths the same algorithm had low sensitivity (45 per cent) and high specificity (87 per cent). For diarrhoea, loose or liquid stools had high sensitivity (89 per cent), but low specificity (61 per cent). Cough with dyspnoea or tachypnoea had 72 per cent sensitivity and 64 per cent specificity. An algorithm for measles (age > or = 120 days, rash) had 71 per cent sensitivity and 85 per cent specificity. The study results suggest verbal autopsy data can be useful to ascertain the leading causes of death in childhood, but may have limitations for health impact evaluation.

Algorithms↗
PubMed1996

Changes in male sexual behaviour in response to the AIDS epidemic: evidence from a cohort study in urban Tanzania.

OBJECTIVE: To examine changes in sexual behaviour among men in urban Tanzania. DESIGN: An observational cohort study among factory workers during 1991-1994. METHODS: Data from five follow-up visits with structured questionnaire-guided interviews and biomedical data were analysed to examine trends in sexual behaviour and sexually transmitted disease/HIV among 752 men. In-depth interviews were conducted to evaluate the magnitude of reporting bias. RESULTS: During the 2 years of observation, the proportion of men with more than one sexual partner during the month preceding the interview declined from 22.3 to 12.2%. The proportion of men reporting casual sex partners during the last month was almost halved: from 9.8 to 5.2%. The decline in the reporting of extramarital partners was gradual and pronounced. There were only minor changes in reported condom use, notably an increase in use with casual partners, and no changes in coital frequency. Data from in-depth interviews confirmed that reduction in sexual partners was the predominant change. CONCLUSIONS: This study documents that, in response to the AIDS epidemic, changes in male sexual behaviour are taking place in urban areas in Africa. The predominant change among these men, who are predominantly married and aged over 25 years, is a reduction of the number of sexual partners, although condom use remains low.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Data on birth weight in developing countries: can surveys help?

The main source of data on birth weight in developing countries is statistics from health facilities, although most developing countries do not produce annual estimates of the incidence of low birth weight from these data. Such estimates would be subject to selection bias as the data are usually limited to babies born within health facilities, and therefore are representative of a subgroup that is markedly different from the overall population of neonates. Since 1990 the Demographic and Health Surveys programme has included questions on recalled birth weight and relative size at birth in 15 national surveys. In this article, we show that these cross-sectional surveys can provide a useful data source for making national estimates of mean birth weight and the incidence of low birth weight. The extent of misclassification of birth weight is, however, too large to use the data on relative size at birth as an indicator of low birth weight at the individual level.

Bias↗
PubMed1993

Maternal education and child survival: a comparative study of survey data from 17 countries.

A uniform analytical methodology was applied to survey data from 17 developing countries with the aim of addressing a series of questions regarding the positive statistical association between maternal education and the health and survival of children under age two. As has been observed previously, the education advantage in survival was less pronounced during than after the neonatal period. Strong but varying education effects on postneonatal risk, undernutrition during the 3-23 month period, and non-use of health services were shown--although a large part of these associations are the result of education's strong link to household economics. Differential use of basic health services, though closely tied to a mother's educational level, does little to explain the education advantage in child health and survival. However, the issue of the actual quality of services measured in the DHS is raised. Other issues concerning the roles of the pattern of family formation and differential physical access to health services are explored and discussed.

Adult↗
PubMed1993

Demographic and health surveys (DHS): contributions and limitations.

Surveys conducted in the context of the Demographic and Health Surveys (DHS) programme are an important source of data on health of families in developing countries. Both at the national and international level, DHS surveys provide much-needed data on fertility and family planning, on mortality and nutrition, and on health services utilization. The use of uniform survey instruments allows detailed international and subnational comparisons of health status and health care. Limitations of the DHS surveys are also discussed.

Adolescent↗
PubMed1993

Using survey data to assess neonatal tetanus mortality levels and trends in developing countries.

Demographic and health surveys are a useful source of information on the levels and trends of neonatal mortality in developing countries. Such surveys provide data on mortality occurring at 4-14 days of life, which is a sensitive indicator of neonatal tetanus mortality. We analyze birth history data from 37 national surveys in developing countries to assess the quality of neonatal mortality data and to estimate levels and trends in mortality occurring at 4-14 days. It is shown that mortality at 4-14 days has declined considerably during the last decade in most developing countries, concomitant with development and expansion of programs to reduce neonatal tetanus. These declines show that reductions in neonatal tetanus mortality probably have been an important contributor to the decline of neonatal and infant mortality during the 1980s.

Adolescent↗
PubMed1992

Child anthropometry in cross-sectional surveys in developing countries: an assessment of the survivor bias.

In cross-sectional surveys, the sample of children with anthropometric measurements is not representative of all children in a birth cohort, since only children surviving to the survey date are measured. This survivor bias may have implications for studies of trends and differentials in anthropometric indicators. In this paper, the effects of the survivor bias on the estimates of child anthropometric indicators are assessed by 1) reviewing evidence from longitudinal studies on the prevalence of malnutrition among deceased children and among surviving children and by 2) analyzing retrospective data on child mortality and cross-sectional data on child anthropometry in 17 national surveys that are part of the Demographic and Health Surveys Program. It is concluded that comparisons of anthropometric data across geographic units, population subgroups, and calendar time are marginally affected by the survivor bias, unless mortality differences between the birth cohorts are very large (e.g., well over 50 per 1,000 births).

Anthropometry↗
PubMed1991

Accuracy and completeness of mothers' recall of diarrhoea occurrence in pre-school children in demographic and health surveys.

In the context of the Demographic and Health Surveys program (DHS), data were collected on diarrhoeal diseases in childhood and related treatment patterns. In this paper we assess the accuracy and completeness of mothers' recall of diarrhoea in 19 national DHS surveys and discuss the implications for health interview surveys in developing countries. It is concluded that there is under-reporting of diarrhoea if the recall period is longer than 2-3 days, whereas there may be over-reporting of very recent or current diarrhoea in most DHS surveys. Reporting errors appear to vary considerably between countries, which affects the comparability of survey results. A second and related issue, that is addressed in this paper, is the reporting of treatment practices by duration of diarrhoeal episode. There were no major differences in reported treatment patterns between children with diarrhoea that terminated in the last two weeks and children with current diarrhoea of at least two days' duration. The implications of the findings for retrospective surveys on childhood morbidity and treatment patterns are discussed.

Child, Preschool↗
PubMed1991

Bottle use for infant feeding in developing countries: data from the demographic and health surveys. Has the bottle battle been lost?

This paper uses data from 22 national surveys in developing countries to estimate the use of bottles for feeding of infants under 6 months of age. These data were collected in the context of the Demographic and Health Surveys programme (DHS) between 1986 and 1989. Bottle use appears to be very common in most countries. Only six of the 22 countries had levels of bottle use of less than 20 per cent, and all these countries are in sub-Saharan Africa. The policy implications are discussed briefly.

Bottle Feeding↗
PubMed1989

Simplifying the evaluation of primary health care programmes.

Currently, there is considerable attention for health impact--as measured by mortality, morbidity or nutrition indicators, in the evaluation of primary health care (PHC) programmes. In most cases, health impact evaluations tend to be dominated by methodological discussions on data collection, analysis and interpretation, which are not relevant to the majority of PHC programmes. In this paper a theoretical framework of variables, affecting child survival, is presented. The key to this action-oriented framework is the identification of a set of intermediate variables which directly affect the health status of children, but can be influenced by PHC interventions as well. It is recommended that evaluations of PHC programmes should focus on these intermediate variables and be less concerned with health impact of the interventions.

Developing Countries↗
PubMedDate not supplied

Preceding birth intervals and child survival: searching for pathways of influence.

The importance of the length of preceding birth intervals for the survival chances of young children has been established, but the debate concerning the causal biomedical or behavioral mechanisms continues. This article uses data from 17 Demographic and Health Surveys to investigate the effect of birth intervals on child mortality: Anthropometry of children, recent morbidity of children, and use of health services are examined in addition to child survival data for children born in the five years before the survey. Various methodological approaches are used to investigate the relative importance of the postulated mechanisms linking birth intervals and child survival. Short preceding birth intervals are associated with increased mortality risks in the neonatal period and at 1-6 months of age, and, to a much lesser extent, at 7-23 months of age. The effects of short birth intervals on nutritional status are rather moderate, and there is a weak relationship with lower attendance at prenatal care services. No consistent relationship exists between the length of birth intervals and other health status or health-service utilization variables. The results indicate that prenatal mechanisms are more important than postnatal factors, such as sibling competition, in explaining the causal nature of the birth interval effect.

Anthropometry↗
PubMedDate not supplied

Identifying maternal mortality through networking: results from coastal Kenya.

This paper presents the results of experience in identifying maternal deaths through "networking." In a survey of child health in coastal Kenya, women of reproductive ages were asked about their knowledge of maternal deaths in the villages. Thirty-five maternal deaths were ultimately identified in the study area, which led to an estimate of maternal mortality of 6 to 7 per 1,000 live births. The leading causes of death were hemorrhage and anemia, followed by sepsis; and nulliparous women appeared to be at higher risks of dying. Special attention is given to the ethnomedical aspects of maternal mortality,which have important implications for strategies to reduce maternal mortality.

Adolescent↗
PubMedDate not supplied

Levels of maternal mortality in developing countries.

This paper is aimed at improving our ability to assess the magnitude of maternal mortality in developing countries, where reliable data on maternal deaths are scarce. First, the upper and lower limits of maternal mortality in a population are determined based on the general levels of mortality and fertility in a population. The relative importance of maternal deaths as a proportion of death among women of reproductive ages may, therefore, vary from less than 1 percent in low-mortality countries to about 25-30 percent in high-mortality countries. Second, the analysis and interpretation of maternal mortality data from health facilities and vital registration systems can be improved if a variety of other data sources are used, such as coverage of deliveries in hospitals and at home, and all causes of death among women of reproductive age. It is estimated that approximately 515,000 women died annually due to pregnancy-related causes in developing countries between 1980 and 1985. Ninety percent of these deaths took place in Africa and South Asia, where births are frequent and maternal mortality levels are high.

Abortion, Induced↗