Use of Capture-Recapture to Assess Poor Pregnancy Outcomes in a Tanzanian Refugee Camp Open Access

Stanfill, Katherine Ann (2016)

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Poor pregnancy outcomes, including neonatal mortality, stillbirths, and abortions, are exacerbated in populations effected by complex humanitarian emergencies (CHEs). The Nyarugusu refugee camp located in northwest Tanzania was established in 1996 and is home to approximately 70,000 refugees, 17,500 of whom are women of reproductive age (15-49 years old). Surveillance on pregnancy outcomes is collected through the camp's health information system (HIS). In order to examine how well the camp's HIS is capturing these events, HIS pregnancy outcome data over a 1-year period was compared to pregnancy outcome data from a household survey covering the same period. A secondary data analysis was conducted on the two data sources utilizing the methodology of record linkage matching and capture-recapture surveillance. For the period of June 20, 2012 to June 20, 2013, household surveys captured 1,883 live births, 5 neonatal deaths, 31 still births and 50 abortions. The HIS captured 1,555 live births, 3 neonatal deaths, 26 stillbirths and 49 abortions. Probabilistic record linkage was utilized to assign similarity scores to identified cases within each database and those above a determined threshold are determined to be matches. Capture-recapture was utilized in order to estimate the number of events in the population. Calculated rates for each of the pregnancy outcomes within the camp's population are as follows: 3.7 neonatal deaths per 1,000 live births, 50.5 stillbirths per 1,000 live births, and 270.3 abortions per 1,000 live births. Analyzing the HIS in conjunction with a household survey revealed that there were high levels of non-matches between the datasets. The identification of cases on one dataset but not the other indicates that neither dataset is fully capturing the events. Therefore, capture-recapture is useful for surveillance evaluation and strengthening the HIS is recommended. Elements of the household surveys can be incorporated into the standard surveillance, such as utilizing community health workers to capture non-facility events.

Table of Contents

Chapter 1: Literature Review 4

Chapter 2: Embedded Manuscript 11

Abstract 11

Background 12

Methods 16

Results 20

Discussion 26

Conclusion 29

Appendices 30

Additional Tables 30

SAS Code 34

IRB Approval 44

References 45

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