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MS 05 27 Under-reporting of Gravidity In a Rural Malawian Population

Humphreys E. Misiri, Adamson S. Muula Department of Community Health, University of Malawi College of Medicine, lantyre, Malawi Address correspondence to! Dr. Adamson S. Muula, Department of Community Health, University of Malawi, College of Medicine, "rivate ag #$%, lantyre #, Malawi. Email! amuula&medcol.mw' (a)! *$+ , $-. -%%' "hone! *$+ / #+- ,/* A0stract ac1ground! Mis2reporting of data 0y study participants in a 3uestionnaire20ased study is an important source of 0ias in studies. 405ective! 6o determine the prevalence and factors influencing under2reporting of gravidity among rural women in Malawi. Materials and Methods! Data from a census conducted in *%%. was analysed using logistic regression analysis and the logit modeling. 7esults! -,,/ women were in the reproductive age group, *#/-8##.+9: had ever attended school, .++$ 8$..%9: had never and results for ,-+ 8*.+9: were missing. 4f those who attended school,;..;9 8**;-: had attained a ma)imum primary level, +.%.9 8,**: secondary level and %.%/9 8*: tertiary level. /,.$9 of the women were aged 0etween ,* and #$ years of age, mean was *$., years 8SD ,%.%+ years:. 6he remaining ,/..9 were aged 0etween #- and .; years of age. 6he mean gravidity was ..% 8SD #..:, live 0irths was #.% 8SD #.*:, mean num0er of still0irths was almost <ero 8SD %.;: and the mean num0er of children alive was *.% 8SD *.#:. 6he prevalence of mis2reporting of gravidity was -.;9. (actors influencing the ris1 of under2reporting gravidity were! previous e)perience of a still20irth, young age, not 0eing married and having ever attended some level of education. Conclusions! =e suggest that women who perceived that the community e)pected them, or they e)pected themselves to have fewer or no pregnancy at all, censured themselves is reported low gravidity. 7esearchers using 3uestionnaires should 1eep in mind possi0ility of under2reporting of gravidity among women and this may introduce error in research results. >ncorporating multiple

3uestions as1ing the same thing has potential to identify 0iases as these other 3uestions serve as consistency chec1s. >ntroduction >n most surveys, 3uestionnaires are used as a data collection tool. ?uestions in these 3uestionnaires may involve provo1ing the respondent to recall some episodes in their life. 7ecall 3uestions introduce 0ias as not many people may 0e a0le to recall accurately personal life events. 7ecall errors could 0e under @ reporting' when a respondent understates an event or over2reporting where a respondent gives an answer which is an overstatement of what actually happened. 6his under or over2reporting is sometimes deli0erate more especially when the 3uestions are as1ing for sensitive details which the respondent regards as em0arrassing. Under2reporting and over2reporting occurs in many surveys. Aiccolai et al. , report the occurrence of under2reporting se)ually transmitted diseases as ranging from *,9 to .-9 and they suggest using multiple sources of information a0out the same issue the respondent is as1ed to give details a0out as a way of reducing errors in reporting that can 0e pic1ed up during data analysis . >n a study of use of hospital emergency department 0y Dendu1uri et al,* an incidence of lower sensitivity 8or under2reporting: on the self2report appeared to 0e associated with higher age, low co2mor0idity and shorter length of recall . 7ennie et al # also report the incidence of under2reporting in reporting energy inta1e among young people. Dia0etes is also under2reported in Aew Bealand as evidenced 0y Coppell et al .. >n this paper, we report on factors affecting low reporting of gravidity and parity in a rural Malawian population. =e are unaware of any previous studies that reported these phenomena in a Malawian setting. Materials and Methods Data for the study was o0tained using a structured 3uestionnaire in a census of Cungwena area, a rural area in Mangochi district in Malawi, on the eastern shore of Ca1e Malawi. A total of +,-. households were recruited, with a population of *-,,%# people , only -,,/ 8*$.#9: were women of child20earing age. 6wo logistic regression models have 0een fitted using S"SS 7elease ,,. 4ne model has the logit of the pro0a0ility of ma1ing an error in reporting as the response. 6he second model has the logit of the pro0a0ility of under2reporting as the response +. Descriptive statistics have also 0een computed 0y the same statistical software. (or the purposes of this study, analysis was done only for the women in reproductive age group. 6he following varia0les were included in the census 3uestionnaire! 6otal pregnancies, 6otal num0er of live 0irths, total num0er of still 0irths and the total num0er of children. 6he sum of the total num0er of still 0irths and the total num0er of live 0irths is what should 0e the actual gravidity of the respondent. 6he difference 0etween the reported total pregnancies and this sum is the discrepancy or error in reporting gravidity 0y recall. >f this is positive,

then the respondent under2reported gravidity. >f this difference is negative, the respondent must have over2reported gravidity. Cungwena area has 0een identified as a research community for the University of Malawi and various research especially regarding maternal and child health has 0een done in this area $2/.

Results Parti ipants de!ographi "hara teristi s 4f the -,,/ women in the reproductive age group, *#/-8##.+9: had ever attended school, .++$ 8$..%9: had never and results for ,-+ 8*.+9: were missing. 4f those who attended school,;..;9 8**;-: had attained a ma)imum primary level, +.%.9 8,**: secondary level and %.%/9 8*: tertiary level. /,.$9 of the women were aged 0etween ,* and #$ years of age, mean was *$., years 8SD ,%.%+ years:. 6he remaining ,/..9 were aged 0etween #- and .; years of age. 6he mean gravidity was ..% 8SD #..:, mean live 0irths was #.% 8SD #.*:, mean num0er of still0irths %.% was 8SD %.;: and the mean num0er of children alive was *.% 8SD *.#:. Misreporting of Gravidity (rom the data, $++#8;*.,9: correctly reported gravidity, ,+;8*.*9: under2 reported gravidity and +.-9 8.%$: over2reported gravidity. (actors related to mis2reporting are presented in 6a0les , and * 0elow. (rom the first model fitting results, it is seen that the num0er of still 0irths 8p DE%.%%%%, :, 0eing divorced or not 8p D%.%#* :, 0eing never married or not 8p DE%.%%%%, : significantly affect accuracy in reporting gravidity among women of child 0earing age. 6he odds of inaccurately reporting gravidity is #../ times higher for women aged 0etween ,* and ,$ years than for women aged 0etween ,- and .; years. 6he odds of error in reporting gravidity is #.-% times higher for women who never married than for women of other marital status. 6he odds of error in reporting is *.*- times higher for women of other marital status than for divorced women of child20earing age. 6he odds of error in reporting increases with a multiplicative factor of ,../ for each unit increase in the num0er of still0irths. (rom the model fitting information for the second model, it is seen that only marital status 8married or not married:, pD%.%%* num0er of live 0irths and still0irths 8p E .%%%,: and schooling 8pD%.%%.: significantly contri0ute to under2 reporting. 6he odds of under2reporting is .../ times higher for those who never married than for child20earing women of other marital status. 6he odd of low reporting gravidity is increases with a multiplicative factor of ,./ and ,.** for each unit increase in the num0er of still0irths and live 0irths respectively. 6he odds of under2reporting gravidity is ,./+ times higher for women who attended school than for women who never attended school.

6a0le ,! (actors Contri0uting 6o Error >n 7eporting Fravidity ;+.%9 C.>.for EG"8 : Haria0le Constant 2..,#. S6>CC %.#;+ AFE,8,: ,.*.MA7,8,: ,.#%MA7#8,: 2%./,+ S.E. %..;; %.%+* %.#;$ %.#% / %.#/, =ald $/.+/ +$.$* ;.;% ,/.%, ..+/ E)p8 df Sig. : , %.%%% %.%,$ , E%.%%%%, ,../ , %.%%* #../ , , E%.%%%%, #.-% %.%#* %... Cower ,.#. ,.$% *.%* %.*, Upper ,.$. -.+$ $.-$ %.;#

6a0le *! (actors 6hat >nfluence Underreporting Fravidity ;+.%9 C.>.for EG"8 : Cower ,.-% ,.$+ ,.,$ ,.*, Upper ,,.-; ,.;,.*/ *./*

"arameter Haria0le MA7,8,: S6>CC C>HE 7>6 SCH44C8,: Constant #is ussion Estimate ,..;; %.+// %.,;%.$,+ 2$.$*, S.E. %..;. %.%.+ %.%*. %.*,+ %.+%=ald ;.*, ,$/./# $$.., /.*% df , , , , Sig. %.%%* %.%%% %.%%% %.%%.

E)p8 : .../ ,./% ,.** ,./+

6he present study found the prevalence of mis2reporting of pregnancy of -.;9 in a rural area on southern Malawi. >ncreasing num0er of still 0irths, having never 0een married and ever having attended school increased the chance of underreporting gravidity among women of child0earing age increased the ris1 of underreporting gravidity. 6here could 0e several reasons why this may 0e the case. As for women who may have has still20irths, they may not have wished to report this as pregnancies as culturally in Malawi, the tendency is to report the live20irths and neglect still20irths. >t may also have 0een painful to some women to 0e reminded of previous still20irths and so reporting as if these never occurred may have 0een preferred. =omen who may not having 0een married may have under2reported gravidity for 3uite different reasons. >n a community where not 0eing married is loo1ed down upon, having a pregnancy outside marriage is cause for stigma and individual low self2esteem. "erhaps fearing censorship from the interviewer respondents decided not to report pregnancy for fear of 0eing categori<ed as IlooseJ and Iirresponsi0leJ for having a pregnancy outside marriage.

=omen with some education also under2reported gravidity. 6his could 0e due to the fact that these are more li1ely to 0e 1nowledgea0le on contraception and the Ie)pectationJ 0y health wor1ers for smaller family si<e. 7eporting that they had 0een pregnant a few times may 0e chosen in order to appear as if they had heeded family planning messages. Upta1e of contraception, though increasing continues to 0e low in su02Saharan Africa ;. 6hat young women aged ,*2,$ years were #.+ times more li1ely to misreport gravidity than child women aged 0etween ,- and .; years is also of interest. 6his could 0e due to the same reason that young women could have censured themselves 0y thin1ing that they ought to have 0een in school, ought to have postponed child 0earing and not to have married 8for those married: as early as they did. 6hey would therefore have reported lower gravidity. =e have determined that 0eing young, unmarried, having e)perienced a still2 0irth is associated with under2reporting of num0er of pregnancies amongst women in a rural area of Malawi. =e suggest that researchers see1ing information on gravidity need to 0e aware of this pro0lem as this may 0ias the data and the interpretation. Having multiple 3uestions scattered within the 3uestionnaire as1ing more or less the same thing, may facilitate detection of mis2 reporting as they may serve as consistency chec1s. $ %nowledge!ents =e are grateful for Dr. Ken Maleta for permission to use the data from this census. (unding for the data collection was o0tained from the Fovernment of Aorway, through the Aorwegian Council of UniversitiesJ Committee for Development 7esearch and Education 8AU(U:. Referen es ,. Aiccolai CM, Kershaw 6S, Cewis L , Cicchetti DH, Ethier KA, >c1ovics L7. Data Collection for Se)ually 6ransmitted Disease Diagnoses! A Comparison of Self2 report, Medical 7ecord 7eviews, and State Health Department 7eports. Annals of Epidemiology *%%+',+8#:!*#$2*.*. 2. Dendu1uri A, McCus1er L, ellavance (, Cardin S, Herdon L, Karp >, el<ile E. Comparing the Halidity of Different Sources of >nformation on Emergency Department Hisits! A Catent Class Analysis. Medical Care *%%+'.#8#:!*$$2*-+. #. 7ennie KC, Le00 SA, =right A, Coward =A. Secular trends in under2reporting in young people. British Journal of Nutrition *%%+';#8*:!*.,2-. .. Coppell K, Mc ride K, =illiams S. 8*%%. Dec ,-:. Under2reporting of dia0etes on death certificates among a population with dia0etes in 4tago "rovince, Aew Bealand. New Zealand Medical Journal.',,-8,*%-:!U,*,-. +. Agresti A. Categorical data analysis. Lohn =iley, Aew Mor1, ,;;% p -;2,%%

$. Maleta K, Haahtera S, Espo M, Kulmala 6, Ashorn ". 6iming of growth faltering in rural Malawi. Arch Dis Child *%%#' //! +-.2/ -. Kulmala 6, Haahtera M, Ade1ha M, Koivisto AM, Cullinan 6, Salin MC, Ashorn ". Festational health and predictors of new0orn weight amongst pregnant women in rural Malawi. Afr J eprod !ealth *%%,' +! ;;2,%/ /. Kulmala 6, Haahtera M, Ade1ha M, Cullinan 6, Salin MC, Koivisto AM, Ashorn ". Socio2economic support for good health in rural Malawi. East Afr Med J *%%%' --! ,$/2-, 9. Clements S, Madise N. Who is being served least by family planning providers? A study of modern contraceptive use in hana, !an"ania And #imbab$e. Afr J Reprod Health 2004% &' ()*+,-

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