title: Measuring coverage in MNCH: a validation study linking population survey derived coverage to maternal, newborn, and child health care records in rural China.
abstract: BACKGROUND
  Accurate data on coverage of key maternal, newborn, and child health (MNCH) interventions are crucial for monitoring progress toward the Millennium Development Goals 4 and 5. Coverage estimates are primarily obtained from routine population surveys through self-reporting, the validity of which is not well understood. We aimed to examine the validity of the coverage of selected MNCH interventions in Gongcheng County, China.
  
  
  RESULTS
  We conducted a validation study by comparing women's self-reported coverage of MNCH interventions relating to antenatal and postnatal care, mode of delivery, and child vaccinations in a community survey with their paper- and electronic-based health care records, treating the health care records as the reference standard. Of 936 women recruited, 914 (97.6%) completed the survey. Results show that self-reported coverage of these interventions had moderate to high sensitivity (0.57 [95% confidence interval (CI): 0.50-0.63] to 0.99 [95% CI: 0.98-1.00]) and low to high specificity (0 to 0.83 [95% CI: 0.80-0.86]). Despite varying overall validity, with the area under the receiver operating characteristic curve (AUC) ranging between 0.49 [95% CI: 0.39-0.57] and 0.90 [95% CI: 0.88-0.92], bias in the coverage estimates at the population level was small to moderate, with the test to actual positive (TAP) ratio ranging between 0.8 and 1.5 for 24 of the 28 indicators examined. Our ability to accurately estimate validity was affected by several caveats associated with the reference standard. Caution should be exercised when generalizing the results to other settings.
  
  
  CONCLUSIONS
  The overall validity of self-reported coverage was moderate across selected MNCH indicators. However, at the population level, self-reported coverage appears to have small to moderate degree of bias. Accuracy of the coverage was particularly high for indicators with high recorded coverage or low recorded coverage but high specificity. The study provides insights into the accuracy of self-reports based on a population survey in low- and middle-income countries. Similar studies applying an improved reference standard are warranted in the future.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Li
authors.initials: L
authors.lastname: Liu
authors.forename: Mengying
authors.initials: M
authors.lastname: Li
authors.forename: Li
authors.initials: L
authors.lastname: Yang
authors.forename: Lirong
authors.initials: L
authors.lastname: Ju
authors.forename: Biqin
authors.initials: B
authors.lastname: Tan
authors.forename: Neff
authors.initials: N
authors.lastname: Walker
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bryce
authors.forename: Harry
authors.initials: H
authors.lastname: Campbell
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
authors.forename: Yan
authors.initials: Y
authors.lastname: Guo
mesh_terms: D000293:Adolescent; D000328:Adult; D002662:Child Health Services / Q000600:supply & distribution*; D002681:China; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000600:supply & distribution*; D008499:Medical Records; D008875:Middle Aged; D011247:Pregnancy; D012424:Rural Population / Q000706:statistics & numerical data*; D057566:Self Report; D055815:Young Adult