Estimating program coverage in the treatment of severe acute malnutrition: a comparative analysis of the validity and operational feasibility of two methods

Sheila Isanaka, Bethany L Hedt-Gauthier, Rebecca F Grais, Ben G S Allen, Sheila Isanaka, Bethany L Hedt-Gauthier, Rebecca F Grais, Ben G S Allen

Abstract

Background: Many health programs can assess coverage using standardized cluster survey methods, but estimating the coverage of nutrition programs presents a special challenge due to low disease prevalence. Used since 2012, the Semi-Quantitative Evaluation of Access and Coverage (SQUEAC) employs both qualitative and quantitative methods to identify key barriers to access and estimate coverage of therapeutic feeding programs. While the tool has been increasingly used in programs, the validity of certain methodological elements has been the subject of debate.

Methods: We conducted a study comparing a SQUEAC conjugate Bayesian analysis to a two-stage cluster survey estimating the coverage of a therapeutic feeding program in Niger in 2016.

Results: We found that the coverage estimate from the conjugate Bayesian analysis was sensitive to the prior estimation. With the exception of prior estimates produced by an external support team, all prior estimates resulted in a conflict with the likelihood result, excluding interpretation of the final coverage estimate. Allowing for increased uncertainty around the prior estimate did not materially affect conclusions.

Conclusion: SQUEAC is a demanding analytical method requiring both qualitative and quantitative data collection and synthesis to identify program barriers and estimate coverage. If the necessary technical capacity is not available to objectively specify an accurate prior for a conjugate Bayesian analysis, alternatives, such as a two-stage cluster survey or a larger likelihood survey, may be considered to ensure valid coverage estimation.

Trial registration: NCT03280082 . Retrospectively registered on September 12, 2017.

Keywords: Bayesian conjugate analysis; Cluster survey; Coverage; SQUEAC; Severe acute malnutrition; Therapeutic feeding program.

Conflict of interest statement

Ethics approval and consent to participate

Ethics approval is not required by National Ethics Committee of Niger (CCNE) for coverage surveys.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Distribution of eight prior estimates, by exercise and participant source.
Fig. 2
Fig. 2
Coverage estimates from the two-stage cluster survey and SQUEAC conjugate Bayesian analysis with conflict (Scenario 1a).

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Source: PubMed

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