Population-based surveys, which are typically conducted at the household level, are the primary source of public health data in low and middle-income countries (LMICs). These surveys collect data on demographics, health, nutrition, HIV and other infectious diseases and are a key source of data on the health status of women and children globally. Additionally, household surveys are the major source of indicators of the sustainable development goals (SDGs). But conducting population-based surveys can be challenging.
Fortunately, not all challenges are inevitable or equal: some can be resolved easily, some are unique to each country, and some, if not addressed head-on, can upend the progress of the survey.
With careful planning, assessment of the ‘on the ground reality’ in the host country, and engagement of in-country partners early on, potential challenges can be identified in advance, giving researchers adequate time to put safeguards in place to prevent or mitigate these challenges, some of which are discussed below.
Biomarker Data Collection
Biomarker data collection is an area that is prone to being overlooked by researchers when planning a survey. A scenario is one in which the principal investigator decides to include biomarker testing in a survey but makes this decision without the input of a technical specialist at the time the survey is planned.
This oversight can result in improper sample collection, unreliable data, under forecasting of lab and field supplies, and an inappropriate testing strategy. The consequences can range from delayed implementation of the survey, a waste of scarce financial resources, and loss of confidence in the survey implementation team. An example that demonstrates how exclusion of a biomarker technical specialist in the survey planning process negatively impacts biomarker data collection is one where the survey budgets for supplies for a two-person team but the team splits into two, one-person teams, during fieldwork.
The most likely reason for the team splitting is the distance between households which makes it impractical for the 2-person team to operate as a single unit. Operationally, this means that biomarker data collection cannot proceed in a second household until the first household is completed, because the 2-person team has equipment and supplies to operate in one household at a time, only.
Recruitment of Survey Participants
It does take a ‘village’ to implement and successfully conduct a population-based health survey in a LMIC. The village includes the members of the international team, host country partners, survey participants, and the local community members. It is important to develop and maintain
professional and respectful relationships with in-country partners, keeping in mind that in-country partners are aware of cultural barriers that can derail the success of the survey.
Further, host country partners can facilitate the introduction of the international team to the local community and particularly, the Village Chief. Without the consent and blessing of the Village Chief or Head, it is nearly impossible to recruit a representative sample of eligible participants.
Household Testing and Confidentiality
Despite the good intentions of the “village”, the village can make it difficult for survey teams to maintain the confidentiality of survey respondents. Confidentiality can be breached due to the closeness of households- which encourages neighbors to ‘visit’ the household that is being surveyed-, ineligible household members who refuse to leave the household at the time a respondent is being interviewed or tested, or familiarity of the local community with surveys.
For example, communities that are ‘familiar’ with surveys have a good understanding of how long it takes to conduct certain point-of-care tests in a household, such as an HIV rapid test. They are aware that surveyors spend more time in a household with an HIV positive result than they do in a household with a negative result, leading to speculation on their part about the HIV status of their neighbors. Despite the challenges, working in LMICs can be rewarding and fulfilling! Planning to conduct a survey in a LMIC? Check out our website for the technical assistance Bio-Metrics, LLC offers!
About the Author:
Dean Garrett is a recognized expert in biomarker research and testing with over 25 years of experience with health surveys and clinical laboratory medicine. He has provided technical leadership to over 45 surveys in 21 countries sub-Saharan Africa, Southeast Asia, the Caribbean, and North Africa and the Middle East funded by USAID, CDC, and PEPFAR. Dr. Garrettt can be reached via email, LinkedIn or on the company’s website.