Abstract
BackgroundMany 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.MethodsWe 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.ResultsWe 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.ConclusionSQUEAC 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 registrationNCT03280082. Retrospectively registered on September 12, 2017.
Highlights
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
In contrast to other survey methods, including two-stage cluster surveys or centric systematic area sampling, Semi-Quantitative Evaluation of Access and Coverage (SQUEAC) relies on a mix of qualitative and quantitative methods to estimate coverage while identifying key barriers to access
We found little differentiation between the individual prior estimates calculated as a simple versus weighted score from the program staff (56% versus 58%), while individual prior estimates calculated using the weighted scores of caregivers tended to be higher (62%) and those calculated using weighted scores from the external support team tended to be lower (48%)
Summary
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. Coverage of many health programs can be assessed using cluster survey methods, but coverage estimates for nutrition programs present special challenges due to the low prevalence of disease and often limited resources for data collection. Since 2012, the Semi-Quantitative Evaluation of Access and Coverage (SQUEAC) methodology has been widely used to assess the coverage of SAM treatment programs [8]. In contrast to other survey methods, including two-stage cluster surveys or centric systematic area sampling, SQUEAC relies on a mix of qualitative and quantitative methods to estimate coverage while identifying key barriers to access. To keep the burden of primary data collection low, coverage estimates are obtained using a conjugate Bayesian analysis, in which information of coverage from routine program data and qualitative information are updated with primary data from a relatively small sample to construct an overall posterior estimate
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