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. 2022 Jul 19;6:80. [Version 1] doi: 10.12688/gatesopenres.13666.1

Table 2. Risk of bias assessment and potential approaches.

Criteria Potential biases Proposed approach admin data Proposed approach survey data
1. Population
representativeness
of available
birthweight data
Biases in newborns included
in data source and biases in
birthweight availability for
included newborns.

(Table 1 – Potential biases 1,2,3)
Exclude if the total births with a
weight in the data source is <80%
of UN-estimated population of live
births.

Consider sensitivity analyses.
Include only surveys designed to be
nationally representative.
Only include surveys with valid
birthweights for ≥30% of births,
and for those, undertake multiple
imputation to impute birthweight
data for included newborns with
missing birthweight. Set a stricter
inclusion criterion of ≥95% requiring
a valid birthweight for surveys where
multiple imputation is not possible.
2. Birthweight
distribution
Biases due to missing
birthweight for very sick babies
and those born around the
threshold of viability

(Table 1 – Potential biases 1,3)
Categorize data where possible
into LBW subgroups % for very
low birthweight, extremely low
birthweight and <500g.

Review distributions and identify data
with evidence of under-capture of
those <1,000g. Consider adjusting
these data or sensitivity analysis
based on excluding these data.
Multiple imputation to impute
birthweight data for included
newborns with missing birthweight.

Very sick or small babies who die
immediately after birth may not be
captured in the birth history at all.
Thus, consider sensitivity analysis
based on excluding data points with
evidence of under-capture of
those <1,000g.
3. Measurement
errors due to
heaping
Heaping of recorded birthweight
on 2,500g.

(Table 1 – Potential biases 4)
Consider use of administrative
data birthweight heaping index for
countries with available information
to identify indicators of countries that
have higher and lower prevalence
of heaping. Use model terms for
categories of administrative data in
the Bayesian model to adjust data in
countries that are expected to have
high heaping.
Exclusion of surveys with extreme
heaping (>55% of all birthweights
falling on the three most frequent
birthweights and <5% of births
on the tail ends of ≤500g and
≥5,000g) Also, heaping adjustment
undertaken as part of the pre-
modelling data processing.
4. Measurement
errors due to
misclassification
of live births as
stillbirths
Most likely in babies around the
perceived thresholds of viability,
which vary by context

(Table 1 – Potential biases 4)
Methods detailed above on
birthweight distribution to attempt
to identify missing babies around the
threshold of vulnerability.
Misclassified newborns will be
missing from the survey dataset.
Methods detailed above on
birthweight distribution to attempt
to identify missing babies around
the threshold of vulnerability.
5. Measurement unit
error
Confusion in surveys where
birthweights may be provided in
both pounds and grams

(Table 1 – Potential biases 5)
Not applicable Exclusions based on >10% of all
birthweights ≥4,500g. 5
6. Incorrect
denominator used
For example, where a large
number of newborns in the
data source did not have a
recorded birthweight and the
denominator used includes
all newborns in data source,
rather than all newborns with a
birthweight in the data source.

(Table 1 – Potential biases 6)
Re-calculate LBW prevalence
estimates using the correct
denominator, if available; explore
other approaches to account for bias
if not.
Re-calculate all LBW prevalence
estimates.

Note: Any remaining error will be captured by model terms for non-sampling variability