A method for adjusting gender bias in neonatal tetanus reports in Egypt 1991

Reports of neonatal tetanus (NT) disease, common in developing countries, often suffers from gender bias because male infants are brought to health facilities while females are attended at home. Using existing health data we applied reasonable assumptions to estimate the true incidence of NT economically. To adjust for gender disparities in national reporting, we ignored the number of female NT cases and doubled the number for males. Governorates with similar demographic risk profiles for NT were assigned to one of six groups. The highest incidence rate within the group was determined and applied to the number of live births represented by the group. Other internal data comparisons were done to support our estimate that the male:female ratio of NT incidence was far less than the reported 412:1. In 1991, the male: female ratio of NT cases was 4.12:1. Decreasing the male: female ratio to 1:1 decreased sensitivity to a 62% estimate. Further adjusting for assumed under-reporting by governorates based on population profiles yielded a reporting sensitivity of 40%. Estimated male and female age-specific NT mortality rates from available data supported the assumption that NT mortality ratios are less than 4.12:1. This report, therefore, describes a unique, economical method to estimate the incidence of a disease assumed to be affected by gender biases in the reporting system. The method relies on two assumptions: that the true NT male:female ratio is close to 1:1 and that populations with similar demographics within a country should have similar incidence rates of NT.