Self-vis-à-vis-proxy reported morbidity prevalence among adults in India: a study based on the national sample survey

Abstract

Purpose – Since inception, National Sample Survey (NSS) is the only large-scale household survey in India, periodically collecting data on morbidity and health care conditions in the country. In these surveys, information for all members of sample households was gathered either from head or a key informant of the household. This paper aims to discuss these issues. Design/methodology/approach – This study was developed to examine whether the use of proxy respondents influences population estimates of morbidity prevalence rates and factors associated with morbidity prevalence rates among adults based on latest 60th round NSS data on morbidity and health care. Findings – The results showed that use of proxy in this survey had severely affected morbidity prevalence rates among adult persons aged 18 years and above. The result showed that use of proxy in the NSS 60th round survey had resulted in underestimation of morbidity prevalence rates among adults in such a way that overall morbidity prevalence rate was 45 per cent higher in direct interviews (148 per 1,000 adult persons) compared to those answered by proxies (81, p<0.001). There were variations in underreporting of morbidities by socio-economic and demographic characteristics of proxies but the direction of the association was the same. Research limitations/implications – The study conclude that morbidity data from the NSS can be used regardless of use of proxies and that the association between worse health condition and socio-economic and demographic factors persisted even when information was collected from a proxy. However, suitable adjustments for proxy-reporting should be made while estimating realistic population at risk from the NSS data. Originality/value – This is the first manuscript that has made an attempt to examine the effect of proxy-reporting on morbidity prevalence in NSS data. Since its inception in 1955, NSS data are the only data source available in India on morbidity and health care conditions. A large number of research manuscripts have been published using this data and there were serious concerns among the researchers on data quality particularly about the reporting of health status. NSS 60th round first time provided information on reporting status, i.e. proxy vs self. In this context, the present study made an effort in this direction.