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August 14, 2026Journal of Epidemiology and Global HealthOpen Access

Enhancing Estimation Precision in Sensitive Public Health Data: Implications for Evidence-Based Decision-Making

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Authors

LHLi HongheFSFaiza ShahMSMuhammad Imran Shahid

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Overview

Cross-sectional survey reveals higher true rates of COVID-19 and vaccine hesitancy in Pakistan, indicating substantial underreporting in standard surveys.

Key Points

  • To improve the estimation precision of sensitive public health outcomes, specifically COVID-19 prevalence and vaccine hesitancy, by mitigating social stigma and nonresponse bias.
  • Conducted a cross-sectional survey of 1,200 participants (600 urban, 600 rural) across Faisalabad, Lahore, Multan, and Rawalpindi, Pakistan (June–August 2021).
  • Implemented multi-stage stratified paired response frameworks (MSPRF-I and MSPRF-II) using two- and three-stage randomization with dual scrambling mechanisms under stratified simple random sampling.
  • MSPRFs demonstrated a percent relative efficiency gain of 290% to 399% compared to traditional direct reporting methods.
  • COVID-19 prevalence was estimated higher than reported rates: MSPRF-I estimated 16.8% urban vs 12.1% reported, and 20.8% rural vs 13.6% reported; MSPRF-II estimated 16.8% urban and 19.2% rural vs 12.6% and 14.6% reported.
  • Vaccine hesitancy was estimated at 33.8% (MSPRF-I) and 29.5% (MSPRF-II) compared with 24.3% reported, with urban respondents demonstrating higher reporting sensitivity (W1 = 0.62) than rural respondents (W2 = 0.48).

Cite This Study

Honghe et al. (2026) studied this question.

synapsesocial.com/papers/6a7ec707b70b84ec8b9132c0https://doi.org/10.1007/s44197-026-00627-7
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