the dhs program demographic and health surveys · (dhs-7, 2013−2019) ... sayana press,...
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© ICF/Hanna Useem
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The DHS Program Demographic and Health surveys
A Project Funded by The United States Agency for International Development and Implemented by ICF
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ICF
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Topics for discussion
2020-21 Myanmar Demographic and Health Survey DHS–8 Questionnaires update Survey instruments Tentative timeline
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• Collect high-quality data for policy formulation, program planning, and monitoring and evaluation
• Foster and reinforce host-country ownership of data collection, analysis, presentation, and use
• Increase the capacity of host-country partners to collect and use data for policy and program purposes
Specific MDHS objectives
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The DHS started in 1984:
• DHS-I (DHS-1, 1984−1989) • DHS-II (DHS-2, 1989−1993) • DHS-III (DHS-3, 1992−1997) • MEASURE DHS+
(DHS-4, 1997−2003) • MEASURE DHS
(DHS-5, 2003−2008) • MEASURE DHS Phase III
(DHS-6, 2008−2014) • The DHS Program
(DHS-7, 2013−2019) • The DHS Program
(DHS-8, 2018−2023)
DHS history
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2007 Min Z
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ourtesy of Photoshare
The MDHS sample will be representative at
• The national level
• For urban and rural areas
• The region and state level _________________________
- With the TFR at 2.3 and U5MR at 50 there is a need to increase the sample size
- Found fewer that expected number of women (13,454 as opposed to 16,829)
- Increase sample size from 13,238 HH to 16,650 HH
- Number of clusters from 442 to 555
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DHS Sample - Myanmar
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‘Core’ questionnaires
• Core set of questions in each type of questionnaire implemented in every country
• Revised and updated every 5 years
• Provide trends in key indicators
• Allow cross-country comparisons
• Country needs met through country-specific questions
DHS Core Questionnaires
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DHS 8 Questionnaire updates
Process from January 2019 – September 2019
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• Questionnaires reflect CAPI
• Pregnancy history
• Prompted questions on contraceptive use
• Marriage certificate
• Reduced HIV content
• Stillbirth included on ANC, delivery, PNC
• Coverage of nutrition intervention, dietary recall for women
• Photographs taken for vaccination cards
DHS 8 - Core Questionnaires
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New Topics • Breast and cervical
cancer screening • alcohol use • household questions
on cook stoves • energy source for
lighting, cooking, heating
DHS 8 - Core Questionnaires
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14 1
[CELLREF] 137
86
[CELLREF]
32 35
[CELLREF]
Additions Deletions % new Additions Deletions % new Additions Deletions % new
Legacy New
14%
Additions and deletions, DHS-7 to DHS-8
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15%
25%
Household Woman’s Man’s
80
491
228
799
93
542
225
860
13 51
-3
61
Household Woman's Man's All 3
DHS-7 DHS-8 Net change
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Net change in length of DHS Questionnaires from DHS-7 to DHS-8
73
337
156
566
80
491
228
799
93
542
225
860
Household Woman's Man's All 3
MDHS2015-16 DHS-7 DHS-8 Net change
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Net change in length of DHS Questionnaires from DHS-7 to DHS-8
39
23 18
15 12 11 11
4 3 1
0 4
1
21
0 0
8
37
1 0
13
1
Nutrition MNH Birthhistory
Othertopics
Gender FP HIV Vaccination WASH Malaria Childhealth
Additions Deletions
12 are filters
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Added and deleted questions in the Woman’s Questionnaire, by topic
Nutrition 35
MNH 22
Other topics
15 Gender 12 FP
3 Vaccination 3
WASH 3
Child health
-1 Birth
history -3 Malaria
-12
HIV -26
12 are filters
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Net changes in the Woman’s Questionnaire by topic
• Pregnancy history
– Non-live births can now be accounted for in postpartum insusceptibility
• Directed questions on use of various methods of family planning:
– sterilization, Sayana Press, coitus-dependent methods, emergency contraception, use of contraception at last sex
• Counseling on method switching
• Expanded list of reasons for non-use
• Expanded list of sources for messages about family planning
• Age at menarche
• Breast and cervical cancer screening
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Family planning/Reproductive health
• More questions on contraceptive decision making.
– More detail on joint decision making; questions are asked of more respondents now (all women in union)
• Marriage certificates/marriage registration
• Duration of current union (for women married more than once)
• Who fetches water for the household
• Woman’s use of a bank account for deposits/withdrawals
• Men: Did your father ever beat your mother?
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Gender and women’s empowerment
• Deletion of behavioral questions that mapped to retired indicators
• Knowledge of antiretroviral treatment and PrEP
• Expanded questions on testing behavior
– Number of lifetime HIV tests
– Changed measurement of time since last test (now ask for date)
• Men: new questions allow for men to be both traditionally and medically circumcised
• Self-reported HIV status and treatment
– Time since diagnosis for PLHIV
– Experience of stigma for PLHIV
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HIV
• If a household owned a net that no one slept under on the night before the survey, we ask why no one slept under that net
• Mother’s report of malaria diagnosis for children
• New optional modules for commonly added questions:
– Prevalence of fever in the population
– SBCC questions for malaria
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Malaria
• Pregnancy history
– Total overhaul of Section 4
– Stillbirths now included in the ANC and delivery questions
• Reference period reduced from 5 to 3 years
• Respectful maternity care
• Expanded questions on content of ANC
• Timing of initiation of postnatal skin-to-skin contact
• Content of postnatal care for women
• Revisions of some question wording – to improve consistency with MICS, or internal consistency
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Maternal, newborn & child health
• New questions on coverage of nutrition interventions
– Counseling on nutrition during pregnancy – Counseling on breastfeeding during ANC – Receipt of food or cash assistance during pregnancy – Counseling on infant feeding – Growth monitoring for children
• Source of iron-containing supplements for women during ANC
• Revision in iron supplementation for children to better capture multiple-micronutrient powder
• Expanded questions on child feeding – Sweetened beverages – Unhealthy foods
• Minimum dietary diversity for women
• Anthropometry – whether hairstyle or heavy clothing interfered with height and weight measurement
• Food insecurity experience scale (FIES) as an optional module (SDG) 12/6/2019 FOOTER GOES HERE 20
Nutrition
• Date of birth written on the vaccination card
• Photographs to be taken of vaccination cards
• Hepatitis B at birth: split one question into two (Yes/No; <24 hours)
• Usual source for vaccination
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Vaccination
• 3 questions on emptying of septic tanks
• 2 questions on menstrual hygiene
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Water, sanitation & hygiene
• Expanded questions on cook stoves (SDG)
• Expanded questions on household energy use (SDG) – Sources of energy for cooking, lighting, and space
heating
• Expanded questions on migration
• Self-reported health status
• Distance to closest health facility
• Alcohol use
• Mobile banking (SDG)
• Measurement of early childhood education down to age 4
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Other topics
Additional Modules
• Domestic Violence
• Female Genital Cutting
• Adult and Maternal Mortality
• Fistula
• Out-of-pocket Health Expenditures
• Disability
• Non-communicable Diseases
• Newborn Care
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DHS Questionnaire Modules
Additional modules included
• Domestic Violence
• Adult and Maternal Mortality
• MICS module- Early childhood development
• MICS module- Child discipline
• MUAC – UNICEF recommendation
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MDHS Questionnaire Modules included in 2015-16 MDHS
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Standard DHS surveys generally include a:
• Household questionnaire • Woman’s questionnaire • Man’s questionnaire • Biomarker questionnaire • Fieldworker questionnaire
Types of DHS Questionnaires
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• For household members: − Age, sex, residence − Head of household and
relationship to the head − Education for all; schooling
for children
• Assets, land ownership, housing characteristics
• Sanitation, water, and other environmental health issues
Household Questionnaire
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Emptying of septic tanks
• assessing the proportion of the population using safely managed sanitation services (SDG indicator 6.2.1) and is also comparable with MICS
Reliability of water source • The new version of the question
contributes to SDG indicator 6.1.1 and is also comparable with MICS. Assets, land ownership, housing characteristics
Household Questionnaire - New
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Reliance on clean fuel energy
• Required for SDG 7.1.2: Proportion of population with reliance on clean fuels and technologies
Mobile money • Household member using mobile for
transaction (SDG).
Household Questionnaire - New
In both woman’s and man’s questionnaires:
• Socio-demographic characteristics
• Number of children
• Contraception
• Marriage and sexual behavior
• Fertility preferences
• STIs and HIV/AIDS, knowledge, attitudes & behavior
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Individual Questionnaire
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• Section 1: sleeping away from home
• Section 7: Partner history - deleted first/last sex with this partner, # times had sex with this partner, age of partner, # partners in past 12 months. Transactional sex, paid sex (men).
– Kept: relationship to partner for last 3 partners, condom use at last sex with last 3 partners. Can still get 2+ partners in past 12 months.
• Section 10:
– Heard of HIV or AIDS now an opt-out question.
– Cut HIV transmitted by witchcraft question. New UNAIDS indicator changed from rejects “two most common local misconceptions” to rejects mosquito bites and sharing food. Restricted to ages 15-24!
– Cut knowledge of MTCT, HIV counseling in ANC, posttest counseling, “offered a test” in ANC and labor.
– Cut 4 questions on enacted stigma (talk badly, hesitate to take HIV test)
– Kept: fresh vegetables, children go to school for UNAIDS indicator
• Section 11: Cut injection safety
HIV section Deletions!
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Only in woman’s questionnaires
• Fertility: Pregnancy history; 5-year calendar
• Infant and child mortality • Maternal health: ANC,
delivery, postpartum care
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Individual Questionnaire
• Child nutrition, including breastfeeding
• Immunization and childhood illness
• Women’s dietary diversity
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IYCF – new indicator on sweet beverages
• IYCF Liquid and food questions separated
• Sodas/malts/energy (new) + Chocolate drinks (new) + Drink sweetened (new) + Juice/juice drinks
• Adaptation: category "soy milk and nut milks" must be added in countries where these items are consumed.
New unhealthy eating indicator - Sweet foods as chocolates,
candies, pastries, cakes, biscuits etc.
- Chips, crisps, puffs, French fries etc.
Minimum dietary diversity for women (healthy and unhealth) – similar to child drink and food questions
• Q418e. Coverage of breastfeeding counseling during antenatal care
• Q418f. Coverage of nutritional counseling during antenatal care
• Q427. Source for iron-containing supplements taken during pregnancy
• Q430. Cash-assistance programs for pregnant women
– Adaptation for name of program, (delete if no wide-scale program)
• Q605. Modified iron for children (12 months instead of 7 days) and ask separately about iron vehicle
• Q607. Coverage of growth monitoring for children
– Adapt wording of MUAC (or remove) as necessary
• Q641. Coverage of nutrition counseling for youngest child
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Maternal and child nutrition interventions
• For children under age 5, women, and men: − Nutritional status (height
and weight) − Anemia test − Other biomarkers
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Biomarker Questionnaire
Chronic conditions
• Blood pressure
• Diabetes
• Lipids
STIs
• Chlamydia
• Hepatitis B
• Hepatitis C
• Herpes
• Syphilis
HIV testing
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Other Biomarkers
Nutrition
• Iodine (salt and urine test)
• Iron
• Lead
• Vitamin A
Antibodies/immunity
• Measles
• Tetanus
Water testing
• Arsenic, chlorine, E.coli
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MDHS Timeline - milestones Activities Tentative dates Remarks
LOPA/MOU Jan-Feb 2020 Determine parties
Consultative meetings Jan – Mar 2020 Before the questionnaire design
Supplies shipment Mar 2020 Import permit takes time
Questionnaire design Mar 2020
Sample design Feb-Mar 2020 Interim census 2019 updated frame
Household Listing April – June 2020 Option of using census list
CAPI programming May – June 2020
Pretest/TOT July 2020
Main training Nov-Dec 2020
Fieldwork Dec 2020 – Mar 2021 Elections
Key indicators report June 2021
Report writing workshop August 2021
National seminar November 2021
Subnational dissemination December 2021