BackgroundThere has been increasing interest in measuring under-five mortality as a health indicator and as a critical measure of human development. In countries with complete vital registration systems that capture all births and deaths, under-five mortality can be directly calculated. In the absence of a complete vital registration system, however, child mortality must be estimated using surveys that ask women to report the births and deaths of their children. Two survey methods exist for capturing this information: summary birth histories and complete birth histories. A summary birth history requires a minimum of only two questions: how many live births has each mother had and how many of them have survived. Indirect methods are then applied using the information from these two questions and the age of the mother to estimate under-five mortality going back in time prior to the survey. Estimates generated from complete birth histories are viewed as the most accurate when surveys are required to estimate under-five mortality, especially for the most recent time periods. However, it is much more costly and labor intensive to collect these detailed data, especially for the purpose of generating small area estimates. As a result, there is a demand for improvement of the methods employing summary birth history data to produce more accurate as well as subnational estimates of child mortality.Methods and FindingsWe used data from 166 Demographic and Health Surveys (DHS) to develop new empirically based methods of estimating under-five mortality using children ever born and children dead data. We then validated them using both in- and out-of-sample analyses. We developed a range of methods on the basis of three dimensions of the problem: (1) approximating the average length of exposure to mortality from a mother's set of children using either maternal age or time since first birth; (2) using cohort and period measures of the fraction of children ever born that are dead; and (3) capturing country and regional variation in the age pattern of fertility and mortality. We focused on improving estimates in the most recent time periods prior to a survey where the traditional indirect methods fail. In addition, all of our methods incorporated uncertainty. Validated against under-five estimates generated from complete birth histories, our methods outperformed the standard indirect method by an average of 43.7% (95% confidence interval [CI] 41.2–45.2). In the 5 y prior to the survey, the new methods resulted in a 53.3% (95% CI 51.3–55.2) improvement. To illustrate the value of this method for local area estimation, we applied our new methods to an analysis of summary birth histories in the 1990, 2000, and 2005 Mexican censuses, generating subnational estimates of under-five mortality for each of 233 jurisdictions.ConclusionsThe new methods significantly improve the estimation of under-five mortality using summary birth history data. In areas without vital registration data, summary birth histories can provide accurate estimates of child mortality. Because only two questions are required of a female respondent to generate these data, they can easily be included in existing survey programs as well as routine censuses of the population. With the wider application of these methods to census data, countries now have the means to generate estimates for subnational areas and population subgroups, important for measuring and addressing health inequalities and developing local policy to improve child survival.Please see later in the article for the Editors' Summary

Abstract

The 1997 the Kyrgyz Republic Demographic and Health Survey (KRDHS) is a nationally representative survey of 3,848 women age 15-49. Fieldwork was conducted from August to November 1997. The KRDHS was sponsored by the Ministry of Health (MOH), and was funded by the United States Agency for International Development. The Research Institute of Obstetrics and Pediatrics implemented the survey with technical assistance from the Demographic and Health Surveys (DHS) program.

The purpose of the KRDHS was to provide data to the MOH on factors which determine the health status of women and children such as fertility, contraception, induced abortion, maternal care, infant mortality, nutritional status, and anemia.

Some statistics presented in this report are currently available to the MOH from other sources. For example, the MOH collects and regularly publishes information on fertility, contraception, induced abortion and infant mortality. However, the survey presents information on these indices in a manner which is not currently available, i.e., by population subgroups such as those defined by age, marital duration, education, and ethnicity. Additionally, the survey provides statistics on some issues not previously available in the Kyrgyz Republic: for example, breastfeeding practices and anemia status of women and children. When considered together, existing MOH data and the KRDHS data provide a more complete picture of the health conditions in the Kyrgyz Republic than was previously available.

A secondary objective of the survey was to enhance the capabilities of institutions in the Kyrgyz Republic to collect, process, and analyze population and health data.

MAIN FINDINGS

FERTILITY

Fertility Rates. Survey results indicate a total fertility rate (TFR) for all of the Kyrgyz Republic of 3.4 children per woman. Fertility levels differ for different population groups. The TFR for women living in urban areas (2.3 children per woman) is substantially lower than for women living in rural areas (3.9). The TFR for Kyrgyz women (3.6 children per woman) is higher than for women of Russian ethnicity (1.5) but lower than Uzbek women (4.2). Among the regions of the Kyrgyz Republic, the TFR is lowest in Bishkek City (1.7 children per woman), and the highest in the East Region (4.3), and intermediate in the North and South Regions (3.1 and3.9, respectively).

Time Trends. The KRDHS data show that fertility has declined in the Kyrgyz Republic in recent years. The decline in fertility from 5-9 to 0-4 years prior to the survey increases with age, from an 8 percent decline among 20-24 year olds to a 38 percent decline among 35-39 year olds. The declining trend in fertility can be seen by comparing the completed family size of women near the end of their childbearing years with the current TFR. Completed family size among women 40-49 is 4.6 children which is more than one child greater than the current TFR (3.4).

Birth Intervals. Overall, 30 percent of births in the Kyrgyz Republic take place within 24 months of the previous birth. The median birth interval is 31.9 months.

Age at Onset of Childbearing. The median age at which women in the Kyrgyz Republic begin childbearing has been holding steady over the past two decades at approximately 21.6 years. Most women have their first birth while in their early twenties, although about 20 percent of women give birth before age 20.

Nearly half of married women in the Kyrgyz Republic (45 percent) do not want to have more children. Additional one-quarter of women (26 percent) want to delay their next birth by at least two years. These are the women who are potentially in need of some method of family planning.

FAMILY PLANNING

Ever Use. Among currently married women, 83 percent report having used a method of contraception at some time. The women most likely to have ever used a method of contraception are those age 30-44 (among both currently married and all women).

Current Use. Overall, among currently married women, 60 percent report that they are currently using a contraceptive method. About half (49 percent) are using a modern method of contraception and another 11 percent are using a traditional method. The IUD is by far the most commonly used method; 38 percent of currently married women are using the IUD. Other modern methods of contraception account for only a small amount of use among currently married women: pills (2 percent), condoms (6 percent), and injectables and female sterilization (1 and 2 percent, respectively). Thus, the practice of family planning in the Kyrgyz Republic places high reliance on a single method, the IUD.

Source of Methods. The vast majority of women obtain their contraceptives through the public sector (97 percent): 35 percent from a government hospital, and 36 percent from a women counseling center. The source of supply of the method depends on the method being used. For example, most women using IUDs obtain them at women counseling centers (42 percent) or hospitals (39 percent). Government pharmacies supply 46 percent of pill users and 75 percent of condom users. Pill users also obtain supplies from women counseling centers or (33 percent).

Fertility Preferences. A majority of women in the Kyrgyz Republic (45 percent) indicated that they desire no more children. By age 25-29, 20 percent want no more children, and by age 30-34, nearly half (46 percent) want no more children. Thus, many women come to the preference to stop childbearing at relatively young ages-when they have 20 or more potential years of childbearing ahead of them. For some of these women, the most appropriate method of contraception may be a long-acting method such as female sterilization. However, there is a deficiency of use of this method in the Kyrgyz Republic. In the interests of providing a broad range of safe and effective methods, information about and access to sterilization should be increased so that individual women can make informed decisions about using this method.

INDUCED ABORTION

Abortion Rates. From the KRDHS data, the total abortion rate (TAR)-the number of abortions a woman will have in her lifetime based on the currently prevailing abortion rates-was calculated. For the Kyrgyz Republic, the TAR for the period from mid-1994 to mid-1997 is 1.6 abortions per woman. The TAR for the Kyrgyz Republic is lower than recent estimates of the TAR for other areas of the former Soviet Union such as Kazakhstan (1.8), and Yekaterinburg and Perm in Russia (2.3 and 2.8, respectively), but higher than for Uzbekistan (0.7).

The TAR is higher in urban areas (2.1 abortions per woman) than in rural areas (1.3). The TAR in Bishkek City is 2.0 which is two times higher than in other regions of the Kyrgyz Republic. Additionally the TAR is substantially lower among ethnic Kyrgyz women (1.3) than among women of Uzbek and Russian ethnicities (1.9 and 2.2 percent, respectively).

INFANT MORTALITY

In the KRDHS, infant mortality data were collected based on the international definition of a live birth which, irrespective of the duration of pregnancy, is a birth that breathes or shows any sign of life (United Nations, 1992). Mortality Rates. For the five-year period before the survey (i.e., approximately mid-1992 to mid1997), infant mortality in the Kyrgyz Republic is estimated at 61 infant deaths per 1,000 births. The estimates of neonatal and postneonatal mortality are 32 and 30 per 1,000.

The MOH publishes infant mortality rates annually but the definition of a live birth used by the MOH differs from that used in the survey. As is the case in most of the republics of the former Soviet Union, a pregnancy that terminates at less than 28 weeks of gestation is considered premature and is classified as a late miscarriage even if signs of life are present at the time of delivery. Thus, some events classified as late miscarriages in the MOH system would be classified as live births and infant deaths according to the definitions used in the KRDHS.

Infant mortality rates based on the MOH data for the years 1983 through 1996 show a persistent declining trend throughout the period, starting at about 40 per 1,000 in the early 1980s and declining to 26 per 1,000 in 1996. This time trend is similar to that displayed by the rates estimated from the KRDHS. Thus, the estimates from both the KRDHS and the Ministry document a substantial decline in infant mortality; 25 percent over the period from 1982-87 to 1992-97 according to the KRDHS and 28 percent over the period from 1983-87 to 1993-96 according to the MOH estimates. This is strong evidence of improvements in infant survivorship in recent years in the Kyrgyz Republic.

It should be noted that the rates from the survey are much higher than the MOH rates. For example, the KRDHS estimate of 61 per 1,000 for the period 1992-97 is twice the MOH estimate of 29 per 1,000 for 1993-96. Certainly, one factor leading to this difference are the differences in the definitions of a live birth and infant death in the KRDHS survey and in the MOH protocols. A thorough assessment of the difference between the two estimates would need to take into consideration the sampling variability of the survey's estimate. However, given the magnitude of the difference, it is likely that it arises from a combination of definitional and methodological differences between the survey and MOH registration system.

MATERNAL AND CHILD HEALTH

The Kyrgyz Republic has a well-developed health system with an extensive infrastructure of facilities that provide maternal care services. This system includes special delivery hospitals, the obstetrics and gynecology departments of general hospitals, women counseling centers, and doctor's assistant/midwife posts (FAPs). There is an extensive network of FAPs throughout the rural areas.

Delivery. Virtually all births in the

Data in table tells us about the year-wise National Family Health Survey- Main Findings.

Indicators used are: Population and Household Profile, Characteristics of Adults (age 15-49), Marriage and fertility, Infant and Child Mortality Rates (per 1,000 live births), Current Use of Family Planning Methods (currently married women age 15-49 years), Unmet Need for Family Planning (currently married women age 15-49 years), Quality of Family Planning Services, Maternal and Child Health includes- Maternity Care (for last birth in the 5 years before the survey), Delivery Care (for births in the 5 years before the survey), Treatment of Childhood Diseases (children under age 5 years), Child Feeding Practices and Nutritional Status of Children, Nutritional Status of Adults (age 15-49 years) includes- Anaemia among Children and Adults 15, Blood Sugar Level among Adults (age 15-49 years)16, Women Age 15-49 Years Who Have Ever Undergone Examinations of: Cervix, breast and oral cavity, Knowledge of HIV/AIDS among Adults (age 15-49 years), Women's Empowerment and Gender Based Violence (age 15-49 years) and Tobacco Use and Alcohol Consumption among Adults (age 15-49 years). NFHS-3 was calculated for 2005-2006 and NFHS-4 for 2015-16 for urban areas, rural areas and total separately.

Abstract

Moldova's first Demographic and Health Survey (2005 MDHS) is a nationally representative sample survey of 7,440 women age 15-49 and 2,508 men age 15-59 selected from 400 sample points (clusters) throughout Moldova (excluding the Transnistria region). It is designed to provide data to monitor the population and health situation in Moldova; it includes several indicators which follow up on those from the 1997 Moldova Reproductive Health Survey (1997 MRHS) and the 2000 Multiple Indicator Cluster Survey (2000 MICS). The 2005 MDHS used a two-stage sample based on the 2004 Population and Housing Census and was designed to produce separate estimates for key indicators for each of the major regions in Moldova, including the North, Center, and South regions and Chisinau Municipality. Unlike the 1997 MRHS and the 2000 MICS surveys, the 2005 MDHS did not cover the region of Transnistria. Data collection took place over a two-month period, from June 13 to August 18, 2005.

The survey obtained detailed information on fertility levels, abortion levels, marriage, sexual activity, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutritional status of women and young children, childhood mortality, maternal and child health, adult health, and awareness and behavior regarding HIV infection and other sexually transmitted diseases. Hemoglobin testing was conducted on women and children to detect the presence of anemia. Additional features of the 2005 MDHS include the collection of information on international emigration, language preference for reading printed media, and domestic violence. The 2005 MDHS was carried out by the National Scientific and Applied Center for Preventive Medicine, hereafter called the National Center for Preventive Medicine (NCPM), of the Ministry of Health and Social Protection. ORC Macro provided technical assistance for the MDHS through the USAID-funded MEASURE DHS project. Local costs of the survey were also supported by USAID, with additional funds from the United Nations Children's Fund (UNICEF), the United Nations Population Fund (UNFPA), and in-kind contributions from the NCPM.

MAIN RESULTS

CHARACTERISTICS OF RESPONDENTS

Ethnicity and Religion. Most women and men in Moldova are of Moldovan ethnicity (77 percent and 76 percent, respectively), followed by Ukrainian (8-9 percent of women and men), Russian (6 percent of women and men), and Gagauzan (4-5 percent of women and men). Romanian and Bulgarian ethnicities account for 2 to 3 percent of women and men. The overwhelming majority of Moldovans, about 95 percent, report Orthodox Christianity as their religion.

Residence and Age. The majority of respondents, about 58 percent, live in rural areas. For both sexes, there are proportionally more respondents in age groups 15-19 and 45-49 (and also 45-54 for men), whereas the proportion of respondents in age groups 25-44 is relatively lower. This U-shaped age distribution reflects the aging baby boom cohort following World War II (the youngest of the baby boomers are now in their mid-40s), and their children who are now mostly in their teens and 20s. The smaller proportion of men and women in the middle age groups reflects the smaller cohorts following the baby boom generation and those preceding the generation of baby boomers' children. To some degree, it also reflects the disproportionately higher emigration of the working-age population.

Education. Women and men in Moldova are universally well educated, with virtually 100 percent having at least some secondary or higher education; 79 percent of women and 83 percent of men have only a secondary or secondary special education, and the remainder pursues a higher education. More women (21 percent) than men (16 percent) pursue higher education.

Language Preference. Among women, preferences for language of reading material are about equal for Moldovan (37 percent) and Russian (35 percent) languages. Among men, preference for Russian (39 percent) is higher than for Moldovan (25 percent). A substantial percentage of women and men prefer Moldovan and Russian equally (27 percent of women and 32 percent of men).

Living Conditions. Access to electricity is almost universal for households in Moldova. Ninety percent of the population has access to safe drinking water, with 86 percent in rural areas and 96 percent in urban areas. Seventy-seven percent of households in Moldova have adequate means of sanitary disposal, with 91 percent of households in urban areas and only 67 percent in rural areas.

Children's Living Arrangements. Compared with other countries in the region, Moldova has the highest proportion of children who do not live with their mother and/or father. Only about two-thirds (69 percent) of children under age 15 live with both parents. Fifteen percent live with just their mother although their father is alive, 5 percent live with just their father although their mother is alive, and 7 percent live with neither parent although they are both alive. Compared with living arrangements of children in 2000, the situation appears to have worsened.

FERTILITY

Fertility Levels and Trends. The total fertility rate (TFR) in Moldova is 1.7 births. This means that, on average, a woman in Moldova will give birth to 1.7 children by the end of her reproductive period. Overall, fertility rates have declined since independence in 1991. However, data indicate that fertility rates may have increased in recent years. For example, women of childbearing age have given birth to, on average, 1.4 children at the end of their childbearing years. This is slightly less than the total fertility rate (1.7), with the difference indicating that fertility in the past three years is slightly higher than the accumulation of births over the past 30 years.

Fertility Differentials. The TFR for rural areas (1.8 births) is higher than that for urban areas (1.5 births). Results show that this urban-rural difference in childbearing rates can be attributed almost exclusively to younger age groups.

CONTRACEPTION

Knowledge of Contraception. Knowledge of family planning is nearly universal, with 99 percent of all women age 15-49 knowing at least one modern method of family planning. Among all women, the male condom, IUD, pills, and withdrawal are the most widely known methods of family planning, with over 80 percent of all women saying they have heard of these methods. Female sterilization is known by two-thirds of women, while periodic abstinence (rhythm method) is recognized by almost six in ten women. Just over half of women have heard of the lactational amenorrhea method (LAM), while 40-50 percent of all women have heard of injectables, male sterilization, and foam/jelly. The least widely known methods are emergency contraception, diaphragm, and implants.

Use of Contraception. Sixty-eight percent of currently married women are using a family planning method to delay or stop childbearing. Most are using a modern method (44 percent of married women), while 24 percent use a traditional method of contraception. The IUD is the most widely used of the modern methods, being used by 25 percent of married women. The next most widely used method is withdrawal, used by 20 percent of married women. Male condoms are used by about 7 percent of women, especially younger women. Five percent of married women have been sterilized and 4 percent each are using the pill and periodic abstinence (rhythm method). The results show that Moldovan women are adopting family planning at lower parities (i.e., when they have fewer children) than in the past. Among younger women (age 20-24), almost half (49 percent) used contraception before having any children, compared with only 12 percent of women age 45-49.

MATERNAL HEALTH

Antenatal Care and Delivery Care. Among women with a birth in the five years preceding the survey, almost all reported seeing a health professional at least once for antenatal care during their last pregnancy; nine in ten reported 4 or more antenatal care visits. Seven in ten women had their first antenatal care visit in the first trimester. In addition, virtually all births were delivered by a health professional, in a health facility. Results also show that the vast majority of women have timely checkups after delivering; 89 percent of all women received a medical checkup within two days of the birth, and another 6 percent within six weeks.

CHILD HEALTH

Childhood Mortality. The infant mortality rate for the 5-year period preceding the survey is 13 deaths per 1,000 live births, meaning that about 1 in 76 infants dies before the first birthday. The under-five mortality rate is almost the same with 14 deaths per 1,000 births. The near parity of these rates indicates that most all early childhood deaths take place during the first year of life. Comparison with official estimates of IMRs suggests that this rate has been improving over the past decade.

NUTRITION

Breastfeeding Practices. Breastfeeding is nearly universal in Moldova: 97 percent of children are breastfed. However the duration of breast-feeding is not long, exclusive breastfeeding is not widely practiced, and bottle-feeding is not uncommon. In terms of the duration of breastfeeding, data show that by age 12-15 months, well over half of children (59 percent) are no longer being breastfed. By age 20-23 months, almost all children have been weaned.

Exclusive breastfeeding is not widely practiced and supplementary feeding begins early: 57 percent of breastfed children less than 4 months are exclusively breastfed, and 46 percent under six months are exclusively breastfeed. The remaining breastfed children also consume plain water, water-based liquids or juice, other milk in addition to breast milk, and complimentary foods. Bottle-feeding is fairly widespread in Moldova;

This dataset compromises all country data included in the UN Inter-agency Group for Child Mortality Estimation (IGME) database (https://childmortality.org/data, downloaded June 2019).

It includes:

Reference area: name of the country

Indicator: child mortality indicator (neonatal mortality, infant mortality, under-5 mortality and mortality rate age 5 to 14)

Sex: sex of the child (male, female and total)

Series name: name of survey/census/VR [note: UN IGME estimates, i.e. not source data, are identified as "UN IGME estimate" in this field]

Series year: year of survey/census/VR series

Observation value: value of indicator from survey/census/VR

Observation status: indicates whether the data point is included or excluded for estimation [status of "normal" indicates UN IGME estimate, i.e. not source data]

Series Category: category of survey/census/VR, and can be:

DHS [Demographic and Health Survey]

MIS [Malaria Indicator Survey]

AIS [AIDS Indicator Survey]

Interim DHS

Special DHS

NDHS [National DHS]

WFS [World Fertility Survey]

MICS [Multiple Indicator Cluster Survey]

NMICS [National MICS]

RHS [Reproductive Health Survey]

PAP [Pan Arab Project for Child or Pan Arab Project for Family Health or Gulf Famly Health Survey]

LSMS [Living Standard Measurement Survey]

Panel [Dual record, multiround/follow-up survey and longitudinal/panel survey]

Census

VR [Vital Registration]

SVR [Sample Vital Registration]

Others [e.g. Life Tables]

Series type: the type of calculation method used to derive the indicator value (direct, indirect, household deaths, life table and vital records)

Standard error: sampling standard error of the observation value

Series method: data collection method, and can be:

Survey/census with Full Birth Histories

Survey/census with Summary Birth Histories

Survey/census with Household death

Vital Registration

Other

Lower and upper bound: the lower and upper bounds of 90% uncertainty interval of UN IGME estimates (for estimates only, i.e., not source data).

The dataset is used in the following paper:

Ezbakhe, F. and Pérez-Foguet, A. (2019) Levels and trends in child mortality: a compositional approach. Demographic Research (Under Review)

Abstract

The 2006-07 Sri Lanka Demographic and Health Survey (SLDHS) is the fourth in a series of DHS surveys to be held in Sri Lanka-the first three having been implemented in 1987, 1993, and 2000. Teams visited 2,106 sample points across Sri Lanka and collected data from a nationally representative sample of almost 20,000 households and over 14,700 women age 15-49.

A nationally representative sample of 21,600 housing units was selected for the survey and 19,872 households were enumerated to give district level estimates (excluding Northern Province). Detailed information was collected from all ever-married women aged 15-49 years and about their children below five years at the time of the survey. Within the households interviewed, a total of 15,068 eligible women were identified, of whom 14,692 were successfully interviewed.

The Department of Census and Statistics (DCS) carried out the 2006-07 SLDHS for the Health Sector Development Project (HSDP) of the Ministry of Healthcare and Nutrition, a project funded by the World Bank. The objective of the survey is to provide data needed to monitor and evaluate the impact of population, health, and nutrition programmes implemented by different government agencies. Additionally, it also aims to measure the impact of interventions made under the HSDP towards improving the quality and efficiency of health care services as a whole.

All 25 districts of Sri Lanka were included at the design stage. The final sample has only 20 districts, however, after dropping the 5 districts of the Northern Province (Jaffna, Kilinochchi, Mannar, Vavuniya, and Mullativu), due to the security situation there.

OBJECTIVES

The objective of this report is to publish the final findings of the 2006-07 SLDHS. This final report provides information mainly on background characteristics of respondents, fertility, reproductive health and maternal care, child health, nutrition, women's empowerment, and awareness of HIV/AIDS and prevention. It is expected that the content of this report will satisfy the urgent needs of users of this information.

MAIN RESULTS

FERTILITY Survey results indicate that there has been a slight upturn in the total fertility rate since the 2000 SLDHS. The total fertility rate for Sri Lanka is 2.3, meaning that, if current age-specific fertility rates were to remain unchanged in the future, a woman in Sri Lanka would have an average of 2.3 children by the end of her childbearing period. This is somewhat higher than the total fertility rate of 1.9 measured in the 2000 SLDHS.

Fertility is only slightly lower in urban areas than in rural areas (2.2 and 2.3 children per woman, respectively); however, it is higher in the estate areas (2.5 children per woman). Interpretation of variations in fertility by administrative districts is limited by the small samples in some districts. Nevertheless, results indicate that Galle and Puttalam districts have fertility rates of 2.1 or below, which is at what is known as “replacement level” fertility, i.e., the level that is necessary to maintain population size over time. Differences in fertility by level of women's education and a measure of relative wealth status are minimal.

FAMILY PLANNING According to the survey findings, knowledge of any method of family planning is almost universal in Sri Lanka and there are almost no differences between ever-married and currently married women. Over 90 percent of currently married women have heard about pills, injectables, female sterilization, and the IUD. Eight out of ten respondents know about some traditional method of delaying or avoiding pregnancies.

Although the proportion of currently married women who have heard of at least one method of family planning has been high for some time, knowledge of some specific methods has increased recently. Since 1993, knowledge of implants has increased five-fold-from about 10 percent in 1993 to over 50 percent in 2006-07. Awareness about pill, IUD, injectables, implants, and withdrawal has also increased. On the other hand, awareness of male sterilization has dropped by 14 percentage points.

CHILD HEALTH The study of infant and child mortality is critical for assessment of population and health policies and programmes. Infant and child mortality rates are also regarded as indices reflecting the degree of poverty and deprivation of a population. Survey data show that for the most recent five-year period before the survey, the infant mortality rate is 15 deaths per 1,000 live births and under-five mortality is 21 deaths per 1,000 live births. Thus, one in every 48 Sri Lankan children dies before reaching age five. The neonatal mortality rate is 11 deaths per 1,000 live births and the postneonatal mortality rate is 5 deaths per 1,000 live births. The child mortality rate is 5 deaths per 1,000 children surviving to age one year.

REPRODUCTIVE HEALTH The survey shows that virtually all mothers (99 percent) in Sri Lanka receive antenatal care from a health professional (doctor specialist, doctor, or midwife). The proportion receiving care from a skilled provider is remarkably uniform across all categories for age, residence, district, woman's education, and household wealth quintile. Even in the estate sector, antenatal care usage is at the same high level. Although doctors are the most frequently seen provider (96 percent), women also go to public health midwives often for prenatal care (44 percent).

BREASTFEEDING AND NUTRITION Poor nutritional status is one of the most important health and welfare problems facing Sri Lanka today and particularly affects women and children. The survey data show that 17 percent of children under five are stunted or short for their age, while 15 percent of children under five are wasted or too thin for their height. Overall, 21 percent of children are underweight, which may reflect stunting, wasting, or both. As for women, at the national level, 16 percent of women are considered to be thin (with a body mass index < 18.5); however, only 6 percent of women are considered to be moderately or severely thin.

Poor breastfeeding and infant feeding practices can have adverse consequences for the health and nutritional status of children. Fortunately, breastfeeding in Sri Lanka is universal and generally of fairly long duration; 97 percent of newborns are breastfed within one day after delivery and 76 percent of infants under 6 months are exclusively breastfed, lower than the recommended 100 percent exclusive breastfeeding for children under 6 months. The median duration of any breastfeeding is 33 months in Sri Lanka and the median duration of exclusive breastfeeding is 5 months.

HIV/AIDS The HIV/AIDS pandemic is a serious health concern in the world today because of its high case fatality rate and the lack of a cure. Awareness of AIDS is almost universal among Sri Lankan adults, with 92 percent of ever-married women saying that they have heard about AIDS. Nevertheless, only 22 percent of ever-married women are classified as having “comprehensive knowledge” about AIDS, i.e., knowing that consistent use of condoms and having just one faithful partner can reduce the chance of getting infected, knowing that a healthy-looking person can be infected, and knowing that AIDS cannot be transmitted by sharing food or by mosquito bites. Such a low level of knowledge about AIDS implies that a concerted effort is needed to address misconceptions about HIV transmission. Programs might be focused in the estate sector and especially in Batticaloa, Ampara, and Nuwara Eliya districts where comprehensive knowledge is lowest.

Moreover, a composite indicator on stigma towards HIV-infected people shows that only 8 percent of ever-married women expressed accepting attitudes toward persons living with HIV/AIDS. Overall, only about one- half of ever-married women age 15-49 years know where to get an HIV test.

WOMEN'S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES The 2006-07 SLDHS collected data on women's empowerment, their participation in decisionmaking, and attitudes towards wife beating. Survey results show that more than 90 percent of currently married women, either alone or jointly with their husband, make decisions on how their income is used. However, husbands' control over women's earnings is higher among women with no education (15 percent) than among women with higher education (4 percent).

In Sri Lanka, the husband is usually the main source of household income; two-thirds of women earn less than their husband. Although the majority of women earn less than their husband, almost half have autonomy in decisions about how to spend their earnings.

The survey also collected information on who decides how the husband's cash earnings are spent. The majority of couples (60 percent) make joint decisions on how the husband's cash income is used. More than 1 in 5 women (23 percent) reported that they decide how their husband's earnings are used; another 16 percent of the women reported that their husband mainly decides how his earnings are spent.

Geographic coverage

A nationally representative sample of 21,600 housing units was selected for the survey and 19,872 households were enumerated to give district level estimates (excluding Northern Province).

Analysis unit

• Household
• Women age 15-49
• Children under five

Universe

In principle, the sample was designed to cover private households in the areas sampled. The population residing in institutions and institutional households was excluded. For the detailed individual interview, the eligibility criteria wereall ever-married women aged 15-49 years who slept in the household the previous night and about their children below five years at the

Abstract

The 1993 Turkish Demographic and Health Survey (TDHS) is a nationally representative survey of ever-married women less than 50 years old. The survey was designed to provide information on fertility levels and trends, infant and child mortality, family planning, and maternal and child health. The TDHS was conducted by the Hacettepe University Institute of Population Studies under a subcontract through an agreement between the General Directorate of Mother and Child Health and Family Planning, Ministry of Health and Macro International Inc. of Calverton, Maryland. Fieldwork was conducted from August to October 1993. Interviews were carried out in 8,619 households and with 6,519 women.

The Turkish Demographic and Health Survey (TDHS) is a national sample survey of ever-married women of reproductive ages, designed to collect data on fertility, marriage patterns, family planning, early age mortality, socioeconomic characteristics, breastfeeding, immunisation of children, treatment of children during episodes of illness, and nutritional status of women and children. The TDHS, as part of the international DHS project, is also the latest survey in a series of national-level population and health surveys in Turkey, which have been conducted by the Institute of Population Studies, Haeettepe University (HIPS).

More specifically, the objectives of the TDHS are to:

Collect data at the national level that will allow the calculation of demographic rates, particularly fertility and childhood mortality rates; Analyse the direct and indirect factors that determine levels and trends in fertility and childhood mortality; Measure the level of contraceptive knowledge and practice by method, region, and urban- rural residence; Collect data on mother and child health, including immunisations, prevalence and treatment of diarrhoea, acute respiratory infections among children under five, antenatal care, assistance at delivery, and breastfeeding; Measure the nutritional status of children under five and of their mothers using anthropometric measurements.

The TDHS information is intended to assist policy makers and administrators in evaluating existing programs and in designing new strategies for improving family planning and health services in Turkey.

MAIN RESULTS

Fertility in Turkey is continuing to decline. If Turkish women maintain current fertility rates during their reproductive years, they can expect to have all average of 2.7 children by the end of their reproductive years. The highest fertility rate is observed for the age group 20-24. There are marked regional differences in fertility rates, ranging from 4.4 children per woman in the East to 2.0 children per woman in the West. Fertility also varies widely by urban-rural residence and by education level. A woman living in rural areas will have almost one child more than a woman living in an urban area. Women who have no education have almost one child more than women who have a primary-level education and 2.5 children more than women with secondary-level education.

The first requirement of success ill family planning is the knowledge of family planning methods. Knowledge of any method is almost universal among Turkish women and almost all those who know a method also know the source of the method. Eighty percent of currently married women have used a method sometime in their life. One third of currently married women report ever using the IUD. Overall, 63 percent of currently married women are currently using a method. The majority of these women are modern method users (35 percent), but a very substantial proportion use traditional methods (28 percent). the IUD is the most commonly used modern method (I 9 percent), allowed by the condom (7 percent) and the pill (5 percent). Regional differences are substantial. The level of current use is 42 percent in tile East, 72 percent in tile West and more than 60 percent in tile other three regions. "File common complaints about tile methods are side effects and health concerns; these are especially prevalent for the pill and IUD.

One of the major child health indicators is immunisation coverage. Among children age 12-23 months, the coverage rates for BCG and the first two doses of DPT and polio were about 90 percent, with most of the children receiving those vaccines before age one. The results indicate that 65 percent of the children had received all vaccinations at some time before the survey. On a regional basis, coverage is significantly lower in the Eastern region (41 percent), followed by the Northern and Central regions (61 percent and 65 percent, respectively). Acute respiratory infections (ARI) and diarrhea are the two most prevalent diseases of children under age five in Turkey. In the two weeks preceding the survey, the prevalence of ARI was 12 percent and the prevalence of diarrhea was 25 percent for children under age five. Among children with diarrhea 56 percent were given more fluids than usual.

Breastfeeding in Turkey is widespread. Almost all Turkish children (95 percent) are breastfed for some period of time. The median duration of breastfeeding is 12 months, but supplementary foods and liquids are introduced at an early age. One-third of children are being given supplementary food as early as one month of age and by the age of 2-3 months, half of the children are already being given supplementary foods or liquids.

By age five, almost one-filth of children arc stunted (short for their age), compared to an international reference population. Stunting is more prevalent in rural areas, in the East, among children of mothers with little or no education, among children who are of higher birth order, and among those born less than 24 months after a prior birth. Overall, wasting is not a problem. Two percent of children are wasted (thin for their height), and I I percent of children under five are underweight for their age. The survey results show that obesity is d problem among mothers. According to Body Mass Index (BMI) calculations, 51 percent of mothers are overweight, of which 19 percent are obese.

Geographic coverage

The Turkish Demographic and Health Survey (TDHS) is a national sample survey.

Analysis unit

• Household
• Women age 12-49
• Children under five

Universe

The population covered by the 1993 DHS is defined as the universe of all ever-married women age 12-49 who were present in the household on the night before the interview were eligible for the survey.

Kind of data

Sample survey data

Sampling procedure

The sample for the TDHS was designed to provide estimates of population and health indicators, including fertility and mortality rates for the nation as a whole, fOr urban and rural areas, and for the five major regions of the country. A weighted, multistage, stratified cluster sampling approach was used in the selection of the TDHS sample.

Sample selection was undertaken in three stages. The sampling units at the first stage were settlements that differed in population size. The frame for the selection of the primary sampling units (PSUs) was prepared using the results of the 1990 Population Census. The urban frame included provinces and district centres and settlements with populations of more than 10,000; the rural frame included subdistricts and villages with populations of less than 10,000. Adjustments were made to consider the growth in some areas right up to survey time. In addition to the rural-urban and regional stratifications, settlements were classified in seven groups according to population size.

The second stage of selection involved the list of quarters (administrative divisions of varying size) for each urban settlement, provided by the State Institute of Statistics (SIS). Every selected quarter was subdivided according tothe number of divisions(approximately 100 households)assigned to it. In rural areas, a selected village was taken as a single quarter, and wherever necessary, it was divided into subdivisions of approximately 100 households. In cases where the number of households in a selected village was less than 100 households, the nearest village was selected to complete the 100 households during the listing activity, which is described below.

After the selection of the secondary sampling units (SSUs), a household listing was obtained for each by the TDHS listing teams. The listing activity was carried out in May and June. From the household lists, a systematic random sample of households was chosen for the TDHS. All ever-married women age 12-49 who were present in the household on the night before the interview were eligible for the survey.

Mode of data collection

Face-to-face

Research instrument

Two questionnaires were used in the main fieldwork for the TDHS: the Household Questionnaire and the Individual Questionnaire for ever-married women of reproductive age. The questionnaires were based on the model survey instruments developed in the DHS program and on the questionnaires that had been employed in previous Turkish population and health surveys. The questionnaires were adapted to obtain data needed for program planning in Turkey during consultations with population and health agencies. Both questionnaires were developed in English and translated into Turkish.

a) The Household Questionnaire was used to enumerate all usual members of and visitors to the selected households and to collect information relating to the socioeconomic position of the households. In the first part of the Household Questionnaire, basic information was collected on the age, sex, educational attainment, marital status and relationship to the head of household for each person listed as a household member

The Pakistan Demographic and Health Survey (PDHS) was fielded on a national basis between the months of December 1990 and May 1991. The survey was carried out by the National Institute of Population Studies with the objective of assisting the Ministry of Population Welfare to evaluate the Population Welfare Programme and maternal and child health services. The PDHS is the latest in a series of surveys, making it possible to evaluate changes in the demographic status of the population and in health conditions nationwide. Earlier surveys include the Pakistan Contraceptive Prevalence Survey of 1984-85 and the Pakistan Fertility Survey of 1975. The primary objective of the Pakistan Demographic and Health Survey (PDHS) was to provide national- and provincial-level data on population and health in Pakistan. The primary emphasis was on the following topics: fertility, nuptiality, family size preferences, knowledge and use of family planning, the potential demand for contraception, the level of unwanted fertility, infant and child mortality, breastfeeding and food supplementation practices, maternal care, child nutrition and health, immunisations and child morbidity. This information is intended to assist policy makers, administrators and researchers in assessing and evaluating population and health programmes and strategies. The PDHS is further intended to serve as a source of demographic data for comparison with earlier surveys, particularly the 1975 Pakistan Fertility Survey (PFS) and the 1984-85 Pakistan Contraceptive Prevalence Survey (PCPS). MAIN RESULTS Until recently, fertility rates had remained high with little evidence of any sustained fertility decline. In recent years, however, fertility has begun to decline due to a rapid increase in the age at marriage and to a modest rise in the prevalence of contraceptive use. The lotal fertility rate is estimated to have fallen from a level of approximately 6.4 children in the early 1980s to 6.0 children in the mid-1980s, to 5.4 children in the late 1980s. The exact magnitude of the change is in dispute and will be the subject of further research. Important differentials of fertility include the degree ofurbanisation and the level of women's education. The total fertility rate is estimated to be nearly one child lower in major cities (4.7) than in rural areas (5.6). Women with at least some secondary schooling have a rate of 3.6, compared to a rate of 5.7 children for women with no formal education. There is a wide disparity between women's knowledge and use of contraceptives in Pakistan. While 78 percent of currently married women report knowing at least one method of contraception, only 21 percent have ever used a method, and only 12 percent are currently doing so. Three-fourths of current users are using a modem method and one-fourth a traditional method. The two most commonly used methods are female sterilisation (4 percent) and the condom (3 percent). Despite the relatively low level of contraceptive use, the gain over time has been significant. Among married non-pregnant women, contraceptive use has almost tripled in 15 years, from 5 percent in 1975 to 14 percent in 1990-91. The contraceptive prevalence among women with secondary education is 38 percent, and among women with no schooling it is only 8 percent. Nearly one-third of women in major cities arc current users of contraception, but contraceptive use is still rare in rural areas (6 percent). The Government of Pakistan plays a major role in providing family planning services. Eighty-five percent of sterilised women and 81 percent of IUD users obtained services from the public sector. Condoms, however, were supplied primarily through the social marketing programme. The use of contraceptives depends on many factors, including the degree of acceptability of the concept of family planning. Among currently married women who know of a contraceptive method, 62 percent approve of family planning. There appears to be a considerable amount of consensus between husbands and wives about family planning use: one-third of female respondents reported that both they and their husbands approve of family planning, while slightly more than one-fifth said they both disapprove. The latter couples constitute a group for which family planning acceptance will require concerted motivational efforts. The educational levels attained by Pakistani women remain low: 79 percent of women have had no formal education, 14 percent have studied at the primary or middle school level, and only 7 percent have attended at least some secondary schooling. The traditional social structure of Pakistan supports a natural fertility pattern in which the majority of women do not use any means of fertility regulation. In such populations, the proximate determinants of fertility (other than contraception) are crucial in determining fertility levels. These include age at marriage, breastfeeding, and the duration of postpartum amenorrhoea and abstinence. The mean age at marriage has risen sharply over the past few decades, from under 17 years in the 1950s to 21.7 years in 1991. Despite this rise, marriage remains virtually universal: among women over the age of 35, only 2 percent have never married. Marriage patterns in Pakistan are characterised by an unusually high degree of consangninity. Half of all women are married to their first cousin and an additional 11 percent are married to their second cousin. Breasffeeding is important because of the natural immune protection it provides to babies, and the protection against pregnancy it gives to mothers. Women in Pakistan breastfeed their children for an average of20months. Themeandurationofpostpartumamenorrhoeais slightly more than 9 months. After tbebirth of a child, women abstain from sexual relations for an average of 5 months. As a result, the mean duration of postpartum insusceptibility (the period immediately following a birth during which the mother is protected from the risk of pregnancy) is 11 months, and the median is 8 months. Because of differentials in the duration of breastfeeding and abstinence, the median duration of insusceptibility varies widely: from 4 months for women with at least some secondary education to 9 months for women with no schooling; and from 5 months for women residing in major cities to 9 months for women in rural areas. In the PDHS, women were asked about their desire for additional sons and daughters. Overall, 40 percent of currently married women do not want to have any more children. This figure increases rapidly depending on the number of children a woman has: from 17 percent for women with two living children, to 52 percent for women with four children, to 71 percent for women with six children. The desire to stop childbearing varies widely across cultural groupings. For example, among women with four living children, the percentage who want no more varies from 47 percent for women with no education to 84 percent for those with at least some secondary education. Gender preference continues to be widespread in Pakistan. Among currently married non-pregnant women who want another child, 49 percent would prefer to have a boy and only 5 percent would prefer a girl, while 46 percent say it would make no difference. The need for family planning services, as measured in the PDHS, takes into account women's statements concerning recent and future intended childbearing and their use of contraceptives. It is estimated that 25 percent of currently married women have a need for family planning to stop childbearing and an additional 12 percent are in need of family planning for spacing children. Thus, the total need for family planning equals 37 percent, while only 12 percent of women are currently using contraception. The result is an unmet need for family planning services consisting of 25 percent of currently married women. This gap presents both an opportunity and a challenge to the Population Welfare Programme. Nearly one-tenth of children in Pakistan die before reaching their first birthday. The infant mortality rate during the six years preceding the survey is estimaled to be 91 per thousand live births; the under-five mortality rate is 117 per thousand. The under-five mortality rates vary from 92 per thousand for major cities to 132 for rural areas; and from 50 per thousand for women with at least some secondary education to 128 for those with no education. The level of infant mortality is influenced by biological factors such as mother's age at birth, birth order and, most importantly, the length of the preceding birth interval. Children born less than two years after their next oldest sibling are subject to an infant mortality rate of 133 per thousand, compared to 65 for those spaced two to three years apart, and 30 for those born at least four years after their older brother or sister. One of the priorities of the Government of Pakistan is to provide medical care during pregnancy and at the time of delivery, both of which are essential for infant and child survival and safe motherhood. Looking at children born in the five years preceding the survey, antenatal care was received during pregnancy for only 30 percent of these births. In rural areas, only 17 percent of births benefited from antenatal care, compared to 71 percent in major cities. Educational differentials in antenatal care are also striking: 22 percent of births of mothers with no education received antenatal care, compared to 85 percent of births of mothers with at least some secondary education. Tetanus, a major cause of neonatal death in Pakistan, can be prevented by immunisation of the mother during pregnancy. For 30 percent of all births in the five years prior to the survey, the mother received a tetanus toxoid vaccination. The differentials are about the same as those for antenatal care generally. Eighty-five percent of the births occurring during the five years preceding the survey were delivered

Abstract

From 2014 to 2015, with the aim of collecting data to monitor progress across Rwanda’s health programs and policies, the Government of Rwanda (GOR) conducted the Rwanda Demographic and Health Survey (RDHS) through the Ministry of Health (MOH) and the National Institute of Statistics of Rwanda (NISR) with the members of the national steering committee to the DHS and the technical assistance of ICF International.

The main objectives of the 2014-15 RDHS were to: • Collect data at the national level to calculate essential demographic indicators, especially fertility and infant and child mortality, and analyze the direct and indirect factors that relate to levels and trends in fertility and child mortality • Measure levels of knowledge and use of contraceptive methods among women and men • Collect data on family health, including immunization practices; prevalence and treatment of diarrhea, acute upper respiratory infections, and fever among children under age 5; antenatal care visits; assistance at delivery; and postnatal care • Collect data on knowledge, prevention, and treatment of malaria, in particular the possession and use of treated mosquito nets among household members, especially children under age 5 and pregnant women • Collect data on feeding practices for children, including breastfeeding • Collect data on the knowledge and attitudes of women and men regarding sexually transmitted infections (STIs) and HIV and evaluate recent behavioral changes with respect to condom use • Collect data for estimation of adult mortality and maternal mortality at the national level • Take anthropometric measurements to evaluate the nutritional status of children, men, and women • Assess the prevalence of malaria infection among children under age 5 and pregnant women using rapid diagnostic tests and blood smears • Estimate the prevalence of HIV among children age 0-14 and adults of reproductive age • Estimate the prevalence of anemia among children age 6-59 months and adult women of reproductive age • Collect information on early childhood development • Collect information on domestic violence

Geographic coverage

National coverage

Analysis unit

• Household
• Individual
• Children age 0-5
• Woman age 15-49
• Man age 15-59

Universe

The survey covered all de jure household members (usual residents), all women age 15-49 years and all men age 15-59 who were usual residents in the household.

Kind of data

Sample survey data [ssd]

Sampling procedure

Sample Design The sampling frame used for the 2014-15 RDHS was the 2012 Rwanda Population and Housing Census (RPHC). The sampling frame consisted of a list of enumeration areas (EAs) covering the entire country, provided by the National Institute of Statistics of Rwanda, the implementing agency for the RDHS. An EA is a natural village or part of a village created for the 2012 RPHC; these areas served as counting units for the census.

The 2014-15 RDHS followed a two-stage sample design and was intended to allow estimates of key indicators at the national level as well as for urban and rural areas, five provinces, and each of Rwanda's 30 districts (for some limited indicators). The first stage involved selecting sample points (clusters) consisting of EAs delineated for the 2012 RPHC. A total of 492 clusters were selected, 113 in urban areas and 379 in rural areas.

The second stage involved systematic sampling of households. A household listing operation was undertaken in all of the selected EAs from July 7 to September 6, 2014, and households to be included in the survey were randomly selected from these lists. Twenty-six households were selected from each sample point, for a total sample size of 12,792 households. However, during data collection, one of the households was found to actually be two households, which increased the total sample to 12,793. Because of the approximately equal sample sizes in each district, the sample is not self-weighting at the national level, and weighting factors have been added to the data file so that the results will be proportional at the national level.

All women age 15-49 who were either permanent residents of the household or visitors who stayed in the household the night before the survey were eligible to be interviewed. In half of the households, all men age 15-59 who either were permanent household residents or were visiting the night before the survey were eligible to be interviewed.

In the subsample of households not selected for the male survey, anemia and malaria testing were performed among eligible women who consented to being tested. With the parent's or guardian's consent, children aged 6-59 months were tested for anemia and malaria in this subsample. Height and weight information was collected from eligible women, and children (age 0-5) in the same subsample. In the subsample of households selected for male survey, blood spot samples were collected for laboratory testing of HIV from eligible women and men who consented. Height and weight information was collected from eligible men. In one-third of the same subsample (or 15 percent of the entire sample), blood spot samples were collected for laboratory testing of children age 0-14 for HIV.

The domestic violence module was implemented in the households selected for the male survey: The domestic violence module for men was implemented in 50 percent of the household selected for male survey and domestic violence for women was conducted in the remaining 50 percent of household selected for male survey (or 25 percent of the entire sample, each).

For further details on sample selection, see Appendix A of the final report.

Mode of data collection

Face-to-face [f2f]

Research instrument

Three types of questionnaires were used in the 2014-15 RDHS: the Household Questionnaire, the Woman’s Questionnaire, and the Man’s Questionnaire. They are based on questionnaires developed by the worldwide DHS Program and on questionnaires used during the 2010 RDHS. To reflect relevant issues in population and health in Rwanda, the questionnaires were adapted during a series of technical meetings with various stakeholders from government ministries and agencies, nongovernmental organizations, and international donors. The questionnaires were translated from English into Kinyarwanda.

The Household Questionnaire was used to list all of the usual members and visitors in the selected households as well as to identify women and men eligible for individual interviews. Basic information was collected on the characteristics of each person listed, including relationship to the head of the household, sex, residence status, age, and marital status along with survival status of children’s parents, education, birth registration, health insurance coverage, and tobacco use.

The Woman’s Questionnaire was administered to all women age 15-49 living in the sampled households.

The Man’s Questionnaire was administered to all men age 15-59 living in every second household in the sample. It was similar to the Woman’s Questionnaire but did not include questions on use of contraceptive methods or birth history; pregnancy and postnatal care; child immunization, health, and nutrition; or adult and maternal mortality.

Cleaning operations

The processing of the 2014-15 RDHS data began as soon as questionnaires were received from the field. Completed questionnaires were returned to NISR headquarters. The numbers of questionnaires and blood samples (DBS and malaria slides) were verified by two receptionists. Questionnaires were then checked, and open-ended questions were coded by four editors who had been trained for this task and who had also attended the questionnaire training sessions for the field staff. Blood samples (DBS and malaria slides) with transmittal sheets were sent respectively to the RBC/NRL and Parasitological and Entomology Laboratory to be screened for HIV and tested for malaria.

Questionnaire data were entered via the CSPro computer program by 17 data processing personnel who were specially trained to execute this activity. Data processing was coordinated by the NISR data processing officer. ICF International provided technical assistance during the entire data processing period.

Processing the data concurrently with data collection allowed for regular monitoring of team performance and data quality. Field check tables were generated regularly during data processing to check various data quality parameters. As a result, feedback was given on a regular basis, encouraging teams to continue in areas of high quality and to correct areas of needed improvement. Feedback was individually tailored to each team. Data entry, which included 100 percent double entry to minimize keying errors, and data editing were completed on April 26, 2015. Data cleaning and finalization were completed on May 15, 2015.

Response rate

A total of 6,249 men age 15-59 were identified in this subsample of households. Of these men, 6,217 completed individual interviews, yielding a response rate of 99.5 percent.

Sampling error estimates

The estimates from a sample survey are affected by two types of errors: (1) nonsampling errors, and (2) sampling errors. Nonsampling errors are the results of mistakes made in implementing data collection and data processing, such as failure to locate and interview the correct household, misunderstanding of the questions on the part of either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the 2014-15 Rwanda

The 1998 Philippines National Demographic and Health Survey (NDHS). is a nationally-representative survey of 13,983 women age 15-49. The NDHS was designed to provide information on levels and trends of fertility, family planning knowledge and use, infant and child mortality, and maternal and child health. It was implemented by the National Statistics Office in collaboration with the Department of Health (DOH). Macro International Inc. of Calverton, Maryland provided technical assistance to the project, while financial assistance was provided by the U.S. Agency for International Development (USAID) and the DOH. Fieldwork for the NDHS took place from early March to early May 1998. The primary objective of the NDHS is to Provide up-to-date information on fertility levels; determinants of fertility; fertility preferences; infant and childhood mortality levels; awareness, approval, and use of family planning methods; breastfeeding practices; and maternal and child health. This information is intended to assist policy makers and program managers in evaluating and designing programs and strategies for improving health and family planning services in the country. MAIN RESULTS Survey data generally confirm patterns observed in the 1993 National Demographic Survey (NDS), showing increasing contraceptive use and declining fertility. FERTILITY Fertility Decline. The NDHS data indicate that fertility continues to decline gradually but steadily. At current levels, women will give birth an average of 3.7 children per woman during their reproductive years, a decline from the level of 4.1 recorded in the 1993 NDS. A total fertility rate of 3.7, however, is still considerably higher than the rates prevailing in neighboring Southeast Asian countries. Fertility Differentials. Survey data show that the large differential between urban and rural fertility levels is widening even further. While the total fertility rate in urban areas declined by about 15 percent over the last five years (from 3.5 to 3.0), the rate among rural women barely declined at all (from 4.8 to 4.7). Consequently, rural women give birth to almost two children more than urban women. Significant differences in fertility levels by region still exist. For example, fertility is more than twice as high in Eastern Visayas and Bicol Regions (with total fertility rates well over 5 births per woman) than in Metro Manila (with a rate of 2.5 births per woman). Fertility levels are closely related to women's education. Women with no formal education give birth to an average of 5.0 children in their lifetime, compared to 2.9 for women with at least some college education. Women with either elementary or high school education have intermediate fertility rates. Family Size Norms. One reason that fertility has not fallen more rapidly is that women in the Philippines still want moderately large families. Only one-third of women say they would ideally like to have one or two children, while another third state a desire for three children. The remaining third say they would choose four or more children. Overall, the mean ideal family size among all women is 3.2 children, identical to the mean found in 1993. Unplanned Fertility. Another reason for the relatively high fertility level is that unplanned pregnancies are still common in the Philippines. Overall, 45 percent of births in the five years prior to the survey were reported to be unplanned; 27 percent were mistimed (wanted later) and 18 percent were unwanted. If unwanted births could be eliminated altogether, the total fertility rate in the Philippines would be 2.7 births per woman instead of the actual level of 3.7. Age at First Birth. Fertility rates would be even higher if Filipino women did not have a pattem of late childbearing. The median age at first birth is 23 years in the Philippines, considerably higher than in most other countries. Another factor that holds down the overall level of fertility is the fact that about 9 or 10 percent of women never give birth, higher than the level of 3-4 percent found in most developing countries. FAMILY PLANNING Increasing Use of Contraception. A major cause of declining fertility in the Philippines has been the gradual but fairly steady increase in contraceptive use over the last three decades. The contraceptive prevalence rate has tripled since 1968, from 15 to 47 percent of married women. Although contraceptive use has increased since the 1993 NDS (from 40 to 47 percent of married women), comparison with the series of nationally representative Family Planning Surveys indicates that there has been a levelling-off in family planning use in recent years. Method Mix. Use of traditional methods of family planning has always accounted for a relatively high proportion of overall use in the Philippines, and data from the 1998 NDHS show the proportion holding steady at about 40 percent. The dominant changes in the "method mix" since 1993 have been an increase in use of injectables and traditional methods such as calendar rhythm and withdrawal and a decline in the proportions using female sterilization. Despite the decline in the latter, female sterilization still is the most widely used method, followed by the pill. Differentials in Family Planning Use. Differentials in current use of family planning in the 16 administrative regions of the country are large, ranging from 16 percent of married women in ARMM to 55 percent of those in Southern Mindanao and Central Luzon. Contraceptive use varies considerably by education of women. Only 15 percent of married women with no formal education are using a method, compared to half of those with some secondary school. The urban-rural gap in contraceptive use is moderate (51 vs. 42 percent, respectively). Knowledge of Contraception. Knowledge of contraceptive methods and supply sources has been almost universal in the Philippines for some time and the NDHS results indicate that 99 percent of currently married women age 15-49 have heard of at least one method of family planning. More than 9 in 10 married women know the pill, IUD, condom, and female sterilization, while about 8 in 10 have heard of injectables, male sterilization, rhythm, and withdrawal. Knowledge of injectables has increased far more than any other method, from 54 percent of married women in 1993 to 89 percent in 1998. Unmet Need for Family Planning. Unmet need for family planning services has declined since I993. Data from the 1993 NDS show that 26 percent of currently married women were in need of services, compared with 20 percent in the 1998 NDHS. A little under half of the unmet need is comprised of women who want to space their next birth, while just over half is for women who do not want any more children (limiters). If all women who say they want to space or limit their children were to use methods, the contraceptive prevalence rate could be increased from 47 percent to 70 percent of married women. Currently, about three-quarters of this "total demand" for family planning is being met. Discontinuation Rates. One challenge for the family planning program is to reduce the high levels of contraceptive discontinuation. NDHS data indicate that about 40 percent of contraceptive users in the Philippines stop using within 12 months of starting, almost one-third of whom stop because of an unwanted pregnancy (i.e., contraceptive failure). Discontinuation rates vary by method. Not surprisingly, the rates for the condom (60 percent), withdrawal (46 percent), and the pill (44 percent) are considerably higher than for the 1UD (14 percent). However, discontinuation rates for injectables are relatively high, considering that one dose is usually effective for three months. Fifty-two percent of injection users discontinue within one year of starting, a rate that is higher than for the pill. MATERNAL AND CHILD HEALTH Childhood Mortality. Survey results show that although the infant mortality rate remains unchanged, overall mortality of children under five has declined somewhat in recent years. Under-five mortality declined from 54 deaths per 1,000 births in 1988-92 to 48 for the period 1993-97. The infant mortality rate remained stable at about 35 per 1,000 births. Childhood Vaccination Coverage. The 1998 NDHS results show that 73 percent of children 12- 23 months are fully vaccinated by the date of the interview, almost identical to the level of 72 percent recorded in the 1993 NDS. When the data are restricted to vaccines received before the child's first birthday, however, only 65 percent of children age 12-23 months can be considered to be fully vaccinated. Childhood Health. The NDHS provides some data on childhood illness and treatment. Approximately one in four children under age five had a fever and 13 percent had respiratory illness in the two weeks before the survey. Of these, 58 percent were taken to a health facility for treatment. Seven percent of children under five were reported to have had diarrhea in the two weeks preceeding the survey. The fact that four-fifths of children with diarrhea received some type of oral rehydration therapy (fluid made from an ORS packet, recommended homemade fluid, or increased fluids) is encouraging. Breastfeeding Practices. Almost all Filipino babies (88 percent) are breastfed for some time, with a median duration of breastfeeding of 13 months. Although breastfeeding has beneficial effects on both the child and the mother, NDHS data indicate that supplementation of breastfeeding with other liquids and foods occurs too early in the Philippines. For example, among newborns less than two months of age, 19 percent were already receiving supplemental foods or liquids other than water. Maternal Health Care. NDHS data point to several areas regarding maternal health care in which improvements could be made. Although most Filipino mothers (86 percent) receive prenatal care from a doctor, nurse, or midwife, tetanus toxoid coverage is far from universal and

The 1995 Uganda Demographic and Health Survey (UDHS-II) is a nationally-representative survey of 7,070 women age 15-49 and 1,996 men age 15-54. The UDHS was designed to provide information on levels and trends of fertility, family planning knowledge and use, infant and child mortality, and maternal and child health. Fieldwork for the UDHS took place from late-March to mid-August 1995. The survey was similar in scope and design to the 1988-89 UDHS. Survey data show that fertility levels may be declining, contraceptive use is increasing, and childhood mortality is declining; however, data also point to several remaining areas of challenge. The 1995 UDHS was a follow-up to a similar survey conducted in 1988-89. In addition to including most of the same questions included in the 1988-89 UDHS, the 1995 UDHS added more detailed questions on AIDS and maternal mortality, as well as incorporating a survey of men. The general objectives of the 1995 UDHS are to: provide national level data which will allow the calculation of demographic rates, particularly fertility and childhood mortality rates; analyse the direct and indirect factors which determine the level and trends of fertility; measure the level of contraceptive knowledge and practice (of both women and men) by method, by urban-rural residence, and by region; collect reliable data on maternal and child health indicators; immunisation, prevalence, and treatment of diarrhoea and other diseases among children under age four; antenatal visits; assistance at delivery; and breastfeeding; assess the nutritional status of children under age four and their mothers by means of anthropometric measurements (weight and height), and also child feeding practices; and assess among women and men the prevailing level of specific knowledge and attitudes regarding AIDS and to evaluate patterns of recent behaviour regarding condom use. MAIN RESULTS Fertility: Fertility Trends. UDHS data indicate that fertility in Uganda may be starting to decline. The total fertility rate has declined from the level of 7.1 births per woman that prevailed over the last 2 decades to 6.9 births for the period 1992-94. The crude birth rate for the period 1992-94 was 48 live births per I000 population, slightly lower than the level of 52 observed from the 1991 Population and Housing Census. For the roughly 80 percent of the country that was covered in the 1988-89 UDHS, fertility has declined from 7.3 to 6.8 births per woman, a drop of 7 percent over a six and a half year period. Birth Intervals. The majority of Ugandan children (72 percent) are born after a "safe" birth interval (24 or more months apart), with 30 percent born at least 36 months after a prior birth. Nevertheless, 28 percent of non-first births occur less than 24 months after the preceding birth, with 10 percent occurring less than 18 months since the previous birth. The overall median birth interval is 29 months. Fertility Preferences. Survey data indicate that there is a strong desire for children and a preference for large families in Ugandan society. Among those with six or more children, 18 percent of married women want to have more children compared to 48 percent of married men. Both men and women desire large families. Family planning: Knowledge of Contraceptive Methods. Knowledge of contraceptive methods is nearly universal with 92 percent of all women age 15-49 and 96 percent of all men age 15-54 knowing at least one method of family planning. Increasing Use of Contraception. The contraceptive prevalence rate in Uganda has tripled over a six-year period, rising from about 5 percent in approximately 80 percent of the country surveyed in 1988-89 to 15 percent in 1995. Source of Contraception. Half of current users (47 percent) obtain their methods from public sources, while 42 percent use non-governmental medical sources, and other private sources account for the remaining 11 percent. Maternal and child health: High Childhood Mortality. Although childhood mortality in Uganda is still quite high in absolute terms, there is evidence of a significant decline in recent years. Currently, the direct estimate of the infant mortality rate is 81 deaths per 1,000 births and under five mortality is 147 per 1,000 births, a considerable decline from the rates of 101 and 180, respectively, that were derived for the roughly 80 percent of the country that was covered by the 1988-89 UDHS. Childhood Vaccination Coverage. One possible reason for the declining mortality is improvement in childhood vaccination coverage. The UDHS results show that 47 percent of children age 12-23 months are fully vaccinated, and only 14 percent have not received any vaccinations. Childhood Nutritional Status. Overall, 38 percent of Ugandan children under age four are classified as stunted (low height-for-age) and 15 percent as severely stunted. About 5 percent of children under four in Uganda are wasted (low weight-for-height); 1 percent are severely wasted. Comparison with other data sources shows little change in these measures over time. AIDS: Virtually all women and men in Uganda are aware of AIDS. About 60 percent of respondents say that limiting the number of sexual partners or having only one partner can prevent the spread of disease. However, knowledge of ways to avoid AIDS is related to respondents' education. Safe patterns of sexual behaviour are less commonly reported by respondents who have little or no education than those with more education. Results show that 65 percent of women and 84 percent of men believe that they have little or no chance of being infected. Availability of Health Services. Roughly half of women in Uganda live within 5 km of a facility providing antenatal care, delivery care, and immunisation services. However, the data show that children whose mothers receive both antenatal and delivery care are more likely to live within 5 km of a facility providing maternal and child health (MCH) services (70 percent) than either those whose mothers received only one of these services (46 percent) or those whose mothers received neither antenatal nor delivery care (39 percent).

Abstract

The Sudan Demographic and Health Survey (SDHS) was conducted in two phases between November 15, 1989 and May 21, 1990 by the Department of Statistics of the Ministry of Economic and National Planning. The survey collected information on fertility levels, marriage patterns, reproductive intentions, knowledge and use of contraception, maternal and child health, maternal mortality, and female circumcision. The survey findings provide the National Population Committee and the Ministry of Health with valuable information for use in evaluating population policy and planning public health programmes.

A total of 5860 ever-married women age 15-49 were interviewed in six regions in northern Sudan; three regions in southern Sudan could not be included in the survey because of civil unrest in that part of the country. The SDHS provides data on fertility and mortality comparable to the 1978-79 Sudan Fertility Survey (SFS) and complements the information collected in the 1983 census.

The primary objective of the SDHS was to provide data on fertility, nuptiality, family planning, fertility preferences, childhood mortality, indicators of maternal health care, and utilization of child health services. Additional information was coUected on educational level, literacy, source of household water, and other housing conditions.

The SDHS is intended to serve as a source of demographic data for comparison with the 1983 census and the Sudan Fertility Survey (SFS) 1978-79, and to provide population and health data for policymakers and researchers. The objectives of the survey are to: - assess the overall demographic situation in Sudan, - assist in the evaluation of population and health programmes, - assist the Department of Statistics in strengthening and improving its technical skills for conducting demographic and health surveys, - enable the National Population Committee (NPC) to develop a population policy for the country, and - measure changes in fertility and contraceptive prevalence, and study the factors which affect these changes, and - examine the basic indicators of maternal and child health in Sudan.

MAIN RESULTS

Fertility levels and trends

Fertility has declined sharply in Sudan, from an average of six children per women in the Sudan Fertility Survey (TFR 6.0) to five children in the Sudan DHS survey flTR 5.0). Women living in urban areas have lower fertility (TFR 4.1) than those in rural areas (5.6), and fertility is lower in the Khartoum and Northern regions than in other regions. The difference in fertility by education is particularly striking; at current rates, women who have attained secondary school education will have an average of 3.3 children compared with 5.9 children for women with no education, a difference of almost three children.

Although fertility in Sudan is low compared with most sub-Saharan countries, the desire for children is strong. One in three currently married women wants to have another child within two years and the same proportion want another child in two or more years; only one in four married women wants to stop childbearing. The proportion of women who want no more children increases with family size and age. The average ideal family size, 5.9 children, exceeds the total fertility rate (5.0) by approximately one child. Older women are more likely to want large families than younger women, and women just beginning their families say they want to have about five children.

Marriage

Almost all Sudanese women marry during their lifetime. At the time of the survey, 55 percent of women 15-49 were currently married and 5 percent were widowed or divorced. Nearly one in five currently married women lives in a polygynous union (i.e., is married to a man who has more than one wife). The prevalence of polygyny is about the same in the SDHS as it was in the Sudan Fertility Survey.

Marriage occurs at a fairly young age, although there is a trend toward later marriage among younger women (especially those with junior secondary or higher level of schooling). The proportion of women 15-49 who have never married is 12 percentage points higher in the SDHS than in the Sudan Fertiliy Survey.

There has been a substantial increase in the average age at first marriage in Sudan. Among SDHS. Since age at first marriage is closely associated with fertility, it is likely that fertility will decrease in the future. With marriages occurring later, women am having their first birth at a later age. While one in three women age 45-49 had her first birth before age 18, only one in six women age 20-24 began childbearing prior to age 18. The women most likely to postpone marriage and childbearing are those who live in urban areas ur in the Khartoum and Northern regions, and women with pest-primary education.

Breastfeeding and postpartum abstinence

Breastfeeding and postpartum abstinence provide substantial protection from pregnancy after the birth uf a child. In addition to the health benefits to the child, breastfeeding prolongs the length of postpartum amenorrhea. In Sudan, almost all women breastfeed their children; 93 percent of children are still being breastfed 10-11 months after birth, and 41 percent continue breastfeeding for 20-21 months. Postpartum abstinence is traditional in Sudan and in the first two months following the birth of a child 90 percent of women were abstaining; this decreases to 32 percent after two months, and to 5 percent at~er one year. The survey results indicate that the combined effects of breastfeeding and postpartum abstinence protect women from pregnancy for an average of 15 months after the birth of a child.

Knowledge and use of contraception

Most currently married women (71 percent) know at least one method of family planning, and 59 percent know a source for a method. The pill (70 percent) is the most widely known method, followed by injection, female sterilisation, and the IUD. Only 39 percent of women knew a traditional method of family planning.

Despite widespread knowledge of family planning, only about one-fourth of ever-married women have ever used a contraceptive method, and among currently married women, only 9 percent were using a method at the time of the survey (6 percent modem methods and 3 percent traditional methods). The level of contraceptive use while still low, has increased from less than 5 percent reported in the Sudan Fertility Survey.

Use of family planning varies by age, residence, and level of education. Current use is less than 4 percent among women 15-19, increases to 10 percent for women 30-44, then decreases to 6 percent for women 45-49. Seventeen percent of urban women practice family planning compared with only 4 percent of rural women; and women with senior secondary education are more likely to practice family planning (26 percent) than women with no education (3 percent).

There is widespread approval of family planning in Sudan. Almost two-thirds of currently married women who know a family planning method approve of the use of contraception. Husbands generally share their wives's views on family planning. Three-fourths of married women who were not using a contraceptive method at the time of the survey said they did not intend to use a method in the future.

Communication between husbands and wives is important for successful family planning. Less than half of currently married women who know a contraceptive method said they had talked about family planning with their husbands in the year before the survey; one in four women discussed it once or twice; and one in five discussed it more than twice. Younger women and older women were less likely to discuss family planning than those age 20 to 39.

Mortality among children

The neonatal mortality rate in Sudan remained virtually unchanged in the decade between the SDHS and the SFS (44 deaths per 1000 births), but under-five mortality decreased by 14 percent (from 143 deaths per 1000 births to 123 per thousand). Under-five mortality is 19 percent lower in urban areas (117 per 1000 births) than in rural areas (144 per 10(30 births).

The level of mother's education and the length of the preceding birth interval play important roles in child survival. Children of mothers with no education experience nearly twice the level of under-five mortality as children whose mother had attained senior secondary or nigher education. Mortality among children under five is 2.7 times higher among children born after an interval of less than 24 months than among children born after interval of 48 months or more.

Maternal mortality

The maternal mortality rate (maternal deaths per 1000 women years of exposure) has remained nearly constant over the twenty years preceding the survey, while the maternal mortality ratio (number of maternal deaths per 100,000 births), has increased (despite declining fertility). Using the direct method of estimation, the maternal mortality ratio is 352 maternal deaths per 100,000 births for the period 1976-82, and 552 per 100,000 births for the period 1983-89. The indirect estimate for the maternal mortality ratio is 537. The latter estimate is an average of women's experience over an extended period before the survey centred on 1977.

Maternal health care

The health care mothers receive during pregnancy and delivery is important to the survival and well-being of both children and mothers. The SDHS results indicate that most women in Sudan made at least one antenatal visit to a doctor or trained health worker/midwife. Eighty-seven percent of births benefitted from professional antenatal care in urban areas compared with 62 percent in rural areas. Although the proportion of pregnant mothers seen by trained health workers/midwives are similar in urban and rural areas, doctors provided antenatal care for 42 percent and 19 percent of births in urban and rural areas, respectively.

Neonatal tetanus, a major

The second National Family Health Survey (NFHS-2), conducted in 1998-99, provides information on fertility, mortality, family planning, and important aspects of nutrition, health, and health care. The International Institute for Population Sciences (IIPS) coordinated the survey, which collected information from a nationally representative sample of more than 90,000 ever-married women age 15-49. The NFHS-2 sample covers 99 percent of India's population living in all 26 states. This report is based on the survey data for 25 of the 26 states, however, since data collection in Tripura was delayed due to local problems in the state. IIPS also coordinated the first National Family Health Survey (NFHS-1) in 1992-93. Most of the types of information collected in NFHS-2 were also collected in the earlier survey, making it possible to identify trends over the intervening period of six and one-half years. In addition, the NFHS-2 questionnaire covered a number of new or expanded topics with important policy implications, such as reproductive health, women's autonomy, domestic violence, women's nutrition, anaemia, and salt iodization. The NFHS-2 survey was carried out in two phases. Ten states were surveyed in the first phase which began in November 1998 and the remaining states (except Tripura) were surveyed in the second phase which began in March 1999. The field staff collected information from 91,196 households in these 25 states and interviewed 89,199 eligible women in these households. In addition, the survey collected information on 32,393 children born in the three years preceding the survey. One health investigator on each survey team measured the height and weight of eligible women and children and took blood samples to assess the prevalence of anaemia. SUMMARY OF FINDINGS POPULATION CHARACTERISTICS Three-quarters (73 percent) of the population lives in rural areas. The age distribution is typical of populations that have recently experienced a fertility decline, with relatively low proportions in the younger and older age groups. Thirty-six percent of the population is below age 15, and 5 percent is age 65 and above. The sex ratio is 957 females for every 1,000 males in rural areas but only 928 females for every 1,000 males in urban areas, suggesting that more men than women have migrated to urban areas. The survey provides a variety of demographic and socioeconomic background information. In the country as a whole, 82 percent of household heads are Hindu, 12 percent are Muslim, 3 percent are Christian, and 2 percent are Sikh. Muslims live disproportionately in urban areas, where they comprise 15 percent of household heads. Nineteen percent of household heads belong to scheduled castes, 9 percent belong to scheduled tribes, and 32 percent belong to other backward classes (OBCs). Two-fifths of household heads do not belong to any of these groups. Questions about housing conditions and the standard of living of households indicate some improvements since the time of NFHS-1. Sixty percent of households in India now have electricity and 39 percent have piped drinking water compared with 51 percent and 33 percent, respectively, at the time of NFHS-1. Sixty-four percent of households have no toilet facility compared with 70 percent at the time of NFHS-1. About three-fourths (75 percent) of males and half (51 percent) of females age six and above are literate, an increase of 6-8 percentage points from literacy rates at the time of NFHS-1. The percentage of illiterate males varies from 6-7 percent in Mizoram and Kerala to 37 percent in Bihar and the percentage of illiterate females varies from 11 percent in Mizoram and 15 percent in Kerala to 65 percent in Bihar. Seventy-nine percent of children age 6-14 are attending school, up from 68 percent in NFHS-1. The proportion of children attending school has increased for all ages, particularly for girls, but girls continue to lag behind boys in school attendance. Moreover, the disparity in school attendance by sex grows with increasing age of children. At age 6-10, 85 percent of boys attend school compared with 78 percent of girls. By age 15-17, 58 percent of boys attend school compared with 40 percent of girls. The percentage of girls 6-17 attending school varies from 51 percent in Bihar and 56 percent in Rajasthan to over 90 percent in Himachal Pradesh and Kerala. Women in India tend to marry at an early age. Thirty-four percent of women age 15-19 are already married including 4 percent who are married but gauna has yet to be performed. These proportions are even higher in the rural areas. Older women are more likely than younger women to have married at an early age: 39 percent of women currently age 45-49 married before age 15 compared with 14 percent of women currently age 15-19. Although this indicates that the proportion of women who marry young is declining rapidly, half the women even in the age group 20-24 have married before reaching the legal minimum age of 18 years. On average, women are five years younger than the men they marry. The median age at marriage varies from about 15 years in Madhya Pradesh, Bihar, Uttar Pradesh, Rajasthan, and Andhra Pradesh to 23 years in Goa. As part of an increasing emphasis on gender issues, NFHS-2 asked women about their participation in household decisionmaking. In India, 91 percent of women are involved in decision-making on at least one of four selected topics. A much lower proportion (52 percent), however, are involved in making decisions about their own health care. There are large variations among states in India with regard to women's involvement in household decisionmaking. More than three out of four women are involved in decisions about their own health care in Himachal Pradesh, Meghalaya, and Punjab compared with about two out of five or less in Madhya Pradesh, Orissa, and Rajasthan. Thirty-nine percent of women do work other than housework, and more than two-thirds of these women work for cash. Only 41 percent of women who earn cash can decide independently how to spend the money that they earn. Forty-three percent of working women report that their earnings constitute at least half of total family earnings, including 18 percent who report that the family is entirely dependent on their earnings. Women's work-participation rates vary from 9 percent in Punjab and 13 percent in Haryana to 60-70 percent in Manipur, Nagaland, and Arunachal Pradesh. FERTILITY AND FAMILY PLANNING Fertility continues to decline in India. At current fertility levels, women will have an average of 2.9 children each throughout their childbearing years. The total fertility rate (TFR) is down from 3.4 children per woman at the time of NFHS-1, but is still well above the replacement level of just over two children per woman. There are large variations in fertility among the states in India. Goa and Kerala have attained below replacement level fertility and Karnataka, Himachal Pradesh, Tamil Nadu, and Punjab are at or close to replacement level fertility. By contrast, fertility is 3.3 or more children per woman in Meghalaya, Uttar Pradesh, Rajasthan, Nagaland, Bihar, and Madhya Pradesh. More than one-third to less than half of all births in these latter states are fourth or higher-order births compared with 7-9 percent of births in Kerala, Goa, and Tamil Nadu. Efforts to encourage the trend towards lower fertility might usefully focus on groups within the population that have higher fertility than average. In India, rural women and women from scheduled tribes and scheduled castes have somewhat higher fertility than other women, but fertility is particularly high for illiterate women, poor women, and Muslim women. Another striking feature is the high level of childbearing among young women. More than half of women age 20-49 had their first birth before reaching age 20, and women age 15-19 account for almost one-fifth of total fertility. Studies in India and elsewhere have shown that health and mortality risks increase when women give birth at such young ages?both for the women themselves and for their children. Family planning programmes focusing on women in this age group could make a significant impact on maternal and child health and help to reduce fertility. INFANT AND CHILD MORTALITY NFHS-2 provides estimates of infant and child mortality and examines factors associated with the survival of young children. During the five years preceding the survey, the infant mortality rate was 68 deaths at age 0-11 months per 1,000 live births, substantially lower than 79 per 1,000 in the five years preceding the NFHS-1 survey. The child mortality rate, 29 deaths at age 1-4 years per 1,000 children reaching age one, also declined from the corresponding rate of 33 per 1,000 in NFHS-1. Ninety-five children out of 1,000 born do not live to age five years. Expressed differently, 1 in 15 children die in the first year of life, and 1 in 11 die before reaching age five. Child-survival programmes might usefully focus on specific groups of children with particularly high infant and child mortality rates, such as children who live in rural areas, children whose mothers are illiterate, children belonging to scheduled castes or scheduled tribes, and children from poor households. Infant mortality rates are more than two and one-half times as high for women who did not receive any of the recommended types of maternity related medical care than for mothers who did receive all recommended types of care. HEALTH, HEALTH CARE, AND NUTRITION Promotion of maternal and child health has been one of the most important components of the Family Welfare Programme of the Government of India. One goal is for each pregnant woman to receive at least three antenatal check-ups plus two tetanus toxoid injections and a full course of iron and folic acid supplementation. In India, mothers of 65 percent of the children born in the three years preceding NFHS-2 received at least one antenatal

Abstract

The second National Family Health Survey (NFHS-2), conducted in 1998-99, provides information on fertility, mortality, family planning, and important aspects of nutrition, health, and health care. The International Institute for Population Sciences (IIPS) coordinated the survey, which collected information from a nationally representative sample of more than 90,000 ever-married women age 15-49. The NFHS-2 sample covers 99 percent of India's population living in all 26 states. This report is based on the survey data for 25 of the 26 states, however, since data collection in Tripura was delayed due to local problems in the state.

IIPS also coordinated the first National Family Health Survey (NFHS-1) in 1992-93. Most of the types of information collected in NFHS-2 were also collected in the earlier survey, making it possible to identify trends over the intervening period of six and one-half years. In addition, the NFHS-2 questionnaire covered a number of new or expanded topics with important policy implications, such as reproductive health, women's autonomy, domestic violence, women's nutrition, anaemia, and salt iodization.

The NFHS-2 survey was carried out in two phases. Ten states were surveyed in the first phase which began in November 1998 and the remaining states (except Tripura) were surveyed in the second phase which began in March 1999. The field staff collected information from 91,196 households in these 25 states and interviewed 89,199 eligible women in these households. In addition, the survey collected information on 32,393 children born in the three years preceding the survey. One health investigator on each survey team measured the height and weight of eligible women and children and took blood samples to assess the prevalence of anaemia.

SUMMARY OF FINDINGS

POPULATION CHARACTERISTICS

Three-quarters (73 percent) of the population lives in rural areas. The age distribution is typical of populations that have recently experienced a fertility decline, with relatively low proportions in the younger and older age groups. Thirty-six percent of the population is below age 15, and 5 percent is age 65 and above. The sex ratio is 957 females for every 1,000 males in rural areas but only 928 females for every 1,000 males in urban areas, suggesting that more men than women have migrated to urban areas.

The survey provides a variety of demographic and socioeconomic background information. In the country as a whole, 82 percent of household heads are Hindu, 12 percent are Muslim, 3 percent are Christian, and 2 percent are Sikh. Muslims live disproportionately in urban areas, where they comprise 15 percent of household heads. Nineteen percent of household heads belong to scheduled castes, 9 percent belong to scheduled tribes, and 32 percent belong to other backward classes (OBCs). Two-fifths of household heads do not belong to any of these groups.

Questions about housing conditions and the standard of living of households indicate some improvements since the time of NFHS-1. Sixty percent of households in India now have electricity and 39 percent have piped drinking water compared with 51 percent and 33 percent, respectively, at the time of NFHS-1. Sixty-four percent of households have no toilet facility compared with 70 percent at the time of NFHS-1.

About three-fourths (75 percent) of males and half (51 percent) of females age six and above are literate, an increase of 6-8 percentage points from literacy rates at the time of NFHS-1. The percentage of illiterate males varies from 6-7 percent in Mizoram and Kerala to 37 percent in Bihar and the percentage of illiterate females varies from 11 percent in Mizoram and 15 percent in Kerala to 65 percent in Bihar. Seventy-nine percent of children age 6-14 are attending school, up from 68 percent in NFHS-1. The proportion of children attending school has increased for all ages, particularly for girls, but girls continue to lag behind boys in school attendance. Moreover, the disparity in school attendance by sex grows with increasing age of children. At age 6-10, 85 percent of boys attend school compared with 78 percent of girls. By age 15-17, 58 percent of boys attend school compared with 40 percent of girls. The percentage of girls 6-17 attending school varies from 51 percent in Bihar and 56 percent in Rajasthan to over 90 percent in Himachal Pradesh and Kerala.

Women in India tend to marry at an early age. Thirty-four percent of women age 15-19 are already married including 4 percent who are married but gauna has yet to be performed. These proportions are even higher in the rural areas. Older women are more likely than younger women to have married at an early age: 39 percent of women currently age 45-49 married before age 15 compared with 14 percent of women currently age 15-19. Although this indicates that the proportion of women who marry young is declining rapidly, half the women even in the age group 20-24 have married before reaching the legal minimum age of 18 years. On average, women are five years younger than the men they marry. The median age at marriage varies from about 15 years in Madhya Pradesh, Bihar, Uttar Pradesh, Rajasthan, and Andhra Pradesh to 23 years in Goa.

As part of an increasing emphasis on gender issues, NFHS-2 asked women about their participation in household decisionmaking. In India, 91 percent of women are involved in decision-making on at least one of four selected topics. A much lower proportion (52 percent), however, are involved in making decisions about their own health care. There are large variations among states in India with regard to women's involvement in household decisionmaking. More than three out of four women are involved in decisions about their own health care in Himachal Pradesh, Meghalaya, and Punjab compared with about two out of five or less in Madhya Pradesh, Orissa, and Rajasthan. Thirty-nine percent of women do work other than housework, and more than two-thirds of these women work for cash. Only 41 percent of women who earn cash can decide independently how to spend the money that they earn. Forty-three percent of working women report that their earnings constitute at least half of total family earnings, including 18 percent who report that the family is entirely dependent on their earnings. Women's work-participation rates vary from 9 percent in Punjab and 13 percent in Haryana to 60-70 percent in Manipur, Nagaland, and Arunachal Pradesh.

FERTILITY AND FAMILY PLANNING

Fertility continues to decline in India. At current fertility levels, women will have an average of 2.9 children each throughout their childbearing years. The total fertility rate (TFR) is down from 3.4 children per woman at the time of NFHS-1, but is still well above the replacement level of just over two children per woman. There are large variations in fertility among the states in India. Goa and Kerala have attained below replacement level fertility and Karnataka, Himachal Pradesh, Tamil Nadu, and Punjab are at or close to replacement level fertility. By contrast, fertility is 3.3 or more children per woman in Meghalaya, Uttar Pradesh, Rajasthan, Nagaland, Bihar, and Madhya Pradesh. More than one-third to less than half of all births in these latter states are fourth or higher-order births compared with 7-9 percent of births in Kerala, Goa, and Tamil Nadu.

Efforts to encourage the trend towards lower fertility might usefully focus on groups within the population that have higher fertility than average. In India, rural women and women from scheduled tribes and scheduled castes have somewhat higher fertility than other women, but fertility is particularly high for illiterate women, poor women, and Muslim women. Another striking feature is the high level of childbearing among young women. More than half of women age 20-49 had their first birth before reaching age 20, and women age 15-19 account for almost one-fifth of total fertility. Studies in India and elsewhere have shown that health and mortality risks increase when women give birth at such young ages?both for the women themselves and for their children. Family planning programmes focusing on women in this age group could make a significant impact on maternal and child health and help to reduce fertility.

INFANT AND CHILD MORTALITY

NFHS-2 provides estimates of infant and child mortality and examines factors associated with the survival of young children. During the five years preceding the survey, the infant mortality rate was 68 deaths at age 0-11 months per 1,000 live births, substantially lower than 79 per 1,000 in the five years preceding the NFHS-1 survey. The child mortality rate, 29 deaths at age 1-4 years per 1,000 children reaching age one, also declined from the corresponding rate of 33 per 1,000 in NFHS-1. Ninety-five children out of 1,000 born do not live to age five years. Expressed differently, 1 in 15 children die in the first year of life, and 1 in 11 die before reaching age five. Child-survival programmes might usefully focus on specific groups of children with particularly high infant and child mortality rates, such as children who live in rural areas, children whose mothers are illiterate, children belonging to scheduled castes or scheduled tribes, and children from poor households. Infant mortality rates are more than two and one-half times as high for women who did not receive any of the recommended types of maternity related medical care than for mothers who did receive all recommended types of care.

HEALTH, HEALTH CARE, AND NUTRITION

Promotion of maternal and child health has been one of the most important components of the Family Welfare Programme of the Government of India. One goal is for each pregnant woman to receive at least three antenatal check-ups plus two tetanus toxoid injections and a full course of iron and folic acid supplementation. In India, mothers of 65 percent of the children

The 1996 Nepal Family Health Survey (NFHS) is a nationally representative survey of 8,429 ever- married women age 15-49. The survey is the fifth in a series of demographic and health surveys conducted in Nepal since 1976. The main purpose of the NFHS was to provide detailed information on fertility, family planning, infant and child mortality, and matemal and child health and nutrition. In addition, the NFHS included a series of questions on knowledge of AIDS. The primary objective of the Nepal Family Health Survey (NFHS) is to provide national level estimates of fertility and child mortality. The survey also provides information on nuptiality, contraceptive knowledge and behaviour, the potential demand for contraception, other proximate determinants of fertility, family size preferences, utilization of antenatal services, breastfeeding and food supplementation practices, child nutrition and health, immunizations, and knowledge about Acquired Immune Deficiency Syndrome (AIDS). This information will assist policy-makers, administrators and researchers to assess and evaluate population and health programmes and strategies. The NFHS is comparable to Demographic and Health Surveys (DHS) conducted in other developing countries. MAIN RESULTS FERTILITY Survey results indicate that fertility in Nepal has declined steadily from over 6 births per woman in the mid-1970s to 4.6 births per woman during the period of 1994-1996. Differentials in fertility by place of residence are marked, with the total fertility rate (TFR) for urban Nepal (2.9 births per woman) about two children less than for rural Nepal (4.8 births per woman). The TFR in the Mountains (5.6 births per woman) is about one child higher than the TFR in the Hills and Terai (4.5 and 4.6 births per woman, respectively). By development region, the highest TFR is observed in the Mid-western region (5.5 births per woman) and the lowest TFR in the Eastern region (4.1 births per woman). Fertility decline in Nepal has been influenced in part by a steady increase in age at marriage over the past 25 years. The median age at first marriage has risen from 15.5 years among women age 45-49 to 17.1 years among women age 20-24. This trend towards later marriage is supported by the fact that the proportion of women married by age 15 has declined from 41 percent among women age 45-49 to 14 percent among women age 15-19. There is a strong relationship between female education and age at marriage. The median age at first marriage for women with no formal education is 16 years, compared with 19.8 years for women with some secondary education. Despite the trend towards later age at marriage, childbearing begins early for many Nepalese women. One in four women age 15-19 is already a mother or pregnant with her first child, with teenage childbearing more common among rural women (24 percent) than urban women (20 percent). Nearly one in three adolescent women residing in the Terai has begun childbearing, compared with one in five living in the Mountains and 17 percent living in the Hills. Regionally, the highest level of adolescent childbearing is observed in the Central development region while the lowest is found in the Western region. Short birth intervals are also common in Nepal, with one in four births occurring within 24 months of a previous birth. This is partly due to the relatively short period of insusceptibility, which averages 14 months, during which women are not exposed to the risk of pregnancy either because they are amenorrhoeic or abstaining. By 12-13 months after a birth, mothers of the majority of births (57 percent) are susceptible to the risk of pregnancy. Early childbearing and short birth intervals remain a challenge to policy-makers. NFHS data show that children born to young mothers and those born after short birth intervals suffer higher rates of morbidity and mortality. Despite the decline in fertility, Nepalese women continue to have more children than they consider ideal. At current fertility levels, the average woman in Nepal is having almost 60 percent more births than she wantsthe total wanted fertility rate is 2.9 births per woman, compared with the actual total fertility rate of 4.6 births per woman. Unplanned and unwanted births are often associated with increased mortality risks. More than half(56 percent) of all births in the five-year period before the survey had an increased risk of dying because the mother was too young (under 18 years) or too old (more than 34 years), or the birth was of order 3 or higher, or the birth occurred within 24 months of a previous birth. Nevertheless, the percentage of women who want to stop childbearing in Nepal has increased substantially, from 40 percent in 1981 to 52 percent in 1991 and to 59 percent in 1996. According to the NFHS, 41 percent of currently married women age 15-49 say they do not want any more children, and an additional 18 percent have been sterilized. Furthermore, 21 percent of married women want to wait at least two years for their next child and only 13 percent want to have a child soon, that is, within two years. FAMILY PLANNING Knowledge of family planning is virtually universal in Nepal, with 98 percent of currently married women having heard of at least one method of family planning. This is a five-fold increase over the last two decades (1976-1996). Much of this knowledge comes from media exposure. Fifty-three percent of ever-married women had been exposed to family planning messages on the radio and/or the television and 23 percent have been exposed to messages through the print media. In addition, about one in four women has heard at least one of three specific family planning programmes on the radio. There has been a steady increase in the level of ever use of modern contraceptive method over the past 20 years, from 4 percent of currently married women in 1976, to 27 percent in 1991 and 35 percent in 1996. Among ever-users, female sterilization and male sterilization are the most popular methods (37 percent), indicating that contraceptive methods have been used more for limiting than for spacing births. The contraceptive prevalence rate among currently married women is 29 percent, with the majority of women using modern methods (26 percent). Again, the most widely used method is sterilization (18 percent, male and female combined), followed by injectables (5 percent). Although current use of modern contraceptive methods has risen steadily over the last two decades, the pace of change has been slowest in the most recent years (1991-1996). Current use among currently married non-pregnant women increased from 3 percent in 1976 to 15 percent in 1986 to 24 percent in 1991 and to 29 percent in 1996. While female sterilization increased by only 3 percent from 45 percent of modern methods in 1986 to 46 percent in 1996, male sterilization declined by almost 50 percent from 41 percent to 21 percent over the same period. The level of current use is nearly twice as high in the urban areas (50 percent) as in rural areas (27 percent). Only 18 percent of currently married women residing in the Mountains are currently using contraception, compared with 30 percent and 29 percent living in the Hills and Terai regions, respectively. There is a notable difference in current contraceptive use between the Far-western region (21 percent) and all the other regions, especially the Central and Eastern regions (31 percent each). Educational differences in current use are large, with 26 percent of women with no education currently using contraception, compared with 52 percent of women who have completed their School Leaving Certificate (SLC). In general, as women's level of education rises, they are more likely to use modem spacing methods. The public sector figures prominently as a source of modem contraceptives. Seventy-nine percent of modem method users obtained their methods from a public source, especially hospitals and district clinics (32 percent) and mobile camps (28 percent). The public sector is the predominant source of sterilizations, 1UDs, injectables, and Norplant, and both the public and private sectors are equally important sources of the pill and condoms. Nevertheless, the public sector's share of the market has fallen over the last five years from 93 percent of current users in 1991 to 79 percent in 1996. There is considerable potential for increased family planning use in Nepal. Overall, one in three women has an unmet need for family planning14 percent for spacing and 17 percent for limiting. The total demand for family planning, including those women who are currently using contraception, is 60 percent. Currently, the family planning needs of only one in two women is being met. While the increase in unmet need between 1991 (28 percent) and 1996 (31 percent) was small, there was a 14 percent increase in the percentage of women using any method of family planning and, over the same period, a corresponding increase of 18 percent in the demand for family planning. MATERNAL AND CHILD HEALTH At current mortality levels, one of every 8 children born in Nepal will die before the fifth birthday, with two of three deaths occurring during the first year of life. Nevertheless, NFHS data show that mortality levels have been declining rapidly in Nepal since the eighties. Under-five mortality in the period 0-4 years before the survey is 40 percent lower than it was 10-14 years before the survey, with child mortality declining faster (45 percent) than infant mortality (38 percent). Mortality is consistently lower in urban than in rural areas, with children in the Mountains faring much worse than children living in the Hills and Terai. Mortality is also far worse in the Far-western and Mid-western development regions than in the other regions. Maternal education is strongly related to mortality, and children of highly educated mothers are least likely to die young. For example, infant mortality is nearly

This SAS macro generates childhood mortality estimates (neonatal, post-neonatal, infant (1q0), child (4q1) and under-five (5q0) mortality) and standard errors based on birth histories reported by women during a household survey. We have made the SAS macro flexible enough to accommodate a range of calculation specifications including multi-stage sampling frames, and simple random samples or censuses. Childhood mortality rates are the component death probabilities of dying before a specific age. This SAS macro is based on a macro built by Keith Purvis at MeasureDHS. His method is described in Estimating Sampling Errors of Means, Total Fertility, and Childhood Mortality Rates Using SAS (www.measuredhs.com/pubs/pdf/OD17/OD17.pdf, section 4). More information about Childhood Mortality Estimation can also be found in the Guide to DHS Statistics (www.measuredhs.com/pubs/pdf/DHSG1/Guide_DHS_Statistics.pdf, page 93). We allow the user to specify whether childhood mortality calculations should be based on 5 or 10 years of birth histories, when the birth history window ends, and how to handle age of death with it is reported in whole months (rather than days). The user can also calculate mortality rates within sub-populations, and take account of a complex survey design (unequal probability and cluster samples). Finally, this SAS program is designed to read data in a number of different formats.

Abstract

The 2009 Kiribati Demographic and Health Survey was the first survey in phase two of Pacific DHS Project with funding support from ADB. The primary objective of this survey was to provide up-to-date information for policy-makers, planners, researchers and programme managers, for use in planning, implementing, monitoring and evaluating population and health programmes within the country. The survey was intended to provide key estimates of Kiribati’s demographic and health situation.

The main objective of the 2009 Kiribati Demographic and Health Survey (2009 KDHS) is to provide current and reliable data on fertility and family planning behaviour, child mortality, adult and maternal mortality, children’s nutritional status, the use of maternal and child healthcare services, and knowledge of HIV and AIDS. Specific objectives are to:

• collect data (at the national level) that will allow the calculation of key demographic rates;
• analyse the direct and indirect factors that determine the level and trends of fertility;
• measure the level of contraceptive knowledge and practice among women and men by method, urban–rural residence and region;
• collect high-quality data on family health, including immunisation coverage among children, prevalence and treatment of diarrhoea and other diseases among children under age 5 years, and maternity care indicators (including antenatal visits, assistance at delivery, and postnatal care);
• collect data on infant and child mortality;
• obtain data on child feeding practices, including breastfeeding, and collect ‘observation’ information to use in assessing the nutritional status of women and children;
• collect data on knowledge and attitudes of women and men about sexually transmitted infections (STIs), HIV and AIDS, and evaluate patterns of recent behaviour regarding condom use; and
• collect data on knowledge and attitudes of women and men about tuberculosis.

Geographic coverage

National coverage.

Analysis unit

• Household,
• Individual.

Universe

The survey covered all de jure household members (usual residents), all women aged between 15-49 years, and all men aged between 15-49 years.

Kind of data

Sample survey data [ssd]

Sampling procedure

The primary focus of the 2009 Kiribati Demographic Health Survey (DHS) was to provide estimates of key population and health indicators, including fertility and mortality rates, for the country as a whole, for the urban area and rural areas (separately) - urban is South Tarawa and urban settlement on Kiritimati Island while the rest of Kiribati is defined as rural areas. The survey used the sampling frame provided by the list of census enumeration areas, with population and household information coming from the 2005 Kiribati Population and Housing Census.

The survey was designed to obtain completed interviews of 2,193 women aged 15-49. In addition, males aged 15-59 in every second household were interviewed. To take non-response into account, 1,480 households countrywide were selected: 640 in the urban area and 840 in rural areas.

Mode of data collection

Face-to-face [f2f]

Research instrument

Three questionnaires were administered during the 2009 Kiribati Demographic Health Survey (KDHS): a Household questionnaire, a Women’s questionnaire and a Men’s questionnaire. These were adapted to reflect population and health issues relevant to Kiribati, and were presented at a series of meetings with various stakeholders, including government ministries and agencies, NGOs and international donors. The final draft of each questionnaire was discussed at a questionnaire design workshop organised by Kiribati National Statistics Office (KNSO) in March 2009 in Tarawa. Survey questionnaires were then translated into the local language (I-Kiribati) and pretested from 7–19 August 2009.

The Household questionnaire was used to list all the usual members and visitors in selected households, and to identify women and men who were eligible for the individual interview. Some basic information was collected on the characteristics of each person listed, including age, sex, education and relationship to the head of the household. For children under age 18 years, the survival status of their parents was ascertained. The Household questionnaire also collected information on characteristics of each household’s dwelling unit, such as source of drinking water, type of toilet facility, material used for the floor, and ownership of various durable goods.

The Women’s questionnaire collected information from all women aged 15–49 about: - education, residential history and media exposure; - pregnancy history and childhood mortality; - knowledge and use of family planning methods; - fertility preferences; - antenatal, delivery and postnatal care; - breastfeeding and infant feeding practices; - immunisation and childhood illnesses; - marriage and sexual activity; - their own work and their husband’s background characteristics; and - awareness and behaviour regarding HIV and other STIs.

The Men’s questionnaire was administered to all men aged 15–49 living in every second household. It collected much of the same information as the women’s questionnaire, but was shorter because it did not contain questions about reproductive history or maternal and child health or nutrition.

Cleaning operations

Processing the 2009 Kiribati Demographic Health Survey (KDHS) results began three weeks after the start of fieldwork. Completed questionnaires were returned periodically from the field to the Kiribati National Statistics Office (KNSO) data processing center in South Tarawa, where the data were entered and edited by seven data processing personnel specially trained for this task. Data processing personnel were supervised by KNSO staff. Data entry and editing of questionnaires was completed by 30 March 30 2010. CSPRo was used for data processing.

Response rate

In total, 1,477 households were selected for the sample, of which 1,451 were found to be occupied during data collection. Of these existing households, 1,422 were successfully interviewed, giving a household response rate of 98%.

In households, 2,193 women were identified as being eligible for the individual interview. Interviews were completed with 1,978 women, yielding a response rate of 90%. Of the 1,337 eligible men identified in the selected sub-sample of households, 85% were successfully interviewed. Response rates were higher in rural areas than in the urban area, with the rural–urban difference in response rates being the greatest among eligible men.

Sampling error estimates

The sample of respondents selected in the 2009 Kiribati Demographic Health Survey (KDHS) is only one of many samples that could have been selected from the same population, using the same design and expected size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability between all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results.

Sampling errors are the errors that result from taking a sample of the covered population through a particular sample design. Non-sampling errors are systematic errors that would be present even if the entire population was covered (e.g. response errors, coding and data entry errors, etc.).

For the entire covered population and for large subgroups, the KDHS sample is generally sufficiently large to provide reliable estimates. For such populations the sampling error is small and less important than the non-sampling error. However, for small subgroups, sampling errors become very important in providing an objective measure of reliability of the data.

Sampling errors will be displayed for total, urban and rural and each sample domain only. No other panels should be included in the sampling error table. The choice of variables for which sampling error computations will be done depends on the priority given to specific variables. However, it is recommended that sampling errors be calculated for at least the following variables, which was not case with Kiribati given the smallness of the sample compared to other countries in the Pacific.

Sampling errors are usually measured in terms of the standard error for a particular statistic (mean, percentage, etc.), which is the square root of the variance. The standard error can be used to calculate confidence intervals within which the true value for the population can reasonably be assumed to fall. For example, for any given statistic calculated from a sample survey, the value of that statistic will fall within a range of plus or minus two times the standard error of that statistic in 95% of all possible samples of identical size and design.

If the sample of respondents had been selected by simple random sampling, it would have been possible to use straightforward formulas for calculating sampling errors. However, the 2009 KDHS sample was the result of a multistage stratified design, and, consequently, it is necessary to use more complex formulae. The computer software used to calculate sampling errors for the 2009 KDHS is the Integrated Sample Survey Analysis (ISSA) Sampling Error Module. This module uses the Taylor linearisation method of variance estimation for survey estimates that are means or proportions. The Jackknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates.

In addition to the standard error, ISSA

The 2016 Timor-Leste Demographic and Health Survey (TLDHS) was implemented by the General Directorate of Statistics (GDS) of the Ministry of Finance in collaboration with the Ministry of Health (MOH). Data collection took place from 16 September to 22 December, 2016. The primary objective of the 2016 TLDHS project is to provide up-to-date estimates of basic demographic and health indicators. The TLDHS provides a comprehensive overview of population, maternal, and child health issues in Timor-Leste. More specifically, the 2016 TLDHS: • Collected data at the national level, which allows the calculation of key demographic indicators, particularly fertility, and child, adult, and maternal mortality rates • Provided data to explore the direct and indirect factors that determine the levels and trends of fertility and child mortality • Measured the levels of contraceptive knowledge and practice • Obtained data on key aspects of maternal and child health, including immunization coverage, prevalence and treatment of diarrhea and other diseases among children under age 5, and maternity care, including antenatal visits and assistance at delivery • Obtained data on child feeding practices, including breastfeeding, and collected anthropometric measures to assess nutritional status in children, women, and men • Tested for anemia in children, women, and men • Collected data on the knowledge and attitudes of women and men about sexually-transmitted diseases and HIV/AIDS, potential exposure to the risk of HIV infection (risk behaviors and condom use), and coverage of HIV testing and counseling • Measured key education indicators, including school attendance ratios, level of educational attainment, and literacy levels • Collected information on the extent of disability • Collected information on non-communicable diseases • Collected information on early childhood development • Collected information on domestic violence • The information collected through the 2016 TLDHS is intended to assist policy makers and program managers in evaluating and designing programs and strategies for improving the health of the country’s population.

Abstract

The main objective of a demographic household survey (DHS) is to provide estimates of a number of basic demographic and health variables. This is done through interviews with a scientifically selected probability sample that is chosen from a well-defined population.

The 2007 Nauru Demographic and Health Survey (2007 NDHS) was one of four pilot demographic and health surveys conducted in the Pacific under an Asian Development Bank ADB/ Secretariat of the Pacific Community (SPC) Regional DHS Pilot Project. The primary objective of this survey was to provide up-to-date information for policy-makers, planners, researchers and programme managers, for use in planning, implementing, monitoring and evaluating population and health programmes within the country. The survey was intended to provide key estimates of Nauru's demographics and health situation. The findings of the 2007 NDHS are very important in measuring the achievements of family planning and other health programmes. To ensure better understanding and use of these data, the results of this survey should be widely disseminated at different planning levels. Different dissemination techniques will be used to reach different segments of society.

The primary purpose of the 2007 NDHS was to furnish policy-makers and planners with detailed information on fertility, family planning, infant and child mortality, maternal and child health, nutrition, and knowledge of HIV and AIDS and other sexually transmitted infections.

NOTE: The only dissemination used was wide distribution of the report. A planned data use workshop was not undertaken. Hence there is some misconceptions and lack of awareness on the results obtained from the survey. The report is provided on the NBOS website free for download.

Geographic coverage

National Coverage - Districts

Analysis unit

• Households
• Children (0-14yrs)
• Individual women of reproductive age (15-49 yrs)
• Individual men of reproductive age (15yrs+)
• Facilities providing reproductive and child health services

Universe

The survey covered all household members (usual residents), - All children (aged 0-14 years) resident in the household - All women of reproductive age (15-49 years) resident in all household - All males (15yrs and above) in every second household (approx. 50%) resident in selected household

Results: The 2007 Nauru Demographic Health Survey (2007 NDHS) is a nationally representative survey of 655 eligible women (aged 15-49) and 392 eligible men (aged 15 and above).

Kind of data

Sample survey data [ssd]

Sampling procedure

IDG NOTES: Locate sampling documentation with SPC (Graeme Brown) and internal files. Add in this sections. Or second option dilute appendix A Sampling and extract key issues.

ESTIMATES OF SAMPLING ERRORS - Refer to Appendix A of final NDHS2007 report or; - External Resources - 2007 DHS- Appendix A and B Sampling (to be created separatedly by IDG progress ongoing)

Sampling deviation

IDG NOTES: Locate sampling documentation with Macro and internal files. Add in this section. Or second option dilute appendix B Sampling and extract key issues.

ESTIMATES OF SAMPLING ERRORS - Refer to Appendix B of final NDHS2007 report or;

• External Resources
  • 2007 DHS- Appendix A and B Sampling (to be created separatedly by IDG progress ongoing)

Extract:

In the 2007 NDHS Report of the survey results, sampling errors for selected variables have been presented in a tabular format. The sampling error tables should include:

.. Variable name

R: Value of the estimate; SE: Sampling error of the estimate; N: Unweighted number of cases on which the estimate is based; WN: Weighted number of cases; DEFT: Design effect value that compensates for the loss of precision that results from using cluster rather than simple random sampling; SE/R: Relative standard error (i.e. ratio of the sampling error to the value estimate); R-2SE: Lower limit of the 95% confidence interval; R+2SE: Upper limit of the 95% confidence interval (never >1.000 for a proportion).

Mode of data collection

Face-to-face [f2f]

Research instrument

DHS questionnaire for women cover the following sections:

• Background characteristics (age, education, religion, etc)
• Reproductive history
• Knowledge and use of contraception methods
• Antenatal care, delivery care and postnatal care
• Breastfeeding and infant feeding
• Immunization, child health and nutrition
• Marriage and recent sexual activity
• Fertility preferences
• Knowledge about HIV/AIDS and other sexually transmitted infections
• Husbands background and women's work

The men's questionnaire covers the same except for sections 4, 5, 6 which are not applicable to men.

It was also recognized that some countries have a need for special information that is not contained in the core questionnaire. Separate questionnaire modules were developed on a series of topics. These topics are optional and include:

• maternal mortality
• pill-taking behaviour
• sterilization experience
• children's education
• women's status
• domestic violence
• health expenditures
• consanguinity

The Papua New Guinea (PNG) questionnaire was proposed for Nauru to adapt as in comparison to the existing DHS model, this is not as lengthy and time-consuming. The PNG questionnaire also dealt with high incidence of alcohol and tobacco in Nauru. Questions on HIV/AIDS and STI knowledge were included in the men's questionnaire where it was not included in the PNG questionnaire.

Response rate

IDG NOTES: Locate response rate documentation with SPC (Graeme Brown) and internal files. Add in this sections.

The 2004 Malawi Demographic and Health Survey (MDHS) is a nationally representative survey of 11,698 women age 1549 and 3,261 men age 15-54. The main purpose of the 2004 MDHS is to provide policymakers and programme managers with detailed information on fertility, family planning, childhood and adult mortality, maternal and child health, as well as knowledge of and attitudes related to HIV/AIDS and other sexually transmitted infections (STIs). The 2004 MDHS is designed to provide data to monitor the population and health situation in Malawi as a followup of the 1992 and 2000 MDHS surveys, and the 1996 Malawi Knowledge, Attitudes, and Practices in Health Survey. New features of the 2004 MDHS include the collection of information on use of mosquito nets, domestic violence, anaemia testing of women and children under 5, and HIV testing of adults. The 2004 MDHS survey was implemented by the National Statistical Office (NSO). The Ministry of Health and Population, the National AIDS Commission (NAC), the National Economic Council, and the Ministry of Gender contributed to the development of the questionnaires for the survey. Most of the funds for the local costs of the survey were provided by multiple donors through the NAC. The United States Agency for International Development (USAID) provided additional funds for the technical assistance through ORC Macro. The Department for International Development (DfID) of the British Government, the United Nations Children's Fund (UNICEF), and the United Nations Population Fund (UNFPA) also provided funds for the survey. The Centers of Disease Control and Prevention provided technical assistance in HIV testing. The survey used a two-stage sample based on the 1998 Census of Population and Housing and was designed to produce estimates for key indicators for ten large districts in addition to estimates for national, regional, and urban-rural domains. Fieldwork for the 2004 MDHS was carried out by 22 mobile interviewing teams. Data collection commenced on 4 October 2004 and was completed on 31 January 2005. The principal aim of the 2004 MDHS project was to provide up-to-date information on fertility and childhood mortality levels, nuptiality, fertility preferences, awareness and use of family planning methods, use of maternal and child health services, and knowledge and behaviours related to HIV/AIDS and other sexually transmitted infections. It was designed as a follow-on to the 2000 MDHS survey, a national-level survey of similar scope. The 2004 MDHS survey, unlike the 2000 MDHS, collected blood samples which were later tested for HIV in order to estimate HIV prevalence in Malawi. In broad terms, the 2004 MDHS survey aimed to: Assess trends in Malawi's demographic indicators, principally fertility and mortality Assist in the monitoring and evaluation of Malawi's health, population, and nutrition programmes Advance survey methodology in Malawi and contribute to national and international databases Provide national-level estimates of HIV prevalence for women age 15-49 and men age 15-54. In more specific terms, the 2004 MDHS survey was designed to: Provide data on the family planning and fertility behaviour of the Malawian population and thereby enable policymakers to evaluate and enhance family planning initiatives in the country Measure changes in fertility and contraceptive prevalence and analyse the factors that affect these changes, such as marriage patterns, desire for children, availability of contraception, breastfeeding habits, and important social and economic factors Examine basic indicators of maternal and child health and welfare in Malawi, including nutritional status, use of antenatal and maternity services, treatment of recent episodes of childhood illness, and use of immunisation services. Particular emphasis was placed on malaria programmes, including malaria prevention activities and treatment of episodes of fever. Provide levels and patterns of knowledge and behaviour related to the prevention of HIV/AIDS and other sexually transmitted infections Provide national estimates of HIV prevalence Measure the level of infant and adult mortality including maternal mortality at the national level Assess the status of women in the country. MAIN FINDINGS Fertility Fertility Levels and Trends. While there has been a significant decline in fertility in the past two decades from 7.6 children in the early 1980s to 6.0 children per woman in the early 2000s, compared with selected countries in Eastern and Southern Africa, such as Zambia, Tanzania, Mozambique, Kenya, and Uganda, the total fertility rate (TFR) in Malawi is high, lower only than Uganda (6.9). Family planning Knowledge of Contraception. Knowledge of family planning is nearly universal, with 97 percent of women age 15-49 and 97 percent of men age 15-54 knowing at least one modern method of family planning. The most widely known modern methods of contraception among all women are injectables (93 percent), the pill and male condom (90 percent each), and female sterilisation (83 percent). Maternal health Antenatal Care. There has been little change in the coverage of antenatal care (ANC) from a medical professional since 2000 (93 percent in 2004 compared with 91 percent in 2000). Most women receive ANC from a nurse or a midwife (82 percent), although 10 percent go to a doctor or a clinical officer. A small proportion (2 percent) receives ANC from a traditional birth attendant, and 5 percent do not receive any ANC. Only 8 percent of women initiated ANC before the fourth month of pregnancy, a marginal increase from 7 percent in the 2000 MDHS. Adult and Maternal Mortality. Comparison of data from the 2000 and 2004 MDHS surveys indicates that mortality for both women and men has remained at the same levels since 1997 (11-12 deaths per 1,000). Child health Childhood Mortality. Data from the 2004 MDHS show that for the 2000-2004 period, the infant mortality rate is 76 per 1,000 live births, child mortality is 62 per 1,000, and the under-five mortality rate is 133 per 1,000 live births. Nutrition Breastfeeding Practices. Breastfeeding is nearly universal in Malawi. Ninety-eight percent of children are breastfed for some period of time. The median duration of breastfeeding in Malawi in 2004 is 23.2 months, one month shorter than in 2000. HIV/AIDS Awareness of AIDS. Knowledge of AIDS among women and men in Malawi is almost universal. This is true across age group, urban-rural residence, marital status, wealth index, and education. Nearly half of women and six in ten men can identify the two most common misconceptions about the transmission of HIV-HIV can be transmitted by mosquito bites, and HIV can be transmitted by supernatural means-and know that a healthy-looking person can have the AIDS virus.