Abstract

The Egypt sub-national Multiple Indicator Cluster Survey (MICS) was carried out in 2013-14 by El-Zanaty & Associates in collaboration with the Ministry of Health and Population. Financial and technical support was provided by the United Nations Children’s Fund (UNICEF) Egypt Country Office, Middle East and North Africa Regional Office, and UNICEF Headquarters.

The global Multiple Indicator Cluster Survey (MICS) programme was developed by UNICEF in the 1990s as an international household survey programme to support countries in the collection of internationally comparable data on a wide range of indicators on the situation of children and women. MICS measures key indicators that allow countries to generate data for use in policies and programmes, and to monitor progress towards the Millennium Development Goals (MDGs) and other internationally agreed upon commitments.

This MICS aims at providing data for monitoring system of the ‘Integrated Perinatal Health and Child Nutrition Programme’ (IPHN) implemented by the Ministry of Health and Population (MOHP) in Egypt with the support of UNICEF. The IPHN covers selected rural districts in 6 governorates, 4 in Upper Egypt and 2 in Lower Egypt.

The MICS in the rural districts cover by the IPHN programme in Egypt was conducted as part of the fifth global round of MICS Surveys (MICS5). The IPHN programme is implemented by the Ministry of Health and Population (MoHP) in collaboration with UNICEF in selected disadvantaged rural areas of Upper and Lower Egypt. The survey has been specifically designed to respond to the data needs of the IPHN program and of its monitoring system (which adopts the model of the Monitoring Results for Equity System, developed by UNICEF). The specific focus of this MICS is on perinatal care. In the MoRES framework developed for the IPHN program, this survey complements the data provided by the routine administrative data collection system and by evidence provided by a qualitative study on perinatal care and nutrition.

The IPHN programme has been initially conducted, since 2008, as a pilot in selected rural village/Family Health Units (FHUs) in 3 Upper Egypt governorates, and then – starting in 2012, it has been expanded in new FHUs in Upper Egypt and Lower Egypt, covering a total of 6 governorates at the time of the survey. A total of 2.5 million people were living in the areas of intervention at the time of the survey.

Consistently with the focus of the survey on perinatal care, this household survey considered as eligible for the interviews ever-married women age 15-49 and children under five. A total of 7046 households were successfully interviewed with response rate of 99.9 percent. A total of 5847 ever-married women age 15-49 were successfully interviewed and 5090 questionnaires were completed for children under-5.

The results of the survey are representative of the full area covered by the IPHN and for three subdomains, namely the pilots FHUs in Upper Egypt, the FHUs of Upper Egypt expansion phase, and the FHUs of the Lower Egypt expansion phase.

Geographic coverage

Sub-national

Analysis unit

• individuals
• households

Universe

The survey covered all de jure household members (usual residents), all women aged between 15-49 years, all children under 5 living in the household.

Kind of data

Sample survey data [ssd]

Sampling procedure

The sample for the survey was designed to provide estimates for a large number of indicators on the situation of children and women in IPHN areas, and for the three domains: Upper Egypt pilot area, Upper Egypt expansion area, and Lower Egypt expansion area. The Family Health Unit (FHU) catchment areas in the villages of the IPHN within each region were identified as the main primary sampling units (PSUs) and the sample was selected in three stages. Within each stratum, a specified number of FHUs were selected systematically with probability proportional to size, where 10 FHUs were selected from Upper Egypt Pilot phase, and 17 FHUs from Upper Egypt Expansion phase, and 11 FHUs from Lower Egypt Expansion phase. Then a number of enumeration areas were selected systematically with probability proportional to size from each FHU catchment area. A total of 234 EAs in the selected FHUs were thus selected, 60 from Upper Egypt pilot, 108 from Upper Egypt expansion, and 66 from Lower Egypt Expansion.

After a household listing was carried out within the selected enumeration areas, a systematic sample of 30-31 households with women age 15 to 49 and/or with children under-5 years was drawn in each sample enumeration area for a total of 7067 sample households. The sample was stratified by the three domains, and is not self-weighting. For reporting results for the entire IPHN area, sample weights are used.

A stratified three-stage cluster sampling design has been adopted: 1- First stage: systematic selection of a sample of FHUs with probability proportional to size (PPS) of the FHU (population/households). 2- Second stage: systematic selection of a sample of Enumeration Areas with PPS to get a sample of EAs from each selected FHU. 3- Third stage: systematic sample of households selected from each EA When a household is selected, all ever-married women (15-49 years) and mothers or caretakers of children (0-4) years were eligible to be interviewed.

The sampling procedures are more fully described in appendix A in document "Multiple Indicator Cluster Survey 2013-14 - Final Report" pp.161-164.

Mode of data collection

Face-to-face [f2f]

Research instrument

The questionnaires for the Generic MICS were structured questionnaires based on the MICS5 model questionnaire with some modifications and additions. Household questionnaires were administered in each household, which collected various information on household members including sex, age and relationship. The household questionnaire includes List of Household Members, Education, Household Characteristics, Water and Sanitation and Hand Washing.

In addition to a household questionnaire, questionnaires were administered in each household for women age 15-49 and children under age five. The questionnaire was administered to the mother or primary caretaker of the child.

The women's questionnaire includes Women's Background, Access to Mass Media and Use of Information/Communication Technology, Marriage, Birth History, Desire for Last Birth, Maternal and New-born Health, Post-natal Health Checks, Illness Symptoms, Attitude Module, and Woman and Husband's work status.

The children's questionnaire includes Child's Age, Birth Registration, Breastfeeding and Dietary Intake, Immunization, Growth Monitoring, Care of Illness and Anthropometry.

The questionnaires were based on the MICS5 model questionnaire. The previous mentioned sections were taken from the MICS5 model Arabic version questionnaires and customized, then translated into Egyptian Arabic. Additional questions were added to respond to the data needs of the monitoring system (MoRES) of the IPHN, especially in antenatal and postnatal sections. A pre-test of the questionnaires was conducted in November 2013. Based on the results of the pre-test, modifications were made to the wording and translation of the questionnaires.

Cleaning operations

Data were entered using the CSPro software. The data were entered on eight microcomputers and carried out by 8 data entry operators, one data entry supervisor and one assistant. In order to ensure quality control, all questionnaires were double-entered and internal consistency checks were performed. Procedures and standard programs developed under the global MICS5 programme were used and adapted to the Egypt questionnaire in the survey. Data processing began simultaneously with data collection in mid-December 2013 and was completed with the clean data set in late January 2014. Data were analysed using the Statistical Package for Social Sciences (SPSS) software program, Version 18, and the model syntax and tabulation plans developed by UNICEF were used for this purpose. In addition the country specific tables that were designed for the survey specific questions were developed using SPSS by the data processing expert of El-Zanaty and reviewed by UNICEF experts at the regional office as well as headquarters.

Response rate

Out of the 7,067 households selected for the survey, 7,050 were found to be occupied. Of these, 7,046 were successfully interviewed for a household response rate of 99.9 percent. In the interviewed households, 5,859 ever-married women (age 15-49 years) were identified. Of these, 5,847 ever-married women were successfully interviewed, yielding a response rate of 99.8 percent. In addition, 5,096 children under-5 were listed in the household questionnaire. Questionnaires were completed for 5,090 of these children, which corresponds to a response rate of 99.9 percent. Overall response rates of 99.7 and 99.8 percent are calculated for individual interviews of ever-married 15-49 year-old women and under-5s respectively.

Sampling error estimates

Sampling errors are a measure of the variability between the estimates from all possible samples. The extent of variability is not known exactly, but can be estimated statistically from the survey data.

The following sampling error measures are presented in this appendix for each of the selected indicators: - Standard error (se): Standard error is the square root of the variance of the estimate. For survey indicators that are means, proportions or ratios, the Taylor series linearization method is used for the estimation of standard errors. For