Abstract

In 2001, the World Health Organization, in collaboration with UNAIDS, UNESCO, and UNICEF, with technical assistance from the US Centers for Disease Control and Prevention (CDC), initiated development of the Global School-based Student Health Survey (GSHS). Since 2003, Ministries/ Department of Health and Education around the world have been using the GSHS to periodically monitor the prevalence of important health risk behaviors and protective factors among students. To date, 15 countries have completed a GSHS. This report describes results from the first GSHS conducted in Philippines by the Department of Health, Manila during September-December of 2003.

The purpose of the GSHS is to provide accurate data on health behaviors and protective factors among students to: - Help countries develop priorities, establish programmes, and advocate for resources for school health and youth health programmes and policies; - Allow international agencies, countries, and others to make comparisons across countries and within countries regarding the prevalence of health behaviors; and protective factors - Establish trends in the prevalence of health behaviors and protective factors by country for use in evaluation of school health and youth health promotion.

Geographic coverage

National coverage

Analysis unit

Students aged 13-15 years

Kind of data

Sample survey data [ssd]

Sampling procedure

The 2003 Philippines' GSHS employed a two-stage cluster sample design to produce a representative sample of students in 2nd-4th year levels of Secondary Education or High School. The first-stage sampling frame consisted of all schools containing any of 2nd-4th year levels. Schools were selected with probability proportional to school enrollment size. One hundred and fifty schools (150) were selected to participate in the Philippines' GSHS.

The second stage of sampling consisted of randomly selecting intact classrooms (using a random start) from each school to participate. All classrooms in each selected school were included in the sampling frame. All students in the sampled classrooms were eligible to participate in the GSHS.

Mode of data collection

Face-to-face [f2f]

Research instrument

The GSHS uses a standardized scientific sample selection process; common school-based methodology; and core questionnaire modules, core-expanded questions, and country-specific questions that are combined to form a self-administered questionnaire that can be administered during one regular class period.

The Philippines' questionnaire contained 92 questions addressing the following topics: - Alcohol and other drug use - Dietary behaviors - Hygiene - Mental health - Physical activity - Protective factors - HIV-related knowledge - Tobacco use - Violence and unintentional injury

A GSHS Project Management Team of the Department of Health and the Institute of Clinical Epidemiology Unit, National Institutes of Health, University of the Philippines had developed the questionnaire. The questionnaire was with a corresponding translation in Filipino, a common language in the country.

Cleaning operations

The data set was cleaned and edited for inconsistencies. Missing data were not statistically imputed. Epi- Info Complex-Sample analysis that takes into consideration the complex sample design was used to compute prevalence estimates and 95% confidence intervals. GSHS data are representative of all students attending 2nd-4th year levels of High School in the Philippines.

Response rate

For the 2003 Philippines GSHS, 7, 338 questionnaires were completed in 148 schools. The school response rate was 99%, the student response rate was 85 %, and the overall response rate was 84%.

Abstract

The 2003 National Demographic and Health Survey (NDHS) is a nationally representative survey of 13,945 women age 15-49 and 5,009 men age 15-54. The main purpose of the 2003 NDHS is to provide policymakers and program managers with detailed information on fertility, family planning, childhood and adult mortality, maternal and child health, and knowledge and attitudes related to HIV/AIDS and other sexually transmitted infections. The 2003 NDHS also collects high quality data on family health: immunizations, prevalence and treatment of diarrhea and other diseases among children under five, antenatal visits, assistance at delivery and breastfeeding.

The 2003 NDHS is the third national sample survey undertaken in Philippines under the auspices of the worldwide Demographic and Health Surveys program.

The 2003 Philippines National Demographic and Health Survey (NDHS) is designed to provide upto-date information on population, family planning, and health to assist policymakers and program managers in evaluating and designing strategies for improving health and family planning services in the country. In particular, the 2003 NDHS has the following objectives: - Collect data at the national level, which will allow the calculation of demographic rates and, particularly, fertility and under-five mortality rates. - Analyze the direct and indirect factors that determine the level and trends of fertility. Indicators related to fertility will serve to inform plans for social and economic development. - Measure the level of contraceptive knowledge and practice by method, urban-rural residence, and region. - Collect data on knowledge and attitudes of women and men about sexually transmitted infections and HIV/AIDS and evaluate patterns of recent behavior regarding condom use. - Collect high-quality data on family health, including immunizations, prevalence and treatment of diarrhea and other diseases among children under five, antenatal visits, assistance at delivery, and breastfeeding.

Geographic coverage

National

Analysis unit

• Household
• Women age 15-49
• Men age 15-54

Universe

The population covered by the 1998 Phillipines NDS is defined as the universe of all females age 15-49 years, who are members of the sample household or visitors present at the time of interview and had slept in the sample households the night prior to the time of interview, regardless of marital status and all men age 15-54 living in the household.

Kind of data

Sample survey data

Sampling procedure

The 2003 NDHS is the first survey that used the new master sample created for household surveys on the basis of the 2000 Census of Population and Housing. The 2003 NDHS used one of the four replicates of the master sample. The sample was designed to represent the country as a whole, urban and rural areas, and each of the 17 administrative regions. In each region, a stratified, three-stage cluster sampling design was employed. In the first stage, 819 primary sampling units (PSUs) were selected with probability proportional to the number of households in the 2000 census. PSUs consisted of a barangay or a group of contiguous barangays. In the second stage, in each PSU, enumeration areas (EAs) were selected with probability proportional to the number of EAs. An EA is defined as an area with discernable boundaries consisting of about 150 contiguous households. All households in the selected EAs were listed in a separate field operation conducted May 7 through 21, 2003. In the third stage, from each EA, an average of 17 households was selected using systematic sampling.

Mode of data collection

Face-to-face

Research instrument

The 2003 NDHS used four questionnaires: a) Household Questionnaire, b) Health Module, c) Women's Questionnaire, and d) Men's Questionnaire. The content of the Women's Questionnaire was based on the MEASURE DHS+ Model “A” Questionnaire, which was developed for use in countries with high levels of contraceptive use. To modify the questionnaire to reflect relevant family planning and health issues in the Philippines, program input was solicited from Department of Health (DOH), Commission on Population (POPCOM), the University of the Philippines Population Institute (UPPI), the Food and Nutrition Research Institute (FNRI), the Philippine Health Insurance Corporation (PhilHealth), USAID, the National Statistics Coordination Board (NSCB), the National Economic and Development Authority (NEDA), the United Nations Children's Fund (UNICEF), and Dr. Mercedes B. Concepcion, professor emeritus at the University of the Philippines, as well as managers of USAID-sponsored projects in the Philippines. The questionnaires were translated from English into six major languages: Tagalog, Cebuano, Ilocano, Bicol, Hiligaynon, and Waray.

a) The Household Questionnaire was used to list all of the usual members and visitors in the selected households. Basic information collected for each person listed includes age, sex, education, and relationship to the head of the household. The main purpose of the Household Questionnaire was to identify women and men who were eligible for the individual interview. Information on characteristics of the household's dwelling unit, such as the source of water, type of toilet facilities, materials used for the floor of the house, and ownership of various durable goods, was also recorded in the Household Questionnaire. These items are indicators of the household's socioeconomic status.

b) The Health Module was aimed at apprising concerned agencies on the health status, practices, and attitude of the population. The module included the following topics:
- Health facility utilization - Noncommunicable diseases - Infectious diseases -Traditional medicines, healing practices, and alternative health care modalities - Health care financing -Environmental health.

c) The Women's Questionnaire was used to collect information from all women age 15-49. These women were asked questions on the following topics: - Background characteristics (e.g., education, media exposure) - Reproductive history - Knowledge and use of family planning methods - Fertility preferences - Antenatal, delivery, and postnatal care - Breastfeeding and infant feeding practices - Vaccinations and childhood illnesses - Marriage and sexual activity - Woman's work and husband's background characteristics - Infant's and children's feeding practices - Childhood mortality - Awareness and behavior regarding AIDS and other sexually transmitted infections - Awareness and behavior regarding tuberculosis

d) The Men's Questionnaire was administered to all men age 15-54 living in every third household in the NDHS sample. The Men's Questionnaire collected much of the same information found in the Women's Questionnaire but was shorter because it did not contain questions on reproductive history, maternal and child health, and nutrition. Instead, men were asked about their knowledge and participation in health-seeking practices for their children.

Cleaning operations

All completed questionnaires and the control forms were returned to the NSO Central Office in Manila for data processing, which consisted of manual editing, data entry and verification, and editing of computer-identified errors. An ad hoc group of seven regular employees of DSSD was created to work full time in the NDHS Data Processing Center. This group was responsible for the different aspects of NDHS data processing. There were 10 manual processors and 25 data encoders hired to process the data.

Manual editing started on July 15, 2003, and data entry started on July 21, 2003. The computer package program called CSPro (Census and Survey Processing System) was used for data entry, editing, and tabulation. To prepare the data entry programs, two NSO staff members spent three weeks in ORC Macro offices in Calverton, Maryland, in April and May 2003. Data processing was completed in October 29, 2003.

Response rate

For the 2003 NDHS sample, 13,914 households were selected, of which 12,694 were occupied (Table). Of these households, 12,586 were successfully interviewed, yielding a household response rate of 99 percent. Household response rates are similar in rural areas and in urban areas (99 percent).

Among the households interviewed, 13,945 women were identified as eligible respondents, and interviews were completed for 13,633 women, yielding a response rate of 98 percent. In a subsample of every third household, 5,009 men were identified to be eligible for individual interview. Of these, 4,766 were successfully interviewed, yielding a response rate of 95 percent.

Sampling error estimates

Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the 2003 NDHS 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.

A sampling error is usually measured in terms of the standard error for a particular statistic (e.g., mean, percentage), 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

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