Abstract

The 2016 Ethiopia Demographic and Health Survey (EDHS) is the fourth Demographic and Health Survey conducted in Ethiopia. It was implemented by the Central Statistical Agency (CSA) at the request of the Federal Ministry of Health (FMoH). The primary objective of the 2016 EDHS is to provide up-to-date estimates of key demographic and health indicators. The EDHS provides a comprehensive overview of population, maternal, and child health issues in Ethiopia. More specifically, the 2016 EDHS: - Collected data at the national level that allowed calculation of key demographic indicators, particularly fertility and under-5 and adult mortality rates - Explored the direct and indirect factors that determine levels and trends of fertility and child mortality ? Measured levels of contraceptive knowledge and practice - Collected data on key aspects of family health, including immunisation coverage among children, prevalence and treatment of diarrhoea and other diseases among children under age 5, and maternity care indicators such as antenatal visits and assistance at delivery - Obtained data on child feeding practices, including breastfeeding - Collected anthropometric measures to assess the nutritional status of children under age 5, women age 15-49, and men age 15-59 - Conducted haemoglobin testing on eligible children age 6-59 months, women age 15-49, and men age 15-59 to provide information on the prevalence of anaemia in these groups - Collected data on knowledge and attitudes of women and men about sexually transmitted diseases and HIV/AIDS and evaluated potential exposure to the risk of HIV infection by exploring high-risk behaviours and condom use - Conducted HIV testing of dried blood spot (DBS) samples collected from women age 15-49 and men age 15-59 to provide information on the prevalence of HIV among adults of reproductive age - Collected data on the prevalence of injuries and accidents among all household members - Collected data on knowledge and prevalence of fistula and female genital mutilation or cutting (FGM/C) among women age 15-49 and their daughters age 0-14 - Obtained data on women’s experience of emotional, physical, and sexual violence.

Geographic coverage

National

Analysis unit

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

Universe

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

Kind of data

Sample survey data [ssd]

Sampling procedure

The sampling frame used for the 2016 EDHS is the Ethiopia Population and Housing Census (PHC), which was conducted in 2007 by the Ethiopia Central Statistical Agency. The census frame is a complete list of 84,915 enumeration areas (EAs) created for the 2007 PHC. An EA is a geographic area covering on average 181 households. The sampling frame contains information about the EA location, type of residence (urban or rural), and estimated number of residential households. With the exception of EAs in six zones of the Somali region, each EA has accompanying cartographic materials. These materials delineate geographic locations, boundaries, main access, and landmarks in or outside the EA that help identify the EA. In Somali, a cartographic frame was used in three zones where sketch maps delineating the EA geographic boundaries were available for each EA; in the remaining six zones, satellite image maps were used to provide a map for each EA.

Administratively, Ethiopia is divided into nine geographical regions and two administrative cities. The sample for the 2016 EDHS was designed to provide estimates of key indicators for the country as a whole, for urban and rural areas separately, and for each of the nine regions and the two administrative cities.

The 2016 EDHS sample was stratified and selected in two stages. Each region was stratified into urban and rural areas, yielding 21 sampling strata. Samples of EAs were selected independently in each stratum in two stages. Implicit stratification and proportional allocation were achieved at each of the lower administrative levels by sorting the sampling frame within each sampling stratum before sample selection, according to administrative units in different levels, and by using a probability proportional to size selection at the first stage of sampling.

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

Mode of data collection

Face-to-face [f2f]

Research instrument

Five questionnaires were used for the 2016 EDHS: the Household Questionnaire, the Woman’s Questionnaire, the Man’s Questionnaire, the Biomarker Questionnaire, and the Health Facility Questionnaire. These questionnaires, based on the DHS Program’s standard Demographic and Health Survey questionnaires, were adapted to reflect the population and health issues relevant to Ethiopia. Input was solicited from various stakeholders representing government ministries and agencies, nongovernmental organisations, and international donors. After all questionnaires were finalised in English, they were translated into Amarigna, Tigrigna, and Oromiffa.

Cleaning operations

All electronic data files for the 2016 EDHS were transferred via IFSS to the CSA central office in Addis Ababa, where they were stored on a password-protected computer. The data processing operation included secondary editing, which required resolution of computer-identified inconsistencies and coding of openended questions; it also required generating a file for the list of children for whom a vaccination card was not seen by the interviewers and whose vaccination records had to be checked at health facilities. The data were processed by two individuals who took part in the main fieldwork training; they were supervised by two senior staff from CSA. Data editing was accomplished using CSPro software. During the duration of fieldwork, tables were generated to check various data quality parameters and specific feedback was given to the teams to improve performance. Secondary editing and data processing were initiated in January 2016 and completed in August 2016.

Response rate

A total of 18,008 households were selected for the sample, of which 17,067 were occupied. Of the occupied households, 16,650 were successfully interviewed, yielding a response rate of 98%.

In the interviewed households, 16,583 eligible women were identified for individual interviews. Interviews were completed with 15,683 women, yielding a response rate of 95%. A total of 14,795 eligible men were identified in the sampled households and 12,688 were successfully interviewed, yielding a response rate of 86%. Although overall there was little variation in response rates according to residence, response rates among men were higher in rural than in urban areas.

Sampling error estimates

The estimates from a sample survey are affected by two types of errors: non-sampling errors and sampling errors. Non-sampling 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 the questions by either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the 2016 Ethiopia DHS (EDHS) to minimise this type of error, non-sampling errors are impossible to avoid and are difficult to evaluate statistically.

Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the 2016 EDHS is only one of many samples that could have been selected from the same population, by using the same design and the expected size. Each of those 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 error is usually measured in terms of the standard error for a particular statistic (such as mean or 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 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 as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the 2016 EDHS sample is the result of a multi-stage stratified design and, consequently, it was necessary to use more complex formulae. Sampling errors are computed in either ISSA or SAS, with programs developed by ICF International. These programs use the Taylor linearisation method of variance estimation for survey estimates that are means, proportions, or ratios. The Jackknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates.

A more detailed description of estimates of sampling errors are presented in Appendix B of the survey final report.

Data appraisal

Data Quality Tables - Household age distribution - Age distribution of eligible and interviewed women - Age distribution of eligible and interviewed men - Completeness of reporting - Births by calendar

Abstract

The 2019 Ethiopia Mini Demographic and Health Survey (EMDHS) is a nationwide survey with a nationally representative sample of 9,150 selected households. All women age 15-49 who were usual members of the selected households and those who spent the night before the survey in the selected households were eligible to be interviewed in the survey. In the selected households, all children under age 5 were eligible for height and weight measurements. The survey was designed to produce reliable estimates of key indicators at the national level as well as for urban and rural areas and each of the 11 regions in Ethiopia.

The primary objective of the 2019 EMDHS is to provide up-to-date estimates of key demographic and health indicators. Specifically, the main objectives of the survey are: ▪ To collect high-quality data on contraceptive use; maternal and child health; infant, child, and neonatal mortality levels; child nutrition; and other health issues relevant to achievement of the Sustainable Development Goals (SDGs) ▪ To collect information on health-related matters such as breastfeeding, maternal and child care (antenatal, delivery, and postnatal), children’s immunizations, and childhood diseases ▪ To assess the nutritional status of children under age 5 by measuring weight and height

Geographic coverage

National coverage

Analysis unit

• Household
• Individual
• Children age 0-5
• Woman age 15-49
• Health facility

Universe

The survey covered all de jure household members (usual residents), all women aged 15-49 and all children aged 0-5 resident in the household.

Kind of data

Sample survey data [ssd]

Sampling procedure

The sampling frame used for the 2019 EMDHS is a frame of all census enumeration areas (EAs) created for the 2019 Ethiopia Population and Housing Census (EPHC) and conducted by the Central Statistical Agency (CSA). The census frame is a complete list of the 149,093 EAs created for the 2019 EPHC. An EA is a geographic area covering an average of 131 households. The sampling frame contains information about EA location, type of residence (urban or rural), and estimated number of residential households.

Administratively, Ethiopia is divided into nine geographical regions and two administrative cities. The sample for the 2019 EMDHS was designed to provide estimates of key indicators for the country as a whole, for urban and rural areas separately, and for each of the nine regions and the two administrative cities.

The 2019 EMDHS sample was stratified and selected in two stages. Each region was stratified into urban and rural areas, yielding 21 sampling strata. Samples of EAs were selected independently in each stratum in two stages. Implicit stratification and proportional allocation were achieved at each of the lower administrative levels by sorting the sampling frame within each sampling stratum before sample selection, according to administrative units in different levels, and by using a probability proportional to size selection at the first stage of sampling.

To ensure that survey precision was comparable across regions, sample allocation was done through an equal allocation wherein 25 EAs were selected from eight regions. However, 35 EAs were selected from each of the three larger regions: Amhara, Oromia, and the Southern Nations, Nationalities, and Peoples’ Region (SNNPR).

In the first stage, a total of 305 EAs (93 in urban areas and 212 in rural areas) were selected with probability proportional to EA size (based on the 2019 EPHC frame) and with independent selection in each sampling stratum. A household listing operation was carried out in all selected EAs from January through April 2019. The resulting lists of households served as a sampling frame for the selection of households in the second stage. Some of the selected EAs for the 2019 EMDHS were large, with more than 300 households. To minimise the task of household listing, each large EA selected for the 2019 EMDHS was segmented. Only one segment was selected for the survey, with probability proportional to segment size. Household listing was conducted only in the selected segment; that is, a 2019 EMDHS cluster is either an EA or a segment of an EA.

In the second stage of selection, a fixed number of 30 households per cluster were selected with an equal probability systematic selection from the newly created household listing. All women age 15-49 who were either permanent residents of the selected households or visitors who slept in the household the night before the survey were eligible to be interviewed. In all selected households, height and weight measurements were collected from children age 0-59 months, and women age 15-49 were interviewed using the Woman’s Questionnaire.

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

Mode of data collection

Computer Assisted Personal Interview [capi]

Research instrument

Five questionnaires were used for the 2019 EMDHS: (1) the Household Questionnaire, (2) the Woman’s Questionnaire, (3) the Anthropometry Questionnaire, (4) the Health Facility Questionnaire, and (5) the Fieldworker’s Questionnaire. These questionnaires, based on The DHS Program’s standard questionnaires, were adapted to reflect the population and health issues relevant to Ethiopia. They were shortened substantially to collect data on indicators of particular relevance to Ethiopia and donors to child health programmes.

Cleaning operations

All electronic data files were transferred via the secure internet file streaming system (IFSS) to the EPHI central office in Addis Ababa, where they were stored on a password-protected computer. The data processing operation included secondary editing, which required resolution of computer-identified inconsistencies and coding of open-ended questions. The data were processed by EPHI staff members and an ICF consultant who took part in the main fieldwork training. They were supervised remotely by staff from The DHS Program. Data editing was accomplished using CSPro System software. During the fieldwork, field-check tables were generated to check various data quality parameters, and specific feedback was given to the teams to improve performance. Secondary editing, double data entry from both the anthropometry and health facility questionnaires, and data processing were initiated in April 2019 and completed in July 2019.

Response rate

A total of 9,150 households were selected for the sample, of which 8,794 were occupied. Of the occupied households, 8,663 were successfully interviewed, yielding a response rate of 99%.

In the interviewed households, 9,012 eligible women were identified for individual interviews; interviews were completed with 8,885 women, yielding a response rate of 99%. Overall, there was little variation in response rates according to residence; however, rates were slightly higher in rural than in urban areas.

Sampling error estimates

The estimates from a sample survey are affected by two types of errors: nonsampling errors and 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 2019 Ethiopia Mini Demographic and Health Survey (EMDHS) to minimize this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically.

Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the 2019 EMDHS 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 among all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results.

Sampling error is 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 as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the 2019 EMDHS sample is the result of a multi-stage stratified design, and, consequently, it was necessary to use more complex formulas. Sampling errors are computed in SAS, using programs developed by ICF. These programs use the Taylor linearization method to estimate variances for survey estimates that are means, proportions, or ratios. The Jackknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates.

Note: A more detailed description of estimates of sampling errors are presented in APPENDIX B of the survey report.

Data appraisal

Data Quality Tables

• Household age distribution

- Age distribution of eligible and interviewed women

Prevalence of undernutrition, Ethiopia Demographic and Health Survey (EDHS), 2016 (N = 9,464).

The individual level characteristics of 6–23 months age children in Ethiopia, EDHS 2016(n = 2919).

Summary of OLS results for short birth interval in Ethiopia, EDHS 2016.

Low birth weight is a significant risk factor associated with high rates of neonatal and infant mortality, particularly in developing countries. However, most studies conducted on this topic in Ethiopia have small sample sizes, often focusing on specific areas and using standard models employing maximum likelihood estimation, leading to potential bias and inaccurate coverage probability. This study used a novel approach, the Bayesian rank likelihood method, within a latent traits model, to estimate parameters and provide a nationwide estimate of low birth weight and its risk factors in Ethiopia. Data from the Ethiopian Demographic and Health Survey (EDHS) of 2016 were used as a data source for the study. Data stratified all regions into urban and rural areas. Among 15, 680 representative selected households, the analysis included complete cases from 10, 641 children. The evaluation of model performance considered metrics such as the root mean square error, the mean absolute error, and t..., , , # Rank likelihood-based estimation of low birth weight in Ethiopia

Low birth weight data was obtained from the Ethiopian Demographic and Health Survey (EDHS).

Raw data: Lowbirthweight.sav

Description of the data and file structure

Lowbirthweightdata_data

childweight: categorical weight of the child at birth motherage: age of the mothers ancvisti: number of antenatal care visits that the mothers attended birthorder: order of birth for the child birthinterval: time between successive births (months) bmi: body mass index of the mothers Regions: the region where the child born CLID: cluster-level ID that indicates from which cluster the information is obtained

Sharing or accessing information

Our data is taken from the DHS website (http://dhsprogram.com. Low birth weight data was extracted from the 2016 EDHS. EDHS 2016 was conducted using standardized survey design and data collection procedures.

Socio-demographic, obstetric and community-level characteristics of women in Ethiopia, EDHS 2016.

Factors associated with mother-to-child HIV transmission knowledge among reproductive-age women in Ethiopia, EDHS 2016.

Multilevel multivariable analysis of factors associated with delayed first ANC booking in Ethiopia, EDHS 2016.

The socio-demography characteristics of 15–59 years old men in Ethiopia: The 2016 EDHS source-based study.

The Community level characteristics of 6–23 months age children in Ethiopian, EDHS 2016 (n = 2919).

Maternal characteristics result of respondents in 2016 EDHS, Ethiopia.

Socio-demographic characteristics of the study population with limited access to an improved drinking water source in Ethiopia, 2016 EDHS.

Antenatal care-related and individual characteristics of reproductive-age women in Ethiopia, EDHS 2016.

Association between individual and combined access to WASH and wasting among children 0–59 months of age, EDHS 2016 (n = 9607).

Variability at community-level and model comparison for perinatal mortality among women’s in the 5 years preceding the survey in Ethiopia, EDHS, 2016.

Distribution of dual alcohol and khat use in Ethiopia among 15–59 years old men: The 2016 EDHS source based study.

WASH facilities and prevalence of child growth failure indicators, 2016 EDHS (weighted n = 11023).

Association between individual and combined access to WASH and stunting among children 0–59 months of age, EDHS 2016 (n = 9588).

Socio-demographic characteristic of young, sexually active women in Ethiopia, EDHS 2016 (N = 2661).