Abstract

The 2019 Ethiopia Mini Demographic and Health Survey (EMDHS) is the second Mini Demographic and Health Survey conducted in Ethiopia. The Ethiopian Public Health Institute (EPHI) implemented the survey at the request of the Federal Ministry of Health (FMoH). Data collection took place from March 21, 2019, to June 28, 2019.

Financial support for the 2019 EMDHS was provided by the government of Ethiopia, the World Bank via the Ministry of Finance and Economic Development’s Enhancing Shared Prosperity through Equitable Services (ESPES) and Promoting Basic Services (PBS) projects, the United Nations Children’s Fund (UNICEF), and the United States Agency for International Development (USAID). ICF provided technical assistance through The DHS Program, which is funded by USAID and offers support and technical assistance for the implementation of population and health surveys in countries worldwide.

SURVEY OBJECTIVES 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 immunisations, and childhood diseases - To assess the nutritional status of children under age 5 by measuring weight and height

Four full-scale DHS surveys were conducted in 2000, 2005, 2011, and 2016. The first Ethiopia Mini-DHS, or EMDHS, was conducted in 2014. The 2019 EMDHS provides valuable information on trends in key demographic and health indicators over time. The information collected through the 2019 EMDHS is intended to assist policymakers and programme managers in evaluating and designing programmes and strategies for improving the health of the country's population.

Geographic coverage

National coverage

Analysis unit

Households Women age 15-49 Children age 0-59 months

Universe

Household members Woman aged 15-49 years Children aged 0-59 months

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.

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.

Input was solicited from various stakeholders representing government ministries and agencies, nongovernmental organisations, and international donors. After the questionnaires were finalised in English, they were translated into Amarigna, Tigrigna, and Afaan Oromo.

The Household Questionnaire was used to list all of the usual members of and visitors to selected households. Basic demographic information was collected on the characteristics of each person listed, including his or her age, sex, education, and relationship to the head of the household. The data on age and sex of household members obtained in the Household Questionnaire were used to identify women who were eligible for individual interviews. The Household Questionnaire was also used to collect information on characteristics of the household’s dwelling unit, such as source of water, type of toilet facilities, materials used for the floor of the dwelling unit, and ownership of various durable goods.

The Woman’s Questionnaire was used to collect information from all eligible women age 15-49. These women were asked questions on the following main topics: background characteristics, reproduction, contraception, pregnancy and postnatal care, child nutrition, childhood immunisations, and health facility information.

In the Anthropometry Questionnaire, height and weight measurements were recorded for eligible children age 0-59 months in all interviewed households.

The Health Facility Questionnaire was used to record vaccination information for all children without a vaccination card seen during the mother’s interview.

The Fieldworker’s Questionnaire collected background information about interviewers and other fieldworkers who participated in the 2019 EMDHS data collection.

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.

Degree of socio-economic marginality in areas with capabilitiy gaps Socio-economic marginality: Socio-economic marginality in Ethiopia was defined by the following economic, health and educational conditional indicators: 1. Economy: 1.1 Regional poverty headcount indices (% of population whose income/consumption is below the poverty line = 3781 birr) 1.2 Food poverty headcount indices (% of population whose income/consumption for food is below the cost of 2.200 kcal/day per adult food consumption) 1.3 Wealth index (% of population being part of the lowest/2.lowest wealth quintile) 2. Health: 2.1 Child mortality rate (no. of deaths out of 1000 live births <5 years) 2.2 Nutritional status of children (% of children <5 years being stunted) 2.3 Nutritional status of adults (% of men/women age 15-49 with BMI <18.5 = acute under nutrition) 3. Education: 3.1 Illiteracy rate (% of population not being able to read/write in their native language) 3.2 Net enrolment ratio primary school 3.3 Net enrolement ratio high school Data source: 1.1/1.2: Ministry of Finance and Economy Development (2012): Ethiopia‘s Progress Towards Eradicating Poverty: An Interim Report on Poverty Analysis Study (2010/11). Addis Ababa, Ethiopia 1.3/2.1/2.2/2.3: Central Statistical Agency(CSA), ICF International (2012): Ethiopia Demographic and Health Survey 2011. Addis Ababa, Ethiopia; Calverton, USA Capability gap: Areas with good agro-ecological suitability, but limited socio-economic capabilities of farmers to make use of this suitability. Agro-ecological suitability in Ethiopia was defined from the raster data set of agro-ecological suitability for rainfed crops (Fischer et al. 2002) Data source: Fischer et al. (2002): Global Agro-ecological Assessment for Agriculture in the 21st Century: Methodology and Results. International Institute for Applied Systems Analysis, Laxenburg, Austria The socio-economic capabilities of farmers were defined by the following indicators: 1. Access to technology (% of holders applying inorganic fertilizer to any crop during Meher season) 2. Access to credit (% of holders utilizing credit services) 3. Access to knowledge (% of holders utilizing advisory services) Data source: Central Statistical Agency (CSA) (2002): Ethiopian Agricultural Sample Enumeration. Addis Ababa, Ethiopia