The probability of dying between birth and the exact age of 1, expressed per 1,000 live births. The data is sorted by both sex and total and includes a range of values from 1900 to 2019. The calculation for infant mortality rates is derived from a standard period abridged life table using the age-specific deaths and mid-year population counts from civil registration data. This data is sourced from the UN Inter-Agency Group for Child Mortality Estimation. The UN IGME uses the same estimation method across all countries to arrive at a smooth trend curve of age-specific mortality rates. The estimates are based on high quality nationally representative data including statistics from civil registration systems, results from household surveys, and censuses. The child mortality estimates are produced in conjunction with national level agencies such as a country’s Ministry of Health, National Statistics Office, or other relevant agencies.

Sample size calculation summery for predictors of neonatal morality at NICU of study hospitals during study period.

VITAL SIGNS INDICATOR Life Expectancy (EQ6)

FULL MEASURE NAME Life Expectancy

LAST UPDATED April 2017

DESCRIPTION Life expectancy refers to the average number of years a newborn is expected to live if mortality patterns remain the same. The measure reflects the mortality rate across a population for a point in time.

DATA SOURCE State of California, Department of Health: Death Records (1990-2013) No link

California Department of Finance: Population Estimates Annual Intercensal Population Estimates (1990-2010) Table P-2: County Population by Age (2010-2013) http://www.dof.ca.gov/Forecasting/Demographics/Estimates/

CONTACT INFORMATION vitalsigns.info@mtc.ca.gov

METHODOLOGY NOTES (across all datasets for this indicator) Life expectancy is commonly used as a measure of the health of a population. Life expectancy does not reflect how long any given individual is expected to live; rather, it is an artificial measure that captures an aspect of the mortality rates across a population. Vital Signs measures life expectancy at birth (as opposed to cohort life expectancy). A statistical model was used to estimate life expectancy for Bay Area counties and Zip codes based on current life tables which require both age and mortality data. A life table is a table which shows, for each age, the survivorship of a people from a certain population.

Current life tables were created using death records and population estimates by age. The California Department of Public Health provided death records based on the California death certificate information. Records include age at death and residential Zip code. Single-year age population estimates at the regional- and county-level comes from the California Department of Finance population estimates and projections for ages 0-100+. Population estimates for ages 100 and over are aggregated to a single age interval. Using this data, death rates in a population within age groups for a given year are computed to form unabridged life tables (as opposed to abridged life tables). To calculate life expectancy, the probability of dying between the jth and (j+1)st birthday is assumed uniform after age 1. Special consideration is taken to account for infant mortality. For the Zip code-level life expectancy calculation, it is assumed that postal Zip codes share the same boundaries as Zip Code Census Tabulation Areas (ZCTAs). More information on the relationship between Zip codes and ZCTAs can be found at https://www.census.gov/geo/reference/zctas.html. Zip code-level data uses three years of mortality data to make robust estimates due to small sample size. Year 2013 Zip code life expectancy estimates reflects death records from 2011 through 2013. 2013 is the last year with available mortality data. Death records for Zip codes with zero population (like those associated with P.O. Boxes) were assigned to the nearest Zip code with population. Zip code population for 2000 estimates comes from the Decennial Census. Zip code population for 2013 estimates are from the American Community Survey (5-Year Average). The ACS provides Zip code population by age in five-year age intervals. Single-year age population estimates were calculated by distributing population within an age interval to single-year ages using the county distribution. Counties were assigned to Zip codes based on majority land-area.

Zip codes in the Bay Area vary in population from over 10,000 residents to less than 20 residents. Traditional life expectancy estimation (like the one used for the regional- and county-level Vital Signs estimates) cannot be used because they are highly inaccurate for small populations and may result in over/underestimation of life expectancy. To avoid inaccurate estimates, Zip codes with populations of less than 5,000 were aggregated with neighboring Zip codes until the merged areas had a population of more than 5,000. In this way, the original 305 Bay Area Zip codes were reduced to 218 Zip code areas for 2013 estimates. Next, a form of Bayesian random-effects analysis was used which established a prior distribution of the probability of death at each age using the regional distribution. This prior is used to shore up the life expectancy calculations where data were sparse.

BackgroundTimely initiation of and exclusive breastfeeding have been recommended as key interventions to enable countries to attain the sustainable development target of reducing neonatal mortality to no more than 12 deaths per 1000 live births and to reduce mortality of children under 5 years to no more than 25 deaths per 1000 live births.MethodsWe conducted a cluster randomized controlled trial with the main objective to assess the effect of an integrated package consisting of: peer counseling, mobile phone messages, and mama kits on promoting health facility births between January 2018 and February 2019, in Lira district, Northern Uganda. In this article, we assessed the effect of the intervention on our two secondary objectives: timely initiation of and exclusivity of breastfeeding. We used a generalized estimation equation of the Poisson family, with a log or identity link, taking clustering into account to estimate prevalence ratios and prevalence differences.ResultsA total of 64% (594/926) of participants in the intervention arm initiated breastfeeding within the first hour after birth compared to 60% (493/829) in the control arm. The proportion of participants in the intervention arm that initiated breastfeeding within the first hour of life did not significantly differ from that in the control arm [Prevalence Ratio (PR) 1.08 (0.97 to 1.21)] and [Prevalence Difference (PD) 0.05 (-0.02 to 0.12)]. When we restricted the analysis to only mothers who decided on when to breastfeed, there was some evidence of intervention effectiveness [PR 1.20, 95% CI (0.99–1.5)]. In the intervention arm, 89% (804/904) of participants exclusively breastfed their infants in the first month of life compared to 81% (656/813) in the control arm. Participants in the intervention arm were 10% more likely to have exclusively breastfed in the preceding 24 hours compared to mothers in the control arm [PR 1.10 (1.04 to 1.17)] and [PD 0.08 (0.04 to 0.13)], and 16% more likely to have exclusively breastfed since birth compared to mothers in the control arm [PR 1.16 (1.03 to 1.30)] and [PD 0.12 (0.03 to 0.20].ConclusionThe intervention improved the proportion of mothers who practiced exclusive breastfeeding in the first month of life, but did not increase the proportion of mothers who initiated breastfeeding in the first hour of life. Future breastfeeding promotion interventions should consider including a health facility component and improving maternal autonomy to promote timely initiation of breastfeeding.

Baby Food And Infant Formula Market Outlook

The global baby food and infant formula market size was valued at approximately USD 57 billion in 2023 and is projected to reach around USD 85 billion by 2032, growing at a compound annual growth rate (CAGR) of 4.5%. This growth trajectory is largely driven by increasing awareness among parents about the importance of nutrition during the early stages of a child's development. Furthermore, the rising number of working women worldwide has amplified the demand for convenient and nutritious food options for infants, as parents seek balanced diet solutions that can support the healthy growth of their babies without compromising on convenience. The evolving consumer preferences towards organic and natural baby food products also contribute significantly to market expansion.

In addition to lifestyle changes, the growth of the baby food and infant formula market is buoyed by technological advancements in food production and packaging. With innovations in food processing techniques, manufacturers are able to offer products with enhanced nutritional profiles while ensuring longer shelf lives without the use of artificial preservatives. This has not only helped meet the demands of consumers who are increasingly health-conscious but has also enabled companies to expand their product lines to cater to the diverse nutritional needs of infants at different developmental stages. The advent of fortified baby foods, which are enriched with essential vitamins and minerals, is another growth driver, as parents become increasingly concerned about filling potential nutritional gaps in their infants' diets.

Another significant factor contributing to the market's growth is the expanding middle-class population in developing regions. As disposable incomes rise, more families are able to afford high-quality baby food and infant formula products. This is particularly evident in countries like India and China, where urbanization and improved economic conditions have led to changes in dietary habits and increased spending on child health and nutrition. The demand for premium and organic baby food products is also growing in these regions, as consumers become more aware of the potential health benefits associated with such products. Moreover, government initiatives aimed at reducing infant mortality rates and improving child nutrition also play a crucial role in boosting market growth.

The growing awareness about the nutritional needs of infants has led to a significant rise in the demand for Infant Formula Foods. These products are meticulously formulated to provide essential nutrients that support the healthy development of infants, especially when breastfeeding is not an option. With advancements in nutritional science, infant formula foods now offer a closer approximation to the nutritional profile of breast milk, ensuring that infants receive the necessary vitamins and minerals for optimal growth. This has been particularly beneficial for working parents who require reliable and nutritious alternatives to meet their infants' dietary needs. As the market for infant formula foods expands, manufacturers are increasingly focusing on enhancing the quality and safety of these products to meet the stringent standards expected by health-conscious consumers.

Regionally, the market presents a diverse outlook with specific growth trends and opportunities. Asia Pacific holds a significant share of the market and is expected to continue its dominance over the forecast period, driven by the large populations in China and India, where increasing urbanization and a growing middle class are major factors. North America, with its high level of health consciousness and substantial expenditure on health-related products, shows a steady growth pattern. Conversely, Europe is experiencing growth driven by technological advancements and a strong inclination towards organic products, whereas Latin America and the Middle East & Africa are emerging markets with potential for expansion due to improving economic conditions and increasing birth rates.

Product Type Analysis

The baby food and infant formula market is segmented by product type, which includes milk formula, dried baby food, prepared baby food, and others. Milk formula remains the leading segment, accounting for a significant portion of the market share. The high demand for milk formula can be attributed to its convenience and nutritional benefits that closely mimic breast milk, making it a preferred choi

VITAL SIGNS INDICATOR Life Expectancy (EQ6)

FULL MEASURE NAME Life Expectancy

LAST UPDATED April 2017

DESCRIPTION Life expectancy refers to the average number of years a newborn is expected to live if mortality patterns remain the same. The measure reflects the mortality rate across a population for a point in time.

DATA SOURCE State of California, Department of Health: Death Records (1990-2013) No link

California Department of Finance: Population Estimates Annual Intercensal Population Estimates (1990-2010) Table P-2: County Population by Age (2010-2013) http://www.dof.ca.gov/Forecasting/Demographics/Estimates/

U.S. Census Bureau: Decennial Census ZCTA Population (2000-2010) http://factfinder.census.gov

U.S. Census Bureau: American Community Survey 5-Year Population Estimates (2013) http://factfinder.census.gov

CONTACT INFORMATION vitalsigns.info@mtc.ca.gov

METHODOLOGY NOTES (across all datasets for this indicator) Life expectancy is commonly used as a measure of the health of a population. Life expectancy does not reflect how long any given individual is expected to live; rather, it is an artificial measure that captures an aspect of the mortality rates across a population that can be compared across time and populations. More information about the determinants of life expectancy that may lead to differences in life expectancy between neighborhoods can be found in the Bay Area Regional Health Inequities Initiative (BARHII) Health Inequities in the Bay Area report at http://www.barhii.org/wp-content/uploads/2015/09/barhii_hiba.pdf. Vital Signs measures life expectancy at birth (as opposed to cohort life expectancy). A statistical model was used to estimate life expectancy for Bay Area counties and ZIP Codes based on current life tables which require both age and mortality data. A life table is a table which shows, for each age, the survivorship of a people from a certain population.

Current life tables were created using death records and population estimates by age. The California Department of Public Health provided death records based on the California death certificate information. Records include age at death and residential ZIP Code. Single-year age population estimates at the regional- and county-level comes from the California Department of Finance population estimates and projections for ages 0-100+. Population estimates for ages 100 and over are aggregated to a single age interval. Using this data, death rates in a population within age groups for a given year are computed to form unabridged life tables (as opposed to abridged life tables). To calculate life expectancy, the probability of dying between the jth and (j+1)st birthday is assumed uniform after age 1. Special consideration is taken to account for infant mortality.

For the ZIP Code-level life expectancy calculation, it is assumed that postal ZIP Codes share the same boundaries as ZIP Code Census Tabulation Areas (ZCTAs). More information on the relationship between ZIP Codes and ZCTAs can be found at http://www.census.gov/geo/reference/zctas.html. ZIP Code-level data uses three years of mortality data to make robust estimates due to small sample size. Year 2013 ZIP Code life expectancy estimates reflects death records from 2011 through 2013. 2013 is the last year with available mortality data. Death records for ZIP Codes with zero population (like those associated with P.O. Boxes) were assigned to the nearest ZIP Code with population. ZIP Code population for 2000 estimates comes from the Decennial Census. ZIP Code population for 2013 estimates are from the American Community Survey (5-Year Average). ACS estimates are adjusted using Decennial Census data for more accurate population estimates. An adjustment factor was calculated using the ratio between the 2010 Decennial Census population estimates and the 2012 ACS 5-Year (with middle year 2010) population estimates. This adjustment factor is particularly important for ZCTAs with high homeless population (not living in group quarters) where the ACS may underestimate the ZCTA population and therefore underestimate the life expectancy. The ACS provides ZIP Code population by age in five-year age intervals. Single-year age population estimates were calculated by distributing population within an age interval to single-year ages using the county distribution. Counties were assigned to ZIP Codes based on majority land-area.

ZIP Codes in the Bay Area vary in population from over 10,000 residents to less than 20 residents. Traditional life expectancy estimation (like the one used for the regional- and county-level Vital Signs estimates) cannot be used because they are highly inaccurate for small populations and may result in over/underestimation of life expectancy. To avoid inaccurate estimates, ZIP Codes with populations of less than 5,000 were aggregated with neighboring ZIP Codes until the merged areas had a population of more than 5,000. ZIP Code 94103, representing Treasure Island, was dropped from the dataset due to its small population and having no bordering ZIP Codes. In this way, the original 305 Bay Area ZIP Codes were reduced to 217 ZIP Code areas for 2013 estimates. Next, a form of Bayesian random-effects analysis was used which established a prior distribution of the probability of death at each age using the regional distribution. This prior is used to shore up the life expectancy calculations where data were sparse.

Abstract

The 1992 Namibia Demographic and Health Survey (NDHS) is a nationally representative survey conducted by the Ministry of Health and Social Services, assisted by the Central Statistical Office, with the aim of gathering reliable information on fertility, family planning, infant and child mortality, maternal mortality, maternal and child health and nutrition. Interviewers collected information on the reproductive histories of 5,421 women 15-49 years and on the health of 3,562 children under the age of five years.

The Namibia Demographic and Health Survey (NDHS) is a national sample survey of women of reproductive age designed to collect data on mortality and fertility, socioeconomic characteristics, marriage patterns, breastfeeding, use of contraception, immunisation of children, accessibility to health and family planning services, treatment of children during episodes of illness, and the nutritional status of women and children. More specifically, the objectives of NDHS are: - To collect data at the national level which will allow the calculation of demographic rates, particularly fertility rates and child mortality rates, and maternal mortality rates; To analyse the direct and indirect factors which determine levels and trends in fertility and childhood mortality, Indicators of fertility and mortality are important in planning for social and economic development; - To measure the level of contraceptive knowledge and practice by method, region, and urban/rural residence; - To collect reliable data on family health: immunisations, prevalence and treatment of diarrhoea and other diseases among children under five, antenatal visits, assistance at delivery and breastfeeding; - To measure the nutritional status of children under five and of their mothers using anthropometric measurements (principally height and weight).

MAIN RESULTS

According to the NDHS, fertility is high in Namibia; at current fertility levels, Namibian women will have an average of 5.4 children by the end of their reproductive years. This is lower than most countries in sub-Saharan Africa, but similar to results from DHS surveys in Botswana (4.9 children per woman) and Zimbabwe (5.4 children per woman). Fertility in the South and Central regions is considerably lower (4.1 children per woman) than in the Northeast (6.0) and Northwest regions (6.7).

About one in four women uses a contraceptive method: 29 percent of married women currently use a method (26 percent use a modem method), and 23 percent of all women are current users. The pill, injection and female sterilisation are the most popular methods among married couples: each is used by about 7 to 8 percent of currently married women. Knowledge of contraception is high, with almost 90 percent of all women age 15-49 knowing of any modem method.

Certain groups of women are much more likely to use contraception than others. For example, urban women are almost four times more likely to be using a modem contraceptive method (47 percent) than rural women (13 percent). Women in the South and Central regions, those with more education, and those living closer to family planning services are also more likely to be using contraception.

Levels of fertility and contraceptive use are not likely to change until there is a drop in desired family size and until the idea of reproductive choice is more widely accepted. At present, the average ideal family size (5.0 children) is only slightly lower than the total fertility rate (5.4 children). Thus, the vast majority of births are wanted.

On average, Namibian women have their first child when they are about 21 years of age. The median age at first marriage is, however, 25 years. This indicates that many women give birth before marriage. In fact, married women are a minority in Namibia: 51 percent of women 15-49 were not married, 27 percent were currently married, 15 percent were currently living with a man (informal union), and 7 percent were widowed, divorced or separated. Therefore, a large proportion of children in Namibia are born out of wedlock.

The NDHS also provides inlbrmation about maternal and child health. The data indicate that 1 in 12 children dies before the fifth birthday. However, infant and child mortality have been declining over the past decade. Infant mortality has fallen from 67 deaths per 1,000 live births for the period 1983-87 to 57 per 1,000 live births for the period 1988-92, a decline of about 15 percent. Mortality is higher in the Northeast region than elsewhere in Namibia.

The leading causes of death are diarrhoea, undemutrition, acute respiratory infection (pneumonia) and malaria: each of these conditions was associated with about one-fifth of under-five deaths. Among neonatal deaths low birth weight and birth problems were the leading causes of death. Neonatal tetanus and measles were not lbund to be major causes of death.

Maternal mortality was estimated from reports on the survival status of sisters of the respondent. Maternal mortality was 225 per 100,000 live births for the decade prior to the survey. NDHS data also show considerable excess male mortality at ages 15-49, which may in part be related to the war of independence during the 1980s.

Utilisation of maternal and child health services is high. Almost 90 percent of mothers received antenatal care, and two-thirds of children were bom in health facilities. Traditional birth attendants assisted only 6 percent of births in the five years preceding the survey. Child vaccination coverage has increased rapidly since independence. Ninety-five percent of children age 12-23 months have received at least one vaccination, while 76 percent have received a measles vaccination, and 70 percent three doses of DPT and polio vaccines.

Children with symptoms of possible acute respiratory infection (cough and rapid breathing) may have pneumonia and need to be seen by a health worker. Among children with such symptoms in the two weeks preceding the survey two-thirds were taken to a health facility. Only children of mothers who lived more than 30 km from a health facility were less likely to be taken to a facility.

About one in five children had diarrhoea in the two weeks prior to the survey. Diarrhoea prevalence was very high in the Northeast region, where almost half of children reportedly had diarrhoea. The dysentery epidemic contributed to this high figure: diarrhoea with blood was reported for 17 percent of children under five in the Northeast region. Among children with diarrhoea in the last two weeks 68 percent were taken to a health facility, and 64 percent received a solution prepared from ORS packets. NDHS data indicate that more emphasis needs to put on increasing fluids during diarrhoea, since only I 1 percent mothers of children with diarrhoea said they increased the amount of fluids given during the episode.

Nearly all babies are breastfed (95 percent), but only 52 percent are put on the breast immediately. Exclusive breastfeeding is practiced for a short period, but not for the recommended 4-6 months. Most babies are given water, formula, or other supplements within the first four months of life, which both jeopardises their nutritional status and increases the risk of infection. On average, children are breastfed for about 17 months, but large differences exist by region. In the South region children are breastfed lor less than a year, in the Northwest region for about one and a half years and in the Northeast region for almost two years.

Most babies are weighed at birth, but the actual birth weight could be recalled for only 44 percent of births. Using these data and data on reported size of the newborn, for all births in the last five years, it was estimated that the mean birth weight in Namibia is 3048 grams, and that 16 percent of babies were low birth weight (less than 2500 grams).

Stunting, an indication of chronic undemutrition, was observed for 28 percent of children under five. Stunting was more common in the Northeast region (42 percent) than elsewhere in Namibia. Almost 9 percent of children were wasted, which is an indication of acute undemutrition. Wasting is higher than expected for Namibia and may have been caused by the drought conditions during 1992.

Matemal height is an indicator of nutritional status over generations. Women in Namibia have an average height of 160 cm and there is little variation by region. The Body Mass Index (BM1), defined as weight divided by squared height, is a measure of current nutritional status and was lower among women in the Northwest and the Northeast regions than among women in the South and Central regions.

On average, women had a health facility available within 40 minutes travel time. Women in the Northwest region, however, had to travel more than one hour to reach the nearest health facility. At a distance of less than 10 km, 56 percent of women had access to antenatal services, 48 percent to maternity services, 72 percent to immunisation services, and 49 percent to family planning services. Within one hour of travel time, fifty-two percent of women had antenatal services, 48 percent delivery services, 64 percent immunisation services and 49 percent family planning services. Distance and travel time were greatest in the Northwest region.

Geographic coverage

The sample for the NDHS was designed to be nationally representative. The design involved a two- stage stratified sample which is self-weighting within each of the three health regions for which estimates of fertility and mortality were required--Northwest, Northeast, and the combined Central/South region. In order to have a sufficient number of cases for analysis, oversampling was necessary for the Northeast region, which has only 14.8 percent of the population. Therefore, the sample was not allocated proportionally across regions and is not completely

The market value of the baby food industry in India, a country with ********* of the world’s children, was around *** million U.S. dollars in 2018. The population in the country was approximately *** billion in mid-2018 and is well on course to beat China as the most populated country in the coming decades. To put things into perspective, *** in every six people on the planet live in the south Asian country.

Advancement in technology and mindset

Technological advancements had a major impact on the mortality rates of infants in the country. However, it can be assumed that it was the change in mindset that has brought about the major change. With awareness campaigns like “Beti bachao, beti padhai” translating to “Save the daughter, educate the daughter” has reduced selective abortions and infanticide in recent years. The infant mortality rate was close to ** deaths per thousand live births in 2017 which was the lowest recorded in the last decade.

Food up for grabs

With the reducing mortality rates, the baby food industry recorded huge profits. Baby food sales were more than *** million U.S. dollars in 2016. With possibilities of delving into the organic baby food segment with milk formula and baby cereal, big players like Nestle India have promising prospects and opportunities to shape the future of the baby food industry.

Maternal Infant Care Product Market Outlook

The global maternal infant care product market size was valued at USD 24 billion in 2023 and is projected to reach USD 42 billion by 2032, growing at a compound annual growth rate (CAGR) of 6.5%. This growth can be attributed primarily to rising awareness about maternal and infant health, increasing disposable incomes, and technological advancements in healthcare products.

One of the key growth factors driving the maternal infant care product market is the increasing awareness and education regarding maternal and infant health. This trend is largely influenced by government initiatives, non-profit organizations, and healthcare providers who are focused on reducing infant mortality rates and enhancing maternal health outcomes. Educational campaigns and community health programs are playing a significant role in encouraging young mothers to adopt better prenatal and postnatal care practices, thereby boosting the demand for specialized maternal and infant care products.

The economic development in emerging markets has also contributed significantly to market growth. With the rise in disposable incomes, there is a growing willingness among consumers to invest in high-quality healthcare products, including maternal and infant care items. Furthermore, urbanization has brought about changes in lifestyle, leading to a greater demand for convenience products such as breast pumps and baby monitors that offer modern solutions for busy parents. This shift towards premium products is also evident in more developed markets, where consumers are increasingly opting for top-of-the-line brands that promise safety and efficacy.

Technological advancements in healthcare are another pivotal growth factor. Innovations such as smart baby monitors, which provide real-time data on a baby’s health, and advanced breast pumps designed for efficiency and comfort, are attracting a significant number of consumers. The integration of IoT and AI in these products is providing parents with enhanced capabilities for monitoring and ensuring the well-being of their infants, thereby fostering market growth. Additionally, advancements in the formulation of infant formula and prenatal vitamins are addressing specific nutritional needs, further driving the market.

From a regional perspective, North America currently dominates the maternal infant care product market, followed closely by Europe and Asia Pacific. North America’s leadership position is underpinned by high healthcare expenditure, robust healthcare infrastructure, and the presence of major market players. Europe’s growth is driven by similar factors, along with supportive government policies. The Asia Pacific region is expected to witness the fastest growth, attributed to its large population base, improving healthcare facilities, and increasing awareness about maternal and infant health.

Product Type Analysis

The prenatal vitamins segment holds a significant share within the maternal infant care product market. This segment's growth is primarily driven by heightened awareness about the importance of prenatal nutrition. Pregnant women are increasingly understanding the benefits of vitamins and minerals in ensuring a healthy pregnancy and fetal development. Health practitioners are also actively recommending these supplements, which has led to a surge in demand. Moreover, advancements in the formulation of prenatal vitamins, tailored to address specific nutritional deficiencies, are further propelling growth in this segment.

Breast pumps represent another vital segment in the maternal infant care product market. The increasing number of working mothers globally has significantly boosted the demand for breast pumps. These devices offer a convenient solution for nursing mothers to express and store milk, ensuring that their babies can be fed breast milk even when they are not around. Technological advancements in breast pump designs, aimed at enhancing comfort and efficiency, have further fueled market growth. Additionally, government initiatives in several countries to promote breastfeeding are positively impacting this segment.

Infant formula is yet another crucial segment, driven by its vital role in infant nutrition, especially for mothers who cannot breastfeed. The increasing number of working mothers and the rising awareness of the nutritional benefits of infant formula are key factors contributing to its growth. Manufacturers are focusing on developing advanced formulations that closely mimic breast milk, thereby attracting a larger consumer bas

Abstract

The 1997 Yemen Demographic Maternal and Child Health Survey (YDMCHS) is part of the worldwide Demographic and Health Surveys (DHS) program. The DHS program is designed to collect data on fertility, family planning and maternal and child health.

The YDMCHS-97 has the following objectives: 1. Provide policymakers and decisionmakers with a reliable database and analyses useful for policy choices and population programs, and provide researchers, other interested persons, and scholars with such data. 2. Update and expand the national population and health data base through collection of data which will allow the calculation of demographic rates, especially fertility rates, and infant and child mortality rates; 3. Analyse the direct and indirect factors which determine levels and trends of fertility. Indicators related to fertility will serve to elaborate plans for social and economic development; 4. Measure the level of contraceptive knowledge and practice by method, by rural and urban residence including some homogeneous governorates (Sana’a, Aden, Hadhramaut, Hodeidah, Hajjah and Lahj). 5. Collect quality data on family health: immunizations, prevalence and treatment of diarrhea and other diseases among children under five, prenatal visits, assistance at delivery and breastfeeding; 6. Measure the nutritional status of mothers and their children under five years (anthropometric measurements: weight and height); 7. Measure the level of maternal mortality at the national level. 8. Develop skills and resources necessary to conduct high-quality demographic and health surveys.

Geographic coverage

National

Analysis unit

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

Kind of data

Sample survey data [ssd]

Sampling procedure

SAMPLE DESIGN

The 1997 YDMCHS was based on a national sample in order to provide estimates for general indicators for the following domains: Yemen as a whole, urban and rural areas (each as a separate domain), three ecological zones identified as Coastal, Mountainous, and Plateau and Desert, as well as governorates with a sample size of at least 500 completed cases. The survey sample was designed as a two-stage cluster sample of 475 enumeration areas (EA), 135 in urban areas and 340 in rural areas. The master sample, based on the 1994 census frame, was used as the frame for the 1997 YDMCHS. The population covered by the Yemen survey was the universe of all ever-married women age 15-49. The initial target sample was 10,000 completed interviews among eligible women, and the final sample was 10,414. In order to get this number of completed interviews, and using the response rate found in the 1991-92 YDMCHS survey, a total of 10,701 of the 11,435 potential households selected for the household sample were completed.

In each selected EA, a complete household listing operation took place between July and September 1997, and was undertaken by nineteen (19) field teams, taking into consideration the geographical closeness of the areas assigned to each team.

Note: See detailed description of sample design in APPENDIX B of the final survey report.

Mode of data collection

Face-to-face [f2f]

Research instrument

Two Questionnaires were used to collect survey data:

Household Questionnaire: The household questionnaire consists of two parts: a household schedule and a series of questions relating to the health and socioeconomic status of the household. The household schedule was used to list all usual household members. For each of the individuals included in the schedule, information was collected on the relationship to the household head, age, sex, marital status (for those 10 years and older), educational level (for those 6 years and older) and work status (for those 10 years and older). It also collects information on fertility, general mortality and child survival. The second part of the household questionnaire included questions on housing characteristics including the type of dwelling, location, materials used in construction, number of rooms, kitchen in use, main source of drinking water and health related aspects, lighting and toilet facilities, disposal of garbage, durable commodities, and assets, type of salt the household uses for cooking, and other related residential information.

Individual Questionnaire: The individual questionnaire was administered to all ever-married women age 15-49 years who were usual residents. It contained 10 sections on the followings topics: - Respondent's background - Reproduction - Family planning - Pregnancy and breastfeeding - Immunization and health - Birth preferences - Marriage and husband's background - Maternal mortality - Female circumcision - Height and weight

Response rate

10,701 households, distributed between urban (3,008 households) and rural areas (7,693), households which were successfully interviewed in the 1997 YDMCHS. This represents a country-wide response rate of 98.2 percent (98.7 and 98.0 percent, respectively, for urban and rural areas).

A total of 11,158 women were identified as eligible to be interviewed. Questionnaires were completed for 10,414 women, which represents a response rate of 93.3 percent. The response rate in urban areas was 93 percent; and in rural areas it was 93.5 percent.

Note: See summarized response rates by place of residence in Table 1.1 of the final survey report.

Sampling error estimates

The estimates from a sample surveys are affected by two types of errors: (1) non-sampling error, and (2) sampling error. 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 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 YDMCHS-97 to minimize this type of error, non-sampling 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 YDMCHS-97 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 have yielded 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 standard error of 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 statistics in 95 percent 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 YDMCHS-97 sample is the result of a two-stage stratified design, and, consequently, it was necessary to use more complex formulae. The computer software used to calculate sampling errors for the YDMCHS-97 is the ISSA Sampling Error Module (SAMPERR). This module used the Taylor linearization method of variance estimate for survey estimates that are means or proportions. The Jackknife repeated replication method is used for variance estimate of more complex statistics such as fertility and mortality rates.

Note: See detailed estimate of sampling error calculation in APPENDIX C of the final survey report.

Data appraisal

Data Quality Tables - Household age distribution - Age distribution of eligible and interviewed women and men - Completeness of reporting - Births by calendar year - Reporting of age at death in days - Reporting of age at death in months

Note: See detailed tables in APPENDIX D of the final survey report.

BackgroundNeonatal deaths contribute to nearly half (47%) of under-five mortality globally and 67% in Bangladesh. Despite high neonatal mortality, care-seeking from qualified providers for newborn danger signs remains low. Identification of direct and indirect factors and their pathways affecting care-seeking will help to design a well-targeted intervention. This study assessed the direct, indirect, and total effect of the predictive factors on neonatal care-seeking in Bangladesh.Materials and methodsThis was a cross-sectional baseline household survey conducted in 14 districts of Bangladesh in 2019 with 17,251 recently delivered women (RDW) with a live birth outcome in the preceding 15 months. We used a two-stage stratified cluster sampling process to select the samples from 14 districts. We investigated the inter-relationship of maternal background characteristics, maternal health utilizations, child/neonate factors, health service delivery-related factors and newborn danger sign knowledge with newborn care-seeking practices and estimated the direct, indirect, and total effects using Generalized Structural Equation Modeling (GSEM) and mediation analysis. p-value = 0.05 was considered statistically significant. The result of the mediation analysis was reported in Log Odds (LOD). The positive LOD (LOD > 0) implies a positive association.ResultsHalf of the mothers (50.8%) reported a neonatal illness and among them, only 36.5% mothers of sick neonates sought care from qualified providers. Our mediation analysis showed that maternal health utilization factors, i.e., 4 + antenatal care visits (ANC) from a qualified provider (LOD: 0.63, 95% CI: 0.49, 0.78), facility delivery (LOD: 0.74, 95% CI: 0.30, 1.17) and postnatal care (PNC) from a qualified provider (LOD: 0.50, 95% CI: 0.21, 0.78) showed the highest total effect over other factors domains, and therefore, were the most important modifiable predictors for qualified neonatal care-seeking. Other important factors that directly and/or indirectly increased the chance of newborn care-seeking from qualified providers were household wealth (LOD: 0.86, 95% CI: 0.70, 1.02), maternal education (LOD: 0.48, 95% CI: 0.32, 0.63), distance to nearest health facility (LOD: 0.20, 95% CI: 0.10, 0.30), community health worker's (CHWs) home visits during ANC (LOD: 0.24, 95% CI: 0.13, 0.36), neonatal danger sign counseling after delivery (LOD: 0.20, 95% CI: 0.06, 0.34) and women's knowledge of neonatal danger signs (LOD: 0.37, 95% CI: 0.09, 0.64).ConclusionThe inter-relationship and highest summative effect of ANC, facility delivery, and PNC on newborn care-seeking suggested the maternal care continuum altogether from ANC to facility delivery and PNC to improve care-seeking for the sick newborn. Additionally, referral training for unqualified providers, targeted intervention for poorer households, increasing CHWs home visits and neonatal danger sign counseling at the facility and community should also be considered.

The primary objective of the 2016 Nepal Demographic and Health Survey (NDHS) is to provide up-to-date estimates of basic demographic and health indicators. The NDHS provides a comprehensive overview of population, maternal, and child health issues in Nepal. Specifically, the 2016 NDHS: Collected data that allowed calculation of key demographic indicators, particularly fertility and under-5 mortality rates, at the national level, for urban and rural areas, and for the country’s seven provinces Collected data that allowed for calculation of adult and maternal mortality rates at the national level 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 immunization coverage among children, prevalence and treatment of diarrhea and other diseases among children under age 5, maternity care indicators such as antenatal visits and assistance at delivery, and newborn care Obtained data on child feeding practices, including breastfeeding Collected anthropometric measures to assess the nutritional status of children under age 5 and women and men age 15-49 Conducted hemoglobin testing on eligible children age 6-59 months and women age 15-49 to provide information on the prevalence of anemia 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 behaviors and condom use Measured blood pressure among women and men age 15 and above Obtained data on women’s experience of emotional, physical, and sexual violence The information collected through the 2016 NDHS is intended to assist policymakers and program managers in the Ministry of Health and other organizations in designing and evaluating programs and strategies for improving the health of the country’s population. The 2016 NDHS also provides data on indicators relevant to the Nepal Health Sector Strategy (NHSS) 2016-2021 and the Sustainable Development Goals (SDGs).

Abstract

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.

Geographic coverage

National

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), 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 TLDHS 2016 survey is the 2015 Timor-Leste Population and Housing Census (TLPHC 2015), provided by the General Directorate of Statistics. The sampling frame is a complete list of 2320 non-empty Enumeration Areas (EAs) created for the 2015 population census. An EA is a geographic area made up of a convenient number of dwelling units which served as counting units for the census, with an average size of 89 households per EA. The sampling frame contains information about the administrative unit, the type of residence, the number of residential households and the number of male and female population for each of the EAs. Among the 2320 EAs, 413 are urban residence and 1907 are rural residence.

There are five geographic regions in Timor-Leste, and these are subdivided into 12 municipalities and special administrative region (SAR) of Oecussi. The 2016 TLDHS sample was designed to produce reliable estimates of indicators for the country as a whole, for urban and rural areas, and for each of the 13 municipalities. A representative probability sample of approximately 12,000 households was drawn; the sample was stratified and selected in two stages. In the first stage, 455 EAs were selected with probability proportional to EA size from the 2015 TLPHC: 129 EAs in urban areas and 326 EAs in rural areas. In the second stage, 26 households were randomly selected within each of the 455 EAs; the sampling frame for this household selection was the 2015 TLPHC household listing available from the census database.

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

Mode of data collection

Face-to-face [f2f]

Research instrument

Four questionnaires were used for the 2016 TLDHS: the Household Questionnaire, the Woman’s Questionnaire, the Man’s Questionnaire, and the Biomarker 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 Timor-Leste.

Cleaning operations

The data processing operation included registering and checking for inconsistencies, incompleteness, and outliers. Data editing and cleaning included structure and consistency checks to ensure completeness of work in the field. The central office also conducted secondary editing, which required resolution of computer-identified inconsistencies and coding of open-ended questions. The data were processed by two staff who took part in the main fieldwork training. Data editing was accomplished with CSPro software. Secondary editing and data processing were initiated in October 2016 and completed in February 2017.

Response rate

A total of 11,829 households were selected for the sample, of which 11,660 were occupied. Of the occupied households, 11,502 were successfully interviewed, which yielded a response rate of 99 percent.

In the interviewed households, 12,998 eligible women were identified for individual interviews. Interviews were completed with 12,607 women, yielding a response rate of 97 percent. In the subsample of households selected for the men’s interviews, 4,878 eligible men were identified and 4,622 were successfully interviewed, yielding a response rate of 95 percent. Response rates were higher in rural than in urban areas, with the difference being more pronounced among men (97 percent versus 90 percent, respectively) than among women (98 percent versus 94 percent, respectively). The lower response rates for men were likely due to their more frequent and longer absences from the household.

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 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 TLDHS 2016 to minimize this type of error, non-sampling 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 TLDHS 2016 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 (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 percent 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 TLDHS 2016 sample is the result of a multi-stage stratified design, and, consequently, it was necessary to use more complex formulae. The computer software used to calculate sampling errors for the TLDHS 2016 is a SAS program. This program used the Taylor linearization 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 years - Reporting of age at death in days - Reporting of age at death in months - Height and weight data completeness and quality for children - Completeness of information on siblings - Sibship size and sex ratio of siblings - Pregnancy-related mortality trends

See details of the data quality tables in Appendix C of the survey final report.

The Global Hunger Index (GHI) is a tool designed to comprehensively measure and track hunger globally, regionally, and by country. Each year, the International Food Policy Research Institute (IFPRI) calculates GHI scores in order to assess progress, or the lack thereof, in decreasing hunger. The GHI is designed to raise awareness and understanding of regional and country differences in the struggle against hunger. Since 2015, GHI scores have been calculated using a revised and improved formula. The revision replaces child underweight, previously the sole indicator of child undernutrition, with two indicators of child undernutrition—child wasting and child stunting—which are equally weighted in the GHI calculation. The revised formula also standardizes each of the component indicators to balance their contribution to the overall index and to changes in the GHI scores over time. The 2016 GHI has been calculated for 118 countries for which data on the four component indicators are available and where measuring hunger is considered most relevant. GHI scores are not calculated for some higher income countries where the prevalence of hunger is very low. The GHI is only as current as the data for its four component indicators. This year's GHI reflects the most recent available country-level data and projections available between 2011 and 2016. It therefore reflects the hunger levels during this period rather than solely capturing conditions in 2016. The 1992, 2000, 2008, and 2016 GHI scores reflect the latest revised data for the four component indicators of the GHI. Where original source data were not available, the estimates of the GHI component indicators were based on the most recent data available. The four component indicators used to calculate the GHI scores draw upon data from the following sources: 1. Undernourishment: Updated data from the Food and Agriculture Organization of the United Nations (FAO) were used for the 1992, 2000, 2008, and 2016 GHI scores. Undernourishment data and projections for the 2016 GHI are for 2014-2016. 2. Child wasting and stunting: The child undernutrition indicators of the GHI—child wasting and child stunting—include data from the joint database of United Nations Children's Fund (UNICEF), the World Health Organization (WHO), and the World Bank, and additional data from WHO's continuously updated Global Database on Child Growth and Malnutrition; the most recent Demographic and Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) reports; and statistical tables from UNICEF. For the 2016 GHI, data on child wasting and child stunting are for the latest year for which data are available in the period 2011-2015. 3. Child mortality: Updated data from the UN Inter-agency Group for Child Mortality Estimation were used for the 1992, 2000, 2008, and 2016 GHI scores. For the 2016 GHI, data on child mortality are from 2015. Resources related to 2016 Global Hunger Index 2016 Global Hunger Index Web App 2016 Global Hunger Index Linked Open Data (LOD) 2016 Global Hunger Index Report

ABSTRACT Objective To associate quality indicators in nutritional therapy and pre-determined clinical outcomes in a neonatal unit. Methods A total of 81 premature newborns were monitored regarding the time to initiate nutrition therapy, time to meet energy needs, energy and protein adequacy, cumulative energy deficit, adequacy of the nutritional formula and fasting periods; weight gain, the occurrence of necrotizing enterocolitis, mortality and length of stay in the intensive care unit. The data were analyzed with the Statistical Package for the Social Sciences at 5% significance level. Results The time to start enteral nutrition and the calories infused/kg/day were predictors of length of hospital stay F(2.46)=6.148; p=0.004; R2=0.211; as well as the cumulative energy deficit+birth weight+infused calories/kg/day (F=3.52; p<0.001; R2=0.422); cumulative energy deficit+calories infused/kg/day+fasting time for Enteral Nutrition (F=15.041; p<0.001; R2=0.474) were predictors of weight gain. The time to start enteral nutrition, gestational age and birth weight were inversely associated with the occurrence of necrotizing enterocolitis (β=-0.38; β=-0.198; β=-0.002). Early enteral nutrition predisposed to mortality (β=0.33). Gestational age, birth weight and calories infused/kg/day were inversely related to mortality (β=-0.442; β=-0.004; β=-0.08). Conclusions Considering the associations between indicators and outcomes, routine monitoring of the time to start enteral nutrition, energy adequacy, energy deficit and fasting time is recommended.

Abstract

The JPFHS is part of the worldwide Demographic and Health Surveys (DHS) program, which is designed to collect data on fertility, family planning, and maternal and child health.

The 1990 Jordan Population and Family Health Survey (JPFHS) was carried out as part of the Demographic and Health Survey (DHS) program. The Demographic and Health Surveys is assisting governments and private agencies in the implementation of household surveys in developing countries.

The JPFIS was designed to provide information on levels and trends of fertility, infant and child mortality, and family planning. The survey also gathered information on breastfeeding, matemal and child health cam, the nutritional status of children under five, as well as the characteristics of households and household members.

The main objectives of the project include: a) Providing decision makers with a data base and analyses useful for informed policy choices, b) Expanding the international population and health data base, c) Advancing survey methodology, and d) Developing skills and resources necessary to conduct high quality demographic and health surveys in the participating countries.

Geographic coverage

National

Analysis unit

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

Kind of data

Sample survey data

Sampling procedure

The sample for the JPFHS survey was selected to be representative of the major geographical regions, as well as the nation as a whole. The survey adopted a stratified, multi-stage sampling design. In each governorate, localities were classified into 9 strata according to the estimated population size in 1989. The sampling design also allowed for the survey results to be presented according to major cities (Amman, Irbid and Zarqa), other urban localities, and the rural areas. Localities with fewer than 5,000 people were considered rural.

For this survey, 349 sample units were drawn, containing 10,708 housing units for the individual interview. Since the survey used a separate household questionnaire, the Department of Statistics doubled the household sample size and added a few questions on labor force, while keeping the original individual sample intact. This yielded 21,172 housing units. During fieldwork for the household interview, it was found that 4,359 household units were ineligible either because the dwelling was vacant or destroyed, the household was absent during the team visit, or some other reason. There were 16,296 completed household interviews out of 16,813 eligible households, producing a response rate of 96.9 percent.

The completed household interviews yielded 7,246 women eligible for the individual interview, of which 6,461 were successfully interviewed, producing a response rate of 89.2 percent.

Note: See detailed description of sample design in APPENDIX A of the survey report.

Mode of data collection

Face-to-face

Research instrument

The 1990 JPFIS utilized two questionnaires, one for the household interview and the other for individual women. Both questionnaires were developed first in English and then translated into Arabic. The household questionnaire was used to list all members of the sample households, including usual residents as well as visitors. For each member of the household, basic demographic and socioeconomic characteristics were recorded and women eligible for the individual interview were identified. To be eligible for individual interview, a woman had to be a usual member of the household (part of the de jure population), ever-married, and between 15 and 49 years of age. The household questionnaire was expanded from the standard DHS-II model questionnaire to facilitate the estimation of adult mortality using the orphanhood and widowhood techniques. In addition, the questionnaire obtained information on polygamy, economic activity of persons 15 years of age and over, family type, type of insurance covering the household members, country of work in the summer of 1990 which coincided with the Gulf crisis, and basic data for the calculation of the crude birth rate and the crude death rate. Additional questions were asked about deceased women if they were ever-married and age 15-49, in order to obtain information for the calculation of materoal mortality indices.

The individual questionnaire is a modified version of the standard DHS-II model "A" questionnaire. Experience gained from previous surveys, in particular the 1983 Jordan Fertility and Family Health Survey, and the questionnaire developed by the Pan Arab Project for Child Development (PAPCHILD), were useful in the discussions on the content of the JPFHS questionnaire. A major change from the DHS-II model questionnaire was the rearrangement of the sections so that the marriage section came before reproduction; this allowed the interview to flow more smoothly. Questions on children's cause of death based on verbal autopsy were added to the section on health, which, due to its size, was split into two parts. The first part focused on antenatal care and breastfeeding; the second part examined measures for prevention of childhood diseases and information on the morbidity and mortality of children loom since January 1985. As questions on sexual relations were considered too sensitive, they were replaced by questions about the husband's presence in the household during the specified time period; this served as a proxy for recent sexual activity.

The JPFHS individual questionnaire consists of nine sections: - Respondent's background and household characteristics - Marriage - Reproduction - Contraception - Breastfeeding and health - Immunization, morbidity, and child mortality - Fertility preferences - Husband's background, residence, and woman's work - Height and weight of children

Response rate

For the individual interview, the number of eligible women found in the selected households and the number of women successfully interviewed are presented. The data indicate a high response rate for the household interview (96.9 percent), and a lower rate for the individual interview (89.2 percent). Women in large cities have a slightly lower response rate (88.6 percent) than those in other areas. Most of the non-response for the individual interview was due to the absence of respondents and the postponement of interviews which were incomplete.

Note: See summarized response rates by place of residence in Table 1.1 of the survey report.

Sampling error estimates

The results from sample surveys are affected by two types of errors, non-sampling error and sampling error. Nonsampling error is due to mistakes made in carrying out field activities, such as failure to locate and interview the correct household, errors in the way the questions are asked, misunderstanding on the part of either the interviewer or the respondent, data entry errors, etc. Although efforts were made during the design and implementation of the JPFHS to minimize this type of error, non-sampling errors are impossible to avoid and difficult to evaluate statistically

Sampling errors, on the other hand, can be measured statistically. The sample of women selected in the JPFHS is only one of many samples that could have been selected from the same population, using the same design and expected size. Each one would have yielded results that differed somewhat from the actual sample selected. The sampling error is a measure of the variability between all possible samples; although it is not known exactly, it can be estimated from the survey results.

Sampling error is usually measured in terms of standard error of 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 one can reasonably assured that, apart from nonsampling errors, the true value of the variable for the whole population falls. For example, for any given statistic calculated from a sample survey, the value of that same statistic as measured in 95 percent of all possible samples with the same design (and expected size) will fall within a range of plus or minus two times the standard error of that statistic.

If the sample of women had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the JPFI-IS sample design depended on stratification, stages and clusters. Consequently, it was necessary to utilize more complex formulas. The computer package CLUSTERS, developed by the International Statistical Institute for the World Fertility Survey, was used to assist in computing the sampling errors with the proper statistical methodology.

Note: See detailed estimate of sampling error calculation in APPENDIX B of the survey report.

Data appraisal

Data Quality Tables - Household age distribution - Age distribution of eligible and interviewed women - Completeness of reporting - Births by calendar year since birth - Reporting of age at death in days - Reporting of age at death in months

Note: See detailed tables in APPENDIX C of the report which is presented in this documentation.

Abstract

This Child and Development Survey - 2000 is a multiple indicator clutster survey (MICS) that was conducted among women and children, with the financial and technical support of UNICEF. The purpose of this survey is to establish comprehensive statistical data to monitor the implementation of Mongolia's National Program of Action for the Development of Children in the 1990s, and to aid future planning and organisation. Overall, the findings of the Child and Development Survey -2000 will be a valuable source of information in determining the current level of infant, child and women's health and education in Mongolia and the factors which influence those levels, and it will be extremely helpful in assessing government efforts towards improving the status of women and children in the country in the past 10 years. The 2000 Mongolia Multiple Indicator Cluster Survey has as its primary objectives:

· To provide up-to-date information for assessing the situation of children and women in Mongolia at the end of the decade and for looking forward to the next decade; · To furnish data needed for monitoring progress toward goals established at the World Summit for Children and as a basis for future action; · To contribute to the improvement of data and monitoring systems in Mongolia and to strengthen technical expertise in the design, implementation, and analysis of such systems.

Geographic coverage

The whole country.

Analysis unit

• Households
• Women
• Children

Universe

The survey covered all Mongolian households/population and foreigners residing in Mongolia. However, it excluded Mongolian citizens residing outside the country or who had been residing, for more than 6 months, in institutions such as military camps, orphanages, care centers for the aged, hospitals, prisons and other correctional institutions.

Kind of data

Sample survey data [ssd]

Sampling procedure

The sample was selected in two stages. At the first stage, 300 census enumeration areas were selected with probability proportional to size. After a household listing was carried out within the selected enumeration areas, a systematic sample of 6000 households was drawn. Because the sample was stratified by region, it is selfweighting. For reporting the national level results, sample weights have not been used.

Survey population: According to the survey objectives, the current survey subjects were women aged 15-49, children under 5 or of pre-school and general education school age, and disabled children under 18 years in the households of the interviewees.

The sample size necessary to achieve the desired level of precision was calculated according to the formula described in the MICS manual.2 Since the MICS survey was intended to provide information on a variety of indicators and several specific target groups, the required sample size is based on the number of households needed to yield valid results with the desired level of precision for the "rarest" indicator-target group combination. This ensures that findings on the less "rare" combinations will also be valid at the chosen level of precision or better. For the Mongolian survey the key indicator for calculating the required sample size was the measles immunization rate in the target group of children aged 12-23 months. Using the formula from the MICS manual it was determined that a sample of 6000 households would be needed to obtain data on all survey indicators with a margin of error not greater than +/-5 percentage points at national level with a 95 per cent confidence level.

Sampling stratification: In the survey, sampling used 2 different stratification's: 1. By region: Most tabulations in this report are disagregated by 6 regions: Western, Northern, Eastern, Southern, Central 1 and Central 2. This is an official government classification based on petrol prices. Specifically, this regional delineation is as follows:

• Western (Uvs, Zavkhan, Gobi-Altai, Bayan-Ulgii, and Khovd aimags)
• Northern (Arhangai, Hovsgol, Bayankhongor, Uverhkangai and Bulgan aimags)
• Eastern (Dornod, Hentii and Suhkbaatar aimags)
• Southern (Omnogobi, Dundgovi, Dornogovi and Govisumber aimags)
• "Central-1" (Tuv, Selenge, Darhkan-Uul and Orhkon aimags)
• "Central-2" (Ulaanbaatar- capital city)

1. By urban and rural: The attached tabulations in this report are classified into urban and rural.

   • "Urban" population and households are defined as those located in the capital city of Ulaanbaatar and any aimag centers. • "Rural " - The rest of the population and all other households are classified as rural.

   Sample unit: The sample unit is a household. A household is a single person or group of people residing in one dwelling, accumulating their income together, having a common food and clothing source.

Sampling deviation

The sample for the Mongolia Multiple Indicator Cluster Survey (MICS) was designed to provide estimates of health indicators at the national level, for urban and rural areas, and for six regions: West, South, North, East, Central-1 and Central-2. The sample for the survey was designed to provide national estimates for the main indicators covered by the survey, with a margin of error of ±5 percentage points at a 95 per cent level of confidence.

Mode of data collection

Face-to-face [f2f]

Research instrument

In addition to a household questionnaire, questionnaires were administered in each household for women aged 15-49 and children under age five. The questionnaires are based on the MICS model questionnaire with the inclusion of the child disability module. From the MICS model English version, the questionnaires were translated into Mongolian. Questionnaires were translated back in to English from the Mongolian version. The questionnaires were pretested during Apr. 2000. Based on the results of the pretest, modifications were made to the wording and translation of the questionnaires.

The questionnaire used in the Mongolian "Child and Development Survey-2000” closely followed the content and format of the model MICS questionnaire recommended by UNICEF5, with some revisions and adjustments to suit specific local circumstances. The MICS model actually consists of 3 types of questionnaires; each designed to collect information on specific topics and distinct target groups.

The household questionnaire collected information such as the construction of the housing, the sex, age, literacy, and marital and orphaned status of the household members. Also included in this questionnaire were questions on education, child labor, supply of water and sanitation, and the use of iodized salt.

The questionnaire for women aged 15-49 included modules on: - Information about women - Child mortality - Maternal and infant health - Contraceptive use - HIV/AIDS. - Vitamin "D" deficiency

 The questionnaire on children under age 5 covered:

• Birth registration
• Early childhood learning
• Vitamin A supplementation
• Breastfeeding
• Hepatitis
• Child immunization
• Anthropometry (measurement of height and weight)

Cleaning operations

After the completion of the data processing of the survey materials, statisticians analyzed particular indicators, checked consistency with other data sources, reviewed results, edited errors, and reviewed concepts and definitions of unclear indicators. Finally based on these, they developed a working document, which would be useful for the next survey, and wrote the survey report.

Data pre-entry preparation, quality control and data entry was carried out in July- August 2000 at a highly professional level and in a shorter time than expected. At this stage of the survey, the working group stayed in close contact with the survey regional office and some questions raised concerning software and mathematical methodology were solved very efficiently. Survey data were processed using software based on the given designed questionnaire. The data processing was carried out in two stages. The goal of the first stage was to obtain a complete file of raw data according to the processing technology order and to ensure the quality of the data. This included following:

• Data entry
• Verification
• Secondary editing
• Production of verified and confirmed data set

The second stage aimed to produce cross tables enabling further analysis to be carried out. This included the following: - Entry of a variety of options and simulations - Production of output tables

Response rate

The selected 6000 households for the "Child and Development Survey -2000" completed the interview (Table 1). About 8606 women aged between 15-49, identified as the select group, were eligible for the women's questionnaire. Out of these, 8257 were interviewed successfully, with a response rate of 95.9 per cent. In addition, 6199 children under the age of 5 were found to be living in the selected households. Children's questionnaires were completed for 6184 of these, yielding a response rate of 99.8 per cent.

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

Abstract

The 2016-16 Malawi Demographic and Health Survey (2015-16 MDHS) was conducted between October 2015 and February 2016 by the National Statistical Office (NSO) of Malawi in joint collaboration with the Ministry of Health (MoH) and the Community Health Services Unit (CHSU). Malawi conducted its first DHS in 1992 and again in 2000, 2004, and 2010. The 2015-16 MDHS is the fifth in the series. The survey is based on a nationally representative sample that provides estimates at the national and regional levels and for urban and rural areas with key indicator estimates at the district level. The survey included 26,361 households, 24,562 female respondents, and 7,478 male respondents.

The primary objective of the 2015-16 MDHS is to provide current estimates of basic demographic and health indicators. The MDHS provides a comprehensive overview of population, maternal, and child health issues in Malawi. More specifically, the 2015-16 MDHS: - collected data that allow the calculation of key demographic indicators, particularly fertility and under 5 and adult 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 family health, such as immunisation coverage among children, prevalence and treatment of diarrhoea and other diseases among children under age 5, and maternity care indicators that include antenatal visits and assistance at delivery - obtained data on child feeding practices including breastfeeding - collected anthropometric measures that assess nutritional status, and conducted anaemia testing for all eligible children under age 5 and women age 15-49 - collected data on knowledge and attitudes of women and men about sexually-transmitted diseases (STDs) and HIV/AIDS, potential exposure to the risk of HIV infection (risk behaviours and condom use) and coverage of HIV Testing and Counselling (HTC) and other key HIV programmes - collected dried blood spot (DBS) specimens for HIV testing from women age 15-49 and men age 15-54 to provide information on the prevalence of HIV among the adult population in the prime reproductive ages.

The micronutrient component of the 2015-16 MDHS was designed to: (1) determine the prevalence of micronutrient deficiencies (vitamin A, B, iron, iodine, zinc) and anaemia among pre-school and school-age children, women, and men of child-bearing age; (2) estimate micronutrient supplementation and fortification coverage; and (3) assess the knowledge and practices in maternal and child nutrition.

The information collected in the 2015-16 MDHS will assist policy makers and programme managers in evaluating and designing programmes and strategies that can improve the health of the country’s population.

Geographic coverage

National coverage

Analysis unit

• Household
• Individual
• Children age 0-5
• Woman age 15-49
• Man age 15-54

Universe

The survey covered all de jure household members (usual residents), women age 15-49 years and men age 15-54 years resident in the household.

Kind of data

Sample survey data [ssd]

Sampling procedure

The sampling frame used for the 2015-16 MDHS is the frame of the Malawi Population and Housing Census (MPHC), conducted in Malawi in 2008, and provided by the Malawi National Statistical Office (NSO). The census frame is a complete list of all census standard enumeration areas (SEAs) created for the 2008 MPHC. A SEA is a geographic area that covers an average of 235 households. The sampling frame contains information about the SEA location, type of residence (urban or rural), and the estimated number of residential households.

Administratively, Malawi is divided into 28 districts. The sample for the 2015-16 MDHS 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 28 districts.

The 2015-16 MDHS sample was stratified and selected in two stages. Each district was stratified into urban and rural areas; this yielded 56 sampling strata. Samples of SEAs 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.

In the first stage, 850 SEAs, including 173 SEAs in urban areas and 677 in rural areas, were selected with probability proportional to the SEA size and with independent selection in each sampling stratum.

In the second stage of selection, a fixed number of 30 households per urban cluster and 33 per rural cluster were selected with an equal probability systematic selection from the newly created household listing.

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

Mode of data collection

Face-to-face [f2f]

Research instrument

Four questionnaires were used in the 2015-16 MDHS: the Household Questionnaire, the Woman’s Questionnaire, the Man’s Questionnaire, and the Biomarker 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 Malawi. Input was solicited from stakeholders who represented government ministries and agencies, nongovernmental organisations, and international donors. After the preparation of the definitive questionnaires in English, the questionnaires were then translated into Chichewa and Tumbuka languages. All four questionnaires were programmed into tablet computers to facilitate computer-assisted personal interviewing (CAPI) for data collection, and to offer the option to choose either English, Chichewa or Tumbuka for each questionnaire.

Cleaning operations

All electronic data collected in the 2015-16 MDHS were received via IFSS at the NSO central office in Zomba, where the data 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 four individuals who took part in the fieldwork training, and were supervised by two senior staff from NSO. Data editing was accomplished with CSPro software. Secondary editing and data processing were initiated in October 2015 and completed in March 2016.

Response rate

A total of 27,516 households were selected for the sample, of which 26,564 were occupied. Of the occupied households, 26,361 were successfully interviewed, for a response rate of 99%.

In the interviewed households, 25,146 eligible women were identified for individual interviews. Interviews were completed with 24,562 women, for a response rate of 98%. In the subsample of households selected for the male survey, 7,903 eligible men were identified and 7,478 were successfully interviewed, for a response rate of 95%.

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 2015-16 Malawi Demographic and Health Survey (2015-16 MDHS) to minimise 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 year acronym 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 2015-16 MDHS sample is the result of a multi-stage stratified design, and, consequently, it was necessary to use more complex formulas. Sampling errors are computed by SAS programs developed by ICF International. These programs use the Taylor linearisation 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

Abstract

The principal objective of the Ethiopia Demographic and Health Survey (DHS) is to provide current and reliable data on fertility and family planning behavior, child mortality, children’s nutritional status, the utilization of maternal and child health services, and knowledge of HIV/AIDS. This information is essential for informed policy decisions, planning, monitoring, and evaluation of programs on health in general and reproductive health in particular at both the national and regional levels. A long-term objective of the survey is to strengthen the technical capacity of the Central Statistical Authority to plan, conduct, process, and analyze data from complex national population and health surveys. Moreover, the 2000 Ethiopia DHS is the first survey of its kind in the country to provide national and regional estimates on population and health that are comparable to data collected in similar surveys in other developing countries. As part of the worldwide DHS project, the Ethiopia DHS data add to the vast and growing international database on demographic and health variables. The Ethiopia DHS collected demographic and health information from a nationally representative sample of women and men in the reproductive age groups 15-49 and 15-59, respectively.

The Ethiopia DHS was carried out under the aegis of the Ministry of Health and was implemented by the Central Statistical Authority. ORC Macro provided technical assistance through its MEASURE DHS+ project. The survey was principally funded by the Essential Services for Health in Ethiopia (ESHE) project through a bilateral agreement between the United States Agency for International Development (USAID) and the Federal Democratic Republic of Ethiopia. Funding was also provided by the United Nations Population Fund (UNFPA).

Geographic coverage

National

Analysis unit

• Household
• Children under five years
• Women age 15-49
• Men age 15-59

Kind of data

Sample survey data

Sampling procedure

The Ethiopia DHS used the sampling frame provided by the list of census enumeration areas (EAs) with population and household information from the 1994 Population and Housing Census. A proportional sample allocation was discarded because this procedure yielded a distribution in which 80 percent of the sample came from three regions, 16 percent from four regions and 4 percent from five regions. To avoid such an uneven sample allocation among regions, it was decided that the sample should be allocated by region in proportion to the square root of the region's population size. Additional adjustments were made to ensure that the sample size for each region included at least 700 households, in order to yield estimates with reasonable statistical precision.

Note: See detailed description of sample design in APPENDIX A of the survey report.

Mode of data collection

Face-to-face

Research instrument

The Ethiopia DHS used three questionnaires: the Household Questionnaire, the Women’s Questionnaire, and the Men’s Questionnaire, which were based on model survey instruments developed for the international MEASURE DHS+ project. The questionnaires were specifically geared toward obtaining the kind of information needed by health and family planning program managers and policymakers. The model questionnaires were then adapted to local conditions and a number of additional questions specific to on-going health and family planning programs in Ethiopia were added. These questionnaires were developed in the English language and translated into the five principal languages in use in the country: Amarigna, Oromigna, Tigrigna, Somaligna, and Afarigna. They were then independently translated back to English and appropriate changes were made in the translation of questions in which the back-translated version did not compare well with the original English version. A pretest of all three questionnaires was conducted in the five local languages in November 1999.

All usual members in a selected household and visitors who stayed there the previous night were enumerated using the Household Questionnaire. Specifically, the Household Questionnaire obtained information on the relationship to the head of the household, residence, sex, age, marital status, parental survivorship, and education of each usual resident or visitor. This information was used to identify women and men who were eligible for the individual interview. Women age 15-49 in all selected households and all men age 15-59 in every fifth selected household, whether usual residents or visitors, were deemed eligible, and were interviewed. The Household Questionnaire also obtained information on some basic socioeconomic indicators such as the number of rooms, the flooring material, the source of water, the type of toilet facilities, and the ownership of a variety of durable items. Information was also obtained on the use of impregnated bednets, and the salt used in each household was tested for its iodine content. All eligible women and all children born since Meskerem 1987 in the Ethiopian Calendar, which roughly corresponds to September 1994 in the Gregorian Calendar, were weighed and measured.

The Women’s Questionnaire collected information on female respondent’s background characteristics, reproductive history, contraceptive knowledge and use, antenatal, delivery and postnatal care, infant feeding practices, child immunization and health, marriage, fertility preferences, and attitudes about family planning, husband’s background characteristics and women’s work, knowledge of HIV/AIDS and other sexually transmitted infections (STIs).

The Men’s Questionnaire collected information on the male respondent’s background characteristics, reproduction, contraceptive knowledge and use, marriage, fertility preferences and attitudes about family planning, and knowledge of HIV/AIDS and STIs.

Response rate

A total of 14,642 households were selected for the Ethiopia DHS, of which 14,167 were found to be occupied. Household interviews were completed for 99 percent of the occupied households. A total of 15,716 eligible women from these households and 2,771 eligible men from every fifth household were identified for the individual interviews. The response rate for eligible women is slightly higher than for eligible men (98 percent compared with 94 percent, respectively). Interviews were successfully completed for 15,367 women and 2,607 men.

There is no difference by urban-rural residence in the overall response rate for eligible women; however, rural men are slightly more likely than urban men to have completed an interview (94 percent and 92 percent, respectively). The overall response rate among women by region is relatively high and ranges from 93 percent in the Affar Region to 99 percent in the Oromiya Region. The response rate among men ranges from 83 percent in the Affar Region to 98 percent in the Tigray and Benishangul-Gumuz regions.

Note: See summarized response rates by place of residence in Table A.1.1 and Table A.1.2 of the survey report.

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 Ethiopia DHS to minimise 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 Ethiopia DHS 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 (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 percent 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 Ethiopia DHS sample is the result of a two-stage stratified design, and, consequently, it was necessary to use more complex formulae. The computer software used to calculate sampling errors for the Ethiopia DHS is the ISSA Sampling Error Module (SAMPERR). This module used 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.

Note: See detailed estimate of sampling error calculation in APPENDIX B of the survey report.

Data appraisal

Data Quality Tables - Household age