Abstract

The 2019 Sierra Leone Demographic and Health Survey (2019 SLDHS) is a nationwide survey with a nationally representative sample of approximately 13,872 selected households. All women age 15-49 who are usual household members or who spent the night before the survey in the selected households were eligible for individual interviews.

The primary objective of the 2019 SLDHS is to provide up-to-date estimates of basic demographic and health indicators. Specifically, the survey collected information on fertility, awareness and use of family planning methods, breastfeeding practices, nutritional status of women and children, maternal and child health, adult and childhood mortality, women’s empowerment, domestic violence, female genital cutting, prevalence and awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections (STIs), and other health-related issues such as smoking.

The information collected through the 2019 SLDHS is intended to assist policymakers and programme managers in evaluating and designing programmes and strategies for improving the health of the country’s population.

Geographic coverage

National coverage

Analysis unit

• 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), all women aged 15-49, all men age 15-59, and all children aged 0-5 resident in the household.

Kind of data

Sample survey data [ssd]

Sampling procedure

The sampling frame used for the 2019 SLDHS is the Population and Housing Census of the Republic of Sierra Leone, which was conducted in 2015 by Statistics Sierra Leone. Administratively, Sierra Leone is divided into provinces. Each province is subdivided into districts, each district is further divided into chiefdoms/census wards, and each chiefdom/census ward is divided into sections. During the 2015 Population and Housing Census, each locality was subdivided into convenient areas called census enumeration areas (EAs). The primary sampling unit (PSU), referred to as a cluster for the 2019 SLDHS, is defined based on EAs from the 2015 EA census frame. The 2015 Population and Housing Census provided the list of EAs that served as a foundation to estimate the number of households and distinguish EAs as urban or rural for the survey sample frame.

The sample for the 2019 SLDHS was a stratified sample selected in two stages. Stratification was achieved by separating each district into urban and rural areas. In total, 31 sampling strata were created. Samples were selected independently in every stratum via a two-stage selection process. Implicit stratifications were achieved at each of the lower administrative levels by sorting the sampling frame before sample selection according to administrative order and by using probability-proportional-to-size selection during the first sampling stage.

In the first stage, 578 EAs were selected with probability proportional to EA size. EA size was the number of households residing in the EA. A household listing operation was carried out in all selected EAs, and the resulting lists of households served as a sampling frame for the selection of households in the second stage. In the second stage’s selection, a fixed number of 24 households were selected in every cluster through equal probability systematic sampling, resulting in a total sample size of approximately 13,872 selected households. The household listing was carried out using tablets, and random selection of households was carried out through computer programming. The survey interviewers interviewed only the pre-selected households. To prevent bias, no replacements and no changes of the pre-selected households were allowed in the implementing stages.

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

Mode of data collection

Computer Assisted Personal Interview [capi]

Research instrument

Five questionnaires were used for the 2019 SLDHS: The Household Questionnaire, the Woman’s Questionnaire, the Man’s Questionnaire, the Biomarker Questionnaire, and the Fieldworker Questionnaire. The questionnaires, based on The DHS Program’s standard Demographic and Health Survey (DHS-7) questionnaires, were adapted to reflect the population and health issues relevant to Sierra Leone. Comments were solicited from various stakeholders representing government ministries and agencies, nongovernmental organisations, and international donors. The survey protocol was reviewed and approved by the Sierra Leone Ethics and Scientific Review Committee and the ICF Institutional Review Board. All questionnaires were finalised in English, and the 2019 SLDHS used computer-assisted personal interviewing (CAPI) for data collection.

Cleaning operations

The processing of the 2019 SLDHS data began almost as soon as the fieldwork started. As data collection was completed in each cluster, all electronic data files were transferred via the IFSS to the Stats SL central office in Freetown. These data files were registered and checked for inconsistencies, incompleteness, and outliers. The field teams received alerts on any inconsistencies and errors. Secondary editing, carried out in the central office, involved resolving inconsistencies and coding open-ended questions. The Stats SL data processor coordinated the exercise at the central office. The biomarker paper questionnaires were compared with electronic data files to check for any inconsistencies in data entry. Data entry and editing were carried out using the CSPro Systems software package. Concurrent processing of the data offered a distinct advantage because it maximised the likelihood of the data being error-free and accurate. Timely generation of field check tables allowed for effective monitoring. The secondary editing of the data was completed in mid-October 2019.

Response rate

A total of 13,793 households were selected for the sample, of which 13,602 were occupied. Of the occupied households, 13,399 were successfully interviewed, yielding a response rate of 99%. In the interviewed households, 16,099 women age 15-49 were identified for individual interviews; interviews were completed with 15,574 women, yielding a response rate of 97%. In the subsample of households selected for the male survey, 7,429 men age 15-59 were identified, and 7,197 were successfully interviewed, yielding a response rate of 97%.

Sampling error estimates

The estimates from a sample survey are affected by two types of errors: nonsampling errors and sampling errors. Nonsampling errors are the results of mistakes made in implementing data collection and data processing, such as failure to locate and interview the correct household, misunderstanding of the questions on the part of either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the 2019 Sierra Leone Demographic and Health Survey (SLDHS) 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 2019 SLDHS 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 errors are usually measured in terms of the standard error for a particular statistic (mean, percentage, etc.), which is the square root of the variance. The standard error can be used to calculate confidence intervals within which the true value for the population can reasonably be assumed to fall. For example, for any given statistic calculated from a sample survey, the value of that statistic will fall within a range of plus or minus two times the standard error of that statistic in 95% of all possible samples of identical size and design.

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

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

Data appraisal

Data Quality Tables

• Household age distribution
• Age distribution of eligible and interviewed women
• 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
• Standardisation exercise results from anthropometry training
• Height measurements from random subsample of measured children
• Sibship size and sex ratio of siblings
• Pregnancy-related mortality trends
• Completeness of information on siblings

See details of the data quality tables in Appendix C of the final

Abstract

The Government of Sierra Leone, through the Ministry of Health and Sanitation and Statistics Sierra Leone (Stats SL), together with its development partners, conducted the 2019 Sierra Leone Demographic and Health Survey (2019 SLDHS). Data collection took place from 15 May to 31 August 2019.

The primary objective of the 2019 SLDHS is to provide up-to-date estimates of basic demographic and health indicators. Specifically, the survey collected information on fertility, awareness and use of family planning methods, breastfeeding practices, nutritional status of women and children, maternal and child health, adult and childhood mortality, women’s empowerment, domestic violence, female genital cutting, prevalence and awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections (STIs), and other health-related issues such as smoking.

The information collected through the 2019 SLDHS is intended to assist policymakers and programme managers in evaluating and designing programmes and strategies for improving the health of the country’s population.

Geographic coverage

National coverage

Analysis unit

Household Women Men Children

Universe

the 2019 SLDHS covered all household members, all women aged 15-49, all children 0-59 months and all men aged 15-59 in one-half of the sample households

Kind of data

Sample survey data [ssd]

Sampling procedure

The sampling frame used for the 2019 SLDHS is the Population and Housing Census of the Republic of Sierra Leone, which was conducted in 2015 by Statistics Sierra Leone. Administratively, Sierra Leone is divided into provinces. Each province is subdivided into districts, each district is further divided into chiefdoms/census wards, and each chiefdom/census ward is divided into sections. During the 2015 Population and Housing Census, each locality was subdivided into convenient areas called census enumeration areas (EAs). The primary sampling unit (PSU), referred to as a cluster for the 2019 SLDHS, is defined based on EAs from the 2015 EA census frame. The 2015 Population and Housing Census provided the list of EAs that served as a foundation to estimate the number of households and distinguish EAs as urban or rural for the survey sample frame.

The sample for the 2019 SLDHS was a stratified sample selected in two stages. Stratification was achieved by separating each district into urban and rural areas. In total, 31 sampling strata were created. Samples were selected independently in every stratum via a two-stage selection process. Implicit stratifications were achieved at each of the lower administrative levels by sorting the sampling frame before sample selection according to administrative order and by using probability-proportional-to-size selection during the first sampling stage.

In the first stage, 578 EAs were selected with probability proportional to EA size. EA size was the number of households residing in the EA. A household listing operation was carried out in all selected EAs, and the resulting lists of households served as a sampling frame for the selection of households in the second stage. In the second stage’s selection, a fixed number of 24 households were selected in every cluster through equal probability systematic sampling, resulting in a total sample size of approximately 13,872 selected households. The household listing was carried out using tablets, and random selection of households was carried out through computer programming. The survey interviewers interviewed only the pre-selected households. To prevent bias, no replacements and no changes of the pre-selected households were allowed in the implementing stages.

Due to the non-proportional allocation of the sample to the different districts and the possible differences in response rates, sampling weights were calculated, added to the data file, and applied so that the results would be representative at the national level as well as the domain level. Because the 2019 SLDHS sample was a two-stage stratified cluster sample selected from the sampling frame, sampling weights were calculated based on sampling probabilities separately for each sampling stage and for each cluster.

The 2019 SLDHS included all women age 15-49 in the sample households. Those who were either permanent residents of the selected households or visitors who stayed in the households the night before the survey were eligible to be interviewed. The men’s survey was conducted in one-half of the sample households, and all men age 15-59 in these households were included. In this subsample, one eligible woman in each household was randomly selected to be asked additional questions about domestic violence. Similarly, biomarker information was collected only in those households selected for the men’s survey. The biomarkers included in this survey were height and weight for women age 15-49, men age 15-59, and children age 0-59 months; haemoglobin testing for women age 15-49, men age 15-59, and children age 6-59 months; and HIV testing for women age 15-49 and men age 15-59. The survey was successfully carried out in 578 clusters.

Mode of data collection

Computer Assisted Personal Interview [capi]

Research instrument

Five questionnaires were used for the 2019 SLDHS: The Household Questionnaire, the Woman’s Questionnaire, the Man’s Questionnaire, the Biomarker Questionnaire, and the Fieldworker Questionnaire. The questionnaires, based on The DHS Program’s standard Demographic and Health Survey (DHS-7) questionnaires, were adapted to reflect the population and health issues relevant to Sierra Leone. Comments were solicited from various stakeholders representing government ministries and agencies, nongovernmental organisations, and international donors. The survey protocol was reviewed and approved by the Sierra Leone Ethics and Scientific Review Committee and the ICF Institutional Review Board. All questionnaires were finalised in English, and the 2019 SLDHS used computer-assisted personal interviewing (CAPI) for data collection.

The Household Questionnaire listed all members of and visitors to selected households. Basic demographic information was collected on each person listed, including age, sex, marital status, education, and relationship to the head of the household. For children under age 18, parents’ survival status was determined. Data on age, sex, and marital status of household members were used to identify women and men who were eligible for individual interviews. The Household Questionnaire also collected information on characteristics of the household’s dwelling unit, such as source of drinking water; type of toilet facilities; materials used for flooring, external walls, and roofing; ownership of various durable goods; and ownership of mosquito nets. In addition, data were gathered on whether iodised salt was present in households.

The Woman’s Questionnaire was used to collect information from all eligible women age 15-49. These women were asked questions on the following topics:

• Background characteristics (including age, education, and media exposure)
• Birth history and child mortality
• Knowledge, use, and source of family planning methods
• Antenatal, delivery, and postnatal care
• Vaccinations and childhood illnesses
• Breastfeeding and infant feeding practices
• Minimum dietary diversity
• Marriage and sexual activity
• Fertility preferences (including desire for more children and ideal number of children)
• Women’s work and husbands’ background characteristics
• Knowledge, awareness, and behaviour regarding HIV/AIDS and other sexually transmitted infections (STIs)
• Knowledge, attitudes, and behaviour related to other health issues (e.g., smoking)
• Female genital cutting
• Adult and maternal mortality
• Domestic violence

The Man’s Questionnaire was administered to all men age 15-59 in the subsample of households selected for the men’s survey. The Man’s Questionnaire collected much of the same information as the Woman’s Questionnaire but was shorter because it did not contain a detailed reproductive history or questions on maternal and child health.

The Biomarker Questionnaire was used to record the results of anthropometry measurements and other biomarkers for men, women, and children. This questionnaire was administered only to a subsample selected for the men’s survey. All children age 0-59 months, all men age 15-59, and all women age 15-49 were eligible for height and weight measurements. Men age 15-59 and women age 15-49 were also eligible for haemoglobin and HIV testing, and children age 6-59 months were also eligible for haemoglobin testing.

The Fieldworker Questionnaire recorded background information from the interviewers to serve as a tool in conducting analyses of data quality. Each interviewer completed the self-administered questionnaire after the final selection of interviewers and before the fieldworkers entered the field. No personal identifiers were attached to the 2019 SLDHS fieldworkers’ data file.

Cleaning operations

The processing of the 2019 SLDHS data began almost as soon as the fieldwork started. As data collection was completed in each cluster, all electronic data files were transferred via the IFSS to the Stats SL central office in Freetown. These data files were registered and checked for inconsistencies, incompleteness, and outliers. The field teams received alerts on any inconsistencies and errors. Secondary editing, carried out in the central office, involved resolving inconsistencies and coding open-ended questions. The Stats SL data processor coordinated the exercise at the central office. The biomarker

Abstract

The World Bank WeTour Project aimed to contribute to improved knowledge of the characteristics of Women-owned/led Micro, Small and Medium Sized Enterprises (WSMEs) in tourism in Ghana and Sierra Leone. It is intended that this knowledge and data will be used by projects and programs in those countries to inform the design of gender-targeted tourism SME support services. This survey is representative of male and female enterprises.

Geographic coverage

In Sierra leone, two destination areas were identified as Freetown and the Western Area.

Analysis unit

Micro, Small and Medium Tourism and tourism-related enterprises

Universe

The universe of MSMEs in Tourism and Tourism-related sectors of Freetown and the Western Area in Sierra Leone comprises 1,067 entities identified individually in the sampling frame.

Kind of data

Sample survey data [ssd]

Sampling procedure

The universe of tourism and tourism related SMEs was constructed in each country using all available sources. For both countries the original sample frame of SMEs was compiled from previous sample frames developed for enterprise surveys by EEC International, the amalgamation of past listings of SMEs from the NSO and other public registries, as well as numerous other sources collated from business associations and other publicly available sources of tourism-related information portals, namely: travel agent reservation systems such as Amadeus and Sabre, tourism and tourism-related websites such as Expedia and TripAdvisor, as well as establishments referenced on Google Maps and appearing on Google Street View. The sample frame for micro enterprises was planned to result from systematic block enumeration in the targeted locations. During the block enumeration, entities were identified by a number on a list and a geographical reference (map or other description of the location), information on its apparent activity (tourism or tourism-related), as well as visible gender composition (no apparent female, no apparent male, mixed presence). Neither the activity composition nor the gender composition were known at inception. The validation of the sample frame consisted in ensuring that there were no foreign elements (activities not included in the universe under study).

The sampling strategy that EECI applied for the Tourism and Tourism related Sectors applying consisted in randomly drawing from the frame of MSMEs a screened sample until the minimum number of male and female respondents targeted was obtained, inclusive of the expected non-response.

For Sierra Leone, the frame contained a total of 1,067 entities, of which 705 micros and 362 SMEs. A random draw of 323 entities, consisting of 212 micros and 111 SMEs generated through a screening 125 female entities and 198 male entities. The entire group of 125 female entities was directed to interviewing, and the first 125 male entities that were screened, were directed to interviewing, with an expected 120 respondents by genre. For more details see Methodology Note provided under Related Documents.

Mode of data collection

Face-to-face [f2f]

Cleaning operations

Data entry and quality controls were implemented by the contractor then data was delivered to the World Bank. The World Bank validated data were validated for logical consistency, flagging problems that were then corrected by the implementing contractor.

Response rate

The response rate was 96.6% for Sierra Leone. There are slight variations of these indicators by sub-groups of businesses.

Sampling error estimates

According to sample design, it is possible to generalize survey results (at a precision of 7.5% and a confidence level of 90%) at the sector level, and the respective gender sub-groups of businesses.

Patient records from the MSF Prince of Wales Freetown Ebola treatment unit during the 2013-2016 West African Ebola outbreak. Contains demographic, clinical and epidemiological data.

The study aimed to investigate the prevalence of cardiometabolic risk factors (CMRFs), target organ damage and its associated factors among adults in Freetown, Sierra Leone. Design This community-based cross-sectional study used a stratified multistage random sampling method to recruit adult participants. Setting The health screening study was conducted between October 2019 and October 2021 in Western Area Urban, Freetown, Sierra Leone. Participants A total of 2394 adults Sierra Leoneans aged 20 years, or more were enrolled. Outcome measure Anthropometric data, fasting lipid profiles, fasting plasma glucose, target organ damage, clinical profiles and demographic characteristic of participants were described. The cardiometabolic risks were further related to target organ damage. Results The prevalence of known CMRFs was 35.3% for hypertension, 8.3% for diabetes mellitus, 21.1% for dyslipidemia, 10.0% for obesity, 13.4% for smoking and 37.9% for alcohol. Additionally, 16.1% had left v...