95.497 (persons) in 2006.

Abstract

The Ministry of Health and Social Welfare (MOHSW) conducted the 2009 Lesotho Demographic and Health Survey (LDHS) to collect population-based data to inform the Health Sector Reform Programme (2000-2009), evaluate the strides made since the first LDHS was conducted in 2004, set a baseline for new programmes, and provide information for policy and strategic planning.

The 2009 LDHS was conducted using a representative sample of women and men of reproductive age.

The objectives were to: - Provide national data on key demographic indicators, particularly fertility and child and adult mortality rates - Analyze the direct and indirect factors that determine the level of and trends in fertility - Measure the level of contraceptive knowledge and practice of women and men by method, urban-rural residence, and region - Provide data on family health, including immunization coverage among children, prevalence and treatment of diarrhoea and other diseases among children under age 5, maternity care indicators including antenatal visits, and assistance at delivery - Provide data on child feeding practices, including breastfeeding, the nutritional status of women and children, and the prevalence of anaemia among children under age 5, women age 15-49, and men age 15-59 - Provide data on knowledge and attitudes of women and men about sexually-transmitted diseases and HIV/AIDS, and evaluate patterns of recent behaviour regarding condom use - Provide information on the prevalence of HIV among women age 15-49 and men age 15-59 - Provide biomarker data on blood pressure among women age 15-49 and men age 15-59

Geographic coverage

The 2009 LDHS was designed to provide estimates of health and demographic indicators at the national level, for urban-rural areas, and for each of the ten districts of Butha-Buthe, Leribe, Berea, Maseru, Mafeteng, Mohale's Hoek, Quthing, Qacha's Nek, Mokhotlong, and Thaba-Tseka.

Analysis unit

• Households
• Individuals
• Women age 15-49
• Men age 15-59

Kind of data

Sample survey data

Sampling procedure

The 2009 LDHS was designed to provide estimates of health and demographic indicators at the national level, for urban-rural areas, and for each of the ten districts of Butha-Buthe, Leribe, Berea, Maseru, Mafeteng, Mohale's Hoek, Quthing, Qacha's Nek, Mokhotlong, and Thaba-Tseka. The 2009 LDHS sample points (clusters) were selected from a list of enumeration areas (EAs) defined for the 2006 Lesotho Population and Housing Census. A total of 400 clusters were drawn from the census sample frame, 94 in the urban areas and 306 in the rural areas. The clusters were selected with probability proportional to size (PPS).

Bureau of Statistics (BOS) staff conducted an exhaustive listing of households in each of the LDHS clusters from July through December 2009. From these lists, a systematic sample of households was drawn for a total of 10,000 households, about 25 households on average per cluster. All women age 15-49 identified in the entire sample of households were eligible for individual interview. In addition, half of these households (5,000 households) were selected randomly, and in these households, all men age 15-59 were eligible for individual interview. In the LDHS households where men were interviewed, all children under age 6 were eligible for height, weight, and mid-upper arm circumference measurements as well as anaemia testing. In the same households, women and men who were eligible for individual interview were also eligible for height, weight, and blood pressure measurements in addition to anaemia and HIV testing.

Note: See detailed sample design information in the APPENDIX A of the final 2009 Lesotho Demographic and Health Survey Final Report.

Mode of data collection

Face-to-face

Research instrument

Three types of questionnaires were used for the LDHS: the Household Questionnaire, the Woman’s Questionnaire, and the Man’s Questionnaire. The contents of the questionnaires were based on questionnaires developed for the MEASURE DHS programme. The LDHS questionnaires were developed in collaboration with a wide range of stakeholders. After the LDHS survey instruments were drafted, they were translated into and printed in the local language, Sesotho, for pre-testing.

The Household Questionnaire was used to list all the usual members and visitors to the selected households. Basic information was collected on the characteristics of each person listed, including age, sex, education, and relationship to the head of the household. The Household Questionnaire was also used to identify persons eligible for the individual interview. In addition, information was collected about the dwelling, such as the source of water, type of toilet facilities, materials used to construct the house, and ownership of various consumer goods. The results of anthropometric measurement and anaemia testing were recorded in the Household Questionnaire, as was the information on the consent of eligible household members for the HIV testing.

The Woman’s Questionnaire was used to collect information on the following topics: - Background characteristics (age, education, employment, religion, etc.) - Birth history and childhood mortality - Knowledge and use of family planning methods - Antenatal, delivery, and postnatal care - Infant feeding practices, including patterns of breastfeeding - Childhood vaccinations - Episodes of childhood illness and responses to illness - Marriage and sexual activity - Fertility preferences - Husband’s background and the woman’s work status - Adult mortality, including maternal mortality - HIV/AIDS-related knowledge, attitudes, and behaviour - Knowledge, attitudes, and behaviour related to other health issues

The Man’s Questionnaire was shorter than the Woman’s Questionnaire but covered many of the same topics, excluding the reproductive history and sections dealing with maternal and child health and maternal mortality.

In this survey, instead of paper questionnaires, personal data assistants (PDAs) were used to record responses during interviews. Bluetooth wireless technology was used for electronic transfer of files, such as transfer of the assignment sheet from the team supervisor to the interviewers, transfer of household questionnaires among survey team members, and transfer of completed questionnaires to team and central office supervisors. The PDA interview applications were implemented using the mobile version of CSPro, which was developed by the MEASURE DHS project in collaboration with the U.S. Census Bureau.

Cleaning operations

All data files for the LDHS were stored in a computer at the MOHSW Headquarters. The data processing operation included secondary editing, which involved checking for inconsistencies. The LDHS data entry and editing programmes used CSPro, a computer software package specifically designed for processing survey data such as that produced by DHS surveys. Data processing commenced in November 2009 and was completed in February 2010.

Response rate

A total of 9,994 households were selected for the sample, of which 9,619 were found occupied during data collection. Of the existing households, 9,391 were successfully interviewed, yielding a household response rate of 98 percent.

In these households, 7,786 women were identified as eligible for the individual interview. Interviews were completed with 98 percent of these women. Of the 3,493 eligible men identified in the sub-sample of households selected, 95 percent were successfully interviewed. Overall, response rates were higher in rural areas than in urban areas.

See summarized response rates in Table 1.2 which is presented in the Final Report.

Sampling error estimates

Estimates derived from a sample survey are affected by two types of errors: 1) non-sampling errors, and 2) 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 2009 Lesotho DHS (LDHS) to minimise 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 2009 LDHS 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 2009 LDHS sample is the

Abstract

The Lesotho Health Results Based Financing Impact Evaluation Baseline Survey was conducted in four districts: Mafeteng, Mohale’s Hoek, Mokhotlong and Thaba-Tseka of Lesotho, between March and June 2015. The pilot survey collected data from two districts (Leribe and Quthing) before scaling up to the four aforementioned districts.

The objective of the survey was to measure outcomes prior to the implementation of the Health Performance-Based Financing (PBF) intervention. Data was collected in the four districts through household surveys and facility assessments of health centers. The survey is largely based on the Health Results Innovation Trust Fund (HRITF) instruments that were modified to the Lesotho and project context.

The baseline survey consists of two main sources of data: 1) a household survey (documented here) and 2) a health facility-based survey. - The primary goal of the household survey is to measure health service coverage at the population level as well as select health outcome indicators measured through anthropometry or tests. The survey also collects broader data on the health of the households, health seeking behaviors and barriers to use of health services. - The goal of the facility-based survey is to measure multiple dimensions of quality of care and collect detailed information on key aspects of facility functioning. It includes multiple components; a facility assessment, health provider interviews, and patient exit interviews.

The household survey is documented here.

Geographic coverage

The baseline survey covers four districts: Mafeteng, Mohale’s Hoek, Mokhotlong and Thaba-Tseka.

Universe

The survey instrument was administered to women in the sampled households.

Kind of data

Sample survey data [ssd]

Sampling procedure

The household sampling follows a two-stage strategy. Enumeration areas (EAs) were initially defined by the 2006 census but in case the enumeration area covered two different catchment areas, the EA was split into smaller units defined by the catchment areas. First, EAs within the catchment area of each health center were ranked for listing by random drawing. In each of the villages in the EA ranked first, a dedicated listing team did a household listing, collecting information on the presence of women who were pregnant in the preceding two years and of adolescent females. The listing team did a complete listing whether eligible or not. In cases in which the EA had less than 80 households or if less than 18 eligible households for any of the two samples were listed, the next ranked EA was added. Listing was always done at the EA level, i.e. all households in the EA were listed unless a village was not found by the listing team. Second, up to 50 households were then randomly selected by the research team for survey. The selection of households was according to the following two criteria: (a) 25 households with at least one birth or pregnancy, regardless of the outcome of the pregnancy, in the two years preceding the survey; (b) 25 households with at least one adolescent girl. In cases with less than 25 eligible households listed, all eligible households were selected for the survey. The selection of the ‘recent pregnancy’ and of the ‘adolescent’ sample was done separately. However, in some cases, the same household was randomly selected for both samples.

The final household sample includes 2120 households. From these the research team was able to link 1252 female questionnaires and 972 adolescent questionnaires. Deleted from the raw sample were 41 female questionnaires and 9 adolescent questionnaires that could not be matched to a household roster.

Mode of data collection

Face-to-face [f2f]

Research instrument

The baseline household survey data was collected using the following 3 questionnaires: - Household Questionnaire - Household Questionnaire: Selected Woman 1 - Household Questionnaire: Selected Woman 2