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

The 2005 Ethiopia Demographic and Health Survey (2005 EDHS) is part of the worldwide MEASURE DHS project which is funded by the United States Agency for International Development (USAID). The principal objective of the 2005 Ethiopia Demographic and Health Survey (DHS) is to provide current and reliable data on fertility and family planning behaviour, child mortality, adult and maternal mortality, children’s nutritional status, the utilization of maternal and child health services, knowledge of HIV/AIDS and prevalence of HIV/AIDS and anaemia. The specific objectives are to: collect data at the national level which will allow the calculation of key demographic rates; analyze the direct and indirect factors which determine the level and trends of fertility; measure the level of contraceptive knowledge and practice of women and men by method, urban-rural residence, and region; collect high quality data on family health including immunization coverage among children, prevalence and treatment of diarrhoea and other diseases among children under five, and maternity care indicators including antenatal visits and assistance at delivery; collect data on infant and child mortality and maternal and adult mortality; obtain data on child feeding practices including breastfeeding and collect anthropometric measures to use in assessing the nutritional status of women and children; collect 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; conduct haemoglobin testing on women age 15-49 and children under age five years in a subsample of the households selected for the survey to provide information on the prevalence of anaemia among women in the reproductive ages and young children; collect samples for anonymous HIV testing from women and men in the reproductive ages to provide information on the prevalence of HIV among the adult population. 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 Agency to plan, conduct, process, and analyse data from complex national population and health surveys. Moreover, the 2005 Ethiopia DHS provides national and regional estimates on population and health that are comparable to data collected in similar surveys in other developing countries. The first ever Demographic and Health Survey (DHS) in Ethiopia was conducted in the year 2000 as part of the worldwide DHS programme. Data from the 2005 Ethiopia DHS survey, the second such survey, add to the vast and growing international database on demographic and health variables. Wherever possible, the 2005 EDHS data is compared with data from the 2000 EDHS. In addition, where applicable, the 2005 EDHS is compared with the 1990 NFFS, which also sampled women age 15-49. Husbands of currently married women were also covered in this survey. However, for security and other reasons, the NFFS excluded from its coverage Eritrea, Tigray, Asseb, and Ogaden autonomous regions. In addition, fieldwork could not be carried out for Northern Gondar, Southern Gondar, Northern Wello, and Southern Wello due to security reasons. Thus, any comparison between the EDHS and the NFFS has to be interpreted with caution.

The 2011 Ethiopia Demographic and Health Survey (EDHS) was conducted by the Central Statistical Agency (CSA) under the auspices of the Ministry of Health. The principal objective of the 2011 Ethiopia Demographic and Health Survey (EDHS) is to provide current and reliable data on fertility and family planning behaviour, child mortality, adult and maternal mortality, children’s nutritional status, use of maternal and child health services, knowledge of HIV/AIDS, and prevalence of HIV/AIDS and anaemia. The specific objectives are these: Collect data at the national level that will allow the calculation of key demographic rates; Analyse the direct and indirect factors that determine fertility levels and trends; Measure the levels of contraceptive knowledge and practice of women and men by family planning method, urban-rural residence, and region of the country; Collect high-quality data on family health, including immunisation coverage among children, prevalence and treatment of diarrhoea and other diseases among children under ge five, and maternity care indicators, including antenatal visits and assistance at delivery; Collect data on infant and child mortality and maternal mortality; Obtain data on child feeding practices, including breastfeeding, and collect anthropometric measures to assess the nutritional status of women and children; Collect 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; Conduct haemoglobin testing on women age 15-49 and children 6-59 months to provide information on the prevalence of anaemia among these groups; Carry out anonymous HIV testing on women and men of reproductive age to provide information on the prevalence of HIV. This information is essential for informed policy decisions, planning, monitoring, and evaluation of programmes 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 Agency to plan, conduct, process, and analyse data from complex national population and health surveys. Moreover, the 2011 EDHS provides national and regional estimates on population and health that are comparable to data collected in similar surveys in other developing countries and to Ethiopia’s two previous DHS surveys, conducted in 2000 and 2005. Data collected in the 2011 EDHS add to the large and growing international database of demographic and health indicators. The survey was intentionally planned to be fielded at the beginning of the last term of the MDG reporting period to provide data for the assessment of the Millennium Development Goals (MDGs). The survey interviewed a nationally representative population in about 18,500 households, and all women age 15-49 and all men age 15-59 in these households. In this report key indicators relating to family planning, fertility levels and determinants, fertility preferences, infant, child, adult and maternal mortality, maternal and child health, nutrition, women’s empowerment, and knowledge of HIV/AIDS are provided for the nine regional states and two city administrations. In addition, this report also provides data by urban and rural residence at the country level. Major stakeholders from various government, non-government, and UN organizations have been involved and have contributed in the technical, managerial, and operational aspects of the survey.

Abstract

The 2016 Ethiopia Demographic and Health Survey (EDHS) is the fourth Demographic and Health Survey conducted in Ethiopia. It was implemented by the Central Statistical Agency (CSA) at the request of the Federal Ministry of Health (FMoH). Data collection took place from January 18, 2016, to June 27, 2016.

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

As the fourth DHS conducted in Ethiopia, following the 2000, 2005, and 2011 EDHS surveys, the 2016 EDHS provides valuable information on trends in key demographic and health indicators over time. The information collected through the 2016 EDHS is intended to assist policymakers and programme managers in evaluating and designing programmes and strategies for improving the health of the country’s population.

Additionally, the 2016 EDHS included a health facility component that recorded data on children’s vaccinations, which were then combined with the household data on vaccinations.

Geographic coverage

National coverage

Analysis unit

• Households
• Men
• Women
• Children

Universe

Household members women age 15-49 men age 15-59 children under age 5

Kind of data

Sample survey data [ssd]

Sampling procedure

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

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

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

In the first stage, a total of 645 EAs (202 in urban areas and 443 in rural areas) were selected with probability proportional to EA size (based on the 2007 PHC) and with independent selection in each sampling stratum. A household listing operation was carried out in all of the selected EAs from September to December 2015. The resulting lists of households served as a sampling frame for the selection of households in the second stage. Some of the selected EAs were large, consisting of more than 300 households. To minimise the task of household listing, each large EA selected for the 2016 EDHS was segmented. Only one segment was selected for the survey with probability proportional to segment size. Household listing was conducted only in the selected segment; that is, a 2016 EDHS cluster is either an EA or a segment of an EA.

In the second stage of selection, a fixed number of 28 households per cluster were selected with an equal probability systematic selection from the newly created household listing. All women age 15-49 and all men age 15-59 who were either permanent residents of the selected households or visitors who stayed in the household the night before the survey were eligible to be interviewed. In half of the selected households, all women age 15-49 were eligible for the FGM/C module, and only one woman per household was selected for the domestic violence module. In all of the selected households, height and weight measurements were collected from children age 0-59 months, women age 15-49, and men age 15-59. Anaemia testing was performed on consenting women age 15-49 and men age 15-59 and on children age 6-59 months whose parent/guardian consented to the testing. In addition, DBS samples were collected for HIV testing in the laboratory from women age 15-49 and men age 15-59 who consented to testing.

Mode of data collection

Computer Assisted Personal Interview [capi]

Research instrument

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

The Household Questionnaire was used to list all members of and visitors to selected households. Basic demographic information was collected on the characteristics of each person listed, including his or her age, sex, marital status, education, and relationship to the head of the household. For children under age 18, parents’ survival status was determined. The data on age and sex of household members obtained in the Household Questionnaire 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 water, type of toilet facilities, and flooring materials, as well as on ownership of various durable goods. The Household Questionnaire included an additional module developed by the DHS Program to estimate the prevalence of injuries/accidents among all household members.

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 childhood mortality - Family planning, including knowledge, use, and sources of contraceptive methods - Fertility preferences - Antenatal, delivery, and postnatal care - Breastfeeding and infant feeding practices - Vaccinations and childhood illnesses - Women’s work and husbands’ background characteristics - Knowledge, awareness, and behaviour regarding HIV/AIDS and other sexually transmitted diseases (STDs) - Knowledge, attitudes, and behaviours related to other health issues (e.g., injections, smoking, use of chat) - Adult and maternal mortality - Female genital mutilation or cutting - Fistula - Violence against women The Man’s Questionnaire was administered to all eligible men age 15-59. This questionnaire collected much of the same information elicited from the Woman’s Questionnaire but was shorter because it did not contain a detailed reproductive history, questions on maternal and child health, or questions on domestic violence. The Biomarker Questionnaire was used to record biomarker data

Abstract

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

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

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

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

Geographic coverage

National coverage

Analysis unit

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

Universe

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

Kind of data

Sample survey data [ssd]

Sampling procedure

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

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

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

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

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

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

Mode of data collection

Computer Assisted Personal Interview [capi]

Research instrument

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

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

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

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

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

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

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

Cleaning operations

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

Response rate

A total of 9,150 households were selected for the sample, of which 8,794 were occupied. Of the occupied households, 8,663 were successfully interviewed, yielding a response rate of 99%. In the interviewed households, 9,012 eligible women were identified for individual interviews; interviews were completed with 8,885 women, yielding a response rate of 99%. Overall, there was little variation in response rates according to residence; however, rates were slightly higher in rural than in urban areas.

Abstract

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

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

Geographic coverage

National coverage

Analysis unit

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

Universe

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

Kind of data

Sample survey data [ssd]

Sampling procedure

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

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

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

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

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

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

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

Mode of data collection

Computer Assisted Personal Interview [capi]

Research instrument

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

Cleaning operations

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

Response rate

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

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

Sampling error estimates

The estimates from a sample survey are affected by two types of errors: nonsampling errors and sampling errors. Nonsampling errors are the results of mistakes made in implementing data collection and data processing, such as failure to locate and interview the correct household, misunderstanding of the questions on the part of either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the 2019 Ethiopia Mini Demographic and Health Survey (EMDHS) to minimize this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically.

Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the 2019 EMDHS is only one of many samples that could have been selected from the same population, using the same design and expected size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability among all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results.

Sampling error is usually measured in terms of the standard error for a particular statistic (mean, percentage, etc.), which is the square root of the variance. The standard error can be used to calculate confidence intervals within which the true value for the population can reasonably be assumed to fall. For example, for any given statistic calculated from a sample survey, the value of that statistic will fall within a range of plus or minus two times the standard error of that statistic in 95% of all possible samples of identical size and design.

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

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

Data appraisal

Data Quality Tables

• Household age distribution

- Age distribution of eligible and interviewed women

Individual and community-level variances for multilevel random intercept Logit models predicting feeding 6–23 months age children with minimum acceptable diet in Ethiopia 2016.

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

Minimum meal frequency, Dietary diversity and minimum acceptable practice among children 6–13 months of age in Ethiopia, 2016 (n = 2919).

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

The definition of urban and rural areas differs across countries, which is evident in household surveys conducted in low- and middle-income countries. This lack of consistency and variation poses challenges for comparative analyses of the relationship between urbanization and health outcomes. Additionally, the binary urban-rural dichotomy fails to acknowledge the existence of an urban-rural continuum, encompassing remote rural areas, semi-urban suburbs, and core urban areas. By utilizing satellite-based datasets, it is possible to employ objective and continuous measures that quantify the level of urbanization with high spatial resolution. We utilize geospatial techniques to derive alternative classifications of the urban continuum from satellite data across nine household surveys conducted from 2005 to 2019 in six African countries and provide the database here

Random effects (measures of variations) and model fitness for no ASF consumption among children at primary sampling units (clusters) level by a multilevel mixed-effects logistic regression modeling based on pooled data from Ethiopia DHS 2016 & 2019.

BackgroundPolicy discussions and debates in the last couple of decades emphasized efficiency of development policies for translating economic growth to development. One of the key aspects in this regard in the developing world is achieving improved nutrition through economic development. Nonetheless, there is a dearth of literature that empirically verifies the association between economic growth and reduction of childhood undernutrition in low- and middle-income countries. Thus, the aim of the study is to assess the interplay between economic growth and reduction of childhood undernutrition in Ethiopia.MethodsThe study used pooled data of three rounds (2000, 2005 and 2010) from the Demographic and Health Surveys (DHS) of Ethiopia. A multilevel mixed logistic regression model with robust standard errors was utilized in order to account for the hierarchical nature of the data. The dependent variables were stunting, underweight, and wasting in children in the household. The main independent variable was real per capita income (PCI) that was adjusted for purchasing power parity. This information was obtained from World Bank.ResultsA total of 32,610 children were included in the pooled analysis. Overall, 11,296 (46.7%) [46.0%-47.3%], 8,197(33.8%) [33.2%-34.4%] and 3,175(13.1%) [12.7%-13.5%] were stunted, underweight, and wasted, respectively. We found a strong correlation between prevalence of early childhood undernutrition outcomes and real per capita income (PCI). The proportions of stunting (r = -0.1207, p