Abstract

The 2013 Turkey Demographic and Health Survey (TDHS-2013) is a nationally representative sample survey. The primary objective of the TDHS-2013 is to provide data on socioeconomic characteristics of households and women between ages 15-49, fertility, childhood mortality, marriage patterns, family planning, maternal and child health, nutritional status of women and children, and reproductive health. The survey obtained detailed information on these issues from a sample of women of reproductive age (15-49). The TDHS-2013 was designed to produce information in the field of demography and health that to a large extent cannot be obtained from other sources.

Specifically, the objectives of the TDHS-2013 included: - Collecting data at the national level that allows the calculation of some demographic and health indicators, particularly fertility rates and childhood mortality rates, - Obtaining information on direct and indirect factors that determine levels and trends in fertility and childhood mortality, - Measuring the level of contraceptive knowledge and practice by contraceptive method and some background characteristics, i.e., region and urban-rural residence, - Collecting data relative to maternal and child health, including immunizations, antenatal care, and postnatal care, assistance at delivery, and breastfeeding, - Measuring the nutritional status of children under five and women in the reproductive ages, - Collecting data on reproductive-age women about marriage, employment status, and social status

The TDHS-2013 information is intended to provide data to assist policy makers and administrators to evaluate existing programs and to design new strategies for improving demographic, social and health policies in Turkey. Another important purpose of the TDHS-2013 is to sustain the flow of information for the interested organizations in Turkey and abroad on the Turkish population structure in the absence of a reliable and sufficient vital registration system. Additionally, like the TDHS-2008, TDHS-2013 is accepted as a part of the Official Statistic Program.

Geographic coverage

National coverage

Analysis unit

• Household
• Women age 15-49
• Children under age of five

Universe

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

Kind of data

Sample survey data [ssd]

Sampling procedure

The sample design and sample size for the TDHS-2013 makes it possible to perform analyses for Turkey as a whole, for urban and rural areas, and for the five demographic regions of the country (West, South, Central, North, and East). The TDHS-2013 sample is of sufficient size to allow for analysis on some of the survey topics at the level of the 12 geographical regions (NUTS 1) which were adopted at the second half of the year 2002 within the context of Turkey’s move to join the European Union.

In the selection of the TDHS-2013 sample, a weighted, multi-stage, stratified cluster sampling approach was used. Sample selection for the TDHS-2013 was undertaken in two stages. The first stage of selection included the selection of blocks as primary sampling units from each strata and this task was requested from the TURKSTAT. The frame for the block selection was prepared using information on the population sizes of settlements obtained from the 2012 Address Based Population Registration System. Settlements with a population of 10,000 and more were defined as “urban”, while settlements with populations less than 10,000 were considered “rural” for purposes of the TDHS-2013 sample design. Systematic selection was used for selecting the blocks; thus settlements were given selection probabilities proportional to their sizes. Therefore more blocks were sampled from larger settlements.

The second stage of sample selection involved the systematic selection of a fixed number of households from each block, after block lists were obtained from TURKSTAT and were updated through a field operation; namely the listing and mapping fieldwork. Twentyfive households were selected as a cluster from urban blocks, and 18 were selected as a cluster from rural blocks. The total number of households selected in TDHS-2013 is 14,490.

The total number of clusters in the TDHS-2013 was set at 642. Block level household lists, each including approximately 100 households, were provided by TURKSTAT, using the National Address Database prepared for municipalities. The block lists provided by TURKSTAT were updated during the listing and mapping activities.

All women at ages 15-49 who usually live in the selected households and/or were present in the household the night before the interview were regarded as eligible for the Women’s Questionnaire and were interviewed. All analysis in this report is based on de facto women.

Note: A more technical and detailed description of the TDHS-2013 sample design, selection and implementation is presented in Appendix B of the final report of the survey.

Mode of data collection

Face-to-face [f2f]

Research instrument

Two main types of questionnaires were used to collect the TDHS-2013 data: the Household Questionnaire and the Individual Questionnaire for all women of reproductive age. The contents of these questionnaires were based on the DHS core questionnaire. Additions, deletions and modifications were made to the DHS model questionnaire in order to collect information particularly relevant to Turkey. Attention also was paid to ensuring the comparability of the TDHS-2013 findings with previous demographic surveys carried out by the Hacettepe Institute of Population Studies. In the process of designing the TDHS-2013 questionnaires, national and international population and health agencies were consulted for their comments.

The questionnaires were developed in Turkish and translated into English.

Cleaning operations

TDHS-2013 questionnaires were returned to the Hacettepe University Institute of Population Studies by the fieldwork teams for data processing as soon as interviews were completed in a province. The office editing staff checked that the questionnaires for all selected households and eligible respondents were returned from the field. A total of 29 data entry staff were trained for data entry activities of the TDHS-2013. The data entry of the TDHS-2013 began in late September 2013 and was completed at the end of January 2014.

The data were entered and edited on microcomputers using the Census and Survey Processing System (CSPro) software. CSPro is designed to fulfill the census and survey data processing needs of data-producing organizations worldwide. CSPro is developed by MEASURE partners, the U.S. Bureau of the Census, ICF International’s DHS Program, and SerPro S.A. CSPro allows range, skip, and consistency errors to be detected and corrected at the data entry stage. During the data entry process, 100% verification was performed by entering each questionnaire twice using different data entry operators and comparing the entered data.

Response rate

In all, 14,490 households were selected for the TDHS-2013. At the time of the listing phase of the survey, 12,640 households were considered occupied and, thus, eligible for interview. Of the eligible households, 93 percent (11,794) households were successfully interviewed. The main reasons the field teams were unable to interview some households were because some dwelling units that had been listed were found to be vacant at the time of the interview or the household was away for an extended period.

In the interviewed 11,794 households, 10,840 women were identified as eligible for the individual interview, aged 15-49 and were present in the household on the night before the interview. Interviews were successfully completed with 9,746 of these women (90 percent). Among the eligible women not interviewed in the survey, the principal reason for nonresponse was the failure to find the women at home after repeated visits to the household.

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 TDHS-2013 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 TDHS-2013 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

Abstract

The 1998 Turkish Demographic and Health Survey (TDHS-98) is a nationally representative sample survey designed to provide information on fertility levels and trends, infant and child mortality, family planning, and maternal and child health. Survey results are presented at the national level, by urban and rural residence and for each of the five regions in the country.

The survey was fielded between August and November 1998. Hacettepe University Institute of Population Studies (HIPS) carried out the TDHS-98 in collaboration with the General Directorate of Mother and Child Health and Family Planning, Ministry of Health. Funding for the TDHS-98 was provided both by the U.S. Agency for International Development through the MEASURE/DHS+ program and United Nations Population Fund.

Interviews were carried out in 8,059 households, with 8,576 women, and with 1,971 husbands. All women at ages 15-49 who were present in the household on the night before the interview or who generally live in that household were eligible for the survey. In half of the selected households for women interview, husbands (of currently married eligible women), who were present in the household on the night before the interview or who generally live in that particular household were eligible husbands for the survey.

The 1998 Turkish Demographic and Health Survey (TDHS-98) is the latest in a series of national- level population and health surveys that have been conducted during the last thirty years in Turkey. The primary objective of the TDHS-98 is to provide data on fertility and mortality, family planning, materaal and child health, and reproductive health. The survey obtained detailed information on these issues from a sample of women in the reproductive ages (15-49) and from fl~e husbands of cun'ently married eligible women.

More specifically, the objectives of the TDHS were to: - Collect data at the national level that allow the calculation of demographic rates, particularly fertility and childhood mortality rates; Obtain information on 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 innnunisations, prevalence and treatment of diarrhoea 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.

Geographic coverage

The 1998 Turkish Demographic and Health Survey (TDHS-98) is a nationally representative sample survey. Results are also presented by urban and rural residence and for each of the five regions in the country (West, South, Central, North and East).

Analysis unit

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

Universe

The population covered by the 1998 DHS is defined as the universe of all women at ages 15-49 who were present in the household on the night before the interview were eligible for the survey. In half of the selected households for women interview, husbands of currently married eligible women, who were present in the household on the night before the interview or who usually lived in the household were eligible for the husband survey.

Kind of data

Sample survey data

Sampling procedure

The sample for tile TDHS-98 was designed to provide estimates of population and health indicators including fertility and mortality rates for the nation as a who/e, for urban and rural areas, and for tile five major regions of tile country (West, South, Central, North and East). A weighted, multi-stage, stratified cluster sampling approach was used in tile selection of the TDHS-98 sample.

The optimal distribution with a target sample size of I0,000 selected households was based on the provisional results of the 1997 General Population Count. Selection of the TDHS-98 sample was undertaken in three stages. Tile sampling units at tile first stage were tile settlements stratified by population size. The ti'ame for the selection of the primary sampling units (PSU) was prepared using the provisional results of the 1997 Population Count. The fi'ame was divided into two groups, one including those settlements with populations of more than 10,000 and the other including settlements with populations less than 10,000. The selection of the settlement in each group was carried out with probability proportional to size (1997 poptdatiou).

The second stage of selection required the selection of the assigned nnmber of clusters in each selected settlement. For the majority of the settlements (340 clusters), the selection of clusters was based on the household lists that were available from the 1995 Structure Schedules. The State Institute of Statistics (SIS) selected the clusters and provided to Hacettepe Institute of Population Studies a description of each selected cluster. Each cluster included approximately 100 households. For those settlements where SIS was not able to provide information (140 clusters), the lists of households were prepared in the field.

Following the selection of the secondary sampling units (SSUs), a household listing was prepared or updated for each SSU by the TDHS-98 listing teams. Using the household lists, a systematic random sample of fixed number of households (25 in clusters located in settlements over 10,000 and 15 in those less than 10,000) was chosen within each cluster for the TDHS-98. All women at ages 15-49 who were present in the household on the night before the interview were eligible for the survey. In half of the selected households for women interview, husbands of currently married eligible women, who were present in the household on the night before the interview or who usually lived in the household were eligible for the husband survey.

SAMPLE FRAME

Different criteria have been used to describe "urban" and "rural" settlements in Turkey. In the demographic surveys of the 1970s a population size of 2,000 was used to differentiate between urban and rural settlements. In the 1980s, this was increased to 10,00O and, in some surveys in the 1990s, to 20,000. A number of surveys used the administrative status of settlements in combination with population size for the purpose of differentiation.

The urban frame of the 1998 TDHS consisted of a list of provincial centres, district centres, and other settlements with populations larger than 10,000, regardless of administrative status. In turn, the rural frame consists of all district centres, subdistricts and villages not included iF the urban fi'ame. Initial information on these settlements was obtained from the preliminary results of 1997 Population Count. The preliminary results of 1997 Population Count provided a computerized list of all settlements (provincial and district centres, , subdistricts and villages) and their population. The population counts were taken from the cumulative enumeration forms for settlements, which were filled by supervisors during the Population Count.

STRATIFICATION

Currently Turkey is divided administratively into 80 provinces. This figure was 67 for a long time, with new provinces formed since the late 1980s, For purposes of selection in prior surveys in Turkey, these provinces have been grouped into five regions, as described in Chapter 1. This regional breakdown has been popularised as a powerful variable for understanding the demographic, social, cultural, and economic differences between different parts of the country. The five regions, West, South, Central, North, and East regions, include varying numbers of provinces.

One of tile priorities of the TDHS was to produce a sample design that was methodologically and conceptually consistent with the designs of previous demographic surveys carried out by the Hacettepe Institute of Population Studies. In surveys prior to the 1993, the five-region division of the country was used for stratification. In the 1993 TDHS, a more detailed stratification taking into account subregions was employed to obtain a better dispersion of file sample. The criteria for subdividing the five major regions into subregions were the infant mortality rates &each province, estimated from the 1990 Population Census using indirect techniques? Using the infant mortality estimates as well as geographic proximity, the provinces in each region were grouped into 14 subregions at the time of the 1993 TDHS. The sub-regional division developed during the 1993 TDHS was used in the 1998 survey.

SAMPLE ALLOCATION

The target sample size of 10,000 households was allocated among the five major divisions using the sampling error estimates from the TDHS-93 in combination with the power allocation technique with the ex- pectation that the target sample size would provide about 8,000 completed individual interviews. During the power allocation calculations, the aim was to keep the allocation as similar as possible to the 1993 TDHS. The optimal distribution (with power 0.4) among the five major regions is shown in Table B.I. For purposes of comparison, Table B.I also shows the allocation of the TDHS-93 sample and the allocation if the TDHS-98 sample had been distributed proportional to the size of the population in each region. To have an adequate representation of clusters within each of the five major regions, it was decided to select 25 households per standard urban segments (each consisting of 100 households) and 15 households per standard rural segment. It was also determined that 70 percent of the 10,000 households would be located in urban settlements and 30 percent in rural settlements.

SAMPLE SELECTION - SELECTION PROCEDURES

The

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 Turkey Demographic and Health Survey (DHS) 2008 has been conducted by the Haccettepe University Institute of Population Studies in collaboration with the Ministry of health General Directorate of Mother and Child Health and Family Planning and Undersecretary of State Planning Organization. The Turkey Demographic and Health Survey 2008 has been financed the scientific and Technological research Council of Turkey (TUBITAK) under the support program for Research Projects of Public Institutions.

The primary objective of the Turkey DHS 2008 is to provide data on fertility, contraceptive methods, maternal and child health. Detailed information on these issues is obtained through questionnaires, filled by face-to face interviews with ever-married women in reproductive ages (15-49).

Another important objective of the survey, with aims to contribute to the knowledge on population and health as well, is to maintain the flow of information for the related organizations in Turkey on the Turkish demographic structure and change in the absence of reliable vital registration system and ascertain the continuity of data on demographic and health necessary for sustainable development in the absence of a reliable vital registration system. In terms of survey methodology and content, the Turkey DHS 2008 is comparable with the previous demographic surveys in Turkey (MEASURE DHS+).

Geographic coverage

National

Analysis unit

• Household
• Women age 15-49
• Children under age of five

Kind of data

Sample survey data

Mode of data collection

Face-to-face

Research instrument

Two main types of questionnaires were used to collect the TDHS-2008 data: a) The Household Questionnaire; b) The Individual Questionnaire for Ever-Married Women of Reproductive Ages.

The contents of these questionnaires were based on the DHS Model "A" Questionnaire, which was designed for the DHS program for use in countries with high contraceptive prevalence. Additions, deletions and modifications were made to the DHS model questionnaire in order to collect information particularly relevant to Turkey. Attention also was paid to ensuring the comparability of the DHS-2008 findings with previous demographic surveys carried out by the Hacettepe Institute of Population Studies. In the process of designing the TDHS-2003 questionnaires, national and international population and health agencies were consulted for their comments.

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, recent migration and residential mobility, employment, marital status, and relationship to the head of household of each person listed as a household member or visitor. The objective of the first part of the Household Questionnaire was to obtain the information needed to identify women who were eligible for the individual interview as well as to provide basic demographic data for Turkish households. The second part of the Household Questionnaire included questions on never married women age 15-49, with the objective of collecting information on basic background characteristics of women in this age group. The third section was used to collect information on the welfare of the elderly people. The final section of the Household Questionnaire was used to collect information on housing characteristics, such as the number of rooms, the flooring material, the source of water, and the type of toilet facilities, and on the household's ownership of a variety of consumer goods. This section also incorporated a module that was only administered in Istanbul metropolitan households, on house ownership, use of municipal facilities and the like, as well as a module that was used to collect information, from one-half of households, on salt iodization. In households where salt was present, test kits were used to test whether the salt used in the household was fortified with potassium iodine or potassium iodate, i.e. whether salt was iodized.

b) The Individual Questionnaire for ever-married women obtained information on the following subjects: - Background characteristics - Reproduction - Marriage - Knowledge and use of family planning - Maternal care and breastfeeding - Immunization and health - Fertility preferences - Husband's background
- Women's work and status - Sexually transmitted diseases and AIDS - Maternal and child anthropometry.

Cleaning operations

The questionnaires were returned to the Hacettepe Institute of Population Studies by the fieldwork teams for data processing as soon as interviews were completed in a province. The office editing staff checked that the questionnaires for all the selected households and eligible respondents were returned from the field.

Abstract

Different countries have different health outcomes that are in part due to the way respective health systems perform. Regardless of the type of health system, individuals will have health and non-health expectations in terms of how the institution responds to their needs. In many countries, however, health systems do not perform effectively and this is in part due to lack of information on health system performance, and on the different service providers.

The aim of the WHO World Health Survey is to provide empirical data to the national health information systems so that there is a better monitoring of health of the people, responsiveness of health systems and measurement of health-related parameters.

The overall aims of the survey is to examine the way populations report their health, understand how people value health states, measure the performance of health systems in relation to responsiveness and gather information on modes and extents of payment for health encounters through a nationally representative population based community survey. In addition, it addresses various areas such as health care expenditures, adult mortality, birth history, various risk factors, assessment of main chronic health conditions and the coverage of health interventions, in specific additional modules.

The objectives of the survey programme are to: 1. develop a means of providing valid, reliable and comparable information, at low cost, to supplement the information provided by routine health information systems. 2. build the evidence base necessary for policy-makers to monitor if health systems are achieving the desired goals, and to assess if additional investment in health is achieving the desired outcomes. 3. provide policy-makers with the evidence they need to adjust their policies, strategies and programmes as necessary.

Geographic coverage

The survey sampling frame must cover 100% of the country's eligible population, meaning that the entire national territory must be included. This does not mean that every province or territory need be represented in the survey sample but, rather, that all must have a chance (known probability) of being included in the survey sample.

There may be exceptional circumstances that preclude 100% national coverage. Certain areas in certain countries may be impossible to include due to reasons such as accessibility or conflict. All such exceptions must be discussed with WHO sampling experts. If any region must be excluded, it must constitute a coherent area, such as a particular province or region. For example if ¾ of region D in country X is not accessible due to war, the entire region D will be excluded from analysis.

Analysis unit

Households and individuals

Universe

The WHS will include all male and female adults (18 years of age and older) who are not out of the country during the survey period. It should be noted that this includes the population who may be institutionalized for health reasons at the time of the survey: all persons who would have fit the definition of household member at the time of their institutionalisation are included in the eligible population.

If the randomly selected individual is institutionalized short-term (e.g. a 3-day stay at a hospital) the interviewer must return to the household when the individual will have come back to interview him/her. If the randomly selected individual is institutionalized long term (e.g. has been in a nursing home the last 8 years), the interviewer must travel to that institution to interview him/her.

The target population includes any adult, male or female age 18 or over living in private households. Populations in group quarters, on military reservations, or in other non-household living arrangements will not be eligible for the study. People who are in an institution due to a health condition (such as a hospital, hospice, nursing home, home for the aged, etc.) at the time of the visit to the household are interviewed either in the institution or upon their return to their household if this is within a period of two weeks from the first visit to the household.

Kind of data

Sample survey data [ssd]

Sampling procedure

SAMPLING GUIDELINES FOR WHS

Surveys in the WHS program must employ a probability sampling design. This means that every single individual in the sampling frame has a known and non-zero chance of being selected into the survey sample. While a Single Stage Random Sample is ideal if feasible, it is recognized that most sites will carry out Multi-stage Cluster Sampling.

The WHS sampling frame should cover 100% of the eligible population in the surveyed country. This means that every eligible person in the country has a chance of being included in the survey sample. It also means that particular ethnic groups or geographical areas may not be excluded from the sampling frame.

The sample size of the WHS in each country is 5000 persons (exceptions considered on a by-country basis). An adequate number of persons must be drawn from the sampling frame to account for an estimated amount of non-response (refusal to participate, empty houses etc.). The highest estimate of potential non-response and empty households should be used to ensure that the desired sample size is reached at the end of the survey period. This is very important because if, at the end of data collection, the required sample size of 5000 has not been reached additional persons must be selected randomly into the survey sample from the sampling frame. This is both costly and technically complicated (if this situation is to occur, consult WHO sampling experts for assistance), and best avoided by proper planning before data collection begins.

All steps of sampling, including justification for stratification, cluster sizes, probabilities of selection, weights at each stage of selection, and the computer program used for randomization must be communicated to WHO

STRATIFICATION

Stratification is the process by which the population is divided into subgroups. Sampling will then be conducted separately in each subgroup. Strata or subgroups are chosen because evidence is available that they are related to the outcome (e.g. health, responsiveness, mortality, coverage etc.). The strata chosen will vary by country and reflect local conditions. Some examples of factors that can be stratified on are geography (e.g. North, Central, South), level of urbanization (e.g. urban, rural), socio-economic zones, provinces (especially if health administration is primarily under the jurisdiction of provincial authorities), or presence of health facility in area. Strata to be used must be identified by each country and the reasons for selection explicitly justified.

Stratification is strongly recommended at the first stage of sampling. Once the strata have been chosen and justified, all stages of selection will be conducted separately in each stratum. We recommend stratifying on 3-5 factors. It is optimum to have half as many strata (note the difference between stratifying variables, which may be such variables as gender, socio-economic status, province/region etc. and strata, which are the combination of variable categories, for example Male, High socio-economic status, Xingtao Province would be a stratum).

Strata should be as homogenous as possible within and as heterogeneous as possible between. This means that strata should be formulated in such a way that individuals belonging to a stratum should be as similar to each other with respect to key variables as possible and as different as possible from individuals belonging to a different stratum. This maximises the efficiency of stratification in reducing sampling variance.

MULTI-STAGE CLUSTER SELECTION

A cluster is a naturally occurring unit or grouping within the population (e.g. enumeration areas, cities, universities, provinces, hospitals etc.); it is a unit for which the administrative level has clear, nonoverlapping boundaries. Cluster sampling is useful because it avoids having to compile exhaustive lists of every single person in the population. Clusters should be as heterogeneous as possible within and as homogenous as possible between (note that this is the opposite criterion as that for strata). Clusters should be as small as possible (i.e. large administrative units such as Provinces or States are not good clusters) but not so small as to be homogenous.

In cluster sampling, a number of clusters are randomly selected from a list of clusters. Then, either all members of the chosen cluster or a random selection from among them are included in the sample. Multistage sampling is an extension of cluster sampling where a hierarchy of clusters are chosen going from larger to smaller.

In order to carry out multi-stage sampling, one needs to know only the population sizes of the sampling units. For the smallest sampling unit above the elementary unit however, a complete list of all elementary units (households) is needed; in order to be able to randomly select among all households in the TSU, a list of all those households is required. This information may be available from the most recent population census. If the last census was >3 years ago or the information furnished by it was of poor quality or unreliable, the survey staff will have the task of enumerating all households in the smallest randomly selected sampling unit. It is very important to budget for this step if it is necessary and ensure that all households are properly enumerated in order that a representative sample is obtained.

It is always best to have as many clusters in the PSU as possible. The reason for this is that the fewer the number of respondents in each PSU, the lower will be the clustering effect which

The urban indicators data available here are analyzed, compiled and published by UN-Habitat’s Global Urban Observatory which supports governments, local authorities and civil society organizations to develop urban indicators, data and statistics. Urban statistics are collected through household surveys and censuses conducted by national statistics authorities. Global Urban Observatory team analyses and compiles urban indicators statistics from surveys and censuses. Additionally, Local urban observatories collect, compile and analyze urban data for national policy development. Population statistics are produced by the United Nations Department of Economic and Social Affairs, World Urbanization Prospects.

This survey is a not up-to-date version. Please, use the updated version included in the EVS integrated data files. This national dataset is only available for replication purposes and analysis with additional country-specific variables (see ´Further Remarks´).

Two online overviews offer comprehensive metadata on the EVS datasets and variables.

The extended study description for the EVS 2008 provides country-specific information on the origin and outcomes of the national surveys The variable overview of the four EVS waves 1981 1990 1999/2000 and 2008 allows for identifying country specific deviations in the question wording within and across the EVS waves.

These overviews can be found at: Extended Study Description Variable Overview

Moral, religious, societal, political, work, and family values of Europeans.

Topics: 1. Perceptions of life: importance of work, family, friends and acquaintances, leisure time, politics and religion; frequency of political discussions with friends; happiness; self-assessment of own health; memberships and unpaid work (volunteering) in: social welfare services, religious or church organisations, education, or cultural activities, labour unions, political parties, local political actions, human rights, environmental or peace movement, professional associations, youth work, sports clubs, women´s groups, voluntary associations concerned with health or other groups; tolerance towards minorities (people with a criminal record, of a different race, left/right wing extremists, alcohol addicts, large families, emotionally unstable people, Muslims, immigrants, AIDS sufferers, drug addicts, homosexuals, Jews, gypsies and Christians - social distance); trust in people; estimation of people´s fair and helpful behaviour; internal or external control; satisfaction with life.

1. Work: reasons for people to live in need; importance of selected aspects of occupational work; employment status; general work satisfaction; freedom of decision-taking in the job; importance of work (work ethics, scale); important aspects of leisure time; attitude towards following instructions at work without criticism (obedience work); give priority to nationals over foreigners as well as men over women in jobs.

2. Religion: Individual or general clear guidelines for good and evil; religious denomination; current and former religious denomination; current frequency of church attendance and at the age of 12; importance of religious celebration at birth, marriage, and funeral; self-assessment of religiousness; churches give adequate answers to moral questions, problems of family life, spiritual needs and social problems of the country; belief in God, life after death, hell, heaven, sin and re-incarnation; personal God versus spirit or life force; own way of connecting with the divine; interest in the sacred or the supernatural; attitude towards the existence of one true religion; importance of God in one´s life (10-point-scale); experience of comfort and strength from religion and belief; moments of prayer and meditation; frequency of prayers; belief in lucky charms or a talisman (10-point-scale); attitude towards the separation of church and state.

3. Family and marriage: most important criteria for a successful marriage (scale); attitude towards childcare (a child needs a home with father and mother, a woman has to have children to be fulfilled, marriage is an out-dated institution, woman as a single-parent); attitude towards marriage, children, and traditional family structure (scale); attitude towards traditional understanding of one´s role of man and woman in occupation and family (scale); attitude towards: respect and love for parents, parent´s responsibilities for their children and the responsibility of adult children for their parents when they are in need of long-term care; importance of educational goals; attitude towards abortion.

4. Politics and society: political interest; political participation; preference for individual freedom or social equality; self-assessment on a left-right continuum (10-point-scale); self-responsibility or governmental provision; free decision of job-taking of the unemployed or no permission to refuse a job; advantage or harmfulness of competition; liberty of firms or governmental control; equal incomes or incentives for indivi...

Abstract

The European Social Survey (ESS) is an academically-driven multi-country survey covering over 20 nations. Its three aims are, firstly - to monitor and interpret changing public attitudes and values within Europe and to investigate how they interact with Europe's changing institutions, secondly - to advance and consolidate improved methods of cross-national survey measurement in Europe and beyond, and thirdly - to develop a series of European social indicators, including attitudinal indicators.

In the second round, the survey covers over 20 nations and employs the most rigorous methodologies. It is funded via the European Commission's 5th Framework Programme, the European Science Foundation, and national funding bodies in each country. It involves strict random probability sampling, a minimum target response rate of 70% and rigorous translation protocols. The hour-long face-to-face interview includes (amongst others) questions on family, work and well-being, health and economic morality.

Geographic coverage

1) European Union countries - Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Luxembourg, Netherlands, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden, United Kingdom. 2) Non-European Union countries - Iceland, Norway, Switzerland, Turkey, Ukraine.

Analysis unit

Individual

Universe

All persons aged 15 and over, resident within private households, regardless of their nationality, citizenship, language or legal status, in participating countries.

Kind of data

Sample survey data [ssd]

Sampling procedure

Sampling procedure varied by country. Please see the "Documentation Report" available in the 'Documentation' section for detailed information on how sampling was conducted in each of the 20 countries.

Mode of data collection

Computer Assisted Personal Interview [capi]

Research instrument

Austria - structured questionnaires in German Belgium - structured questionnaires in Dutch and French Czech Republic - structured questionnaires in Czech Denmark - structured questionnaires in Danish Estonia - structured questionnaires in Estonian and Russian Finland - structured questionnaires in Finnish and Swedish France - structured questionnaires in French Germany - structured questionnaires in German Greece - structured questionnaires in Greek Hungary - structured questionnaires in Hungarian Iceland - structured questionnaires in Icelandic Ireland - structured questionnaires in English Italy - structured questionnaires in Italian Luxembourg - structured questionnaires in French, German, Luxembourgish, Portuguese, English Netherlands - structured questionnaires in Dutch Norway - structured questionnaires in Norwegian and English Poland - structured questionnaires in Polish Portugal - structured questionnaires in Portuguese Slovakia - structured questionnaires in Slovak and Hungarian Slovenia - structured questionnaires in Slovenian Spain - structured questionnaires in Spanish and Catalan Sweden - structured questionnaires in Swedish Switzerland - structured questionnaires in Swiss German, French, and Italian Turkey - structured questionnaires in Turkish Ukraine - structured questionnaires in Ukrainian and Russian United Kingdom - structured questionnaires in English

Response rate

Response rate varied by country. Please see the "Documentation Report" available in the 'Documentation' section for detailed information on the response rate in each of the 20 countries.