Abstract

The primary objective of the 2018 NDHS is to provide up-to-date estimates of basic demographic and health indicators. Specifically, the NDHS collected information on fertility, awareness and use of family planning methods, breastfeeding practices, nutritional status of women and children, maternal and child health, adult and childhood mortality, women’s empowerment, domestic violence, female genital cutting, prevalence of malaria, awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections (STIs), disability, and other health-related issues such as smoking.

The information collected through the 2018 NDHS is intended to assist policymakers and programme managers in evaluating and designing programmes and strategies for improving the health of the country’s population. The 2018 NDHS also provides indicators relevant to the Sustainable Development Goals (SDGs) for Nigeria.

Geographic coverage

National coverage

Analysis unit

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

Universe

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

Kind of data

Sample survey data [ssd]

Sampling procedure

The sampling frame used for the 2018 NDHS is the Population and Housing Census of the Federal Republic of Nigeria (NPHC), which was conducted in 2006 by the National Population Commission. Administratively, Nigeria is divided into states. Each state is subdivided into local government areas (LGAs), and each LGA is divided into wards. In addition to these administrative units, during the 2006 NPHC each locality was subdivided into convenient areas called census enumeration areas (EAs). The primary sampling unit (PSU), referred to as a cluster for the 2018 NDHS, is defined on the basis of EAs from the 2006 EA census frame. Although the 2006 NPHC did not provide the number of households and population for each EA, population estimates were published for 774 LGAs. A combination of information from cartographic material demarcating each EA and the LGA population estimates from the census was used to identify the list of EAs, estimate the number of households, and distinguish EAs as urban or rural for the survey sample frame. Before sample selection, all localities were classified separately into urban and rural areas based on predetermined minimum sizes of urban areas (cut-off points); consistent with the official definition in 2017, any locality with more than a minimum population size of 20,000 was classified as urban.

The sample for the 2018 NDHS was a stratified sample selected in two stages. Stratification was achieved by separating each of the 36 states and the Federal Capital Territory into urban and rural areas. In total, 74 sampling strata were identified. Samples were selected independently in every stratum via a two-stage selection. Implicit stratifications were achieved at each of the lower administrative levels by sorting the sampling frame before sample selection according to administrative order and by using a probability proportional to size selection during the first sampling stage.

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

Mode of data collection

Computer Assisted Personal Interview [capi]

Research instrument

Four questionnaires were used for the 2018 NDHS: the Household Questionnaire, the Woman’s Questionnaire, the Man’s Questionnaire, and the Biomarker Questionnaire. The questionnaires, based on The DHS Program’s standard Demographic and Health Survey (DHS-7) questionnaires, were adapted to reflect the population and health issues relevant to Nigeria. Comments were solicited from various stakeholders representing government ministries and agencies, nongovernmental organisations, and international donors. In addition, information about the fieldworkers for the survey was collected through a self-administered Fieldworker Questionnaire.

Cleaning operations

The processing of the 2018 NDHS data began almost immediately after the fieldwork started. As data collection was completed in each cluster, all electronic data files were transferred via the IFSS to the NPC central office in Abuja. These data files were registered and checked for inconsistencies, incompleteness, and outliers. The field teams were alerted to any inconsistencies and errors. Secondary editing, carried out in the central office, involved resolving inconsistencies and coding the open-ended questions. The NPC data processor coordinated the exercise at the central office. The biomarker paper questionnaires were compared with electronic data files to check for any inconsistencies in data entry. Data entry and editing were carried out using the CSPro software package. The concurrent processing of the data offered a distinct advantage because it maximised the likelihood of the data being error-free and accurate. Timely generation of field check tables allowed for effective monitoring. The secondary editing of the data was completed in the second week of April 2019.

Response rate

A total of 41,668 households were selected for the sample, of which 40,666 were occupied. Of the occupied households, 40,427 were successfully interviewed, yielding a response rate of 99%. In the households interviewed, 42,121 women age 15-49 were identified for individual interviews; interviews were completed with 41,821 women, yielding a response rate of 99%. In the subsample of households selected for the male survey, 13,422 men age 15-59 were identified and 13,311 were successfully interviewed, yielding a response rate of 99%.

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 2018 Nigeria Demographic and Health Survey (NDHS) 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 2018 NDHS 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 2018 NDHS sample is the result of a multistage 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 linearisation method to estimate variances for survey estimates that are means, proportions, or ratios. The Jackknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates.

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

Data appraisal

Data Quality Tables - Household age distribution - Age distribution of eligible and interviewed women - Age distribution of eligible and interviewed men - Completeness of reporting - Births by calendar years - Reporting of age at death in days - Reporting of age at death in months - Standardisation exercise results from anthropometry training - Height and weight data completeness and quality for children - Height measurements from random subsample of measured children - Sibship size and sex ratio of siblings - Pregnancy-related mortality trends - Data collection period - Malaria prevalence according to rapid diagnostic test (RDT)

Note: See detailed data quality tables in APPENDIX C of the report.

The 2008 Nigeria Demographic Health Survey (NDHS) is a nationally representative survey of 33,385 women age 15-49 and 15,486 men age 15-59. The 2008 NDHS is the fourth comprehensive survey conducted in Nigeria as part of the Demographic and Health Surveys (DHS) programme. The data are intended to furnish programme managers and policymakers with detailed information on levels and trends in fertility; nuptiality; sexual activity; fertility preferences; awareness and use of family planning methods; infants and young children feeding practices; nutritional status of mothers and young children; early childhood mortality and maternal mortality; maternal and child health; and awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections. Additionally, the 2008 NDHS collected information on malaria prevention and treatment, neglected tropical diseases, domestic violence, fistulae, and female genital cutting (FGC). The 2008 Nigeria Demographic and Health Survey (2008 NDHS) was implemented by the National Population Commission from June to October 2008 on a nationally representative sample of more than 36,000 households. All women age 15-49 in these households and all men age 15-59 in a sub-sample of half of the households were individually interviewed. While significantly expanded in content, the 2008 NDHS is a follow-up to the 1990, 1999, and 2003 NDHS surveys and provides updated estimates of basic demographic and health indicators covered in these earlier surveys. In addition, the 2008 NDHS includes the collection of information on violence against women. Although previous surveys collected data at the national and zonal levels, the 2008 NDHS is the first NDHS survey to collect data on basic demographic and health indicators at the state level. The primary objectives of the 2008 NDHS project were to provide up-to-date information on fertility levels; nuptiality; sexual activity; fertility preferences; awareness and use of family planning methods; breastfeeding practices; nutritional status of mothers and young children; early childhood mortality and maternal mortality; maternal and child health; and awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections. MAIN FINDINGS FERTILITY The survey results show fertility in Nigeria has remained at a high level over the last 17 years from 5.9 births per woman in 1991 to 5.7 births in 2008. On average, rural women are having two children more than urban women (6.3 and 4.7 children, respectively). Fertility differentials by education and wealth are noticeable. Women who have no formal education and women in the lowest wealth quintile on average are having 7 children, while women with higher than a secondary education are having 3 children and women in the highest wealth quintile are having 4 children. FAMILY PLANNING In the 2008 NDHS, 72 percent of all women and 90 percent of all men know at least one contraceptive method. Male condoms, the pill, and injectables are the most widely known methods. Twenty-nine percent of currently married women have used a family planning method at least once in their lifetime. Fifteen percent of currently married women are using any contraceptive method and 10 percent are using a modern method. The most commonly used methods among currently married women are injectables (3 percent), followed by male condoms and the pill (2 percent each). Current use of contraception in Nigeria has increased from 6 percent in 1990 and 13 percent in 2003 to 15 percent in 2008. There has been a corresponding increase in the use of modern contraceptive methods, from 4 percent in 1990 and 8 percent in 2003 to 10 percent in 2008. CHILD HEALTH Data from the 2008 NDHS indicate that the infant mortality rate is 75 deaths per 1,000 live births, while the under-five mortality rate is 157 per 1,000 live births for the five-year period immediately preceding the survey. The neonatal mortality rate is 40 per 1,000 births. Thus, almost half of childhood deaths occurred during infancy, with one-quarter taking place during the first month of life. Child mortality is consistently lower in urban areas than in rural areas. There is also variation in the mortality level across zones. The infant mortality and under-five mortality rates are highest in the North East, and lowest in the South West. In Nigeria, children are considered fully vaccinated when they receive one dose of BCG vaccine, three doses of DPT vaccine, three doses of polio vaccine, and one dose of measles vaccine. Overall, 23 percent of children 12-23 months have received all vaccinations at the time of the survey. Fifty percent of children have received the BCG vaccination, and 41 percent have been vaccinated against measles. The coverage of the first dose of DPT vaccine and polio 1 is 52 and 68 percent, respectively). However, only 35 percent of children have received the third dose of DPT vaccine, and 39 percent have received the third dose of polio vaccine. A comparison of the 2008 NDHS results with those of the earlier surveys shows there has been an increase in the overall vaccination coverage in Nigeria from 13 percent in 2003 to the current rate of 23 percent. However, the percentage of children with no vaccinations has not improved for the same period, 27 percent in 2003 and 29 percent in 2008. MATERNAL HEALTH In Nigeria more than half of women who had a live birth in the five years preceding the survey received antenatal care from a health professional (58 percent); 23 percent from a doctor, 30 percent from a nurse or midwife, and 5 percent from an auxiliary nurse or midwife. Thirty-six percent of mothers did not receive any antenatal care. Tetanus toxoid injections are given during pregnancy to prevent neonatal tetanus. Overall, 48 percent of last births in Nigeria were protected against neonatal tetanus. More than one-third of births in the five years before the survey were delivered in a health facility (35 percent). Twenty percent of births occurred in public health facilities and 15 percent occurred in private health facilities. Almost two-thirds (62 percent) of births occurred at home. Nine percent of births were assisted by a doctor, 25 percent by a nurse or midwife, 5 percent by an auxiliary nurse or midwife, and 22 percent by a traditional birth attendant. Nineteen percent of births were assisted by a relative and 19 percent of births had no assistance at all. Two percent of births were delivered by a caesarean section. Overall, 42 percent of mothers received a postnatal check-up for the most recent birth in the five years preceding the survey, with 38 percent having the check-up within the critical 48 hours after delivery. Results from the 2008 NDHS show that the estimated maternal mortality ratio during the seven-year period prior to the survey is 545 maternal deaths per 100,000 live births. BREASTFEEDING AND NUTRITION Ninety-seven percent of Nigerian children under age five were breastfed at some point in their life. The median breastfeeding duration in Nigeria is long (18.1 months). On the other hand, the median duration for exclusive breastfeeding is only for half a month. A small proportion of babies (13 percent) are exclusively breastfed throughout the first six months of life. More than seven in ten (76 percent) children age 6-9 months receive complementary foods. Sixteen percent of babies less than six months of age are fed with a bottle with a nipple, and the proportion bottle-fed peaks at 17 percent among children in the age groups 2-3 months and 4-5 months. Anthropometric measurements carried out at the time of the survey indicate that, overall, 41 percent of Nigerian children are stunted (short for their age), 14 percent are wasted (thin for their height), and 23 percent are underweight. The indices show that malnutrition in young children increases with age, starting with wasting, which peaks among children age 6-8 months, underweight peaks among children age 12-17 months, and stunting is highest among children age 18-23 months. Stunting affects half of children in this age group and almost one-third of children age 18-23 months are severely stunted. Overall, 66 percent of women have a body mass index (BMI) in the normal range; 12 percent of women are classified as thin and 4 percent are severely thin. Twenty-two percent of women are classified as overweight or obese, with 6 percent in the latter category. MALARIA Seventeen percent of all households interviewed during the survey had at least one mosquito net, while 8 percent had more than one. Sixteen percent of households had at least one net that had been treated at some time (ever-treated) with an insecticide. Eight percent of households had at least one insecticide-treated net (ITN). Mosquito net usage is low among young children and pregnant women, groups that are particularly vulnerable to the effects of malaria. Overall, 12 percent of children under five slept under a mosquito net the night before the survey. Twelve percent of children slept under an ever-treated net and 6 percent slept under an ITN. Among pregnant women, 12 percent slept under any mosquito net the night before the interview. Twelve percent slept under an ever-treated net and 5 percent slept under an ITN. Among women who had their last birth in the two years before the survey, 18 percent took an anti-malarial drug during the pregnancy. Eleven percent of all pregnant women took at least one dose of a sulphadoxine-pyrimethamine (SP) drug such as Fansidar, Amalar, or Maloxine, while 7 percent reported taking two or more doses of an SP drug. Eight percent of the women who took an SP drug were given the drug during an antenatal care visit, a practice known as intermittent preventive treatment (IPT). HIV/AIDS KNOWLEDGE AND BEHAVIOUR The majority of women (88 percent) and men (94 percent) age 15-49 have heard of HIV or AIDS. However, only 23 percent

The 2001 Nepal Demographic and Health Survey (NDHS) is a nationally representative survey of 8,726 women age 15-49 and 2,261 men age 15-59. This Survey is the sixth in a series of national-level population and health surveys conducted in Nepal. It is the second nationally representative comprehensive survey conducted as part of the global Demographic and Health Survey (DHS) program, the first being the 1996 Nepal Family Health Survey (NFHS). The 2001 NDHS is the first in the history of demographic and health surveys conducted in Nepal that included a male sample. The 2001 NDHS was carried out under the aegis of the Family Health Division of the Department of Health Services, Ministry of Health, and was implemented by New ERA, a local research organization, which also conducted the 1996 NFHS. ORC Macro provided technical support through its MEASURE DHS+ project. The survey was funded by the United States Agency for International Development (USAID) through its mission in Nepal. The principal objective of the 2001 NDHS is to provide current and reliable data on fertility and family planning, infant and child mortality, children's and women'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 Family Health Division of the Ministry of Health to plan, conduct, process, and analyze data from complex national population and health surveys. The 2001 NDHS data is comparable to data collected in the 1996 NFHS and similar to survey data conducted in other developing countries. This allows for temporal and spatial comparisons of demographic health information. The 2001 NDHS also adds to the vast and growing international database on demographic and health variables. The inclusion of data on men adds to the richness of this data.

The principal objective of the 2006 Nepal Demographic and Health Survey (NDHS) is to provide current and reliable data on fertility and family planning behavior, child mortality, adult and maternal mortality, children’s nutritional status, the utilization of maternal and child health services, and knowledge of HIV/AIDS. For the first time, the 2006 NDHS conducted anemia testing at the household level for the country as a whole to provide information on the prevalence of anemia at the population level. The specific objectives of the survey 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 among 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 diarrhea and other diseases among children under five, and maternity care indicators including antenatal visits, assistance at delivery, and postnatal care; 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 infections and HIV/AIDS and evaluate patterns of recent behavior regarding condom use; conduct hemoglobin testing on women age 15-49 and children age 6-59 months in the households selected for the survey to provide information on the prevalence of anemia among women in the reproductive ages and young children. 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 government organizations to plan, conduct, process, and analyze data from complex national population and health surveys. Moreover, the 2006 NDHS provides national, regional and subregional estimates on population and health that are comparable to data collected in similar surveys in other developing countries. The first Demographic and Health Survey (DHS) in Nepal was the 1996 Nepal Family Health Survey (NFHS) conducted as part of the worldwide DHS program, and was followed five years later by the 2001 Nepal Demographic and Health Survey (NDHS). Data from the 2006 NDHS survey, the third such survey, allow for comparison of information gathered over a longer period of time and add to the vast and growing international database on demographic and health variables. Wherever possible, the 2006 NDHS data are compared with data from the two earlier DHS surveys—the 2001 NDHS and the 1996 NFHS—which also sampled women age 15-49. Additionally, men age 15-59 were interviewed in the 2001 NDHS and the 2006 NDHS to provide comparable data for men over the last five years.

Abstract

The 2013 Nigeria Demographic and Health Survey (NDHS) was designed to provide data to monitor the population and health situation in Nigeria with an explicit goal of providing reliable information about maternal and child health and family planning services. The primary objective of the 2013 NDHS was to provide up-to-date information on fertility levels, marriage, fertility preferences, awareness and use of family planning methods, child feeding practices, nutritional status of women and children, adult and childhood mortality, awareness and attitudes regarding HIV/AIDS, and domestic violence. This information is intended to assist policymakers and programme managers in evaluating and designing programmes and strategies for improving health and family planning services in the country.

Geographic coverage

National coverage

Analysis unit

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

Kind of data

Sample survey data [ssd]

Sampling procedure

Sample Design The sample for the 2013 NDHS was nationally representative and covered the entire population residing in non-institutional dwelling units in the country. The survey used as a sampling frame the list of enumeration areas (EAs) prepared for the 2006 Population Census of the Federal Republic of Nigeria, provided by the National Population Commission. The sample was designed to provide population and health indicator estimates at the national, zonal, and state levels. The sample design allowed for specific indicators to be calculated for each of the six zones, 36 states, and the Federal Capital Territory, Abuja.

Administratively, Nigeria is divided into states. Each state is subdivided into local government areas (LGAs), and each LGA is divided into localities. In addition to these administrative units, during the 2006 population census, each locality was subdivided into census enumeration areas. The primary sampling unit (PSU), referred to as a cluster in the 2013 NDHS, is defined on the basis of EAs from the 2006 EA census frame. The 2013 NDHS sample was selected using a stratified three-stage cluster design consisting of 904 clusters, 372 in urban areas and 532 in rural areas. A representative sample of 40,680 households was selected for the survey, with a minimum target of 943 completed interviews per state.

A complete listing of households and a mapping exercise were carried out for each cluster from December 2012 to January 2013, with the resulting lists of households serving as the sampling frame for the selection of households. All regular households were listed. The NPC listing enumerators were trained to use Global Positioning System (GPS) receivers to calculate the coordinates of the 2013 NDHS sample clusters.

A fixed sample take of 45 households were selected per cluster. All women age 15-49 who were either permanent residents of the households in the 2013 NDHS sample or visitors present in the households on the night before the survey were eligible to be interviewed. In a subsample of half of the households, all men age 15-49 who were either permanent residents of the households in the sample or visitors present in the households on the night before the survey were eligible to be interviewed. Also, a subsample of one eligible woman in each household was randomly selected to be asked additional questions regarding domestic violence.

For further details on sample size and design, see Appendix B of the final report.

Mode of data collection

Face-to-face [f2f]

Research instrument

Three questionnaires were used in the 2013 NDHS: the Household Questionnaire, the Woman’s Questionnaire, and the Man’s Questionnaire.

The Household Questionnaire was used to list all of the usual members of and visitors to the selected households. Some basic information was collected on the characteristics of each person listed, including age, sex, marital status, education, and relationship to the head of the household. Information on other characteristics of household members was collected as well, including current school attendance and survivorship of parents among those under age 18. If a child in the household had a parent who was sick for more than three consecutive months in the 12 months preceding the survey or a parent who had died, additional questions related to support for orphans and vulnerable children were asked. Furthermore, if an adult in the household was sick for more than three consecutive months in the 12 months preceding the survey or an adult in the household had died, questions were asked relating to support for sick people or people in households where a member had died.

The Household Questionnaire also collected 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 house; ownership of various durable goods; ownership of agricultural land; ownership of livestock, farm animals, or poultry; and ownership and use of mosquito nets and long-lasting insecticidal nets. The Household Questionnaire was further used to record height and weight measurements for children age 0-59 months and women age 15-49. In addition, data on the age and sex of household members in the Household Questionnaire were used to identify women and men who were eligible for individual interviews.

The Woman’s Questionnaire was used to collect information from all women age 15-49. These women were asked questions on the following main topics: • Background characteristics (age, religion, education, literacy, media exposure, etc.) • Reproductive history and childhood mortality • Knowledge, source, and use of family planning methods • Fertility preferences • Antenatal, delivery, and postnatal care • Breastfeeding and infant feeding practices • Child immunisation and childhood illnesses • Marriage and sexual activity • Women’s work and husbands’ background characteristics • Malaria prevention and treatment • Women’s decision making • Awareness of AIDS and other sexually transmitted infections • Maternal mortality • Domestic violence

The Man’s Questionnaire was administered to all men age 15-49 in every second household in the 2013 NDHS sample. The Man’s Questionnaire collected much of the same information found in the Woman’s Questionnaire but was shorter because it did not contain a detailed reproductive history or questions on maternal and child health or nutrition.

Cleaning operations

The processing of the 2013 NDHS data began simultaneously with the fieldwork. Completed questionnaires were edited in the field immediately by the field editors and checked by the supervisors before being dispatched to the data processing centre in Abuja. The questionnaires were then edited and entered by 26 data processing personnel specially trained for this task. Data were entered using the CSPro computer package, and all data were entered twice to allow 100 percent verification. The concurrent processing of the data offered a distinct advantage because of the assurance that the data were error free and authentic. Moreover, the double entry of data enabled easy comparisons and identification of errors and inconsistencies. Inconsistencies were resolved by tallying results with the paper questionnaire entries. Secondary editing of the data was completed in the last week of July 2013. The final cleaning of the data set was carried out by the ICF data processing specialist and completed in August.

Response rate

A total of 40,320 households were selected from 896 sample points, of which 38,904 were found to be occupied at the time of the fieldwork. Of the occupied households, 38,522 were successfully interviewed, yielding a household response rate of 99 percent. In view of the security challenges in the country, this response rate is highly encouraging and appears to be the result of a well-coordinated team effort.

In the interviewed households, a total of 39,902 women age 15-49 were identified as eligible for individual interviews, and 98 percent of them were successfully interviewed. Among men, 18,229 were identified as eligible for interviews, and 95 percent were successfully interviewed. As expected, response rates were slightly lower in urban areas than in rural areas.

Note: See summarized response rates by residence (urban/rural) in Table 1.2 of the survey report.

Sampling error estimates

The estimates from a sample survey are affected by two types of errors: non-sampling errors and sampling errors. Non-sampling errors are the results of mistakes made in implementing data collection and data processing, such as failure to locate and interview the correct household, misunderstanding of the questions on the part of either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the 2013 Nigeria DHS (NDHS) to minimize this type of error, non-sampling errors are impossible to avoid and difficult to evaluate statistically.

Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the 2013 NDHS 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.

Sampling error is usually measured in terms of the standard error

The 2011 Nepal Demographic and Health Survey is the fourth nationally representative comprehensive survey conducted as part of the worldwide Demographic and Health Surveys (DHS) project in the country. The survey was implemented by New ERA under the aegis of the Population Division, Ministry of Health and Population. Technical support for this survey was provided by ICF International with financial support from the United States Agency for International Development (USAID) through its mission in Nepal. The primary objective of the 2011 NDHS is to provide up-to-date and reliable data on different issues related to population and health, which provides guidance in planning, implementing, monitoring, and evaluating health programs in Nepal. The long term objective of the survey is to strengthen the technical capacity of the local institutions to plan, conduct, process and analyze data from complex national population and health surveys. The survey includes topics on fertility levels and determinants, family planning, fertility preferences, childhood mortality, children and women’s nutritional status, the utilization of maternal and child health services, knowledge of HIV/AIDS and STIs, women’s empowerment and for the first time, information on women facing different types of domestic violence. The survey also reports on the anemia status of women age 15-49 and children age 6-59 months. In addition to providing national estimates, the survey report also provides disaggregated data at the level of various domains such as ecological region, development regions and for urban and rural areas. This being the fourth survey of its kind, there is considerable trend information on reproductive and health care over the past 15 years. Moreover, the 2011 NDHS is comparable to similar surveys conducted in other countries and therefore, affords an international comparison. The 2011 NDHS also adds to the vast and growing international database on demographic and health-related variables. The 2011 NDHS collected demographic and health information from a nationally representative sample of 10,826 households, which yielded completed interviews with 12,674 women age 15-49 in all selected households and with 4, 121 men age 15-49 in every second household. This survey is the concerted effort of various individuals and institutions.

Abstract

The main objective of a demographic household survey (DHS) is to provide estimates of a number of basic demographic and health variables. This is done through interviews with a scientifically selected probability sample that is chosen from a well-defined population.

The 2007 Nauru Demographic and Health Survey (2007 NDHS) was one of four pilot demographic and health surveys conducted in the Pacific under an Asian Development Bank ADB/ Secretariat of the Pacific Community (SPC) Regional DHS Pilot Project. The primary objective of this survey was to provide up-to-date information for policy-makers, planners, researchers and programme managers, for use in planning, implementing, monitoring and evaluating population and health programmes within the country. The survey was intended to provide key estimates of Nauru's demographics and health situation. The findings of the 2007 NDHS are very important in measuring the achievements of family planning and other health programmes. To ensure better understanding and use of these data, the results of this survey should be widely disseminated at different planning levels. Different dissemination techniques will be used to reach different segments of society.

The primary purpose of the 2007 NDHS was to furnish policy-makers and planners with detailed information on fertility, family planning, infant and child mortality, maternal and child health, nutrition, and knowledge of HIV and AIDS and other sexually transmitted infections.

NOTE: The only dissemination used was wide distribution of the report. A planned data use workshop was not undertaken. Hence there is some misconceptions and lack of awareness on the results obtained from the survey. The report is provided on the NBOS website free for download.

Geographic coverage

National Coverage - Districts

Analysis unit

• Households
• Children (0-14yrs)
• Individual women of reproductive age (15-49 yrs)
• Individual men of reproductive age (15yrs+)
• Facilities providing reproductive and child health services

Universe

The survey covered all household members (usual residents), - All children (aged 0-14 years) resident in the household - All women of reproductive age (15-49 years) resident in all household - All males (15yrs and above) in every second household (approx. 50%) resident in selected household

Results: The 2007 Nauru Demographic Health Survey (2007 NDHS) is a nationally representative survey of 655 eligible women (aged 15-49) and 392 eligible men (aged 15 and above).

Kind of data

Sample survey data [ssd]

Sampling procedure

IDG NOTES: Locate sampling documentation with SPC (Graeme Brown) and internal files. Add in this sections. Or second option dilute appendix A Sampling and extract key issues.

ESTIMATES OF SAMPLING ERRORS - Refer to Appendix A of final NDHS2007 report or; - External Resources - 2007 DHS- Appendix A and B Sampling (to be created separatedly by IDG progress ongoing)

Sampling deviation

IDG NOTES: Locate sampling documentation with Macro and internal files. Add in this section. Or second option dilute appendix B Sampling and extract key issues.

ESTIMATES OF SAMPLING ERRORS - Refer to Appendix B of final NDHS2007 report or;

• External Resources
  • 2007 DHS- Appendix A and B Sampling (to be created separatedly by IDG progress ongoing)

Extract:

In the 2007 NDHS Report of the survey results, sampling errors for selected variables have been presented in a tabular format. The sampling error tables should include:

.. Variable name

R: Value of the estimate; SE: Sampling error of the estimate; N: Unweighted number of cases on which the estimate is based; WN: Weighted number of cases; DEFT: Design effect value that compensates for the loss of precision that results from using cluster rather than simple random sampling; SE/R: Relative standard error (i.e. ratio of the sampling error to the value estimate); R-2SE: Lower limit of the 95% confidence interval; R+2SE: Upper limit of the 95% confidence interval (never >1.000 for a proportion).

Mode of data collection

Face-to-face [f2f]

Research instrument

DHS questionnaire for women cover the following sections:

• Background characteristics (age, education, religion, etc)
• Reproductive history
• Knowledge and use of contraception methods
• Antenatal care, delivery care and postnatal care
• Breastfeeding and infant feeding
• Immunization, child health and nutrition
• Marriage and recent sexual activity
• Fertility preferences
• Knowledge about HIV/AIDS and other sexually transmitted infections
• Husbands background and women's work

The men's questionnaire covers the same except for sections 4, 5, 6 which are not applicable to men.

It was also recognized that some countries have a need for special information that is not contained in the core questionnaire. Separate questionnaire modules were developed on a series of topics. These topics are optional and include:

• maternal mortality
• pill-taking behaviour
• sterilization experience
• children's education
• women's status
• domestic violence
• health expenditures
• consanguinity

The Papua New Guinea (PNG) questionnaire was proposed for Nauru to adapt as in comparison to the existing DHS model, this is not as lengthy and time-consuming. The PNG questionnaire also dealt with high incidence of alcohol and tobacco in Nauru. Questions on HIV/AIDS and STI knowledge were included in the men's questionnaire where it was not included in the PNG questionnaire.

Response rate

IDG NOTES: Locate response rate documentation with SPC (Graeme Brown) and internal files. Add in this sections.

Abstract

The 2022 Philippines National Demographic and Health Survey (NDHS) was implemented by the Philippine Statistics Authority (PSA). Data collection took place from May 2 to June 22, 2022.

The primary objective of the 2022 NDHS is to provide up-to-date estimates of basic demographic and health indicators. Specifically, the NDHS collected information on fertility, fertility preferences, family planning practices, childhood mortality, maternal and child health, nutrition, knowledge and attitudes regarding HIV/AIDS, violence against women, child discipline, early childhood development, and other health issues.

The information collected through the NDHS is intended to assist policymakers and program managers in designing and evaluating programs and strategies for improving the health of the country’s population. The 2022 NDHS also provides indicators anchored to the attainment of the Sustainable Development Goals (SDGs) and the new Philippine Development Plan for 2023 to 2028.

Geographic coverage

National coverage

Analysis unit

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

Universe

The survey covered all de jure household members (usual residents), all women aged 15-49, and all children aged 0-4 resident in the household.

Kind of data

Sample survey data [ssd]

Sampling procedure

The sampling scheme provides data representative of the country as a whole, for urban and rural areas separately, and for each of the country’s administrative regions. The sample selection methodology for the 2022 NDHS was based on a two-stage stratified sample design using the Master Sample Frame (MSF) designed and compiled by the PSA. The MSF was constructed based on the listing of households from the 2010 Census of Population and Housing and updated based on the listing of households from the 2015 Census of Population. The first stage involved a systematic selection of 1,247 primary sampling units (PSUs) distributed by province or HUC. A PSU can be a barangay, a portion of a large barangay, or two or more adjacent small barangays.

In the second stage, an equal take of either 22 or 29 sample housing units were selected from each sampled PSU using systematic random sampling. In situations where a housing unit contained one to three households, all households were interviewed. In the rare situation where a housing unit contained more than three households, no more than three households were interviewed. The survey interviewers were instructed to interview only the preselected housing units. No replacements and no changes of the preselected housing units were allowed in the implementing stage in order to prevent bias. Survey weights were calculated, added to the data file, and applied so that weighted results are representative estimates of indicators at the regional and national levels.

All women age 15–49 who were either usual residents of the selected households or visitors who stayed in the households the night before the survey were eligible to be interviewed. Among women eligible for an individual interview, one woman per household was selected for a module on women’s safety.

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

Mode of data collection

Computer Assisted Personal Interview [capi]

Research instrument

Two questionnaires were used for the 2022 NDHS: the Household Questionnaire and the Woman’s Questionnaire. The questionnaires, based on The DHS Program’s model questionnaires, were adapted to reflect the population and health issues relevant to the Philippines. Input was solicited from various stakeholders representing government agencies, academe, and international agencies. The survey protocol was reviewed by the ICF Institutional Review Board.

After all questionnaires were finalized in English, they were translated into six major languages: Tagalog, Cebuano, Ilocano, Bikol, Hiligaynon, and Waray. The Household and Woman’s Questionnaires were programmed into tablet computers to allow for computer-assisted personal interviewing (CAPI) for data collection purposes, with the capability to choose any of the languages for each questionnaire.

Cleaning operations

Processing the 2022 NDHS data began almost as soon as fieldwork started, and data security procedures were in place in accordance with confidentiality of information as provided by Philippine laws. As data collection was completed in each PSU or cluster, all electronic data files were transferred securely via SyncCloud to a server maintained by the PSA Central Office in Quezon City. These data files were registered and checked for inconsistencies, incompleteness, and outliers. The field teams were alerted to any inconsistencies and errors while still in the area of assignment. Timely generation of field check tables allowed for effective monitoring of fieldwork, including tracking questionnaire completion rates. Only the field teams, project managers, and NDHS supervisors in the provincial, regional, and central offices were given access to the CAPI system and the SyncCloud server.

A team of secondary editors in the PSA Central Office carried out secondary editing, which involved resolving inconsistencies and recoding “other” responses; the former was conducted during data collection, and the latter was conducted following the completion of the fieldwork. Data editing was performed using the CSPro software package. The secondary editing of the data was completed in August 2022. The final cleaning of the data set was carried out by data processing specialists from The DHS Program in September 2022.

Response rate

A total of 35,470 households were selected for the 2022 NDHS sample, of which 30,621 were found to be occupied. Of the occupied households, 30,372 were successfully interviewed, yielding a response rate of 99%. In the interviewed households, 28,379 women age 15–49 were identified as eligible for individual interviews. Interviews were completed with 27,821 women, yielding a response rate of 98%.

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 in 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 2022 Philippines National Demographic and Health Survey (2022 NDHS) 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 2022 NDHS is only one of many samples that could have been selected from the same population, using the same design and identical 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% 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 2022 NDHS sample was the result of a multistage 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.

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

Data appraisal

Data Quality Tables

• Household age distribution
• Age distribution of eligible and interviewed women
• Age displacement at age 14/15
• Age displacement at age 49/50
• Pregnancy outcomes by years preceding the survey
• Completeness of reporting
• Observation of handwashing facility
• School attendance by single year of age
• Vaccination cards photographed
• Population pyramid
• Five-year mortality rates

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

Percentage of normal and abnormal birth weights among different groups in urban Nigeria: NDHS 2008–2018.

The 2003 Nigeria Demographic and Health Survey (2003 NDHS) is the third national Demographic and Health Survey conducted in Nigeria. The 2003 NDHS is based on a nationally representative sample of over 7,000 households. All women age 15-49 in these households and all men age 15-59 in a subsample of one-third of the households were individually interviewed. The survey provides up-to-date information on the population and health situation in Nigeria. The 2003 NDHS was designed to provide estimates for key indicators such as fertility, contraceptive use, infant and child mortality, immunization levels, use of family planning, maternal and child health, breastfeeding practices, nutritional status of mothers and young children, use of mosquito nets, female genital cutting, marriage, sexual activity, and awareness and behaviour regarding AIDS and other sexually transmitted infections in Nigeria. MAIN RESULTS FERTILITY Fertility Levels, Trends, and Preferences. The total fertility rate (TFR) in Nigeria is 5.7. This means that at current fertility levels, the average Nigerian woman who is at the beginning of her childbearing years will give birth to 5.7 children by the end of her lifetime. Compared with previous national surveys, the 2003 survey shows a modest decline in fertility over the last two decades: from a TFR of 6.3 in the 1981-82 National Fertility Survey (NFS) to 6.0 in the 1990 NDHS to 5.7 in the 2003 NDHS. However, the 2003 NDHS rate of 5.7 is significantly higher than the 1999 NDHS rate of 5.2. Analysis has shown that the 1999 survey underestimated the true levels of fertility in Nigeria. On average, rural women will have one more child than urban women (6.1 and 4.9, respectively). Fertility varies considerably by region of residence, with lower rates in the south and higher rates in the north. Fertility also has a strong negative correlation with a woman's educational attainment. Most Nigerians, irrespective of their number of living children, want large families. The ideal number of children is 6.7 for all women and 7.3 for currently married women. Nigerian men want even more children than women. The ideal number of children for all men is 8.6 and for currently married men is 10.6. Clearly, one reason for the slow decline in Nigerian fertility is the desire for large families. FAMILY PLANNING Knowledge of Family Planning Methods. About eight in ten women and nine in ten men know at least one modern method of family planning. The pill, injectables, and the male condom are the most widely known modern methods among both women and men. Mass media is an important source of information on family planning. Radio is the most frequent source of family planning messages: 40 percent of women and 56 percent of men say they heard a radio message about family planning during the months preceding the survey. However, more than half of women (56 percent) and 41 percent men were not exposed to family planning messages from a mass media source. Current Use. A total of 13 percent of currently married women are using a method of family planning, including 8 percent who are using a modern method. The most common modern methods are the pill, injectables, and the male condom (2 percent each). Urban women are more than twice as likely as rural women to use a method of contraception (20 percent versus 9 percent). Contraceptive use varies significantly by region. For example, one-third of married women in the South West use a method of contraception compared with just 4 percent of women in the North East and 5 percent of women in the North West. CHILD HEALTH Mortality. The 2003 NDHS survey estimates infant mortality to be 100 per 1,000 live births for the 1999-2003 period. This infant mortality rate is significantly higher than the estimates from both the 1990 and 1999 NDHS surveys; the earlier surveys underestimated mortality levels in certain regions of the country, which in turn biased downward the national estimates. Thus, the higher rate from the 2003 NDHS is more likely due to better data quality than an actual increase in mortality risk overall. The rural infant mortality rate (121 per 1,000) is considerably higher than the urban rate (81 per 1,000), due in large part to the difference in neonatal mortality rates. As in other countries, low maternal education, a low position on the household wealth index, and shorter birth intervals are strongly associated with increased mortality risk. The under-five mortality rate for the 1999-2003 period was 201 per 1,000. Vaccinations. Only 13 percent of Nigerian children age 12-23 months can be considered fully vaccinated, that is, have received BCG, measles, and three doses each of DPT and polio vaccine (excluding the polio vaccine given at birth). This is the lowest vaccination rate among African countries in which DHS surveys have been conducted since 1998. Less than half of children have received each of the recommended vaccinations, with the exception of polio 1 (67 percent) and polio 2 (52 percent). More than three times as many urban children as rural children are fully vaccinated (25 percent and 7 percent, respectively). WHO guidelines are that children should complete the schedule of recommended vaccinations by 12 months of age. In Nigeria, however, only 11 percent of children age 12-23 months received all of the recommended vaccinations before their first birthday. WOMEN'S HEALTH Breastfeeding. Breastfeeding is almost universal in Nigeria, with 97 percent of children born in the five years preceding the survey having been breastfed. However, just one-third of children were given breast milk within one hour of birth (32 percent), and less than two-thirds were given breast milk within 24 hours of birth (63 percent). Overall, the median duration of any breastfeeding is 18.6 months, while the median duration of exclusive breastfeeding is only half a month. Complementary Feeding. At age 6-9 months, the recommended age for introducing complementary foods, three-quarters of breast-feeding infants received solid or semisolid foods during the day or night preceding the interview; 56 percent received food made from grains, 25 percent received meat, fish, shellfish, poultry or eggs, and 24 percent received fruits or vegetables. Fruits and vegetables rich in vitamin A were consumed by 20 percent of breastfeeding infants age 6-9 months. Maternal Care. Almost two-thirds of mothers in Nigeria (63 percent) received some antenatal care (ANC) for their most recent live birth in the five years preceding the survey. While one-fifth of mothers (21 percent) received ANC from a doctor, almost four in ten women received care from nurses or midwives (37 percent). Almost half of women (47 percent) made the minimum number of four recommended visits, but most of the women who received antenatal care did not get care within the first three months of pregnancy. In terms of content of care, slightly more than half of women who received antenatal care said that they were informed of potential pregnancy complications (55 percent). Fifty-eight percent of women received iron tablets; almost two-thirds had a urine or blood sample taken; and 81 percent had their blood pressure measured. Almost half (47 percent) received no tetanus toxoid injections during their most recent birth. WOMEN'S CHARACTERISTICS AND STATUS Across all maternal care indicators, rural women are disadvantaged compared with urban women, and there are marked regional differences among women. Overall, women in the south, particularly the South East and South West, received better care than women in the north, especially women in the North East and North West. Female Circumcision. Almost one-fifth of Nigerian women are circumcised, but the data suggest that the practice is declining. The oldest women are more than twice as likely as the youngest women to have been circumcised (28 percent versus 13 percent). Prevalence is highest among the Yoruba (61 percent) and Igbo (45 percent), who traditionally reside in the South West and South East. Half of the circumcised respondents could not identify the type of procedure performed. Among those women who could identify the type of procedure, the most common type of circumcision involved cutting and removal of flesh (44 percent of all circumcised women). Four percent of women reported that their vaginas were sewn closed during circumcision. MALARIA CONTROL PROGRAM INDICATORS Nets. Although malaria is a major public health concern in Nigeria, only 12 percent of households report owning at least one mosquito net. Even fewer, 2 percent of households, own an insecticide treated net (ITN). Rural households are almost three times as likely as urban households to own at least one mosquito net. Overall, 6 percent of children under age five sleep under a mosquito net, including 1 percent of children who sleep under an ITN. Five percent of pregnant women slept under a mosquito net the night before the survey, one-fifth of them under an ITN. Use of Antimalarials. Overall, 20 percent of women reported that they took an antimalarial for prevention of malaria during their last pregnancy in the five years preceding the survey. Another 17 percent reported that they took an unknown drug, and 4 percent took paracetamol or herbs to prevent malaria. Only 1 percent received intermittent preventative treatment (IPT)-or preventive treatment with sulfadoxine-pyrimethamine (Fansidar/SP) during an antenatal care visit. Among pregnant women who took an antimalarial, more than half (58 percent) used Daraprim, which has been found to be ineffective as a chemoprophylaxis during pregnancy. Additionally, 39 percent used chloroquine, which was the chemoprophylactic drug of choice until the introduction of IPT in Nigeria in 2001. Among children who were sick with fever/convulsions, one-third took antimalarial drugs, the majority receiving the drugs

The 2000 Namibia Demographic and Health Survey (NDHS) was implemented to assess the progress made in the health sector since the 1992 NDHS. It therefore focused on measuring achievements related to the same indicators as in 1992, but also included new aspects, e.g. HIV/AIDS. Furthermore, the 2000 NDHS was designed to obtain reliable data for all 13 administrative regions, which had not been established at the time of the 1992 NDHS. In addition, data for the four MOHSS Regional Directorates are included, which provide comparison to the 1992 NDHS results at the sub-national level. A nationally representative sample of 6,755 women age 15-49 and a sub-sample of about 2,954 men age 15-59 were interviewed in the 2000 NDHS. Twenty mobile teams conducted the interviews from late September to mid-December 2000. The primary objective of the 2000 NDHS was to provide up-to-date information on fertility and mortality, family planning, fertility preferences, maternal and child health, and knowledge and behaviour regarding HIV/AIDS. The 2000 NDHS was patterned after the 1992 NDHS so as to maximise the ability to measure trends on similar indicators between 1992 and 2000. The ultimate intent is to use this information to evaluate existing programmes and design new strategies in order to ensure delivery of health and social welfare services to the population in a cost effective and efficient manner.

The 1990 Nigeria Demographic and Health Survey (NDHS) is a nationally representative survey conducted by the Federal Office of Statistics with the aim of gathering reliable information on fertility, family planning, infant and child mortality, maternal care, vaccination status, breastfeeding, and nutrition. Data collection took place two years after implementation of the National Policy on Population and addresses issues raised by that policy. Fieldwork for the NDHS was conducted in two phases: from April to July 1990 in the southern states and from July to October 1990 in the northern states. Interviewers collected information on the reproductive histories of 8,781 women age 15-49 years and on the health of their 8,113 children under the age of five years. OBJECTIVES The Nigeria Demographic and Health Survey (NDHS) is a national sample survey of women of reproductive age designed to collect data on socioeconomic characteristics, marriage patterns, history of child bearing, breastfeeding, use of contraception, immunisation of children, accessibility to health and family planning services, treatment of children during episodes of illness, and the nutritional status of children. The primary objectives of the NDHS are: (i) To collect data for the evaluation of family planning and health programmes; (ii) To assess the demographic situation in Nigeria; and (iii) To support dissemination and utilisation of the results in planning and managing family planning and health programmes. MAIN RESULTS According to the NDHS, fertility remains high in Nigeria; at current fertility levels, Nigerian women will have an average of 6 children by the end of their reproductive years. The total fertility rate may actually be higher than 6.0, due to underestimation of births. In a 1981/82 survey, the total fertility rate was estimated to be 5.9 children per woman. One reason for the high level of fertility is that use of contraception is limited. Only 6 percent of married women currently use a contraceptive method (3.5 percent use a modem method, and 2.5 percent use a traditional method). These levels, while low, reflect an increase over the past decade: ten years ago just 1 percent of Nigerian women were using a modem family planning method. Periodic abstinence (rhythm method), the pill, IUD, and injection are the most popular methods among married couples: each is used by about 1 percent of currently married women. Knowledge of contraception remains low, with less than half of all women age 15-49 knowing of any method. Certain groups of women are far more likely to use contraception than others. For example, urban women are four times more likely to be using a contraceptive method (15 percent) than rural women (4 percent). Women in the Southwest, those with more education, and those with five or more children are also more likely to be using contraception. Levels of fertility and contraceptive use are not likely to change until there is a drop in desired family size and until the idea of reproductive choice is more widely accepted. At present, the average ideal family size is essentially the same as the total fertility rate: six children per woman. Thus, the vast majority of births are wanted. The desire for childbearing is strong: half of women with five children say that they want to have another child. Another factor leading to high fertility is the early age at marriage and childbearing in Nigeria. Half of all women are married by age 17 and half have become mothers by age 20. More than a quarter of teenagers (women age 15-19 years) either are pregnant or already have children. National statistics mask dramatic variations in fertility and family planning between urban and rural areas, among different regions of the country, and by women's educational attainment. Women who are from urban areas or live in the South and those who are better educated want and have fewer children than other women and are more likely to know of and use modem contraception. For example, women in the South are likely to marry and begin childbearing several years later than women in the North. In the North, women continue to follow the traditional pattern and marry early, at a median age of 15, while in the South, women are marrying at a median age of 19 or 20. Teenagers in the North have births at twice the rate of those in the South: 20 births per 1130 women age 15-19 in the North compared to 10 birdas per 100 women in the South. Nearly half of teens in the North have already begun childbearing, versus 14 percent in South. This results in substantially lower total fertility rates in the South: women in the South have, on average, one child less than women in the North (5.5 versus 6.6). The survey also provides information related to maternal and child health. The data indicate that nearly 1 in 5 children dies before their fifth birthday. Of every 1,000 babies born, 87 die during their first year of life (infant mortality rate). There has been little improvement in infant and child mortality during the past 15 years. Mortality is higher in rural than urban areas and higher in the North than in the South. Undemutrition may be a factor contributing to childhood mortality levels: NDHS data show that 43 percent of the children under five are chronically undemourished. These problems are more severe in rural areas and in the North. Preventive and curative health services have yet to reach many women and children. Mothers receive no antenatal care for one-third of births and over 60 percent of all babies arc born at home. Only one-third of births are assisted by doctors, trained nurses or midwives. A third of the infants are never vaccinated, and only 30 percent are fully immunised against childhood diseases. When they are ill, most young children go untreated. For example, only about one-third of children with diarrhoea were given oral rehydration therapy. Women and children living in rural areas and in the North are much less likely than others to benefit from health services. Almost four times as many births in the North are unassisted as in the South, and only one-third as many children complete their polio and DPT vaccinations. Programmes to educate women about the need for antenatal care, immunisation, and proper treatment for sick children should perhaps be aimed at mothers in these areas, Mothers everywhere need to learn about the proper time to introduce various supplementary foods to breastfeeding babies. Nearly all babies are breastfed, however, almost all breastfeeding infants are given water, formula, or other supplements within the first two months of life, which both jeopardises their nutritional status and increases the risk of infection.

Distribution of live births followed up by years of DHS.

The 2006-07 Namibia Demographic and Health Survey (NDHS) is a nationally representative survey of 9,804 women age 15-49 and 3,915 men age 15-49. The 2006-07 NDHS is the third comprehensive survey conducted in Namibia as part of the Demographic and Health Surveys (DHS) programme. The data are intended to provide programme managers and policymakers with detailed information on levels and trends in fertility; nuptiality; sexual activity; fertility preferences; awareness and use of family planning methods; breastfeeding practices; nutritional status of mothers and young children; early childhood mortality, adult and maternal mortality; maternal and child health; and awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections. The 2006-07 NDHS is the first NDHS survey to collect information on malaria prevention and treatment. The 2006-07 NDHS has been a large-scale research project. Twenty-eight field teams interviewed about 9,200 households, 9,800 women and 3,900 men age 15-49. The interviews were conducted between November 2006 and March 2007. The survey covered about 500 primary sampling units in all regions. The 2006-07 Namibia Demographic and Health Survey is designed to: Determine key demographic rates, particularly fertility, under-five mortality, and adult mortality rates; Investigate the direct and indirect factors that determine the level and trends of fertility; Measure the level of contraceptive knowledge and practice among women and men by method; Determine immunisation coverage and prevalence and treatment of diarrhoea and acute respiratory diseases among children under five; identify infant and young child feeding practices and assess the nutritional status of children age 6-59 months and women age 15-49 years; Assess knowledge and attitudes of women and men regarding sexually transmitted infections and HIV/AIDS, and evaluate patterns of recent behaviour regarding condom use; Identify behaviours that protect or predispose people to HIV infection and examine social, economic, and cultural determinants of HIV; Determine the proportion of households with orphans and vulnerable children (OVCs); and Determine the proportion of households with sick people taken care of at household level. The 2006-07 NDHS is part of the worldwide Demographic and Health Surveys (DHS) programme funded by the United States Agency for International Development (USAID). DHS surveys are designed to collect data on fertility, family planning, and maternal and child health; assist countries in conducting periodic surveys to monitor changes in population, health, and nutrition; and provide an international database that can be used by researchers investigating topics related to population, health, and nutrition. MAIN RESULTS Fertility : The survey results show that Namibia has experienced a decline in fertility of almost two births over the past 15 years, with the fertility rate falling from 5.4 births per woman in 19901992 to 3.6 births in 2005-07. Family planning : Knowledge of family planning in Namibia has been nearly universal since 1992. In the 2006-07 NDHS, 98 percent of all women reported knowing about a contraceptive method. Male condoms, injectables, and the pill are the most widely known methods. Child health : Data from the 2006-07 NDHS indicate that the under-five mortality rate in Namibia is 69 deaths per 1,000 live births (based on the five-year period preceding the survey). Maternal health : In Namibia, almost all women who had a live birth in the five years preceding the survey received antenatal care from health professionals (95 percent): 16 percent from a doctor and 79 percent from a nurse or midwife. Only 4 percent of mothers did not receive any antenatal care. Breastfeeding and nutrition : Breastfeeding is common in Namibia, with 94 percent of children breastfed at some point during childhood. The median breastfeeding duration in Namibia is 16.8 months. Malaria: One in four households interviewed in the survey has at least one mosquito net, and most of these households have a net that has been treated at some time with an insecticide (20 percent). HIV/AIDS and STIS : Knowledge of HIV and AIDS is universal in Namibia; 99 percent of women age 15-49 and 99 percent of men age 15-49 have heard of AIDS. Orphans and vulnerable children : One-quarter of Namibian children under age 18 in the households sampled for the 2006-07 NDHS live with both parents, while one in three does not live with either parent. Seventeen percent of children under age 18 are orphaned, that is, one or both parents is dead. Access to health facilities : Households interviewed in the 2006-07 NDHS were asked to name the nearest government health facility, the mode of transport they would use to visit the facility, and how long it takes to get to the facility using the transport of choice.

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

Abstract

The 2013 NDHS is part of the worldwide Demographic and Health Surveys (DHS) programme funded by the United States Agency for International Development (USAID). DHS surveys are designed to collect data on fertility, family planning, and maternal and child health; assist countries in monitoring changes in population, health, and nutrition; and provide an international database that can be used by researchers investigating topics related to population, health, and nutrition.

The overall objective of the survey is to provide demographic, socioeconomic, and health data necessary for policymaking, planning, monitoring, and evaluation of national health and population programmes. In addition, the survey measured the prevalence of anaemia, HIV, high blood glucose, and high blood pressure among adult women and men; assessed the prevalence of anaemia among children age 6-59 months; and collected anthropometric measurements to assess the nutritional status of women, men, and children.

A long-term objective of the survey is to strengthen the technical capacity of local organizations to plan, conduct, and process and analyse data from complex national population and health surveys. At the global level, the 2013 NDHS data are comparable with those from a number of DHS surveys conducted in other developing countries. The 2013 NDHS adds to the vast and growing international database on demographic and health-related variables.

Geographic coverage

National coverage

Analysis unit

Households and individuals

Kind of data

Sample survey data [ssd]

Sampling procedure

Sample Design The primary focus of the 2013 NDHS was to provide estimates of key population and health indicators, including fertility and mortality rates, for the country as a whole and for urban and rural areas. In addition, the sample was designed to provide estimates of most key variables for the 13 administrative regions.

Each of the administrative regions is subdivided into a number of constituencies (with an overall total of 107 constituencies). Each constituency is further subdivided into lower level administrative units. An enumeration area (EA) is the smallest identifiable entity without administrative specification, numbered sequentially within each constituency. Each EA is classified as urban or rural. The sampling frame used for the 2013 NDHS was the preliminary frame of the 2011 Namibia Population and Housing Census (NSA, 2013a). The sampling frame was a complete list of all EAs covering the whole country. Each EA is a geographical area covering an adequate number of households to serve as a counting unit for the population census. In rural areas, an EA is a natural village, part of a large village, or a group of small villages; in urban areas, an EA is usually a city block. The 2011 population census also produced a digitised map for each of the EAs that served as the means of identifying these areas.

The sample for the 2013 NDHS was a stratified sample selected in two stages. In the first stage, 554 EAs-269 in urban areas and 285 in rural areas-were selected with a stratified probability proportional to size selection from the sampling frame. The size of an EA is defined according to the number of households residing in the EA, as recorded in the 2011 Population and Housing Census. Stratification was achieved by separating every region into urban and rural areas. Therefore, the 13 regions were stratified into 26 sampling strata (13 rural strata and 13 urban strata). Samples were selected independently in every stratum, with a predetermined number of EAs selected. A complete household listing and mapping operation was carried out in all selected clusters. In the second stage, a fixed number of 20 households were selected in every urban and rural cluster according to equal probability systematic sampling.

Due to the non-proportional allocation of the sample to the different regions and the possible differences in response rates, sampling weights are required for any analysis using the 2013 NDHS data to ensure the representativeness of the survey results at the national as well as the regional level. Since the 2013 NDHS sample was a two-stage stratified cluster sample, sampling probabilities were calculated separately for each sampling stage and for each cluster.

See Appendix A in the final report for details

Mode of data collection

Face-to-face [f2f]

Research instrument

Three questionnaires were administered in the 2013 NDHS: the Household Questionnaire, the Woman’s Questionnaire, and the Man’s Questionnaire. These questionnaires were adapted from the standard DHS6 core questionnaires to reflect the population and health issues relevant to Namibia at a series of meetings with various stakeholders from government ministries and agencies, nongovernmental organisations, and international donors. The final draft of each questionnaire was discussed at a questionnaire design workshop organised by the MoHSS from September 25-28, 2012, in Windhoek. The questionnaires were then translated from English into the six main local languages—Afrikaans, Rukwangali, Oshiwambo, Damara/Nama, Otjiherero, and Silozi—and back translated into English. The questionnaires were finalised after the pretest, which took place from February 11-25, 2013.

The Household Questionnaire was used to list all usual household members as well as visitors in the selected households. Basic information was collected on the characteristics of each person listed, including age, sex, education, and relationship to the head of the household. For children under age 18, parents’ survival status was determined. In addition, the Household Questionnaire included questions on knowledge of malaria and use of mosquito nets by household members, along with questions regarding health expenditures. The Household Questionnaire was used to identify women and men who were eligible for the individual interview and the interview on domestic violence. The questionnaire also collected 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 house, and ownership of various durable goods. The results of tests assessing iodine levels were recorded as well.

In half of the survey households (the same households selected for the male survey), the Household Questionnaire was also used to record information on anthropometry and biomarker data collected from eligible respondents, as follows: • All eligible women and men age 15-64 were measured, weighed, and tested for anaemia and HIV. • All eligible women and men age 35-64 had their blood pressure and blood glucose measured. • All children age 0 to 59 months were measured and weighed. • All children age 6 to 59 months were tested for anaemia.

The Woman’s Questionnaire was also used to collect information from women age 50-64 living in half of the selected survey households on background characteristics, marriage and sexual activity, women’s work and husbands’ background characteristics, awareness and behaviour regarding AIDS and other STIs, and other health issues.

The Man’s Questionnaire was administered to all men age 15-64 living in half of the selected survey households. The Man’s Questionnaire collected much of the same information as the Woman’s Questionnaire but was shorter because it did not contain a detailed reproductive history or questions on maternal and child health or nutrition.

Cleaning operations

CSPro—a Windows-based integrated census and survey processing system that combines and replaces the ISSA and IMPS packages—was used for entry, editing, and tabulation of the NDHS data. Prior to data entry, a practical training session was provided by ICF International to all data entry staff. A total of 28 data processing personnel, including 17 data entry operators, one questionnaire administrator, two office editors, three secondary editors, two network technicians, two data processing supervisors, and one coordinator, were recruited and trained on administration of questionnaires and coding, data entry and verification, correction of questionnaires and provision of feedback, and secondary editing. NDHS data processing was formally launched during the week of June 22, 2013, at the National Statistics Agency Data Processing Centre in Windhoek. The data entry and editing phase of the survey was completed in January 2014.

Response rate

A total of 11,004 households were selected for the sample, of which 10,165 were found to be occupied during data collection. Of the occupied households, 9,849 were successfully interviewed, yielding a household response rate of 97 percent.

In these households, 9,940 women age 15-49 were identified as eligible for the individual interview. Interviews were completed with 9,176 women, yielding a response rate of 92 percent. In addition, in half of these households, 842 women age 50-64 were successfully interviewed; in this group of women, the response rate was 91 percent.

Of the 5,271 eligible men identified in the selected subsample of households, 4,481 (85 percent) were successfully interviewed.

Response rates were higher in rural than in urban areas, with the rural-urban difference more marked among men than among women.

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

Abstract

The 2018 Nigeria Demographic and Health Survey (2018 NDHS) was implemented by the National Population Commission (NPC). Data collection took place from 14 August to 29 December 2018. ICF provided technical assistance through The DHS Program, which is funded by the United States Agency for International Development (USAID) and offers financial support and technical assistance for population and health surveys in countries worldwide. Other agencies and organisations that facilitated the successful implementation of the survey through technical or financial support were the Global Fund, the Bill and Melinda Gates Foundation (BMGF), the United Nations Population Fund (UNFPA), and the World Health Organization (WHO).

SURVEY OBJECTIVES The primary objective of the 2018 NDHS is to provide up-to-date estimates of basic demographic and health indicators. Specifically, the NDHS collected information on fertility, awareness and use of family planning methods, breastfeeding practices, nutritional status of women and children, maternal and child health, adult and childhood mortality, women’s empowerment, domestic violence, female genital cutting, prevalence of malaria, awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections (STIs), disability, and other health-related issues such as smoking.

The information collected through the 2018 NDHS is intended to assist policymakers and programme managers in evaluating and designing programmes and strategies for improving the health of the country’s population. The 2018 NDHS also provides indicators relevant to the Sustainable Development Goals (SDGs) for Nigeria.

Geographic coverage

national coverage

Analysis unit

Households Women Men children

Universe

the survey covered all household members (permanent residents and visitor), all Women aged 15-49 years, all children 0-59 months and all men aged 15-59 years in one-third of households

Kind of data

Sample survey data [ssd]

Sampling procedure

The sampling frame used for the 2018 NDHS is the Population and Housing Census of the Federal Republic of Nigeria (NPHC), which was conducted in 2006 by the National Population Commission. Administratively, Nigeria is divided into states. Each state is subdivided into local government areas (LGAs), and each LGA is divided into wards. In addition to these administrative units, during the 2006 NPHC each locality was subdivided into convenient areas called census enumeration areas (EAs). The primary sampling unit (PSU), referred to as a cluster for the 2018 NDHS, is defined on the basis of EAs from the 2006 EA census frame. Although the 2006 NPHC did not provide the number of households and population for each EA, population estimates were published for 774 LGAs. A combination of information from cartographic material demarcating each EA and the LGA population estimates from the census was used to identify the list of EAs, estimate the number of households, and distinguish EAs as urban or rural for the survey sample frame. Before sample selection, all localities were classified separately into urban and rural areas based on predetermined minimum sizes of urban areas (cut-off points); consistent with the official definition in 2017, any locality with more than a minimum population size of 20,000 was classified as urban.

The sample for the 2018 NDHS was a stratified sample selected in two stages. Stratification was achieved by separating each of the 36 states and the Federal Capital Territory into urban and rural areas. In total, 74 sampling strata were identified. Samples were selected independently in every stratum via a two-stage selection. Implicit stratifications were achieved at each of the lower administrative levels by sorting the sampling frame before sample selection according to administrative order and by using a probability proportional to size selection during the first sampling stage.

In the first stage, 1,400 EAs were selected with probability proportional to EA size. EA size was the number of households in the EA. A household listing operation was carried out in all selected EAs, and the resulting lists of households served as a sampling frame for the selection of households in the second stage. In the second stage’s selection, a fixed number of 30 households was selected in every cluster through equal probability systematic sampling, resulting in a total sample size of approximately 42,000 households. The household listing was carried out using tablets, and random selection of households was carried out through computer programming. The interviewers conducted interviews only in the pre-selected households. To prevent bias, no replacements and no changes of the pre-selected households were allowed in the implementing stages.

Due to the non-proportional allocation of the sample to the different states and the possible differences in response rates, sampling weights were calculated, added to the data file, and applied so that the results would be representative at the national level as well as the domain level. Because the 2018 NDHS sample was a two-stage stratified cluster sample selected from the sampling frame, sampling weights were calculated based on sampling probabilities separately for each sampling stage and for each cluster.

The survey was successfully carried out in 1,389 clusters after 11 clusters with deteriorating law-and-order situations during fieldwork were dropped. These areas were in Zamfara (4 clusters), Lagos (1 cluster), Katsina (2 clusters), Sokoto (3 clusters), and Borno (1 cluster). In the case of Borno, 11 of the 27 LGAs were dropped due to high insecurity, and therefore the results might not represent the entire state. Please refer to Appendix A in the final report for details.

Mode of data collection

Computer Assisted Personal Interview [capi]

Research instrument

Four questionnaires were used for the 2018 NDHS: the Household Questionnaire, the Woman’s Questionnaire, the Man’s Questionnaire, and the Biomarker Questionnaire. The questionnaires, based on The DHS Program’s standard Demographic and Health Survey (DHS-7) questionnaires, were adapted to reflect the population and health issues relevant to Nigeria. Comments were solicited from various stakeholders representing government ministries and agencies, nongovernmental organisations, and international donors. In addition, information about the fieldworkers for the survey was collected through a self-administered Fieldworker Questionnaire.

The survey protocol was reviewed and approved by the National Health Research Ethics Committee of Nigeria (NHREC) and the ICF Institutional Review Board. After all questionnaires were finalised in English, they were translated into Hausa, Yoruba, and Igbo. The 2018 NDHS used computer-assisted personal interviewing (CAPI) for data collection.

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

The Woman’s Questionnaire was used to collect information from all eligible women age 15-49. These women were asked questions on the following topics: - Background characteristics (including age, education, and media exposure) - Birth history and child mortality - Knowledge, use, and source of family planning methods - Antenatal, delivery, and postnatal care - Vaccinations and childhood illnesses - Breastfeeding and infant feeding practices - Women’s minimum dietary diversity - Marriage and sexual activity - Fertility preferences (including desire for more children and ideal number of children) - Women’s work and husbands’ background characteristics - Knowledge, awareness, and behaviour regarding HIV/AIDS and other sexually transmitted infections (STIs) - Knowledge, attitudes, and behaviour related to other health issues (e.g., smoking) - Female genital cutting - Fistula - Adult and maternal mortality - Domestic violence

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

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

The purpose of the Fieldworker Questionnaire was to collect basic background information on the people who were collecting data in the field, including the team supervisor, field editor, interviewers, and the biomarker team

The main objective of a demographic household survey (DHS) is to provide estimates of a number of basic demographic and health variables. This is done through interviews with a scientifically selected probability sample that is chosen from a well-defined population.

The 2007 Nauru Demographic and Health Survey (2007 NDHS) was one of four pilot demographic and health surveys conducted in the Pacific under an Asian Development Bank ADB/ Secretariat of the Pacific Community (SPC) Regional DHS Pilot Project. The primary objective of this survey was to provide up-to-date information for policy-makers, planners, researchers and programme managers, for use in planning, implementing, monitoring and evaluating population and health programmes within the country. The survey was intended to provide key estimates of Nauru's demographics and health situation. The findings of the 2007 NDHS are very important in measuring the achievements of family planning and other health programmes. To ensure better understanding and use of these data, the results of this survey should be widely disseminated at different planning levels. Different dissemination techniques will be used to reach different segments of society.

The primary purpose of the 2007 NDHS was to furnish policy-makers and planners with detailed information on fertility, family planning, infant and child mortality, maternal and child health, nutrition, and knowledge of HIV and AIDS and other sexually transmitted infections.

NOTE: The only dissemination used was wide distribution of the report. A planned data use workshop was not undertaken. Hence there is some misconceptions and lack of awareness on the results obtained from the survey. The report is provided on the NBOS website free for download.

Version 1.0

• v1.0: Edited data, second version for internal use only

DHS questionnaire for women cover the following sections:

• Background characteristics (age, education, religion, etc)
• Reproductive history
• Knowledge and use of contraception methods
• Antenatal care, delivery care and postnatal care
• Breastfeeding and infant feeding
• Immunization, child health and nutrition
• Marriage and recent sexual activity
• Fertility preferences
• Knowledge about HIV/AIDS and other sexually transmitted infections
• Husbands background and women's work

The men's questionnaire covers the same except for sections 4, 5, 6 which are not applicable to men.

It was also recognized that some countries have a need for special information that is not contained in the core questionnaire. Separate questionnaire modules were developed on a series of topics. These topics are optional and include:

• maternal mortality
• pill-taking behaviour
• sterilization experience
• children's education
• women's status
• domestic violence
• health expenditures

• consanguinity

• Collection start: 2007

• Collection end: 2007

Abstract

The 2022 Nepal Demographic and Health Survey (NDHS) is the sixth survey of its kind implemented in the country as part of the worldwide Demographic and Health Surveys (DHS) Program. It was implemented by New ERA under the aegis of the Ministry of Health and Population (MoHP) of the Government of Nepal with the objective of providing reliable, accurate, and up-to-date data for the country.

The primary objective of the 2022 NDHS is to provide up-to-date estimates of basic demographic and health indicators. Specifically, the 2022 NDHS collected information on fertility, marriage, family planning, breastfeeding practices, nutrition, food insecurity, maternal and child health, childhood mortality, awareness and behavior regarding HIV/AIDS and other sexually transmitted infections (STIs), women’s empowerment, domestic violence, fistula, mental health, accident and injury, disability, and other healthrelated issues such as smoking, knowledge of tuberculosis, and prevalence of hypertension.

The information collected through the 2022 NDHS is intended to assist policymakers and program managers in evaluating and designing programs and strategies for improving the health of Nepal’s population. The survey also provides indicators relevant to the Sustainable Development Goals (SDGs) for Nepal.

Geographic coverage

National coverage

Analysis unit

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

Universe

The survey covered all de jure household members (usual residents), all women aged 15-49, men ageed 15-49, and all children aged 0-4 resident in the household.

Kind of data

Sample survey data [ssd]

Sampling procedure

The sampling frame used for the 2022 NDHS is an updated version of the frame from the 2011 Nepal Population and Housing Census (NPHC) provided by the National Statistical Office. The 2022 NDHS considered wards from the 2011 census as sub-wards, the smallest administrative unit for the survey. The census frame includes a complete list of Nepal’s 36,020 sub-wards. Each sub-ward has a residence type (urban or rural), and the measure of size is the number of households.

In September 2015, Nepal’s Constituent Assembly declared changes in the administrative units and reclassified urban and rural areas in the country. Nepal is divided into seven provinces: Koshi Province, Madhesh Province, Bagmati Province, Gandaki Province, Lumbini Province, Karnali Province, and Sudurpashchim Province. Provinces are divided into districts, districts into municipalities, and municipalities into wards. Nepal has 77 districts comprising a total of 753 (local-level) municipalities. Of the municipalities, 293 are urban and 460 are rural.

Originally, the 2011 NPHC included 58 urban municipalities. This number increased to 217 as of 2015. On March 10, 2017, structural changes were made in the classification system for urban (Nagarpalika) and rural (Gaonpalika) locations. Nepal currently has 293 Nagarpalika, with 65% of the population living in these urban areas. The 2022 NDHS used this updated urban-rural classification system. The survey sample is a stratified sample selected in two stages. Stratification was achieved by dividing each of the seven provinces into urban and rural areas that together formed the sampling stratum for that province. A total of 14 sampling strata were created in this way. Implicit stratification with proportional allocation was achieved at each of the lower administrative levels by sorting the sampling frame within each sampling stratum before sample selection, according to administrative units at the different levels, and by using a probability-proportional-to-size selection at the first stage of sampling. In the first stage of sampling, 476 primary sampling units (PSUs) were selected with probability proportional to PSU size and with independent selection in each sampling stratum within the sample allocation. Among the 476 PSUs, 248 were from urban areas and 228 from rural areas. A household listing operation was carried out in all of the selected PSUs before the main survey. The resulting list of households served as the sampling frame for the selection of sample households in the second stage. Thirty households were selected from each cluster, for a total sample size of 14,280 households. Of these households, 7,440 were in urban areas and 6,840 were in rural areas. Some of the selected sub-wards were found to be overly large during the household listing operation. Selected sub-wards with an estimated number of households greater than 300 were segmented. Only one segment was selected for the survey with probability proportional to segment size.

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

Mode of data collection

Computer Assisted Personal Interview [capi]

Research instrument

Four questionnaires were used in the 2022 NDHS: the Household Questionnaire, the Woman’s Questionnaire, the Man’s Questionnaire, and the Biomarker Questionnaire. The questionnaires, based on The DHS Program’s model questionnaires, were adapted to reflect the population and health issues relevant to Nepal. In addition, a self-administered Fieldworker Questionnaire collected information about the survey’s fieldworkers.

Input was solicited from various stakeholders representing government ministries and agencies, nongovernmental organizations, and international donors. After all questionnaires were finalized in English, they were translated into Nepali, Maithili, and Bhojpuri. The Household, Woman’s, and Man’s Questionnaires were programmed into tablet computers to facilitate computer-assisted personal interviewing (CAPI) for data collection purposes, with the capability to choose any of the three languages for each questionnaire. The Biomarker Questionnaire was completed on paper during data collection and then entered in the CAPI system.

Cleaning operations

Data capture for the 2022 NDHS was carried out with Microsoft Surface Go 2 tablets running Windows 10.1. Software was prepared for the survey using CSPro. The processing of the 2022 NDHS data began shortly after the fieldwork started. When data collection was completed in each cluster, the electronic data files were transferred via the Internet File Streaming System (IFSS) to the New ERA central office in Kathmandu. The data files were registered and checked for inconsistencies, incompleteness, and outliers. Errors and inconsistencies were immediately communicated to the field teams for review so that problems would be mitigated going forward. Secondary editing, carried out in the central office at New ERA, involved resolving inconsistencies and coding the open-ended questions. The New ERA senior data processor coordinated the exercise at the central office. The NDHS core team members assisted with the secondary editing. The paper Biomarker Questionnaires were compared with the electronic data file to check for any inconsistencies in data entry. The pictures of vaccination cards that were captured during data collection were verified with the data entered. Data processing and editing were carried out using the CSPro software package. The concurrent data collection and processing offered a distinct advantage because it maximized the likelihood of the data being error-free and accurate. Timely generation of field check tables allowed for effective monitoring. The secondary editing of the data was completed by July 2022, and the final cleaning of the data set was completed by the end of August.

Response rate

A total of 14,243 households were selected for the sample, of which 13,833 were found to be occupied. Of the occupied households, 13,786 were successfully interviewed, yielding a response rate of more than 99%. In the interviewed households, 15,238 women age 15-49 were identified as eligible for individual interviews. Interviews were completed with 14,845 women, yielding a response rate of 97%. In the subsample of households selected for the men’s survey, 5,185 men age 15-49 were identified as eligible for individual interviews and 4,913 were successfully interviewed, yielding a response rate of 95%.

Sampling error estimates

The estimates from a sample survey are affected by two types of errors: nonsampling errors and sampling errors. Nonsampling errors result from mistakes made in implementing data collection and in data processing, such as failing to locate and interview the correct household, misunderstanding of the questions on the part of either the interviewer or the respondent, and entering the data incorrectly. Although numerous efforts were made during the implementation of the 2022 Nepal Demographic and Health Survey (2022 NDHS) 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 2022 NDHS is only one of many samples that could have been selected from the same population, using the same design and expected sample size. Each of these samples would yield results that differ somewhat from the results of the selected sample. Sampling errors are a measure of the variability among all possible samples. Although the exact degree of variability is unknown, 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, and so on), which is the square root of the variance. The standard error can be used to calculate confidence intervals within which the

Background characteristics of mother and child with non-missing birth weight, NDHS 2016 (n = 3095).