Abstract

Purpose: The multi-country Study on Global Ageing and Adult Health (SAGE) is run by the World Health Organization's Multi-Country Studies unit in the Innovation, Information, Evidence and Research Cluster. SAGE is part of the unit's Longitudinal Study Programme which is compiling longitudinal data on the health and well-being of adult populations, and the ageing process, through primary data collection and secondary data analysis. SAGE baseline data (Wave 0, 2002/3) was collected as part of WHO's World Health Survey http://www.who.int/healthinfo/survey/en/index.html (WHS). SAGE Wave 1 (2007/10) provides a comprehensive data set on the health and well-being of adults in six low and middle-income countries: China, Ghana, India, Mexico, Russian Federation and South Africa. Objectives: To obtain reliable, valid and comparable health, health-related and well-being data over a range of key domains for adult and older adult populations in nationally representative samples To examine patterns and dynamics of age-related changes in health and well-being using longitudinal follow-up of a cohort as they age, and to investigate socio-economic consequences of these health changes To supplement and cross-validate self-reported measures of health and the anchoring vignette approach to improving comparability of self-reported measures, through measured performance tests for selected health domains To collect health examination and biomarker data that improves reliability of morbidity and risk factor data and to objectively monitor the effect of interventions Additional Objectives: To generate large cohorts of older adult populations and comparison cohorts of younger populations for following-up intermediate outcomes, monitoring trends, examining transitions and life events, and addressing relationships between determinants and health, well-being and health-related outcomes To develop a mechanism to link survey data to demographic surveillance site data To build linkages with other national and multi-country ageing studies To improve the methodologies to enhance the reliability and validity of health outcomes and determinants data To provide a public-access information base to engage all stakeholders, including national policy makers and health systems planners, in planning and decision-making processes about the health and well-being of older adults Methods: SAGE's first full round of data collection included both follow-up and new respondents in most participating countries. The goal of the sampling design was to obtain a nationally representative cohort of persons aged 50 years and older, with a smaller cohort of persons aged 18 to 49 for comparison purposes. In the older households, all persons aged 50+ years (for example, spouses and siblings) were invited to participate. Proxy respondents were identified for respondents who were unable to respond for themselves. Standardized SAGE survey instruments were used in all countries consisting of five main parts: 1) household questionnaire; 2) individual questionnaire; 3) proxy questionnaire; 4) verbal autopsy questionnaire; and, 5) appendices including showcards. A VAQ was completed for deaths in the household over the last 24 months. The procedures for including country-specific adaptations to the standardized questionnaire and translations into local languages from English follow those developed by and used for the World Health Survey. Content Household questionnaire 0000 Coversheet 0100 Sampling Information 0200 Geocoding and GPS Information 0300 Recontact Information 0350 Contact Record 0400 Household Roster 0450 Kish Tables and Household Consent 0500 Housing 0600 Household and Family Support Networks and Transfers 0700 Assets and Household Income 0800 Household Expenditures 0900 Interviewer Observations Individual questionnaire 1000 Socio-Demographic Characteristics 1500 Work History and Benefits 2000 Health State Descriptions and Vignettes 2500 Anthropometrics, Performance Tests and Biomarkers 3000 Risk Factors and Preventive Health Behaviours 4000 Chronic Conditions and Health Services Coverage 5000 Health Care Utilization 6000 Social Cohesion 7000 Subjective Well-Being and Quality of Life (WHOQoL-8 and Day Reconstruction Method) 8000 Impact of Caregiving 9000 Interviewer Assessment

Geographic coverage

National coverage

Analysis unit

households and individuals

Universe

The household section of the survey covered all households in all nine provinces in South Africa. Institutionalised populations are excluded. The individual section covered all persons aged 18 years and older residing within individual households. As the focus of SAGE is older adults, a much larger sample of respondents aged 50 years and older were selected with a smaller comparative sample of respondents aged 18-49 years.

Kind of data

Sample survey data [ssd]

Sampling procedure

South Africa used a stratified multistage cluster sample design. Strata were defined by the nine provinces:(Eastern Cape, Free State, Gauteng, Kwa-Zulu Natal, Limpopo, Mpumalanga, North West, Northern Cape and Western Cape), locality (urban or rural), and predominant race group (African/Black, White, Coloured and Indian/Asian), as not all combinations of stratification variables were possible, there were 50 strata in total. The Human Science Research Council's master sample was used as the sampling frame which comprised 1000EAs. A sample of 600 EAs was selected as the primary sampling units(PSU). The number of EAs to be selected from each strata was based on proportional allocation (determined by the number of EAs in each strataspecified on the Master Sample). EAs were then selected from each strata with probability proportional to size; the measure of size being the number of individuals aged 50 years or more in the EA. In each selected EA 30 households were randomly selected from the Master Sample. A listing of the 30 selected households was conducted to classify each household into one of two mutually exclusive categories: (1) households with one or more members aged 50 years or more (defined as '50 plus households'); (2) households which did not include any members aged 50 years or more, but included residents aged 18-49 (defined as '18-49 households'). All 50 plus households were eligible for the household interview, and all 50 plus members of the household were eligible for the individual interview. Two of the remaining 18-49 households were randomly selected for the household interview. In each of these household one person aged 18-49 was eligible for the individual interview, and the individual to be included was selected using a Kish Grid.

Stages of selection Strata: Province, Predominant Race Group, Locality=50 PSU: EAs=408 surveyed SSU: Households=4020 surveyed TSU: Individual=4227 surveyed

Sampling deviation

Originally 600 EAs were drawn into the sample. However due to time and financial contraints only 396 EAs were visited.

Mode of data collection

Face-to-face [f2f] PAPI

Research instrument

The questionnaires were based on the WHS Model Questionnaire with some modification and many new additions. A household questionnaire was administered to all households eligible for the study. A Verbal Autopsy questionnaire was administered to households that had a death in the last 24 months. An Individual questionnaire was administered to eligible respondents identified from the household roster. A Proxy questionnaire was administered to individual respondents who had cognitive limitations. The questionnaires were developed in English and were piloted as part of the SAGE pretest in 2005. All documents were translated into six of the major languages in South Africa: Afrikaans, IsiZulu, IsiXhosa, Sepedi, Setswana and Xitsonga. All SAGE generic questionnaires are available as external resources.

Cleaning operations

Data editing took place at a number of stages including: (1) office editing and coding (2) during data entry (3) structural checking of the CSPro files (4) range and consistency secondary edits in Stata

Response rate

Household Response rate=67% Cooperation rate=99%

Individual: Response rate=77% Cooperation rate=99%

Abstract

Purpose: The multi-country Study on Global Ageing and Adult Health (SAGE) is run by the World Health Organization's Multi-Country Studies unit in the Innovation, Information, Evidence and Research Cluster. SAGE is part of the unit's Longitudinal Study Programme which is compiling longitudinal data on the health and well-being of adult populations, and the ageing process, through primary data collection and secondary data analysis. INDEPTH SAGE Wave 1 (2006/7) provides data on the health and well-being of adults in: Ghana, India and South Africa.

Objectives: To obtain reliable, valid and comparable health, health-related and well-being data over a range of key domains for adult and older adult populations in nationally representative samples To examine patterns and dynamics of age-related changes in health and well-being using longitudinal follow-up of a cohort as they age, and to investigate socio-economic consequences of these health changes To supplement and cross-validate self-reported measures of health and the anchoring vignette approach to improving comparability of self-reported measures, through measured performance tests for selected health domains To collect health examination and biomarker data that improves reliability of morbidity and risk factor data and to objectively monitor the effect of interventions

Additional Objectives: To generate large cohorts of older adult populations and comparison cohorts of younger populations for following-up intermediate outcomes, monitoring trends, examining transitions and life events, and addressing relationships between determinants and health, well-being and health-related outcomes To develop a mechanism to link survey data to demographic surveillance site data To build linkages with other national and multi-country ageing studies To improve the methodologies to enhance the reliability and validity of health outcomes and determinants data To provide a public-access information base to engage all stakeholders, including national policy makers and health systems planners, in planning and decision-making processes about the health and well-being of older adults

Methods: INDEPTH SAGE's first full round of data collection included persons aged 50 years and older in the health and demographic surveillance sites. All persons aged 50+ years (for example, spouses and siblings) were invited to participate. Standardized SAGE survey instruments were used in all countries consisting of two main parts: 1) household questionnaire; 2) individual questionnaire. The procedures for including country-specific adaptations to the standardized questionnaire and translations into local languages from English follow those developed by and used for the World Health Survey.

Content: - Household questionnaire 0000 Coversheet 0100 Sampling Information 0200 Geocoding and GPS Information 0300 Recontact Information 0350 Contact Record 0400 Household Roster 0450 Kish Tables and Household Consent 0500 Housing 0600 Household and Family Support Networks and Transfers 0700 Assets and Household Income 0800 Household Expenditures 0900 Interviewer Observations

• Individual questionnaire 1000 Socio-Demographic Characteristics 1500 Work History and Benefits 2000 Health State Descriptions and Vignettes 2500 Anthropometrics, Performance Tests and Biomarkers 3000 Risk Factors and Preventive Health Behaviours 4000 Chronic Conditions and Health Services Coverage 5000 Health Care Utilization 6000 Social Cohesion 7000 Subjective Well-Being and Quality of Life (WHOQoL-8 and Day Reconstruction Method) 8000 Impact of Caregiving 9000 Interviewer Assessment

Geographic coverage

Kassena-Nankana District of the Upper East region of Ghana.

Analysis unit

households and individuals

Universe

Navrongo Health and Demographic Surveillance Site fifty plus population

Kind of data

Sample survey data [ssd]

Sampling procedure

Single random sample of individuals 50+ years. Sampling frame obtained from demographic surveillance database. No replacement of individuals not met, not found or for refusals.

Mode of data collection

Face-to-face [f2f]

Research instrument

The questionnaires were based on the WHS Model Questionnaire with some modification and many new additions. A household questionnaire was administered to all households eligible for the study. An Individual questionnaire was administered to eligible respondents identified from the household roster. The questionnaires were developed in English and were piloted as part of the SAGE pretest. All documents were translated into XX. All INDEPTH SAGE generic questionnaires are available as external resources.

Cleaning operations

Data editing took place at a number of stages including: (1) office editing and coding (2) during data entry (3) structural checking of the CSPro files (4) range and consistency secondary edits in Stata

Response rate

A total of 900 were sampled. 593 successful respondents in data set. Response rate (593/900) is 65.9%

Abstract

Purpose: The multi-country Study on Global Ageing and Adult Health (SAGE) is run by the World Health Organization's Multi-Country Studies unit in the Innovation, Information, Evidence and Research Cluster. SAGE is part of the unit's Longitudinal Study Programme which is compiling longitudinal data on the health and well-being of adult populations, and the ageing process, through primary data collection and secondary data analysis. SAGE baseline data (Wave 0, 2002/3) was collected as part of WHO's World Health Survey http://www.who.int/healthinfo/survey/en/index.html (WHS). SAGE Wave 1 (2007/10) provides a comprehensive data set on the health and well-being of adults in six low and middle-income countries: China, Ghana, India, Mexico, Russian Federation and South Africa. Objectives: To obtain reliable, valid and comparable health, health-related and well-being data over a range of key domains for adult and older adult populations in nationally representative samples To examine patterns and dynamics of age-related changes in health and well-being using longitudinal follow-up of a cohort as they age, and to investigate socio-economic consequences of these health changes To supplement and cross-validate self-reported measures of health and the anchoring vignette approach to improving comparability of self-reported measures, through measured performance tests for selected health domains To collect health examination and biomarker data that improves reliability of morbidity and risk factor data and to objectively monitor the effect of interventions

Additional Objectives: To generate large cohorts of older adult populations and comparison cohorts of younger populations for following-up intermediate outcomes, monitoring trends, examining transitions and life events, and addressing relationships between determinants and health, well-being and health-related outcomes To develop a mechanism to link survey data to demographic surveillance site data To build linkages with other national and multi-country ageing studies To improve the methodologies to enhance the reliability and validity of health outcomes and determinants data To provide a public-access information base to engage all stakeholders, including national policy makers and health systems planners, in planning and decision-making processes about the health and well-being of older adults

Methods: SAGE's first full round of data collection included both follow-up and new respondents in most participating countries. The goal of the sampling design was to obtain a nationally representative cohort of persons aged 50 years and older, with a smaller cohort of persons aged 18 to 49 for comparison purposes. In the older households, all persons aged 50+ years (for example, spouses and siblings) were invited to participate. Proxy respondents were identified for respondents who were unable to respond for themselves. Standardized SAGE survey instruments were used in all countries consisting of five main parts: 1) household questionnaire; 2) individual questionnaire; 3) proxy questionnaire; 4) verbal autopsy questionnaire; and, 5) appendices including showcards. A VAQ was completed for deaths in the household over the last 24 months. The procedures for including country-specific adaptations to the standardized questionnaire and translations into local languages from English follow those developed by and used for the World Health Survey.

Content Household questionnaire 0000 Coversheet 0100 Sampling Information 0200 Geocoding and GPS Information 0300 Recontact Information 0350 Contact Record 0400 Household Roster 0450 Kish Tables and Household Consent 0500 Housing 0600 Household and Family Support Networks and Transfers 0700 Assets and Household Income 0800 Household Expenditures 0900 Interviewer Observations

Individual questionnaire 1000 Socio-Demographic Characteristics 1500 Work History and Benefits 2000 Health State Descriptions and Vignettes 2500 Anthropometrics, Performance Tests and Biomarkers 3000 Risk Factors and Preventive Health Behaviours 4000 Chronic Conditions and Health Services Coverage 5000 Health Care Utilization 6000 Social Cohesion 7000 Subjective Well-Being and Quality of Life (WHOQoL-8 and Day Reconstruction Method) 8000 Impact of Caregiving 9000 Interviewer Assessment

Geographic coverage

National coverage

Analysis unit

households and individuals

Universe

The household section of the survey covered all households in 19 of the 28 states in India which covers 96% of the population. Institutionalised populations are excluded. The individual section covered all persons aged 18 years and older residing within individual households.

Kind of data

Sample survey data [ssd]

Sampling procedure

World Health Survey Sampling India has 28 states and seven union territories. 19 of the 28 states were included in the design representing 96% of the population. India used a stratified multistage cluster sample design. Six states were selected in accordance with their geographic location and level of development. Strata were defined by the 6 states:(Assam, Karnataka, Maharashtra, Rajasthan, Uttar Pradesh and West Bengal), and locality (urban or rural). There are 12 strata in total. The 2000 Census demarcation was used as the sampling frame. Two stage and three stage sampling was adopted in rural and urban areas, respectively. In rural areas PSUs(villages) were selected probability proportional to size. The measure of size being the 2001 Census population in the village. SSUs (households) were selected using systematic sampling. TSUs (individuals) were selected using Kish tables. In urban areas, PSUs(city wards) were selected probability proportional to size. SSUs(census enumeration blocks), two were randomly selected from each PSU. TSU (households) were selected using systematic sampling. QSU (individuals) were selected as in rural areas. A sample of 379 EAs was selected as the primary sampling units(PSU).

SAGE Sampling The SAGE sample was pre-determined as all PSUs and households selected for the WHS/SAGE Wave 0 survey were included. Exceptions are three PSUs in Assam which were replaced as they were inaccessible due to flooding. And a further six PSUs were omitted for which the household roster information was not available. In each selected EA, a listing of the households was conducted to classify each household into the following mutually exclusive categories: 1)Households with a WHS/SAGE Wave 0 respondent aged 50-plus: all members aged 50-plus including the WHS/SAGE Wave 0 respondent were eligible for the individual interview. 2)Households with a WHS/SAGE Wave 0 respondent aged 47-49: all members aged 50-plus including the WHS/SAGE Wave 0 respondent aged 47-49 was eligible for the individual interview. 3)Households with a WHS/SAGE Wave 0 female respondent aged 18-46: all females members aged 18-49 including the WHS/SAGE Wave 0 female respondent aged 18-46 were eligible for the individual interview. 4)Households with a WHS/SAGE Wave 0 male respondent aged 18-46: three households were selected using systematic sampling and one male aged 18-49 was eligible for the individual interview. In the households not selected, all members aged 50-plus were eligible for the individual interview.

Stages of selection Strata: State, Locality=12 PSU: EAs=375 surveyed SSU: Households=10424 surveyed TSU: Individual=12198 surveyed

Mode of data collection

Face-to-face [f2f] PAPI

Research instrument

The questionnaires were based on the WHS Model Questionnaire with some modification and many new additions. A household questionnaire was administered to all households eligible for the study. A Verbal Autopsy questionnaire was administered to households that had a death in the last 24 months. An Individual questionniare was administered to eligible respondents identified from the household roster. A Proxy questionnaire was administered to individual respondents who had cognitive limitations. A Womans Questionnaire was administered to all females aged 18-49 years identified from the household roster. The questionnaires were developed in English and were piloted as part of the SAGE pretest in 2005. All documents were translated into Hindi, Assamese, Kanada and Marathi. SAGE generic questionnaires are available as external resources.

Cleaning operations

Data editing took place at a number of stages including: (1) office editing and coding (2) during data entry (3) structural checking of the CSPro files (4) range and consistency secondary edits in Stata

Response rate

Household Response rate=88% Cooperation rate=92%

Individual: Response rate=68% Cooperation rate=92%