Abstract

The 2019-20 Rwanda Demographic and Health Survey (2019-20 RDHS) follows those implemented in 1992, 2000, 2005, 2010, and 2014-15. A nationally representative sample of 500 clusters and 13,000 households were selected. All women age 15-49 who were usual residents of the selected households or who slept in the households the night before the survey were eligible for the survey.

The primary objective of the 2019-20 RDHS is to provide up-to-date estimates of basic demographic and health indicators. Specifically, the 2019-20 RDHS: • collected data on fertility levels and preferences; contraceptive use; maternal and child health; infant, child, and neonatal mortality levels; maternal mortality; gender; nutrition; awareness about HIV/AIDS; self-reported sexually transmitted infections (STIs); and other health issues relevant to the achievement of the Sustainable Development Goals (SDGs) • obtained information on the availability of, access to, and use of mosquito nets as part of the National Malaria Control Program • gathered information on other health issues such as injections, tobacco use, and health insurance • collected data on women’s empowerment and domestic violence • tested household salt for iodine levels • obtained data on child feeding practices, including breastfeeding, and conducted anthropometric measurements to assess the nutritional status of children under age 5 and women age 15-49 • conducted anemia testing of women age 15-49 and children age 6-59 months • conducted malaria testing of women age 15-49 and children age 6-59 months • conducted HIV testing of women age 15-49 and men age 15-59 • conducted micronutrient testing of women age 15-49 and children age 6-59 months

The information collected through the 2019-20 RDHS is intended to assist policymakers and program managers in evaluating and designing programs and strategies for improving the health of the country’s population.

Geographic coverage

National coverage

Analysis unit

• Household
• Individual
• Children age 0-5
• Woman age 15-49
• Man age 15 to 59

Universe

The survey covered all de jure household members (usual residents), all women aged 15-49, all men age 15-59, and all children aged 0-5 resident in the household.

Kind of data

Sample survey data [ssd]

Sampling procedure

The sampling frame used for the 2019-20 RDHS is the fourth Rwanda Population and Housing Census (RPHC), which was conducted in 2012 by the National Institute of Statistics of Rwanda (NISR). The sampling frame is a complete list of enumeration areas (EAs) covering the whole country provided by the National Institute of Statistics, the implementing agency for the RDHS. An EA is a natural village or part of a village created for the 2012 RPHC; these areas served as the counting units for the census.

The 2019-20 RDHS followed a two-stage sample design and was intended to allow estimates of key indicators at the national level as well as for urban and rural areas, five provinces, and each of Rwanda’s 30 districts for some limited indicators. The first stage involved selecting sample points (clusters) consisting of EAs delineated for the 2012 RPHC. A total of 500 clusters were selected, 112 in urban areas and 388 in rural areas.

The second stage involved systematic sampling of households. A household listing operation was undertaken in all selected EAs from June to August 2019, and households to be included in the survey were randomly selected from these lists. Twenty-six households were selected from each sample point, for a total sample size of 13,000 households. Because of the approximately equal sample sizes in each district, the sample is not self-weighting at the national level, and weighting factors have been added to the data file so that the results will be proportional at the national level.

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

Mode of data collection

Computer Assisted Personal Interview [capi]

Research instrument

Five questionnaires were used for the 2019-20 RDHS: the Household Questionnaire, the Woman’s Questionnaire, the Man’s Questionnaire, the Biomarker Questionnaires, and the Fieldworker Questionnaire. These 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 Rwanda.

Cleaning operations

The processing of the 2019-20 RDHS data began almost as soon as the fieldwork started. As data collection was completed in each cluster, all electronic data files were transferred via the Internet File Streaming System (IFSS) to the NISR central office in City of Kigali. 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 NISR 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 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 in the second week of September 2020.

Response rate

A total of 13,005 households were selected for the sample, of which 12,951 were occupied. All but two occupied households (12,949) were successfully interviewed, yielding a response rate of 100.0%. In the interviewed households, 14,675 women age 15-49 were identified for individual interviews; interviews were completed with 14,634 women, yielding a response rate of 99.7%. In the subsample selected for the male survey, 6,503 households were selected, of which 6,472 were occupied. All but one occupied household (6,471) were successfully interviewed, yielding a response rate of 100.0%. In this subsample, 6,544 men age 15-59 were identified and 6,513 were successfully interviewed, yielding a response rate of 99.5%. In the subsample selected for the micronutrient survey, 3,501 households were selected, of which 3,492 were occupied. All but one of the occupied households (3,491) were successfully interviewed, yielding a response rate of 100.0%.

Sampling error estimates

The estimates from a sample survey are affected by two types of errors: nonsampling errors and sampling errors. Nonsampling errors are the results of mistakes made in implementing data collection and data processing, such as failure to locate and interview the correct household, misunderstanding of the questions on the part of either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the 2019-20 Rwanda Demographic and Health Survey (2019-20 RDHS) to minimize this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically.

Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the 2019-20 RDHS is only one of many samples that could have been selected from the same population, using the same design and sample 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 by simple random sampling, it would have been possible to use straightforward formulas for calculating sampling errors. However, the 2019-20 RDHS sample was the result of a multi-stage stratified design, and, consequently, it was necessary to use more complex formulas. Sampling errors are computed using SAS programs developed by ICF. These programs use the Taylor linearization method to estimate variances for survey estimates that are means, proportions, or ratios. The Jackknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates.

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

Data appraisal

Data Quality Tables

• Household age distribution
• Age distribution of eligible and interviewed women
• 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
• Standardization exercise results from anthropometry training
• Height and weight data completeness and quality for children
• Height measurements from random sub-sample of measured children
• Number of enumeration areas

DHS - Rwanda

From 2014 to 2015, with the aim of collecting data to monitor progress across Rwanda’s health programs and policies, the Government of Rwanda (GOR) conducted the Rwanda Demographic and Health Survey (RDHS) through the Ministry of Health (MOH) and the National Institute of Statistics of Rwanda (NISR) with the members of the national steering committee to the DHS and the technical assistance of ICF International. The main objectives of the 2014-15 RDHS were to: • Collect data at the national level to calculate essential demographic indicators, especially fertility and infant and child mortality, and analyze the direct and indirect factors that relate to levels and trends in fertility and child mortality • Measure levels of knowledge and use of contraceptive methods among women and men • Collect data on family health, including immunization practices; prevalence and treatment of diarrhea, acute upper respiratory infections, and fever among children under age 5; antenatal care visits; assistance at delivery; and postnatal care • Collect data on knowledge, prevention, and treatment of malaria, in particular the possession and use of treated mosquito nets among household members, especially children under age 5 and pregnant women • Collect data on feeding practices for children, including breastfeeding • Collect data on the knowledge and attitudes of women and men regarding sexually transmitted infections (STIs) and HIV and evaluate recent behavioral changes with respect to condom use • Collect data for estimation of adult mortality and maternal mortality at the national level • Take anthropometric measurements to evaluate the nutritional status of children, men, and women • Assess the prevalence of malaria infection among children under age 5 and pregnant women using rapid diagnostic tests and blood smears • Estimate the prevalence of HIV among children age 0-14 and adults of reproductive age • Estimate the prevalence of anemia among children age 6-59 months and adult women of reproductive age • Collect information on early childhood development • Collect information on domestic violence

This survey was conducted in Rwanda by the Office National de la Population 6,551 women between the ages of 15 - 49 and 598 husbands were interviewed from June 1992 - October 1992. Major topics covered: Anthropometry; Husband's Survey; Men's Survey

Data access requires registration with USAID. USAID now makes this data available directly on their website, which can be accessed here: https://dhsprogram.com/methodology/survey/survey-display-43.cfm - along with additional years of data here: https://dhsprogram.com/data/available-datasets.cfm

We advise you use this location to access the data as they have updated formats, etc. This material remains in the archive for preservation and historical purposes.

Abstract

The 2019-20 Rwanda Demographic and Health Survey (RDHS) is the sixth Demographic and Health Survey (DHS) conducted in Rwanda, following those implemented in 1992, 2000, 2005, 2010, and 2014-15. The National Institute of Statistics of Rwanda (NISR), in collaboration with the Ministry of Health (MOH), implemented the survey. Data collection took place from November 9, 2019, to July 20, 2020. The data collection was interrupted for more than 2 months from March 21 to June 7, 2020, due to the nationwide lockdown for the coronavirus disease (COVID-19) pandemic.

The primary objective of the 2019-20 RDHS is to provide up-to-date estimates of basic demographic and health indicators. Specifically, the 2019-20 RDHS: - collected data on fertility levels and preferences; contraceptive use; maternal and child health; infant, child, and neonatal mortality levels; maternal mortality; gender; nutrition; awareness about HIV/AIDS; self-reported sexually transmitted infections (STIs); and other health issues relevant to the achievement of the Sustainable Development Goals (SDGs) - obtained information on the availability of, access to, and use of mosquito nets as part of the National Malaria Control Program - gathered information on other health issues such as injections, tobacco use, and health insurance - collected data on women’s empowerment and domestic violence - tested household salt for iodine levels - obtained data on child feeding practices, including breastfeeding, and conducted anthropometric measurements to assess the nutritional status of children under age 5 and women age 15-49 - conducted anemia testing of women age 15-49 and children age 6-59 months - conducted malaria testing of women age 15-49 and children age 6-59 months - conducted HIV testing of women age 15-49 and men age 15-59 - conducted micronutrient testing of women age 15-49 and children age 6-59 months

The information collected through the 2019-20 RDHS is intended to assist policymakers and program managers in evaluating and designing programs and strategies for improving the health of the country’s population.

Geographic coverage

National coverage

Analysis unit

households Women Men Children

Universe

the survey covered all household members, all women aged 15-49 years, all children 6-59 months and all men aged 15-59 years

Kind of data

Sample survey data [ssd]

Sampling procedure

The sampling frame used for the 2019-20 RDHS is the fourth Rwanda Population and Housing Census (RPHC), which was conducted in 2012 by the National Institute of Statistics of Rwanda (NISR). The sampling frame is a complete list of enumeration areas (EAs) covering the whole country provided by the National Institute of Statistics, the implementing agency for the RDHS. An EA is a natural village or part of a village created for the 2012 RPHC; these areas served as the counting units for the census.

The 2019-20 RDHS followed a two-stage sample design and was intended to allow estimates of key indicators at the national level as well as for urban and rural areas, five provinces, and each of Rwanda’s 30 districts for some limited indicators. The first stage involved selecting sample points (clusters) consisting of EAs delineated for the 2012 RPHC. A total of 500 clusters were selected, 112 in urban areas and 388 in rural areas.

The second stage involved systematic sampling of households. A household listing operation was undertaken in all selected EAs from June to August 2019, and households to be included in the survey were randomly selected from these lists. Twenty-six households were selected from each sample point, for a total sample size of 13,000 households. Because of the approximately equal sample sizes in each district, the sample is not self-weighting at the national level, and weighting factors have been added to the data file so that the results will be proportional at the national level.

All women age 15-49 who were either permanent residents of the selected households or visitors who stayed in the household the night before the survey were eligible to be interviewed. In half of the households, all men age 15-59 who were either permanent residents of the selected households or visitors who stayed in the household the night before the survey were eligible to be interviewed. In the subsample of households selected for the male survey, height and weight measurements, anemia testing, and malaria testing were performed among eligible women who consented to being tested and children less than age 5 with the parent’s or guardian’s consent. In the same subsample, blood samples were collected for testing of HIV from eligible women and men who consented. The domestic violence module for men was implemented in one-half of the households selected for the male survey (25% of the entire sample), and the domestic violence module for women was implemented in the other one-half of households selected for that survey (25% of the entire sample). In one-half of subsample households not selected for the male survey (25% of the entire sample), venous blood samples were collected for micronutrient testing among children age 0-5 and women age 15-49. In this micronutrient subsample, height and weight measurements, anemia testing, and malaria testing (rapid test only) for children and women were also performed.

Mode of data collection

Computer Assisted Personal Interview [capi]

Research instrument

Five questionnaires were used for the 2019-20 RDHS: the Household Questionnaire, the Woman’s Questionnaire, the Man’s Questionnaire, the Biomarker Questionnaires, and the Fieldworker Questionnaire. These 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 Rwanda. Comments were solicited from various stakeholders representing government ministries and agencies, nongovernmental organizations, and development partners. The survey protocol was reviewed and approved by the Rwanda National Ethics Committee (RNEC) and the ICF Institutional Review Board. After all questionnaires were finalized in English, they were translated into Kinyarwanda. The 2019-20 RDHS 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, a disability module was added into this questionnaire.

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 - 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 behavior regarding HIV/AIDS and other sexually transmitted infections (STIs) - Knowledge, attitudes, and behavior related to other health issues (e.g., smoking) - Early childhood development - 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 first Biomarker Questionnaire was used to record the results of anthropometry measurements and other biomarkers (anemia, malaria, and HIV) for women, men, and children. This questionnaire was administered only to the subsamples selected for the men’s survey.

The second Biomarker Questionnaire was used to record the results of anthropometry measurements and other biomarkers (anemia, malaria, and micronutrient) for women and children. This questionnaire was administered only to the subsamples of seven households per cluster.

The Fieldworker Questionnaire recorded background information from the interviewers that will serve as a tool in conducting analyses of data quality. Each interviewer completed the self-administered questionnaire after the final selection of interviewers and before the fieldworkers entered the field. No personal identifiers were attached to the 2019-20 RDHS fieldworkers’ data file.

Cleaning operations

The processing of the 2019-20 RDHS data began almost as soon as the fieldwork started. As data collection was completed in each cluster, all electronic data files were transferred via the Internet File Streaming System (IFSS) to the NISR central office in City of Kigali. These data files were registered and checked for inconsistencies, incompleteness, and outliers. The

GridSample output replicating 2010 Rwanda Demographic and Health Survey.

Not specified

Abstract

The 2010 Rwanda Demographic and Health Survey (RDHS) is designed to provide data for monitoring the population and health situation in Rwanda. The 2010 RDHS is the fifth Demographic and Health Survey to be conducted in Rwanda. The objective of the survey is to provide up-to-date information on fertility, family planning, childhood mortality, nutrition, maternal and child health, domestic violence, malaria, maternal mortality, awareness and behavior regarding HIV/AIDS, HIV prevalence, malaria prevalence, and anemia prevalence. A nationally representative sample of 13,671 women, age 15–49 from 12,540 surveyed households, and 6,329 men, age 15–59 from half of these households, were interviewed. This represents a response rate of 99 percent for women and 99 percent for men. The sample provides estimates at the national and provincial levels.

The main objectives of the 2010 RDHS were to: - Collect data at the national level to facilitate calculation of essential demographic rates, especially rates for fertility and infant and child mortality, and to analyze the direct and indirect factors that determine levels and trends in fertility and child mortality - Measure the levels of knowledge of contraceptive practices among women - Collect data on family health, including immunization practices; prevalence and treatment of diarrhea, acute upper respiratory infections, fever and/or convulsions among children under age 5; antenatal visits; and assistance at delivery - Collect data on the prevention and treatment of malaria, in particular the possession and use of bed nets among children under 5 and among women and pregnant women - Collect data on nutritional practices of children, including breastfeeding - Collect data on the knowledge and attitudes of men and women concerning sexually transmitted infections (STIs) and acquired immune deficiency syndrome (AIDS) and evaluate recent behavioral changes with regard to condom use - Collect data for the estimation of adult mortality and maternal mortality at the national level - Take anthropometric measurements in half of surveyed households in order to evaluate the nutritional status of children, men, and women - Conduct confidential testing for malaria parasitemia using Rapid Diagnostic Testing in half of the surveyed households and anonymous blood smear testing at the National Reference Laboratory - Collect dried blood spots (from finger pricks) for anonymous HIV testing at the National Reference Laboratory in half of surveyed households - Measure hemoglobin level (by finger prick) for anemia of surveyed respondents in half of surveyed households.

Geographic coverage

National. The sample provides estimates at the national and provincial levels.

Analysis unit

Household, adult woman, adult man

Kind of data

Sample survey data

Sampling procedure

The sample for the 2010 RDHS was designed to provide population and health indicator estimates for the country as a whole and for urban and rural areas in particular. Survey estimates are also reported for the provinces (South, West, North, and East) and for the City of Kigali. The results presented in this report show key indicators that correspond to these provinces and the City of Kigali.

A representative sample of 12,792 households was selected for the 2010 RDHS. The sample was selected in two stages. In the first stage, 492 villages (also known as clusters or enumeration areas) were selected with probability proportional to the village size. The village size is the number of households residing in the village. Then, a complete mapping and listing of all households existing in the selected villages was conducted. The resulting lists of households served as the sampling frame for the second stage of sample selection. Households were systematically selected from those lists for participation in the survey.

All women age 15-49 who were either permanent residents of the household or visitors present in the household on the night before the survey were eligible to be interviewed. In addition, in a subsample of half of all households selected for the survey, all men age 15-59 were eligible to be interviewed if they were either permanent residents or visitors present in the household on the night before the survey.

SAMPLING FRAME

The sampling frame used for the 2010 RDHS is the preparatory frame for the Rwanda General Population and Housing Census (RGPH), which will be conducted in 2012. Provided by the National Institute of Statistics of Rwanda (NISR), the sampling frame is a complete list of natural villages covering the entire country. Though it is preferable to work with a frame consisting of enumeration areas (EAs) because the natural villages are too variable in size, an EA frame is not available at the time of sampling design. The sampling frame that was available is the list of 14,837 natural villages, which contains the administrative characteristics for each village and village population. The village population comes from the national ID card project carried out in 2007-08, which may be under estimated compared with the population projection conducted in 2009 by NISR.

Rwanda's administrative units were reformed in 2006, so the country is currently divided into 5 provinces; 30 districts, 417 sectors, and 14,837 villages.The average village size is 610 residents, which is equivalent to 133 households. The sizes of the districts are quite homogeneous, varying from 2.7 percent to 4.4 percent. There is no urban-rural specification in the sampling frame because the urban-rural definition has not been released by the Ministry of Local Administration (MINALOC). It was expected that the urban-rural definition of the sampled villages will be determined during the data collection or in the office once the MINALOC releases the definition.

Mode of data collection

Face-to-face

Research instrument

Three questionnaires were used for the 2010 RDHS: the Household Questionnaire, the Woman’s Questionnaire, and the Man’s Questionnaire. They are based on questionnaires developed by the worldwide Demographic and Health Surveys (DHS) program and on questionnaires used during the 2005 RDHS and 2007-08 RIDHS surveys. To reflect relevant issues in population and health in Rwanda, the questionnaires were adapted during a series of technical meetings with various stakeholders from government ministries and agencies, nongovernmental organizations, and international donors. The questionnaires were translated from English and French into Kinyarwanda.

The Household Questionnaire was used to list all the usual members and visitors in the selected households as well as to identify women and men eligible for individual interviews. Basic information was collected on the characteristics of each person listed, including age, sex, education, and relationship to the head of household. For children under 18, survival status of the parents was determined. The Household Questionnaire also collected information on the following: - Dwelling characteristics - Utilization of health services and health expenditures for recent illness and injury - Possession of iodized salt - Possession and utilization of mosquito nets - Height and weight of women and children - Hemoglobin measurement of women and children - Blood collection from women and children for rapid test and laboratory testing of malaria - Blood collection from women and men for laboratory testing for HIV

The Woman’s Questionnaire was used to collect information from all women age 15-49 and was organized by the following sections: - Respondent background characteristics - Reproduction, including a complete birth and death history of respondents’ children and information on abortion - Contraception - Pregnancy and postnatal care - Child’s immunization, health, and nutrition - Marriage and sexual activity - Fertility preferences - Husband’s background and woman’s work - HIV/AIDS and other sexually transmitted infections - Other health issues - Adult mortality - Relationship in the household

The Man’s Questionnaire was administered to all men age 15-59 living in every other household in the RDHS sample. 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.

An instruction manual was also developed to support standardized data collection. All data collection instruments were pretested in June-July 2010. The observations and experiences gathered from the pretest were used to improve the instruments for the main survey data collection.

Cleaning operations

Data entry began on November 1, 2010, almost one month after the survey was launched in the field. Data were entered by a team of 15 data processing personnel recruited and trained for this task. They were assisted during these operations by 4 data verification and codification officers and 2 receptionists. Completed questionnaires were periodically brought in from the field to the National Institute of Statistics headquarters, where assigned agents checked them and coded the open-ended questions. Next, the questionnaires were sent to the data entry facility and the blood samples (DBS and malaria slides) were sent to the NRL to be screened for HIV. Data were entered using CSPro, a program developed jointly by the United States Census Bureau, the ORC Macro MEASURE DHS+ program, and Serpro S.A. Processing the data concurrently with data collection allowed for regular monitoring of teams’ performance and data quality. Field check tables were regularly generated during data processing to check

The 2010 Rwanda Demographic and Health Survey (RDHS) is designed to provide data for monitoring the population and health situation in Rwanda. The 2010 RDHS is the fifth Demographic and Health Survey to be conducted in Rwanda. The objective of the survey is to provide up-to-date information on fertility, family planning, childhood mortality, nutrition, maternal and child health, domestic violence, malaria, maternal mortality, awareness and behavior regarding HIV/AIDS, HIV prevalence, malaria prevalence, and anemia prevalence. A nationally representative sample of 13,671 women, age 15–49 from 12,540 surveyed households, and 6,329 men, age 15–59 from half of these households, were interviewed. This represents a response rate of 99 percent for women and 99 percent for men. The sample provides estimates at the national and provincial levels. The main objectives of the 2010 RDHS were to: Collect data at the national level to facilitate calculation of essential demographic rates, especially rates for fertility and infant and child mortality, and to analyze the direct and indirect factors that determine levels and trends in fertility and child mortality Measure the levels of knowledge of contraceptive practices among women Collect data on family health, including immunization practices; prevalence and treatment of diarrhea, acute upper respiratory infections, fever and/or convulsions among children under age 5; antenatal visits; and assistance at delivery Collect data on the prevention and treatment of malaria, in particular the possession and use of bed nets among children under 5 and among women and pregnant women Collect data on nutritional practices of children, including breastfeeding Collect data on the knowledge and attitudes of men and women concerning sexually transmitted infections (STIs) and acquired immune deficiency syndrome (AIDS) and evaluate recent behavioral changes with regard to condom use Collect data for the estimation of adult mortality and maternal mortality at the national level Take anthropometric measurements in half of surveyed households in order to evaluate the nutritional status of children, men, and women Conduct confidential testing for malaria parasitemia using Rapid Diagnostic Testing in half of the surveyed households and anonymous blood smear testing at the National Reference Laboratory Collect dried blood spots (from finger pricks) for anonymous HIV testing at the National Reference Laboratory in half of surveyed households Measure hemoglobin level (by finger prick) for anemia of surveyed respondents in half of surveyed households.

Rwanda Demographic Health Surveys, part of the USAID Demographic Health Surveys Program, provide reliable estimates of fertility levels, marriage, sexual activity, fertility preferences, family planning methods, breastfeeding practices, nutrition, childhood and maternal mortality, maternal and child health, early childhood development, malaria, domestic violence, and HIV/AIDS and other STIs. The information collected is intended to assist policymakers and program managers in evaluating and designing programs and strategies for improving the health of the country’s population. The Demographic and Health Survey has been conducted in Rwanda for the following years: 1992, 2000, 2005, 2010, 2014-15, and 2019-20.

Abstract

Rwanda Interim Demographic and Health Survey (RIDHS) follows the Demographic and Health Surveys (RDHS) that were successfully conducted in 1992, 2000, and 2005, and is part of a broad, worldwide program of socio-demographic and health surveys conducted in developing countries since the mid-1980s. RIDHS collected the indicators on fertility, family planning and maternal and child health which the survey normally provides. In addition, RIDHS integrated a malaria module and tests for the prevalence of malaria and anemia among women and children, thus determining the prevalence of malaria and anemia for women and children at the national level.

The main objectives of the RIDHS were: • At the national level, gather data to determine demographic rates, particularly fertility and infant and child mortality rates, and analyze the direct and indirect factors that determine fertility and child mortality rates and trends. • Evaluate the level of knowledge and use of contraceptives among women and men. • Gather data concerning family health: vaccinations; prevalence and treatment of diarrhea, acute respiratory infections (ARI), and fever in children under the age of five; antenatal care visits; and assistance during childbirth. • Gather data concerning the prevention and treatment of malaria, particularly the possession and use of mosquito nets, and the prevention of malaria in pregnant women. • Gather data concerning child feeding practices, including breastfeeding. • Gather data concerning circumcision among men between the ages of 15 and 59. • Collect blood samples in all of the households surveyed for anemia testing of women age 15-49, pregnant women and children under age five. • Collect blood samples in all of the households surveyed for hemoglobin and malaria diagnostic testing of women age 15 to 49, pregnant women and children under age five.

Geographic coverage

National coverage

Analysis unit

Household Individual Woman age 15-49 Man age 15-59

Kind of data

Sample survey data [ssd]

Sampling procedure

The sample for the RIDHS is a two-stage stratified area sample. Clusters are the primary sampling units and are constituted from enumeration areas (EA). The EA were defined in the 2002 General Population and Housing Census (RGPH) (SNR, 2005).

These enumeration areas provided the master frame for the drawing of 250 clusters (187 rural and 63 urban), selected with a representative probability proportional to their size. Only 249 of these clusters were surveyed, because one cluster located in a refugee camp had to be eliminated from the sample. A strictly proportional sample allocation would have resulted in a very low number of urban households in certain provinces. It was therefore necessary to slightly oversample urban areas in order to survey a sufficient number of households to produce reliable estimates for urban areas. The second stage involved selecting a sample of households in these enumeration areas. In order to adequately guarantee the accuracy of the indicators, the total number drawn was limited to 30 households per cluster. Because of the nonproportional distribution of the sample among the different strata and the fact that the number of households was set for each cluster, weighting was used to ensure the validity of the sample at both national and provincial levels.

All women age 15-49 years who were either usual residents of the selected household or visitors present in the household on the night before the survey were eligible to be interviewed (7,528 women). In addition, a sample of men age 15-59 who were either usual residents of the selected household or visitors present in the household on the night before the survey were eligible for the survey (7,168 men). Finally, all women age 15-49 and all children under the age of five were eligible for the anemia and malaria diagnostic tests.

The sample for the 2007-08 RIDHS covered the population residing in ordinary households across the country. A national sample of 7,469 households (1,863 in urban areas and 5,606 in rural areas) was selected. The sample was first stratified to provide adequate representation from urban and rural areas as well as all the four provinces and the city of Kigali, the nation’s capital.

Sampling deviation

One cluster located in a refugee camp had to be eliminated from the sample.

Mode of data collection

Face-to-face [f2f]

Research instrument

Three questionnaires were used in the 2007-08 RIDHS: the Household Questionnaire, the Women’s Questionnaire, and the Men’s Questionnaire. The content of these questionnaires was based on model questionnaires developed by the MEASURE DHS project.

Initial technical meetings that were held beginning in September 2007 allowed a wide range of government agencies as well as local and international organizations to contribute to the development of the questionnaires. Based on these discussions, the DHS model questionnaires were modified to reflect the needs of users and relevant issues in population, family planning, anemia, malaria and other health concerns in Rwanda. The questionnaires were then translated from French into Kinyarwanda. These questionnaires were finalized in December 2007 before the training of male and female interviewers.

The Household Questionnaire was used to list all of the usual members and visitors in the selected households. In addition, some basic information was collected on the characteristics of each person listed, including age, sex, education, and relationship to the head of the household. The main purpose of the Household Questionnaire was to identify women and men who were eligible for the individual interview. The Household Questionnaire also collected information on characteristics of the household’s dwelling unit such as the main source of drinking water, type of toilet facilities, materials used for the floor of the house, the main energy source used for cooking and ownership of various durable goods. Finally, the Household Questionnaire was also used to identify women and children eligible for the hemoglobin (anemia) and malaria diagnostic tests.

The Women’s Questionnaire was used to collect information on women of reproductive age (15-49 years) and covered questions on the following topics: • Background characteristics • Marital status • Birth history • Knowledge and use of family planning methods • Fertility preferences • Antenatal and delivery care • Breastfeeding practices • Vaccinations and childhood illnesses

The Men’s Questionnaire was administered to all men age 15-59 years living in the selected households. The Men’s Questionnaire collected information similar to that of the Women’s Questionnaire, with the only difference being that it did not include birth history or questions on maternal and child health or nutrition. In addition, the Men’s Questionnaire also collected information on circumcision.

Cleaning operations

Data entry began on January 7, 2008, three weeks after the beginning of data collection activities in the field. Data were entered by a team of five data processing personnel recruited and trained by staff from ICF Macro. The data entry team was reinforced during this work with an additional staffer. Completed questionnaires were periodically brought in from the field to the National Institute of Statistics in Kigali, where assigned staff checked them and coded the open-ended questions. Next, the questionnaires were sent to the data entry staff. Data were entered using CSPro, a program developed jointly by the United States Census Bureau, the ICF Macro MEASURE DHS program, and Serpro S.A. All questionnaires were entered twice to eliminate as many data entry errors as possible from the files. In addition, a quality control program was used to detect data collection errors for each team. This information was shared with field teams during supervisory visits to improve data quality. The data entry and internal consistency verification phase of the survey was completed on May 14, 2008.

Response rate

The response rate was high for both men (95.4 percent) and women (97.5 percent).

Sampling error estimates

The estimates from a sample survey are affected by two types of errors: (1) nonsampling errors, and (2) sampling errors. Nonsampling errors are the results of mistakes made in implementing data collection and data processing, such as failure to locate and interview the correct household, misunderstanding of the questions on the part of either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the 2007-08 RIDHS 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 2007-08 RIDHS is only one of many samples that could have been selected from the same population, using the same design and expected size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability between all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results.

A sampling error is usually measured in terms of the standard error for a particular statistic (mean, percentage, etc.), which is the square root of the variance. The standard error can be used to calculate confidence intervals within which the true value for the population

Analysis unit

Woman, Birth, Child, Man, Member

Universe

Women age 15-49, Births, Children age 0-4, Men age 15-59, All persons

Kind of data

Demographic and Household Survey [hh/dhs]

Sampling procedure

MICRODATA SOURCE: Office National de la Population [Rwanda] and ORC Macro.

SAMPLE UNIT: Woman SAMPLE SIZE: 10421

SAMPLE UNIT: Birth SAMPLE SIZE: 27602

SAMPLE UNIT: Child SAMPLE SIZE: 7922

SAMPLE UNIT: Man SAMPLE SIZE: 2717

SAMPLE UNIT: Member SAMPLE SIZE: 45247

Mode of data collection

Face-to-face [f2f]

Analysis unit

Woman, Birth, Child, Man, Member

Universe

Women age 15-49, Births, Children age 0-4, Men age 15-59, All persons

Kind of data

Demographic and Household Survey [hh/dhs]

Sampling procedure

MICRODATA SOURCE: National Institute of Statistics of Rwanda, Ministry of Health [Rwanda] and ICF International.

SAMPLE UNIT: Woman SAMPLE SIZE: 13497

SAMPLE UNIT: Birth SAMPLE SIZE: 30058

SAMPLE UNIT: Child SAMPLE SIZE: 7856

SAMPLE UNIT: Man SAMPLE SIZE: 6217

SAMPLE UNIT: Member SAMPLE SIZE: 54905

Mode of data collection

Face-to-face [f2f]

Analysis unit

Woman, Birth, Child, Man, Member

Universe

Women age 15-49, Births, Children age 0-4, Husbands of women age 15-49, All persons

Kind of data

Demographic and Household Survey [hh/dhs]

Sampling procedure

MICRODATA SOURCE: Office National de la Population [Rwanda] and Macro International Inc.

SAMPLE UNIT: Woman SAMPLE SIZE: 6551

SAMPLE UNIT: Birth SAMPLE SIZE: 19440

SAMPLE UNIT: Child SAMPLE SIZE: 5510

SAMPLE UNIT: Man SAMPLE SIZE: 598

SAMPLE UNIT: Member SAMPLE SIZE: 31881

Mode of data collection

Face-to-face [f2f]

Feed the Future Rwanda Interim Survey in the Zone of Influence: This dataset contains records for all children under 3 years of age (0-35 months) (n=438, vars=31) . This file includes data in Module I. Note that the children's anthropometry indicators and dietary intake indicators were calculated with secondary data, the 2014-2015 Rwanda Demographic and Health Survey.

Geographic coverage

National coverage

Analysis unit

households/individuals

Kind of data

survey

Frequency of data collection

Yearly

Sampling procedure

Sample size:

Analysis unit

Woman, Birth, Child, Man, Member

Universe

Women age 15-49, Births, Children age 0-4, Men age 15-59, All persons

Kind of data

Demographic and Household Survey [hh/dhs]

Sampling procedure

MICRODATA SOURCE: Institut National de la Statistique, Ministère des Finances et de la Planification Économique [Rwanda] and ORC Macro.

SAMPLE UNIT: Woman SAMPLE SIZE: 11321

SAMPLE UNIT: Birth SAMPLE SIZE: 30072

SAMPLE UNIT: Child SAMPLE SIZE: 8649

SAMPLE UNIT: Man SAMPLE SIZE: 4820

SAMPLE UNIT: Member SAMPLE SIZE: 47851

Mode of data collection

Face-to-face [f2f]

Anemia remains a public health problem in Rwanda, affecting 38% of young children and 17% of reproductive-aged women (Demographic and Health Survey [DHS] 2010). The importance of iron deficiency (ID) as a cause of anemia in Rwanda is not known. We conducted a cluster randomized survey, selecting 408 rural households each in the Northern and Southern Provinces of Rwanda in 2010, to estimate the prevalence of ID and iron deficiency anemia (IDA) among young children and women of reproductive age.

Abstract

The 2013 Rwanda Malaria Indicator Survey (RMIS) is a nationally representative, household-based survey that provides data on malaria indicators, which are used to assess the progress of a malaria control program. The control program is geared toward meeting Millennium Development Goals.

The objectives of the 2013 Rwanda Malaria Indicator Survey (RMIS) were to collect data on (1) ownership and utilization of treated mosquito nets and (2) knowledge of symptoms, causes, treatments, and prevention of malaria.

A related objective was to produce survey results in a timely manner and to ensure that the data were disseminated to a wide audience of potential users in government and nongovernmental organizations within and outside of Rwanda. Most survey indicators were produced separately for each of the five provinces.

Key indicators were malaria-specific and general. Malaria indicators: • Ownership of insecticide-treated mosquito nets • Usage of insecticide-treated mosquito nets among persons in the household, children under age 5, and pregnant women • Proportion of children under age 5 with recent fever who were treated with timely, appropriate antimalarial drugs • Proportions of mothers who know the symptoms, treatments, and prevention of malaria

General indicators: • Source of household drinking water; type of toilet facility • Household socioeconomic status (wealth quintile)

Geographic coverage

National coverage

Analysis unit

• Household
• Woman age 15 to 49

Kind of data

Sample survey data [ssd]

Sampling procedure

Sample Design The sample for the 2013 RMIS was designed to provide malaria indicator estimates for the country as a whole and for separate urban and rural areas. Survey estimates are also be reported for the provinces (South, West, North, and East provinces) and Kigali City.

A representative sample of 4,772 households was selected for the 2013 RMIS. The sample was selected in two stages. In the first stage, 159 villages (also known as clusters or enumeration areas) were selected with probability proportional to village size. Village size is determined by the number of households residing in the village. Then, a complete mapping and listing of all households in the selected villages was conducted. The resulting lists of households served as the sampling frame for the second stage of sample selection. Households were systematically selected from those lists for participation in the survey.

All women age 15-49 who were either permanent residents of the households or visitors present in the household on the night before the survey were eligible for interviews.

Note: Detailed description of the sample design is presented in Appendix A of the final report.

Mode of data collection

Face-to-face [f2f]

Research instrument

The 2013 RMIS involved two questionnaires: a Household Questionnaire and a Woman’s Questionnaire for all women age 15-49 in the selected households. Both of these instruments were based on the model Demographic and Health Survey Phase III and the model Roll Back Malaria (RBM) Malaria Indicator Survey (MIS) questionnaires developed by the MEASURE DHS program, as well as on previous surveys conducted in Rwanda, including the 2007-08 Rwanda Interim DHS (RIDHS) and the 2010 Rwanda Demographic and Health Survey (RDHS). The MAL & OPD Division reviewed the draft questionnaires with potential stakeholders, including government health agencies and interested donor groups.

The Household Questionnaire was used to list all the usual members and visitors in the selected households. Some basic information was collected on the characteristics of each person listed, including age, sex, education, and relationship to the head of household. The main purpose of the Household Questionnaire was to identify women eligible for individual interview. Questions on ownership and use of mosquito nets were included in the Household Questionnaire as were questions about proxy indicators for wealth such as ownership of various durable goods, dwelling unit characteristics, and land.

The Woman’s Questionnaire was used to collect information from women age 15-49 on the following topics: • Background characteristics (age, education, media exposure, employment, religion, and so on) • Reproductive history (number of births, date of last birth, current pregnancy status, and antimalarial treatment for children under age 5 with recent fever) • Knowledge about malaria symptoms, causes, and prevention

Cleaning operations

Processing of the 2013 RMIS data began as soon as questionnaires were received from the field. Completed questionnaires were returned from the field to MAL & OPD Division headquarters, where they were entered and edited by data processing personnel who were specially trained for this task. Processing the data concurrently with data collection allowed for regular monitoring of team performance and data quality. Field check tables were regularly generated during data processing to check various data quality parameters. As a result, feedback was given on a regular basis, encouraging teams to continue their high quality work and to correct areas in need of improvement. Feedback was individually tailored to each team. Data entry, which included 100 percent double entry to minimize errors in keying and data editing, was completed on May 10, 2013. Data cleaning and finalization was completed on June 3, 2013.

Response rate

A total of 4,772 households was selected, of which 4,769 households were identified and occupied at the time of the survey. Among these households, 4,766 completed the Household Questionnaire, yielding a response rate of nearly 100 percent.

In the 4,766 households surveyed, 5,164 women age 15-49 were identified as being eligible for the individual interview. Interviews were completed with 5,135 of these women, yielding a response rate of 99.4 percent. The response rates were slightly higher in rural areas than in urban areas.

Sampling error estimates

The estimates from a sample survey are affected by two types of errors: (1) nonsampling errors, and (2) sampling errors. Nonsampling errors are the results of mistakes made in implementing data collection and data processing, such as failure to locate and interview the correct household, misunderstanding of the questions on the part of either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the 2013 Rwanda Malaria Indicator Survey (2013 RMIS) 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 2013 RMIS 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 error is a measure of the variability between all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results.

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

If the sample of respondents had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the 2013 RMIS sample is the result of a multi-stage stratified design, and, consequently, it was necessary to use more complex formulas. The computer software used to calculate sampling errors for the 2013 RMIS is an SAS program. This program used the Taylor linearization method for variance estimation for survey estimates that are means or proportions.

The Taylor linearization method treats any percentage or average as a ratio estimate, r = y/x, where y represents the total sample value for variable y, and x represents the total number of cases in the group or subgroup under consideration.

Note: Detailed description of estimate of sampling error is presented in APPENDIX B of the final report.

Data appraisal

Data quality tables are produced to review the quality of the data: - Household age distribution - Age distribution of eligible and interviewed women - Completeness of reporting

Note: The tables are presented in APPENDIX C of the final report.

Individual and household variables.