The 1995 Kazakstan Demographic and Health Survey (KDHS) is part of the worldwide Demographic and Health Surveys (DHS) program, which is designed to collect data on fertility, family planning and maternal and child health. The 1995 KDHS was the first national level population and health survey in Kazakstan. The purpose of the survey was to provide the Ministry of Health of Kazakstan with information on fertility, reproductive practices of women, maternal care, child health and mortality, child nutrition practices, breastfeeding, nutritional status and anemia. This information is important for understanding the factors that influence the reproductive health of women and the health and survival of infants and young children. It can be used in planning effective policies and programs regarding the health and nutrition of women and their children. This is especially important now during this the time of economic transition which involves virtually all aspects of life for the people of Kazakstan. The survey provides data important to the assessment of the overall demographic situation in the country. It is expected that the findings of the KDHS will become a useful source of information necessary for the ongoing health care reform in Kazakstan.

Abstract

The 1995 Kazakstan Demographic and Health Survey (KDHS) is part of the worldwide Demographic and Health Surveys (DHS) program, which is designed to collect data on fertility, family planning and maternal and child health. The 1995 KDHS was the first national level population and health survey in Kazakstan. The purpose of the survey was to provide the Ministry of Health of Kazakstan with information on fertility, reproductive practices of women, maternal care, child health and mortality, child nutrition practices, breastfeeding, nutritional status and anemia. This information is important for understanding the factors that influence the reproductive health of women and the health and survival of infants and young children. It can be used in planning effective policies and programs regarding the health and nutrition of women and their children. This is especially important now during this the time of economic transition which involves virtually all aspects of life for the people of Kazakstan. The survey provides data important to the assessment of the overall demographic situation in the country. It is expected that the findings of the KDHS will become a useful source of information necessary for the ongoing health care reform in Kazakstan.

Geographic coverage

National

Analysis unit

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

Kind of data

Sample survey data

Sampling procedure

The 1995 KDHS employed a nationally representative probability sample of women age 15-49. The country was divided into five survey regions. Four survey regions consisted of groups of contiguous oblasts (except the East Kazakstanskaya oblast which is not contiguous). Almaty City constituted a survey region by itself although it is part of the Almatinskaya oblast. The five survey regions were defined as follows:

I) Almaty City 2) South Region: Taldy-Korganskaya, Almatinskaya (except Almaty city), Dzhambylskaya, South Kazakstanskaya, and Kzyl-Ordinskaya 3) West Region: Aktiubinskaya, Mangistauskaya, Atyrauskaya, and West Kazakstanskaya 4) Central Region: Semipalatinskaya, Zhezkazganskaya, and Tourgaiskaya 5) North and East Region: East Kazakstanskaya, Pavlodarskaya, Karagandinskaya, Akmolinskaya, Kokchetauskaya, North Kazakstanskaya, and Koustanaiskaya

It is important to note that the oblast composition of regions outside of Almaty City was determined on the basis of geographic proximity, and in order to achieve similarity with respect to reproductive practices within regions. The South and West Regions are comprised of oblasts which traditionally have a high proportion of Kazak population and high fertility levels. The Central Region contains three oblasts in which the fertility level is similar to the national average. The North and East Region contains seven oblasts situated in northern Kazakstan in which a relatively high proportion of the population is of Russian origin, and the fertility level is lower than the national average.

In Almaty City, the sample for the 1995 KDHS was selected in two stages. In the first stage, 40 census counting blocks were selected with equal probability from the 1989 list of census counting blocks. A complete listing of the households in the selected counting blocks was carried out. The lists of households served as the frame for second-stage sampling; i.e., the selection of the households to be visited by the KDHS interviewing teams. In each selected household, women age 15-49 were eligible to be interviewed.

In the rural areas, the primary sampling units (PSUs) were the raions which were selected with probability proportional to size, the size being the 1993 population published by Goskomstat (1993). At the second stage, one village was selected in each selected raion, from the 1989 Registry of Villages. This resulted in 50 rural clusters being selected. At the third stage, households were selected in each cluster following the household listing operation as in Almaty City.

In the urban areas other than Almaty City, the PSUs were the cities and towns themselves. In the second stage, one health block was selected from each town except in self-representing cities (large cities that were selected with certainty) where more than one health block was selected. The selected health blocks were segmented prior to the household listing operation which provided the household lists for the third stage selection of households. In total, 86 health blocks were selected.

On average, 22 households were selected in each urban cluster, and 33 households were selected in each rural cluster. It was expected that the sample would yield interviews with approximately 4,000 women between the ages of 15 and 49.

Note: See detailed description of sample design in APPENDIX B of the survey report.

Mode of data collection

Face-to-face

Research instrument

Two questionnaires were used for the 1995 KDHS: the Household Questionnaire and the Individual Questionnaire. The questionnaires were based on the model survey instruments developed in the DHS program. They were adapted to the data needs of Kazakhstan during consultations with specialists in the areas of reproductive health, child health and nutrition in Kazakhstan.

The Household Questionnaire was used to enumerate all usual members and visitors in tile sample households and to collect information relating to the socioeconomic position of a household. In the: first part of the Household Questionnaire, information was collected on age, sex, educational attainment, marital status, and relationship to the head of household of each person listed as a household member or visitor. A primary objective of the first part of the Household Questionnaire was to identify women who were eligible for the individual interview. In the second part of the Household Questionnaire, questions were included on the dwelling unit, such as the number of rooms, the flooring material, the source of water, the type of toilet facilities, and on the availability of a variety of consumer goods.

The Individual Questionnaire was used to collect information from women age 15-49. These women were asked questions on the following major topics: - Background characteristics - Pregnancy history - Outcome of pregnancies and antenatal care - Child health and nutrition practices - Child immunization and episodes of diarrhea and respiratory illness - Knowledge and use of contraception - Marriage and fertility preferences - Husband's background and woman's work - Anthropometry of children and mothers - Hemoglobin measurement of women and children

One of the major efforts of the 1995 KDHS was testing women and children for iron-deficiency anemia. Testing was done by measuring hemoglobin levels in the blood using the Hemocue technique. Before collecting the blood sample, each woman was asked to sign a consent form giving permission for the collection of a finger-stick blood droplet from herself and her children. Results of anemia testing were kept confidential (as are all KDHS data); however, strictly with the consent of respondents, local health care facilities were informed of women and children who had severely low levels of hemoglobin (less than 7 g/dl).

Cleaning operations

Questionnaires were returned to the Institute of Nutrition in Almaty for data processing. The office editing staff checked that the questionnaires for all selected households and eligible respondents were returned from the field. The few questions which had not been pre-coded (e.g., occupation, type of chronic disease) were coded at this time. Data were then entered and edited on microcomputers using the ISSA (Integrated System for Survey Analysis) package, with the data entry software translated into Russian. Office editing and data entry activities began in May 1995 (i.e., the same time that fieldwork started) and were completed in September 1995.

Response rate

A total of 4,480 households were selected in the sample, of which 4,241 were occupied at the time of fieldwork. The main reason for the difference was that some dwelling units which were occupied at the time of the household listing operation were either vacant or the household members were away for an extended period at the time of interviewing. Of the 4,241 occupied households, 4,178 were interviewed, yielding a household response rate of 99 percent.

In the interviewed households, 3,899 women were eligible for the individual interview (i.e., all women 15-49 years of age who were either usual residents or visitors who had spent the previous night in the household). Interviews were successfully completed with 3,771 of these women, yielding a response rate of 97 percent. The principal reason for non-response was the failure to find an eligible woman at home after repeated visits to the household. The overall response rate for the survey--the product of the household and the individual response rates--was 95 percent.

Note: See summarized response rates by place of residence in Table 1.1 of the survey report .

Sampling error estimates

The estimates from a sample survey are affected by two types of errors: (1) non-sampling errors, and (2) 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 KDHS to minimize this type of error, non-sampling errors are impossible to avoid and difficult to evaluate