The 2011 Bangladesh Demographic and Health Survey (BDHS) is the sixth DHS undertaken in Bangladesh, following those implemented in 1993-94, 1996-97, 1999-2000, 2004, and 2007. The main objectives of the 2011 BDHS are to: • Provide information to meet the monitoring and evaluation needs of health and family planning programs, and • Provide program managers and policy makers involved in these programs with the information they need to plan and implement future interventions. The specific objectives of the 2011 BDHS were as follows: • To provide up-to-date data on demographic rates, particularly fertility and infant mortality rates, at the national and subnational level; • To analyze the direct and indirect factors that determine the level of and trends in fertility and mortality; • To measure the level of contraceptive use of currently married women; • To provide data on knowledge and attitudes of women and men about sexually transmitted infections and HIV/AIDS; • To assess the nutritional status of children (under age 5), women, and men by means of anthropometric measurements (weight and height), and to assess infant and child feeding practices; • To provide data on maternal and child health, including antenatal care, assistance at delivery, breastfeeding, immunizations, and prevalence and treatment of diarrhea and other diseases among children under age 5; • To measure biomarkers, such as hemoglobin level for women and children, and blood pressure, and blood glucose for women and men 35 years and older; • To measure key education indicators, including school attendance ratios and primary school grade repetition and dropout rates; • To provide information on the causes of death among children under age 5; • To provide community-level data on accessibility and availability of health and family planning services; • To measure food security. The 2011 BDHS was conducted under the authority of the National Institute of Population Research and Training (NIPORT) of the Ministry of Health and Family Welfare. The survey was implemented by Mitra and Associates, a Bangladeshi research firm located in Dhaka. ICF International of Calverton, Maryland, USA, provided technical assistance to the project as part of its international Demographic and Health Surveys program (MEASURE DHS). Financial support was provided by the U.S. Agency for International Development (USAID).

Abstract

The 2011 Bangladesh Demographic and Health Survey (BDHS) is the sixth DHS undertaken in Bangladesh, following those implemented in 1993-94, 1996-97, 1999-2000, 2004, and 2007. The main objectives of the 2011 BDHS are to: • Provide information to meet the monitoring and evaluation needs of health and family planning programs, and • Provide program managers and policy makers involved in these programs with the information they need to plan and implement future interventions.

The specific objectives of the 2011 BDHS were as follows: • To provide up-to-date data on demographic rates, particularly fertility and infant mortality rates, at the national and subnational level; • To analyze the direct and indirect factors that determine the level of and trends in fertility and mortality; • To measure the level of contraceptive use of currently married women; • To provide data on knowledge and attitudes of women and men about sexually transmitted infections and HIV/AIDS; • To assess the nutritional status of children (under age 5), women, and men by means of anthropometric measurements (weight and height), and to assess infant and child feeding practices; • To provide data on maternal and child health, including antenatal care, assistance at delivery, breastfeeding, immunizations, and prevalence and treatment of diarrhea and other diseases among children under age 5; • To measure biomarkers, such as hemoglobin level for women and children, and blood pressure, and blood glucose for women and men 35 years and older; • To measure key education indicators, including school attendance ratios and primary school grade repetition and dropout rates; • To provide information on the causes of death among children under age 5; • To provide community-level data on accessibility and availability of health and family planning services; • To measure food security.

The 2011 BDHS was conducted under the authority of the National Institute of Population Research and Training (NIPORT) of the Ministry of Health and Family Welfare. The survey was implemented by Mitra and Associates, a Bangladeshi research firm located in Dhaka. ICF International of Calverton, Maryland, USA, provided technical assistance to the project as part of its international Demographic and Health Surveys program (MEASURE DHS). Financial support was provided by the U.S. Agency for International Development (USAID).

Geographic coverage

National

Analysis unit

• Household
• Children under five years
• Women age 15-49
• Men age 15-54

Universe

The 2011 BDHS covers the entire population residing in noninstitutional dwelling units in the country.

Kind of data

Sample survey data

Sampling procedure

Sample Design The sample for the 2011 BDHS is nationally representative and covers the entire population residing in noninstitutional dwelling units in the country. The survey used as a sampling frame the list of enumeration areas (EAs) prepared for the 2011 Population and Housing Census, provided by the Bangladesh Bureau of Statistics (BBS). The primary sampling unit (PSU) for the survey is an EA that was created to have an average of about 120 households.

Bangladesh has seven administrative divisions: Barisal, Chittagong, Dhaka, Khulna, Rajshahi, Rangpur, and Sylhet. Each division is subdivided into zilas, and each zila into upazilas. Each urban area in an upazila is divided into wards, and into mohallas within a ward. A rural area in the upazila is divided into union parishads (UP) and mouzas within a UP. These divisions allow the country as a whole to be easily separated into rural and urban areas.

The survey is based on a two-stage stratified sample of households. In the first stage, 600 EAs were selected with probability proportional to the EA size, with 207 clusters in urban areas and 393 in rural areas. A complete household listing operation was then carried out in all the selected EAs to provide a sampling frame for the second-stage selection of households. In the second stage of sampling, a systematic sample of 30 households on average was selected per EA to provide statistically reliable estimates of key demographic and health variables for the country as a whole, for urban and rural areas separately, and for each of the seven divisions. With this design, the survey selected 18,000 residential households, which were expected to result in completed interviews with about 18,000 ever-married women. In addition, in a subsample of one-third of the households, all evermarried men age 15-54 were selected and interviewed for the male survey. In this subsample, a group of eligible members were selected to participate in testing of the biomarker component, including blood pressure measurements, anemia, blood glucose testing, and height and weight measurements.

Note: See Appendix A (in final survey report) for the details of the sample design.

Sampling deviation

The 2007 BDHS sampled all ever-married women age 10-49. The number of eligible women age 10-49 was 11,234, of whom 11,051 were interviewed for a response rate of 98.4 percent. However, there were very few ever-married women age 10-14 (55 unweighted cases or less than one percent). These women have been removed from the data set and weights recalculated for the 15-49 age group. The tables in the survey report discuss only women age 15-49.

Mode of data collection

Face-to-face

Research instrument

The 2011 BDHS used five types of questionnaires: a Household Questionnaire, a Woman’s Questionnaire, a Man’s Questionnaire, a Community Questionnaire, and two Verbal Autopsy Questionnaires to collect data on causes of death among children under age 5. The contents of the household and individual questionnaires were based on the MEASURE DHS model questionnaires. These model questionnaires were adapted for use in Bangladesh during a series of meetings with a Technical Working Group (TWG) that consisted of representatives from NIPORT, Mitra and Associates, International Centre for Diarrheal Diseases and Control, Bangladesh (ICDDR,B), USAID/Bangladesh, and MEASURE DHS. Draft questionnaires were then circulated to other interested groups and were reviewed by the 2011 BDHS Technical Review Committee. The questionnaires were developed in English and then translated and printed into Bangla.

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 the household. The main purpose of the Household Questionnaire was to identify women and men who were eligible for the individual interview. In addition, information was collected about the dwelling unit, such as the source of water, type of toilet facilities, materials used to construct the floors and walls, and ownership of various consumer goods. The Household Questionnaire was also used to record for eligible individuals: • Height and weight measurements • Anemia test results • Measurements of blood pressure and blood glucose

The Woman’s Questionnaire was used to collect information from ever-married women age 12-49. Women were asked questions on the following topics: • Background characteristics (e.g., age, education, religion, and media exposure) • Reproductive history • Use and source of family planning methods • Antenatal, delivery, postnatal, and newborn care • Breastfeeding and infant feeding practices • Child immunizations and childhood illnesses • Marriage • Fertility preferences • Husband’s background and respondent’s work • Awareness of AIDS and other sexually transmitted infections • Food security

The Man’s Questionnaire was used to collect information from ever-married men age 15-54. Men were asked questions on the following topics: • Background characteristics (including respondent’s work) • Marriage • Fertility preferences • Participation in reproductive health care • Awareness of AIDS and other sexually transmitted infections

The Community Questionnaire was administered in each selected cluster during the household listing operation. Data were collected by administering the Community Questionnaire to a group of four to six community leaders who were knowledgeable about socioeconomic conditions and the availability of health and family planning services/facilities, in or near the sample area (cluster). Community leaders included such persons as government officials, social workers, teachers, religious leaders, traditional healers, and health care providers.

The Community Questionnaire collected information about the existence of development organizations in the community and the availability and accessibility of health services and other facilities. During the household listing operation, the geographic coordinates and altitude of each cluster were also recorded. The information obtained in these questionnaires was also used to verify information gathered in the Woman’s and Man’s Questionnaires on the types of facilities accessed and health services personnel seen.

The Verbal Autopsy Questionnaires were developed based on the work done by an expert group led by the WHO, consisting of researchers, data users, and other stakeholders under the sponsorship of the Health Metrics Network (HMN). The verbal autopsy tools are intended to serve the various needs of the users of mortality information. Two questionnaires were used to collect information related to the causes of death among young children; the first questionnaire collected data on neonatal deaths (deaths at 0-28 days), and the