The 2011 Ethiopia Demographic and Health Survey (EDHS) was conducted by the Central Statistical Agency (CSA) under the auspices of the Ministry of Health. The principal objective of the 2011 Ethiopia Demographic and Health Survey (EDHS) is to provide current and reliable data on fertility and family planning behaviour, child mortality, adult and maternal mortality, children’s nutritional status, use of maternal and child health services, knowledge of HIV/AIDS, and prevalence of HIV/AIDS and anaemia. The specific objectives are these: Collect data at the national level that will allow the calculation of key demographic rates; Analyse the direct and indirect factors that determine fertility levels and trends; Measure the levels of contraceptive knowledge and practice of women and men by family planning method, urban-rural residence, and region of the country; Collect high-quality data on family health, including immunisation coverage among children, prevalence and treatment of diarrhoea and other diseases among children under ge five, and maternity care indicators, including antenatal visits and assistance at delivery; Collect data on infant and child mortality and maternal mortality; Obtain data on child feeding practices, including breastfeeding, and collect anthropometric measures to assess the nutritional status of women and children; Collect data on knowledge and attitudes of women and men about sexually transmitted diseases and HIV/AIDS and evaluate patterns of recent behaviour regarding condom use; Conduct haemoglobin testing on women age 15-49 and children 6-59 months to provide information on the prevalence of anaemia among these groups; Carry out anonymous HIV testing on women and men of reproductive age to provide information on the prevalence of HIV. This information is essential for informed policy decisions, planning, monitoring, and evaluation of programmes on health in general and reproductive health in particular at both the national and regional levels. A long-term objective of the survey is to strengthen the technical capacity of the Central Statistical Agency to plan, conduct, process, and analyse data from complex national population and health surveys. Moreover, the 2011 EDHS provides national and regional estimates on population and health that are comparable to data collected in similar surveys in other developing countries and to Ethiopia’s two previous DHS surveys, conducted in 2000 and 2005. Data collected in the 2011 EDHS add to the large and growing international database of demographic and health indicators. The survey was intentionally planned to be fielded at the beginning of the last term of the MDG reporting period to provide data for the assessment of the Millennium Development Goals (MDGs). The survey interviewed a nationally representative population in about 18,500 households, and all women age 15-49 and all men age 15-59 in these households. In this report key indicators relating to family planning, fertility levels and determinants, fertility preferences, infant, child, adult and maternal mortality, maternal and child health, nutrition, women’s empowerment, and knowledge of HIV/AIDS are provided for the nine regional states and two city administrations. In addition, this report also provides data by urban and rural residence at the country level. Major stakeholders from various government, non-government, and UN organizations have been involved and have contributed in the technical, managerial, and operational aspects of the survey.

Abstract

The 2011 Ethiopia Demographic and Health Survey (EDHS) was conducted by the Central Statistical Agency (CSA) under the auspices of the Ministry of Health.

The principal objective of the 2011 Ethiopia Demographic and Health Survey (EDHS) is to provide current and reliable data on fertility and family planning behaviour, child mortality, adult and maternal mortality, children’s nutritional status, use of maternal and child health services, knowledge of HIV/AIDS, and prevalence of HIV/AIDS and anaemia. The specific objectives are these: - Collect data at the national level that will allow the calculation of key demographic rates; - Analyse the direct and indirect factors that determine fertility levels and trends; - Measure the levels of contraceptive knowledge and practice of women and men by family planning method, urban-rural residence, and region of the country; - Collect high-quality data on family health, including immunisation coverage among children, prevalence and treatment of diarrhoea and other diseases among children under ge five, and maternity care indicators, including antenatal visits and assistance at delivery; - Collect data on infant and child mortality and maternal mortality; - Obtain data on child feeding practices, including breastfeeding, and collect anthropometric measures to assess the nutritional status of women and children; - Collect data on knowledge and attitudes of women and men about sexually transmitted diseases and HIV/AIDS and evaluate patterns of recent behaviour regarding condom use; - Conduct haemoglobin testing on women age 15-49 and children 6-59 months to provide information on the prevalence of anaemia among these groups; - Carry out anonymous HIV testing on women and men of reproductive age to provide information on the prevalence of HIV.

This information is essential for informed policy decisions, planning, monitoring, and evaluation of programmes on health in general and reproductive health in particular at both the national and regional levels. A long-term objective of the survey is to strengthen the technical capacity of the Central Statistical Agency to plan, conduct, process, and analyse data from complex national population and health surveys.

Moreover, the 2011 EDHS provides national and regional estimates on population and health that are comparable to data collected in similar surveys in other developing countries and to Ethiopia’s two previous DHS surveys, conducted in 2000 and 2005. Data collected in the 2011 EDHS add to the large and growing international database of demographic and health indicators.

The survey was intentionally planned to be fielded at the beginning of the last term of the MDG reporting period to provide data for the assessment of the Millennium Development Goals (MDGs).

The survey interviewed a nationally representative population in about 18,500 households, and all women age 15-49 and all men age 15-59 in these households. In this report key indicators relating to family planning, fertility levels and determinants, fertility preferences, infant, child, adult and maternal mortality, maternal and child health, nutrition, women’s empowerment, and knowledge of HIV/AIDS are provided for the nine regional states and two city administrations. In addition, this report also provides data by urban and rural residence at the country level.

Major stakeholders from various government, non-government, and UN organizations have been involved and have contributed in the technical, managerial, and operational aspects of the survey.

Geographic coverage

A nationally representative sample of 17,817 households was selected.

Universe

All women 15-49 who were usual residents or who slept in the selected households the night before the survey were eligible for the survey. A male survey was also conducted. All men 15-49 who were usual residents or who slept in the selected households the night before the survey were eligible for the male survey.

Kind of data

Sample survey data

Sampling procedure

The sample for the 2011 EDHS was designed to provide population and health indicators at the national (urban and rural) and regional levels. The sample design allowed for specific indicators, such as contraceptive use, to be calculated for each of Ethiopia's 11 geographic/administrative regions (the nine regional states and two city administrations). The 2007 Population and Housing Census, conducted by the CSA, provided the sampling frame from which the 2011 EDHS sample was drawn.

Administratively, regions in Ethiopia are divided into zones, and zones, into administrative units called weredas. Each wereda is further subdivided into the lowest administrative unit, called kebele. During the 2007 census each kebele was subdivided into census enumeration areas (EAs), which were convenient for the implementation of the census. The 2011 EDHS sample was selected using a stratified, two-stage cluster design, and EAs were the sampling units for the first stage. The sample included 624 EAs, 187 in urban areas and 437 in rural areas.

Households comprised the second stage of sampling. A complete listing of households was carried out in each of the 624 selected EAs from September 2010 through January 2011. Sketch maps were drawn for each of the clusters, and all conventional households were listed. The listing excluded institutional living arrangements and collective quarters (e.g., army barracks, hospitals, police camps, and boarding schools). A representative sample of 17,817 households was selected for the 2011 EDHS. Because the sample is not self-weighting at the national level, all data in this report are weighted unless otherwise specified.

In the Somali region, in 18 of the 65 selected EAs listed households were not interviewed for various reasons, such as drought and security problems, and 10 of the 65 selected EAs were not listed due to security reasons. Therefore, the data for Somali may not be totally representative of the region as a whole. However, national-level estimates are not affected, as the percentage of the population in the EAs not covered in the Somali region is proportionally very small.

SAMPLING FRAME

The sampling frame used for 2011 EDHS is the Population and Housing Census (PHC) conducted in 2007 provided by the Central Statistical Agency (CSA, 2008). CSA has an electronic file consisting of 81,654 Enumeration Areas (EA) created for the 2007 census in 10 of its 11 geographic regions. An EA is a geographic area consisting of a convenient number of dwelling units which served as counting unit for the census. The frame file contains information about the location, the type of residence, and the number of residential households for each of the 81,654 EAs. Sketch maps are also available for each EA which delimitate the geographic boundaries of the EA. The 2007 PHC conducted in the Somali region used a different methodology due to difficulty of access. Therefore, the sampling frame for the Somali region is in a different file and in different format. Due to security concerns in the Somali region, in the beginning it was decided that 2011 EDHS would be conducted only in three of nine zones in the Somali region: Shinile, Jijiga, and Liben, same as in the 2000 and 2005 EDHS. However, a later decision was made to include three other zones: Afder, Gode and Warder. This was the first time that these three zones were included in a major nationwide survey such as the 2011 EDHS. The sampling frame for the 2011 EDHS consists of a total of 85,057 EAs.

The sampling frame excluded some special EAs with disputed boundaries. These EAs represent only 0.1% of the total population.

Ethiopia is divided into 11 geographical regions. Each region is sub-divided into zones, each zone into Waredas, each Wareda into towns, and each town into Kebeles. Among the 85,057 EAs, 17,548 (21 percent) are in urban areas and 67,509 (79 percent) are in rural areas. The average size of EA in number of households is 169 in an urban EA and 180 in a rural EA, with an overall average of 178 households per EA. Table A.2 shows the distributions of households in the sampling frame, by region and residence. The data show that 81 percent of the Ethiopia’s households are concentrated in three regions: Amhara, Oromiya and SNNP, while 4 percent of all households are in the five smallest regions: Afar, Benishangul-Gumuz, Gambela, Harari and Dire Dawa.

Mode of data collection

Face-to-face [f2f]

Research instrument

The 2011 EDHS used three questionnaires: the Household Questionnaire, the Woman’s Questionnaire, and the Man’s Questionnaire. These questionnaires were adapted from model survey instruments developed for the MEASURE DHS project to reflect the population and health issues relevant to Ethiopia. Issues were identified at a series of meetings with the various stakeholders. In addition to English, the questionnaires were translated into three major languages—Amharigna, Oromiffa, and Tigrigna.

The Household Questionnaire was used to list all the usual members and visitors of selected households. Basic information was collected on the characteristics of each person listed, including age, sex, education, and relationship to the head of the household. For children under age 18, survival status of the parents was determined. The data on the age and sex of household members obtained in the Household Questionnaire were used 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 source of water, type of toilet facilities, materials used for the floor of the house, and ownership of various consumer