The 2016 Ethiopia Demographic and Health Survey (EDHS) is the fourth Demographic and Health Survey conducted in Ethiopia. It was implemented by the Central Statistical Agency (CSA) at the request of the Federal Ministry of Health (FMoH). The primary objective of the 2016 EDHS is to provide up-to-date estimates of key demographic and health indicators. The EDHS provides a comprehensive overview of population, maternal, and child health issues in Ethiopia. More specifically, the 2016 EDHS: Collected data at the national level that allowed calculation of key demographic indicators, particularly fertility and under-5 and adult mortality rates Explored the direct and indirect factors that determine levels and trends of fertility and child mortality ? Measured levels of contraceptive knowledge and practice Collected data on key aspects of family health, including immunisation coverage among children, prevalence and treatment of diarrhoea and other diseases among children under age 5, and maternity care indicators such as antenatal visits and assistance at delivery Obtained data on child feeding practices, including breastfeeding Collected anthropometric measures to assess the nutritional status of children under age 5, women age 15-49, and men age 15-59 Conducted haemoglobin testing on eligible children age 6-59 months, women age 15-49, and men age 15-59 to provide information on the prevalence of anaemia in these groups Collected data on knowledge and attitudes of women and men about sexually transmitted diseases and HIV/AIDS and evaluated potential exposure to the risk of HIV infection by exploring high-risk behaviours and condom use Conducted HIV testing of dried blood spot (DBS) samples collected from women age 15-49 and men age 15-59 to provide information on the prevalence of HIV among adults of reproductive age Collected data on the prevalence of injuries and accidents among all household members Collected data on knowledge and prevalence of fistula and female genital mutilation or cutting (FGM/C) among women age 15-49 and their daughters age 0-14 Obtained data on women’s experience of emotional, physical, and sexual violence.

Abstract

The 2016 Ethiopia Demographic and Health Survey (EDHS) is the fourth Demographic and Health Survey conducted in Ethiopia. It was implemented by the Central Statistical Agency (CSA) at the request of the Federal Ministry of Health (FMoH). The primary objective of the 2016 EDHS is to provide up-to-date estimates of key demographic and health indicators. The EDHS provides a comprehensive overview of population, maternal, and child health issues in Ethiopia. More specifically, the 2016 EDHS: - Collected data at the national level that allowed calculation of key demographic indicators, particularly fertility and under-5 and adult mortality rates - Explored the direct and indirect factors that determine levels and trends of fertility and child mortality ? Measured levels of contraceptive knowledge and practice - Collected data on key aspects of family health, including immunisation coverage among children, prevalence and treatment of diarrhoea and other diseases among children under age 5, and maternity care indicators such as antenatal visits and assistance at delivery - Obtained data on child feeding practices, including breastfeeding - Collected anthropometric measures to assess the nutritional status of children under age 5, women age 15-49, and men age 15-59 - Conducted haemoglobin testing on eligible children age 6-59 months, women age 15-49, and men age 15-59 to provide information on the prevalence of anaemia in these groups - Collected data on knowledge and attitudes of women and men about sexually transmitted diseases and HIV/AIDS and evaluated potential exposure to the risk of HIV infection by exploring high-risk behaviours and condom use - Conducted HIV testing of dried blood spot (DBS) samples collected from women age 15-49 and men age 15-59 to provide information on the prevalence of HIV among adults of reproductive age - Collected data on the prevalence of injuries and accidents among all household members - Collected data on knowledge and prevalence of fistula and female genital mutilation or cutting (FGM/C) among women age 15-49 and their daughters age 0-14 - Obtained data on women’s experience of emotional, physical, and sexual violence.

Geographic coverage

National

Analysis unit

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

Universe

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

Kind of data

Sample survey data [ssd]

Sampling procedure

The sampling frame used for the 2016 EDHS is the Ethiopia Population and Housing Census (PHC), which was conducted in 2007 by the Ethiopia Central Statistical Agency. The census frame is a complete list of 84,915 enumeration areas (EAs) created for the 2007 PHC. An EA is a geographic area covering on average 181 households. The sampling frame contains information about the EA location, type of residence (urban or rural), and estimated number of residential households. With the exception of EAs in six zones of the Somali region, each EA has accompanying cartographic materials. These materials delineate geographic locations, boundaries, main access, and landmarks in or outside the EA that help identify the EA. In Somali, a cartographic frame was used in three zones where sketch maps delineating the EA geographic boundaries were available for each EA; in the remaining six zones, satellite image maps were used to provide a map for each EA.

Administratively, Ethiopia is divided into nine geographical regions and two administrative cities. The sample for the 2016 EDHS was designed to provide estimates of key indicators for the country as a whole, for urban and rural areas separately, and for each of the nine regions and the two administrative cities.

The 2016 EDHS sample was stratified and selected in two stages. Each region was stratified into urban and rural areas, yielding 21 sampling strata. Samples of EAs were selected independently in each stratum in two stages. Implicit stratification and proportional allocation were achieved at each of the lower administrative levels by sorting the sampling frame within each sampling stratum before sample selection, according to administrative units in different levels, and by using a probability proportional to size selection at the first stage of sampling.

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

Mode of data collection

Face-to-face [f2f]

Research instrument

Five questionnaires were used for the 2016 EDHS: the Household Questionnaire, the Woman’s Questionnaire, the Man’s Questionnaire, the Biomarker Questionnaire, and the Health Facility Questionnaire. These questionnaires, based on the DHS Program’s standard Demographic and Health Survey questionnaires, were adapted to reflect the population and health issues relevant to Ethiopia. Input was solicited from various stakeholders representing government ministries and agencies, nongovernmental organisations, and international donors. After all questionnaires were finalised in English, they were translated into Amarigna, Tigrigna, and Oromiffa.

Cleaning operations

All electronic data files for the 2016 EDHS were transferred via IFSS to the CSA central office in Addis Ababa, where they were stored on a password-protected computer. The data processing operation included secondary editing, which required resolution of computer-identified inconsistencies and coding of openended questions; it also required generating a file for the list of children for whom a vaccination card was not seen by the interviewers and whose vaccination records had to be checked at health facilities. The data were processed by two individuals who took part in the main fieldwork training; they were supervised by two senior staff from CSA. Data editing was accomplished using CSPro software. During the duration of fieldwork, tables were generated to check various data quality parameters and specific feedback was given to the teams to improve performance. Secondary editing and data processing were initiated in January 2016 and completed in August 2016.

Response rate

A total of 18,008 households were selected for the sample, of which 17,067 were occupied. Of the occupied households, 16,650 were successfully interviewed, yielding a response rate of 98%.

In the interviewed households, 16,583 eligible women were identified for individual interviews. Interviews were completed with 15,683 women, yielding a response rate of 95%. A total of 14,795 eligible men were identified in the sampled households and 12,688 were successfully interviewed, yielding a response rate of 86%. Although overall there was little variation in response rates according to residence, response rates among men were higher in rural than in urban areas.

Sampling error estimates

The estimates from a sample survey are affected by two types of errors: non-sampling errors and 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 the questions by either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the 2016 Ethiopia DHS (EDHS) to minimise this type of error, non-sampling errors are impossible to avoid and are difficult to evaluate statistically.

Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the 2016 EDHS is only one of many samples that could have been selected from the same population, by using the same design and the expected size. Each of those 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.

Sampling error is usually measured in terms of the standard error for a particular statistic (such as mean or percentage), 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 as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the 2016 EDHS sample is the result of a multi-stage stratified design and, consequently, it was necessary to use more complex formulae. Sampling errors are computed in either ISSA or SAS, with programs developed by ICF International. These programs use the Taylor linearisation method of variance estimation 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.

A more detailed description of estimates of sampling errors are presented in Appendix B of the survey final 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

Abstract

The 2016 Ethiopia Demographic and Health Survey (EDHS) is the fourth Demographic and Health Survey conducted in Ethiopia. It was implemented by the Central Statistical Agency (CSA) at the request of the Federal Ministry of Health (FMoH). Data collection took place from January 18, 2016, to June 27, 2016.

SURVEY OBJECTIVES The primary objective of the 2016 EDHS is to provide up-to-date estimates of key demographic and health indicators. The EDHS provides a comprehensive overview of population, maternal, and child health issues in Ethiopia. More specifically, the 2016 EDHS: - Collected data at the national level that allowed calculation of key demographic indicators, particularly fertility and under-5 and adult mortality rates - Explored the direct and indirect factors that determine levels and trends of fertility and child mortality - Measured levels of contraceptive knowledge and practice - Collected data on key aspects of family health, including immunisation coverage among children, prevalence and treatment of diarrhoea and other diseases among children under age 5, and maternity care indicators such as antenatal visits and assistance at delivery - Obtained data on child feeding practices, including breastfeeding - Collected anthropometric measures to assess the nutritional status of children under age 5, women age 15-49, and men age 15-59 - Conducted haemoglobin testing on eligible children age 6-59 months, women age 15-49, and men age 15-59 to provide information on the prevalence of anaemia in these groups - Collected data on knowledge and attitudes of women and men about sexually transmitted diseases and HIV/AIDS and evaluated potential exposure to the risk of HIV infection by exploring high-risk behaviours and condom use - Conducted HIV testing of dried blood spot (DBS) samples collected from women age 15-49 and men age 15-59 to provide information on the prevalence of HIV among adults of reproductive age - Collected data on the prevalence of injuries and accidents among all household members - Collected data on knowledge and prevalence of fistula and female genital mutilation or cutting (FGM/C) among women age 15-49 and their daughters age 0-14 - Obtained data on women’s experience of emotional, physical, and sexual violence.

As the fourth DHS conducted in Ethiopia, following the 2000, 2005, and 2011 EDHS surveys, the 2016 EDHS provides valuable information on trends in key demographic and health indicators over time. The information collected through the 2016 EDHS is intended to assist policymakers and programme managers in evaluating and designing programmes and strategies for improving the health of the country’s population.

Additionally, the 2016 EDHS included a health facility component that recorded data on children’s vaccinations, which were then combined with the household data on vaccinations.

Geographic coverage

National coverage

Analysis unit

• Households
• Men
• Women
• Children

Universe

Household members women age 15-49 men age 15-59 children under age 5

Kind of data

Sample survey data [ssd]

Sampling procedure

The sampling frame used for the 2016 EDHS is the Ethiopia Population and Housing Census (PHC), which was conducted in 2007 by the Ethiopia Central Statistical Agency. The census frame is a complete list of 84,915 enumeration areas (EAs) created for the 2007 PHC. An EA is a geographic area covering on average 181 households. The sampling frame contains information about the EA location, type of residence (urban or rural), and estimated number of residential households. With the exception of EAs in six zones of the Somali region, each EA has accompanying cartographic materials. These materials delineate geographic locations, boundaries, main access, and landmarks in or outside the EA that help identify the EA. In Somali, a cartographic frame was used in three zones where sketch maps delineating the EA geographic boundaries were available for each EA; in the remaining six zones, satellite image maps were used to provide a map for each EA.

Administratively, Ethiopia is divided into nine geographical regions and two administrative cities. The sample for the 2016 EDHS was designed to provide estimates of key indicators for the country as a whole, for urban and rural areas separately, and for each of the nine regions and the two administrative cities.

The 2016 EDHS sample was stratified and selected in two stages. Each region was stratified into urban and rural areas, yielding 21 sampling strata. Samples of EAs were selected independently in each stratum in two stages. Implicit stratification and proportional allocation were achieved at each of the lower administrative levels by sorting the sampling frame within each sampling stratum before sample selection, according to administrative units in different levels, and by using a probability proportional to size selection at the first stage of sampling.

In the first stage, a total of 645 EAs (202 in urban areas and 443 in rural areas) were selected with probability proportional to EA size (based on the 2007 PHC) and with independent selection in each sampling stratum. A household listing operation was carried out in all of the selected EAs from September to December 2015. The resulting lists of households served as a sampling frame for the selection of households in the second stage. Some of the selected EAs were large, consisting of more than 300 households. To minimise the task of household listing, each large EA selected for the 2016 EDHS was segmented. Only one segment was selected for the survey with probability proportional to segment size. Household listing was conducted only in the selected segment; that is, a 2016 EDHS cluster is either an EA or a segment of an EA.

In the second stage of selection, a fixed number of 28 households per cluster were selected with an equal probability systematic selection from the newly created household listing. All women age 15-49 and 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 half of the selected households, all women age 15-49 were eligible for the FGM/C module, and only one woman per household was selected for the domestic violence module. In all of the selected households, height and weight measurements were collected from children age 0-59 months, women age 15-49, and men age 15-59. Anaemia testing was performed on consenting women age 15-49 and men age 15-59 and on children age 6-59 months whose parent/guardian consented to the testing. In addition, DBS samples were collected for HIV testing in the laboratory from women age 15-49 and men age 15-59 who consented to testing.

Mode of data collection

Computer Assisted Personal Interview [capi]

Research instrument

Five questionnaires were used for the 2016 EDHS: the Household Questionnaire, the Woman’s Questionnaire, the Man’s Questionnaire, the Biomarker Questionnaire, and the Health Facility Questionnaire. These questionnaires, based on the DHS Program’s standard Demographic and Health Survey questionnaires, were adapted to reflect the population and health issues relevant to Ethiopia. Input was solicited from various stakeholders representing government ministries and agencies, nongovernmental organisations, and international donors. After all questionnaires were finalised in English, they were translated into Amarigna, Tigrigna, and Oromiffa.

The Household Questionnaire was used to list all members of and visitors to selected households. Basic demographic information was collected on the characteristics of each person listed, including his or her age, sex, marital status, education, and relationship to the head of the household. For children under age 18, parents’ survival status was determined. The data on age and sex of household members obtained in the Household Questionnaire 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 water, type of toilet facilities, and flooring materials, as well as on ownership of various durable goods. The Household Questionnaire included an additional module developed by the DHS Program to estimate the prevalence of injuries/accidents among all household members.

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 childhood mortality - Family planning, including knowledge, use, and sources of contraceptive methods - Fertility preferences - Antenatal, delivery, and postnatal care - Breastfeeding and infant feeding practices - Vaccinations and childhood illnesses - Women’s work and husbands’ background characteristics - Knowledge, awareness, and behaviour regarding HIV/AIDS and other sexually transmitted diseases (STDs) - Knowledge, attitudes, and behaviours related to other health issues (e.g., injections, smoking, use of chat) - Adult and maternal mortality - Female genital mutilation or cutting - Fistula - Violence against women The Man’s Questionnaire was administered to all eligible men age 15-59. This questionnaire collected much of the same information elicited from the Woman’s Questionnaire but was shorter because it did not contain a detailed reproductive history, questions on maternal and child health, or questions on domestic violence. The Biomarker Questionnaire was used to record biomarker data