At the beginning of the 1990s, the United Nations Economic Commission for Europe (ECE) launched a project to conduct international comparative surveys on family and birth rates in European countries (Fertility and Family Surveys - FFS). For the past three decades, Europe has seen profound changes in birth rates, education and family structures. In this context, various authors speak of a "second demographic upheaval". In many European countries, the following trends are emerging: declining birth rates, together with combined birth rates which remain below the level necessary for generational survival (1.49 in Switzerland at the time of the survey in 1994 and 1.50 in 1996), a declining tendency to marry and the emergence of new family forms (consensual couples, single-parent families, blended families). If these trends continue, significant demographic consequences are to be expected, with correspondingly drastic consequences for social and economic organisation (one issue is above all the ageing of the population). The collection of biographical data makes it possible to collect detailed information at the individual level, which supplements the census data. The course of life in our society is becoming increasingly complex and diverse. Censuses can collect little information on the biography of individuals, but this information is essential for understanding and explaining changes in behaviour in terms of birth rates and partnership. The collection of biographical data thus provides an important basis for statistics and scientific research. Another objective of this study is to provide information to those involved in the development of family and social policies. An optional module of the questionnaire (not adopted by Switzerland) is dedicated to population policy and serves to monitor the effectiveness of this policy. The plan for an international survey on family and birth rates in Europe therefore pursues the following objectives: - Providing information on families and birth rates that complements census and marital status data and can be used for scientific purposes, but also for political and administrative purposes; - Provision of data that can be used to develop more precise population scenarios; - Testing of new hypotheses concerning the determinants of parental and partnership behaviour; - Investigation of problems related to family and birth policies; - Comparisons of recent developments in family and birth rates in European countries. Each participating country carries out a representative sample survey based on a standardised questionnaire. The data collected are therefore comparable with those of other countries. The Swiss Federal Statistical Office had planned to conduct a survey on family and birth rates as part of its microcensus programme. Official statistics in our country have few data that allow an analysis of the profound changes in this area. The project of the Economic Commission for Europe offered Switzerland the opportunity to conduct such a survey and at the same time participate in an international comparative research programme. The basic concept for this was drawn up in 1992. The Swiss Federal Statistical Office, which collaborated with the Institute of Sociology at the University of Zurich and the Laboratoire de démographie économique et sociale at the University of Geneva, was in charge of the overall management of the project on behalf of the Federal Council. The objectives of the survey were as follows: - To provide an overview of recent developments and the current situation of the family and the birth rate in Switzerland; - To study the interactions between education, employment, family lifestyles and birth rates; - To shed light on the changes in attitudes and values about family and child. This survey allows (lifecourse-related) longitudinal analyses as a supplement to the (momentary) cross-sectional studies of the situation in the areas of birth rate, tendency to marry and household structure based on census and civil status data. This information is intended for those involved in social and family policy decisions and for scientific research. Anfangs der 90er Jahre lanciert die Wirtschaftskommission für Europa (Economic Commission for Europe - ECE) der Vereinten Nationen ein Projekt, das die Durchführung international vergleichender Erhebungen über Familie und Geburtenhäufigkeit in den Ländern Europas vorsah (Fertility and Family Surveys - FFS). Seit drei Jahrzehnten ist in Europa ein tiefgreifender Wandel in den Bereichen Geburtenhäufigkeit, Ausbildung und Familienstrukturen zu beobachten. Verschiedene Autoren sprechen in diesem Zusammenhang von einem "zweiten demographischen Umbruch". In zahlreichen europäischen Ländern zeichnen sich folgende Trends ab: sinkende Geburtenhäufigkeit, zusammen mit zusammengefassten Geburtenziffern, welche weiterhin unter den für den Generationenerhalt notwendigen Wert liegen (1,49 in der Schweiz zum Erhebungszeitpunkt 1994 und 1,50 im Jahr 1996), Rückgang der Heiratsneigung und Aufkommen neuer Familienformen (Konsensualpaare, Einelternfamilien, Fortsetzungsfamilien). Falls diese Trends weiter anhalten, ist mit bedeutenden demographischen Konsequenzen zu rechnen, mit entsprechend einscheidenden Folgen für die gesellschaftliche und wirtschaftliche Organisation (ein Thema ist vor allem die Alterung der Bevölkerung). Die Erhebung von biographischen Daten gestattet es, detaillierte Informationen auf der Stufe des Einzelnen zu sammeln, welche die Volkszählungsdaten ergänzen. Die Lebensverläufe in unserer Gesellschaft werden immer komplexer und vielfältiger. Bei den Volkszählungen können nur wenige Informationen zur Biographie des Einzelnen erhoben werden; diese Angaben sind aber von grundlegender Bedeutung, wenn es darum geht, Verhaltensänderungen im Bereich Geburtenhäufigkeit und Partnerschaft zu verstehen und zu erklären. Die Erhebung von biographischen Daten liefert demnach wichtige Grundlagen für die Statistik und die wissenschaftliche Forschung. Ein weiteres Ziel dieses Projekts besteht darin, Informationen für die Personen bereitszustellen, die mit der Ausarbeitung der Familien- und Sozialpolitik befasst sind. Ein (von der Schweiz nicht übernommenes) fakultatives Modul des Fragebogens ist denn auch der Bevölkerungspolitik gewidmet und dient zur Überprüfung der Wirksamkeit dieser Politik. Der Plan einer internationalen Erhebung über Familie und Geburtenhäufigkeit in Europa verfolgt somit folgende Zielsetzungen: - Bereitstellung von Informationen über Familien und Geburtenhäufigkeit, welche die Volkszählungs- und Zivilstandsdaten ergänzen und für wissenschaftliche Zwecke, aber auch für die Belange der Politik und der Verwaltung verwendet werden können; - Bereitstellung von Daten, welche zur Erarbeitung von genaueren Bevölkerungsszenarien dienen können; - Testen neuer Hypothesen betreffend die Determinanten des Eltern- und Partnerschaftsverhaltens; - Untersuchung der Probleme im Zusammenhang mit der Familien- und Geburtenpolitik; - Vergleiche der neueren Entwicklungen im Bereich Familie und Geburtenhäufigkeit in den europäischen Ländern. Jedes teilnehmende Land führt eine für die Bevölkerung repräsentative Stichprobenerhebung durch, welche auf einem standardisierten Fragebogen basiert. Die erhobenen Daten sind demnach mit denjenigen anderer Länder vergleichbar. Das Bundesamt für Statistik hatte im Rahmen seines Mikrozensus-Programms die Durchführung einer Erhebung über Familie und Geburtenhäufigkeit geplant. Die amtliche Statistik in unserem Land verfügt nur über wenige Daten, die eine Analyse des tiefgreifenden Wandels in diesem Bereich ermöglichen. Das Projekt der Wirtschaftskommission für Europa bot der Schweiz die Möglichkeit, eine solche Erhebung durchzuführen und sich gleichzeitig an einem international vergleichenden Forschungsprogramm zu beteiligen. 1992 wurde das Grundkonzept dafür erstellt. Die Gesamtleitung des im Auftrag des Bundesrats realisierten Projekts lag beim Bundesamt für Statistik, das mit dem Soziologischen Institut der Universität Zürich und dem Laboratoire de démographie économique et sociale der Universität Genf zusammenarbeitete. Die Erhebung verfolgte folgende Zielsetzungen: - Erarbeiten eines Überblicks über die jüngste Entwicklung und die aktuelle Lage der Familie und der Geburtenhäufigkeit in der Schweiz; - Untersuchen der Wechselwirkungen zwischen Ausbildung, Erwerbstätigkeit, familialen Lebensformen und Geburtenhäufigkeit; - Aufschluss geben über den Wandel der Einstellungen und Werthaltungen über Familie und Kind. Diese Erhebung ermöglicht (lebenslaufbezogene) Längsschnittanalysen als Ergänzung zu den auf Volkszählungs- und Zivilstandsdaten basierenden (momentbezogenen) Querschnittuntersuchungen der Situation in den Bereichen Geburtenhäufigkeit, Heiratsneigung und Haushaltsstruktur. Diese Informationen sind für die mit sozial- und familienpolitischen Entscheiden befassten Personen sowie für die wissenschaftliche Forschung bestimmt.

In 2024, the birth rate in South Korea stood at 0.75 births per woman. The country has long struggled with a declining birth rate, dropping below one birth per woman in 2018.

The 2008 National Demographic and Health Survey (2008 NDHS) is a nationally representative survey of 13,594 women age 15-49 from 12,469 households successfully interviewed, covering 794 enumeration areas (clusters) throughout the Philippines. This survey is the ninth in a series of demographic and health surveys conducted to assess the demographic and health situation in the country. The survey obtained detailed information on fertility levels, marriage, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutritional status of women and young children, childhood mortality, maternal and child health, and knowledge and attitudes regarding HIV/AIDS and tuberculosis. Also, for the first time, the Philippines NDHS gathered information on violence against women. The 2008 NDHS was conducted by the Philippine National Statistics Office (NSO). Technical assistance was provided by ICF Macro through the MEASURE DHS program. Funding for the survey was mainly provided by the Government of the Philippines. Financial support for some preparatory and processing phases of the survey was provided by the U.S. Agency for International Development (USAID). Like previous Demographic and Health Surveys (DHS) conducted in the Philippines, the 2008 National Demographic and Health Survey (NDHS) was primarily designed to provide information on population, family planning, and health to be used in evaluating and designing policies, programs, and strategies for improving health and family planning services in the country. The 2008 NDHS also included questions on domestic violence. Specifically, the 2008 NDHS had the following objectives: Collect data at the national level that will allow the estimation of demographic rates, particularly, fertility rates by urban-rural residence and region, and under-five mortality rates at the national level. Analyze the direct and indirect factors which determine the levels and patterns of fertility. Measure the level of contraceptive knowledge and practice by method, urban-rural residence, and region. Collect data on family health: immunizations, prenatal and postnatal checkups, assistance at delivery, breastfeeding, and prevalence and treatment of diarrhea, fever, and acute respiratory infections among children under five years. Collect data on environmental health, utilization of health facilities, prevalence of common noncommunicable and infectious diseases, and membership in health insurance plans. Collect data on awareness of tuberculosis. Determine women's knowledge about HIV/AIDS and access to HIV testing. Determine the extent of violence against women. MAIN RESULTS FERTILITY Fertility Levels and Trends. There has been a steady decline in fertility in the Philippines in the past 36 years. From 6.0 children per woman in 1970, the total fertility rate (TFR) in the Philippines declined to 3.3 children per woman in 2006. The current fertility level in the country is relatively high compared with other countries in Southeast Asia, such as Thailand, Singapore and Indonesia, where the TFR is below 2 children per woman. Fertility Differentials. Fertility varies substantially across subgroups of women. Urban women have, on average, 2.8 children compared with 3.8 children per woman in rural areas. The level of fertility has a negative relationship with education; the fertility rate of women who have attended college (2.3 children per woman) is about half that of women who have been to elementary school (4.5 children per woman). Fertility also decreases with household wealth: women in wealthier households have fewer children than those in poorer households. FAMILY PLANNING Knowledge of Contraception. Knowledge of family planning is universal in the Philippines- almost all women know at least one method of fam-ily planning. At least 90 percent of currently married women have heard of the pill, male condoms, injectables, and female sterilization, while 87 percent know about the IUD and 68 percent know about male sterilization. On average, currently married women know eight methods of family planning. Unmet Need for Family Planning. Unmet need for family planning is defined as the percentage of currently married women who either do not want any more children or want to wait before having their next birth, but are not using any method of family planning. The 2008 NDHS data show that the total unmet need for family planning in the Philippines is 22 percent, of which 13 percent is limiting and 9 percent is for spacing. The level of unmet need has increased from 17 percent in 2003. Overall, the total demand for family planning in the Philippines is 73 percent, of which 69 percent has been satisfied. If all of need were satisfied, a contraceptive prevalence rate of about 73 percent could, theoretically, be expected. Comparison with the 2003 NDHS indicates that the percentage of demand satisfied has declined from 75 percent. MATERNAL HEALTH Antenatal Care. Nine in ten Filipino mothers received some antenatal care (ANC) from a medical professional, either a nurse or midwife (52 percent) or a doctor (39 percent). Most women have at least four antenatal care visits. More than half (54 percent) of women had an antenatal care visit during the first trimester of pregnancy, as recommended. While more than 90 percent of women who received antenatal care had their blood pressure monitored and weight measured, only 54 percent had their urine sample taken and 47 percent had their blood sample taken. About seven in ten women were informed of pregnancy complications. Three in four births in the Philippines are protected against neonatal tetanus. Delivery and Postnatal Care. Only 44 percent of births in the Philippines occur in health facilities-27 percent in a public facility and 18 percent in a private facility. More than half (56 percent) of births are still delivered at home. Sixty-two percent of births are assisted by a health professional-35 percent by a doctor and 27 percent by a midwife or nurse. Thirty-six percent are assisted by a traditional birth attendant or hilot. About 10 percent of births are delivered by C-section. The Department of Health (DOH) recommends that mothers receive a postpartum check within 48 hours of delivery. A majority of women (77 percent) had a postnatal checkup within two days of delivery; 14 percent had a postnatal checkup 3 to 41 days after delivery. CHILD HEALTH Childhood Mortality. Childhood mortality continues to decline in the Philippines. Currently, about one in every 30 children in the Philippines dies before his or her fifth birthday. The infant mortality rate for the five years before the survey (roughly 2004-2008) is 25 deaths per 1,000 live births and the under-five mortality rate is 34 deaths per 1,000 live births. This is lower than the rates of 29 and 40 reported in 2003, respectively. The neonatal mortality rate, representing death in the first month of life, is 16 deaths per 1,000 live births. Under-five mortality decreases as household wealth increases; children from the poorest families are three times more likely to die before the age of five as those from the wealthiest families. There is a strong association between under-five mortality and mother's education. It ranges from 47 deaths per 1,000 live births among children of women with elementary education to 18 deaths per 1,000 live births among children of women who attended college. As in the 2003 NDHS, the highest level of under-five mortality is observed in ARMM (94 deaths per 1,000 live births), while the lowest is observed in NCR (24 deaths per 1,000 live births). NUTRITION Breastfeeding Practices. Eighty-eight percent of children born in the Philippines are breastfed. There has been no change in this practice since 1993. In addition, the median durations of any breastfeeding and of exclusive breastfeeding have remained at 14 months and less than one month, respectively. Although it is recommended that infants should not be given anything other than breast milk until six months of age, only one-third of Filipino children under six months are exclusively breastfed. Complementary foods should be introduced when a child is six months old to reduce the risk of malnutrition. More than half of children ages 6-9 months are eating complementary foods in addition to being breastfed. The Infant and Young Child Feeding (IYCF) guidelines contain specific recommendations for the number of times that young children in various age groups should be fed each day as well as the number of food groups from which they should be fed. NDHS data indicate that just over half of children age 6-23 months (55 percent) were fed according to the IYCF guidelines. HIV/AIDS Awareness of HIV/AIDS. While over 94 percent of women have heard of AIDS, only 53 percent know the two major methods for preventing transmission of HIV (using condoms and limiting sex to one uninfected partner). Only 45 percent of young women age 15-49 know these two methods for preventing HIV transmission. Knowledge of prevention methods is higher in urban areas than in rural areas and increases dramatically with education and wealth. For example, only 16 percent of women with no education know that using condoms limits the risk of HIV infection compared with 69 percent of those who have attended college. TUBERCULOSIS Knowledge of TB. While awareness of tuberculosis (TB) is high, knowledge of its causes and symptoms is less common. Only 1 in 4 women know that TB is caused by microbes, germs or bacteria. Instead, respondents tend to say that TB is caused by smoking or drinking alcohol, or that it is inherited. Symptoms associated with TB are better recognized. Over half of the respondents cited coughing, while 39 percent mentioned weight loss, 35 percent mentioned blood in sputum, and 30 percent cited coughing with sputum. WOMEN'S STATUS Women's Status and Employment.

The second National Family Health Survey (NFHS-2), conducted in 1998-99, provides information on fertility, mortality, family planning, and important aspects of nutrition, health, and health care. The International Institute for Population Sciences (IIPS) coordinated the survey, which collected information from a nationally representative sample of more than 90,000 ever-married women age 15-49. The NFHS-2 sample covers 99 percent of India's population living in all 26 states. This report is based on the survey data for 25 of the 26 states, however, since data collection in Tripura was delayed due to local problems in the state. IIPS also coordinated the first National Family Health Survey (NFHS-1) in 1992-93. Most of the types of information collected in NFHS-2 were also collected in the earlier survey, making it possible to identify trends over the intervening period of six and one-half years. In addition, the NFHS-2 questionnaire covered a number of new or expanded topics with important policy implications, such as reproductive health, women's autonomy, domestic violence, women's nutrition, anaemia, and salt iodization. The NFHS-2 survey was carried out in two phases. Ten states were surveyed in the first phase which began in November 1998 and the remaining states (except Tripura) were surveyed in the second phase which began in March 1999. The field staff collected information from 91,196 households in these 25 states and interviewed 89,199 eligible women in these households. In addition, the survey collected information on 32,393 children born in the three years preceding the survey. One health investigator on each survey team measured the height and weight of eligible women and children and took blood samples to assess the prevalence of anaemia. SUMMARY OF FINDINGS POPULATION CHARACTERISTICS Three-quarters (73 percent) of the population lives in rural areas. The age distribution is typical of populations that have recently experienced a fertility decline, with relatively low proportions in the younger and older age groups. Thirty-six percent of the population is below age 15, and 5 percent is age 65 and above. The sex ratio is 957 females for every 1,000 males in rural areas but only 928 females for every 1,000 males in urban areas, suggesting that more men than women have migrated to urban areas. The survey provides a variety of demographic and socioeconomic background information. In the country as a whole, 82 percent of household heads are Hindu, 12 percent are Muslim, 3 percent are Christian, and 2 percent are Sikh. Muslims live disproportionately in urban areas, where they comprise 15 percent of household heads. Nineteen percent of household heads belong to scheduled castes, 9 percent belong to scheduled tribes, and 32 percent belong to other backward classes (OBCs). Two-fifths of household heads do not belong to any of these groups. Questions about housing conditions and the standard of living of households indicate some improvements since the time of NFHS-1. Sixty percent of households in India now have electricity and 39 percent have piped drinking water compared with 51 percent and 33 percent, respectively, at the time of NFHS-1. Sixty-four percent of households have no toilet facility compared with 70 percent at the time of NFHS-1. About three-fourths (75 percent) of males and half (51 percent) of females age six and above are literate, an increase of 6-8 percentage points from literacy rates at the time of NFHS-1. The percentage of illiterate males varies from 6-7 percent in Mizoram and Kerala to 37 percent in Bihar and the percentage of illiterate females varies from 11 percent in Mizoram and 15 percent in Kerala to 65 percent in Bihar. Seventy-nine percent of children age 6-14 are attending school, up from 68 percent in NFHS-1. The proportion of children attending school has increased for all ages, particularly for girls, but girls continue to lag behind boys in school attendance. Moreover, the disparity in school attendance by sex grows with increasing age of children. At age 6-10, 85 percent of boys attend school compared with 78 percent of girls. By age 15-17, 58 percent of boys attend school compared with 40 percent of girls. The percentage of girls 6-17 attending school varies from 51 percent in Bihar and 56 percent in Rajasthan to over 90 percent in Himachal Pradesh and Kerala. Women in India tend to marry at an early age. Thirty-four percent of women age 15-19 are already married including 4 percent who are married but gauna has yet to be performed. These proportions are even higher in the rural areas. Older women are more likely than younger women to have married at an early age: 39 percent of women currently age 45-49 married before age 15 compared with 14 percent of women currently age 15-19. Although this indicates that the proportion of women who marry young is declining rapidly, half the women even in the age group 20-24 have married before reaching the legal minimum age of 18 years. On average, women are five years younger than the men they marry. The median age at marriage varies from about 15 years in Madhya Pradesh, Bihar, Uttar Pradesh, Rajasthan, and Andhra Pradesh to 23 years in Goa. As part of an increasing emphasis on gender issues, NFHS-2 asked women about their participation in household decisionmaking. In India, 91 percent of women are involved in decision-making on at least one of four selected topics. A much lower proportion (52 percent), however, are involved in making decisions about their own health care. There are large variations among states in India with regard to women's involvement in household decisionmaking. More than three out of four women are involved in decisions about their own health care in Himachal Pradesh, Meghalaya, and Punjab compared with about two out of five or less in Madhya Pradesh, Orissa, and Rajasthan. Thirty-nine percent of women do work other than housework, and more than two-thirds of these women work for cash. Only 41 percent of women who earn cash can decide independently how to spend the money that they earn. Forty-three percent of working women report that their earnings constitute at least half of total family earnings, including 18 percent who report that the family is entirely dependent on their earnings. Women's work-participation rates vary from 9 percent in Punjab and 13 percent in Haryana to 60-70 percent in Manipur, Nagaland, and Arunachal Pradesh. FERTILITY AND FAMILY PLANNING Fertility continues to decline in India. At current fertility levels, women will have an average of 2.9 children each throughout their childbearing years. The total fertility rate (TFR) is down from 3.4 children per woman at the time of NFHS-1, but is still well above the replacement level of just over two children per woman. There are large variations in fertility among the states in India. Goa and Kerala have attained below replacement level fertility and Karnataka, Himachal Pradesh, Tamil Nadu, and Punjab are at or close to replacement level fertility. By contrast, fertility is 3.3 or more children per woman in Meghalaya, Uttar Pradesh, Rajasthan, Nagaland, Bihar, and Madhya Pradesh. More than one-third to less than half of all births in these latter states are fourth or higher-order births compared with 7-9 percent of births in Kerala, Goa, and Tamil Nadu. Efforts to encourage the trend towards lower fertility might usefully focus on groups within the population that have higher fertility than average. In India, rural women and women from scheduled tribes and scheduled castes have somewhat higher fertility than other women, but fertility is particularly high for illiterate women, poor women, and Muslim women. Another striking feature is the high level of childbearing among young women. More than half of women age 20-49 had their first birth before reaching age 20, and women age 15-19 account for almost one-fifth of total fertility. Studies in India and elsewhere have shown that health and mortality risks increase when women give birth at such young ages?both for the women themselves and for their children. Family planning programmes focusing on women in this age group could make a significant impact on maternal and child health and help to reduce fertility. INFANT AND CHILD MORTALITY NFHS-2 provides estimates of infant and child mortality and examines factors associated with the survival of young children. During the five years preceding the survey, the infant mortality rate was 68 deaths at age 0-11 months per 1,000 live births, substantially lower than 79 per 1,000 in the five years preceding the NFHS-1 survey. The child mortality rate, 29 deaths at age 1-4 years per 1,000 children reaching age one, also declined from the corresponding rate of 33 per 1,000 in NFHS-1. Ninety-five children out of 1,000 born do not live to age five years. Expressed differently, 1 in 15 children die in the first year of life, and 1 in 11 die before reaching age five. Child-survival programmes might usefully focus on specific groups of children with particularly high infant and child mortality rates, such as children who live in rural areas, children whose mothers are illiterate, children belonging to scheduled castes or scheduled tribes, and children from poor households. Infant mortality rates are more than two and one-half times as high for women who did not receive any of the recommended types of maternity related medical care than for mothers who did receive all recommended types of care. HEALTH, HEALTH CARE, AND NUTRITION Promotion of maternal and child health has been one of the most important components of the Family Welfare Programme of the Government of India. One goal is for each pregnant woman to receive at least three antenatal check-ups plus two tetanus toxoid injections and a full course of iron and folic acid supplementation. In India, mothers of 65 percent of the children born in the three years preceding NFHS-2 received at least one antenatal

The 2004 Malawi Demographic and Health Survey (MDHS) is a nationally representative survey of 11,698 women age 1549 and 3,261 men age 15-54. The main purpose of the 2004 MDHS is to provide policymakers and programme managers with detailed information on fertility, family planning, childhood and adult mortality, maternal and child health, as well as knowledge of and attitudes related to HIV/AIDS and other sexually transmitted infections (STIs). The 2004 MDHS is designed to provide data to monitor the population and health situation in Malawi as a followup of the 1992 and 2000 MDHS surveys, and the 1996 Malawi Knowledge, Attitudes, and Practices in Health Survey. New features of the 2004 MDHS include the collection of information on use of mosquito nets, domestic violence, anaemia testing of women and children under 5, and HIV testing of adults. The 2004 MDHS survey was implemented by the National Statistical Office (NSO). The Ministry of Health and Population, the National AIDS Commission (NAC), the National Economic Council, and the Ministry of Gender contributed to the development of the questionnaires for the survey. Most of the funds for the local costs of the survey were provided by multiple donors through the NAC. The United States Agency for International Development (USAID) provided additional funds for the technical assistance through ORC Macro. The Department for International Development (DfID) of the British Government, the United Nations Children's Fund (UNICEF), and the United Nations Population Fund (UNFPA) also provided funds for the survey. The Centers of Disease Control and Prevention provided technical assistance in HIV testing. The survey used a two-stage sample based on the 1998 Census of Population and Housing and was designed to produce estimates for key indicators for ten large districts in addition to estimates for national, regional, and urban-rural domains. Fieldwork for the 2004 MDHS was carried out by 22 mobile interviewing teams. Data collection commenced on 4 October 2004 and was completed on 31 January 2005. The principal aim of the 2004 MDHS project was to provide up-to-date information on fertility and childhood mortality levels, nuptiality, fertility preferences, awareness and use of family planning methods, use of maternal and child health services, and knowledge and behaviours related to HIV/AIDS and other sexually transmitted infections. It was designed as a follow-on to the 2000 MDHS survey, a national-level survey of similar scope. The 2004 MDHS survey, unlike the 2000 MDHS, collected blood samples which were later tested for HIV in order to estimate HIV prevalence in Malawi. In broad terms, the 2004 MDHS survey aimed to: Assess trends in Malawi's demographic indicators, principally fertility and mortality Assist in the monitoring and evaluation of Malawi's health, population, and nutrition programmes Advance survey methodology in Malawi and contribute to national and international databases Provide national-level estimates of HIV prevalence for women age 15-49 and men age 15-54. In more specific terms, the 2004 MDHS survey was designed to: Provide data on the family planning and fertility behaviour of the Malawian population and thereby enable policymakers to evaluate and enhance family planning initiatives in the country Measure changes in fertility and contraceptive prevalence and analyse the factors that affect these changes, such as marriage patterns, desire for children, availability of contraception, breastfeeding habits, and important social and economic factors Examine basic indicators of maternal and child health and welfare in Malawi, including nutritional status, use of antenatal and maternity services, treatment of recent episodes of childhood illness, and use of immunisation services. Particular emphasis was placed on malaria programmes, including malaria prevention activities and treatment of episodes of fever. Provide levels and patterns of knowledge and behaviour related to the prevention of HIV/AIDS and other sexually transmitted infections Provide national estimates of HIV prevalence Measure the level of infant and adult mortality including maternal mortality at the national level Assess the status of women in the country. MAIN FINDINGS Fertility Fertility Levels and Trends. While there has been a significant decline in fertility in the past two decades from 7.6 children in the early 1980s to 6.0 children per woman in the early 2000s, compared with selected countries in Eastern and Southern Africa, such as Zambia, Tanzania, Mozambique, Kenya, and Uganda, the total fertility rate (TFR) in Malawi is high, lower only than Uganda (6.9). Family planning Knowledge of Contraception. Knowledge of family planning is nearly universal, with 97 percent of women age 15-49 and 97 percent of men age 15-54 knowing at least one modern method of family planning. The most widely known modern methods of contraception among all women are injectables (93 percent), the pill and male condom (90 percent each), and female sterilisation (83 percent). Maternal health Antenatal Care. There has been little change in the coverage of antenatal care (ANC) from a medical professional since 2000 (93 percent in 2004 compared with 91 percent in 2000). Most women receive ANC from a nurse or a midwife (82 percent), although 10 percent go to a doctor or a clinical officer. A small proportion (2 percent) receives ANC from a traditional birth attendant, and 5 percent do not receive any ANC. Only 8 percent of women initiated ANC before the fourth month of pregnancy, a marginal increase from 7 percent in the 2000 MDHS. Adult and Maternal Mortality. Comparison of data from the 2000 and 2004 MDHS surveys indicates that mortality for both women and men has remained at the same levels since 1997 (11-12 deaths per 1,000). Child health Childhood Mortality. Data from the 2004 MDHS show that for the 2000-2004 period, the infant mortality rate is 76 per 1,000 live births, child mortality is 62 per 1,000, and the under-five mortality rate is 133 per 1,000 live births. Nutrition Breastfeeding Practices. Breastfeeding is nearly universal in Malawi. Ninety-eight percent of children are breastfed for some period of time. The median duration of breastfeeding in Malawi in 2004 is 23.2 months, one month shorter than in 2000. HIV/AIDS Awareness of AIDS. Knowledge of AIDS among women and men in Malawi is almost universal. This is true across age group, urban-rural residence, marital status, wealth index, and education. Nearly half of women and six in ten men can identify the two most common misconceptions about the transmission of HIV-HIV can be transmitted by mosquito bites, and HIV can be transmitted by supernatural means-and know that a healthy-looking person can have the AIDS virus.

The 2000 Malawi Demographic and Health Survey (MDHS) is a nationally representative sample survey covering 14,213 households, 13,220 women age 15-49, and 3,092 men age 15-54. The 2000 MDHS is similar, but much expanded in size and scope, to the 1992 MDHS. The survey was designed to provide information on fertility trends, family planning knowledge and use, early childhood mortality, various indicators of maternal and child health and nutrition, HIV/AIDS, adult and maternal mortality, and malaria control programme indicators. Unlike earlier surveys in Malawi, the 2000 MDHS sample was sufficiently large to allow for estimates of certain indicators to be produced for 11 districts in addition to estimates for national, regional, and urban-rural domains. Twenty-two mobile survey teams, trained and supervised by the National Statistical Office, conducted the survey from July to November 2000. The principal aim of the 2000 MDHS project is to provide up-to-date information on fertility and childhood mortality levels, nuptiality, fertility preferences, awareness and use of family planning methods, use of maternal and child health services, and knowledge and behaviours related to HIV/AIDS and other sexually transmitted infections. It was designed as a follow-on to the 1992 MDHS survey, a national-level survey of similar scope. The 2000 MDHS survey also strived to collect data that would be comparable to those collected under the international Multiple Indicator Cluster Survey (MICS), sponsored by UNICEF. In broad terms, the 2000 MDHS survey aimed to : Assess trends in Malawi's demographic indicators-principally, fertility and mortality Assist in the evaluation of Malawi's health, population, and nutrition programmes Advance survey methodology in Malawi and contribute to national and international databases. In more specific terms, the 2000 MDHS survey was designed to provide data on the family planning and fertility behaviour of the Malawian population and to thereby enable policymakers to evaluate and enhance family planning initiatives in the country. Measure changes in fertility and contraceptive prevalence and at the same time, study the factors that affect these changes, such as marriage patterns, desire for children, availability of contraception, breastfeeding habits, and important social and economic factors. Examine basic indicators of maternal and child health and welfare in Malawi, including nutritional status, use of antenatal and maternity services, treatment of recent episodes of childhood illness, and use of immunisation services. A particular emphasis was placed on the area of malaria programmes, including prevention activities and treatment of episodes of fever. Describe levels and patterns of knowledge and behaviour related to the prevention of HIV/AIDS and other sexually transmitted infections. Measure the level of adult and maternal mortality at the national level. Assess the status of women in the country. SUMMARY OF FINDINGS FERTILITY Fertility Decline. The 2000 MDHS data indicate that there has been a modest decline in fertility since the 1992 MDHS. Large Fertility Differentials. Fertility levels remain high in Malawi, especially in rural parts of the country. The total fertility rate among rural women is 6.7 births per woman compared with 4.5 births in urban areas. Childbearing at Young Ages. One-third of adolescent females (age 15-19) have either already had a child or are currently pregnant. FAMILY PLANNING Increasing Use of Contraception. A principle cause of the fertility decline in Malawi is the steady increase in contraceptive use over the last decade. Changing Method Mix. Currently, the most widely used methods among married women are injectable contraceptives (16 percent), female sterilisation (5 percent), and the pill (3 percent). Source of Family Planning Methods. The survey results show that government-run facilities remain the major source for contraceptives in Malawi-providing family planning methods to 68 percent of the current users. CHILD HEALTH AND SURVIVAL Progress in Reducing Early Childhood Mortality. The 2000 MDHS data indicate that mortality of children under age 5 has declined since the early 1990s. Childhood Vaccination Coverage Declines. The 2000 MDHS results show that 70 percent of children age 12-23 months are fully vaccinated. Improved Breastfeeding Practices. The 2000 MDHS results show that exclusive breast-feeding of children under 4 months of age has increased to 63 percent from only 3 percent in the 1992 MDHS. Nutritional Status of Children. The results show no appreciable change in the nutritional status of children in Malawi since 1992; still, nearly half (49 percent) of the children under age five are chronically malnourished or stunted in their growth. MALARIA CONTROL PROGRAMME INDICATORS Bednets. The use of insecticide-treated bednets (mosquito nets) is a primary health intervention proven to reduce malaria transmission. Treatment of Fever in Children Under Age Five. The survey found that 42 percent of children under age five had a fever in the two weeks preceding the survey. WOMEN'S HEALTH Maternal Health Care. The survey findings indicate that use of antenatal services remains high in Malawi. Constraints to Use of Health Services. Women in the 2000 MDHS were asked whether certain circumstances constrain their access to and use of health services for themselves. Rising Maternal Mortality. The survey collected data allowing measurement of maternal mortality. For the period 1994-2000, the maternal mortality ratio was estimated at 1,120 maternal deaths per 100,000 live births. This represents a rise from 620 maternal deaths per 100,000 estimated from the 1992 MDHS for the period 1986-1992. HIV/AIDS Impact of the Epidemic on Adult Mortality. All-cause mortality has risen by 76 percent among men and 74 percent among women age 15-49 during the 1990s. The age patterns of the increase are consistent with causes related to HIV/AIDS. Improved Knowledge of AIDS Prevention Methods. The 2000 MDHS results indicate that practical AIDS prevention knowledge has improved since the 1996 MKAPH survey. Condom Use. One of the main objectives of the National AIDS Control Programme is to encourage consistent and correct use of condoms, especially in high-risk sexual encounters. The HIV-testing Experience. The 2000 MDHS data show that 9 percent of women and 15 percent of men have been tested for HIV. However, more than 70 percent of both men and women, while not yet tested, said that they would like to be tested.

Fertility rates in developing countries have declined over the past decades, and the trend of delayed fatherhood is rising as societies develop. The reasons behind the decline in male fertility with advancing age remain mysterious, making it a compelling and crucial area for further research. However, the limited number of studies dedicated to unraveling this enigma poses a challenge. Thus, our objective is to illuminate some of the upregulated and downregulated mechanisms in the male testis during the aging process. Herein, we present a critical overview of the studies addressing the alterations of testicular proteome through the aging process, starting from sexually matured young males to end-of-life-expectancy aged males. The comparative studies of the proteomic testicular profile of men with and without spermatogenic impairment are also discussed and key proteins and pathways involved are highlighted. The difficulty of making age-comparative studies, especially of advanced-age study subjects, makes this topic of study quite challenging. Another topic worth mentioning is the heterogeneous nature and vast cellular composition of testicular tissue, which makes proteome data interpretation tricky. The cell type sorting and comorbidities testing in the testicular tissue of the studied subjects would help mitigate these problems.

Abstract

The 2022 Ghana Demographic and Health Survey (2022 GDHS) is the seventh in the series of DHS surveys conducted by the Ghana Statistical Service (GSS) in collaboration with the Ministry of Health/Ghana Health Service (MoH/GHS) and other stakeholders, with funding from the United States Agency for International Development (USAID) and other partners.

The primary objective of the 2022 GDHS is to provide up-to-date estimates of basic demographic and health indicators. Specifically, the GDHS collected information on: - Fertility levels and preferences, contraceptive use, antenatal and delivery care, maternal and child health, childhood mortality, childhood immunisation, breastfeeding and young child feeding practices, women’s dietary diversity, violence against women, gender, nutritional status of adults and children, awareness regarding HIV/AIDS and other sexually transmitted infections, tobacco use, and other indicators relevant for the Sustainable Development Goals - Haemoglobin levels of women and children - Prevalence of malaria parasitaemia (rapid diagnostic testing and thick slides for malaria parasitaemia in the field and microscopy in the lab) among children age 6–59 months - Use of treated mosquito nets - Use of antimalarial drugs for treatment of fever among children under age 5

The information collected through the 2022 GDHS is intended to assist policymakers and programme managers in designing and evaluating programmes 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 15-59

Universe

The survey covered all de jure household members (usual residents), all women aged 15-49, men aged 15-59, and all children aged 0-4 resident in the household.

Kind of data

Sample survey data [ssd]

Sampling procedure

To achieve the objectives of the 2022 GDHS, a stratified representative sample of 18,450 households was selected in 618 clusters, which resulted in 15,014 interviewed women age 15–49 and 7,044 interviewed men age 15–59 (in one of every two households selected).

The sampling frame used for the 2022 GDHS is the updated frame prepared by the GSS based on the 2021 Population and Housing Census.1 The sampling procedure used in the 2022 GDHS was stratified two-stage cluster sampling, designed to yield representative results at the national level, for urban and rural areas, and for each of the country’s 16 regions for most DHS indicators. In the first stage, 618 target clusters were selected from the sampling frame using a probability proportional to size strategy for urban and rural areas in each region. Then the number of targeted clusters were selected with equal probability systematic random sampling of the clusters selected in the first phase for urban and rural areas. In the second stage, after selection of the clusters, a household listing and map updating operation was carried out in all of the selected clusters to develop a list of households for each cluster. This list served as a sampling frame for selection of the household sample. The GSS organized a 5-day training course on listing procedures for listers and mappers with support from ICF. The listers and mappers were organized into 25 teams consisting of one lister and one mapper per team. The teams spent 2 months completing the listing operation. In addition to listing the households, the listers collected the geographical coordinates of each household using GPS dongles provided by ICF and in accordance with the instructions in the DHS listing manual. The household listing was carried out using tablet computers, with software provided by The DHS Program. A fixed number of 30 households in each cluster were randomly selected from the list for interviews.

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

Mode of data collection

Face-to-face computer-assisted interviews [capi]

Research instrument

Four questionnaires were used in the 2022 GDHS: the Household Questionnaire, the Woman’s Questionnaire, the Man’s Questionnaire, and the Biomarker Questionnaire. The questionnaires, based on The DHS Program’s model questionnaires, were adapted to reflect the population and health issues relevant to Ghana. In addition, a self-administered Fieldworker Questionnaire collected information about the survey’s fieldworkers.

The GSS organized a questionnaire design workshop with support from ICF and obtained input from government and development partners expected to use the resulting data. The DHS Program optional modules on domestic violence, malaria, and social and behavior change communication were incorporated into the Woman’s Questionnaire. ICF provided technical assistance in adapting the modules to the questionnaires.

Cleaning operations

DHS staff installed all central office programmes, data structure checks, secondary editing, and field check tables from 17–20 October 2022. Central office training was implemented using the practice data to test the central office system and field check tables. Seven GSS staff members (four male and three female) were trained on the functionality of the central office menu, including accepting clusters from the field, data editing procedures, and producing reports to monitor fieldwork.

From 27 February to 17 March, DHS staff visited the Ghana Statistical Service office in Accra to work with the GSS central office staff on finishing the secondary editing and to clean and finalize all data received from the 618 clusters.

Response rate

A total of 18,540 households were selected for the GDHS sample, of which 18,065 were found to be occupied. Of the occupied households, 17,933 were successfully interviewed, yielding a response rate of 99%. In the interviewed households, 15,317 women age 15–49 were identified as eligible for individual interviews. Interviews were completed with 15,014 women, yielding a response rate of 98%. In the subsample of households selected for the male survey, 7,263 men age 15–59 were identified as eligible for individual interviews and 7,044 were successfully interviewed.

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 2022 Ghana Demographic and Health Survey (2022 GDHS) 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 2022 GDHS 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 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 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 2022 GDHS sample was the result of a multistage stratified design, and, consequently, it was necessary to use more complex formulas. The computer software used to calculate sampling errors for the GDHS 2022 is an SAS program. This program used 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.

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

Data appraisal

Data Quality Tables

• Age distribution of eligible and interviewed women
• Age distribution of eligible and interviewed men
• Age displacement at age 14/15
• Age displacement at age 49/50
• Pregnancy outcomes by years preceding the survey
• Completeness of reporting
• Standardisation exercise results from anthropometry training
• Height and weight data completeness and quality for children
• Height measurements from random subsample of measured children
• Interference in height and weight measurements of children
• Interference in height and weight measurements of women and men
• Heaping in anthropometric measurements for children (digit preference)
• Observation of mosquito nets
• Observation of handwashing facility
• School attendance by single year of age
• Vaccination cards photographed
• Number of

Abstract

The 2022 Philippines National Demographic and Health Survey (NDHS) was implemented by the Philippine Statistics Authority (PSA). Data collection took place from May 2 to June 22, 2022.

The primary objective of the 2022 NDHS is to provide up-to-date estimates of basic demographic and health indicators. Specifically, the NDHS collected information on fertility, fertility preferences, family planning practices, childhood mortality, maternal and child health, nutrition, knowledge and attitudes regarding HIV/AIDS, violence against women, child discipline, early childhood development, and other health issues.

The information collected through the NDHS is intended to assist policymakers and program managers in designing and evaluating programs and strategies for improving the health of the country’s population. The 2022 NDHS also provides indicators anchored to the attainment of the Sustainable Development Goals (SDGs) and the new Philippine Development Plan for 2023 to 2028.

Geographic coverage

National coverage

Analysis unit

• Household
• Individual
• Children age 0-5
• Woman age 15-49

Universe

The survey covered all de jure household members (usual residents), all women aged 15-49, and all children aged 0-4 resident in the household.

Kind of data

Sample survey data [ssd]

Sampling procedure

The sampling scheme provides data representative of the country as a whole, for urban and rural areas separately, and for each of the country’s administrative regions. The sample selection methodology for the 2022 NDHS was based on a two-stage stratified sample design using the Master Sample Frame (MSF) designed and compiled by the PSA. The MSF was constructed based on the listing of households from the 2010 Census of Population and Housing and updated based on the listing of households from the 2015 Census of Population. The first stage involved a systematic selection of 1,247 primary sampling units (PSUs) distributed by province or HUC. A PSU can be a barangay, a portion of a large barangay, or two or more adjacent small barangays.

In the second stage, an equal take of either 22 or 29 sample housing units were selected from each sampled PSU using systematic random sampling. In situations where a housing unit contained one to three households, all households were interviewed. In the rare situation where a housing unit contained more than three households, no more than three households were interviewed. The survey interviewers were instructed to interview only the preselected housing units. No replacements and no changes of the preselected housing units were allowed in the implementing stage in order to prevent bias. Survey weights were calculated, added to the data file, and applied so that weighted results are representative estimates of indicators at the regional and national levels.

All women age 15–49 who were either usual residents of the selected households or visitors who stayed in the households the night before the survey were eligible to be interviewed. Among women eligible for an individual interview, one woman per household was selected for a module on women’s safety.

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

Mode of data collection

Computer Assisted Personal Interview [capi]

Research instrument

Two questionnaires were used for the 2022 NDHS: the Household Questionnaire and the Woman’s Questionnaire. The questionnaires, based on The DHS Program’s model questionnaires, were adapted to reflect the population and health issues relevant to the Philippines. Input was solicited from various stakeholders representing government agencies, academe, and international agencies. The survey protocol was reviewed by the ICF Institutional Review Board.

After all questionnaires were finalized in English, they were translated into six major languages: Tagalog, Cebuano, Ilocano, Bikol, Hiligaynon, and Waray. The Household and Woman’s Questionnaires were programmed into tablet computers to allow for computer-assisted personal interviewing (CAPI) for data collection purposes, with the capability to choose any of the languages for each questionnaire.

Cleaning operations

Processing the 2022 NDHS data began almost as soon as fieldwork started, and data security procedures were in place in accordance with confidentiality of information as provided by Philippine laws. As data collection was completed in each PSU or cluster, all electronic data files were transferred securely via SyncCloud to a server maintained by the PSA Central Office in Quezon City. These data files were registered and checked for inconsistencies, incompleteness, and outliers. The field teams were alerted to any inconsistencies and errors while still in the area of assignment. Timely generation of field check tables allowed for effective monitoring of fieldwork, including tracking questionnaire completion rates. Only the field teams, project managers, and NDHS supervisors in the provincial, regional, and central offices were given access to the CAPI system and the SyncCloud server.

A team of secondary editors in the PSA Central Office carried out secondary editing, which involved resolving inconsistencies and recoding “other” responses; the former was conducted during data collection, and the latter was conducted following the completion of the fieldwork. Data editing was performed using the CSPro software package. The secondary editing of the data was completed in August 2022. The final cleaning of the data set was carried out by data processing specialists from The DHS Program in September 2022.

Response rate

A total of 35,470 households were selected for the 2022 NDHS sample, of which 30,621 were found to be occupied. Of the occupied households, 30,372 were successfully interviewed, yielding a response rate of 99%. In the interviewed households, 28,379 women age 15–49 were identified as eligible for individual interviews. Interviews were completed with 27,821 women, yielding a response rate of 98%.

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 in 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 2022 Philippines National Demographic and Health Survey (2022 NDHS) 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 2022 NDHS 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 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 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 2022 NDHS sample was the result of a multistage stratified design, and, consequently, it was necessary to use more complex formulas. Sampling errors are computed in SAS using 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.

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 displacement at age 14/15
• Age displacement at age 49/50
• Pregnancy outcomes by years preceding the survey
• Completeness of reporting
• Observation of handwashing facility
• School attendance by single year of age
• Vaccination cards photographed
• Population pyramid
• Five-year mortality rates

See details of the data quality tables in Appendix C of the final report.

Abstract

The 2022 Kenya Demographic and Health Survey (2022 KDHS) was implemented by the Kenya National Bureau of Statistics (KNBS) in collaboration with the Ministry of Health (MoH) and other stakeholders. The survey is the 7th KDHS implemented in the country.

The primary objective of the 2022 KDHS is to provide up-to-date estimates of basic sociodemographic, nutrition and health indicators. Specifically, the 2022 KDHS collected information on: • Fertility levels and contraceptive prevalence • Childhood mortality • Maternal and child health • Early Childhood Development Index (ECDI) • Anthropometric measures for children, women, and men • Children’s nutrition • Woman’s dietary diversity • Knowledge and behaviour related to the transmission of HIV and other sexually transmitted diseases • Noncommunicable diseases and other health issues • Extent and pattern of gender-based violence • Female genital mutilation.

The information collected in the 2022 KDHS will assist policymakers and programme managers in monitoring, evaluating, and designing programmes and strategies for improving the health of Kenya’s population. The 2022 KDHS also provides indicators relevant to monitoring the Sustainable Development Goals (SDGs) for Kenya, as well as indicators relevant for monitoring national and subnational development agendas such as the Kenya Vision 2030, Medium Term Plans (MTPs), and County Integrated Development Plans (CIDPs).

Geographic coverage

National coverage

Analysis unit

• Household
• Individual
• Children age 0-5
• Woman age 15-49
• Man age 15-54

Universe

The survey covered all de jure household members (usual residents), all women aged 15-49, men ageed 15-54, and all children aged 0-4 resident in the household.

Kind of data

Sample survey data [ssd]

Sampling procedure

The sample for the 2022 KDHS was drawn from the Kenya Household Master Sample Frame (K-HMSF). This is the frame that KNBS currently uses to conduct household-based sample surveys in Kenya. The frame is based on the 2019 Kenya Population and Housing Census (KPHC) data, in which a total of 129,067 enumeration areas (EAs) were developed. Of these EAs, 10,000 were selected with probability proportional to size to create the K-HMSF. The 10,000 EAs were randomised into four equal subsamples. A survey can utilise a subsample or a combination of subsamples based on the sample size requirements. The 2022 KDHS sample was drawn from subsample one of the K-HMSF. The EAs were developed into clusters through a process of household listing and geo-referencing. The Constitution of Kenya 2010 established a devolved system of government in which Kenya is divided into 47 counties. To design the frame, each of the 47 counties in Kenya was stratified into rural and urban strata, which resulted in 92 strata since Nairobi City and Mombasa counties are purely urban.

The 2022 KDHS was designed to provide estimates at the national level, for rural and urban areas separately, and, for some indicators, at the county level. The sample size was computed at 42,300 households, with 25 households selected per cluster, which resulted in 1,692 clusters spread across the country, 1,026 clusters in rural areas, and 666 in urban areas. The sample was allocated to the different sampling strata using power allocation to enable comparability of county estimates.

The 2022 KDHS employed a two-stage stratified sample design where in the first stage, 1,692 clusters were selected from the K-HMSF using the Equal Probability Selection Method (EPSEM). The clusters were selected independently in each sampling stratum. Household listing was carried out in all the selected clusters, and the resulting list of households served as a sampling frame for the second stage of selection, where 25 households were selected from each cluster. However, after the household listing procedure, it was found that some clusters had fewer than 25 households; therefore, all households from these clusters were selected into the sample. This resulted in 42,022 households being sampled for the 2022 KDHS. Interviews were conducted only in the pre-selected households and clusters; no replacement of the preselected units was allowed during the survey data collection stages.

For further details on sample design, see APPENDIX A of the survey report.

Mode of data collection

Computer Assisted Personal Interview [capi]

Research instrument

Four questionnaires were used in the 2022 KDHS: Household Questionnaire, Woman’s Questionnaire, Man’s Questionnaire, and the Biomarker Questionnaire. The questionnaires, based on The DHS Program’s model questionnaires, were adapted to reflect the population and health issues relevant to Kenya. In addition, a self-administered Fieldworker Questionnaire was used to collect information about the survey’s fieldworkers.

Cleaning operations

CAPI was used during data collection. The devices used for CAPI were Android-based computer tablets programmed with a mobile version of CSPro. The CSPro software was developed jointly by the U.S. Census Bureau, Serpro S.A., and The DHS Program. Programming of questionnaires into the Android application was done by ICF, while configuration of tablets was completed by KNBS in collaboration with ICF. All fieldwork personnel were assigned usernames, and devices were password protected to ensure the integrity of the data.

Work was assigned by supervisors and shared via Bluetooth® to interviewers’ tablets. After completion, assigned work was shared with supervisors, who conducted initial data consistency checks and edits and then submitted data to the central servers hosted at KNBS via SyncCloud. Data were downloaded from the central servers and checked against the inventory of expected returns to account for all data collected in the field. SyncCloud was also used to generate field check tables to monitor progress and identify any errors, which were communicated back to the field teams for correction.

Secondary editing was done by members of the KNBS and ICF central office team, who resolved any errors that were not corrected by field teams during data collection. A CSPro batch editing tool was used for cleaning and tabulation during data analysis.

Response rate

A total of 42,022 households were selected for the survey, of which 38,731 (92%) were found to be occupied. Among the occupied households, 37,911 were successfully interviewed, yielding a response rate of 98%. The response rates for urban and rural households were 96% and 99%, respectively. In the interviewed households, 33,879 women age 15-49 were identified as eligible for individual interviews. Of these, 32,156 women were interviewed, yielding a response rate of 95%. The response rates among women selected for the full and short questionnaires were similar (95%). In the households selected for the men’s survey, 16,552 men age 15-54 were identified as eligible for individual interviews and 14,453 were successfully interviewed, yielding a response rate of 87%.

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 2022 Kenya Demographic and Health Survey (2022 KDHS) to minimise this type of error, non-sampling 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 2022 KDHS 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 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 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 2022 KDHS sample is the result of a multi-stage stratified design, and, consequently, it was necessary to use more complex formulae. The computer software used to calculate sampling errors for the 2022 KDHS is a SAS program. This program used the Taylor linearisation method for 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 report.

Data