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The DHS Program Demographic and Health surveys

A Project Funded by The United States Agency for International Development and Implemented by ICF

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A project that provides, at the global level, assistance to developing countries in the areas of

Collection and use of data

to monitor and evaluate population, health, and nutrition programs

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What is The DHS Program?

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• Collect high-quality data for policy formulation, program planning, and monitoring and evaluation

• Foster and reinforce host-country ownership of data collection, analysis, presentation, and use

• Increase the capacity of host-country partners to collect and use data for policy and program purposes

Specific DHS objectives

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The DHS started in 1984:

• DHS-I (DHS-1, 1984−1989) • DHS-II (DHS-2, 1989−1993) • DHS-III (DHS-3, 1992−1997) • MEASURE DHS+

(DHS-4, 1997−2003) • MEASURE DHS

(DHS-5, 2003−2008) • MEASURE DHS Phase III

(DHS-6, 2008−2014) • The DHS Program

(DHS-7, 2013−2019) • The DHS Program

(DHS-8, 2018−2023)

DHS history

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Demographic and Health Survey (DHS): National survey that includes fertility, mortality, family planning, maternal and child health, nutrition, HIV/AIDS, and other health indicators. Malaria Indicator Survey (MIS): Indicators include mosquito net ownership and use, IPTp, prevalence and treatment of fever in children; can include testing for malaria and/or anemia; shorter than full DHS to allow for more frequent monitoring. Service Provision Assessment (SPA) Survey: Survey of health facilities, providers, and clients; indicators include service infrastructure, service availability at facilities and providers’ practices toward clients.

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Surveys in The DHS Program

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• Generates data that are comparable across countries and over time

• Reinforces the institutional capacities within participating countries

• Develops new procedures and methodologies

• Improves access to data for dissemination and further analysis

Main Characteristics of the DHS

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• Cross-sectional, nationally representative sample of households

−Women and men interviewed in sample households −Standard sample size: 3,000−100,000+ households

(India is exception)

• Standardized sample design, questionnaires, and implementation procedures

−Key indicators measured with the same approach over time

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Basics of the DHS

The DHS sample is typically representative at

• The national level

• For urban and rural areas

• The regional level (sometimes groups of regions)

• Some surveys are representative at the state/provincial, or district level.

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DHS Sample

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‘Core’ questionnaires • Core set of questions in each

type of questionnaire implemented in every country

• Revised and updated every 5 years

• Provide trends in key indicators

• Allow cross-country comparisons

• Country needs met through country-specific questions

DHS Core Questionnaires

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Standard DHS surveys generally include a:

• Household questionnaire • Woman’s questionnaire • Man’s questionnaire • Biomarker questionnaire • Fieldworker questionnaire

Types of DHS Questionnaires

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Additional Modules

• Domestic Violence

• Female Genital Cutting

• Adult and Maternal Mortality

• Fistula

• Out-of-pocket Health Expenditures

• Disability

• Non-communicable Diseases

• Newborn Care

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DHS Questionnaire Modules

Chronic conditions

• Blood pressure

• Diabetes

• Lipids

STIs

• Chlamydia

• Hepatitis B

• Hepatitis C

• Herpes

• Syphilis

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Biomarkers Nutrition

• Anemia

• Anthropometry

• Iodine (salt and urine test)

• Iron

• Lead

• Vitamin A

Antibodies/immunity

• Measles

• Tetanus

Water testing

• Arsenic, chlorine, E.coli

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• Generates data that are comparable across countries and over time

• Reinforces the institutional capacities within participating countries

• Develops new procedures and methodologies

• Improves access to data for dissemination and further analysis

Main Characteristics of the DHS

The CAPACITY ASSESSMENT TOOL (CAT) has been designed to evaluate an implementing organization’s capacity and readiness to implement DHS surveys

Data collected via:

• Self assessment

• Assessment of implementing agency by its partners

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Capacity Assessment

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CAT Modules: Skills Assessed • Survey planning and management

• Sampling

• Questionnaire design and testing

• Field staffing and training

• Field operations

• Data processing

• Laboratory testing

• Report writing

• GIS

• Data analysis

• Data dissemination

• Overall institutional capacity of the organization

• Close collaboration with implementing agencies and partners throughout survey design and implementation for on-the-job skills transfer

• Workshops on data analysis, data processing, report writing, data use for decision making, and more

• Distance learning and online tools

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DHS Strengthens Capacity Through:

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• www.globalhealthlearning.org − Register for free and then find the course called “Demographic and

Health Surveys” • 2-hour course on DHS topics, survey structure, basic terminology, and

how to use DHS data for decisionmaking • 1,000 learners per year complete the DHS e-Learning course

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Introductory E-Learning Course

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Social Media and Data Visualization e-Learning Courses

Globalhealthlearning.org

– Key Findings

– Topical interviews

– Tutorials on use of datasets, sampling and weighting, key indicators, and much more

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Youtube.com/dhsprogram

• Generates data that are comparable across countries and over time

• Reinforces the institutional capacities within participating countries

• Develops new procedures and methodologies

• Improves access to data for dissemination and further analysis

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Main Characteristics of the DHS

In collaboration with the World Bank, The DHS Program developed a wealth index that uses household asset information from DHS surveys to calculate the relative wealth of households. The wealth index allows for an analysis of the effect of wealth on health.

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Measurement of Poverty

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As the result of the implementation of Geographic Information Systems (GIS), DHS data can now be linked with a number of databases (climatic, agricultural, road network, etc.), allowing for mapping of indicators across regions and countries.

The Spatial Data Repository (spatialdata.dhsprogram.com) warehouses GIS data and provides tutorials for use.

Collection and Analysis of Geographic Data

Computer Assisted Personal Interviewing (CAPI):

Tablets are now used to collect data in the field in some countries

• Advantages: − Built-in quality control − Field work is faster − Less time needed for data entry and editing;

analysis comes faster

• Limitations: − Need for regular power source to charge batteries daily − Field work protocol needs to be adjusted − More technical assistance needed

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Technological Advances in Data Collection

Nutrition Data Quality

• Biomarker Checklist to assess the performance

• The DHS Program has developed a program to automatically calculate anthropometry Z-scores and flag extreme cases in the CAPI system. A user-friendly interface on the tablet produces a report with the children who need to be re-measured (The range for flagged z-scores is < -3 SD or > 3 SD based the WHO Child Growth Standards

reference population).

• A random re-measurement of height and weight in a subsample of children was also piloted in Nigeria

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• Generates data that are comparable across countries and over time

• Reinforces the institutional capacities within participating countries

• Develops new procedures and methodologies

• Improves access to data for dissemination and further analysis

Main Characteristics of the DHS

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Dissemination and use activities: • Print materials (Final Report, Key

Indicators Report, Key Findings report, factsheets)

• Survey datasets

• National seminar PowerPoint presentations

• Journalist workshop

• Data to action

• TOT for subnational dissemination

• Further analysis of DHS results

• Data use seminars and workshops Web

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Data Dissemination and Use

The DHS mobile app: Put DHS data at your fingertips!

Make your own charts, graphs, and data tables at STATcompiler.com

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Digital Dissemination

userforum.DHSProgram.com

• A web-based forum to ask and discuss DHS-related questions with the larger user community.

• Get help with analysis, data use, and more from other data users

• Help others!!

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User Forum

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Social Media

Facebook: @DHSProgram Twitter: @DHSProgram

YouTube: @DHSProgram

LinkedIn: @DHS-program

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A behind-the-scenes look at the work at DHS, new activities, staff, and fun commentary

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Blog.dhsprogram.com

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DHSprogram.com

Email us at: info@dhsprogram.com