The DHS Program Demographic and Health surveys · (DHS-7, 2013−2019) ... Sayana Press,...

© ICF/Hanna Useem

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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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ICF

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Topics for discussion

2020-21 Myanmar Demographic and Health Survey DHS–8 Questionnaires update Survey instruments Tentative timeline

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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 MDHS 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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2007 Min Z

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ourtesy of Photoshare

The MDHS sample will be representative at

• The national level

• For urban and rural areas

• The region and state level _________________________

- With the TFR at 2.3 and U5MR at 50 there is a need to increase the sample size

- Found fewer that expected number of women (13,454 as opposed to 16,829)

- Increase sample size from 13,238 HH to 16,650 HH

- Number of clusters from 442 to 555

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DHS Sample - Myanmar

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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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DHS 8 Questionnaire updates

Process from January 2019 – September 2019

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• Questionnaires reflect CAPI

• Pregnancy history

• Prompted questions on contraceptive use

• Marriage certificate

• Reduced HIV content

• Stillbirth included on ANC, delivery, PNC

• Coverage of nutrition intervention, dietary recall for women

• Photographs taken for vaccination cards

DHS 8 - Core Questionnaires

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New Topics • Breast and cervical

cancer screening • alcohol use • household questions

on cook stoves • energy source for

lighting, cooking, heating

DHS 8 - Core Questionnaires

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14 1

[CELLREF] 137

86

[CELLREF]

32 35

[CELLREF]

Additions Deletions % new Additions Deletions % new Additions Deletions % new

Legacy New

14%

Additions and deletions, DHS-7 to DHS-8


15%

25%

Household Woman’s Man’s

80

491

228

799

93

542

225

860

13 51

-3

61

Household Woman's Man's All 3

DHS-7 DHS-8 Net change


Net change in length of DHS Questionnaires from DHS-7 to DHS-8

73

337

156

566

80

491

228

799

93

542

225

860

Household Woman's Man's All 3

MDHS2015-16 DHS-7 DHS-8 Net change


Net change in length of DHS Questionnaires from DHS-7 to DHS-8

39

23 18

15 12 11 11

4 3 1

0 4

1

21

0 0

8

37

1 0

13

1

Nutrition MNH Birthhistory

Othertopics

Gender FP HIV Vaccination WASH Malaria Childhealth

Additions Deletions

12 are filters


Added and deleted questions in the Woman’s Questionnaire, by topic

Nutrition 35

MNH 22

Other topics

15 Gender 12 FP

3 Vaccination 3

WASH 3

Child health

-1 Birth

history -3 Malaria

-12

HIV -26

12 are filters


Net changes in the Woman’s Questionnaire by topic


– Non-live births can now be accounted for in postpartum insusceptibility

• Directed questions on use of various methods of family planning:

– sterilization, Sayana Press, coitus-dependent methods, emergency contraception, use of contraception at last sex

• Counseling on method switching

• Expanded list of reasons for non-use

• Expanded list of sources for messages about family planning

• Age at menarche

• Breast and cervical cancer screening


Family planning/Reproductive health

• More questions on contraceptive decision making.

– More detail on joint decision making; questions are asked of more respondents now (all women in union)

• Marriage certificates/marriage registration

• Duration of current union (for women married more than once)

• Who fetches water for the household

• Woman’s use of a bank account for deposits/withdrawals

• Men: Did your father ever beat your mother?


Gender and women’s empowerment

• Deletion of behavioral questions that mapped to retired indicators

• Knowledge of antiretroviral treatment and PrEP

• Expanded questions on testing behavior

– Number of lifetime HIV tests

– Changed measurement of time since last test (now ask for date)

• Men: new questions allow for men to be both traditionally and medically circumcised

• Self-reported HIV status and treatment

– Time since diagnosis for PLHIV

– Experience of stigma for PLHIV


HIV

• If a household owned a net that no one slept under on the night before the survey, we ask why no one slept under that net

• Mother’s report of malaria diagnosis for children

• New optional modules for commonly added questions:

– Prevalence of fever in the population

– SBCC questions for malaria


Malaria


– Total overhaul of Section 4

– Stillbirths now included in the ANC and delivery questions

• Reference period reduced from 5 to 3 years

• Respectful maternity care

• Expanded questions on content of ANC

• Timing of initiation of postnatal skin-to-skin contact

• Content of postnatal care for women

• Revisions of some question wording – to improve consistency with MICS, or internal consistency


Maternal, newborn & child health

• New questions on coverage of nutrition interventions

– Counseling on nutrition during pregnancy – Counseling on breastfeeding during ANC – Receipt of food or cash assistance during pregnancy – Counseling on infant feeding – Growth monitoring for children

• Source of iron-containing supplements for women during ANC

• Revision in iron supplementation for children to better capture multiple-micronutrient powder

• Expanded questions on child feeding – Sweetened beverages – Unhealthy foods

• Minimum dietary diversity for women

• Anthropometry – whether hairstyle or heavy clothing interfered with height and weight measurement

• Food insecurity experience scale (FIES) as an optional module (SDG) 12/6/2019 FOOTER GOES HERE 20

Nutrition

• Date of birth written on the vaccination card

• Photographs to be taken of vaccination cards

• Hepatitis B at birth: split one question into two (Yes/No; <24 hours)

• Usual source for vaccination


Vaccination

• 3 questions on emptying of septic tanks

• 2 questions on menstrual hygiene


Water, sanitation & hygiene

• Expanded questions on cook stoves (SDG)

• Expanded questions on household energy use (SDG) – Sources of energy for cooking, lighting, and space

heating

• Expanded questions on migration

• Self-reported health status

• Distance to closest health facility

• Alcohol use

• Mobile banking (SDG)

• Measurement of early childhood education down to age 4


Other topics

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

Additional modules included

• Domestic Violence

• Adult and Maternal Mortality

• MICS module- Early childhood development

• MICS module- Child discipline

• MUAC – UNICEF recommendation

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MDHS Questionnaire Modules included in 2015-16 MDHS

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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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• For household members: − Age, sex, residence − Head of household and

relationship to the head − Education for all; schooling

for children

• Assets, land ownership, housing characteristics

• Sanitation, water, and other environmental health issues

Household Questionnaire

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Emptying of septic tanks

• assessing the proportion of the population using safely managed sanitation services (SDG indicator 6.2.1) and is also comparable with MICS

Reliability of water source • The new version of the question

contributes to SDG indicator 6.1.1 and is also comparable with MICS. Assets, land ownership, housing characteristics

Household Questionnaire - New

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Reliance on clean fuel energy

• Required for SDG 7.1.2: Proportion of population with reliance on clean fuels and technologies

Mobile money • Household member using mobile for

transaction (SDG).

Household Questionnaire - New

In both woman’s and man’s questionnaires:

• Socio-demographic characteristics

• Number of children

• Contraception

• Marriage and sexual behavior

• Fertility preferences

• STIs and HIV/AIDS, knowledge, attitudes & behavior

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Individual Questionnaire

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• Section 1: sleeping away from home

• Section 7: Partner history - deleted first/last sex with this partner, # times had sex with this partner, age of partner, # partners in past 12 months. Transactional sex, paid sex (men).

– Kept: relationship to partner for last 3 partners, condom use at last sex with last 3 partners. Can still get 2+ partners in past 12 months.

• Section 10:

– Heard of HIV or AIDS now an opt-out question.

– Cut HIV transmitted by witchcraft question. New UNAIDS indicator changed from rejects “two most common local misconceptions” to rejects mosquito bites and sharing food. Restricted to ages 15-24!

– Cut knowledge of MTCT, HIV counseling in ANC, posttest counseling, “offered a test” in ANC and labor.

– Cut 4 questions on enacted stigma (talk badly, hesitate to take HIV test)

– Kept: fresh vegetables, children go to school for UNAIDS indicator

• Section 11: Cut injection safety

HIV section Deletions!


Only in woman’s questionnaires

• Fertility: Pregnancy history; 5-year calendar

• Infant and child mortality • Maternal health: ANC,

delivery, postpartum care

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Individual Questionnaire

• Child nutrition, including breastfeeding

• Immunization and childhood illness

• Women’s dietary diversity

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IYCF – new indicator on sweet beverages

• IYCF Liquid and food questions separated

• Sodas/malts/energy (new) + Chocolate drinks (new) + Drink sweetened (new) + Juice/juice drinks

• Adaptation: category "soy milk and nut milks" must be added in countries where these items are consumed.

New unhealthy eating indicator - Sweet foods as chocolates,

candies, pastries, cakes, biscuits etc.

- Chips, crisps, puffs, French fries etc.

Minimum dietary diversity for women (healthy and unhealth) – similar to child drink and food questions

• Q418e. Coverage of breastfeeding counseling during antenatal care

• Q418f. Coverage of nutritional counseling during antenatal care

• Q427. Source for iron-containing supplements taken during pregnancy

• Q430. Cash-assistance programs for pregnant women

– Adaptation for name of program, (delete if no wide-scale program)

• Q605. Modified iron for children (12 months instead of 7 days) and ask separately about iron vehicle

• Q607. Coverage of growth monitoring for children

– Adapt wording of MUAC (or remove) as necessary

• Q641. Coverage of nutrition counseling for youngest child

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Maternal and child nutrition interventions

• For children under age 5, women, and men: − Nutritional status (height

and weight) − Anemia test − Other biomarkers

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Biomarker Questionnaire

Chronic conditions

• Blood pressure

• Diabetes

• Lipids

STIs

• Chlamydia

• Hepatitis B

• Hepatitis C

• Herpes

• Syphilis

HIV testing

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Other Biomarkers

Nutrition

• Iodine (salt and urine test)

• Iron

• Lead

• Vitamin A

Antibodies/immunity

• Measles

• Tetanus

Water testing

• Arsenic, chlorine, E.coli

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MDHS Timeline - milestones Activities Tentative dates Remarks

LOPA/MOU Jan-Feb 2020 Determine parties

Consultative meetings Jan – Mar 2020 Before the questionnaire design

Supplies shipment Mar 2020 Import permit takes time

Questionnaire design Mar 2020

Sample design Feb-Mar 2020 Interim census 2019 updated frame

Household Listing April – June 2020 Option of using census list

CAPI programming May – June 2020

Pretest/TOT July 2020

Main training Nov-Dec 2020

Fieldwork Dec 2020 – Mar 2021 Elections

Key indicators report June 2021

Report writing workshop August 2021

National seminar November 2021

Subnational dissemination December 2021

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The DHS Program Demographic and Health surveys · (DHS-7, 2013−2019) ... Sayana Press,...

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