Demographic and Health Survey: Women's Questionnaire

Name: Demographic and Health Survey (DHS) Woman's Questionnaire

Origin/Source: The Demographic and Health Survey is part of the MeasureDHS+ project. DHS is a worldwide survey program involving many agencies and organizations. Depending on the country, the survey is implemented though a collaborative effort of local institutions such as the Ministry of Health, National Statistics Office, and other local agencies/institutions/organizations. Technical assistance is provided by MACRO International.

Technical Area: Maternal and Newborn Health

Tool 1
DHS Web site

Basic Description: The DHS woman's questionnaire is designed to collect countrywide information through individual interviews with women of reproductive age (15-49 years old) at the household level. The questionnaire consists of different modules. Among others, it obtains information on the following:

• levels and trends of fertility
• family planning knowledge and use
• maternal health care including antenatal, delivery and postnatal care
• maternal nutritional status and anemia status
• knowledge of HIV/AIDS related practices
• perinatal, neonatal and childhood mortality
• maternal mortality.

Country Applications:

Asia

Latin America/Caribbean

Near East/North Africa

Sub-Saharan Africa

Languages Available: English, French and Spanish

Purpose: Assessment and Monitoring

Technical Scope/Purpose: DHS employs the woman's questionnaire to assess the overall demographic and health situation in the country and to provide reliable and up-to-date data on health of women and children as the basis for informed policy decisions and planning and monitoring of programs at both national and local government levels. With specific regard to maternal and newborn health, it collects information on knowledge, attitudes, and practices of women of reproductive age, as well as maternal and newborn morbidity and mortality.

Design: The questionnaire is to be administered in a cross-sectional household survey using a nationally representative sample of women age 15-49 years old. The fieldwork usually lasts for 3 to 5 months and the final report is published about a year after the start of the survey.

Method: Quantitative

Frequency of Administration: Depends on the country. Usually four to five years from the original survey.

Key Users of the Information:

Primary Users: Governments, particularly Ministries of Health and Social Sector, as well as National Statistics Offices.

Secondary Users: USAID Missions, Cooperating Agencies and other international donors (WHO, UNICEF, UNFPA, WB), as well as private sector, including NGOs and PVOs.

Objectives and Scope of the Tool

General Objectives:

• Assess the overall demographic and health situation in the country,
• Assist in the evaluation of the population and health programs, and
• Advance survey methodology

Specific Objectives:

Provide up-to-date and reliable information on:

Nuptiality;

Fertility preferences, levels, and trends;

Knowledge and use of family planning and HIV/AIDS and STD safe practices;

Breastfeeding practices;

Nutritional status of women and children;

Women and child health status and utilization of health services;

Childhood and maternal mortality.

Key Maternal and Newborn Health Indicators:

1. Total fertility rate: total number of children a woman would have by the end of her reproductive period if she experienced the currently prevailing age-specific fertility rates throughout childbearing life.
2. Contraceptive prevalence rate: percentage of women of reproductive age who are using (or whose partner is using) a contraceptive method at a particular point in time.
3. Maternal mortality ratio: annual number of maternal deaths per 100,000 live births.
4. Antenatal care coverage: Percentage of women attended, at least once during pregnancy, by skilled health personnel (excluding trained or untrained traditional birth attendants) for reasons relating to pregnancy. (a) percent distribution of births in the five years preceding the survey by source of antenatal care (type of health care provider); (b) percentage of live births in the five years preceding the survey by number of antenatal care visits, and by the stage of pregnancy at the time of the first visit; (c) percent distribution of live births in the five years preceding the survey for which mothers received antenatal care, by content of antenatal care.
5. Delivery care: Percentage of births attended by skilled health personnel (excluding trained or untrained traditional birth attendants) (a) percentage of live births in the five years preceding the survey by place of delivery and type of health provider during delivery, and (b) percentage of live births by cesarean sections. (women's report)
6. Postnatal care: percentage of live births in the five years preceding the survey for which mothers received postnatal care by place of care, type of health care provider, and time of care (days after delivery).
7. Perinatal mortality rate: number of perinatal deaths per 1000 total births.
8. Neonatal Mortality: number of neonatal deaths per 1000 live births.
9. Low birth weight prevalence: percentage of live births that weigh less than 2500 g.
10. Prevalence of anemia in women: percentage of women of reproductive age (15-49) screened for hemoglobin levels with moderate-to-severe anemia.
11. Knowledge of HIV-related prevention practices: the percentage of women of reproductive age who correctly identify valid ways (one, two or more) to prevent the sexual transmission of HIV/AIDS.

Tool Design

• The woman's questionnaire consists of several modules and requires that the women of reproductive age (15-49) report on several health, nutrition and lifestyle issues.
• The DHS survey is conducted in a national statistically representative sample of households and gathers information from eligible respondents, i.e. the women within a 15-49 years of age.
• It requires active participation of the health, social and statistical institutions in the country.
• External technical assistance is provided during survey design, sampling, training, for monitoring quality of fieldwork, assistance during data processing and report writing.
• Fieldwork requires 3-5 months to be completed.

Implementation and Training

Training for the main survey takes usually four to five weeks. Recruitment criteria for the trainees include educational attainment, maturity, ability to spend one month in training and at least three months in the field, and experience in other surveys. Training should take place in a central location. Initially, training consists of lectures on how to complete questionnaires, with mock and demonstration interviews. Participants spend several days practicing interviewing in urban and rural areas. Trainees with the best performance are selected as supervisors and field editors. In this case, they receive an additional two to three day training.

Usually each survey field team is composed of 1 male supervisor, 1 female field editor, and 5 female interviewers. In order to monitor quality of the data collection, a number of quality control teams are set up by the implementing organization to check on the field teams.

Manuals and Guidelines

• Training Guidelines for DHS Surveys
• Interviewer's Training Manual for Use with Model A/B Questionnaire
• Supervisor's and Editor's Manual
• Guidelines for the DHS III Men's Survey
• Data processing Guidelines
• Guidelines for MEASURE/DHS+ Main Survey Report

Data Processing and Analysis

Questionnaires are checked by field editors at the end of each day. After field editing they are returned to the main survey office for data processing. The processing operation consists of office editing, coding of open-ended questions, data entry, and editing inconsistencies found by the computer programs. The DHS data entry and editing

programs are written in ISSA (Integrated System for Survey Analysis) or CSPro.

Reporting and Dissemination of Results

• A preliminary survey report is done in the country. The preparation of the final report is the responsibility of the local implementing institutions but is usually completed with the technical assistance and in the offices of MACRO International. MACRO has prepared a manual "Guidelines for MEASURE/DHS+ Main Survey Report" that helps in report writing.
• The final official survey report is in English, French, or Spanish depending on the region of the country, and sometimes in local languages as well. The report is released and disseminated by the local authorities, usually by the Ministry of Health and Statistics Office. A national seminar is organized with donors and agencies (local and international) with the purpose of officially releasing the report. Once the final report is released, survey files become public domain. They also serve for further analysis in the future.

Lessons from Experience

Interviewers: For the effectiveness of the survey, interviewers should have experience with household surveys. Additionally, they should speak and write the main language of the country as well as the local language of the region where they are conducting the interview. The interviewers should also be prepared and willing to spend one month in training and three to four months in the field.

Time Requirements: The survey needs between 18-24 months to be completed depending on the country and sample size.

Contact Person/Agency
DHS/MEASURE+
MACRO International, Inc.
11785 Beltsville Drive
Calverton, MD 207005
(301) 572 0200