Using the DHS Household and Women's Questionnaires to Measure Nutritional StatusTool Name: Using the DHS Household and Women's Questionnaires to Measure Nutritional Status Origin/Source: Demographic and Health Survey (DHS) Household and Woman's Questionnaires Technical Area: Maternal and Newborn Health Basic Description: The DHS Surveys are population-based surveys designed to collect good quality, nationally representative data on demographic and health indicators. The DHS Woman's Questionnaires provides data which allow the calculation of many maternal and newborn health indicators. These are described in the abstract that accompanies the DHS Woman's Questionnaire. This partial abstract highlights how the DHS Woman's Questionnaire can be used as a tool to measure indicators of nutritional status of women and children. Country Applications: International standards have been applied throughout the world. Language(s) Available: The tool is available in English, French, and Spanish. It has also been translated into local languages specific to the countries where it has been applied. Technical Scope/Purpose: The DHS utilizes the woman's questionnaire to secure the data needed for nationally representative indicators of the nutritional status of women and children. The internationally comparable data provides information for policy decisions and program planning and monitoring at regional, national and international levels. Design: The questionnaires are administered at the household level using a nationally representative sample of women 15- 49 years of age and children from birth to 59 months. In addition to the interviews, height and weight measurements, and anemia testing provide information on key indicators of maternal and newborn nutrition. Method: Quantitative Frequency of Administration: Usually every five years (from the previous survey in country) Depending on the country, interim surveys may be conducted. Key Users of the Information: Primary (regional and national government agencies, research and academic institutions). Secondary (international governments, donors and aid agencies, i.e., UNICEF, WHO, NGOs, and PVOs, and the private sector). Objectives and Scope of the Tool: See abstract for DHS Women's Questionnaire Key Indicators: The data collected via the DHS Woman's Questionnaire can be used to calculate nutrition indicators in the following areas: anthropometry, micronutrient supplementation/fortification, micronutrient deficiencies, and breast feeding/newborn feeding practices. The corresponding questionnaire and question numbers are indicated in parentheses; HH indicates Household Questionnaire and WQ Woman's Questionnaire. 1. Anthropometry Women: Short stature: Percentage of non-pregnant, non-lactating women aged 15-49 measuring less than 145 cm. Maternal height is a risk indicator for poor pregnancy outcomes, obstetrical complications, low birth weight, and perinatal, neonatal and infant mortality. (HH--Q# 36-43) Body Mass Index (BMI):Percentage of non-pregnant, non-lactating women with a BMI below 18.5 and percentage above 25.0. BMI is calculated as follows: weight (in kg)/height (in cm) 2, and is used as an indicator of underweight (< 18.5) and overweight (>25.0). Measurements between 18.5 and 25.0 are considered normal. (HH Q# 36-43) Newborns: (1) Prevalence of Low Birth Weight: Percentage of live births in the 3 (or 5) years preceding the survey weighing less than 2.5 kg at birth. Birth weight data are taken from the birth card (when available). Alternatively, the mother's perception of birth size (very small, small, average or larger than average) is used as a proxy. (WQ--Q# 423-425) Prevalence of Stunting: Percent of infants with length-for-age measurements below -2 or -3 standard deviations from the median of the International Reference Population. Stunting, the slowing of skeletal growth, results from extended periods of inadequate intake and/or increased morbidity. It is a measure of past or chronic nutritional status. (HH page 8) Prevalence of Underweight: Percent of infants with weight-for-age measurements below -2 or -3 standard deviations from the median of the International Reference Population. This is an index of acute malnutrition widely used to assess acute protein-energy malnutrition and over nutrition. This indicator is particularly useful during infancy when the measurement of length is difficult. The exact age of the child must be known. (HH page 8) Prevalence of Wasting:Percent of infants with weight-for-height measurements below -2 or -3 standard deviations from the median of the International Reference Population. Wasting is a sensitive index of current nutritional status fairly independent of age between one and ten years and is therefore useful in areas where ages of children are uncertain. It is useful in evaluation of the benefits of intervention programs, as it is more sensitive to changes in nutritional status than height-for-age. (HH page 8) 2. Micronutrient Supplementation/Fortification Women: Iron Supplementation: Percentage of women with a live birth in the 5 years preceding the survey who received iron supplements as part of their antenatal care. (WQ Q# 417) Iodine: Percentage of women who gave birth in the 5 years preceding the survey who live in households using adequately (>15 ppm) iodized salt. (HH Q# 35) Vitamin A Supplementation: Percentage of women who gave birth in the 5 years preceding the survey who received Vitamin A in the first two months after delivery. (WQ Q# 433) 3. Micronutrient Deficiency Women: Night Blindness: Percentage of women with a live birth in the 5 years preceding the survey who suffered night blindness during pregnancy. This indicator provides a proxy measurement of Vitamin A status during pregnancy. (WQ Q# 419-420) Anemia: Percentage of women ages 15-49 with mild, moderate, or severe anemia. (2) This indicator provides a measure of iron status. (HH Q# 44-49) 4. Breastfeeding/ Newborn Feeding Practices Timing of breastfeeding initiation:Percentage of children born in the five years preceding the survey who were breastfed within one hour of birth. (WQ Q# 440-441) Exclusive breastfeeding: Percentage of newborns/infants who are exclusively breastfeeding (3). (WQ Q# 445-452) Prelacteal feeds: Percentage of children born in the five years preceding the survey who received a prelacteal feed (4). (WQ Q#442-443) Tool Design: Population-based, household interview survey Implementation and Training: Training usually takes four to five days. Interviewers are recruited based on their educational attainment, maturity, their ability to spend one month in training and three months in the field, and their prior experience with surveys. Training consists of lectures on how to complete the questionnaire, mock and demonstration interviews, and practice interviews in the field. In addition, a team consisting of members with some medical background is trained on anthropometric data collection and anemia testing. Manuals and Guidelines: Training Guidelines for DHS Surveys Interviewer's Training Manual for Use with Model A/B Questionnaire "How to weigh and measure children: Assessing the nutritional status of young children in household surveys", United Nations Department of Technical Cooperation for Development and Statistical Office, New York, 1986. Supervisor's and Editor's Manual Data Processing Guidelines Guidelines for MEASURE/DHS+ Main Survey Report Data Processing and Analysis: Field editors check questionnaires at the end of each day. After field editing questionnaires 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 prepared in the country. The final report is prepared by the local implementing institution according to the "Guidelines for MEASURE/DHS+ Main Survey Report" with technical assistance provided by MACRO International. The report is released and disseminated by local authorities and a national seminar is organized with the purpose of releasing the report after which the survey files become public domain. In addition to the main survey report, a series of materials is produced to highlight the nutrition results. These include: Nutrition Chart Books--graphs of key indicators for presentation/dissemination Nutrition Wall Charts--Posters that include graphs and summaries of key findings Brochures--Graphs and summaries of key findings for more widespread dissemination Cost: With the proper equipment, the costs of adding a nutrition component to an existing survey are minimal dependent upon the design and sample size. Lessons from Experience: See abstract for DHS Woman's Questionnaire Contact Person: Altrena Mukuria, email: amukuria@macroint 1. Data for calculating prevalence of stunting, underweight, and wasting are collected for all children 0-59 months of age. However due to methodological limitations, these indicators cannot be stratified beyond 6-month age intervals. These indicators are therefore calculated for all infants less than 6 months of age, not just newborns. 2. Mild anemia is defined as hemoglobin values between 10.0 and 10.9 g/dl; moderate anemia as 7.0-9.9 g/dl; and severe anemia as < 7.0 g/dl. 3. Data on breastfeeding practices are collected for the youngest child under three years of age. Due to sample size limitations data cannot be stratified beyond 2-month age intervals. This indicator is therefore reported as the percentage of infants under 2 months who are exclusively breastfed to approximate exclusive breastfeeding rates among newborns. 4. Prelacteal feeds include anything other than breastmilk during the first three days of life before the mother started breastfeeding regularly. The sample size limitation described for exclusive breastfeeding also applies for this indicator. |