27 May 2020

Service Provision Assessments Shed Light on Health Facility Readiness to Control COVID-19

Are facilities prepared to face infectious disease pandemics like COVID-19? A new fact sheet explores infection control and readiness in health facilities from seven Service Provision Assessments (SPA) conducted in Afghanistan, Bangladesh, the Democratic Republic of Congo, Haiti, Nepal, Senegal, and Tanzania. The SPA collects information on the availability of different health services in a country and facilities’ readiness to provide those services.

  • In six out of seven countries, fewer than 75% of facilities have soap and running water or alcohol-based disinfectant for handwashing. Senegal is the exception, where 95% of health facilities in Senegal have these resources for handwashing.
  • Availability of personal protective equipment (PPE) such as latex gloves, medical masks, and gowns varies. In Nepal, latex gloves are available in 80% of facilities, while only 19% have medical masks and 9% have gowns. In the Democratic Republic of Congo, gowns (83%) and latex gloves (75%) are more common than medical masks (14%).
  • In Haiti, only 17% of facilities have appropriate storage of infectious waste, and fewer than half of facilities have safe final disposal of infectious waste. In Tanzania, 44% of facilities have appropriate storage of infectious waste, while 36% have safe final disposal of infectious waste.
  • Fewer than 1 in 4 facilities in five countries offer in-patient care. Few facilities have oxygen.
  • Most facilities have a thermometer and stethoscope. In Bangladesh, 86% of facilities have a thermometer and 94% have a stethoscope.

Explore indicators on infection prevention, PPE, diagnostic capacity, and newly tabulated indicators on therapeutic readiness in the new fact sheet.

Access SPA survey final reports here.


Featured Image © YoPho, stock.adobe.com

14 May 2020

Collecting Quality Anthropometric Data in The DHS Program

The DHS Program has been a leading source of anthropometric (height and weight) data for more than 30 years. Measurements are collected from children, women, and men in some surveys. This information enables countries to make data-driven decisions and to monitor their progress in improving nutritional status and achieving the Sustainable Development Goals.

The DHS Program continually improves anthropometric data collection processes. In 2018, The DHS Program undertook a qualitative study to identify how to further enhance the quality of anthropometry data. The findings prompted several tools and processes to be tested in the field in Nigeria, including biomarker checklists and anthropometry remeasurement, which have now become standard practice.

Here are some examples of how The DHS Program supports countries to collect quality anthropometric data.

Designing surveys that incorporate best practices for collecting anthropometric data

To increase knowledge and enhance capacity of countries to implement DHS surveys, The DHS Program provides technical assistance on anthropometric data collection. An anthropometry brochure summarizes the key inputs needed to collect quality anthropometric data. It is based on the recently released WHO-UNICEF guidelines for anthropometric data collection.  

Training fieldworkers to take precise and accurate measurements

DHS Program staff participate in an in-house standardization exercise to become gold standard measurers. © 2019 Valene Bia, ICF

DHS anthropometry trainings are interactive, including standardization exercises. Trainees take two separate measurements of multiple children which are compared to those of a gold standard measurer. Staff at The DHS Program, consultants, and in-country trainers have been certified as gold standard measurers. These data are entered into the DHS Anthropometry Standardization Tool to identify trainees who need re-training and re-standardization.

Monitoring and improving anthropometric data in real-time

During data collection, field check tables are run, summarizing recently collected data that reflect team performance. If problems are discovered, feedback is provided to data collection supervisors. The DHS Anthropometry Field Check Tables are based on years of experience and analytical studies.

The DHS Program has also implemented new height and weight re-measurement procedures, in which repeat measurements are taken for a random set of children and from children with an unusual first measurement. During field work, the Computer-Assisted Personal Interviewing (CAPI) system produces a report on children selected for remeasurement. This provides information on overall anthropometry data quality and reduces the number of incorrect measurements.

Conducting data entry in the field. © ICF

Communicating quality of anthropometric data to users

Information on anthropometric data collection and quality helps users have confidence in the results and make correct inferences when comparing estimates over time and across countries. Recent DHS survey final reports provide a summary of anthropometric data quality in addition to documentation on survey implementation. For more in-depth information on data quality, DHS datasets can be inputted into the WHO Anthro Survey Analyser.

Data quality procedures lead to high quality anthropometry data for children in Nigeria
97% of trainees passed the standardization exercise
Nearly all trainees passed the standardization accuracy and precision criteria.
Only 2% of random remeasurement cases had a height difference > 1 cm
Data collectors’ precision for height measurements was high.
< 1% of data were implausible for each anthropometric index
This meets the WHO-UNICEF data quality criteria of < 1% implausible values based on WHO Growth Standards.
< 1% missing data for month and year of birth
Completeness of date of birth data was high.
< 3% missing data for height and weight measurements
There does not appear to be selection bias in height and weight data collection.

Data quality is an iterative process. As The DHS Program continues to learn, further enhancements and innovations will be implemented to ensure quality anthropometric data.

Featured image: © 2018 Arturo Sanabria, Courtesy of Photoshare

29 Apr 2020

World Immunization Week 2020

World Immunization Week is observed annually in the last week of April (April 24-30, 2020), to promote the use of vaccines to protect people of all ages against disease. Already, nearly 20 million children in the world are unvaccinated and under-vaccinated. Now, COVID-19 is disrupting the delivery of routine vaccines in low- and middle-income countries. This year’s theme for World Immunization Week, #VaccinesWork for All, highlights the heroes who develop, deliver, and receive vaccines to protect the health of everyone, everywhere.

The DHS Program has collected immunization data for over 30 years and has dozens of vaccination indicators available for 90+ countries on STATcompiler. Use STATcompiler to explore a map of basic vaccination coverage among children age 12-23 months in 47 countries. Or explore vaccination rates by background characteristics, such as wealth quintile.

Sustainable Development Goal (SDG) 3 aims to ensure healthy lives and promote well-being for all at all ages. Coverage of the diphtheria-pertussis-tetanus vaccine (the percent of children age 12-23 months who have received the third dose of the vaccine) is one DHS survey indicator that tracks countries’ progress towards achieving SDG 3. Learn about coverage of the DPT 3 vaccination and all eight basic vaccinations from five recent DHS surveys in the infographic below.

Share this infographic on Facebook and Twitter, and don’t forget to tag #VaccinesWork to engage with others in this global conversation!

Featured image: Courtesy of the World Health Organization

22 Apr 2020

New on the Learning Hub: Interpreting Malaria Trends eLearning Course

In honor of World Malaria Day, The DHS Program introduces a new open-access online course, Interpreting Trends in Malaria Indicators. The course is available on The DHS Program’s new online learning platform, the Learning Hub.

Based on an in-person Malaria Indicator Trends Workshop developed by The DHS Program in 2017, this free, self-guided course takes 2-3 hours to complete. This course is designed for malaria data users, such as professionals from National Malarial Control Programs, Ministries of Health, implementing and collaborating agencies, donor agencies, and anyone who works in malaria programming or is interested in malaria data.

The purpose of this course is to increase the capacity of participants to understand and interpret trends in malaria indicators from population-based household surveys to answer key malaria programmatic questions.

In Interpreting Trends in Malaria Indicators, participants will learn:

  • Sampling and weighting techniques used by The DHS Program
  • How sampling errors are displayed in DHS final reports
  • To accurately interpret a malaria case study for programmatic decision making
  • To generate graphics of malaria trends using Excel

To take this course, create an account on The DHS Program Learning Hub. It’s free; just choose a username and password. Then register for the course and start learning!

This new course on malaria trends complements existing malaria resources offered by The DHS Program, including another free, self-guided course, Measuring Malaria through Household Surveys, available on the Global Health eLearning Center platform in English and French. Measuring Malaria takes 2-3 hours to complete and provides an overview of key malaria indicators collected through household surveys. Since Measuring Malaria covers data collection, calculation, and interpretation of key malaria indicators, taking it first can lay a strong foundation before taking Interpreting Trends in Malaria Indicators.

For World Malaria Day, explore malaria indicators using The DHS Program’s malaria mini-tool and read the newly revised Malaria Indicator Survey questionnaires. Or use STATcompiler to visualize key malaria indicators globally such as household ownership and use of insecticide-treated nets.

Featured image: © ICF

17 Apr 2020

Introducing The DHS Program Learning Hub

As the world responds to the COVID-19 outbreak, The DHS Program remains committed to promoting the use of DHS data. As many DHS data users transition to distance teaching and learning, do not forget about existing capacity strengthening resources available through The DHS Program to close statistical skills gaps.


The DHS Program is pleased to announce The DHS Program Learning Hub, a virtual learning and collaboration space, at learning.dhsprogram.com. The Learning Hub offers a solution to make learning opportunities more widely available with online courses, either standalone or as part of The DHS Program workshops.

What types of courses are found on the Learning Hub?

All courses on the Learning Hub are asynchronous, meaning learners engage on their own time, from any time zone. Course formats vary.

Self-guided: Anyone can enroll in these open-access online courses, which can be taken any time, at your own pace. Currently, The DHS Program is offering Interpreting Trends in Malaria Indicators as a self-guided course. Learn about Malaria Indicator Surveys, key malaria indicators, and how to interpret trends in data to answer malaria programmatic questions. This course takes 2-3 hours to complete. Just create an account on the Learning Hub, enroll in the course, and start learning!

Blended: All DHS Program regional workshops (such as Data Mapping and Data Processing Procedures) have both online and in-person components in tailored combinations. Participants complete pre-work assignments online before meeting in-person for a capacity strengthening workshop. This helps ensure that all participants have the same foundation and are equally ready to maximize their time together in-person. The DHS Fellows Program is another example of a blended course. For all DHS Program workshops, participants go through a rigorous application process.

The 2020 DHS Fellows completed online assignments before an in-person workshop in Kenya, February/March 2020. They will continue collaborating virtually throughout the year. © ICF

Instructor-led: These courses are 100% online, time-bound, and led by an instructor, usually a staff member of The DHS Program, who is available to assist participants and answer their questions. Learners must apply to instructor-led courses, as space is limited. Applications are reviewed by The DHS Program staff to ensure course participants have the required knowledge and skills. A proportion of applicants are formally accepted to the course. The Survey Sampling Training Course, for instance, equips participants with the knowledge, tools, skills, and abilities to design samples for population surveys, such as DHS surveys. Participants in the Survey Sampling course spend an average of 5-10 hours a week for 8 weeks engaging with modules, completing coursework, and interacting with their peers and instructor(s) in a discussion forum. The call for applications for the first Survey Sampling Training Course to be offered en français will be available soon.

All courses on The DHS Program Learning Hub include interactive modules, videos, and links to further reading and useful resources. Courses and associated resources remain available to participants even after they complete the course or the course ends.

More courses on different topics related to household surveys are in development now. Check The DHS Program’s capacity strengthening page and the Learning Hub for announcements regarding upcoming courses and calls for applications.

Follow The DHS Program on Facebook, Twitter, or LinkedIn for updates on capacity strengthening opportunities and more!


Featured image caption: © ICF

03 Apr 2020

Data Should Drive COVID-19 Mitigation Strategies in Lower- and Middle-Income Countries

The current World Health Organization’s guidelines call for the public focus on handwashing, social distancing, communication with medical providers, and staying informed to help mitigate the spread of COVID-19. However, such guidance may be more aspirational than actionable for millions at risk of exposure to the virus in lower- and middle-income countries (LMICs) as revealed by recent Demographic and Health Surveys (DHS). DHS data from 2014 onward from more than 50 countries in Africa, Asia, and Latin America highlight the very different contexts for daily living in LMICs. These realities must be considered when developing country or context-specific strategies for reducing COVID-19 transmission.

Handwashing:

The basics required for handwashing (soap and water) are taken for granted by many but are not readily available for millions of people. In Burundi (2016-17 DHS), only 5% of households were observed to have soap and water for handwashing (among those where handwashing places were observed). Soap and water were present in fewer than 20% of households in Malawi, Ethiopia, Benin, and Mali (see chart). A location for handwashing with soap and water was found in fewer than half of households in 21 out of 36 recent surveys for which The DHS Program has this information.

Household Size and Sleeping Arrangements:

Messaging about social distancing in the current pandemic focuses on staying home and reducing contact with people. In LMICs, self-quarantining to individual households and nuclear families may not be a particularly useful concept.

Households in Sierra Leone, Tajikistan, Guinea, Pakistan, Afghanistan, and Senegal are the largest, with six or more members on average. The ability to distance from sick or vulnerable family members within the household is crucial, but in many households sleeping quarters are crowded. Households in Pakistan, Madagascar, Ethiopia, and Cambodia have the highest average of people per sleeping room, at three or more.

Household Age Structure:

A recent article in the Hindustan Times pointed out that multi-generational households in India might be a risk factor for coronavirus transmission to the elderly. The 2015-16 India National Family Health Survey (India’s DHS) reported that 4 in 10 Indian households are non-nuclear families, many of which are multi-generational. This type of family structure makes social distancing, especially for the elderly, very challenging. When younger children go to school, or working-age adults go to work, they return home to multi-generational families in which the elderly are particularly vulnerable to coronavirus. While the proportion of population age 65+ in DHS countries is not large, there are some key things to note, particularly within the context of multigenerational households. In recent surveys, on average, about 5% of the population is 65+, but in countries like India (6.6%) and Indonesia (6.2%), these seemingly small percentages correspond to many millions of people due to population size.

Explore these data in STATcompiler

The DHS Program’s STATcompiler allows users to create custom tables, charts, and maps from 1000s of indicators across 90 countries.

Just this week, the STATcompiler has been updated to include new indicators to help contextualize the COVID-19 crisis in DHS countries, and two “COVID19” tags have been added to help users identify these indicators. Explore data on handwashing, sanitation, household size, sleeping arrangements, access to media, spousal violence, and more. Other relevant DHS indicators on household age structure, access to internet and cell phones, and tobacco use will be added in the coming weeks.

COVID tags

Select indicators and explore two new COVID tags in STATcompiler.com.

Access to Information:

Health emergencies necessitate that urgent information be shared with the public in a timely manner. And yet large portions of the global population live without regular access to mass media. More than half of women age 15-49 in Liberia, Nigeria, Sierra Leone, Guinea, Benin, Timor-Leste, Niger, Malawi, Mozambique, the Democratic Republic of the Congo, Burundi, Papua New Guinea, Ethiopia, and Chad report that they do not have weekly access to information via radio, television, or newspaper.

In 30 out of 47 recent DHS surveys, at least 75% of households owned at least one mobile telephone. Still, ownership is lower in rural areas, and still uncommon in some countries; in Madagascar, for example, only one-third of households owned a mobile phone in 2016. Internet access, however, is very low across DHS countries. In Nigeria, only 16% of women and 35% of men age 15-49 used the internet in the past year (2018 NDHS). In Zambia, use was even lower, at 12% of women and 26% of men (2018 ZDHS).

Additional Considerations: Domestic Violence, Tobacco Use, and Access to Basic Health Services

And then there are potential secondary risk factors. How does cigarette smoking affect vulnerability? How will families cope with the stresses of a pandemic and the interpersonal conflicts exacerbated in quarantine settings? Will women and children continue to get the general health services they need, such as vaccinations, antenatal and delivery care, family planning, and nutritional support? These questions are important in all settings, but especially in those that are still in the process of building systems to support accessible, quality health care services. In Nigeria, for example, fewer than one-third of children age 12-23 months have received all 8 basic vaccinations, only about 40% of births are delivered in a health facility, and 19% of women have an unmet need for family planning.

Averaging across countries with data on spousal violence shows that 1 out of 4 women report physical, sexual, or emotional violence committed by their husband or partner within the last 12 months, and 36% report ever having faced such violence in their lifetime. These data suggest that social distancing may expose a significant proportion of already vulnerable women to a heightened risk of violence as women are forced to spend even more time with their abusers than usual and their access to sources of help is further limited by the pandemic.

There are countless other factors that are likely affecting COVID-19 transmission throughout the world. Urbanization, and slum environments in particular, are breeding grounds for contagion. In LMICs, millions of people migrate to city-centers for employment and are now migrating home to rural areas seeking safe-haven. These and myriad other factors can be explored in DHS datasets and final reports.

Conclusion:

Pandemics require data-driven decisions. While it is one unique virus that has spanned the globe, individual nations, communities, cultures, and families all face it within their own contexts. We can’t collect DHS household data during a pandemic. But we owe it to families in DHS countries to use the information already collected to better inform decisions to provide recommendations that resonate in their settings and to safeguard their already fragile health infrastructure.


17 Mar 2020

DHS Data Users: Ibrahima Gaye, Institute of Health and Development

Don’t read French? You can use the translate feature at the top of the page!

Si vous êtes intéressé à être présenté dans la série de blogs ‘DHS Data Users’, faites-le nous savoir ici en nous soumettant votre exemple d’utilisation des données du programme DHS.


Comment êtes-vous impliqué dans les enquêtes de The DHS Program ?

J’ai travaillé pendant trois années comme superviseur national du volet ménage des Enquêtes Démographiques et de Santé (EDS)-Continue au Sénégal. Durant cette expérience, en plus du suivi de la collecte, j’ai participé activement dans le traitement des données (éditions secondaires) et dans l’analyse des données. Lors de l’EDS-Continue, j’ai bénéficié de formations en matière de :

  • L’échantillonnage de l’EDS ;
  • Les procédures de traitement des données de l’EDS ;
  • Les méthodes dynamiques de formation pour adultes.

Cette dernière a changé ma façon d’animer les ateliers. En toute modestie, si aujourd’hui la qualité de mon enseignement ou d’animation est appréciée, c’est en grande partie grâce à la formation sur les méthodes dynamiques de formation pour adultes que j’ai suivi.

Et les ateliers de l’utilisation et de l’analyse de données des enquêtes de The DHS Program ?

En novembre 2019, The DHS Program m’a engagé pour animer un atelier, Tendances des Indicateurs du Paludisme au Bénin.

L’atelier portait sur l’analyse des tendances temporelles des indicateurs du paludisme au Bénin. La finalité était de contribuer à l’amélioration des capacités des 18 acteurs opérationnels de la mise en œuvre du programme paludisme par :

Discussion des intervalles de confiance. © ICF

Comment utilisez-vous les données des enquêtes de The DHS Program lors de votre travail actuel ?

Depuis 2018, je suis Data Manager de l’Evaluation prospective des programmes du Fonds Mondial (Tuberculose, VIH, Paludisme) où je suis chargé de la gestion et de l’analyse des données de l’évaluation.

Les données de l’EDS nous permettent de vérifier l’exactitude des données des programmes de santé mais aussi d’estimer les connaissances, attitudes et pratiques de la population sur les maladies telles que la tuberculose, le VIH ou encore le paludisme.

Quel est le problème de population ou de santé qui vous intéresse le plus, et pourquoi ?

Je suis particulièrement intéressé par la planification familiale. La plupart des décès maternels restent liés aux grossesses rapprochées, trop nombreuses, précoces ou tardives. C’est pourquoi la planification familiale constitue une méthode des plus efficaces et peu couteuse pour améliorer la santé des femmes et des enfants et lutter contre la mortalité maternelle et infantile.

En effet, en dépit des progrès réalisés dans le secteur de la santé au Sénégal, les taux de mortalité maternelle et infantile n’ont pas connu l’évolution espérée ces dix dernières années. Le pourcentage de décès de femmes liés à la grossesse est l’un des plus élevés de la sous-région (29%).  Par ailleurs, la mortalité infantile (42 décès pour 1 000 naissances vivantes, EDS-C 2017) reste au même niveau depuis quelques années et ce à cause, notamment, du nombre important de décès néonataux (28 décès pour 1 000 naissances vivantes, EDS-C 2017) qui représentent la moitié des décès infantiles.


Un rapport a été produit à partir des analyses des participants. Lisez le, Tendances des indicateurs du paludisme au Bénin : Résultats d’un atelier de l’utilisation des données des Enquêtes Démographiques et de Santé.


Écrit par : Ibrahima Gaye

Ingénieur statisticien de formation avec une spécialisation en informatique décisionnelle, Ibrahima GAYE est aussi titulaire d’un Master en management de projets et d’un Master en santé publique spécialité Méthode Quantitatives et Économétriques pour la Recherche en santé, pour lequel il a utilisé les données de l’EDS dans le cadre de son mémoire de Master en santé publique sur : « Analyse multiniveau de l’utilisation de la contraception au Sénégal ». Il est maintenant en train d’écrire sa thèse de Doctorat en santé publique : « Contribution du modèle Age-Période-Cohorte (APC) à l’étude de la prévalence contraceptive au Sénégal », pour lequel il utilisera également les données de l’EDS.


Featured image caption: © ICF

06 Mar 2020

International Women’s Day 2020: Measuring Gender-related Power

Five years since world leaders agreed to the Sustainable Development Goals (SDGs) to create a better world by 2030, this year’s theme for International Women’s Day, I am Generation Equality: Realizing Women’s Rights, challenges everyone to reflect on how a gender-equal world will be achieved. DHS data describe the status of women around the world. Over time, women have made gains in education, employment, health care, and family life. However, progress towards gender equality is halting and inconsistent.

In a gender-equal world, women and men will have equal power: the power within to know their right to equality, the power to create change, and the power with others. In a gender-equal world, other people’s power over women will be reduced, especially the most extreme expression of power over, gender-based violence (GBV).

DHS questionnaires already give insight into the types of power that women and men do and do not have. For instance, a composite scale of three DHS survey items is used to measure progress toward SDG Indicator 5.6.1: the proportion of women age 15-49 who make their own informed decisions regarding sexual relations, contraceptive use, and reproductive health care.

DHS data have been used to construct other composite scales, such as the Survey-based Women’s emPowERment (SWPER) index to measure women’s empowerment. The Population Council’s Gender and Power Metrics database includes several scales that use DHS data to measure gender, agency, power, and control.

The DHS Program has recently updated DHS-8 questionnaires and optional modules, including the Domestic Violence module, to fill gender-related data gaps and respond to emerging gender data needs. For instance, in several countries around the world, many people live together in unions that have not been officially registered. A registered marriage is related to a range of social protections and rights, such as divorce and inheritance, that are especially important for gender equality. New questions have been added to the Woman’s Questionnaire on marriage registration:

  • Did you have a marriage certificate for your last marriage?
  • Do you have a marriage certificate for this marriage?
  • Was this marriage ever registered with the civil authority?

Measuring gender-related power using DHS data highlights countries’ progress towards gender equality, especially in the areas of reproductive empowerment, male engagement, and reduction of GBV. Measuring power can also help program managers and policymakers understand how power manifests within couples, between service providers and clients, and how different interventions can cultivate positive expressions of power and mitigate harmful expressions of power over for a more equal world.

For International Women’s Day 2020, explore gender-related power measures in DHS surveys in an inventory and a presentation. You can also explore many common gender indicators using The DHS Program’s Gender mini tool.


Featured image caption: © Mary Long

25 Feb 2020

Inside The DHS Program: Q&A with Gisèle Dunia

Name: Gisèle Dunia

Position title: Senior Advisor for Capacity Strengthening

Languages spoken: French, English, Swahili, Lingala, and Haitian Creole

When did you start at The DHS Program? March 2019

Favorite DHS survey cover: I prefer it when we have an image that represents the country. For example, the report for the 2007 Democratic Republic of the Congo DHS had an okapi on the cover, and you find okapis only in DRC.

2007 DRC DHS Final Report

What is your role at The DHS Program? As the Senior Advisor for Capacity Strengthening, I oversee the implementation of strategies to strengthen host country individual and institutional capacity, working with different technical teams.

My work involves assessing survey implementing agencies’ capacity at the beginning and at the end of a survey and working on capacity strengthening activities to improve and sustain institutional capacity. Capacity strengthening activities are either survey-related or competency-based trainings. Our training opportunities are offered both online, on The DHS Program Learning Hub, and in-person during national and regional workshops.

Another way of strengthening capacity at the country level is by collaborating with consultants. The DHS Program has been using south-to-south consultants for several years. Consultants help build and reinforce capacity in host countries and across regions. Under DHS-8, we are designing a certification program for these consultants, streamlining processes to equip them with skills to better support survey implementation and dissemination.

What work are you most proud of? I have designed and facilitated several capacity strengthening activities in the past. In my work now at The DHS Program, I’m no longer in front of people facilitating trainings. I am mostly behind the scenes. I am very much involved in the design process, making sure that we have the right tools to facilitate engaging trainings. I am proud of the way I’ve been able to help technical teams design trainings, and I trust them to successfully run the show.

I am most proud of completely designing the DHS-8 Global Capacity Strengthening Strategy within my first six months at a program that has so many components as The DHS Program.

What’s your favorite trip to date? So far, my second trip is my favorite one. In December, I went to Madagascar to conduct a capacity assessment of the Institut National de la Statistique (INSTAT), the implementing agency for the forthcoming fifth Madagascar Demographic and Health Survey. While there I pilot-tested our updated Capacity Assessment Tools, which I used to assess INSTAT’s current capacity. Based on the results, I shared with INSTAT a list of capacity strengthening activities that I think would benefit them, like how they can restructure the way they work so that whatever capacity is built during the DHS survey process can be managed and shared throughout INSTAT to build long-term institutional capacity.

For more information about The DHS Program’s capacity strengthening approaches, visit our website.

Featured Image: © 2019 ICF

11 Feb 2020

Luminare: Geospatial Modeling for Locally Available Data

This blog post is part of Luminare, our blog series exploring innovative solutions to data collection, quality assurance, biomarker measurement, data use, and further analysis.


Demographic and Health Surveys (DHS) collect nationally representative data and data representative at the first subnational administrative level (ADMIN 1). The 2016 Ethiopia DHS was designed to produce representative estimates for nine regions and two administrative cities. The 2014 Kenya DHS produced estimates for eight regions (formerly provinces). In addition to national-level indicators, STATcompiler also presents subnational data, as shown in the map of childhood stunting at the ADMIN 1 level in Ethiopia and Kenya.

Childhood Stunting by Subnational Level, 2016 Ethiopia DHS & 2014 Kenya DHS

Click the map to explore childhood stunting using STATcompiler.

National and ADMIN 1 data help countries track their progress towards achieving the Sustainable Development Goals, for instance. However, as countries decentralize their health service delivery systems, local health officials increasingly need local data. In Ethiopia, nine regions are further divided into zones and special districts (ADMIN 2). In Kenya, eight regions are further divided into counties.

One option to get data representative at the ADMIN 2 level is to increase the survey sample size, requiring more time and more money. Another option is to produce spatially interpolated maps, which use Bayesian geospatial modeling techniques to predict indicator values at non-surveyed locations.

The DHS Program’s Geospatial team assembled data for 12 geospatial covariates, such as elevation, precipitation, and population density. These covariates are related to and can partially explain variation in health indicators of interest, allowing for more accurate predictions across the map.

Next, the Geospatial team imported georeferenced cluster data points from the 2016 Ethiopia DHS and 2014 Kenya DHS. (Did you know? You can download shapefiles or geodatabases of georeferenced data for most DHS surveys from the Spatial Data Repository.)

Using the geospatial covariates and survey data, the Geospatial team employed a new modeling approach–a stacked ensemble model–which combines multiple models. This increases predictive power and captures the potentially complex interactions and non-linear effects among the geospatial covariates. Three sub-models were fit to the health indicator data using the geospatial covariates as exploratory predictors. The prediction surfaces generated from the sub-models were then used in the final Bayesian geospatial model, producing 5 X 5 km pixel-level mean estimates of health indicators with associated uncertainty.

Childhood Stunting by 5 X 5 km Pixel, 2016 Ethiopia DHS & 2014 Kenya DHS

Modeled surface maps available from the Spatial Data Repository.

Pixel-level estimates were then used to calculate population-weighted averages to aggregate estimates to the ADMIN 2 level. For Ethiopia, this produced estimates of childhood stunting by zone, and in Kenya, estimates by county.

Childhood Stunting by ADMIN 2 level, 2016 Ethiopia DHS & 2014 Kenya DHS

Health system program managers in Ethiopia and Kenya can now use these zonal- and county-specific estimates to make decisions and manage locally administered health programs to address childhood stunting in their areas.

The DHS Program will continue exploring model-based geostatistics as a feasible, reliable, and cost-effective way to produce local data for local needs.

Read the full report, Interpolation of DHS Survey Data at Subnational Administrative Level 2.

Explore available spatially modeled map surfaces of DHS indicators on the Spatial Data Repository.

The information provided on this Web site is not official U.S. Government information and does not represent the views or positions of the U.S. Agency for International Development or the U.S. Government.

The DHS Program, ICF
530 Gaither Road, Suite 500, Rockville, MD 20850
Tel: +1 (301) 407-6500 • Fax: +1 (301) 407-6501
dhsprogram.com

Anthropometry measurement (height and weight) is a core component of DHS surveys that is used to generate indicators on nutritional status. The Biomarker Questionnaire now includes questions on clothing and hairstyle interference on measurements for both women and children for improved interpretation.