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!
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.
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.
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 Indicatorsas 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.
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!
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.
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.
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.
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.
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.
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.