Category Archives: Analysis

10 Sep 2019

Nutrition in the Health System: Linking SPA and DHS Surveys

Global momentum on quality of care in the health system continues to expand. The United Nations Decade of Action on Nutrition (2016-2025) recognizes that the health system is a key pillar in providing universal coverage of essential nutrition actions. Reliable data for monitoring is central to understanding and improving the health system for nutrition. In addition to data from Health Management Information Systems, Service Provision Assessment (SPA) surveys also provide nationally representative facility information that can be used to explore the quality of facility-based health services.

­SPA surveys are a rich source of nutrition information providing insight on the availability and quality of services. Similarly, DHS surveys provide a significant amount of information about nutrition behaviors of populations. By linking SPA and DHS surveys, users can examine how the health facility environment contributes to these behaviors.

Two recently released DHS Working Papers examine the health service environment for key nutrition interventions: breastfeeding counseling and iron folic acid supplementation. The papers use Haiti and Malawi as case studies to describe the facility readiness, such as the availability of trained providers and essential medicines (see infographics below), and service delivery including observations of provider-client consultations of the two interventions in the context of antenatal care. The papers go on further to link SPA and DHS surveys to examine relationships between the health service environment and the nutrition behaviors.

The papers illustrate how linking SPA and DHS surveys can be useful for enhancing essential nutrition actions at the facility by identifying key programmatic gaps that can be strengthened to improve effective intervention coverage.

Download Working Papers 160 and 161 to find out more about the results in each country and their implications. And now, Analytical Briefs are available for DHS Program Analytical Reports. Download the Analytical Briefs for a shorter, more concise summary of these working papers.

Facility readiness to provide iron folic acid supplements
and counseling during antenatal care.



19 Aug 2019

DHS Data Users: Samuel Oppong, Ghana National Malaria Control Programme M&E Specialist

If you are interested in being featured in the ‘DHS Data Users’ blog series, let us know here by submitting your example of DHS Program data use. 


How are you involved in DHS Program surveys and analysis workshops?

My first time working on a DHS Program survey was for the 2016 Ghana Malaria Indicator Survey (GMIS). I helped with fieldwork monitoring and report writing. After the 2016 GMIS, I participated in the 2017 Regional DHS/MIS Malaria Analysis Workshop. At this workshop, I worked with my team members from the Ghana National Malaria Control Program (NMCP) to write an abstract, “Factors Influencing Malaria Prevalence in Children Under 5,” using the 2016 GMIS data.

Samuel Oppong (left) with participants from Ghana at
the 2017 DHS/MIS Malaria Analysis Workshop. © ICF

I then transitioned from being a workshop participant to a workshop co-facilitator, facilitating the 2017 Regional Malaria Indicator Trends Workshop in Uganda. This workshop brought together NMCP monitoring and evaluation (M&E) program managers from Liberia, Malawi, Nigeria, Sierra Leone, and Uganda to examine trends in malaria indicators.

More recently, I co-facilitated the 2018 Ghana Malaria Trends Workshop. This workshop brought together district malaria health officers to analyze trends in household survey indicators in Ghana. This was a great workshop because I was able to work with the data I am most familiar with! The output from this workshop is published on The DHS Program website.

Samuel Oppong (left) and Annē Linn co-facilitated the 2018
Ghana Malaria Indicator Trends Workshop. © ICF

How has NMCP used DHS data for programmatic decision making?

After the release of the 2016 GMIS, NMCP noticed a low uptake of artemisinin-based combination therapy (ACTs) in the Northern region, but the use of SP/Fansidar was high, which is not a recommended treatment for malaria in children. This triggered us to do additional research to figure out what was going on in this region and investigate which outlets were distributing SP. We realized that people were not receiving SP from public health facilities but from private clinical shops and other drug peddlers. The 2016 GMIS results provided a snapshot of the malaria case management situation in the Northern region and provided us justification to explore further. To solve this problem, NMCP implemented a sensitization activity to ensure people in the region know the recommended treatment and sources to get the correct treatment.

Another example of evidence-based decision making was the implementation of a malaria sensitization campaign using data the 2016 GMIS. Malaria prevalence by microscopy in the Eastern region increased between the 2014 GDHS and 2016 GMIS. This was a worrying trend because in Ghana we normally only see high malaria prevalence in the Northern and Upper West regions. NMCP looked more critically at the 2016 GMIS results and saw that while insecticide-treated net (ITN) ownership was high, the proportion of people who recognized the cause and symptoms of malaria was very low. As a result, NMCP implemented a community level sensitization activity in four districts of the Eastern region.

How do you use MIS survey data during your daily job?

I recently collaborated on a research paper using DHS data. The paper, published in The Malaria Journal, used survey data from the 2014 GDHS and the 2016 GMIS to examine ITN use behavior by exploring how several household and environmental variables related to use among Ghanaians with access to an ITN. This further analysis paper has been extremely helpful for programmatic decision making here at NMCP.

What data are you looking forward to in the upcoming 2019 GMIS?

I am interested in further examining the information about the type of nets in households. NMCP finished a mass long-lasting insecticidal net (LLIN) distribution campaign in 2018 and implemented a school-based piperonyl butoxide (PBO) net distribution campaign in 2019. The 2019 GMIS results will provide information on the reach and use of these nets across Ghana as well as where people obtained their nets.


Featured photo: © 2014 C. Hanna-Truscott/Midwives for Haiti, Courtesy of Photoshare


Written by: Samuel Oppong

Samuel Oppong is a Monitoring and Evaluation Specialist with the Ghana National Malaria Control Programme. He coordinators M&E activities in vector control interventions, routine data quality audits, and SMC. He is involved in capacity building of national, regional, district and health facility staff on capturing, reporting, and analyzing malaria-related data from routine health information systems as well as other malaria data sources. He also leads capacity building programs of national, regional, and district staff on conducting data quality audits as well as onsite training, supportive supervision (OTSS) on malaria data management.

06 Aug 2019

DHS Program Analysis Highlights: Summer 2019

Many students and faculty are out of school at this time of year, but The DHS Program’s analysis team is busy at work. In addition to finalizing their annual analytical papers, the team continues to support country-specific further analysis, train Fellows, write code to share with other researchers, and support data quality improvements.

Here are some of the highlights of 2019 so far:

  • The DHS Program hosted a showcase of the major findings from a dozen further analysis papers based on the 2015-16 Myanmar Demographic and Health Survey in Yangon in early July. More than 50 population and health professionals in Myanmar participated in DHS data analysis trainings, resulting in the publication of 9 papers now available on The DHS Program website. Several more will be published in the coming months.
  • Another class of DHS Fellows has graduated! This year, 6 teams from universities in Afghanistan, Indonesia, Myanmar, Ethiopia, Ghana, and Senegal have prepared working papers in areas covering child vaccination, nutrition, malaria, contraceptive discontinuation, men’s family planning, and HIV testing.
2019 DHS Fellows Program facilitators and participants. © ICF
  • A recent analysis workshop in Ghana linked research to action by integrating policy brief writing with statistical analysis of data from the 2017 Ghana Maternal Health Survey. Proposed policy recommendations address inequalities and advocate for programs that protect and promote the health of women. Policy briefs will be published soon on The DHS Program website.
Participants from the policy brief writing workshop in Ghana. © ICF

Coming Soon in 2019!

  • By geographically linking SPA and DHS data, two upcoming working papers explore the relationship between the antenatal care service environment and maternal health behaviors including iron-folic acid consumption and early breastfeeding. Working Papers 160 and 161 will be published in mid-August.
  • What are the determinants of child marriage in Asia? In Bangladesh and Nepal, marriage by age 15 is more common in clusters where women’s acceptance of wife-beating is more prevalent. Find out more in Analytical Studies 69.
  • Do regional disparities in fertility preferences and family planning satisfied by modern methods persist when controlling for poverty? Analytical Report 7 will explore this question for 12 DHS Program countries and 3 groups of absolute poverty measurements.
  • The DHS Program explores strategies to identify potential data quality issues after data collection in Methodological Report 26.
  • For the first time, summary briefs will be available for almost all analytical studies and comparative reports published this year. Briefs will feature figures and maps and easily digestible bullets of key findings for a variety of audiences.

Featured photo: © 2014 C. Hanna-Truscott/Midwives for Haiti, Courtesy of Photoshare

10 Jul 2019

Luminare: Programming Code for DHS Indicators

DHS Staff Programming

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.


Have you ever wondered how to write a Stata program for vaccination coverage or struggled to construct mortality rates using DHS data? Well, DHS Program staff are busy writing SPSS and Stata code for all indicators listed in the Guide to DHS Statistics, and you can use this code to jump-start your exploration of the data. And as they are completed, the code will be posted on GitHub for open access to the public. 

The DHS Program GitHub site contains two repositories: DHS-Indicators-Stata and DHS-Indicators-SPSS. Users can download the code from these repositories or clone the repository to their own Github site. Users can also suggest changes to the code that will be reviewed by DHS Program staff before acceptance. 

Don’t see what you need? The programming for all indicators listed in the Guide to DHS Statistics will be available by September 2020. The Guide corresponds to the topics/chapters that are typically found in a DHS survey final report in addition to the modules for malaria and HIV prevalence. As of July 2019, about half of the indicators have been coded and shared in Stata including indicators covering child health, family planning, and reproductive health. SPSS code will follow later in 2019 and 2020, along with the remainder of the indicators. Review the Readme text file for more details.

Questions? Email codeshare@DHSprogram.com 


Featured photo: © 2014 C. Hanna-Truscott/Midwives for Haiti, Courtesy of Photoshare

28 Feb 2019

Strengthening Nutrition Data Quality at The DHS Program

A health technician tests a child for anemia during a survey training. © 2018 ICF/Sorrel Namaste

“Everything bad can go wrong at collecting the sample, and you can’t get any good results from a bad sample. ” – Informant from the Enhancing Nutrition Data Quality Report

Data for decision-making is vital as countries work to reduce the burden of malnutrition and to measure progress towards the Sustainable Development Goals and the Global Nutrition Targets 2025.

The DHS Program, a leading source of nutrition data globally, has invigorated its focus on the quality and depth of the types of nutrition data collected. To this end, a qualitative study was undertaken to identify how to enhance the quality of nutrition data. Interviews were conducted with 50 experts internal and external to The DHS Program, and DHS staff participated in focus group discussions. Informants highlighted critical challenges that exist in collecting anemia, anthropometry, and infant and young child feeding data in large surveys while also offering solutions to strengthen data quality.

The outcomes from the study are summarized in the report “Enhancing Nutrition Data Quality in The DHS Program” which calls for the implementation of 32 recommendations. The DHS Program is already addressing most of these recommendations (21 out of the 32) and plans to take up additional recommendations throughout DHS-8. These include revising hemoglobin cutoffs in STATcompiler, working with the WHO to develop a technical error of measurement value for passing an anthropometry standardization exercise, and testing new procedures and indicators for real-time monitoring of fieldwork. Future blog posts will explore the application of these recommendations across the stages of a DHS survey.

Recommendations to enhance nutrition data quality were identified across The DHS Program survey stages. © 2018 ICF

The DHS Program is committed to continuous quality improvement and is uniquely positioned to implement new data quality measures. Yet, the report is not only intended to inform operations at The DHS Program. The lessons learned are applicable to wider audiences involved in the collection and use of nutrition data throughout the world. Strengthening the quality of nutrition data will lead to improved data-driven nutrition actions.


Written by Sorrel Namaste and Rukundo K. Benedict

Dr. Sorrel Namaste is the Senior Nutrition Technical Advisor for The DHS Program. She is an epidemiologist with expertise in nutrition assessment and implementation research. 

Dr. Rukundo K. Benedict is the Nutrition Technical Specialist for The DHS Program. She is a public health nutrition practitioner with expertise in infant and young child feeding (IYCF), water-sanitation hygiene (WASH), community health systems, and the delivery of integrated interventions in low-resource settings. 

20 Feb 2019

Inside the DHS Program Q&A: Tom Pullum

Name: Tom Pullum

Position title: Director of Research

What is your role at The DHS Program? I manage the analysis team, which prepares the majority of analysis reports that are released after the Final Reports and standard recode files have been produced. I am the lead author or co-author of at least a couple of these reports each year. The analysis team also conducts the DHS Fellows Program and Data Analysis Workshops. I also assist with data quality issues that occasionally arise during the preparation of Final Reports and frequently answer questions related to statistics, demography, or Stata that are submitted to the DHS User Forum.

When did you start at The DHS Program? I joined The DHS Program in May 2011. Previously, I had been a demographer in the academic world at the University of Texas at Austin and the University of Washington. In 2010-11, I took a non-academic break to work with USAID as part of the Global Health Fellows Program, expecting to return to the University of Texas. However, the opportunity to join The DHS Program came up and I retired from the University of Texas to join The DHS Program.

What has been the biggest change in The DHS Program during your time here? The biggest change has been in the sheer volume of work, indicated by the increased number of surveys, Final Reports, and analysis reports that are conducted annually. The analysis team has become very efficient in producing analysis reports that include a large number of surveys.

What work are you most proud of? Personally, I am most proud of the methodological reports that I have been directly involved in, but in a broader way, I’m very pleased with the growth and development of the analysis team. The capacity to conduct high-quality research and workshops has steadily increased. My colleagues work well together, take initiative, and are very productive.

Do you have any newly authored publications or articles you would like to share? I would like to point people to some methodological reports that came out late in 2017 and 2018.

         

                          

How are the topics for analysis reports selected? Every year, we work with USAID/Washington to develop a list of topics for reports that will be completed by the end of the year. Reports in the Further Analysis series originate within the USAID Missions in countries that have recently done a survey. Those reports generally examine trends across at least the two most recent surveys. The Methodological Reports are intended to lead to improvements in future data collection or to increase our ability to extract useful information from the data that have already been collected.

Who is the audience for analysis reports? In addition to meeting the programmatic needs of USAID, there is a large community of DHS data users who would benefit from these reports. It is always a pleasure to hear from that larger community and to help them get the most out of the data. We hope that as many people as possible will visit our website become familiar with the reports that are available there.

18 Dec 2018

Thermal Care and Umbilical Cord Care Practices and Their Associations with Newborn Mortality

The global public health agenda spotlight is increasingly focused on reducing preventable newborn deaths. Skilled care at birth and delivery in a health facility equipped with life-saving medical technologies is a clear path to prevention. However, many women continue to deliver at home, impeded by lack of access to a health facility, concerns of sub-par quality at nearby facilities, or financial constraints where healthcare is not well subsidized.

Steps can be taken immediately after birth that may improve the chance of newborn survival and can be applied with nominal costs. Keeping infants warm—thermal care—and preventing infection where the umbilical cord was cut—hygienic cord care—are two key practices.

The DHS Program undertook efforts in 2014 in order to improve the assessment of newborn care practices. They worked with the recommendations from the Newborn Care Technical Working Group to:

  1. Develop an optional Supplemental Module on Maternal Health Care with a standardized set of questions assessing newborn care. This module collects information on drying, bathing, cord cutting, and cord care including the application of chlorhexidine.
  2. Add questions to the DHS-7 core questionnaire regarding care at the time of birth, pre and post-discharge contacts for mothers and newborns, the content of postnatal care for newborns, and other essential newborn care practices (immediate skin-to-skin, early initiation of breastfeeding).

Questions related to thermal care and cord care have been included in some DHS surveys since 2003, a total of 16 surveys conducted between 2003-2016 in 10 countries: Bangladesh, Ethiopia, Ghana, India, Morocco, Nepal, Nigeria, Pakistan, Sierra Leone, and Timor Leste.

A Journal of Global Health Collection on Measuring Coverage of Essential Maternal and Newborn Care Interventions: An Unfinished Agenda issued a call for action to use these data to track progress over time and make comparisons between countries in order to assess whether newborns are receiving life–saving interventions, prompting The DHS Program to conduct further analyses.

This recent DHS Analytical Study (68) sought to explore three things: 1) what’s been happening with these practices over time; 2) is there an association between these practices and newborn deaths among home births; and 3) what factors predict these practices among home births?  The analysis includes an in-depth exploration of newborn care in three South Asian countries: Bangladesh, India, and Nepal.

Key Findings

  • In countries with more than one survey available, coverage of recommended thermal care and hygienic cord care practices increased over time, with more frequent application among facility births than home births.
  • Among home births in South Asia, skilled care during pregnancy and birth increased the odds of receiving the recommended practices.
  • In Bangladesh and Nepal, application of an antiseptic (chlorhexidine or an unspecified antibiotic or antiseptic) to the cord was highly protective against newborn mortality compared with dry cord care.
  • Among newborns who died, there was a high proportion of missing responses regarding recommended behaviors.

These findings highlight the importance of cord care in preventing newborn mortality as well as the importance of skilled care during pregnancy and birth for the implementation of recommended practices. Although thermal care did not predict newborn survival, sample size and missing cases limited the analyses. The findings also suggest that the recall or reporting of details around the traumatic event of newborn death may be incomplete.

While the analysis could not control for all potential cofactors of newborn mortality and receipt of care, this report provides additional insight on important predictors of these outcomes in several countries, including mothers’ education, household wealth, and maternal age as well as the sex of the baby.

A research article adapated from this report can be found on the BMC Pediatrics Journal.

Photo Credit: © 2011 Faisal Azim, Courtesy of Photoshare


Written by Jennifer Yourkavitch and Lindsay Mallick

Jennifer Yourkavitch, MPH, PhD, IBCLC is an epidemiologist whose research and program work focuses on documenting and addressing determinants of health, particularly in relation to lactation and breastfeeding practices; maternal and child health and nutrition; HIV/AIDS, malaria and other infectious diseases; gender; equity; health systems; and, service delivery around the world. In her 14 years with ICF, Dr. Yourkavitch has helped various clients to plan, implement, monitor and evaluate health programs, including WHO, USAID, PMI, CDC, and dozens of NGOs. She conducts population health research with the Demographic and Health Surveys Program and the University of North Carolina in Chapel Hill and Greensboro.

Lindsay Mallick joined The DHS Program via Avenir Health in 2014. As a Senior Research Associate for The DHS Program’s Analysis team, she conducts research using data from both DHS and SPA surveys on health services and outcomes related to reproductive, maternal, newborn, and child health. She has an MPH in International Health and Development from Tulane University and served in the Peace Corps in Mauritania, West Africa. Prior to joining The DHS Program, Ms. Mallick fulfilled two consecutive fellowship roles as an epidemiologist for the US Air Force and then the US Army.

31 Jan 2018

IPUMS-DHS Unlocks Research Possibilities with New Contextual Data

Have you ever wondered if high-levels of precipitation affect birthweights and infant and child survival? Is increased use of insecticide-treated bed nets associated with lower incidence of malaria? Do children in households near battle zones or other violent contexts have higher levels of child malnutrition? Do some staple crop regimes promote better health outcomes than others?

Now with IPUMS-DHS, you can easily study these questions and others on how environmental and social contexts affect human health and behavior.

Using GPS coordinates, we’ve linked contextual variables drawn from many data sources directly to individual DHS survey respondent records. All context variables describe the features of a small geographic area (5-10 kilometers) surrounding each DHS survey cluster location.

New variables include:

Environmental
Variables
Agricultural
Variables
Social
Variables
  • Soil type
  • Ecoregion
  • Level of vegetation
  • Precipitation
  • Proportion of land area used for agriculture or pastureland
  • Total harvested area and yield for 17 major crops
  • Dominant livelihood
  • Population density
  • Counts of violent episodes
  • Incidence of malaria

Keep checking back! Over the next year, IPUMS-DHS will still be adding more contextual variables, including summary statistics calculated from large census-based samples.

Plan a new research project linking individual characteristics and outcomes with the surrounding context, and let us know about it. We’re always eager to hear how people are using IPUMS-DHS!

________________________________

IPUMS-DHS is a system that makes it easy to find and review the thousands of DHS survey variables and to download a single fully-harmonized data file with precisely the variables and samples that interest you. The system currently includes variables from all DHS survey samples taken in India and 22 African countries; more samples are constantly being added.

For DHS survey samples with GPS cluster data that are not yet in IPUMS-DHS, the contextual variables are available in linkable CSV files.

To learn more about the IPUMS-DHS contextual variables, check out our Technical Note, Using IPUMS-DHS Contextual Variables, which provides much more detail.

21 Mar 2017

7 Tips to Matching DHS Final Report Tables

Can't match DHS Final Report tables?
Feeling frustrated because you can’t match DHS Final Report tables in your statistical software?

 

Our new four-part video series shows the Top 7 Tips & Tricks for Matching DHS Final Report Tables.

In this four-part video series, we will be covering the top 7 tips and tricks to matching The DHS Program Final Reports using a statistical software program.

The videos will guide you through the following questions:

  1. Are you using the correct data file?
  2. Are you using the correct denominator of cases?
  3. Are you using the correct variable(s)?
  4. Are you properly recoding?
  5. Are you applying the correct weights?
  6. Are you selecting the correct software specific code?
  7. Are you properly coding the tabulation commands in your statistical program?

Watch the four videos in the series below on Matching DHS Final Report tables to get all the details on the top 7 tips and tricks.


Additional help can be found on our website and the User Forum.
16 Nov 2016

From National to Local: A New Way to Leverage DHS Data

In DHS survey final reports, data are presented on a national or first-level administrative sub-national level. However, this is usually not the level at which program planning and decision making are truly happening. To support more decentralized decision making at lower administrative levels, data need to be presented on a more disaggregated level.

The DHS Program is producing a standard set of spatially modeled map surfaces for each population-based survey for a select list of indicators that provide smaller area estimates of data. Geostatistics are used to predict (interpolate) the indicator value for unsampled areas based on data from sampled data locations. DHS creates standardized modeled map surfaces using DHS survey data along with global covariate datasets. Currently, sets of standard surfaces are available for 16 surveys. Spatial data packages and stand-alone maps are available for download through The DHS Program’s Spatial Data Repository.

How can modeled map surfaces be used?

These new spatially modeled surfaces can help in several ways to improve decision making for many development sectors that include health, population, nutrition, and water and sanitation programs on multiple levels. Users can combine the maps with other resources to support:

  1. Monitoring and evaluation: analysis and evaluation of past initiatives (impact analysis) or understanding existing situations
  2. Program planning: future planning of appropriate programs and policies

Data in the modeled surfaces can be used to evaluate past programs or to better understand existing situations. Such evaluations can help to understand deviations from the norm, attribute cause, or to contribute to impact evaluations, which analyze what would have happened to the population of an area if a program had not been implemented.

Program managers can also use modeled surfaces to plan, target, and develop interventions and programs that aim to improve situations in targeted geographic areas. Interventions can be targeted more precisely, saving money, time, and human resources in the search for the most effective outcomes.

The matrix below shows potential approaches for monitoring and evaluating past and planning future programs using modeled surfaces.

This matrix is by no means comprehensive, and it is expected that map users will come up with many more potential uses after analyzing their particular situation and maps for their country.

To read more, please see the Spatial Analysis Report 14, “Guidance for Use of The DHS Program Modeled Map Surfaces.” The report delivers more in-depth information on what modeled surfaces The DHS Program is creating, as well as an explanation of their creation process. In addition, the report provides guidance on limitations and assumptions.

The DHS Program is looking forward to seeing how groups will use this new data product to enhance their activities. There is enormous potential for innovative uses of these modeled surfaces beyond those discussed in the report. Users are encouraged to submit ideas and case studies to The DHS Program (spatialdata@dhsprogram.com) as only a large community of users who share their experiences will fully expose the maps’ potential.


Aileen Marshall is the Knowledge Management/Monitoring & Evaluation Specialist at The DHS Program. She is responsible for planning, development, implementation and evaluation of the KM strategy, KM activities as well as the project-wide SharePoint site. Additionally, she is involved in measuring and evaluating capacity strengthening activities at DHS and works closely with all teams to ensure knowledge at DHS is captured, stored and shared efficiently among staff. Aileen holds an MA in English Linguistics from the Westfaelische Wilhelms-University in Muenster, Germany, and an MLIS from the University of South Carolina.

Trinadh Dontamsetti is the Health Geographic Analyst for The DHS Program. He contributes to geospatial analysis, mapmaking, and geographic data processing activities. His research interests include geospatial interpolation, tuberculosis, and vector arthropod-borne diseases.

 

Clara R. Burgert is the GIS Coordinator for The DHS Program. She oversees all  geographic data, mapping, and geospatial analysis activities at The DHS Program.  Additionally, she facilitates workshops in partner countries on using maps for better decision making using open source GIS software.

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