Over the next four days, demographers and public health professionals will present research, view and comment on posters, and network with peers. For those attending the PAA Annual Meeting, DHS Program staff will be presenting their findings using DHS data. Find the schedule below:
The DHS Program recently released three YouTube tutorial videos to help DHS data users access The DHS Program’s Code Share Library on GitHub. The Code Share Library was started in 2018 to provide code for producing DHS indicators listed in the Guide to DHS Statistics using statistical software like Stata or SPSS. This year, The DHS Program has begun preparing R code as well. You do not need to create a GitHub account to copy or download any code to produce DHS indicators; it is publicly available for use.
The first video, Overview of The DHS Program’s Code Share Library on GitHub, explains the main components of the Code Share Library, including Stata and SPSS repositories, the indicator list, ReadMe file, and chapter folder contents. In each repository on GitHub, there is an important ReadMe file with instructions for users to read before using the code provided.
One way to start using the Code Share Library is to download the entire repository on your computer. If any update is made to the code in the future, you will need to download the updated code from the Code Share Library. Another way to run the code is to copy and paste the code for your indicator of interest from GitHub to your own personal do file, without having to download the entire repository.
The third video, Running The DHS Program’s Shared Code on Stata, demonstrates how to run the code in Stata to construct indicator variables and produce tables for the indicators. The tables provide a simple tabulation that follows the standard DHS tabulation plan used for survey final reports.
The DHS Fellows Program builds the long-term institutional capacity of universities in DHS countries to train students and faculty to analyze DHS data. Since 2011, the DHS Fellows Program has trained more than 150 researchers from over 40 universities in 25 countries in Africa, Asia, and the Middle East. Typically, Fellows attend two separate in-person workshops, prepare publication-quality research papers in teams using DHS datasets, and implement capacity strengthening activities at their home universities.
For the 2020 DHS Fellows Program, a cohort of university faculty from Bangladesh, Burkina Faso, Cameroon, Guinea, Jordan, and Pakistan convened for the first workshop in Nairobi, Kenya, in February 2020. The second workshop, scheduled to begin in April 2020, was canceled due to the COVID-19 pandemic. The DHS Program worked quickly to convert the second workshop into online activities. A remote teaching space was created on The DHS Program Learning Hub with presentations and assignments for the Fellows to complete. Virtual meetings were held with each Fellows team to discuss drafts of their working papers.
The 2020 DHS Fellows produced working papers that addressed a variety of research topics including:
As of this blog’s publication, the teams from Jordan and Cameroon have published their working papers in peer-reviewed journals. Visit The DHS Program Fellows page to see all DHS Fellows’ working papers and publications in peer-reviewed journals.
We interviewed teams of 2020 Fellows from the Asian University for Women in Bangladesh and the Gamal Abdel Nasser University of Conakry in Guinea about the virtual DHS capacity strengthening activities conducted for faculty and students.
For their working paper, Nazmul Alam, Mohammad Manir Hossain Mollah, and Sharin Shajahan Naomi wrote about the prevalence and determinants of adolescent fertility. They conducted two virtual capacity strengthening sessions via Zoom, one for 21 faculty members, researchers, and development practitioners, and another session for 25 students. In the sessions, the Fellows introduced participants to The DHS Program, reviewed basic characteristics of DHS data, and highlighted how one can effectively generate new ideas from available DHS data without needing to conduct field research, which has become difficult during the COVID-19 pandemic. “Although we were a bit hesitant about the outcome of online sessions, they appeared to be beneficial…faculty members from social sciences, public health, and natural sciences joined…after the workshop, we got very positive feedback.”
Bienvenu Salim Camara, Sidikiba Sidibé, and Nafissatou Dioubate wrote about non-use of contraceptives among married women. Days before their planned capacity strengthening presentations, Guinea declared a health emergency due to COVID-19. Universities were closed and gatherings of more than 20 people were prohibited, so the Fellows recorded video presentations introducing The DHS Program survey questionnaires and datasets and uploaded them to Google drive. Students watched the videos at their own pace and emailed the Fellows with questions. Now some students are using DHS data in their research. “One of my students is currently working on his Master’s thesis in maternal health using DHS data, and I am supporting him in the data analysis,” explains Camara. Dioubate notes, “I am proud that I was able to pass on the knowledge gained from the DHS Fellows Program to others and show the opportunities that DHS data can offer.”
The DHS Program Research and Analysis team has recently published several studies that analyze new DHS data or employ novel approaches to analyze existing DHS data.
Analysis of New Sickle Cell Data
The 2018 Nigeria DHS includes sickle cell genotyping of a subsample of 11,186 children age 6-59 months, the first population-based household survey to do so at a national level. A new Working Paper, Analysis of Sickle Cell Genotypes of Young Children in Nigeria Using the 2018 DHS Survey, finds that the siblings of genotyped children with sickle cell disease are about 2.5 times as likely to have died as the siblings of other genotyped children. The main value of the data is the description of the spatial distribution of the genotypes within Nigeria. The S and C alleles, which result in sickle cell disease, sickle cell trait, or Hemoglobin C trait, are primarily concentrated in states in the South West Zone, including Lagos, and secondarily in the North Central Zone. This information is helpful for estimating the burden of risk and for prioritizing interventions in different areas of Nigeria.
New Insights Into Wealth Inequality Using DHS Wealth Index Data
In 9 of 10 countries, households that are poor relative to their communities were more likely to use at least one maternal health care (antenatal care and facility delivery) or vaccination service, suggesting that a household that is poor relative to the community is potentially better able to access the services of a relatively wealthy community. Read the analysis brief for this Analytical Study, a user-friendly summary of the methods, key findings, and relevant action steps. Analysis briefs are available for many recent analytical reports from The DHS Program.
New Analysis of DHS Contraceptive Calendar Data
A new web feature highlights a series of publications that put to new use retrospective, longitudinal data from DHS contraceptive calendars. Three working papers were recently published. In Fertility and Family Planning Characteristics of Contraceptive Clusters in Burundi researchers apply sequence and cluster analysis to identify six discrete clusters that characterize women’s dynamic contraceptive and pregnancy behaviors over the previous five years. Factors most consistently associated with cluster membership are the need for family planning, lifetime experience of contraceptive use, marital status, pregnancy experience, and age.
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.
The DHS Program recently published a Methodological Report providing a framework for estimating “level-weights” in DHS surveys – weights that correspond to each stage of sampling. These weights are required for multilevel modeling. While the audience for the framework itself is academic researchers, the challenge of protecting respondent confidentiality while supporting data analysis is of general interest.
We sat down with two of the authors, Mahmoud Elkasabi, Senior Sampling Statistician, and Tom Pullum, Senior Advisor for Research and Analysis, to learn more about this innovative strategy.
How did the idea for this activity come about?
Post from Data User:
I have been reading the posts on the forum regarding the use of weights with multilevel analyses and wanted to check to see if there were any updates on recommendations on how to go about this. . . Since we cannot separate out the household weights from the cluster weights to incorporate them in the statistical coding, does the DHS have any recommendations on how to go about running multilevel models with DHS data? . . . I would like to run multilevel models looking at childhood vaccinations and want to make sure I am going about it in the most proper way. Any help or guidance on this from those at DHS or out in the forum would be greatly appreciated!
Mahmoud: There has been huge user demand for DHS survey level-weights. We have seen many posts on The DHS Program User Forum over the years, where analysts are trying to apply weights in multilevel analysis. It is a common type of research question, to use multilevel modeling to understand the effects of cluster-level characteristics such as region on individual-level outcomes, such as contraceptive use or children’s nutritional status.
For those of us who aren’t statistically inclined, why do researchers need to include sampling weights in their analysis?
Mahmoud: Sampling weights compensate for different probabilities of selection within the samples, and for different levels of non-response. Providing weights at multiple levels allows for the best level of representativeness for that unit. That is, the data from each interviewed woman becomes as representative as possible of similar women in the population. That is ultimately the goal of a survey: to obtain data that are nationally and subnationally representative without interviewing the entire population.
Why aren’t level-weights standardly provided with DHS datasets?
Mahmoud: After a survey is completed, The DHS Program destroys the information required for exact calculation of the cluster weights. Providing the true cluster-level weight for each cluster would pose a risk to respondent confidentiality—anyone with access to the sampling frame could use the cluster-level weights to identify the specific clusters that were drawn in the sample—and then, potentially, identify households or individuals. For that reason, The DHS Program only releases the final survey weights in the datasets.
How does the level-weights framework respond to the challenge of protecting confidentiality?
Tom: We propose a framework that uses publicly available data from DHS datasets and Final Reports, along with a process to estimate other inputs. The framework starts with the household final weight from the household recode file or the woman final weight from the woman recode file. Most of the numbers required to separate the final weight into a cluster-level weight and a household-level (or woman-level) weight are included in the data files or in Appendix A – Sample Design of DHS Final Reports. Some of the required information is not available there (see Table 1), but we provide guidance on how to estimate these inputs with other publicly available data. In this way, we can estimate or approximate the level-weights for the clusters and households (or women).
Have these level-weights been used in any DHS analysis?
Tom: This report shows how to use data from the 2015 Zimbabwe DHS to estimate level-weights and then include them in a multilevel regression model. We fitted several regression models with data for married women in 400 clusters to examine modern contraceptive use with age, education, residence, and number of children as covariates. We provide the STATA code for this example.
The recently released Analytical Study Contraceptive Use, Method Mix, and Method Availabilityis the first DHS research to use the proposed methodology. This analysis used the method described here to estimate cluster-level and woman-level weights and then to assess the effect of cluster-level and woman-level factors on contraceptive use in Haiti and Malawi.
Dr. Mahmoud Elkasabi is a Sampling Statistician at The DHS Program. He joined The DHS Program in 2013 after earning his Ph.D in Survey Methodology from the University of Michigan at Ann Arbor, with a specialty in Survey Statistics and Sampling. Dr. Elkasabi is responsible for the sampling design for the DHS surveys as well as building sampling capacity in many countries, such as Ghana, Egypt, Nigeria, India, Malawi, Zambia, Bangladesh, and Afghanistan. Dr. Elkasabi likes to work closely with the sampling statisticians in different countries. In these win-win relationships, he shares his knowledge in sampling and gains new knowledge & experiences.
Dr. Tom Pullum directs the research program, including the analysis of DHS data beyond the country reports, such as the analytical studies, comparative reports, further analysis studies, and methodological reports. He also has overall responsibility for The DHS Fellows Program and workshops. Current interests include maternal mortality and the measurement of child vulnerability. A continuing effort is the adaptation of demographic methods to statistical frameworks and software. His work with DHS has included methodological reports on data quality. He joined the DHS staff in 2011, following a lengthy career in academia, primarily at the University of Texas at Austin. Dr. Pullum has a Ph.D. in sociology from the University of Chicago.
The DHS Program’s analysis team uses DHS data to explore topics related to global health, demography, and social epidemiology. Since our last update, the analysis team has used DHS data to explore the following questions:
How have the sexual and reproductive health behaviors among young women age 15-24 in the Philippines changed over time? From 2008-2017, women’s correct knowledge of their fertile period decreased. Regions with relatively high levels of unions and fertility, but relatively low levels of contraceptive use and demand satisfied are identified in Trends of Sexual and Reproductive Health Behaviors among Youth in the Philippines.
A series of Further Analysis reports uses DHS data to shed light on women’s empowerment in Pakistan:
Which factors influence early initiation of breastfeeding? Exploring DHS data from 31 countries with DHS surveys since 2015, Initiation of Breastfeeding in Low- and Middle-Income Countries: A Time-to-Event Analysis finds that the mean and median time to initiation of breastfeeding by hour is much greater for births delivered by Cesarean section, compared with births delivered vaginally. Immediate skin-to-skin contact and higher parity are significantly associated with shorter time to initiation.
A series of Further Analysis reports uses DHS data from surveys in Mali:
Over the last 30 years, The DHS Program has published more than 500 analytical reports in collaboration with researchers and institutions around the world. These reports extend to a wide variety of topics covering population and health issues with the ultimate purpose to be used in policy formation, program planning, and monitoring and evaluation. However, many potential beneficiaries of DHS Program research findings are intimidated by these long, technical reports.
In order to expand the reach of DHS analyses to program managers, policymakers, and academic researchers, The DHS Program is pleased to announce a new user-friendly format of analysis reports. Analysis Briefs are two- to three-page user-friendly documents summarizing the methods, key findings, and any relevant action steps.
These abbreviated, colorful briefs with graphics highlight major findings in a more accessible way that allow readers to use the findings for program or policy use in their respective country. If readers choose to dive into the full report, the brief still provides an orientation through the technical data in the full report. The graphics are presented in a simplified way to orient the information in a clear, visual display. Readers with limited time and attention are encouraged to review the accompanying briefs for a condensed summary of the full analysis report.
The 2020 DHS Fellows Program is currently accepting applications from Bangladesh, Indonesia, Jordan, Maldives, Pakistan, Philippines, Tajikistan, Benin, Burkina Faso, Cameroon, Guinea, Mali, Rwanda, Senegal, and Zambia. Apply to join us for the DHS Fellows Program in 2020. The deadline to apply is November 24, 2019.
In this blog post, we interview two DHS Fellows who served as DHS Program workshop facilitators.
Dr. Kyaw Swa Mya is an Associate Professor and Head of Department of Biostatistics and Medical Demography at the University of Public Health, Yangon, Myanmar and Mr. Ehab Sakr is an assistant lecturer in the department of Demography and Bio-statistics at the Faculty of Graduate Studies for Statistical Research in Cairo University in Egypt. Both Fellows were both co-facilitators for the DHS Fellows Program (2019 and 2018, respectively) in addition to co-facilitating other DHS Program capacity strengthening workshops.
When was your first experience with the DHS Fellows Program?
ES: In January 2017, my colleagues and I were selected to be the first Egyptian team to participate in the 2017 DHS Fellows Program. I was eager for this opportunity because I used DHS data in my studies when I specialized in demography 17 years ago.
What was your experience as a DHS Fellows Program participant?
KSM: The Fellows Program provided many opportunities for the participants. First, we learned how DHS data was systematically collected and prepared for data users. Second, the Fellows Program improved our data management and analytical skills using STATA, as well as report writing skills. Third, as a requirement of the Fellows Program, we conducted capacity building activities at our University. These activities raised awareness among the Myanmar government and NGO public health professionals about using DHS data and DHS resources during planning, implementation, and evaluation of their health programs. We also disseminated the findings to stakeholders who impact policy implementation. Finally, we produced a DHS working paper that was published in the PLOS One journal.
ES: The Fellows Program was a great opportunity to enhance my knowledge about survey tools and improve my skills to use DHS data more efficiently and effectively. We were exposed to different cultures and academic trends from five other teams around the world. It’s also worth mentioning that implementing the capacity building project at our home university enriched my technical, teaching, and coaching skills. In two workshops facilitated by Dr. Wenjuan Wang and Dr. Shireen Assaf, we learned to use DHS data tools and techniques when analyzing DHS data. My teammates, Prof. Emeritus Mona Khalifa and Dr. Wafaa Hussein, and I wrote a DHS working paper titled “Changes in Contraceptive Use Dynamics in Egypt: Analysis of the 2008 and 2014 Demographic and Health Surveys.”
What was your experience as a facilitator?
KSM: The DHS Program gave me a second opportunity to participate in the DHS Fellows Program as a co-facilitator. I am thankful to The DHS Program for this opportunity. It was quite a challenging experience to be a co-facilitator. As a Fellow, I only needed to focus on my research topic, but as co-facilitator, I needed to learn all the research topics of participating countries. Moreover, I had to prepare lecture topics and this helped me become more familiar and confident with DHS methodology, analytical skills, and interpretation of the results.
ES: July 2019 was another great moment when I was asked to co-facilitate a workshop in Jordan on producing report tables using SPSS syntax at the Department of Statistics. It was a great experience communicating with lovely and skilled trainees, and we adapted to situations that forced us to customize the agenda of the workshop to suit the skills and knowledge of the trainees.
What impact has the DHS Fellows Program made on you?
KSM: The DHS Fellows Program changed my career, and DHS data has become a core part of my life. Since 2018, I published two journal articles and presented two oral presentations at the 10th and 11th International Conference on Public Health among Greater Mekong Sub-Regional Countries. One of my Masters in Public Health (MPH) students received a degree and I reviewed two master theses of two junior colleagues using DHS data and they achieved their master’s degree from foreign countries. I also received some emails from different countries asking for help with DHS coding and analysis challenges, and I helped them as far as I could. In addition, three of my MPH students prepared their proposals using DHS data this year. Myanmar is now realizing the data quality and accuracy of DHS indicators, so, not only academicians and students but also program managers and policymakers are using DHS indicators in relevant situations.
The DHS Fellow Program is one of the best and most effective programs that I have ever attended. I am grateful to USAID for providing financial and technical support to collect and disseminate quality data to monitor and evaluate population, health, and nutrition programs for developing countries.
ES: The DHS Fellows Program was life-changing and it gave me the opportunity to deepen my scientific and practical knowledge in an international, inspiring, creative, and diversified environment. Special thanks to USAID, The DHS Program team, and all the people I mentioned above. I learned a lot from them and hope to continue collaborating with them in the future.
Dr. Kyaw Swa Mya is a Biostatistician. He is an Associate Professor and Head of the Department of Biostatistics and Medical Demography, University of Public Health, Yangon, Myanmar. He holds a master’s degree in Public Health in Biostatistics. He is a member of the Institutional Review Board of the University of Public Health, Yangon. He currently works as a module supervisor of Diploma in Research Methodology and Research Ethics program conducted in the University of Medicine (I). His research interests are maternal and child health, nutrition, and non-communicable diseases.
Mr. Ehab Sakr is an assistant lecturer in the department of Demography and Bio-statistics, Faculty of Graduate Studies for Statistical Research, Cairo University in Egypt. He holds a master’s degree in Statistics from the Faculty of Economics and Political Science. His thesis theme was related to the levels and trends of age at first marriage for women in Egypt. He taught and consulted on various topics related to population dynamics and development and is currently a Ph.D. student.
The 2020 DHS Fellows Program is currently accepting applications from Bangladesh, Indonesia, Jordan, Maldives, Pakistan, Philippines, Tajikistan, Benin, Burkina Faso, Cameroon, Guinea, Mali, Rwanda, Senegal, and Zambia. The deadline to apply is November 24th.
The DHS Fellows Program was an opportunity for us to analyze DHS data, and we are particularly fortunate to live in Senegal, which released the Senegal Continuous Survey, providing nationally representative data annually between 2012 and 2018.
Prior to the Fellows Program we used DHS reports and results without knowing the methodology, data collection, analysis, and reporting work that was behind it. The possibility of using the data for secondary analysis was also unknown to us. The DHS Fellows Program allowed us to master the DHS survey structure, sampling design, and understand how to analyze population-based survey data using Stata software. The Fellows Program was a learning process, but it was also an opportunity for culture-sharing with other participants from diverse backgrounds such as Ghana, Ethiopia, Myanmar, Indonesia, and Afghanistan. Each group has advised the others in their work so everyone can present the best possible results. The co-facilitators of the Fellows program were former DHS Fellows and this gave us an opportunity to see Fellows alumni presenting their experiences with the program.
Thanks to the Fellows Program, we are better equipped to use this data again in other future work and have shared it with our colleagues during our capacity building activities. Some colleagues are already hoping to participate in future Fellows Program or other DHS workshops. This program not only allowed us to better understand the DHS surveys, but also make in-depth statistical analyses and to use DHS data to write analysis reports.
Download the DHS Working Paper authored by the Senegalese DHS Fellows participants, Coverage and Associated Factors for HIV Screening in Senegal: Further Analysis of the 2017 Demographic and Health Survey.
We were one of the first Francophone teams to participate in the Fellows Program, which initially caused us some apprehension. The call for applications required a skilled level of English as the course is taught in English, but thanks to the availability of our facilitators, Shireen, Wenjuan, and co-facilitators, Kyaw and Gedefaw, we did very well!
We could never thank ICF and The DHS Program enough for this amazing experience. In addition, we formed a real family with teams from other countries. We strongly recommend that researchers from French-speaking countries submit their applications for the 2020 DHS Fellows Program.
Written by: Ndeye Aïssatou Lakhe, Prof. Cheikh Tidiane Ndour, and Dr. Khardiata Diallo Mbaye
Dr. Ndeye Aïssatou Lakhe is a medical doctor specializing in infectious and tropical diseases. She currently works as a lecturer in infectious diseases at the Faculty of Medicine of Dakar. She is also a practicing MD at the Clinic of Infectious Diseases at Fann Teaching Hospital, the third largest hospital in Dakar. She is the head of the Infection and Prevention Control (IPC) committee of the hospital. Her interests are in policy making, particularly in IPC and health program evaluation.
Prof. Cheikh Tidiane Ndour is a Professor of infectious and tropical diseases, working in the Department of Diseases at the Fann University Hospital and the Faculty of Medicine at the Cheikh Anta Diop University in Dakar. He has been the head of the AIDS and STI Control Division of the Ministry of Health for the last three years. His current focus is the implementation of innovative strategies to achieve the 90-90-90 strategy: identify 90% of people infected by HIV, put 90% of identified HIV-positive individuals on antiretroviral treatment, and ensure that 90% of those on ART have undetectable viral loads, in accordance with commitments to the international community.
Dr . Khardiata Diallo Mbaye specializes in Infectious and tropical diseases. She works as a teacher/researcher at the University Cheikh Anta DIOP at the Faculty of Medicine of Dakar, and as a physician at the Clinic of Infectious Diseases at Fann Teaching Hospital. She also specializes in public health.
Data from the World Health Organization (WHO) estimate that, globally, 289,000 women of reproductive age die of maternal causes each year. Over 80% of these deaths are due to complications during childbirth and the postpartum period. Skilled birth attendance at health facilities equipped to handle complications is crucial for ensuring maternal survival. While Kenya has made progress in improving maternal health services in the last decade, data from the 2014 Kenya Demographic and Health Survey show that less than two-thirds of births are delivered in a health facility.
The DHS Program recently published a study on place of delivery and shared the results with county stakeholders and USAID project implementers at dissemination events in Kisumu, Turkana, Nakuru, and Nairobi counties. One aim of the study was to explore the “why” questions that sometimes are left unanswered with indicator estimates and other quantitative analysis; specifically: Why do women in Kenya deliver at home, even in instances when health facilities appear to be available?
Click photos to enlarge.
Exploring this research question included the use of journey mapping methods. In particular, the data collection tools were designed with the aim of mapping the journey for Kenyan women from the time when they learn they are pregnant to when and where they give birth.
A journey mapping approach recognizes that often a journey does not follow a straight line; instead, a journey—from pregnancy to delivery in this case—includes many economic, familial, and sociocultural factors that must be navigated along the way. In addition, the focus on mapping journeys works to uncover the story related to a woman’s delivery experience.
Data from the study suggest that place of delivery is not as simple as grouping women into the dichotomy of those who choose to deliver in a health facility and those who choose to deliver outside a health facility. Numerous factors influence place of delivery, and women do not necessarily always choose the place of delivery. The study’s conclusions recognize that contextual factors and decision making pertaining to place of delivery are complex. The pregnancy-to-delivery continuum follows an ever-shifting terrain influenced by myriad individual and collective beliefs, perceptions, tensions, and experiences.
Key Conclusions: Understanding the Nuances of a Women’s Journey along the Pregnancy-to-Delivery Continuum
Decision making occurs over time
Limited options for services to address fears and insecurities
Gendered views regarding male partner involvement in health care
Geographic and transportation challenges
Free maternity care is not always free
Expectation of support and respectful maternal care not always met
Prominence of and preferences for traditional birth attendant (TBA)
Challenges negotiating decisions and power dynamics in a marriage or partnership
Hesitancy of health facilities to accommodate for traditional practice
Potential reliance on financial support from male partners
The conclusions from this study represent a platform to galvanize momentum and facilitate a commitment to take positive steps forward. Past and present strategies and programs put into operation by USAID/Kenya, the Government of Kenya, and their partners have made substantial progress in improving the uptake of optimal maternal and child health practices. Research studies such as this one—and the use of journey mapping methods—can make a valuable contribution to knowledge about both the context in which women experience pregnancy and delivery and the specific challenges they face along the pregnancy-to-delivery continuum.
Download the full study, “Place of Delivery: Perceptions, Tensions, and Experiences. Results from a Study in Baringo, Kisumu, Migori, Samburu, and Turkana Counties, Kenya” on The DHS Program website.