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.
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.
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.
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.
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.
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.
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.
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.
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.
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 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.