Category Archives: Analysis

04 May 2021

The DHS Program at the 2021 PAA Annual Meeting

May 5th marks the first day of the 2021 Population Association of America (PAA) Annual Meeting. The premier conference of demographers and social and health scientists from the United States and abroad, this year’s PAA Annual Meeting is virtual. You must register to access sessions of the 2021 PAA Annual Meeting.

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:

Wednesday, May 5, 2021Time*Type & Number
Trends and the Relationship between Maternal Health and Empowerment in Pakistan, 2012-2018
Lindsay Mallick, Rabia Zafar, Christina Juan, Johanna Useem
1:00pm-2:15pmSession 45
Thursday, May 6, 2021Time*Type & Number
Stunting and Anemia for Children in Urban Poor Environments
Shireen Assaf, Christina Juan
9:30-11:00amPoster 3-103
Trajectories Into Contraceptive Use Among Adolescents in Burundi, Colombia, and Nepal
Kerry L.D. MacQuarrie
10:45am-12:00pmSession 114
Gender- and Sexuality-Based Violence
Discussant: Dr. Sunita Kishor, Director, The DHS Program
1:00-2:15pmSession 134
Friday, May 7, 2021Time*Type & Number
Intention to Use Contraceptives in Jordan: Further Analysis of the Jordan Population and Family Health Survey 2017-18
Sara Riese
9:30-11:00amPoster 6-66
Disability Status and the Experience of Unintended Pregnancy in 5 Low- and Middle-Income Countries
Kerry L.D. MacQuarri
e, Julia Fleuret
1:30-3:00pmPoster 7-48
Contraceptive Use, Method Mix, and Method Availability: A Multilevel Analysis
Lindsay Mallick, Shireen Assaf, Michelle Weinberger, Gbaike Ajayi
2:30-3:45pmSession 238
*All times listed are in Central Daylight Time

Use web and mobile tools from The DHS Program to explore DHS survey data for yourself:


Featured image © rexandpan, stock.adobe.com

21 Apr 2021

Learn How to Use The DHS Program’s Code Share Library on GitHub

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.

The second tutorial video, Preparing to Run The DHS Program’s Shared Code in Stata, demonstrates how to prepare to run code to produce DHS indicators in the statistical software Stata using the model datasets. The model datasets were created strictly for practice and do not represent any country’s actual data. Unlike datasets for specific surveys, users do NOT need to register to download model datasets.

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.

If you do not understand why an indicator was coded in a specific way, check the Guide to DHS Statistics. If you have further questions, email us at codeshare@dhsprogram.com or post your question on The DHS Program User Forum. Follow The DHS Program on Twitter, Facebook, and LinkedIn for the latest news about code updates (including forthcoming R code), survey dataset releases, and more. Happy coding!

31 Mar 2021

Reflections from the 2020 DHS Fellows Program

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.

Bangladesh

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.”

Mohammad Manir Hossain Mollah, Sharin Shajahan Naomi, and Nazmul Alam, 2020 DHS Fellows from the Asian University for Women. “We believed that we could deliver the outcome despite the challenges of the pandemic due to our teamwork and mutual understanding.”

Guinea

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.”

Sidikiba Sidibé, Nafissatou Dioubate, and Bienvenu Salim Camara, 2020 DHS Fellows from the Gamal Abdel Nasser University of Conakry. “My favorite part was the capacity building in DHS database analysis. This allowed me to undertake other analyses on nutrition indicators using Guinea datasets (food practices for infants and young children) as well as capacity building activities for my students,” notes Sidibé.

Due to the ongoing COVID-19 pandemic, the DHS Fellows Program was suspended for 2021. In the meantime, take open courses available on The DHS Program Learning Hub and watch for upcoming Workshop and Training Announcements.

02 Dec 2020

DHS Program Analysis Updates: Fall 2020

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

DHS surveys include a wealth index, a composite measure calculated using easy-to-collect data on a household’s ownership of selected assets. The DHS wealth index categorizes households into five wealth quintiles. In Household Wealth Relative to Community Wealth: Associations with Specific Asset Ownership and Maternal and Child Health Indicators, researchers computed an additional measure of wealth inequality, calculating a mean wealth score for each sampling cluster. Each household was then categorized according to its wealth relative to the average wealth of the community.

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.

Additionally, two working papers, Associations between Women’s Current Contraceptive Method Decision Making and their Reproductive Calendar Histories in Burundi, and Attributes Associated with Women’s Contraceptive Profiles in Burundi: Knowledge, Attitudes, and Interactions with Media and Health Services, further explore two “Family Builder” clusters. Women from the Family Builder 1 cluster had higher relative risks of deciding jointly whether or not to use contraception with their partners or husbands than of not deciding about contraception. Moreover, both “Family Builder” clusters are characterized by the presence and differences in the timing of multiple pregnancies in their calendar histories. Women with high contraceptive knowledge, intentions to use contraception, and well-articulated family size ideals are characteristic of Family Builder 1, while low contraceptive knowledge, no use of contraception, and vague family size preferences are characteristic of Family Builder 2. These results can guide reproductive health programs as they target interventions to the unique subpopulations they seek to serve.

Find all recent analysis publications in our latest newsletter and on The DHS Program website.


Featured image © Jonathan Torgovnik, Getty Images, Images of Empowerment

07 Oct 2020

Luminare: Providing Sample Weights for Multilevel Analysis while Protecting Confidentiality

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 Availability is 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.

Can this approach be used for other surveys?

Yes! The approximation approach is valid for other household surveys, such as the Malaria Indicator Survey (MIS) and UNICEF’s Multiple Indicator Clusters Survey (MICS), so long as the inputs for the framework are available.


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.

23 Jul 2020

DHS Program Analysis Updates: Summer 2020

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:

Modern Mother is one of six profiles of women’s contraceptive and pregnancy behaviors in Nepal.
A Bayesian geospatial modelling approach generates subnational estimates of stunting and wasting in Mali, and identifies key factors associated with undernutrition.

Follow The DHS Program on Twitter and Facebook for updates when new analysis publications are published later this summer!


Featured image: © 2014 Froi Rivera, Courtesy of Photoshare

07 Jan 2020

Introducing DHS Program Analysis Briefs

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.

 

Featured image: © ICF

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.

Briefs can be found on the full report publication summary page or by filtering by publication type ‘Analysis Briefs’ in The DHS Program publication search.

 
20 Nov 2019

From Participant to Facilitator: DHS Fellows from Myanmar and Egypt

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?

KSM: In 2018, I was selected as part of a three-member team for the 2018 DHS Fellows Program from the University of Public Health, Yangon. We were the first Fellows from Myanmar where only one DHS survey has been conducted in 2015-2016. In Myanmar, most public health professionals, including myself, were not aware of DHS surveys.

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.


Photo caption: Facilitators and participants from the 2018 DHS Fellows Data Analysis Workshop. ©ICF


Written by: Kyaw Swa Mya and Ehab Sakr

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.

06 Nov 2019

Reflections from the 2019 DHS Fellows Program: Senegal

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.

Click to view the 2019 DHS Fellows Facebook photo album

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.

 

Featured photo caption: Dr. Khardiata Diallo Mbaye, Prof. Cheikh Tidiane Ndour, and Dr. Ndeye Aïssatou Lakhe at the 2019 DHS Fellows Report Writing Workshop. ©ICF


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.

22 Oct 2019

Journey Mapping Methods: Results from a Study on Place of Delivery

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.


Photo gallery captions (left to right):

  1. Participants at the Kisumu County dissemination and data use workshop, August 1, 2019. © ICF
  2. Participants at the Turkana County dissemination and data use workshop, August 5, 2019. © ICF
  3. Participants at the Nakuru County dissemination and data use workshop, July 29, 2019. © ICF
  4. Participants at the Nairobi dissemination and data use workshop, July 17, 2019. The group included Nairobi-based stakeholders as well as key stakeholders who traveled to Nairobi from Baringo, Kisumu, Migori, Nakuru, Samburu, and Turkana counties. © ICF

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

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