Even though COVID-19 has paused survey fieldwork and kept DHS Program staff from traveling, DHS data continue to inform the COVID-19 conversation around the world. The just-launched COVID-19 feature page on The DHS Program website provides a hub for all of this essential information.
This new page features the tools released this year by The DHS Program to support the use of DHS COVID-19-related data:
Our story map on availability of handwashing facilities and sleeping space allows users to explore national and subnational variation in these infection-prevention measures.
SPA data on health facility readiness to manage infection control, diagnose respiratory infections, and provide treatment were compiled in a new publication.
The global community relies on DHS data in their work to understand COVID-19, and we are eager to share those resources. The new web hub provides frequently updated news and journal articles that feature DHS data. These articles highlight the broad impact of COVID-19. The effects of lockdowns, social distancing, and isolation are far-reaching and have caused great concern in the global health community. DHS data help to contextualize these other effects of the pandemic: food insecurity in Nepal, concerns about the impact of COVID-19 on family planning use in Nigeria, and an increase in domestic violence in the Philippines are just a few examples. The journal articles feed lists COVID-19-related peer-reviewed journal articles that use DHS data. Recently posted articles cover the public health consequences of COVID-19 on malaria in Africa (Nature Medicine), preventing COVID-19 in Indian slums (World Medical and Health Policy), and a vulnerability index for COVID-19 in India (Lancet Global Health).
Finally, the COVID-19 feature page will be home to any COVID-19-related press releases issued by The DHS Program. This is where you can find more detailed information about the status of survey operations, including plans for returning to the field and adjusted survey timelines.
In response to the COVID-19 pandemic, The DHS Program has paused in-person survey trainings and activities. Recognizing the desire for opportunities to showcase new survey results despite global stay-at-home orders and social distancing guidelines, The DHS Program has devised virtual dissemination strategies for surveys.
In observation of World Mosquito Day 2020, learn more about these two MIS surveys conducted in Uganda and Ghana.
2018-19 Uganda Malaria Indicator Survey (UMIS)
To commemorate World Malaria Day 2020, the Uganda National Malaria Control Division (NMCD), Uganda Bureau of Statistics (UBOS), the US President’s Malaria Initiative (PMI) Uganda, and The DHS Program virtually disseminated the 2018-19 UMIS on April 23, 2020. Dr. Jimmy Opigo, Ministry of Health Assistant Commissioner and head of the NMCD, welcomed the global, virtual audience, and technical remarks were made by James Muwonge of UBOS and Dr. Mame K. Niang of PMI Uganda. More than 100 participants attended the webinar that included a presentation of the 2018-19 UMIS key findings and discussion about the survey results.
“COVID-19 doesn’t lock down mosquitos. Mosquitos aren’t in a quarantine.”
DR. JIMMY OPIGO, UGANDA MINISTRY OF HEALTH, ASSISTANT COMMISSIONER AND HEAD OF THE UGANDA NMCD
About the survey: The 2018-19 UMIS interviewed 8,351 households and 8,231 women age 15-49. The 2018-19 UMIS was implemented by NMCD and UBOS. Financial support for the survey was provided by the United States Agency for International Development (USAID) through the PMI, United Kingdom Department for International Development (DFID), Government of Uganda with Global Fund support, and World Health Organization (WHO).
2019 Ghana Malaria Indicator Survey (GMIS)
The 2019 GMIS was implemented by the Ghana Statistical Service (GSS) in close collaboration with the Ghana National Malaria Control Programme (NMCP) and the National Public Health Reference Laboratory (NPHRL) of the Ghana Health Service (GHS). On July 28, 2020, the 2019 GMIS results were virtually disseminated during a webinar.
Professor Kwadwo Ansah Koram, former Director of the Noguchi Memorial Institute for Medical Research, chaired the webinar. Professor Samuel Kobina Annim, Government Statistician of GSS, thanked the survey teams for their commitment to collecting high quality, accurate data. Dr. Keziah L. Malm, Programme Manager of NMCP, provided an overview of malaria control strategies. US Ambassador to Ghana Stephanie S. Sullivan spoke of the collaboration between the US and the government of Ghana to improve malaria treatment, control, and prevention. Representatives from GSS and NMCP presented the results of the 2019 GMIS and facilitated a Q&A discussion about the implications of the survey findings. An additional webinar for the media was produced, highlighting GMIS survey findings and data use tools.
About the survey: The 2019 GMIS provides up-to-date estimates of basic demographic and health indicators for malaria at the national level, for urban and rural areas, and for each of the 10 former administrative regions. A total of 5,181 women age 15-49 were interviewed, representing a response rate of 99%. Financial support for the survey was provided by USAID through PMI, the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and the Government of Ghana.
Are facilities prepared to face infectious disease pandemics like COVID-19? A new fact sheet explores infection control and readiness in health facilities from seven Service Provision Assessments (SPA) conducted in Afghanistan, Bangladesh, the Democratic Republic of Congo, Haiti, Nepal, Senegal, and Tanzania. The SPA collects information on the availability of different health services in a country and facilities’ readiness to provide those services.
In six out of seven countries, fewer than 75% of facilities have soap and running water or alcohol-based disinfectant for handwashing. Senegal is the exception, where 95% of health facilities in Senegal have these resources for handwashing.
Availability of personal protective equipment (PPE) such as latex gloves, medical masks, and gowns varies. In Nepal, latex gloves are available in 80% of facilities, while only 19% have medical masks and 9% have gowns. In the Democratic Republic of Congo, gowns (83%) and latex gloves (75%) are more common than medical masks (14%).
In Haiti, only 17% of facilities have appropriate storage of infectious waste, and fewer than half of facilities have safe final disposal of infectious waste. In Tanzania, 44% of facilities have appropriate storage of infectious waste, while 36% have safe final disposal of infectious waste.
Fewer than 1 in 4 facilities in five countries offer in-patient care. Few facilities have oxygen.
Most facilities have a thermometer and stethoscope. In Bangladesh, 86% of facilities have a thermometer and 94% have a stethoscope.
Explore indicators on infection prevention, PPE, diagnostic capacity, and newly tabulated indicators on therapeutic readiness in the new fact sheet.
The current World Health Organization’s guidelines call for the public focus on handwashing, social distancing, communication with medical providers, and staying informed to help mitigate the spread of COVID-19. However, such guidance may be more aspirational than actionable for millions at risk of exposure to the virus in lower- and middle-income countries (LMICs) as revealed by recent Demographic and Health Surveys (DHS). DHS data from 2014 onward from more than 50 countries in Africa, Asia, and Latin America highlight the very different contexts for daily living in LMICs. These realities must be considered when developing country or context-specific strategies for reducing COVID-19 transmission.
The basics required for handwashing (soap and water) are taken for granted by many but are not readily available for millions of people. In Burundi (2016-17 DHS), only 5% of households were observed to have soap and water for handwashing (among those where handwashing places were observed). Soap and water were present in fewer than 20% of households in Malawi, Ethiopia, Benin, and Mali (see chart). A location for handwashing with soap and water was found in fewer than half of households in 21 out of 36 recent surveys for which The DHS Program has this information.
Household Size and Sleeping Arrangements:
Messaging about social distancing in the current pandemic focuses on staying home and reducing contact with people. In LMICs, self-quarantining to individual households and nuclear families may not be a particularly useful concept.
Households in Sierra Leone, Tajikistan, Guinea, Pakistan, Afghanistan, and Senegal are the largest, with six or more members on average. The ability to distance from sick or vulnerable family members within the household is crucial, but in many households sleeping quarters are crowded. Households in Pakistan, Madagascar, Ethiopia, and Cambodia have the highest average of people per sleeping room, at three or more.
Household Age Structure:
A recent article in the Hindustan Times pointed out that multi-generational households in India might be a risk factor for coronavirus transmission to the elderly. The 2015-16 India National Family Health Survey (India’s DHS) reported that 4 in 10 Indian households are non-nuclear families, many of which are multi-generational. This type of family structure makes social distancing, especially for the elderly, very challenging. When younger children go to school, or working-age adults go to work, they return home to multi-generational families in which the elderly are particularly vulnerable to coronavirus. While the proportion of population age 65+ in DHS countries is not large, there are some key things to note, particularly within the context of multigenerational households. In recent surveys, on average, about 5% of the population is 65+, but in countries like India (6.6%) and Indonesia (6.2%), these seemingly small percentages correspond to many millions of people due to population size.
The DHS Program’s STATcompiler allows users to create custom
tables, charts, and maps from 1000s of indicators across 90 countries.
Just this week, the STATcompiler has been updated to include new indicators to help contextualize the COVID-19 crisis in DHS countries, and two “COVID19” tags have been added to help users identify these indicators. Explore data on handwashing, sanitation, household size, sleeping arrangements, access to media, spousal violence, and more. Other relevant DHS indicators on household age structure, access to internet and cell phones, and tobacco use will be added in the coming weeks.
Health emergencies necessitate that urgent information be shared with the public in a timely manner. And yet large portions of the global population live without regular access to mass media. More than half of women age 15-49 in Liberia, Nigeria, Sierra Leone, Guinea, Benin, Timor-Leste, Niger, Malawi, Mozambique, the Democratic Republic of the Congo, Burundi, Papua New Guinea, Ethiopia, and Chad report that they do not have weekly access to information via radio, television, or newspaper.
In 30 out of 47 recent DHS surveys, at least 75% of households owned at least one mobile telephone. Still, ownership is lower in rural areas, and still uncommon in some countries; in Madagascar, for example, only one-third of households owned a mobile phone in 2016. Internet access, however, is very low across DHS countries. In Nigeria, only 16% of women and 35% of men age 15-49 used the internet in the past year (2018 NDHS). In Zambia, use was even lower, at 12% of women and 26% of men (2018 ZDHS).
Additional Considerations: Domestic Violence, Tobacco Use, and Access to Basic Health Services
And then there are potential secondary risk factors. How does cigarette smoking affect vulnerability? How will families cope with the stresses of a pandemic and the interpersonal conflicts exacerbated in quarantine settings? Will women and children continue to get the general health services they need, such as vaccinations, antenatal and delivery care, family planning, and nutritional support? These questions are important in all settings, but especially in those that are still in the process of building systems to support accessible, quality health care services. In Nigeria, for example, fewer than one-third of children age 12-23 months have received all 8 basic vaccinations, only about 40% of births are delivered in a health facility, and 19% of women have an unmet need for family planning.
Averaging across countries with data on spousal violence shows that 1 out of 4 women report physical, sexual, or emotional violence committed by their husband or partner within the last 12 months, and 36% report ever having faced such violence in their lifetime. These data suggest that social distancing may expose a significant proportion of already vulnerable women to a heightened risk of violence as women are forced to spend even more time with their abusers than usual and their access to sources of help is further limited by the pandemic.
There are countless other factors that are likely affecting COVID-19 transmission throughout the world. Urbanization, and slum environments in particular, are breeding grounds for contagion. In LMICs, millions of people migrate to city-centers for employment and are now migrating home to rural areas seeking safe-haven. These and myriad other factors can be explored in DHS datasets and final reports.
Pandemics require data-driven decisions. While it is one unique virus that has spanned the globe, individual nations, communities, cultures, and families all face it within their own contexts. We can’t collect DHS household data during a pandemic. But we owe it to families in DHS countries to use the information already collected to better inform decisions to provide recommendations that resonate in their settings and to safeguard their already fragile health infrastructure.
Anthropometry measurement (height and weight) is a core component of DHS surveys that is used to generate indicators on nutritional status. The Biomarker Questionnaire now includes questions on clothing and hairstyle interference on measurements for both women and children for improved interpretation.