These indicators and more can be found in STATcompiler, a tool that allows users to create custom tables, charts, and maps. Use the SDG tag to select from a list of SDG indicators and view them by background characteristics, overtime, and across countries.
This week we are highlighting three Global Goals using DHS data from five recent DHS surveys. Click an SDG indicator in the infographic below and compare the indicators of demand for family planning satisfied by modern methods, secondary education, and age at first marriage in Albania, Benin, Jordan, Mali, and Pakistan. Customize the tables by background characteristics or trends over time to create your own data visualization. Share your results with the #GlobalGoals community.
Share this infographic on Facebook and Twitter, and don’t forget to tag #GlobalGoals to engage with others in this global conversation!
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.
If you are interested in being featured in the ‘DHS Data Users’ blog series, let us know here by submitting your example of DHS Program data use.
Over the past four years, the IPUMS-DHS program has grown substantially, in both the magnitude of available data and in use. As of June 2019, more than 2,000 users have accessed the IPUMS-DHS database, and multiple papers have been published using DHS data through IPUMS-DHS.
One of the advantages of accessing DHS data through IPUMS-DHS is that variables are harmonized across surveys, facilitating comparative research. Recent research using IPUMS-DHS data highlight innovative methods and fascinating results:
Becker conducted a comparative study looking at control of female sexuality and male absenteeism in 34 countries and found that women in historically pastoralist societies face more restrictive norms.
Boyle and Svec recently published a paper on the international transmission of gender norms and female genital cutting (FGC) in six DHS countries. Results indicate that women’s decision making status is an important factor in FGC abandonment.
Di Brisco and Farina explored the methodological challenge of measuring gender disparities through individual perceptions and enlightening the pertinence of the poset methodology for the analysis of ordinal variables and response profiles. They used IPUMS-DHS data from 16 African countries.
IPUMS-DHS is also being used to train the next generation of analysts and data users. The Quantitative Global Health Analysis course taught at the University of Minnesota this spring relied on IPUMS-DHS as a primary data source for its students. Final products were research posters using the data. Research questions explored by students analyzing IPUMS-DHS data included:
How Violence against Women Affects Fertility and Family Planning in Uganda
Changes in and Predictors of Antenatal Care for Women in Mali
Effects of Family Size and Food Insecurity on Child Mortality in Ethiopia
Understanding Variation in Vaccination Status in Ethiopia
Vitamin A Vaccination and Deficiency in Uganda
Perceptions of HIV/AIDS in India in the Context of Education
IPUMS-DHS Data Update: As of June 2019, the IPUMS-DHS database includes 156 samples from 38 countries and nearly 15,000 consistently coded variables, including all standard DHS variables from DHS Phases 1 through 7 and many country-specific variables. Learn more on our website and read our previous blogs on the IPUMS-DHS collaboration here.
This blog post is part of Luminare, our new blog series exploring innovative solutions to data collection, quality assurance, biomarker measurement, data use, and further analysis. This is the second post in the series that focuses on innovations using DHS.rates data.
Ever struggled to calculate fertility or child mortality indicators from survey data? Want to customize the reference period? DHS.rates can do it for you!
What is DHS.rates?
The DHS.rates is a user-friendly R package to calculate fertility
and childhood mortality rates based on DHS datasets. First released in March
2018, the current version of DHS.rates calculates the Total Fertility Rate,
General Fertility Rate, Age-Specific Fertility Rates, Neonatal Mortality Rate,
Post-Neonatal Mortality Rate, Infant Mortality Rate, Child Mortality Rate, Under-5
Mortality Rate and mortality probabilities. For each indicator, the package
calculates standard error, design effect, relative standard error, and
confidence intervals. Data users can customize rates:
periods other than DHS standard reference periods
Based on calendar
years so the end of the reference period is not the date of the survey
sub-populations or domains other than those produced by The DHS Program
Based on other surveys
other than DHS if the required variables are available
Not an R user? Try
theweb-application, DHS.rates Shiny
This web-application provides all the DHS.rates functions without needing to download or use R. The DHS.rates Shiny web application includes two main tabs, fert and chmort. After uploading the relevant survey dataset, the application calculates fertility or childhood mortality rates according to the DHS methodology.
Just as with the R package, Shiny web application users can customize the reference period as well as the end date of the reference period. By adding a variable to “Class of the rate”, users can do the calculations for different subpopulations other than the ones produced by The DHS Program. Users also can change any of the fields on the screen allowing them to use the application with other surveys other than the DHS.
This new blog series, DHS Data Users, captures examples of how you, the data user, have incorporated data from DHS, MIS, and/or SPA surveys into your analyses, at your institution, or to influence policies or programs. If you are interested in being featured in the ‘DHS Data Users’ blog series, let us know here by submitting your example of DHS Program data use.
The year 2018 saw an upswell of interest in health system quality with the publication of three global reports highlighting critical deficits in quality in health systems in low- and middle-income countries [1,2,3]. Much of the empirical basis for these reports was drawn from the Service Provision Assessments (SPA), the lesser-known surveys conducted by The Demographic and Health Surveys (DHS) Program, which provide comprehensive assessments of health systems in low-resource settings from Haiti to Nepal.
These surveys include a detailed audit of facility resources, provider interviews, direct observations of primary care services, and exit interviews with patients or caretakers. Each assessment is a sample of the complete health system (public and private) or in some cases a complete census. The resulting wealth of data enables assessment of structural inputs to quality of care, the care process – both competent care and user experience – and some outcomes from care, primarily user confidence in the health system. A small but increasing number of researchers is delving into all the SPA data have to offer. Among the insights the SPA surveys have yielded just from my own research are:
Most health systems assessed are not fully prepared for basic health care.
A comparative study of 8,443 facilities in 9 countries based on SPA surveys between 2007 and 2015 found that hospitals averaged between 69% (Senegal 2012-2014) and 82% (Tanzania 2015, Namibia 2009) on the service readiness index defined by the World Health Organization for primary health facilities. Non-hospitals achieved at best 68% readiness (Namibia 2009) and at worst only 41% (Uganda 2007, Bangladesh 2014) . Within primary care services – antenatal care, family planning, and sick child care – service-specific service readiness is not highly predictive of competent care being delivered.
In Kenya, where the 2010 SPA did include direct observation of labor and delivery, both structural quality of maternity care and observed clinical quality was higher in facilities in wealthier areas than facilities in poorer areas, with women in the poorest areas receiving care that complied with only half of recommended clinical guidelines on average .
Across 8 countries, adherence to clinical guidelines was lower in sick child care, where providers completed only 38% of the standard Integrated Management of Childhood Illness (IMCI) items, than in family planning (46%) and antenatal care (57%) . The median sick child consultation lasted only 8 minutes . Focusing specifically on Malawi, where the survey team conducted a limited re-examination of sick children, providers diagnosed pneumonia in only 1 in 5 children who showed symptoms of pneumonia per the IMCI guidelines .
Analysis of the 2013-2014 Malawi SPA survey with a simultaneous household survey suggested that poor quality care may contribute to avertable neonatal mortality, with a predicted prevalence of neonatal mortality of 28.3 deaths per 1,000 in lower quality facilities and 5.2 deaths per 1,000 in higher quality facilities, among women who would choose higher quality if it were more accessible to them .
As attention shifts from describing health system quality to improving it at scale, robust and ongoing measurement will be an essential tool for governments and researchers alike, particularly the direct observation of care delivery and perspective from patients themselves that makes the SPA such a unique and valuable resource.
Dr. Hannah Leslie is a Research Associate at the Harvard Chan School of Public Health; she served as the Measurement Research Lead for the Lancet Global Health Commission on High-Quality Health Systems in the SDG Era. She received her MPH and Ph.D. in Epidemiology from the University of California, Berkeley. Her research has made extensive use of the Service Provision Assessment surveys to 1) develop metrics of structure and process quality in LMICs, 2) describe current quality of care, and 3) assess predictors and effects of poor quality. Her recent work focuses on effective coverage calculations, patient experience measurement, and quality of care as a driver of HIV testing and treatment retention.
The DHS Program is now in its 35th year with a long history of helping to collect, analyze, and disseminate data on women’s empowerment, gender equality, men’s engagement, and gender-based violence within the context of health and development. Historically, The DHS Program has integrated attention to gender in all its activities and aspects of its operations, from the types of data collected and disaggregated and analyses conducted, and the “how” and the “who” of data collection, capacity strengthening, dissemination, and use.
Over the coming five years, The DHS Program will continue its cross-cutting approach to gender integration into its work and surveys. In particular, The Program will endeavor to help achieve the agency-wide commitments mandated by USAID’s Gender Equality and Female Empowerment Policy. The DHS Program supports USAID’s objectives and has adopted an updated Gender Integration Strategy with the following priorities:
Continued collection of high-quality data for gender indicators and sex disaggregation: The project will continue to contribute to evidence-based, gender-integrated health programming by providing the data necessary for understanding gender disparities related to health, including disparities in wealth, access to resources, and decision making power. Similarly, it will continue to collect data on domestic violence; early marriage and skewed sex ratio; household headship; women’s relative earnings and control of their earnings; women’s ownership of a house, of land of a bank account, and of a mobile phone; as well as female genital cutting and fistula.
The DHS Program will monitor and respond to emerging needs for gender data important for women’s health and demographic behavior. The DHS Program is soliciting public feedback through March 15, 2019, on potential new areas/indicators/questions, including on the measurement of gender equality, male engagement, women’s empowerment, decision making, and domestic violence. This feedback will help identify some of the current gender-related data gaps.
Increased focus of dissemination efforts to highlight gender disparities in health and resource and opportunity access: Data collected on gender and women’s empowerment are widely disseminated using digital, print, and other means. Most indicators are readily available on the STATcompiler, The DHS Program’s Mobile App, and the DHS API. The DHS Program website also maintains a “Gender” topic page, which provides a one-stop shop for gender indicators from DHS surveys.
Enabling gender equality in access to opportunities, capabilities, learning, and resources: The DHS Program will continue its efforts to ensure that there is no discrimination by sex, pregnancy status, sexual orientation, or gender identity in access to opportunities for training, employment, and learning all along the survey continuum.
By maintaining confidentiality and gender-sensitive protections. The DHS Program has strict ethical guidelines to protect respondents and interviewers and ensure confidentiality of respondents, their families, and of the data. While these guidelines apply to all respondents, they also specifically recognize the need for special protections for women in certain circumstances.
By exploring technologies to ask highly sensitive questions: Several of the questions asked in DHS surveys are highly sensitive. While some of these sensitive questions are asked of both women and men, such as number of sexual partners, some others are mainly asked of women, including questions on experience of sexual violence. Improving the validity of responses to these questions remains a challenge for any survey program, and it is important to look for ways to both improve reporting and also provide respondents with a more secure platform to disclose sensitive information, such as audio computer assisted self-interviewing (ACASI).
By continuing to integrate gender into the research agenda: The DHS Program’s research agenda continues to include innovative studies that shed light on the linkages between gender and health. The DHS Program will undertake many new research projects that will contribute to a better understanding of the level and changes in women’s empowerment and the interface between gender and health outcomes as well as gender disparities in health, while also applying a gender lens to analyses that do not directly involve gender indicators. In the meantime, read the latest gender analytical publications.
For International Women’s Day 2019, The DHS Program invites you to explore the wealth of gender-related resources and publications available at dhsprogram.com. Learn more about Sustainable Development Goal #5, Gender Equality indicators available in DHS surveys in the infographic below.
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.
The basic approach of The DHS Program is to collect data that are comparable across countries. This is achieved through the use of model questionnaires and the subsequent processing of the raw data into standardized data formats known as recode files. The DHS-VII Recode Manual is an introduction to the DHS standard recode files and serves as a reference document for those analyzing DHS data.
Who is the manual for?
Data users who are analyzing DHS datasets in statistical software receive the DHS recode data files for each survey along with the survey specific recode documentation. We strongly recommend that users download this documentation as well as the questionnaires used in the surveys they analyze. The questionnaire for a survey can be located in the appendix of the final report.
What is new in this version of the manual?
This updated manual describes the characteristics of the recode files defined for the seventh round of the DHS surveys (DHS-VII). The manual highlights the 234 new variables added during DHS-VII. In addition to an explanation of new variables, the manual now also contains:
A description of the DHS Recode Data Files distributed and file naming convention used.
An explanation of the Century Day Code (CDC). Beginning with the DHS-VII questionnaire (surveys with fieldwork in about 2015 and later), the woman’s questionnaire collects the day of birth for all children listed in the birth history in addition to their month and year of birth to calculate the age of children more accurately. The use of CDC affect virtually all tables related to children, particularly to children under the age of five.
A list of the locations of DHS-VII core questionnaire variables in the DHS-VII standard recode variables.