Five years since world leaders agreed to the Sustainable Development Goals (SDGs) to create a better world by 2030, this year’s theme for International Women’s Day, I am Generation Equality: Realizing Women’s Rights, challenges everyone to reflect on how a gender-equal world will be achieved. DHS data describe the status of women around the world. Over time, women have made gains in education, employment, health care, and family life. However, progress towards gender equality is halting and inconsistent.
In a gender-equal world, women and men will have equal power: the power within to know their right to equality, the power to create change, and the power with others. In a gender-equal world, other people’s power over women will be reduced, especially the most extreme expression of power over, gender-based violence (GBV).
DHS questionnaires already give insight into the types of power that women and men do and do not have. For instance, a composite scale of three DHS survey items is used to measure progress toward SDG Indicator 5.6.1: the proportion of women age 15-49 who make their own informed decisions regarding sexual relations, contraceptive use, and reproductive health care.
The DHS Program has recently updated DHS-8 questionnaires and optional modules, including the Domestic Violence module, to fill gender-related data gaps and respond to emerging gender data needs. For instance, in several countries around the world, many people live together in unions that have not been officially registered. A registered marriage is related to a range of social protections and rights, such as divorce and inheritance, that are especially important for gender equality. New questions have been added to the Woman’s Questionnaire on marriage registration:
Did you have a marriage certificate for your
Do you have a marriage
certificate for this marriage?
Was this marriage ever
registered with the civil authority?
Measuring gender-related power using DHS data highlights countries’ progress towards gender equality, especially in the areas of reproductive empowerment, male engagement, and reduction of GBV. Measuring power can also help program managers and policymakers understand how power manifests within couples, between service providers and clients, and how different interventions can cultivate positive expressions of power and mitigate harmful expressions of power over for a more equal world.
For International Women’s Day 2020, explore gender-related power measures in DHS surveys in an inventory and a presentation. You can also explore many common gender indicators using The DHS Program’s Gender mini tool.
Position title: Senior
Advisor for Capacity Strengthening
Languages spoken: French, English, Swahili, Lingala, and Haitian Creole
When did you start at The DHS Program? March
Favorite DHS survey cover: I prefer it when we have an image that represents the country. For example, the report for the 2007 Democratic Republic of the Congo DHS had an okapi on the cover, and you find okapis only in DRC.
What is your role at The DHS Program? As the Senior Advisor for Capacity Strengthening, I oversee the implementation of strategies to strengthen host country individual and institutional capacity, working with different technical teams.
My work involves assessing survey implementing agencies’ capacity at the beginning and at the end of a survey and working on capacity strengthening activities to improve and sustain institutional capacity. Capacity strengthening activities are either survey-related or competency-based trainings. Our training opportunities are offered both online, on The DHS Program Learning Hub, and in-person during national and regional workshops.
Another way of strengthening capacity at the country
level is by collaborating with consultants. The DHS Program has been using south-to-south
consultants for several years. Consultants help build and reinforce capacity in
host countries and across regions. Under DHS-8, we are designing a
certification program for these consultants, streamlining processes to equip
them with skills to better support survey implementation and dissemination.
What work are you most proud of? I have designed and facilitated several capacity strengthening activities in the past. In my work now at The DHS Program, I’m no longer in front of people facilitating trainings. I am mostly behind the scenes. I am very much involved in the design process, making sure that we have the right tools to facilitate engaging trainings. I am proud of the way I’ve been able to help technical teams design trainings, and I trust them to successfully run the show.
I am most proud of completely designing the DHS-8 Global Capacity Strengthening Strategy within my first six months at a program that has so many components as The DHS Program.
What’s your favorite trip to date? So far, my second trip is my favorite one. In December, I went to Madagascar to conduct a capacity assessment of the Institut National de la Statistique (INSTAT), the implementing agency for the forthcoming fifth Madagascar Demographic and Health Survey. While there I pilot-tested our updated Capacity Assessment Tools, which I used to assess INSTAT’s current capacity. Based on the results, I shared with INSTAT a list of capacity strengthening activities that I think would benefit them, like how they can restructure the way they work so that whatever capacity is built during the DHS survey process can be managed and shared throughout INSTAT to build long-term institutional capacity.
For more information about The DHS Program’s capacity strengthening approaches, visit our website.
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.
Demographic and Health Surveys (DHS) collect nationally representative data and data representative at the first subnational administrative level (ADMIN 1). The 2016 Ethiopia DHS was designed to produce representative estimates for nine regions and two administrative cities. The 2014 Kenya DHS produced estimates for eight regions (formerly provinces). In addition to national-level indicators, STATcompiler also presents subnational data, as shown in the map of childhood stunting at the ADMIN 1 level in Ethiopia and Kenya.
Childhood Stunting by Subnational Level, 2016 Ethiopia DHS & 2014 Kenya DHS
Click the map to explore childhood stunting using STATcompiler.
National and ADMIN 1 data help countries track their progress towards achieving the Sustainable Development Goals, for instance. However, as countries decentralize their health service delivery systems, local health officials increasingly need local data. In Ethiopia, nine regions are further divided into zones and special districts (ADMIN 2). In Kenya, eight regions are further divided into counties.
One option to get data representative at the ADMIN 2 level is
to increase the survey sample size, requiring more time and more money. Another
option is to produce spatially interpolated maps, which use Bayesian geospatial
modeling techniques to predict indicator values at non-surveyed locations.
The DHS Program’s Geospatial team assembled data for 12 geospatial
covariates, such as elevation, precipitation, and population density. These
covariates are related to and can partially explain variation in health indicators
of interest, allowing for more accurate predictions across the map.
Next, the Geospatial team imported georeferenced cluster data points from the 2016 Ethiopia DHS and 2014 Kenya DHS. (Did you know? You can download shapefiles or geodatabases of georeferenced data for most DHS surveys from the Spatial Data Repository.)
Using the geospatial covariates and survey data, the Geospatial team employed a new modeling approach–a stacked ensemble model–which combines multiple models. This increases predictive power and captures the potentially complex interactions and non-linear effects among the geospatial covariates. Three sub-models were fit to the health indicator data using the geospatial covariates as exploratory predictors. The prediction surfaces generated from the sub-models were then used in the final Bayesian geospatial model, producing 5 X 5 km pixel-level mean estimates of health indicators with associated uncertainty.
Childhood Stunting by 5 X 5 km Pixel, 2016 Ethiopia DHS & 2014 Kenya DHS
Modeled surface maps available from the Spatial Data Repository.
Pixel-level estimates were then used to calculate population-weighted averages to aggregate estimates to the ADMIN 2 level. For Ethiopia, this produced estimates of childhood stunting by zone, and in Kenya, estimates by county.
Childhood Stunting by ADMIN 2 level, 2016 Ethiopia DHS & 2014 Kenya DHS
Health system program managers in Ethiopia and Kenya can now use these zonal- and county-specific estimates to make decisions and manage locally administered health programs to address childhood stunting in their areas.
The DHS Program will continue exploring model-based
geostatistics as a feasible, reliable, and cost-effective way to produce local
data for local needs.
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 clearly
loves data, but what good is collecting data if it is not used, or used only in
isolation? This was the motivation behind a Malaria Data Consultative Meeting
implemented by The DHS Program and co-facilitated by Dr. Katherine Battle of
the Malaria Atlas Project in Malawi in July 2019.
The quality and
completeness of DHIS2 data vary by facility and only data on people who seek
and receive care are included. By contrast, household surveys, such as
Demographic and Health Surveys (DHS) and Malaria Indicator Surveys (MIS), are
representative of the general population, with comparable data for trend
analysis and multi-country comparisons.
At the consultative meeting, malaria data experts developed and presented case studies on indicators that were found in both data sources to check for external consistency and evaluate progress towards Malawi’s Malaria Strategic Plan (MSP) targets. For instance, effective malaria case management is a key component of the 2017–2022 MSP, with targets to test 95% of suspected malaria cases and treat 100% of confirmed cases by 2022.
The DHIS2 data above depicts suspected malaria cases in children under 5 that received a confirmatory test at a health facility. The household survey data above represents children under 5 who had a fever in the previous 2 weeks for whom advice or treatment was sought and who had blood taken from a finger or heel for diagnostic testing. See the table below for more information on these indicators.
Percent of suspected malaria cases in children under 5 who received a confirmatory test at facility or village clinic
Number of suspected malaria cases in children under 5 who received a confirmatory test
Total number of suspected cases in children under 5 at facility or village clinic
Household survey data
2014 Malawi MIS and 2017 Malawi MIS
Percent of children under 5 with fever in the previous 2 weeks for whom advice or treatment was sought and who had blood taken from a finger or heel for testing
Number of children under 5 with fever in the previous 2 weeks for whom advice or treatment was sought and who had blood taken from a finger or heel for testing
Total number of children under 5 with fever in the previous 2 weeks for whom advice or treatment was sought
Both the DHIS2 and MIS
data show improvement in confirmatory testing of suspected cases over time,
although absolute values differ. Differences were attributed to recall bias
among survey respondents. Because the study populations (denominators) of the
two datasets are different, it is more meaningful to compare trends rather than
As countries move towards malaria elimination it is essential that programs begin monitoring performance using multiple data sources. By using routine surveillance data and household survey data together, malaria data experts have a more complete, unbiased picture of malaria in Malawi.
A report of this Malaria Data Consultative Meeting was published in the Malaria Journal. You can read it here!
Explore Malawi household survey data for yourself using STATcompiler.
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.
Nutrition is central to the health, well-being, and economic development of individuals, communities, and nations. Comprehensive and credible data are needed to capture the current state of nutrition and track the implementation of nutrition interventions. The DHS Program is a leading source of nutrition data in low and middle-income countries.
The DHS Program has standard Model Questionnaires, updated every 5 years, which form the basis for the data that are collected in each country. In 2019, we underwent a rigorous process to update the questionnaires for DHS-8. A total of 89 nutrition-related questions are now in the Woman’s Questionnaire, up from 54 questions in DHS-7.
The DHS-8 questionnaires meet several current and emerging nutrition data needs which can be used to track progress and inform national and global decisions on nutrition policies and programs. This week we are highlighting the new and revised nutrition questions in DHS-8.
These new and revised questions strengthen the nutrition portfolio in DHS surveys, filling major data gaps and enhancing countries’ ability to address malnutrition in all its forms.
Click the icon below to view the new nutrition information by topic:
Click the life cycle below to view all nutrition data collected in DHS surveys:
When will updated nutrition data be available?
The DHS-8 Model Questionnaires will
be ready for use in surveys with fieldwork starting
in late 2020 with data released starting in late 2021. In the meantime, The
DHS Program will:
Translate the questionnaires
Revise training manuals and materials
Develop an adaptation guide for questions which require country-specific adaptation, such as infant and young child feeding and minimum dietary diversity for women
Create data processing applications
Define indicators, design table templates, and draft report templates
Pilot select new questions, modules, and alternative approaches for entering data in CAPI
The 16 Days of Activism against Gender-based Violence campaign is back in action for 2019 under the theme “Orange the World: Generation Equality Stands against Rape!” This year, The DHS Program is highlighting sexual and physical violence indicators, as well as help seeking behavior in Tajikistan, Pakistan, Nigeria, Benin, and Mali.
Click on a graph below to open the indicator in STATcompiler. Use STATcompiler to compare other domestic violence indicators across countries, and share your results on social media using #orangetheword and #generationeqaulity. You can even add additional background characteristics and view the data over time or by region. For more ways to use STATcompiler, watch our STATcompiler tutorials.
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.
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.