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COVID-19 and The DHS Program: A New Web Hub for Up-to-Date Information

Written by: The DHS Program

02 Sep, 2020

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:

  • The STATcompiler now has “COVID-19 Prevention” and “COVID-19 Additional Factors” tagged indicators including handwashing, household size, multi-generational households, and number of people sharing a sleeping room.
  • Our StoryMap 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. 

Featured Image © Marina, stock.adobe.com

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Because Mosquitos Are Not Under Lockdown

Written by: Sally Zweimueller

20 Aug, 2020

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.

Since April 2020, The DHS Program has worked with implementing agencies in Uganda and Ghana to virtually disseminate two Malaria Indicator Surveys (MIS). MIS surveys provide data to evaluate and design programs for malaria elimination, but also reveal context-specific data to inform strategies for COVID-19 mitigation, such as access to handwashing facilities and the number of people sleeping in the same space.

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.

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World Breastfeeding Week 2020

Written by: The DHS Program

04 Aug, 2020

Countless studies have shown that breast milk is beneficial to an infant’s growth and development during the first year of life. This year’s theme for World Breastfeeding Week from the WHO and World Alliance for Breastfeeding Action highlights the importance of supporting breastfeeding with skilled breastfeeding counseling.

The DHS Program has collected data for more than 30 years about initial breastfeeding, breastfeeding status and frequency, and the median duration of breastfeeding. Additionally, the Service Provision Assessment (SPA) provides insight on the overall readiness of health facilities to promote and support early breastfeeding as part of the antenatal care and newborn services package. Putting the baby to the breast within one hour of birth ensures that the infant receives the colostrum or “first milk” which contains antibodies to protect against infectious diseases and lipids to promote weight gain. Choosing to breastfeed exclusively for at least six months provides natural, renewable, and free food that does not require preparation or packaging.

In 2019, The DHS Program authored a study, Examining the Role of Health Facilities in Supporting Early Breastfeeding in Haiti and Malawi, about the relationship between the breastfeeding-related health service environment during antenatal care (ANC) and early initiation of breastfeeding. Using data from recent SPA surveys in Haiti and Malawi, three variables related to the health service environment are defined: availability of facilities with ANC services that report routine counseling on breastfeeding, provider training on breastfeeding, and observation of breastfeeding counseling during ANC and client’s report of breastfeeding counseling.

In Haiti, nearly all ANC facilities in both urban and rural areas report routine breastfeeding counseling during ANC, while 29% of urban and 26% of rural ANC providers received recent training in breastfeeding or infant and young child feeding (IYCF). Among urban and rural clients, 4% received counseling on breastfeeding.

The results of the analysis show that over 95% of facilities in both urban and rural areas of Haiti and Malawi report that breastfeeding counseling is provided. However, 26% to 40% of providers have received training in counseling on breastfeeding in the two years before the surveys, and only 4% to 10% of clients have received counseling. Analysis of linked SPA and DHS data show that having more providers recently trained on breastfeeding is significantly associated with increased odds of early breastfeeding among ANC clients in urban areas of Haiti and Malawi.  

In Malawi, nearly all ANC facilities in both urban and rural areas report routine breastfeeding counseling during ANC, while 40% of both urban and rural ANC providers received recent training in breastfeeding or IYCF. Only 10% of urban clients and 4% of rural clients received counseling on breastfeeding.

This study clearly defines the role health institutions can play in promoting breastfeeding by providing support and education to new mothers and their families. By doing so health institutions can enable mothers to exclusively breastfeed for the first six months of life to ensure optimal growth, health, and development.  

Featured image: © 2007 Virginia Lamprecht, Courtesy of Photoshare

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DHS Program Analysis Updates: Summer 2020

Written by: The DHS Program

23 Jul, 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

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World Population Day 2020

Written by: The DHS Program

07 Jul, 2020

July 11th is World Population Day. This year’s UNFPA theme, Putting the brakes on COVID-19, is focused on safeguarding the health of women and girls during the pandemic. World Population Day is an opportunity to pause and reflect on how women are uniquely affected by the COVID-19 crisis:

  • Women make up the largest share of frontline health workers, so they are disproportionately exposed to the novel coronavirus.
  • Disrupted supply chains impact women’s access to modern contraceptives, which can result in unintended pregnancies.
  • Staying home to prevent the spread of COVID-19 puts already vulnerable women at a heightened risk of violence. In addition, gender-based violence prevention and protection efforts, social services, and care have been reduced during the pandemic.
  • The pandemic creates additional barriers to people who are pregnant to access antenatal care and safe-delivery services.
  • With the disruption of schools and community-based services, adolescents and young people may struggle to access information and services related to sexual and reproductive health.  

A population pyramid is a great visualization of a country’s distribution of age groups by sex. Take The DHS Program’s #PopPyramid Quiz to test your knowledge of population pyramids from recently published Demographic and Health Surveys (DHS) and learn more about DHS indicators related to COVID-19 prevention.

Click here to open the quiz in a new window

Pro tip: Use STATcompiler to explore indicators and find the answers to the population day quiz!

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Disseminating DHS Data at the Subnational Level in Nigeria

Written by: The DHS Program

25 Jun, 2020

As health systems and programs are increasingly managed at subnational levels (regions, states, or counties), DHS data are frequently available at smaller geographic units. For instance, the 2018 Nigeria DHS provides estimates at the national level, by urban-rural residence, and for 6 zones and 36 states and the Federal Capital Territory (FCT). There is an increased demand for subnational dissemination activities to present DHS survey findings to local stakeholders to encourage data use in program design, evaluation, and research at the local level. To train communicators on survey dissemination to local program managers, The DHS Program developed a ‘Communicating DHS Data at the National and State Levels’ workshop.

The capacity strengthening training was piloted with the 2016 Kenya DHS, the first Kenya DHS survey to collect data at the county level. The workshop was then formalized into a five-day training, different versions of which have now been implemented in Tanzania, Malawi, Myanmar, Mali, Philippines, Uganda, and Haiti.

Staff members of National Population Commission and National Malaria Elimination Programme demonstrate data visualization best practices. © 2019 Annette McFarland, ICF

On November 5, 2019, more than 300 people attended the official launch of the 2018 Nigeria Demographic and Health Survey (NDHS) in Abuja. Following the national seminar, The DHS Program Dissemination team trained teams from the survey implementing agencies, the National Population Commission (NPC) and National Malaria Elimination Programme (NMEP). Participants learned about dissemination, data use, and data visualization best practices and developed data use activities and presentations with state-level data.

From November to December 2019, the NPC and NMEP teams facilitated state-level data use workshops in each of Nigeria’s 36 states and the FCT. The audience included government officials (Governors’ representatives, Deputy Governors, State Public Health Directors), state-level representatives from UNICEF and WHO, traditional leaders, academia, and others. NPC and NMEP officials trained state-level data users on how to read the tables in the 2018 NDHS final report, demonstrated STATcompiler and The DHS Program mobile app, and facilitated locally relevant discussions about using the 2018 NDHS state-level findings to inform evidence-based programs and policies.

During the Jigawa state dissemination workshop, Governor Mohammed Badaru Abubakar of Jigawa state called for action, “this report can also be used for planning purposes in our ministries, departments, boards and parastatals as well as other relevant agencies in Jigawa state.” The Federal Commissioner for NPC in Anambra state, where 53% of ever-married women age 15-49 have experienced physical, sexual, or emotional spousal violence, said that the 2018 NDHS would be used for “proper planning for sustainable development.”

More than 5,000 people attended dissemination workshops facilitated by NPC and NMEP teams in all 36 states and the FCT.

Thanks to the hard work of the NPC and NMEP dissemination teams, more than 5,000 people attended dissemination workshops in their states and learned the 2018 NDHS findings first-hand.

In Borno state, in North Eastern Nigeria, Dr. Aliyu Kwaya Bura, Commissioner of Health, represented by State Public Health Director, Dr. Lawi Auta Mshelia, pledged full implementation and use of the 2018 NDHS report to deliver quality health services to the people.

See here for the latest update on The DHS Program fieldwork activities during COVID-19.

Featured image: Dissemination training participants from the National Population Commission (NPC) and National Malaria Elimination Programme (NMEP). © ICF

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Spotlight on Implementing Agencies: Cameroon

Written by: The DHS Program

11 Jun, 2020

In October 2019, The DHS Program welcomed visitors from Cameroon who came to the office to finalize the report for the 2018 Cameroon DHS. This post is one in a series of interviews with visitors to DHS headquarters.

Don’t read French? You can use the translate feature at the top of the page!

(English speakers: You may need to set the language to French first, before you can see the English lanugage option.)

Nom, titre et organisation : Anaclet Désiré DZOSSA, Chef de Division des Statistiques Démographiques à l’Institut National de la Statistique (INS) ; Paul Roger LIBITE, Chef de Département des Statistiques Démographiques et Sociales, INS

Racontez un peu de la première fois que vous avez travaillé sur des données du « The DHS Program » :

DZOSSA : C’était en 2004 lorsque j’ai participé pour la première fois à l’analyse des données de l’Enquête Démographique et de Santé du Cameroun (l’EDSC-III). J’ai été émerveillé, par curiosité lors de ces travaux en 2004, de voir les données et rapports des autres pays aussi.

LIBITE : Il y a presque 27 ans en 1992, j’avais eu la charge d’analyser les résultats de l’Enquête Démographique et de Santé du Cameroun de 1991. J’avais reçu les tableaux de 7 chapitres et c’est moi qui étais chargé de préparer les drafts qui devraient être par la suite enrichis par mes supérieurs hiérarchiques. Moi je n’étais que jeune cadre.

Quel est votre chapitre ou indicateur préféré, et pourquoi ?

DZOSSA : L’indicateur de niveau de bien-être économique parce qu’il résume plusieurs aspects des caractéristiques sociodémographiques et des conditions de vie des populations.

Quel est le problème de population ou de santé qui vous intéresse le plus, et pourquoi ?

LIBITE : De ma part, ma formation et mes fonctions, c’est difficile de faire un choix. Tous les problèmes sont politiquement préoccupants et comportent chacun un intérêt scientifique pertinent. Je suis prêt à travailler sur n’importe quelle thématique.

Comment espérez-vous que les données de l’EDS sur votre pays soient utilisées ?

DZOSSA : J’espère que cela sera effectivement utilisé pour évaluer les politiques et stratégies mises en œuvre, et réorienter au besoin celles qui devraient l’être pour le bien-être des populations.

Qu’avez-vous appris en travaillant avec « The DHS Program » ?

LIBITE : Au-delà de la formation universitaire, c’est en travaillant avec le programme DHS que j’ai compris comment mettre en pratique les connaissances académiques. C’est une valeur ajoutée très importante. Dans les universités et les écoles de formation, les cours sont généralement très théoriques, et après la fin des études supérieures, il peut arriver que l’on soit affecté à des tâches purement administratives qui ne donnent pas l’opportunité de mettre en pratique les connaissances accumulées. De plus, avec le programme DHS, il faut rester éveillé sur les évolutions méthodologiques et scientifiques.

L’Enquête Démographique et de Santé 2018 de la République du Cameroun a été publiée le 10 juin 2020. Téléchargez le rapport final, la base de données et autres documents ici.

Featured image: © 2019 Chrystelle Jean, ICF

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Service Provision Assessments Shed Light on Health Facility Readiness to Control COVID-19

Written by: The DHS Program

27 May, 2020

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.

Access SPA survey final reports here.

Featured Image © YoPho, stock.adobe.com

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Collecting Quality Anthropometric Data in The DHS Program

Written by: The DHS Program

14 May, 2020

The DHS Program has been a leading source of anthropometric (height and weight) data for more than 30 years. Measurements are collected from children, women, and men in some surveys. This information enables countries to make data-driven decisions and to monitor their progress in improving nutritional status and achieving the Sustainable Development Goals.

The DHS Program continually improves anthropometric data collection processes. In 2018, The DHS Program undertook a qualitative study to identify how to further enhance the quality of anthropometry data. The findings prompted several tools and processes to be tested in the field in Nigeria, including biomarker checklists and anthropometry remeasurement, which have now become standard practice.

Here are some examples of how The DHS Program supports countries to collect quality anthropometric data.

Designing surveys that incorporate best practices for collecting anthropometric data

To increase knowledge and enhance capacity of countries to implement DHS surveys, The DHS Program provides technical assistance on anthropometric data collection. An anthropometry brochure summarizes the key inputs needed to collect quality anthropometric data. It is based on the recently released WHO-UNICEF guidelines for anthropometric data collection.  

Training fieldworkers to take precise and accurate measurements

DHS Program staff participate in an in-house standardization exercise to become gold standard measurers. © 2019 Valene Bia, ICF

DHS anthropometry trainings are interactive, including standardization exercises. Trainees take two separate measurements of multiple children which are compared to those of a gold standard measurer. Staff at The DHS Program, consultants, and in-country trainers have been certified as gold standard measurers. These data are entered into the DHS Anthropometry Standardization Tool to identify trainees who need re-training and re-standardization.

Monitoring and improving anthropometric data in real-time

During data collection, field check tables are run, summarizing recently collected data that reflect team performance. If problems are discovered, feedback is provided to data collection supervisors. The DHS Anthropometry Field Check Tables are based on years of experience and analytical studies.

The DHS Program has also implemented new height and weight re-measurement procedures, in which repeat measurements are taken for a random set of children and from children with an unusual first measurement. During field work, the Computer-Assisted Personal Interviewing (CAPI) system produces a report on children selected for remeasurement. This provides information on overall anthropometry data quality and reduces the number of incorrect measurements.

Conducting data entry in the field. © ICF

Communicating quality of anthropometric data to users

Information on anthropometric data collection and quality helps users have confidence in the results and make correct inferences when comparing estimates over time and across countries. Recent DHS survey final reports provide a summary of anthropometric data quality in addition to documentation on survey implementation. For more in-depth information on data quality, DHS datasets can be inputted into the WHO Anthro Survey Analyser.

Data quality procedures lead to high quality anthropometry data for children in Nigeria
97% of trainees passed the standardization exercise
Nearly all trainees passed the standardization accuracy and precision criteria.
Only 2% of random remeasurement cases had a height difference > 1 cm
Data collectors’ precision for height measurements was high.
< 1% of data were implausible for each anthropometric index
This meets the WHO-UNICEF data quality criteria of < 1% implausible values based on WHO Growth Standards.
< 1% missing data for month and year of birth
Completeness of date of birth data was high.
< 3% missing data for height and weight measurements
There does not appear to be selection bias in height and weight data collection.

Data quality is an iterative process. As The DHS Program continues to learn, further enhancements and innovations will be implemented to ensure quality anthropometric data.

Featured image: © 2018 Arturo Sanabria, Courtesy of Photoshare

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World Immunization Week 2020

Written by: The DHS Program

29 Apr, 2020

World Immunization Week is observed annually in the last week of April (April 24-30, 2020), to promote the use of vaccines to protect people of all ages against disease. Already, nearly 20 million children in the world are unvaccinated and under-vaccinated. Now, COVID-19 is disrupting the delivery of routine vaccines in low- and middle-income countries. This year’s theme for World Immunization Week, #VaccinesWork for All, highlights the heroes who develop, deliver, and receive vaccines to protect the health of everyone, everywhere.

The DHS Program has collected immunization data for over 30 years and has dozens of vaccination indicators available for 90+ countries on STATcompiler. Use STATcompiler to explore a map of basic vaccination coverage among children age 12-23 months in 47 countries. Or explore vaccination rates by background characteristics, such as wealth quintile.

Sustainable Development Goal (SDG) 3 aims to ensure healthy lives and promote well-being for all at all ages. Coverage of the diphtheria-pertussis-tetanus vaccine (the percent of children age 12-23 months who have received the third dose of the vaccine) is one DHS survey indicator that tracks countries’ progress towards achieving SDG 3. Learn about coverage of the DPT 3 vaccination and all eight basic vaccinations from five recent DHS surveys in the infographic below.

Share this infographic on Facebook and Twitter, and don’t forget to tag #VaccinesWork to engage with others in this global conversation!

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Featured image: Courtesy of the World Health Organization

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.

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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.

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