The DHS Program maintains strict standards for protecting the privacy of respondents and household members in all DHS surveys.
Procedures and questionnaires for standard DHS surveys have been reviewed and approved by the ICF International Institutional Review Board (IRB). Additionally, country-specific DHS survey protocols are reviewed by the ICF IRB and typically by an IRB in the host country. The ICF International IRB ensures that the survey complies with the U.S. Department of Health and Human Services regulations for the protection of human subjects (45 CFR 46), while the host country IRB ensures that the survey complies with laws and norms of the nation.
Informed and Voluntary Participation
Before each interview or biomarker test is conducted, an informed consent statement is read to the respondent, who may accept or decline to participate. A parent or guardian must provide consent prior to participation by a child or adolescent. DHS informed consent statements provide details regarding:
Most importantly, the informed consent statement emphasizes that participation is voluntary; that the respondent may refuse to answer any question, decline any biomarker test, or terminate participation at any time; and that the respondent's identity and information will be kept strictly confidential.
Privacy and Confidentiality during Data Collection and Data Processing
Interviews and biomarker testing are performed as privately as possible. Within each household, an eligible respondent may not be interviewed in the presence of another eligible respondent. Privacy is particularly important when respondents are husband and wife, as interview questions may involve sensitive subjects such as sexual activity or domestic violence and biomarker testing may involve HIV serostatus. Results of interviews and biomarker testing are strictly confidential. DHS interviewers, health specialists, editors, and supervisors are only allowed to discuss data with other team members, and these conversations are limited to essential communications.
Each respondent's interview and biomarker data files are identified only by a series of numbers, including enumeration area (EA) number, household number, and individual number. After data processing, questionnaire cover sheets containing these identifier numbers are destroyed, and EA and household numbers are randomly reassigned. Furthermore, the geographic coordinates of each survey are displaced at a random distance and in a random direction. The displacement distance is up to two kilometers for urban EAs and up to five kilometers for rural EAs, with one percent of randomly selected rural clusters displaced a distance up to ten kilometers. This protocol ensures that neither the individual nor the household can be identified.
Many DHS surveys include questions pertaining to domestic violence against women, and several special precautions are taken to protect the privacy and well-being of respondents. First, interviewers are provided with additional training on administering the questions, dealing with crisis situations, avoiding further endangering respondents, and preparing themselves emotionally. Second, interviewers reiterate informed consent immediately prior to administering domestic violence questions. Third, interviewers ensure absolute privacy, interrupting or terminating the domestic violence interview if privacy is breached. Fourth, as a further privacy protection, only one woman per household receives the questions in the domestic violence module so that no one else in the household knows these issues were discussed during the interview. The woman is selected at random from among all women in the household who are eligible to be interviewed. Finally, respondents are provided with information and referrals for options and services available for women experiencing domestic violence or in need of other social services.
Biomarker Referral, Treatment, and Counselling
Biomarker testing in DHS surveys benefits the well-being of respondents, while assuring privacy and confidentiality. Currently, rapid testing technologies used in DHS surveys allow respondents to be tested and for many biomarkers, receive results at home. Interviewers provide referrals, information, and for some conditions, treatment. Anemia testing is typically offered to women and men age 15-49 years and children age 6-59 months;respondents with moderate to severe anemia are referred to a local health care facility for appropriate care. In some surveys with malaria testing among children age 6-59 months, medication is offered to children with malaria, and they are referred to a local health care facility, as appropriate. Women and men age 15-49 are offered HIV home-based testing and counselling in some surveys. In such cases, respondents are provided with pre- and post-test counselling, and HIV-positive respondents are referred to a local health care facility for appropriate care. For all biomarker testing, verbal counseling and printed information are provided to respondents, and test results are kept confidential.