Description of The Demographic and Health Surveys Program

 

The DHS Program

 

The DHS Program was established by the United States Agency for International Development (USAID) in 1984. Originally designed as a follow-up to the World Fertility Survey (WFS) and the Contraceptive Prevalence Survey (CPS) projects, it has provided technical assistance to more than 350 surveys in over 90 countries, advancing global understanding of health and population trends in developing countries. The DHS Program has been implemented in overlapping five-year phases:

 

DHS-I     1984 – 1990

DHS-II    1989 – 1993

DHS-III  1992 – 1998

DHS-IV  1997 – 2003 (MEASURE DHS)

DHS-V    2003 – 2008 (MEASURE DHS+)

DHS-VI  2008 – 2013 (MEASURE DHS Phase III)

DHS-7    2013 – 2018

DHS-8   2018 – 2023

 

The DHS Program has been implemented by the same team since its inception although the name of the organization has changed through acquisitions. It was first awarded in 1984 to Westinghouse Health Systems, which subsequently evolved into part of Macro Systems, ORC Macro, Macro International and is now part of ICF. The DHS Program is implemented by ICF and its partners Path, Avenir Health, Johns Hopkins Center for Communication Programs, Vysnova, Blue Raster, and Encompass.

 

The main objective of The DHS Program is to improve the collection, analysis, and dissemination of population, health, and nutrition data and to facilitate use of these data for planning, policy-making and program management, resulting in:

·        Improved tools, methods, partnerships, and technical guidance to collect quality population, health, and nutrition data.

·        Increased in-country individual and institutional capacity for identification of data needs and for survey design, management, and data collection to meet those needs.

·        Improved availability of DHS Program survey data and information.

·        Advanced availability and synthesis of DHS Program survey data.

·        Improved facilitation of DHS Program data use among stakeholders worldwide.

 

Many countries have conducted multiple surveys to establish trend data that enable them to gauge progress in their programs. Countries that participate in The DHS Program are primarily countries that receive USAID assistance; however, several non-USAID supported countries have participated with funding from other donors such as UNICEF, UNFPA, the World Bank, and national governments. The Demographic and Health Survey was the original survey tool developed by The DHS Program in 1984. More than 300 DHS surveys in over 90 countries have been conducted since the program’s inception.

 

The DHS Program has evolved over the years to incorporate several other survey types:

 

The DHS Program created the AIDS Indicator Survey (AIS) in 2003 to respond to the need for global monitoring of the HIV/AIDS epidemic.  The AIS is a household based survey focusing on HIV and AIDS knowledge, attitudes, behavior, and prevalence. Demand for the AIS was not as high as had been anticipated, largely because the DHS was also designed to collect the same HIV data as a subset of the larger DHS and most countries requested a DHS rather than an AIS. Eleven AIS surveys were conducted in 2003-2015.

 

In 2006, The DHS Program began implementing the Malaria Indicator Survey (MIS), also a household based survey, designed to collect data focused on internationally accepted malaria indicators. More than 30 MIS have been conducted since 2006.  Though a DHS collects the same malaria indicators as an MIS, differences between the two surveys include the collection of malaria parasitemia and data collection during malaria high transmission season during an MIS, whereas a DHS typically collects data during the dry season.

 

Finally, the Service Provision Assessment (SPA) survey is a health facility assessment that provides a comprehensive overview of a country’s health service delivery. It meets the need for monitoring health system strengthening in developing countries.

 

This Guide will focus on DHS surveys and the statistics produced in the reports; note that most DHS survey reports include all the statistics that are presented in the more narrowly focused AIS and MIS reports.

 


 

Model Questionnaires

 

One of the key aims of The DHS Program is to collect data that are comparable across countries. To achieve this, standard model questionnaires have been developed. These model questionnaires—which have been reviewed and modified in each of the eight phases of The DHS program—form the basis for the questionnaires that are implemented in each country. Typically, a country is asked to adopt the model questionnaire in its entirety, but can add questions of particular interest. However, questions in the model may be deleted when they are irrelevant in a particular country.

 

DHS surveys are designed to collect data on marriage, fertility, mortality, family planning, reproductive health, child health, nutrition, and HIV/AIDS. Due to the subject matter of the survey, women of reproductive age (15–49) are the focus of the survey. Women eligible for an individual interview are identified through the households selected in the sample. Consequently, all DHS surveys utilize a minimum of two questionnaires—a Household Questionnaire and a Woman’s Questionnaire.

 

The Household Questionnaire is used to list all the usual members and visitors in the selected households. The respondent for the Household Questionnaire is any knowledgeable person age 15 or older living in the household. Some basic information is collected on the characteristics of each person listed, including his/her age, sex, education, and relationship to the head of the household. The main purpose of the Household Questionnaire is to provide the mechanism for identifying women eligible for individual interview and children under five who are to be weighed, measured, and tested for anemia. In addition, information is collected about the dwelling itself, such as the source of water, type of sanitation facilities, materials used to construct the house, ownership of various consumer goods, and use of iodized salt.

 

The Biomarker Questionnaire, introduced as part of DHS-7, collects biomarker data for eligible household members. These include anthropometric measurements (height and weight), tests for the hemoglobin level in blood for anemia, samples for HIV testing, malaria testing and other lab-based biomarkers.  Previously, in DHS-IV to DHS-VI, the biomarker questionnaire was part of the Household Questionnaire.

 

The Woman’s Questionnaire forms the central part of the DHS questionnaires and covers all of the key topics of the survey. The Woman’s Questionnaire surveys women of reproductive age (15-49). The Woman’s Questionnaire, along with other questionnaires, has undergone changes in every phase of DHS. In DHS-I through DHS-IV, questionnaires for women distinguished between countries with high and low contraceptive prevalence rates. The DHS Model “A” Woman’s Questionnaire was for use in the high contraceptive prevalence countries, while the DHS Model “B” Woman’s Questionnaire was for use in countries with relatively low contraceptive use. The main difference between these questionnaires was that the “A” core collected considerably more information on family planning than the “B” core. In DHS-V and later, these have been combined into a single Woman’s Questionnaire.

 

The DHS-7 Woman’s Questionnaire includes the following standard sections:

1)     Background characteristics (age, education, religion, etc.)

2)     Reproduction

3)     Contraception

4)     Pregnancy and postnatal care

5)     Child immunization

6)     Child health and nutrition

7)     Marriage and sexual activity

8)     Fertility preferences

9)     Husband’s background and woman’s work

10)  HIV/AIDS

11)  Other health issues

 

The Man’s Questionnaire is similar but shorter than the Woman’s Questionnaire and is used to collect data on background characteristics, reproduction and fertility preferences, contraception, employment and gender roles, HIV/AIDS, and other health issues. The respondent to the Man’s questionnaire is men of reproductive age (typically 15 to 49, 54, or 59).

 

In 2015, The DHS Program introduced the Fieldworker Questionnaire to collect data on the background characteristics of interviewers, supervisors, field editors and health technicians. Data from the fieldworker questionnaire permit users to include characteristics of the fieldworkers as well as the survey respondents in their analysis.

 

In 2019, The DHS Program revised the core Household, Woman’s, Man’s and Biomarker questionnaires for DHS-8. Changes include the shift from a birth history to a full pregnancy history and the addition of minimum dietary diversity for women. Revisions involved the addition of 183 questions, deletion of 122 questions, and new topic areas such as alcohol consumption and breast and cervical cancer screening. This questionnaire will not be implemented in fieldwork until 2020. See https://www.dhsprogram.com/publications/publication-DHSM11-DHS-Questionnaires-and-Manuals.cfm for more information about the questionnaire revision process and https://www.dhsprogram.com/What-We-Do/Survey-Types/DHS-Questionnaires.cfm for more information on the DHS questionnaires.

 

The model questionnaires for all eight phases of DHS can be found at:

 

DHS-8     https://www.dhsprogram.com/publications/publication-DHSQ8-DHS-Questionnaires-and-Manuals.cfm

DHS-7    https://www.dhsprogram.com/publications/publication-DHSQ7-DHS-Questionnaires-and-Manuals.cfm

DHS-VI   https://www.dhsprogram.com/publications/publication-DHSQ6-DHS-Questionnaires-and-Manuals.cfm

DHS-V    https://www.dhsprogram.com/publications/publication-DHSQ5-DHS-Questionnaires-and-Manuals.cfm

DHS-IV   https://www.dhsprogram.com/publications/publication-DHSQ4-DHS-Questionnaires-and-Manuals.cfm

DHS-III    https://www.dhsprogram.com/publications/publication-DHSQ3-DHS-Questionnaires-and-Manuals.cfm

DHS-II     https://www.dhsprogram.com/publications/publication-DHSQ2-DHS-Questionnaires-and-Manuals.cfm

DHS-I      https://www.dhsprogram.com/publications/publication-DHSQ1-DHS-Questionnaires-and-Manuals.cfm

 


 

Questionnaire Modules

 

Some countries have a need for special information not contained in the model questionnaires. To accommodate this need and to achieve some level of comparability across countries that apply them, optional questionnaire modules have been developed on a series of topics. The modules currently available in the DHS-7 phase are:

·        Accident and Injury

·        Adult and Maternal mortality

·        Disability

·        Domestic Violence

·        Female Genital Cutting

·        Fistula

·        Male Child Circumcision

·        Newborn Care

·        Non-communicable Diseases

·        Out-of-pocket Health Expenditures

 

The modules can be found at https://www.dhsprogram.com/publications/publication-DHSQM-DHS-Questionnaires-and-Manuals.cfm and are available in English and French.

 

Various other modules have been used in previous phases of DHS, but are no longer maintained as supported modules, including:

·        Children’s education

·        Consanguinity

·        HIV/AIDS

·        Malaria

·        Pill-taking behavior

·        Sterilization experience

·        Verbal autopsy

·        Women’s status

 

Some of these modules have been incorporated into the standard DHS questionnaire, including much of the HIV/AIDS, Malaria, and Women’s Status modules.  Earlier versions of some of these modules can be found at https://www.dhsprogram.com/publications/publication-DHSQMP-DHS-Questionnaires-and-Manuals.cfm.

 

DHS surveys are also sometimes requested to include UNICEF Multiple Indicator Cluster Surveys (MICS) modules, such as:

·        Child Discipline

·        Child Labor

·        Early Childhood Development

 

These modules can be found as part of the MICS tools at http://mics.unicef.org/tools.


 

Other Basic Documentation

 

To achieve comparable information across countries, it is necessary to ensure that the questionnaires and the survey procedures followed in each country are similar. Therefore, The DHS Program has developed a set of basic documentation to go with the model questionnaires. The basic documentation consists of the following manuals, most of which are available in English and French:

 

The DHS Interviewer’s Manual provides a detailed explanation of the survey questions and tips on conducting interviews.

 

The DHS Supervisor’s and Editor’s Manual explains the roles of the supervisor in leading the field teams, and for editors, how to check completed questionnaires.

 

Training Field Staff for DHS Surveys is designed for survey managers to provide tips on how to organize and conduct training for field staff. It describes techniques of mock interviewing, demonstration interviews in front of the class, field practice, and sample tests for trainees.

 

The DHS Sampling Manual presents the DHS approach to issues like optimum sampling frames, sample domains, stages, and sample selection. The Household Listing portion of the sampling manual describes how to locate selected sample points, how to draw a sketch map, and how to list the households and structures.

 

The DHS Tabulation Plan for Key Indicators Report describe the key tabulations in the Key Indicators Report.

 

The Tabulation Plan for DHS Final Report details the tabulations that will be produced with the survey data for each chapter of the report. This manual also aids data processing staff in determining the exact tabulations that are required for the survey reports. The Guide to DHS Statistics should be used in conjunction with the Tabulation Plan and describes the statistics presented in each tabulation.

 

The Biomarker Field Manual is designed to be used, in combination with classroom instruction and practical experience, to teach fieldworkers how to collect biomarkers for a DHS, MIS or AIS.

 

The DHS User’s Guide for Questionnaires in Excel is guide to using the Excel versions of the DHS questionnaires in adapting them to individual surveys.

 

Incorporating Geographic Information into Demographic and Health Surveys: A Field Guide to GPS Data Collection is designed to be a start-to-finish guide to Global Positioning System (GPS) data collection in DHS, MIS, and AIS. This guide provides background information on GPS, how the technology works, how GPS data are collected, and how they are used in the context of a DHS.

 

DHS Survey Organization Manual is intended as an aid to host country survey staff, donors, and others, and explains the standard approach to implementing a DHS.

 

The basic documentation for The DHS Program can be found at https://www.dhsprogram.com/publications/Publication-Search.cfm?type=35.


 

Reports and Data

 

The survey results for each participating country are published initially in a Key Indicators Report (KIR - formerly known as a preliminary report), followed by a more detailed Final Report and a summary type Key Findings report. The latter two reports are widely distributed and constitute primary outputs of the project. Results are also presented through fact sheets and other dissemination materials.

 

Further dissemination of survey data is achieved through the publication of analytical and other reports. Of particular relevance for program and policy purposes are the Comparative Report series. These descriptive reports provide information across survey countries and can contribute greatly to the policy debate through the exhaustive view they provide on a particular situation in a large number of countries. Analytical Studies are also published and provide rigorous analysis of survey data, emphasizing policy and program-relevant themes and research questions.  Further Analysis reports provide results emanating from research that is typically based in and on a single DHS country. Methodological reports cover issues relating to the collection and analysis of DHS data, particularly focusing on new types of data.

 

DHS data are also shared through a number of tools, including the STATcompiler, Mobile app, API, Spatial Data Repository (see Other Tools and Resources).  However, the major output of the surveys is the micro-level datasets distributed through the DHS Data Archive.

 


 

Data Archiving

 

The DHS Program believes that widespread access to survey data by responsible researchers has enormous advantages for the countries concerned and the international community in general. Therefore, The DHS Program policy is to release survey data to the public when the main survey report is published, generally within 12 months after the end of fieldwork.

 

DHS Archive

 

DHS maintains a data archive of all survey datasets collected over the more than 30 years of The DHS Program. Datasets are available at https://www.dhsprogram.com/data/available-datasets.cfm. Users log in or register for access to datasets at https://dhsprogram.com/data/dataset_admin/login_main.cfm.

 

Once registered and access permission has been provided, users may download the datasets from the required countries.  The DHS Program has developed a set of tutorial videos on YouTube on dataset registration, modifying dataset requests, dataset names, dataset types, downloading datasets, downloading multiple datasets, and an introduction to DHS datasets (these are just a few of the DHS tutorial videos on YouTube).

 

The reformatting of each dataset into standard recode files facilitates use of DHS data. These files standardize the variable names and coding categories across countries and construct many of the commonly used variables such as marital status or age in five-year groups. Because DHS surveys collect an enormous amount of information on different subjects for the household, household members, women age 15–49, children under age five, and men age 15–59, these standard recode files are a particular advantage for cross-country analysis.  The DHS recode datasets are described in more detail in Organization of DHS Data.

 

IPUMS-DHS

 

IPUMS-DHS is designed to facilitate further analysis of DHS data. It provides an interface to select and download a customized set of variables across a number of surveys or countries in a single dataset. IPUMS-DHS contains thousands of consistently coded variables on the health and well-being of women, children, and births, and on all household members, for 24 African countries and 4 Asian countries.

 

IPUMS-DHS datasets do differ from datasets available directly through The DHS Program website. The IUPMS-DHS datasets are created from the original recode datasets. Either dataset can be used to reproduce the results published in the DHS survey reports, but the variable names and the coding schemes within the datasets are different.  While the original datasets use a naming system of letters and digits for the variables (e.g. v705), the IPUMS-DHS datasets use short names for the variables (e.g. currwork).  Additionally, the coding of each variable is different.  The IPUMS-DHS datasets have harmonized coding schemes across the phases of DHS with more detailed coding schemes incorporating survey-specific codes consistently over time.

 

The indicator definitions in the Guide to DHS Statistics refer to the variable names and coding from the DHS standard recode datasets available through https://www.dhsprogram.com/.

 

Model Datasets

 

The DHS Program has created model datasets so users can become familiar with datasets without having to register for access. These datasets have been created strictly for practice and do not represent any country's actual data. Model datasets are based on the DHS 6 Questionnaire and Recode. They can be downloaded from the Download Model Datasets page on the website.

 


 

DHS Website

 

The DHS Program website provides access to survey documentation, survey reports, analytical studies, datasets and much more. Resources include:

·        Core documentation: questionnaires, manuals, and methodology

·        Microdata and Indicator data: Datasets, support for dataset use, and links to online data tools

·        Publications: including survey reports, and dissemination materials

·        Further analysis reports: analytical reports, comparative reports and methodological reports

·        Journal articles database: a database of peer-reviewed journal articles that feature DHS data

·        Indicator information: Topical pages provide an in-depth look at key topics including SDGs

 

Other Tools and Resources

 

STATcompiler allows users to make custom tables, charts, and maps with DHS indicator-level data.  The STATcompiler contains over 1,000 indicators for all DHS countries.  It is designed to explore trends and cross-country comparisons. The tool is available in English and French. 

 

API: The DHS Program Application Programming Interface (API) provides software developers access to aggregated indicator data from The DHS Program. The API can be used to create various applications to help analyze, visualize, explore and disseminate data on population, health, HIV, and nutrition from more than 90 countries.

 

Mobile app: The DHS Program mobile application provides up-to-date indicator data through tables, charts, and maps, as well as basic survey information and links to publications.  It is available for free for Apple and Android devices.  Search “DHS Program” in your app store.

 

GitHub: This DHG Program Code Share Project is aimed at providing Stata and SPSS code for all DHS Program indicators listed in the Guide to DHS Statistics. The project began in 2019 and will run for two years. By September 2020, all code in Stata and SPSS will be available for the public. The code will be published on the DHS Program Github site which 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.

 

The DHS Program User Forum is an online community designed to foster conversation and data use support between DHS data users.  Users can search the forum for answers to frequently asked questions on technical or analytical topics, post new questions, or respond to queries from other users.  The DHS Program staff moderate the forum and often provide answers to questions.

 

Spatial Data Repository: The DHS Program Spatial Data Repository (SDR) provides geographically-linked health and demographic data from The DHS Program and the U.S. Census Bureau for mapping in a geographic information system (GIS).

·        Boundaries: Explore how DHS region boundaries have changed over time and download survey boundary data.

·        Modeled surfaces: Modeled surfaces are produced using standardized geostatistical methods, publicly available DHS data, and a standardized set of covariates across countries. Each map package contains a mean estimate surface, an uncertainty surface, and corresponding information on the model creation process and validation.

·        Covariates: Datasets containing key covariate data for DHS Program survey clusters from external geospatial covariate datasets covering agriculture, climate, environment, health, infrastructure, and population variables.

 

Blog: The DHS Program blog highlights new tools, explores complex data topics, and keeps followers abreast of changes to the questionnaire and other developments

 

eLearning courses:  The DHS Program has partnered with K4Health to develop 3 elearning courses on the Global Health eLearning Center:

·        Demographic and Health Surveys: Data Use

·        Data Visualization: an Introduction

·        Social Media for Health and Development

 

YouTube: The DHS Program’s YouTube channel is the home of tutorial videos, Key Findings videos, and interviews with topical experts.  Of particular relevance to dataset users are the following:

DHS Program and Data Use Videos

 

Topical Videos

Family Planning 

·        Contraceptive Prevalence Rate: Indicator Snapshot (4 min) 

·        Contraceptive Calendar Tutorial Part I & Part II (15 min total)  

·        Demand satisfied by modern methods: Indicator Snapshot (8 min) 

Malaria 

·        ITN Access: Indicator Snapshot (English or French) (6-9 min) 

Maternal Mortality Ratio (MMR) and Pregnancy-related Mortality Ratio (PRMR) 3 video playlist 

·        MMR Indicator Snapshot (8 min) (English) 

·        Differences between MMR and PRMR (9 min) (English) 

·        Interpreting trends in PRMR (14 min) (English) 

 

Announcements and updates about new surveys, data, and resources are made on the DHS website, through email alerts (register on the website), and through social media channels:

 

Twitter                                @dhsprogram

API Twitter                         @dhsprogramAPI

Facebook                           facebook.com/dhsprogram

LinkedIn                             linkedin.com/company/dhs-program

 

DHS Newsletter                bit.ly/DHSsubscribe

DHS Blog                            blog.dhsprogram.com