The relative risk ratio is the ratio of children in high-risk fertility behavior categories to children not in any high-risk category.
Coverage:
Population base: Children born to all women (BR or KR file)
Time period: Five years preceding the survey (b19 < 60)
Numerator: Proportion dead of children born in each high-risk category
Denominator: Proportion dead of children born in non-high-risk category
Risk categories:
High-risk fertility behavior categories:
1) Children born to mothers under age 18 years (b3 - v011 < 216)
2) Children born to mothers 35 years and older (b3 - v011 >= 420)
3) Children of birth order 4 or higher (order >= 4 – see Calculation below)
4) Children born less than 24 months since a preceding birth (b11 < 24)
Unavoidable risk category:
5) First birth order children born to mothers between ages 18 and 34 years
(order = 1 & b3 - v011 in 216:419)
Children not in any high-risk category:
6) Second- and third-birth-order children born to mothers between ages 18 and 34 years
(order = 2 or 3 & b3 - v011 in 216:419)
Women who are sterilized (v312 = 6) are excluded from any high-risk category.
The high-risk categories are also combined into two-way and three-way combinations of elevated risk.
Variables: BR file.
|
v011 |
Date of birth of respondent (CMC) |
|
b5 |
Child is alive (1 = yes, 0 = no) |
|
bord |
Birth order number |
|
b0 |
Child is twin |
|
b19 |
Age of child in months |
|
v005 |
Woman’s individual sample weight |
|
v312 |
Current contraceptive method |
To calculate relative risk ratios by categories of high-risk due to fertility behavior, first the proportions dead for each category need to be calculated. For each risk category:
Numerator: Number of children born in the five years preceding the survey who died at any age (b19 < 60 & b5 = 0).
Denominator: Number of children born in the five years preceding the survey (b19 < 60).
Proportion dead: Numerator divided by denominator.
Then the risk ratio is calculated as a ratio of the proportions dead:
Risk ratio numerators: Proportion dead of children born in each high-risk category.
Risk ratio denominator: Proportion dead of children born in non-high-risk category (see Definition above).
Relative risk ratios: Risk ratio numerators for each category divided by the risk ratio denominator.
None of the information needed to calculate relative risk ratios is allowed to have missing or unknown data. Note that age at death is not used, only survival status at the time of the survey.
Women who are sterilized are not considered at risk and are excluded from the numerators of any of the high-risk categories.
To provide a more robust estimate of the elevated relative risk, proportions dead are used instead of period mortality rates in the calculation of relative risk, since period mortality rates have higher sampling errors. In DHS reports, risk ratios are not shown where the proportion dead is based on fewer than 25 births. Risk ratios where the proportion dead is based on 25 to 49 births are placed in parentheses to indicate large variability due to sampling.
Assumptions: It is assumed that the number of births and death rates do not vary substantially by time period within the preceding five years.
Risk ratios are presented in single high-risk categories where the births were only in one of the high-risk categories, and in multiple high-risk categories where births were in two or three of the high-risk categories. Subtotals by single category and multiple categories are also presented, and in DHS-7 onwards for individual high-risk categories irrespective of whether the birth was in a single or multiple risk categories.
Originally, prior to about 1998, the denominator for the risk ratio included the unavoidable risk category of first-order births to mothers between 18 and 24 years of age.
The calculation of months since birth has changed in DHS-7 compared to prior rounds of DHS. In DHS-7 and DHS-8 recode files b19 provides months since birth for both living and dead children calculated from the date of birth in days. In prior rounds of The DHS Program, months since birth were calculated based on the date of birth in months as v008-b3. The selection for births in the five years preceding the survey is based on b19 < 60 or, in datasets without b19, v008-b3 < 60.
Govindasamy, P., M.K. Stewart, S.O. Rutstein, J.T. Boerma, and A.E. Sommerfelt. 1993. High-risk birth and maternity care. DHS Comparative Studies No. 8. Columbia, Maryland, USA: Macro International. https://www.dhsprogram.com/publications/publication-CS8-Comparative-Reports.cfm
DHS-8 Tabulation plan: Tables 8.5
API Indicator ID:
CM_HRFR_C_NON, CM_HRFR_C_FOB, CM_HRFR_C_A18, CM_HRFR_C_A34, CM_HRFR_C_B24, CM_HRFR_C_BO3, CM_HRFR_C_SNG, CM_HRFR_C_A1B, CM_HRFR_C_A2B, CM_HRFR_C_ABO, CM_HRFR_C_A3B, CM_HRFR_C_BIO, CM_HRFR_C_MLT, CM_HRFR_C_ANY
Percentage of children born in the five years preceding the survey by category of elevated risk of mortality.
Coverage:
Population base: Children born to all women (BR or KR file)
Time period: Births in the five years preceding the survey (b19 < 60)
Numerator: Number of births in each risk category for children born in the five years preceding the survey
Risk categories:
High-risk fertility behavior categories:
1) Children born to mothers under age 18 years (b3 - v011 < 216)
2) Children born to mothers 35 years and older (b3 - v011 >= 420)
3) Children of birth order 4 or higher (order >= 4 – see Calculation below)
4) Children born less than 24 months since a preceding birth (b11 < 24)
Unavoidable high-risk category:
5) First birth order children born to mothers between ages 18 and 34 years
(order = 1 & b3 - v011 in 216:419)
Children not in any high-risk category:
6) Second- and third-birth-order children born to mothers between ages 18 and 34 years
(order = 2, 3 & b3 - v011 in 216:419)
The high-risk categories are also combined into two-way and three-way combinations of elevated risk.
Denominator: Number of children born in the five years preceding the survey (b19 < 60)
Variables: BR file.
|
v011 |
Date of birth of respondent (CMC) |
|
bord |
Birth order number |
|
b0 |
Child is twin |
|
b19 |
Age of child in months |
|
v005 |
Woman’s individual sample weight |
Numerator divided by the denominator, multiplied by 100.
None of the information needed to calculate the high-risk categories is allowed to have missing or unknown data.
Percentages are presented in single high-risk categories where the births were only in one of the high-risk categories, and in multiple high-risk categories where births were in two or three of the high-risk categories. Subtotals by single category and multiple categories are also presented, and in DHS-7 onwards for individual high-risk categories irrespective of whether the birth was in a single or in multiple risk categories.
The calculation of months since birth has changed in DHS-7 compared to prior rounds of DHS. In DHS-7 and DHS-8 recode files b19 provides months since birth for both living and dead children calculated from the date of birth in days. In prior rounds of The DHS Program, months since birth were calculated based on the date of birth in months as v008-b3. The selection for births in the five years preceding the survey is based on b19 < 60 or, in datasets without b19, v008-b3 < 60.
DHS-8 Tabulation plan: Tables 8.5
API Indicator IDs:
CM_HRFB_C_NON, CM_HRFB_C_FOB, CM_HRFB_C_A18, CM_HRFB_C_A34, CM_HRFB_C_B24, CM_HRFB_C_BO3, CM_HRFB_C_SNG, CM_HRFB_C_A1B, CM_HRFB_C_A2B, CM_HRFB_C_ABO, CM_HRFB_C_A3B, CM_HRFB_C_BIO, CM_HRFB_C_MLT, CM_HRFB_C_ANY
Percentage of women currently married or in union by category of risk if they were to conceive a child at the time of the survey.
Coverage:
Population base: Women currently married or in union (v502 = 1) (IR file)
Time period: Current status at time of survey
Numerator: Number of currently married women in each risk category
Risk categories:
High-risk fertility behavior categories:
1) Women under age 17 years and 3 months (v008 - v011 < 207)
2) Women over age 34 years and 2 months (v008 - v011 > 410)
3) Women who have given birth to 3 or more children (v201 >= 3)
4) Women whose last birth was less than 15 months ago (v222 < 15)
Unavoidable high-risk category:
5) Women who have never given birth (v201 = 0) and are between 17 years and 3 months of age and 34 years and 2 months of age (v008 - v011 in 207:410)
Women not in any high-riskcategory:
6) Women who have given birth to one or two children (v201 = 1 or 2) and are between 17 years and 3 months of age and 34 years and 2 months of age (v008 - v011 in 207:410). Women who are sterilized (v312 = 6) are also included in this category and are removed from any of the above high-risk categories.
Women are assigned to risk categories according to the status they would have at the birth of a child if they were to conceive at the time of the survey, assuming the birth would take place in 9 months from the time of the survey. Current pregnancy is not taken into account in this definition.
The high-risk categories are also combined into two-way and three-way combinations of elevated risk.
Denominator: Number of currently married women (v502 = 1)
Variables: IR file.
|
v008 |
Date of interview (CMC) |
|
v011 |
Date of birth of respondent (CMC) |
|
v502 |
Currently/formerly/never in union |
|
v201 |
Total children ever born |
|
v222 |
Last birth to interview (months) |
|
v312 |
Current contraceptive method |
|
v005 |
Woman’s individual sample weight |
Women who are sterilized (v312 = 6) are not considered at risk and are removed from the numerator for any high-risk category. Numerator divided by the denominator, multiplied by 100.
None of the information needed to calculate the high-risk categories is allowed to have missing or unknown data.
Percentages are presented in single high-risk categories where the women were only in one of the high-risk categories, and in multiple high-risk categories where women were in two or three of the high-risk categories. Subtotals by single category and multiple categories are also presented, and in DHS-7 onwards for individual high-risk categories irrespective of whether the woman was in a single or in multiple risk categories.
References
Rutstein, S., and R. Winter. 2015. Contraception Needed to Avoid High-Fertility-Risk Births, and Maternal and Child Deaths That Would Be Averted. DHS Analytical Studies No. 50. Rockville, Maryland, USA: ICF International. https://dhsprogram.com/publications/publication-as50-analytical-studies.cfm
DHS-8 Tabulation plan: Tables 8.5
API Indicator IDs:
CM_HRFW_W_NON, CM_HRFW_W_FOB, CM_HRFW_W_A18, CM_HRFW_W_A34, CM_HRFW_W_B24, CM_HRFW_W_BO3, CM_HRFW_W_SNG, CM_HRFW_W_A1B, CM_HRFW_W_A2B, CM_HRFW_W_ABO, CM_HRFW_W_A3B, CM_HRFW_W_BIO, CM_HRFW_W_MLT, CM_HRFW_W_ANY