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The DHS Program is a leading source of nutrition data globally. Producing high-quality data is core to The DHS Program’s mission. Throughout the survey process, there are many measures in place that ensure data quality, and continual quality improvement measurers are regularly reviewed and refined. This report describes the factors that facilitate or hinder nutrition data quality during the survey process and provides recommendations to ensure that The DHS Program continues to provide high-quality data for its users.
The nutrition topics of interest in this investigation were anthropometry, hemoglobin, and Infant and Young Child Feeding (IYCF) practices because these topics present challenges in data collection. A total of 54 key informants were interviewed (21 who were internal to The DHS Program and 33 who were external) and two focus groups were conducted with 13 staff members from The DHS Program.
Participants emphasized the unique considerations for nutrition data quality within The DHS Program. The collection of anthropometry and anemia data requires quality measures that are distinctly different from interviewing. Participants also identified IYCF as one of the more difficult topics to collect within the questionnaire because capturing dietary data is inherently challenging and also requires context-specific adaptation of the questionnaire.
A high level of capacity exists within The DHS Program. Although they identified important challenges, the informants felt that collecting quality data was achievable. The informants spoke with confidence about realistic precision in large-scale surveys, and they identified specific steps needed to improve data quality. Informants who were external to the DHS surveys cited DHS’s reputation and the infrastructure built and maintained by DHS over many years, which has collected difficult-to-obtain data that informs public health planning at the global, national, and local levels.
A total of 32 recommendations emerged from the key informant interviews and focus groups. Under each recommendation are steps to be considered by The DHS Program for enhancing the quality of anthropometry, hemoglobin, and IYCF data. Informants noted the critical role of country ownership of surveys and the importance of buy-in from the host country to adopt data-quality measures for nutrition.
Collecting high-quality data in some cases will require new changes to The DHS Program’s existing procedures, and in other cases it is a matter of selecting data-quality activities that have worked well in some surveys and making them standard practice. In addition, different strategies to increase data quality are recommended, although not all strategies have been tested for use in the DHS surveys, thus pilots will be needed prior to wide-scale adoption. It is important to recognize that because each recommendation in this report has budget implications, the recommendations must be prioritized.
The DHS Program is the largest and most enduring survey program of its kind and has contributed to our understanding of population, health, and nutrition in low- and middle-income countries. Strengthening the quality of nutrition data in The DHS Program will, in turn, improve decision-making for child nutrition and growth. Such an endeavor will require careful evaluation of the recommendations, adequate funding, piloting of strategies, and continued monitoring over several years to achieve the desired results.