Demographic and Health Survey 2016 - Ethiopia

Abstract
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The 2016 Ethiopia Demographic and Health Survey (EDHS) is the fourth Demographic and Health Survey conducted in Ethiopia. It was implemented by the Central Statistical Agency (CSA) at the request of the Federal Ministry of Health (FMoH). The primary objective of the 2016 EDHS is to provide up-to-date estimates of key demographic and health indicators. The EDHS provides a comprehensive overview of population, maternal, and child health issues in Ethiopia. More specifically, the 2016 EDHS:
- Collected data at the national level that allowed calculation of key demographic indicators, particularly fertility and under-5 and adult mortality rates
- Explored the direct and indirect factors that determine levels and trends of fertility and child mortality ? Measured levels of contraceptive knowledge and practice
- Collected data on key aspects of family health, including immunisation coverage among children, prevalence and treatment of diarrhoea and other diseases among children under age 5, and maternity care indicators such as antenatal visits and assistance at delivery
- Obtained data on child feeding practices, including breastfeeding
- Collected anthropometric measures to assess the nutritional status of children under age 5, women age 15-49, and men age 15-59
- Conducted haemoglobin testing on eligible children age 6-59 months, women age 15-49, and men age 15-59 to provide information on the prevalence of anaemia in these groups
- Collected data on knowledge and attitudes of women and men about sexually transmitted diseases and HIV/AIDS and evaluated potential exposure to the risk of HIV infection by exploring high-risk behaviours and condom use
- Conducted HIV testing of dried blood spot (DBS) samples collected from women age 15-49 and men age 15-59 to provide information on the prevalence of HIV among adults of reproductive age
- Collected data on the prevalence of injuries and accidents among all household members
- Collected data on knowledge and prevalence of fistula and female genital mutilation or cutting (FGM/C) among women age 15-49 and their daughters age 0-14
- Obtained data on women’s experience of emotional, physical, and sexual violence.

Geographic coverage
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National

Analysis unit
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- Household
- Individual
- Children age 0-5
- Woman age 15-49
- Man age 15-59
- Health facility

Universe
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The survey covered all de jure household members (usual residents), women age 15-49 years and men age 15-59 years resident in the household.

Kind of data
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Sample survey data [ssd]

Sampling procedure
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The sampling frame used for the 2016 EDHS is the Ethiopia Population and Housing Census (PHC), which was conducted in 2007 by the Ethiopia Central Statistical Agency. The census frame is a complete list of 84,915 enumeration areas (EAs) created for the 2007 PHC. An EA is a geographic area covering on average 181 households. The sampling frame contains information about the EA location, type of residence (urban or rural), and estimated number of residential households. With the exception of EAs in six zones of the Somali region, each EA has accompanying cartographic materials. These materials delineate geographic locations, boundaries, main access, and landmarks in or outside the EA that help identify the EA. In Somali, a cartographic frame was used in three zones where sketch maps delineating the EA geographic boundaries were available for each EA; in the remaining six zones, satellite image maps were used to provide a map for each EA.

Administratively, Ethiopia is divided into nine geographical regions and two administrative cities. The sample for the 2016 EDHS was designed to provide estimates of key indicators for the country as a whole, for urban and rural areas separately, and for each of the nine regions and the two administrative cities.

The 2016 EDHS sample was stratified and selected in two stages. Each region was stratified into urban and rural areas, yielding 21 sampling strata. Samples of EAs were selected independently in each stratum in two stages. Implicit stratification and proportional allocation were achieved at each of the lower administrative levels by sorting the sampling frame within each sampling stratum before sample selection, according to administrative units in different levels, and by using a probability proportional to size selection at the first stage of sampling.

For further details on sample design, see Appendix A of the final report.

Mode of data collection
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Face-to-face [f2f]

Research instrument
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Five questionnaires were used for the 2016 EDHS: the Household Questionnaire, the Woman’s Questionnaire, the Man’s Questionnaire, the Biomarker Questionnaire, and the Health Facility Questionnaire. These questionnaires, based on the DHS Program’s standard Demographic and Health Survey questionnaires, were adapted to reflect the population and health issues relevant to Ethiopia. Input was solicited from various stakeholders representing government ministries and agencies, nongovernmental organisations, and international donors. After all questionnaires were finalised in English, they were translated into Amarigna, Tigrigna, and Oromiffa.

Cleaning operations
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All electronic data files for the 2016 EDHS were transferred via IFSS to the CSA central office in Addis Ababa, where they were stored on a password-protected computer. The data processing operation included secondary editing, which required resolution of computer-identified inconsistencies and coding of openended questions; it also required generating a file for the list of children for whom a vaccination card was not seen by the interviewers and whose vaccination records had to be checked at health facilities. The data were processed by two individuals who took part in the main fieldwork training; they were supervised by two senior staff from CSA. Data editing was accomplished using CSPro software. During the duration of fieldwork, tables were generated to check various data quality parameters and specific feedback was given to the teams to improve performance. Secondary editing and data processing were initiated in January 2016 and completed in August 2016.

Response rate
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A total of 18,008 households were selected for the sample, of which 17,067 were occupied. Of the occupied households, 16,650 were successfully interviewed, yielding a response rate of 98%.

In the interviewed households, 16,583 eligible women were identified for individual interviews. Interviews were completed with 15,683 women, yielding a response rate of 95%. A total of 14,795 eligible men were identified in the sampled households and 12,688 were successfully interviewed, yielding a response rate of 86%. Although overall there was little variation in response rates according to residence, response rates among men were higher in rural than in urban areas.

Sampling error estimates
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The estimates from a sample survey are affected by two types of errors: non-sampling errors and sampling errors. Non-sampling errors are the results of mistakes made in implementing data collection and data processing, such as failure to locate and interview the correct household, misunderstanding the questions by either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the 2016 Ethiopia DHS (EDHS) to minimise this type of error, non-sampling errors are impossible to avoid and are difficult to evaluate statistically.

Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the 2016 EDHS is only one of many samples that could have been selected from the same population, by using the same design and the expected size. Each of those samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability between all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results.

Sampling error is usually measured in terms of the standard error for a particular statistic (such as mean or percentage), which is the square root of the variance. The standard error can be used to calculate confidence intervals within which the true value for the population can reasonably be assumed to fall. For example, for any given statistic calculated from a sample survey, the value of that statistic will fall within a range of plus or minus two times the standard error of that statistic in 95% of all possible samples of identical size and design.

If the sample of respondents had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the 2016 EDHS sample is the result of a multi-stage stratified design and, consequently, it was necessary to use more complex formulae. Sampling errors are computed in either ISSA or SAS, with programs developed by ICF International. These programs use the Taylor linearisation method of variance estimation for survey estimates that are means, proportions, or ratios. The Jackknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates.

A more detailed description of estimates of sampling errors are presented in Appendix B of the survey final report.

Data appraisal
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Data Quality Tables
- Household age distribution
- Age distribution of eligible and interviewed women
- Age distribution of eligible and interviewed men
- Completeness of reporting
- Births by calendar years
- Reporting of age at death in days
- Reporting of age at death in months
- Nutritional status of children based on the NCHS/CDC/WHO International Reference Population
- Sibling size and sex ratio of siblings

See details of the data quality tables in Appendix C of the survey final report.

摘要
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2016年埃塞俄比亚人口与健康调查（EDHS）是埃塞俄比亚进行的第四次人口与健康调查。该调查由国家统计局（CSA）应联邦卫生部长（FMoH）的要求实施。2016年EDHS的主要目标是提供关键人口与健康指标的最新估计。EDHS对埃塞俄比亚的人口、母婴健康问题提供了全面概述。具体而言，2016年EDHS包括以下内容：
- 收集了国家级数据，允许计算关键人口指标，尤其是生育率以及5岁以下儿童和成年人的死亡率
- 探讨了决定生育率和儿童死亡率水平及趋势的直接和间接因素
- 测量了避孕知识的普及率和实践情况
- 收集了家庭健康关键方面的数据，包括儿童免疫接种覆盖率、5岁以下儿童腹泻和其他疾病的流行率和治疗方法，以及产前检查和分娩时的医疗支持等指标
- 获得了关于儿童喂养习惯的数据，包括母乳喂养
- 收集了5岁以下儿童、15至49岁女性和15至59岁男性的体格测量数据，以评估这些人群的营养状况
- 对6至59个月大的合格儿童、15至49岁女性和15至59岁男性进行了血红蛋白测试，以提供这些群体贫血流行情况的信息
- 收集了关于女性和男性对性传播疾病和HIV/AIDS的知识和态度的数据，并通过探讨高风险行为和安全套使用来评估HIV感染风险的可能暴露
- 对15至49岁女性和15至59岁男性收集的干血斑（DBS）样本进行了HIV检测，以提供育龄成年人群HIV流行情况的信息
- 收集了所有家庭成员中受伤和事故的流行情况数据
- 收集了关于15至49岁女性及其0至14岁女儿对产道瘘和女性生殖器切割（FGM/C）的知识和流行情况的数据
- 收集了关于女性在情感、身体和性暴力方面的经历的数据。
地理覆盖范围
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全国
分析单元
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- 家庭
- 个人
- 0至5岁儿童
- 15至49岁女性
- 15至59岁男性
- 医疗机构
总体
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调查涵盖了所有法定家庭成员（常住居民）、15至49岁的女性和居住在家庭中的15至59岁的男性。
数据类型
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样本调查数据 [ssd]
抽样程序
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2016年EDHS使用的抽样框架是2007年由埃塞俄比亚国家统计局进行的埃塞俄比亚人口与住房普查（PHC）。普查框架是2007年PHC为创建的84,915个统计区域的完整清单。一个统计区域是一个平均覆盖181个家庭的地理区域。抽样框架包含有关统计区域位置、居住类型（城市或农村）和估计的住宅家庭数量的信息。除索马里地区的六个区域外，每个统计区域都有相应的地图材料。这些材料描绘了统计区域的地理位置、边界、主要通道和地标，有助于识别统计区域。在索马里，使用了地图框架，在三个区域中，每个统计区域都提供了描绘统计区域地理边界的草图地图；在其余六个区域中，使用了卫星图像地图为每个统计区域提供地图。
行政上，埃塞俄比亚分为九个地理区域和两个行政城市。2016年EDHS的样本设计旨在为整个国家、城市和农村地区以及九个地区和两个行政城市提供关键指标估计。
2016年EDHS样本分为两个阶段进行分层和选择。每个地区分为城市和农村地区，产生了21个抽样层。在每个层中独立选择统计区域样本，分为两个阶段。通过在每个抽样层中根据不同行政级别的行政单位对抽样框架进行排序，并在抽样第一阶段使用规模成比例的概率抽样，实现了在每个较低行政级别的隐含分层和比例分配。
有关样本设计的更多详细信息，请参阅最终报告的附录A。
数据收集方式
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面对面 [f2f]
研究工具
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2016年EDHS使用了五份问卷：家庭问卷、女性问卷、男性问卷、生物标志物问卷和医疗机构问卷。这些问卷基于DHS计划的标准人口与健康调查问卷，并针对与埃塞俄比亚相关的人口与健康问题进行了调整。征求了代表政府部門和机构、非政府组织和国际捐助者的各种利益相关者的意见。所有问卷在英语最终确定后，被翻译成了阿姆哈拉语、提格雷尼亚语和奥罗莫语。
数据清理操作
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所有2016年EDHS的电子数据文件都通过IFSS传输到亚的斯亚贝巴的国家统计局中央办公室，在那里它们存储在密码保护的计算机上。数据处理操作包括二级编辑，需要解决计算机识别的不一致和开放式问题的编码；还需要生成一份儿童名单文件，这些儿童在访谈者那里未看到疫苗接种卡，其疫苗接种记录需要在医疗机构进行检查。数据处理由两名参与主要实地工作培训的人员进行；他们由两名国家统计局的高级工作人员监督。数据编辑使用CSPro软件完成。在实地工作期间，生成了表格来检查各种数据质量参数，并针对团队提供了具体反馈，以改善表现。二级编辑和数据处理于2016年1月开始，并于2016年8月完成。
应答率
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共选择了18,008个家庭作为样本，其中17,067个被占用。在占用的家庭中，16,650个被成功访谈，应答率为98%。在访谈的家庭中，确定了16,583名符合条件的女性进行个别访谈。15,683名女性完成了访谈，应答率为95%。在样本家庭中确定了14,795名符合条件的男性，其中12,688名被成功访谈，应答率为86%。尽管总体上应答率根据居住地变化不大，但农村地区的男性应答率高于城市地区。
抽样误差估计
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样本调查的估计受到两种类型误差的影响：非抽样误差和抽样误差。非抽样误差是由于在实施数据收集和数据处理过程中出现的错误造成的，例如未能找到和访谈正确的家庭、访谈者或受访者误解问题，以及数据输入错误。尽管在实施2016年埃塞俄比亚DHS（EDHS）期间采取了众多措施来最大限度地减少此类错误，但非抽样误差是无法避免的，并且难以进行统计评估。
另一方面，抽样误差可以通过统计方法进行评估。2016年EDHS中选的受访者样本只是从同一人口中选出的许多可能样本之一，使用相同的设计和预期规模。每个这样的样本都会产生与实际选定的样本结果略有不同的结果。抽样误差是所有可能样本之间差异的度量。虽然变异程度无法确切知道，但可以从调查结果中估计。
抽样误差通常以特定统计量（例如均值或百分比）的标准误差来衡量，它是方差的平方根。标准误差可以用来计算置信区间，其中可以合理地假设人口的真值落在其中。例如，对于从样本调查中计算出的任何给定统计量，该统计量的值将在95%的所有可能样本中落在该统计量标准误差的两倍范围内。
如果受访者样本被选为简单随机样本，则可以使用简单的公式来计算抽样误差。然而，2016年EDHS样本是多层次分层设计的产物，因此有必要使用更复杂的公式。抽样误差使用ISSA或SAS计算，由ICF国际开发的程序。这些程序使用泰勒线性化方法进行方差估计，以对调查估计的均值、比例或比率进行估计。使用Jackknife重复复制方法对更复杂的统计量（如生育率和死亡率率）的方差进行估计。
抽样误差估计的更详细描述见调查最终报告的附录B。
数据评估
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数据质量表
- 家庭年龄分布
- 符合条件和被访谈女性的年龄分布
- 符合条件和被访谈男性的年龄分布
- 报告的完整性
- 日历年度出生情况
- 死亡年龄报告（以天为单位）
- 死亡年龄报告（以月为单位）
- 基于NCHS/CDC/WHO国际参考人群的儿童营养状况
- 兄弟姐妹的大小和性别比

有关数据质量表的详细信息，请参阅调查最终报告的附录C。