National Demographic and Health Survey 2008 - Philippines

Abstract
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The 2008 National Demographic and Health Survey (2008 NDHS) is a nationally representa­tive survey of 13,594 women age 15-49 from 12,469 households successfully interviewed, covering 794 enumeration areas (clusters) throughout the Philippines. This survey is the ninth in a series of demographic and health sur­veys conducted to assess the demographic and health situation in the country. The survey obtained detailed information on fertility levels, marriage, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutritional status of women and young children, childhood mortality, maternal and child health, and knowledge and attitudes regarding HIV/AIDS and tuberculosis. Also, for the first time, the Philippines NDHS gathered information on violence against women.

The 2008 NDHS was conducted by the Phil­ippine National Statistics Office (NSO). Techni­cal assistance was provided by ICF Macro through the MEASURE DHS program. Funding for the survey was mainly provided by the Gov­ernment of the Philippines. Financial support for some preparatory and processing phases of the survey was provided by the U.S. Agency for International Development (USAID).

Like previous Demographic and Health Surveys (DHS) conducted in the Philippines, the 2008 National Demographic and Health Survey (NDHS) was primarily designed to provide information on population, family planning, and health to be used in evaluating and designing policies, programs, and strategies for improving health and family planning services in the country. The 2008 NDHS also included questions on domestic violence. Specifically, the 2008 NDHS had the following objectives:

- Collect data at the national level that will allow the estimation of demographic rates, particularly, fertility rates by urban-rural residence and region, and under-five mortality rates at the national level.
- Analyze the direct and indirect factors which determine the levels and patterns of fertility.
- Measure the level of contraceptive knowledge and practice by method, urban-rural residence, and region.
- Collect data on family health: immunizations, prenatal and postnatal checkups, assistance at delivery, breastfeeding, and prevalence and treatment of diarrhea, fever, and acute respiratory infections among children under five years.
- Collect data on environmental health, utilization of health facilities, prevalence of common non­communicable and infectious diseases, and membership in health insurance plans.
- Collect data on awareness of tuberculosis.
- Determine women's knowledge about HIV/AIDS and access to HIV testing.
- Determine the extent of violence against women.

MAIN RESULTS

FERTILITY

Fertility Levels and Trends. There has been a steady decline in fertility in the Philippines in the past 36 years. From 6.0 children per woman in 1970, the total fertility rate (TFR) in the Phil­ippines declined to 3.3 children per woman in 2006. The current fertility level in the country is relatively high compared with other countries in Southeast Asia, such as Thailand, Singapore and Indonesia, where the TFR is below 2 children per woman.

Fertility Differentials. Fertility varies substan­tially across subgroups of women. Urban women have, on average, 2.8 children compared with 3.8 children per woman in rural areas. The level of fer­tility has a negative relationship with education; the fertility rate of women who have attended college (2.3 children per woman) is about half that of women who have been to elementary school (4.5 children per woman). Fertility also decreases with household wealth: women in wealthier households have fewer children than those in poorer households.

FAMILY PLANNING

Knowledge of Contraception. Knowledge of family planning is universal in the Philippines- almost all women know at least one method of fam-ily planning. At least 90 percent of currently married women have heard of the pill, male condoms, injectables, and female sterilization, while 87 percent know about the IUD and 68 percent know about male sterilization. On aver­age, currently married women know eight meth­ods of family planning.

Unmet Need for Family Planning. Unmet need for family planning is defined as the percentage of currently married women who either do not want any more children or want to wait before having their next birth, but are not using any method of family planning. The 2008 NDHS data show that the total unmet need for family planning in the Philip­pines is 22 percent, of which 13 percent is limiting and 9 percent is for spacing. The level of unmet need has increased from 17 percent in 2003.

Overall, the total demand for family planning in the Philippines is 73 percent, of which 69 percent has been satisfied. If all of need were satisfied, a contraceptive prevalence rate of about 73 percent could, theoretically, be expected. Comparison with the 2003 NDHS indicates that the percentage of de­mand satisfied has declined from 75 percent.

MATERNAL HEALTH

Antenatal Care. Nine in ten Filipino mothers received some antenatal care (ANC) from a medical professional, either a nurse or midwife (52 percent) or a doctor (39 percent). Most women have at least four antenatal care visits. More than half (54 per­cent) of women had an antenatal care visit during the first trimester of pregnancy, as recommended. While more than 90 percent of women who received ante­natal care had their blood pressure monitored and weight measured, only 54 percent had their urine sample taken and 47 percent had their blood sample taken. About seven in ten women were informed of pregnancy complications. Three in four births in the Philippines are protected against neonatal tetanus.

Delivery and Postnatal Care. Only 44 per­cent of births in the Philippines occur in health facilities-27 percent in a public facility and 18 percent in a private facility. More than half (56 percent) of births are still delivered at home. Sixty-two percent of births are assisted by a health professional-35 percent by a doctor and 27 percent by a midwife or nurse. Thirty-six percent are assisted by a traditional birth atten­dant or hilot. About 10 percent of births are de­livered by C-section.

The Department of Health (DOH) recom­mends that mothers receive a postpartum check within 48 hours of delivery. A majority of women (77 percent) had a postnatal checkup within two days of delivery; 14 percent had a postnatal checkup 3 to 41 days after delivery.

CHILD HEALTH

Childhood Mortality. Childhood mortality continues to decline in the Philippines. Cur­rently, about one in every 30 children in the Philippines dies before his or her fifth birthday. The infant mortality rate for the five years be­fore the survey (roughly 2004-2008) is 25 deaths per 1,000 live births and the under-five mortality rate is 34 deaths per 1,000 live births. This is lower than the rates of 29 and 40 reported in 2003, respectively. The neonatal mortality rate, representing death in the first month of life, is 16 deaths per 1,000 live births. Under-five mortal­ity decreases as household wealth increases; children from the poorest families are three times more likely to die before the age of five as those from the wealthiest families.

There is a strong association between under-five mortality and mother's education. It ranges from 47 deaths per 1,000 live births among chil­dren of women with elementary education to 18 deaths per 1,000 live births among children of women who attended college. As in the 2003 NDHS, the highest level of under-five mortality is observed in ARMM (94 deaths per 1,000 live births), while the lowest is observed in NCR (24 deaths per 1,000 live births).

NUTRITION

Breastfeeding Practices. Eighty-eight percent of children born in the Philippines are breastfed. There has been no change in this practice since 1993. In addition, the median durations of any breastfeeding and of exclusive breastfeeding have remained at 14 months and less than one month, re­spectively. Although it is recommended that infants should not be given anything other than breast milk until six months of age, only one-third of Filipino children under six months are exclusively breastfed. Complementary foods should be in­troduced when a child is six months old to re­duce the risk of malnutrition. More than half of children ages 6-9 months are eating complemen­tary foods in addition to being breastfed.

The Infant and Young Child Feeding (IYCF) guidelines contain specific recommendations for the number of times that young children in vari­ous age groups should be fed each day as well as the number of food groups from which they should be fed. NDHS data indicate that just over half of children age 6-23 months (55 percent) were fed according to the IYCF guidelines.

HIV/AIDS

Awareness of HIV/AIDS. While over 94 percent of women have heard of AIDS, only 53 percent know the two major methods for pre­venting transmission of HIV (using condoms and limiting sex to one uninfected partner). Only 45 percent of young women age 15-49 know these two methods for preventing HIV transmis­sion. Knowledge of prevention methods is higher in urban areas than in rural areas and in­creases dramatically with education and wealth. For example, only 16 percent of women with no education know that using condoms limits the risk of HIV infection compared with 69 percent of those who have attended college.

TUBERCULOSIS

Knowledge of TB. While awareness of tubercu­losis (TB) is high, knowledge of its causes and symptoms is less common. Only 1 in 4 women know that TB is caused by microbes, germs or bacteria. Instead, respondents tend to say that TB is caused by smoking or drinking alcohol, or that it is inherited. Symptoms associated with TB are better recognized. Over half of the respondents cited coughing, while 39 percent mentioned weight loss, 35 percent men­tioned blood in sputum, and 30 percent cited cough­ing with sputum.

WOMEN'S STATUS

Women's Status and Employment. Sixty percent of currently married women age 15-49 interviewed in the 2008 NDHS were employed in the year before the survey. Among those who are employed, most earn cash, while 6 percent are unpaid. Most women decide how their earn­ings are spent jointly with their husbands. Only four percent report that mainly their husband decides how their earnings are spent.

DOMESTIC VIOLENCE

Spousal Violence. Emotional and other forms of non-personal violence-such as insults, humiliation, and threats of harm-are the most common types of spousal violence: 23 percent of ever-married women report having experienced such violence by their husbands, with 15 percent reporting these types of violence occurred in the year prior to the survey.

Geographic coverage
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National. The NDHS sample was designed to represent each of the country's 17 administrative regions.

Analysis unit
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- Household
- Women age 15-49
- Men age 15-54
- Children under five years

Universe
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The population covered by the 1998 Phillipines NDS is defined as the universe of all females age 15-49 years, who are members of the sample household or visitors present at the time of interview and had slept in the sample households the night prior to the time of interview, regardless of marital status and all men age 15-54 living in the household.

Kind of data
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Sample survey data

Sampling procedure
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The 2008 NDHS used the 2003 master sample created by NSO for its household-based surveys. The 2008 NDHS used one of the four replicates of the master sample. The NDHS sample was designed to represent each of the country's 17 administrative regions. In each region, a stratified three-stage sample design was employed. At the first stage, primary sampling units (PSUs) were selected with probability proportional to the estimated number of households from the 2000 Census. PSUs consisted of one barangay or a group of contiguous barangays. At the second stage, enumeration areas (EAs) were selected within sampled PSUs with probability proportional to size. At the third stage, housing units were selected with equal probability within sampled EAs.

An EA is defined as an area with discernable boundaries within barangays and consisting of about 150 contiguous households. These EAs were identified during the 2000 Census.

The 2008 NDHS sample contains 794 enumeration areas (EAs). From each EA, an average of 17 housing units was selected using systematic sampling. All households in a sampled housing unit were interviewed, except when there were three or more households in the housing unit. For such a housing unit, three households were selected using simple random sampling. Over 13,500 households were selected for the 2008 NDHS. The sampled households per EA ranged from as low as 3 to as high as 32.

Mode of data collection
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Face-to-face

Research instrument
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Three questionnaires were used for the 2008 NDHS: a) the Household Questionnaire, b) the Women's Questionnaire and c) the Women's Safety Module. These questionnaires were based on the standard questionnaires developed by the MEASURE DHS program and modified-as recommended by the technical working groups and approved by the Steering Committee-to address relevant family planning and health issues in the Philippines. The three questionnaires were translated from English into six major dialects-Tagalog, Cebuano, Ilocano, Bicol, Hiligaynon, and Waray.

a) The Household Questionnaire was used to list all the usual members and visitors in the selected households, as well as some background information on each person listed such as age, sex, relationship to head of the household, health insurance coverage, and education. The main purpose of the Household Questionnaire was to identify women who were eligible for the individual interview. Information on characteristics of the household's dwelling unit, such as the source of water, type of toilet facilities, materials used for the floor, roof, and walls of the house, and ownership of various durable goods was recorded in the Household Questionnaire. These items are indicators of the household's socioeconomic status. Finally, this questionnaire was used to gather information on prevalence of common noncommuni­cable and infectious diseases, health-seeking behavior, and utilization of health facilities by household members.

b) The Women's Questionnaire was used to collect information from all women age 15-49. These women were asked questions on the following topics:
- Background characteristics (e.g., education, media exposure)
- Reproductive history
- Knowledge and use of family planning methods
- Prenatal, delivery, and postnatal care and breastfeeding
- Child immunization and health and nutrition of mothers and children
- Marriage and sexual activity
- Fertility preferences
- Woman's work and husband's background characteristics
- Awareness and behavior regarding HIV/AIDS
- Other health issues

c) The Women's Safety Module was used to interview one respondent selected from all eligible women age 15 to 49 years who were identified from the Household Questionnaire. It collected information on the following topics:
- Women's experience of violence since age 15 and in the 12 months preceding the survey
- Violence during pregnancy
- Marital control
- Interspousal violence
- Experience of forced sex at sexual initiation
- Help-seeking behavior by women who have experienced violence

Three pretests were conducted in 2008 prior to finalizing the survey instruments. The first was conducted in March, the second in April, and the third in May. The pretests primarily aimed to test the questionnaires for clarity and correctness of the new questions; the suitability of the translations in the six dialects (Tagalog, Cebuano, Ilocano, Bicol, Hiligaynon, and Waray); the sustainability of respondents' participation in the survey; and the actual field operation procedures.

Cleaning operations
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Data processing was carried out at the NSO central office in Manila. It consisted of manual editing, data entry, verification, and editing of computer-identified errors. Forty-five hired data processors who underwent training October 6-17, 2008 processed the 2008 NDHS data.

An ad hoc group composed of eight employees from the Demographic and Social Statistics Division, the Information Resources Division, and the Information Technology Operations Division of the NSO was created. They worked full time at the NDHS Data Processing Center and were responsible for various aspects of the NDHS data processing.

Manual editing began October 7, 2008 and data entry began October 21, 2008. The computer software package called CSPro (Census and Survey Processing System) was used for data entry. The data entry program was developed in Manila at NSO with the assistance of data processing specialists from ICF Macro. Data processing was completed on December 22, 2008.

Response rate
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In the 2008 NDHS a total of 13,764 households were selected in the sample, of which 12,555 households were occupied. Of these households, 12,469 were successfully interviewed, yielding a household response rate of 99 percent.

In the interviewed households 13,833 women were identified for the individual interview. A total of 13,594 women were successfully interviewed, yielding a response rate of 98 percent. A total of 9,458 women were identified as eligible for the Women's Safety Module, of whom 9,316 were interviewed with privacy, yielding a response rate of 99 percent. Response rates in urban and rural areas were similar.

Sampling error estimates
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Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents se­lected in the 2008 NDHS is only one of many samples that could have been selected from the same popu­lation, using the same design and expected size. Each of these 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.

A sampling error is usually measured in terms of the standard error for a particular statistic (mean, percentage, etc.), 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 percent 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 2008 NDHS sam­ple is the result of a multi-stage stratified design, and, consequently, it was necessary to use more com­plex formulae. The computer software used to calculate sampling errors for the 2008 NDHS is a Macro SAS procedure. This procedure used the Taylor linearization method of variance estimation for survey estimates that are means or proportions. The Jackknife repeated-replication method is used for variance estimation of more complex statistics such as fertility and mortality rates.

The Jackknife repeated-replication method derives estimates of complex rates from each of sev­eral replications of the parent sample, and calculates standard errors for these estimates using simple for­mulae. Each replication considers all but one cluster in the calculation of the estimates. Pseudo-independent replications are thus created. In the 2008 NDHS, there were 792 non-empty clusters. Hence, 792 replications were created.

In addition to the standard error, the procedure computes the design effect (DEFT) for each esti­mate, which is defined as the ratio between the standard error using the given sample design and the stan­dard error that would result if a simple random sample had been used. A DEFT value of 1.0 indicates that the sample design is as efficient as a simple random sample, while a value greater than 1.0 indicates the increase in the sampling error because of the use of a more complex and less statistically efficient design. The procedure also computes the relative error and confidence limits for the estimates.

Sampling errors for the 2008 NDHS are calculated for selected variables considered to be of pri­mary interest. The results are presented in an appendix to the Final Report for the country as a whole, for urban and rural areas, and for each of the 17 geographical regions. For each variable, the type of statistic (mean, propor­tion, or rate) and the base population are given in Table B.1 of the Final Report. Tables B.2 to B.21 present the value of the statistic (R), its standard error (SE), the number of unweighted (N-UNWE) and weighted (N-WEIG) cases, the design effect (DEFT), the relative standard error (SE/R), and the 95 percent confidence limits (R±2SE), for each variable. The DEFT is considered undefined when the standard error considering sim­ple random sample is zero (when the estimate is close to 0 or 1). In the case of the total fertility rate, the number of unweighted cases is not relevant, as there is no known unweighted value for woman-years of exposure to childbearing.

The confidence interval (e.g., as calculated for children ever born to women 40-49) can be inter­preted as follows: the overall average from the national sample is 3.964 and its standard error is 0.060. Therefore, to obtain the 95 percent confidence limits, one adds and subtracts twice the standard error to the sample estimate, i.e., 3.964±2×0.060. There is a high probability (95 percent) that the true average number of children ever born to all women is between 3.845 and 4.083. For the total sample, the value of the DEFT, averaged over all variables, is 1.219. This means that, because of multi-stage clustering of the sample, the average standard error is increased by a factor of 1.219 over that in an equivalent simple random sample.

Data appraisal
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Nonsampling 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 of the questions on the part of either the interviewer or the respondent, and data entry errors. Although numer­ous efforts were made during the implementation of the 2008 Philippines National Demographic and Health Survey (NDHS) to minimize this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically.

2008年菲律宾全国人口与健康调查（2008年NDHS）是对12,469户家庭中13,594名15至49岁女性的全国代表性调查。此次调查涵盖了菲律宾全国794个抽样单位（聚类），旨在评估国家的人口与健康状况。调查收集了关于生育水平、婚姻、生育偏好、家庭规划方法的认知和使用、母乳喂养实践、妇女和幼儿的营养状况、儿童死亡率、母婴健康以及关于艾滋病和结核病的知识和态度的详细信息。此外，菲律宾NDHS首次收集了针对女性的暴力信息。该调查由菲律宾国家统计办公室（NSO）实施，技术援助由ICF Macro通过MEASURE DHS项目提供。调查资金主要由菲律宾政府提供。部分筹备和处理阶段的资金由美国国际开发署（USAID）提供。与菲律宾以往进行的其他人口与健康调查（DHS）一样，2008年NDHS旨在提供有关人口、家庭规划和健康的信息，以便评估和设计改善国家健康和家庭规划服务的政策、项目和战略。2008年NDHS还包括有关家庭暴力的调查。具体而言，2008年NDHS的目标如下：
- 收集全国范围内的数据，以估计人口增长率，特别是按城乡居住地和地区划分的生育率以及全国5岁以下死亡率。
- 分析决定生育水平和模式的直接和间接因素。
- 测量避孕知识的水平及其使用方法、城乡居住地和地区。
- 收集有关家庭健康的数据：免疫接种、产前和产后检查、分娩援助、母乳喂养，以及5岁以下儿童腹泻、发热和急性呼吸道感染的发生率和治疗方法。
- 收集有关环境卫生、医疗设施利用率、常见非传染性和传染性疾病的发生率以及健康保险计划的成员资格的数据。
- 收集有关结核病的认知数据。
- 确定妇女对艾滋病/艾滋病的知识和艾滋病检测的可及性。
- 确定针对女性的暴力程度。

主要结果

生育率
- 生育水平和趋势。过去36年来，菲律宾的生育率持续下降。从1970年的每名女性6.0个孩子降至2006年的每名女性3.3个孩子。与东南亚其他国家相比，如泰国、新加坡和印度尼西亚，菲律宾的生育率相对较高，这些国家的总和生育率（TFR）低于每名女性2个孩子。
- 生育差异。生育率在不同女性群体中差异很大。城市女性的平均生育率为2.8个孩子，而农村地区为每名女性3.8个孩子。生育率与教育水平呈负相关；受过大学教育的女性（每名女性2.3个孩子）的生育率约为受过小学教育女性（每名女性4.5个孩子）的一半。生育率也随着家庭财富的增加而降低：富裕家庭的女性比贫困家庭的女性孩子更少。

家庭规划
- 避孕知识。菲律宾的家庭规划知识普及率很高——几乎所有的女性都知道至少一种家庭规划方法。目前，至少90%的已婚妇女听说过避孕药、男用避孕套、注射剂和女性绝育术，而87%的人知道宫内节育器，68%的人知道男性绝育术。平均而言，目前已婚妇女知道8种家庭规划方法。

未满足的家庭规划需求。未满足的家庭规划需求是指目前已婚妇女中那些不想再要孩子或想要在下次生育前等待，但未使用任何家庭规划方法的女性比例。2008年NDHS数据显示，菲律宾的总未满足家庭规划需求为22%，其中13%是限制生育，9%是生育间隔。未满足需求的比例从2003年的17%有所上升。

总体而言，菲律宾的家庭规划总需求为73%，其中69%已经得到满足。如果所有需求都得到满足，理论上避孕普及率可以达到73%左右。与2003年NDHS的比较表明，满足需求的比例从75%下降。

母婴健康
- 产前护理。90%的菲律宾母亲接受了某种形式的产前护理（ANC），由医务人员提供，包括护士或助产士（52%）或医生（39%）。大多数女性至少进行了四次产前护理访问。超过一半（54%）的女性在怀孕的第一个 trimester期间进行了产前护理访问，如推荐的那样。虽然接受产前护理的女性中超过90%的人血压被监测并测量体重，但只有54%的人尿液样本被检测，47%的人血液样本被检测。大约七成女性被告知了怀孕并发症。菲律宾的74%的出生是保护了新生儿破伤风的。

分娩和产后护理。菲律宾只有44%的分娩发生在医疗机构——27%在公共设施，18%在私人设施。超过一半（56%）的分娩仍在家中分娩。62%的分娩由医务人员协助——35%由医生协助，27%由助产士或护士协助。36%由传统接生员或hilot协助。大约10%的分娩是通过剖腹产进行的。卫生部门（DOH）建议母亲在分娩后48小时内接受产后检查。77%的女性在分娩后两天内进行了产后检查；14%的女性在分娩后3至41天内进行了产后检查。

儿童健康
- 儿童死亡率。儿童死亡率在菲律宾持续下降。目前，每30个儿童中就有1个在5岁之前死亡。调查前五年（大约2004-2008年）的婴儿死亡率是每1000个活产婴儿25个死亡，5岁以下死亡率是每1000个活产婴儿34个死亡。这些比率分别低于2003年报告的29和40。新生儿死亡率，代表生命第一个月的死亡，是每1000个活产婴儿16个死亡。5岁以下死亡率随着家庭财富的增加而降低；来自最贫困家庭的孩子在5岁之前死亡的可能性是来自最富裕家庭孩子的三倍。

5岁以下死亡率与母亲的教育水平有很强的关联。从受过小学教育的女性孩子中每1000个活产婴儿47个死亡到受过大学教育的女性孩子中每1000个活产婴儿18个死亡。与2003年NDHS一样，ARMM（每1000个活产婴儿94个死亡）观察到5岁以下死亡率最高，而NCR（每1000个活产婴儿24个死亡）观察到最低。

营养
- 母乳喂养实践。88%的菲律宾出生婴儿接受了母乳喂养。自1993年以来，这种做法没有变化。此外，任何形式的母乳喂养和纯母乳喂养的中位持续时间分别为14个月和不到一个月。尽管建议婴儿在6个月大之前不应接受除母乳以外的任何食物，但只有三分之一的菲律宾6个月以下的儿童是纯母乳喂养的。当孩子6个月大时，应引入辅食以减少营养不良的风险。6至9个月大的儿童中，超过一半（55%）的儿童在母乳喂养的同时还食用辅食。

婴儿和幼儿喂养（IYCF）指南包含关于不同年龄组儿童每天应喂食的次数以及他们应从哪些食物组中获取食物的具体建议。NDHS数据显示，6至23个月大的儿童中，有55%的儿童根据IYCF指南喂养。

艾滋病/艾滋病病毒
- 艾滋病/艾滋病认知。尽管超过94%的女性听说过艾滋病，但只有53%的人知道两种预防HIV传播的主要方法（使用避孕套和将性行为限制为一名未感染的伴侣）。只有45%的15至49岁年轻女性知道这两种预防HIV传播的方法。预防方法的知识在城市地区比在农村地区更高，并且随着教育和财富的增加而显著提高。例如，只有16%的无教育女性知道使用避孕套可以限制HIV感染的风险，而69%的受过大学教育的女性知道这一点。

结核病
- 结核病知识。尽管对结核病（TB）的认知很高，但对其病因和症状的了解却很少。只有四分之一的女性知道结核病是由微生物、细菌或细菌引起的。相反，受访者倾向于说结核病是由吸烟或饮酒引起的，或者说是遗传的。与结核病相关的症状更容易被识别。超过一半的受访者提到了咳嗽，39%的人提到了体重减轻，35%的人提到了痰中带血，30%的人提到了咳嗽并伴有痰。

女性地位
- 女性地位和就业。在2008年NDHS中调查的15至49岁已婚女性中，有60%在调查前一年就业。在就业的女性中，大多数人赚取现金，而6%的人是无报酬的。大多数女性与丈夫共同决定如何使用她们的收入。只有4%的人报告说主要是由丈夫决定如何使用她们的收入。

家庭暴力
- 配偶暴力。情感和其他非个人形式的暴力——如侮辱、羞辱和威胁伤害——是最常见的配偶暴力类型：23%的已婚女性报告曾遭受丈夫的此类暴力，其中15%的人报告在调查前一年内发生了这类暴力。

地理覆盖范围
- 全国。NDHS样本旨在代表该国的17个行政区域。

分析单位
- 家庭
- 15-49岁女性
- 15-54岁男性
- 5岁以下儿童

总体
- 菲律宾1998年NDS所涵盖的人口被定义为所有15-49岁女性，她们是样本家庭的成员或调查时在场并在前一晚睡在样本家庭中的访客，无论婚姻状况如何，以及所有居住在家庭中的15-54岁男性。

数据类型
- 样本调查数据

抽样程序
- 2008年NDHS使用了NSO为其家庭调查创建的2003年主样本。2008年NDHS使用了主样本的四个副本之一。NDHS样本旨在代表该国的17个行政区域。在每个地区，采用了分层三阶段样本设计。在第一阶段，根据2000年人口普查估计的家庭数量以概率比例选取了初级抽样单位（PSU）。PSU由一个barangay或一组相邻的barangay组成。在第二阶段，在样本PSU内以规模比例的概率选取了抽样单位（EA）。在第三阶段，在样本EA内以等概率选取了住房单元。

EA被定义为barangay内具有可识别边界的区域，由大约150个相邻的住房单元组成。这些EA在2000年人口普查期间被识别。2008年NDHS样本包含794个抽样单位（EA）。从每个EA，平均选择17个住房单元使用系统抽样。所有样本住房单元中的家庭都被调查，除非住房单元中有三个或更多家庭。对于此类住房单元，使用简单随机抽样选择三个家庭。为2008年NDHS选择了超过13,500个家庭。每个EA的样本家庭数量从最低的3个到最高的32个不等。

数据收集方式
- 面对面

研究工具
- 2008年NDHS使用了三个问卷：a）家庭问卷，b）女性问卷和c）女性安全模块。这些问卷基于MEASURE DHS项目开发的标准化问卷，并根据技术工作组的建议和指导委员会的批准进行了修改，以解决菲律宾相关的家庭规划和健康问题。这三个问卷被翻译成六种主要方言——他加禄语、宿务语、伊洛科语、比科尔语、希利盖农语和瓦莱语。

a）家庭问卷用于列出所选家庭的全部常住成员和访客，以及关于每个被列出人员的一些背景信息，例如年龄、性别、与户主的关系、医疗保险覆盖范围和教育。家庭问卷的主要目的是确定有资格进行个别访谈的女性。在家庭问卷中记录了有关家庭居住单位特征的信息，例如水源、卫生设施类型、地板、屋顶和墙壁的材料，以及各种耐用品的所有权。这些项目是家庭社会经济地位的指标。最后，该问卷用于收集有关家庭成员常见非传染性和传染性疾病的发生率、健康寻求行为和利用医疗设施的信息。

b）女性问卷用于收集所有15-49岁女性的信息。这些女性被问及以下主题：
- 背景（例如，教育、媒体接触）
- 生育史
- 家庭规划方法的认知和使用
- 产前、分娩和产后护理及母乳喂养
- 儿童免疫接种和母亲及儿童的健康和营养
- 婚姻和性行为
- 生育偏好
- 妇女工作和丈夫的背景特征
- 关于艾滋病/艾滋病的认知和行为
- 其他健康问题

c）女性安全模块用于访谈从家庭问卷中确定的15至49岁有资格的女性中的一个受访者。它收集了以下主题的信息：
- 女性自15岁以来的暴力经历以及在调查前12个月内的暴力经历
- 怀孕期间的暴力
- 婚姻控制
- 配偶间的暴力
- 性生活中被迫性行为的经历
- 经历过暴力的女性寻求帮助的行为

在2008年对调查工具进行最终确定之前，进行了三次预测试。第一次是在3月，第二次是在4月，第三次是在5月。预测试的主要目的是测试问卷的清晰度和新问题的正确性；六种方言（他加禄语、宿务语、伊洛科语、比科尔语、希利盖农语和瓦莱语）翻译的适宜性；受访者参与调查的可持续性；以及实际现场操作程序。

数据清理
- 数据处理在NSO中央办公室马尼拉进行。它包括手动编辑、数据输入、验证和编辑计算机识别的错误。45名于2008年10月6日至17日接受培训的数据处理员处理了2008年NDHS数据。

由来自NSO人口与社会统计司、信息资源司和信息技术运营司的8名员工组成的临时小组被创建。他们在NDHS数据处理中心全职工作，负责NDHS数据处理的各种方面。

手动编辑始于2008年10月7日，数据输入始于10月21日。用于数据输入的计算机软件包是CSPro（人口普查和调查处理系统）。数据输入程序在马尼拉NSO开发，并得到ICF Macro的数据处理专家的帮助。数据处理于2008年12月22日完成。

响应率
- 在2008年NDHS中，共选择了13,764个家庭样本，其中12,555个家庭有人居住。在这些家庭中，12,469个家庭被成功调查，家庭响应率为99%。在调查的家庭中，确定了13,833名女性进行个别访谈。总共调查了13,594名女性，响应率为98%。总共确定了9,458名有资格进行女性安全模块的女性，其中9,316名女性在私密环境下进行了访谈，响应率为99%。城市和农村地区的响应率相似。

抽样误差估计
- 另一方面，抽样误差可以统计地评估。2008年NDHS中选定的受访者样本只是从同一人口中选取的许多样本之一，使用相同的设计和预期规模。每个样本都会产生与实际样本选择的结果略有不同的结果。抽样误差是衡量所有可能样本之间变异性的指标。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（平均值、百分比等）的标准误差来衡量，这是方差的平方根。标准误差可用于计算置信区间，其中可以合理地假设人口的真实值落在该区间内。例如，从样本调查中计算出的任何给定统计量的值将在95%的所有可能样本（大小和设计相同）的标准误差的正负两倍范围内。

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，2008年NDHS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。用于计算2008年NDHS抽样误差的计算机软件是Macro SAS过程。该过程使用泰勒线性化方法估计调查估计的方差，这些估计是平均值或比例。用于更复杂的统计量（如生育率和死亡率）的方差估计使用Jackknife重复复制方法。

Jackknife重复复制方法从父样本的每个重复中推导出复杂率的估计值，并使用简单公式计算这些估计值的标准误差。每个重复在计算估计值时考虑了除一个聚类以外的所有聚类。从而创建了伪独立重复。在2008年NDHS中，有792个非空聚类。因此，创建了792个重复。

除了标准误差外，该程序还计算每个估计的设计效应（DEFT），定义为使用给定样本设计计算的标准误差与使用简单随机样本会得到的标准误差之间的比率。DEFT值为1.0表示样本设计与简单随机样本一样有效，而大于1.0的值表示由于使用更复杂且统计效率较低的样本设计而增加的抽样误差。该程序还计算估计的相对误差和置信限。

2008年NDHS的抽样误差是为被认为具有主要兴趣的选定变量计算的。结果在最终报告的附录中按国家整体、城市和农村地区以及每个地理区域进行呈现。对于每个变量，给出了统计量类型（平均值、比例或比率）和基人口在最终报告表B.1中。表B.2至B.21呈现了统计量的值（R）、其标准误差（SE）、未加权（N-UNWE）和加权（N-WEIG）案例的数量、设计效应（DEFT）、相对标准误差（SE/R）和95%置信限（R±2SE），对于每个变量。当考虑简单随机样本的标准误差为零时，DEFT被视为未定义（当估计接近0或1时）。对于总和生育率，未加权案例的数量不相关，因为没有已知的未加权值，即妇女的生育暴露年数。

置信区间（例如，为女性40-49岁所生的所有孩子计算）可以这样解释：国家样本的平均值为3.964，其标准误差为0.060。因此，为了获得95%置信限，将样本估计值加上和减去两倍标准误差，即3.964±2×0.060。有很高的可能性（95%）表明，所有女性实际上出生的孩子总数在3.845和4.083之间。对于总体样本，所有变量的平均值DEFT为1.219。这意味着，由于样本的多阶段聚类，平均标准误差比等效简单随机样本增加了1.219倍。

数据评估
- 非抽样误差是由于在数据收集和处理过程中出现的错误而产生的结果，例如未能找到和调查正确的家庭、访谈员或受访者对问题的误解以及数据输入错误。尽管在实施2008年菲律宾全国人口与健康调查（NDHS）期间做出了大量努力来最大限度地减少此类错误，但非抽样误差是无法避免且难以进行统计评估的。