Demographic and Health Survey 2004 - Bangladesh

Abstract
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The Bangladesh Demographic and Health Survey (BDHS) is part of the worldwide Demographic and Health Surveys program, which is designed to collect data on fertility, family planning, and maternal and child health.

The main objective of this survey is to provide policy-makers and program managers in health and family planning with detailed information on fertility and family planning, childhood mortality, maternal and child health, nutritional status of children and mothers, and awareness of HIV/AIDS. The survey consisted of two parts: a household-level survey of women and men and a community survey around the sample points from which the households were selected. Preparations for the survey started in mid-2003 and the fieldwork was carried out between January and May 2004.The urvey was conducted under the authority of the National Institute for Population Research and Training (NIPORT) of the Ministry of Health and Family Welfare. The survey was implemented by Mitra and Associates, a Bangladeshi research firm located in Dhaka. ORC Macro of Calverton, Maryland, provided technical assistance to the project as part of its international Demographic and Health Surveys program, and financial assistance was provided by the U.S. Agency for International Development (USAID)/Bangladesh.

In general, the objectives of the BDHS are to:
- Assess the overall demographic situation in Bangladesh
- Assist in the evaluation of the population and health programs in Bangladesh
- Advance survey methodology.

More specifically, the objective of the BDHS survey is to provide up-to-date information on fertility and childhood mortality levels; nuptiality; fertility preferences; awareness, approval, and use of family planning methods; breastfeeding practices; nutrition levels; and maternal and child health. This information is intended to assist policymakers and administrators in evaluating and designing programs and strategies for improving health and family planning services in the country.

Geographic coverage
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National

Analysis unit
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- Household
- Children under five years
- Women age 10-49
- Men age 15-54

Kind of data
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Sample survey data

Sampling procedure
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The sample for the 2004 BDHS covered the entire population residing in private dwellings units in the country. Administratively, Bangladesh is divided into six divisions. In turn, each division is divided into zilas, and in turn each zila into upazilas. Each urban area in the upazila is divided into wards, and into mahallas within the ward; each rural area in the upazila is divided into union parishads (UP) and into mouzas within the UPs. The urban areas were stratified into three groups, i) Standard metropolitan areas, ii) Municipality areas, and iii) Other urban areas. These divisions allow the country as a whole to be easily separated into rural and urban areas.

For the 2001 census, subdivisions called enumeration areas (EAs) were created based on a convenient number of dwellings units. Because sketch maps of EAs were accessible, EAs were considered suitable to use as primary sampling units (PSUs) for the 2004 BDHS. In each division, the list of EAs constituted the sample frame for the 2004 BDHS survey.

A target number of completed interviews with eligible women for the 2004 BDHS was set at 10,000, based on information from the 1999-2000 BDHS. The 2004 BDHS sample is a stratified, a multistage cluster sample consisting of 361 PSUs, 122 in the urban area and 239 in the rural area. After the target sample was allocated to each group area according to urban and rural areas, the number of PSUs was calculated in terms of an average of 28 completed interviews of eligible women per PSU (or an average of 30 selected households per PSU).

Mitra and Associates conducted a household listing operation in all the sample points from 3 October 2003 to 15 December 2003. A systematic sample of 10,811 households was then selected from these lists. All ever-married women age 10-49 in the selected households were eligible respondents for the women's questionnaire. For the men's survey, 50 percent of the selected households were chosen through systematic sampling. Interviewers interviewed one randomly selected man, regardless of marital status, in the age group 15-54, from each of the selected households. It was expected that the sample would yield interviews with approximately 10,000 ever-married women age 10-49 and 4,400 men age 15-54.

Note: See detailed in APPENDIX A of the survey report.

Sampling deviation
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Data collected for women 10-49, indicators calculated for women 15-49.

Mode of data collection
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Face-to-face

Research instrument
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The BDHS used a Household Questionnaire, a Women’s Questionnaire, a Men’s Questionnaire, and a Community Questionnaire. The contents of these questionnaires was based on MEASURE DHS+ model questionnaire. These model questionnaires were adapted for use in Bangladesh during a series of meetings with the Technical Task Force, which consisted of representatives from NIPORT, Mitra and Associates, USAID/Dhaka, ICDDR,B’s Center for Health and Population Research, Bangladesh, Pathfinder/Dhaka, and ORC Macro. Draft questionnaires were then circulated to other interested groups and were reviewed by the BDHS Technical Review Committee. The questionnaires were developed in English and then translated into and printed in Bangla. In addition, two versions of a Verbal Autopsy Questionnaire were used. One version was for neonatal deaths (0-28 days old at death) and the other was for deaths among older children (age 29 days to 5 years at death). The verbal autopsy instruments were developed using the previous two BDHS verbal autopsy surveys, the WHO verbal autopsy questionnaire, and the instrument used since 2003 in the Matlab Health and Demographic Surveillance System.

The Household Questionnaire was used to list all the usual members and visitors in the selected households. Some basic information was 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 was to identify women and men who were eligible for individual interview. In addition, information was collected about the dwelling itself, such as the source of water, type of toilet facilities, materials used to construct the house, and ownership of various consumer goods. The arsenic level of the water used by households for drinking was also tested. The Household Questionnaire was also used to record the heights and weights of all children under six years of age.

The Women’s Questionnaire was used to collect information from ever-married women age 10-49. These women were asked questions on the following topics:
- Background characteristics (age, education, religion, etc.)
- Reproductive history
- Knowledge and use of family planning methods
- Antenatal and delivery care
- Breastfeeding and weaning practices
- Vaccinations and health of children under age five
- Marriage
- Fertility preferences
- Husband’s background and respondent’s work
- Awareness of AIDS and other sexually transmitted diseases
- Causes of deaths of children under five years of age

The Men’s Questionnaire was used to collect information from men age 15-54 whether ever married or not. The men were asked questions on the following topics:
- Background characteristics (including respondent’s work)
- Health and life style (illness, use of tobacco)
- Marriage and sexual activity
- Participation in reproductive health care
- Awareness of AIDS and other sexually transmitted diseases
- Attitudes on women’s decision making roles
- Domestic violence

The Community Questionnaire was completed for each sample cluster and included questions about the existence of development organizations in the community and the availability and accessibility of health and family planning services.

The Verbal Autopsy Questionnaire was used for collection of open-ended information including narrative stories on the following topics:
- Identification including detailed address of respondent
- Informed consent
- Detailed age description of deceased child
- Information about caretaker or respondent of deceased child
- Detailed birth and delivery information
- Open-ended section allowing the respondent to provide a narrative history
- Maternal history including questions on prenatal care, labor and delivery, and obstetrical complications
- Information about accidental deaths
- Detailed signs and symptoms preceding death
- Treatment module and information on direct, underlying
- Contributing causes of death from the death certificate, if available.

Cleaning operations
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All questionnaires for the BDHS were periodically returned to Dhaka for data processing at Mitra and Associates. The processing of the data collected began shortly after the fieldwork commenced. The processing operation consisted of office editing, coding of open-ended questions, data entry, and editing inconsistencies found by the computer programs. The data were processed on six microcomputers working in double shifts and carried out by 10 data entry operators and two data entry supervisors. The concurrent processing of the data was an advantage since the quality control teams were able to advise field teams of problems detected during the data entry. In particular, tables were generated to check various data quality parameters. Data processing commenced on 12 January 2004 and was completed by 24 June 2004.

Response rate
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A total of 10,811 households were selected for the sample; 10,523 were occupied, of which 10,500 were successfully interviewed. The shortfall is primarily due to dwellings that were vacant or destroyed or in which the inhabitants had left for an extended period at the time the interviewing teams visited them. Of the households occupied, 99.8 percent were successfully interviewed. In these households, 11,601 women were identified as eligible for the individual interview (i.e., ever-married and age 10-49) and interviews were completed for 11,440 or 98.6 percent of them. In households that were selected for inclusion in the man’s survey, 4,490 eligible men age 15-54 were identified, of which 4,297 or 95.7 percent were interviewed.

The principal reason for nonresponse among eligible women and men was the failure to find them at home despite repeated visits to the household. The nonresponse rates for the current survey were lower than those for the 1999-2000 survey.

Note: See summarized response rates by residence (urban/rural) in Table 1.1 of the survey report.

Sampling error estimates
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The estimates from a sample survey are affected by two types of errors: (1) nonsampling errors, and (2) sampling errors. 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 2004 Bangladesh Demographic and Health Survey (BDHS) to minimize this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically.

Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the 2004 BDHS 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 2004 BDHS 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 2004 BDHS is the ISSA Sampling Error Module. This module 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.

Note: See detailed estimate of sampling error calculation in APPENDIX B of the survey 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

Note: See detailed tables in APPENDIX C of the report which is presented in this documentation.

摘要
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孟加拉国人口与健康调查（BDHS）是全球人口与健康调查项目的一部分，旨在收集有关生育、家庭规划以及母婴健康的数据。

本调查的主要目标是向健康和家庭规划领域的政策制定者和项目管理者提供关于生育和家庭规划、儿童死亡率、母婴健康、儿童和母亲的营养状况以及HIV/AIDS认知的详细信息。调查分为两部分：对家庭层面的男性和女性进行的调查以及对样本家庭所在社区的社区调查。调查准备工作始于2003年中期，实地工作于2004年1月至5月进行。调查在孟加拉国卫生和家庭福利部的国家人口研究与培训研究所（NIPORT）的授权下进行。该调查由位于达卡的孟加拉国研究公司Mitra and Associates实施。作为其国际人口与健康调查项目的一部分，马里兰州Calverton的ORC Macro为该项目提供了技术援助，美国国际开发署（USAID）/孟加拉国提供了资金援助。

总的来说，BDHS的目标是：
- 评估孟加拉国的整体人口状况
- 协助评估孟加拉国的人口与健康项目
- 推进调查方法。

具体而言，BDHS调查的目标是提供有关生育和儿童死亡率水平、婚配率、生育偏好、家庭规划方法的认知、接受度和使用情况、母乳喂养实践、营养水平和母婴健康的最新信息。这些信息旨在协助政策制定者和行政管理人员评估和设计改善国家健康和家庭规划服务的项目和策略。

地理覆盖范围
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全国

分析单元
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- 家庭
- 五岁以下儿童
- 10-49岁女性
- 15-54岁男性

数据类型
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样本调查数据

抽样程序
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2004年BDHS的样本涵盖了全国所有居住在私人住宅单元的居民。在行政上，孟加拉国分为六个行政区。每个行政区再分为zilla，每个zilla再分为upazila。每个upazila内的城镇区域分为wards，再分为wards内的mahallas；每个upazila内的农村区域分为union parishads（UP）和UP内的mouzas。城镇区域被分为三组，i）标准大都市地区，ii）市政地区和iii）其他城镇地区。这些划分使得整个国家可以轻松地分为城市和农村地区。

对于2001年的普查，根据住宅单元的便利数量创建了称为普查区（EAs）的次级行政区。由于EAs的草图地图可获取，因此认为它们适合用作2004年BDHS的主要抽样单元（PSU）。在每个行政区中，EAs的列表构成了2004年BDHS调查的样本框。

根据1999-2000年BDHS的信息，为2004年BDHS设定了10,000名合格女性的目标完成访谈。2004年BDHS样本是一个分层、多阶段集群样本，由361个PSU组成，其中城市地区有122个，农村地区有239个。根据城市和农村地区将目标样本分配到每个区域后，计算了PSU的数量，以平均每个PSU完成28次合格女性的访谈（或平均每个PSU选择30个家庭）。

Mitra and Associates在2003年10月3日至2003年12月15日期间对所有样本点进行了家庭清单操作。然后从这些清单中选择了10,811户家庭的系统样本。所有被选中的家庭中，10-49岁的所有已婚女性都是女性问卷的合格受访者。对于男性调查，通过系统抽样选择了所选家庭的50％。访谈员从每个被选中的家庭中随机选择一名15-54岁的男性（无论婚姻状况如何）进行访谈。预计样本将产生大约10,000名10-49岁的已婚女性和4,400名15-54岁的男性的访谈。

注意：请参阅调查报告附录A中的详细内容。

抽样偏差
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收集了10-49岁女性的数据，计算了15-49岁女性的指标。

数据收集方式
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面对面

研究工具
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BDHS使用了家庭问卷、女性问卷、男性问卷和社区问卷。这些问卷的内容基于MEASURE DHS+模型问卷。这些模型问卷在由NIPORT、Mitra and Associates、USAID/Dhaka、ICDDR,B的人口与健康研究中心、Bangladesh的Pathfinder/Dhaka和ORC Macro组成的技