Household Health Survey 2010 - South Sudan

Abstract
---------------------------

The second South Sudan Household Health Survey (SHHS 2) was conducted in 2010 by the Ministry of Health and National Bureau of Statistics.

The primary objectives of the second South Sudan Household Health Survey (SHHS 2) were:
- To provide up-to-date information for assessing the situation of children and women in South Sudan;
- To furnish data needed for monitoring progress toward goals established in the Millennium Declaration and other internationally agreed upon goals, as a basis for future action;
- To contribute to the improvement of data and monitoring systems in South Sudan and to strengthen technical expertise in the design, implementation, and analysis of such systems.
- To generate data on the situation of children and women, including the identification of vulnerable groups and of disparities, to inform policies and interventions.
- To provide up-to-date information on the health status of children and women of South Sudan in order to understand differences related to determinants of health, such as poverty, education, gender, residence type (rural/urban), and the State of residence;
- To generate data that assist in monitoring progress towards achieving the MDGs and WFFC’s goals; and
- To contribute to essentially desired improvements of data collection, quality, and analysis in South Sudan.

Sudan Household Health Survey is modelled on MICS, an international household survey programme developed by UNICEF. SHHS 2 was conducted as part of the fourth global round of MICS surveys (MICS4). MICS provides up-to-date information on the situation of children and women and measures key indicators that allow countries to monitor progress towards the Millennium Development Goals (MDGs) and other internationally agreed upon commitments. Additional information on the global MICS project may be obtained from www.childinfo.org.

Geographic coverage
---------------------------

The ten states of South Sudan: Upper Nile, Jonglei, Unity, Warap Northern Bahr El Ghazal, Western Bahr El Ghazal, Lakes, Western Equatoria, Central Equatoria, and Eastern Equatoria.

Sampling procedure
---------------------------

The sample for the second South Sudan Household Health Survey (SHHS 2) was designed to provide estimates for a large number of indicators on the situation of children and women at the national level, for urban and rural areas, and for the 10 states across the country: The said States are Upper Nile, Jonglei, Unity, Warap Northern Bahr El Ghazal, Western Bahr El Ghazal, Lakes, Western Equatoria, Central Equatoria, Eastern Equatoria.

The sampling frame used for the SHHS 2 is the 2008 Sudan Population and Housing Census. States were identified as the sampling domains or domains of analysis. The sample uses 20 urban and rural strata, two per State.

The sample size for the survey was determined by the degree of precision required for survey estimates for each state: 1,000 households in each state. Since a similar level of precision was required for the survey results from each state, it was decided to draw 40 clusters from each state and 25 households from each cluster. However, in each of Unity and Jonglei states only 39 clusters were selected and that yields 975 households by state. The total sample was finally 9,950 households or 398 clusters (enumeration areas).

The sample was selected in two stages: within each State, enumeration areas were randomly selected with probability proportional to size as primary sampling units. After a household listing was carried out within the selected enumeration areas, a sample of 25 households was drawn in each sampled enumeration area.

Mode of data collection
---------------------------

Face-to-face [f2f]

Research instrument
---------------------------

Four sets of questionnaires were used in the survey:
1) a household questionnaire which was used to collect information on all de jure household members (usual residents), the household, and the dwelling;
2) a women’s questionnaire administered in each household to all women aged 15-49 years;
3) a men’s questionnaire administered in each household to all men aged 15-49 years; and
4) an under-5 questionnaire, administered to mothers or caretakers for all children under 5 living in the household.

The questionnaires included the following modules:

The household questionnaire included the following modules:
- Household information panel
- Household Listing Form and Education
- Water and Sanitation (country specific tables were produced for use of improved water sources, Household water treatment, Time to source of drinking water; and Drinking water and sanitation ladders)
- Household Characteristics
- Insecticide Treated Nets (Results are only available for household possession of at least one mosquito net and one long-lasting treated net)Salt Iodization

The questionnaire for individual women was administered to all women aged 15-49 years living in the households, and included the following modules:
- Woman’s Information Panel
- Women’s Background
- Child Mortality
- Live Birth History
- Desire for Last Birth (Results not available)
- Maternal and Newborn Health
- Contraception
- Unmet Need
- Attitudes Towards Domestic Violence
- Marriage/Union
- Female Genital Mutilation/Cutting (Results not available)
- Sexual Behaviour
- HIV/AIDS
- Sexually Transmitted Infections (Results not available)

The questionnaire for individual men was administered to all men aged 15-49 years living in the households, and included the following modules:
- Men’s information panel
- Men’s Background
- Attitudes Towards Domestic Violence
- Marriage/Union
- Sexual Behaviour
- HIV/AIDS
- Sexually Transmitted Infections

The questionnaire for children under five was administered to mothers or caretakers of children under 5 years of age1 living in the households. Normally, the questionnaire was administered to mothers of under-5 children; in cases when the mother was not listed in the household roster, a primary caretaker for the child was identified and interviewed. The
questionnaire included the following modules:
- Under five Child Information Panel
- Age
- Birth Registration
- Breastfeeding
- Early Child Development (Results not available)
- Care of Illness
- Malaria
- Immunization
- Anthropometry

The questionnaires are based on the MICS4 model questionnaire2. Based on the results of the pre-test, modifications were made to the wording and translation of the questionnaires.

Cleaning operations
---------------------------

Data were entered using the CSPro software. The data were entered on 20 microcomputers and carried out by 40 data entry operators and 4 data entry supervisors. In order to ensure quality control, all questionnaires were double entered and internal consistency checks were performed. Procedures and standard programs developed under the global MICS4 programme and adapted to the South Sudan questionnaire were used throughout. Data processing began after the end of data collection and was completed in July 2010. Data were analysed using the Statistical Package for Social Sciences (SPSS) software program, Version 18, and the model syntax and tabulation plans developed by UNICEF were used for this purpose.

Response rate
---------------------------

Of the 9,950 households selected for the sample, 9,760 were found to be occupied. Of these, 9,369 were successfully interviewed for a household response rate of 96 percent. In the interviewed households, 11,568 women (age 15-49 years) were identified. Of these, 9,069 were successfully interviewed, yielding a response rate of 78 percent within interviewed households. In addition, 8,656 men (age 15-49 years) were listed in the household questionnaire. Questionnaires were completed for 4,345 of eligible men, which corresponds to a response rate of 50 percent within interviewed households. There were 10,040 children under age five listed in the household questionnaire. Questionnaires were completed for 8,338 of these children, which corresponds to a response rate of 83 percent within interviewed households. Overall response rates of 75, 48, and 80 are calculated for the women’s, men’s and under-5’s interviews respectively. See Table HH.1 of the survey report.

Across the 10 States, women’s response rates, except Northern Bahr el Ghazal, are below 85 percent. The results for these States should thus be interpreted with some caution, as their response rates are low. The response rates for the children under five years of age in 5 of the 10 States were equally low. These are Western Equatoria, Central Equatoria, Unity, Upper Nile and Lakes States. These results are low, and therefore interpretation in these States should also be handled with caution. Response rates for urban and rural areas for the three categories (women, men and children under-five) are also below 85 percent; this as well requires some caution in the interpretation of the results. Crucially, response for the men’s module was exceedingly low, as their overall response rate is 48. Accordingly, all analysis on men was dropped from the survey report.

摘要
---------------------------
第二次南苏丹家庭健康调查（SHHS 2）于2010年由卫生部和国家统计局组织实施。
第二次南苏丹家庭健康调查（SHHS 2）的主要目标是：
- 提供最新信息，以评估南苏丹儿童和妇女的状况；
- 提供所需数据，以监测实现千年宣言和其他国际共识目标所设定的目标，作为未来行动的基础；
- 贡献于改进南苏丹的数据和监测系统，并加强此类系统设计、实施和分析的技术专长；
- 生成关于儿童和妇女状况的数据，包括识别脆弱群体和差异，以指导政策和干预措施；
- 提供最新信息，以了解南苏丹儿童和妇女的健康状况，从而理解与健康状况决定因素（如贫困、教育、性别、居住类型（农村/城市）和居住州）相关的差异；
- 生成有助于监测实现千年发展目标和WFFC目标进展的数据；
- 贡献于南苏丹数据收集、质量和分析的根本性改进。
南苏丹家庭健康调查是根据联合国儿童基金会开发的国际家庭调查项目MICS（多指标集群调查）进行的。SHHS 2是MICS第四次全球调查轮（MICS4）的一部分。MICS提供有关儿童和妇女状况的最新信息，并衡量关键指标，使各国能够监测实现千年发展目标和其它国际共识的进展。有关全球MICS项目的更多信息，请访问www.childinfo.org。
地理覆盖范围
---------------------------
南苏丹的十个州：上尼罗州、琼莱州、统一州、瓦拉普北巴希尔埃尔加扎尔州、西部巴希尔埃尔加扎尔州、湖泊州、西部赤道州、中赤道州和东部赤道州。
抽样程序
---------------------------
第二次南苏丹家庭健康调查（SHHS 2）的样本设计旨在为国家层面、城市和农村地区以及全国10个州提供大量关于儿童和妇女状况的估计值：上述各州包括上尼罗州、琼莱州、统一州、瓦拉普北巴希尔埃尔加扎尔州、西部巴希尔埃尔加扎尔州、湖泊州、西部赤道州、中赤道州和东部赤道州。
SHHS 2所使用的抽样框架是2008年苏丹人口和住房普查。各州被视为抽样域或分析域。样本使用20个城市和农村层，每个州两个。
调查的样本量是根据每个州所需调查估计值的精度程度确定的：每个州1000户家庭。由于每个州所需的精度水平相似，因此决定从每个州抽取40个聚居区，每个聚居区25户家庭。然而，在统一州和琼莱州，只选择了39个聚居区，从而每个州产生975户家庭。最终样本总量为9,950户家庭或398个聚居区（普查区域）。
样本在两个阶段进行选择：在每个州内，根据规模概率随机选择普查区域作为一级抽样单位。在选定的普查区域进行家庭登记后，从每个抽样普查区域抽取25户家庭。
数据收集方式
---------------------------
面对面（f2f）
研究工具
---------------------------
调查中使用了四套问卷：
1) 家庭问卷，用于收集有关所有法定家庭成员（常住居民）、家庭和住宅的信息；
2) 每户均向所有15-49岁女性进行的女性问卷；
3) 每户均向所有15-49岁男性进行的男性问卷；
4) 5岁以下儿童问卷，由居住在家庭中的母亲或照料者对所有5岁以下儿童进行。
问卷包括以下模块：
家庭问卷包括以下模块：
- 家庭信息面板
- 家庭登记表和教育
- 水和卫生（为国家特定表格的产生使用改善了的水源、家庭水处理、饮用水源的时间；以及饮用水和卫生阶梯）
- 家庭特征
- 杀虫剂处理蚊帐（仅提供家庭至少拥有一张蚊帐和一张长效处理蚊帐的结果）盐碘化
个人女性问卷是对所有居住在家庭中的15-49岁女性进行的，并包括以下模块：
- 女性信息面板
- 女性背景
- 儿童死亡率
- 存活出生史
- 最后一次出生的愿望（结果不可用）
- 母亲和新生儿健康
- 避孕
- 未满足的需求
- 对家庭暴力的态度
- 婚姻/联合
- 女性割礼/切割（结果不可用）
- 性行为
- 艾滋病
- 性传播感染（结果不可用）
个人男性问卷是对所有居住在家庭中的15-49岁男性进行的，并包括以下模块：
- 男性信息面板
- 男性背景
- 对家庭暴力的态度
- 婚姻/联合
- 性行为
- 艾滋病
- 性传播感染
5岁以下儿童问卷是对居住在家庭中的5岁以下儿童的母亲或照料者进行的。通常，问卷由5岁以下儿童的母亲进行。如果母亲未列入家庭名单，则确定儿童的主要照料者并进行访谈。问卷包括以下模块：
- 5岁以下儿童信息面板
- 年龄
- 出生登记
- 哺乳
- 早期儿童发展（结果不可用）
- 疾病护理
- 疟疾
- 免疫
- 人体测量学
问卷基于MICS4模型问卷。根据预测试的结果，对问卷的文字和翻译进行了修改。
数据清洗操作
---------------------------
使用CSPro软件录入数据。数据在20台微型计算机上录入，由40名数据录入员和4名数据录入监督员完成。为确保质量控制，所有问卷都进行了双录入，并执行了内部一致性检查。在整个全球MICS4项目下开发和适应南苏丹问卷的程序和标准程序得到了应用。数据处理在数据收集结束后开始，并于2010年7月完成。数据使用社会科学统计软件包（SPSS）软件程序，版本18进行分析，并使用联合国儿童基金会开发的模型语法和表格计划进行了此目的。
响应率
---------------------------
在选定的9,950户家庭样本中，发现有9,760户被占用。其中，9,369户成功接受访谈，家庭响应率为96％。在访谈的家庭中，确定了11,568名（15-49岁）女性。其中，9,069名成功接受访谈，家庭内部响应率为78％。此外，家庭问卷中列出了8,656名（15-49岁）男性。在合格的男性中，完成了4,345份问卷，家庭内部响应率为50％。家庭问卷中列出了10,040名5岁以下儿童。完成了这些儿童的8,338份问卷，家庭内部响应率为83％。总体而言，女性、男性和5岁以下儿童的访谈响应率分别为75、48和80。请参阅调查报告的HH.1表。
在10个州中，除北巴希尔埃尔加扎尔州外，女性的响应率均低于85％。因此，应谨慎解释这些州的结果，因为它们的响应率较低。在10个州中的5个州，5岁以下儿童的响应率同样较低。这些州是西部赤道州、中赤道州、统一州、上尼罗州和湖泊州。这些结果较低，因此在这些州的处理结果也应谨慎对待。三个类别（女性、男性和5岁以下儿童）的城市和农村地区的响应率也低于85％；这也需要对结果的处理持谨慎态度。至关重要的是，男性模块的响应率异常低，因为他们的总体响应率为48。因此，所有关于男性的分析都被从调查报告中删除了。