Demographic and Health Survey 1989-1990 - Sudan

Abstract
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The Sudan Demographic and Health Survey (SDHS) was conducted in two phases between November 15, 1989 and May 21, 1990 by the Department of Statistics of the Ministry of Economic and National Planning. The survey collected information on fertility levels, marriage patterns, reproductive intentions, knowledge and use of contraception, maternal and child health, maternal mortality, and female circumcision. The survey findings provide the National Population Committee and the Ministry of Health with valuable information for use in evaluating population policy and planning public health programmes.

A total of 5860 ever-married women age 15-49 were interviewed in six regions in northern Sudan; three regions in southern Sudan could not be included in the survey because of civil unrest in that part of the country. The SDHS provides data on fertility and mortality comparable to the 1978-79 Sudan Fertility Survey (SFS) and complements the information collected in the 1983 census.

The primary objective of the SDHS was to provide data on fertility, nuptiality, family planning, fertility preferences, childhood mortality, indicators of maternal health care, and utilization of child health services. Additional information was coUected on educational level, literacy, source of household water, and other housing conditions.

The SDHS is intended to serve as a source of demographic data for comparison with the 1983 census and the Sudan Fertility Survey (SFS) 1978-79, and to provide population and health data for policymakers and researchers. The objectives of the survey are to:
- assess the overall demographic situation in Sudan,
- assist in the evaluation of population and health programmes,
- assist the Department of Statistics in strengthening and improving its technical skills for conducting demographic and health surveys,
- enable the National Population Committee (NPC) to develop a population policy for the country, and
- measure changes in fertility and contraceptive prevalence, and study the factors which affect these changes, and
- examine the basic indicators of maternal and child health in Sudan.

MAIN RESULTS

Fertility levels and trends

Fertility has declined sharply in Sudan, from an average of six children per women in the Sudan Fertility Survey (TFR 6.0) to five children in the Sudan DHS survey flTR 5.0). Women living in urban areas have lower fertility (TFR 4.1) than those in rural areas (5.6), and fertility is lower in the Khartoum and Northern regions than in other regions. The difference in fertility by education is particularly striking; at current rates, women who have attained secondary school education will have an average of 3.3 children compared with 5.9 children for women with no education, a difference of almost three children.

Although fertility in Sudan is low compared with most sub-Saharan countries, the desire for children is strong. One in three currently married women wants to have another child within two years and the same proportion want another child in two or more years; only one in four married women wants to stop childbearing. The proportion of women who want no more children increases with family size and age. The average ideal family size, 5.9 children, exceeds the total fertility rate (5.0) by approximately one child. Older women are more likely to want large families than younger women, and women just beginning their families say they want to have about five children.

Marriage

Almost all Sudanese women marry during their lifetime. At the time of the survey, 55 percent of women 15-49 were currently married and 5 percent were widowed or divorced. Nearly one in five currently married women lives in a polygynous union (i.e., is married to a man who has more than one wife). The prevalence of polygyny is about the same in the SDHS as it was in the Sudan Fertility Survey.

Marriage occurs at a fairly young age, although there is a trend toward later marriage among younger women (especially those with junior secondary or higher level of schooling). The proportion of women 15-49 who have never married is 12 percentage points higher in the SDHS than in the Sudan Fertiliy Survey.

There has been a substantial increase in the average age at first marriage in Sudan. Among SDHS. Since age at first marriage is closely associated with fertility, it is likely that fertility will decrease in the future. With marriages occurring later, women am having their first birth at a later age. While one in three women age 45-49 had her first birth before age 18, only one in six women age 20-24 began childbearing prior to age 18. The women most likely to postpone marriage and childbearing are those who live in urban areas ur in the Khartoum and Northern regions, and women with pest-primary education.

Breastfeeding and postpartum abstinence

Breastfeeding and postpartum abstinence provide substantial protection from pregnancy after the birth uf a child. In addition to the health benefits to the child, breastfeeding prolongs the length of postpartum amenorrhea. In Sudan, almost all women breastfeed their children; 93 percent of children are still being breastfed 10-11 months after birth, and 41 percent continue breastfeeding for 20-21 months. Postpartum abstinence is traditional in Sudan and in the first two months following the birth of a child 90 percent of women were abstaining; this decreases to 32 percent after two months, and to 5 percent at~er one year. The survey results indicate that the combined effects of breastfeeding and postpartum abstinence protect women from pregnancy for an average of 15 months after the birth of a child.

Knowledge and use of contraception

Most currently married women (71 percent) know at least one method of family planning, and 59 percent know a source for a method. The pill (70 percent) is the most widely known method, followed by injection, female sterilisation, and the IUD. Only 39 percent of women knew a traditional method of family planning.

Despite widespread knowledge of family planning, only about one-fourth of ever-married women have ever used a contraceptive method, and among currently married women, only 9 percent were using a method at the time of the survey (6 percent modem methods and 3 percent traditional methods). The level of contraceptive use while still low, has increased from less than 5 percent reported in the Sudan Fertility Survey.

Use of family planning varies by age, residence, and level of education. Current use is less than 4 percent among women 15-19, increases to 10 percent for women 30-44, then decreases to 6 percent for women 45-49. Seventeen percent of urban women practice family planning compared with only 4 percent of rural women; and women with senior secondary education are more likely to practice family planning (26 percent) than women with no education (3 percent).

There is widespread approval of family planning in Sudan. Almost two-thirds of currently married women who know a family planning method approve of the use of contraception. Husbands generally share their wives's views on family planning. Three-fourths of married women who were not using a contraceptive method at the time of the survey said they did not intend to use a method in the future.

Communication between husbands and wives is important for successful family planning. Less than half of currently married women who know a contraceptive method said they had talked about family planning with their husbands in the year before the survey; one in four women discussed it once or twice; and one in five discussed it more than twice. Younger women and older women were less likely to discuss family planning than those age 20 to 39.

Mortality among children

The neonatal mortality rate in Sudan remained virtually unchanged in the decade between the SDHS and the SFS (44 deaths per 1000 births), but under-five mortality decreased by 14 percent (from 143 deaths per 1000 births to 123 per thousand). Under-five mortality is 19 percent lower in urban areas (117 per 1000 births) than in rural areas (144 per 10(30 births).

The level of mother's education and the length of the preceding birth interval play important roles in child survival. Children of mothers with no education experience nearly twice the level of under-five mortality as children whose mother had attained senior secondary or nigher education. Mortality among children under five is 2.7 times higher among children born after an interval of less than 24 months than among children born after interval of 48 months or more.

Maternal mortality

The maternal mortality rate (maternal deaths per 1000 women years of exposure) has remained nearly constant over the twenty years preceding the survey, while the maternal mortality ratio (number of maternal deaths per 100,000 births), has increased (despite declining fertility). Using the direct method of estimation, the maternal mortality ratio is 352 maternal deaths per 100,000 births for the period 1976-82, and 552 per 100,000 births for the period 1983-89. The indirect estimate for the maternal mortality ratio is 537. The latter estimate is an average of women's experience over an extended period before the survey centred on 1977.

Maternal health care

The health care mothers receive during pregnancy and delivery is important to the survival and well-being of both children and mothers. The SDHS results indicate that most women in Sudan made at least one antenatal visit to a doctor or trained health worker/midwife. Eighty-seven percent of births benefitted from professional antenatal care in urban areas compared with 62 percent in rural areas. Although the proportion of pregnant mothers seen by trained health workers/midwives are similar in urban and rural areas, doctors provided antenatal care for 42 percent and 19 percent of births in urban and rural areas, respectively.

Neonatal tetanus, a major cause of infant deaths in developing countries, can be prevented if mothers receive tetanus toxoid vaccinations. One-third of Sudanese mothers received two doses of tetanus toxoid during their pregnancy, while an additional one-tenth received one dose. The proportion of births whose mothers received two doses of tetanus toxoid is substantially higher in urban areas than in rural.

For births occurring in the five years preceding the survey, 18 percent of urban mothers were attended by doctors, 68 percent by trained health workers/midwives, and 11 percent by traditional birth attendants; for rural mothers these percentages were 4 percent, 56 percent, and 34 percent, respectively, indicating that rural women still depend on the traditional attendants more than doctors for assistance at delivery.

Sudan's Expanded Programme of Immunisation (EPI) recommends that all children receive immunisations in the first year of life against common childhood diseases. In the SDHS mothers of 46 percent of children age 12-23 months were able to show interviewers the health card documenting their child's immunisations. For 33 percent of children the health card was not available but their mothers reported that they had received at least one immunisation.

The SDHS results indicate that immunisation coverage for children 12-23 months is moderate: 76 percent of children had been immunised against BCG, 60 percent had received three doses of DPT, 61 percent had received three doses of polio, 61 percent were vaccinated against measles, and 52 percent had had all primary immunisations, lmmunisation coverage is higher for urban children than for rural children; it is higher in the Khartoum and Northern regions than in other regions; and it increases sharply with the mother's level of education.

Diarrhea, a common illness among infants and young children, can cause severe dehydration and if left untreated, can lead to death. The SDHS results show that 30 percent of children under five had had diarrhea in the two weeks preceding the survey, and 18 percent in the 24 hours preceding the survey. Prevalence was highest among children between the ages of 6 and 23 months.

Dehydration caused by diarrhea can be treated effectively and inexpensively using oral rehydration therapy (ORT). In Sudan 29 percent of children with diarrhea were treated with a solution prepared from ORS packets (salts), and 8 percent with a homemade salt and sugar solution. About half of the children with diarrhea were taken to a medical facility; however, 30 percent neither visited a health facility nor received any treatment.

Coughing together with difficult breathing is symptom of lower respiratory tract infection particularly pneumonia. Of all children under five, 48 percent had had a cough and 19 percent had had both a cough and difficult breathing during the two weeks before the survey. About 50 percent of the children suffering from cough were taken for treatment to a government health facility, 11 percent went to private doctors or hospitals and 4 percent consulted pharmacies. Children having cough in urban areas were more likely to be taken to private doctors (25 percent) than children in rural areas (3 percent).

Female circumcision

The SDHS collected data on the prevalence of female circumcision and the attitudes of women and men toward the practice. Eighty-nine percent of ever-married women in Sudan have been circumcised, representing a slight drop from 96 percent reported by the SFS. The majority of women received Pharaonic circumcision (82 percent); 15 percent received Sunna, and 3 percent had an intermediate type of circumcision.

More than three-quarters of ever-married women support continuation of the practice of female circumcision. Support for circumcising their own daughters is even stronger than for circumcision in general. Among those wanting to retain the practice, Sunna circumcision (the least severe type) is preferred by 48 percent of the ever-married women; 46 percent prefer Pharaonic circumcision and 5 percent prefer the intermediate type. Those who oppose continuation of female circumcision said they believe the best way to abolish the practice is through education campaigns and the enforcement of laws against female circumcision.

Geographic coverage
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Due to security problems at the time of the survey, southern Sudan was excluded from the survey. The sample for the Sudan DHS survey was drawn from the six regions in northem Sudan: Darfur, Kordofan, Northern, Central, Eastern, and Khartoum. The nomadic population of northern Sudan was also excluded from the survey. The SDHS covered approximately 80 percent of the total population of the country.

Analysis unit
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- Household
- Women age 15-49

Universe
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The population covered by the 1989 DHS is defined as the universe of all eligible women, i.e. ever-married women 15-49 years of age who slept in the selected household the night before the interview.

Kind of data
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Sample survey data

Sampling procedure
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The sample design used for the Sudan Demographic and Health Survey was a stratified, clustered, self-weighted probability sample of ever-married women 15-49. Due to security problems at the time of the survey, southern Sudan was excluded from the survey. The sample for the Sudan DHS survey was drawn from the six regions in northem Sudan: Darfur, Kordofan, Northern, Central, Eastern, and Khartoum. The nomadic population of northern Sudan was also excluded from the survey. The SDHS covered approximately 80 percent of the total population of the country.

An important element in the sample selection was the utilization of a combination of sampling procedures to overcome the lack of an adequate sample frame. Threee major area groups were considered: major cities, all other urban areas, and all rural areas. The main objective of one of the sampling procedures was to allocate the sample size in each of the areas; a secondary objective was to update the data for the major cities.

Based on the most available information, the target sample size was fixed at 5,000 completed interviews. Specific numbers of clusters were selected for the Sudan DHS survey with an average sample take of 10 households for the major cities (except Khartoum), 20 for Khartoum city and the rest of the urban area, and 30 for the rural area.

The major cities were sampled with special procedure by selecting 116 areas with probability proportional to the surface area. Each listed area contained 50 households (100 in Khartoum). The area encompassed by the households listed was measured for each primary sampling unit (PSU), and the density calculated. Finally, a sample take for each area was calculated as bi = b(di/d*) where:
- di is the density of households per km 2 of surface,
- d* is the average of densities values in a domain area,
- b is equal to 10 households (20 in Khartoum).

In the rest of the urban area, the major sampling unit was defined on the basis of the town council. A designated number of town councils were systematically selected in each province with probability proportional to size. Then two quarter councils within each town council were systematically selected with probability proportional to size (size = census population of 1983). After a household listing operation was carried out in each selected quarter council, 20 households were selected from each quarter council.

In the rural areas, rural councils were selected as PSUs with probability proportional to size (size = census population of 1983). Similar to the procedure in the rest of the urban area, two villages councils were selected for the Sudan DHS. Prior to the final selection of households, every village council's chief gave information about the actual composition of villages together with an estimation of the actual number of households in each village. According to this information, one village (or one combined group of villages) was selected. Finally in each selected village, 30 households were chosen for the sample.

Mode of data collection
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Face-to-face

Research instrument
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Two questionnaires in Arabic were used for the SDHS: the Household Questionnaire and the Individual Questionnaire. Both were adapted from the DHS Model "B" Questionnaire, designed for use in countries with low contraceptive prevalence. The questionnaires were finalised after a pretest was carried out in June and July 1989.

a) The Household Questionnaire was used to list information including name, age, sex, and residence status for all usual members of the household and any visitors. For those ten years and older, information on marital status and level and grade of education was also recorded. The major purpose of the Household Questionnaire was to identify those women who were eligible for the Individual Questionnaire.

b) The Individual Questionnaire was used to collect data from ever-married women 15-49 years who were present in a sampled household the night prior to the household interview. The questionnaire collected information on the following topics:
- Respondent's background
- Reproductive history
- Female circumcision
- Knowledge and use of family planning
- Maternal and child health, and
- Breastfeeding
- Marriage
- Fertility preferences
- Husband's background
- Maternal mortality

Cleaning operations
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The central office of the SDHS in Khartoum was responsible for collecting the completed questionnaires from supervisors as soon as a sufficient number of clusters was completed in a province. The field coordinator from the central office, or staff from the regional census offices, hand-carried the batches of questionnaires to Khartoum for data entry and editing. At the central office, the questionnaires were coded and reviewed for consistency and completeness by office editors who also carried out the data entry. To provide feedback for the field teams, the office editors were instructed to report any problems detected while editing the questionnaires. These reports were reviewed by the senior staff and, when warranted, team supervisors were contacted in order to inform them of the steps to be taken to avoid these problems in the future.

The data entry and editing phase began soon after the start of the fieldwork. The data from the questionnaires were entered and edited on microcomputers using the Integrated System for Survey Analysis (ISSA), a package developed especially for the Demographic and Health Survey programme. Eight data entry personnel used three IBM-compatible microcomputers to process the SDHS survey. The data entry and editing were completed one month after the end of the fieldwork. All data processing, including preliminary tabulations, was completed by July 1990.

Response rate
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In the Sudan Demographic and Health Survey, 7,280 households were selected for the sample; 6,945 of these were identified. Household interviews were completed in 6,891 identified households, which represents a response rate of 99 percent. A total of 6,131 eligible women were identified and 5,860 were successfully interviewed. The response rate at the individual level was 96 percent.

Sampling error estimates
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Sampling error is a measure of the variability between all possible samples that could have been selected from the same population using the same design and size. For the entire population and for large subgroups, the SDHS sample is sufficiently large so that the sampling error for most estimates is small. However, for small subgroups, sampling errors are larger and, thus, affect the reliability of the data.

Sampling error is usually measured in terms of the standard error for a particular statistic (mean, percentage, ratio, etc.), i.e., the square root of the variance. The standard error can be used also 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 as measured in 95 percent of all possible samples with the same design will fall within a range of plus or minus two times the standard error for that statistic.

The computations required to provide sampling errors for survey estimates which are based on complex sample designs like those used for the SDHS survey are more complicated than those based on simple random samples. The software package CLUSTERS was used to assist in computing the sampling errors with the proper statistical methodology. The CLUSTERS program treats any percentage or average as a ratio estimate, r=y/x, where y represents the total sample value for variable y and x represents the total number of cases in the group or subgroup under consideration.

In addition to the standard errors, CLUSTERS 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 due to the use of a more complex and less statistically efficient design. CLUSTERS also computes the relative error and confidence limits for estimates.

Sampling errors are presented below for selected variables considered to be of major interest. Results are presented for the whole country, urban and rural areas. For each variable, the type of statistic (mean, proportion) and the base population are given in Table B.1. For each variable, Tables B.2-B.4 present the value of the statistic, its standard error, the number of cases, the design effect, the relative standard errors, and the 95 percent confidence limits.

The relative standard error for most estimates for the country as a whole is small, which means that the SDHS results are reliable. There are some differentials in the relative standard error for the estimates by urban-rural residence. For example, for the variable, the proportion ever using a contraceptive method, the relative standard error as a percent of the estimated proportion for the whole country, for urban areas and for rural areas is 4.3 percent, 3.9 percent and 8.2 percent, respectively.

The confidence interval has the following interpretation. The mean number of children ever born among ever-married women is 4.404 and its standard error is 0.046. Therefore, to obtain the upper bound of the 95 percent confidence limit, twice the standard error, i.e., 0.092 is added to the sample mean. To obtain the lower bound, the same amount is subtracted from the mean. There is a high probability (95 percent) that the true mean ideal number of children falls within the interval of 4.311 and 4.496.

Data appraisal
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Nonsampling error is the result of mistakes made in carrying out data collection and data processing, including the failure to locate and interview the correct household, errors in the way questions are asked, and data entry errors. Although efforts were made during the implementation of the SDHS to minimize this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically.

摘要
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苏丹人口与健康调查（SDHS）分为两个阶段，于1989年11月15日至1990年5月21日由经济与国家规划部统计局进行。该调查收集了关于生育水平、婚姻模式、生育意图、避孕知识的运用、母婴健康、孕产妇死亡率和女性割礼的信息。调查结果为国家人口委员会和卫生部提供了评估人口政策和公共卫生计划的宝贵信息。

总计5860名曾已婚的15至49岁女性在苏丹北部的六个地区接受了采访；由于该国的部分地区发生内乱，苏丹南部的三个地区未能纳入调查。SDHS提供的数据与1978-79年苏丹生育调查（SFS）的可比，并补充了1983年人口普查收集的信息。

SDHS的主要目标是提供关于生育、婚姻、计划生育、生育偏好、儿童死亡率、母婴保健指标和儿童健康服务利用情况的数据。此外，还收集了关于教育水平、识字率、家庭用水来源和其他住房条件的信息。

SDHS旨在作为比较1983年人口普查和1978-79年苏丹生育调查（SFS）的苏丹人口数据的来源，并为政策制定者和研究人员提供人口与健康数据。调查的目标包括：
- 评估苏丹的整体人口状况，
- 协助评估人口与健康计划，
- 协助统计局加强和提高其进行人口与健康调查的技术技能，
- 使国家人口委员会（NPC）能够为该国制定人口政策，
- 衡量生育率和避孕普及率的变化，研究影响这些变化的因素，
- 检查苏丹母婴健康的基本指标。

主要结果
生育水平和趋势

生育率在苏丹急剧下降，从苏丹生育调查（TFR 6.0）中每名女性的平均六个孩子降至苏丹DHS调查（TFR 5.0）中的五个孩子。居住在城市地区的女性生育率（TFR 4.1）低于农村地区的女性（5.6），而喀土穆和北部地区的生育率低于其他地区。教育程度对生育率的差异尤为显著；按照当前比率，受过中学教育的女性的平均孩子数为3.3个，而未受过教育的女性的孩子数为5.9个，相差近三个孩子。

尽管苏丹的生育率与大多数撒哈拉以南国家相比较低，但生育意愿强烈。三分之一的已婚女性希望在两年内再要一个孩子，同样的比例希望在两年或更长时间内再要一个孩子；只有四分之一的已婚女性希望停止生育。希望不再生育的女性比例随着家庭规模和年龄的增长而增加。平均理想家庭规模为5.9个孩子，比总生育率（5.0）高出约一个孩子。

婚姻
几乎所有的苏丹女性在其一生中都会结婚。在调查时，55%的15至49岁女性目前已婚，5%的女性丧偶或离婚。几乎五分之一的已婚女性生活在一夫多妻的联合中（即与一个有多个妻子的男性结婚）。一夫多妻制的普遍程度在SDHS中与苏丹生育调查中的情况相同。

婚姻发生在相当年轻的时候，尽管年轻女性（特别是受过初中或更高教育水平的女性）有晚婚的趋势。15至49岁从未结婚的女性比例在SDHS中比在苏丹生育调查中高出12个百分点。

苏丹首次结婚的平均年龄有所上升。在SDHS中，由于首次结婚的年龄与生育率密切相关，预计未来生育率将会下降。由于结婚年龄推迟，女性在较晚的年龄生育第一个孩子。虽然45至49岁的女性中有三分之一在18岁之前就生育了第一个孩子，但只有六分之一的20至24岁女性在18岁之前就开始了生育。最有可能推迟婚姻和生育的是那些居住在城市地区或在喀土穆和北部地区的女性，以及受过初级教育水平的女性。

母乳喂养和产后禁欲
母乳喂养和产后禁欲在儿童出生后为预防怀孕提供了实质性的保护。除了对儿童的身体健康有益外，母乳喂养还延长了产后闭经的持续时间。在苏丹，几乎所有女性都会哺乳她们的孩子；93%的孩子在出生后10至11个月仍在哺乳，41%的孩子继续哺乳长达20至21个月。产后禁欲在苏丹是传统的，在儿童出生后的前两个月，90%的女性都在禁欲；两个月后降至32%，一年后降至5%。调查结果显示，母乳喂养和产后禁欲的综合作用可以保护女性在儿童出生后平均15个月的时间内免受怀孕。

避孕知识的运用
目前已婚女性中，71%的人至少知道一种计划生育方法，59%的人知道一种方法的来源。避孕药（70%）是最广为人知的方法，其次是注射、女性绝育和宫内节育器。只有39%的女性知道一种传统的计划生育方法。

尽管广泛了解计划生育，但只有约四分之一的已婚女性曾使用过避孕方法，在已婚女性中，只有9%的人在调查时正在使用方法（6%为现代方法，3%为传统方法）。尽管避孕使用率仍然很低，但已从苏丹生育调查中报告的不到5%有所增加。

计划生育的使用因年龄、居住地和受教育程度而异。15至19岁的女性中，目前的避孕使用率不到4%，30至44岁的女性为10%，45至49岁的女性降至6%。17%的城市女性实行计划生育，而农村地区只有4%；受过高级中学教育的女性比未受过教育的女性更有可能实行计划生育（26%）。

在苏丹，计划生育得到了广泛的认可。几乎三分之二的已婚女性知道计划生育方法并赞同避孕的使用。丈夫通常与妻子在计划生育问题上有相同的看法。在调查时未使用避孕方法的已婚女性中，四分之三的人表示她们将来也不打算使用方法。

夫妻间的沟通对于成功的计划生育至关重要。不到一半的已婚女性知道避孕方法并表示她们在与丈夫讨论计划生育方面在调查前一年内进行了交流；四分之一的女性讨论过一次或两次；五分之一的女性讨论过两次以上。20至39岁的女性比年轻女性和老年女性更有可能讨论计划生育。

儿童死亡率
在SDHS和SFS之间的一十年里，苏丹的婴儿死亡率基本保持不变（每1000次出生44人死亡），但5岁以下儿童死亡率下降了14%（从每1000次出生143人死亡降至123人）。城市地区的5岁以下儿童死亡率（每1000次出生117人）比农村地区（每1000次出生144人）低19%。

母亲的受教育程度和前一次生育间隔的长度在儿童存活率方面发挥着重要作用。未受过教育的母亲的孩子的5岁以下死亡率是受过中学或更高教育水平的母亲的孩子的近两倍。在间隔少于24个月生育的儿童中，5岁以下儿童的死亡率是间隔为48个月或更长时间的儿童的2.7倍。

孕产妇死亡率
孕产妇死亡率（每1000名女性暴露年的孕产妇死亡数）在调查前的二十年中基本保持不变，而孕产妇死亡率比（每10万次出生的孕产妇死亡数）有所增加（尽管生育率有所下降）。使用直接估计方法，1976-82年期间的孕产妇死亡率比为每10万次出生352孕产妇死亡，1983-89年期间的孕产妇死亡率比为每10万次出生552。间接估计的孕产妇死亡率比为537。后者是对调查前一段时间内女性经验的平均估计，以1977年为基准。

孕产妇保健
孕产妇在怀孕和分娩期间所接受的健康保健对儿童和母亲的生存和福祉至关重要。SDHS的结果表明，苏丹大多数女性至少接受了一次产前访问医生或受过培训的健康工作者/助产士。在城市地区，87%的分娩受益于专业产前保健，而在农村地区为62%。尽管在城市和农村地区接受过培训的健康工作者/助产士看过的孕产妇比例相似，但在城市地区，医生提供的产前保健占42%，而在农村地区为19%。

新生儿破伤风是发展中国家婴儿死亡的主要原因之一，如果母亲接受了破伤风类毒素疫苗接种，就可以预防。苏丹三分之一的母亲在怀孕期间接种了两剂破伤风类毒素，另外十分之一接种了一剂。在城市地区，接受两剂破伤风类毒素的分娩比例比农村地区高得多。

对于调查前五年内发生的分娩，城市地区的18%的母亲由医生照顾，68%的母亲由受过培训的健康工作者/助产士照顾，11%的母亲由传统接生员照顾；在农村地区，这些比例分别为4%、56%和34%，这表明农村女性在分娩时仍然比医生更多地依赖于传统接生员。

苏丹扩大免疫规划（EPI）建议所有儿童在生命的第一年接种针对常见儿童疾病的疫苗。在SDHS中，46%的12至23个月大的儿童的母亲能够向调查员出示记录其孩子接种疫苗的健康卡。对于33%的儿童，健康卡不可用，但他们的母亲报告说他们至少接种过一次疫苗。

SDHS的结果表明，12至23个月大的儿童的疫苗接种覆盖率适中：76%的儿童接种了BCG疫苗，60%的儿童接种了三次DPT疫苗，61%的儿童接种了三次脊灰疫苗，61%的儿童接种了麻疹疫苗，52%的儿童接种了所有初级疫苗。城市儿童的疫苗接种覆盖率高于农村儿童；喀土穆和北部地区的覆盖率高于其他地区；并且随着母亲受教育程度的提高而急剧增加。

腹泻是婴幼儿的常见疾病，可导致严重脱水，如果得不到治疗，可能导致死亡。SDHS的结果显示，在调查前的两周内，5岁以下儿童中有30%患有腹泻，在调查前的24小时内，有18%的儿童患有腹泻。患病率在6至23个月大的儿童中最高。

腹泻引起的脱水可以通过口服补液疗法（ORT）有效地、经济地治疗。在苏丹，29%的腹泻儿童接受了从ORS包（盐）中制备的溶液治疗，8%的儿童接受了自制的盐和糖溶液治疗。大约一半的腹泻儿童被带到医疗设施；然而，30%的儿童既没有访问医疗机构，也没有接受任何治疗。

咳嗽和呼吸困难是下呼吸道感染，尤其是肺炎的症状。在调查前的两周内，5岁以下儿童中有48%的儿童咳嗽，19%的儿童既有咳嗽又有呼吸困难。大约50%的咳嗽儿童被带到政府医疗设施接受治疗，11%的儿童去看私人医生或医院，4%的儿童咨询药店。在城市地区咳嗽的儿童更有可能去看私人医生（25%），而在农村地区则较少（3%）。

女性割礼
SDHS收集了关于女性割礼的普遍程度以及女性和男性对这一做法的态度的数据。苏丹89%的曾已婚女性进行了割礼，这比SFS报告的96%略有下降。大多数女性接受了法老式割礼（82%）；15%的人接受了逊纳割礼，3%的人接受了介于两者之间的割礼类型。

超过三分之二的已婚女性支持继续进行女性割礼的做法。支持给自己的女儿割礼的态度甚至比一般割礼的态度更加强烈。在那些想要保留这一做法的人中，48%的已婚女性更喜欢逊纳割礼（最轻微的类型）；46%的人更喜欢法老式割礼，5%的人更喜欢介于两者之间的类型。反对继续进行女性割礼的人认为，通过教育运动和执行禁止女性割礼的法律是废除这一做法的最佳方式。

地理覆盖范围
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由于调查时的安全问题，苏丹南部被排除在调查之外。苏丹DHS调查的样本是从苏丹北部的六个地区抽取的：达尔富尔、科尔多凡、北部、中部、东部和喀土穆。苏丹北部的游牧人口也被排除在调查之外。SDHS覆盖了该国总人口的约80%。

分析单位
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- 家庭
- 15至49岁的女性

总体
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1989年DHS调查覆盖的人口是所有符合条件的女性的总体，即前一夜在选定家庭中过夜的15至49岁已婚女性。

数据类型
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样本调查数据

抽样程序
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苏丹人口与健康调查使用的抽样设计是对15至49岁已婚女性的分层、聚类、自加权概率样本。由于调查时的安全问题，苏丹南部被排除在调查之外。苏丹DHS调查的样本是从苏丹北部的六个地区抽取的：达尔富尔、科尔多凡、北部、中部、东部和喀土穆。苏丹北部的游牧人口也被排除在调查之外。SDHS覆盖了该国总人口的约80%。

抽样过程中的一个重要元素是结合使用多种抽样程序，以克服缺乏足够的样本框架。考虑了三个主要区域群体：主要城市、所有其他城市地区和所有农村地区。其中一种抽样程序的主要目标是分配每个区域的样本量；次要目标是更新主要城市的数据。

根据最可用的信息，目标样本量定为5000次完成的采访。为苏丹DHS调查选择了特定数量的聚类，平均样本量为主要城市（除喀土穆外）10户，喀土穆市和其他城市地区20户，农村地区30户。

主要城市采用特殊程序进行抽样，通过选择面积概率相等的116个区域。每个列出区域包含50户（喀土穆为100户）。测量每个初级抽样单位（PSU）所涵盖的家庭区域，并计算密度。最后，为每个区域计算样本量为b_i = b(di/d*)，其中：
- di是每平方公里家庭密度，
- d*是区域区域内密度值的平均值，
- b等于10户（喀土穆为20户）。

在城市地区的其余部分，主要抽样单位是根据市政委员会定义的。在每个省份中，根据规模概率系统地选择了指定数量的市政委员会。然后在每个市政委员会内系统地选择了两个四分之一委员会，其选择概率与规模成正比（规模=1983年的人口普查人口）。在每个选定的四分之一委员会中进行了家庭登记操作后，从每个四分之一委员会中选择了20户。

在农村地区，农村委员会作为PSU以规模概率（规模=1983年的人口普查人口）进行选择。与城市地区的其余部分类似，为苏丹DHS选择了两个村庄委员会。在最终选择家庭之前，每个村庄委员会的负责人提供了有关村庄的实际组成以及每个村庄实际家庭数量的信息。根据这些信息，选择了一个村庄（或一个由多个村庄组成的联合体）。最后，在每个选定的村庄中，选择了30户进行样本。

数据收集方式
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面对面

研究工具
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SDHS使用了两种阿拉伯语问卷：家庭问卷和个人问卷。两者都改编自DHS模型“B”问卷，该问卷是为在避孕普及率较低的国家使用而设计的。问卷在1989年6月和7月进行了预测试后最终确定。

a) 家庭问卷用于列出有关所有常驻家庭成员和任何访客的信息，包括姓名、年龄、性别和居住状态。对于10岁及以上的成员，还记录了婚姻状况和教育水平和等级。家庭问卷的主要目的是确定那些符合个人问卷条件的女性。

b) 个人问卷用于收集前一夜在样本家庭中接受家庭采访的15至49岁已婚女性的数据。问卷收集了以下主题的信息：
- 响应者的背景
- 生殖历史
- 女性割礼
- 计划生育知识的运用
- 母婴保健
- 哺乳
- 婚姻
- 生育偏好
- 丈夫的背景
- 孕产妇死亡率

清洗操作
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苏丹DHS在喀土穆的中心办公室负责从监督员那里收集完成后的问卷，一旦在某个省份完成足够的聚类，就开始进行。来自中央办公室的现场协调员或地区人口普查办公室的工作人员将问卷批次手提至喀土穆进行数据录入和编辑。在中央办公室，由办公室编辑对问卷进行编码和审查，以检查一致性、完整性和数据录入。为了为现场团队提供反馈，指示办公室编辑报告在编辑问卷时发现的问题。这些报告由高级工作人员审查，如有必要，联系团队主管，告知他们为避免未来出现这些问题应采取的措施。

数据录入和编辑阶段在实地工作开始后不久就开始了。使用为人口与健康调查项目特别开发的集成调查分析系统（ISSA）软件包，在微计算机上录入和编辑来自问卷的数据。使用三台IBM兼容微计算机处理了SDHS调查。数据录入和编辑在实地工作结束后一个月内完成。包括初步汇总在内的所有数据处理均在1990年7月完成。

响应率
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在苏丹人口与健康调查中，选择了7280户家庭作为样本；其中6,945户被识别。在6,891个被识别的家庭中完成了家庭采访，这代表了99%的响应率。总共识别了6,131名符合条件的女性，其中5,860人接受了成功采访。个人层面的响应率为96%。

抽样误差估计
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抽样误差是衡量所有可能样本之间差异的指标，这些样本是从使用相同设计和大小从同一人口中选择的。对于整个总体和大型子群体，SDHS样本量足够大，因此大多数估计的抽样误差很小。然而，对于小型子群体，抽样误差较大，因此会影响数据的可靠性。

抽样误差通常以特定统计量（均值、百分比、比率等）的标准误差来衡量，即方差的平方根。标准误差也可用于计算包含总体真实值合理假设范围的置信区间。例如，对于从样本调查中计算出的任何给定统计量，该统计量在相同设计中计算的值在95%的所有可能样本中将在加上或减去该统计量标准误差两倍的范围之内。

为基于复杂抽样设计（如SDHS调查所使用的）的抽样估计提供抽样误差的计算比基于简单随机样本的计算更为复杂。软件包CLUSTERS用于辅助计算抽样误差，采用适当的统计方法。CLUSTERS程序将任何百分比或平均值视为比率估计，r=y/x，其中y代表变量y的总样本值，x代表考虑中的组或子组的总案例数。

除了标准误差外，CLUSTERS还为每个估计计算设计效应（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计算的标准误差之比。DEFT值为1.0表示样本设计与简单随机样本一样有效，而值大于1.0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。CLUSTERS还计算估计的相对误差和置信限。

以下为选定变量的抽样误差进行了展示，这些变量被认为是最重要的。结果按整个国家、城市和农村地区进行展示。对于每个变量，类型（均值、比例）和基人口在表B.1中给出。对于每个变量，表B.2-B.4展示了统计量的值、其标准误差、案例数、设计效应、相对标准误差和95%置信限。

整个国家的估计的相对标准误差对于大多数估计来说很小，这意味着SDHS结果是可靠的。对于城乡居住地估计的相对标准误差存在一些