Demographic and Health Survey 1993 - Ghana

Abstract
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The 1993 Ghana Demographic and Health Survey (GDHS) is a nationally representative survey of 4,562 women age 15-49 and 1,302 men age 15-59. The survey is designed to furnish policymakers, planners and program managers with factual, reliable and up-to-date information on fertility, family planning and the status of maternal and child health care in the country. The survey, which was carried out by the Ghana Statistical Service (GSS), marks Ghana's second participation in the worldwide Demographic and Health Surveys (DHS) program.

The principal objective of the 1993 GDHS is to generate reliable and current information on fertility, mortality, contraception and maternal and child health indicators. Such data are necessary for effective policy formulation as well as program design, monitoring and evaluation. The 1993 GDHS is, in large measure, an update to the 1988 GDHS. Together, the two surveys provide comparable information for two points in time, thus allowing assessment of changes and trends in various demographic and health indicators over time.

Long-term objectives of the survey include (i) strengthening the capacity of the Ghana Statistical Service to plan, conduct, process and analyze data from a complex, large-scale survey such as the Demographic and Health Survey, and (ii) contributing to the ever-expanding international database on demographic and health-related variables.

Geographic coverage
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National

Analysis unit
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- Household
- Children under five years
- Women age 15-49
- Men age 15-59

Kind of data
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Sample survey data

Sampling procedure
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The 1993 GDHS is a stratified, self-weighting, nationally representative sample of households chosen from 400 Enumeration Areas (EAs). The 1984 Population Census EAs constituted the sampling frame. The frame was first stratified into three ecological zones, namely coastal, forest and savannah, and then into urban and rural EAs. The EAs were selected with probability proportional to the number of households. Households within selected EAs were subsequently listed and a systematic sample of households was selected for the survey. The survey was designed to yield a sample of 5,400 women age 15-49 and a sub-sample of males age 15-59 systematically selected from one-third of the 400 EAs.

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

Mode of data collection
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Face-to-face

Research instrument
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Survey instruments used to elicit information for the 1993 GDHS are
1) Household Schedule
2) Women's Questionnaire and
3) Men's Questionnaire.

The questionnaires were structured based on the Demographic and Health Survey Model B Questionnaire designed for countries with low levels of contraceptive use. The final version of the questionnaires evolved out of a series of meetings with personnel of relevant ministries, institutions and organizations engaged in activities relating to fertility and family planning, health and nutrition and rehabilitation of persons with disabilities.

The questionnaires were first developed in English and later translated and printed in five major local languages, namely: Akan, Dagbani, Ewe, Ga, and Hausa. In the selected households, all usual members and visitors were listed in the household schedule. Background information, such as age, sex, relationship to head of household, marital status and level of education, was collected on each listed person. Questions on economic activity, occupation, industry, employment status, number of days worked in the past week and number of hours worked per day was asked of all persons age seven years and over. Those who did not work during the reference period were asked whether or not they actively looked for work.

Information on the health and disability status of all persons was also collected in the household schedule. Migration history was elicited from all persons age 15 years and over, as well as information on the survival status and residence of natural parents of all children less than 15 years in the household.

Data on source of water supply, type of toilet facility, number of sleeping rooms available to the household, material of floor and ownership of specified durable consumer goods were also elicited.

Finally, the household schedule was the instrument used to identify eligible women and men from whom detailed information was collected during the individual interview.

The women's questionnaire was used to collect information on eligible women identified in the household schedule. Eligible women were defined as those age 15-49 years who are usual members of the household and visitors who spent the night before the interview with the household. Questions asked in the questionnaire were on the following topics:

- Background Characteristics
- Reproductive History
- Contraceptive Knowledge and Use
- Pregnancy and Breastfeeding
- Immunization and Health
- Marriage
- Fertility Preferences
- Maternal Mortality
- Husband's Background and Women's Work
- Knowledge of AIDS and Other Sexually Transmitted Diseases (STDs).

All female respondents with at least one live birth since January 1990 and their children born since 1st January 1990 had their height and weight taken.

The men's questionnaire was administered to men in sample households in a third of selected EAs. An eligible man was 15-59 years old who is either a usual household member or a visitor who spent the night preceding the day of interview with the household.

Topics enquired about in the men's questionnaire included the following:
- Background Characteristics
- Reproductive History
- Contraceptive Knowledge and Use
- Marriage
- Fertility Preferences
- Knowledge of AIDS and Other STDs.

Cleaning operations
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Questionnaires from the field were sent to the secretariat at the Head Office for checking and office editing. The office editing, which was undertaken by two officers, involved correcting inconsistencies in the questionnaire responses and coding open-ended questions. The questionnaires were then forwarded to the data processing unit for data entry. Data capture and verification were undertaken by four data entry operators. Nearly 20 percent of the questionnaires were verified. This phase of the survey covered four and a half months - that is, from mid-October, 1993 to the end of February, 1994.

After the data entry, three professional staff members performed the secondary editing of questionnaires that were flagged either because entries were inconsistent or values of specific variables were out of range or missing. The secondary editing was completed on 17th March, 1994 and the tables for the preliminary report were generated on 18th March, 1994. The software package used for the data processing was the Integrated System for Survey Analysis (ISSA).

Response rate
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A sample of 6,161 households was selected, from which 5,919 households were contacted for interview. Interviews were successfully completed in 5,822 households, indicating a household response rate of 98 percent. About 3 percent of selected households were absent during the interviewing period, and are excluded from the calculations of the response rate.

Even though the sample was designed to yield interviews with nearly 5,400 women age 15-49 only 4,700 women were identified as eligible for the individual interview. Individual interviews were successfully completed for 4,562 eligible women, giving a response rate of 97 percent. Similarly, instead of the expected 1,700 eligible men being identified in the households only 1,354 eligible men were found and 1,302 of these were successfully interviewed, with a response rate of 96 percent.

The principal reason for non-response among eligible women and men was not finding them at home despite repeated visits to the households. However, refusal rates for both eligible women and men were low, 0.3 percent and 0.2 percent, respectively.

Note: See summarized response rates in Table 1.1 of the survey report.

Sampling error estimates
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The results from sample surveys are affected by two types of errors, non-sampling error and sampling error. Non-sampling error is due to mistakes made in carrying out field activities, such as failure to locate and interview the correct household, errors in the way the questions are asked, misunderstanding on the part of either the interviewer or the respondent, data entry errors, etc. Although efforts were made during the design and implementation of the 1993 GDHS to minimize this type of error, non-sampling errors are impossible to avoid and difficult to evaluate statistically.

Sampling errors, on the other hand, can be measured statistically. The sample of eligible women selected in the 1993 GDHS is only one of many samples that could have been selected from the same population, using the same design and expected size. Each one would have yielded results that differed somewhat from the actual sample selected. The sampling error is a measure of the variability between all possible samples; although it is not known exactly, it can be estimated from the survey results.

Sampling error is usually measured in terms of standard error of a particular statistic (mean, percentage, etc.), which is the square root of the variance of the statistic. The standard error can be used to calculate confidence intervals within which, apart from non-sampling errors, 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 same statistic as measured in 95 percent of all possible samples with the same design (and expected size) will fall within a range of plus or minus two times the standard error of that statistic.

If the sample of women had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the 1993 GDHS sample design depended on stratification, stages and clusters. Consequently, it was necessary to utilize more complex formulas. The computer package CLUSTERS, developed for the World Fertility Survey program by the International Statistical Institute, was used to assist in computing the sampling errors with the proper statistical methodology.

Note: See detailed estimate of sampling error calculation in APPENDIX C of the survey report.

Data appraisal
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QUALITY OF THE DATA: NONSAMPLING ERRORS

Non-sampling errors arise in surveys from a variety of causes, such as the failure to locate and interview the selected household, mistakes in the way questions are asked, misunderstanding on the part of either the interviewer or respondent, coding errors, data entry errors, etc. Although it is impossible to avoid non-sampling errors entirely, great efforts were expended in the GDHS to keep them under control. These efforts included very careful questionnaire design; a pretest of survey instruments to guarantee their functionality; a four-week interviewers' training course; careful fieldwork supervision, including field visits by headquarters' personnel; a swift editing process prior to data entry; and, finally, the use of interactive data entry software to keep keying errors to a minimum. Nevertheless, there is still a need to investigate content errors such as misreporting of ages, ignorance of dates of birth or marriage, and other recall problems.

Table B. 1 of the survey Report shows the distribution of the household population by single years of age. There is rather substantial heaping on ages ending in 0 and 5 throughout the distribution, and it is somewhat more pronounced for females than for males. Errors are particularly notable in the age reporting of females around the borders of eligibility for the individual questionnaire, i.e., ages 15 and 49. Both this table and Table B.2 show an evident deficit of women at ages 15-17 years and a corresponding surplus at ages 12-14. At the other extreme, many women of ages 45-49 have been classified as being 50-54 years old.

Little difference can be seen between the age distribution of women recorded in the household schedule and those interviewed with the individual questionnaire, indicating that response rates vary little across the age of respondents (Table B.2).

Information on the completeness of reporting in connection with a set of important variables is provided in Table B.3. The month of birth was missing for nearly 18 percent of births reported in the birth history for the most recent 15-year period; however, both month and year were missing for less than I percent of these births. For the remaining variables, the percentage of cases with missing information is low.

According to Table B.4, information on month and year of birth is available for 78 percent of all children included in the birth history; the figure for living children is 81 percent, and for dead children is only 62 percent. However, reporting is much better for recent births. For children born since 1990, complete dates are given for over 93 percent; the figure reaches 95 percent for living children, but falls to 75 percent for dead children. Table B.4 also shows that the overall sex ratio at birth is 106; from year to year there are random fluctuations around this value without any indication of bias. The sex ratio for dead children (119) is much higher than for surviving children (104), indicating higher mortality among male children.

Another aspect of Table B.4 is the heavy concentration of births in 1989 (965) relative to 1990 (605). This may represent displacement by some interviewers so as to avoid having to ask the long sequence of questions in Section 4 of the interview. The calendar-year ratio at 1990 is 72, versus 150 at 1989. The effect is to produce a spike in the distribution of births at the fourth year prior to the survey (see Figure B.I). Though the displacement is serious, there is no indication of omission of births from the birth history. For this reason, a 5-year reference period for the measurement of current fertility was adopted in Chapter 3. A 3-year rate would have been artificially low.

Note: See detailed tables (Table B.1, Table B.2, Table B.3 and Table B.4) in APPENDIX B of the survey report.

摘要
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1993年加纳人口与卫生调查（GDHS）是一项全国代表性的调查，调查对象为4,562名15-49岁的女性和1,302名15-59岁的男性。该调查旨在为政策制定者、规划者和项目管理者提供关于该国生育率、家庭规划和母婴保健状况的准确、可靠和最新信息。由加纳统计局（GSS）进行的此次调查是加纳第二次参与全球人口与卫生调查（DHS）项目。

1993年GDHS的主要目标是生成关于生育率、死亡率、避孕和母婴健康指标的可靠和最新信息。此类数据对于有效的政策制定以及项目设计、监控和评估至关重要。1993年GDHS在很大程度上是对1988年GDHS的更新。这两项调查共同提供了两个时间点的可比信息，从而允许评估各种人口和健康指标随时间的变化和趋势。

调查的长期目标包括：（i）加强加纳统计局规划、实施、处理和分析如人口与卫生调查等复杂、大规模调查数据的 Capacity；（ii）为不断扩大的国际人口与健康相关变量数据库做出贡献。

地理覆盖范围
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全国

分析单位
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- 家庭
- 5岁以下儿童
- 15-49岁女性
- 15-59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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1993年GDHS是一项分层、自加权、全国代表性的家庭样本调查，样本来自400个统计区域（EAs）。1984年人口普查EAs构成了抽样框架。框架首先被分为三个生态区，即沿海、森林和草原，然后分为城市和农村EAs。EAs是根据家庭数量按比例选择的。随后，在选定的EAs内列出了家庭，并对家庭进行了系统抽样。调查旨在产生5,400名15-49岁女性的样本，并对400个EAs中三分之一的男性进行了系统抽样。

注意：有关样本设计详情，请参阅调查报告附录A。

数据收集方式
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面对面

研究工具
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用于收集1993年GDHS信息的调查工具包括：
1) 家庭日程
2) 妇女问卷和
3) 男性问卷。

问卷基于为避孕使用率低的国家设计的人口与卫生调查模型B问卷构建。最终版本的问卷是在与相关部、机构和组织的生育和避孕、健康与营养以及残疾人康复活动人员的一系列会议中逐步形成的。

问卷最初用英语编写，后来翻译并打印成五种主要地方语言，即：阿坎语、达甘比语、埃维语、加语和豪萨语。在选定的家庭中，家庭日程中列出了所有常驻成员和访客。收集了每个列出的个人的背景信息，如年龄、性别、与户主的关系、婚姻状况和教育水平。向7岁及以上的所有人询问经济活动、职业、行业、就业状况、过去一周工作的天数和每天工作的小时数。那些在参考期间未工作的人被问及是否积极寻找工作。

家庭日程还收集了所有人员的健康和残疾状况信息。从15岁及以上的所有人中收集了迁移历史，以及关于家庭中所有15岁以下儿童的自然父母的生存状况和居住地信息。

还收集了有关水源、厕所设施类型、家庭可用的睡眠房间数量、地板材料和指定耐用品所有权的资料。

最后，家庭日程是用于确定在个人访谈中收集详细信息的合格女性和男性的工具。

妇女问卷用于收集家庭日程中确定的合格女性的信息。合格女性被定义为15-49岁且是家庭的常驻成员或前一天晚上与家庭同住访客。问卷中询问的问题涉及以下主题：
- 背景特征
- 生殖历史
- 避孕知识和使用
- 怀孕和哺乳
- 疫苗接种和健康
- 婚姻
- 生育偏好
- 母亲死亡率
- 丈夫的背景和妇女的工作
- 艾滋病和其他性传播疾病（STDs）的知识。

自1990年1月以来至少有一个活产的女性受访者及其自1990年1月1日以来出生的孩子都测量了身高和体重。

男性问卷在选定的EAs中三分之一的样本家庭中向男性发放。合格男性为15-59岁，要么是家庭的常驻成员，要么是前一天晚上与家庭同住访客。

男性问卷中询问的主题包括以下内容：
- 背景特征
- 生殖历史
- 避孕知识和使用
- 婚姻
- 生育偏好
- 艾滋病和其他STDs的知识。

数据清理操作
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从现场送来的问卷被送到总部秘书处进行检查和办公室编辑。办公室编辑由两名官员执行，涉及纠正问卷回答中的不一致性以及编码开放式问题。然后将问卷转发到数据处理单位进行数据录入。数据录入和验证由四名数据录入操作员执行。近20％的问卷得到了验证。这一阶段的调查持续了四个月半——即从1993年10月中旬到1994年2月底。

数据录入后，三名专业工作人员对因数据不一致或特定变量的值超出范围或缺失而被标记的问卷进行了二级编辑。二级编辑于1994年3月17日完成，初步报告的表格于1994年3月18日生成。用于数据处理的软件包是综合调查分析系统（ISSA）。

响应率
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选定了6,161个家庭样本，其中5,919个家庭接受了访谈。在5,822个家庭中成功完成了访谈，表明家庭响应率为98％。大约3％的选定家庭在访谈期间缺席，并被排除在响应率计算之外。

尽管样本旨在产生近5,400名15-49岁女性的访谈，但只确定了4,700名符合条件的女性。成功完成了对4,562名合格女性的个人访谈，响应率为97％。同样，在家庭中，预期的1,700名合格男性中只有1,354名被发现，其中1,302名成功接受了访谈，响应率为96％。

合格女性和男性的非响应的主要原因是在多次访问家庭后仍找不到他们。然而，合格女性和男性的拒绝率都很低，分别为0.3％和0.2％。

注意：请参阅调查报告第1.1表中的总结响应率。

抽样误差估计
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样本调查的结果受到两种类型误差的影响，即非抽样误差和抽样误差。非抽样误差是由于在执行现场活动时出现的错误造成的，例如未能找到和访谈选定的家庭、提问方式错误、访谈员或受访者的误解、编码错误、数据录入错误等。尽管在设计实施1993年GDHS期间努力最小化此类错误，但非抽样误差是不可能完全避免且难以进行统计分析的。

另一方面，抽样误差可以通过统计方法进行衡量。1993年GDHS中选定的合格女性样本只是从同一人口中可以选出的许多样本之一，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定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差异的指标；尽管它并不完全清楚，但可以从调查结果中估计。

抽样误差通常以特定统计量（平均数、百分比等）的标准误差来衡量，这是该统计量方差的平方根。标准误差可以用来计算置信区间，在此区间内，除了非抽样误差外，可以合理地假设总体真实值落在其中。例如，对于从样本调查中计算出的任何给定统计量，该统计量在95％的所有可能样本中的值（具有相同的设计和预期规模）将落在该统计量标准误差的正负两倍范围内。

如果女性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，1993年GDHS的样本设计依赖于分层、阶段和聚类。因此，有必要使用更复杂的公式。用于世界生育调查项目并由国际统计研究所开发的计算机软件包CLUSTERS被用于使用适当的统计方法辅助计算抽样误差。

注意：请参阅调查报告附录C中抽样误差计算详细估计。

数据评估
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数据质量：非抽样误差

调查中出现的非抽样误差源于各种原因，例如未能找到和访谈选定的家庭、提问方式错误、访谈员或受访者的误解、编码错误、数据录入错误等。尽管不可能完全避免非抽样误差，但在GDHS中付出了巨大努力来控制这些误差。这些努力包括非常仔细的问卷设计；对调查工具进行预测试以确保其功能；为期四周的访谈员培训课程；仔细的现场工作监督，包括总部人员的现场访问；在数据录入之前进行快速编辑；最后，使用交互式数据录入软件将键入错误降至最低。尽管如此，仍需要调查内容错误，如年龄错误报告、对出生或婚姻日期的无知，以及其他回忆问题。

调查报告的第B.1表显示了按单一年龄分布的家庭人口分布。在整个分布中，以0和5结尾的年龄存在相当大的累积，女性的情况比男性更为明显。错误在个人问卷资格边界的女性年龄报告（即15岁和49岁）中尤其明显。这两个表都显示15-17岁女性的明显短缺和12-14岁女性的相应过剩。在另一端，许多45-49岁的女性被归类为50-54岁。

在家庭日程中记录的女性年龄分布与通过个人问卷访谈的女性年龄分布之间几乎没有差异，这表明受访者的响应率在不同年龄之间变化不大（见表B.2）。

在表B.3中提供了关于一组重要变量报告完整性的信息。在最近15年期间报告的出生史中，近18％的出生月份缺失；然而，在这些出生中，不到1％的月份和年份都缺失。对于其他变量，具有缺失信息的案例百分比很低。

根据表B.4，所有出生儿童中有78％的出生月份和年份信息可用；活产儿童的比例为81％，而死亡儿童的比例仅为62％。然而，对于最近出生的儿童，报告情况要好得多。对于1990年以来出生的儿童，超过93％的出生日期是完整的；活产儿童的比例达到95％，但死亡儿童的比例下降到75％。表B.4还显示，总体出生性别比为106；从年到年，围绕此值的随机波动没有显示出任何偏差。死亡儿童的性别比（119）远高于存活儿童的性别比（104），表明男性儿童的死亡率更高。

表B.4的另一个方面是相对于1990年的605（965）来说，1989年的出生集中程度很高。这可能是某些访谈员为了避免在访谈的第4部分中询问一系列长问题而进行的位移。1990年的日历年比率为72，而1989年的比率为150。这种影响是在调查前四年出生分布中产生了一个峰值（见图B.I）。尽管位移是严重的，但没有迹象表明出生史中遗漏了出生。因此，在第3章中采用了5年的参考期来衡量当前的生育率。3年的比率将会人为地偏低。

注意：请参阅调查报告附录B中的详细表格（表B.1、表B.2、表B.3和表B.4）。