Demographic and Health Survey 1999-2000 - Bangladesh

Abstract
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The 1999-2000 Bangladesh Demographic and Health Survey (BDHS) is a nationally representative sample survey designed to provide information on basic national indicators of social progress including fertility, contraceptive knowledge and use, fertility preference, childhood mortality, maternal and child health, nutritional status of mothers and children and awareness of AIDS.

The 1999-2000 BDHS provides a comprehensive look at levels and trends in key health and demographic parameters for policy makers and program managers. The fertility has declined from 6.3 children per women in 1975 to 3.3 in 1999-2000. The pace of fertility decline has slowed in the most recent period compared to the rapid decline during late 1980s and early 1990s. The BDHS 1999-2000 findings also show the increasing trend of contraceptive use, declining childhood mortality, and improving nutritional status.

The Bangladesh Demographic and Health Survey (BDHS) is intended to serve as a source of population and health data for policymakers and the research community. In general, the objectives of the BDHS survey 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.

The 1999-2000 BDHS survey 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. Macro International Inc. 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.

Geographic coverage
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National

Analysis unit
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- Household
- Children under five years
- Women age 10-49
- Men age 15-59

Kind of data
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Sample survey data

Sampling procedure
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Bangladesh is divided into 6 administrative divisions, 64 districts (zillas), and 490 thanas. In rural areas, thanas are divided into unions and then mauzas, a land administrative unit. Urban areas are divided into wards and then mahallas. The 1999-2000 BDHS survey employed a nationally representative, two-stage sample that was selected from the master sample maintained by the Bangladesh Bureau of Statistics for the implementation of surveys before the next census (2001). The master sample consists of 500 primary sampling units (PSUs) with enough PSUs in each stratum except for the urban strata of the Barisal and Sylhet divisions. In the rural areas, the primary sampling unit was the mauza, while in urban areas, it was the mahalla. Because the primary sampling units in the master sample were selected with probability proportional to size from the 1991 census frame, the units for the BDHS survey were subselected from the master sample with equal probability to make the BDHS selection equivalent to selection with probability proportional to size. A total of 341 primary sampling units were used for the BDHS survey (99 in urban areas and 242 in rural areas).

Since one objective of the BDHS survey is to provide separate survey estimates for each division as well as for urban and rural areas separately, it was necessary to increase the sampling rate for the Barisal and Sylhet divisions and for urban areas relative to the other divisions. Thus, the BDHS sample is not self-weighting and weighting factors have been applied to the data in this report.

Mitra and Associates conducted a household listing operation in all the sample points from September to December 1999. A systematic sample of 10,268 households was then selected from these lists. Every third household was selected for the men's survey, meaning that in addition to interviewing all ever-married women age 10-49, interviewers also interviewed all currently married men age 15-59 in those selected households. It was expected that the sample would yield interviews with approximately 10,000 ever-married women age 10-49 and 3,000 currently married men age 15-59.

Note: See detailed in APPENDIX A of the survey report

Mode of data collection
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Face-to-face

Research instrument
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Four types of questionnaires were used for the BDHS survey: a Household Questionnaire, a Women’s Questionnaire, a Men’s Questionnaire, and a set of questionnaires for the Service Provision Assessment (SPA) (community, health facilities, fieldworkers). The contents of these questionnaires were based on the MEASURE DHS+ Model A Questionnaire, which is designed for use in countries with relatively high levels of contraceptive use. These model questionnaires were adapted for use in Bangladesh during a series of meetings with a small Technical Task Force (TTF) that consisted of representatives from NIPORT; Mitra and Associates; USAID/Dhaka; the International Centre for Diarrheal Disease Research, Bangladesh (ICDDR,B); Dhaka University; and Macro International Inc. (see Appendix A for a list of members). 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 in to and printed in Bangla.

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 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
· Height and weight of children under age five and of their mother
· HIV and AIDS.

The Men’s Questionnaire was similar to that for women except that it omitted the sections on reproductive history, antenatal and delivery care, breastfeeding, vaccinations, and height and weight. The questionnaire for the Service Provision Assessment was completed for each sample point and included questions about the existence in the community of income-generating activities and other development organizations and the availability and accessibility of health and family planning services. Detailed analysis of the SPA data will be presented in a separate report.

Cleaning operations
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All questionnaires for the BDHS survey were returned to Dhaka for data processing at Mitra and Associates. 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 ten data entry operators and two data entry supervisors. The BDHS data entry and editing programs were written in ISSA (Integrated System for Survey Analysis). Data processing commenced in mid-December 1999 and was completed by end of April 2000.

Response rate
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A total of 10,268 households were selected for the sample, of which 9,854 were successfully interviewed. The shortfall is primarily due to dwellings that were vacant or in which the inhabitants had left for an extended period at the time they were visited by the interviewing teams. Of the 9,922 households occupied, 99 percent were successfully interviewed. In these households, 10,885 women were identified as eligible for the individual interview (i.e., ever-married and age 10-49) and interviews were completed for 10,544 or 97 percent of them. In the one-third of the households that were selected for inclusion in the men’s survey, 2,817 currently married men age 15-59 were identified, of which 2,556 or 91 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 rate was low.

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 1999-2000 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 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 BDHS sample is the result of a two-stage stratified design, and, consequently, it was necessary to use more complex formulae. The computer software used to calculate sampling errors for the BDHS is the ISSA Sampling Error Module (SAMPERR). This module used the Taylor linearisation 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
- Completeness of reporting
- Births by calendar years since birth
- Reporting of age at death in days
- Reporting of age at death in months

Note: See detailed tables in APPENDIX C of the survey report.

摘要
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1999-2000年孟加拉国人口与卫生调查（BDHS）是一项全国代表性样本调查，旨在提供有关社会进步基本国家指标的信息，包括生育率、避孕知识及使用情况、生育偏好、儿童死亡率、母婴健康、母婴营养状况以及艾滋病 awareness。

1999-2000年BDHS提供了对政策制定者和项目管理人员关键健康和人口参数水平和趋势的全面审视。生育率自1975年的每名妇女6.3名儿童下降到1999-2000年的3.3名。与20世纪80年代末和90年代初的快速下降相比，最近时期的生育率下降速度有所放缓。BDHS 1999-2000年的调查结果还显示出避孕使用率上升、儿童死亡率下降以及营养状况改善的趋势。

孟加拉国人口与卫生调查（BDHS）旨在为政策制定者和研究界提供人口和健康数据来源。总体而言，BDHS调查的目标是：
- 评估孟加拉国的总体人口状况
- 协助评估孟加拉国的人口和卫生项目
- 推进调查方法。

具体而言，BDHS调查的目标是提供有关生育率和儿童死亡率水平、婚姻状况、生育偏好、家庭规划方法的认知、接受和使用、母乳喂养实践、营养水平以及母婴健康的最新信息。这些信息旨在协助政策制定者和管理人员评估和设计改善国家卫生和家庭规划服务的项目和策略。

1999-2000年BDHS调查在孟加拉国卫生和家庭福利部国家人口研究培训研究所（NIPORT）的授权下进行。调查由位于达卡的孟加拉国研究公司Mitra and Associates实施。马里兰州Calverton的Macro International Inc.作为其国际人口与卫生调查项目的一部分，向该项目提供了技术援助，并由美国国际开发署（USAID）/孟加拉国提供了资金支持。

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
- 10-49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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孟加拉国分为6个行政分区、64个区（zilla）和490个Thanas。在农村地区，Thanas分为Union和Mauzas，这是一个土地行政单位。城市地区分为wards，然后是mahallas。1999-2000年BDHS调查采用了一个全国代表性的两阶段样本，该样本是从孟加拉国统计局为下一届人口普查（2001年）实施调查前保留的主样本中选择的。主样本由500个一级抽样单位（PSUs）组成，每个层级的PSUs数量足够，除了Barisal和Sylhet分区的城市层。在农村地区，一级抽样单位是Mauza，而在城市地区，是Mahalla。由于主样本中的一级抽样单位是根据1991年人口普查框架的规模成比例地从抽样中选择的，因此BDHS调查的单位是从主样本中以相等概率进行子选择的，以使BDHS选择等同于规模成比例的选择。BDHS调查总共使用了341个一级抽样单位（99个在城市地区，242个在农村地区）。