Mortality Survey 2010 - Afghanistan

Abstract
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The Afghanistan Mortality Survey (AMS) 2010 was designed to measure mortality levels and causes of death, with a special focus on maternal mortality. In addition, the data obtained in the survey can be used to derive mortality trends by age and sex as well as sub-national estimates. The study also provides current data on fertility and family planning behavior and on the utilization of maternal and child health services.

OBJECTIVES

The specific objectives of the survey include the following:
- National estimates of maternal mortality; causes and determinants of mortality for adults, children, and infants by age, sex, and wealth status; and other key socioeconomic background variables;
- Estimates of indicators for the country as a whole, for the urban and the rural areas separately, and for each of the three survey domains of North, Central, and South, which were created by regrouping the eight geographic regions;
- Information on determinants of maternal health;
- Other demographic indicators, including life expectancy, crude birth and death rates, and fertility rates.

ORGANIZATION OF THE SURVEY

The AMS 2010 was carried out by the Afghan Public Health Institute (APHI) of the Ministry of Public Health (MoPH) and the Central Statistics Organization (CSO) Afghanistan. Technical assistance for the survey was provided by ICF Macro, the Indian Institute of Health Management Research (IIHMR) and the World Health Organization Regional Office for the Eastern Mediterranean (WHO/EMRO). The AMS 2010 is part of the worldwide MEASURE DHS project that assists countries in the collection of data to monitor and evaluate population, health, and nutrition programs. Financial support for the survey was received from USAID, and the United Nations Children’s Fund (UNICEF). WHO/EMRO’s contribution to the survey was supported with funds from USAID and the UK Department for International Development and the Health Metrics Network (DFID/HMN). Ethical approval for the survey was obtained from the institutional review boards at the MoPH, ICF Macro, IIHMR, and the WHO.

A steering committee was formed to coordinate, oversee, advise, and make decisions on all major aspects of the survey. The steering committee comprised representatives from various ministries and key stakeholders, including MoPH, CSO, USAID, ICF Macro, IIHMR, UNICEF, UNFPA, WHO, and local and international NGOs. A technical advisory group (TAG) made up of experts in the field of mortality and health was also formed to provide technical guidance throughout the survey, including reviewing the questionnaires, the tabulation plan for this final report, the final report, and the results of the survey.

Geographic coverage
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National

Kind of data
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Sample survey data [ssd]

Sampling procedure
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The AMS 2010 is the first nationwide survey of its kind. A nationally representative sample of 24,032 households was selected. All women age 12-49 who were usual residents of the selected households or who slept in the households the night before the survey were eligible for the survey. The survey was designed to produce representative estimates of indicators for the country as a whole, for the urban and the rural areas separately, and for each of the three survey domains, which are regroupings of the eight geographical regions. The compositions of the domains are given below:
- The North, which combines the Northern region and the North Eastern region, consists of nine provinces: Badakhshan, Baghlan, Balkh, Faryab, Jawzjan, Kunduz, Samangan, Sari Pul, and Takhar.
- The Central, which combines the Western region, the Central Highland region, and the Capital region, consists of 12 provinces: Badghis, Bamyan, Daykundi, Farah, Ghor, Hirat, Kabul, Kapisa, Logar, Panjsher, Parwan, and Maydan Wardak.
- The South, which combines the Southern region, the South Eastern region, and the Eastern region, consists of 13 provinces: Ghazni, Hilmand, Kandahar, Khost, Kunar, Laghman, Nangarhar, Nimroz, Nuristan, Paktika, Paktya, Uruzgan, and Zabul.

The sample for the AMS 2010 is a stratified sample selected in two stages from the 2011 Population and Housing Census (PHC) preparatory frame obtained from the Central Statistics Organization (CSO). Stratification was achieved by separating each domain into urban and rural areas. Because of the low urban proportion for most of the provinces, the combined urban areas of each domain form a single sampling stratum, which is the urban stratum of the domain. On the other hand, the rural areas of each domain are further split into strata according to province; that is, the rural areas of each province form a sampling stratum. In total, 34 sampling strata have been created after excluding the rural areas of Hilmand, Kandahar, and Zabul from the domain of the south. Among the 34 sampling strata, 3 are urban strata, and the remaining 31 are rural strata, which correspond with the total number of provinces and their rural areas. Samples were selected independently in each sampling stratum by a twostage selection process. Implicit stratification and proportional allocation were achieved at each of the lower administrative levels within a sampling stratum, by sorting the sampling frame according to administrative units at different levels within each stratum, and by using a probability proportional to size selection at the first stage of sampling.

The primary sampling unit was the enumeration area (EA). After selection of the EA and before the main fieldwork, a household listing operation was carried out in the selected EAs to provide the most updated sampling frame for the selection of households in the second stage. The household listing operation consisted of (1) visiting each of the 751 selected EAs, (2) drawing a location map and a detailed sketch, and (3) recording on the household listing forms all structures found in the EA and all households residing in the structure with the address and the name of the household head. The resulting lists of households serve as the sampling frame for the selection of households at the second stage of sampling. In the second stage of sampling, a fixed number of 32 households was selected randomly in each selected cluster by an equal probability systematic sampling technique. The household selection procedure was carried out at the IIHMR office in Kabul prior to the start of fieldwork. An Excel spreadsheet prepared by ICF Macro to facilitate the household selection was used. A level of non response, or refusals on the part of households and individuals, had already been taken into consideration in the sample design and sample calculation.

The survey interviewers interviewed only pre-selected households, and no replacements of pre-selected households were made during the fieldwork, thus maintaining the representativeness of the final results from the survey for the country. Interviewers were also trained to optimize their effort to identify selected households and to ensure that individuals cooperated to minimize non-response. It is important to note here that interviewers in the AMS were not remunerated according to the number of questionnaires completed but given a daily per diem for the number of days they spent in the field; in addition, it is also important to note that respondents were neither compensated in any way for agreeing to be interviewed nor coerced into completing an interview.

For security reasons, the rural areas of Kandahar, Hilmand, and Zabul, which constitute less than 9 percent of the population, were excluded during sample design from the sample selection; however, the urban areas of these provinces were included. Of the 751 EAs that were included in the sample, 34 EAs (5 urban and 29 rural) were not surveyed. Six of the selected EAs in Ghazni, 16 in Paktika, 1 in Uruzgan, 3 in Kandahar, 3 in Daykundi, and 2 in Faryab were not surveyed because of the security situation. In addition, two EAs from Badakshan and one from Takhar were not surveyed because base maps from the CSO were unavailable. The non-surveyed EAs-which were primarily in rural areas-represent 4 percent of the total population of the country,

Table 1.1 - Sample coverage (Percentage of the population represented by the sample surveyed in the Afghanistan Mortality Survey, Afghanistan 2010)
Region / Urban / Rural / Total
North / 97 / 98 / 98
Central / 100 / 98 / 99
South / 94 / 63 / 66
Total / 98 / 84 / 87

Overall, approximately 13 percent of the country was not surveyed; most of these areas were in the South zone. As shown in Table 1.1, the survey covered only 66 percent of the population in the South zone. Sample weights were adjusted accordingly to take into account those EAs that were selected but not completed for security or other reasons.

Overall, the AMS 2010 covered 87 percent of the population of the country, 98 percent of the urban population and 84 percent of the rural population. Nevertheless, the lack of total coverage and the disproportionate exclusion of areas in the South, and particularly the rural South, should be taken into consideration when interpreting national level estimates of key demographic indicators and estimates for the South zone and regions within. For this reason key indicators will be presented for all Afghanistan and Afghanistan excluding the South zone. Despite these exclusions, the AMS is the most comprehensive mortality survey conducted in Afghanistan in the last few decades in terms of geographic coverage of the country.

Throughout this report, numbers in the tables reflect weighted numbers unless indicated otherwise. In most cases, percentages based on 25-49 cases are shown in parentheses and percentages based on fewer than 25 unweighted cases are suppressed and replaced with an asterisk, to caution readers when interpreting data that a percentage may not be statistically reliable. For child mortality rates, parentheses are used if based on 250-499 children exposed to the risk of mortality in any of the component rates, and suppressed if based on fewer than 250 children exposed to the risk of mortality in any of the component rates.

Gregorian calendar years are greater by approximately 621 years than the Afghan calendar years. However, the Afghan calendar years start in 1 Hammal which is approximately March 21 in the Gregorian calendar. Calculations in the tables are based on the Afghan calendar but in the report calendar years are presented in the Gregorian calendar with approximate reference to the Afghan calendar in parentheses.

For more detailed information, see Appendix A - SAMPLE IMPLEMENTATION of the Survey Report.

Sampling deviation
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This survey was completed in 87% of the country. However, the survey teams were unable to cover rural areas of Helmand, Kandahar and Zabul provinces for security reasons that account for 9% of the total population or one-third of the population of the south of Afghanistan. The insecurity compromised monitoring of field work especially in the South zone.

Mode of data collection
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Face-to-face [f2f]

Research instrument
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Four questionnaires were administered in the AMS 2010: the Household Questionnaire, the Woman’s Questionnaire, the Verbal Autopsy (VA) Questionnaire and a Cluster Level Questionnaire. These questionnaires were based on the DHS model questionnaires and WHO VAs adapted to reflect the population and health issues relevant to Afghanistan. They were finalized at a series of meetings with MoPH and stakeholders from other government ministries and agencies, NGOs, and international donors. The survey questionnaires were then translated from English into the two main local languages—Pashto and Dari—and back translated into English by persons not involved in the original translation to ensure that nothing was lost in the translation before being pretested. Following the pretest, the questionnaires were revised to take into account lessons learnt during the pretest.

The Household Questionnaire was used to list all the usual members and visitors in the selected households and to identify women who were eligible for the individual interview. Some basic information was collected on the characteristics of each person listed, including age, sex, education, and relationship to the head of the household. The survival status of the parents was determined for all the listed members and visitors to the households. The Household Questionnaire also collected information on characteristics of the household’s dwelling unit, such as the source of water, type of toilet facilities, materials used for flooring, and ownership of various durable goods. Additionally, information pertaining to migration in the five years before the survey, household deaths for the same time frame, and health expenditures for inpatient and outpatient care were collected. [Data on health expenditures for inpatient and outpatient care was analyzed and reported in a separate document (MoPH GIRoA, 2011).]

The Woman’s Questionnaire was used to collect information from all women age 12-49, on their age, education, ethnicity, marital status, and sibling history (whether alive or dead). Ever-married women were also asked about their pregnancy history, the number of children they had in their lifetime, and the survival status of their children. Ever-married women who had given birth in the five years preceding the survey were also asked questions on maternal health care for their most recent birth. Currently married women were additionally asked about their knowledge and use of family planning methods. Each death that occurred in the selected households in the three years before the survey was followed up with one of three Verbal Autopsy Questionnaires, depending on the age at death: Form 1 for deaths to children 0-28 days; Form 2 for deaths to children 29 days-11 years; and Form 3 for deaths to adults age 12 years and above. An attempt was always made to interview the person(s) present at the time of death to ensure accurate information surrounding the circumstances that led to the death of the deceased.

The Cluster Level Questionnaire was used to gather information from the head of the village or some other knowledgeable informant, on access to basic amenities such as the presence of a cell phone signal, a paved road, a police station or post. In addition, information was collected on the largest medical facility, the highest level of school, and the frequency of public transport to and from the cluster. The questionnaire was also used to collect information on the availability of daily necessities, including petrol, vegetables, meats, bread, rice, and fuel for cooking.

Response rate
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A total of 22,897 households were selected from the 717 completed clusters, of which 22,609 were found to be occupied during data collection. Of these occupied households, 22,351 were successfully interviewed, giving a household response rate of nearly 99 percent. In the selected households, 48,717 women were identified as eligible for the individual interview. Interviews were completed for 47,848 women, yielding an overall response rate of 98 percent. Response rates in urban areas (98 percent) were marginally lower than in rural areas (99 percent) for both households and eligible women. Response rates by zone and region are presented in Appendix Table A.1 of the survey report. The high response rates were due to several reasons: interviewers were instructed to make at least three callbacks, on different days and times, to complete an interview and minimize non-response; the vast majority of women were at home at the time of the survey; Afghans are hospitable people and were very welcoming of visitors into their homes. In addition, prior to the start of interviewing in a selected cluster, the village elder was contacted and the team leader explained the purpose of the survey and obtained his permission and cooperation to work in the cluster. In some instances, health workers from the selected clusters were called upon to assist with locating selected households. High household response rates were also recorded in the NRVA 2007/8 (91 percent), AHS 2006 (99 percent) and the MICS 2003 (99 percent). [Note: The AMS interviewed only pre-selected households with no replacements allowed. The NRVA 2007/8 recorded 91 percent response with households that were not found or that refused to be interviewed replaced from a pre-selected list of additional replacement households. It is unclear if a similar procedure was followed in the AHS 2006 or the MICS 2003.]

Sampling error estimates
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See Appendix B - ESTIMATES OF SAMPLING ERRORS of the Survey Report.

Data appraisal
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Wherever possible, results from the AMS 2010 are compared with results from a number of other surveys conducted in Afghanistan since 2003. Comparisons of the AMS 2010 data and data from other sources have to be interpreted with caution however, since the sample design, coverage and/or methodological approach to the estimation of key demographic and health indicators differ. A brief description of the four principal surveys to which AMS results will be most frequently compared follows to assist in placing comparisons within their proper context.

National Risk and Vulnerability Assessment (NRVA) 2007/8.

The NRVA was designed to provide representative data on key socioeconomic development indicators for Afghanistan, including 25 MDG indicators. The NRVA used the CSO pre-census household listing data to create a geographically ordered list of primary sampling units (PSUs), rural settlements and urban blocks with their estimated number of households from the 34 provinces and 11 urban centers (ICON-INSTITUTE, 2009). In addition, the NRVA 2007/8 sampled the Kuchi population or nomadic pastoralist population. The Kuchi population, considered one of the most vulnerable groups in the country, was not included in the CSO pre-census listing, which focused on the settled population; instead information from the National Multi-Sectoral Assessment for Kuchi (NMAK), which was conducted during the winter/spring of 2004 was used to determine the total size of the Kuchi population and to identify the summer locations from which the Kuchi population sample was drawn for the NRVA. Thus, national estimates of key indicators provided in the NRVA 2007/8 represent the situation among both settled and nomadic (Kuchi) populations. Fieldwork for the NRVA 2007/8 started in mid-August 2007 and ended in mid-August 2008, a period of 12 months. The survey sampled 2,441 PSUs and 20,576 households of which 19,528 households were from the settled urban and rural population and 131 PSUs comprising 1,048 households from the Kuchi population. The NRVA 2007/8 administered a 20-section Household Questionnaire with 14 sections administered by a male interviewer to the male head of the household and 6 sections by a female interviewer (in most parts of the country) to a female respondent. Two community-level questionnaires were also administered: one male and one female Shura questionnaire. With respect to comparisons between the NVRA and AMS 2010 results, the major difference lies in the fact that the AMS 2010 did not separately sample the nomadic Kuchi population while the NVRA included an explicit Kuchi population domain. The implications of this on the overall comparability between the NRVA 2007/8 and the AMS 2010 is not clear as the updated sampling frame used in the AMS 2010 may have included a proportion of the Kuchi population which had since become a part of the settled population. To the extent that the Kuchi population may be underrepresented in the AMS 2010, there may be a positive bias in the AMS indicators although the bias is not likely to be large.

Afghanistan Health Survey (AHS) 2006.

The AHS 2006 is a population-based rural survey designed to provide information on maternal and child health, child survival, family planning, health care utilization and related expenditures in Afghanistan. Sampling and selection in the AHS 2006 differed considerably from the AMS 2010 (JHBSPH and IIHMR, 2008) A key difference is the fact that the AHS 2006 entirely excluded the six largest cities (Kabul, Hirat, Mazar-e-Sharif, Kunduz, Jalalabad and Kandahar) from its sample design. The AHS also excluded 5 of the 34 provinces in the country. The precensus household listing conducted by the CSO between 2003 and 2005 that was used in the AHS 2006 also was not completed in all areas. The areas that were not covered included 17 districts mainly in Kandahar, Zabul and Hilmand, with one district missing from Ghazni and Hilmand. In addition, in one district in Daykundi, 26 villages were not enumerated (JHUBSPH and IIHMR, 2008). Finally, fieldwork was completed in only 397 clusters out of the 425 clusters selected for the AHS 2006; the remaining 28 clusters were not completed due to security reasons. The final sample included 8,278 households, with interviews of all ever-married women age 10-49, as well as interviews of primary caretakers of children 0-59 months. Data collection spanned three months from mid-September 2006 to mid-December 2006. Because of the exclusion of major urban areas from the AHS, comparisons of the AMS 2010 data to the AHS 2006 data are limited to rural areas. The results from the AHS 2006 are representative of 72 percent of the rural population of the country. In comparison, the AMS 2010 covered 84 percent of the rural population.

Multiple Indicator Cluster Survey (MICS) 2003.

The MICS 2003 is the first survey to be conducted in the country since decades of conflict and provides baseline data on key demographic and health indicators (CSO and UNICEF, 2004). The sampling frame for the 2003 MICS was derived from two sources: the 1979 Population Census conducted by CSO; and the National Immunization Day (NID) coverage data from the MoPH for Nuristan and the major cities due to the lack of a detailed breakdown of the population. The survey covered all 32 provinces in existence at that time in the country, and provides estimates of key indicators at the national, urban, rural and provincial levels. The Kuchi population is not covered in the sample as well as 10 percent of villages throughout the country for which census documents were missing. The survey sampled 765 PSUs, selected 21,038 households, and completed 20,806 households. Nevertheless, for various reasons, key findings from the MICS 2003 were considered flawed. A reanalysis of the data was carried out by CSO and UNICEF and modeled estimates of key indicators from the adjusted MICS 2003 data as well as from the 1997 and 2000 MICS5 were published in the Best Estimates of Social Indicators for Children 1990-2005 (UNICEF, 2006).

Reproductive Age Mortality Survey (RAMOS) in Four Districts (2002).

Bartlett and others carried out a study of women age 15–49 years who died between March 21, 1999, and March 21, 2002, in sampled villages in four selected districts in four provinces in Afghanistan (Bartlett et al., 2005). These districts were: Kabul city, Kabul province; Alisheng district, Laghman province; Maywand district, Kandahar province; and Ragh district, Badakshan province, with the selected sample representing less than 4 percent of the population of the country at that time. The districts were not selected randomly but were purposively selected to serve as proxies for urban, semirural, rural and very rural parts of the country, respectively. All 13,848 households in randomly selected villages in these four districts were surveyed and 294 deaths among women of reproductive age were investigated through verbal autopsy interviews of family members. Based on their findings of maternal deaths in these districts, the authors extrapolated the data to provide a national estimate of maternal mortality for the country.

摘要
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阿富汗死亡率调查（AMS）2010旨在测量死亡率水平和死亡原因，特别关注孕产妇死亡率。此外，调查中获得的数据可用于推导按年龄和性别划分的死亡率趋势以及次国家估计。该研究还提供了关于生育和家庭规划行为以及孕产妇和儿童健康服务利用现状的数据。
目标
调查的具体目标包括以下内容：
- 国家孕产妇死亡率估计；按年龄、性别和财富状况划分的成年人、儿童和婴儿的死亡原因和决定因素；以及其他关键社会经济背景变量；
- 对整个国家、城市和农村地区分别以及三个调查领域（北部、中部和南部）的指标进行估计，这些领域是通过重新组合八个地理区域而创建的；
- 关于孕产妇健康状况的决定因素的资料；
- 其他人口统计学指标，包括预期寿命、粗出生率和死亡率以及生育率。
调查的组织
2010年AMS由阿富汗公共卫生研究所（APHI）和公共卫生部（MoPH）以及阿富汗中央统计局（CSO）共同实施。调查的技术援助由ICF Macro、印度健康管理与研究学院（IIHMR）和世界卫生组织中东地区办事处（WHO/EMRO）提供。AMS 2010是全球MEASURE DHS项目的一部分，该项目协助各国收集数据以监测和评估人口、健康和营养计划。调查的财务支持来自USAID和联合国儿童基金会（UNICEF）。WHO/EMRO对调查的贡献得到了USAID、英国国际发展部（DFID）和健康计量网络（DFID/HMN）的资金支持。调查的伦理批准获得了MoPH、ICF Macro、IIHMR和WHO的机构审查委员会的批准。
指导委员会成立，以协调、监督、咨询和就调查的所有主要方面做出决定。指导委员会由来自各个部门和关键利益相关者的代表组成，包括MoPH、CSO、USAID、ICF Macro、IIHMR、UNICEF、UNFPA、WHO以及当地和国际非政府组织。还成立了一个技术顾问组（TAG），由死亡率与健康领域的专家组成，以在整个调查过程中提供技术指导，包括审查问卷、本最终报告的表格计划、最终报告和调查结果。
地理覆盖范围
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全国
数据类型
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样本调查数据 [ssd]
抽样程序
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AMS 2010是此类调查中的首次全国性调查。从24,032个家庭中选取了一个具有全国代表性的样本。所有12-49岁的女性，如果她们是所选家庭的常住居民或在前一天晚上调查时在家庭中过夜，都有资格参加调查。调查旨在产生整个国家、城市和农村地区分别以及三个调查领域（北部、中部和南部）的代表性估计指标，这些领域是通过重新组合八个地理区域而创建的。领域组成如下：
- 北部，结合了北部地区和东北部地区，包括九个省份：巴达克山、巴格兰、巴勒哈、法里亚布、朱兹詹、昆都士、萨曼甘、萨里普尔和塔哈尔。
- 中部，结合了西部地区、中部高原地区和首都地区，包括12个省份：巴吉斯、巴米扬、代克迪、法拉、加兹尼、赫尔曼、赫拉特、喀布尔、卡皮萨、洛加尔、帕杰谢尔、帕尔旺和马丹瓦达克。
- 南部，结合了南部地区、东南部地区和东部地区，包括13个省份：加兹尼、赫尔曼德、坎大哈、库纳尔、拉格曼、纳格哈尔、楠格哈尔、尼莫罗兹、努尔斯坦、帕克蒂卡、帕克蒂亚、乌尔兹甘和扎布尔。
AMS 2010的样本是从2011年人口和住房普查（PHC）准备框架中选取的分层样本，该框架由中央统计局（CSO）获得。分层是通过将每个领域分为城市和农村地区来实现的。由于大多数省份的城市比例较低，每个领域的合并城市地区形成一个单独的抽样层，即该领域的城市层。另一方面，每个领域的农村地区根据省份进一步分为层；即每个省份的农村地区形成一个抽样层。总共创建了34个抽样层，排除了南部领域的赫尔曼德、坎大哈和扎布尔的农村地区。在34个抽样层中，3个是城市层，其余31个是农村层，这与省份及其农村地区的总数相对应。在每个抽样层中独立进行两阶段选择过程以选择样本。在每个抽样层内，通过根据每个层内不同层级的行政单位对抽样框架进行排序，并在抽样第一阶段使用按规模比例的选择来达到隐含分层和比例分配。
主要抽样单位是人口普查区（EA）。在选定EA并进行主要实地调查之前，在选定的EA中进行了一次家庭清单操作，以提供选择第二阶段家庭的最新的抽样框架。家庭清单操作包括（1）访问每个选定的751个EA，（2）绘制位置图和详细草图，以及（3）在家庭清单表格上记录EA中发现的全部结构以及居住在这些结构中的所有家庭的地址和家庭负责人姓名。产生的家庭清单作为第二阶段选择家庭的抽样框架。在第二阶段抽样中，通过等概率系统抽样技术，在每个选定的聚类中随机选择32个家庭。在实地工作开始之前，在喀布尔的IIHMR办公室进行了家庭选择程序。ICF Macro准备的Excel电子表格用于简化家庭选择。在样本设计和样本计算中已经考虑了非响应或家庭和个人的拒绝情况。
调查员仅对预选家庭进行访谈，在实地工作中没有替换预选家庭，从而保持了调查结果的代表性。调查员还接受了培训，以优化识别选定家庭的努力，并确保个人合作以最大限度地减少非响应。值得注意的是，AMS中的调查员不是根据完成的问卷数量获得报酬，而是根据他们在实地工作的天数获得每日生活费；此外，还应注意的是，受访者既没有因同意接受访谈而获得任何形式的补偿，也没有被迫完成访谈。
出于安全原因，坎大哈、赫尔曼德和扎布尔的农村地区（占全国总人口的不到9%）在样本设计中被排除在外，但这些省份的城市地区包括在内。在样本中包括的751个EA中，有34个EA（5个城市和29个农村）未进行调查。加兹尼的6个、帕克蒂卡的16个、乌尔兹甘的1个、坎大哈的3个、代克迪的3个和法拉布的2个选定的EA未进行调查，因为安全状况。此外，巴达克山和塔哈尔各有两个EA未进行调查，因为CSO的基础地图不可用。未调查的EA（主要是农村地区）代表了国家总人口的4%。
表1.1 - 样本覆盖范围（阿富汗2010年死亡率调查中样本调查的人口百分比）
区域 / 城市 / 农村 / 总计
北部 / 97 / 98 / 98
中部 / 100 / 98 / 99
南部 / 94 / 63 / 66
总计 / 98 / 84 / 87
总体而言，大约有13%的国家未进行调查；其中大部分位于南部地区。如表1.1所示，调查仅覆盖了南部地区的66%的人口。样本权重据此进行调整，以考虑那些因安全或其他原因而选定的但未完成的EA。
总体而言，AMS 2010覆盖了全国87%的人口，98%的城市人口和84%的农村人口。尽管如此，由于缺乏全面覆盖以及南部，特别是农村南部的不成比例的排除，因此在解释国家层面关键人口统计学指标估计以及南部地区和地区估计时，应加以考虑。因此，将为所有阿富汗和阿富汗（不包括南部地区）的关键指标提供关键指标。
尽管存在这些排除，但AMS是过去几十年在阿富汗进行的地理覆盖范围最广泛的死亡率调查。
在整个报告中，除非另有说明，表中的数字反映的是加权数字。在大多数情况下，基于25-49个案例的百分比在括号中显示，而基于少于25个未加权案例的百分比被抑制，并用星号替换，以提醒读者在解释数据时，百分比可能不具有统计可靠性。对于儿童死亡率，如果基于250-499名暴露于任何组成部分的死亡率风险的儿童，则括号中显示，如果基于少于250名暴露于任何组成部分的死亡率风险的儿童，则被抑制。
阿富汗日历年份比公历年份晚约621年。然而，阿富汗日历年份从1年哈马尔开始，在公历中大约是3月21日。表中的计算基于阿富汗日历，但在报告中以公历年份呈现，并括号中提供对阿富汗日历的近似参考。
有关更详细的信息，请参阅调查报告附录A - 样本实施。
抽样偏差
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这项调查在87%的国家完成。然而，由于安全原因，调查团队无法覆盖赫尔曼德、坎大哈和扎布尔省的农村地区，这些地区占全国总人口的9%或阿富汗南部人口的1/3。不稳定性尤其影响了南部地区的实地工作监控。
数据收集方式
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面对面 [f2f]
研究工具
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在AMS 2010中实施了四个问卷：家庭问卷、妇女问卷、口头尸检（VA）问卷和集群层级问卷。这些问卷基于DHS模型问卷和WHO VA，并根据阿富汗的人口和健康问题进行了调整。它们在一系列与MoPH和其他政府部门和机构、非政府组织和国际捐助者的利益相关者会议中最终确定。调查问卷随后从英语翻译成两种主要地方语言——普什图语和达里语，并由未参与原始翻译的人员翻译回英语，以确保翻译过程中没有损失任何内容。在预测试之后，根据预测试中学到的经验教训对问卷进行了修订。
家庭问卷用于列出所选家庭的所有常住成员和访客，并确定有资格进行个别访谈的女性。收集了有关所列每个人的特征的某些基本信息，包括年龄、性别、教育和与家庭负责人之间的关系。确定了所有列出成员和访客的父母的生存状况。家庭问卷还收集了有关家庭居住单位特征的资料，例如水源、厕所设施类型、地板材料以及各种耐用商品的拥有权。此外，还收集了关于调查前五年内的迁移、家庭死亡以及住院和门诊保健的支出情况。 [住院和门诊保健的支出数据在单独的文件（MoPH GIRoA，2011）中进行分析和报告。]
妇女问卷用于收集所有12-49岁女性的信息，包括她们的年龄、教育、民族、婚姻状况和兄弟姐妹历史（是否存活或死亡）。已婚女性还关于她们怀孕历史、她们一生中生育的孩子数量以及她们孩子的生存状况进行了询问。在调查前五年内生育的女性还就她们最近一次生育的孕产妇保健进行了询问。已婚女性还就她们对家庭规划方法的了解和使用进行了询问。在调查前三年内，在所选家庭中发生的每次死亡都通过以下三种口头尸检问卷之一进行跟进，具体取决于死亡时的年龄：表1号用于0-28天婴儿的死亡；表2号用于29天-11岁儿童的死亡；表3号用于12岁及以上成人的死亡。始终试图采访死亡时在场的人，以确保准确的信息，这些信息涉及导致死者死亡的情况。
集群层级问卷用于从村长或其他知识渊博的知情者那里收集信息，关于基本设施的可访问性，例如手机信号、铺砌道路、警察局或邮政局的存在。此外，还收集了关于最大的医疗机构、最高级别的学校和集群之间公共交通的频率的信息。该问卷还用于收集有关日常必需品的可用性信息，包括汽油、蔬菜、肉类、面包、大米和烹饪燃料。
响应率
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从717个完成集群中选取了22,897个家庭，其中22,609个家庭在数据收集时被发现有人居住。在这些有人居住的家庭中，22,351个家庭成功接受了访谈，家庭响应率接近99%。在选定的家庭中，确定了48,717名有资格进行个别访谈的女性。完成了47,848名女性的访谈，整体响应率为98%。城市地区的响应率（98%）略低于农村地区（99%），无论是家庭还是合格女性。调查报告附录A.1中按区域和地区呈现了响应率。高响应率归因于以下几个原因：调查员被指示至少进行三次回访，在不同的日期和时间，以完成访谈并最大限度地减少非响应；在调查时，绝大多数女性都在家中；阿富汗人热情好客，非常欢迎访客进入他们的家庭。此外，在选定集群开始采访之前，联系了村长，团队负责人解释了调查的目的，并获得了他在该集群工作的许可和合作。在某些情况下，来自选定集群的卫生工作者被要求协助寻找选定家庭。在NRVA 2007/8（91%）、AHS 2006（99%）和MICS 2003（99%）中也记录了高家庭响应率。[注意：AMS仅采访预选家庭，不允许替换。NRVA 2007/8记录了91%的响应率，家庭未找到或拒绝接受访谈的家庭从预先选定的附加替换家庭清单中替换。不清楚在AHS 2006或MICS 2003中是否遵循了类似的程序。]
抽样误差估计
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请参阅调查报告附录B - 抽样误差估计。
数据评估
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wherever possible, results from the AMS 2010 are compared with results from a number of other surveys conducted in Afghanistan since 2003. Comparisons of the AMS 2010 data and data from other sources have to be interpreted with caution however, since the sample design, coverage and/or methodological approach to the estimation of key demographic and health indicators differ. A brief description of the four principal surveys to which AMS results will be most frequently compared follows to assist in placing comparisons within their proper context.
阿富汗风险和脆弱性评估（NRVA）2007/8。
NRVA旨在为阿富汗的关键社会经济发
展指标提供代表性数据，包括25个MDG指标。NRVA使用CSO预普查家庭清单数据创建了一个按地理顺序排列的初级抽样单位（PSU）、农村定居点和城市街区列表，以及从34个省份和11个城市中心估计的家庭数量（ICON-INSTITUTE，2009）。此外，NRVA 2007/8还抽样了库奇人口或游牧牧民人口。库奇人口被认为是该国最脆弱的群体之一，并未包括在CSO预普查清单中，该清单侧重于定居人口；相反，使用了2004年冬季/春季进行的国家多部门库奇评估（NMAK）的信息，以确定库奇人口的总数，并确定库奇人口样本的夏季位置。因此，NRVA 2007/8中提供的关键指标的国家估计代表了定居和游牧（库奇）人口的情况。NRVA 2007/8的实地工作于2007年8月中旬开始，并于2008年8月中旬结束，为期12个月。NRVA 2007/8抽样了2,441个PSU和20,576个家庭，其中19,528个家庭来自定居的城镇和农村人口，以及131个PSU，包括1,048个家庭来自库奇人口。NRVA 2007/8实施了一个20个部分的家庭问卷，其中14个部分由男性调查员向家庭负责人男性进行，6个部分由女性调查员（在大多数地区）向女性受访者进行。还实施了两个社区层级问卷：一个男性和一个女性Shura问卷。关于NVRA和AMS 2010结果之间的比较，主要区别在于AMS 2010没有单独抽样游牧的库奇人口，而NVRA包括一个明确的库奇人口领域。这种差异对NVRA 2007/8和AMS 2010之间整体可比性的影响尚不清楚，因为AMS 2010中使用的更新的抽样框架可能包括了一定比例的库奇人口，这些人口已经成为了定居人口的一部分。在NVRA 2007/8和AMS 2010之间可能存在正偏差，尽管这种偏差不太可能很大。
阿富汗健康调查（AHS）2006。
AHS 2006是一项基于人口的农村调查，旨在提供关于孕产妇和儿童健康、儿童生存、家庭规划、卫生保健利用和相关支出的信息。AHS 2006的抽样和选择与AMS 2010有很大不同（JHBSPH和IIHMR，2008）。一个主要区别是AHS 2006完全排除了六个最大的城市（喀布尔、赫尔曼、马扎尔-e-沙里夫、昆都士、贾拉拉巴德和坎大哈）的样本设计。AHS还排除了国家中的5个省份。2003年至2005年间由CSO进行的预普查家庭清单，用于AHS 2006，在所有地区都没有完成。未覆盖的地区包括主要在坎大哈、扎布尔和赫尔曼的17个地区，加兹尼和赫尔曼的一个地区缺失。此外，在代克迪的一个地区，26个村庄未进行人口普查（JHUBSPH和IIHMR，2008）。最后，在为AHS 2006选定的425个集群中，只有397个集群完成了实地工作；其余28个集群由于安全原因而未完成。最终样本包括8,278个家庭，对所有10-49岁已婚女性进行了访谈，以及对0-59个月儿童的主要照顾者进行了访谈。数据收集从2006年9月中旬到2006年12月中旬，持续了三个月。由于排除了主要城市地区，因此AMS 2010数据与AHS 2006数据的比较仅限于农村地区。AHS 2006的结果代表了国家72%的农村人口。相比之下，AMS 2010覆盖了84%的农村人口。
多指标集群调查（MICS）2003。
MICS 2003是自几十年的冲突以来在该国进行的首次调查，提供了关键人口统计学和健康指标的基础数据（CSO和UNICEF，2004）。2003年MICS的抽样框架来自两个来源：CSO进行的1979年人口普查；以及MoPH的全国免疫日（NID）覆盖率数据，由于缺乏人口详细分解，因此用于努尔斯坦和主要城市。MICS 2003涵盖了当时在该国存在的所有32个省份，并在国家、城市、农村和省级层面提供了关键指标的估计。样本中不包括库奇人口，以及全国10%的村庄，因为这些村庄的人口普查文件缺失。MICS 2003抽样了765个PSU，选择了21,038个家庭，并完成了20,806个家庭。然而，由于各种原因，MICS 2003的关键发现被认为是有缺陷的。CSO和UNICEF对数据进行重新分析，并从调整后的MICS 2003数据以及1997年和2000年MICS5数据中发布了关键指标的模型估计，这些数据在《1990-2005年儿童社会指标最佳估计》中公布（UNICEF，2006）。
四个地区（2002年）的生育年龄死亡率调查（RAMOS）。
Bartlett等人对1999年3月