Demographic and Health Survey 2010 - Rwanda

Abstract
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The 2010 Rwanda Demographic and Health Survey (RDHS) is designed to provide data for monitoring the population and health situation in Rwanda. The 2010 RDHS is the fifth Demographic and Health Survey to be conducted in Rwanda. The objective of the survey is to provide up-to-date information on fertility, family planning, childhood mortality, nutrition, maternal and child health, domestic violence, malaria, maternal mortality, awareness and behavior regarding HIV/AIDS, HIV prevalence, malaria prevalence, and anemia prevalence. A nationally representative sample of 13,671 women, age 15–49 from 12,540 surveyed households, and 6,329 men, age 15–59 from half of these households, were interviewed. This represents a response rate of 99 percent for women and 99 percent for men. The sample provides estimates at the national and provincial levels.

The main objectives of the 2010 RDHS were to:
- Collect data at the national level to facilitate calculation of essential demographic rates, especially rates for fertility and infant and child mortality, and to analyze the direct and indirect factors that determine levels and trends in fertility and child mortality
- Measure the levels of knowledge of contraceptive practices among women
- Collect data on family health, including immunization practices; prevalence and treatment of diarrhea, acute upper respiratory infections, fever and/or convulsions among children under age 5; antenatal visits; and assistance at delivery
- Collect data on the prevention and treatment of malaria, in particular the possession and use of bed nets among children under 5 and among women and pregnant women
- Collect data on nutritional practices of children, including breastfeeding
- Collect data on the knowledge and attitudes of men and women concerning sexually transmitted infections (STIs) and acquired immune deficiency syndrome (AIDS) and evaluate recent behavioral changes with regard to condom use
- Collect data for the estimation of adult mortality and maternal mortality at the national level
- Take anthropometric measurements in half of surveyed households in order to evaluate the nutritional status of children, men, and women
- Conduct confidential testing for malaria parasitemia using Rapid Diagnostic Testing in half of the surveyed households and anonymous blood smear testing at the National Reference Laboratory
- Collect dried blood spots (from finger pricks) for anonymous HIV testing at the National Reference Laboratory in half of surveyed households
- Measure hemoglobin level (by finger prick) for anemia of surveyed respondents in half of surveyed households.

Geographic coverage
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National. The sample provides estimates at the national and provincial levels.

Analysis unit
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Household, adult woman, adult man

Kind of data
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Sample survey data

Sampling procedure
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The sample for the 2010 RDHS was designed to provide population and health indicator estimates for the country as a whole and for urban and rural areas in particular. Survey estimates are also reported for the provinces (South, West, North, and East) and for the City of Kigali. The results presented in this report show key indicators that correspond to these provinces and the City of Kigali.

A representative sample of 12,792 households was selected for the 2010 RDHS. The sample was selected in two stages. In the first stage, 492 villages (also known as clusters or enumeration areas) were selected with probability proportional to the village size. The village size is the number of households residing in the village. Then, a complete mapping and listing of all households existing in the selected villages was conducted. The resulting lists of households served as the sampling frame for the second stage of sample selection. Households were systematically selected from those lists for participation in the survey.

All women age 15-49 who were either permanent residents of the household or visitors present in the household on the night before the survey were eligible to be interviewed. In addition, in a subsample of half of all households selected for the survey, all men age 15-59 were eligible to be interviewed if they were either permanent residents or visitors present in the household on the night before the survey.

SAMPLING FRAME

The sampling frame used for the 2010 RDHS is the preparatory frame for the Rwanda General Population and Housing Census (RGPH), which will be conducted in 2012. Provided by the National Institute of Statistics of Rwanda (NISR), the sampling frame is a complete list of natural villages covering the entire country. Though it is preferable to work with a frame consisting of enumeration areas (EAs) because the natural villages are too variable in size, an EA frame is not available at the time of sampling design. The sampling frame that was available is the list of 14,837 natural villages, which contains the administrative characteristics for each village and village population. The village population comes from the national ID card project carried out in 2007-08, which may be under estimated compared with the population projection conducted in 2009 by NISR.

Rwanda's administrative units were reformed in 2006, so the country is currently divided into 5 provinces; 30 districts, 417 sectors, and 14,837 villages.The average village size is 610 residents, which is equivalent to 133 households. The sizes of the districts are quite homogeneous, varying from 2.7 percent to 4.4 percent. There is no urban-rural specification in the sampling frame because the urban-rural definition has not been released by the Ministry of Local Administration (MINALOC). It was expected that the urban-rural definition of the sampled villages will be determined during the data collection or in the office once the MINALOC releases the definition.

Mode of data collection
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Face-to-face

Research instrument
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Three questionnaires were used for the 2010 RDHS: the Household Questionnaire, the Woman’s Questionnaire, and the Man’s Questionnaire. They are based on questionnaires developed by the worldwide Demographic and Health Surveys (DHS) program and on questionnaires used during the 2005 RDHS and 2007-08 RIDHS surveys. To reflect relevant issues in population and health in Rwanda, the questionnaires were adapted during a series of technical meetings with various stakeholders from government ministries and agencies, nongovernmental organizations, and international donors. The questionnaires were translated from English and French into Kinyarwanda.

The Household Questionnaire was used to list all the usual members and visitors in the selected households as well as to identify women and men eligible for individual interviews. Basic information was collected on the characteristics of each person listed, including age, sex, education, and relationship to the head of household. For children under 18, survival status of the parents was determined. The Household Questionnaire also collected information on the following:
- Dwelling characteristics
- Utilization of health services and health expenditures for recent illness and injury
- Possession of iodized salt
- Possession and utilization of mosquito nets
- Height and weight of women and children
- Hemoglobin measurement of women and children
- Blood collection from women and children for rapid test and laboratory testing of malaria
- Blood collection from women and men for laboratory testing for HIV

The Woman’s Questionnaire was used to collect information from all women age 15-49 and was organized by the following sections:
- Respondent background characteristics
- Reproduction, including a complete birth and death history of respondents’ children and information on abortion
- Contraception
- Pregnancy and postnatal care
- Child’s immunization, health, and nutrition
- Marriage and sexual activity
- Fertility preferences
- Husband’s background and woman’s work
- HIV/AIDS and other sexually transmitted infections
- Other health issues
- Adult mortality
- Relationship in the household

The Man’s Questionnaire was administered to all men age 15-59 living in every other household in the RDHS sample. The Man’s Questionnaire collected much of the same information as the Woman’s Questionnaire but was shorter because it did not contain a detailed reproductive history or questions on maternal and child health or nutrition.

An instruction manual was also developed to support standardized data collection. All data collection instruments were pretested in June-July 2010. The observations and experiences gathered from the pretest were used to improve the instruments for the main survey data collection.

Cleaning operations
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Data entry began on November 1, 2010, almost one month after the survey was launched in the field. Data were entered by a team of 15 data processing personnel recruited and trained for this task. They were assisted during these operations by 4 data verification and codification officers and 2 receptionists. Completed questionnaires were periodically brought in from the field to the National Institute of Statistics headquarters, where assigned agents checked them and coded the open-ended questions. Next, the questionnaires were sent to the data entry facility and the blood samples (DBS and malaria slides) were sent to the NRL to be screened for HIV. Data were entered using CSPro, a program developed jointly by the United States Census Bureau, the ORC Macro MEASURE DHS+ program, and Serpro S.A. Processing the data concurrently with data collection allowed for regular monitoring of teams’ performance and data quality. Field check tables were regularly generated during data processing to check various data quality parameters. As a result, feedback was given on a regular basis, encouraging teams to continue their high quality work and to correct areas in need of improvement. Feedback was individually tailored to each team. Data entry, which included 100 percent double entry to minimize keying error and data editing, was completed on April 21, 2011. Data cleaning and finalization was completed on May 27, 2011.

Response rate
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All of the 492 clusters selected for the sample were surveyed for the 2010 RDHS. A total of 12,792 households were selected, of which 12,570 households were identified and occupied at the time of the survey. Among these households, 12,540 completed the Household Questionnaire, yielding a response rate of nearly 100 percent.

In the 12,540 households surveyed, 13,790 women age 15-49 were identified as being eligible for the individual interview; interviews were completed with 13,671 of these women, yielding a response rate of 99.1 percent. Male interviews were conducted in every second household. A total of 6,414 men age 15-59 were identified in the subsample of households. Of these 6,414 men, 6,329 completed the individual interviews, yielding a response rate of 98.7 percent.

The response rates were slightly higher in rural areas for men, while for women they were almost the same in rural and urban areas.

Sampling error estimates
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Sampling errors for the 2010 RDHS are calculated for selected variables considered to be of primary interest for women’s surveys and for men’s surveys, respectively. The results are presented in an appendix to the Final Report for the country as a whole, for the urban and the rural areas separately, and for each of the five provinces. For each variable, the type of statistic (mean, proportion, or rate) and the base population are given in Table B.1 of the Final Report. Tables B.2 to B.9 present the value of the statistic (R), its standard error (SE), the number of unweighted (N-UNWE) and weighted (N-WEIG) cases, the design effect (DEFT), the relative standard error (SE/R), and the 95 percent confidence limits (R±2SE), for each variable. The DEFT is considered undefined when the standard error considering simple random sample is zero (when the estimate is close to 0 or 1). In the case of the total fertility rate, the number of unweighted cases is not relevant, as there is no known unweighted value for woman-years of exposure to child-bearing.

摘要
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2010年卢旺达人口与健康调查（RDHS）旨在为监测卢旺达的人口与健康状况提供数据。2010年RDHS是卢旺达第五次进行的人口与健康调查。调查的目的是提供关于生育率、家庭计划、儿童死亡率、营养、母婴健康、家庭暴力、疟疾、孕产妇死亡率、对HIV/AIDS的认知和行为、HIV感染率、疟疾感染率和贫血感染率的最新信息。对12,540个家庭中的13,671名15至49岁的女性和12,540个家庭中的一半家庭中的6,329名15至59岁的男性进行了访谈。这代表了女性和男性的99%的响应率。该样本提供了全国和省级层面的估计。

2010年RDHS的主要目标包括：
- 收集全国层面的数据，以促进计算基本的人口统计指标，特别是生育率和婴儿及儿童死亡率，并分析决定生育率和儿童死亡率水平和趋势的直接和间接因素
- 测量女性对避孕实践知识的了解程度
- 收集关于家庭健康的数据，包括疫苗接种实践；5岁以下儿童中腹泻、急性上呼吸道感染、发热和/或抽搐的流行率和治疗情况；产前检查和分娩时的援助
- 收集关于疟疾的预防和治疗数据，特别是5岁以下儿童、女性和孕妇拥有和使用蚊帐的情况
- 收集关于儿童营养实践的数据，包括母乳喂养
- 收集关于男性和女性对性传播感染（STIs）和获得性免疫缺陷综合征（AIDS）的认知和态度的数据，并评估与避孕套使用相关的近期行为变化
- 收集数据以估计全国层面的成人死亡率和孕产妇死亡率
- 在一半的受访家庭中进行人体测量测量，以评估儿童、男性和女性的营养状况
- 在一半的受访家庭中使用快速诊断测试进行疟原虫症的保密检测，并在国家参考实验室进行匿名血涂片检测
- 在一半的受访家庭中收集干血斑（来自指尖穿刺）以在国家参考实验室进行匿名HIV检测
- 在一半的受访家庭中测量受访者的血红蛋白水平（通过指尖穿刺）以检测贫血

地理覆盖范围
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全国。样本提供了全国和省级层面的估计。

分析单位
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家庭、成年女性、成年男性

数据类型
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样本调查数据

抽样程序
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2010年RDHS的样本设计旨在为整个国家以及特定于城市和农村地区的人口和健康指标提供估计。调查估计还包括对省（南部、西部、北部和东部）和基加利市的报告。本报告中的结果展示了与这些省份和基加利市相对应的关键指标。

2010年RDHS的样本选择了12,792个家庭。样本选择分为两个阶段。在第一阶段，根据村庄规模以概率比例选择492个村庄（也称为集群或调查区域）。村庄规模是指村庄中居住的家庭数量。然后，对所选村庄中所有存在的家庭进行了完整的测绘和清单编制。结果产生的家庭清单成为样本选择第二阶段的选择框架。从这些清单中系统地选择了家庭以参与调查。

所有15-49岁的女性，无论是家庭的永久居民还是调查前夜在家庭中出现的访客，都有资格接受访谈。此外，在所有被选为调查的家庭的一半家庭中，如果男性是家庭的永久居民或调查前夜在家庭中出现的访客，则所有15-59岁的男性都有资格接受访谈。

抽样框架

2010年RDHS使用的抽样框架是2006年进行的卢旺达全国人口和住房普查（RGPH）的预备框架。由卢旺达国家统计局（NISR）提供，该抽样框架是覆盖整个国家的自然村庄的完整清单。虽然使用由调查区域（EAs）组成的框架更为可取，因为自然村庄的规模变化太大，但在抽样设计时没有EA框架。可用的抽样框架是包含每个村庄的行政特征和村庄人口的14,837个自然村庄的清单。村庄人口来自2007-08年进行的全国身份证项目，可能比2009年NISR进行的的人口预测低估。

卢旺达的行政单位在2006年进行了改革，因此该国目前分为5个省；30个区、417个部门以及14,837个村庄。平均村庄规模为610居民，相当于133个家庭。区的规模相当均匀，从2.7％到4.4％不等。抽样框架中没有城市-农村的指定，因为地方行政管理部（MINALOC）尚未发布城市-农村的定义。预计样本村庄的城市-农村定义将在数据收集期间或MINALOC发布定义后确定。

数据收集方式
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面对面

研究工具
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2010年RDHS使用了三个问卷：家庭问卷、女性问卷和男性问卷。它们基于全球人口与健康调查（DHS）项目开发的问卷，以及2005年RDHS和2007-08年RIDHS调查中使用的问卷。为了反映卢旺达人口与健康的相关问题，问卷在一系列与政府各部和机构、非政府组织以及国际捐助者等各方利益相关者的技术会议上进行了调整。问卷从英语和法语翻译成基卢瓦纳语。

家庭问卷用于列出所选家庭中的所有常驻成员和访客，以及确定有资格进行个别访谈的女性和男性。收集了关于列出每个人的特征的详细信息，包括年龄、性别、教育和与户主的关系。对于18岁以下的儿童，确定了父母的生存状况。家庭问卷还收集了以下信息：
- 居住环境特征
- 近期疾病和伤害的健康服务利用和医疗支出
- 碘盐的拥有情况
- 蚊帐的拥有和使用
- 女性和儿童的身高和体重
- 女性和儿童的血红蛋白测量
- 女性和儿童的血液采集用于快速测试和疟疾的实验室检测
- 女性和男性的血液采集用于HIV的实验室检测

女性问卷用于收集所有15-49岁女性的信息，并按以下部分组织：
- 受访者背景特征
- 再生产，包括受访者子女的完整出生和死亡史以及关于人工流产的信息
- 避孕
- 妊娠和产后护理
- 儿童免疫、健康和营养
- 婚姻和性行为
- 生育偏好
- 丈夫的背景和女性的工作
- HIV/AIDS和其他性传播感染
- 其他健康问题
- 成人死亡率
- 家庭关系

男性问卷用于对RDHS样本中每户的一半15-59岁男性进行访谈。男性问卷收集了与女性问卷类似的大量信息，但篇幅较短，因为没有包含详细的生育史或关于母婴健康或营养的问题。

还开发了一本操作手册以支持标准化的数据收集。所有数据收集工具在2010年6月至7月进行了预测试。从预测试中收集到的观察和经验用于改进主要调查数据收集的工具。

数据清理操作
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数据录入始于2010年11月1日，比调查在实地启动后近一个月。数据由15名数据处理人员录入，这些人员为此任务招募和接受了培训。在操作过程中，他们得到了4名数据验证和编码官员和2名接待员的协助。完成后的问卷定期从现场运送到国家统计局总部，指定的代理检查它们并编码开放式问题。接下来，问卷被送到数据录入设施，血液样本（DBS和疟疾涂片）被送到国家参考实验室进行HIV筛查。数据使用CSPro程序录入，该程序是由美国人口普查局、ORC Macro MEASURE DHS+项目和Serpro S.A.共同开发的。与数据收集同时处理数据允许定期监测团队的表现和数据质量。在数据处理过程中定期生成现场检查表，以检查各种数据质量参数。因此，定期提供了反馈，鼓励团队继续其高质量的工作，并纠正需要改进的领域。反馈针对每个团队个别定制。包括100％的双录入以最大限度地减少按键错误和数据编辑在内，数据录入于2011年4月21日完成。数据清理和最终确定于2011年5月27日完成。

响应率
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为2010年RDHS调查的所有492个集群进行了调查。共选择了12,792个家庭，其中12,570个家庭在调查时被识别和占用。在这些家庭中，12,540个家庭完成了家庭问卷，几乎达到了100％的响应率。

在调查的12,540个家庭中，确定了13,790名15-49岁的女性有资格进行个别访谈；对其中13,671名女性进行了访谈，响应率为99.1％。每户的一半进行了男性访谈。在RDHS样本的一半家庭中，确定了6,414名15-59岁的男性。在这些6,414名男性中，6,329名完成了个别访谈，响应率为98.7％。农村地区的男性响应率略高，而女性的响应率在农村和城市地区几乎相同。

抽样误差估计
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2010年RDHS的抽样误差按对女性调查和男性调查分别具有主要兴趣的选定变量计算。结果以国家整体、城市和农村地区分别以及五个省份之一的附录形式呈现。对于每个变量，统计量的类型（均值、比例或比率）和基人口在最终报告的表B.1中给出。表B.2至B.9展示了统计量（R）的值、其标准误差（SE）、未加权（N-UNWE）和加权（N-WEIG）案例的数量、设计效应（DEFT）、相对标准误差（SE/R）和95％置信限（R±2SE），对于每个变量。当考虑简单随机样本的标准误差为零时，DEFT被视为未定义（当估计接近0或1时）。在总生育率的情况下，未加权案例的数量不相关，因为没有已知的女性生育年的未加权值。