Interim Demographic and Health Survey 2007-2008 - Rwanda

Abstract
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Rwanda Interim Demographic and Health Survey (RIDHS) follows the Demographic and Health Surveys (RDHS) that were successfully conducted in 1992, 2000, and 2005, and is part of a broad, worldwide program of socio-demographic and health surveys conducted in developing countries since the mid-1980s. RIDHS collected the indicators on fertility, family planning and maternal and child health which the survey normally provides. In addition, RIDHS integrated a malaria module and tests for the prevalence of malaria and anemia among women and children, thus determining the prevalence of malaria and anemia for women and children at the national level.

The main objectives of the RIDHS were:
• At the national level, gather data to determine demographic rates, particularly fertility and infant and child mortality rates, and analyze the direct and indirect factors that determine fertility and child mortality rates and trends.
• Evaluate the level of knowledge and use of contraceptives among women and men.
• Gather data concerning family health: vaccinations; prevalence and treatment of diarrhea, acute respiratory infections (ARI), and fever in children under the age of five; antenatal care visits; and assistance during childbirth.
• Gather data concerning the prevention and treatment of malaria, particularly the possession and use of mosquito nets, and the prevention of malaria in pregnant women.
• Gather data concerning child feeding practices, including breastfeeding.
• Gather data concerning circumcision among men between the ages of 15 and 59.
• Collect blood samples in all of the households surveyed for anemia testing of women age 15-49, pregnant women and children under age five.
• Collect blood samples in all of the households surveyed for hemoglobin and malaria diagnostic testing of women age 15 to 49, pregnant women and children under age five.

Geographic coverage
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National coverage

Analysis unit
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Household
Individual
Woman age 15-49
Man age 15-59

Kind of data
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Sample survey data [ssd]

Sampling procedure
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The sample for the RIDHS is a two-stage stratified area sample. Clusters are the primary sampling units and are constituted from enumeration areas (EA). The EA were defined in the 2002 General Population and Housing Census (RGPH) (SNR, 2005).

These enumeration areas provided the master frame for the drawing of 250 clusters (187 rural and 63 urban), selected with a representative probability proportional to their size. Only 249 of these clusters were surveyed, because one cluster located in a refugee camp had to be eliminated from the sample. A strictly proportional sample allocation would have resulted in a very low number of urban households in certain provinces. It was therefore necessary to slightly oversample urban areas in order to survey a sufficient number of households to produce reliable estimates for urban areas. The second stage involved selecting a sample of households in these enumeration areas. In order to adequately guarantee the accuracy of the indicators, the total number drawn was limited to 30 households per cluster. Because of the nonproportional distribution of the sample among the different strata and the fact that the number of households was set for each cluster, weighting was used to ensure the validity of the sample at both national and provincial levels.

All women age 15-49 years who were either usual residents of the selected household or visitors present in the household on the night before the survey were eligible to be interviewed (7,528 women). In addition, a sample of men age 15-59 who were either usual residents of the selected household or visitors present in the household on the night before the survey were eligible for the survey (7,168 men). Finally, all women age 15-49 and all children under the age of five were eligible for the anemia and malaria diagnostic tests.

The sample for the 2007-08 RIDHS covered the population residing in ordinary households across the country. A national sample of 7,469 households (1,863 in urban areas and 5,606 in rural areas) was selected. The sample was first stratified to provide adequate representation from urban and rural areas as well as all the four provinces and the city of Kigali, the nation’s capital.

Sampling deviation
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One cluster located in a refugee camp had to be eliminated from the sample.

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

Research instrument
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Three questionnaires were used in the 2007-08 RIDHS: the Household Questionnaire, the Women’s Questionnaire, and the Men’s Questionnaire. The content of these questionnaires was based on model questionnaires developed by the MEASURE DHS project.

Initial technical meetings that were held beginning in September 2007 allowed a wide range of government agencies as well as local and international organizations to contribute to the development of the questionnaires. Based on these discussions, the DHS model questionnaires were modified to reflect the needs of users and relevant issues in population, family planning, anemia, malaria and other health concerns in Rwanda. The questionnaires were then translated from French into Kinyarwanda. These questionnaires were finalized in December 2007 before the training of male and female interviewers.

The Household Questionnaire was used to list all of the usual members and visitors in the selected households. In addition, 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 main purpose of the Household Questionnaire was to identify women and men who were eligible for the individual interview. The Household Questionnaire also collected information on characteristics of the household’s dwelling unit such as the main source of drinking water, type of toilet facilities, materials used for the floor of the house, the main energy source used for cooking and ownership of various durable goods. Finally, the Household Questionnaire was also used to identify women and children eligible for the hemoglobin (anemia) and malaria diagnostic tests.

The Women’s Questionnaire was used to collect information on women of reproductive age (15-49 years) and covered questions on the following topics:
• Background characteristics
• Marital status
• Birth history
• Knowledge and use of family planning methods
• Fertility preferences
• Antenatal and delivery care
• Breastfeeding practices
• Vaccinations and childhood illnesses

The Men’s Questionnaire was administered to all men age 15-59 years living in the selected households. The Men’s Questionnaire collected information similar to that of the Women’s Questionnaire, with the only difference being that it did not include birth history or questions on maternal and child health or nutrition. In addition, the Men’s Questionnaire also collected information on circumcision.

Cleaning operations
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Data entry began on January 7, 2008, three weeks after the beginning of data collection activities in the field. Data were entered by a team of five data processing personnel recruited and trained by staff from ICF Macro. The data entry team was reinforced during this work with an additional staffer. Completed questionnaires were periodically brought in from the field to the National Institute of Statistics in Kigali, where assigned staff checked them and coded the open-ended questions. Next, the questionnaires were sent to the data entry staff. Data were entered using CSPro, a program developed jointly by the United States Census Bureau, the ICF Macro MEASURE DHS program, and Serpro S.A. All questionnaires were entered twice to eliminate as many data entry errors as possible from the files. In addition, a quality control program was used to detect data collection errors for each team. This information was shared with field teams during supervisory visits to improve data quality. The data entry and internal consistency verification phase of the survey was completed on May 14, 2008.

Response rate
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The response rate was high for both men (95.4 percent) and women (97.5 percent).

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 2007-08 RIDHS 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 2007-08 RIDHS 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 2007-08 RIDHS sample is the result of a multistage stratified design, and, consequently, it was necessary to use more complex formula. The computer software used to calculate sampling errors for the 2007-08 RIDHS is a macro SAS procedure. This procedure used the Taylor linearization 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.

The Taylor linearization method 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.

Refer to Appendix B in the final report for details of estimates of sampling errors.

Data appraisal
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The following data quality tables are produced:
- Age distribution of household population
- Age distribution of eligible and interviewed women
- Age distribution of eligible and interviewed men
- Completeness of reporting
- Births by calendar years
- Reporting of age at death in days
- Reporting of age at death in months

See the tables in Appendix C of the final report.

摘要
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卢旺达临时人口与健康调查（RIDHS）继1992年、2000年和2005年成功开展的调查之后，成为自1980年代中期以来在发展中国家开展的广泛、全球性社会人口与健康调查项目的一部分。RIDHS收集了调查通常提供的生育率、家庭计划以及母婴健康等指标。此外，RIDHS整合了疟疾模块和针对妇女和儿童疟疾及贫血患病率的检测，从而确定了全国范围内妇女和儿童的疟疾及贫血患病率。
RIDHS的主要目标包括：
• 在国家层面，收集数据以确定人口统计数据，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的直接和间接因素及其趋势。
• 评估妇女和男子对避孕知识的掌握程度及其使用情况。
• 收集有关家庭健康的资料：疫苗接种；5岁以下儿童腹泻、急性呼吸道感染（ARI）和发热的患病率和治疗情况；产前护理访问以及分娩时的援助。
• 收集有关疟疾的预防和治疗资料，特别是蚊帐的拥有和使用情况，以及孕妇疟疾的预防。
• 收集有关儿童喂养习惯的资料，包括母乳喂养。
• 收集有关15至59岁男性割礼的资料。
• 在所有调查的家庭中收集15至49岁妇女、孕妇及5岁以下儿童的血液样本，用于贫血检测。
• 在所有调查的家庭中收集15至49岁妇女、孕妇及5岁以下儿童的血液样本，用于血红蛋白和疟疾诊断检测。
地理覆盖范围
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全国覆盖
分析单元
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家庭
个体
15至49岁妇女
15至59岁男子
数据类型
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样本调查数据 [ssd]
抽样程序
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RIDHS的样本为两阶段分层区域样本。聚类是主要抽样单元，由统计区域（EA）构成。EA是在2002年的人口与住房普查（RGPH）中定义的。
这些统计区域为绘制250个聚类（187个农村和63个城市）提供了主框架，这些聚类以与其规模成比例的代表性概率被选中。由于一个位于难民营的聚类必须从样本中剔除，因此只有249个聚类被调查。严格按比例的样本分配会导致某些省份城市家庭的数量非常低。因此，有必要稍微增加城市地区的抽样比例，以便调查足够数量的家庭，以产生可靠的城市地区估计。
第二阶段涉及在这些统计区域中选择家庭样本。为了充分保证指标准确性，每个聚类抽取的总数限制为30户。由于样本在不同层中的非比例分配以及每个聚类中家庭数量的设定，因此使用了加权来确保样本在国家及省级层面的有效性。
所有15至49岁的妇女，无论是否为所选家庭的常住居民或调查前夜在家庭中出现的访客，均有资格接受访谈（7,528名妇女）。此外，15至59岁的男子，无论是否为所选家庭的常住居民或调查前夜在家庭中出现的访客，均有资格接受调查（7,168名男子）。最后，所有15至49岁的妇女和所有5岁以下的儿童均有资格接受贫血和疟疾诊断测试。
2007-08年RIDHS的样本涵盖了全国普通家庭中的居民。一个全国性的7,469户家庭的样本（城市地区1,863户，农村地区5,606户）被选中。样本首先分层，以确保城市和农村地区以及所有四个省份和首都基加利得到充分的代表性。
抽样偏差
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一个位于难民营的聚类必须从样本中剔除。
数据收集方式
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面对面 [f2f]
研究工具
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2007-08年RIDHS使用了三个问卷：家庭问卷、妇女问卷和男子问卷。这些问卷的内容基于MEASURE DHS项目开发的模型问卷。
从2007年9月开始举行的初步技术会议允许广泛的政府机构以及地方和国际组织为问卷的开发做出贡献。根据这些讨论，DHS模型问卷被修改以反映用户的需求以及卢旺达人口、家庭计划、贫血、疟疾以及其他健康问题相关的问题。然后，问卷从法语翻译成基卢瓦纳语。这些问卷于2007年12月最终确定，在男性和女性访谈员的培训之前完成。
家庭问卷用于列出所选家庭的所有常住成员和访客。此外，还收集了所列每个人的基本特征信息，包括年龄、性别、教育和与户主的关系。家庭问卷的主要目的是确定有资格接受个人访谈的妇女和男子。家庭问卷还收集了有关家庭居住单元特征的资料，如饮用水的主要来源、厕所设施的类型、房屋地板使用的材料、烹饪使用的主要能源以及各种耐用商品的拥有情况。最后，家庭问卷还用于确定有资格接受血红蛋白（贫血）和疟疾诊断测试的妇女和儿童。
妇女问卷用于收集关于育龄妇女（15-49岁）的信息，并涵盖了以下主题：
• 背景特征
• 婚姻状况
• 出生史
• 家庭计划方法的认知和使用
• 生育偏好
• 产前和分娩护理
• 母乳喂养实践
• 疫苗接种和儿童疾病
男子问卷适用于所有居住在所选家庭中的15-59岁男子。男子问卷收集的信息与妇女问卷类似，唯一的区别是不包括出生史或关于母亲和儿童健康或营养的问题。此外，男子问卷还收集了割礼的信息。
数据清理操作
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数据录入于2008年1月7日开始，比数据收集活动开始后的三周还要晚。数据由ICF Macro的员工招聘和培训的五名数据处理人员录入。在此工作中，数据录入团队增加了一名额外的工作人员。完成后的问卷定期从现场带到基加利的国家统计局，由指定的工作人员进行检查并编码开放式问题。接下来，问卷被发送到数据录入人员处。数据使用CSPro程序录入，该程序由美国人口普查局、ICF Macro MEASURE DHS项目以及Serpro S.A.共同开发。所有问卷都录入两次，以最大限度地减少文件中的数据录入错误。此外，还使用质量控制程序检测每个团队的数据收集错误。这些信息在监督访问期间与现场团队分享，以提高数据质量。调查的数据录入和内部一致性验证阶段于2008年5月14日完成。
应答率
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男性和女性的应答率都很高（男子为95.4%，妇女为97.5%）。
抽样误差估计
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样本调查的估计受到两种类型的误差的影响：（1）非抽样误差，和（2）抽样误差。非抽样误差是实施数据收集和数据处理过程中所犯错误的结果，例如未能找到和访谈正确的家庭、访谈员或受访者的误解，以及数据录入错误。尽管在实施2007-08年RIDHS过程中做出了大量努力以最大限度地减少此类误差，但非抽样误差是不可避免的，并且难以从统计上进行评估。
另一方面，抽样误差可以统计评估。2007-08年RIDHS中选定的受访者样本只是从同一人口中选出的许多样本之一，使用相同的设计和预期规模。这些样本中的每一个都会产生与实际选定样本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一种度量。虽然差异的程度并不完全清楚，但可以从调查结果中估计出来。
抽样误差通常以特定统计量（平均值、百分比等）的标准误差来衡量，这是方差的平方根。标准误差可用于计算置信区间，在此区间内可以合理地假定真实值。
例如，对于从样本调查计算出的任何给定统计量，该统计量的值将在95%的所有可能样本的相同大小和设计范围内，正负两倍标准误差之间。
如果受访者的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，2007-08年RIDHS的样本是多重阶段分层设计的产物，因此有必要使用更复杂的公式。用于计算2007-08年RIDHS抽样误差的计算机软件是一个SAS宏过程。该过程使用Taylor线性化方法估计调查估计的方差，对于均值或比例等统计量。对于生育率和死亡率等更复杂的统计量的方差估计，使用Jackknife重复复制方法。
Taylor线性化方法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代表考虑中的群体或子群体中的总案例数。
请参阅最终报告中附录B的抽样误差估计的详细信息。
数据评估
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以下数据质量表被生成：
- 家庭人口年龄分布
- 有资格和接受访谈的妇女年龄分布
- 有资格和接受访谈的男子年龄分布
- 报告的完整性
- 按日历年份的出生数
- 报告的死亡年龄（以天为单位）
- 报告的死亡年龄（以月为单位）
请参阅最终报告中附录C的表格。