Demographic and Health Survey 2014 - Ghana

Abstract
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The primary objective of the 2014 GDHS was to generate recent reliable information on fertility, family planning, infant and child mortality, maternal and child health, and nutrition. In addition, the survey collected specialised data on malaria treatment, prevention, and prevalence among children age 6-59 months; blood pressure among adults; anaemia among women and children; and HIV prevalence among adults. This information is essential for making informed policy decisions and for planning, monitoring, and evaluating programmes related to health in general, and reproductive health in particular, at both the national and regional levels. Analysis of data collected in the 2014 GDHS provides updated estimates of basic demographic and health indicators covered in the earlier rounds of the 1988, 1993, 1998, 2003, and 2008 surveys.

The GDHS will assist policymakers and programme managers in evaluating and designing programmes and strategies for improving the health of Ghana’s population. The 2014 GDHS also provides comparable data for long-term trend analysis in Ghana, since the surveys were implemented by the same organisation, using similar data collection procedures. Furthermore, the survey adds to the international database on demographic and health–related information for research purposes.

Geographic coverage
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National

Analysis unit
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- Household
- Individual
- Children age 0-5
- Children age 4-15
- 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 sampling frame used for the 2014 GDHS is an updated frame from the 2010 Ghana Population and Housing Census provided by the Ghana Statistical Service (GSS 2013b). The sampling frame excluded nomadic and institutional populations such as persons in hotels, barracks, and prisons.

The 2014 GDHS followed a two-stage sample design and was intended to allow estimates of key indicators at the national level as well as for urban and rural areas and each of Ghana's 10 administrative regions. The first stage involved selecting sample points (clusters) consisting of enumeration areas (EAs) delineated for the 2010 PHC. A total of 427 clusters were selected, 216 in urban areas and 211 in rural
areas.

The second stage involved the systematic sampling of households. A household listing operation was undertaken in all the selected EAs in January-March 2014, and households to be included in the survey were randomly selected from the list. About 30 households were selected from each cluster to constitute the total sample size of 12,831 households. Because of the approximately equal sample sizes in each region, the sample is not self-weighting at the national level, and weighting factors have been added to the data file so that the results will be proportional at the national level.

All women age 15-49 who were either permanent residents of the selected households or visitors who stayed in the household the night before the survey were eligible to be interviewed and have their blood pressure measured.

In half of the households, all men age 15-59 who were either permanent residents of the selected households or visitors who stayed in the households the night before the survey were eligible to be interviewed. In addition, in the subsample of households selected for the male survey:
• blood pressure measurements were performed among eligible men who consented to being tested;
• children age 6-59 months were tested for anaemia and malaria with the parent's or guardian's consent;
• eligible women who consented were tested for anaemia;
• blood samples were collected for laboratory testing of HIV from eligible women and men who consented; and
• height and weight information was collected from eligible women, men, and children age 0- 59 months.

For further details on sample selection, see Appendix A of the final report.

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

Research instrument
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Three questionnaires were used for the 2014 GDHS: the Household Questionnaire, the Woman’s Questionnaire, and the Man’s Questionnaire. These questionnaires, which were based on standard Demographic and Health Survey (DHS) questionnaires, were adapted to reflect the population and health issues relevant to Ghana. Comments on the questionnaires were solicited from various stakeholders representing government ministries and agencies, nongovernmental organisations, and international donors. The definitive questionnaires were first prepared in English; they were then translated into the major local languages, namely Akan, Ga, and Ewe.

The Household Questionnaire was used to list all the members of and visitors to the selected households. Basic demographic information was collected on the characteristics of each person listed, including his or her age, sex, marital status, education, and relationship to the head of the household. For children under age 18, parents’ survival status was determined. The data on age and sex of household members obtained in the Household Questionnaire were used to identify women and men who were eligible for individual interviews. The Household Questionnaire also included questions on child education as well as the characteristics of the household’s dwelling unit, such as source of water, type of toilet facilities, materials used for the floor of the dwelling unit, and ownership of various durable goods.

The Woman’s Questionnaire was used to collect information from all eligible women age 15-49.

In half of the selected households, the Man’s Questionnaire was administered to all men age 15-59. The Man’s Questionnaire collected much of the same information found in the Woman’s Questionnaire but was shorter because it did not contain a detailed reproductive history or questions on maternal and child health.

Cleaning operations
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The data processing operation included 100 percent verification (also called second data entry) and secondary editing, which involved resolution of computer-identified inconsistencies. The data processing activities at the central office were led by one key GSS officer who took part in the main fieldwork training. Data processing was accomplished using CSPro software. Data entry and editing were initiated in September 2014 and completed in February 2015.

Response rate
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A total of 12,831 households were selected for the sample, of which 12,010 were occupied. Of the occupied households, 11,835 were successfully interviewed, yielding a response rate of 99 percent, the same as the 2008 GDHS household response rate (GSS, GHS, and ICF Macro 2009).

In the interviewed households, 9,656 eligible women were identified for individual interviews; interviews were completed with 9,396 women, yielding a response rate of 97 percent. In the subsample of households selected for the male survey, 4,609 eligible men were identified and 4,388 were successfully interviewed, yielding a response rate of 95 percent. The lower response rate for men was likely due to their more frequent and longer absences from the household.

Sampling error estimates
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The estimates from a sample survey are affected by two types of errors: non-sampling errors and sampling errors. Non-sampling 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 2014 Ghana DHS (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 evaluated statistically. The sample of respondents selected in the 2014 GDHS 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.

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 2014 GDHS sample is the result of a multi-stage stratified design, and, consequently, it was necessary to use more complex formulae. Sampling errors are computed in either ISSA or SAS, using programs developed by ICF International. These programs use the Taylor linearization method of variance estimation for survey estimates that are means, proportions or ratios. 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.

Note: A more detailed description of estimate of sampling error is presented 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
- 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
- Nutritional status of children based on the NCHS/CDC/WHO International Reference Population

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

摘要
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2014年GDHS（加纳人口与健康调查）的主要目标是生成关于生育、家庭规划、婴儿和儿童死亡率、孕产妇健康和营养的最新可靠信息。此外，调查还收集了关于6-59个月龄儿童疟疾治疗、预防和流行情况；成人血压；妇女和儿童贫血；以及成人HIV流行情况的专业数据。这些信息对于制定明智的政策决策，以及在国家及地区层面规划、监控和评估与公共卫生，尤其是生殖健康相关的项目至关重要。对2014年GDHS收集的数据进行分析，提供了关于1988年、1993年、1998年、2003年和2008年调查中涵盖的基本人口和健康指标的更新估计。
GDHS将协助政策制定者和项目管理者评估和设计旨在改善加纳人口健康的计划和策略。2014年GDHS还提供了加纳长期趋势分析的可比数据，因为这些调查由同一机构实施，使用了类似的数据收集程序。此外，该调查还为国际人口与健康相关信息的数据库增添了内容，以供研究之用。
地理覆盖范围
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全国
分析单元
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- 家庭
- 个人
- 0-5岁儿童
- 4-15岁儿童
- 15-49岁妇女
- 15-59岁男性
数据类型
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样本调查数据 [ssd]
抽样程序
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2014年GDHS使用的抽样框架是来自2010年加纳人口和住房普查的更新框架，由加纳统计服务（GSS 2013b）提供。抽样框架排除了游牧民族和机构人口，例如酒店、军营和监狱中的人员。
2014年GDHS遵循两阶段抽样设计，旨在允许估计国家层面、城市和农村地区以及加纳的10个行政区域的关键指标。第一阶段涉及选择样本点（聚类），包括为2010年PHC划定的普查区。共选择了427个聚类，其中216个位于城市地区，211个位于农村地区。
第二阶段涉及对家庭的系统抽样。在2014年1月至3月对所选的普查区进行了家庭清单操作，并从清单中随机选择了要纳入调查的家庭。每个聚类中大约选择了30个家庭，以构成12,831户家庭的总样本量。由于每个地区的样本量大致相等，因此样本在国家层面不是自加权，数据文件中已添加了加权因子，以确保结果在国家层面是成比例的。
所有15-49岁的妇女，无论是所选家庭的永久居民还是前一天晚上在家庭过夜的访客，都有资格接受访谈并测量血压。
在所选家庭中的一半，15-59岁的所有男性，无论是所选家庭的永久居民还是前一天晚上在家庭过夜的访客，都有资格接受访谈。此外，在为男性调查选择的子样本家庭中：
• 对同意接受测试的合格男性进行了血压测量；
• 在家长或监护人的同意下，对6-59个月龄的儿童进行了贫血和疟疾测试；
• 在同意的合格妇女中进行了贫血测试；
• 从同意的合格妇女和男性中收集了血液样本，以供实验室进行HIV检测；
• 从合格的妇女、男性和0-59个月龄的儿童中收集了身高和体重信息。
有关样本选择的进一步详细信息，请参阅最终报告的附录A。
数据收集方式
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面对面 [f2f]
研究工具
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2014年GDHS使用了三个问卷：家庭问卷、妇女问卷和男性问卷。这些问卷基于标准的人口与健康调查（DHS）问卷，并根据加纳的人口和健康问题进行了调整。从代表政府部
门和机构、非政府组织和国际捐助者的各个利益相关者那里征求了对问卷的评论。最终问卷首先用英语准备；然后翻译成主要的地方语言，即阿坎语、加语和依维语。
家庭问卷用于列出所选家庭的成员和访客。收集了关于列出的每个人的基本人口信息，包括其年龄、性别、婚姻状况、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。家庭问卷中获得的家庭成员年龄和性别数据用于确定有资格进行个人访谈的妇女和男性。家庭问卷还包括有关儿童教育和家庭住宅单元特征的问题，例如水源、厕所设施类型、住宅单元地板使用的材料以及各种耐用商品的拥有权。
妇女问卷用于收集所有有资格的15-49岁妇女的信息。
在所选家庭的一半中，对15-59岁的所有男性进行了男性问卷。男性问卷收集了与妇女问卷中找到的大部分相同的信息，但由于它不包含详细的生育史或关于孕产妇健康的问题，因此较短。
数据清理操作
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数据处理操作包括100％的验证（也称为第二次数据录入）和二级编辑，涉及解决计算机识别的不一致性。中央办公室的数据处理活动由一位关键GSS官员领导，该官员参与了主要实地工作培训。数据处理使用CSPro软件完成。数据录入和编辑始于2014年9月，并于2015年2月完成。
应答率
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共选择了12,831户家庭作为样本，其中12,010户有人居住。在有人居住的家庭中，11,835户成功接受了访谈，应答率为99％，与2008年GDHS的家庭应答率相同（GSS，GHS和ICF Macro 2009）。
在受访的家庭中，确定了9,656名有资格的妇女进行个人访谈；完成了9,396名妇女的访谈，应答率为97％。在为男性调查选择的子样本家庭中，确定了4,609名有资格的男性，其中4,388名成功接受了访谈，应答率为95％。男性应答率较低可能是由于他们更频繁且更长时间的离家。
抽样误差估计
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样本调查的估计受到两种类型误差的影响：非抽样误差和抽样误差。非抽样误差是由于在实施数据收集和数据处理过程中出现的错误造成的，例如未能找到并访谈正确的家庭、访谈员或受访者对问题的误解，以及数据录入错误。尽管在实施2014年加纳DHS（GDHS）期间做出了众多努力以最大限度地减少此类错误，但非抽样误差是无法避免且难以进行统计评估的。
另一方面，抽样误差可以通过统计方法进行评估。2014年GDHS中选定的受访者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。这些样本中的每一个都会产生与实际选定的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指标。虽然变异程度并不完全清楚，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，它是方差的平方根。标准误差可用于计算置信区间，其中可以合理地假定真实值位于该区间内。例如，对于从样本调查中计算出的任何给定统计量，该统计量的值将在95％的所有可能样本中落在该统计量的标准误差的两倍范围内。
如果受访者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，2014年GDHS样本是多层次分层设计的产物，因此有必要使用更复杂的公式。抽样误差使用ICF国际开发的程序在ISSA或SAS中计算，这些程序使用泰勒线性化方法进行方差估计，以估计调查估计的均值、比例或比率。对于更复杂的统计量，如生育率和死亡率，使用Jackknife重复复制方法进行方差估计。
泰勒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代表考虑中的组或子组的总案例数。
注：关于抽样误差估计的更详细描述请参阅调查报告的附录B。
数据评估
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数据质量表
- 家庭年龄分布
- 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性年龄分布
- 报告的完整性
- 按日历年出生情况
- 死亡年龄报告（以天为单位）
- 死亡年龄报告（以月为单位）
- 基于NCHS/CDC/WHO国际参考人群的儿童营养状况
注：请参阅报告附录C中的详细数据质量表。