Demographic Maternal and Child Health Survey 1991-1992 - Yemen, Rep.

Abstract
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The Yemen Demographic and Maternal and Child Health Survey (YDMCHS) is the first national survey conducted in Yemen since unification of the country. It was designed to collect data on households, ever-married women of reproductive age, and children under age five. The subjects covered in the household survey were: characteristics of households, housing and living conditions, school enrollment, labor force participation, general mortality, disability, fertility, and child survival. The areas covered in the survey of women of reproductive age were: demographic and socioeconomic characteristics, marriage and reproductive history, fertility regulation and preferences, antenatal care, breastfeeding, and child care. For children under five in the survey, the topics included diarrheal and other morbidity, nutritional supplementation, accidents, vaccination, and nutritional status.

The survey was carried out as a part of the DHS program and also the PAPCHILD program. The DHS program is assisting governments and private agencies in the implementation of household surveys in developing countries; PAPCHILD has similar goals for developing countries in the Arab League. The main objectives of the DHS project are to: (a) provide decision makers with a data base and analyses useful for informed policy choices, (b) expand the international population and health data base, (c) advance survey methodology, and (d) develop skills and resources necessary to conduct high quality demographic and health surveys in the participating countries.

The YDMCHS was specifically aimed at furnishing information on basic population and household characteristics, maternal and child health, fertility, family planning, and infant and child mortality in Yemen. The survey also presents information on breastfeeding practices and the nutritional status of children under age five. The survey will provide policymakers and planners with important information for use in formulating programs and policies regarding maternal and child health, child mortality, and reproductive behavior.

Geographic coverage
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National

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

Kind of data
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Sample survey data

Sampling procedure
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SAMPLE DESIGN AND IMPLEMENTATION

The YDMCHS sample was designed to enable data analysis for Yemen as a whole, and separately for urban and rural areas, and for two regions: (1) the Northern and Western governorates, and (2) the Southern and Eastern governorates. The target sample was set at completed interviews for about 12,000 households with about 6,000 eligible women. No target number was fixed for children under five, for whom information was to be collected for all children in each household that was selected for the women's interview. In half of the selected households, only the Household Questionnaire was administered; in the other half, in addition to administering the Household Questionnaire, all eligible women were interviewed and information on eligible children was collected.

The YDMCHS covered the entire country, except for nomadic peoples and those living on hard-to-reach Yemeni islands. The survey adopted a stratified, multi-stage sampling design. The sample was stratified by urban and rural areas in the two regions. In this report, the Northern and Western governorates region includes: Sana'a City and the governorates of Sana'a, Taiz, Hodeidah, lbb, Dhamar, Hajjah, A1-Beida, Sa'adah, AI-Mahweet, Ma'areb, and AI-Jawf. The Southern and Eastern governorates region consists of Aden, Laheg, Abyen, Shabwah, Hadramout, and AI-Mahrah govemoratcs. In the first stage, sampling units or clusters were selected; the second stage involved selection of households. The initial objective of having a self-weighted sample was compromised in order to have reliable estimates for urban and rural areas within each region. Sana'a City, the urban (not rural) areas of Aden, and the rural areas of Laheg were oversampled.

For the survey, 258 sampling units were selected, which contained 13,712 households. In half of the selected households, only the Household and Housing Characteristics Questionnaires were administered. In the other half, the Women's and Child's Questionnaires were also administered to all eligible women and children.

Note: See detailed description of sample design in APPENDIX B of the final survey report.

Mode of data collection
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Face-to-face

Research instrument
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Design, Preparation and Revision of Questionnaires

The YDMCHS survey includes the following questionnaires:
- Household Questionnaire
- Housing Characteristics Questionnaire
- Reproductive Health Questionnaire (also called the Women's Questionnaire
- Child Health Questionnaire (also called the Children's Questionnaire)
- Community Questionnaire

The items included in these questionnaires were selected after reviewing similar surveys such as those carried out by the Pan Arab Project for Child Development (PAPCHILD), which was sponsored by the Arab League Organization, and the model questionnaires of the Demographic and Health Surveys (DHS) in Calverton, Maryland, USA. The final YDMCHS questionnaires were mainly based on PAPCHILD's model questionnaires. The questionnaires were modified to suit the conditions of Yemen society and to meet the information requirements of the country. A large number of questions were included in the YDMCHS questionnaires in order to obtain as much information as possible on demographic and population dynamics, health and environmental issues, other indicators of standards of living, housing conditions, maternal and child health, and characteristics of local communities regarding provision of health services. English versions of the questionnaires (except the Community Questionnaire) are reproduced in Appendix E.

The Household Questionnaire consists of a household roster, including questions on orphan hood, education level and economic activity of household members. It also collects information on general mortality, disability and, for ever-married women under age 55, information on fertility and child survival.

The Housing Characteristics Questionnaire was administered as pan of the household survey. It includes eight sections: housing, cooking, water, lighting, sanitation, and waste disposal, ownership of objects and assets, and drainage.

The YDMCHS Women's Questionnaire or Reproductive Health Questionnaire consists of nine sections:
- Respondent's background
- Marriage and co-residence
- Reproduction and child survival
- Antenatal care: current pregnancy
- Maternal care: the last five years
- Child feeding
- Cause of death for children who died
- Family planning and childbearing attitudes
- Husband's background

The Child Health Questionnaire, which is also referred to as Children's Questionnaire, consists of six sections:
- General child care
- Morbidity: diarrhea
- Morbidity: other illnesses
- Immunization
- Weight and height

Cleaning operations
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Editing and Coding

Data preparation began one week after the start of fieldwork and continued simultaneously with the fieldwork activities. Field editors checked the questionnaires for completeness and consistency. Field supervisors also checked completed questionnaires on a sample basis. Completed questionnaires were then sent to the central office in Sana'a or brought by staff when they returned after visiting the teams. In the central office in Sana'a the questionnaires were edited again, and open-ended and other questions requiring coding were coded. This stage started on 22 November 1991 and was completed by the end of January 1992.

Response rate
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Of the 13,712 households selected for inclusion in the survey, 13,206 were found and 12,836, or 97 percent, were successfully interviewed. In all, 6,150 ever-married women age 15-49 years were identified in the households selected for individual interviews. Of these, 5,687 women were successfully interviewed and information was collected for 6,715 of 7,022 eligible children under five. The response rates for eligible women and children are 93 and 96 percent, respectively. The response rates for urban and rural areas are almost the same. The main reason for not completing some household interviews was that the dwellings were vacant at the time of fieldwork, although they were occupied when the household listing was carried out. The principal reason for non-response in the case of eligible women was that respondents were not at home despite repeated visits by interviewers to the selected households.

Note: See summarized response rates by place of residence in Table 1.1 of the final survey report.

Sampling error estimates
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The results from sample surveys are affected by two types of errors, non-sampling error and sampling error. Non-sampling error is due to mistakes made in carrying out field activities, such as failure to locate and interview the correct household, errors in the way the questions are asked, misunderstanding on the part of either the interviewer or the respondent, data entry errors, etc. Although efforts were made during the design and implementation of the YDMCHS 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 measured statistically. The sample of women selected in the YDMCHS is only one of many samples that could have been selected from the same population, using the same design and expected size. Each one would have yielded results that differed somewhat from the actual sample selected. The sampling error is a measure of the variability between all possible samples; although it is not known exactly, it can be estimated from the survey results.

Sampling error is usually measured in terms of standard error of 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 one can reasonably be assumed that, apart from non-sampling errors, the true value of the variable for the whole population falls. For example, for any given statistic calculated from a sample survey, the value of that same statistic as measured in 95 percent of all possible samples with the same design (and expected size) will fall within a range of plus or minus two times the standard error of that statistic.

If the sample of women had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the YDMCHS sample design depended on stratification, stages and clusters. Consequently, it was necessary to utilize more complex formulas. The computer package CLUSTERS, developed by the International Statistical Institute for the World Fertility Survey, was used to assist in computing the sampling errors with the proper statistical methodology.

Note: See detailed estimate of sampling error calculation in APPENDIX C of the final 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 year since birth
- Reporting of age at death in days
- Reporting of age at death in months

Note: See detailed tables in APPENDIX D of the report which is presented in this documentation.

摘要
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也门人口、孕产妇及儿童健康调查（YDMCHS）是也门自国家统一以来的首次全国性调查。该调查旨在收集关于家庭、已婚育龄妇女和五岁以下儿童的数据。家庭调查涵盖的主题包括：家庭特征、住房和居住条件、学校入学、劳动力参与、一般死亡率、残疾、生育和儿童存活率。针对育龄妇女的调查内容包括：人口和社会经济特征、婚姻和生育史、生育调节和偏好、产前护理、母乳喂养和儿童护理。对于五岁以下儿童，调查涉及的主题包括：腹泻和其他疾病、营养补充、事故、疫苗接种和营养状况。

该调查作为DHS项目（发展中国家家庭调查项目）和PAPCHILD项目（由阿拉伯联盟组织赞助的泛阿拉伯儿童发展项目）的一部分进行。DHS项目协助政府和私人机构在发展中国家实施家庭调查；PAPCHILD旨在为阿拉伯联盟内的发展中国家实现类似目标。DHS项目的主要目标是：（a）为决策者提供数据库和分析，以支持明智的政策选择，（b）扩展国际人口和健康数据库，（c）推进调查方法，（d）在参与国开发和培养开展高质量人口和健康调查所需的能力和资源。

YDMCHS的具体目标是提供有关也门基本人口和家庭特征、孕产妇及儿童健康、生育、家庭计划和婴儿及儿童死亡率的详细信息。调查还提供了关于母乳喂养实践和五岁以下儿童营养状况的信息。该调查将为政策制定者和规划者提供制定有关孕产妇及儿童健康、儿童死亡率和生育行为的项目和政策的重要信息。

地理覆盖范围
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全国

分析单位
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- 家庭
- 五岁以下儿童
- 15-49岁妇女
- 男性

数据类型
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样本调查数据

抽样程序
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样本设计和实施

YDMCHS样本的设计旨在能够对也门整体以及城市和农村地区以及两个地区（1）北方和西部地区，（2）南方和东部地区进行数据分析。目标样本设定为约12,000个家庭的完整访谈，其中约6,000名符合条件的妇女。五岁以下儿童没有设定具体的目标数量，对于每个被选中的妇女访谈家庭中的所有儿童都收集信息。在所选家庭中，一半的家庭只进行了家庭问卷；另一半家庭除了进行家庭问卷外，还对所有符合条件的妇女进行了访谈，并收集了合格儿童的信息。

YDMCHS覆盖了整个国家，除游牧民族和居住在难以到达的也门岛屿上的人外。调查采用了分层、多阶段抽样设计。样本按两个地区的城市和农村地区进行分层。在本报告中，北方和西部地区包括：萨那市及萨那、塔伊兹、荷台达、伊卜、达马尔、哈吉亚、阿比达、萨达、艾尔马赫维特、马阿里布和艾尔朱夫省。南方和东部地区包括亚丁、拉赫格、阿比恩、沙布瓦、哈德拉毛和艾尔马赫拉省。第一阶段是选择抽样单元或集群；第二阶段涉及选择家庭。为了在每个区域内对城市和农村地区进行可靠的估计，最初旨在拥有自加权样本的目标被妥协了。萨那市、亚丁的城市（非农村）地区和拉赫格的农村地区进行了过度抽样。

为了进行调查，选择了258个抽样单元，其中包含13,712个家庭。在所选家庭中，一半的家庭只进行了家庭和住房特征问卷。在另一半家庭中，除了进行家庭问卷外，还对所有符合条件的妇女和儿童进行了妇女和儿童问卷。

注意：有关样本设计的详细描述，请参阅最终调查报告附录B。

数据收集方式
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面对面

研究工具
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问卷的设计、准备和修订

YDMCHS调查包括以下问卷：
- 家庭问卷
- 住房特征问卷
- 生育健康问卷（也称为妇女问卷）
- 儿童健康问卷（也称为儿童问卷）
- 社区问卷

这些问卷中的项目是在审查了类似调查，如由阿拉伯联盟组织赞助的泛阿拉伯儿童发展项目（PAPCHILD）进行的调查以及美国马里兰州卡尔弗顿的人口和健康调查（DHS）的模型问卷后选定的。最终的YDMCHS问卷主要基于PAPCHILD的模型问卷。问卷经过修改以适应也门社会的条件，并满足国家的信息需求。YDMCHS问卷中包含了大量问题，以便尽可能多地收集有关人口和人口动态、健康和环境问题、生活水平其他指标、住房条件、孕产妇及儿童健康以及当地社区提供健康服务特征的详细信息。问卷的英文版本（除社区问卷外）复制在附录E中。

家庭问卷包括家庭名单，包括关于孤儿、教育水平和家庭成员经济活动的问题。它还收集有关一般死亡率、残疾的信息，以及对于55岁以下的已婚妇女，有关生育和儿童存活率的信息。

住房特征问卷作为家庭调查的一部分进行。它包括八个部分：住房、烹饪、水、照明、卫生和废物处理、物品和资产所有权以及排水。

YDMCHS妇女问卷或生育健康问卷包括九个部分：
- 受访者背景
- 婚姻和共同居住
- 生育和儿童存活率
- 产前护理：当前妊娠
- 孕产妇护理：过去五年
- 儿童喂养
- 死亡儿童的死因
- 家庭计划和生育态度
- 丈夫的背景

儿童健康问卷，也称为儿童问卷，包括六个部分：
- 一般儿童护理
- 疾病：腹泻
- 疾病：其他疾病
- 免疫接种
- 体重和身高

数据清理操作
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编辑和编码

数据准备开始于实地工作开始后一周，并同时在实地工作活动进行中继续。实地编辑人员检查问卷的完整性和一致性。实地监督人员也对完成问卷进行了抽样检查。完成后的问卷随后被发送到萨那的中心办公室，或者由工作人员在访问团队返回时带回。在萨那的中心办公室，问卷再次进行了编辑，并对开放式和其他需要编码的问题进行了编码。这一阶段始于1991年11月22日，并于1992年1月底完成。

响应率
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在选定的13,712个家庭中，找到了13,206个家庭，其中12,836个，即97%，成功接受了访谈。总共确定了6,150名15-49岁的已婚妇女，她们是选择进行个别访谈的家庭中的妇女。在这些妇女中，5,687名妇女成功接受了访谈，并收集了7,022名合格五岁以下儿童中的6,715名儿童的信息。合格妇女和儿童的响应率分别为93%和96%。城市和农村地区的响应率几乎相同。未完成一些家庭访谈的主要原因是在实地工作期间住房空置，尽管在家庭登记时这些住房是有人居住的。合格妇女未响应的主要原因是在访谈员多次访问选定家庭后，受访者不在家。

注意：请参阅最终调查报告表1.1中按居住地汇总的响应率。

抽样误差估计
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样本调查的结果受到两种类型误差的影响，即非抽样误差和抽样误差。非抽样误差是由于在执行实地活动时犯下的错误造成的，例如未能找到并访谈正确的家庭、提问方式错误、访谈员或受访者一方误解、数据输入错误等。尽管在设计YDMCHS和实施过程中努力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测量。YDMCHS中选定的妇女样本只是从同一总体中可能选择的许多样本之一，使用相同的设计和预期规模。每个样本都会产生与实际样本选择略有不同的结果。抽样误差是衡量所有可能样本之间差异的指标；尽管它并不完全清楚，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（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，其中可以合理地假设，除了非抽样误差外，变量的真实值对于整个总体落在该区间内。例如，对于从样本调查中计算出的任何给定统计量，该统计量在相同设计（和预期规模）的所有可能样本中测量的值将在加减两倍标准误差的范围内。

如果妇女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，YDMCHS样本设计依赖于分层、阶段和集群。因此，有必要使用更复杂的公式。用于辅助计算抽样误差的正确统计方法的计算机软件包CLUSTERS是由国际统计研究所为世界生育调查开发的。

注意：请参阅最终调查报告附录C中抽样误差计算的详细估计。

数据评估
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数据质量表
- 家庭年龄分布
- 合格和接受访谈妇女的年龄分布
- 报告的完整性
- 自出生以来按日历年份的出生情况
- 死亡年龄按日的报告
- 死亡年龄按月的报告

注意：请参阅本文档中提供的报告附录D中的详细表格。