NATIONAL LEVEL SURVEYS RELEVANT TO HEALTH

Presenter: Dr. VishalModerator: Dr. Jugal Kishore

PLAN OF PRESENTATIONSURVEY-DEFINITIONPURPOSE OF SURVEYTYPES OF SURVEYIMPORTANT NATIONAL LEVEL

SURVEYS• CENSUS• NFHS• DLHS• SRS• AHS

WHAT IS SURVEY?????? Is an epidemiological investigation undertaken to

examine certain selected features of a community, with a view to work out the frequency (either incidence or prevalence), of diseases or health related phenomena, and their distribution related to time, place and person, by obtaining information from a sample drawn from the population of interest.

PURPOSE OF SURVEY To generate information about the health status and

related aspects.

Provide general socio - demographic and basic health data for planning and organizing the health services or to make a community diagnosis.

To estimate the frequency (incidence or prevalence) of important diseases.

PURPOSE OF SURVEYTo evaluate the effectiveness of a health program, eg.

immunization program.

To assess the availability and accessibility of health care facilities.

To assess local beliefs, behaviour patterns, customs and awareness about health / risk factors as well as attitudes towards health services.

TYPES OF SURVEY

CROSS SECTIONAL SURVEY

LONGITUDINAL SURVEY

HYBRID SURVEY

HOW TO CONDUCT SURVEY????? Clearly define the survey objective “What you want to learn” ???

Determine your sample “Whom you will interview” ???

Choose interviewing methodology “How you will interview” ???

Create your questionnaire “What you will ask” ???

HOW TO CONDUCT SURVEY?????

Pre-test the questionnaire Test the questions Data collection Ask the questions Analyze the data – Produce the reports

Important National Level Survey

CENSUS NFHS DLHS SRS AHS

CENSUS

Census : An official count of a population carried

out at set intervals.

Population census: is the total process of collecting,

compiling, evaluating, analysing and publishing or

otherwise disseminating demographic, economic and

social data pertaining, at a specified time.

Census is : about you, by you and for you

Our Census ,Our future

WHY CENSUS IS IMPORTANT??? The Indian Census is the most credible source of information

on Demography, Economic Activity, Literacy and Education, Housing & Household Amenities, Urbanisation, Fertility and Mortality, Scheduled Castes and Scheduled Tribes, Language, Religion, Migration, Disability and many other socio-cultural data.

This is the only source of primary data in the village, town and ward level.

WHY CENSUS IS IMPORTANT??? Census is the basis for reviewing the country's

progress in the past decade, monitoring the on going Schemes of the Government and most importantly, plan for the future.

Provides a basic frame for conduct of other surveys.

Key Features

The recently concluded Census 2011 was the 15th

National Census of the Country in the unbroken

series since 1872 and the seventh after Independence.

The responsibility of conducting the decennial

Census rests with the Office of the Registrar General

and Census Commissioner, India (ORGI).

Census is a joint effort by the Union and State

Governments in India. Under the Census Act, 1948

ORGANISATIONAL STRUCTUREMINISTRY OF HOME

AFFAIRS

METHODOLOGY

• Conducted once in a decade,• An extended de facto canvasser method TWO PHASES:

First phase:

Each building, house and other structures were systematically listed and numbered. Useful data on the amenities available to the households as well as the assets owned

were collected.

Second phase: The Population Enumeration exercise was held throughout the country for period of

3 weeks. Enumerators visit the households for collecting information on every person living

in the house. On the night of 3rd week the Houseless population is enumerated.

Revision Round

Strengths Covering not only the settled population but also homeless

persons and nomadic groups.

Allow analysis in terms of statistics on persons and households and for a wide variety of geographical units, ranging from the country as a whole to individual small localities or city blocks.

Many new initiatives introduced eg. Video conferencing, social networking site

The average cost of Census taking in the world is estimated as $ 4.6 per person. In India, the cost was less than $ 0.5 per person in Census 2011.

WHY NATIONAL LEVEL SAMPLE SURVEY???

Need of demographic and health related data for annual and five year planning.

The period between two census is quite large.

For periodic evaluation of various policies and national health programme.

Comparison

NFHSNFHS surveys are conducted under the

stewardship of MoHFW

IIPS is the nodal agency for the National Family

Health Surveys

NFHS covered around 99 % population of

country

GOALS To provide essential data on health and family

welfare needed by the MOHFW & other agencies for policy and program purposes.

To provide information on important emerging health and family welfare issues.

OBJECTIVE • To provide National and state estimates of fertility, Family planning, infant and child mortality, Reproductive and child health Nutrition of women and children Quality of health and family welfare services

socioeconomic conditions

Year Region & Population included

Health Issues covered

NFHS 1 1992-1993 89,777 ever married women age 13-49In 24 states and Delhi

1. Indicator on family welfare2. Maternal and child Health3. Nutrition

NFHS 2 1998-1999 91,000 ever married women age 15-49In 26 states and Delhi

1. NFHS 1 Issue2. Reproductive Health problem3. The status of women & domestic

violence4. Anthropometric measurement

extended to ever married women5. Hb estimation, lead content, iodine

content

NFHS 3 2005-2006 1,24,385 ever married women age 15-49.74,369 Men age 15-54In 29 states and Delhi - Never married women age 15-49

1. NFHS 1 + NFHS 2 issue2. Perinatal mortality3. Male involvement 4. Adolescent reproductive health5. High risk sexual behaviour, safe inj.6. Family life education7. Knowledge about TB8. Blood testing for HIV

Contd… Sample size calculation: The target sample size for NFHS

in each state was estimated in terms of the number of ever-married women in the reproductive age group to be interviewed.

• 4000 completed interview = more than 30 million• 3,000 completed interviews = between 5 and 30 million• 1,500 completed interviews = less than 5 million

• In addition, sample-size adjustments was made to meet the need for HIV prevalence estimates for the high HIV prevalence states and UP and for slum and non-slum estimates in eight selected cities.

Sample Design: The sample within each state was allocated proportionally to the size of the state’s urban and rural populations.

State

Rural Urban

PSU

Households

Wards

CEB

Households

Sample selection: the Census list of villages and wards served as the sampling frame.

Stratification:• The first level of stratification was geographic.• Further stratified using selected variables from the

following list: village size, percentage of males working in the non-agricultural sector, percentage of the population belonging to scheduled castes or scheduled tribes, and female literacy.

• HIV prevalence state - ‘High’, ‘Medium’ or ‘Low’, as estimated for all the districts was used for stratification .

• Three types of questionnaires: Household Questionnaire, Woman’s Questionnaire and Village Questionnaire. • For each state and at national level three data files are

associated with these questionnaires. Also available are data files with information on children born during the three years preceding the survey along with mother's basic characteristics.

• Data files are available in user-friendly formats for SPSS, SAS, and STATA users. Data files are available in three formats: the flat format, the rectangular format and the hierarchical format.

STRENGTHS Random sampling improve the external validity.

Validated questionnaires and trained manpower with good supervision.

Wide range of health information was collected –IMR, contraception, immunization, anemia, breast feeding and HIV exposure.

WEAKNESS

Sample did not include union territories.

HIV testing include only adult population leaving

most vulnerable group.

Large number of interviewers were recruited that may

have introduced interviewer bias.

HemoCue method overestimated Hb level as

compared to the standard Cyanmethemoglobin

method.

D L H S

Objective : of the survey was to estimate the service coverage of the following:

Ante Natal Care (ANC) and Immunization services Extent of safe deliveries Contraceptive prevalence Unmet need for family planning Awareness about RTI/STI and HIV/AIDS Utilization of government health services and users’

satisfaction

WHY DLHS???

The district being the basic nucleus of planning and

implementation, and for decentralize approach GoI

has been interested in generating district level data on

utilization of the services provided by government

health facilities.

To assess people’s perceptions on quality of

services. Therefore, it was decided to undertake the

DLHS under the RCH programme in the country.

District Level House Hold Survey (DLHS) Conducted by Indian Institute of Population Science ( IIPS)

Initiated in 1997 ( I: 98-99, II : 2002-04 and, III : 2007-08)

One of the largest ever demographic and health surveys carried out in India, with a sample size of about 1000-1500 hhs. per district

To provide estimate on important indicators on1. Maternal & Child Health 2. Family Planning & other reproductive health services.3. Important interventions of NRHM ( DLHS – III)

Year Population covered

Health issue covered

DLHS -1 1998-99 529,817 households were contacted during the survey.Currently married women age 15-44 years

Objective of DLHS

DLHS -2 2002-04 the data was collected from 6, 20,107 householdsCurrently married women age 15-44 years

Health questionnaire includedtesting of cooking salttesting of blood of children (ages below 72 months), adolescents and pregnant women to assess the level of anaemia measuring weight of children

DLHS -3 2007-08 7 lakh housholdsEver-married women (age 15-49).never married women (age 15-24)

-Population linked facility survey conducted-Assess the effectiveness of ASHA and JSY-Adolescent health problem

SURVEY DESIGN AND SAMPLE SIZE

• Systematic random sampling : was adopted for the selection of the districts for

PHASE1: districts within the state were arranged alphabetically, and starting at random from either first or second district, alternative districts were selected.

• Second phase : covered all the remaining districts of the country.

Survey Design and Sample Size

• In each of the selected districts, 50 Primary Sampling Units (PSUs), i.e. either villages or urban wards were selected adopting probability proportional to size (PPS) sampling. The village/ ward level population as per the previous census was used for this purpose

• The sample size for RHS-RCH was fixed at 1000 households with 20 households from each PSU. In order to take care of non-response due to various reasons, 10 percent over sampling was done.

• Further, all Sub-Centres and Primary Health Centres which were expected to serve the population of the selected Primary Sampling Units (PSUs) were also covered.

• Study tool: Household questionnaire and Woman’s questionnaire.

STRENGTHS Whole country covered under DLHS

Validated questionnaires and trained manpower with good supervision

Wide range of health information was collected –IMR, contraception, immunization, anemia, breast feeding and HIV exposure.

Along with individual data health facility services also assessed.

S R S

OBJECTIVE: Is to provide reliable estimates of birth rate,

death rate and infant mortality rate at the natural division level

for rural areas and at the State level for urban areas

Initiated on a pilot basis by the OFFICE OF THE REGISTRAR

GENERAL, INDIA in a few selected states in 1964-65, it

became fully operational during 1969-70 with about 3700

sample units

S R S• Continuous enumeration of births and deaths in selected

sample units by resident part time enumerators, generally

anganwadi workers & teachers, and an independent survey

every six months by full-time SRS supervisors.

• In rural areas : the sample unit is a village or a segment of it,

if the village population is 2000 or more.

• In urban areas: the sampling unit is a census enumeration

block with population ranging from 750 to 1000

S R S• Matching of data

• The unmatched and partially matched events are re-verified in

the field to get an unduplicated count of correct events.

• The advantage of this procedure, in addition to elimination of

errors of duplication, is that it leads to a quantitative

assessment of the sources of distortion in the two sets of

records making it a self-evaluating technique

A H S

OBJECTIVE: “ To yield benchmarks of core vital and health indicators at the district level and to map changes therein on an annual basis”

Scheme is sponsored by Ministry of Health & Family Welfare(MOHFW)

Largest Sample Survey in the World

N E E D F O R A H S9 AHS States namely, Rajasthan, Uttar Pradesh,

Uttarakhand, Bihar, Jharkhand, Orissa, Madhya Pradesh, Chhattisgarh and Assam constitute:

48 % of country’s Population 59 % of Births 70 % of Infant Deaths 75 % of Under 5 Deaths 62 % of Maternal DeathsThere is large inter-district variations in these

States.

KEY FEATURES

• Coverage- All the 284 districts of 8 EAG States and Assam

• Sample Units- 20,694 statistically selected sample units

(Census Enumeration Blocks in urban areas and Villages in

rural areas)

• Sample Population- About 18.2 million

• Sample Households- 3.6 million households

• Average Sample households per district- About 13 thousand

KEY FEATURES• Sample Size- District level sample size is based

on Infant Mortality Rate• Conduct of Field Work- Hybrid approach wherein

fieldwork has been outsourced and supervision done by the ORGI

• Third Party Audit- Third Party Audit was implemented under AHS to verify the correctness of data through an independent arrangement.

• This was over and above the regular supervision by ORGI

INDICATORS COVEREDCrude Birth Rate (CBR)

Crude Death Rate (CDR)

Infant Mortality Rate (IMR)

Neo-Natal Mortality Rate (NNMR)

Under Five Mortality Rate (U5MR)

Maternal Mortality Ratio (MMR)

Sex Ratio at Birth (SRB)

Sex Ratio (0-4 years)

Sex Ratio (All ages)

References• Comparison of HemoCue Method with Cyanmethemoglobin Method for

Estimation of Hemoglobin S.K. Kapoor* Umesh Kapil , sadanand et al.

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