Demographic and Health Survey 2014 - 2015
Rwanda, 2014 - 2015
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RWA_2014_DHS_v01_M
Demographic and Health Survey 2014 - 2015
| Name | Country code |
|---|---|
| Rwanda | RWA |
Demographic and Health Survey (Standard) - DHS VII
The 2014-15 Rwanda Demographic and Health Survey (RDHS) is the fifth survey of its kind, following standard DHS surveys conducted in 1992, 2000, 2005, and 2010. In addition in Rwanda interim RDHS was conducted in 2007-08. A nationally representative sample of 12,800 households, was selected. All women age 15-49 who were usual residents of the selected households or who slept in the households the night before the survey were eligible for the survey. A survey of men was also conducted in a subsample consisting of every second household. All men age 15-59 who were usual residents or who slept in the subsampled households the night before the survey were eligible to be interviewed. Altogether, 13,497 women age 15-49 and 6,217 men age 15-59 were interviewed. As with prior surveys, the main objectives of the 2014-15 RDHS are to provide up-to-date information on fertility and childhood mortality levels; fertility preferences; awareness, approval, and use of family planning methods; maternal and child health; knowledge and attitudes toward HIV/AIDS and other sexually transmitted infections (STIs); and prevalence of HIV among the population.
The survey was designed to produce representative estimates for the main demographic and health indictors for the country as a whole, for the urban and rural areas, and for each of the five provinces. For some indicators, representative results may be available for each of the thirty districts.
From 2014 to 2015, with the aim of collecting data to monitor progress across Rwanda’s health programs and policies, the Government of Rwanda (GOR) conducted the Rwanda Demographic and Health Survey (RDHS) through the Ministry of Health (MOH) and the National Institute of Statistics of Rwanda (NISR) with the members of the national steering committee to the DHS and the technical assistance of ICF International.
The main objectives of the 2014-15 RDHS were to:
• Collect data at the national level to calculate essential demographic indicators, especially fertility and infant and child mortality, and analyze the direct and indirect factors that relate to levels and trends in fertility and child mortality
• Measure levels of knowledge and use of contraceptive methods among women and men
• Collect data on family health, including immunization practices; prevalence and treatment of diarrhea, acute upper respiratory infections, and fever among children under age 5; antenatal care visits; assistance at delivery; and postnatal care
• Collect data on knowledge, prevention, and treatment of malaria, in particular the possession and use of treated mosquito nets among household members, especially children under age 5 and pregnant women
• Collect data on feeding practices for children, including breastfeeding
• Collect data on the knowledge and attitudes of women and men regarding sexually transmitted infections (STIs) and HIV and evaluate recent behavioral changes with respect to condom use
• Collect data for estimation of adult mortality and maternal mortality at the national level
• Take anthropometric measurements to evaluate the nutritional status of children, men, and women
• Assess the prevalence of malaria infection among children under age 5 and pregnant women using rapid diagnostic tests and blood smears
• Estimate the prevalence of HIV among children age 0-14 and adults of reproductive age
• Estimate the prevalence of anemia among children age 6-59 months and adult women of reproductive age
• Collect information on early childhood development
• Collect information on domestic violence
Sample survey data [ssd]
- Household
- Individual
- Children age 0-5
- Woman age 15-49
- Man age 15-59
Scope
The 2014-2015 Rwanda Demographic and Health Survey covered the following topics:
HOUSEHOLD
• Identification
• Usual members and visitors in the selected households
• Background information on each person listed, such as relationship to head of the household, age, sex, marital status, survivorship and residence of bilogical parents, and highest educational attainment
• Characteristics of the household's dwelling unit, such as the source of water, type of toilet facilities, type of fuel used for cooking, materials used for the floor, roof and walls of the house, and ownership of various durable goods (these items are used as proxy indicators of the household's socioeconomic status)
• Weight, height, hemoglobin measurements and malaria testing for children age 0-5
• Weight, height, hemoglobin measurements and malaria testing for women age 15-49
• HIV testing for women age 15-49
• Weight, height, measurement and HIV testing for men age 15-59
• HIV testing for children age 0-14
INDIVIDUAL WOMAN
• Background characteristics (education, religion, media exposure, etc.)
• Reproduction
• Contraception
• Pregnancy and postnatal care
• Child immunization, health and nutrition
• Marriage and sexual activity
• Fertility preferences
• Husband's background and woman's work
• HIV/AIDS
• Other health issues
• Adult mortality
• Female domestic violence
INDIVIDUAL MAN
• Respondent background
• Reproduction
• Contraception
• Marriage and sexual activity
• Fertility preferences
• Employment and gender roles
• HIV/AIDS
• Other health issues
• Male domestic violence
Coverage
National coverage
The survey covered all de jure household members (usual residents), all women age 15-49 years and all men age 15-59 who were usual residents in the household.
Producers and sponsors
| Name | Affiliation |
|---|---|
| National Institute of Statistics of Rwanda (NISR) | Government of Rwanda |
| Name | Role |
|---|---|
| Ministry of Health | Collaboration |
| IFC International | Provided technical assistance |
| Name | Role |
|---|---|
| Government of Rwanda | Funded the study |
| United States Agency for International Development | Funded the study |
| One United Nations | Funded the study |
| Global Fund | Funded the study |
| World Vision International | Funded the study |
| Partners in Health | Funded the study |
| Suisse Development Cooperation | Funded the study |
Sampling
Sample Design
The sampling frame used for the 2014-15 RDHS was the 2012 Rwanda Population and Housing Census (RPHC). The sampling frame consisted of a list of enumeration areas (EAs) covering the entire country, provided by the National Institute of Statistics of Rwanda, the implementing agency for the RDHS. An EA is a natural village or part of a village created for the 2012 RPHC; these areas served as counting units for the census.
The 2014-15 RDHS 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, five provinces, and each of Rwanda's 30 districts (for some limited indicators). The first stage involved selecting sample points (clusters) consisting of EAs delineated for the 2012 RPHC. A total of 492 clusters were selected, 113 in urban areas and 379 in rural areas.
The second stage involved systematic sampling of households. A household listing operation was undertaken in all of the selected EAs from July 7 to September 6, 2014, and households to be included in the survey were randomly selected from these lists. Twenty-six households were selected from each sample point, for a total sample size of 12,792 households. However, during data collection, one of the households was found to actually be two households, which increased the total sample to 12,793. Because of the approximately equal sample sizes in each district, 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 household or visitors who stayed in the household the night before the survey were eligible to be interviewed. In half of the households, all men age 15-59 who either were permanent household residents or were visiting the night before the survey were eligible to be interviewed.
In the subsample of households not selected for the male survey, anemia and malaria testing were performed among eligible women who consented to being tested. With the parent's or guardian's consent, children aged 6-59 months were tested for anemia and malaria in this subsample. Height and weight information was collected from eligible women, and children (age 0-5) in the same subsample. In the subsample of households selected for male survey, blood spot samples were collected for laboratory testing of HIV from eligible women and men who consented. Height and weight information was collected from eligible men. In one-third of the same subsample (or 15 percent of the entire sample), blood spot samples were collected for laboratory testing of children age 0-14 for HIV.
The domestic violence module was implemented in the households selected for the male survey: The domestic violence module for men was implemented in 50 percent of the household selected for male survey and domestic violence for women was conducted in the remaining 50 percent of household selected for male survey (or 25 percent of the entire sample, each).
For further details on sample selection, see Appendix A of the final report.
A total of 6,249 men age 15-59 were identified in this subsample of households. Of these men, 6,217 completed individual interviews, yielding a response rate of 99.5 percent.
Due to the non-proportional allocation of the sample to the different provinces and to their districts and the possible differences in response rates, sampling weights are required for any analysis using the 2014-15 RDHS-V data to ensure the actual representative of the survey results at national level and as well as at domain level. Since the RDHS sample is a two-stage stratified cluster sample, sampling weights were calculated based on sampling probabilities separately for each sampling stage and for each cluster.
The final sampling weights were normalized in order to give the total number of un-weighted cases equal to the total number of weighted cases at national level, for both household weights and individual weights. The normalized weights are relative weights which are valid for estimating means, proportions and ratios, but not valid for estimating population totals and for pooled data. The sampling weights for HIV testing were calculated in a similar way, but the normalization of the HIV testing weights is different compared to the individual survey weights. The HIV testing weights are normalized for women and men together at the national level, in order that the HIV prevalence rates calculated for both sexes combined are valid. Sampling weights for the domestic violence surveys were calculated based on the number of eligible respondents in the households selected for domestic violence module, for male and female surveys respectively.
A number of sets of weights were calculated:
• one set for all households selected for the survey
• one set for the women’s individual survey
• one set for households selected for the male survey
• one set for the male individual survey
• one set for women selected for the domestic violence survey
• one set for men selected for the domestic violence survey
• one set for women’s HIV testing
• one set for men’s HIV testing
• one set for HIV testing for children 0-14 years
Also the number of weighted cases by using the normalized weight has no direct relationship with the survey precision because it is relative. Especially for oversampled areas, the number of weighted cases is much smaller than the number of un-weighted cases which is directly related to survey precision.
For further details on sampling weight, see Appendix A.4 of the final report.
Survey instrument
Three types of questionnaires were used in the 2014-15 RDHS: the Household Questionnaire, the Woman’s Questionnaire, and the Man’s Questionnaire. They are based on questionnaires developed by the worldwide DHS Program and on questionnaires used during the 2010 RDHS. 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 into Kinyarwanda.
The Household Questionnaire was used to list all of 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 relationship to the head of the household, sex, residence status, age, and marital status along with survival status of children’s parents, education, birth registration, health insurance coverage, and tobacco use.
The Woman’s Questionnaire was administered to all women age 15-49 living in the sampled households.
The Man’s Questionnaire was administered to all men age 15-59 living in every second household in the sample. It was similar to the Woman’s Questionnaire but did not include questions on use of contraceptive methods or birth history; pregnancy and postnatal care; child immunization, health, and nutrition; or adult and maternal mortality.
Data collection
| Start | End |
|---|---|
| 2014-11 | 2015-04 |
| Name | Affiliation |
|---|---|
| National Institute of Statistics of Rwanda | Government of Rwanda |
PRETEST
A pretest was conducted from August 25 to September 22, 2014. Thirty-four individuals (17 women and 17 men) participated in the four-week pretest training and fieldwork practice for the 2014-15 RDHS. The majority of participants had worked in previous RDHS surveys. Training was conducted by representatives from the NISR, the MOH, the RBC Malaria and Other Parasitic Diseases Division, the RBC HIV division, and the RBC NRL, with technical assistance from ICF International. UNICEF provided training on the early childhood development module. Classroom instruction was provided during the first three weeks, and pretest fieldwork took place over five days in three rural villages and two urban villages. After the fieldwork, a debriefing session was held with the pretest field staff, and modifications to the questionnaires were made based on lessons drawn from the exercise.
TRAINING OF FIELD STAFF
The main training for the 2014-15 RDHS started on October 5, 2014, and ended on November 2, 2014. A total of 136 participants from across the country were invited to participate in the training. They were selected based on merit. Eighty-eight of the participants were female, and 48 were male. From October 6-25, the training focused on the questionnaires. These sessions were conducted by NISR trainers with support from ICF International. Class presentations by trainers were followed by mock interviews, group practice, and role playing among participants in the classroom. Guest speakers and experts (e.g., from the MOH, the RBC, and UNICEF) made brief presentation son the national health strategies related to nutrition, contraception, malaria, maternal and child health, the HIV voluntary counseling and testing component, and early childhood development before the questionnaire training session corresponding to each of these topics. This led to an understanding among fieldworkers that items included in the questionnaire would be useful in evaluating these health topics.
All participants were trained on the questionnaires through October 26. From October 27-30, 34 participants identified as health technicians were separated and trained on biomarkers. Meanwhile, the remaining participants continued to be trained on the questionnaires. Training on biomarkers was provided by representatives from the NRL with support from ICF International. Health technicians learned how to withdrawal blood samples for HIV testing, how to prepare blood slides for malaria testing, and how to conduct anemia and rapid malaria testing. In addition, procedures for handling and packaging dried blood spots and slides were reviewed and demonstrated. Training on taking anthropometry measurements (weight and height) was also covered in detail. Training included PowerPoint presentations to illustrate procedures and emphasized practice among lab technicians in order to ensure accuracy.
At the end of the main training, 17 teams were formed, each consisting of a team leader, a field editor, a health technician, a male interviewer, and three female interviewers. Team leaders received additional training on how to identify the selected households and different subsamples, data quality control procedures, and fieldwork coordination. Field editors received additional training on how to edit the questionnaires and on data quality control procedures.
FIELDWORK
Data collection for the 2014-15 RDHS was carried out by 17 field teams from November 9, 2014, to April 8, 2015. Each team was provided a vehicle with a driver. All questionnaires and blood specimens were transferred to the NISR office every 3-4 days by 10 supervisors from the NISR and NRL/RBC who also coordinated and supervised fieldwork activities. ICF International provided technical assistance during the entire five months of data collection period.
Data processing
The processing of the 2014-15 RDHS data began as soon as questionnaires were received from the field. Completed questionnaires were returned to NISR headquarters. The numbers of questionnaires and blood samples (DBS and malaria slides) were verified by two receptionists. Questionnaires were then checked, and open-ended questions were coded by four editors who had been trained for this task and who had also attended the questionnaire training sessions for the field staff. Blood samples (DBS and malaria slides) with transmittal sheets were sent respectively to the RBC/NRL and Parasitological and Entomology Laboratory to be screened for HIV and tested for malaria.
Questionnaire data were entered via the CSPro computer program by 17 data processing personnel who were specially trained to execute this activity. Data processing was coordinated by the NISR data processing officer. ICF International provided technical assistance during the entire data processing period.
Processing the data concurrently with data collection allowed for regular monitoring of team performance and data quality. Field check tables were generated regularly during data processing to check various data quality parameters. As a result, feedback was given on a regular basis, encouraging teams to continue in areas of high quality and to correct areas of needed improvement. Feedback was individually tailored to each team. Data entry, which included 100 percent double entry to minimize keying errors, and data editing were completed on April 26, 2015. Data cleaning and finalization were completed on May 15, 2015.
Data appraisal
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 2014-15 Rwanda Demographic and Health Survey (RDHS) 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 2014-15 RDHS is only one of many samples that could have been selected from the same population, using the same design and identical 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 2014-15 RDHS sample is the result of a multi-stage stratified design, and, consequently, it was necessary to use more complex formulae. The computer software used to calculate sampling errors for the 2014-15 RDHS is a SAS program. This program used the Taylor linearization method for 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.
Note: A more detailed description of estimate of sampling error is presented in APPENDIX B of the survey report.
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
- Nutritional status of children based on the NCHS/CDC/WHO International Reference Population
- Prevalence of anemia in children in 2005
- Prevalence of anemia in women in 2005
- Prevalence of anemia in children in 2007-08
- Prevalence of anemia in women in 2007-08
- Rotavirus and pneumococcal vaccinations by source of information
- Rotavirus and pneumococcal vaccinations by background characteristics
- Support for learning
- Adult mortality rates
- Smoking
Note: See detailed data quality tables in APPENDIX C of the report.
Access policy
The DHS Program
The DHS Program
http://dhsprogram.com/data/available-datasets.cfm
Cost: None
Data Access
| Name | URL | |
|---|---|---|
| The DHS Program | http://www.DHSprogram.com | archive@dhsprogram.com |
Request Dataset Access
The following applies to DHS, MIS, AIS and SPA survey datasets (Surveys, GPS, and HIV).
To request dataset access, you must first be a registered user of the website. You must then create a new research project request. The request must include a project title and a description of the analysis you propose to perform with the data.
The requested data should only be used for the purpose of the research or study. To request the same or different data for another purpose, a new research project request should be submitted. The DHS Program will normally review all data requests within 24 hours (Monday - Friday) and provide notification if access has been granted or additional project information is needed before access can be granted.
DATASET ACCESS APPROVAL PROCESS
Access to DHS, MIS, AIS and SPA survey datasets (Surveys, HIV, and GPS) is requested and granted by country. This means that when approved, full access is granted to all unrestricted survey datasets for that country. Access to HIV and GIS datasets requires an online acknowledgment of the conditions of use.
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- the survey reference number
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Contacts
| Name | Affiliation | URL | |
|---|---|---|---|
| Information about The DHS Program | The DHS Program | reports@DHSprogram.com | http://www.DHSprogram.com |
| General Inquiries | The DHS Program | info@dhsprogram.com | http://www.DHSprogram.com |
| Data and Data Related Resources | The DHS Program | archive@dhsprogram.com | http://www.DHSprogram.com |