The Turkmenistan Demographic and Health Survey (TDHS 2000) is the first national survey of maternal and child health in Turkmenistan.
The Turkmenistan Demographic and Health Survey (TDHS 2000) is the first national survey of maternal and child health in Turkmenistan. It is a nationally representative survey of 7,919 women of reproductive age (15-49). Survey fieldwork was conducted from June to September 2000.
The TDHS was sponsored by the Ministry of Health and Medical Industry (MOHMI) of the Republic of Turkmenistan. The Gurbansoltan Eje Clinical Research Center for Maternal and Child Health implemented the survey with technical assistance from the Demographic and Health Surveys Program. The National Institute of State Statistics and Information (Turkmenmelihasabat) conducted sampling activities for the survey. The U.S. Agency for InternationalDevelopment (USAID) provided funding for the survey. UNFPA/Turkmenistan assisted with survey coordination and logistic support.
The purpose of the survey was to develop a single integrated set of data for the government of Turkmenistan to use in planning effective policies and programs in the areas of health and nutrition. TDHS 2000 collected data on women's reproductive history, knowledge and use of contraceptive methods, breastfeeding practices and nutrition, vaccination coverage, and episodes of diseases among children under the age of five. Information on the knowledge of and attitudes toward HIV/AIDS, other sexually transmitted infections, and tuberculosis were also collected. The survey also included the measurement of the hemoglobin level in the blood to assess the prevalence of anemia and measurements of height and weight to assess nutrition status.
The TDHS 2000 also contributes to the growing international database on demographic and health-related variables.
The TDHS was designed to provide policymakers and program managers at MOHMI with detailed information on the health status of women and children. Some of the health indicators provided by the TDHS-such as fertility and infant mortality rates-are available from other sources. However, other survey indicators are not available from other sources-for example anemia status and nutritional indices for women and children. Thus, when taken together, the TDHS and existing data provide a more complete picture of health conditions in Turkmenistan than was previously available.
- Fertility rates. For the three years preceding the survey (mid-1997 to mid-2000), the estimated crude birth rate was 24.6 births per 1,000 population. This is higher than the MOHMI rate of 20.3 (the average of the annual rates for calendar years 1997 to 1999).
- Knowledge of contraceptive methods is widespread in Turkmenistan. Among currently married women, knowledge of at least one method is universal (99 percent). Married women have knowledge of, on average, six methods of contraception. Married women of all ages, all educational levels, all ethnic groups, and all regions of the country have a high level of knowledge of contraceptive methods.
- Abortion rates. For the three-year period preceding the survey (mid-1977 to mid2000), the total abortion rate for Turkmenistan was 0.9. The total abortion rate was higher in urban areas (1.0 abortions per woman) than in rural areas (0.7 abortions per woman). The highest levels of induced abortion were in Ashgabad City and the Lebap Region (1.1 and 1.2 abortions per woman, respectively).
- Antenatal care. Almost all respondents who gave birth in the last five years (98 percent) received antenatal care from either a doctor (81 percent) or a nurse/midwife (17 percent). In general, in Turkmenistan women seek antenatal care early and continue to receive care throughout their pregnancy. The median number of antenatal care visits is ten.
- Infant Mortality Rates In the TDHS, infant mortality data were collected based on the international definition of a live birth, i.e., a birth that shows any sign of life, irrespective of the gestational age at the time of delivery (United Nations, 1999). Because of the difference between the government data collection system and that of the TDHS in the definition of a live birth, the TDHS estimate of the infant mortality rate (IMR) would be expected to exceed the official government estimates.
- The TDHS was the first study of anemia in Turkmenistan based on a nationally representative sample of women and children. The survey measured the hemoglobin level of capillary blood.
- Acquired Immune deficiency Syndrome(Aids) Compared with other parts of the world, Turkmenistan has been relatively untouched by the AIDS epidemic. Currently, there is only one known case of AIDS and one other person known to be HIV positive in Turkmenistan. Almost no respondents reported that they knew an HIV-infected person or anyone who had died of AIDS.
- Knowledge. Awareness and knowledge ofHIV/AIDSislimited. Seventy-threepercentof respondents reported having heard of HIV/ AIDS, but only 50 percent believe that they could adoptbehavior patterns thatwould reduce their risk of contracting the disease. Further evidence of limited knowledge of HIV/AIDS was the fact that only 31 percent of respondents recognized that condom use is a risk-reducing behavior.
Kind of Data
Sample survey data
Unit of Analysis
- Women age 15-49
The Turkmenistan Demographic and Health Survey (TDHS 2000) covers the following topics:
- Anemia Questions
- Anemia Testing
- Blood Pressure (measure)
- HIV Knowledge
- Iodine salt test
- TB Questions
- Vitamin A Questions
- Women's Status
The Turkmenistan Demographic and Health Survey (TDHS) is a nationally representative survey. The sample for the 2000 TDHS was designed to allow statistical analysis at the national level, for urban and rural areas, and for the six regions of the country (Ashgabad City, Akhal, Balkan, Dashoguz, Lebap, and Mary).
The population covered by the 2000 TKMDHS is defined as the universe of all women in the reproductive ages (i.e., women 15-49).
Producers and sponsors
Gurbansoltan Eje Clinical Research Center for Maternal and Child Health (MCH Institute)
Ministry of Health and Medical Industry
U.S. Agency for International Development
United Nations Population Fund
The sample for the 2000 TDHS was designed to allow statistical analysis at the national level, for urban and rural areas, and for the six regions of the country (Ashgabad City, Akhal, Balkan, Dashoguz, Lebap, and Mary).
The sample design was specified in terms of a target number of households in the six regions of Turkmenistan. The overall target number of households was set at 6,800. This number was allocated to the regions as follows: 800 to Ashgabad City, 1,000 to each of 4 regions (Akhal, Balkan, Lebap and Mary) and 2,000 to the remaining region (Dashoguz), for which more intensive analysis was desired.
The six regions of the country were further stratified into urban areas (cities, towns and small settlements) and rural areas (villages). The sampling frame consisted of the list of standard segments. Each standard segment was created on the basis of contiguous blocks that have clear boundaries-coinciding to the extent possible with census supervisor areas-and have between 200 and 500 households according to measures of size estimated by projection from to the 1995 Census data.
The sample was designed as a two-stage probability sample. Within regions the sample was to be self-weighting. The first stage involved the selection of standard segments (PSUs) by systematic sampling with probability proportional to size. This resulted in the selection of 231 standard segments:118 in urban areas and 113 in rural areas. A household listing operation was conducted in each selected standard segment. In the second stage, households were selected with probability proportional to the inverse of the first stage selection probability. On average, the number of households selected per standard segment was 28.
Since the sample for each of the six survey regions was self-weighting, the sampling fraction for each region was an important design parameter. The sampling fractions were estimated with projected census figures. The weighting factors for the six survey regions are inversely proportional to the sampling fractions.
Implementation of the sample design resulted in the selection of 6,850 households. The data on household membership and age collected in the Household Questionnaire identified 8,250 women eligible for the Women's Questionnaire (i.e., women age 15-49 who were usual household members or who stayed in the household the night before the interviewer's visit).
From the 6,850 selected households, 6,391 were identified as current households and household interviews were completed in 6,302. This yields a household response rate of 98.6 percent. Of the 8,250 women who were eligible respondents, a total of 7,919 were interviewed. This yields an eligible woman response rate of 96.0 percent.
The overall response rate (94.7 percent) is the product of the household response rate and the eligible woman response rate. The overall response rate varies by region from 85.6 percent in Ashgabad City to 97.4 percent in the Balkan Region.
Among the 6,391 currently occupied households in the selected sample, the Household Schedule was completed in 6,302, for a response rate of 98.6 percent. Of the eligible 8,250 women age 15-49 in those households, 7,919 were interviewed for a response rate of 96.0 percent. The overall survey response rate was 94.7 percent.
Overall, the household response rate was 98.6 percent and the individual women response rate was 96.0 percent. As is usually the case in household surveys, response rates were somewhat higher in rural than in urban areas.
Dates of Data Collection
Data Collection Mode
Data Collection Notes
The TDHS 2000 questionnaires were pretested in April 2000. Eight interviewers were trained during a one-week period at the MCH Institute of Turkmenistan. The pretest included one week of interviewing in an urban area (Ashgabad City). A total of 100 women were interviewed. Pretest interviewers were retained to serve as supervisors and field editors for the main survey.
Fifty-five people, mostly physicians, were recruited as field supervisors, editors, health investigators, and interviewers for the main survey fieldwork. They were trained at the MCH Institute for three and a half weeks in June 2000. Training consisted of lectures and practice in the classroom, as well as role playing. The training of health investigators, who were responsible for anthropometric measurements (height and weight) and hemoglobin testing of women and children, was accomplished in two days in the classroom and three days in the field. At the end of the training, the field staff was divided into six survey teams. Each team consisted of eight people, including one supervisor, one editor, five interviewers, and one health investigator. Besides this, six field coordinators were recruited from the staff of the MCH Institute and were responsible for communication and coordination of activities between the center and field teams.
The personnel for the survey teams were partly recruited from the staff of the MCH Institute and partly from different regions of the country.
All six teams started data collection on June 28, 2000, in Ashgabad. Beginning in mid-July, all six teams started data collection in the field. Data collection was completed on September 15, 2000.
Gurbansoltan Eje Clinical Research Center for Maternal and Child Health
Ministry of Health and Medical Industry
Two questionnaires were used for TDHS 2000: a) the Household Questionnaire and b) Women's Questionnaire. These questionnaires were based on the model survey instruments developed for the MEASURE DHS+ project and were adapted to the data needs of Turkmenistan during consultations with specialists in the area of reproductive health and child health and nutrition. The questionnaires were developed at first in English and then translated into Russian and Turkmen. A pretest was conducted in April 2000. Based on the pretest, the questionnaires were revised and finalized.
a) The Household Questionnaire was used to enumerate all usual members and visitors in a sample household and to collect information related to the socioeconomic status of the household. In the first part of the Household Questionnaire, information was collected on age, sex, education attainment, and relationship to the head of household for each person listed as a household member or visitor. A primary objective of the first part of the Household Questionnaire was to identify women who would be eligible for the individual interview. In the second part of the Household Questionnaire, information was collected on the characteristics of the dwelling unit, such as the source of water and the type of toilet facilities, and on the availability of a variety of consumer goods.
b) The Women's Questionnaire was used to collect information from eligible respondents (i.e., women age 15-49 who were usual household members or who were present in the household the night before interviewer's visit) on the following major topics:
- Background characteristics
- Pregnancy history
- Outcome of pregnancies, antenatal and postnatal care
- Child health and nutrition practices
- Child immunization and episodes of diarrhea and respiratory illness
- Knowledge and use of contraception
- Marriage and fertility preferences
- Husband's background and women's work
- Knowledge of HIV/AIDS and other sexually transmitted infections
- Maternal and child anthropometry
- Hemoglobin measurement of women and children.
Questionnaires were returned to the MCH Institute for final editing and data processing. The office editing staff checked that questionnaires for all selected households and eligible respondents were returned from the field. Additionally, final editing included coding for a set of categories such as occupation and type of iron pills. Data were then entered and edited on computers using the Integrated System for Survey Analysis (ISSA) package, with data software translated into Russian. Office editing and data entry activities began on August 15 and were completed on October 14, 2000.
Estimates of Sampling Error
Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the TDHS 2000 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 2000 Turkmenistan DHS sample is the result of a two-stage stratified design, and consequently, it was necessary to use more complex formulae. The computer software used to calculate sampling errors for the TDHS 2000 is the ISSA Sampling Error Module (SAMPERR). This module 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 Jackknife repeated replication method derives estimates of complex rates from each of several replications of the parent sample and calculates standard errors for these estimates using simple formulae. Each replication considers all but one cluster in the calculation of the estimates. Pseudoindependent replications are thus created. In the TDHS 2000, there were 231 non-empty clusters. Hence, 231 replications were created.
In addition to the standard error, SAMPERR computes the design effect (DEFT) for each estimate, which is defined as the ratio between the standard error using the given sample design and the standard error that would result if a simple random sample had been used. A DEFT value of 1.0 indicates that the sample design is as efficient as a simple random sample, while a value greater than 1.0 indicates the increase in the sampling error due to the use of a more complex and less statistically efficient design. SAMPERR also computes the relative error and confidence limits for the estimates.
Sampling errors for the TDHS 2000 are calculated for selected variables considered to be of primary interest. One set of results for women is presented in an appendix to the Final Report for the country as a whole, for urban and rural areas, for each of the six domains: Ashgabad City, Akhal, Balkan, Dashoguz, Lebap, and Mary regions. For each variable, the type of statistic (mean, proportion, or rate) and the base population are given in Table B.1 of the Final Report. Tables B.2 to B.10 present the value of the statistic (R), its standard error (SE), the number of unweighted (N) and weighted (WN) cases, the design effect, the relative standard error (SE/R), and the 95 percent confidence limits (R±2SE), for each variable. The DEFT is considered undefined when the standard error considering simple random sample is zero (when the estimate is close to 0 or 1).
In general, the relative standard error for most estimates for the country as a whole is small, except for estimates of very small proportions. There are some differentials in the relative standard error for the estimates of subpopulations. For example, for the variable using any contraceptive method, the relative standard errors as a percentage of the estimated mean for the whole country, for urban areas, and for rural areas are 1.1 percent, 1.6 percent, and 1.5 percent, respectively.
The confidence interval (e.g., as calculated for the variable using any method can be interpreted as follows: the overall national sample proportion is 0.618 and its standard error is 0.007. Therefore, to obtain the 95 percent confidence limits, one adds and subtracts twice the standard error to the sample estimate, i.e., 0.618±2(0.007). There is a high probability (95 percent) that the true proportion of all women 15-49 using a contraceptive method is between 60.4 and 63.2 percent.
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 TDHS 2000 to minimize this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically.
Data and Data Related Resources
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- the Identification of the Primary Investigator
- the title of the survey (including country, acronym and year of implementation)
- the survey reference number
- the source and date of download
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