Questionnaires
Each round of NFHS has had two specific goals: a) to provide essential state and national level data to monitor health and family welfare programmes and policies implemented by the Ministry of Health and Family Welfare and other ministries and agencies, and b) to provide information on important emerging health and family welfare issues.
NFHS-3 used three types of questionnaires: the Household Questionnaire, the Women's Questionnaire, and the Men's Questionnaire. The overall content and format of the questionnaires were determined through a series of workshops and meetings held in 2005-06. The workshops were attended by representatives of a wide range of research and development organizations in the population and health fields, officials from the Ministry of Health and Family Welfare and other government agencies, representatives from international agencies, and experts working on gender and HIV/AIDS issues. The questionnaires for each state were bilingual, with questions in both the principal language of the state and English.
a) The Household Questionnaire was used to list all usual residents in each sample household plus any visitors who stayed in the household the night before the interview. For each person listed, information was collected on age, sex, marital status, relationship to the head of the household, and education. For children age 0-4 years, information was collected on birth registration. Questions were asked about school/college attendance for children age 5-18 years, and questions were asked about the activities of children age 5-14 years. The Household Questionnaire also collected information on the main source of drinking water, type of toilet facility, source of lighting, type of cooking fuel, religion and caste/tribe of the household head, ownership of a house, ownership of agricultural land, ownership of livestock, ownership of other selected items, and whether the household had a BPL (Below Poverty Line) card. Information was also collected on health issues such as the prevalence of tuberculosis, use of private or public health facilities, and ownership of mosquito nets. In addition, a test was conducted to assess whether the household uses cooking salt fortified with iodine.
Biomarker Measurement: The Household Questionnaire also included several biomarker measurements. Two health investigators on each survey team measured the height and weight of women age 15-49, men age 15-54, and children born since January 2000 (in states where fieldwork started in 2005) or January 2001 (in states where fieldwork started in 2006) [see Table
1.2 for the month and year of fieldwork in each state]. Height and weight data are used for assessing nutritional levels of the population. The health investigators also took blood samples from women age 15-49, men age 15-54, and children age 6-59 months to measure haemoglobin levels, which indicate the prevalence of anaemia. Haemoglobin levels were measured in the field using portable HemoCue instruments that provide test results in less than one minute. All respondents were given an informational brochure about anaemia and proper nutrition. Severely anaemic adults and children were referred to local public health facilities for treatment.
HIV testing: One of the major biomarker components incorporated in NFHS-3 was the collection of Dried Blood Spots (DBS) on filter paper cards to test for HIV. This component of the survey was included in response to the urgent need to have nationally-representative data on HIV prevalence and comprehensive information on knowledge and attitudes about HIV/AIDS, high-risk sexual behaviour, and practices related to HIV testing in India. Blood spots from a finger prick were collected on filter paper cards for HIV testing. If the respondent gave consent for blood collection for both HIV and anaemia testing, the standard protocol was to first collect 3-5 blood spots on the filter paper card for HIV testing, and then to collect an additional drop of blood from the same finger prick in a microcuvette for anaemia testing. The blood spots on filter paper cards were dried overnight in special drying boxes. The packaged filter paper cards were delivered to SRL Ranbaxy blood collections centres throughout the country, and they were shipped by courier from the blood collection centres to the SRL Ranbaxy laboratory in Mumbai for HIV testing. DBS were collected from consenting women age 15-49 and men age 15-54 to provide HIV prevalence estimates at the national level and for each of the six high HIV prevalence states identified by the National AIDS Control Organization (NACO), namely Andhra Pradesh, Karnataka, Maharashtra, Manipur, Nagaland, and Tamil Nadu. However, blood for HIV testing and anaemia testing could not be collected in Nagaland due to local opposition. It was also decided to provide estimates of HIV prevalence for one low HIV prevalence state, Uttar Pradesh.
The HIV testing was anonymous. No names or other contact information were recorded on the DBS samples. Instead, a bar code label with randomly generated numbers was pasted on the filter paper sample and on the questionnaires. Respondents were not given the HIV test results since the protocol design made it impossible for the survey staff to know the HIV status of individual participants. All of the information obtained from the household and individual interviews, however, can be linked to the HIV test results through the bar codes. In order to preserve the anonymity of the results, the original cluster and household identifiers were replaced in the data set by randomly generated cluster and household numbers. All individuals who were eligible for testing in the survey, whether they accepted the testing or not, received referrals for free HIV counseling and testing at a local health facility.
b) The Women's Questionnaire was employed to interview all women (ever-married and never-married) age 15-49 who were usual residents of the sample household or visitors who stayed in the sample household the night before the survey. The questionnaire covered the following topics:
- Background characteristics: age, marital status, caste/tribe, religion, education, employment status, exposure to mass media, place of residence, and husband's background.
- Reproductive behaviour and intentions: dates and survival status of all births, current pregnancy status, pregnancy losses, use of ultrasound for recent pregnancies, and future childbearing intentions.
- Marriage and cohabitation: duration of marriage and cohabitation, number of times married.
- Knowledge and use of contraception: knowledge and use of specific contraceptive methods, source of family planning methods, and reasons for non-use of contraception and intentions not to use contraception in the future.
- Quality of care and contacts with health personnel: quality of family planning and health services.
- Antenatal, delivery, and postnatal care: antenatal and postnatal care, antenatal services received, place of delivery, attendance at delivery, and complications during pregnancy for recent births.
- General health: smoking, alcohol use, injections, tuberculosis, asthma, diabetes, and thyroid disorders.
- Child immunizations, child health, and child feeding practices: immunization coverage, breastfeeding and feeding practices, and recent occurrences of diarrhoea, fever, and cough for young children.
- Women's and children's nutrition: food intake and nutrition-related practices for women and children.
- Utilization of ICDS Services: utilization of various services of the Integrated Child Development Services (ICDS) Scheme for women and children.
- Status of women and spousal violence: women's autonomy, gender relations, men's involvement in health care for women, and various forms of physical and sexual violence experienced by women.
- Sexual life: sexual intercourse (first and recent intercourse), high-risk sexual behaviour, number of sexual partners, age difference between partners, and duration of sexual relationships.
- HIV/AIDS and other sexually transmitted infections: knowledge of AIDS and the sources of knowledge, knowledge of ways to avoid getting HIV/AIDS, prior HIV testing, knowledge of places for HIV testing and medications for HIV/AIDS, perceptions and stigma related to HIV infected persons, attitudes about family life education for children, and knowledge and prevalence of other sexually transmitted infections.
c) The Men's Questionnaire was employed to interview men age 15-54 who were usual residents of the sample household or visitors who stayed in the sample household the night before the survey. The Men's Questionnaire contains a subset of questions that are covered in the Women's Questionnaire, plus some additional questions only administered to men. The questionnaire covered the following topics:
- Background characteristics: age, marital status, caste/tribe, religion, education, employment status, exposure to mass media, and place of residence.
- Reproductive behaviour and intentions: number of children, number of surviving children, fertility preferences, and future intentions to have children.
- Knowledge and use of contraception: knowledge and use of specific contraceptive methods, and sources of family planning methods.
- Male involvement in health care: men's involvement in health care for their child and the mother of their children, and quality of health services obtained by men.
- Sexual life: sexual intercourse (first and recent intercourse), high-risk sexual behaviour, number of sexual partners, age difference between partners, and duration of sexual relationships.
- Health and nutrition: food intake, smoking, alcohol use, injections, tuberculosis, asthma, diabetes, and thyroid disorders.
- Attitude toward gender roles: attitude about gender roles, attitude about spousal violence, and men's perception of wife's involvement in decision making.
- HIV/AIDS and other sexually transmitted infections: knowledge of AIDS and the sources of knowledge, knowledge of ways to avoid getting HIV/AIDS, prior HIV testing, knowledge of places for HIV testing and medications for HIV/AIDS, perceptions and stigma related to HIV-infected persons, knowledge and prevalence of other sexually transmitted infections, and attitudes about family life education for children.