Data Collection Notes
Training and Fieldwork Data Collection
Thirty-eight women and men were trained from June 14-July 2, 2010, in the administration of the RDHS survey instruments, anthropometric measurement, hemoglobin testing, malaria testing, and blood drawing for HIV testing. Seven days of fieldwork were followed by one day of interviewer debriefing and examination. Pre-test fieldwork was conducted in 230 households in two rural and two urban villages outside of City of Kigali. The majority of pretest participants attended the main training and served as field editors and team leaders for the main survey.
NISR recruited and trained 117 participants, and at the end of the training it retained 105 to work as field personnel. The main training was conducted from August 16-September 14, 2010. The training consisted of instruction regarding interviewing techniques and field procedures, a detailed review of items on the questionnaires followed by tests, instruction and practice in weighing and measuring children, and mock interviews and role plays among participants in the classroom. Each of the fifteen data collection teams included a team leader, a field editor, three female interviewers, one male interviewer, and one biomarker staff member.
The main fieldwork was launched immediately upon the conclusion of field staff training. Each of the 15 teams was assigned to 2 of the 30 districts. Fieldwork supervision was conducted by NISR, NRL, and ICF International through regular visits to teams to review their work and monitor data quality. The UNICEF team also regularly visited the teams in the field. Additional contact between the central office and the teams was maintained through cell phones. Fieldwork was conducted from September 26, 2010, to March 10, 2011. Questionnaires and blood samples were regularly delivered to NISR headquarters.
Hemoglobin, Malaria and HIV Testing
In a subsample of one-half of all households selected for the Man’s Questionnaire, blood specimens were collected from women age 15-49 and children age 6-59 months for measurement of hemoglobin in the field. The specimens were tested for malaria in the field using the Rapid Diagnostic Test (RDT) and tested for malaria in the lab using the microscopic method. Additionally, in the same one-half of all households, blood specimens for HIV testing were collected from all women age 15-49 and men age 15-59 who consented to the test. The protocol for the blood specimen collection and testing for HIV was reviewed and approved by the Rwanda National Ethics Committee, the Institutional Review Board of ICF International, and the Centers for Disease Control and Prevention (CDC) in Atlanta.
The 2010 RDHS included anemia testing of children age 6 to 59 months and women age 15-49 in the same one-half of households that were selected for interviews of men. A consent statement was read to the eligible respondent or to the parent or responsible adult for children and young women age 15-17. This statement explained the purpose of the test, informed respondents that the results would be made available as soon as the test was completed, and requested permission for the test to be carried out.
Anemia levels were determined by measuring the level of hemoglobin in the blood (a decreased concentration of hemoglobin characterizes anemia). The concentration of hemoglobin in the blood was measured in the field using the HemoCue system. A special-purpose photometer is used to determine hemoglobin levels. A capillary blood sample is taken from the palm side of the end of a finger, punctured with a sterile, non-reusable, selfretractable lancet. The blood drop is collected in a HemoCue microcuvette, which serves as a measuring tool, and placed in the HemoCue photometer to determine the level of hemoglobin in the blood. A pamphlet was given to each respondent, explaining symptoms of anemia, prevention methods, and the individual results of the hemoglobin measurement of the respondent and any children for whom the respondent gave permission to be measured. Each person whose hemoglobin level was lower than the recommended cutoff point (testing severely anemic) was advised to visit a health facility for follow-up with a health professional.
Malaria diagnostic tests, including a rapid diagnostic test (RDT) and a test using thick and thin blood smears, were given to eligible women and children in the 2010 RDHS. For the RDT for malaria, a drop of blood was obtained by a prick at the end of the finger, usually at the same time as anemia testing. First Response test kits were used according to manufacturer recommendations. The results of the malaria RDT were recorded in the Household Questionnaire, which allows linking with the characteristics of the respondents. Results from the RDTs were used to diagnose malaria and guide treatment of parasitemic children during the survey. The parent or guardian of children with a positive RDT was provided with written results, and children were given Coartem for treatment, according to the current malaria treatment guidelines. Women with a positive RDT were referred to the nearest health center for treatment.
Thin and thick blood smears were also collected from participants who agreed to malaria testing. Blood slides were stained with Giemsa stain prepared by the laboratory in advance of the fieldwork. Parasite densities were calculated by counting the number of asexual stage parasites/200 white blood cells (WBCs), assuming 6,000 WBCs/dl of blood. Blood smears were considered negative if no parasites were found after counting 200 fields.
An informed consent form was read to the eligible person or parent/responsible adult of the child or teenager age 15-18 . This consent form asks, first of all, for the authorization of the person before undertaking the test and then explains the objectives of the test, informing the individual taking the test or those responsible for children that the results would be communicated immediately after the test. For each eligible woman and child, a slide with thick and thin blood smears was prepared, transmitted, and stored for microscopic examination of malaria parasites at the NRL.
Women and men who were interviewed in the subsample of households selected for the men’s survey of the 2010 RDHS were asked to voluntarily provide blood for HIV testing. The HIV test is anonymous; that is, the results of the test were not linked to survey data until the individual respondent’s identifying information was destroyed by NISR. Therefore, the respondents’ HIV test results can never be linked to identifying data. For women and men willing to be tested, drops of blood were drawn and dried on filter paper. Only an identification number (barcode) drawn at random was assigned to each specimen. Since no information containing personal identification accompanied the samples, it was not possible to inform the respondents of the result of their test. Analysis of the samples for HIV was carried out at the NRL.
Information and educational brochures about HIV/AIDS prevention and the existing Voluntary Counseling and Testing (VCT) and Prevention of Mother-To-Child Transmission (PMTCT) sites were distributed to all households selected for the survey, whether these households were selected for testing or not. These brochures were prepared by TRAC-Plus and the Commission Nationale de Lutte contre le Sida (CNLS) or National AIDS Control Commission in close collaboration with NISR and were adapted to the population surveyed.