The 2004 Lesotho Demographic and Health Survey is the first survey of this type conducted in Lesotho.
The Ministry of Health and Social Welfare (MOHSW) initiated the 2004 Lesotho Demographic and Health Survey (LDHS) to collect population-based data to inform the Health Sector Reform Programme (2000-2009). The 2004 LDHS will assist in monitoring and evaluating the performance of the Health Sector Reform Programme since 2000 by providing data to be compared with data from the first baseline survey, which was conducted when the reform programme began. The LDHS survey will also provide crucial information to help define the targets for Phase II of the Health Sector Reform Programme (2005-2008). Additionally, the 2004 LDHS results will serve as the main source of key demographic indicators in Lesotho until the 2006 population census results are available.
The LDHS was conducted using a representative sample of women and men of reproductive age.
The specific objectives were to:
- Provide data at national and district levels that allow the determination of demographic indicators, particularly fertility and childhood mortality rates;
- Measure changes in fertility and contraceptive use and at the same time analyse the factors that affect these changes, such as marriage patterns, desire for children, availability of contraception, breastfeeding patterns, and important social and economic factors;
- Examine the basic indicators of maternal and child health in Lesotho, including nutritional status, use of antenatal and maternity services, treatment of recent episodes of childhood illness, and immunisation coverage for children;
- Describe the patterns of knowledge and behaviour related to the transmission of HIV/AIDS, other sexually transmitted infections, and tuberculosis;
- Estimate adult and maternal mortality ratios at the national level;
- Estimate the prevalence of anaemia among children, women and men, and the prevalence of HIV among women and men at the national and district levels.
Kind of Data
Sample survey data
Unit of Analysis
- Women age 15-49
- Men age 15-59
The 2004 Lesotho Demographic and Health Survey covered the following topics:
- Household Identification
- Household Demographic Characteristics
- Household Schedule
- Hight, Weight, and Hemoglobin Measurement
- Hemoglobin and HIV Testing - Women and Men
- Respondent's Background
- Pregnancy, Postnatal Care and Breastfeeding
- Immunization, Health and Nutrition
- Marriage and Sexual Activity
- Fertility Preferences
- Husband's Background and Women's Work
- HIV and AIDS, Other Sexually Transmitted Diseases, and Tuberculosis
- Maternal Mortality
- Respondent's Background
- Marriage, Sexual Activity and Contraceptive Use
- Fertility Preferences
- Participation in Heath Care
- HIV and AIDS, Other Sexually Transmitted Infections, and Tuberculosis
- Attitudes towards Gender Roles
Producers and sponsors
Bureau of Statistics
Ministry of Health and Social Welfare
Government of Lesotho
United States Agency for Intemational Development, Regional HIV/AIDS Program
USAID / RHAP
Development Cooperation Ireland
United Nations Children's Fund
The sample for the 2004 LDHS covered the household population. A representative probability sample of more than 9,000 households was selected for the 2004 LDHS sample. This sample was constructed to allow for separate estimates for key indicators in each of the ten districts in Lesotho, as well as for urban and rural areas separately.
The survey utilized a two-stage sample design. In the first stage, 405 clusters (109 in the urban and 296 in the rural areas) were selected from a list of enumeration areas from the 1996 Population Census frame. In the second stage, a complete listing of households was carried out in each selected cluster. Households were then systematically selected for participation in the survey.
All women age 15-49 who were either permanent household residents in the 2004 LDHS sample or visitors present in the household on the night before the survey were eligible to be interviewed. In addition, in every second household selected for the survey, all men age 15-59 years were eligible to be interviewed if they were either permanent residents or visitors present in the household on the night before the survey. In the households selected for the men's survey, height and weight measurements were taken for eligible women and children under five years of age. Additionally, eligible women, men, and children under age five were tested in the field for anaemia, and eligible women and men were asked for an additional blood sample for anonymous testing for HIV.
Note: See detailed sample implementation in the APPENDIX A of the final 2004 Lesotho Demographic and Health Survey Final Report.
Response rates are important because high non-response may affect the reliability of the results. A total of 9,903 households were selected for the sample, of which 9,025 were found to be occupied during data collection. Of the 9,025 existing households, 8,592 were successfully interviewed, yielding a household response rate of 95 percent.
In these households, 7,522 women were identified as eligible for the individual interview. Interviews were completed with 94 percent of these women. Of the 3,305 eligible men identified, 85 percent were successfully interviewed. The response rate for urban women and men is somewhat higher than for rural respondents (96 percent compared with 94 percent for women and 88 percent compared with 84 percent for men). The principal reason for non-response among eligible women and men was the failure to find individuals at home despite repeated visits to the household. The lower response rate for men reflects the more frequent and longer absences of men from the household, principally because of employment and life style.
Response rates for the HIV testing component were lower than those for the interviews.
See summarized response rates in Table 1.2 of the Final Report.
Dates of Data Collection
Data Collection Mode
Data Collection Notes
Eighty-two people (about half women and half men) were recruited by the MOHSW and BOS to serve as supervisors, field editors, male and female interviewers, and reserves. They all participated in the main interviewer training, which began on 16 August 2004 in Roma and lasted for a period of about four weeks. The trainees came from the BOS and the MOHSW from both the central and district levels. Most of the participants from the BOS had had prior experience as interviewers in other surveys, while most of the participants from the MOHSW had had experience with blood collection and HIV/AIDS testing and counselling.
The training was conducted mainly in English and included lectures, presentations, practical demonstrations, and practice interviewing in small groups. The training included two days of field practice with households living close to the training site. The participants also received training relating to height and weight measurements, haemoglobin testing, and blood collection for HIV. The trainers were officers of BOS and MOHSW as well as staff from ORC Macro. In addition to the main trainers, guest lecturers gave presentations in plenary sessions on specialized topics, such as family planning, nutrition, maternal and child health, and HIV/AIDS.
Towards the end of the training course, some interviewers were selected as supervisors and field editors. This group was further trained on how to supervise fieldwork and editing of the questionnaires in the field, as well as how to read global positioning system (GPS) coordinates.
Data collection began on 28 September 2004. The 12 data collection teams were made up of one supervisor, one field editor, three female interviewers and one male interviewer (with the exception of two teams that had two female interviewers and two male interviewers). Fieldwork was completed on 18 January 2005. Fieldwork supervision was coordinated at MOHSW and BOS headquarters; three teams of Regional Coordinators consisting of one representative from MOHSW and one from BOS for each team periodically visited the field teams to review their work and to monitor data quality. Additionally, close contact between MOHSW and BOS headquarters and the field teams was maintained through mobile phones.
Three questionnaires were used for the 2004 LDHS: the Household Questionnaire, the Women’s Questionnaire, and the Men’s Questionnaire. To reflect relevant issues in population and health in Lesotho, the questionnaires were adapted during a series of technical meetings with various stakeholders from government ministries and agencies, nongovernmental organizations and international donors. The final draft of the questionnaire was discussed at a large meeting of the LDHS Technical Committee organized by the MOHSW and BOS. The adapted questionnaires were translated from English into Sesotho and pretested during June 2004.
The Household Questionnaire was used to list all of the usual members and visitors in the selected households. The main purpose of the Household Questionnaire was to identify women and men who were eligible for the individual interview. Some basic information was also collected on the characteristics of each person listed, including age, sex, education, residence and emigration status, and relationship to the head of the household. For children under 18, survival status of the parents was determined. The Household Questionnaire also collected information on characteristics of the household’s dwelling unit, such as the source of water, type of toilet facilities, materials used for the floor of the house, ownership of various durable goods, and access to health facilities. For households selected for the male survey subsample, the questionnaire was used to record height, weight, and haemoglobin measurements of women, men and children, and the respondents’ decision about whether to volunteer to give blood samples for HIV.
The Women’s Questionnaire was used to collect information from all women age 15-49. The women were asked questions on the following topics:
- Background characteristics (education, residential history, media exposure, etc.)
- Birth history and childhood mortality
- Knowledge and use of family planning methods
- Fertility preferences
- Antenatal and delivery care
- Breastfeeding and infant feeding practices
- Vaccinations and childhood illnesses
- Marriage and sexual activity
- Woman’s work and husband’s background characteristics
- Awareness and behaviour regarding AIDS, other sexually transmitted infections (STIs), and tuberculosis (TB)
- Maternal mortality
The Men’s Questionnaire was administered to all men age 15-59 living in every other household in the 2004-05 LDHS sample. The Men’s Questionnaire collected much of the same information found in the Women’s Questionnaire, but was shorter because it did not contain a detailed reproductive history or questions on maternal and child health, nutrition, and maternal mortality.
Geographic coordinates were collected for each EA in the 2004 LDHS.
The processing of the 2004 LDHS results began shortly after the fieldwork commenced. Completed questionnaires were returned periodically from the field to BOS headquarters, where they were entered and edited by data processing personnel who were specially trained for this task. The data processing personnel included two supervisors, two questionnaire administrators/office editors-who ensured that the expected number of questionnaires from each cluster was received-16 data entry operators, and two secondary editors. The concurrent processing of the data was an advantage because BOS was able to advise field teams of problems detected during the data entry. In particular, tables were generated to check various data quality parameters. As a result, specific feedback was given to the teams to improve performance. The data entry and editing phase of the survey was completed in May 2005.
Estimates of Sampling Error
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 2004 Lesotho Demographic and Health Survey (LSDHS) 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 2004 LSDHS 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 2004 LSDHS sample is the result of a multistage stratified design, and, consequently, it was necessary to use more complex formulae. The computer software used to calculate sampling errors for the 2004 LSDHS is the ISSA Sampling Error Module. 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.
Note: See detailed sampling error calculation in the APPENDIX B of the Final Report.
Data Quality Tables
- Household age distribution
- Age distribution of eligible and interviewed women
- Completeness of reporting
- Birth by calendar years
- Reporting of age at death in days
- Reporting of age at death in months
Note: See these data quality tables in APPENDIX C of the Final Report.
Data and Data Related Resources
Use of the dataset must be acknowledged using a citation which would include:
- the Identification of the Primary Investigator
- the title of the survey (including acronym and year of implementation)
- the survey reference number
- the source and date of download
Disclaimer and copyrights
The user of the data acknowledges that the original collector of the data, the authorized distributor of the data, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses.