This is the third Demographic and Health Survey (DHS) to be carried out in Nepal. The first one was carried out in 1996 and the second one in 2001.
The principal objective of the 2006 Nepal Demographic and Health Survey (NDHS) is to provide current and reliable data on fertility and family planning behavior, child mortality, adult and maternal mortality, children’s nutritional status, the utilization of maternal and child health services, and knowledge of HIV/AIDS. For the first time, the 2006 NDHS conducted anemia testing at the household level for the country as a whole to provide information on the prevalence of anemia at the population level. The specific objectives of the survey are to:
- collect data at the national level which will allow the calculation of key demographic rates;
- analyze the direct and indirect factors which determine the level and trends of fertility;
- measure the level of contraceptive knowledge and practice among women and men by method, urban-rural residence and region,
- collect high-quality data on family health including immunization coverage among children, prevalence and treatment of diarrhea and other diseases among children under five, and maternity care indicators including antenatal visits, assistance at delivery, and postnatal care;
- collect data on infant and child mortality, and maternal and adult mortality;
- obtain data on child feeding practices including breastfeeding, and collect anthropometric measures to use in assessing the nutritional status of women and children;
- collect data on knowledge and attitudes of women and men about sexually transmitted infections and HIV/AIDS and evaluate patterns of recent behavior regarding condom use;
- conduct hemoglobin testing on women age 15-49 and children age 6-59 months in the households selected for the survey to provide information on the prevalence of anemia among women in the reproductive ages and young children.
This information is essential for informed policy decisions, planning, monitoring, and evaluation of programs on health in general and reproductive health in particular at both the national and regional levels. A long-term objective of the survey is to strengthen the technical capacity of government organizations to plan, conduct, process, and analyze data from complex national population and health surveys. Moreover, the 2006 NDHS provides national, regional and subregional estimates on population and health that are comparable to data collected in similar surveys in other developing countries. The first Demographic and Health Survey (DHS) in Nepal was the 1996 Nepal Family Health Survey (NFHS) conducted as part of the worldwide DHS program, and was followed five years later by the 2001 Nepal Demographic and Health Survey (NDHS). Data from the 2006 NDHS survey, the third such survey, allow for comparison of information gathered over a longer period of time and add to the vast and growing international database on demographic and health variables.
Wherever possible, the 2006 NDHS data are compared with data from the two earlier DHS surveys—the 2001 NDHS and the 1996 NFHS—which also sampled women age 15-49. Additionally, men age 15-59 were interviewed in the 2001 NDHS and the 2006 NDHS to provide comparable data for men over the last five years.
Kind of Data
Sample survey data
Unit of Analysis
- Children under five years
- Women age 15-49
- Men age 15-59
The 2006 Nepal Demographic and Health Survey covered the following topics:
- Anemia Questions-Questions or testing assessing prevalence/severity of iron-def. anemia among women or children
- Anemia Testing
- Birth Registration
- Causes of Death
- Early Childhood Education
- GPS/Georeferenced-Global Positioning System or Georeferenced Data
- HIV Behavior
- HIV Knowledge-Questions assess knowledge/sources of knowledge/ways to avoid HIV
- Malaria/Bednet Questions
- Maternal Mortality
- Men's Survey
- Reproductive Calendar
- TB Questions
- Tobacco Use
- Verbal Autopsy
- Vitamin A Questions
Producers and sponsors
Macro International Inc.
United States Agency for International Development
The primary focus of the 2006 NDHS was to provide estimates of key population and health indicators, including fertility and mortality rates, for the country as a whole and for urban and rural areas separately. In addition, the sample was designed to provide estimates of most key indicators for the 13 domains obtained by cross-classifying the three ecological zones (mountain, hill and terai) with the five development regions (East, Central, West, Mid-west, and Far-west).
The 2006 NDHS used the sampling frame provided by the list of census enumeration areas with population and household information from the 2001 Population Census. Each of the 75 districts in Nepal is subdivided into Village Development Committees (VDCs), and each VDC into wards. The primary sampling unit (PSU) for the 2006 NDHS is a ward, subward, or group of wards in rural areas, and subwards in urban areas. In rural areas, the ward is small enough in size for a complete household listing, but in urban areas the ward is large. It was therefore necessary to subdivide each urban ward into subwards. Information on the subdivision of the urban wards was obtained from the updated Living Standards Measurement Survey. The sampling frame is representative of 96 percent of the noninstitutional population.
The sample for the survey is based on a two-stage, stratified, nationally representative sample of households. At the first stage of sampling, 260 PSUs (82 in urban areas and 178 in rural areas) were selected using systematic sampling with probability proportional to size. A complete household listing operation was then carried out in all the selected PSUs to provide a sampling frame for the second stage selection of households. At the second stage of sampling, systematic samples of about 30 households per PSU on average in urban areas and about 36 households per PSU on average in rural areas were selected in all the regions, in order to provide statistically reliable estimates of key demographic and health variables. However, since Nepal is predominantly rural, in order to obtain statistically reliable estimates for urban areas, it was necessary to oversample the urban areas. As such, the total sample is weighted and a final weighting procedure was applied to provide estimates for the different domains, and for the urban and rural areas of the country as a whole.
The survey was designed to obtain completed interviews of 8,600 women age 15-49. In addition, males age 15-59 in every second household were interviewed. To take nonresponse into account, a total of 9,036 households nationwide were selected.
A total of 9,036 households were selected, of which 8,742 were found to be occupied during data collection. Of these existing households, 8,707 were successfully interviewed, giving a household response rate of nearly 100 percent.
In the selected households, 10,973 women were identified as eligible for the individual interview. Interviews were completed for 10,793 women, yielding a response rate of 98 percent. Of the 4,582 eligible men identified in the selected subsample of households, 4,397 were successfully interviewed, giving a 96 percent response rate. Response rates were higher in rural than urban areas, especially for eligible men.
Dates of Data Collection
Data Collection Mode
Data Collection Notes
After the selection of the 260 clusters throughout the 13 subregions, a listing operation was carried out in the selected clusters starting from September 2005. For this purpose, training was conducted for 53 listers and mappers who had been recruited from all the regions to do the listing of households and delineation of EAs. A manual that described the listing procedure was prepared as a guideline and the training was conducted using classroom demonstrations and field practices. Instructions were given on the use of Global Positioning System (GPS) units to obtain location coordinates for selected clusters. The listing was performed by teams composed of one lister and one mapper. Five core team members were also assigned to perform quality checks and handle all the administrative and financial issues of the listing staff.
Prior to the start of the fieldwork, the questionnaires were pretested in all the three local languages, Nepali, Bhojpuri and Maithali, to make sure that the questions were clear and could be understood by the respondents. In order to conduct the pilot survey, 14 interviewers were recruited to interview in the three local languages. The pilot survey was conducted from November 16 to December 13, 2005, in three selected sites. The areas selected for the pretest were Kathmandu for the Nepali language, Parsa district for the Bhojpuri language and Dhanusha district for the Maithili language. Both rural and urban households were selected for the pretest in all three districts. Based on the findings of the pretest, the Household, the Women’s and Men’s Questionnaires were further refined in all the three local languages.
The training of interviewers, editors, supervisors, quality control staff and reserves was conducted from January 4 to February 3, 2006. The Nepali questionnaires were used during the training, while the Bhojpuri and Maithali versions were simultaneously checked against the Nepali questionnaires to ensure accurate translation. In addition to classroom training, trainees did several days of field practice to gain more experience on interviewing in the three local languages and fieldwork logistics. A total of 86 trainees were trained in two classrooms. In each class the training was conducted by two senior staff members of New ERA. The Population Division of MOHP, and staff of the Department of Health Services conducted different sessions on population and health issues. After the training on how to complete the Household, Women’s and Men’s Questionnaires was completed, all trainees were given written and oral tests to gauge their understanding of the DHS questionnaires and interviewing techniques. On the basis of the scores on the exam and overall performance in the classroom, 78 trainees were selected to participate in the main fieldwork. From the group, 6 of the best trainees were selected as quality control staff, 12 of the best male trainees were selected as supervisors and 12 of the best female interviewers were identified as field editors. The remaining 48 trainees were selected to be interviewers. The trainees not selected to participate in the fieldwork were kept as reserves.
After completing the interviewers’ training, the field editors and supervisors were trained for an additional three days on how to supervise the fieldwork and edit questionnaires in the field, in order to ensure data quality. The participants also received training on anthropometric measurements and hemoglobin testing.
Data collection began on February 5, 2006 by 12 field teams each consisting of three female interviewers, one male interviewer, a male supervisor and a female field editor. Fieldwork was completed on August 18, 2006. Fieldwork supervision was coordinated by New ERA; 3 quality control teams made up of one male and one female member each monitored data quality. Additionally, close contact between New ERA and the field teams was maintained through field visits by senior staff, members of the steering committee and Macro International Inc. staff. Regular communication was also maintained through cell phones.
Three questionnaires were administered for the 2006 NDHS: the Household Questionnaire, the Women’s Questionnaire, and the Men’s Questionnaire. These questionnaires were adapted to reflect the population and health issues relevant to Nepal at a series of meetings with various stakeholders from government ministries and agencies, NGOs and international donors. The final draft of the questionnaires was discussed at a questionnaire design workshop organized by MOHP in September 2005 in Kathmandu. The survey questionnaires were then translated into the three main local languages—Nepali, Bhojpuri and Maithili and pretested from November 16 to December 13, 2005.
The Household Questionnaire was used to list all the usual members and visitors in the selected households and to identify women and men who were eligible for the individual interview. Some basic information was collected on the characteristics of each person listed, including age, sex, education, and relationship to the head of the household. For children under age 18, the 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 ownership of mosquito nets. Additionally, the Household Questionnaire was used to record height, weight, and hemoglobin measurements of women age 15-49 and children age 6-59 months. The Women’s Questionnaire was used to collect information from all women age 15-49.
These women were asked questions on the following topics:
- respondent’s characteristics such as education, residential history, media exposure,
- pregnancy history, childhood mortality,
- knowledge and use of family planning methods,
- fertility preferences,
- antenatal, delivery, and postnatal care,
- breastfeeding and infant feeding practices,
- immunization and childhood illnesses,
- marriage and sexual activity,
- woman’s work and husband’s background characteristics,
- awareness and behavior regarding AIDS and other sexually transmitted infections (STIs), and
- maternal mortality.
The Men’s Questionnaire was administered to all men age 15-59 living in every second household in the 2006 NDHS 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 or nutrition.
In addition, the Verbal Autopsy Module into the causes of under-five mortality was administered to all women age 15-49 (and anyone else who remembered the circumstances surrounding the reported death) who reported a death or stillbirth in the five years preceding the survey to children under five years of age.
The processing of the 2006 NDHS results began soon after the start of fieldwork. Completed questionnaires were returned periodically from the field to the New ERA data processing center in Kathmandu, where they were entered and edited by 17 data processing personnel who were specially trained for this task. The data processing personnel included a supervisor, a questionnaire administrator, 4 office editors and 11 data entry operators. The concurrent processing of the data was an advantage since field check tables were generated early on to monitor various data quality parameters. As a result, specific and ongoing feedback was given to the field teams to improve performance. The data entry and editing of the questionnaires was completed by September 17, 2006.
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 2006 Nepal Demographic and Health Survey (NDHS) 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 2006 NDHS 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.
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 by simple random sampling, it would have been possible to use straightforward formulas for calculating sampling errors. However, the 2006 NDHS sample was the result of a multistage stratified design, and, consequently, it is necessary to use more complex formulae. The computer software used to calculate sampling errors for the 2006 NDHS is the ISSA Sampling Error Module. This module uses 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.
See detailed estimate of sampling error calculation in APPENDIX C of the Final 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
- Data on siblings
- Indicators on data quality
- Sibship size and sex ratio of siblings
See these tables in APPENDIX D 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 country, 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.