Resultados de la Encuesta Demographica y salud Familiar Peru 2000 1993
Demographic and Health Survey (standard) - DHS III
The 1993 Philippines Demographic and Health Survey (PDHS) is the sixth DHS survey carried out every five years since 1968 in order to measure trends in demographic and family planning indicators in Philippines. But the 1993 NDHS is the first national sample survey undertaken in Philippines under the auspices of the worldwide Demographic and Health Surveys program.
The 1993 National Demographic Survey (NDS) is a nationally representative sample survey of women age 15-49 designed to collect information on fertility; family planning; infant, child and maternal mortality; and maternal and child health. The survey was conducted between April and June 1993. The 1993 NDS was carried out by the National Statistics Office in collaboration with the Department of Health, the University of the Philippines Population Institute, and other agencies concerned with population, health and family planning issues. Funding for the 1993 NDS was provided by the U.S. Agency for International Development through the Demographic and Health Surveys Program.
Close to 13,000 households throughout the country were visited during the survey and more than 15,000 women age 15-49 were interviewed. The results show that fertility in the Philippines continues its gradual decline. At current levels, Filipino women will give birth on average to 4.1 children during their reproductive years, 0.2 children less than that recorded in 1988. However, the total fertility rate in the Philippines remains high in comparison to the level achieved in the neighboring Southeast Asian countries.
The primary objective of the 1993 NDS is to provide up-to-date inform ation on fertility and mortality levels; nuptiality; fertility preferences; awareness, approval, and use of family planning methods; breastfeeding practices; and maternal and child health. This information is intended to assist policymakers and administrators in evaluating and designing programs and strategies for improving health and family planning services in 'the country.
Fertility varies significantly by region and socioeconomic characteristics. Urban women have on average 1.3 children less than rural women, and uneducated women have one child more than women with college education. Women in Bicol have on average 3 more children than women living in Metropolitan Manila.
Virtually all women know of a family planning method; the pill, female sterilization, IUD and condom are known to over 90 percent of women. Four in 10 married women are currently using contraception. The most popular method is female sterilization ( 12 percent), followed by the piU (9 percent), and natural family planning and withdrawal, both used by 7 percent of married women.
Contraceptive use is highest in Northern Mindanao, Central Visayas and Southern Mindanao, in urban areas, and among women with higher than secondary education. The contraceptive prevalence rate in the Philippines is markedly lower than in the neighboring Southeast Asian countries; the percentage of married women who were using family planning in Thailand was 66 percent in 1987, and 50 percent in Indonesia in 199l.
The majority of contraceptive users obtain their methods from a public service provider (70 percent). Government health facilities mainly provide permanent methods, while barangay health stations or health centers are the main sources for the pill, IUD and condom.
Although Filipino women already marry at a relatively higher age, they continue to delay the age at which they first married. Half of Filipino women marry at age 21.6. Most women have their first sexual intercourse after marriage.
Half of married women say that they want no more children, and 12 percent have been sterilized. An additional 19 percent want to wait at least two years before having another child. Almost two thirds of women in the Philippines express a preference for having 3 or less children. Results from the survey indicate that if all unwanted births were avoided, the total fertility rate would be 2.9 children, which is almost 30 percent less than the observed rate,
More than one quarter of married women in the Philippines are not using any contraceptive method, but want to delay their next birth for two years or more (12 percent), or want to stop childbearing (14 percent). If the potential demand for family planning is satisfied, the contraceptive prevalence rate could increase to 69 percent. The demand for stopping childbearing is about twice the level for spacing (45 and 23 percent, respectively).
Information on various aspects of maternal and child health---antenatal care, vaccination, breastfeeding and food supplementation, and illness was collected in the 1993 NDS on births in the five years preceding the survey. The findings show that 8 in 10 children under five were bom to mothers who received antenatal care from either midwives or nurses (45 percent) or doctors (38 percent). Delivery by a medical personnel is received by more than half of children born in the five years preceding the survey. However, the majority of deliveries occurred at home.
Tetanus, a leading cause of infant deaths, can be prevented by immunization of the mother during pregnancy. In the Philippines, two thirds of bitlhs in the five years preceding the survey were to mothers who received a tetanus toxoid injection during pregnancy.
Based on reports of mothers and information obtained from health cards, 90 percent of children aged 12-23 months have received shots of the BCG as well as the first doses of DPT and polio, and 81 percent have received immunization from measles. Immunization coverage declines with doses; the drop out rate is 3 to 5 percent for children receiving the full dose series of DPT and polio. Overall, 7 in 10 children age 12-23 months have received immunization against the six principal childhood diseases---polio, diphtheria, ~rtussis, tetanus, measles and tuberculosis.
During the two weeks preceding the survey, 1 in 10 children under 5 had diarrhea. Four in ten of these children were not treated. Among those who were treated, 27 percent were given oral rehydration salts, 36 percent were given recommended home solution or increased fluids.
Breasffeeding is less common in the Philippines than in many other developing countries. Overall, a total of 13 percent of children born in the 5 years preceding the survey were not breastfed at all. On the other hand, bottle feeding, a widely discouraged practice, is relatively common in the Philippines. Children are weaned at an early age; one in four children age 2-3 months were exclusively breastfed, and the mean duration of breastfeeding is less than 3 months.
Infant and child mortality in the Philippines have declined significantly in the past two decades. For every 1,000 live births, 34 infants died before their first birthday. Childhood mortality varies significantly by mother's residence and education. The mortality of urban infants is about 40 percent lower than that of rural infants. The probability of dying among infants whose mother had no formal schooling is twice as high as infants whose mother have secondary or higher education. Children of mothers who are too young or too old when they give birth, have too many prior births, or give birth at short intervals have an elevated mortality risk. Mortality risk is highest for children born to mothers under age 19.
The 1993 NDS also collected information necessary for the calculation of adult and maternal mortality using the sisterhood method. For both males and females, at all ages, male mortality is higher than that of females. Matemal mortality ratio for the 1980-1986 is estimated at 213 per 100,000 births, and for the 1987-1993 period 209 per 100,000 births. However, due to the small number of sibling deaths reported in the survey, age-specific rates should be used with caution.
Information on health and family planning services available to the residents of the 1993 NDS barangay was collected from a group of respondents in each location. Distance and time to reach a family planning service provider has insignificant association with whether a woman uses contraception or the choice of contraception being used. On the other hand, being close to a hospital increases the likelihood that antenatal care and births are to respondents who receive ANC and are delivered by a medical personnel or delivered in a health facility.
Kind of Data
Sample survey data
Unit of Analysis
- Women age 15-49
The 1993 Philippines Demographic and Health Survey covers the following topics:
- Availability of family planning
- Background characteristics (education, religion, etc.)
- Breastfeeding and child health
- Full Pregnancy History
- Knowledge and use of contraception
- Maternal Mortality
- Reproductive behavior and intentions
- Service Availability
National. The main objective of the 1993 NDS sample is to allow analysis to be carried out for urban and rural areas separately, for 14 of the 15 regions in the country. Due to the recent formation of the 15th region, Autonomous Region in Muslim Mindanao (ARMM), the sample did not allow for a separate estimate for this region.
The population covered by the 1993 Phillipines NDS is defined as the universe of all females age 15-49 years, who are members of the sample household or visitors present at the time of interview and had slept in the sample households the night prior to the time of interview, regardless of marital status.
Producers and sponsors
National Statistics Office (NSO)
Macro International, Inc.
Department of Health (DOH)
U.S. Agency for International Development
University of the Philippines (UP)
The main objective of the 1993 National Demographic Survey (NDS) sample is to provide estimates with an acceptable precision for sociodemographics characteristics, like fertility, family planning, health and mortality variables and to allow analysis to be carried out for urban and rural areas separately, for 14 of the 15 regions in the country. Due to the recent formation of the 15th region, Autonomous Region in Muslim Mindanao (ARMM), the sample did not allow for a separate estimate for this region.
The sample is nationally representative with a total size of about 15,000 women aged 15 to 49. The Integrated Survey of Households (ISH) was used as a frame. The ISH was developed in 1980, and was comprised of samples of primary sampling units (PSUs) systematically selected and with a probability proportional to size in each of the 14 regions. The PSUs were reselected in 1991, using the 1990 Population Census data on population size, but retaining the maximum number of PSUs selected in 1980.
This sample is self-weighted in each of the 14 regions, but not at the national level. It was selected using a two-stage sample design; the first involved the selection of barangays,and the second, the selection of households in the sampled barangays. Barangays are the smallest political subdivisions. In general, the barangay corresponds to a census enumeration area. However, they vary widely in size, some covering more than 1,000 households. In the case when the barangay size was very large, it was segmented into several enumeration areas.
To maximize the efficiency of the sample design, the sample was allocated to the regions using a method called "power allocation procedure." This method optimizes the precision by taking into account sampling errors found in previous demographic surveys, in particular the 1978 Republic of the Philippines Fertility Survey. For this purpose, the following characteristics were considered: mean number of children ever born, proportion of women who want no more children, mean number of children desired, and proportion of married women who are using a family planning method.
A total of 2100 PSUs were selected for ISH, 750 of which were selected for the 1993 NDS. Individual households were selected with a probability of selection inversely proportional to the barangay's size to maintain a fixed overall sampling fraction within each region. An average of 20 completed interviews was targeted in each PSU.
In total, 750 PSUs and about 13,700 households were selected. The survey was well received by the respondents. Response rate for the household interview varies slightly by region (see Table A. 1). In some regions, all of the households in the sample were successfully interviewed. For the individual women's interview, Bicol women have the lowest overall response rate (93 percent).
A total of 15,029 women aged 15-49 years were successfully interviewed. The weighting factors to provide national estimates were calculated as the inverse of the overall sampling fractions, adjusted with the corresponding household and individual responses rates.
Deviations from the Sample Design
The household interviews identified 15,332 eligible women. Of these, 15,029 were successfully interviewed, giving a response rate of 98 percent. The principal reason for nonresponse among eligible women was the failure of interviewers to find them at home despite repeated visits to the household. Refusals were few in number (less than one percent).
A total of 13,728 households was selected for the survey, of which 12,995 were successfully interviewed. The difference was due to one of the following reasons: some selected households had moved out or could not be located by the NDS team; there were no eligible respondents found for the selected household during the NDS team's visit; or the household simply refused to be interviewed.
Dates of Data Collection
Data Collection Mode
During the first two weeks of the field work, statisticians from the Central Office, who served as trainers during the training of interviewers, went on field trips to observe and guide the teams in their initial interviews.
Data Collection Notes
The 1993 NDS questionnaires were pretested in December 1992. Three pretest areas were selected; namely, the barangays of Malolos and Calumpit, Bulacan Province, and Barangay Tatalon in Metropolitan Manila. Fifteen female interviewers were recruited. Three NSO employees were assigned as field editors, and three statisticians from the NSO were assigned to supervise the fieldwork. About 180 interviews of women 15-49 were completed in the pretest. The pretest results were used as basis for revising the questionnaires and the translations into the six dialects. They also provided a basis for firming up survey operational procedures.
Training of field staff for the main survey was conducted in the following designated training sites: Baguio City, Manila, Cebu City and Davao City. The training course consisted of instructions in general interviewing techniques, field procedures, a detailed review of items on the questionnaires, mock interviews between participants in the classroom, and practice interviews in the field. Trainees who performed satisfactorily in the training program were selected as interviewers, while those whose performance was rated as superior were selected as field editors.
The fieldwork for the Philippine NDS was carried out by 31 interviewing teams. Each team consisted of one team supervisor, one field editor, and an average of five interviewers. The Regional Administrators of NSO served as field coordinators during the data collection phase of the survey.
Philippines National Statistics Office (NSO)
Three types of questionnaires were used for the 1993 NDS: the Household Questionnaire, the Individual Woman's Questionnaire and the Service Availability Questionnaire. The contents of the first two questionnaires were based on the DHS Model Questionnaire, which was designed for use in countries with high levels of contraceptive use. Additions and modifications to the model questionnaires were made after consultation with members of a Technical Working Group convened for the purpose of providing technical assistance to the NSO in the implementation of the survey.
The household and individual questionnaires were developed in English and then translated into and printed in six of the most widely spoken languages in the Philippines, namely: Tagalog, Cebuano, Ilocano, Hiligaynon, Bicol and Waray.
a) The Household Questionnaire was used to list all the usual members and visitors of selected households. Some basic information was collected on the characteristics of each person listed, including his/her age, sex, education, and relationship to the head of the household. The main purpose of the Household Questionnaire was to identify women who were eligible for individual interview. In addition, information was collected about the dwelling, such as the source of water, type of toilet facilities, materials used for the floor of the house, and ownership of various consumer goods.
b) The Individual Woman's Questionnaire was used to collect information from women aged 15-49. An important change from the past practice in large-scale demographic surveys in the Philippines is that the 1993 NDS covered all women 15-49 instead of limiting the interview to ever-married women. In keeping with past practice, the questionnaire contained a pregnancy history instead of the usual DHS birth history. Women were asked questions on the following topics:
- Background characteristics (education, religion, etc.)
- Reproductive behavior and intentions
- Knowledge and use of contraception
- Availability of family planning
- supplies and services
- Breastfeeding and child health
- Maternal mortality
c) The Health Service Availability Questionnaire was designed to collect information about health and family planning services available to the individual women respondents. This questionnaire was administered at the cluster level, that is, one questionnaire was filled for each of the 750 sample points. Combined with information collected in the main survey, data from the two surveys can identify subgroups of women who are underserved by the health and family planning providers.
Editing of the questionnaires was an integral part of the field data collection in the sense that questionnaires based on successful interviews were immediately edited by field editors. Further review and coding of some variables were done at the NSO central office. Machine processing was also done at the central office.
Processing of the NDS data was done with the use of the DHS computer program ISSA (Integrated System for Survey Analysis), from data entry to tabulation. Seven microcomputers were made available by NSO for data entry while Macro International provided four microcomputers for data management as well as for running edit and tabulation programs. Initial tabulations were generated by the end of August 1993, and a preliminary report was released in October 1993.
Estimates of Sampling Error
Sampling errors, on the other hand, can be measured statistically. The sample of women selected in the 1993 NDS is only one of many samples that could have been selected from the same population, using the same design and expected size. Each one would have yielded results that differed somewhat from the actual sample selected. The sampling error is a measure of the variability between all possible samples; although it is not known exactly, it can be estimated from the survey results.
Sampling error is usually measured in terms of standard error of 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, apart from nonsampling errors, 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 same statistic as measured in 95 percent of all possible samples with the same design (and expected size) will fall within a range of plus or minus two times the standard error of that statistic.
If the sample of women had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the 1993 NDS sample was designed using stratification (region and urban/rural), clustering (barangay or a segment thereof) and stages of selection (barangay and household on the first and second stage, respectively). Consequently, it was necessary to utilize more complex formulas. The module on sampling errors in the ISSA package developed for the Demographic and Health Surveys program was used to assist in computing the sampling errors with the proper statistical methodology.
In addition to the standard errors, the program 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 ifa 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. The ISSA program also computes the relative error and confidence limits for the estimates.
For each variable, the type of statistic (mean or proportion) and the base population are given in Table B.1 of the Final Report. Sampling errors are presented in Tables B.2.1-B.2.17 of the Final Report for variables considered to be of major interest. Results are presented for the whole country, divided into urban and rural areas, and for each of the 14 regions. For each variable, Tables B.2.1-B.2.17 present the value of the statistic (R), its standard error (SE), the number of unweighted (N) and weighted cases (WN), the design effect (DEFT), the relative standard error (SE/R), and the 95 percent confidence limits (R+2SE).
More complex estimates like the total fertility rate, infant mortality rate or medians are calculated using the Jackknife replication procedure incorporated in this ISSA module. Results are presented only for the whole country, divided into urban and rural areas, but not for each of the 14 regions, because these estimates need to have a large sample size to provide accurate precision.
The confidence limits have the following interpretation. For the proportion of married women currently using a contraceptive method (currently using any method), the overall average from the sample is 0.400 and its standard error is 0.006. Therefore, to obtain the 95 percent confidence limits, one adds and subtracts twice the standard error to the sample estimate, i.e., 0.400 + (2 x 0.006), which means that there is a high probability (95 percent) that the true proportion currently using is between 0.387 and 0.412.
The relative standard error for most estimates for the country as a whole is small, except for estimates of very small proportions. The magnitude of the error increases as estimates for subpopulations such as geographical areas are considered. For the variable currently using any method, for instance, the relative standard error (as a percentage of the estimated proportion) for the whole country and for urban and rural areas is 1.5 percent, 2.1 percent, and 2.3 percent, respectively.
Nonsampling error is due to mistakes made in carrying out field activities, such as failure to locate and interview the correct household, errors in the way the questions are asked, misunderstanding on the part of either the interviewer or the respondent, data entry errors, etc. Although efforts were made during the design and implementation of the 1993 NDS to minimize this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically.
Data and Data Related Resources
National Statistics Office
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