1. District Level Household Survey Dr K. Sushma

2. Introduction The District Level Household and Facility Survey is one of the largest demographic and health surveys carried out in India, with a sample size of about seven lakh households covering all the districts of the country. The Ministry of Health and Family Welfare (MOHFW), Government of India, initiated District Level Household Surveys (DLHS) in 1997. To provide district level estimates on health indicators to assist policy makers and program administrators in decentralized planning, monitoring and evaluation.

3. Introduction DLHS -1 in 1998-99 and DLHS-2 in 2002-04. DLHS-3 in 2007-08 In addition, DLHS-3 provided information related to the programmes of National Rural Health Mission (NRHM). In DLHS-3, along with ever-married women age 15-49, never married women (age 15-24) were also included as respondents.

4. Methodology: Rapid Household Survey(RCH ) In 1 st phase of survey 50% of total districts were selected Systematic random sampling was used for selection of districts Second phase covered all the remaining districts

5. Methodology: Rapid Household Survey(RCH ) A systematic multi-stage stratified sampling was used 40 primary sampling units (PSUs) either villages/ urban wards were selected from each district using Probability Proportionate to Size (PPS) sampling The target sample size in each district was set at 1,000 complete residential households from 40 selected PSUs. In the second stage, within each PSU, 28 residential households were selected with Circular Systematic Random Sampling (CSRS) procedure after house listing. In order to take care of non-response due to various reasons, sample was inflated by 10 percent (i.e. 1,100).

6. DLHS:2 DLHS II was designed to provide the district level estimates separately for urban and rural areas. The number of PSUs in rural and urban areas was decided on the basis of percent of urban population in the district. However, a minimum of 12 urban PSUs was selected in case the percent urban population was low.

7. Methodology: Rural sampling was done with stratification of villages into 3 strata <50 household 50-300 household >300 household As per 2001 census villages with <50 household linked with one or more adjoining villages to form PSUs with a minimum of 50 household Villages with <5 households were excluded from the sampling frame No replacement was made if selected household was absent during data collection.

8. Instruments: Household questionnaire: Information on age, sex, marital status, relationship with the head of household, education & prevalence/ incidence of TB, blindness & malaria Information on main source of drinking water, source of lightening, type of cooking fuel, religion & caste of household head, ownership of other durable goods in the household. Details of marriage & deaths, maternal deaths Assessment was done to see whether household used cooking salt has been fortified with iodine Women questionnaire: To collect information from currently married women age 15- 44yrs who are usual residents of the sample household or visitors who stayed in the sample household the night before the interview

9. Women questionnnaire 1) Background characteristics: Age, educational status & births & deaths, H/O biological children including still birth, induced & spontaneous abortion 2) Antenatal, natal & postnatal care: Information from only women who have live birth, still birth, induced & spontaneous abortion during last 3yrs preceding the survey date. Also information on whether women received ANC & postpartum care & who attended the delivery & nature of complications during pregnancy for recent births were also collected. 3) Immunization & childcare: Feeding practices, length of breastfeeding, immunization coverage & recent episodes of diarrhoea& pneumonia for young children(<3yrs)

10. 4. Contraception: -Knowledge & use of specific family planning methods -Reasons for non-use, intensions about future use, desire for additional child, sex preferences for next child 5. Assessment of quality of government health services & client satisfaction - Assessment of quality of family planning & health services provided by Govt -Rating of government health facilities & staff -Reasons for not visiting government health facilities by eligible women 6. Awareness about RTI/ STI & HIV/ AIDs: -Women’s knowledge about RTI/ STI & HIV/ AIDs -Source of knowledge, awareness about modes of transmission, curability, symptoms & t/t seeking behaviour

11. 7. Husband questionnaire: - In first round male questionnaire (20-54yrs) was used instead of husband questionnaire - In second round husband questionnaire was used - Information was collected from eligible women’s husband - Husband’s age, educational status, knowledge & source of knowledge of RTI/ STI & HIV/ AIDs, reported symptoms of RTI/ STI & HIV/ AIDs - Information on desires for children, reasons for not using any family planning methods, future intension to use any family planning methods & knowledge about no scalpel vasectomy

12. Health questionnaire: In 2 nd round of DLHS It was included Information on weight of children (0-72) months were taken Haemoglobin estimation of adolesents 10-19 yrs & pregnant women was done. All such information helps in assessing the levels of nutrition in the population Prevalence of anaemia in adolescent girls & children Village questionnaire: Information on availability & accessibility of various facilities in the village more focus on accessibility of educational & health facilities

13. Non-response were categorized under following conditions  Not at home  Dwelling not found  Refusal  Deliberate incapability of investigators  Hb estimation was done with Whatman No.1 filter paper

14. Collection of blood sample Hb estimation was done with Whatman No.1 filter paper Measured by adding 20ml of blood into Drabkin’s solution Instruments: Hb pipette, Whatman No.1 filter paper(1.5*1.5), disposable lancet, spirit swab & guaze pieces, Drabkin’s solution & Vortex mixture Procedure: 20ml of blood pipetted on the filter paper Allowed to dry & then kept in polythene bag Test in laboratory done within 6 days The blood is then eluted from the filter paper in 5ml of Drabkin’s solution for 2hrs The tube then shaken well for 1min & optical density measured

15. IndicatorIndiaMaharashtraWardha DLHSIIIIIIIIIIIIIII Toilet facility 46.8 36.2 41.841.753.332.6 Piped Drinking water 39.688.152.762.656.852.2 Any method 54.152.5 63.863.378.674.1 Any modern method 47.345.2 62.660.878.174 Female sterilizatio n 34.434.3 51.548.365.263.9 Male sterilizatio n 1.00.9 2.52.03.74.7

16. IndicatorIndiaMaharashtraWardha DLHSIIIIIIIIIIIIIII Mean age f (boys) 24.224.5 24.6NA Mean age (girls) 19.919.4 19.1NA Boys(<2122.121.1 12.4 NA Girls(<1821.528.5 17.721.105.5

17. DLHS-III(2007-2008)DLHS-II(2002-04) IndicatorTotalRuralUrbanTotalRuralUrban Electricit y 69.458.392.171.663.592.6 Toilet facility 46.8 30.979.336.2 19.279.9 Kaccha house 34.345.112.231.839.911.1 Pucca house 33.920.461.429.218.556.7 Piped Drinking water 39.626.366.788.185.894.0

18. DLHS-III(2007-2008)DLHS-II(2002-04) IndicatorTotalRuralUrbanTotalRuralUrban DOTS(TB)60.655.471.2NA Leprosy Eradication51.044.564.1NA Malaria/Dengue/Chik un Guinea 83.279.291.3NA Prevention of sex selection 56.547.774.4NA Awareness about government health programmes

19. Current use of family planning methods DLHS-III(2007-2008)DLHS-II(2002-04) IndicatorTotalRuralUrbanTotalRuralUrban Any method54.151.260.452.548.861.9 Any modern method47.344.653.245.242.053.4 Female sterilization34.434.534.434.334.134.7 Male Sterilization1.01.10.80.9 Pill4.03.94.33.53.04.7 IUD1.81.32.91.81.13.7 Condom6.03.810.84.62.89.3 Any Traditional method 6.56.37.07.26.88.4

20. Marriage: DLHS-III(2007-2008)DLHS-II(2002-04) IndicatorTotalRuralUrbanTotalRuralUrban Mean age f (boys) 24.223.525.624.523.926.0 Mean age (girls)19.919.312.319.418.821.0 Boys(<2122.127.011.721.125.59.7 Girls(<1821.526.610.428.534.513.0 Currently married women (20-24) who married <18yrs 43.448.729.4NA

21. Antenatal care (women who had live/still birth during reference period) IndicatorIndiaMaharashtraWardha DLHSIIIII IIIIIIIIII Any ANC checkup 75.373.6 91.892.9NA ANC 1 st tri45.040.4 61.651.780.7 79.0 ANC checkups 3 0r more 51.050.4 76.069.288.2 82.2 1 TT73.580.2 89.687.699.2 88.4 Full ANC checkup 19.116.5 33.932.6NA

22. Delivery care (women who had live/still birth during reference period) Indicator IndiaMaharashtraWardha DLHSIIIIIIIIIIIIIII Institutional delivery 47.040.9 63.657.981.4 61.7 Home delivery52.258.6 35.841.7NA Home delivery by skilled birth attendant 5.613.5 16.011.310 15.9 PNC care within 2wks 50.8NA 79.7 NA JSY13.6NA 8.2 NA

23. Child Immunization IndiaMaharashtra Wardha IndicatorIII II IIIIIIIIII Fully immunized54.145.9 69.170.987.9 60.7 No vaccine11.319.8 2.52.6NA BCG vaccine86.975.0 95.796.2100 95.3 3 DTP doses63.658.3 78.988.292.6 88.4 3 Polio doses66.257.3 86.280.291.1 70.9 Measles69.656.1 84.585.4NA 1 dose of Vit A at 9months 23.9NA 70.571.590.5 NA Children under 3 year’s breastfed within one hour of birth10 39.4NA 53.344.367.7 NA 6-9mon semisolid& breast milk 23.9NA 46.6NA97.4 NA

24. Child feeding practices DLHS-III(2007-2008)DLHS-II(2002-04) IndicatorTotalRuralUrbanTotalRural Children under 3 year’s breastfed within one hour of birth10 40.239.442.127.825.134.7 0-5 mths EBF46.447.842.5NA 6-35mo breastfeed for 6months 24.925.722.822.7NA 6-9mon semisolid& breast milk 23.924.422.5NA