Ethiopia Demographic and Health Survey 2011 Introduction and Methodology

The 2011 EDHS was carried out under the aegis of the Ministry of Health (MOH) and was implemented by the Central Statistical Agency (CSA). The testing of the blood samples for HIV status was handled by the Ethiopia Health and Nutrition Research Institute (EHNRI). ICF International provided technical assistance as well as funding to the project through the MEASURE DHS project, a United States Agency for International Development USAID-funded project providing support and technical assistance in the implementation of population and health surveys in countries worldwide.

The resources for the conduct of the survey were provided by the government of Ethiopia and various international donor organizations and governments: the United States Agency for International Development (USAID), the HIV/AIDS Prevention and Control Office (HAPCO), the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), the United Kingdom Department for International Development (DFID), and the United States Centers for Disease Control and Prevention (CDC).

Objectives Provide updated and reliable data on: fertility and family planning behaviour, childhood, adult, and maternal mortality, nutritional status, use of maternal and child health services, knowledge of HIV/AIDS, and prevalence of HIV/AIDS and anaemia

The Survey It is the 3 rd Demographic and Health Survey conducted in Ethiopia as part of the DHS program. The EDHS sample is a nationally representative sample. It was designed to provide estimates for the whole country, for urban and rural areas, and for most indicators, each of Ethiopia’s 11 geographic/administrative regions (the nine regional states and two city administrations).

Sample Design Sampling frame: 2007 Population and Housing Census First stage: 624 EAs (enumeration areas) were selected, 187 in urban areas and 437 in rural areas. Second stage: 17,817 households selected from EAs. 17,018 households were occupied. Selected households were visited and interviewed; all women age were interviewed as well as all men age

Pretest 3 Questionnaires: Household, Women’s and Men’s Questionnaires pretested in Amharigna, Oromiffa, and Tigrigna. Testing of blood sample collection September 20 – October 8, 2010 training and fieldwork in 5 sites (Addis Ababa, Ambo, Debre Birhan, Hawassa, and Mekele)

Main Survey Training Main survey Training: November 24 – December 23, field staff trained – Supervisors – Editors – Interviewers – Reserves Field practice in anthropometry, anaemia testing, and blood sample collection was also carried out for interviewers who were assigned as team biomarker technicians.

Fieldwork and Data Processing Total of 35 teams (consisting of a team supervisor, field editor, 4 female interviewers, 2 male interviewers, one cook, and one driver) Fieldwork conducted from December 27, June 3, Quality control teams in each region (field coordinator, one female and one male staff member to monitor the quality of the interviews, and one biomarker quality control staff member). Data processing in Addis Ababa from January– June 2011.

Biomarkers Only respondents who consented were tested. Height and weight measurements: women age 15-49, men age 15-59, and children under age 5 in all selected households. Anaemia testing: all children age 6-59 months, women age 15-49, and men age Blood samples were drawn from a drop of blood taken from a finger prick and analysed using HemoCue analyser. – Results were given verbally and in writing. Parents of children with a haemoglobin level under 7 g/dl were instructed to take the child to a health facility for follow-up care. Likewise, non- pregnant women were referred for follow-up care if their haemoglobin level was below 7 g/dl, and pregnant women and men were referred if their haemoglobin level was below 9 g/dl. All households in which anaemia testing was conducted received a brochure explaining the causes and prevention of anaemia.

Biomarkers Only respondents who consented were tested. HIV testing: all women age and men age – Anonymous linked protocol to maintain confidentiality. – Blood from a finger prick collected on filter paper as dried blood spots. Samples dried overnight and then shipped to EHNRI in Addis Ababa for testing. – Each household, whether individuals consented to HIV testing or not, received an informational brochure on HIV/AIDS and a list of fixed sites providing voluntary counselling and testing (VCT) services within the surrounding 10 km radius from the cluster for each region. For households farther than 10 km from a fixed VCT site, mobile VCT units were set up in or near survey areas following data collection. The USAID and CDC partners provided the logistical services for the provisions of mobile VCT services.

Results of the household and individual interviews Households Selected Households Occupied Households Interviewed Response rate (%) 17,817 17,018 16,702 98% Eligible Women Women Interviewed Response rate (%) 17,385 16,515 95% Eligible Men Men Interviewed Response rate (%) 15,908 14,110 89%