1. REVISING THE CORE QUESTIONNAIRES FOR DHS-8
Sunita Kishor & Joy Fishel
The Demographic and Health Surveys Program
19 December 2018

2. Which of these does DHS NOT measure? Household questionnaire
List of all usual household residents and visitors
Cooking fuel
Household assets
Household income
Crops grown by the household
Source of drinking water
Survivorship of parents of children under age 18
Bednet use

3. Which of these does DHS NOT measure? Woman’s questionnaire
Literacy
Attendant at childbirth
Unmet need for family planning
Infant mortality
Life satisfaction
Breastfeeding
Fertility
Childhood immunization

4. Which of these does DHS NOT measure? Man’s questionnaire
Favorite condom brand
Age
Occupation
Payment for sex
Internet use
Circumcision status
Alcohol consumption
Age at first marriage/cohabitation

5. Objectives of the presentation
Review the content of the instruments The DHS Program currently uses in population-based surveys
Present the rationale for reviewing & revising the DHS core questionnaires every 5 years
Summarize the questionnaire review process from DHS-7
Present the questionnaire review process for DHS-8

6. What data do DHS questionnaires collect?

7. Types of DHS questionnaires
Standard DHS surveys generally include:
Household questionnaire
Woman’s questionnaire
Man’s questionnaire
© ICF International √
Biomarker questionnaire
Fieldworker questionnaire
Optional modules √ √ √
Each DHS phase has a “Core” questionnaire: A set of questions that are asked in every DHS survey. Usually core questions do not change much over time – many questions have been asked the same way since Using the same core questionnaire for all countries ensures that data are comparable across countries and over time.

8. Household questionnaire
For household members:
Age, sex, residence
Head of household and relationship to the head
Education for all; schooling for children and young adults
For household members age 0-4 years:
Birth registration
Assets, land ownership, housing characteristics
Sanitation, water, and other environmental health issues
© ICF International
The household questionnaire collects basic information about each resident in an interviewed household: Age and sex; whether the individual is the head of the household and if not, their relationship to the head of household; and education level. The household questionnaire is also the source of most environmental health data collected.
The household questionnaire also includes information about the household’s assets, which is used to calculate the DHS wealth index.
Household assets, housing characteristics, and ownership of land and animals comprise the wealth index

9. Individual questionnaire
© ICF International
In both woman’s and man’s questionnaires:
Socio-demographic characteristics
Number of children
Contraception
Marriage and sexual behavior
Fertility preferences
HIV/AIDS knowledge, attitudes & behavior
STIs
Both woman’s and man’s questionnaires collect basic socio-demographic information, including the respondent’s age, precise level of education, literacy, and exposure to media.
The core questionnaire covers men’s and women’s fertility, contraceptive knowledge and use, sexual behavior, fertility preferences, and knowledge about HIV and other STIs.

10. Individual questionnaire
Only in woman’s questionnaires
Fertility: Birth history; 5-year calendar including pregnancy history
Infant and child mortality
Maternal health: ANC, delivery, postpartum care
Child nutrition, including breastfeeding
Immunization and childhood illness
The woman’s questionnaire includes a detailed history of all births and deaths of any of their children. For children born in the 5 years prior to the survey, the questionnaire covers information about antenatal care and delivery assistance, as well as child nutrition, immunizations, and illnesses.
© ICF International

11. Length of questionnaires in DHS-7
Roughly 700 questions across all 3 core DHS questionnaires
Average woman’s interview time is roughly minutes
Around 40% of interviewed women are also the respondent for the household questionnaire

12. DHS questionnaire modules
Accident and injury
Adult and maternal mortality
Disability
Domestic violence
Female genital cutting
Fistula
Male child circumcision
Newborn care
Non-communicable diseases
Out-of-pocket health expenditures
Supplemental module on maternal health care
Each country’s individual needs are met through the use of modules and country-specific questions. Country-specific questions are, as indicated by the name, specific to the needs of the country, and are not replicated in other surveys.
Modules are added to the core questionnaire at the host country’s request. The modules are only implemented where appropriate – clearly the Female Genital Cutting module is far more relevant in some countries than others.
In previous phases of the DHS, questionnaire modules were designed for consanguinity (to determine the prevalence of marriage between partners who are related by blood), contraceptive pill failure and use, and women’s experiences around contraceptive sterilization.
All modules and questionnaires can be found online at dhsprogram.com.
8/31/2019

13. Module frequency in DHS-7
Average # optional
modules per survey
3.1

14. Most common biomarkers
For children under age 5, women, and men:
Height and weight
Hemoglobin measurement
For women and men:
HIV prevalence
Biomarkers, including height, weight, and often anemia status are collected from women and children as part of the household questionnaire. These biomarkers are also occasionally collected from men. If the survey includes HIV testing, the HIV test is conducted as part of the biomarker questionnaire.

15. Less common biomarkers and other tests
Infectious disease
Malaria parasitemia
Chronic conditions
Blood pressure
Diabetes
Lipids
STIs
Chlamydia
Hepatitis B
Hepatitis C
Herpes
Syphilis
Nutrition
Iodine (salt and urine test)
Iron
Lead
Vitamin A
Antibodies/immunity
Measles
Tetanus
Water testing
Arsenic, chlorine, E. coli
Other biomarkers have been used to explore adult health, STI prevalence, nutrition, immunity, and water safety.

16. Objectives of The DHS Program questionnaire review process

17. Two major themes of the core questionnaire revision process
Meet existing and emerging critical data needs
Maintain data quality

18. Additional considerations for core questionnaire revision process
Facilitate assessment of trends – avoid unnecessary question changes
Measure relevant SDG indicators
Harmonize with other survey programs, e.g., UNICEF (MICS)
Minimize duration of interviews by deleting questions that:
do not produce reliable data
are not policy relevant or widely used
Most surveys also include DHS modules, and/or modules from other survey programs (e.g., MICS)

19. DHS-7 questionnaire review process
Open comment period implemented for the first time
Comments submitted through the DHS Program User Forum
Guidance for requested additions:
What is the information needed?
What questions will elicit this information?
How will the resulting information be used?
What is the priority of suggested additions compared with what is already in the questionnaires?
If suggesting more than one addition, what is the priority among the suggested additions?
Should the additional data be collected in all countries, or only in selected types of countries?
Also provided guidelines on suggesting revisions and deletions

20. DHS-7 questionnaire review process – Results
Received over 160 posts through Questionnaire Portal on the DHS Program User Forum
Added roughly 100 new questions; deleted roughly 40
Example additions/revisions to DHS-7 questionnaires:
Postnatal care for women and newborns
Ownership of title and deed to dwelling/land
HIV stigma
Smoking
Revision/expansion of vaccination questions
Day of birth added to birth history
Developed several new optional modules

21. Survey design adaptations
We utilize survey and questionnaire design innovations help to accommodate new content
Split samples
Different questionnaire sections and biomarkers in subsamples
Long and short questionnaires
Indicators requiring smaller sample sizes not asked in all households
Reducing reference periods
e.g., reduced reference period for immunization from children born in past 5 years to past 3 years
Ask questions of last live birth rather than all births in past 5 years

22. 2016 Haiti DHS survey design Households 13,409
2/3 HH
Sec 1-6
Cdisc
UHS
1/3 HH
Sec 1-6
Chol
Women
15-49
Sec 1-11 MM
Cdev DV
Men
15-64
Sec 1-8
Women
15-49
Sec 1-9, 11
ARF MM
Women
50-64
Sec 1, 11
ARF
Men
35-64
Sec 1, 8
ARF
Anthro 0-5 yrs
Hb 6-59 mo
Anthro W 15-49
Hb W 15-49
HIV W 15-49, M 15-64
W&M 35-64:
Anthro, Hb, BP, diabetes
Anthro 0-14 yrs
Hb 6 mo-14 yrs
Key: Cdisc=Child discipline, UHS=Use of health services, Chol=Cholera, MM=Maternal mortality, Cdev=Child development, DV=Domestic violence, ARF=Alcohol and other risk factors, Hb=hemoglobin, BP=blood pressure

23. Lessons learned from the DHS-7 questionnaire review process
High volume of posts demonstrated high level of interest, not possible to accommodate all reasonable requests, need to make difficult choices
Opportunity for greater coordination of requests
Multiple postings for the same requests
Requests on similar topics that were not consistent

24. What will the questionnaire review process look like for DHS-8?

25. What’s new in the questionnaire review process for DHS-8
Overall, similar to DHS-7
Explicitly solicit comments on modules and biomarkers
Encourage collaboration among stakeholders within health topics
Strengthen guidance we provide for submissions

26. What’s new in the questionnaire review process for DHS-8 – Guidance for submissions
Provide a template designed to focus attention on data use
Template will frame requests in terms of indicators and will inquire about:
Indicator definition, including numerators and denominators
How the indicator is currently used (international reporting, statistical models, policymakers, programs)
How would it be used, if new
What questions are requested, recommended response options
What information is available on validation studies or other testing of questions
Feasibility in the DHS
Sample size considerations, easy for respondents to comprehend and answer accurately, etc.
Applicability across a wide-range of LMIC’s, or limited to particular settings
There are no strict criteria for acceptance! Rather, try to set priorities balancing quality, feasibility, and importance of the data need.

27. How to handle HIV content in the DHS-8 questionnaires?
Questionnaire content:
How much HIV content should go in the core questionnaire?
Should HIV-related questionnaire content be moved into an optional module?
Should we consider new requests for HIV content during this review cycle?
Biomarkers:
Countries still insist on including testing for HIV prevalence

28. Review process for DHS-8
Prepare for open comment period
Send out an announcement for the questionnaire review process
Develop instructions/tools
Develop template for submitting suggestions
Provide current questionnaire content divided by topic area
Instructions to register on the DHS Program User Forum
Construct space on the DHS Program User Forum
Launch questionnaire portal
All suggestions must be submitted through the public portal for transparency
USAID will also submit suggestions through the portal
All postings will be open to comments from other users

29. Review process for DHS-8
3. Internal DHS review of comments, developing draft questionnaires
Topic-based working groups
Review and discuss comments received
Recommend changes to the DHS Questionnaire Review Committee
Questionnaire Review Committee reviews recommendations from working groups, makes decisions
Incorporate decisions into draft questionnaires
Submit draft questionnaires and a report to DHS-8 USAID management team for review
4. USAID review/approval process
USAID reviews draft questionnaires
DHS responds to USAID comments
USAID approves DHS-8 core questionnaires
Questionnaires posted to DHS website
The DHS Program will make public a report summarizing additions and deletions to the questionnaires

30. Timeline Level 1 bullet goes here. Level 2 bullet goes here. Dec Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Prepare for Open Comment period
Portal open on the DHS Program User Forum
Synthesize requests received, schedule internal topic group meetings
Hold internal topic group meetings, make rec’s to DHS Q’re committee
DHS Q’re committee reviews internal rec’s, makes decisions
Decisions implemented in core questionnaires
Submit draft core q’res to USAID
Decisions implemented in optional modules
Submit draft modules to USAID, rolling
Level 1 bullet goes here.
Level 2 bullet goes here.
Jan 21-Mar 1

31. THANK YOU