Demographic and Health Surveys Methodology - Measure DHS

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Notes and ConsiderationsThe DHS maternal mortality module questionnaire collects information from respondents (female andmale) about the maternal status of the death of their sisters born to the same mother by asking if the sisterdied while pregnant, during delivery or within two months after the end of a pregnancy or a childbirth.Younger (and male) respondents may not know that their older sister was even pregnant if the sister wasseveral years older or died during pregnancy or from an induced abortion, thus biasing maternal mortalityrates downward. Women who intend to have an induced abortion may also not disclose their pregnancystatus to family members. On the other hand, deaths due to non-maternal causes, such as accidents andillnesses, will be included as maternal deaths if they occurred during pregnancy or within two monthsafter the end of the pregnancy or childbirth. Simulation models show that up to one-third of classified asmaternal may not be due to maternal causes, resulting in an upward bias. The final result of both thesebiases, which operate simultaneously, is unknown.Another important issue is location. The DHS does not collect information on the residence of neithersisters who died nor of the residence during the exposure period of both living and dead sisters. Theresidence at the time of interview of respondents is not necessarily the same as that of their sisters.Therefore, DHS usually does not publish maternal mortality rates and maternal mortality ratios by area.Maternal mortality rates and ratios are subject to high levels of relative sampling error due to theirrelatively rare occurrence. For example, a maternal mortality ratio of 500 maternal deaths per 100,000births has the same sampling error as an infant mortality rate of 5 infant deaths per 1000 births. For asample of about 15,000 respondents, the 95% confidence interval of the MMR would be about 406 to 594maternal deaths per 100,000 births.ReferencesRutenberg, N. and Sullivan, J.M. Direct and indirect estimates of maternal mortality from the sisterhoodmethod. IRD/Macro International Inc., Washington DC, 1991.Hanley, J.A., Hagen, C.A. and Shiferaw, T. Confidence intervals and sample size calculations for thesisterhood method of estimating maternal mortality. Studies in Family Planning 27(4) July/August 1996.WHO/UNICEF. The Sisterhood method to estimate maternal mortality. Report of a technical meeting,5-6 December 1996.Stanton, C., Abderrahim, N. and Hill, K. DHS maternal mortality indicators: An assessment of dataquality and implications for data use. Demographic and Health Surveys Analytical Report No 4, MacroInternational Inc. Calverton, Maryland, USA, September 1997.Guide to DHS Statistics 157 Updated September 2006
ADULT MORTALITY (INDIRECT METHOD)Statistics: Total Maternal Mortality Rate; Maternal Mortality Ratio (Indirect Method)DefinitionJ. Coverage: Women age 15-49 years.K. Numerator:1. Number of female siblings of respondents who died during pregnancy, delivery or within twomonths of delivery by five-year age group of respondent.L. Denominator:1. Number of years of sister-units of exposure of female siblings of respondents by five-yearage group of respondent.M. Calculation of Maternal Mortality Rates:g. Numerator: Deaths that occurred during pregnancy, delivery or within two months ofdelivery are tabulated.h. Denominator:i. For respondents age 30 to 49 the numbers of sisters who attained fifteen or moreyears of age are tabulated by the five-year age-group of the respondents. Forrespondents 15 to 29 the numbers of sisters for age groups 15-19, 20-24 and 25-29 are calculated by multiplying the number of respondents in each five-year agegroup by the average number of sisters who attained age 15 or more for the totalof respondents age 30 to 49 years.ii. Sister-units of exposure are calculated by applying an adjustment factor to thenumber of sisters who attained fifteen or more years of age tabulated by five-yearage groups of respondents. The adjustment factors are 0.107, 0.206, 0.343, 0.503,0.664, 0.882, and 0.900 for the five year age groups from 15-19 to 45-49.Once the numerators and denominators are properly established, the life-time risks of maternal mortalityby five-year age group are obtained by the division of the numerators by the corresponding denominators.The total life-time risk of maternal mortality (for age 15-49) is obtained by the quotient of the sums of theage-group specific numerators and denominators.N. Calculation of the Maternal Mortality Ratio:The maternal mortality ratio (MMR) is calculated by taking the root (equal to the total fertilityrate--TFR for the period 10-14 years prior to the survey) of (one minus the total life-time risk ofmaternal mortality) and subtracting the result from one. This calculation gives the average perbirth risk of maternal mortality. Multiplying by 100,000 gives the maternal mortality ratio. Theformula is expressed as:MMR= 100,000 x (1- [1- total lifetime risk] (1/TFR) )Guide to DHS Statistics 158 Updated September 2006
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Guide to DHS statisticsDemographic
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GUIDE TO DHS STATISTICSShea Oscar R
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Preferred Method of Contraception f
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ForewordDHS surveys collect a wealt
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MODEL QUESTIONNAIRESThe basic appro
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The Guidelines for the Main Survey
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The figure on the previous page ill
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Before using an exported DHS data f
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In this list “xx” represent dig
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At data entry time, contrary to the
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CalculationInitial sample weights a
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DHS uses century month codes extens
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AgeTotal ChildrenTotal ChildrenSmoo
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All Women Ever-Married Women All Wo
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it is not possible to merge the hou
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ename = (HVIDX$01, HV101$01, HV102$
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III. Guide to Individual Statistics
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Births in the month of interview ar
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Statistics: Total Fertility RateDef
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Statistics: Crude Birth RateDefinit
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CHILDREN EVER BORN AND LIVINGStatis
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BIRTH INTERVALSStatistics: Percent
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AGE AT FIRST BIRTHStatistics: Perce
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TEENAGE PREGNANCY AND MOTHERHOODSta
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4. Traditional methods: The number
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CURRENT USE OF CONTRACEPTIVE METHOD
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Changes over TimeThe list of specif
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Median: Women with a missing value
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KNOWLEDGE OF THE FERTILE PERIODStat
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Statistics: Median Age at Contracep
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INFORMED CHOICEStatistics:A. Percen
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B. In the standard recode file, the
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REASONS FOR DISCONTINUING CONTRACEP
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FUTURE USE OF CONTRACEPTIONStatisti
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PREFERRED METHOD OF CONTRACEPTION F
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CONTACT OF NONUSERS WITH FAMILY PLA
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ATTITUDES TOWARD FAMILY PLANNINGSta
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NUMBER OF CO-WIVESStatistics: Perce
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MEDIAN AGE AT FIRST MARRIAGEDefinit
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Statistics: Median Age at First Sex
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B. Denominator: Number of all birth
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Notes and ConsiderationsAssumptions
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FERTILITY PREFERENCESNEED FOR FAMIL
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ii. Say they do not know whether th
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NEED FOR FAMILY PLANNING—NOT CURR
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5. Unmet need for spacing.a) Includ
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AssumptionsWomen who are not curren
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1. Higher age group: A woman’s ag
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INFANT AND CHILD MORTALITYEARLY CHI
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Statistics: Neonatal Mortality Rate
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MORTALITY RATE CALCULATIONNeonatal
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Statistics: Perinatal Mortality Rat
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HIGH-RISK FERTILITY BEHAVIOR RISK R
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MATERNAL AND CHILD HEALTHANTENATAL
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Handling of Missing Values“Don’
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ANTENATAL CAREPrenatal tetanus toxo
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Page 119 and 120: CHILD MORBIDITY PREVALENCE AND TREA
Page 125 and 126: CHILDHOOD MORBIDITY PREVENTION: DIA
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Page 145 and 146: CHILDREN’S AND WOMEN’S NUTRITIO
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Page 149 and 150: ReferencesCenters for Disease Contr
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Page 153 and 154: ReferencesNational Center for Healt
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Page 157 and 158: HIV/AIDS/STDSHIV/AIDS PREVENTION KN
Page 159 and 160: CONDOM USE AT LAST SEXStatistics: P
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Page 163: ADULT MORTALITY (DIRECT METHOD)Stat
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