In June 2009, the MHTF hosted an online forum to discuss the maternal health content of the Demographic and Health Surveys core questionnaires. Following the forum, a coordinated set of comments and recommendations was sent to the DHS program for their consideration as they revised the core questionnaires for Phase 6 of the project. The final revised questionnaires have now been posted by DHS here.
A summary of the recommendations from the DHS e-forum have been sent to the Demographic and Health Surveys program. We have also sent a recommendation and some preliminary suggestions for the development of an optional maternal health module with an expanded set of questions related to maternal health. The MHTF will follow up with DHS and post any information we receive as the questionnaires are finalized.
Thanks again to everyone who commented and please check back here for next steps.
You must be registered and logged in to participate in this eForum.
If you have not already done so, please read the background documents that we previously posted.
The Demographic and Health Surveys are nationally representative household surveys. A Household Questionnaire is used to identify members of the sampled household who are eligible for an individual interview and to collect basic information about the household. Eligible respondents for the Individual Women’s Questionnaire are women of reproductive age (age 15-49 in most surveys.) Data are also collected from men in many countries; the Individual Men’s Questionnaire is used to collect data from men age 15-59.
DHS has a standard Individual Women’s questionnaire that is used as a starting point for data collection, which allows for the establishment of a core set of information to be collected for all countries. However, countries often also examine issues and problems of national interest inserting additional questions into the questionnaire. This results in some differences in final reports, illustrates the variety of country level interests, and highlights the range of data it is possible to collect with the DHS. [Maternal mortality information is collected in the Maternal Mortality Module of the questionnaire, which is an optional addition to the standard questionnaire. This module asks information about the respondent's brothers and sisters, including the number of pregnancies of their sisters and if they are deceased, and whether or not they were pregnant or within two months postpartum at the time of death.]
The standard questionnaires are revised periodically (roughly every 5 years). The recently revised version of the Individual Women’s Questionnaire is the basis for this e-forum discussion.
Section 4, “Pregnancy and Postnatal Care”, of the new questionnaire contains 33 standard questions related to maternal health, including questions on the frequency and content of antenatal, delivery, and postnatal care for births in the three years prior to the survey. This section also includes three questions on desired timing of pregnancies, three questions on the weight of children at birth, four questions on infant feeding practices and eleven questions on child immunizations (the remaining information on child health comes from section 5 of the questionnaire).
The questionnaire contains 18 questions related to antenatal care which are only asked about the last birth. All women are asked about tetanus toxoid injections, iron supplementation, treatment for intestinal worms, utilization of antimalarials, and attendance at antenatal care. Questions on vision trouble during the day and night blindness have been deleted from the revised version. For those who respond “yes” to having attended antenatal care, follow-up questions include the timing of the first visit, number of antenatal visits and physical components of the exam (blood pressure, urine sample, blood sample).
Changes from previous questionnaire:
The new revised questionnaire eliminated four questions related to antenatal care:
- During any of your antenatal care visits, were you told about the signs of pregnancy complications?
- Were you told where to go if you had any of these complications?
- During this pregnancy, did you have difficulty with your vision during daylight?
- During this pregnancy, did you suffer from night blindness?
The questionnaire contains 3 questions on delivery. All women are asked about the location and type of assistance at delivery for each of their previous births in the recent past. Those who delivered in a health facility are asked whether the birth was a caesarian. Follow-up questions on length of stay at place of delivery and whether they received a postnatal check up before discharge have been deleted from the revised questionnaire.
Changes from the previous questionnaire:
The new revised questionnaire eliminated five questions related to delivery:
- How long after delivery did you stay there (in the place of delivery)?
- Before you were discharged after (NAME) was born, did any health care provider check on your health?
- How long after delivery did the first check take place?
- Who checked on your health at that time?
- Why didn’t you deliver in a health facility?
The questionnaire contains 12 questions related to postnatal care and the postpartum period. All women are asked if they had a postnatal visit following their most recent birth. Based on their response, follow-up questions include length of time between delivery and postnatal visit, who performed the postnatal check up, and location of the postnatal visit. Regardless of whether they received postnatal care, women are asked about receiving vitamin A in the first two months after delivery, whether their menstruation has returned since their last birth, and the length of time between delivery and initiating breastfeeding for the last birth. Questions regarding length of time with no menstruation, length of postpartum abstinence, and breastfeeding are asked of all pregnancies.
Changes from the previous questionnaire:
The new revised questionnaire differs from the previous version in the following ways:
- Whether a woman had a postnatal care check up is only asked for the last pregnancy (previously it was asked for all pregnancies)
- A question on the timing of initiation for breastfeeding was added.
- Questions on postnatal check ups for babies were eliminated.
We encourage the following types of inputs:
- Comments on existing questions—their utility for monitoring, programming, policy making
- Recommendations for improving the wording of questions
- Recommendations for additions and deletions of questions
- Suggestions for additions or modifications to standard response categories for questions
You must be registered on the site to post a comment. To post a comment, click on the word ‘Comment’ in blue below. The eForum will remain open until June 15th. Comments will be summarized and submitted to the DHS program by June 18th.
The DHS eforum will launch any day now! If you haven’t already done so, register here so that you will be able to participate in this important online discussion that will provide input to the DHS program on the maternal health content of the revised DHS questionnaire.
Meanwhile, check out these excellent background documents that our colleagues from The Futures Institute (who will be moderating the eforum) have put together.
Note that these documents are from the last round of the DHS and are provided for background purposes. The newly revised questionnaires were posted on 6/2/2009.
Questionnaire Section4: Pregnancy & Postnatal Care. part1
Tabulation Plan for Reproductive Health
Please spread the word about our online discussion. We hope to engage and involve a broad array of experts around the world, especially those working in developing countries, who use DHS data for maternal health research and programming.
More to come! Stay tuned…