District Level Household Survey

Dr K. Sushma

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.

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.

Methodology: Rapid Household Survey(RCH)

In 1st 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

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).

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.

Methodology: Rural sampling was done with stratification of villages

into 3 strata<50 household50-300 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.

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

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)

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

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

Health questionnaire: • In 2nd 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

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

Indicator India Maharashtra Wardha

DLHS III II III II III II

Toilet facility

46.8 36.2 41.8 41.7 53.3 32.6

Piped Drinking water

39.6 88.1 52.7 62.6 56.8 52.2

Any method

54.1 52.5 63.8 63.3 78.6 74.1

Any modern method

47.3 45.2 62.6 60.8 78.1 74

Female sterilization

34.4 34.3 51.5 48.3 65.2 63.9

Male sterilization

1.0 0.9 2.5 2.0 3.7 4.7

Indicator India Maharashtra Wardha

DLHS III II III II III II

Mean age f (boys)

24.2 24.5 24.5 24.6 NA NA

Mean age (girls)

19.9 19.4 19.4 19.1 NA NA

Boys(<21 22.1 21.1 12.4 12.4 NA NA

Girls(<18 21.5 28.5 17.7 21.1 0 5.5

Antenatal care (women who had live/still birth during reference period)

Indicator India Maharashtra Wardha

DLHS III II III II III II

Any ANC checkup

75.3 73.6 91.8 92.9 NA NA

ANC 1st tri 45.0 40.4 61.6 51.7 80.7 79.0

ANC checkups 3 0r more

51.0 50.4 76.0 69.2 88.2 82.2

1 TT 73.5 80.2 89.6 87.6 99.2 88.4

Full ANC checkup

19.1 16.5 33.9 32.6 NA NA

Delivery care (women who had live/still birth during reference period)Indicator India Maharashtra Wardha

DLHS III II III II III II

Institutional delivery

47.0 40.9 63.6 57.9 81.4 61.7

Home delivery 52.2 58.6 35.8 41.7 NA NA

Home delivery by skilled birth attendant

5.6 13.5 16.0 11.3 10 15.9

PNC care within 2wks

50.8 NA 79.7 NA NA NA

JSY 13.6 NA 8.2 NA NA NA

Child Immunization

India Maharashtra Wardha

Indicator III II III II III II

Fully immunized 54.1 45.9 69.1 70.9 87.9 60.7

No vaccine 11.3 19.8 2.5 2.6 NA NA

BCG vaccine 86.9 75.0 95.7 96.2 100 95.3

3 DTP doses 63.6 58.3 78.9 88.2 92.6 88.4

3 Polio doses 66.2 57.3 86.2 80.2 91.1 70.9

Measles 69.6 56.1 84.5 85.4 NA NA

1 dose of Vit A at 9months

23.9 NA 70.5 71.5 90.5 NA

Children under 3 year’s breastfed within one hour of birth10

39.4 NA 53.3 44.3 67.7 NA

6-9mon semisolid& breast milk

23.9 NA 46.6 NA 97.4 NA