National level survey relevant to health seminar (2)


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National level survey relevant to health seminar (2)

  1. 1. NATIONAL LEVEL SURVEYS RELEVANT TO HEALTH Presenter: Dr. Vishal Moderator: Dr. Jugal Kishore
  3. 3. WHAT IS SURVEY??????  Is an epidemiological investigation undertaken to examine certain selected features of a community, with a view to work out the frequency (either incidence or prevalence), of diseases or health related phenomena, and their distribution related to time, place and person, by obtaining information from a sample drawn from the population of interest.
  4. 4. PURPOSE OF SURVEY  To generate information about the health status and related aspects.  Provide general socio - demographic and basic health data for planning and organizing the health services or to make a community diagnosis. To estimate the frequency (incidence or prevalence) of important diseases.
  5. 5. PURPOSE OF SURVEY To evaluate the effectiveness of a health program, eg. immunization program. To assess the availability and accessibility of health care facilities. To assess local beliefs, behaviour patterns, customs and awareness about health / risk factors as well as attitudes towards health services.
  7. 7. HOW TO CONDUCT SURVEY?????  Clearly define the survey objective “What you want to learn” ???  Determine your sample “Whom you will interview” ???  Choose interviewing methodology “How you will interview” ???  Create your questionnaire “What you will ask” ???
  8. 8. HOW TO CONDUCT SURVEY?????  Pre-test the questionnaire Test the questions  Data collection Ask the questions  Analyze the data – Produce the reports
  9. 9. Important National Level Survey CENSUS NFHS DLHS SRS AHS
  10. 10. CENSUS Census is : about you, by you and for you Census : An official count of a population carried out at set intervals. Population census: is the total process of collecting, compiling, evaluating, analysing and publishing or otherwise disseminating demographic, economic and social data pertaining, at a specified time. Our Census ,Our future
  11. 11. WHY CENSUS IS IMPORTANT???  The Indian Census is the most credible source of information on Demography, Economic Activity, Literacy and Education, Housing & Household Amenities, Urbanisation, Fertility and Mortality, Scheduled Castes and Scheduled Tribes, Language, Religion, Migration, Disability and many other socio-cultural data.  This is the only source of primary data in the village, town and ward level.
  12. 12. WHY CENSUS IS IMPORTANT??? Census is the basis for reviewing the country's progress in the past decade, monitoring the on going Schemes of the Government and most importantly, plan for the future. Provides a basic frame for conduct of other surveys.
  13. 13. Key Features The recently concluded Census 2011 was the 15th National Census of the Country in the unbroken series since 1872 and the seventh after Independence. The responsibility of conducting the decennial Census rests with the Office of the Registrar General and Census Commissioner, India (ORGI). Census is a joint effort by the Union and State Governments in India. Under the Census Act, 1948
  15. 15. METHODOLOGY • Conducted once in a decade, • An extended de facto canvasser method  TWO PHASES:  First phase:  Each building, house and other structures were systematically listed and numbered.  Useful data on the amenities available to the households as well as the assets owned were collected.  Second phase:  The Population Enumeration exercise was held throughout the country for period of 3 weeks.  Enumerators visit the households for collecting information on every person living in the house.  On the night of 3rd week the Houseless population is enumerated.  Revision Round
  16. 16. Strengths  Covering not only the settled population but also homeless persons and nomadic groups.  Allow analysis in terms of statistics on persons and households and for a wide variety of geographical units, ranging from the country as a whole to individual small localities or city blocks.  Many new initiatives introduced eg. Video conferencing, social networking site  The average cost of Census taking in the world is estimated as $ 4.6 per person. In India, the cost was less than $ 0.5 per person in Census 2011.
  17. 17. WHY NATIONAL LEVEL SAMPLE SURVEY??? Need of demographic and health related data for annual and five year planning. The period between two census is quite large.  For periodic evaluation of various policies and national health programme.  Comparison
  18. 18. NFHS NFHS surveys are conducted under the stewardship of MoHFW  IIPS is the nodal agency for the National Family Health Surveys  NFHS covered around 99 % population of country
  19. 19. GOALS To provide essential data on health and family welfare needed by the MOHFW & other agencies for policy and program purposes. To provide information on important emerging health and family welfare issues.
  20. 20. OBJECTIVE • To provide National and state estimates of fertility,  Family planning, infant and child mortality, Reproductive and child health  Nutrition of women and children  Quality of health and family welfare services socioeconomic conditions
  21. 21. Year Region & Population included Health Issues covered NFHS 1 1992-1993 89,777 ever married women age 13-49 In 24 states and Delhi 1. Indicator on family welfare 2. Maternal and child Health 3. Nutrition NFHS 2 1998-1999 91,000 ever married women age 15-49 In 26 states and Delhi 1. NFHS 1 Issue 2. Reproductive Health problem 3. The status of women & domestic violence 4. Anthropometric measurement extended to ever married women 5. Hb estimation, lead content, iodine content NFHS 3 2005-2006 1,24,385 ever married women age 15-49. 74,369 Men age 15-54 In 29 states and Delhi - Never married women age 15-49 1. 2. 3. 4. 5. 6. 7. 8. NFHS 1 + NFHS 2 issue Perinatal mortality Male involvement Adolescent reproductive health High risk sexual behaviour, safe inj. Family life education Knowledge about TB Blood testing for HIV
  22. 22. Contd…  Sample size calculation: The target sample size for NFHS in each state was estimated in terms of the number of ever-married women in the reproductive age group to be interviewed. • 4000 completed interview = more than 30 million • 3,000 completed interviews = between 5 and 30 million • 1,500 completed interviews = less than 5 million • In addition, sample-size adjustments was made to meet the need for HIV prevalence estimates for the high HIV prevalence states and UP and for slum and nonslum estimates in eight selected cities.
  23. 23. Sample Design: The sample within each state was allocated proportionally to the size of the state‟s urban and rural populations. State Rural PSU Urban Wards CEB Households Households
  24. 24. Sample selection: the Census list of villages and wards served as the sampling frame. Stratification: • The first level of stratification was geographic. • Further stratified using selected variables from the following list: village size, percentage of males working in the non-agricultural sector, percentage of the population belonging to scheduled castes or scheduled tribes, and female literacy. • HIV prevalence state - ‘High’, „Medium‟ or „Low‟, as estimated for all the districts was used for stratification .
  25. 25. • Three types of questionnaires:  Household Questionnaire,  Woman’s Questionnaire and  Village Questionnaire. • For each state and at national level three data files are associated with these questionnaires. Also available are data files with information on children born during the three years preceding the survey along with mother's basic characteristics. • Data files are available in user-friendly formats for SPSS, SAS, and STATA users. Data files are available in three formats: the flat format, the rectangular format and the hierarchical format.
  26. 26. STRENGTHS  Random sampling improve the external validity.  Validated questionnaires and trained manpower with good supervision.  Wide range of health information was collected – IMR, contraception, immunization, anemia, breast feeding and HIV exposure.
  27. 27. WEAKNESS  Sample did not include union territories.  HIV testing include only adult population leaving most vulnerable group.  Large number of interviewers were recruited that may have introduced interviewer bias.  HemoCue method overestimated Hb level as compared to the standard Cyanmethemoglobin method.
  28. 28. DLHS  Objective : of the survey was to estimate the service coverage of the following:  Ante Natal Care (ANC) and Immunization services  Extent of safe deliveries  Contraceptive prevalence  Unmet need for family planning  Awareness about RTI/STI and HIV/AIDS  Utilization of government health services and users‟ satisfaction
  29. 29. WHY DLHS??? The district being the basic nucleus of planning and implementation, and for decentralize approach GoI has been interested in generating district level data on utilization of the services provided by government health facilities. To assess people’s perceptions on quality of services. Therefore, it was decided to undertake the DLHS under the RCH programme in the country.
  30. 30. District Level House Hold Survey (DLHS)  Conducted by Indian Institute of Population Science ( IIPS)  Initiated in 1997 ( I: 98-99, II : 2002-04 and, III : 2007-08)  One of the largest ever demographic and health surveys carried out in India, with a sample size of about 1000-1500 hhs. per district  To provide estimate on important indicators on 1. Maternal & Child Health 2. Family Planning & other reproductive health services. 3. Important interventions of NRHM ( DLHS – III)
  31. 31. Year Population covered Health issue covered DLHS -1 1998-99 529,817 households were contacted during the survey. Currently married women age 15-44 years Objective of DLHS DLHS -2 2002-04 the data was collected from 6, 20,107 households Currently married women age 15-44 years Health questionnaire included testing of cooking salt testing of blood of children (ages below 72 months), adolescents and pregnant women to assess the level of anaemia measuring weight of children DLHS -3 2007-08 7 lakh housholds Ever-married women (age 15-49). never married women (age 15-24) -Population linked facility survey conducted -Assess the effectiveness of ASHA and JSY -Adolescent health problem
  32. 32. SURVEY DESIGN AND SAMPLE SIZE • Systematic random sampling : was adopted for the selection of the districts for PHASE1: districts within the state were arranged alphabetically, and starting at random from either first or second district, alternative districts were selected. • Second phase : covered all the remaining districts of the country.
  33. 33. Survey Design and Sample Size • In each of the selected districts, 50 Primary Sampling Units (PSUs), i.e. either villages or urban wards were selected adopting probability proportional to size (PPS) sampling. The village/ ward level population as per the previous census was used for this purpose • The sample size for RHS-RCH was fixed at 1000 households with 20 households from each PSU. In order to take care of non-response due to various reasons, 10 percent over sampling was done.
  34. 34. • Further, all Sub-Centres and Primary Health Centres which were expected to serve the population of the selected Primary Sampling Units (PSUs) were also covered. • Study tool: Household questionnaire and Woman‟s questionnaire.
  35. 35. STRENGTHS  Whole country covered under DLHS  Validated questionnaires and trained manpower with good supervision  Wide range of health information was collected – IMR, contraception, immunization, anemia, breast feeding and HIV exposure.  Along with individual data health facility services also assessed.
  36. 36. SRS OBJECTIVE: Is to provide reliable estimates of birth rate, death rate and infant mortality rate at the natural division level for rural areas and at the State level for urban areas  Initiated on a pilot basis by the OFFICE OF THE REGISTRAR GENERAL, INDIA in a few selected states in 1964-65, it became fully operational during 1969-70 with about 3700 sample units
  37. 37. SRS • Continuous enumeration of births and deaths in selected sample units by resident part time enumerators, generally anganwadi workers & teachers, and an independent survey every six months by full-time SRS supervisors. • In rural areas : the sample unit is a village or a segment of it, if the village population is 2000 or more. • In urban areas: the sampling unit is a census enumeration block with population ranging from 750 to 1000
  38. 38. SRS • Matching of data • The unmatched and partially matched events are re-verified in the field to get an unduplicated count of correct events. • The advantage of this procedure, in addition to elimination of errors of duplication, is that it leads to a quantitative assessment of the sources of distortion in the two sets of records making it a self-evaluating technique
  39. 39. AHS  OBJECTIVE: “ To yield benchmarks of core vital and health indicators at the district level and to map changes therein on an annual basis” Scheme is sponsored by Ministry of Health & Family Welfare(MOHFW) Largest Sample Survey in the World
  40. 40. NEED FOR AHS 9 AHS States namely, Rajasthan, Uttar Pradesh, Uttarakhand, Bihar, Jharkhand, Orissa, Madhya Pradesh, Chhattisgarh and Assam constitute:  48 % of country‟s Population  59 % of Births  70 % of Infant Deaths  75 % of Under 5 Deaths  62 % of Maternal Deaths There is large inter-district variations in these States.
  41. 41. KEY FEATURES • Coverage- All the 284 districts of 8 EAG States and Assam • Sample Units- 20,694 statistically selected sample units (Census Enumeration Blocks in urban areas and Villages in rural areas) • Sample Population- About 18.2 million • Sample Households- 3.6 million households • Average Sample households per district- About 13 thousand
  42. 42. KEY FEATURES • Sample Size- District level sample size is based on Infant Mortality Rate • Conduct of Field Work- Hybrid approach wherein fieldwork has been outsourced and supervision done by the ORGI • Third Party Audit- Third Party Audit was implemented under AHS to verify the correctness of data through an independent arrangement. • This was over and above the regular supervision by ORGI
  43. 43. INDICATORS COVERED Crude Birth Rate (CBR) Crude Death Rate (CDR) Infant Mortality Rate (IMR) Neo-Natal Mortality Rate (NNMR) Under Five Mortality Rate (U5MR) Maternal Mortality Ratio (MMR) Sex Ratio at Birth (SRB) Sex Ratio (0-4 years) Sex Ratio (All ages)
  44. 44. References • Comparison of HemoCue Method with Cyanmethemoglobin Method for Estimation of Hemoglobin S.K. Kapoor* Umesh Kapil , sadanand et al.
  45. 45. 45