District Level Household Survey

1. District Level Household Survey Dr K. Sushma

2. 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.

3. 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.

4. 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

5. 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).

6. 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.

7. Methodology: • Rural sampling was done with stratification of villages into 3 strata • <50 household • 50-300 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.

8. 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

9. Women questionnnaire • Background characteristics: Age, educational status & births & deaths, H/O biological children including still birth, induced & spontaneous abortion • 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. • Immunization & childcare: Feeding practices, length of breastfeeding, immunization coverage & recent episodes of diarrhoea& pneumonia for young children(<3yrs)

10. 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

11. 7. Husband questionnaire: -In first round male questionnaire (20-54yrs) was used instead of husband questionnaire - In second roundhusband 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

12. 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

13. 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

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

17. Delivery care (women who had live/still birth during reference period)

18. Child Immunization