Exploring associations between water, sanitation, and anemia through 47 nationally representative demographic and health surveys

This study aimed to examine the trends in the prevalence of overweight and obesity and to determine the associated socioeconomic and household environmental factors among women in Nepal. Using nationally representative data from the 1996, 2001, 2006, 2011, and 2016 cross-sectional Nepal Demographic and Health Surveys (NDHSs) (n = 33,507), the prevalence of overweight–obesity (body mass index (BMI) ≥ 25 kg/m2) and obesity (BMI ≥ 30 kg/m2) among women aged 15–49 years were examined. From the latest NDHS 2016, non-pregnant women with recorded anthropometric measurements (n = 6165) were included in the final analyses. Multivariate logistic regression models were used to determine the socioeconomic and household environmental factors associated with BMI ≥ 25 and BMI ≥ 30. Between 1996 and 2016, the prevalence of overweight–obesity increased from 1.8% to 19.7%, while the prevalence of obesity increased from 0.2% to 4.1%. Age, marital status, wealth index, province of residence, type of cooking fuel, and household possessions—refrigerator and bicycle were significantly associated with having overweight–obesity and obesity. Similarly, educational status, religion, type of toilet facility, and household possessions—television and mobile phone were significantly associated with having overweight–obesity. Given the alarming increase in the prevalence of overweight and obesity among Nepalese women, there is an urgent need for interventions addressing these critical socioeconomic and household environmental factors.

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Refusal bias in HIV data from the Demographic and Health Surveys: Evaluation, critique and recommendations

Statistical Methods in Medical Research ◽

10.1177/0962280219844536 ◽

2019 ◽

Vol 29 (3) ◽

pp. 811-826

Author(s):

Oyelola A Adegboye ◽

Tomoki Fujii ◽

Denis HY Leung

Keyword(s):

Health Surveys ◽

Population Based ◽

Hiv Prevalence ◽

Estimation Methods ◽

Demographic And Health Surveys ◽

Test Results ◽

Hiv Test ◽

Prevalence Estimates ◽

Nationally Representative ◽

Practical Implications

Non-response is a commonly encountered problem in many population-based surveys. Broadly speaking, non-response can be due to refusal or failure to contact the sample units. Although both types of non-response may lead to bias, there is much evidence to indicate that it is much easier to reduce the proportion of non-contacts than to do the same with refusals. In this article, we use data collected from a nationally representative survey under the Demographic and Health Surveys program to study non-response due to refusals to HIV testing in Malawi. We review existing estimation methods and propose novel approaches to the estimation of HIV prevalence that adjust for refusal behaviour. We then explain the data requirement and practical implications of the conventional and proposed approaches. Finally, we provide some general recommendations for handling non-response due to refusals and we highlight the challenges in working with Demographic and Health Surveys and explore different approaches to statistical estimation in the presence of refusals. Our results show that variation in the estimated HIV prevalence across different estimators is due largely to those who already know their HIV test results. In the case of Malawi, variations in the prevalence estimates due to refusals for women are larger than those for men.

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Depends Who's Asking: Interviewer Effects in Demographic and Health Surveys Abortion Data

Demography ◽

10.1215/00703370-8937468 ◽

2021 ◽

Vol 58 (1) ◽

pp. 31-50

Author(s):

Tiziana Leone ◽

Laura Sochas ◽

Ernestina Coast

Keyword(s):

Health Surveys ◽

Demographic Data ◽

Demographic And Health Surveys ◽

Household Surveys ◽

Gender Based Violence ◽

Interviewer Effects ◽

Survey Questions ◽

Wide Range ◽

Nationally Representative ◽

The Impact

Abstract Responses to survey questions about abortion are affected by a wide range of factors, including stigma, fear, and cultural norms. However, we know little about how interviewers might affect responses to survey questions on abortion. The aim of this study is to assess how interviewers affect the probability of women reporting abortions in nationally representative household surveys: Demographic and Health Surveys (DHS). We use cross-classified random intercepts at the level of the interviewer and the sampling cluster in a Bayesian framework to analyze the impact of interviewers on the probability of reporting abortions in 22 DHS conducted worldwide. Household surveys are the only available data we can use to study the determinants and pathways of abortion in detail and in a representative manner. Our analyses are motivated by improving our understanding of the reliability of these data. Results show an interviewer effect accounting for between 0.2% and 50% of the variance in the odds of a woman reporting ever having had an abortion, after women's demographic characteristics are controlled for. In contrast, sampling cluster effects are much lower in magnitude. Our findings suggest the need for additional effort in assessing the causes of abortion underreporting in household surveys, including interviewers' skills and characteristics. This study also has important implications for improving the collection of other sensitive demographic data (e.g., gender-based violence and sexual health). Data quality of responses to sensitive questions could be improved with more attention to interviewers—their recruitment, training, and characteristics. Future analyses will need to account for the role of interviewer to more fully understand possible data biases.

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Knowledge and use of lactational amenorrhea as a family planning method among adolescent mothers in Uganda: a secondary analysis of Demographic and Health Surveys between 2006 and 2016

10.1101/2021.06.17.21259067 ◽

2021 ◽

Author(s):

Catherine Birabwa ◽

Pamela Bakkabulindi ◽

Solomon T Wafula ◽

Peter Waiswa ◽

Lenka Benova

Keyword(s):

Adolescent Mothers ◽

Young Women ◽

Health Surveys ◽

Demographic And Health Surveys ◽

Modern Contraceptive ◽

Cross Sectional ◽

Survey Question ◽

Lactational Amenorrhea ◽

Wide Range ◽

Nationally Representative

Objective: To assess the level of knowledge and use of lactational amenorrhea method (LAM) among adolescents in Uganda between 2006 and 2016 using nationally representative data from Demographic and Health Surveys (DHS). Design: Cross-sectional design involving analysis of three DHS (2006, 2011, and 2016) in Uganda. Setting: The data was collected in Uganda. The DHS are nationally representative surveys on a wide range of indicators including contraception knowledge and use. Participants: A total of 8,250 adolescents (15-19 years) and 7,110 young women (20-24 years) were included. Primary outcome measure: Use of LAM among adolescents and young women with a livebirth within six months before each survey. Results: In 2016, less than 1% of eligible adolescents correctly used LAM and 56% were passively benefitting from LAM. The median duration of postpartum amenorrhea (PPA) among adolescents in 2016 was 6.9 months, declining from 8.3 months in 2006. Compared to adolescents, eligible young women had higher knowledge of LAM and higher medianPPA duration in 2016. The percentage of eligible adolescents who met the LAM criteria irrespective of whether they reported LAM use (protected by LAM) decreased from 76% in 2006 to 57% in 2016. More than 50% of eligible adolescents were aware of LAM in 2016, increasing from 6% in 2006, potentially in part due to change in survey question. Conclusion: Despite increasing awareness of LAM, reported and correct use of LAM was low among adolescents who could benefit from this method in Uganda, and declining over time. Support for adolescents to harness the benefits of correct LAM use should be increased. Additional research is needed to better understand the dynamics of LAM use in adolescents, including the transition to use of other modern contraceptive methods.

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The Forgotten Agenda of Wasting in Southeast Asia: Burden, Determinants and Overlap with Stunting: A Review of Nationally Representative Cross-Sectional Demographic and Health Surveys in Six Countries

Nutrients ◽

10.3390/nu12020559 ◽

2020 ◽

Vol 12 (2) ◽

pp. 559 ◽

Cited By ~ 1

Author(s):

Mueni Mutunga ◽

Severine Frison ◽

Matteo Rava ◽

Paluku Bahwere

Keyword(s):

Public Health ◽

Southeast Asia ◽

Health Problem ◽

Health Surveys ◽

Public Health Problem ◽

Wealth Index ◽

Absolute Number ◽

Demographic And Health Surveys ◽

Cross Sectional ◽

Nationally Representative

Childhood wasting is among the most prevalent forms of undernutrition globally. The Southeast Asia region is home to many wasted children, but wasting is not recognized as a public health problem and its epidemiology is yet to be fully examined. This analysis aimed to determine the burden of wasting, its predictors, and the level of wasting and stunting concurrence. Datasets from Demographic and Health Surveys and Multiple Indicator Cluster Surveys in six countries in the region were analyzed. The pooled weighted prevalence for wasting and concurrent wasting and stunting among children 0–59 months in the six countries was 8.9%, 95% CI (8.0–9.9) and 1.6%, 95% CI (1.5–1.8), respectively. This prevalence is approximately 12-fold higher than the 0.7% prevalence of high-income countries; and translated into an absolute number of 1,088,747 children affected by wasting and 272,563 concurrent wasting and stunting. Wasting prevalence was 50 percent higher in the 0–23-month age group. Predictors for wasting included source of drinking water, wealth index, urban residence, child’s age and history of illness and mother’s body mass index. In conclusion, our analysis showed that wasting is a serious public health problem in the region that should be addressed urgently using both preventive and curative approaches.

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Trends in obesity by socioeconomic status among non-pregnant women aged 15–49 y: a cross-sectional, multi-dimensional equity analysis of demographic and health surveys in 11 sub-Saharan Africa countries, 1994–2015

International Health ◽

10.1093/inthealth/ihaa093 ◽

2020 ◽

Author(s):

Oghenebrume Wariri ◽

Jacob Albin Korem Alhassan ◽

Godwin Mark ◽

Oyinkansola Adesiyan ◽

Lori Hanson

Keyword(s):

Health Surveys ◽

Reproductive Age ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Women Of Reproductive Age ◽

Or Education ◽

Cross Sectional ◽

Nationally Representative ◽

Sub Saharan ◽

Ssa Countries

Abstract Background Global obesity estimates show a steadily increasing pattern across socioeconomic and geographical divides, especially among women. Our analysis tracked and described obesity trends across multiple equity dimensions among women of reproductive age (15–49 y) in 11 sub-Saharan African (SSA) countries during 1994–2015. Methods This study consisted of a cross-sectional series analysis using nationally representative demographic and health surveys (DHS) data. The countries included were Cameroon, Comoros, Congo, Cote d'Ivoire, Ghana, Kenya, Lesotho, Nigeria, Senegal, Zambia and Zimbabwe. The data reported are from a reanalysis conducted using the WHO Health Equity Assessment Toolkit that assesses inter- and intra-country health inequalities across socioeconomic and geographical dimensions. We generated equiplots to display intra- and inter-country equity gaps. Results There was an increasing trend in obesity among women of reproductive age across all 11 SSA countries. Obesity increased unequally across wealth categories, place of residence and educational measures of inequality. The wealthiest, most educated and urban dwellers in most countries had a higher prevalence of obesity. However, in Comoros, obesity did not increase consistently with increasing wealth or education compared with other countries. The most educated and wealthiest women in Comoros had lower obesity rates compared with their less wealthy and less well-educated counterparts. Conclusion A window of opportunity is presented to governments to act structurally and at policy level to reduce obesity generally and prevent a greater burden on disadvantaged subpopulation groups in sub-Saharan Africa.

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Changes in demand for children between 2003 and 2013 in Nigeria: Evidence from survey data

Population Horizons ◽

10.2478/pophzn-2018-0006 ◽

2018 ◽

Vol 15 (1) ◽

pp. 16-29

Author(s):

Stella Babalola ◽

Joshua O. Akinyemi ◽

Clifford O. Odimegwu

Keyword(s):

Health Surveys ◽

Contraceptive Use ◽

Religious Affiliation ◽

Large Family ◽

Fertility Rate ◽

Demographic And Health Surveys ◽

High Fertility ◽

Fertility Desire ◽

The North ◽

Demand For Children

Abstract Nigeria has one of the highest fertility rates in Africa. Data from 2013 Demographic and Health Surveys indicate a virtual stagnation of fertility rate since 2003. Low contraceptive use and pronatalist attitudes are among the factors contributing to the high fertility rate in Nigeria. In this manuscript, we pooled data from three most recent waves of Demographic and Health Surveys to examine trends in demand for children over time and identify the factors associated with change in demand for children. The data show that demand for children has declined since 2003 although not monotonically so. Variables that were positively associated with increased likelihood of desiring no additional children were residence in the South-West (as opposed to residence in the North-Central), exposure to family planning (FP) messages on the mass media, number of children ever born, educational level, and urban residence. In contrast, uncertainty about fertility desire was more widespread in 2008 compared to 2013 although less widespread in 2003 than in 2013. The likelihood of being undecided about fertility desire was positively associated with discrepancies in family size desires between husband and wife, parity and Islamic religious affiliation. Programs should aim to increase access to effective contraceptive methods and promote demand for contraceptives as a way of fostering a sustainable reduction in demand for children. Furthermore, strategies that address uncertainty by fostering women’s understanding of the social and health implications of large family sizes are relevant.

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Faculty Opinions recommendation of Association between economic growth and early childhood undernutrition: evidence from 121 Demographic and Health Surveys from 36 low-income and middle-income countries.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718325326.793492832 ◽

2014 ◽

Author(s):

David Stuckler ◽

Aaron Reeves

Keyword(s):

Economic Growth ◽

Early Childhood ◽

Low Income ◽

Health Surveys ◽

Demographic And Health Surveys ◽

Middle Income ◽

Middle Income Countries ◽

Childhood Undernutrition

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Wasting and Associated Factors among Children under 5 Years in Five South Asian Countries (2014–2018): Analysis of Demographic Health Surveys

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094578 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4578

Author(s):

Nidhi Wali ◽

Kingsley E. E. Agho ◽

Andre M. N. Renzaho

Keyword(s):

South Asia ◽

South Asian ◽

Health Surveys ◽

Associated Factors ◽

Common Factor ◽

Household Wealth ◽

Health Concern ◽

Demographic And Health Surveys ◽

Asian Countries ◽

Sampling Weights

Child wasting continues to be a major public health concern in South Asia, having a prevalence above the emergency threshold. This paper aimed to identify factors associated with wasting among children aged 0–23 months, 24–59 months, and 0–59 months in South Asia. A weighted sample of 564,518 children aged 0–59 months from the most recent demographic and health surveys (2014–2018) of five countries in South Asia was combined. Multiple logistic regression analyses that adjusted for clustering and sampling weights were used to examine associated factors. Wasting prevalence was higher for children aged 0–23 months (25%) as compared to 24–59 months (18%), with variations in prevalence across the South Asian countries. The most common factor associated with child wasting was maternal BMI [adjusted odds ratio (AOR) for 0–23 months = 2.02; 95% CI: (1.52, 2.68); AOR for 24–59 months = 2.54; 95% CI: (1.83, 3.54); AOR for 0–59 months = 2.18; 95% CI: (1.72, 2.77)]. Other factors included maternal height and age, household wealth index, birth interval and order, children born at home, and access to antenatal visits. Study findings suggest need for nutrition specific and sensitive interventions focused on women, as well as adolescents and children under 2 years of age.

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Time trends in socio-economic, urban-rural and regional disparities in prevalence of obesity among non-pregnant women in Lesotho: evidence from Lesotho demographic and health surveys (2004–2014)

BMC Public Health ◽

10.1186/s12889-021-10571-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Betregiorgis Zegeye ◽

Gebretsadik Shibre ◽

Gashaw Garedew Woldeamanuel

Keyword(s):

Pregnant Women ◽

Health Surveys ◽

Educational Inequality ◽

Statistical Significance ◽

World Health ◽

Demographic And Health Surveys ◽

Obesity Prevalence ◽

Urban Rural ◽

Prevalence Of Obesity ◽

Health Organization

Abstract Background The growing rates of obesity in developing countries are alarming. There is a paucity of evidence about disparities of obesity in Lesotho. This study examined socioeconomic and area-based inequalities in obesity among non-pregnant women in Lesotho. Methods Data were extracted from the 2004, 2009 and 2014 Lesotho Demographic and Health Surveys (LDHS) and analyzed through the recently updated Health Equity Assessment Toolkit (HEAT) of the World Health Organization. Obesity prevalence was disaggregated by four equity stratifiers, namely education, wealth, residence and sub-national region. For each equity stratifier, simple and complex as well as relative and absolute summary measures were calculated. A 95% confidence interval was used to measure statistical significance of findings. Results We noticed substantial wealth-driven (D = -21.10, 95% CI; − 25.94, − 16.26), subnational region (PAR = -11.82, 95%CI; − 16.09, − 7.55) and urban-rural (− 9.82, 95% CI; − 13.65, − 5.99) inequalities in obesity prevalence without the inequalities improved over time in all the studied years. However, we did not identify educational inequality in obesity. Conclusions Wealth-driven and geographical inequalities was identified in Lesotho in all the studied time periods while education related inequalities did not appear during the same time period. All population groups in the country need to be reached with interventions to reduce the burden of obesity in the country.

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