The Egypt Demographic and Health Survey (2008 EDHS) is the latest in a series of a nationally representative population and health surveys conducted in Egypt. The 2008 EDHS was conducted under the auspices of the Ministry of Health (MOH) and implemented by El-Zanaty & Associates. Technical support for the 2008 EDHS was provided by Macro International through the MEASURE DHS project. MEASURE DHS is sponsored by the U.S. Agency for International Development (USAID) to assist countries worldwide in conducting surveys to obtain information on key population and health indicators.
The 2008 EDHS was undertaken to provide estimates for key population indicators including fertility, contraceptive use, infant and child mortality, immunization levels, coverage of antenatal and delivery care, maternal and child health, and nutrition. In addition, the survey was designed to provide information on a number of health topics and on the prevalence of hepatitis C and high blood pressure among the population age 15-59 years. The survey results are intended to assist policymakers and planners in assessing the current health and population programs and in designing new strategies for improving reproductive health and health services in Egypt.
Kind of data
Sample survey data
Unit of analysis
- Children under five years
- Women age 15-49
Producers and sponsors
Ministry of Health (MOH) and implemented by El-Zanaty and Associates
United State Agency for International Development
United Nations Children's Fund
The primary objective of the sample design for the 2008 EDHS was to provide estimates of key population and health indicators including fertility and child mortality rates for the country as a whole and for six major administrative regions ( Urban Governorates, urban Lower Egypt, rural Lower Egypt, urban Upper Egypt, rural Upper Egypt, and the Frontier Governorates). In the Urban Governorates, Lower Egypt, and Upper Egypt, the 2008 EDHS design allowed for governorate-level estimates of most of the key variables, with the exception of the fertility and mortality rates. In the Frontier Governorates, the sample size was not sufficiently large to provide separate estimates for the individual governorates. To meet the survey objectives, the number of households selected in the 2008 EDHS sample from each governorate was not proportional to the size of the population in the governorate. As a result, the 2008 EDHS sample is not self-weighting at the national level, and weights have to be applied to the data to obtain the national-level estimates.
The sample for the 2008 EDHS was selected in three stages. The first stage included selecting the primary sampling units. The units of selection were shiakhas/towns in urban areas and villages in rural areas. A list of these units which was based on the 2006 census was obtained from CAPMAS, and this list was used in selecting the primary sampling units (PSUs). Prior to the selection of the PSUs, the frame was further reviewed to identify any administrative changes that had occurred after the 2006 Census. The updating process included both office work and field visits for a period of around 2 months. After it was completed, urban and rural units were separately stratified by geographical location in a serpentine order from the northwest corner to the southeast corner within each governorate. During this process, shiakhas or villages with a population less than 2,500 were grouped with contiguous shiakhas or villages (usually within the same kism or marquez) to form units with a population of at least 5,000. After the frame was ordered, a total of 610 primary sampling units (275 shiakhas/towns and 335 villages) were selected.
The second stage of selection involved several steps. First, detailed maps of the PSUs chosen during the first stage were obtained and divided into parts of roughly equal population size (about 5,000). In shiakhas/towns or villages with a population of 100,000 or more, three parts were selected, two parts were selected from PSU's with population 20,000 or more (and less than 100,000). In the remaining smaller shiakhas/towns or villages, only one part was selected. Overall, a total of 998 parts were selected from the shiakhas/towns and villages in the 2008 EDHS sample.
A quick count was then carried out to provide an estimate of the number of households in each part. This information was needed to divide each part into standard segments of about 200 households. A group of 48 experienced field workers participated in the quick count operation. They were organized into 15 teams, each consisting of 1 supervisor, 1 cartographer and 1 counter. A one-week training course conducted prior to the quick count included both classroom sessions and two field practices in a shiakha/town and a village not covered in the survey. The quick-count operation took place between the end of October 2007 and end of December 2007.
As a quality control measure, the quick count was repeated in 10 percent of the parts. If the difference between the results of the first and second quick count was less than 2 percent, then the first count was accepted. No major discrepancies were found between the two counts in most of the areas for which the count was repeated.
After the quick count, a total of 1,267 segments were chosen from the parts in each shiakha/ town and village in the 2008 EDHS sample (i.e., two segments were selected from 561 PSUs and three segments from 48 PSUs and one segment from one PSU). A household listing operation was then implemented in each of the selected segments. To conduct this operation, 14 supervisors and 28 listers were organized into 14 teams. Generally, each listing team consisted of a supervisor and two listers. A one-week training course for the listing staff was held at the beginning of January 2008. The training involved classroom lectures and two days of field practice in three urban and rural locations not covered in the survey. The listing operation took place during a six-week period, beginning immediately after the training.
About 10 percent of the segments were relisted. Two criteria were used to select segments for relisting. First, segments were relisted when the number of households in the listing differed markedly from that expected according to the quick count information. Second, a number of segments were randomly selected to be relisted as an additional quality control test. Overall, the discrepancies found in comparisons of the listings were not major.
The third stage involved selecting the household sample. Using the household listing for each segment, a systematic random sample of households was selected for the 2008 EDHS sample. All evermarried women 15-49 who were present in the sampled households on the night before the survey team visited were eligible for the main DHS interview. In addition, in a subsample of one-quarter of the households in each segment, all women and men age 15-59 who were present in the household on the night before the interview were eligible for the health issues interviews and the hepatitis C testing.
Note: See detailed description of the sample design in Appendix B of the survey report.
Out of 19,739 households selected for the 2008 EDHS 19,147 households were found, and 18,968 households were successfully interviewed which represents a response rate of 99.1 percent.
As noted above, for the ever-married woman interviews, an eligible respondent was defined as an ever-married woman age 15-49 who was present in the household on the night before the interview. A total of 16,571 eligible ever-married women were identified in the households in the 2008 EDHS sample. Of these women, 16,527 were successfully interviewed. The ever-married women response rate was 99.7 percent.
A total of 4,953 households were selected for the health issues subsample. Of these, 4,757 were found and 4,662 interviewed. The household response rate in the health issues subsample was only slightly lower than the response rate in the entire EDHS sample (98 percent).
Women and men were eligible for the health issues interview if they were age 15-59 years (regardless of marital status) and were present in the household on the night before the interview. A total of 12,780 individuals (6,702 women and 6,078 men) who met these criteria were identified in the subsample of households selected for the special health issues interviews, of which 12,008 were successfully interviewed. Taking into account both eligible women and men, the response rate for the health issues was 94 percent. As expected, the response rate among women (98 percent) was higher than the rate among men (89 percent), with the principal reason being the fact that men were more likely to be working and, thus, not as easy to contact for interview as women.
Note: See summarized response rates in Table 1.4 of the report which is presented in this documentation.
Dates of collection
Mode of data collection
Three questionnaires were used in the 2008 EDHS: a household questionnaire, an ever-married woman questionnaire, and a health issues questionnaire. The household and ever-married woman’s questionnaires were based on the questionnaires that had been used in earlier EDHS surveys and on model survey instruments developed in the MEASURE DHS program. The majority of the content of the health issues questionnaire was developed especially for the 2008 EDHS although some sections (e.g., the questions on female circumcision and HIV/AIDS knowledge and attitudes) were also based on questionnaires used in earlier EDHS surveys or were drawn from the model instruments from the MEASURE DHS program. The questionnaires were developed in English and translated into Arabic.
The first part of the household questionnaire was used to enumerate all usual members and visitors to the selected households and to collect information on the age, sex, marital status, educational attainment, and relationship to the household head of each household member or visitor. This information provided basic demographic data for Egyptian households. It was also used to identify the women who were eligible for the individual interview (i.e., ever-married women 15-49) as well as individuals eligible for the special health issues interviews and the hepatitis testing subsample. In the second part of the household questionnaire, there were questions relating to the socioeconomic status of the household including questions on housing characteristics (e.g., the number of rooms, the flooring material, the source of water and the type of toilet facilities) and on ownership of a variety of consumer goods. A special module was included in the household questionnaire on ownership of poultry and birds. In addition, height and weight measurements of respondents, youth, and children under age six were taken during the survey and recorded in the household questionnaire. The informed consent for the hepatitis C testing obtained from eligible respondents age 15-59 was also recorded in the household questionnaire.
The woman’s questionnaire was administered to all ever-married women age 15-49 who were usual residents or who were present in the household during the night before the interviewer’s visit. It obtained information on the following topics:
• Respondent’s background
• Contraceptive knowledge and use
• Fertility preferences and attitudes about family planning
• Pregnancy and breastfeeding
• Immunization and child health
• Husband’s background and women’s work
• Female circumcision
• Health care access and other health concerns
• Mother and child nutrition.
The woman’s questionnaire included a monthly calendar, which was used to record the history of the respondent’s marriage status, fertility, contraceptive use including the source where the method was obtained, and the reason for discontinuation for each segment of use status during each month of an approximately five-year period starting from January 2003.
The health issues questionnaire collected information on the following topics:
• Background characteristics of men age 15-59, never-married women age 15-59, and evermarried
women age 50-59
• Female circumcision
• Health insurance coverage and health care cost
• Knowledge and attitudes about HIV/AIDS
• Medical procedures and safe injections
• Hepatitis C
• Hypertension, heart disease and diabetes
• Avian influenza
Blood pressure readings were also obtained for respondents at three points during the health issues interview.
Office editing: Staff from the central office were responsible for collecting questionnaires from the teams as soon as interviewing in a cluster was completed. Office editors reviewed questionnaires for consistency and completeness, and a few questions (e.g., occupation) were coded in the office prior to data entry. To provide feedback for the field teams, the office editors were instructed to report any problems detected while editing the questionnaires, which were reviewed by the senior staff. If serious errors were found in one or more questionnaires from a cluster, the supervisor of the team working in that cluster was notified and advised of the steps to be taken to avoid these problems in the future.
Machine entry and editing: Machine entry and editing began while interviewing teams were still in the field. The data from the questionnaires were entered and edited on microcomputers using the Census and Survey Processing System (CSPro), a software package for entering, editing, tabulating, and disseminating data from censuses and surveys. In addition the transmittal forms for Hepatitis C individuals as well as the blood sample sheet including the bar code were entered by one person.
Special computer programs were also set up to facilitate the tracking of the results of the testing of the blood samples collected during the survey at the Central Health Laboratory. The bar codes attached to the samples in the field were used for logging in and identifying the samples throughout the processing, which took place at three separate locations within the Central Laboratory. The bar code also served as the means to link the laboratory test results and the survey data file.
Twelve data entry personnel used twelve microcomputers to process the 2008 EDHS survey data. During the machine entry, 100 percent of each segment was re-entered for verification. The data processing staff completed the entry and editing of data by mid July 2008.
The estimates from a sample survey are affected by two types of errors: (1) nonsampling errors, and (2) sampling errors. Nonsampling errors are the results of mistakes made in implementing data collection and data processing, such as the failure to locate and interview the correct household, misunderstanding of the questions on the part of either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the 2008 Egypt DHS to minimize this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically.
Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the 2008 EDHS is only one of many samples that could have been selected from the same population, using the same design and expected size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability between all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results.
If the sample of EDHS respondents had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the 2008 EDHS sample is the result of a multi-stage stratified design, and, consequently, it was necessary to use more complex formulae, specifically the Taylor linearization method of variance estimation, to calculate sampling errors for means or proportions from the survey. The Jacknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates.
Note: See detailed estimate of sampling error calculation in APPENDIX C of the survey report.
Other forms of data appraisal
Data Quality Tables
- Household age distribution
- Age distribution of eligible and interviewed women
- Completeness of reporting
- Reporting of age at death in days
- Reporting of age at death in months
- Births by calendar years
NOTE: See these tables in APPENDIX D of the report which is presented in this documentation.
MEASURE DHS believes that widespread access to survey data by responsible researchers has enormous advantages for the countries concerned and the international community in general. Therefore, MEASURE DHS policy is to release survey data to researchers after the main survey report is published, generally within 12 months after the end of fieldwork. with few limitations these data have been made available for wide use.
DISTRIBUTION OF DATASETS
MEASURE DHS is authorized to distribute, at no cost, unrestricted survey data files for legitimate academic research, with the condition that we receive a description of any research project that will be using the data.
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- the title of the survey (including country, acronym and year of implementation)
- the survey reference number
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