Demographic and Health Survey 2011

LISTING, PRETEST, MAIN TRAINING, FIELDWORK, AND DATA PROCESSING

Listing

After the selection of the 624 clusters throughout the 11 regions and administrative areas, a listing operation was conducted in the selected clusters for about four months, starting in September 2010. For this purpose, training was conducted for 44 listing staff and 11 supervisors who had been recruited from all the regions and from the CSA head office to carry out the listing of households and preparation of the sketch map for each selected EA. A manual that described the listing and mapping procedures was prepared as a guideline, and the training involved both classroom demonstrations and field practice. The listing was performed by organizing the listing staff into teams, with two listers per team. Eleven supervisors were also assigned from the CSA branch offices to perform quality checks and handle all the administrative and financial aspects of the listing operation. Rounds of supervision were carried out by CSA central office staff to assess the quality of the field operation and to ensure proper listing.

Pretest

Before the start of fieldwork, the questionnaires were pretested in all three local languages to make sure that the questions were clear and could be understood by the respondents. Testing of blood sample collection was also conducted during the pretest. CSA staff and various experts from government ministries and donor organizations participated in a three-week pretest training and fieldwork conducted by staff from ICF International, from 20 September to 8 October 2010. Fifty-five participants were trained to administer paper questionnaires, take anthropometric measurements, and collect blood samples for anaemia and HIV testing. Representatives from EHNRI assisted in training participants on the finger prick for blood collection and proper handling and storage of the dried blood spots (DBS) for HIV testing. The pretest fieldwork was conducted over five days in the selected urban kebeles of Addis Ababa; and in both urban and rural kebeles in the surrounding towns of Ambo, Debre Birhan, Hawassa, and Mekele, covering 191 households. Debriefing sessions were held with the pretest field staff, and the questionnaires were modified based on lessons drawn from the pretest exercise.

Main Training

Recruitment of interviewers, editors, and supervisors for the main fieldwork was conducted in the nine regions and two city administrations, taking into account the languages of the specific areas. Accommodation was arranged for the trainees and trainers at a training site, Ethiopian Civil Service College in Addis Ababa. CSA recruited and trained 307 people for the main fieldwork to serve as supervisors, editors, male and female interviewers, and reserve interviewers. Also trained were field quality control staff, office editors, and office supervisors. The training of interviewers, editors and supervisors was conducted from 24 November to 23 December 2010. The training consisted of instruction on interviewing techniques and field procedures, a detailed review of the questionnaire content, instruction and practice in weighing and measuring children, mock interviews between participants in the classroom, and practice interviews with real respondents in areas outside the 2011 EDHS sample points. Field practice in anthropometry, anaemia testing, and blood sample collection was also carried out for interviewers who were assigned as team biomarker technicians. Team supervisors and editors were trained in data quality control procedures and fieldwork coordination.

The Amharic questionnaires were mainly used during the training, while the Tigrigna and Oromiffa versions were simultaneously checked against the Amharic questionnaires to ensure accurate translation.

Fieldwork

Thirty-five interviewing teams carried out data collection for the 2011 EDHS. Each team consisted of one team supervisor, one field editor, four female interviewers, two male interviewers, one cook, and one driver. Ten staff members from CSA coordinated and supervised fieldwork activities. An ICF International staff and representatives from other organisations supporting the survey, including EHNRI, CDC, and USAID, participated in fieldwork monitoring. In addition to the field teams, a quality control team was present in each of the 11 regions. Each quality control team included a field coordinator, one female and one male staff member to monitor the quality of the interviews, and one biomarker quality control staff member. The quality control teams regularly visited and often stayed with the EDHS teams throughout the fieldwork period to closely supervise and monitor them. Data collection took place over a five-month period from 27 December 2010 to 3 June 2011.

ANTHROPOMETRY, ANAEMIA, AND HIV TESTING

The 2011 EDHS included height and weight measurement, anaemia testing, and blood sample collection for HIV testing in the laboratory.

Height and Weight Measurement

Height and weight measurements were carried out on women age 15-49, men age 15-59, and children under age 5 in all selected households. Weight measurements were obtained using lightweight, SECA mother-infant scales with a digital screen, designed and manufactured under the guidance of UNICEF. Height measurements were carried out using a measuring board. Children younger than 24 months were measured for height while lying down, and older children, while standing.

Anaemia Testing

Blood specimens were collected for anaemia testing from all children age 6-59 months, women age 15-49, and men age 15-59 who voluntarily consented to the testing. Blood samples were drawn from a drop of blood taken from a finger prick (or a heel prick in the case of young children with small fingers) and collected in a microcuvette.

Haemoglobin analysis was carried out onsite using a battery-operated portable HemoCue analyser. Results were given verbally and in writing. Parents of children with a haemoglobin level under 7 g/dl were instructed to take the child to a health facility for follow-up care. Likewise, nonpregnant women were referred for follow-up care if their haemoglobin level was below 7 g/dl, and pregnant women and men were referred if their haemoglobin level was below 9 g/dl. All households
in which anaemia testing was conducted received a brochure explaining the causes and prevention of anaemia.

HIV Testing

Blood specimens for laboratory testing of HIV were collected by the EDHS biomarker technicians from all women age 15-49 and men age 15-59 who consented to the test. The protocol for the blood specimen collection and analysis was based on the anonymous linked protocol developed for MEASURE DHS. This protocol allows for the merging of the HIV test results with the sociodemographic data collected in the individual questionnaires after all information that could potentially identify an individual respondent has been destroyed.

Interviewers explained the procedure, the confidentiality of the data, and the fact that the test results would not be made available to the respondent. If a respondent consented to the HIV testing, five blood spots from the finger prick were collected on a filter paper card labelled with a barcode unique to the respondent. Respondents were asked whether they consented to having the laboratory store their blood sample for future unspecified testing. If the respondent did not consent to additional testing using their sample, the words “no additional testing” were written on the filter paper card.

Each household, whether individuals consented to HIV testing or not, received an informational brochure on HIV/AIDS and a list of fixed sites providing voluntary counselling and testing (VCT) services within the surrounding 10 km radius from the cluster for each region. For households farther than 10 km from a fixed VCT site, mobile VCT units were set up in or near survey areas following data collection. The USAID and CDC partners provided the logistical services for the provisions of mobile VCT services.

For each barcoded blood sample, a duplicate label was attached to the Biomarker Data Collection Form. A third copy of the same barcode was affixed to the Blood Sample Transmittal Form to track the blood samples from the field to the laboratory. Blood samples were dried overnight and packaged for storage the following morning. Samples were periodically collected in the field, along with the completed questionnaires, and transported to CSA in Addis Ababa to be logged in and checked; blood samples were then transported and submitted for testing to EHNRI in Addis Ababa.

Upon arrival at EHNRI, each blood sample was logged into the CSPro HIV Test Tracking System (CHTTS) database, given a laboratory number, and stored at -20°C until tested. The HIV testing protocol stipulates that testing of blood can be conducted only after the questionnaire data entry is completed, verified, and cleaned, and all unique identifiers except the anonymous barcode number are removed from the questionnaire file. The testing algorithm calls for testing all samples on the first ELISA assay test, the Vironostika® HIV Uni-Form II Plus O (Biomerieux). All positives were subjected to a second ELISA, the Murex HIV Ag/Ab Combination. If the first and second tests were discordant, a third confirmatory test, the HIV 2.2 western blot (DiaSorin), was conducted to resolve the discordance. The final result was rendered positive if the western blot confirmed the result to be positive and was rendered negative if the western blot confirmed it to be negative. When the western blot results were indeterminate, the sample result was recorded indeterminate.

Following HIV testing, the HIV test results for the 2011 EDHS were entered into the CHTTS database with a barcode as the unique identifier to the result. The barcodes identifying the HIV test results were linked with the data from the individual interviews to enable analysis and publication of HIV data linked with other EDHS data.