The 1993 Kenya Demographic and Health Survey (KDHS) was a nationally representative survey of 7,540 women age 15-49 and 2,336 men age 20-54. The KDHS was designed to provide information on levels and trends of fertility, infant and child mortality, family planning knowledge and use, maternal and child health, and knowledge of AIDS. In addition, the male survey obtained data on men's knowledge and attitudes towards family planning and awareness of AIDS. The data are intended for use by programme managers and policymakers to evaluate and improve family planning and matemal and child health programmes. Fieldwork for the KDHS took place from mid-February until mid-August 1993. All areas of Kenya were covered by the survey, except for seven northem districts which together contain less than four percent of the country's population.
The KDHS was conducted by the National Council for Population and Development (NCPD) and the Central Bureau of Statistics of the Government of Kenya. Macro International Inc. provided financial and technical assistance to the project through the intemational Demographic and Health Surveys (DHS) contract with the U.S. Agency for International Development.
The KDHS is intended to serve as a source of population and health data for policymakers and the research community. It was designed as a follow-on to the 1989 KDHS, a national-level survey of similar size that was implemented by the same organisations. In general, the objectives of KDHS are to:
- assess the overall demographic situation in Kenya,
- assist in the evaluation of the population and health programmes in Kenya,
- advance survey methodology, and
- assist the NCPD to strengthen and improve its technical skills to conduct demographic and health surveys.
The KDHS was specifically designed to:
- provide data on the family planning and fertility behaviour of the Kenyan population to enable the NCPD to evaluate and enhance the National Family Planning Programme,
- measure changes in fertility and contraceptive prevalence and at the same time study the factors which affect these changes, such as marriage patterns, urban/rural residence, availability of contraception, breastfeeding habits and other socioeconomic factors, and
- examine the basic indicators of maternal and child health in Kenya.
The 1993 KDHS reinforces evidence of a major decline in fertility which was first revealed by the findings of the 1989 KDHS. Fertility continues to decline and family planning use has increased. However, the disparity between knowledge and use of family planning remains quite wide. There are indications that infant and under five child mortality rates are increasing, which in part might be attributed to the increase in AIDS prevalence.
Kind of data
Sample survey data
The 1993 KDHS sample is national in scope, with the exclusion of all three districts in North Eastern Province and four other northern districts (Samburu and Turkana in Rift Valley Province and Isiolo and 4 Marsabit in Eastern Province). Together the excluded areas account for less than 4 percent of Kenya's population.
Unit of analysis
- Women age 15-49
- Men age 20-54
- Children under five
The population covered by the 1993 KDHS is defined as the universe of all women age 15-49 in Kenya and all husband age 20-54 living in the household.
Producers and sponsors
National Council for Population Development (NCPD)
Central Bureau of Statistics (CBS)
Macro International Inc
U.S. Agency for International Development
The sample for the 1993 KDHS was national in scope, with the exclusion of all three districts in Northeastern Province and four other northern districts (Isiolo and Marsabit from Eastern Province and Samburu and Turkana from Rift Valley Province). Together the excluded areas account for less than four percent of Kenya's population. The KDHS sample points were selected from a national master sample maintained by the Central Bureau of Statistics, the third National Sample Survey and Evaluation Programme (NASSEP-3), which is an improved version of NASSEP2 used in the 1989 survey. This master sample follows a two-stage design, stratified by urban-rural residence, and within the rural stratum, by individual district. In the first stage, 1989 census enumeration areas (EAs) were selected with probability proportional to size. The selected EAs were segmented into the expected number of standard-sized clusters to form NASSEP clusters. The entire master sample consists of 1,048 rural and 325 urban ~ sample points ("clusters"). A total of 536 clusters---92 urban and 444 rural--were selected for coverage in the KDHS. Of these, 520 were successfully covered. Sixteen clusters were inaccessible for various reasons.
As in the 1989 KDHS, selected districts were oversampled in the 1993 survey in order to produce more reliable estimates for certain variables at the district level. Fifteen districts were thus targetted in the 1993 KDHS: Bungoma, Kakamega, Kericho, Kilifi, Kisii, Machakos, Meru, Murang'a, Nakuru, Nandi, Nyeri, Siaya, South Nyanza, Taita-Taveta, and Uasin Gishu; in addition, Nairobi and Mombasa were also targetted. Although six of these districts were subdivided shortly before the sample design was finalised) the previous boundaries of these districts were used for the KDHS in order to maintain comparability with the 1989 survey. About 400 rural households were selected in each of these 15 districts, just over 1000 rural households in other districts, and about 18130 households in urban areas, for a total of almost 9,000 households. Due to this oversampling, the KDHS sample is not self-weighting at the national level.
After the selection of the KDHS sample points, fieldstaff from the Central Bureau of Statistics conducted a household listing operation in January and early February 1993, immediately prior to the launching of the fieldwork. A systematic sample of households was then selected from these lists, with an average "take" of 20 households in the urban clusters and 16 households in rural clusters, for a total of 8,864 households selected. Every other household was identified as selected for the male survey, meaning that, in addition to interviewing all women age 15-49, interviewers were to also interview all men age 20-54. It was expected that the sample would yield interviews with approximately 8,000 women age 15-49 and 2,500 men age 20-54.
A total of 8,805 households was selected for the survey, of which 7,950 were successfully interviewed. The shortfall is primarily due to dwellings being vacant or in which the inhabitants had left for an extended period at the time they were visited by the interviewing teams. Of the 8,185 households that were found, 97 percent were interviewed. Within these households, 7,952 women were identified as eligible for an individual interview and of these, 7,540, or 95 percent, were interviewed. In the one half of the households that were selected for inclusion in the male survey, 2,762 eligible men were identified, of which 2,336, or 85 percent, were interviewed. Response rates were higher in rural than in urban areas.
Dates of collection
Mode of data collection
Four types of questionnaires were used for the KDHS: a Household Questionnaire, a Woman's Questionnaire, a Man's Questionnaire and a Services Availability Questionnaire. The contents of these questionnaires were based on the DHS Model B Questionnaire, which is designed for use in countries with low levels of contraceptive use. Additions and modifications to the model questionnaires were made during a series of meetings organised around specific topics or sections of the questionnaires (e.g., fertility, family planning). The NCPD invited staff from a variety of organisations to attend these meetings, including the Population Studies Research Institute and other departments of the University of Nairobi, the Woman's Bureau, and various units of the Ministry of Health. The questionnaires were developed in English and then translated into and printed in Kiswahili and eight of the most widely spoken local languages in Kenya (Kalenjin, Kamba, Kikuyu, Kisii, Luhya, Luo, Meru, and Mijikenda).
a) The Household Questionnaire was used to list all the usual members and visitors of selected households. Some basic information was collected on the characteristics of each person listed, including his/her age, sex, education, and relationship to the head of the household. The main purpose of the Household Questionnaire was to identify women and men who were eligible for individual interview. In addition, information was collected about the dwelling itself, such as the source of water, type of toilet facilities, materials used to construct the house, and ownership of various consumer goods.
b) The Woman's Questionnaire was used to collect information from women aged 15-49. These women were asked questions on the following topics: Background characteristics (age, education, religion, etc.), Reproductive history, Knowledge and use of family planning methods, Antenatal and delivery care, Breastfeeding and weaning practices, Vaccinations and health of children under age five, Marriage, Fertility preferences, Husband's background and respondent's work, Awareness of AIDS. In addition, interviewing teams measured the height and weight of children under age five (identified through the birth histories) and their mothers.
c) Information from a subsample of men aged 20-54 was collected using a Man's Questionnaire. Men were asked about their background characteristics, knowledge and use of family planning methods, marriage, fertility preferences, and awareness of AIDS.
d) The Services Availability Questionnaire was used to collect information on the health and family planning services obtained within the cluster areas. One service availability questionnaire was to be completed in each cluster.
All questionnaires for the KDHS were returned to the NCPD headquarters for data processing. The processing operation consisted of office editing, coding of open-ended questions, data entry, and editing errors found by the computer programs. One NCPD officer, one data processing supervisor, one questionnaire administrator, two office editors, and initially four data entry operators were responsible for the data processing operation. Due to attrition and the need to speed up data processing, another four data entry operators were later hired temporarily. The data were processed on seven microcomputers, two of which were supplied specifically for the survey. The DHS data entry and editing programs were written in ISSA (Integrated System for Survey Analysis). Data processing commenced in early March and was completed by mid-September 1993.
Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the KDHS 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. The sampling error is 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.
Sampling error is usually measured in terms of the standard error for a particular statistic (mean, percentage, etc.), which is the square root of the variance. The standard error can be used to calculate confidence intervals within which the true value for the population can reasonably be assumed to fall. For example, for any given statistic calculated from a sample survey, the value of that statistic will fall within a range of plus or minus two times the standard error of that statistic in 95 percent of all possible samples of identical size and design.
If the sample of respondents had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the KDHS sample is the result of a two-stage stratified design, and, consequently, it was necessary to use more complex formulas. The computer software used to calculate sampling errors for the KDHS is the ISSA Sampling Error Module (ISSAS). This module used the Taylor linearization method of variance estimation for survey estimates that are means or proportions. The Jacknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates.
In addition to the standard errors, ISSAS computes the design effect (DEFT) for each estimate, which is defined as the ratio between the standard error using the given sample design and the standard error that would result if a simple random sample had been used. A DEFT value of 1.0 indicates that the sample design is as efficient as a simple random sample, while a value greater than 1.0 indicates the increase in the sampling error due to the use of a more complex and less statistically efficient design. ISSAS also computes the relative error and confidence limits for the estimates.
Sampling errors for the KDHS are calculated for selected variables considered to be of primary interest. The results are presented in an appendix to the Final Report for the country as a whole, for urban and rural areas, and for the nine provinces. In addition, sampling errors for contraceptive variables are calculated for certain smaller subsamples of female respondents, namely, Mombasa and the rural areas of the special districts. For each variable, the type of statistic (mean, proportion, or rate) and the base population are given in Table B. 1 in the Final Report's appendix. Tables B.2 to B. 17 present the value of the statistic (R), its standard error (SE), the number of unweighted (N) and weighted (WN) cases, the design effect (DEFT), the relative standard error (SE/R), and the 95 percent confidence limits (R+2SE), for each variable. In general, the relative standard error for most estimates for the country as a whole is small, except for estimates of very small proportions. There are some differentials in the relative standard error for the estimates of sub-populations such as geographical areas. For example, for the variable Children ever born to women aged 15-49, the relative standard error as a percent of the estimated mean for the whole country, for urban areas and for Nairobi is 1.3 percent, 4.3 percent, and 7.9 percent, respectively.
The confidence interval (e.g., as calculated for Children ever born to women aged 15-49) can be interpreted as follows: the overall average from the national sample is 3.167 and its standard error is .042. Therefore, to obtain the 95 percent confidence limits, one adds and subtracts twice the standard error to the sample estimate, ie. 3.167+.084. There is a high probability (95 percent) that the true average number of children ever born to all women aged 15 to 49 is between 3.083 and 3.251.
Other forms of data appraisal
Nonsampling error is the result of mistakes made in implementing data collection and data processing, such as 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 KDHS to minimize this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically.
Use of the dataset must be acknowledged using a citation which would include:
- the Identification of the Primary Investigator
- the title of the survey (including country, acronym and year of implementation)
- the survey reference number
- the source and date of download
Disclaimer and copyrights
The user of the data acknowledges that the original collector of the data, the authorized distributor of the data, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses.
Data and Data Related Resources
National Co-ordination Agency for Population & Development (NCPD)