The 1997 the Kyrgyz Republic Demographic and Health Survey (KRDHS) is a nationally representative survey of 3,848 women age 15-49. Fieldwork was conducted from August to November 1997. The KRDHS was sponsored by the Ministry of Health (MOH), and was funded by the United States Agency for International Development. The Research Institute of Obstetrics and Pediatrics implemented the survey with technical assistance from the Demographic and Health Surveys (DHS) program.
The purpose of the KRDHS was to provide data to the MOH on factors which determine the health status of women and children such as fertility, contraception, induced abortion, maternal care, infant mortality, nutritional status, and anemia.
Some statistics presented in this report are currently available to the MOH from other sources. For example, the MOH collects and regularly publishes information on fertility, contraception, induced abortion and infant mortality. However, the survey presents information on these indices in a manner which is not currently available, i.e., by population subgroups such as those defined by age, marital duration, education, and ethnicity. Additionally, the survey provides statistics on some issues not previously available in the Kyrgyz Republic: for example, breastfeeding practices and anemia status of women and children. When considered together, existing MOH data and the KRDHS data provide a more complete picture of the health conditions in the Kyrgyz Republic than was previously available.
A secondary objective of the survey was to enhance the capabilities of institutions in the Kyrgyz Republic to collect, process, and analyze population and health data.
Fertility Rates. Survey results indicate a total fertility rate (TFR) for all of the Kyrgyz Republic of 3.4 children per woman. Fertility levels differ for different population groups. The TFR for women living in urban areas (2.3 children per woman) is substantially lower than for women living in rural areas (3.9). The TFR for Kyrgyz women (3.6 children per woman) is higher than for women of Russian ethnicity (1.5) but lower than Uzbek women (4.2). Among the regions of the Kyrgyz Republic, the TFR is lowest in Bishkek City (1.7 children per woman), and the highest in the East Region (4.3), and intermediate in the North and South Regions (3.1 and3.9, respectively).
Time Trends. The KRDHS data show that fertility has declined in the Kyrgyz Republic in recent years. The decline in fertility from 5-9 to 0-4 years prior to the survey increases with age, from an 8 percent decline among 20-24 year olds to a 38 percent decline among 35-39 year olds. The declining trend in fertility can be seen by comparing the completed family size of women near the end of their childbearing years with the current TFR. Completed family size among women 40-49 is 4.6 children which is more than one child greater than the current TFR (3.4).
Birth Intervals. Overall, 30 percent of births in the Kyrgyz Republic take place within 24 months of the previous birth. The median birth interval is 31.9 months.
Age at Onset of Childbearing. The median age at which women in the Kyrgyz Republic begin childbearing has been holding steady over the past two decades at approximately 21.6 years. Most women have their first birth while in their early twenties, although about 20 percent of women give birth before age 20.
Nearly half of married women in the Kyrgyz Republic (45 percent) do not want to have more children. Additional one-quarter of women (26 percent) want to delay their next birth by at least two years. These are the women who are potentially in need of some method of family planning.
Ever Use. Among currently married women, 83 percent report having used a method of contraception at some time. The women most likely to have ever used a method of contraception are those age 30-44 (among both currently married and all women).
Current Use. Overall, among currently married women, 60 percent report that they are currently using a contraceptive method. About half (49 percent) are using a modern method of contraception and another 11 percent are using a traditional method. The IUD is by far the most commonly used method; 38 percent of currently married women are using the IUD. Other modern methods of contraception account for only a small amount of use among currently married women: pills (2 percent), condoms (6 percent), and injectables and female sterilization (1 and 2 percent, respectively). Thus, the practice of family planning in the Kyrgyz Republic places high reliance on a single method, the IUD.
Source of Methods. The vast majority of women obtain their contraceptives through the public sector (97 percent): 35 percent from a government hospital, and 36 percent from a women counseling center. The source of supply of the method depends on the method being used. For example, most women using IUDs obtain them at women counseling centers (42 percent) or hospitals (39 percent). Government pharmacies supply 46 percent of pill users and 75 percent of condom users. Pill users also obtain supplies from women counseling centers or (33 percent).
Fertility Preferences. A majority of women in the Kyrgyz Republic (45 percent) indicated that they desire no more children. By age 25-29, 20 percent want no more children, and by age 30-34, nearly half (46 percent) want no more children. Thus, many women come to the preference to stop childbearing at relatively young ages-when they have 20 or more potential years of childbearing ahead of them. For some of these women, the most appropriate method of contraception may be a long-acting method such as female sterilization. However, there is a deficiency of use of this method in the Kyrgyz Republic. In the interests of providing a broad range of safe and effective methods, information about and access to sterilization should be increased so that individual women can make informed decisions about using this method.
Abortion Rates. From the KRDHS data, the total abortion rate (TAR)-the number of abortions a woman will have in her lifetime based on the currently prevailing abortion rates-was calculated. For the Kyrgyz Republic, the TAR for the period from mid-1994 to mid-1997 is 1.6 abortions per woman. The TAR for the Kyrgyz Republic is lower than recent estimates of the TAR for other areas of the former Soviet Union such as Kazakhstan (1.8), and Yekaterinburg and Perm in Russia (2.3 and 2.8, respectively), but higher than for Uzbekistan (0.7).
The TAR is higher in urban areas (2.1 abortions per woman) than in rural areas (1.3). The TAR in Bishkek City is 2.0 which is two times higher than in other regions of the Kyrgyz Republic. Additionally the TAR is substantially lower among ethnic Kyrgyz women (1.3) than among women of Uzbek and Russian ethnicities (1.9 and 2.2 percent, respectively).
In the KRDHS, infant mortality data were collected based on the international definition of a live birth which, irrespective of the duration of pregnancy, is a birth that breathes or shows any sign of life (United Nations, 1992).
Mortality Rates. For the five-year period before the survey (i.e., approximately mid-1992 to mid1997), infant mortality in the Kyrgyz Republic is estimated at 61 infant deaths per 1,000 births. The estimates of neonatal and postneonatal mortality are 32 and 30 per 1,000.
The MOH publishes infant mortality rates annually but the definition of a live birth used by the MOH differs from that used in the survey. As is the case in most of the republics of the former Soviet Union, a pregnancy that terminates at less than 28 weeks of gestation is considered premature and is classified as a late miscarriage even if signs of life are present at the time of delivery. Thus, some events classified as late miscarriages in the MOH system would be classified as live births and infant deaths according to the definitions used in the KRDHS.
Infant mortality rates based on the MOH data for the years 1983 through 1996 show a persistent declining trend throughout the period, starting at about 40 per 1,000 in the early 1980s and declining to 26 per 1,000 in 1996. This time trend is similar to that displayed by the rates estimated from the KRDHS. Thus, the estimates from both the KRDHS and the Ministry document a substantial decline in infant mortality; 25 percent over the period from 1982-87 to 1992-97 according to the KRDHS and 28 percent over the period from 1983-87 to 1993-96 according to the MOH estimates. This is strong evidence of improvements in infant survivorship in recent years in the Kyrgyz Republic.
It should be noted that the rates from the survey are much higher than the MOH rates. For example, the KRDHS estimate of 61 per 1,000 for the period 1992-97 is twice the MOH estimate of 29 per 1,000 for 1993-96. Certainly, one factor leading to this difference are the differences in the definitions of a live birth and infant death in the KRDHS survey and in the MOH protocols. A thorough assessment of the difference between the two estimates would need to take into consideration the sampling variability of the survey's estimate. However, given the magnitude of the difference, it is likely that it arises from a combination of definitional and methodological differences between the survey and MOH registration system.
MATERNAL AND CHILD HEALTH
The Kyrgyz Republic has a well-developed health system with an extensive infrastructure of facilities that provide maternal care services. This system includes special delivery hospitals, the obstetrics and gynecology departments of general hospitals, women counseling centers, and doctor's assistant/midwife posts (FAPs). There is an extensive network of FAPs throughout the rural areas.
Delivery. Virtually all births in the Kyrgyz Republic (96 percent) are delivered at health facilities: 95 percent in delivery hospitals and another 1 percent in either general hospitals or FAPs. Only 4 percent of births are delivered at home. Almost all births (98 percent) are delivered under the supervision of medically trained persons: 61 percent by a doctor and 37 percent by a nurse or midwife.
Antenatal Care. As expected, the survey data indicate that a high proportion of respondents (97 percent) receive antenatal care from professional health providers: the majority from a doctor (65 percent) and a significant proportion from a nurse or midwife (32 percent). The general pattern in the Kyrgyz Republic is that women seek antenatal care early and continue to receive care throughout their pregnancies. The median number of antenatal care visits reported by respondents is 8.
Immunization. Information on vaccination coverage was collected in the KRDHS for all children under three years of age. In the Kyrgyz Republic, child health cards are maintained in the local health care facilities or day care centers rather than in the homes of respondents. The vaccination data were obtained from the health cards in the health facilities or day care centers.
In the Kyrgyz Republic, the percentage of children 12-23 months of age who have received all World Health Organization (WHO) recommended vaccinations is high (82 percent). BCG vaccination is usually given in delivery hospitals and was nearly universal (99 percent). Almost all children (100 percent) have received the first doses of polio and DPT/DT. Coverage for the second doses of polio and DPT/DT is also nearly universal (98 percent). The third doses of polio and DPT/DT have been received by 95 percent of children. This represents a dropout rate of 5 percent for both the polio and DPT/DT vaccinations. A high proportion of children (85 percent) have received the measles vaccine.
Breastfeeding. Breastfeeding is almost universal in the Kyrgyz Republic; 95 percent of children born in the three years preceding the survey are breastfed. Overall, 41 percent of children are breastfed within an hour of delivery and 65 percent within 24 hours of delivery. The median duration of breastfeeding is lengthy (16 months). However, durations of exclusive and full breastfeeding, recommended by WHO, are short (2.1 and 2.9 months, respectively).
Supplementary feeding. Supplementary feeding starts early in the Kyrgyz Republic. At age 0-3 months, 10 percent of breastfeeding children are given infant formula and 13 percent are given powdered or evaporated milk. By 4-7 months of age, 17 percent of breastfeeding children are given foods high in protein (meat, poultry, fish, and eggs) and 33 percent are given fruits or vegetables.
Nutritional Status. In the KRDHS, the height and weight of children under three years of age were measured. These data are used to determine the proportion of children who are stunted (short for their age, a condition which may reflect chronic undernutrition) and the proportion who are wasted (underweight according to their height, a condition which may reflect an acute episode of undernutrition resulting from a recent illness).
In a well-nourished population of children, it is expected that about 2.3 percent of children will be measured as moderately or severely stunted or wasted. For all of the Kyrgyz Republic, the survey found that 25 percent of children are severely or moderately stunted and 3 percent are severely or moderately wasted.
PREVALENCE OF ANEMIA
Testing of women and children for anemia was one of the major efforts of the 1997 KRDHS. Anemia has been considered a major public health problem in the Kyrgyz Republic for decades. Nevertheless, this was the first anemia study in the Kyrgyz Republic done on a national basis. The study involved hemoglobin (Hb) testing for anemia using the Hemocue system.
Women. Thirty-eight percent of the women in the Kyrgyz Republic suffer from some degree of anemia. The great majority of these women have either mild (28 percent) or moderate anemia (9 percent). One percent have severe anemia.
Children. Fifty percent of children under the age of three suffer from some degree of anemia. Twenty-four percent have moderate anemia. One percent of children are severely anemic. Thirty-two percent of the children living in the North Region and 24 percent of children living in the South and East Regions were diagnosed as having moderate or severe anemia. In Bishkek City the prevalence of moderate anemia among children was relatively low (13 percent).
Certain relationships are observed between the prevalence of anemia among mothers and their children. Among children of mothers with moderate anemia, 0.5 percent have severe anemia and 37 percent have moderate anemia. The prevalence of moderate anemia among these children is more than twice as high as among children of non-anemic mothers.
Kind of data
Sample survey data
Unit of analysis
- Women age 15-49
The population covered by the 2007 UDHS is defined as the universe of all women age 15-49 who were permanent residents of the households.
Producers and sponsors
Research Institute of Obstetrics and Pediatrics
Ministry of Health of the Kyrgyz Republic
Macro International Inc.
United States Agency for International Development
The KRDHS employed a representative probability sample of women age 15 to 49. Selected survey estimates were to be produced for four survey regions. The capital city of Bishkek and Narynskaya oblast, which is located in the mountainous eastern part of the Republic, constituted two survey regions by themselves (survey regions 1 and 3, respectively). The remaining two survey regions consisted of groups of contiguous oblasts located in the north (Survey Region 2) and south (Survey Region 4) of the Kyrgyz Republic (Figure 1.1). The four survey regions were defined as follows:
Survey Region 1: Bishkek City
Survey Region 2 (North): Issyk-Kulskaya, Chuiskaya and Talasskaya oblasts.
Survey Region 3 (East): Narynskaya oblast.
Survey Region 4 (South): Oshskaya and Dzhelal-Abadskaya oblasts.
In rural areas, the primary sampling units (PSUs) were the raions, which were selected with probabilities proportional to size, the size being the population size as published by Goskomstat. At the second stage, one village was selected in each selected raion, from the list of villages collected by the Institute of Obstetrics and Pediatrics. This resulted in 76 rural clusters being selected. Very large villages (with 400 households or more) that were selected were divided in the field into smaller segments, and one segment was selected prior to the household listing operation. A complete listing of the households in the selected clusters was carried out. The lists of households served as the frame for third-stage sampling, i.e., the selection of the households to be visited by the KRDHS interviewing teams. In each selected household, all women age 15-49 were eligible to be interviewed.
In the urban areas, the sampling frame is the list of therapeutical uchastoks that have been collected by the Institute of Obstetrics and Pediatrics. However the list of uchastoks only exists for main cities and not for small towns. For small towns, each town was divided into segments of equal size (around 2,000 population), and these segments have been treated as if they were uchastoks. The selected uchastoks were segmented prior to the household listing operation, which provided the household lists for the third-stage selection of households. In total, 86 uchastoks were selected. On average, 20 households were selected in each urban cluster, and 30 households were selected in each rural cluster. It was expected that the sample would yield interviews with approximately 4,000 women between the ages of 15 and 49.
A total of 3,821 households were selected in the sample, of which 3,695 were occupied at the time fieldwork was conducted. The main reason for the difference was that some dwelling units which were occupied at the time of the household listing operation were either vacant or the household was away for an extended period at the time of interviewing. Of the 3,695 occupied households, 3,672 were interviewed, yielding a household response rate of 99 percent.
In the interviewed households, 3,954 women were eligible for the individual interview (i.e., all women 15-49 years of age who were either usual residents or visitors who had spent the previous night in the household). Interviews were successfully completed with 3,848 of these women, yielding a response rate of 97 percent. The principal reason for nonresponse was a failure to find an eligible woman at home after repeated visits to the household. The overall response rate for the survey, the product of the household and the individual response rates, was 97 percent.
Dates of collection
Mode of data collection
Two questionnaires were used for the KRDHS: the Household Questionnaire and the Individual Questionnaire. The questionnaires were based on the model survey instruments developed in the DHS program. The questionnaires were adapted to the data needs of the Kyrgyz Republic during consultations with specialists in the areas of reproductive health and child health in the Kyrgyz Republic. Both questionnaires were developed in English and then translated into Russian and Kyrgyz. A pretest was conducted in June 1997. Based on the pretest experience, the questionnaires were further modified.
a) The Household Questionnaire was used to enumerate all usual members and visitors in a sample household and to collect information relating to the socioeconomic position of the household. In the first part of the Household Questionnaire, information was collected on age, sex, educational attainment, and relationship to the head of household of each person listed as a household member or visitor. A primary objective of the first part of the Household Questionnaire was to identify women who were eligible for the individual interview. In the second part of the Household Questionnaire, questions were included on the dwelling unit, such as the number of rooms, the flooring material, the source of drinking water, and the type of toilet facilities, and on the availability of a variety of consumer goods.
b) The Individual Questionnaire was used to collect information from women age 15-49. These women were asked questions on the following major topics:
- Background characteristics
- Pregnancy history
- Outcome of pregnancies and antenatal care
- Child health and nutrition practices
- Child immunization and episodes of diarrhea and respiratory illness
- Knowledge and use of contraception
- Marriage and fertility preferences
- Husband's background and woman's work
- Maternal and child anthropometry
- Hemoglobin measurement of women and children
One of the major efforts of the KRDHS was the testing of women and children for anemia. Testing was done by measuring hemoglobin levels in the blood, using the Hemocue technique. Before collecting the blood sample, each woman was asked to sign a consent form, giving permission for the collection of a blood droplet from her and her children. Results of the anemia testing were kept confidential (as are all KRDHS data); however, strictly with the consent of respondents, local health care facilities were informed of women who had severely low levels of hemoglobin (less than 7 g/dl).
Research Institute of Obstetrics and Pediatrics
Ministry of Health of the Kyrgyz Republic
Questionnaires were returned to the Institute of Obstetrics and Pediatrics in Bishkek for data processing. The office editing staff checked that questionnaires for all selected households and eligible respondents were returned from the field. The few questions which had not been pre-coded (e.g., occupation, type of chronic disease) were coded at this time. Data were then entered and edited on microcomputers using the ISSA (Integrated System for Survey Analysis) package, with the data entry software translated into Russian. Office editing and data entry activities began on September 15, and were completed on December 17, 1997.
Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the KRDHS 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.
A 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 KRDHS sample is the result of a multistage stratified design, and consequently it was necessary to use more complex formulae. The computer software used to calculate sampling errors for the KRDHS is the ISSA Sampling Error Module. This module used the Taylor linearization method of variance estimation for survey estimates that are means or proportions. The Jackknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates.
The Jackknife repeated replication method derives estimates of complex rates from each of several replications of the parent sample, and calculates standard errors for these estimates using simple formulae. Each replication considers all but one clusters in the calculation of the estimates. Pseudo-independent replications are thus created. In the KRDHS, there were 162 non-empty clusters. Hence, 162 replications were created.
In addition to the standard error, ISSA 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. ISSA also computes the relative error and confidence limits for the estimates.
Sampling errors for the KRDHS are calculated for selected variables considered to be of primary interest. The results are presented in an appendix of the Final Report for the country as a whole, for urban and rural areas, for four survey regions, and for four ethnic groups (Kyrgyz, Russian, Uzbek and other ethnic groups together). 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. Tables B.2 to B.12 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. The DEFT is considered undefined when the standard error considering simple random sample is zero (when the estimate is close to 0 or 1). Estimates and sampling errors of childhood mortality rates only apply to the national sample, the urban and rural samples. In the case of the total fertility rate, the number of unweighted cases is not relevant, as there is no known unweighted value for woman-years of exposure to childbearing.
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 2.351 and its standard error is .05. Therefore, to obtain the 95 percent confidence limits, one adds and subtracts twice the standard error to the sample estimate, i.e., 2.351±2×.05. 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 2.250 and 2.452.
Sampling errors are analyzed for the national sample and for two separate groups of estimates: (1) means and proportions and (2) complex demographic rates. The relative standard errors for the means and proportions range from 0.1 percent to 29.5 percent with an average of 6 percent; the highest relative standard errors are for estimates of very low value (e.g., severe anemia among women who were tested). If estimates of very low values (less than 10 percent) were removed, than the average would drop to 3.7 percent. So in general, the relative standard errors for most estimates for the country as a whole is small, except for estimates of very small proportions. The relative standard error for the total fertility rate is small, 4.4 percent. However, for the mortality rates, the average relative standard error is much higher, 17.1 percent.
There are differentials in the relative standard error for the estimates of population subgroups. For example, for the variable primary/secondary education, the relative standard errors as a percent of the estimated mean for the whole country, for the rural areas, and for Bishkek are 3 percent, 2.6 percent, and 7.1 percent, respectively.
For the total sample, the value of the design effect (DEFT) averaged over all variables is 1.35, which means that, due to multistage clustering of the sample, variance is increased by a factor of 1.8 over that in an equivalent simple random sample.
Other forms of data appraisal
Nonsampling errors are the results 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 KRDHS 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.