Demographic and Health Survey 2009
Lesotho, 2009 - 2010
Ministry of Health and Social Welfare (MOHSW)
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Identification
Survey ID Number
LSO_2009_DHS_v01_M
Title
Demographic and Health Survey 2009
Country/Economy
| Name | Country code |
|---|---|
| Lesotho | LSO |
Study type
Demographic and Health Survey (standard) - DHS IV
Series Information
The 2009 Lesotho Demographic and Health Survey is the second survey of this type conducted in Lesotho. The first one was conducted in 2004.
Abstract
The Ministry of Health and Social Welfare (MOHSW) conducted the 2009 Lesotho Demographic and Health Survey (LDHS) to collect population-based data to inform the Health Sector Reform Programme (2000-2009), evaluate the strides made since the first LDHS was conducted in 2004, set a baseline for new programmes, and provide information for policy and strategic planning.
The 2009 LDHS was conducted using a representative sample of women and men of reproductive age.
The objectives were to:
- Provide national data on key demographic indicators, particularly fertility and child and adult mortality rates
- Analyze the direct and indirect factors that determine the level of and trends in fertility
- Measure the level of contraceptive knowledge and practice of women and men by method, urban-rural residence, and region
- Provide data on family health, including immunization coverage among children, prevalence and treatment of diarrhoea and other diseases among children under age 5, maternity care indicators including antenatal visits, and assistance at delivery
- Provide data on child feeding practices, including breastfeeding, the nutritional status of women and children, and the prevalence of anaemia among children under age 5, women age 15-49, and men age 15-59
- Provide data on knowledge and attitudes of women and men about sexually-transmitted diseases and HIV/AIDS, and evaluate patterns of recent behaviour regarding condom use
- Provide information on the prevalence of HIV among women age 15-49 and men age 15-59
- Provide biomarker data on blood pressure among women age 15-49 and men age 15-59
The 2009 LDHS was conducted using a representative sample of women and men of reproductive age.
The objectives were to:
- Provide national data on key demographic indicators, particularly fertility and child and adult mortality rates
- Analyze the direct and indirect factors that determine the level of and trends in fertility
- Measure the level of contraceptive knowledge and practice of women and men by method, urban-rural residence, and region
- Provide data on family health, including immunization coverage among children, prevalence and treatment of diarrhoea and other diseases among children under age 5, maternity care indicators including antenatal visits, and assistance at delivery
- Provide data on child feeding practices, including breastfeeding, the nutritional status of women and children, and the prevalence of anaemia among children under age 5, women age 15-49, and men age 15-59
- Provide data on knowledge and attitudes of women and men about sexually-transmitted diseases and HIV/AIDS, and evaluate patterns of recent behaviour regarding condom use
- Provide information on the prevalence of HIV among women age 15-49 and men age 15-59
- Provide biomarker data on blood pressure among women age 15-49 and men age 15-59
Kind of Data
Sample survey data
Unit of Analysis
- Households
- Individuals
- Women age 15-49
- Men age 15-59
- Individuals
- Women age 15-49
- Men age 15-59
Scope
Notes
The 2009 Lesotho Demographic and Health Survey covered the following topics:
- Alcohol Consumption
- Anemia Testing
- Anthropometry
- Birth Registration
- Blood Pressure (measure)
- Diabetes Questions
- GPS/Georeferenced–Global Positioning System or Georeferenced Data
- HIV Behavior
- HIV Knowledge–Questions assess knowledge/sources of knowledge/ways to avoid HIV
- HIV Testing
- Iodine salt test
- Male circumcision
- Maternal Mortality
- Men's Survey
- Reproductive Calendar
- TB Questions
- Tobacco Use
- Vitamin A Questions
- Women's Status–Questions: women's autonomy (household decisionmaking/free movement/access money) & Dom. violence
- Alcohol Consumption
- Anemia Testing
- Anthropometry
- Birth Registration
- Blood Pressure (measure)
- Diabetes Questions
- GPS/Georeferenced–Global Positioning System or Georeferenced Data
- HIV Behavior
- HIV Knowledge–Questions assess knowledge/sources of knowledge/ways to avoid HIV
- HIV Testing
- Iodine salt test
- Male circumcision
- Maternal Mortality
- Men's Survey
- Reproductive Calendar
- TB Questions
- Tobacco Use
- Vitamin A Questions
- Women's Status–Questions: women's autonomy (household decisionmaking/free movement/access money) & Dom. violence
Coverage
Geographic Coverage
The 2009 LDHS was designed to provide estimates of health and demographic indicators at the national level, for urban-rural areas, and for each of the ten districts of Butha-Buthe, Leribe, Berea, Maseru, Mafeteng, Mohale's Hoek, Quthing, Qacha's Nek, Mokhotlong, and Thaba-Tseka.
Producers and sponsors
Primary investigators
| Name |
|---|
| Ministry of Health and Social Welfare (MOHSW) |
Producers
| Name | Affiliation | Role |
|---|---|---|
| Bureau of Statistics | Technical assistance | |
| ICF Macro | MEASURE DHS | Technical assistance |
Funding Agency/Sponsor
| Name | Abbreviation | Role |
|---|---|---|
| Government of Lesotho | GoL | Financial assistance |
| United States Agency for Intemational Development | USAID | Financial assistance |
| Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund) | Financial assistance | |
| Millennium Challenge Account | MCA | Financial assistance |
| President's Emergency Plan for AIDS Relief | PEPFAR | Financial assistance |
| National AIDS Commission | NAC | Financial assistance |
| United Nations Population Fund | UNFPA | Financial assistance |
| United Nations Children's Fund | UNICEF | Financial assistance |
| World Health Organisation | WHO | Financial assistance |
Sampling
Sampling Procedure
The 2009 LDHS was designed to provide estimates of health and demographic indicators at the national level, for urban-rural areas, and for each of the ten districts of Butha-Buthe, Leribe, Berea, Maseru, Mafeteng, Mohale's Hoek, Quthing, Qacha's Nek, Mokhotlong, and Thaba-Tseka. The 2009 LDHS sample points (clusters) were selected from a list of enumeration areas (EAs) defined for the 2006 Lesotho Population and Housing Census. A total of 400 clusters were drawn from the census sample frame, 94 in the urban areas and 306 in the rural areas. The clusters were selected with probability proportional to size (PPS).
Bureau of Statistics (BOS) staff conducted an exhaustive listing of households in each of the LDHS clusters from July through December 2009. From these lists, a systematic sample of households was drawn for a total of 10,000 households, about 25 households on average per cluster. All women age 15-49 identified in the entire sample of households were eligible for individual interview. In addition, half of these households (5,000 households) were selected randomly, and in these households, all men age 15-59 were eligible for individual interview. In the LDHS households where men were interviewed, all children under age 6 were eligible for height, weight, and mid-upper arm circumference measurements as well as anaemia testing. In the same households, women and men who were eligible for individual interview were also eligible for height, weight, and blood pressure measurements in addition to anaemia and HIV testing.
Note: See detailed sample design information in the APPENDIX A of the final 2009 Lesotho Demographic and Health Survey Final Report.
Bureau of Statistics (BOS) staff conducted an exhaustive listing of households in each of the LDHS clusters from July through December 2009. From these lists, a systematic sample of households was drawn for a total of 10,000 households, about 25 households on average per cluster. All women age 15-49 identified in the entire sample of households were eligible for individual interview. In addition, half of these households (5,000 households) were selected randomly, and in these households, all men age 15-59 were eligible for individual interview. In the LDHS households where men were interviewed, all children under age 6 were eligible for height, weight, and mid-upper arm circumference measurements as well as anaemia testing. In the same households, women and men who were eligible for individual interview were also eligible for height, weight, and blood pressure measurements in addition to anaemia and HIV testing.
Note: See detailed sample design information in the APPENDIX A of the final 2009 Lesotho Demographic and Health Survey Final Report.
Response Rate
A total of 9,994 households were selected for the sample, of which 9,619 were found occupied during data collection. Of the existing households, 9,391 were successfully interviewed, yielding a household response rate of 98 percent.
In these households, 7,786 women were identified as eligible for the individual interview. Interviews were completed with 98 percent of these women. Of the 3,493 eligible men identified in the sub-sample of households selected, 95 percent were successfully interviewed. Overall, response rates were higher in rural areas than in urban areas.
See summarized response rates in Table 1.2 which is presented in the Final Report.
In these households, 7,786 women were identified as eligible for the individual interview. Interviews were completed with 98 percent of these women. Of the 3,493 eligible men identified in the sub-sample of households selected, 95 percent were successfully interviewed. Overall, response rates were higher in rural areas than in urban areas.
See summarized response rates in Table 1.2 which is presented in the Final Report.
Data Collection
Dates of Data Collection
| Start | End |
|---|---|
| 2009-09-16 | 2010-01-26 |
Data Collection Mode
Face-to-face
Data Collection Notes
TRAINING
A total of 109 persons, 34 males and 75 females, were trained to be the 2009 LDHS field staff. The training followed the standard DHS training procedures, including instructions on how to conduct interviews and how to fill in all three questionnaires, classroom demonstration and practice in administering the questionnaires using both paper questionnaires and PDAs, and tests. The participants also practiced interviewing in actual households. Their field experiences were discussed in class.
The first two weeks of the 2009 LDHS training were spent building the participants’ familiarity with the survey instruments, enhancing knowledge and skills in conducting interviews, and practicing how to record responses in paper questionnaires. The PDAs were introduced in the third week of training. Participants were also trained to use the case-management system on the PDA to accomplish such tasks as selecting assigned interviews and receiving electronic case assignments from their supervisor. The fourth week was used to practice skills—interviewing in Sesotho, taking measurements of height, weight, and mid-upper arm circumference, testing for anaemia, and taking blood samples for HIV testing in the field; also during this week, supervisors and editors were selected. The training continued through the fifth week with a general overview of biomarkers and the PDA. The supervisors and editors were given instructions on how to perform their tasks during the fieldwork.
All participants received extensive classroom training plus additional field practice on biomarker data collection. They learned how to use informed consent procedures; how to take height, weight, and blood pressure measurements, how to collect finger prick blood spot samples for anaemia and HIV testing, and how to handle and package the dried blood spots. All staff received training in universal precautions and the disposal of hazardous waste.
FIELDWORK
Fieldwork for the 2009 LDHS commenced on 16 October 2009 and was completed on 26 January 2010. Data collection was carried out by 15 interviewing teams, each consisting of one supervisor, one field editor, three to four female interviewers, and one or two male interviewers. After Christmas break, due to drop out and iteration, the field staff was regrouped into 13 teams. Three Field Coordinator (FC) teams were formed; two consisted of one senior MOHSW staff and one data processing supervisor, and one team consisted of two senior MOHSW staff. The FC teams supervised the data collection teams throughout the fieldwork period.
Collected data were transferred from the interviewer’s PDA to the team supervisor’s at the end of the day. During visits by the FC teams, data files were transferred from the team supervisors’ PDAs to the FCs’ PDAs. Blood samples were also collected during these visits and transferred to the Lesotho Blood Transfusion Service (BLTS) laboratory.
A total of 109 persons, 34 males and 75 females, were trained to be the 2009 LDHS field staff. The training followed the standard DHS training procedures, including instructions on how to conduct interviews and how to fill in all three questionnaires, classroom demonstration and practice in administering the questionnaires using both paper questionnaires and PDAs, and tests. The participants also practiced interviewing in actual households. Their field experiences were discussed in class.
The first two weeks of the 2009 LDHS training were spent building the participants’ familiarity with the survey instruments, enhancing knowledge and skills in conducting interviews, and practicing how to record responses in paper questionnaires. The PDAs were introduced in the third week of training. Participants were also trained to use the case-management system on the PDA to accomplish such tasks as selecting assigned interviews and receiving electronic case assignments from their supervisor. The fourth week was used to practice skills—interviewing in Sesotho, taking measurements of height, weight, and mid-upper arm circumference, testing for anaemia, and taking blood samples for HIV testing in the field; also during this week, supervisors and editors were selected. The training continued through the fifth week with a general overview of biomarkers and the PDA. The supervisors and editors were given instructions on how to perform their tasks during the fieldwork.
All participants received extensive classroom training plus additional field practice on biomarker data collection. They learned how to use informed consent procedures; how to take height, weight, and blood pressure measurements, how to collect finger prick blood spot samples for anaemia and HIV testing, and how to handle and package the dried blood spots. All staff received training in universal precautions and the disposal of hazardous waste.
FIELDWORK
Fieldwork for the 2009 LDHS commenced on 16 October 2009 and was completed on 26 January 2010. Data collection was carried out by 15 interviewing teams, each consisting of one supervisor, one field editor, three to four female interviewers, and one or two male interviewers. After Christmas break, due to drop out and iteration, the field staff was regrouped into 13 teams. Three Field Coordinator (FC) teams were formed; two consisted of one senior MOHSW staff and one data processing supervisor, and one team consisted of two senior MOHSW staff. The FC teams supervised the data collection teams throughout the fieldwork period.
Collected data were transferred from the interviewer’s PDA to the team supervisor’s at the end of the day. During visits by the FC teams, data files were transferred from the team supervisors’ PDAs to the FCs’ PDAs. Blood samples were also collected during these visits and transferred to the Lesotho Blood Transfusion Service (BLTS) laboratory.
Questionnaires
Questionnaires
Three types of questionnaires were used for the LDHS: the Household Questionnaire, the Woman’s Questionnaire, and the Man’s Questionnaire. The contents of the questionnaires were based on questionnaires developed for the MEASURE DHS programme. The LDHS questionnaires were developed in collaboration with a wide range of stakeholders. After the LDHS survey instruments were drafted, they were translated into and printed in the local language, Sesotho, for pre-testing.
The Household Questionnaire was used to list all the usual members and visitors to the selected households. Basic information was collected on the characteristics of each person listed, including age, sex, education, and relationship to the head of the household. The Household Questionnaire was also used to identify persons eligible for the individual interview. In addition, information was collected about the dwelling, such as the source of water, type of toilet facilities, materials used to construct the house, and ownership of various consumer goods. The results of anthropometric measurement and anaemia testing were recorded in the Household Questionnaire, as was the information on the consent of eligible household members for the HIV testing.
The Woman’s Questionnaire was used to collect information on the following topics:
- Background characteristics (age, education, employment, religion, etc.)
- Birth history and childhood mortality
- Knowledge and use of family planning methods
- Antenatal, delivery, and postnatal care
- Infant feeding practices, including patterns of breastfeeding
- Childhood vaccinations
- Episodes of childhood illness and responses to illness
- Marriage and sexual activity
- Fertility preferences
- Husband’s background and the woman’s work status
- Adult mortality, including maternal mortality
- HIV/AIDS-related knowledge, attitudes, and behaviour
- Knowledge, attitudes, and behaviour related to other health issues
The Man’s Questionnaire was shorter than the Woman’s Questionnaire but covered many of the same topics, excluding the reproductive history and sections dealing with maternal and child health and maternal mortality.
In this survey, instead of paper questionnaires, personal data assistants (PDAs) were used to record responses during interviews. Bluetooth wireless technology was used for electronic transfer of files, such as transfer of the assignment sheet from the team supervisor to the interviewers, transfer of household questionnaires among survey team members, and transfer of completed questionnaires to team and central office supervisors. The PDA interview applications were implemented using the mobile version of CSPro, which was developed by the MEASURE DHS project in collaboration with the U.S. Census Bureau.
The Household Questionnaire was used to list all the usual members and visitors to the selected households. Basic information was collected on the characteristics of each person listed, including age, sex, education, and relationship to the head of the household. The Household Questionnaire was also used to identify persons eligible for the individual interview. In addition, information was collected about the dwelling, such as the source of water, type of toilet facilities, materials used to construct the house, and ownership of various consumer goods. The results of anthropometric measurement and anaemia testing were recorded in the Household Questionnaire, as was the information on the consent of eligible household members for the HIV testing.
The Woman’s Questionnaire was used to collect information on the following topics:
- Background characteristics (age, education, employment, religion, etc.)
- Birth history and childhood mortality
- Knowledge and use of family planning methods
- Antenatal, delivery, and postnatal care
- Infant feeding practices, including patterns of breastfeeding
- Childhood vaccinations
- Episodes of childhood illness and responses to illness
- Marriage and sexual activity
- Fertility preferences
- Husband’s background and the woman’s work status
- Adult mortality, including maternal mortality
- HIV/AIDS-related knowledge, attitudes, and behaviour
- Knowledge, attitudes, and behaviour related to other health issues
The Man’s Questionnaire was shorter than the Woman’s Questionnaire but covered many of the same topics, excluding the reproductive history and sections dealing with maternal and child health and maternal mortality.
In this survey, instead of paper questionnaires, personal data assistants (PDAs) were used to record responses during interviews. Bluetooth wireless technology was used for electronic transfer of files, such as transfer of the assignment sheet from the team supervisor to the interviewers, transfer of household questionnaires among survey team members, and transfer of completed questionnaires to team and central office supervisors. The PDA interview applications were implemented using the mobile version of CSPro, which was developed by the MEASURE DHS project in collaboration with the U.S. Census Bureau.
Data Processing
Data Editing
All data files for the LDHS were stored in a computer at the MOHSW Headquarters. The data processing operation included secondary editing, which involved checking for inconsistencies. The LDHS data entry and editing programmes used CSPro, a computer software package specifically designed for processing survey data such as that produced by DHS surveys. Data processing commenced in November 2009 and was completed in February 2010.
Data Appraisal
Estimates of Sampling Error
Estimates derived from a sample survey are affected by two types of errors: 1) non-sampling errors, and 2) sampling errors. Non-sampling 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 2009 Lesotho DHS (LDHS) to minimise this type of error, non-sampling 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 2009 LDHS 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 2009 LDHS sample is the result of a multi-stage stratified design, and, consequently, it was necessary to use a more complex formula. The computer software used to calculate sampling errors for the 2009 LDHS is the sampling error module in ISSA (Integrated System for Survey Analysis). This module uses the Taylor linearisation method of variance estimation for survey estimates that are means or proportions. Another approach, the Jackknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates.
Note: See detailed sampling error calculation in the APPENDIX B of the Final Report.
Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the 2009 LDHS 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 2009 LDHS sample is the result of a multi-stage stratified design, and, consequently, it was necessary to use a more complex formula. The computer software used to calculate sampling errors for the 2009 LDHS is the sampling error module in ISSA (Integrated System for Survey Analysis). This module uses the Taylor linearisation method of variance estimation for survey estimates that are means or proportions. Another approach, the Jackknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates.
Note: See detailed sampling error calculation in the APPENDIX B of the Final Report.
Data Appraisal
Data Quality Tables
- Household age distribution
- Age distribution of eligible and interviewed women
- Completeness of reporting
- Birth by calendar years
- Reporting of age at death in days
- Reporting of age at death in months
- Nutritional status of children
Note: See these data quality tables in APPENDIX C of the Final Report.
- Household age distribution
- Age distribution of eligible and interviewed women
- Completeness of reporting
- Birth by calendar years
- Reporting of age at death in days
- Reporting of age at death in months
- Nutritional status of children
Note: See these data quality tables in APPENDIX C of the Final Report.
Access policy
Access authority
| Name | URL | |
|---|---|---|
| MEASURE DHS | archive@measuredhs.com | www.measuredhs.com |
Contacts
| Name | Affiliation | URL | |
|---|---|---|---|
| General Inquiries | MEASURE DHS | info@measuredhs.com | www.measuredhs.com |
| Data and Data Related Resources | MEASURE DHS | archive@measuredhs.com | www.measuredhs.com |
Citation requirements
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 acronym and year of implementation)
- the survey reference number
- the source and date of download
- the Identification of the Primary Investigator
- the title of the survey (including acronym and year of implementation)
- the survey reference number
- the source and date of download
Disclaimer and copyrights
Disclaimer
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.
Metadata production
DDI Document ID
DDI_WB_LSO_2009_DHS_v01_M
Producers
| Name | Abbreviation | Role |
|---|---|---|
| World Bank, Development Economics Data Group | DECDG | Production of metadata |
DDI Document version
Version 01: (July 2011)