Survey ID Number
Demographic and Health Survey 2006-2007
The 2006-07 PDHS is the largest-ever household based survey conducted in Pakistan. The sample is designed to provide reliable estimates for a variety of health and demographic variables for various domains of interest. The survey provides estimates at national, urban and rural, and provincial levels (each as a separate domain). One of the main objectives of the 2006-07 Pakistan Demographic and Health Survey (PDHS) is to provide a reliable estimate of the maternal mortality ratio (MMR) at the national level. In order to estimate MMR, a large sample size was required. Based on prior rough estimates of the level of maternal mortality in Pakistan, a sample of about 100,000 households was proposed to provide estimates of MMR for the whole country. For other indicators, the survey is designed to produce estimates at national, urban-rural, and provincial levels (each as a separate domain). The sample was not spread geographically in proportion to the population; rather, the smaller provinces (e.g., Balochistan and NWFP) as well as urban areas were over-sampled. As a result of these differing sample proportions, the PDHS sample is not self-weighting at the national level.
The sample for the 2006-07 PDHS represents the population of Pakistan excluding the Federally Administered Northern Areas (FANA) and restricted military and protected areas. Although the Federally Administered Tribal Areas (FATA) were initially included in the sample, due to security and political reasons, it was not possible to cover any of the sample points in the FATA.
In urban areas, cities like Karachi, Lahore, Gujranwala, Faisalbad, Rawalpindi, Multan, Sialkot, Sargodha, Bahawalpur, Hyderabad, Sukkur, Peshawar, Quetta, and Islamabad were considered as large-sized cities. Each of these cities constitutes a stratum, which has further been substratified into low, middle, and high-income groups based on the information collected during the updating of the urban sampling frame. After excluding the population of large-sized cities from the population of respective former administrative divisions, the remaining urban population within each of the former administrative divisions of the four provinces was grouped together to form a stratum.
In rural areas, each district in Punjab, Sindh, and NWFP provinces is considered as an independent stratum. In Balochistan province, each former administrative division has been treated as a stratum. The survey adopted a two-stage, stratified, random sample design. The first stage involved selecting 1,000 sample points (clusters) with probability proportional to size-390 in urban areas and 610 in rural areas. A total of 440 sample points were selected in Punjab, 260 in Sindh, 180 in NWFP, 100 in Balochistan, and 20 in FATA. In urban areas, the sample points were selected from a frame maintained by the FBS, consisting of 26,800 enumeration blocks, each including about 200-250 households. The frame for rural areas consists of the list of 50,588 villages/mouzas/dehs enumerated in the 1998 population census.
The FBS staff undertook the task of a fresh listing of the households in the selected sample points. Aside from 20 sample points in FATA, the job of listing of households could not be done in four areas of Balochistan due to inability of the FBS to provide household listings because of unrest in those areas. Another four clusters in NWFP could not be covered because of resistance and refusal of the community. In other words, the survey covered a total of 972 sample points.
The second stage of sampling involved selecting households. In each sample point, 105 households were selected by applying a systematic random sampling technique. This way, a total of 102,060 households were selected. Out of 105 sampled households, ten households in each sample point were selected using a systematic random sampling procedure to conduct interviews for the Long Household and the Women's Questionnaires. Any ever-married woman aged 12-49 years who was a usual resident of the household or a visitor in the household who stayed there the night before the survey was eligible for interview.
The following six types of questionnaires were used in the PDHS:
- Community Questionnaire
- Short Household Questionnaire
- Long Household Questionnaire
- Women’s Questionnaire
- Maternal Verbal Autopsy Questionnaire
- Child Verbal Autopsy Questionnaire
The contents of the Household and Women’s Questionnaires were based on model questionnaires developed by the MEASURE DHS programme, while the Verbal Autopsy Questionnaires were developed by Pakistani experts and the Community Questionnaire was patterned on the basis of one used by NIPS in previous surveys.
NIPS developed the draft questionnaires in consultation with a broad spectrum of technical experts, government agencies, and local and international organizations so as to reflect relevant issues of population, family planning, HIV/AIDS, and other health areas. A number of meetings were organized by NIPS and the inputs received in these meetings were used to finalize survey questionnaires. These questionnaires were then translated into Urdu, Punjabi, Sindhi, and Pushto languages. After the pretest, which was done in Peshawar, Rawalpindi, and Hyderabad, the questionnaires were finalized on the basis of feedback of the pretest.
The Community Questionnaire, a brief form that was filled out for each sample point in rural areas, included questions about the availability of various kinds of health and family planning facilities and services. Also, information on the availability of transportation, education, and communication facilities was recorded. The geographic coordinates were taken for each sample point using a geographic positioning system (GPS) unit.
The Short Household Questionnaire was administered in 92,340 households to list all the usual members and visitors. Likewise, the Long Household Questionnaire was used in the 9,720 households where the Women’s Questionnaire was also administered. In addition to some basic information collected on characteristics like age, sex, marital status, education, and relationship to the head of the household of each person listed, another purpose of the two household questionnaires was to record births and deaths that occurred since January 2003 and, for verbal autopsies, to identify any death of child under age 5 since January 2005 and any death to a woman age 12-49 since January 2003.
In addition, the Long Household Questionnaire collected more details, e.g., current school attendance, survivorship status of parents of children under age 18, and the registration status of each person. It also identified eligible ever-married women age 12-49 for interview with the Women’s Questionnaire. The Long Household Questionnaire also collected information regarding various characteristics of the dwelling unit, such as the source of water; type of toilet facilities; type of cooking fuel; materials used for the floor, roof, and walls of the house; ownership status of various durable goods; ownership of agricultural land; ownership of livestock/farm animals/poultry; and ownership and use of mosquito nets.
As mentioned above, the Women’s Questionnaire collected information from ever-married women age 12-49 years on the following topics:
- Background characteristics (education, literacy, native language, marriage characteristics, etc.)
- Reproductive history
- Knowledge and use of family planning methods
- Prenatal and postnatal care
- Child immunization, health, and nutrition
- Fertility preferences
- Breastfeeding practices
- Woman’s work and husband’s background characteristics
- Awareness about HIV/AIDS and other sexually transmitted infections
- Other health issues (knowledge of tuberculosis and hepatitis, experience with fistula, use of clean syringes for injections).
The Verbal Autopsy Questionnaire for deaths of women was administered in households in which a death of a woman aged 12-49 was reported since 2003. The questionnaire covered details about the woman’s characteristics and the symptoms and circumstances prior to her death. A verbatim history was also recorded so as to help assign a cause of death. Questions were also asked about any treatment or health care that might have been sought before her death.
The Child Verbal Autopsy Questionnaire was administered in households in which a death of a child under age five years or a stillbirth was reported in 2005 or later. The questionnaire elicited details about the illness and causes of death from the parents and/or others who were present at the time of death of the child. Separate teams of physicians reviewed both these verbal autopsy questionnaires to assign causes of death.