Knowledge, Attitudes and Practices in Health Survey 1996
The primary objectives of the MKAPH were to provide information on malaria prevention, family planning, immunization, management of childhood illnesses, marriage and partner relations, and STDs including AIDS. Specifically, the objectives were as follows:
- Collect information on methods used to prevent malaria infection.
- Establish current contraceptive prevalence.
- Gather from caretakers of children under age five information on vaccination coverage and the prevalence of diarrhoea, respiratory infection, and fevers among under-five children during the two weeks preceding the survey.
- Collect information on current and past partner relations in and outside of marriage among women aged 15-49 and men 15-54.
- Collect information on knowledge, attitudes, and practices regarding AIDS and STDs among women aged 15-49 and men aged 15-54.
In fulfilling these objectives, the MKAPH findings provide data for monitoring current programmes of the Ministry of Health and Population and for planning future public health activities. Additionally, the immunization and contraceptive prevalence sections of the MKAPH contain information which can be compared with the 1992 Malawi Demographic and Health Survey (MDHS) to provide updated estimates of the extent of immunization and contraceptive usage.
Kind of data
Sample survey data [ssd]
Producers and sponsors
National Statistical Office (NSO)
Government of Malawi
United States Agency for International Development
Funding the survey
United Nations Children's Fund
Funding the survey
The area sampling frame used for the MKAPH survey consisted of the 8,652 enumeration areas (EA) from the 1987 Malawi Census. For the MKAPH, six sampling strata were identified, with an urban and a rural stratum for each of the three regions of the country. The MKAPH sample of households was selected in two stages.
In the first stage, 106 enumeration areas were selected from the 1987 census. This was done by choosing a systematic sample with random entry of 106 EAs from the 225 EAs of the 1992 MDHS, which was a subset of the 1987 census EAs. Because Malawi has a predominantly rural population, urban areas were over-sampled to ensure that the sampling errors for the urban domain would not be unacceptably large. The Northern Region also comprises a small proportion of the total and was similarly over-sampled to control sampling errors. Over-sampling by region and urban location means that the MKAPH sample is not self weighting at the national level, but it is self-weighting within each of the six strata determined by regional and urban-rural location.
Within each of the 106 EAs, a complete household listing and mapping were done from April through May 1996. For the listing and mapping, permanent NSO enumerators were trained. Institutional populations (army barracks, police camps, hospitals, etc.) were not listed.
In the second stage, a systematic sample of households was selected from the household list compiled for each EA. The sampling interval for each EA was proportional to its size based on the results from the listing. In selected households, all women 15-49, men 15-54, and children under five years were eligible for the survey. Information for each eligible child was gathered from the mother or principal caretaker.
A total of 3,035 households were selected in the sample, of which 2,830 were found to be occupied. Of these households, 2,798 were interviewed, yielding a household response rate of 99 percent.
In the interviewed households, 2,737 eligible women were identified and, of these, 2,683 were interviewed, yielding a response rate of 98 percent for women. The number of men identified was 2,861, of which 2,658 were successfully interviewed for a 93 percent response rate. The main reason for non-response among women and men was failure to be at home despite repeated visits to the household. The lower response rate among man as compared to women was due to the more frequent and longer absences of men from the household. There were no major differences between urban and rural response rates.
The number of children under five years who were listed in household schedules was 2,433. The number of interviews conducted with caretakers of these children was 2,418, yielding a response rate for under-five children of 99 percent.
Dates of collection
Mode of data collection
Four types of questionnaires were used for the MKAPH: the Household Questionnaire, the Women's Questionnaire, the Men's Questionnaire, and the Caretaker's Questionnaire. Some elements of the standard DHS Questionnaire were used in all four questionnaires----e.g., the household schedule, the contraceptive usage table, and the immunization module. However, many questions, particularly in the Caretaker's Questionnaire, were specially designed to meet the data collection needs of public health programmes in Malawi.
The Household Questionnaire was used to list all the usual members and visitors of households in the sample. Basic information was collected on the characteristics of each person listed, including 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. Mothers or caretakers of children under five were similarly identified and interviewed using the Caretaker's Questionnaire. In addition, the Household Questionnaire collected information on characteristics of the household's dwelling units, such as the source of water, type of toilet facilities, materials used for the floor of the house, ownership of various consumer goods, and household practices for preventing malaria infection.
The Women's Questionnaire was used to collect information on all women aged 15-49 living in sample households. These women were asked questions on the following topics:
- Background characteristics (education, residential history, etc.)
- Reproduction and antenatal care
- Knowledge and use of family planning methods
- Marital status and partner relations
- Awareness and risk-related behavior regarding AIDS and other STDs.
The Men's Questionnaire was administered to all males aged 15-54 living in households in the MKAPH sample. Men were asked most of the same questions that were addressed to women. The Men's Questionnaire omitted questions on pregnancy and antenatal care. However, men were asked some questions on STD symptoms such as urethritis and genital ulceration that were not asked of women.
The Caretaker's Questionnaire was asked of each person, male or female, who was the individual most responsible for taking care of each child under five identified in the Household Questionnaire. In most cases, the caretaker was the mother of a child. In other cases, when the mother was living away from the household or was deceased, the caretaker was someone else closely connected to the child and familiar with the child's immunizations and recent health history. The Caretaker's Questionnaire contained questions on the following aspects of a child's health:
- Immunization and vitamin A dosage
- Symptoms of illness in the past two weeks
- Management of respiratory illnesses, fever, and diarrhoea symptoms that occurred in the past two weeks.
The MKAPH questionnaires were pretested in March 1996. Nine interviewers consisting of seven nurses, and two additional persons with prior survey experience were hired and trained to carry out the pretest. Most of these individuals were later selected to serve as field supervisors and editors for the main survey. The Chichewa and Tumbuka questionnaires were field tested during a one-week period in the town of Zomba and surrounding villages in the Southern Region. Approximately 200 pretest interviews were conducted. Subsequent discussions with the pretest interviewers contributed to refinement of the questionnaires.
The estimates 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 MKAPH to minimize 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 MKAPH 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 MKAPH sample is the result of a two-stage stratified design, and, consequently, it was necessary to use more complex formulae. The computer software used to calculate sampling errors for the MKAPH is the ISSA Sampling Error Module (SAMPERR). 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.
Note: Detailed description of sampling error information is presented in Appendix B of 1996 Knowledge, Attitudes and Practices in Health Survey report.
Other forms of data appraisal
Data Quality Tables
- Household age distribution
- Age distribution of eligible and interviewers women and men
Tables are available in Appendix C of 1996 Knowledge, Attitudes and Practices in Health Survey report.
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.