Epidemiology and Family Health Survey 1987
Honduras, 1987
Identification
HND_1987_EFHS_v01_M
Epidemiology and Family Health Survey 1987
| Name | Country code |
|---|---|
| Honduras | HND |
Other Household Health Survey [hh/hea]
During the past ten years there have been several national level household surveys related to health and demography. In 1981, a Contraceptive Prevalence Survey (ENPA 1981) was carried out by the Honduran Association for Family Planning (ASHONPLAFA), the Bureau of Census and Statistics, the Superior Council for Economic Planning (CONSUPLANE) and the Ministry of Public Health (MOH). Westinghouse Health Systems provided technical assistance. Like other contraceptive prevalence surveys, it was designed to collect data that would be used by family planning program administrators and development planners.
In 1983 the Latin American Center for Demography (CELADE) carried out a demographic survey (EDENH-II) to estimate fertility rates and infant, child and adult mortality rates. The survey also provided data on internal and international migration.
The Maternal and Child Health/Family Planning Survey, 1984 (MCH/FP 1984) was carried out by the MOH and ASHONPLAFA with technical assistance from Family Health International and Management Sciences for Health. It was broader in scope than either of the two earlier surveys. In addition to data on family planning, fertility and infant mortality, it also obtained information on maternal and child health. Finally, the 1987 Epidemiology and Family Health Survey (EFHS 1987) was modeled after the 1984 survey, and was carried out by the same agencies.
Results of the 1981, 1984, and 1987 surveys can be used to evaluate ongoing maternal and child health and family planning programs of the Ministry of Public Health, the Honduran Social Security Institute, and ASHONPLAFA. They also serve to aid in the design of new programs, to restructure ongoing programs, and to serve as baseline data to evaluate new initiatives.
Between 1981 and 1987 many health programs were initiated or expanded. Several examples follow. The polio epidemic of 1984 stimulated massive immunization campaigns. The large number of infants dying of dehydration led to diarrhea control programs and the promotion of oral rehydration therapy. Campaigns to encourage breastfeeding have been initiated to reduce the incidence of diarrhea and to improve the nutritional status of infants. Family planning efforts have also been stepped up. These include expansion of facilities and training of physicians in sterilization, IUD insertion, the expansion of the Community Based Distribution Program, the introduction of a Social Marketing Program for contraceptives, and new family planning clinics operated by the Honduran Institute of Social Security. In recent years, AIDS has become a problem. To control the spread of AIDS, the MOH has implemented educational messages in the media.
The objectives of the survey included the following:
- Estimate current levels of fertility.
- Estimate levels of neonatal, infant and child mortality.
- Determine the prevalence, pattern and mean duration of breastfeeding.
- Determine the prevalence and severity of diarrhea and acute respiratory infections among children under age five, the percentage that received treatment, and the type of treatment received.
- Determine the percentage of children under five that have been immunized against various childhood diseases.
- Determine the sources of prenatal, delivery and postpartum care and for women delivering at home, the care provided by traditional birth attendants.
- Determine contraceptive prevalence by method and by source.
- Identify reasons for terminating the use of family planning and for not using contraception: determine the extent of unmet need for contraception.
- Determine the percentage of women who have experienced unplanned pregnancies, the pregnancy intentions of all women, ideal family size and the percentage of women who want more children.
- Determine what advice is given and the impact of this advice on the decision to discontinue pill use among women with problems related to oral contraception.
- Explore characteristics of adolescents and young women 20-24 as they relate to first intercourse and patterns of family building.
- Determine levels of knowledge concerning STDs and AIDS.
Sample survey data [ssd]
Coverage
National, except two departments which were excluded from the sample, Gracias a Dios and the Bay Islands, due to difficult access and their small and scattered population. Together they make up only 1.5 percent of the total population of Honduras.
Producers and sponsors
| Name | Affiliation |
|---|---|
| Unit of Science and Technology | Ministry of Public Health |
| Association for Family Planning in Honduras (ASHONPLAFA) |
| Name | Affiliation | Role |
|---|---|---|
| Dr. William Kalsbeek | Department of Biostatistics at the University of North Carolina | Technical assistance |
| Name |
|---|
| United States Agency for International Development |
Sampling
The 1987 National Epidemiology and Family Health Survey (EFHS) employed a multistage probability sample of over 11,000 households. Two departments were excluded from the sample, Gracias a Dios and the Bay Islands, due to difficult access and their small and scattered population. Together they make up only 1.5 percent of the total population of Honduras.
To carry out such a survey, adequate maps must be available to construct small area units to serve as sampling units in the later stages of selection. However, for the 1987 survey, current maps were not readily available for all parts of the country. At the time of sample preparation, the Honduran Bureau of Census and Statistics was updating maps for the 1988 Census and had updated maps of municipios (counties) representing a little less than half of the country's population. Included in the updated maps were those of 16 major cities. These cities had been selected for their importance in terms of employment by the Bureau of Census and Statistics which in September of 1986 carried out the Encuesta de Hogares (Labor Force Survey) to determine employment patterns of the labor force. Thus for the 1987 survey, two groups of recently updated maps were available: urban maps of 16 cities divided into colonias (neighborhoods) which were divided into sectors for the Encuesta de Hogares, and census maps of rural municipios divided into aldeas (villages) which Ministry of Health and Management Sciences for Health staff subsequently divided into sectors.
In the remainder of the country where Census personnel had not updated maps, the 1974 Census sector maps were used for the first stage of selection. Once these area units were selected, teams composed of survey staff and cartographers from the Vector Control Division of the Ministry of Public Health visited the sites and updated the maps.
The partial availability of current maps led to the designation of the following four cells (see Table II B1 of the Final Report) which served as the first level of stratification in the primary sample.
This four cell partitioning of the primary sample is not equivalent to stratification using the official definition of urbanization since Cells 2, 3 and 4 in Table II B1 contained both urban and rural areas. However, it is important to note that this feature of the design did not compromise our ability to produce estimates by official urban or rural designations.
Once the interview was completed and questionnaires were coded for data processing, all sectors were classified according to strata: 1) urban Tegucigalpa and urban San Pedro Sula, 2) other urban areas, and 3) rural areas. This classification of strata maintains the final strata designation used in the 1984 MCH/FP Survey. Urban was defined according to criteria used by the Bureau of Census and Statistics: population greater than 2000 inhabitants with public utilities, water and sewage. Since population estimates are based on 1974 census information, rural areas with less than but close to 2000 inhabitants were assumed to have grown and were reclassified as urban.
The 1986 population of Honduras based on estimates from the Latin American Center for Demography (CELADE) and the Secretary for Planning and Finances (SECPLAN) was about 4.2 million inhabitants. With about 5.5 persons per household, this corresponds to 763,636 households. Thus the overall sampling rate in selecting 11,660 households was 0.0153, or about one out of every 65 households. Our aim was to select a sample in which the sample and Census distributions by cell were approximately equal.
In January of 1987 the Ministry of Public Health implemented the National Nutrition Survey which used the sampling frame originally designed for the 1987 Epidemiology and Family Health Survey. Cell 1 of the Nutrition Survey was a subsample of the Encuesta de Hogares.
We selected 550 primary sampling units (PSUs) for the EFHS, 275 of which had been chosen earlier for the Nutrition Survey. However, new segments or secondary sampling units (SSUs) were selected for the EFHS in the previously used PSUs. An additional 275 PSUs were chosen independently from the four original stratified listings which correspond to the 4 design cells. To facilitate selection of the additional PSUs, we doubled the number of PSUs in each cell. To achieve the desired sample size for the EFHS, we increased the segment size used in the Nutrition Survey by 50 percent. The targeted number of households per segment varied.
Selection Protocol for each Cell
Cell 1
In preparation for the Encuesta de Hogares, cartography staff made a rapid enumeration of blocks and households in the 16 selected cities. Blocks were grouped in units that averaged 50 households. However, the units ranged from 25 to 125 households. These units were called PSUs and were listed and sorted hierarchically by health region, city, socioeconomic status, and population size or geographic proximity. Since probability proportional to size (PPS) systematic sampling was used ultimately to choose the PSU sample for each design cell, ordering according to the above variables implicitly stratified the sample. In the Encuesta de Hogares, the measure of size for PPS selection was the number of HHs. PSUs were selected with PPS. For the EFHS and Nutrition Surveys, a subsample of the Encuesta de Hogares sample was chosen. PSUs for these surveys were selected at random using equal probability.
Once the appropriate number of PSUs was selected, the SSUs or segments were delineated to contain approximately 15 households in Tegucigalpa and San Pedro Sula and about 8 households in the other 14 cities. Survey staff chose one segment at random and identified it on the map. In the field, the supervisor counted the number of households in the segment and when there were more than the predetermined cluster size, she chose at random a house with which to begin. Following a clockwise direction, interviewers visited households until the appropriate number was attained. An interview was attempted with all eligible respondents (women aged 15 to 44) in each household selected.
Cell 2
The updated (as of October 24, 1986) rural and urban maps not included in Cell 1, were used to define Cell 2. Municipios were divided into villages which were designated as the PSUs. PSU selection was done by PPS systematic sampling where the selection probability for each PSU was proportional to its size (total number of households) and an interval of fixed length was applied to the frame after a random start. The list of PSUs was ordered according to health region, department, municipio and geographical proximity which means a serpentine route was followed so that any two consecutive PSUs on the list were neighbors geographically. Once chosen, the PSU was divided into segments of about 33 households and one segment was chosen at random. All households in that chosen segment were contacted.
Cells 3 and 4
These cells used 1974 Census sector maps at the first stage of selection. The PSUs for urban areas were ordered according to health region, municipio, city and SES status when possible or geographic proximity. In rural areas, lists were sorted by health region, department, municipio and geographic proximity. PSUs were chosen separately in each cell by PPS systematic sampling and these "census sector maps" were updated for the EFHS and Nutrition Survey. The updated sectors averaged 70 households but ranged from 25 to 130 households. As in Cell 2, one segment of about 33 households was chosen at random for each PSU.
Summary of the sample for the 1987 Epidemiology and Family Health Survey
General description: Two stage area sample of households with stratification in the first stage and area segments of 8-33 households as the ultimate sampling unit. Expected number of selected households: 11,660 Overall household sampling rate: About 1 in 65 households Expected number of responding households: 9,736
Expected number of responding eligible women in selected households: 9,713 Expected number of eligible children in selected households: 7,334
( Based on sample attrition in the 1984 MCH/FP Survey.)
Survey instrument
The following study documents were prepared.
Questionnaires
We prepared two questionnaires: one for the household and another for individual respondents. The household questionnaire included a complete roster of household members and questions related to characteristics of the household and its residents, basic sanitation, identification of symptoms of respiratory ailments and malaria, accessibility to health services, and recent mortality. This questionnaire could be answered by any knowledgeable member of the household older than 15 years of age.
The individual questionnaire was directed towards all women 15 to 44 years of age who were members of the household. This questionnaire covered various sociodemographic aspects of the female population including age, education, marital status, parity and residence. For women who had had their last live birth within five years prior to the interview, inquiries were made about the pregnancy. These women were asked about the delivery and puerperal period, breastfeeding and weaning patterns. For all children under five years of age, immunization status and morbidity related to diarrhea and acute respiratory infections were investigated. The questionnaire also included modules about family planning, pregnancy intentions, knowledge and attitudes about STDs, the sexual behavior of young women (15-24 years), mass media communication and a module to determine cause of death for children who were born and subsequently died in the past five years.
Elaboration of the questionnaire was demanding and at times, exhausting, considering the sheer quantity of information to be gathered. Use of appropriate language was stressed. The questionnaire had complex skip patterns and required different recall periods depending on the variable being investigated.
Multiple revisions were made. The majority of the questions were pre-coded. Household questionnaires were consecutively numbered before entering the field and the individual questionnaires were linked by the household questionnaire number and a woman number.
The final pre-test was carried out during the last week of May, 1987, in the town of Comayagua, where teams visited urban and rural areas not included in the final sample. During this activity, the supervising staff evaluated how well the questionnaire functioned, the average length of an interview, the ease or difficulty with which the respondent answered, as well as the performance of the trained field staff. The pre-test identified inconsistencies which were corrected.
Manual
A manual was created for each questionnaire in order to standardize criteria and technical procedures for the staff.
Sector control sheet
These sheets were completed by the supervisor in the field to keep a running tally of the result of each visit to every household and for each eligible woman of every sample sector.
Delivery of questionnaires sheet
Each supervisor completed a "delivery" sheet for every sector which was sent from the field to the office in Tegucigalpa where the questionnaires were received. The coders verified that the material received was complete.
Organization of field work
These guidelines described the different functions of each participant, travel instructions, rules of conduct, etc.
Other documents
These include the internal administrative regulations of the survey, control sheets for keypunching of data, etc.
Data collection
| Start | End |
|---|---|
| 1987-06-08 | 1987-11-20 |
To minimize errors, the interviewer reviewed the questionnaire as soon as it was complete. It was then reviewed by the supervisor and/or coordinator. In Tegucigalpa, coders verified the integrity of information and consistencies in logic were checked at the time of data entry with a special edit program.
The supervisor and/or coordinator frequently observed interviews to identify errors. Likewise, periodic meetings among field staff created an ongoing review.
Staff:
The field staff consisted of sixteen interviewers and four supervisors. They worked in four groups, each assigned a vehicle and a driver.
Staff at the central office in Tegucigalpa included three high school graduates who were employed to receive the questionnaires from the field, code and organize them. There were six keypunchers, working two different schedules, who entered the data. They were supervised by a systems analyst who was also in charge of handling the different computer software packages that were used in the survey. Also, there was an accountant and a secretary trained in word processing.
Activity at the different levels was coordinated by two physicians (general practitioners) under the supervision of the Head of the Unit of Science and Technology.
Interviewer selection and training:
The selection and training of the interviewers began with a review of the resumes of 120 candidates and a personal interview. Thirty were chosen to participate in the interviewer training and were required to have a minimum of a high school education; seven supervisor candidates were also chosen, all of whom were university graduates.
The training took place during the last two weeks of May, 1987, and it consisted of a theoretical classroom component and practice in the field. The first week covered general aspects of the survey and its objectives, training in the handling of questionnaires and interviewer techniques, as well as background information regarding the different modules of the questionnaire. Representatives from different divisions of the Ministry of Health and representatives of interested institutions (ASHONPLAFA, PROALMA, etc.) were present and gave informal lectures.
During the second week, candidates were evaluated on their performance as interviewers or supervisors in urban and rural areas. Also, candidates were trained in reading maps, familiarized themselves with the organization of the field work and increased their skills in interviewing and handling of the questionnaires.
The group of 37 was reduced to 16 interviewers, four supervisors and three keypunchers. Field staff were females, given the maternal-child health focus of the survey and the fact that only females would be interviewed. During the selection process, potential field staff were evaluated on their cultural and social sensitivity. Other factors taken into consideration were their adaptability to travel and spend extended periods of time in the interior of the country, their motivation to be involved in this kind of activity, and the results of a written evaluation.
Field work
Field work began June 8 and was completed on November 20, 1987. Data collection began in Tegucigalpa and required three weeks. Visits to other parts of the country were planned according to seasonal accessibility, availability of maps, and the distribution of sampling units within the sector segment.
The four teams worked in close geographical proximity whenever possible, which helped the supervisor to move from one group to another. The average length of a trip was about 30 days, with four days in between for rest. In spite of adverse weather conditions, there were few significant deviations from the original plan.
Since a high response rate from households and eligible women was important for this survey, field workers were strongly encouraged to complete interviews with all women in the sample. The planning of revisits to households and/or to women not initially interviewed helped raise the response rates considerably. The questionnaires were periodically reviewed and sent to the Tegucigalpa office for coding and data entry.
The report prepared by the supervisor of each group after each trip and a general report prepared by the group coordinator permitted the identification of problems and limitations in the field as well as a measurement of each group's production.
To carry out these activities each group was assigned sufficient office materials as well as raincoats, flashlights, etc. A complete package of maps, reviewed and verified for each planned trip, was given to the supervisor before the trip.
Data processing
IBM personal computers (ATs) and XT microcomputers as well as EPSONs (compatible with an IBM-XT) were used for data processing. The program Survey was used for data entry. It contains a special program to identify inconsistencies in logic and creates ASCII files. This program was adapted specifically for this survey with the collaboration of the Centers for Disease Control (CDC) in Atlanta and Family Health International (FHI). The entry process was finalized in December having registered 11,732 households and 11,233 eligible women. Survey helped significantly to accelerate the preparation of preliminary fertility, mortality and prevalence results. The two databases (household and individual respondents) were transformed into the following smaller data files:
- Family Planning
- Fertility
- Births
- Acute Respiratory Infections (ARI)
- Immunization
- Diarrhea
- Household
- Maternal Health
FOXBASE was used to create the smaller files. SPSS-PC (version 2.0) was used to run frequencies and crosstabulations. Also, PANDEM was used for the indirect estimation of infant mortality. Each of the files used the GENOA back-up system. A UNISYS A4 mainframe computer was used at FHI for some of the analyses too difficult to perform on the microcomputers.
Data appraisal
Like all sample surveys, the values reported in this final report are affected by both nonsampling error and sampling error. Percentages and distributions in all tables represent an estimate of the population at large; the true values will never be known for sure. Very briefly, nonsampling errors occur during the data collection and data entry phase of the study. Interviewing the incorrect household, phrasing a question incorrectly which unknowingly answers a different question, misunderstanding on the part of interviewers or respondents, and coding errors in data entry are examples of this type of error. Efforts to minimize these problems are an important aspect of any sample survey, yet some degree of nonsampling error is unavoidable. The magnitude of this type of error and how it affects the statistics (e.g. percentages and means) in this report is unknown.
Surveys of the same design and size, if administered once again, would yield different values from those shown in this report; sampling errors reflect the variability associated with repeated applications of the same design. By taking into account the survey design, the magnitude of this type of error can be estimated from the results, and the reported statistics for particular subgroups of people can be "bracketed" with high and low possible values (confidence intervals).
The sampling design for the EFHS 1987 was described in the second chapter. The computer program SESUDAAN incorporates this information to produce estimates of the variability of a given statistic and then calculates the efficiency of the sample design (on that particular statistic) in comparison to the most efficient design, a simple random sample. The efficiency of the design is measured as the "design effect"; the closer the value is to 1, the more the survey sample design resembles a simple random sample. A large design effect indicates that the variable of concern is strongly affected by the heterogeneity among clusters and the homogeneity within clusters.
For these purposes, two key variables in the multi-stage design were identified to enable the calculation of this information. The first variable known as VCELDA, represents map availability and approximates the geographic stratum in which the household is located, and was the first level of selection in the survey design. Within the stratum variable, primary sampling units (PSUs) were identified and came to represent the variable VSECTOR. With numerous formulas and reasonable assumptions, SESUDAAN computes the level of variation for a given statistic using this information.
The annex to the Final Report lists a sample of important variables, their description, and the population they describe. Table 2 in this annex lists the variables and shows the estimated value, standard error (variance), design effect, and 95% confidence interval for the total population. Tables 3 through 8 stratify these varibles on place of residence and age. The 95% confidence interval can be interpreted to mean, for example, that we are 95% sure that the value for EDUC2, the proportion of women who have achieved some secondary education, lies somewhere between .229 and .265 for the total population of women aged 15 to 44. In Table 2, the small design effect of BFEED (1.16), the proportion of women with an infant of six months or younger who was breastfeeding at the time of the interview, suggests that there is little effect from the use of clusters. Regardless of where the sample cluster was located, the proportion of breastfeeding women with six month old infants or less, was about the same. On the other hand, such variables as WATER, piped water in the household or on the property, or ELECT, availability of electricity in the home, tend to be large because of the homogeneity within clusters and the variability among clusters.
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.
Metadata production
DDI_HND_1987_EFHS_v01_M_WBDG