The 2003 Ghana Demographic and Health Survey (GDHS) is a nationwide sample survey carried out to provide information on population, family planning, maternal and child health, nutrition, childhood mortality, and AIDS and sexually transmitted infections (STIs). This is the fourth round in a series of national-level population and health surveys conducted in Ghana under the worldwide Demographic and Health Surveys Program, others being in 1988, 1993, and 1998. This latest GDHS included, for the first time, testing of blood samples to provide national rates of anaemia and HIV. All four demographic and health surveys have been implemented by the Ghana Statistical Service, in close collaboration with other stakeholders.
The principal objective of the 2003 Ghana Demographic and Health Survey (GDHS) is to provide data to monitor the population and health situation in the country. The primary objective is to provide current and reliable data on fertility and family planning behaviour, infant and child mortality, breastfeeding, antenatal care, children’s immunisations and childhood diseases, nutritional status of mothers and children, use of maternal and child health services, and awareness and behaviour regarding AIDS and other STIs. New features of the 2003 GDHS include the collection of information on female and male circumcision, information on malaria and ownership and use of insecticide-treated bed nets, and haemoglobin and HIV testing.
The long-term objective of the survey includes strengthening the technical capacity of major government institutions, including the Ghana Statistical Service (GSS). The 2003 GDHS also provides comparable data for long-term trend analyses in Ghana, since the surveys were implemented by the same organisation, using similar data collection procedures. It also contributes to the ever-growing international database on demographic and health-related information.
Kind of Data
Sample survey data
Unit of Analysis
- Children under five years
- Women age 15-49
- Men age 15-59
The 2003 Ghana Demographic and Health Survey covers the following topics:
- Anemia Questions–Questions or testing assessing prevalence/severity of iron-def. anemia among women or children
- Anemia Testing
- Birth Registration
- GPS/Georeferenced–Global Positioning System or Georeferenced Data
- HIV Behavior
- HIV Knowledge–Questions assess knowledge/sources of knowledge/ways to avoid HIV
- HIV Testing
- Husband's Survey
- Malaria Module (bednets)
- Male circumcision
- Men's Survey
- Reproductive Calendar
- Tobacco Use
Producers and sponsors
Ghana Statistical Service (GSS)
Noguchi Memorial Institute for Medical Research
Ghana Health Service
United States Agency for International Development
The sample for the 2003 GDHS covered the population residing in private households in the country. A representative probability sample of about 6,600 households was selected nationwide. The list of enumeration areas (EAs) from the 2000 Ghana Population and Housing Census was used as a frame for the sample. The frame was first stratified into the 10 administrative regions in the country, then into rural and urban EAs. The sample was selected in such a manner as to allow for separate estimates for key indicators for the country as a whole, for each of the 10 regions in Ghana, as well as for urban and rural areas separately.
The 2003 GDHS used a two-stage stratified sample design. At the first stage of sampling, 412 sample points or EAs were selected, each with probability proportional to size, based on the number of households. A complete household listing exercise was carried out between May and June 2003 within all the selected EAs (clusters). The second stage of selection involved systematic sampling of households from this list. The sample selected per EA varied by region depending on the population size. Fifteen households per EA were selected in all the regions except in Brong Ahafo, Upper East, and Upper West regions, where 20 households per EA were selected, and in the Northern region, where 16 households per EA were selected. The objective of this exercise was to ensure adequate numbers of complete interviews to provide estimates for important population characteristics with acceptable statistical precision. Due to the disproportional number of EAs and different sample sizes selected per EA among regions, the household sample for the 2003 GDHS is not selfweighted at the national level.
Note: See detailed description of sample design in APPENDIX A of the survey report.
Response rates are important because high nonresponse may affect the reliability of the results. A total of 6,628 households were selected in the sample, of which 6,333 were occupied at the time of fieldwork. The difference between selected and occupied households is largely due to structures being vacant or destroyed. Successful interviews were conducted in 6,251 households, yielding a response rate of 99 percent.
In the households interviewed in the survey, a total of 5,949 eligible women age 15-49 were identified; interviews were completed with 5,691 of these women, yielding a response rate of 96 percent. In the same households, a total of 5,345 eligible men age 15-59 were identified and interviews were completed with 5,015 of these men, yielding a male response rate of 94 percent. The response rates are slightly lower for the urban than rural sample, and among men than women. The principal reason for non-response among both eligible women and men was the failure to find individuals at home despite repeated visits to the household. The lower response rate for men reflects the more frequent and longer absences of men from the household, principally related to their employment and life style.
Response rates for the HIV testing component were lower than those for the interviews. Details of the HIV testing response rates are discussed in Chapter 13 of the final GDHS report which is presented in this documentation.
Note: See summarized response rates by place of residence in Table 1.2 of the survey report.
Dates of Data Collection
Data Collection Mode
Data Collection Notes
A pretest of the Household, Women’s, and Men’s questionnaires used in the GDHS was conducted in May 2003 in English and five major local languages. The pretest training was conducted by GSS staff for two weeks from 5-17 May 2003. In addition, nurses recruited from the Ghana Health Service were trained in testing for haemoglobin and collecting blood samples for HIV/AIDS. Five teams were formed to conduct the pretest. Each team consisted of a supervisor, four interviewers, and a nurse. Urban and rural areas were chosen for the pretest to get a better overall sense of the response level and acceptance of HIV/AIDS testing. The lessons learned from the pretest were used to finalize the survey instruments and logistical arrangements.
TRAINING AND FIELDWORK
A total of 102 interviewers, 23 nurses, and 12 data entry operators participated in the main survey training that took place from 6-27 July 2003. All participants were trained in interviewing techniques and the contents of the GDHS questionnaires. The training was conducted following the standard DHS training procedures, including class presentations, mock interviews, and tests using the Household, Women’s, and Men’s Questionnaires. All interviewers were trained in taking height and weight measurements. In addition to interviewer training, 23 persons (most of whom were nurses from the Ghana Health Service) were trained for a period of 10 days in anaemia testing, collection of blood samples for the HIV testing, and in informed consent procedures. An additional 20 interviewers were also trained in blood collecting techniques. In addition to in-class practice, the nurses were taken to the local health clinic to practice blood-collecting techniques on women, men, and children.
Interviewers and nurses were selected based on their in-class participation, performance in the field practices, fluency in the Ghanaian languages, and assessment tests. The most experienced trainees, those who took part in the pretest, and those who did extremely well, were selected to be supervisors and editors. Trainees selected as supervisors and field editors were given an additional two-days training on how to supervise fieldwork and edit questionnaires. In addition, there was one standby supervisor and nine interviewers ready for relief assignment whenever necessary. Ten regional statisticians acted as regional coordinators, and GSS staff coordinated and supervised fieldwork activities.
Fifteen teams were constituted for data collection. Each team was made up of a supervisor, an editor, a nurse, four interviewers, and a driver. Fieldwork lasted for three months from late July to late October.
ORC Macro provided technical assistance on all aspects of the survey; staff from ORC Macro participated in field supervision of interviews, height and weight measurements, and blood sample collection.
The questionnaire for each DHS can be found as an appendix in the final report for each study.
Three questionnaires were used for the 2003 GDHS: the Household Questionnaire, the Women’s Questionnaire, and the Men’s Questionnaire. The contents of these questionnaires were based on the model questionnaires developed by the MEASURE DHS+ programme and were designed to provide information needed by health and family planning programme managers and policymakers. The questionnaires were adapted to the Ghanaian situation and a number of questions pertaining to ongoing health, HIV, and family planning programmes were added. These questionnaires were translated from English into the five major languages (Akan, Nzema, Ewe, Ga, and Dagbani).
The Household Questionnaire was used to list all the usual members and visitors in the selected households. Information was collected on the characteristics of each person listed, including the age, sex, education, and relationship to the head of household. The main purpose of the Household Questionnaire was to identify eligible women and men for the individual interview. The Household Questionnaire collected information on characteristics of the household’s dwelling unit, such as the source of drinking water, type of toilet facilities, flooring materials, ownership of various consumer goods, and ownership and use of mosquito nets. It was also used to record height and weight measurements of women 15-49 and children under the age of 5, and to record the respondents’ consent to the haemoglobin and HIV testing.
The Women’s Questionnaire was used to collect information from all women age 15-49. These women were asked questions on the following topics: respondent’s background characteristics, such as education, residential history, media exposure, knowledge and use of family planning methods, fertility preferences, antenatal and delivery care, breastfeeding and infant and child feeding practices, vaccinations and childhood illnesses, childhood mortality, marriage and sexual activity, woman’s work and husband’s background characteristics, and awareness and behaviour regarding AIDS and other STIs.
The Men’s Questionnaire was administered to all men age 15-59 in every household in the GDHS sample. The Men’s Questionnaire collected much of the same information found in the Women’s Questionnaire, but was shorter because it did not contain a reproductive history or questions on maternal and child health and nutrition.
The processing of the GDHS results began shortly after the fieldwork commenced. Completed questionnaires were returned periodically from the field to the GSS headquarters in Accra, where they were entered and edited by data processing personnel who were specially trained for this task. Twelve data entry operators from GSS were trained for one week on data entry procedures using CSPro. All data were entered twice (100 percent verification). In addition, tables were run periodically to monitor the quality of the data collected. The concurrent processing of the data was an advantage for data quality because field coordinators were able to advise teams of problems detected during the data entry. The data entry and editing phase of the survey was completed in mid-December 2003.
Estimates of Sampling Error
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 2003 Ghana Demographic and Health Survey (GDHS) 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 2003 GDHS 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 2003 GDHS sample is the result of a multi-stage stratified design, and, consequently, it was necessary to use more complex formulae. The computer software used to calculate sampling errors for the 2003 GDHS 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.
Note: See detailed estimate of sampling error calculation in APPENDIX B of the survey report.
Data Quality Tables
- Household age distribution
- Age distribution of eligible and interviewed women and men
- Completeness of reporting
- Births by calendar years
- Reporting of age at death in days
- Reporting of age at death in months
Note: See detailed tables in APPENDIX C of the survey report.
Data and Data Related Resources
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 of the data files (for datasets obtained on-line)
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.