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- (c) 2016 The authors; licensee World Health Organization.
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- 10.2471/BLT.15.158493
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Abstract
Policy & practice Policy & practice a a a Rakhi Dandona, Anamika Pandey & Lalit Dandona Abstract Several rounds of national health surveys have generated a vast amount of data in India since 1992. We describe and compare the key health information gathered, assess the availability of health data in the public domain, and review publications resulting from the National Family Health Survey (NFHS), the District Level Household Survey (DLHS) and the Annual Health Survey (AHS). We highlight issues that need attention to improve the usefulness of the surveys in monitoring changing trends in India’s disease burden: (i) inadequate coverage of noncommunicable diseases, injuries and some major communicable diseases; (ii) modest comparability between surveys on the key themes of child and maternal mortality and immunization to understand trends over time; (iii) short time intervals between the most recent survey rounds; and (iv) delays in making individual-level data available for analysis in the public domain. We identified 337 publications using NFHS data, in contrast only 48 and three publications were using data from the DLHS and AHS respectively. As national surveys are resource-intensive, it would be prudent to maximize their benefits. We suggest that India plan for a single major national health survey at five-year intervals in consultation with key stakeholders. This could cover additional major causes of the disease burden and their risk factors, as well as causes of death and adult mortality rate estimation. If done in a standardized manner, such a survey would provide useable and timely data to inform health interventions and facilitate assessment of their impact on population health. Introduction Themes Health information gathering is an important part of any We reviewed the survey questionnaires to assess: survey period health system, but is often weak in low-income countries, and sample sizes; types of respondent; key themes; timeframe plagued by poor quality data that are inadequate for inform- for availability of data in the public domain; and analytical 1–4 ing health policy. publications resulting from the data. A more detailed review of Population-based surveys are an invaluable source of the number of children, reference period and age groups was health information. A key aim of these surveys is to provide undertaken to gauge the utility of the data for assessment of high-quality data for policy development and programme trends in child mortality, maternal mortality and immunization. planning, monitoring and evaluation. Population-based To determine how well the household, male and female surveys have been used extensively to gather information on survey questionnaires corresponded to disease burden in the fertility, mortality, family planning, maternal and child health, country, we assessed the proportion of questions covering and some other aspects of health, nutrition and health care major themes: maternal and child health; reproductive health in India. other than infections; reproductive tract infections; other adult We have previously reported that the health information infections; noncommunicable diseases; and injuries. Data on system in India has not kept up with the epidemiological anthropometric and biological markers were analysed in ad- transition. In this paper, we assess national health surveys dition to the questionnaires. conducted in India since 1992 that were designed to provide We recorded the time between the completion of data information on health indicators at subnational levels. We collection for each survey round and the availability of individ- describe and compare the health information covered by ual-level data in the public domain. We conducted a PubMed these surveys over time, the availability of resulting data in database search to identify peer-reviewed research papers from the public domain and the use of these survey data in publica- January 1993 to March 2015 that had used data from either or tions. Based on our findings, we highlight the issues that need all of the first three rounds of the NFHS and DLHS. For the consideration to improve the usefulness of these surveys. We AHS, this search was done for research papers published be- believe they should be able to provide more effective, useable tween January 2011 and March 2015. The fourth rounds of the and timely data on the health status of the population, given NFHS and DLHS were not included in this search as the data the evolving disease burden in India. collection for the former is not yet complete and the data for the latter have not yet been released in the public domain. The search terms used in PubMed to identify relevant publications Reviewing surveys were “National Family Health Survey” or “NFHS and India”, We selected large-scale, national, population-based house- “District Level Household Survey” or “DLHS and India” and hold surveys that provided data on health indicators at the “Annual Health Survey” or “AHS and India”. We screened the subnational levels in India from 1992 to 2015. These were the titles and abstracts of identified articles and reviewed the full National Family Health Survey (NFHS), the District Level texts of those that analysed data from the surveys. Review papers Household Survey (DLHS) and the Annual Health Survey and the papers that merely made reference to survey data in (AHS), (Box 1). The surveys are summarized in Table 1. background or discussion sections were excluded. Public Health Foundation of India, Plot 47, Sector 44, Gurgaon – 122 002, National Capital Region New Delhi, India. Correspondence to Rakhi Dandona (email: [email protected]). (Submitted: 19 May 2015 – Revised version received: 28 December 2015 – Accepted: 5 January 2016 – Published online: 12 February 2016 ) 286 Bull World Health Organ 2016;94:286–296A | doi: http://dx.doi.org/10.2471/BLT.15.158493 Policy & practice National health surveys in India Rakhi Dandona et al. Box 1. Description of major surveys done in India between 1992 and 2016 Survey characteristics The National Family Health Survey (NFHS) is the equivalent of demographic and health surveys Survey period done in many countries around the world. The NFHS is overseen by the Ministry of Health and The first survey conducted was NFHS- is coordinated by the International Institute for Population Sciences (IIPS) in Mumbai, as the 1 in 1992–1993. The following three nodal agency, with support from ORC Macro and other agencies. The primary aim of the NFHS has been to provide information on maternal and child health and reproductive health. Three rounds of NHFS were done in 6–9 year rounds of the NFHS were conducted in 1992–1993, 1998–1999 and 2005–2006, and the fourth intervals, which were longer than the 9–12 round is currently underway. The first three rounds of the NFHS were designed to provide DLHS interval of 4–5 years. The period state level data, but the fourth round, with a much larger sample size, will generate estimates of the first DLHS survey overlapped of most indicators for all 640 districts in the country. with NFHS-2 and the following survey The District Level Household Survey (DLHS) was launched in response to the need for district- rounds done with close proximity. The level data on the Reproductive and Child Health Programme. The DLHS is carried out by the AHS, which is complementary to DLHS- International Institute for Population Sciences with oversight by the Ministry of Health. Four 14–17 4, was initially done in 2010–11, with rounds of DLHS have been undertaken: 1998–1999, 2002–2004, 2007–2008 and 2012–2014. two further rounds between 2011 and The fourth round was done in coordination with the Annual Health Survey (AHS), with the former not conducted in nine states covered by the latter. The AHS has been conducted in the 2013 (Table 1). less developed states of India (Assam, Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Types of respondents Rajasthan, Uttar Pradesh and Uttarakhand). The sample sizes at the district level in the AHS are much larger than those in the DLHS and aim to generate more robust estimates at the district There were some changes in the types level, especially of infant mortality. The AHS is implemented by the Office of the Registrar General of respondents across these surveys of India with funding from the Ministry of Health. The baseline round of the AHS was undertaken over time (Table 2). Ever-married in 2010–2011, while two subsequent rounds in 2011–2012 and 2012–2013 collected data on 19–21 the same households as in the baseline. In contrast, the DLHS and the NFHS have new women were surveyed in all rounds cross-sectional samples for each round. of the NFHS and AHS. DLHS-1 and DLHS-2 surveyed only currently mar- ried women but DLHS-3 and DLHS-4 Table 1. Survey and sample size for major health surveys in India, 1992 to 2016 surveyed ever-married women. NFHS- 3, NFHS-4 and DLHS-3 also included Survey Survey years No. of households in the never-married women. sample The ever and/or currently married women interviewed in all surveys were NFHS of reproductive age; however, the age NFHS-1 1992–1993 88 562 boundaries for inclusion varied both NFHS-2 1998–1999 91 196 across surveys and between different NFHS-3 2005–2006 109 041 rounds of the same survey. Women NFHS-4 2015–2016 568 200 up to 49 years of age were selected as DLHS respondents in all rounds of the NFHS; DLHS-1 1998–1999 529 817 the lower age limit for NFHS-1 was DLHS-2 2002–2004 620 107 13 years, which was raised to 15 years DLHS-3 2007–2008 720 320 during subsequent rounds. Women DLHS-4 2012–2014 350 000 aged 15–44 years were surveyed dur- AHS ing the first two rounds of the DLHS AHS baseline 2010–2011 4 140 000 and the upper age limit was raised to AHS 1st update 2011–2012 4 280 000 49 years for ever-married women in AHS 2nd update 2012–2013 4 320 000 DLHS-3 and DLHS-4. The age group for never-married women was 15–24 years AHS: Annual Health Survey; DLHS: District Level Household Survey; NFHS: National Family Health Survey. Data collection is ongoing as of February 2016. in DLHS-3. The AHS surveyed women DLHS-4 covered 336 districts in 26 states and union territories of India. The AHS covered 284 districts in 15–49 years of age. the other nine states of India. Male representation across surveys has been inconsistent. Only in four disease- or condition-specific questions noncommunicable diseases increased for rounds have men been represented. increased in all surveys over time. From each round in the NFHS and DLHS, from Men aged 15–54 years were inter- 246 to 868 questions in the NFHS, from two to 41 and zero to 10, respectively. viewed in NFHS-3 and NFHS-4. Men 200 to 339 questions in the DLHS and NFHS-4, DLHS-4 and the AHS aged 20–54 years were interviewed from 137 to 207 questions in the AHS. baseline had questions on tobacco and in DLHS-1, whereas the husbands of Of these questions, more than 90.5% of alcohol use, which are major risk factors eligible women, regardless of age, were questions were about maternal and child for chronic diseases. However, these interviewed in DLHS-2. The AHS did health and reproductive health (range: questions did not fully meet the criteria not interview men. 90.6–99.1%; Table 3). Adult infections for the STEPwise approach to surveil- Key survey themes other than those of the reproductive lance, recommended by the World tract received very little attention in the Health Organization (WHO) for moni- Interview 22,23 surveys, constituting only 0.6–3.0% of toring risk factors over time. Only The key survey themes are shown in the total disease- or condition-specific NFHS-3 and NFHS-4 had more than Table 2 and Table 3. The numbers of questions. The number of questions on three questions related to injury (24 and Bull World Health Organ 2016;94:286–296A| doi: http://dx.doi.org/10.2471/BLT.15.158493 287 Policy & practice Rakhi Dandona et al. National health surveys in India Table 2. Types of respondents and key themes identified in major health surveys, India, 1992 to 2016 Survey Household Women Men Respondent Key survey themes Respondent Key survey themes Respondent Key survey themes NFHS NFHS-1 Household - Sociodemographic Ever-married - Birth history Not included in N/A head characteristics women 13–49 - Maternal and child health survey - Household amenities years of age - Child mortality - Morbidity - Family planning and fertility - Mortality (all ages) preferences - Woman and husband’s background characteristics - Women’s employment status NFHS-2 Household - Sociodemographic Ever-married - Birth history Not included in N/A head characteristics women 15–49 - Maternal and child health survey - Household amenities years of age - Child mortality - Morbidity and risk - Family planning and fertility factors preferences - Health care use - Woman and husband’s - Mortality (all ages) background characteristics - Women’s employment status - Women’s autonomy and domestic violence - Quality of health services STIs and HIV/AIDS NFHS-3 Household - Sociodemographic Ever-married - Birth history Men 15–54 - Reproductive history head characteristics women 15–49 - Maternal and child health years of age - Marital and sexual - Household amenities years of age and - Child mortality relationships, and - Child labour never-married - Family planning and fertility living arrangements - Morbidity women 15–49 preferences - Family planning and - Health care use years of age - Woman and husband’s fertility preferences background characteristics - Male involvement in - Women’s employment status health care - Women’s autonomy and - Quality of health domestic violence services - Quality of health services - NCDs and - STIs and HIV/AIDS behavioural risk - NCDs and behavioural risk factors factors - Attitude towards - Use of ICDS women’s autonomy - Marital and sexual and domestic relationships and living violence arrangements - STIs and HIV/AIDS NFHS-4 Household - Sociodemographic Ever-married - Birth history Men 15–54 - Reproductive history head characteristics women 15–49 - Maternal and child health years of age - Marital and sexual - Household amenities years of age and - Child mortality relationship, and - Morbidity and risk never-married - Family planning and fertility living arrangements factors women15–49 preferences - Family planning and - Health care use years of age - Women’s and husbands’ fertility preferences - Mortality (all ages) background characteristics - Male involvement in - Women’s employment status health care - Women’s autonomy and - Quality of health domestic violence services - Marital and sexual - NCDs and relationships and living behavioural risk arrangements factors - Quality of health services - Attitudes towards STIs and HIV/AIDS women’s autonomy - NCDs and behavioural risk and domestic factors violence - Use of ICDS services - STIs and HIV/AIDS (continues. . .) 288 Bull World Health Organ 2016;94:286–296A| doi: http://dx.doi.org/10.2471/BLT.15.158493 Policy & practice National health surveys in India Rakhi Dandona et al. (. . .continued) Survey Household Women Men Respondent Key survey themes Respondent Key survey themes Respondent Key survey themes DLHS DLHS-1 Household - Sociodemographic Currently-married - Birth history Men 20–54 - STIs and HIV/AIDS head characteristics women 15–44 - Maternal and child health years of age - Family planning - Household amenities years of age - Family planning - Morbidity - Quality of health services - Health care use - STIs and HIV/AIDS - Child mortality - Maternal mortality DLHS-2 Household - Sociodemographic Currently-married - Birth history Husbands of - STIs and HIV/AIDS head characteristics women 15–44 - Maternal and child health eligible women - Family planning and - Household amenities years of age - Child mortality fertility preferences - Morbidity - Family planning - Mortality (all ages) - Quality of health services - STIs and HIV/AIDS DLHS-3 Household - Sociodemographic Ever-married - Birth history Not included in N/A head characteristics women 15–49 - Maternal and child health survey - Household amenities years of age - Child mortality - Health care use - Family planning and fertility - Government health preferences programmes - Reproductive health - Mortality (all ages) - STIs and HIV/AIDS - Use of government health programmes Never-married - Sex education and age at women 15–24 marriage years of age - Reproductive health - STIs and HIV/AIDS DLHS-4 Household - Sociodemographic Ever-married - Birth history Not included in N/A head characteristics women15–49 - Maternal and child health survey - Household amenities years of age - Family planning and fertility - Morbidity and preferences behavioural risk factors - Woman’s background - Health care use characteristics - Mortality (all ages) - STIs and HIV/AIDS - Reproductive health - NCDs and behavioural risk factors AHS AHS Household - Sociodemographic Ever-married - Birth history Not included in N/A baseline head characteristics women15–49 - Maternal and child health survey - Household amenities years of age - Birth registration - Morbidity and Currently married - Family planning and fertility behavioural risk factors women 15–49 preferences - Health care use years of age - STIs and HIV/AIDS - Mortality (all ages) - Awareness of childhood illness AHS 1st Household - Sociodemographic Ever-married - Birth history Not included in N/A update head characteristics women15–49 - Maternal and child health survey - Household amenities years of age - Birth registration - Morbidity Currently married - Family planning and fertility - Health care use women 15–49 preferences - Mortality (all ages) years of age - STIs and HIV/AIDS - Awareness of childhood illness and danger signs in newborns AHS 2nd Household - Sociodemographic Ever-married - Birth history Not included in N/A update head characteristics women15–49 - Maternal and child health survey - Household amenities years of age - Birth registration - Morbidity Currently married - Family planning and fertility - Health care use women 15–49 preferences - Mortality (all ages) years of age - STIs and HIV/AIDS - Awareness of childhood illness and danger signs in newborns AHS: Annual Health Survey; AIDS: acquired immunodeficiency syndrome; DLHS: District Level Household Survey; HIV: human immunodeficiency virus; ICDS: integrated child development services; N/A: not applicable; NCD: noncommunicable disease; NFHS: National Family Health Survey; STI: sexually transmitted infection. Bull World Health Organ 2016;94:286–296A| doi: http://dx.doi.org/10.2471/BLT.15.158493 289 Policy & practice Rakhi Dandona et al. National health surveys in India 26 questions, respectively). However, DLHS-2 included weight measurement various rounds of the DLHS, the refer- all of these concerned intimate partner only for children younger than 6 years to ence period for the collection of data on violence only (Table 3). calculate weight-for-age as an indicator maternal deaths varies from 1 to 3 years Questions on antenatal care, de- of nutritional status. Height and weight preceding the survey. In the AHS, the livery and postnatal care, birth history were measured in DLHS-4 and in a reference period for maternal deaths and family planning were included in all subsample of households in the AHS ranges from 1 to 5 years preceding the surveys with the exception of postnatal for children 1 month of age and older, last survey (Table 5). care in NFHS-1. Key subthemes regard- as well as women and men. Immunization ing child health were immunization, The surveys evaluated various breastfeeding practices and common biomarkers, especially in the later Assessment of immunization trends childhood morbidity symptoms (cough, rounds (Table 4). NFHS-2 included over time using all the NFHS, DLHS fever and diarrhoea). assessment of anaemia among children and AHS rounds is possible only for the All rounds of the NFHS included 6–35 months of age and ever-married last two surviving children born in the questions on women’s employment sta- women 15–49 years of age. Anaemia 3 years preceding the surveys, due to tus and fertility preferences. Rounds 2, testing was also done for men in NFHS- variation in the reference periods and in 3 and 4 of the NFHS included questions 3 and NFHS-4. Anaemia testing was the number of births and living children on quality of health services, sexually done for children, girls and women in for which immunization data were col- transmitted infections (STIs), human DLHS-2, but not in DLHS-3. DLHS-4 lected in the various rounds (Table 5). immunodeficiency virus/acquired im - and the AHS included anaemia testing munodeficiency syndrome (HIV/AIDS) for children 6 months or older as well and women’s autonomy. Several com- as women and men. HIV testing was Timeliness of data mon themes were identified in the sepa - included in a subsample of men and availability rate questionnaires completed by both women in NFHS-3 and NFHS-4. Blood women and men during NFHS-3 and pressure measurement and blood testing Individual-level NFHS and DLHS NFHS-4: reproductive history; marital for fasting plasma glucose were done in data – without individual identifiers to and sexual relationships; co-habitation; men and women in NFHS-4 and DLHS- maintain participants’ confidentiality – family planning and fertility preferences; 4 and in a subsample of men and women have to be made available in the public quality of health services; STIs and HIV/ in the AHS. domain for analytical use. Table 6 (avail- AIDS. Additional themes in the men’s able at: http://www.who.int/bulletin/ questionnaire were male involvement in volumes/94/4/15-158493) shows the health care and male attitudes towards Trend analyses time between completion of data collec- women’s autonomy and domestic vio- tion and release of individual-level data Estimating child mortality lence (Table 2). in the public domain. The time for the DLHS-1 and DLHS-2 included e Th information collected on deaths and NFHS and DLHS to release their data questions on the quality of public sec- age at death among all children born to varied between nine and 22 months. tor health services; however, these were ever-married women 15–49 years of age Until recently, only summary data had dropped in subsequent rounds. Several in their lifetime is consistent across all been reported for the AHS rounds. The new themes were added to DLHS-3, rounds of the NFHS, clarifying trends in individual-level data for the three AHS including sex education, age at marriage, child mortality over time using the life- rounds were made available in Novem- infertility, obstetric fistula, knowledge time data on births. In contrast, the data ber 2015, following 29 months of data about reproduction and public sec- on birth histories varied in the different collection for the second update round. tor health programmes; these were DLHS rounds, ranging from the preced- Survey data publications all dropped in DLHS-4. Additional ing 3 years of the survey to lifetime data. information on fertility preferences The AHS baseline round collected birth We identified 600, 95 and 73 publica- and menstruation was documented in history information for the preceding tions resulting from the NFHS, DLHS DLHS-3 and DLHS-4. The husbands’ 3-year period, and the update rounds and AHS respectively. Based on the questionnaire in DLHS-2 collected data captured this information for the pre- review of the title and abstract, 337, on family planning and fertility prefer- ceding year. On assessing the compara- 48 and three publications had used the ences and on STIs and HIV/AIDS. In bility of childhood mortality indicators NFHS, DLHS and AHS data, respec- addition to the core themes of maternal across all rounds of the NFHS, DLHS tively ; we reviewed the full text of these and child health, birth registration was and AHS, analogous estimates can be publications. Data from only NFHS-1 documented in the AHS. generated only for 3 years preceding the were used in 56 articles, data from surveys for currently married women NFHS-2 in 83 articles and data from Anthropometry and biomarkers aged 15–44 years (Table 5). NFHS-3 in 145 articles. The remaining Height and weight were measured for 53 publications used data from two or Estimating maternal mortality children during all rounds of the NFHS, more of the NFHS rounds. Only data though the age varied in the different Comparable estimates of maternal from DLHS-2 and/or DLHS-3 were rounds (Table 4). Height and weight deaths in the 2 years preceding the used in publications. No publication were measured for men and women survey among women aged 15–49 years using DLHS-1 data was identified. One in NFHS-2, NFHS-3 and NFHS-4. are possible using NFHS-1, NFHS-2 publication used AHS baseline survey DLHS-1 and DLHS-3 did not include and NFHS-4, but maternal death data data and two used the first update of any anthropometric measurements. were not collected in NFHS-3. In the the AHS survey data. 290 Bull World Health Organ 2016;94:286–296A| doi: http://dx.doi.org/10.2471/BLT.15.158493 Policy & practice National health surveys in India Rakhi Dandona et al. Table 3. Disease burden categories in major health surveys in India, 1992 to 2016 Survey No. of No. (%) a,b questions Maternal and child Reproductive Reproductive Other adult NCDs Injury health health issues tract infection infections other than infection NFHS NFHS-1 246 123 (50.0) 118 (48.0) 0 (0.0) 3 (1.2) 2 (0.8) 0 (0.0) NFHS-2 294 157 (53.4) 110 (37.4) 15 (5.1) 4 (1.4) 5 (1.7) 3 (1.0) NFHS-3 694 254 (36.6) 313 (45.1) 71 (10.2) 10 (1.4) 22 (3.2) 24 (3.5) NFHS-4 868 278 (32.0) 307 (35.4) 204 (23.5) 12 (1.4) 41 (4.7) 26 (3.0) DLHS DLHS-1 200 105 (52.5) 57 (28.5) 32 (16.0) 6 (3.0) 0 (0.0) 0 (0.0) DLHS-2 315 167 (53.0) 84 (26.7) 61 (19.4) 2 (0.6) 1 (0.3) 0 (0.0) DLHS-3 385 165 (42.9) 153 (39.7) 57 (14.8) 9 (2.3) 1 (0.3) 0 (0.0) DLHS-4 339 186 (54.9) 103 (30.4) 37 (10.9) 2 (0.6) 10 (2.9) 1 (0.3) AHS AHS baseline 137 70 (51.1) 52 (38.0) 2 (1.5) 2 (1.5) 10 (7.3) 1 (0.7) AHS 1st update 207 131 (63.3) 63 (30.4) 3 (1.4) 2 (1.0) 7 (3.4) 1 (0.5) AHS 2nd update 207 131 (63.3) 63 (30.4) 3 (1.4) 2 (1.0) 7 (3.4) 1 (0.5) AIDS: acquired immunodeficiency syndrome; AHS: Annual Health Survey; DLHS: District Level Household Survey; HIV: human immunodeficiency virus; NCD: noncommunicable disease; NFHS: National Family Health Survey. Includes only questions on disease – or condition-specific – and excludes questions on background and sociodemographic characteristics, general health and health care. Based on household, separate questionnaires for women and men. Includes questions on family life education, family planning, fertility and reproductive preferences, and gender status and relations. Includes questions on non-sexually and sexually transmitted infections including HIV/AIDS. inclusion in large-scale national health fully meet the STEPS standardized data Discussion surveys, not having nationwide esti- criteria. Low fruit and vegetable intake The national population-based health mates for the conditions causing major and physical inactivity are not yet being surveys in India started a quarter of a disease burden is problematic. Reliable measured. Among the biological risk century ago with a predominant focus nationwide population-based data on factors besides body mass index (which on maternal and child health, as these major noncommunicable diseases, has been included in most surveys), were considered the most visible and such as ischaemic heart disease, chronic blood pressure and fasting blood glucose prominent health problems at that time. obstructive pulmonary disease, stroke, have been added in the most recent Over this period, the disease burden low-back and neck pain and depression rounds of the national surveys, but has shifted significantly towards non- are scanty in India, as are similar data on blood cholesterol is still not included. communicable diseases. Data from the injuries. Such data are also unavailable Recent national health surveys have only global burden of disease study suggest for tuberculosis and pneumonia. partly addressed these data gaps since that in India in 1990, diseases among Attempts to improve coverage of our previous report, which preceded children younger than 15 years and noncommunicable diseases in national these surveys. maternal disorders accounted for 57% health surveys are a move in the right National health surveys have the of the total disease burden (with about direction, but more could be done. The potential to increase data on disease 60% of this in the first year of life). In surveys could be expanded to meet burden by including biomarker mea- 2013, this burden had decreased to 33% WHO’s criteria for monitoring of non- surements and diagnostic tests. For of total disease burden, while noncom- communicable diseases, the STEPwise example, inclusion of HIV testing in municable diseases made up 52% of the approach to surveillance. This approach NFHS-3 enabled a more accurate es- 24 26,27 total disease burden. However, in the includes standardized data on four timation of HIV prevalence. Rapid 25,28 latest national health surveys, ques- behavioural risk factors (tobacco use, diagnostic tests for tuberculosis tions on noncommunicable diseases alcohol use, low fruit and vegetable and malaria and assays for measuring constituted less than 5% of the total intake and physical inactivity) and four blood lipids in the field could also be questions. Similarly, injuries are barely biological risk factors (body mass index, included. While a detailed assessment represented in national health surveys blood pressure, fasting blood glucose of all major diseases is not feasible in even though these contributed 13% of and blood cholesterol). Among the a single national survey, opportunities the total disease burden in 2013. behavioural risk factors, tobacco and exist for adding additional categories While estimation of disease burden alcohol use are being assessed in na- of information. Some countries use a should not be the only criterion for tional health surveys, but these do not range of clinical and biomarker tests in Bull World Health Organ 2016;94:286–296A| doi: http://dx.doi.org/10.2471/BLT.15.158493 291 Policy & practice Rakhi Dandona et al. National health surveys in India Table 4. Anthropometry and biomarker measurements in three major health surveys in India, 1992 to 2016 Survey Height and weight Blood pressure Blood test for: Anaemia HIV Fasting plasma glucose NFHS NFHS-1 - Children younger Not done Not done Not done Not done than 4 years NFHS-2 - Children younger Not done - Children 6–35 Not done Not done than 3 years months of age - Ever-married women - Ever-married 15–49 years of age women 15–49 years of age NFHS-3 - Children younger Not done - Children 6–59 - Women 15–49 years of Not done than 5 years months of age age in a subsample of - Women 15–49 years - Women 15–49 years households of age of age - Men15–54 years of - Men 15–54 years - Men 15–54 years age in a subsample of of age of age households NFHS-4 - Children younger - Women15–49 - Children 6–71 - Subsample of women - Women15–49 years than 6 years years of age months of age 15–49 years of age of age - Women 15–49 years Men15–54 - Women 15–49 years in a subsample of - Men15–54 years of of age years of age in of age households age in a subsample of - Men 15–54 years a subsample of - Men 15–54 years of - Men 15–54 years of households of age in the households age in a subsample age in a subsample of subsample of of households households households DLHS DLHS-1 Not done Not done Not done Not done Not done DLHS-2 - Children younger Not done - Children younger Not done Not done than 6 years (weight than 6 years of age only) - Girls 10–19 years of age - Currently married pregnant women 15–44 years of age DLHS-3 Not done Not done Not done Not done Not done DLHS-4 - Women, men and - Women and men - Women, men and Not done - Women and men 18 children 1 month or 18 years or older children 6 years or years or more of age older older AHS - Women and men 18 All AHS - Women, men and - Women and - Women, men and Not done years or more of age children 1 month or men 18 years or children 6 months or in a subsample of older in a subsample more of age in older in a subsample households of households a subsample of of households households AHS: Annual Health Survey; DLHS: District Level Household Survey; HIV: human immunodeficiency virus; NFHS: National Family Health Survey. Testing of salt for iodine content was done for all households. Testing of salt for iodine content was done in households that had maternal death. their surveys and some regularly rotate efficient than the resource-intensive time as all births were captured with 40,41 the health and/or disease topics between physician-coding methods. no restriction on reference period. rounds to make each round more man- Comparability of measurements However, the DLHS and AHS rounds 31–39 ageable and frequent. over time and across population groups captured births and/or pregnancies only Reliable cause-of-death data are is fundamental to optimal interpretation for specific reference periods, which 2,42,43 important for informing decision- and use of survey data. Given the varied within and between surveys, makers. India lacks an effective vital enormous amount of data collected in thereby limiting the potential for using registration system that can provide national surveys, we calculated the feasi- all the collected data for this purpose. such data across the country. To in- bility of trends assessment over time for Similarly, the reference period for data crease data on cause of death, auto- child mortality, maternal mortality and on immunization coverage varied within mated algorithms could be used, which immunization between and within these and between the surveys. enable researchers to assign cause of surveys. All rounds of the NFHS had A systematic review reports that death from large-scale verbal autopsy documented birth history consistently, among publications in PubMed con- data. This is both more reliable and allowing for comparable estimates over cerning global demographic and health 292 Bull World Health Organ 2016;94:286–296A| doi: http://dx.doi.org/10.2471/BLT.15.158493 Policy & practice National health surveys in India Rakhi Dandona et al. health in India. We propose that con- Table 5. Birth history data for child mortality, maternal mortality and immunization sultation – similar to the consultative across the three major health surveys in India, 1992 to 2016 development process underpinning the National Health Survey in Brazil Survey Birth history for Maternal mortality Immunization – could improve the design of national child mortality health surveys in India. We have sev- NFHS eral recommendations. First, instead of NFHS-1 All births Women13–49 Last three live births in the having multiple, frequent surveys with years of age in the preceding 4 years overlapping goals, India should have a preceding 2 years single major national health survey at NFHS-2 All births Women 15–49 Last two births in the five-year intervals. This could provide years of age in the preceding 3 years data on additional major causes of preceding 2 years disease burden and their risk factors, NFHS-3 All births Not available All births in the preceding along with cause-of-death data using 5 years automated verbal autopsy methods and NFHS-4 All births Women 12 years of All births in the preceding include adult mortality rate estimation. age in the preceding 5 years The sample sizes should aim to provide 2 years state-level estimates for all indicators and DLHS district-level estimates for crucial indica- DLHS-1 All births in the All women in the Last two surviving children preceding 3 years preceding 3 years born in the preceding tors to capture the key features of health 3 years status heterogeneity across the country. DLHS-2 All births Women 15–44 Last two surviving children Second, data collection on the key vari- years of age in the born in the preceding ables should be standardized to meet preceding 1 year 3 years monitoring standards and to provide DLHS-3 All pregnancies Women 15–49 Last two surviving children comparable data over time. Third, ee ff c - in the preceding years of age in the born in the preceding tive partnerships with a larger range of 3 years preceding 3 years 3 years relevant stakeholders, including the aca- DLHS-4 All pregnancies Women 15–49 Last two surviving children demic community, should be established in the preceding years of age in the born in the preceding to increase the relevance and usefulness 5–6 years preceding 4 years 5–6 years of the data. Fourth, detailed methods AHS should be published. Fifth, individual- AHS baseline All pregnancies Women 15–49 Last two surviving children level data from these surveys should be in the preceding years of age in the born in the preceding made publicly available as soon as pos- 3 years preceding 3 years 3 years sible so that it can be used in the urgent AHS update All pregnancies in Women 15–49 Last two surviving children tasks of informing policy and developing rounds the preceding year years of age in the born in the preceding year preceding 1 year a more effective health system. Sixth, linking household survey data with AHS: Annual Health Survey; DLHS: District Level Household Survey; NFHS: National Family Health Survey. Birth includes only live births; pregnancy includes spontaneous abortions, induced abortions, live births health service use and administrative and still births. data, preferably using geospatial coding methods could be considered. Over time, surveys, there were many using the decreased between the first and third India could also consider a continuous Indian NFHS data. We report 336 rounds of the NFHS and DLHS, but design for its national health survey, with original research publications using increased again for the last round of the advantages for survey management and NFHS data. On the other hand, the DLHS. Part of the reason for this delay timely provision of findings. ■ three DLHS rounds completed to date could be the effort needed to synchro - resulted in only 48 publications. This nize the DLHS-4 data with the AHS Acknowledgements is puzzling, given that DLHS surveys data, as these two surveys are comple- We thank Arti Bhimjiyani and G Anil were designed to provide district-level mentary, with each covering approxi- Kumar. LD is also affiliated with the estimates, whereas the first three NFHS mately half the country’s population. In Institute for Health Metrics and Evalu- rounds, with smaller sample sizes, were any case, such delays in use of a public ation, University of Washington, Seattle, designed only to provide state-level good resource should be avoided. The United States of America. estimates. One of the reasons for the recent availability of individual-level poorer use of DLHS could be that the AHS data on request is a positive step Funding: The Indian Council of Medical data are made available in a format towards increasing the effectiveness of Research, New Delhi, India. AP was sup- which is not user friendly. The AHS has the data. ported by the Wellcome Trust Capacity provided individual-level data in the Building Strategic Award. public domain only very recently, so the Conclusion low number of publications from these Competing interests: None declared. data is not surprising. As national health surveys are resource- The time between completion of intensive, it would be wise to maximize data collection and individual-level data the knowledge gained from them that availability for analysis by researchers could be used to improve population Bull World Health Organ 2016;94:286–296A| doi: http://dx.doi.org/10.2471/BLT.15.158493 293 Policy & practice Rakhi Dandona et al. National health surveys in India صخلم دنلها في ةحصلاب ةينعلما ةينطولا ةيئاصقتسلاا تاساردلل ةعجارم ىوتسلما لىع تانايبلا ةحاتإ في رخأتلا تاترف 4(و ) ؛ةيئاصقتسلاا ةينطولا ةيئاصقتسلاا تاساردلا نم ةديدع تلاوج تضختم ةعوبطم 337 انددحو .اهليلتح ضرغب ةماعلا ةيكلملل يدرفلا .1992 ماع ذنم دنلها في تانايبلا نم لئاه مك لىإ لصوتلا نع ةحصب ةينعلما ةينطولا ةيئاصقتسلاا ةساردلا تانايب يتلا مدختست ةيساسلأا ةيحصلا تامولعلما ةنراقمو حشر لىع لمعن اننإو تاعوبطم ثلاثو ةعوبطم 48 تمدختسا ضيقنلا لىعو ،ةسرلأا ،ةماعلا ةيكلملل ةيحصلا تانايبلا ةحاتإ ىدم مييقتو ،اهعجم مت لىع ةيشيعلما سرلأل ةيئاصقتسلاا ةساردلا في ةدراولا تانايبلا طقف ةينطولا ةيئاصقتسلاا ةساردلل جاتن ا لثتم يتلا تاعوبطلما ةعجارمو ةحصلاب ةينعلما ةيونسلا ةيئاصقتسلاا ةساردلاو تاعطاقلما ىوتسم سرلأل ةيئاصقتسلاا ةساردلاو ،) NFHS( ةسرلأا ةحصب ةينعلما رداصلماب ةينطولا ةيئاصقتسلاا تاساردلا ىنغل رظنو .لياوتلا ا لىع ةيئاصقتسلاا ةساردلاو ،) DLHS( تاعطاقلما ىوتسم لىع ةيشيعلما ةطلخ دنلها عضو حترقنو .اهنم ةدافتسا صىقأ ققتح ةمكلحا ضيتقت اياضقلا لىع ءوضلا يقلنAHS ماك .)( ةحصلاب ةينعلما ةيونسلا ةحصلا نع ةدحاو ةيسيئر ةينطو ةيئاصقتسا ةسارد ءارجإ ضرغب تاساردلا ىودج ىوتسم عفرل اهيلإ تافتللاا بجوتست يتلا تاهلجا عم رواشتلاب كلذو ،تاونس سخم غلبت ةلصاف ةينمز ضرلما ةترفب ءبع في يرغتلا تاهاتجا ةبقارمب قلعتي مايف ةيئاصقتسلاا ةيسيئرلا بابسلأا نم ديزلما رملأا اذه لمشي دقو .ةيسيئرلا ةينعلما ،تاباصلإاو ،ةيدعلما يرغ ضارملأا ةيطغت في روصقلا :دنلها في بابسلأا كلذكو ،ابه ةطبترلما ةرطاخلما لماوعو ضرلما ءبعل ةنراقم ءارجإ ةيناكمإ 2(و ) ؛ةيدعلما ةيسيئرلا ضارملأا ضعبو كلذ مت اذإو .نيدشارلا ينب تايفولا لدعم ريدقتو ،ةافولل ةيساسلأا ةيدؤلما تاعوضولماب ةقلعتلما ةيئاصقتسلاا تاساردلا ينب ةطيسب تقولا في تانايب ةساردلا كلت مدقتسف ،يرياعلما يعاري بولسأب ىودعلا دض مهنيصتحو تاهملأاو لافطلأا دنع تايفولا نأشب ةمزلالا تامولعلما ميدقت لجأ نم مادختسلال حلصت بسانلما صرق ) 3(و ؛نمزلا نم تاترف ىدم لىع كلذ تاهاتجا مهفل .ناكسلا ةحص لىع اهراثآ مييقت يرسيتو ةيحصلا تلاخدتلا ءارجلإ تاساردلا ثدحأ ءارجإ تارم ينب ةلصافلا ةينمزلا تاترفلا 摘要 对印度全国健康调查的评审 自 年起，印度展开了多次全国健康调查，从而生 层面的数据用于公共领域内分析有所拖延。我们利 NFHS 337 成大量数据。我们描述并比较收集到的关键健康信息， 用 数据确定了 种出版物，相比之下，分别 DLHS AHS 48 3 评估健康数据在公共领域的可用性，并且评审依据全 利用 和 数据确定的出版物只有 种和 NFHS DLHS 国家庭健康调查 ( )、地区家庭调查 ( ) 和年 种。由于全国调查占用大量资源，因此需谨慎地在最 AHS 度健康调查 ( ) 数据而产生的出版物。我们强调 大程度上发挥其效益。我们建议印度与关键的利害关 需要注意的问题，以提升监控印度疾病负担改变趋势 系人协商，为每隔五年展开一次主要全国健康调查制 方面调查的有用性：( ) 非传染性疾病、受伤和一些 定计划。这可能涵盖疾病负担的额外主要致因和风险 ii 主要传染性疾病的覆盖面不足 ；( ) 以孩子和产妇死 因素，以及死因和成人死亡率评估。如果以标准化的 亡率为关键主题的调查和以免疫力为关键主题的调 方式进行，此类调查将提供及时有用的数据，告知健 查之间的适度可比性，可以了解随时间发展的趋势； 康干预并促进对人口健康影响的评估。 iii iv ( ) 最近几次调查的间隔时间较短；以及 ( ) 让个体 Résumé Examen des enquêtes nationales sur la santé en Inde Les différentes séries d’enquêtes nationales sur la santé menées depuis et (iv) retards dans la mise à disposition des données individuelles pour 1992 en Inde ont généré d’importants volumes de données. Dans analyse dans le domaine public. Nous avons identifié 337 publications cet article, nous décrivons et comparons les informations sanitaires qui utilisaient les données de l’enquête NFHS, contre seulement 48 et clés recueillies, évaluons la disponibilité des données sanitaires dans 3 qui utilisaient respectivement les données de l’enquête DLHS et de le domaine public et examinons les publications issues de l’enquête l’enquête AHS. Étant donné que les enquêtes nationales nécessitent nationale sur la santé des familles (NFHS, National Family Health Survey), d’importantes ressources, il serait prudent d’en optimiser les bénéfices. de l’enquête réalisée auprès des ménages à l’échelle du district (DLHS, Nous suggérons que l’Inde prévoie une seule grande enquête nationale District Level Household Survey) et de l’enquête annuelle sur la santé sur la santé tous les cinq ans, en consultation avec les principaux acteurs (AHS, Annual Health Survey). Nous mettons en avant les questions à concernés. Celle-ci pourrait s’intéresser aux autres causes importantes de traiter pour renforcer l’utilité des enquêtes et pouvoir suivre l’évolution la charge de morbidité et à leurs facteurs de risque, ainsi qu’aux causes de des tendances concernant la charge de morbidité en Inde: (i) intérêt décès, et réaliser une estimation du taux de mortalité des adultes. Si elle insuffisant porté aux maladies non transmissibles, aux blessures et à est effectuée de façon standardisée, cette enquête pourrait fournir des certaines des principales maladies transmissibles; (ii) faible comparabilité données utilisables et récentes permettant d’orienter les interventions entre les enquêtes sur les thèmes essentiels de la mortalité maternelle et en matière de santé et faciliter l’évaluation de leur impact sur la santé infantile et de la vaccination permettant de comprendre les tendances de la population dans le temps; (iii) intervalles courts entre les dernières séries d’enquêtes; 294 Bull World Health Organ 2016;94:286–296A| doi: http://dx.doi.org/10.2471/BLT.15.158493 Policy & practice National health surveys in India Rakhi Dandona et al. Резюме Обзор национальных исследований состояния здоровья в Индии В результате серии национальных исследований состояния между последними раундами исследований; (iv) запоздалый здоровья, проводимых в Индии с 1992 года, было получено переход данных индивидуального уровня в общественное огромное количество информации. В статье описываются и достояние для их анализа. Были определены 337 публикаций, сравниваются основные полученные сведения о состоянии основывающихся на данных NFHS. Для сравнения: лишь здоровья, оценивается доступность подобных сведений, 48 и 3 публикации были составлены на основании данных DLHS находящихся в общественной собственности, и анализируются и AHS соответственно. Поскольку для проведения национальных публикации, составленные на основе данных Национального исследований требуются значительные ресурсы, целесообразно исследования состояния здоровья семей (NFHS), Окружного извлекать из них максимальную пользу. Авторы статьи предлагают исследования домашних хозяйств (DLHS) и Ежегодного Индии разработать единое крупное национальное исследование исследования состояния здоровья (AHS). На первый план состояния здоровья населения, которое проводилось бы с выдвигаются проблемы, которые требуют внимания и интервалом в пять лет при консультативной поддержке со решение которых позволит повысить практическую ценность стороны основных заинтересованных лиц. Такое исследование исследований для отслеживания меняющихся тенденций в могло бы охватить ряд основных причин бремени заболевания бремени заболеваний в Индии. В их число входят: (i) недостаточный и их факторы риска, а также причины смерти и оценку уровня охват неинфекционных заболеваний, травм и некоторых смертности взрослого населения. Такое исследование, основных инфекционных заболеваний; (ii) недостаточная проводимое в соответствии с единым стандартом, позволило сопоставимость исследований на такие основные темы, как бы получать ценную и актуальную информацию, необходимую детская и материнская смертность и иммунизация, для понимания для мероприятий здравоохранения и упрощающую оценку их тенденций во временной динамике; (iii) небольшие интервалы влияния на здоровье населения. Resumen Una revisión de las encuestas nacionales de salud en India Varias rondas de encuestas nacionales de salud han generado una encuestas más recientes; y (iv) retrasos para obtener datos individuales gran cantidad de datos en India desde 1992. Se describe y compara la para analizar en el dominio público. Se identificaron 337 publicaciones información sanitaria fundamental recopilada, se evalúa la disponibilidad utilizando datos de la NFHS, en contraste con las 48 y 3 publicaciones de datos sanitarios de dominio público y se revisan publicaciones que utilizaban datos de la DLHS y la AHS, respectivamente. Puesto que las derivadas de la Encuesta Nacional de Salud Familiar (NFHS, por sus siglas encuestas nacionales exigen gran cantidad de recursos, sería prudente en inglés), la encuesta de las Instalaciones a Nivel de Distrito (DLHS, por multiplicar sus beneficios. Nuestra sugerencia es que India planifique sus siglas en inglés) y la Encuesta Anual de Salud (AHS, por sus siglas en una única encuesta nacional sobre salud en intervalos de cinco años inglés). Se destacan los asuntos que requieren atención para mejorar la en consulta con las principales partes interesadas. Esto podría abarcar utilidad de las encuestas en cuanto al control del cambio de tendencias más causas principales de las enfermedades y sus factores de riesgo, de las enfermedades en India: (i) cobertura inadecuada de enfermedades así como las causas de muerte y el cálculo de las tasas de mortalidad no contagiosas, daños y algunas enfermedades contagiosas importantes; adulta. Si se realiza de forma estandarizada, dicha encuesta puede ofrecer (ii) modesta comparación entre encuestas sobre temas fundamentales información útil y oportuna para informar sobre intervenciones sanitarias de mortalidad infantil y materna e inmunización para comprender las y facilitar la evaluación de su impacto en la salud pública. tendencias a lo largo del tiempo; (iii) intervalos cortos entre las rondas de References 1. Everybody’s business: strengthening health systems to improve health 7. The DHS program [Internet]. Rockville: United States Agency for outcomes: WHO’s framework for action. Geneva: World Health Organization; International Development; Available from: http://www.dhsprogram.com/ 2007. Available from: http://www.who.int/healthsystems/strategy/ [cited 2016 Jan 7]. everybodys_business.pdf?ua=1 [cited 2015 Mar 21]. 8. National family health survey, India [Internet]. Mumbai: International 2. AbouZahr C, Boerma T. Health information systems: the foundations of Institute for Population Sciences (IIPS) and Macro International; 2009. public health. Bull World Health Organ. 2005 Aug;83(8):578–83. PMID: Available from: http://www.rchiips.org/nfhs/ [cited 2014 Dec 18]. 16184276 9. National family health survey (NFHS-1) 1992–93 [Internet]. Mumbai: 3. Boerma JT, Stansfield SK. Health statistics now: are we making the right International Institute for Population Sciences (IIPS) and Macro investments? Lancet. 2007 Mar 3;369(9563):779–86. doi: http://dx.doi. International; 2009. Available from: http://www.rchiips.org/nfhs/nfhs1. org/10.1016/S0140-6736(07)60364-X PMID: 17336655 shtml [cited 2014 Dec 18]. 4. Stansfield SK, Walsh J, Prata N, Evans T. Information to improve decision 10. National family health survey (NFHS-2) 1998–99 [Internet]. Mumbai: making for health. In: Jamison DT, Breman JG, Measham AR, Alleyne G, International Institute for Population Sciences (IIPS) and Macro Claeson M, Evans DB, et al., editors. Disease control priorities in developing International; 2009. Available from: http://www.rchiips.org/nfhs/nfhs2. countries. Washington: The International Bank for Reconstruction and shtml [cited 2014 Dec 18]. Development and The World Bank; 2006. 11. National family health survey (NFHS-3) 2005–06 [Internet]. Mumbai: 5. Framework and standards for country health information systems. Geneva: International Institute for Population Sciences (IIPS) and Macro World Health Organization; 2008. Available from: http://www.who.int/ International; 2009. Available from: http://www.rchiips.org/nfhs/nfhs3. healthmetrics/documents/hmn_framework200803.pdf [cited 2015 March 21]. shtml [cited 2014 Dec 18]. 6. Raban MZ, Dandona R, Dandona L. Essential health information available 12. National family health survey (NFHS-4) 2012–14 [Internet]. Mumbai: for India in the public domain on the internet. BMC Public Health. International Institute for Population Sciences (IIPS) and Macro 2009;9(1):208. doi: http://dx.doi.org/10.1186/1471-2458-9-208 PMID: International; 2009. Available from: http://www.rchiips.org/nfhs/nfhs4. 19563626 shtml [cited 2014 Dec 18]. Bull World Health Organ 2016;94:286–296A| doi: http://dx.doi.org/10.2471/BLT.15.158493 295 Policy & practice Rakhi Dandona et al. National health surveys in India 13. District level household & facility survey (reproductive & child health 29. Malaria rapid diagnostic tests [Internet]. Geneva: World Health Organization; project) [Internet]. Mumbai: International Institute for Population Sciences. 2016. Available from: http://www.who.int/malaria/areas/diagnosis/rapid- Available from: www.rchiips.org [cited 2014 Dec 18]. diagnostic-tests/en/ [cited 2015 Dec 20]. 14. District level household & facility survey (DLHS-1) [Internet]. Mumbai: 30. Plüddemann A, Thompson M, Price CP, Wolstenholme J, Heneghan C. International Institute for Population Sciences. Available from: http://www. Point-of-care testing for the analysis of lipid panels: primary care diagnostic rchiips.org/ARCH-1.html [cited 2014 Dec 18]. technology update. Br J Gen Pract. 2012 Mar;62(596):e224–6. doi: http:// 15. District level household & facility survey (DLHS-2) [Internet]. Mumbai: dx.doi.org/10.3399/bjgp12X630241 PMID: 22429442 International Institute for Population Sciences. Available from: http://www. 31. Australian health survey 2011–13 [Internet]. Canberra: Australian rchiips.org/ARCH-2.html [cited 2014 Dec 18]. Bureau of Statistics; 2015. Available from: http://www.abs.gov.au/ 16. District level household & facility survey (DLHS-3) [Internet]. Mumbai: australianhealthsurvey [cited 2015 Jan 28]. International Institute for Population Sciences. Available from: http://www. 32. Canadian community health survey - annual component [Internet]. Ottawa: rchiips.org/ARCH-3.html [cited 2014 Dec 18]. Government of Canada; 2015. Available from: http://www23.statcan.gc.ca/ 17. District level household & facility survey (DLHS-4) [Internet]. Mumbai: imdb/p2SV.pl?Function=getSurvey&SDDS=3226 [cited 2015 Jan 281]. International Institute for Population Sciences. Available from: http://www. 33. Health survey for England (HSE) [Internet]. London: The Health & Social Care rchiips.org/DLHS-4.html [cited 2014 Dec 18]. Information System; 1999–2016. Available from: https://www.ucl.ac.uk/ 18. Annual health survey bulletin 2010–11. New Delhi: Office of Registrar hssrg/studies/hse [cited 2015 Jan 29]. General & Census Commissioner, Ministry of Home Affairs, Government of 34. New Zealand health survey [Internet]. Wellington: Ministry of Health; 2015. India; 2011. Available from: http://www.censusindia.gov.in/vital_statistics/ Available from: http://www.health.govt.nz/nz-health-statistics/national- AHSBulletins/files/AHS%20bulletinppt.pdf [cited 2014 Dec 18]. collections-and-surveys/surveys/current-recent-surveys/new-zealand- 19. Annual health survey (AHS) factsheet 2010–11 [Internet]. New Delhi: Office health-survey [cited 2015 Jan 28]. of Registrar General & Census Commissioner, Ministry of Home Affairs, 35. The Korea national health and nutrition examination survey (KNHANES) Government of India; 2010–2011. Available from: http://www.censusindia. [Internet]. Seoul: Korea Centers for Disease Control and Prevention; gov.in/vital_statistics/AHSBulletins/Factsheets.html [cited 2014 Dec 18]. Available from: https://knhanes.cdc.go.kr/knhanes/eng/index.do [cited 20. Annual health survey (AHS) factsheet 2011–12 [Internet]. New Delhi: Office 2015 Jan 28]. of Registrar General & Census Commissioner, Ministry of Home Affairs, 36. National health and nutrition examination survey (NHANES) [Internet]. Government of India; 2010–2011. Available from: http://www.censusindia. Atlanta: Centers for Disease Control and Prevention; 2014. Available from: gov.in/vital_statistics/AHSBulletins/AHS_Factsheets_2011_12.html [cited http://www.cdc.gov/nchs/nhanes/about_nhanes.htm [cited 2015 May 13]. 2014 Dec 18]. 37. National health survey 2013 (PNS) [Internet]. Brasilia: IBGE; 2016. Available 21. Annual health survey (AHS) factsheet 2012–13 [Internet]. New Delhi: Office from: http://www.saladeimprensa.ibge.gov.br/en/noticias?view=noticia&id of Registrar General & Census Commissioner, Ministry of Home Affairs, =1&busca=1&idnoticia=2445 [cited 2015 Jan 29]. Government of India; 2010–2011. Available from: http://www.censusindia. 38. China health and nutrition survey [Internet]. Chapel Hill: Carolina Population gov.in/vital_statistics/AHSBulletins/AHS_Factsheets_2012_13.html [cited Center and the National Institute of Nutrition and Food Safety; 2016. 2014 Dec 18]. Available from: http://www.cpc.unc.edu/projects/china [cited 2015 Jan 29]. 22. Surveillance of noncommunicable diseases: report of a WHO Meeting. 39. The South African national health and nutrition examination survey Geneva: World Health Organization; 2009. Available from: http://www.who. SANHANES-1 [Internet]. South Africa: Human Sciences Research Council; int/nmh/events/2009/meeting_report_20090822.pdf [cited 2015 March 24]. 2012. Available from: http://www.hsrc.ac.za/en/research-data/view/6493 23. Raban MZ, Dandona R, Dandona L. Availability of data for monitoring [cited 2015 Jan 28]. noncommunicable disease risk factors in India. Bull World Health Organ. 40. Verbal autopsy tools [Internet]. Seattle: Institute for Health Metrics and 2012 Jan 1;90(1):20–9. doi: http://dx.doi.org/10.2471/BLT.11.091041 PMID: Evaluation; 2016. Available from: http://www.healthdata.org/verbal- 22271961 autopsy/tools [cited 2015 March 21]. 24. Murray CJ, Barber RM, Foreman KJ, Abbasoglu Ozgoren A, Abd-Allah 41. Interva-4.net [Internet]. Umea: Umea Centre for Global Health Research; F, Abera SF, et al.; GBD 2013 DALYs and HALE Collaborators. Global, Available from: http://www.interva.net [cited 2015 March 21]. regional, and national disability-adjusted life years (DALYs) for 306 42. Mathers CD, Murray CJ, Ezzati M, Gakidou E, Salomon JA, Stein C. diseases and injuries and healthy life expectancy (HALE) for 188 countries, Population health metrics: crucial inputs to the development of evidence 1990–2013: quantifying the epidemiological transition. Lancet. 2015 for health policy. Popul Health Metr. 2003 Apr 14;1(1):6. doi: http://dx.doi. Nov 28;386(10009):2145–91. doi: http://dx.doi.org/10.1016/S0140- org/10.1186/1478-7954-1-6 PMID: 12773210 6736(15)61340-X PMID: 26321261 43. Murray C, Tandon A, Salomon J, Mathers C. Enhancing cross-population 25. Cowling K, Dandona R, Dandona L. Improving the estimation of the comparability of survey results [Global Programme on Evidence for Health tuberculosis burden in India. Bull World Health Organ. 2014 Nov Policy Series, Discussion Paper No 35]. Geneva: World Health Organization; 1;92(11):817–25. doi: http://dx.doi.org/10.2471/BLT.13.129775 PMID: 2000. Available from: www.who.int/evidence [cited 2015 March 9]. 25378743 44. Short Fabic M, Choi Y, Bird S. A systematic review of Demographic and 26. Dandona L, Dandona R. Drop of HIV estimate for India to less than half. Health Surveys: data availability and utilization for research. Bull World Lancet. 2007 Dec 1;370(9602):1811–3. doi: http://dx.doi.org/10.1016/ Health Organ. 2012 Aug 1;90(8):604–12. doi: http://dx.doi.org/10.2471/ S0140-6736(07)61756-5 PMID: 18061043 BLT.11.095513 PMID: 22893744 27. National family health survey (NFHS-3), 2005–06 India. Mumbai, 45. Szwarcwald CL, Viacava F. Planning the national health survey in Brazil. Cad India: International Institute for Population Sciences (IIPS) and Macro Saude Publica. 2010 Feb;26(2):216–7. doi: http://dx.doi.org/10.1590/S0102- International; 2007. pp. 385–409. Available from: http://www.rchiips. 311X2010000200001 PMID: 20396837 org/NFHS/NFHS-3%20Data/VOL-1/Chapter%2012%20-%20HIV%20 46. Clark RG, Templeton R, McNicholas A. Developing the design of a Prevalence%20%28422K%29.pdf [cited 2015 March 15]. continuous national health survey for New Zealand. Popul Health Metr. 28. Vadwai V, Boehme C, Nabeta P, Shetty A, Alland D, Rodrigues C. Xpert 2013;11(1):25. doi: http://dx.doi.org/10.1186/1478-7954-11-25 PMID: MTB/RIF: a new pillar in diagnosis of extrapulmonary tuberculosis? J Clin 24364838 Microbiol. 2011 Jul;49(7):2540–5. doi: http://dx.doi.org/10.1128/JCM.02319- 10 PMID: 21593262 296 Bull World Health Organ 2016;94:286–296A| doi: http://dx.doi.org/10.2471/BLT.15.158493 Policy & practice National health surveys in India Rakhi Dandona et al. Table 6. Time lag for public availability of individual-level data from three major health surveys in India, 1992 to 2016 Survey Data collection Publicly available No. of months between data phase individual-level collection completion and publicly data available individual-level data NFHS NFHS-1 April 1992 to August 1995 22 September 1993 NFHS-2 November 1998 October 2000 9 to December NFHS-3 November 2005 September 2007 12 to August 2006 NFHS-4 March 2015 Data being N/A onwards collected as of February 2016 DLHS DLHS-1 May 1998 to August 2001 21 October 1999 DLHS-2 March 2002 to August 2006 13 June 2005 DLHS-3 December 2007 April 2010 15 to December DLHS-4 August 2012 to December 2015 21 February 2014 AHS AHS baseline July 2010 to November 2015 55 March 2011 AHS 1st update October 2011 to November 2015 42 April 2012 AHS 2nd November 2012 November 2015 29 update to May 2013 AHS: Annual Health Survey; DLHS: District Level Household Survey; N/A: not applicable; NFHS: National Family Health Survey. Bull World Health Organ 2016;94:286–296A| doi: http://dx.doi.org/10.2471/BLT.15.158493 296A
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Bulletin of the World Health Organization – Pubmed Central
Published: Feb 12, 2016