{"doc_desc":{"title":"Ghana Maternal Health Survey 2007","idno":"DDI-GHA-GSS-GMHS-2007-v1.0","producers":[{"name":"Ghana Statiscal Service","abbreviation":"GSS","affiliation":"","role":"Lead documenting institution"}],"prod_date":"2012-07-09","version_statement":{"version":"version 2.0 (January 2013) This document has been reviewed"}},"study_desc":{"title_statement":{"idno":"GHA-GSS-GMHS-2007","title":"Ghana Maternal Health Survey 2007","alt_title":"GMHS 2007"},"authoring_entity":[{"name":"Ghana Statistical Service","affiliation":"Autonomous"}],"production_statement":{"producers":[{"name":"Ministry of Health\/Ghana Health Service","affiliation":"GOG","role":"Releasing staff for secretariat and field work"},{"name":"ICF Macro","affiliation":"USAID","role":"Offered Technical Assistance "}],"funding_agencies":[{"name":"United States Agency for International Development","abbreviation":"USAID","role":"Provided funds for the survey"}],"grant_no":"-"},"distribution_statement":{"contact":[{"name":"Government Statistician","affiliation":"Ghana Statistical Service","email":"info@statsghana.gov.gh ","uri":"http:\/\/www.statsghana.gov.gh\/ContactUs.html"}]},"series_statement":{"series_name":"Other Household Health Survey [hh\/hea]","series_info":"This is the first time the Maternal Health Survey has been implemented in Ghana."},"version_statement":{"version":"v2.0 - Public use dataset and other documentation on the Ghana Maternal Health Survey.","version_date":"2012-07-09","version_notes":"This is the first time the Maternal Health Survey has been implemented in the country. The project started with the name Maternal Mortality Survey before it was changed to Maaternal Health Survey"},"study_info":{"keywords":[{"keyword":"Mortality","vocab":"","uri":""}],"topics":[{"topic":"Childbearing, Family Planning and Abortion [8.2]","vocab":"CESSDA","uri":"http:\/\/www.nesstar.org\/rdf\/common"}],"abstract":"The principal objective of the 2007 Ghana Maternal Health Survey (GMHS) is intended to serve as a source of data on maternal health and maternal death for policymakers and the research community involved in the Reducing Maternal Morbidity and Mortality (R3M) program.\nSpecifically, the data collected in the GMHS is intended to help the Government of Ghana and the consortium of organizations participating in the R3M program to launch a series of collaborative efforts to significantly expand women's access to modern family planning services and comprehensive abortion care (CAC), reduce unwanted fertility, and reduce severe complications and deaths resulting from unsafe abortion.\nThe GMHS collected data from a nationally representative sample of households and women of reproductive age (15-49). The data were collected in two phases. The primary objectives of the 2007 GMHS were:\n\u2022 To collect data at the national level that will allow an assessment of the level of maternal mortality in Ghana for the country as a whole, for the R3M program regions (Greater Accra, Ashanti and Eastern Regions), and for the non-program regions;\n\u2022 To identify specific causes of maternal and non-maternal deaths, and specifically to be able to identify deaths due to abortion-related causes, among adult women; \n\u2022To collect data on women\u2019s perceptions and experience with antenatal, maternity, and emergency obstetrical care, especially with regard to care received before, during, and after the termination or abortion of a pregnancy;\n\u2022 To measure indicators of the utilization of maternal health services and especially post-abortion care services in Ghana; and\n\u2022 To provide baseline data for the R3M program and for follow-on studies and surveys that will be used to observe possible reductions in maternal mortality as well as reductions in abortion-related mortality.It also contributes to the ever-growing international database on maternal health-related information.\n\nThe pregnancy-related mortality ratio (PRMR) for the 7-year period preceding the survey, calculated from the sibling history data, is 451 deaths per 100,000 live births and for the 5-year period preceding the survey is 378 deaths per 100,000 live births.Induced\nabortion accounts for more than one in ten maternal deaths and the obstetric risk from induced abortion is highest among young women age 15-24. Although almost all women seek antenatal care from a health professional, only one in two women deliver in a health facility, and three in four women seek postnatal care. Despite the emphasis on continuity of care, less than one in two women receive all three maternity care components (antenatal care, delivery care, and postnatal care) from a skilled provider. Clearly, Ghana has a long way to go towards achieving the MDG-5 target.","coll_dates":[{"start":"2007-10-01","end":"2007-12-31","cycle":"-"}],"nation":[{"name":"Ghana","abbreviation":"GHA"}],"geog_coverage":"National","geog_unit":"Regional","analysis_unit":"Individual","universe":"1. All women age 12-49 years in households and residents in Ghana","data_kind":"Sample survey data [ssd]","notes":"The survey gathered information on maternal health in two phases. Phase I was fielded\nin some 240,000 households to obtain information on deaths in the households and more specifically female deaths. Phase II followed with a verbal autopsy on the causes of deaths for 4,203 women age 12-49 identified in Phase I. In addition, a woman\u2019s questionnaire fielded in Phase II in a sub-sample of households collected information from 10,370 women age 15-49 on a wide range of maternal health-related issues pertaining to pregnancies, live births, abortions and miscarriages, and utilization of health services in relation to these events. Also included in this questionnaire was a sibling history that allowed for the calculation of maternal mortality in\nGhana. The GMHS was conducted to serve as a source of baseline information for the Reducing Maternal Morbidity and Mortality (R3M) program initiated in 2006 in three regions in Ghana: Greater Accra, Ashanti, and Eastern regions. The primary aim of the R3M program was to increase the contraceptive prevalence rate (CPR) by making contraceptive methods and comprehensive abortion care services more available and more highly utilized at all levels of the public and private sectors of the health care system, and to reduce morbidity and mortality due to unsafe abortions."},"method":{"data_collection":{"data_collectors":[{"name":"Ghana Statistical Service","abbreviation":"GSS","affiliation":"Autonomous"},{"name":"Ghana Health Service","abbreviation":"GHS","affiliation":"MOH"}],"sampling_procedure":"To achieve the above-mentioned objectives and to obtain an accurate measure of the causes of maternal\nmortality at the national level, and for the Reducing Maternal Morbidity and Mortality( R3M) regions (Greater Accra, Ashanti and Eastern regions) and other\nregions (Western, Central, Volta, Brong Ahafo, Northern, Upper East and Upper West), 1600 primary sampling\nunits were selected (half from the R3M regions and half from the other regions) within the 10 administrative\nregions of the country, across urban and rural areas. The primary sampling units consisted of wards or subwards\ndrawn from the 2000 Population Census. This sample size was estimated from information in the 2003 Ghana DHS survey; it was expected that each primary sampling unit would yield, on average, 150 households. GSS and GHS enumerators carried out a complete mapping and listing of the 1600 selected clusters. This first phase of data collection yielded a total of 227,715 households. \n\nA short household questionnaire was administered to identify deaths that occurred in the five years preceding the survey to women age 12-49 in each household listed in the selected cluster. In the second phase of data collection a verbal autopsy questionnaire was administered in all households identified in the first phase as having experienced the death of a woman age 12-49. This yielded a total of 4,203 completed verbal autopsy questionnaires. \n\nIn the second phase of fieldwork, 400 clusters were randomly selected from the 1600 clusters identified in the first phase. Households with women age 15-49 were selected from these 400 clusters (half from the R3M regions and half from the other regions) and were stratified by region and urban-rural residence to yield 10,858 completed household interviews and 10,370 individual women's interviews. These households were selected randomly and independently from the households identified in the first phase as having experienced a female death.\n\nInstitutional populations (those in hospitals, army barracks, etc.) and households residing in refugee camps were excluded from the GMHS sample.","sampling_deviation":"No deviation of the original sample design was made","coll_mode":["Face-to-face [f2f]"],"research_instrument":"The GMHS used four questionnaires: (1) a Phase I short household questionnaire administered at\nthe time of listing; (2) a Phase II verbal autopsy questionnaire administered in households identified at listing as\nhaving experienced the death of a female household member age 12-49; (3) a Phase II long-form household\nquestionnaire administered in independently selected households chosen for the individual woman\u2019s interview,\nand (4) a Phase II questionnaire for individual women age 15-49 in the same phase two selected households. The\nprimary purpose of the short household questionnaire administered at the time of listing during Phase I was to\nidentify deaths to women age 12-49, for administering the verbal autopsy questionnaire on the causes of female\ndeaths, particularly maternal deaths and abortion-related deaths. Unique identifiers for households in phase one\nand households in phase two were not maintained; therefore households cannot be matched across both phases\nof the survey.\nDuring the first phase of the survey, all households in each selected cluster were listed and administered\nthe short household questionnaire. This questionnaire was administered to identify households that experienced\nthe death of a female [regular] household member in the five years preceding the survey. The verbal autopsy\nquestionnaire (VAQ) was administered during the second phase of fieldwork in those households in which thefemale who died was age 12-49. The VAQ was designed to collect as much information as possible on the causes\nof all female deaths, to inform the subsequent categorization of maternal deaths, and facilitate specific\nidentification of abortion-related deaths. During the second phase of fieldwork, a longer household\nquestionnaire was administered in the independent subsample of households, to identify eligible women age 15-\n49 for the individual woman\u2019s questionnaire and to obtain some background information on the socioeconomic\nstatus of these women. The individual questionnaire included the maternal mortality module, which allows for\nthe calculation of direct estimates of pregnancy-related mortality rates and ratios based on the sibling history.\nThe individual questionnaire also gathered information on abortions and miscarriages, the utilization of\nmaternal health services and post-abortion care, women\u2019s knowledge of the legality of abortion in Ghana, the\nservices they have utilized for abortion and if not, the reasons they have not been able to access professional\nhealth care for abortions, the places that offer abortion-related care, the persons offering such services, and other\nrelated questions.\nDuring the design of these questionnaires, input was sought from a variety of organizations that are\nexpected to use the resulting data. After preparation of the questionnaires in English, they were translated into\nthree languages: Akan, Ga, and Ewe. Back translations into English were carried out by people other than the\ninitial translators to verify the accuracy of the translations in the three languages to be used. All problems arising\nduring the translations were resolved before the pretest.\nThe translated questionnaires were pretested to detect any problems in the translations or the flow of\nthe questionnaire, as well as to gauge the length of time required for interviews. GSS and GHS engaged 20\ninterviewers for approximately two weeks for the pretest (with proficiency in each of the local languages used in\nthe survey). All the pretest interviewers were trained for two weeks. The pretest interviewing took about one\nweek to complete, during which approximately 30 women were interviewed in each of the local languages. The\npretest results were used to modify the survey instruments as necessary. All changes in the questionnaire after the\npretest were agreed to by GSS, GHS, and Macro. GSS and GHS were responsible for producing a sufficient\nnumber of the various questionnaires for the main fieldwork.\nDuring the pretest and main survey training, experts in the areas of health and family planning were\nidentified by GSS and GHS to provide guidance in the presentation of topics in their fields, as they relate to the\nGMHS questionnaires.\nOther technical documents that were finalized include:\n\u2022 Household listing manual, listing forms and cartographic materials;\n\u2022 Interviewer\u2019s manual;\n\u2022 Supervisor\u2019s manual;\n\u2022 Interviewer and Supervisor\u2019s assignment sheets.","coll_situation":"Ten days training was organized for field staff comprising of 19 supervisor trainees, 58 editor\/interviewer trainees for women questionnaires (WQ) and 25 editor\/interviewer trainees (nurses) for verbal autopsy questionnaires (VAQ). \nThe training took place between 16th and 27th September 2007, 15 teams were constituted for data collection. In all 15 teams were formed, 10 for WQ and 5 for VAQ of which a team is made up of a supervisor, an editor and four interviewers.\nInterviews were conducted in both english and local languages (Akan, Ga & Ewe)\nEffective field monitoring was planned and executed.\nThere was a pre-test of the questionnaire to fine-tune the questionnaires before the main survey.","act_min":"Quality control was assured through supervision and monitoring of teams during fieldwork. Team\nsupervisors and editors were responsible for the performance of their teams. Work sessions were held frequently\nwithin each team (on a daily basis during fieldwork), with the goal of reinforcing the training received and\ncorrecting data collection errors. In addition to the internal supervision of each field team (by the team\nsupervisor and editor), the GSS and GHS Field Coordinators maintained close contact with the teams under\ntheir responsibility. Several Macro staff also travelled to Ghana over the course of the fieldwork to observe the\nprogress and to monitor the quality of data collection. In addition, a set of field control tables (data quality\ntables) were run at GSS every two weeks on the questionnaires that had been captured into the computers as of\nthat time. These tables were specially designed to detect systematic errors made by individual interviewers and\nspecific interviewing teams. Data collection errors detected during fieldwork were discussed with the appropriate\ninterviewers and interviewing teams to ensure that the problems did not persist.","weight":"Sample weights were calculated for each of the data files. Sample weights for the household data, women data and sister answered data were computed as the inverse of the probability of selection of the household, women and sistered answered data computed at the sampling domain (urban\/rural within each region). The weights were adjusted for non-response at the domain level and were then normalized by a constant factor so that the total weighted number of cases equals the total unweighted number of cases.","cleaning_operations":"Data editing took place at a number of stages throughout the processing, including \na) office editing and coding\nb) during data entry\nc) structure checking and completeness\nd) secondary editing\ne) structure checking of SPSS data files\nDetailed documentation of the editing of the data can be found in the edit guidelines documents provided as an external resource.\n\nThe editing guidelines presented in this chapter are concerned only with those checks that must be carried out to verify the internal consistency of responses to questions in the GMMS questionnaires.  The specifications do not cover range or skip checks.  Most of the simpler consistency checks were handled at the data entry stage.  However, the majority of the more complex consistency checks were carried out during a secondary stage of machine editing.  Some checks were repeated both in the data entry and editing stages.  During data entry these checks were used primarily to look for data entry errors.\n\n\tThe consistency edit guidelines included instructions on the steps to take to resolve inconsistencies detected during the editing process as well as the action to take if the inconsistencies cannot be resolved through an examination of the responses to other pertinent questions.  While editing data, the supervisor, the data entry clerk and secondary editor were to REVIEW ALL OF THE PERTINENT QUESTIONS INVOLVED IN A SKIP ERROR OR AN INCONSISTENCY before making a change.  Changes were never be made in a rote manner without a thorough review of all relevant responses.\n\n\tWhen an error message appears during data entry, the data entry operator checked the question entered and the preceding questions, going back to previous pages and ensuring no data entry error had been made.  The operator also went  back to the related questions mentioned in the error message, to verify that no typing mistake was made in any question.  If no keying error was made, the operator request that the data entry supervisor to resolve the problem.\n\n\tDuring the data-editing phase, the process was organized in such a way as to maximize consistency in the correcting process.  Care was taken to ensure that all procedures were followed in a standard manner.  Each of the editing rules was applied in accordance with the guidelines.  All of the computer outputs specifying the errors detected at this stage were retained.\n\n\tThe editing staff made sure that all changes made to the data file on the computer were noted in the questionnaire with a GREEN pen.  Use of green pens  allowed corrections made by office staff to be distinguished from those made by the interviewers (blue\/black pen) and the field editors (red pen).  All corrections to the data were noted on the original questionnaire by crossing through the original response with a single line and writing the new response next to it.\n\n\tThe editing phase of the machine processing of the GMMS data began immediately after the verification of the questionnaires has been completed for a particular sample point.  The editing process was then be repeated for the sample point until no further errors were detected.\n\n\tSupervision at this stage ensured that the rules outlined below for correcting inconsistencies are applied uniformly and that errors, which recur across questionnaires were corrected in a standardized manner.  Again, the primary rule of data editing whether in the field or office were observed: UNDER NO CIRCUMSTANCES SHOULD AN ANSWER BE MADE UP.  Changes were made only if there was evidence supporting a modification to the response.  If an inconsistent value could not be corrected and a modification was required, the value was replaced with a code signifying inconsistency (7, 97 or 997).  Care was taken not to confuse the 7 codes (used to replace an inconsistent response that cannot be corrected) with the 8 (98 or 998) codes (used by the interviewer to indicate that the respondent answered a question with the statement, \"I don't know\") or with the 9 (99 or 999) codes (used in cases of skip errors where the respondent was not asked a question or refused to answer a question to which she should have responded).\n\n\tFinally, the editing phase for the GMMS data necessitated close involvement of the survey coordinator as well as other senior project staff.  Resolving inconsistencies in the responses, particularly those involving date and interval information, required a detailed understanding of the nature and overall objectives of the survey questionnaire as well as the interrelationships among specific questions.  The data processing staff itself ordinarily will not include personnel with this background or expertise.  Consequently, the data editing at this phase were organized so as to encourage close interaction between the survey's technical staff and the data processing personnel.","method_notes":"The data were processed on microcomputers using CSPro. Data processing,including training of data entry personnel, began in October 2007 and was completed by the end of January 2008. Additional data entry of the first phase household questionnaires was completed in September 2008. The processing operation consisted of office editing, coding of open-ended questions, data entry, and resolving inconsistencies found by the computer edit programs.\nData were processed in clusters, with each cluster being processed as a complete unit through each stage of data processing.  Each cluster goes through the following steps:\n1) Questionnaire reception\n2) Office editing and coding\n3) Data entry\n4) Structure and completeness checking\n5) Verification entry\n6) Comparison of verification data\n7) Back up of raw data\n8) Secondary editing\n9) Edited data back up\nAfter all clusters are processed, all data is concatenated together and then the following steps are completed for all data files:\n10) Export to SPSS in 4 files (hh - household, wm - women, va - verbal authopsy)\n11) Recoding of variables needed for analysis\n12) Adding of sample weights\n13) Calculation of wealth quintiles and merging into data\n14) Structural checking of SPSS files\n15) Data quality tabulations\n16) Production of analysis tabulations\n \nDetails of each of these steps can be found in the data processing documentation, data editing guidelines, data processing programs in CSPro and SPSS, and tabulation guidelines.\n\nData entry was conducted by 12 data entry operators in tow shifts, supervised by 2 data entry supervisors, using a total of 7 computers (6 data entry computers plus one supervisors' computer).  All data entry was conducted at the GenCenStat head office using manual data entry.  For data entry, CSPro version 4.0 was used with a highly structured data entry program, using system controlled approach that controlled entry of each variable.  All range checks and skips were controlled by the program and operators could not override these.  A limited set of consistency checks were also included in the data entry program. Open-ended responses in the verbal authopsy questionnaires were recoded, except in rare circumstances where the response matched an existing code in the questionnaire.   \n\nStructure and completeness checking ensured that all questionnaires for the cluster had been entered, were structurally sound, and that women's  questionnaires existed for each eligible woman. \n100% verification of all variables was performed using independent verification, i.e. double entry of data, with separate comparison of data followed by modification of one or both datasets to correct keying errors by original operators who first keyed the files. \n\nAfter completion of all processing in CSPro, all individual cluster files were backed up before concatenating data together using the CSPro file concatenate utility.\nFor tabulation and analysis SPSS versions 11.0 used.  \nAfter transferring all files to SPSS, certain variables were recoded for use as background characteristics in the tabulation of the data, including grouping age, education, geographic areas as needed for analysis.  In the process of recoding ages and dates some random imputation of dates (within calculated constraints) was performed to handle missing or \"don't know\" ages or dates."},"analysis_info":{"response_rate":"A total of 11,579 households were selected for the sample, of which 10,994 were occupied at the time of the survey and 10,858 (or 99 percent) were successfully interviewed. The difference is primarily due to dwellings being vacant or the inhabitants being gone\nfor an extended period at the time of the survey. In the interviewed households, 10,627 women were identified as eligible for the individual interview (women age 15-49), and interviews were completed for 10,370, or 98 percent. The principal reason for nonresponse among eligible women was the failure to find them at home, despite repeated visits to the household. The refusal rate was low in both urban and rural areas.","sampling_error_estimates":"Sampling errors were computed on specific variables. Please refer to pages 141-156 of the main report  attached as external resource."}},"data_access":{"dataset_use":{"conf_dec":[{"txt":"Ghana Statistical Service (GSS) requires all users to keep information and microdata strictly confidential. In this regard, before being granted access to microdatasets, all users have to formally agree to observe the following:\n\n1. Not to make copies of any files or portions of files to which access has been granted except with the authorization by GSS\n\n2. Not to willfully identify any individual or household or establishment in the microdataset\n\n3. To hold in strictest confidence, the identity of any individual or household or establishment that may be inadvertently revealed in any documents or discussion, or analysis. Such unintended identification revealed should be immediately brought to the attention of GSS.\n\n4. Microdata obtained from GSS are protected by copyright law and therefore not for re-distribution or sale\n\n5. Prospective clients or data users may be required to submit and sign an affidavit of confidentiality of microdata they access","required":"yes","form_no":"","uri":""}],"contact":[{"name":"Govenment Statistician","affiliation":"Government of Ghana","email":"info@statsghana.gov.gh ","uri":"http:\/\/www.statsghana.gov.gh\/ContactUs.html"}],"conditions":"The Ghana Statistical Service as a public institution has the obligation to promote data dissemination to facilitate national development. Making mcrodata available will enable students and the academia to conduct research works, assist investors to take business decision, help the individual to evaluate and take appropriate decisions. It will also assist the government to formulate appropriate policies and programmes to facilitate national development. GSS' policy framework provides access to data through:\n\n1. Public use files. These categories of data sets are accessible by all without any payment. They are available on-line to all interested users, for research and statistical purposes only. \n\n2. Licensed datasets. These categories of data sets are accessible under certain conditions. Thus, prospective clients\/data users may access any data based on certain conditions set by the GSS\n\n3. Datasets only accessible on location. We consider this category as a data enclave where some data sets are only accessible at GSS offices and prospective data users and researches have to physically be available at GSS offices for further discussions before data are released. Thus, data enclave would not be linked to the outside world through our web site or other medium. \n\nThe following terms and conditions apply: \n\nBefore being granted access to the dataset, all users have to formally agree: \n\n1. To make no copies of any files or portions of files for which access has been granted, except those authorized by GSS. \n\n2. Not to use any technique in an attempt to identify any person, establishment, or sampling unit. \n\n3. To hold in strictest confidence, the identification of any establishment or individual that may be inadvertently revealed in any documents or discussion, or analysis. Such inadvertent identification revealed in her\/his analysis will be immediately brought to the attention of the GSS.\n\n4. The data and other materials will not be redistributed or sold to other individuals, institutions, or organizations without the written agreement of GSS.\n\n5. The data will be used for statistical and scientific research purposes only.\n\n6. The data will be used solely for reporting of aggregated information, and not for investigation of specific individuals or organizations.\n\n7. No attempt will be made to identify respondents, and no use will be made of the identity of any person or establishment discovered inadvertently. Any such discovery would immediately be reported to the GSS.\n\n8. No attempt will be made to produce links among datasets provided by the GSS with other datasets that could identify individuals or organizations.\n\n9. Any books, articles, conference papers, theses, dissertations, reports, or other publications that employ data obtained from the GSS would cite the source of data in accordance with the citation statement provided with the dataset\n\n10. An electronic copy of all reports and publications based on the requested data will be sent to the GSS.","disclaimer":"The original collector of the data, GSS and any producers or sponsors cited in this document bear no responsibility for use of the data or for interpretations or inferences based upon such uses."}}},"schematype":"survey"}