Abstract
Due to an urgent need for information on the coverage of health service for women and children after the fall of Taliban regime in Afghanistan, a multiple indicator cluster survey (MICS) was conducted in 2003 using the outdated 1979 census as the sampling frame. When 2004 pre-census data became available, population-sampling weights were generated based on the survey-sampling scheme. Using these weights, the population estimates for seven maternal and child healthcare-coverage indicators were generated and compared with the unweighted MICS 2003 estimates. The use of sample weights provided unbiased estimates of population parameters. Results of the comparison of weighted and unweighted estimates showed some wide differences for individual provincial estimates and confidence intervals. However, the mean, median and absolute mean of the differences between weighted and unweighted estimates and their confidence intervals were close to zero for all indicators at the national level. Ranking of the five highest and the five lowest provinces on weighted and unweighted estimates also yielded similar results. The general consistency of results suggests that outdated sampling frames can be appropriate for use in similar situations to obtain initial estimates from household surveys to guide policy and programming directions. However, the power to detect change from these estimates is lower than originally planned, requiring a greater tolerance for error when the data are used as a baseline for evaluation. The generalizability of using outdated sampling frames in similar settings is qualified by the specific characteristics of the MICS 2003-low replacement rate of clusters and zero probability of inclusion of clusters created after the 1979 census.
Highlights
The Afghanistan Ministry of Public Health (MoPH) initiated a strategy to reconstruct the health system in 2002 with a focus on laying “the foundations for equitable, quality health care for the people of Afghanistan” [1]
Among the four indicators relating to the coverage of health services for children, the widest range of differences between weighted and unweighted estimates was for the percentage of children, aged less than five years, who did not receive BCG immunization
The sampling weights generated based on the 2004 precensus data improved the generalizability of the results for the population living in Afghanistan in 2003
Summary
The Afghanistan Ministry of Public Health (MoPH) initiated a strategy to reconstruct the health system in 2002 with a focus on laying “the foundations for equitable, quality health care for the people of Afghanistan” [1]. In the post-Taliban period, the first population-based health survey of national scope was conducted by the United Nations Children’s Fund (UNICEF) and the Central Statistics Office (CSO) for the MoPH in 2003. This Multiple Indicator Cluster Survey (MICS) used data of the outdated population census from 1979 for sampling of households. This pragmatic decision was guided by the lack of a national census since 1979 and the urgent need to collect information on the coverage of health services across the country [2]. Questions persisted about the accuracy of the 2003 MICS estimates, given the substantial changes that occurred
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