Iraq Family Health Survey - Methods

Methods

The Iraq Family Health Survey (IFHS) was a cross-sectional, nationally representative survey of 9345 households that was conducted by relevant federal and regional ministries in Iraq in collaboration with the World Health Organization (WHO). The sampling frame that was used in the southern and central provinces was derived from the 1997 Iraq census, which had been updated for the 2004 Iraq Living Conditions Survey. The sampling frame used in Kurdistan was based on information provided by the Statistical Offices in the region. Population estimates for Iraq for the survey period were projected by Iraq's Central Organization for Statistics and Information Technology (COSIT).

Training of central and local supervisors from all 18 governorates was conducted in Amman, Jordan. Training of interviewers was done separately in each governorate for one week during May and June 2006 and a one day refresher training session was conducted the day before the start of the survey in each governorate. Following interviewer training, the survey instruments and procedures were pilot tested in all governorates. The survey fieldwork was conducted during August and September 2006 in the 14 South/Centre governorates. In Anbar governorate, the fieldwork was conducted in October and November 2006, while fieldwork for the Kurdistan region was conducted during February and March 2007. Overall, 407 personnel participated in the implementation of the survey, consisting of 100 central, local and field supervisors, 224 interviewers evenly split between males and females, and 83 central editors and data entry personnel.

The survey had an original target sample size of 10,080 households. Interviewers visited 89.4% of 1086 household clusters during the study period and the household response rate was 96.2%. 115 clusters (10.6%) were not visited due to security problems. The IFHS argues that past mortality is likely to be higher in these missed clusters. Ratios derived from comparing their surveyed clusters to corresponding data from Iraq Body Count were used to impute elevated mortality rates to these missed clusters. Using this method, the IFHS derives death rates for the missed clusters in Baghdad that are 4.0 times as high as the clusters visited by the survey in Baghdad. The same procedure in Anbar derived rates that are 1.7 times as high as clusters visited in Anbar.

The IFHS also argues that underreporting is likely to be common in household surveys, particularly due to household dissolution after the death of a household member. On this basis the authors used several demographic assessments such as the growth balance method to derive an adjustment for reporting bias. This adjustment raised the violence-related death rate by roughly 50%, from 1.09 (95% CI, 0.81 to 1.50) to 1.67 (95% uncertainty range 1.24 to 2.30).

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