MOH Metadata

Citation

Citation

References

1. 1. 1. Questionnaire(s)
         1. Household
         2. Individual
         3. Screening Form
      2. Training Manual(s)
         1. Interviewer
         2. Interviewer – CAPI
         3. Editor
         4. Supervisor
         5. Nurse/Phlebotomist
         6. Code Book
      3. Administrative Report
      4. Scope – Summary Data Description
      5. Methodology – Data Collection and Processing
      6. Sampling
      7. Accessibility

Producers & Sponsors

Statistical Institute of Belize (SIB), Ministry of Health (MoH), Taiwan (ICDF)

Primary Investigator(s)

Statistical Institute of Belize, MoH

Other Producer(s)

International Cooperation Development Fund (ICDF), Taiwan, Technical Assistance in questionnaire designInternational Cooperation Development Fund (ICDF), Taiwan, Technical Assistance in training and data processingMinistry of Health (MOH), Belize, Technical Assistance in questionnaire design

Funding Agency/ies

International Cooperation Development Fund (ICDF), Main funder Statistical Institute of Belize (SIB), Funding in kind Ministry of Health (MoH), Funding in kind

Overview

Type                Survey of Risk Factors for Chronic Disease, Belize, 2017

Version           Production Date:         2017-02-07

Series:             A one-off survey

The Survey of Risk Factors for Chronic Kidney Disease (SRFCKD) is a 10,000 household survey that was conducted at the request of the Ministry of Health (MoH) with the support of the International Cooperation Development Fund (ICDF). The Statistical Institute of Belize served as the implementing agency for the survey, with responsibility for designing the sample, testing and finalizing the questionnaires, planning and conducting the data collection, and producing a final, anonymized data set.

Kind of Data:	Sample survey data
Unit of Analysis:	Households, Persons 20 to 55 years old

Scope: The Survey of Risk Factors for Chronic Kidney Disease consisted of two components carried out by a team that consisted of the SIB’s field staff and the MoH’s trained employees. These components were:

Component 1: Questionnaires

Household Questionnaire:

This questionnaire collected socio-demographic information and was used by the interviewer to identify household members who were eligible (20 to 55 years old) for the Individual Questionnaire. Individual Questionnaire:After all eligible respondents (20 to 55 years old) were identified, an Individual Questionnaire was administered to each of these persons. This questionnaire collected information on the persons’ job and exposure to chemicals, self-perceived health status, history of diseases, health behavior, and usage of medical services. 

Component 2: Screening

On site:

After each eligible household member was interviewed, he/she was asked by the nurse in the team for his/her written consent to participate in the screening exercise which entailed the following:

• A nurse taking the measurements of the individual such as the height, weight, and waist size.
• A blood sugar test, blood pressure test and urine test was performed by the nurse on-site.
• A phlebotomist then took a sample of the individual’s blood which was then delivered to the designated laboratory in the region.

Analysis in lab:

The blood sample of each individual was analyzed to obtain measurements such as cholesterol, urea and creatinine levels.

PAPI

The paper form of the data collection instruments consisted of two questionnaires; one for the household, and one for individuals 20 to 55 years old. The following modules were included in the questionnaires:

Table 2
Household Questionnaire Content, SRFCKD

Abbreviation	Name of Module
HL	Household Listing
ED	Educational Achievement (20-55 years)

Table 3
Individual Questionnaire Content, SRFCKD

Abbreviation	Name of Module
IB	Individual Background
ES	Employment
SP	Self-perceived Health Status
HD	History of Disease
HB	Health Behavior
MS	Usage of Medical Services

 

Additionally, a Screening Form was designed to complement the Individual Questionnaire; it was used to record the respondent’s physical and biochemical measurements. 

Household Questionnaire 

 To be administered to one knowledgeable member of the selected household.   

Data collected: 

1. List of all members of the household
2. Socio-demographic information such as age, sex, ethnicity, and educational attainment
3. Properly identify all members within each household who were eligible for the Individual Questionnaire (20-55 years).  

 Individual Questionnaire 

 All members of the household 20 to 55 years were considered eligible for the Individual questionnaire.  

Modules were designed to capture information on the different risk factors related to chronic kidney disease.

Screening Form 

Designed for all eligible respondents after the Individual Questionnaire was administered.  

Screening Form Content 

1. Recorded the results of the onsite tests conducted in the screening component. 
2. Verified the receipt of a blood sample.  
3. Captured the household identification information. 
4. Provided an informed consent signature line.
5. Incorporated skip instructions for a smooth transition of the screening process. 

 Translation of PAPI Questionnaires  

Spanish paper versions of the Household and Individual questionnaires were produced.   

1. SIB staff fluent in Spanish translated the questionnaires to Spanish.
2. Other SIB staff who are also fluent in Spanish but are not familiar with the questionnaires back-translated to English.

CAPI 

The CAPI versions of both questionnaires and the Screening Form were designed using World Bank’s CAPI Survey Solution.  

Code Book 

SIB revised the code book to accommodate the MoH restructured and new questions.  

Team Composition

One team was assigned to each district, except for Belize, which was separated into two regions, Belize Northside and Belize Southside. Each team consisted of the following: 

1. I field supervisor 
2. driver
3. 1 field editor
4. 5 interviewers (on weekly rotations)
5. 1 nurse
6. 1 phlebotomist  

Survey Procedures

The procedure for conducting the interview and screening of a single case entails the following: 

1. The Field Supervisor located the household.
2. The interviewer visited the household and a knowledgeable member of the household was identified and interviewed.
3. The Household Questionnaire was administered first, where all members of the household were listed and all eligible members identified.
4. The interviewer filled out the screening form for each eligible household member and passed it on to the nurse and phlebotomist.
5. Once consent was given and confirmed, the nurse proceeded with the Screening Exercise by:
   1. 1. Taking of the body temperature
      2. Anthropometric measurements: height, weight, waistline
      3. Blood pressure
      4. Blood Sugar
      5. Urine Test: Protein and Glucose
6. The phlebotomist then took a blood sample from the respondent and the screening form was then passed to the interviewer to enter the data in the tablet.
7. The questionnaires and screening form were checked and the samples were delivered to the assigned laboratory for analysis. 

Design of Data Processing Procedures 

The procedure for data processing of a single case entailed the following: 

1. Phlebotomist Cluster Control Form was sent to SIB headquarters and entered in a tracking form. 
2. Phlebotomist Cluster Form was passed to the Systems Development and Data Processing department of the SIB for data entry.  
3. The case entered was merged with questionnaire by its Cluster Number, Household Number, Social Security etc.   

Preparation of Manuals  

The following manuals were designed to assist in facilitating quality data collection for the Survey of the Risk Factors for Chronic Kidney Disease: 

1. Interviewer’s Training Manual (PAPI & CAPI manuals)
   • Areas: 
     • Important concepts and definitions used in the questionnaire,
     • The structure of the questionnaire
     • Correct procedures needed to successfully conduct the survey using PAPI and CAPI
     • Outline of the roles and responsibility of all person involved in the survey
     • Important procedures in navigating through the PAPI and CAPI versions of the questionnaire.   
2. Editor’s Manual
   • Familiarize the field editors with the procedures for identifying and correcting errors and inconsistencies in the questionnaires and forms used for the survey. 
3. Supervisor’s Manual
   • Provided instructions and procedures for properly conducting the fieldwork and ensuring the progress and quality of the data collection.  
4. Training Manual of Nurse and Phlebotomist
   • The nurse and phlebotomist’s manual outlined the background, objectives and fieldwork procedures of the survey and provided specific instructions of the elements involved in the screening process.  

Preparation of Control Forms 

The control forms were designed to effectively keep track of fieldwork. All interviews conducted were accounted for at multiple levels and blood samples received were recorded in its corresponding control forms. 

The control forms designed by the SIB includes: 

1. Interviewer Cluster Control Form
   • This control form allowed the interviewer to properly keep track of all the households and eligible persons that they needed to interview in each cluster. This form also allowed the interviewer to kept track of appointments, result codes, screenings and additional notes. The form was a useful tool for the supervisor to update his/her control form and keep track of the progress of the data collection of each interviewer.  
2. Field Supervisor Cluster Control Form
   • This form was designed to keep track of the status of all households in each cluster. The control form allowed the supervisor to keep track the total number of interviews, screenings, result codes and any other useful information such as the change of a household head.  
3. Editor Cluster Control Form
   • This form allowed the editor to record all documents that were checked in the cluster. It was also useful in keeping track of errors made and ensuring all questionnaires and forms that contained errors were rechecked.  
4. Phlebotomist Cluster Control Form
   • The phlebotomist control form was essential in keeping a record of all the blood samples received during fieldwork. This form was designed to be sent to the laboratory for the test results to be recorded.      

 

Testing of Questionnaires  

Date of in-house test of the paper-based Questionnaires: 13th -17th March, 2017.  

Place of in-house test:  Belmopan City, Belize City, and Punta Gorda Town  

Test conducted by:  Three SIB district officers.  

Pilot  

A pilot of the entire fieldwork and data processing procedures was conducted.  

Pilot Notes 

1. The SIB hired six temporary field staff to conduct the data collection for the pilot.
2. The Ministry of Health recruited a nurse and a phlebotomist to be trained to conduct the screening exercise.
3. Participants were trained using both the paper based (PAPI) and computer based (CAPI) version of the questionnaire.
4. All draft manuals were used for the pilot training.
5. Following the training, the pilot was conducted using the computer–based version of the questionnaire.    

Frame 

The list of households from the 2010 census was used as the sampling frame. 

 Disaggregation 

1. national urban/rural
2. six administrative districts: Corozal, Orange Walk, Belize, Cayo, Stann Creek and Toledo
3. within each of the six districts, urban and rural areas were defined as the sampling strata. 

Sampling Design  

The Ministry of Health determined that a sample size of 10,000 households be selected. 

A two-stage stratified sampling technique was employed.  Each of the country’s six (6) districts was treated as an independent domain.   

First Stage 

In the first stage of the selection process, each District (domain) is assigned a number of Enumeration Areas (EA); these are the clusters or primary sampling units (PSUs).   

The methodology is as follows: 

Step 1.Calculate for each domain (say Domain a) the number of households (say na) allotted from the sample of n = 10,000 households. This was determined using the formula below. 

na=n Npa∑6i=1Npi

n=Total sample size at the national level.  (n = 10,000) 

na=Sample size in Domain a 

Npa=Number of households

 in Domain a to the power p  

(p = 0.75 in this application and in general 0≤p≤1)1  

 

Step 2.Using a take of 24 households in each EA calculate the number of EAs (say ma) to be sampled in each Domain a (approximately ma=na24) 

Each domain (district) was stratified into urban/rural areas.  In the case of the Belize District, the urban households were disaggregated by Belize City Northside and Southside.  The EAs in each stratum was allocated proportionally to the number of households in urban and rural areas of each domain. 

Step 3.Allocate some of these ma EAs to urban and the rest to rural areas for each Domain a.   

Second Stage 

The second stage of the sample design involves the selection of households from each PSU sampled in the first stage. The households selected for both rural and urban areas will be selected via systematic random sampling.  

 Publicity Campaign  

The publicity activities for the SRFCKD was divided into two phases, the pre-survey and survey periods.  

 Pre-survey Phase 

Leading up the beginning of the data collection in August, the following publicity efforts occurred: 

1. Production of advertisement video
2. Airing of radio and television advertisements
3. Talk Show appearances 
   • Appearances on Open Your Eyes and the Morning Show.
4. Printing and distribution of posters and fliers
5. Feature on the SIB website 

Survey Period 

1. Airing of radio and television advertisements
   • Airings were scheduled during the midday and evening newscasts on major and local television and radio stations.  These stations include Love TV, Estereo Amor, Krem FM, Reef Radio, and Wamalali Radio.
2. Talk Show appearances
   • Media appearances throughout the survey on Love TV and Krem.  
3. Photos of field staff
   • Photos of field staff were obtained and published on the SIB website during the survey. No photos of any respondents were published.   
4. Community visits
   • Visits were made to Mennonite communities that required the cooperation of its leaders in obtaining interviews and translators where necessary. Visits were made to Springfield, Spanish Lookout, Little Belize, Neuland, Indian Creek, Shipyard and Blue Creek.  

 Mapping 

 A mapping exercise was conducted from January 23rd – February 21st, 2017 to allow the accurate locating of households during surveys. The SRFCKD had a large sample of 10,000, and having updated and accurate mapping information, along with an updated listing, was crucial to correctly verify the location of households that were sampled.  

A total of 24 persons were recruited and trained from all districts as EDs were selected from all district for the mapping exercise. 

Approximately two thousand streets and blocks were demarcated and mapped for the mapping exercise. The breakdown by district can be seen in the Table 4 below.  

Table 4
Number of streets and blocks updated during mapping exercise, 2017

 

District	Number of EDs	Number of Tracks	Number of Blocks
Corozal	19	332	338
Orange Walk	20	314	277
Belize	88	858	564
Cayo	71	617	644
Stann Creek	2	27	39
Toledo	11	27	39
Total	211	2,175	1901

The SIB conducted a listing exercise to facilitate the SRFCKD; this exercise commenced on March 28th to June 11th, 2017. The purpose of the exercise was to get an updated list of all buildings, dwelling units, households and the number of persons in each household, as well as businesses and institutions and their type of activity. The exercise was done using CAPI with the use of GPS Devices.   

Maps were uploaded on each field supervisor’s Android tablet via the Collector App. These maps consisted of all ED’s that were sampled in each region, with the exception of the maps for San Pedro and Caye Caulker which was placed on the tablet of the field supervisor of the Corozal team.

Listing 

The listing exercise started on 2 February 2015 and ended on March 6th. However, recruitment of field staff for the listing exercise occurred between the months of December 2014 and January 2015. Approximately 122 listing personnel and 15 supervisors were hired. Additionally, SIB’s 7 District officers served as supervisors. The training sessions were staggered across three training sites, to allow the two main trainers to lead the training across the country.  The first training session (2 days) was held for the two northern regions, Orange Walk and Corozal on the 29th and 30th of January.  Training for the central regions, Belize and Cayo, were held from February 2nd to 3rd, and the final session was held for the southern regions, Stann Creek and Toledo, from February 5th to 6th. 

Training and Fieldwork 

Training for the fieldwork was conducted for 19 days in between 17th August and including 9th September 2015. Training included lectures on interviewing techniques and the contents of the questionnaires using PAPI for the first 10 days of the training then CAPI was introduced and used for, mock interviews between trainees to gain practice in asking questions. Towards the end of the training period, trainees spent 2days in practice interviewing in Belize City and Belize Rural for pilot survey.

The data were collected by 7 teams; each was comprised of 4 interviewers, one driver, one measurer and a supervisor. Fieldwork began in September 2015 and concluded in January, 2016.

Data Processing

Each supervisor and interviewer was equipped with a Tablet and Stylus to facilitate the use of CAPI.

Data were entered into Lenovo tablets with Windows Operating system using the CSPro software, Version 5.0. The data were transferred to the office via Internet for secondary editing on 2 desktop computers. Procedures and standard programs developed under the global MICS programme and adapted to the Multiple Indicator Cluster Survey questionnaire were used throughout. Data processing began simultaneously with data collection in September, 2015 and was completed in May, 2016. Data were analysed using the Statistical Package for Social Sciences (SPSS) software, Version 21. Model syntax and tabulation plans developed by UNICEF were customized and used for this purpose. 

Sampling Procedure 

Deviations from Sample Design 

None 

EAs and Domains 

• The country was divided into 527 enumeration areas (EAs). 
• In addition to national urban/rural disaggregation, estimates from the MICS5 are to be disaggregated to seven domains/regions.  The regions include the five districts of Corozal, Orange Walk, Cayo, Stann Creek and Toledo.   
• Belize District is partitioned into two regions: Belize City Southside and the remainder of Belize Urban along with Rural Belize District.  

 Weighting 

Sample weights were calculated for each of the data files.  Sample weights for the household data were computed as the inverse of the probability of selection of the household, computed at the sampling domain level (urban/rural within each region). The household weights were adjusted for nonresponse at the domain level and were then normalized by a constant factor so that the total weighted number of households equals the total unweighted number of households. The household weight variable is called HHWEIGHT and is used with the HH data and the HL data.   

Sample weights for the women’s data used the un-normalized household weights, adjusted for non-response for the women’s questionnaire, and were then normalized by a constant factor so that the total weighted number of women’s cases equals the total unweighted number of women’s cases.

Sample weights for the men’s data followed the same approach as the women’s and used the un-normalized household weights, adjusted for non-response for the men’s questionnaire, and were then normalized by a constant factor so that the total weighted number of men’s cases equals the total unweighted number of men’s cases.

Sample weights for the children’s data followed the same approach as the women’s and used the un-normalized household weights, adjusted for non-response for the children’s questionnaire, and were then normalized by a constant factor so that the total weighted number of children’s cases equals the total unweighted number of children’s cases. 

Data Collection 

Data Collection Dates start 14 September 2015      end 20 December 2015 

Data Collection Mode Face-to-face [f2f] 

Data Collection Notes

Pre Test: An in-house test of the paper-based Household and Individual Questionnaires designed for the Survey of Risk Factors for Chronic Disease was conducted by the SIB from the 13th -17th March, 2017.

Testing was conducted in Belmopan City, Belize City, and Punta Gorda Town by three SIB district officers.

Pilot: The SIB conducted a pilot of the entire fieldwork and data processing procedures as a measure to ensure the success of the SRFCKD.  The SIB hired six temporary field staff to participate in the training and conduct the data collection for the pilot. In addition, the Ministry of Health recruited a nurse and a phlebotomist from the Punta Gorda Hospital to be trained to conduct the screening exercise.

Training sessions were held on May 8th to 12th, 2017 in the Conference Room at the Punta Gorda Hospital in Toledo. The participants were trained using both the paper based (PAPI) and computer based (CAPI) version of the questionnaire. All draft manuals designed by the SIB were used for the pilot training so that it could be finalized after, based on the findings of the exercise.

Following the training, the pilot was conducted using the computer based version of the questionnaire on May 15th and 16th in the villages of Sunday Wood, Conejo and Midway in Toledo.

Sensitization: The publicity activities for the SRFCKD was divided into two phases, the pre-survey and survey periods. Prior to the start of the survey, various public awareness appearances were made, publicity materials were produced, and the airing of informative advertisements begun. Throughout the survey period, advertisements and media appearances were sustained in order to maintain public awareness, especially given the length of the data collection period.

Pre-survey Phase

Leading up the beginning of the data collection for the SRCKD in August, the following publicity efforts occurred: 

1. Production of advertisement video
   • The Data Dissemination department produced a one minute video advertisement that entailed important information about the survey such as its purpose and what the respondents can expect if their household is selected. The recorded voice-over of the video advertisement served as the radio version of the advertisement. 
2. Airing of radio and television advertisements
   • The airing of the video and radio version of the advertisements commenced on August 3rd, 2017. Airings were scheduled during the midday and evening newscasts on major and local television and radio stations. 
3. Talk Show appearances
   • Appearances were made prior to the commencement of the survey on August 3rd, 2017 on Open Your Eyes and the Morning Show. Representatives from the SIB, MoH and ICDF were present for the appearances to speak on the purpose, importance, methodology and confidentiality aspect of the survey. Graphics and samples of the SIB identification card and field staff uniform was also shared during the appearance.  
4. Printing and distribution of posters and fliers
   • An 18 by 24-inch colour poster and an 8.5 by 5.5 inch flier was designed by the SIB. The poster was featured at health facilities and strategically placed at public places such as the bus terminals. The flier was distributed by the field supervisor in clusters worked by the team.  
5. Feature on the SIB website
   • A link was placed on the homepage of the SIB website with general information about the survey. The link was on the website for the duration of the entire survey, it led to a more detailed page of the survey.   

Survey Period 

1. Airing of radio and television advertisements
   1. The airing of the video and radio version of the advertisements continued throughout the entire duration of data collection. Airings were scheduled during the midday and evening newscasts on major and local television and radio stations.  These stations include Love TV, Estereo Amor, Krem FM, Reef Radio, and Wamalali Radio.  
2. Talk Show appearances
   • The SIB and MoH representatives maintained media appearances throughout the survey on Love TV and Krem interviews, particularly to address issues and misconceptions that occurred during data collection, particularly the issue of confidentiality and legitimacy of the survey.  
3. Photos of field staff 
   • Photos of field staff were obtained and published on the SIB website during the survey. No photos of any respondents were published.
4. Community visits
   • Visits were made to Mennonite communities to solicit the cooperation of leaders in obtaining interviews and translators where necessary. Visits were made to Springfield, Spanish Lookout, Little Belize, Nueland, Indian Creek, Shipyard and Blue Creek. 

The national response rate of the Household Questionnaire is 88.6% and for the Individual Questionnaire was 87.7%.  Other response rates are provided in Table 5 and Table 6 below.

Table 5
Response rates for the household questionnaire by region

Region	Response Rate (%)
Corozal	93.6
Orange Walk	93.2
Belize Southside	92.0
Belize Northside	74.2
Cayo	85.2
Stann Creek	83.4
Toledo	96.6
National	88.6

Table 6
Response rates for the individual questionnaire by region

Region	Response Rate (%)
Corozal	89.2
Orange Walk	86.2
Belize Southside	81.7
Belize Northside	83.0
Cayo	89.3
Stann Creek	92.1
Toledo	91.5
National	87.7

 

Estimates of Sampling Error 

Not available 

File Description 

Code Book 

Access Authority

Disclaimer

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