4

II.

Sample and Survey Methodology

Sample Design
The sample for the Ghana Multiple Indicator Cluster Survey (MICS) was designed to provide estimates for a
large number of indicators on the situation of children and women at the national level, for urban and rural
areas, and for 10 regions: Western, Central, Greater Accra, Volta, Ashanti, Brong Ahafo, Northern, Eastern,
Upper East and Upper West regions. The urban and rural areas within each region were identified as the
main sampling strata and the sample was selected in two stages. Within each stratum, a specified number
of census enumeration areas were selected systematically with probability proportional to size. Since the
sampling frame (the 2000 Ghana Population Census) was up-to-date, a new listing of households was not
conducted in all the sample enumeration areas prior to a systematic sample selection of 15 households in
each selected cluster. The sample was stratified by region, urban and rural areas, and is not self-weighting
since Central, Northern, Upper East and Upper West regions were over-sampled. For reporting national
level results, sample weights are used. A more detailed description of the sample design can be found in
Appendix A.
Questionnaires
Four sets of questionnaires were used in the survey: 1) a household questionnaire which was used to
collect information on all de jure household members (usual residents), the household, and the dwelling;
2) a womens questionnaire administered in each household to all women aged 15-49 years; 3) an under-5
questionnaire administered to mothers or caretakers for all children under 5 living in the household; and 4)
a mens questionnaire administered in each third household to all men aged 15-59 years. The contents of
the questionnaires are indicated below:
The Household Questionnaire included the following modules:
Household Listing Form
Education
Water and Sanitation
Household Characteristics
Insecticide Treated Nets
Indoor Residual Spraying
Child Labour
Child Discipline
Handwashing
Salt Iodization
The Questionnaire for Individual Women was administered to all women aged 15-49 years living in the
household, and included the following modules:
Womens Background
Access to Mass Media and Use of Information/Communication Technology
Child Mortality
Desire for Last Birth
Maternal and Newborn Health
Post-natal Health Checks
Illness Symptoms
Contraception
Unmet Need
Female Genital Mutilation/Cutting

Sample and Survey Methodology

Behaviour Change Communication on Malaria

Attitudes Towards Domestic Violence
Marriage/Union
Sexual Behaviour
HIV/AIDS
National Health Insurance

The Questionnaire for Children Under-Five was administered to mothers or caretakers of children under
- 5 years of age1 living in the households. Normally, the questionnaire was administered to mothers of
under-5 children; in cases where the mother was not listed in the household roster, a primary caretaker for
the child was identified and interviewed. The questionnaire included the following modules:
Age
Birth Registration
Early Childhood Development
Breastfeeding
Diet Diversity
Care of Illness
Malaria
Immunization
National Health Insurance
Anthropometry
Anaemia and Malaria Testing
The Questionnaire for Individual Men was administered to all men aged 15-59 years living in each third
household, and included the following modules:
Mens Background
Access to Mass media and use of Information/Communication Technology
Marriage/Union
Attitude Towards Contraception
Behaviour Change Communication on Malaria
Attitudes Towards Domestic Violence
Sexual Behaviour
HIV/AIDS
National Health Insurance
The questionnaires are based on the English version of the MICS4 model questionnaire2 . From the MICS4
model, the Ghana questionnaires were customized and pre-tested in two districts: Ga West district in
Greater Accra region and Akwapim South district in Eastern region during the period 2 - 5 August 2011.
Based on the results of the pre-test, modifications were made to the wording of the questionnaires. A copy
of the Ghana MICS4 questionnaires is provided in Appendix F.
In addition to the administration of questionnaires, fieldwork teams tested the salt used for cooking in the
households for iodine content, collected a sample in each male survey household for titration, observed
1 The terms children under 5, children age 0-4 years, and children aged 0-59 months are used interchangeably in this report.
2 The model MICS4 questionnaires can be found at www.childinfo.org

Sample and Survey Methodology

the place for handwashing and measured the weights and heights of children age under 5 years. Details
and findings of these measurements are provided in the respective sections of the report.
Training and Fieldwork
Training for the fieldwork was conducted for 14 days, from 29 August to 11 September 2011. The data
entry clerks attended the first week of interviewer training in order to get a better understanding of
questionnaires and survey techniques. The training included lectures on interviewing techniques and
the contents of the questionnaires, blood testing for malaria and anaemia, and mock interviews between
trainees to gain practice in asking questions. All fieldworkers also trained in testing iodine in salt found in
selected households as well as taking measurements of weight and height for children under 5 years.
The Ghana MICS4 2011 incorporated three malaria biomarkers, namely: anaemia testing, malaria testing
using rapid diagnostic tests (RDTs), and thick blood smear samples prepared on microscope slides. After
obtaining informed consent from caregivers, blood samples were obtained from a heel- or finger-prick
from children aged 6 to 59 months to perform on-the-spot anaemia and malaria tests, and to prepare thick
blood smears that were later transported and read in the laboratory at NHRC to determine the presence
of malaria parasites. The microscopy was used as the gold standard to obtain prevalence rates. The rapid
diagnostic test was utilized primarily for ethical reasons, in order to identify and treat malaria in participating
children while in the field.
The biomarker training was led by a DHS biomarker specialist with assistance from NHRC, NMCP and PMI
staff. Towards the end of the training period, trainees spent several hours during 2 half-days in practicing
interviews and blood testing in Sunyani East and Sunyani West areas.
The data were collected by 20 teams; each team was comprised of 3 interviewers, one driver, one editor,
one measurer (health technician) and a supervisor. Fieldwork began on 15 September 2011 and concluded
on 14 December 2011. The field monitoring, for quality assurance, was conducted by staff from ICF Macro,
USAID, President Malaria Initiative (PMI), NHRC, UNICEF, GSS and NMCP.
As described above, each of the 20 field team in the 2011 Ghana MICS4 included a health technician, who
was responsible for completing the anthropometry and biomarker portions of the Children Under-Five
Questionnaire, and conducting the biomarker tests. In accordance with the Ghana MICS4 biomarker testing
protocol pre-approved by the Ghana Health Service Institution Review Board, the health technicians were
responsible for ensuring that informed consent was obtained from the childrens caregivers; administering
medications for uncomplicated malaria in the field when indicated; and providing medical referrals for
clinically severe malaria, severe anaemia, and other conditions when indicated.
Data Processing
Data were entered using the CSPro software. The data were entered on 20 microcomputers and carried out
by 20 data entry operators and 3 data entry supervisors. In order to ensure quality control, all questionnaires
were double entered and internal consistency checks were performed. Procedures and standard programs
developed under the global MICS4 programme and adapted to the Ghana questionnaire were used
throughout. Data capture began in October 2011 and was completed in January 2012. Data were analysed
using the Statistical Package for Social Sciences (SPSS) software program, Version 18, and the model syntax
and tabulation plans developed by UNICEF were used for this purpose.