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INTRODUCTION This epidemiological study on reproductive health of Armenian men and women is implemented in 1997-1998, in support to the Armenian National Program on Reproductive Health, and has the following goals and objectives: Goal The purpose of the study is to provide information on sexual and reproductive health status of Armenian men and women and to develop rational approach towards their health protection.
Implementation
objectives
Specific
objectives
To
assess:
To
develop:
The
outcome objectives The outcome objective is to provide governmental authorities, non-governmental organizations and international agencies with representative data on sexual and reproductive health status of Armenian men and women. In particularly, the knowledge about the family planning and abortion practice, as well as STDs and the prevalence of infertility and associated factors will help them make informed decisions during development and implementation of Reproductive Health oriented projects. Methodology of sample selection
This
questionnaire-based survey was designed to collect information from a
national representative sample of 1400 men and 1400 women, ever married
or in consensual union, between 15 and 44 years of age throughout
Armenia. Both surveys of men and women were carried out in all 11
regions ("marzes") of the country, including the capital
Yerevan. Determination of the sample size was based on official data concerning the size of the target population, as well as the confidence, precision desired, and variables of the study. The sample of eligible respondents was selected from the total population of men and women of reproductive age using the method of Random Cluster Sampling with a multistage sampling design. Each eligible respondent had exactly the same chance to be selected for the survey-interview. The sampling procedure was done in different stages. At the first stage cities, towns and rural areas were selected. The sample universe was divided into 100 clusters of approximately equal numbers of people following administrative or geographic subdivisions, as far as possible. Starting from a randomly chosen number of respondents 100 clusters were selected, with intervals between the clusters equal to the number "K". This number was obtained through division of the total cumulative number of reproductive age men by 100. The separate clusters were selected for each of the surveys. The list of selected clusters is provided in the Annex 1. In each selected geographical location the group of interviewers arbitrarily chose the starting points for the survey (the first and subsequent houses to be visited). Finally, 14 eligible respondents were identified and interviewed in each selected cluster, either in their homes or at the nearest work place, supermarket or roadway. Only adolescents and single persons who have never been married or lived with a woman in consensual union, as if married, were excluded from the survey.
Fieldwork
and interviewing methods The RCPOG research team was responsible for the recruitment and training of interviewers and data collection. There were ten male and ten female interviewers who were provided with two weeklong training courses and practical training in the pilot survey. The male interviewers have been involved in the survey in men, while the female interviewers – in the survey in women. The experienced trainers with an appropriate background conducted the training of interviewers. Interviewers received instruction on household selection methods, interviewing techniques and questionnaire completion. Each interviewer received written instruction with particular emphasis on the methodology of selection of eligible respondents, the importance of obtaining of their informed consent, asking the questions exactly as they are phrased in the questionnaire, and on recording the responses as they are given. It was reinforced that all interviewers should ask each question in an identical manner to minimize interviewer's bias. Data collection was started in the last week of August 1997 and finalized by the end of November1997. Interviewers were divided into teams and provided with transportation. Each team received a working plan and the list of selected clusters to be surveyed. Interviews were administered in the homes of eligible respondents, in the work place, or on the streets. The team leaders supervised selection of the starting points and subsequent houses for the survey, and monitored data collection. Before leaving selected locations they checked questionnaires in order to obtain missing information, if necessary. On making verbal contact with the first respondents in the household, the interviewers introduced themselves and explained the purpose of their visit. They mentioned that all information about their household and family members will be used only for research purposes and would be treated in a confidential manner. After obtaining consent from the first respondents, information related to the household characteristics were collected and the eligible persons were identified. If a selected respondent was available, the interviewer explained the purpose and benefits of the survey, and tried to obtain his informed consent to participate. However, participation by each selected respondent was absolutely on a voluntary basis. As far as possible, the interview was conducted in the absence of any other family members. If the selected respondent was not at home, any other eligible respondent was chosen outside of the house, at the nearest work place, the supermarket or the street. The interview was carried out as far as possible in confidential manner and in a place convenient for the interview.
Data
analysis and evaluation The AFHA research team was responsible for verification of the questionnaires, data processing, analysis and evaluation. After the each interview, at every selected location, the team leader hand-checked the questionnaire for consistency and completeness. If necessary, an additional visit was made to the selected household in order to complete any missing information. The researchers and, finally, the project supervisor hand-checked each of 2800 completed questionnaires. Some of randomly selected questionnaires (about 2%) were verified. Only fully completed and consistent questionnaires were submitted for data entry. In tandem with the fieldwork and questionnaire checking an experienced computer specialist developed and installed data entry/edit software, and a team of computer operators performed data entry. After creation of the database, the computer specialist checked the quality of data entry and verified inconsistent records with the questionnaires. The algorithm for determination of the risk of exposure to pregnancy and for the fertility classification were developed and installed. The standard software program "EpiInfo” was used for statistical analysis of data. The elementary statistics that were used at the first stage included cross-tabulations, Chi-square and classical F-Nova tests. Possible variables that might influence fertility were analyzed at the next stage. Finally, the AFHA project supervisor performed data evaluation and developed this report. The data presented is an overview of selected survey results and recommendations towards improvement of the Reproductive Health status of Armenians. The information that is provided in this report could be used to plan effective reproductive health-oriented policies and projects.
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