Agency for International Development (USAID). ICF provided technical assistance through The DHS Program,

a USAID-funded project providing support and technical assistance in the implementation of population and

health surveys in countries worldwide.

Additional information about the 2022 NDHS may be obtained from the Ministry of Health and Population, Ram

Shah Path, Kathmandu, Nepal; Telephone: +977-1-4262543/4262802; Internet: http://www.mohp.org.np; and

New ERA, Rudramati Marg, Kalopul, P.O. Box 722, Kathmandu 44600, Nepal; Telephone: +977-1-4413603;

Email: info@newera.com.np; Internet: http://www.newera.com.np.

Information about The DHS Program may be obtained from ICF, 530 Gaither Road, Suite 500, Rockville, MD

20850, USA; Telephone: +1-301-407-6500; Fax: +1-301-407-6501; Email: info@DHSprogram.com; Internet:

www.DHSprogram.com.

TABLES AND FIGURES ............................................................................................................................ v

ACRONYMS AND ABBREVIATIONS ...................................................................................................vii

FOREWORD ............................................................................................................................................... ix

1 INTRODUCTION ........................................................................................................................... 1

2 SURVEY IMPLEMENTATION ................................................................................................... 3

3 KEY FINDINGS............................................................................................................................ 11

REFERENCES............................................................................................................................................ 47

Table 1 Results of the household and individual interviews .......................................................... 11

Table 2 Background characteristics of respondents........................................................................ 12

Table 3 Current fertility .................................................................................................................. 14

Table 10 Childhood vaccinations by background characteristics ..................................................... 29

Table 11 Treatment for ARI symptoms, fever, and diarrhea ............................................................ 31

Table 12 Nutritional status of children ............................................................................................. 34

Table 13 Infant and young child feeding (IYCF) indicators ............................................................. 35

Table 14 Prevalence of anemia in children ....................................................................................... 37

Table 15 Prevalence of anemia in women ........................................................................................ 39

Table 16 Knowledge of HIV prevention methods among young people.......................................... 41

Table 17.1 Coverage of prior HIV testing: Women ............................................................................ 43

Table 17.2 Coverage of prior HIV testing: Men .................................................................................. 44

Table 18 Disability by domain and age ............................................................................................ 45

Figure 3 Trends in early childhood mortality rates .......................................................................... 23

Figure 7 Trends in exclusive breastfeeding ..................................................................................... 36

ARI acute respiratory infection

ART antiretroviral therapy

CDC Center for Disease Control

COVID-19 coronavirus disease of 2019

CSPro Census and Survey Processing

DPT diphtheria, pertussis, and tetanus vaccine

GFR general fertility rate

GPS global position system

IYCF infant and young child feeding

LAM lactational amenorrhea method

MoHP Ministry of Health and Population

NDHS Nepal Demographic and Health Survey

Questionnaire collected information about the survey’s fieldworkers. Input was solicited from various

stakeholders representing government ministries and agencies, nongovernmental organizations, and

international donors. The survey protocol was reviewed by the Nepal Health Research Council and the ICF

Institutional Review Board. The 2022 NDHS required written consent from the household head to carry

out the interviews and to test for anemia. Similarly, written consent/assent was required from individuals

for anemia testing and from parents/guardians for children age 6–59 months.

After all questionnaires were finalized in English, they were translated into Nepali, Maithili, and Bhojpuri

languages. The Household, Woman’s, and Man’s Questionnaires were programmed into tablet computers

to facilitate computer-assisted personal interviewing (CAPI) for data collection purposes, with the

capability to choose any of the three languages for each questionnaire. The Biomarker Questionnaire was

completed on paper during the data collection and then entered in the CAPI system.

household dwelling unit, such as source of water, type of toilet facilities, materials used for the floor of the

dwelling unit, and ownership of various durable goods. Additional modules on disability, accident and

injury, and food insecurity were included in the household questionnaire.

The Woman’s Questionnaire was used to collect information from all women age 15–49. These women

were asked questions on the following topics:

▪ Background characteristics (including age, education, and media exposure)

▪ Pregnancy history and child mortality

▪ Knowledge, use, and source of family planning methods

▪ Fertility preferences (including desire for more children, ideal number of children)

▪ Antenatal, delivery, and postnatal care

▪ Fistula

▪ Knowledge, attitudes, and behavior related to other health issues (for example, cancer, smoking,

tuberculosis, and COVID-19)

The Man’s Questionnaire was administered to all men age 15–49 in the subsample of households selected

for the men’s survey. The Man’s Questionnaire collected much of the same information as the Woman’s

Questionnaire but was shorter because it did not contain a detailed reproductive history or questions on

maternal and child health.

The Biomarker Questionnaire recorded the anthropometry measurements, anemia testing, and blood

pressure measurements. These questionnaires were administered only in a subsample that was not selected

tool in conducting analyses of data quality. Each interviewer completed the self-administered Fieldworker

Questionnaire after the final selection of interviewers and before the fieldworkers entered the field. No

personal identifiers were attached to the 2022 NDHS fieldworker data file.

Tablet computers were used for data collection by the enumerators. The tablet computers were equipped

questionnaires from interviewers to team supervisors. The computer-assisted personal interviewing (CAPI)

The DHS Program.

blood pressure. Biomarker data was collected in half of the households that were not selected for the

survey of men. Height and weight measurements were carried out for eligible women age 15–49 and

children age 0–59 months in these households. Similarly, anemia testing was carried out for eligible

women age 15–49 and children age 6–59 months in these households. Blood pressure measurements were

collected for adults age 15 and above in half of the households selected for biomarkers, along with height

and weight measurements.

Anthropometry. Weight measurements were taken using SECA scales with a digital display (model

number SECA874U), designed and supplied by the United Nations Children’s Fund (UNICEF). Height

and length were measured with a measuring board (ShorrBoard®). Children younger than age 24 months

were measured lying down (recumbent length), while older children and adults were measured standing

(height).

Children with a z score of less than -3 for weight-for-height were considered severely wasted (acute

undernutrition) and were eligible for referral. The team supervisor or the biomarker specialist provided a

referral form to the parent/responsible adult of the child identified with acute undernutrition. The referral

form included the name, height (cm), weight (kg), and weight-for-height (z score) result for the child. The

parent/responsible adult was informed about the effects of acute undernutrition and instructed to take the

child to a local health facility to ensure the child receives proper assessment and treatment. They were

instructed to take the referral form with them during such visits to the health facility.

Anemia. Blood specimens for anemia testing were collected from women age 15–49 who consented to be

tested. Blood specimens were also collected from children age 6–59 months whose parents or guardians

had given consent for the testing. Blood samples were drawn from a drop of blood taken from a finger

above in the subsample of households selected for biomarkers. Blood pressure was measured using a

Multi-User Upper Arm Blood Pressure Monitor with an automatic upper-arm inflation pressure release.

Each team was equipped with three monitors having different cuff sizes: (a) UA-767F/FAC with medium

cuff, (b) UA-767PVS with small cuff, and (c) UA-789AC with extra-large cuff. An additional cuff of each

average of the second and third measurements was used to classify the results of hypertension, according

symptoms of high blood pressure and ways it can be prevented, were immediately provided to the

respondent via the Blood Pressure Reporting Form. Respondents found to have high blood pressure,

defined as systolic pressure greater than 140 mmHg and/or diastolic pressure greater than 90 mmHg, were

provided a referral form to take to a local health facility.

followed national guidelines. There was a total of 25 participants for the training (6 core team members, 4

data processing team members, 3 biomarker specialists, 9 female interviewers, and 3 male interviewers).

The interviewers were recruited based on their experience working in household surveys, including the

previous NDHS, and their language proficiency in the three local languages: Nepali, Maithili, and

Bhojpuri. Training was facilitated by the ICF staff who focused on the technical components of the survey,

biomarkers, and the CAPI system.

▪ Probing for age

▪ Interview techniques and procedures for completing the NDHS questionnaires

interview that took the trainees step-by-step through the questionnaires during the different sessions. The

participants also worked in groups using various training techniques, for example, interactive question-

and-answer sessions, case studies, group work, and role play. Emphasis was placed on hands-on training

Technical support for the Mental Health Module was provided by technical experts from Transcultural

Psychosocial Organization Nepal (TPO Nepal) who supported the training. The anthropometry

standardization exercise was conducted and completed successfully by all the biomarker specialists.

The main training for the 2022 NDHS was held at a residential facility in Kathmandu from November 28

to December 23, 2021, followed by four days of field practice and a review session held on December 29,

2021. After an intense recruitment process that included a written test, a computer test, and a personal

interview, the shortlisted candidates took RT-PCR tests for COVID-19. Those presenting negative results

for the RT-PCR test were invited to join the training in the residential facility. Almost all the selected

participants were fully vaccinated against COVID-19; a few received their second dose during the training.

The training followed strict guidelines for COVID-19 risk mitigation that included:

▪ Daily symptom checks using a Google form developed and coordinated by New ERA

Three training halls were used, two for training interviewers and one for training biomarker specialists.

assigned as male supervisors, 19 as male interviewers, 57 as female interviewers, and 20 males as

biomarker specialists. Further, there were 4 male and 4 female quality control team members who

participated during the main training. Most supervisors and interviewers had previous experience in

conducting household surveys, including the previous rounds of the NDHS. The biomarker specialists had

previous experience in collecting biomarker data.

The biomarker training took place from December 12 to December 23, 2021. The training utilized a

variety of different learning tools such as formal lectures on technical aspects of biomarker collection,

target population and eligibility, videos to demonstrate the process of anthropometry and blood collection,

hands-on demonstrations, group reading sessions, and in-house practice sessions.

Biomarker specialists were trained to measure the height and weight of children and adults using standard

December 23, 2021, to provide training on fieldwork management and data quality monitoring. These

sessions included discussions on roles and responsibilities, preparation and mobilization for fieldwork,

managing assignments for biomarker specialists and facilitating remeasurements, completing biomarker

checklists, conducting re-interviews in CAPI, and monitoring the progress and workload of team members.

departed on December 24, 2021, and the field practice was carried out from December 25 to December 28,

discuss the experience and feedback from the field practice. Overall, it was a fruitful exercise whereby the

teams could experience real field conditions and be prepared before being mobilized for the actual data

collection.

Data collection for the 2022 NDHS was carried out by 19 teams. Each team consisted of a supervisor, one

male interviewer, three female interviewers, and one biomarker specialist. The teams were first deployed

in locations away from Kathmandu because at that time the capital city was a COVID-19 hotspot. The

fieldwork began on January 5, 2022, in two central locations—Itahari and Chitwan—under close

supervision. On completion of the fieldwork in these first locations, a review session was held on January

9, 2022, and the teams departed to their respective assigned clusters on January 10, 2022, to continue with

data collection for the survey. Caution was taken while mobilizing the teams throughout the data collection

period to mitigate the risk of COVID-19. Except for few mild cases, there were no major impacts of

COVID-19 during data collection. The fieldwork was slightly disrupted when local elections took place.

The field teams had to go home to cast their votes, and the local people were engaged in election activities.

Fieldwork monitoring was an integral part of the 2022 NDHS, and several rounds of monitoring were

carried out by the New ERA core team and quality control teams. ICF provided technical assistance during

the data collection period through weekly virtual meetings. The technical teams from the Ministry of

Data capture for the 2022 NDHS was carried out with Microsoft Surface Go 2 tablets running Windows

10.1. Software was prepared for the survey using the Census and Survey Processing System (CSPro). The

(IFSS) to the New ERA central office in Kathmandu. The data files were registered and checked for

NDHS core team members assisted with the secondary editing. The paper Biomarker Questionnaires were

compared with the electronic data file to check for any inconsistencies in data entry. The pictures of

Throughout this report, numbers in the tables reflect weighted numbers. Percentages based on 25 to 49

unweighted cases are shown in parentheses and percentages based on fewer than 25 unweighted cases are

suppressed and replaced with an asterisk. This is to caution readers when interpreting data that a

which 13,833 were found to be occupied. Of the occupied households, 13,786 were successfully

interviewed, yielding a response rate of 99.7%. In the interviewed households, 15,238 women age 15–49

yielding a response rate of 95%.

▪ Women were less likely to report that they have good or very good health than men (34% and 48%,

Christian.

women and 8% of men have more than secondary education.

Twenty-six percent of women and 8%

▪ If fertility were to remain constant at current levels, a woman in Nepal would bear an average of 2.1

children in her lifetime.

▪ Fertility is low among adolescents (71 births per 1,000 women age 15–19), peaks at 160 births per

1,000 among women age 20–24, and then deceases thereafter.