Biomarkers in demographic and health surveys: promising tools for policy making

Jasbir K. Sangha, ORC Macro
Alfredo L. Fort, ORC Macro

The Demographic and Health Surveys (DHS) program has measured biomarkers such as the prevalence of micronutrient deficiencies (iron-deficiency anaemia and vitamin A deficiency); STI (syphilis, chlamydia, hepatitis B, HSV-2) and HIV; immunization coverage (measles and tetanus testing); and environmental exposure (lead and arsenic testing) in national surveys in 35 countries. DHS has also collected chronic disease markers such as lipids, diabetes and blood pressure. High levels of anaemia and vitamin A deficiency found in surveys have helped governments’ better plan iron supplementation and food fortification programs. In contrast, surveys finding lower levels of HIV than estimated have lead countries to re-visit their intervention strategies. The paper will review collection methodologies, ethical considerations, and challenges in the field and lab testing for different biomarkers. Illustrative results and the relationship of biomarkers to respondents’ characteristics and health outcomes will also be discussed.