Selection within households in health surveys

OBJECTIVE: To compare the efficiency and accuracy of sampling designs including and excluding the sampling of individuals within sampled households in health surveys. METHODS: From a population survey conducted in Baixada Santista Metropolitan Area, SP, Southeastern Brazil, lowlands between 2006 and 2007, 1,000 samples were drawn for each design and estimates for people aged 18 to 59 and 18 and over were calculated for each sample. In the first design, 40 census tracts, 12 households per sector, and one person per household were sampled. In the second, no sampling within the household was performed and 40 census sectors and 6 households for the 18 to 59-year old group and 5 or 6 for the 18 and over age group or more were sampled. Precision and bias of proportion estimates for 11 indicators were assessed in the two final sets of the 1000 selected samples with the two types of design. They were compared by means of relative measurements: coefficient of variation, bias/mean ratio, bias/standard error ratio, and relative mean square error. Comparison of costs contrasted basic cost per person, household cost, number of people, and households. RESULTS: Bias was found to be negligible for both designs. A lower precision was found in the design including individuals sampling within households, and the costs were higher. CONCLUSIONS: The design excluding individual sampling achieved higher levels of efficiency and accuracy and, accordingly, should be first choice for investigators. Sampling of household dwellers should be adopted when there are reasons related to the study subject that may lead to bias in individual responses if multiple dwellers answer the proposed questionnaire.