Cambodia - Demographic and Health Survey - 2001

Publication date: 2001

2000Demographic andHealth Survey Cambodia KINGDOM OF CAMBODIA Nation Religion King Cambodia Demographic and Health Survey 2000 National Institute of Statistics Directorate General for Health Ministry of Planning Ministry of Health Phnom Penh, Cambodia ORC Macro Calverton, Maryland USA June 2001 Sponsored by UNFPA, UNICEF, and USAID The following persons contributed to the analysis of the Cambodia Demographic and Health Survey and the preparation of this report: Bernard Barrère, ORC Macro Sovanratnak Sao, DGH/MoH Robert Johnston, ORC Macro Darith Hor, NIS/MoP Kiersten Johnson, ORC Macro Jasbir Saggu, ORC Macro Sunita Kishor, ORC Macro The 2000 Cambodia DHS survey was implemented by the National Institute of Statistics of the Ministry of Planning and the Directorate General for Health of the Ministry of Health. ORC Macro provided technical assistance through its MEASURE DHS+ program. The survey was funded principally by the United Nations Population Fund (UNFPA), United Nations Children=s Fund (UNICEF), and the U.S. Agency for International Development (USAID). Additional information about the Cambodia DHS survey may be obtained from the National Institute of Statistics, 386 Monivong Blvd., Phnom Penh, Cambodia (telephone: 855 23 364 371; e-mail: sansythan@forum.org.kh). Information about the MEASURE DHS+ project may be obtained from ORC Macro, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705 (telephone: 301-572-0200; fax: 301-572-0999; e-mail: reports@macroint.com; internet: www.measuredhs.com). Suggested citation: National Institute of Statistics, Directorate General for Health [Cambodia], and ORC Macro. 2001. Cambodia Demographic and Health Survey 2000. Phnom Penh, Cambodia, and Calverton, Maryland USA: National Institute of Statistics, Directorate General for Health, and ORC Macro. Contents * iii CONTENTS Page Tables and figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix Summary of Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxi Map of Cambodia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvi CHAPTER 1 INTRODUCTION 1.1 Geodemography, History, and Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 Health Status and Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1.3 Objective and Survey Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.4 Sample Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.5 Questionnaires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1.6 Training and Fieldwork . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1.7 Data Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1.8 Coverage of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2.1 Demographic Characteristics of Households . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2.2 Household Composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2.3 Household Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 2.3.1 Educational attainment of household population . . . . . . . . . . . . . . . . . 14 2.3.2 School attendance ratios . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 2.4 Housing Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2.5 Household Possessions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 2.6 Iodized Salt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 CHAPTER 3 HEALTH STATUS AND UTILIZATION OF HEALTH SERVICES 3.1 Accidental Death or Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 3.2 Physical Impairment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 3.3 Prevalence and Severity of Illness or Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 3.4 Treatment Sought for Illness or Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 3.5 Utilization of Health Care Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 3.6 Cost for Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 iv * Contents Page CHAPTER 4 RESPONDENTS’ CHARACTERISTICS AND STATUS 4.1 Background Characteristics of Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 4.2 Educational Attainment by Background Characteristics . . . . . . . . . . . . . . . . . . 42 4.3 Literacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 4.4 Exposure to Mass Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 4.5 Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 4.6 Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 4.7 Employer and Form of Earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 4.8 Decision on Use of Earnings and Proportion of Household Expenditures Met by Earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 CHAPTER 5 FERTILITY 5.1 Current Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 5.2 Fertility Differentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 5.3 Trends in Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 5.4 Children Ever Born and Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 5.5 Birth Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 5.6 Age at First Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 5.7 Teenage Pregnancy and Motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 CHAPTER 6 PRACTICE OF ABORTION 6.1 Number of Induced Abortions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 6.2 Abortion in the Past Five Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 CHAPTER 7 FERTILITY REGULATION 7.1 Knowledge of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 7.2 Ever Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 7.3 Current Use of Contraceptive Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 7.4 Number of Children at First Use of Family Planning . . . . . . . . . . . . . . . . . . . . . 83 7.5 Knowledge of Fertile Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 7.6 Source of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 7.7 Intention to Use Family Planning among Nonusers . . . . . . . . . . . . . . . . . . . . . 86 7.8 Reasons for Nonuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 7.9 Preferred Methods of Contraception for Future Use . . . . . . . . . . . . . . . . . . . . . 87 7.10 Exposure to Family Planning Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 7.11 Exposure to Family Planning Messages through the Print Media . . . . . . . . . . . 89 7.12 Discussion of Family Planning between Spouses . . . . . . . . . . . . . . . . . . . . . . . . 91 7.13 Attitudes toward Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Contents * v Page CHAPTER 8 OTHER PROXIMATE DETERMINANTS OF FERTILITY 8.1 Marital Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 8.2 Age at First Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 8.3 Age at First Sexual Intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 8.4 Recent Sexual Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 8.5 Postpartum Amenorrhea, Abstinence, and Insusceptibility . . . . . . . . . . . . . . . 101 8.6 Termination of Exposure to Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 CHAPTER 9 FERTILITY PREFERENCE 9.1 Desire for More Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 9.2 Need for Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 9.3 Ideal Family Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 9.4 Fertility Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 CHAPTER 10 ADULT AND MATERNAL MORTALITY 10.1 Data Quality Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 10.2 Adult Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 10.3 Maternal Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 CHAPTER 11 INFANT AND CHILD MORTALITY 11.1 Assessment of Data Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 11.2 Levels and Trends in Infant and Child Mortality . . . . . . . . . . . . . . . . . . . . . . . 121 11.3 Comparison of the Results of the CDHS Survey with Previous Estimates of Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 11.4 Socioeconomic Differentials in Childhood Mortality . . . . . . . . . . . . . . . . . . . . 124 11.5 Demographic Differentials in Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 11.6 High-Risk Fertility Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 CHAPTER 12 MATERNAL AND CHILD HEALTH 12.1 Maternal Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 12.1.1 Perceived problems in accessing women’s health care . . . . . . . . . . . . . 131 12.1.2 Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 12.1.3 Maternal night blindness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 12.2 Childbirth and Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 12.3 Postnatal Care and Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 12.4 Use of Tobacco and Betel Nuts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 vi * Contents Page 12.5 Birth Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 12.6 Vaccination Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 12.7 Acute Respiratory Infection and Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 12.8 Prevalence of Diarrhea and Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 CHAPTER 13 MATERNAL AND CHILD NUTRITION 13.1 Breastfeeding and Supplmentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 13.2 Nutritional Status of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172 13.3 Nutritional Status of Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176 13.4 Micronutrient Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 13.4.1 Iron-deficiency anemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178 13.4.2 Vitamin A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 13.4.3 Iodine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 CHAPTER 14 HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS 14.1 AIDS Awareness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187 14.2 Knowledge of HIV/AIDS Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188 14.3 Knowledge of HIV/AIDS-related Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192 14.4 Social Aspects of HIV/AIDS Prevention and Mitigation . . . . . . . . . . . . . . . . . . 193 14.5 Discussion of HIV/AIDS in the Media or in Specific Locations . . . . . . . . . . . . 194 14.6 Testing for AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 14.7 Knowledge of Signs and Symptoms of Sexually Transmitted Infections . . . . . 198 14.8 Self-reporting of STIs or Symtpoms of STIs and Resulting Actions Taken . . . . 199 14.9 Sexual Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201 14.10 Knowledge and Use of Condoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202 CHAPTER 15 WOMEN’S STATUS AND EMPOWERMENT 15.1 Marriage Patterns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 15.2 Interspousal Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210 15.3 Decisionmaking within Households . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212 15.4 Attitudes toward Gender Roles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216 15.5 Support from Birth Family . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223 15.6 Financial Empowerment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224 15.7 Involvement with Civil Society . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 CHAPTER 16 DOMESTIC VIOLENCE 16.1 Approach to Violence Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232 16.2 Women's Experience of Violence since Age 15 and in the 12 Months Preceding the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233 Contents * vii Page 16.3 Violence during Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234 16.4 Marital Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235 16.5 Interspousal Violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237 16.6 Help-Seeking Behavior by Women Who Have Experienced Violence . . . . . . . 247 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249 APPENDIX A SAMPLE DESIGN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251 APPENDIX B ESTIMATES OF SAMPLING ERRORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259 APPENDIX C DATA QUALITY TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267 APPENDIX D PERSONS INVOLVED IN THE 2000 CAMBODIA DEMOGRAPHIC AND HEALTH SURVEY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273 APPENDIX E QUESTIONNAIRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277 Tables and Figures * ix TABLES AND FIGURES Page CHAPTER 1 INTRODUCTION Table 1.1 Basic demographic indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Table 1.2 Results of the household and women’s interviews . . . . . . . . . . . . . . . . . . . . 7 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS Table 2.1 Household population by age, sex, and residence . . . . . . . . . . . . . . . . . . . . 10 Table 2.2 Population by age, according to selected sources . . . . . . . . . . . . . . . . . . . . 11 Table 2.3 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Table 2.4 Children’s living arrangements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Table 2.5.1 Educational attainment of household population: male . . . . . . . . . . . . . . . 15 Table 2.5.2 Educational attainment of household population: female . . . . . . . . . . . . . 16 Table 2.6 School attendance ratios . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Table 2.7 Drinking water and sanitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Table 2.8 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Table 2.9 Household durable goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Table 2.10 Iodized salt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Figure 2.1 Population Pyramid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Figure 2.2 Age-Specific Attendance Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 CHAPTER 3 HEALTH STATUS AND UTILIZATION OF HEALTH SERVICES Table 3.1 Injury or death in an accident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Table 3.2 Injury and death in an accident by type of accident . . . . . . . . . . . . . . . . . . 27 Table 3.3 Physical impairment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Table 3.4 Prevalence and severity of illness or injury in previous 30 days . . . . . . . . . 31 Table 3.5 Percentage of ill or injured population who sought treatment . . . . . . . . . . 33 Table 3.6 Utilization of health care facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Table 3.7 Distribution of cost for health care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Table 3.8 Expenditures for health care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Table 3.9 Source of money spent on health care . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Figure 3.1 Percentage of Household Members Ill or Injured Seeking Treatment by Order of Treatment and Sector of Health Care . . . . . . . . . . . . . . . . . . . . 34 CHAPTER 4 RESPONDENTS’ CHARACTERISTICS AND STATUS Table 4.1 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . 41 Table 4.2 Educational attainment by background characteristics . . . . . . . . . . . . . . . . 43 x * Tables and Figures Page Table 4.3 Literacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Table 4.4 Exposure to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Table 4.5 Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Table 4.6 Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Table 4.7 Employer and form of earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Table 4.8 Decision on use of earnings and contribution of earnings to household expenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Table 4.9 Control over earnings according to contribution to household expenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Figure 4.1 Percent Distribution of Women 15-49 by Age . . . . . . . . . . . . . . . . . . . . . . . 42 Figure 4.2 Distribution of Women Receiving Cash Earnings by the Proportion of Household Expenditures Met by Those Earnings . . . . . . . . . . . . . . . . . . 54 CHAPTER 5 FERTILITY Table 5.1 Current fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Table 5.2 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Table 5.3 Trends in age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Table 5.4 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Table 5.5 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Table 5.6 Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Table 5.7 Median age at first birth by background characteristics . . . . . . . . . . . . . . . 65 Table 5.8 Teenage pregnancy and motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Figure 5.1 Age-Specific Fertility Rates by Urban-Rural Residence . . . . . . . . . . . . . . . . 58 Figure 5.2 Age-Specific Fertility Rates, NHS 1998 and CDHS 2000 . . . . . . . . . . . . . . . 59 CHAPTER 6 PRACTICE OF ABORTION Table 6.1 Number of induced abortions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Table 6.2 Pregnancy duration at the time of abortion . . . . . . . . . . . . . . . . . . . . . . . . 70 Table 6.3 Abortion procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Table 6.4 Place of abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Table 6.5 Persons who helped with abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Figure 6.1 Distribution of Number of Abortions for Women Who Report Having an Induced Abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 CHAPTER 7 FERTILITY REGULATION Table 7.1 Knowledge of contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Table 7.2 Knowledge of contraceptive methods by background characteristics . . . . . 77 Table 7.3 Ever use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Tables and Figures * xi Page Table 7.4 Current use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Table 7.5 Current use of contraception by background characteristics . . . . . . . . . . . . 82 Table 7.6 Number of children at first use of contraception . . . . . . . . . . . . . . . . . . . . . 84 Table 7.7 Knowledge of fertile period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Table 7.8 Source of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Table 7.9 Future use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Table 7.10 Reason for not intending to use contraception . . . . . . . . . . . . . . . . . . . . . . 87 Table 7.11 Preferred method of contraception for future use . . . . . . . . . . . . . . . . . . . . 87 Table 7.12 Exposure to family planning messages on radio and television . . . . . . . . . . 88 Table 7.13 Exposure to family planning messages in print media . . . . . . . . . . . . . . . . . 90 Table 7.14 Discussion of family planning with husband . . . . . . . . . . . . . . . . . . . . . . . . 91 Table 7.15 Women’s approval of family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Figure 7.1 Trends in Contraceptive Use (Currently Married Women 15-49) . . . . . . . . 81 Figure 7.2 Current Use of Modern Contraceptive Methods by Selected Background Characteristics (Currently Married Women 15-49), NHS 1998 and CDHS 2000) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 CHAPTER 8 OTHER PROXIMATE DETERMINANTS OF FERTILITY Table 8.1 Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Table 8.2 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Table 8.3 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Table 8.4 Age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Table 8.5 Median age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Table 8.6 Recent sexual activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Table 8.7 Postpartum amenorrhea, abstinence, and insusceptibility . . . . . . . . . . . . . 101 Table 8.8 Median duration of postpartum insusceptibility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Table 8.9 Menopause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Figure 8.1 Current Marital Status by Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 CHAPTER 9 FERTILITY PREFERENCE Table 9.1 Fertility preferences by number of living children . . . . . . . . . . . . . . . . . . . 103 Table 9.2 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Table 9.3 Desire to limit childbearing by background characteristics . . . . . . . . . . . . 105 Table 9.4 Need for family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Table 9.5 Ideal and actual number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Table 9.6 Mean ideal number of children by background characteristics . . . . . . . . . 109 Table 9.7 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Table 9.8 Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 xii * Tables and Figures Page CHAPTER 10 ADULT AND MATERNAL MORTALITY Table 10.1 Data on siblings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Table 10.2 Indicators on data quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Table 10.3 Sibship size and sex ratio of siblings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Table 10.4 Adult mortality rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Table 10.5 Direct estimates of maternal mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 CHAPTER 11 INFANT AND CHILD MORTALITY Table 11.1 Early childhood mortality rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Table 11.2 Early childhood mortality by socioeconomic characteristics . . . . . . . . . . . 125 Table 11.3 Early childhood mortality by demographic characteristics . . . . . . . . . . . . 127 Table 11.4 High-risk fertility behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Figure 11.1 Infant Mortality Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Figure 11.2 Under-Five Mortality Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Figure 11.3 Infant and Child Mortality (1998 Census, NHS 1998, and CDHS 2000) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Figure 11.4 Infant Mortality by Selected Demographic Characteristics . . . . . . . . . . . . 127 CHAPTER 12 MATERNAL AND CHILD HEALTH Table 12.1 Perceived big problem in accessing women's health care by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Table 12.2 Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Table 12.3 Number of antenatal care visits and stage of pregnancy . . . . . . . . . . . . . . 135 Table 12.4 Antenatal care content . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Table 12.5 Tetanus toxoid injections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Table 12.6 Night blindness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Table 12.7 Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Table 12.8 Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Table 12.9 Delivery characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Table 12.10 Postnatal care by background characteristics . . . . . . . . . . . . . . . . . . . . . . 144 Table 12.11 Postnatal care providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 Table 12.12 Postnatal roasting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Table 12.13 Use of smoking tobacco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 Table 12.14 Chew tobacco and/or betel nuts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Table 12.15 Birth registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 Table 12.16 Vaccinations by source of information . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Table 12.17 Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . 153 Table 12.18 Vaccinations in first year of life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 Table 12.19 Prevalence and treatment of fever and acute respiratory infection (ARI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Table 12.20 Treatment of fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Tables and Figures * xiii Page Table 12.21 Prevalence of diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 Table 12.22 Knowledge of ORS packets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 Table 12.23 Diarrhea treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Table 12.24 Feeding practices during diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 Figure 12.1 Source of Antenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Figure 12.2 Percent Distribution of Live Births by Place of Delivery . . . . . . . . . . . . . . . 140 Figure 12.3 Source of Antenatal Care and Assistance During Delivery . . . . . . . . . . . . . 142 Figure 12.4 Vaccination Coverage among Children Age 12-23 Months . . . . . . . . . . . . 152 Figure 12.5 Prevalence of ARI, Fever, and Diarrhea by Age in Months . . . . . . . . . . . . 156 CHAPTER 13 MATERNAL AND CHILD NUTRITION Table 13.1 Initial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 Table 13.2 Breastfeeding status by child's age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 Table 13.3 Median duration and frequency of breastfeeding . . . . . . . . . . . . . . . . . . . 167 Table 13.4 Foods consumed by youngest children in preceding 24 hours . . . . . . . . . . 168 Table 13.5 Frequency of foods received by youngest children in preceding seven days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 Table 13.6 Frequency of foods consumed by youngest children in preceding 24 hours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Table 13.7 Nutritional status of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174 Table 13.8 Nutritional status of women by background characteristics . . . . . . . . . . . 177 Table 13.9 Prevalence of anemia in children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 Table 13.10 Prevalence of anemia in women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 Table 13.11 Prevalence of anemia in children by severity of anemia in the mother . . . 183 Table 13.12 Vitamin A intake among children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 Table 13.13 Micronutrients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 Figure 13.1 Nutritional Status of Children Under Five Years by Age in Months . . . . . . 175 Figure 13.2 Anemia and Nutritional Status of Children Under Five Years by Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180 Figure 13.3 Anemia in Children and Women by Region . . . . . . . . . . . . . . . . . . . . . . . 182 CHAPTER 14 HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS Table 14.1 Knowledge of AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188 Table 14.2 Knowledge of ways to avoid HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 Table 14.3 Knowledge of programmatically important ways to avoid HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 Table 14.4 Knowledge of HIV/AIDS-related issues . . . . . . . . . . . . . . . . . . . . . . . . . . . 192 Table 14.5 Social aspects of HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194 Table 14.6 Discussion of HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 Table 14.7 Testing for AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 Table 14.8 Knowledge of signs and symptoms of STIs . . . . . . . . . . . . . . . . . . . . . . . . 198 xiv * Tables and Figures Page Table 14.9 Self-reporting of sexually transmitted infections and STI symptoms . . . . . 200 Table 14.10 STIs and behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201 Table 14.11 Number of sexual partners of married and unmarried women . . . . . . . . . 202 Table 14.12 Knowledge and use of male condoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 Table 14.13 Use of condoms by type of partner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204 CHAPTER 15 WOMEN’S STATUS AND EMPOWERMENT Table 15.1 Choice of spouse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 Table 15.2 Differences in age and education between spouses . . . . . . . . . . . . . . . . . . 209 Table 15.3 Spousal communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211 Table 15.4 Household decision-making . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 Table 15.5 Women's participation in household decision-making . . . . . . . . . . . . . . . . 215 Table 15.6 Gender-related attitudes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218 Table 15.7 Women's agreement with reasons justifying a husband beating his wife . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220 Table 15.8 Women's agreement with reasons for refusing to have sexual relations with husband . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222 Table 15.9 Birth family interaction and support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223 Table 15.10 Ownership of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224 Table 15.11 Economic autonomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226 Table 15.12 Involvement in civil society . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228 Figure 15.1 Percent Distribution of Women by Number of Household Decisions in Which They Participate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216 CHAPTER 16 DOMESTIC VIOLENCE Table 16.1 Experience of beatings or physical mistreatment . . . . . . . . . . . . . . . . . . . 232 Table 16.2 Perpetrators of violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233 Table 16.3 Violence during pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234 Table 16.4 Marital control exercised by husband . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236 Table 16.5 Marital violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238 Table 16.6 Frequency of spousal violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240 Table 16.7 Onset of spousal violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241 Table 16.8 Physical consequences of spousal violence . . . . . . . . . . . . . . . . . . . . . . . . 242 Table 16.9 Spousal violence, women's status, and spousal characteristics . . . . . . . . . 244 Table 16.10 Help seeking by women who have experienced violence . . . . . . . . . . . . . . 247 Figure 16.1 Percentage of Women Who Have Experienced Different Forms of Violence Ever (Since Age 15) and in the 12 Months Preceding the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239 Figure 16.2 Interspousal Violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246 Tables and Figures * xv Page APPENDIX A SAMPLE DESIGN Table A.1 Household distribution (Source: 1998 Census) . . . . . . . . . . . . . . . . . . . . . 252 Table A.2 Allocation of the target number of women . . . . . . . . . . . . . . . . . . . . . . . . 253 Table A.3 Number of households to yield the target number of women . . . . . . . . . . 254 Table A.4 Number of clusters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255 Table A.5 Sample implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of selected variables for sampling errors, Cambodia 2000 . . . . . . . . . 262 Table B.2 Sampling errors: National sample, Cambodia 2000 . . . . . . . . . . . . . . . . . 263 Table B.3 Sampling errors: Urban sample, Cambodia 2000 . . . . . . . . . . . . . . . . . . . 264 Table B.4 Sampling errors: Rural sample, Cambodia 2000 . . . . . . . . . . . . . . . . . . . . 265 APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267 Table C.2 Age distribution of eligible and interviewed women . . . . . . . . . . . . . . . . . 268 Table C.3 Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268 Table C.4 Births by calendar years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269 Table C.5 Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 270 Table C.6 Reporting of age at death in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271 Foreword * xvii FOREWORD With great pleasure, we would like to introduce the first ever Cambodia Demographic and Health Survey that was conducted successfully in the year 2000. This survey is sponsored by UNFPA, UNICEF, and USAID, and technical assistance was provided by ORC Macro. The National Institute of Statistics (NIS) of the Ministry of Planning and the Directorate General for Health of the Ministry of Health (MoH) were the project implementation agencies. The NIS was responsible for monitoring the progress of the project. Fieldwork for the CDHS took place from early February to the end of July 2000. This report presents the main findings of the CDHS 2000. It includes information on demography, family planning, infant and child mortality, domestic violence, and health-related information such as breastfeeding, antenatal care, children’s immunization, childhood diseases, and HIV/AIDS. Also, the questionnaires are designed to evaluate the nutritional status of mothers and children and to measure the prevalence of anemia. The findings from the CDHS 2000 are expected to be used by policymakers to evaluate the demographic and health status of the Cambodian population in order to formulate appropriate population and health policies and programmes in Cambodia. Reproductive health and child health programmes and facilities need to be expanded and improved to reduce the gaps between the levels of social and economic development of other ASEAN countries. We deeply appreciate the UNFPA, UNICEF, and USAID for sponsoring the project and ORC Macro for providing technical assistance. We gratefully acknowledge the support and encourage- ment extended by HE. Mam Bun Heng, Secretary of State-Ministry of Health, HE. Lay Prohas, Secretary of State-Ministry of Planning, HE. Eng Huot, Director General of Health, HE. San Sy Than, Director, NIS, and other members of the Executive Committee and Technical Committee who contributed greatly to the timely execution of survey activities and successful completion of the survey as planned. We are grateful to all the persons involved in survey design and implementation, data processing, analysis of the results, and report writing for the CDHS 2000, and especially NIS and MoH staff at central and provincial offices who contributed in making the survey a success. Chhay Than Minister of Planning Acknowledgments * xix ACKNOWLEDGMENTS The Cambodia Demographic and Health Survey 2000 is the first survey of its kind conducted in Cambodia. The survey was sponsored by UNFPA, UNICEF, and USAID. It was implemented by the National Institute of Statistics (NIS), Ministry of Planning (MoP) in collaboration with the Directorate General for Health, Ministry of Health (MoH). The survey covered a sample of 12,810 households and 15,557 eligible women. The response rate was about 98 percent. The successful implementation of the CDHS 2000 would not have been possible without the close cooperation and dedicated efforts of many institutions and individuals. We are indeed very grateful to H.E. Chhay Than, Minister of Planning for his continuous support and encouragement, from the stage of planning for the survey until the finalization of the report. The Executive Committee and Technical Committee for the survey provided overall guidance and technical advice, from time to time, which proved invaluable. The active support and guidance of Excellencies Secretaries of State, HE. Dr. Mam Bun Heng, Ministry of Health and HE. Lay Prohas, Ministry of Planning is acknowledged with deep gratitude. We highly appreciate the contribution made by Ms. Yoshiko Zenda, UNFPA Representative, Ms. Nuzhat Ehsan, Deputy Representative of UNFPA, Mr. May Tum, UNFPA National Programme Officer, Dr. Kees Goudswaard, Monitoring and Evaluation Officer, UNICEF, Dr. Randy Kolstad and Ngudup Paljor from USAID, and Ms. Raji Rao, consultant of UNFPA. Our deep appreciation also goes to ORC Macro for providing technical support to the Project. The efforts of ORC Macro’s team led by Mr. Bernard Barrère, Senior Demographic Expert and his colleagues Mr. Robert Johnston, Mr. Marc Souliè, Mr. Mamadou Thiam, and others in assisting us in several aspects of the survey went a long way in improving the analyses and presentation. We highly appreciate their help. We also gratefully acknowledge the assistance from UNFPA, UNICEF, WFP, and WHO especially for loaning vehicles for the fieldwork, which increased efficiency and permitted better supervision, tremendously improving the quality of data. We extend our deepest gratitude to all supervisors, field editors and interviewers from NIS of MOP, MOP central and local offices (planning and statistics staff) and MOH staff (central and local offices) whose dedicated efforts ensured the quality and timeliness of the survey and to all respondents for contributing their time and for giving the required information, enabling us to produce high-quality data for the country. Finally, we would like to thank the core staff of CDHS, the CDHS field and office staff, and other individuals who contributed to the success of the survey. San Sy Than Survey Director Summary of Findings * xxi SUMMARY OF FINDINGS This report presents the results of the 2000 Cambodia Demographic and Health Survey (CDHS 2000). The principal objective of the survey is to provide policymakers and planners with current and reliable data on household and women’s characteristics, fertility and family planning behavior, child and maternal mortality, children’s nutritional status, utiliza- tion of maternal and child health services, women’s status and household relations, illnesses and injuries, and knowledge of HIV/AIDS. During the course of the CDHS survey, 15,351 women between the ages of 15 and 49 were interviewed, comprising the largest demo- graphic and health survey in Cambodia to date and providing population and health data for analysis at the national and regional levels. Although significantly expanded in content, the CDHS 2000 survey is a successor to the 1998 National Health Survey (NHS) and provides updated estimates of demographic and health indicators covered in the earlier survey. The CDHS survey also provides com- plementary information to the 1998 General Population Census. Together, these sources of information will be used for formulating strate- gies of development for Cambodia. FERTILITY Cambodia’s age and sex distributions reflect the impact of the Khmer Rouge regime be- tween 1975 and 1979. During and after the regime, mortality levels were high, particularly for men, and fertility decreased. After the civil conflict, a baby boom occurred, reflected in the large proportion of the population that is aged 20 or less (55 percent of the total population). At current fertility levels, a Cambodian woman will give birth to an average of four children during her lifetime. Women in rural areas will give birth to an average of one child more than women in urban areas (4.2 compared with 3.1 children, respectively). Women with no educa- tion have on average half a child more than those with primary education, but 1.6 children more than those who have secondary and higher levels of education. Longer birth intervals contribute to lower total fertility levels, as well as to the improved health status of the mother and child. Most Cambo- dian women (79 percent) have a birth interval of 24 months or greater. Median birth intervals are shortest in the regions of Mondol Kiri/ Rotanak Kiri and Kampong Chhnang (29.3 and 29.5 months, respectively) and longest in Phnom Penh and Prey Veaeng (37.7 and 37.6 months, respectively). FERTILITY PREFERENCES AND DEMAND FOR FAMILY PLANNING Knowledge of family planning is very high in Cambodia, with 92 percent of all women and 96 percent of married women knowing a con- traceptive method. Desire to space or limit the number of children is also high, as expressed by half of currently married Cambodian women. This suggests that there is a demand for family planning services among the women who would like to space or limit their births. Interestingly, there is not a great difference in demand for family planning between urban and rural wom- en: 60 percent of urban women compared with 56 percent of rural women have an unmet need for spacing or limiting their births. About one-third (32 percent) of births in Cam- bodia are unplanned: 9 percent were mistimed and 24 percent were not wanted at all. The total wanted fertility rate is 3.1 children, which is almost one child less than the actual fertility rate of 4.0. The gap between wanted and actual fertility is greatest among women living in rural areas and uneducated women. These xxii * Summary of Findings results suggest that while the level of knowl- edge about contraception is very high in Cam- bodia, the level of unmet need for family planning services is high as well. WOMEN’S EMPLOYMENT, WOMEN’S STATUS, AND DOMESTIC VIOLENCE Almost three-quarters of women were working at the time of the survey; most women work seasonally (48 percent), while 24 percent of women work year-round. Fifty-one percent of all working women in Cambodia are either paid in kind or not paid at all; highly educated women and women in nonagricultural occupa- tions are much more likely to earn cash than other women. Among currently married women who earn cash for their work, 47 per- cent report that they alone make the decisions about how their earnings will be used, while 50 percent report that they and their husband make the decisions jointly. It is interesting to note that large proportions of household expenditures are met with Cambodian wom- en’s earnings. Women’s ability to access health services and information, which is associated with their status or empowerment within their society or household, is crucial to their own health as well as that of their family. One important aspect of women’s status and empowerment is the belief in the ideal of gender equality in roles and rights in society as well as in the home. The CDHS survey explored women’s acceptance of unequal gender roles and found that although most women believe that it is better to educate a son than a daughter (59 percent), indicating an acquiescence to societal gender inequality, even greater pro- portions of women believe that husbands should help with household chores, that it is unacceptable for a man to have extramarital sex, and that a woman should not tolerate beatings to keep the family together (85 per- cent, 89 percent, and 86 percent, respectively). Sixty-five percent of Cambodian women do not agree with any of the specific reasons that a husband might be justified in beating his wife. Despite this widespread intolerance of a hus- band’s physical abuse of his wife, the CDHS survey found that one out of four ever-married women in Cambodia age 15-49 have experi- enced physical violence since age 15, and one out of seven (15 percent) have experienced violence in the 12 months preceding the survey. The most common form of violence is by cur- rent and previous husbands. Among women who reported experiencing severe violence in the last 12 months, 53 percent report having had bruises and aches, and 13 percent report injuries and broken bones because of something the husband did. MATERNAL HEALTH Access to professional maternity care is rela- tively low in Cambodia: 38 percent of women received antenatal care from trained health personnel for pregnancies that occurred in the last five years. During the same period, more than half of Cambodian mothers (55 percent) did not receive any antenatal care for their pregnancies. However, 40 percent of women who received antenatal care reported that they were informed of pregnancy-related complica- tions during their visits. The median number of visits is 2, about 6 times less than the recom- mended number of 12 or 13 visits, and the median duration of pregnancy for the first antenatal care visit is 5.8 months, indicating that women start antenatal care at a relatively late stage of their pregnancy. Most Cambodian babies (89 percent) born in the five years before the survey were delivered at home. Only 10 percent of births took place in a health facility. Although traditional birth attendants assisted at the majority of births (66 percent), 32 percent of births were at- tended by a trained health professional: 28 per- cent by a midwife and the remaining 4 percent by a doctor or nurse. Fifty-seven percent of urban women received delivery assistance from a trained professional, in contrast to rural wom- en, of whom 28 percent received trained profes- sional help: rural women are more likely to Summary of Findings * xxiii receive assistance from a traditional birth attendant (70 percent). Forty-six percent of mothers who gave birth during the five years preceding the survey received no postnatal care at all. One-third of women who delivered outside of a health facility received postnatal care from traditional birth attendants, about one in seven received care from a midwife, and only 1 percent re- ceived care from a doctor/nurse. CHILD HEALTH Forty percent of Cambodian children age 12-23 months are fully vaccinated, while 71 percent have received the BCG vaccination and 55 per- cent have been vaccinated against measles. The coverage for the first dose of DPT is higher (68 percent), compared with the third dose (49 percent): the drop rate is 29 percent be- tween the first and the third dose of DPT. Polio coverage is much higher than DPT cover- age, primarily due to the success of the na- tional immunization day campaigns during which polio vaccines are administered. Three in four children age 12-23 months received the first dose of polio, 64 percent received the second dose, and 52 percent received the third dose. In addition, about 30 percent of children received polio vaccination at birth. Regarding childhood illnesses, 20 percent of children under five years of age showed symp- toms of acute respiratory infection (ARI), the leading cause of childhood morbidity and mortality, at some time in the two weeks preceding the survey. Children age 6-11 months are most likely to suffer symptoms of ARI (27 percent), compared with all other age groups. As with ARI, children age 6-11 and 12-23 months are more commonly sick with fever (48 and 44 percent, respectively) than other children. Regional variations were significant, ranging from 4 percent in Prey Veng to 54 per- cent in Kampong Chhnang. Thirty-one percent of children with fever, cough, and rapid breath- ing were not taken for treatment. Nineteen percent of children under five years of age had diarrhea in the two weeks preceding the survey. The occurrence of diarrhea varies by age of the child and follows the same pattern as ARI and fever. Only 22 percent of children with diarrhea were taken to a health provider. One in two women who gave birth in the five years preceding the survey knew about oral rehydration salts (ORS). However, 48 percent of children with diarrhea were treated with some kind of oral rehydration therapy (ORT): 18 percent were treated with a solution pre- pared from an ORS packet, 3 percent were given recommended home fluids (RHF), and 40 percent were given rice water. Other treat- ments for diarrhea consisted of pills or syrup (57 percent), injections (7 percent), and other/home remedies (9 percent). BREASTFEEDING AND NUTRITION Breastfeeding is nearly universal in Cambodia, with 96 percent of children born in the five years preceding the survey ever breastfed. However, only 11 percent of infants were put to breast within an hour after delivery and one- fourth of infants were breastfed within the first day. The median duration of breastfeeding among children under 3 years of age is 24 months. Contrary to the recommendation of the World Health Organization to exclusively breastfeed for the first six months, only 18 percent of Cambodian children under two months are exclusively breastfed. Complementary feeding starts early: 70 percent of children under two months of age receive breast milk and water, 4 percent receive breast milk and other water- based liquids, and another 4 percent receive breast milk and complementary food. The practice of bottle-feeding is not common. About 77 percent of children under age three receive some type of solid or mushy food by 6-9 months of age. Grain supplements are more xxiv * Summary of Findings commonly consumed than roots, tubers, beans and legumes and lentils. Meat, fish, poultry, and eggs are received by half of the children age 6-9 months. Chronic malnutrition among Cambodian children under five years of age is very high: 45 percent of children are stunted (short for their age), and more than one in five children (21 percent) is severely stunted. Fifteen per- cent of children less than five years of age are wasted (too thin for their height), and 45 per- cent of children age five and below are under- weight. The nutritional status of women is also an issue of importance. The mean height of Cambodian women is 153 centimeters. About 6 percent of women are shorter than 145 centimeters and are considered to be at nutri- tional risk. One in five women falls below the cutoff of 18.5 (kg/m2) for the body mass index (BMI). In general, very young women age 15- 19 and rural women are more likely than other women to suffer from chronic energy defi- ciency. KNOWLEDGE OF HIV/AIDS A very high percentage of Cambodian women (95 percent) have heard of AIDS, and a sur- prising 48 percent of women say that they know someone personally who has AIDS or who has died of AIDS. Given the high levels of awareness of this syndrome in both urban and rural areas, it is not surprising that 69 percent of women were able to cite two or three impor- tant ways to avoid contracting HIV/AIDS and another 4 percent were able to cite one way. Seventy-two percent of respondents mentioned the use of condoms as a specific way to avoid HIV/AIDS, 68 percent mentioned limiting the number of one’s sexual partners, and 60 percent cited abstinence, all of which are methods of avoidance considered to be programmatically important. Women in urban areas and women who have more education are more likely to know about HIV and ways to avoid it than other women. Knowledge of HIV-related issues is also impor- tant in understanding how to prevent contract- ing HIV and in checking the spread of the disease in a population. Sixty-three percent of women believe that a healthy-looking person can have the virus, and most women also recog- nize that the infection can be transmitted from a mother to her children in a variety of ways: during pregnancy (70 percent), during delivery (62 percent), and by breastfeeding (67 per- cent). Introduction * 1 Table 1.1 Basic demographic indicators Demographic indicators from various sources, Cambodia ___________________________________ Population (millions) 11,437,656 Density (per square km.) 64 Percent urban 15.7 Annual population growth rate (percent) 2.5 ___________________________________ Source: General Population Census of Cambodia, 1998 (National Institute of Statistics, 1999) INTRODUCTION 1 1.1 GEODEMOGRAPHY, HISTORY, AND ECONOMY Geodemography Cambodia is an agricultural country located in Southeast Asia; it is bounded by Thailand to the west, Laos and Thailand to the north, the gulf of Thailand to the south, and Vietnam to the east. It has a total land area of 181,035 square kilometers. The maximum extent of the country from the east to the west is approximately 580 kilometers; it extends for 450 kilometers from the north to the south. Cambodia has a tropical climate with two distinct monsoon seasons, which set the rhythm of rural life. From November to February, the cool, dry northeastern monsoon brings little rain, whereas the southwestern monsoon carries strong winds, high humidity, and heavy rains. The mean annual temperature for Phnom Penh, the capital city, is 27oC. April is the hottest month in which maximum daily temperature can soar up to more than 40oC. The 1962 Census was the last official census to be conducted prior to 1998; it revealed a population of 5.7 million. The population census in 1998 recorded the number of the people in the country at 11,437,656 with an annual growth rate of 2.5 percent (National Institute of Statistics, 1999). The 1998 census showed that 51.8 per- cent of the population was female and 48.2 percent was male. The percentage of the population age 0-14 was 42.8 percent, with 53.7 percent age 15-64 (Table 1.1). In Cambodia, 84 percent of the population lives in rural areas whereas 16 percent lives in urban areas. The population density in the country as a whole is 64 per square kilometer. This density differs significantly from one province to another: for example, the density can range from a mere 2 per square kilometer in Mondol Kiri province (a remote and mountainous area) to 3,448 per square kilometer in the capital city of Phnom Penh. It is shown that, according to the 1998 census, about one million inhabitants (999, 809) live in Phnom Penh. The average household size of a Cambodian family is 5.4 people. In urban areas it is 5.7 people—higher than that of the rural areas (5.3 people per household on average). History After nearly a century under French control, Cambodia had gained complete independence from France under the leadership of Prince Norodom Sihanouk on 9 November 1954 with the recognition of the Geneva Conference in May 1954. However, under his reign, an internal political 2 * Introduction conflict continued. In March 1970, a promilitary coup led by General Lon Nol overthrew Prince Sihanouk. On 17 April 1975, the Khmer Rouge ousted the Lon Nol regime and took control of the country. Under the new regime, the country was renamed Democratic Kampuchea. Just a few weeks after taking power, the radical Khmer Rouge forced the whole population of the capital city and provincial towns to leave for the countryside where they were placed in mobile teams and worked as slaves in the fields from 12 to 15 hours a day. Cut off from the outside world, Cambodia then came into a dark era, or year zero society, as all national infrastructures were completely eradicated. Nearly three million Cambodian people died during the Khmer Rouge’s most radical and genocidal regime. On 7 January 1979, the revolutionary army of the National Front for Solidarity and Liberation of Cambodia defeated the Khmer Rouge regime and then proclaimed the country as the People’s Republic of Kampuchea and later the State of Cambodia in 1989. The most important event was the free elections on 25 May 1993 with the turnout of 89.6 percent under the close supervision of the United Nations Transitional Authority in Cambodia (UNTAC). Since then, Cambodia was proclaimed as the Kingdom of Cambodia again with a system of constitutional monarchy. Now, Cambodia is stable and on its way to democracy and a brilliant future. Economy Since the 1991 Paris Peace Accord, Cambodia’s economy has made remarkable progress after more than two decades of political unrest (Ministry of Planning, 1999). However, Cambodia still remains the poorest and least developed country in Asia, with the gross domestic product per capita estimated at approximately $238 in 2000. The government expenditure on health is $1 per capita. Agriculture, mainly rice production, is still the main economic activity for Cambodia. In addition, small-scale subsistence agriculture, such as fisheries, forestry, and livestock, are still the most important sector, which accounted for about 38 percent of the GDP in 2000. Tourism services are also important components of foreign direct investment. 1.2 HEALTH STATUS AND POLICY Cambodian health is still among the worst in the Western Pacific Region. The overall health system performance was ranked 174th among other member states of the World Health Organization (WHO, 2000). The average life expectancy at birth is estimated at 54.4 years. For males, life expectancy at birth is 54 years, whereas females can expect to live an average of 58 years. Due to poverty, poor sanitation, and inadequate health services, it is estimated that more than one in ten Cambodian children dies before his or her fifth birthday. The pattern of morbidity and mortality have remained virtually unchanged for years, and the general populace seems to be greatly affected by the same diseases including diarrhea, acute respiratory infections (ARI), dengue hemorrhagic fever, malaria, malnutrition, and other vaccine-preventable diseases. The maternal mortality rate (MMR) is 437 per 100,000 live births, due mainly to abortion complications, eclampsia, and hemorrhage. Introduction * 3 HIV/AIDS now poses a serious public health problem in Cambodia due to the epidemic rapid pace of growth. In 2000, a sero-prevalence rate of 2.8 percent was found among the population age 15-49. Currently, it is estimated that there are about 169,000 HIV-infected people living in Cambodia. Landmine accidents also pose a major health concern. However, a significant decrease in the number of cases, from 1,265 in 1997 to 727 in 1998, was reported by public health services. Cambodia is still recorded as having the highest prevalence rate of amputation, 1 per 236 persons, in the world. It is estimated that 4 to 6 million landmines remain in the ground in Cambodia (Ministry of Planning, 1999). The goal of the Ministry of Health (MoH) is the promotion of the people’s health, which will enable them to participate in economic and social development and to contribute to the alleviation of poverty (Ministry of Health, 2000). The government’s policies for health sectors hinge on the following priorities: ! Providing basic health services to all Cambodian people, with community involvement ! Decentralizing financial and administrative functions ! Developing human resources ! Fostering competition among public and private sectors based on technology and professional ethics ! Promoting people’s awareness of the qualifications of health care providers and a healthy lifestyle ! Promoting health legislation ! Paying special attention to women’s and children’s health, and controlling and preventing communicable diseases ! Taking into account specific priority groups such as the elderly and the disabled, and specific health issues, including mental health, eye care, and oral health ! Strengthening the health information system. 1.3 OBJECTIVE AND SURVEY ORGANIZATION The Cambodia Demographic and Health Survey 2000 (CDHS) is the first nationally representative survey ever conducted in Cambodia on population and health issues. The primary objective of the survey is to provide the Ministry of Health, Ministry of Planning (MoP), and other relevant institutions and users with updated and reliable data on infant and child mortality, fertility preferences, family planning behavior, maternal mortality, utilization of maternal and child health services, health expenditures, women’s status, domestic violence, and knowledge and behavior regarding AIDS and other sexually transmitted infections (STIs). This information contributes to policy decisions, planning, monitoring, and program evaluation for the development of Cambodia, at both national- and local-government levels. 4 * Introduction The long-term objectives of the survey are to technically strengthen the capacity both of the Ministry of Health and the National Institute of Statistics (NIS) of MoP for planning, conducting, and analyzing the results of further surveys. The CDHS 2000 survey was conducted by the National Institute of Statistics of the Ministry of Planning, and the Ministry of Health. The CDHS executive committee and technical committee were established to oversee all technical aspects of implementation. They consisted of repre- sentatives from the Ministry of Health, the Ministry of Planning, the National Institute of Statistics, the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), and the U.S. Agency for International Development (USAID). ORC Macro provided technical assistance including sampling design, survey methodology, interviewer training, and data analysis through the MEASURE DHS+ project. Funding for the survey came from UNFPA, UNICEF, and USAID. 1.4 SAMPLE DESIGN The CDHS survey called for a nationally representative sample of 15,300 women between the ages of 15 and 49. Survey estimates are produced for 12 individual provinces (Banteay Mean Chey, Kampong Cham, Kampong Chhnang, Kampong Spueu, Kampong Thum, Kandal, Kaoh Kong, Phnom Penh, Prey Veaeng, Pousat, Svay Rieng, and Takaev) and for the following 5 groups of provinces: • Bat Dambang and Krong Pailin • Kampot, Krong Preah Sihanouk, and Krong Kaeb • Kracheh, Preah Vihear, and Stueng Traeng • Mondol Kiri and Rotanak Kiri • Otdar Mean Chey and Siem Reab. The master sample developed in 1998 by the National Institute of Statistics served as the sampling frame for the CDHS survey. The master sample is based on the 1998 Cambodia General Population Census and consists of 600 villages selected with probability proportional to the number of households within the village. Villages are listed with the total population count and the number of enumeration areas (EAs), households, and segments. Enumeration areas were created during the cartography conducted in preparation for the 1998 census. A segment in a village corresponds to a block of about ten households. Segments were created only for villages retained in the master sample and maps showing their boundaries were also available for all of them. The sample for the CDHS survey is a stratified sample selected in three stages. As for the master sample, stratification was achieved by separating every reporting domain into urban and rural areas. The sample was selected independently in every stratum. The master sample contains a small number of villages for some of the provinces. For this reason, additional villages were directly selected from the census frame in order to reach the required sample size in these provinces. In the first stage, 471 villages were selected with probability proportional to the number of households in the village. Of these 471 villages, 63 were directly selected from the 1998 census frame. In the second stage, 5 or fewer segments were retained from each of the villages selected from the master sample, while 1 EA was retained from each of the 63 villages directly selected from the 1998 census frame. Each of these EAs consists of several segments. Introduction * 5 A household listing was carried out in all selected segments and EAs, and the resulting lists of households served as the sampling frame for the selection of households in the third stage. All women 15-49 were interviewed in selected households. In addition, a subsample of 50 percent of households was selected for data collection of anthropometry. Anemia testing was implemented in 25 percent of the sample. Only the women identified in the households with anemia testing were eligible for the section related to women’s status. In this subsample of households, only one woman was selected in each household to be interviewed on domestic violence. 1.5 QUESTIONNAIRES Two types of questionnaires were used in the CDHS 2000 survey: the Household Questionnaire and the Women’s questionnaire. The contents of these questionnaires were based on the international MEASURE DHS+ model. They were modified according to the situation in Cambodia and were designed to provide information needed by health and family planning program managers and policymakers, mainly the Ministry of Health, the Ministry of Planning, and other relevant institutions and organizations. The agencies involved in developing these questionnaires were the National Institute of Public Health/MoH, the National Institute of Statistics/MoP, UNFPA, UNICEF, USAID, WHO, Hellen Keller International, Marie Stopes International, the Ministry of Women’s Affairs, Project Against Domestic Violence, and the Demographic and Health Surveys (DHS) project of ORC Macro. The questionnaires were developed in English and then translated into Khmer. Back translation of the questionnaires, from Khmer to English, was also conducted. The Household Questionnaire enumerated all the usual members and visitors of the selected households and collected information on the socioeconomic status of the households. The first part of the questionnaire collected information on the relationship of the persons to the head of household and items such as residence, sex, age, marital status, and level of education. This information was used to identify women who were eligible for the individual interview. The Household Questionnaire also contained information on the prevalence of accidents, physical impairment, illness, and health expenditures. Information was also collected on the dwelling units, including source of water, type of toilet facilities, fuels used for cooking, materials used for the house’s floor and roof, and ownership of a variety of consumer goods. In addition, during the household survey, anthropometry and anemia testing were carried out to determine nutritional status among children less than five years old and women age 15-49. The Women’s Questionnaire collected information from all women age 15-49 on the following topics: • Respondent’s background characteristics • Reproduction • Contraception (knowledge and use of family planning) • Pregnancy, antenatal care, delivery, and postnatal care • Infant feeding practices, child immunization, and health • Marriage and sexual activity • Fertility preference • Husband’s background characteristics and women’s work • Knowledge of HIV/AIDS and other sexually transmitted infections • Maternal mortality and adult mortality 6 * Introduction • Women’s status • Domestic violence (household relations module). 1.6 TRAINING AND FIELDWORK Prior to the main survey, the pretest training and fieldwork were conducted in November and December 1999. Twenty-two interviewers (5 health staff from the MoH in Phnom Penh and 17 from provincial health departments) were trained to perform the pretest within three-week periods. The pretest fieldwork was carried out over a one-week period in both rural and urban areas and resulted in 240 completed pretest interviews. In addition, anemia testing and iodine testing for household salt were also included in the pretest. Debriefing sessions were held with the field staff and survey coordinators, and questionnaires were then modified based on the outcome of the pretest. The training of the main survey was carried out from January 3 to February 9, 2000. Instruction on interviewing techniques, fieldwork procedures, and a detailed review of questionnaires section by section were thoroughly and clearly explained. In addition, in-class mock interviews among participants, anemia testing, and anthropometry practices were also performed. The practice of the main survey was conducted, in both rural and urban areas, at several locations. For practice purposes, anemia testing, weighing, and measuring children were carried out by team supervisors and field editors as well as team members at two kindergartens and an orphanage in Phnom Penh. The interviewing practices with real respondents took place in areas outside of the main sample. Moreover, during the practice period, team supervisors and field editors were additionally instructed in the procedures for contacting local authorities, editing filled-out questionnaires, and controlling data quality. The CDHS data were collected by 17 teams, each consisting of a team supervisor, a field editor, and four female interviewers. Each team was in charge of data collection in one province or a group of provinces. Coordination and supervision of the interviewing activities were done by four survey coordinators and four supervisory staff members from the National Institute of Sta- tistics/MoP and the Ministry of Health. Data collection took place over a six-month period, from February to July 2000. 1.7 DATA PROCESSING All completed questionnaires were brought to the National Institute of Statistics for data processing. Questionnaires were checked for the selected households and eligible respondents by the office editors. Moreover, the few questions that had not been precoded (e.g., occupation) were coded prior to data entry. Data were then entered and edited using the software package Integrated System for Survey Analysis (ISSA) developed specially for the Demographic and Health Survey program. Data entry and office editing commenced in February and was completed in October 2000. To provide feedback for the field teams, the office editors were instructed to report any problems found during the editing of questionnaires. These reports were reviewed by the senior staff. If serious errors were detected in one or more questionnaires from a cluster, the team’s supervisor working in the cluster was informed and advised of the measures to be taken to prevent these problems in the future. Introduction * 7 Table 1.2 Results of the household and women’s interviews Results of the household and women’s interviews, according to residence, Cambodia 2000 ___________________________________________________ Residence _______________ Result Urban Rural Total ___________________________________________________ Household interviews Households sampled Households occupied Households interviewed Household response rate Women’s interviews Number of eligible women Number of eligible women interviewed Eligible woman response rate 1,892 10,918 12,810 1,842 10,633 12,475 1,817 10,419 12,236 98.6 98.0 98.1 2,656 12,901 15,557 2,627 12,724 15,351 98.9 98.6 98.7 1.8 COVERAGE OF THE SURVEY Table 1.2 presents the information on the survey coverage of the households and individual interviews. The table shows that a total of 12,810 households were selected in the sample, of which 12,475 were occupied at the time the fieldwork was carried out. Of the 12,475 occupied households, 12,236 were successfully interviewed, resulting in a household response rate of 98.1 percent. The main reason for the noninterviewed households was that those households no longer existed in the sampled clusters at the time of the interview. A total of 15,558 women in these households were identified as women eligible to be interviewed. Questionnaires were then completed for 15,351 of those women, which represented a response rate of 98.7 percent. The principal reason for nonresponse among eligible women was a failure to find them at home despite repeated visits to their household. Household Population and Characteristics * 9 2HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS This chapter provides a summary of the socioeconomic characteristics of households and respondents surveyed, including age, sex, place of residence, educational status, household facilities, and household characteristics. Information collected on the characteristics of the households and respondents is important in understanding and interpreting the findings of the survey and provides indicators of the representativeness of the survey. The information is also useful in understanding and identifying the major factors that determine or influence the basic demographic indicators of the population. Throughout this report, numbers in the tables reflect weighted numbers. Due to the way the sample was designed, the number of cases in some regions appears small since they are weighted to make the regional distribution nationally representative. However, roughly the same number of households and women were interviewed in each province or group of provinces and the number of unweighted cases are always large enough to make the data statistically significant. Estimates based on an insufficient number of cases are shown into parentheses or suppressed. In this report, the CDHS 2000 data is compared with data from the 1998 National Health Survey (NHS) and the General Population Census of Cambodia 1998. The NHS survey primarily targeted women age 15-49. The NHS survey had a sample size that was half that of the CDHS 2000 survey and used a more limited questionnaire. The NHS survey was conducted by the National Institute of Public Health. The 1998 Census did a complete enumeration of the Cambodian population. The Census instrument consisted of a two-page form that served to collect information on basic sociodemographic information. The Census was conducted by the National Institute of Statistics. The CDHS 2000 survey collected information from all usual residents of a selected household (the de jure population) and persons who had stayed in the selected household the night before the interview (the de facto population). Since the difference between these two populations is small and to avoid double counting, all tables in this report refer to the de facto population unless otherwise specified. The CDHS survey used the same definition of household as the Census. A household was defined as a person or group of related and unrelated persons who live together in the same dwelling unit(s) or in connected premises, who acknowledge one adult member as head of the household, and who have common arrangements for cooking and eating meals. 2.1 DEMOGRAPHIC CHARACTERISTICS OF HOUSEHOLDS Age and sex are important demographic variables and are the primary basis of demographic classification in vital statistics, censuses, and surveys. They are also important variables in the study of mortality, fertility, and nuptiality. The effect of variations in sex composition from one population group to another should be taken into account in comparative studies of mortality. In general, a cross-classification with sex is useful for the effective analysis of all forms of data obtained in surveys. In the household schedule, the CDHS 2000 survey collected information on age in completed years for each household member. When the age was not known, interviewers were instructed to 10 * Household Population and Characteristics Table 2.1 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age group, according to sex and residence, Cambodia 2000____________________________________________________________________________________________________ Urban Rural Total_______________________ _______________________ _______________________ Age group Male Female Total Male Female Total Male Female Total____________________________________________________________________________________________________ 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80 + Total Number 10.9 8.6 9.7 12.4 11.2 11.8 12.2 10.8 11.5 15.4 13.2 14.2 16.9 15.5 16.2 16.7 15.1 15.9 14.7 12.7 13.7 16.0 15.3 15.7 15.8 14.9 15.4 13.7 14.6 14.2 13.0 10.2 11.5 13.1 10.9 11.9 7.2 7.0 7.1 6.5 6.2 6.4 6.6 6.3 6.5 6.4 7.2 6.8 5.9 6.2 6.1 6.0 6.4 6.2 7.5 7.4 7.4 6.3 6.6 6.4 6.5 6.7 6.6 6.6 6.4 6.5 5.8 6.5 6.2 5.9 6.5 6.2 4.5 6.1 5.3 4.0 5.7 4.9 4.1 5.7 4.9 3.6 4.9 4.3 3.2 4.4 3.8 3.3 4.4 3.9 3.1 3.2 3.1 2.6 3.3 3.0 2.7 3.3 3.0 2.1 2.4 2.3 2.2 2.6 2.4 2.1 2.6 2.4 1.8 2.2 2.1 1.7 2.2 2.0 1.7 2.2 2.0 1.0 1.9 1.5 1.5 1.7 1.6 1.4 1.7 1.6 0.9 0.6 0.7 1.0 1.1 1.0 0.9 1.0 1.0 0.6 0.9 0.8 0.6 0.7 0.6 0.6 0.8 0.7 0.2 0.5 0.3 0.4 0.5 0.4 0.3 0.5 0.4 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 4,745 5,158 9,903 26,027 28,343 54,373 30,772 33,502 64,276 ____________________________________________________________________________________________________ Note: The table is based on the de facto population, i.e., persons who stayed in the household the night before the interview. inquire first for the date of birth in the Gregorian calendar, second using the Khmer calendar, and third using a historical calendar. The age was then calculated using conversion charts. These charts were specifically designed for the purpose of the survey. Interviewers were urged to be precise when recording ages and were warned against omission, especially among children under five years of age. The distribution of the household population in the CDHS 2000 survey is shown in Table 2.1 by five-year age groups, according to urban-rural residence and sex. The total population counted in the survey was 64,276, with females outnumbering males. The results indicate an overall sex ratio of 92 males per 100 females. The sex ratio does not vary between rural areas and urban areas (92 males per 100 females). The sex ratio observed in the CDHS 2000 is lower than that of the NHS (93 males per 100 females). The Census urban sex ratio (93 males per 100 females) was slightly higher than the CDHS urban sex ratio, while the NHS urban sex ratio was lower (91 males per 100 females). Both the Census rural sex ratio (96 males per 100 females) and the NHS rural sex ratio were higher (93 males per 100 females) than the CDHS rural sex ratio. The age structure of the household population observed in the survey is typical of a society with a youthful population. The sex and age distribution of the population is also shown in the population pyramid in Figure 2.1. Cambodia has a broad-based pyramid structure due to the majority of the population being under 20 years of age. Household Population and Characteristics * 11 Table 2.2 Population by age, according to selected sources Percent distribution of the de facto population by age group, according to selected sources, Cambodia 2000 _________________________________ 2000 1998 DHS Age group Census1 survey _________________________________ <15 15-64 65+ Total 42.8 42.7 53.7 53.6 3.5 3.6 100.0 100.0 _________________________________ 1 General Population Census of Cambodia, 1998 (National Institute of Statistics, 1999) Above the age of 25 years, the pyramid follows a usual pattern with decreasing numbers as age increases. As a consequence of the high levels of male mortality in the 1970s, the male/female ratio is lower than usual above the age of 35 years. There is an unusual gap in the pyramid structure for the age groups 20-24 and 25-29: these two age groups are smaller than those above and below. These two groups represent the cohorts born between February through July of 1971 and February through July of 1980. The time of escalating civil war and Khmer Rouge rule falls between these two periods; this era was characterized by few births and very high infant and child mortality. After the Khmer Rouge rule, a large increase in births occurred and continued until the last five-year period at the base of the pyramid. This last period corresponding to the years 1995 to 2000 reflects a decline in fertility. It also may illustrate an increase in infant mortality. The reduced number of population in the last five-year group also may be due to a generational effect of the population gap mentioned above. There are fewer women entering into their reproduc- tive lives in the 20-24 age group; therefore, there are fewer children born than in the previous periods. Cambodia has a large dependent population of children and adolescents. Children under 15 years of age account for almost 43 percent of the population, a feature of populations with high fertility levels (Table 2.2). Fifty-four percent of the population is in the age group 15-64, and slightly less than 4 percent are over 65 years of age. The results from the CDHS 2000 survey match almost perfectly those reported by the Census. 12 * Household Population and Characteristics Table 2.3 Household composition Percent distribution of households by sex of head of household and by household size, according to residence, Cambodia 2000_________________________________________ Residence_____________ Characteristic Urban Rural Total_________________________________________ Sex of head of household Male Female Total Number of usual members 1 2 3 4 5 6 7 8 9+ Total Mean size 72.1 75.0 74.6 27.9 25.0 25.4 100.0 100.0 100.0 1.8 1.9 1.9 4.7 6.3 6.1 10.3 12.2 12.0 16.6 17.5 17.4 17.6 18.3 18.2 14.5 16.2 16.0 14.5 11.8 12.2 8.9 8.0 8.1 11.0 7.6 8.1 100.0 100.0 100.0 5.7 5.3 5.4 _______________________________________ Note: The table is based on de jure members; i.e., usual residents. 2.2 HOUSEHOLD COMPOSITION Table 2.3 shows the distribution of households in the survey by the sex of the head of the household and by the number of household members in urban and rural areas. Households in Cambodia are predominantly male headed. However, a high percentage of households (25 percent) are headed by females with the proportion of female-headed households higher in urban areas than in rural areas. The average household size observed in the survey is 5.4 persons, which is similar to the average household size observed in the NHS survey (5.5 persons). Rural households have 5.3 persons per household and are slightly smaller than urban households (5.7 persons). Households with nine or more members are more common in urban areas (11 percent) than in rural areas (8 percent). Detailed information on children’s living arrangements and orphanhood is presented in Table 2.4. In Cambodia, 84 percent of children under 15 live with both parents, 9 percent live with only their mother, a little more than 1 percent live with only their father, and 4 percent live with neither parent. Four percent of children live with their mother even though their father is alive, less than 1 percent of children live with their father even though their moth- er is alive, and almost 3 percent live with neither parent even though both of them are alive. Six percent of children do not have a father who is alive, and 1 percent do not have a mother who is alive. In total, 7 percent of children have experienced the death of one or both parents. The percentage of children not living with their parents increases with age of the child. The proportion of children living with both parents varies little by sex. Rural children are slightly more likely to live with both parents (81 percent) than urban children (84 percent). The highest proportion of children living with both parents is in Kaoh Kong (90 percent), while the lowest proportion is in the Siem Reab/Otdar Mean Chey provinces (80 percent). In this group of provinces, 12 percent of children have experienced the death of one or both of their parents. Household Population and Characteristics * 13 Table 2.4 Children’s living arrangements Percent distribution of de jure children under age 15 by survival status of parents and children's living arrangements, according to background characteristics, Cambodia 2000 ______________________________________________________________________________________________________ Living Living with mother with father but not father but not mother Not living with either parent Missing Living ____________ _____________ ________________________ informa- with Only Only tion on Background both Father Father Mother Mother Both father mother Both father/ characteristic parents alive dead alive dead alive alive alive dead mother Total Number ______________________________________________________________________________________________________ Age <2 2-4 5-9 10-14 Sex Male Female Residence Urban Rural Region Banteay Mean Chey Kampong Cham Kampong Chhnang Kampong Spueu Kampong Thum Kandal Kaoh Kong Phnom Penh Prey Veaeng Pousat Svay Rieng Takaev Bat Dambang/Krong Pailin Kampot/Krong Kaeb/ Krong Preah Sihanouk Preah Vihear/Stueng Traeng/Kracheh Mondol Kiri/Rotanak Kiri Siem Reab/Otdar Mean Chey Specific project areas1 CDCP BHSP Total 92.8 4.2 1.4 0.1 0.1 0.6 0.2 0.1 0.1 0.4 100.0 4,134 89.7 4.0 2.6 0.2 0.4 1.5 0.4 0.2 0.2 0.8 100.0 4,837 83.8 4.2 4.5 0.5 0.8 3.0 0.6 0.5 0.6 1.5 100.0 8,730 77.6 4.0 8.0 0.9 1.4 3.5 0.6 0.8 0.9 2.3 100.0 9,985 83.8 4.0 4.9 0.5 0.9 2.6 0.5 0.5 0.6 1.6 100.0 13,892 84.1 4.1 5.0 0.5 0.8 2.5 0.6 0.5 0.6 1.4 100.0 13,794 81.4 4.9 5.5 0.6 0.7 3.3 0.8 0.6 0.7 1.4 100.0 3,780 84.3 4.0 4.9 0.5 0.8 2.4 0.5 0.5 0.6 1.5 100.0 23,906 86.0 1.9 5.2 0.1 0.0 2.1 0.2 0.6 0.7 3.3 100.0 1,390 82.3 4.7 4.1 0.3 0.8 4.5 0.7 0.4 0.7 1.5 100.0 3,597 82.8 4.7 5.7 0.6 0.6 2.5 0.8 0.8 0.6 0.9 100.0 1,123 81.8 4.2 6.8 1.2 0.8 2.4 1.1 0.7 0.4 0.6 100.0 1,678 80.3 4.4 7.7 0.1 1.0 1.5 1.2 0.6 0.8 2.4 100.0 1,484 86.6 4.4 4.2 0.4 0.4 2.1 0.1 0.7 0.1 0.9 100.0 2,612 90.1 1.6 3.8 0.5 0.2 1.1 0.3 0.0 0.4 2.1 100.0 302 82.3 6.3 3.0 1.2 0.1 5.1 0.5 0.6 0.3 0.6 100.0 1,809 81.8 4.4 5.8 0.9 1.6 2.9 0.3 0.4 0.5 1.4 100.0 2,262 82.1 4.3 5.7 0.7 1.4 2.1 0.4 0.6 0.6 1.9 100.0 915 84.6 3.9 5.1 0.1 0.5 1.4 0.1 0.5 0.4 3.5 100.0 1,216 89.3 4.7 2.0 0.8 0.6 1.6 0.1 0.2 0.2 0.5 100.0 1,973 86.8 2.9 5.0 0.3 0.9 2.2 0.1 0.3 0.4 1.0 100.0 1,914 83.0 3.7 6.0 0.1 0.8 2.5 1.2 0.5 0.5 1.9 100.0 1,927 88.8 3.1 4.0 0.3 0.7 1.1 0.2 0.2 0.7 0.9 100.0 1,137 88.4 2.1 3.5 0.1 1.7 1.2 0.7 0.2 0.9 1.2 100.0 333 80.0 3.2 6.8 0.7 1.9 1.7 0.8 0.5 2.1 2.4 100.0 2,013 83.4 4.1 5.5 0.6 0.9 2.5 0.6 0.5 0.6 1.4 100.0 14,537 83.9 4.5 4.4 0.5 0.9 3.0 0.5 0.4 0.5 1.4 100.0 10,171 83.9 4.1 5.0 0.5 0.8 2.6 0.5 0.5 0.6 1.5 100.0 27,686 ___________________________________________________________________________________________________________ Note: Orphans are children with both parents dead. 1 The CDCP (Cambodia Disease Control and Health Development Project) area contains Bat Dambang, Kampong Spueu, Kampot, Krong Kaeb, Kandal, Kampong Thum, Kracheh, Phnom Penh, Pousat, Rotanak Kiri, and Siem Reab. The BHSP (Basic Health Services Project) area contains Kampong Chhnang, Kampong Cham, Prey Veaeng, Svay Rieng, and Takaev. The total includes project areas BHSP and CDCP and all remaining provinces. 1 The provinces covered by these two projects are listed in the note of Table 2.4. 2 Secondary education refers to both lower secondary (grades 7-9) and upper secondary (grades 10- 12). 14 * Household Population and Characteristics To provide indicators of project impact for the specific Basic Health Services Project (BHSP) financed by the Asian Development Bank (ADB) and the Cambodia Disease Control and Health Development Project (CDCP)1 financed by the World Bank, the conditions for the combined provinces are presented under the specific project areas subtitle. The percentages of children who live with both parents do not vary greatly between the specific project areas and the national total. 2.3 HOUSEHOLD EDUCATION Studies show that education is one of the major socioeconomic factors that influence a person’s behavior and attitude. In general, the higher the level of education of a woman, the more knowledgeable she is about the use of health facilities, family planning methods, and the health of her children. 2.3.1 Educational attainment of household population Information on the educational level of the male and female population age six and over is presented in Table 2.5.1 and Table 2.5.2. Survey results show that the majority of Cambodians have little or no education, and females are considerably less educated than males. Nineteen percent of males and 34 percent of females have no education. The same amount of males and females have been to preschool (a little more than 1 percent). Fifty-three percent of males and 50 percent of females have only some primary education. Less than 7 percent of males and 4 percent of females have completed primary education only, and 17 percent of males and 9 percent of females have attended, but not completed, secondary school.2 Only 2 percent of males and 1 percent of females have completed secondary school or higher. An investigation of the changes in educational attainment by successive age groups indicates the long-term trend of the country’s educational achievement. Survey results show that there has been a strong improvement in the educational attainment of women. For example, the proportion of women with no education has declined significantly from 92 percent among women age 65 and over to 13 percent among women age 10-14. A similar trend is noticeable among men, with the proportion of men with no education declining from 45 percent among those age 65 and over to 9 percent among those age 10-14. As expected, educational attainment is much higher among the urban than among the rural population. For example, 89 percent of males and 77 percent of females in urban areas have some education, compared with only 79 percent of males and 63 percent of females in rural areas. Regarding regional variation, the percentage of males and females with no education is the highest in the region of Mondol Kiri/Rotanak Kiri (60 percent and 75 percent, respectively), and lowest (5 percent and 14 percent, respectively) in Phnom Penh. Household Population and Characteristics * 15 Table 2.5.1 Educational attainment of household population: male Percent distribution of the de facto male household population age six and over by highest level of education attended, according to background characteristics, Cambodia 2000 ___________________________________________________________________________________________________________ Level of education ____________________________________________________________ Com- More No Com- Some pleted than Median Background educa- Pre- Some pleted second- second- second- years of characteristic tion school primary primary1 ary ary2 ary Total Number schooling ___________________________________________________________________________________________________________ Age 6-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Residence Urban Rural Region Banteay Mean Chey Kampong Cham Kampong Chhnang Kampong Spueu Kampong Thum Kandal Kaoh Kong Phnom Penh Prey Veaeng Pousat Svay Rieng Takaev Bat Dambang/ Krong Pailin Kampot/Krong Kaeb/ Krong Preah Sihanouk Preah Vihear/Stueng Traeng/Kracheh Mondol Kiri/ Rotanak Kiri Siem Reab/Otdar Mean Chey Specific project areas CDCP BHSP Total 42.4 6.0 51.3 0.0 0.0 0.0 0.0 100.0 4,343 - 8.8 1.0 85.1 3.3 1.8 0.0 0.0 100.0 4,869 1.4 11.1 0.0 47.4 10.9 28.4 1.6 0.4 100.0 4,030 4.3 13.0 0.0 40.0 7.5 32.3 4.8 2.3 100.0 2,044 4.7 13.6 0.0 36.2 6.7 33.4 7.2 2.8 100.0 1,853 5.0 13.1 0.0 33.1 7.1 37.8 6.7 2.0 100.0 1,988 5.5 19.5 0.0 48.6 6.7 20.6 3.8 0.8 100.0 1,826 3.2 16.3 0.0 54.8 9.6 17.4 1.4 0.5 100.0 1,254 2.9 12.0 0.0 53.1 11.9 17.7 4.3 0.9 100.0 1,014 3.7 15.6 0.0 44.3 15.0 19.1 4.5 1.6 100.0 816 4.0 19.6 0.0 45.0 14.6 16.5 2.7 0.8 100.0 659 3.5 29.5 0.0 43.5 13.5 11.6 1.4 0.6 100.0 537 2.7 44.8 0.0 41.7 6.2 5.5 0.4 0.0 100.0 1,004 1.4 11.0 1.4 42.5 6.8 26.0 8.5 3.7 100.0 4,103 4.3 20.7 1.2 54.7 6.6 15.2 1.3 0.2 100.0 22,135 2.2 22.2 3.5 49.7 5.7 17.6 1.3 0.0 100.0 1,227 2.3 21.7 0.5 54.7 6.4 14.8 1.0 0.1 100.0 3,416 2.4 17.3 0.1 64.4 4.3 12.2 1.4 0.2 100.0 941 1.7 26.4 2.5 51.0 4.9 14.3 0.8 0.1 100.0 1,426 1.7 20.1 0.7 62.7 5.2 10.5 0.8 0.0 100.0 1,245 1.9 16.7 0.1 55.0 8.1 18.4 1.7 0.1 100.0 2,655 2.6 29.0 0.1 50.6 5.4 12.7 1.6 0.1 100.0 271 1.7 4.6 2.8 35.4 8.3 29.5 12.2 7.2 100.0 2,401 5.9 16.8 0.0 58.5 8.3 15.3 1.1 0.0 100.0 2,242 2.6 23.0 0.6 59.6 4.2 11.5 0.6 0.4 100.0 770 1.6 14.4 0.9 58.7 7.8 17.0 0.8 0.3 100.0 1,160 2.7 15.0 3.5 49.5 7.4 22.6 2.0 0.0 100.0 1,927 3.1 15.7 0.9 51.8 8.5 19.7 2.7 0.6 100.0 1,821 2.9 14.7 1.8 56.9 6.6 17.3 2.1 0.1 100.0 1,670 2.6 27.2 0.6 52.6 5.8 12.3 1.2 0.1 100.0 1,017 1.5 59.9 0.4 27.8 2.9 8.4 0.5 0.0 100.0 279 0.0 35.0 0.0 51.2 3.2 9.1 1.3 0.2 100.0 1,772 0.7 18.9 1.1 51.3 6.5 17.3 3.4 1.4 100.0 14,020 2.5 17.9 1.0 56.0 7.0 16.5 1.2 0.1 100.0 9,685 2.5 19.2 1.2 52.8 6.6 16.9 2.4 0.8 100.0 26,238 2.5 _________________________________________________________________________________________________________________ Note: Total includes men with missing information on level of education who are not shown separately. 1 Completed grade 6 at the primary level 2 Completed grade 12 at the secondary level 16 * Household Population and Characteristics Table 2.5.2 Educational attainment of household population: female Percent distribution of the de facto female household population age six and over by highest level of education attended, according to background characteristics, Cambodia 2000 ___________________________________________________________________________________________________________ Level of education ____________________________________________________________ Com- More No Com- Some pleted than Median Background educa- Pre- Some pleted second- second- second- years of characteristic tion school primary primary1 ary ary2 ary Total Number schooling ___________________________________________________________________________________________________________ Age 6-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Residence Urban Rural Region Banteay Mean Chey Kampong Cham Kampong Chhnang Kampong Spueu Kampong Thum Kandal Kaoh Kong Phnom Penh Prey Veaeng Pousat Svay Rieng Takaev Bat Dambang/Krong Pailin Kampot/Krong Kaeb/ Krong Preah Sihanouk Preah Vihear/Stueng Traeng/Kracheh Mondol Kiri/ Rotanak Kiri Siem Reab/Otdar Mean Chey Specific project areas CDCP BHSP Total 41.7 6.8 51.3 0.0 0.0 0.0 0.0 100.0 4,314 - 12.9 0.8 80.4 3.6 2.1 0.0 0.0 100.0 5,001 1.5 18.7 0.0 49.0 9.1 20.9 1.7 0.4 100.0 3,649 3.6 27.3 0.0 45.2 6.1 17.9 2.5 0.9 100.0 2,116 3.0 21.3 0.0 47.4 6.3 22.1 2.5 0.4 100.0 2,131 3.5 26.5 0.0 48.5 5.4 17.3 1.9 0.6 100.0 2,249 2.6 41.6 0.0 48.7 3.6 5.4 0.3 0.3 100.0 2,187 1.2 35.6 0.0 52.3 4.0 7.0 0.7 0.2 100.0 1,914 1.7 36.3 0.0 49.7 5.8 6.8 0.9 0.3 100.0 1,489 1.8 55.9 0.0 32.6 4.1 6.0 1.0 0.0 100.0 1,102 0.0 68.7 0.1 23.7 3.6 2.9 0.4 0.2 100.0 874 0.0 82.4 0.0 14.4 1.4 0.8 0.4 0.2 100.0 749 0.0 91.5 0.0 7.2 0.0 0.6 0.0 0.0 100.0 1,342 0.0 22.8 1.4 44.0 6.4 19.9 4.0 1.3 100.0 4,602 2.8 36.3 1.1 51.5 3.8 6.7 0.3 0.0 100.0 24,515 0.8 40.9 3.5 43.8 3.5 7.7 0.3 0.1 100.0 1,300 0.4 37.1 0.6 52.0 2.9 6.1 0.7 0.1 100.0 3,789 0.9 31.2 0.3 60.1 2.5 5.5 0.4 0.0 100.0 1,107 0.7 48.5 2.1 42.3 2.6 4.2 0.3 0.0 100.0 1,552 - 32.5 0.5 57.4 3.3 5.9 0.4 0.0 100.0 1,483 0.9 30.9 0.2 53.5 6.0 9.1 0.3 0.0 100.0 2,816 1.3 44.2 0.1 47.2 2.9 4.5 0.5 0.1 100.0 273 0.0 14.2 3.0 41.7 7.7 26.0 4.9 2.3 100.0 2,737 4.0 39.7 0.0 53.3 2.7 4.0 0.3 0.0 100.0 2,458 0.6 40.4 0.3 50.1 3.1 5.8 0.2 0.1 100.0 864 0.1 30.4 1.0 57.4 4.3 6.6 0.3 0.0 100.0 1,311 1.4 29.3 2.9 52.5 5.6 9.2 0.3 0.0 100.0 2,160 1.5 27.7 0.7 52.9 5.0 12.5 0.8 0.1 100.0 1,996 1.7 30.4 1.9 54.7 4.0 8.1 0.7 0.0 100.0 1,970 1.2 36.2 0.3 50.1 4.1 8.8 0.4 0.0 100.0 1,112 1.0 75.1 0.4 18.8 1.8 3.5 0.1 0.0 100.0 300 0.0 48.4 0.0 41.9 3.8 4.9 0.9 0.0 100.0 1,890 - 32.2 1.1 49.0 4.8 11.0 1.3 0.4 100.0 15,552 1.3 34.7 0.9 53.9 3.5 6.2 0.5 0.0 100.0 10,825 1.0 34.2 1.2 50.3 4.2 8.8 0.9 0.2 100.0 29,117 1.1 ___________________________________________________________________________________________________________ Note: Total includes women with missing information on level of education who are not shown separately. 1 Completed grade 6 at the primary level 2 Completed grade 12 at the secondary level 3 Students who are overage for a given level of schooling may have started school overage, may have repeated one or more grades in school, or may have dropped out of school and later returned. Household Population and Characteristics * 17 2.3.2 School attendance ratios Data on net attendance ratios (NARs) and gross attendance ratios (GARs) by school level, sex, residence, and region are shown in Table 2.6. The NAR indicates participation in primary schooling for the population age 6-12 and secondary schooling for the population age 13-18. The GAR measures participation at each level of schooling among those age 5-24. The GAR is nearly always higher than the NAR for the same level because the GAR includes participation by those who may be older or younger than the official age range for that level.3 An NAR of 100 percent would indicate that all those in the official age range for the level are attending at that level. The GAR can exceed 100 percent if there is significant overage or underage participation at a given level of schooling. Almost 68 percent of children who should be attending primary school are currently doing so at that level. At the same time, only 16 percent of secondary-school-age youths are in school at that level. There is little difference between the NAR of males and females at the primary level (69 percent and 67 percent, respectively). The NAR is higher among males than among females at the secondary level. Attendance ratios are lower in rural areas than in urban areas and are the lowest in the region of Mondol Kiri/Rotanak Kiri. The GAR is higher among males than among females, at a rate of 97 and 87 percent, respectively, at the primary-school level, and at a rate of 26 and 14, respectively, at the secondary- school level, indicating higher attendance among males than among females. Although the overall GAR at the primary-school level is 92 percent, there are considerable levels of overage and/or underage participation in Kaoh Kong (104 percent) and Takaev provinces (101 percent). The age-specific attendance rates (ASARs) for the population age five and over by sex are shown in Figure 2.2. The ASAR indicates participation in schooling at any level, from primary to higher levels of education. Although the minimum age for schooling in Cambodia is six, there are some children enrolled prior to this age. Nevertheless, less than one-third of children age six are attending school, indicating that the majority of children in Cambodia at that age have not entered the school system. There is little difference in the proportion of males and females attending school up to age 12, after which a significantly higher proportion of males than females attend school. 18 * Household Population and Characteristics Table 2.6 School attendance ratios Net attendance ratios (NARs) and gross attendance ratios (GARs) for the de jure household population by level of schooling and sex, according to background characteristics, Cambodia 2000 ______________________________________________________________________________________________ Net attendance ratio (NAR)1 Gross attendance ratio (GAR)2 Background ____________________________ ___________________________ characteristic Male Female Total Male Female Total ______________________________________________________________________________________________ PRIMARY SCHOOL ______________________________________________________________________________________________ Residence Urban Rural Region Banteay Mean Chey Kampong Cham Kampong Chhnang Kampong Spueu Kampong Thum Kandal Kaoh Kong Phnom Penh Prey Veaeng Pousat Svay Rieng Takaev Bat Dambang/Krong Pailin Kampot/Krong Kaeb/ Krong Preah Sihanouk Preah Vihear/Stueng Traeng/Kracheh Mondol Kiri/Rotanak Kiri Siem Reab/Otdar Mean Chey Total 75.1 72.9 74.1 97.7 94.3 96.1 67.6 65.6 66.6 97.1 85.8 91.4 73.8 70.2 72.0 97.5 86.3 91.8 69.7 68.7 69.3 97.0 87.8 92.3 71.4 65.7 68.6 94.4 81.0 87.9 61.8 59.6 60.7 88.5 75.4 82.1 67.3 65.9 66.6 98.9 83.3 90.8 71.2 72.4 71.7 102.4 94.6 98.6 55.3 51.8 53.6 79.7 66.0 73.2 83.4 82.9 83.1 109.2 99.6 104.4 71.7 65.2 68.5 106.6 85.7 96.2 57.3 51.8 54.6 84.2 71.1 77.9 71.5 68.5 70.0 105.5 90.5 98.0 68.7 71.3 70.0 104.6 96.8 100.6 70.4 71.4 70.9 94.4 98.7 96.5 70.9 63.9 67.3 99.5 87.8 93.6 59.6 55.8 57.7 80.6 77.2 78.9 32.6 26.1 29.4 52.7 36.3 44.6 60.5 55.8 58.3 87.3 76.5 82.3 68.7 66.5 67.6 97.1 86.9 92.0 _____________________________________________________________________________________________ SECONDARY SCHOOL _____________________________________________________________________________________________ Residence Urban Rural Region Banteay Mean Chey Kampong Cham Kampong Chhnang Kampong Spueu Kampong Thum Kandal Kaoh Kong Phnom Penh Prey Veaeng Pousat Svay Rieng Takaev Bat Dambang/Krong Pailin Kampot/Krong Kaeb/ Krong Preah Sihanouk Preah Vihear/Stueng Traeng/Kracheh Mondol Kiri/Rotanak Kiri Siem Reab/Otdar Mean Chey Total 39.7 27.8 33.4 49.7 30.9 39.7 17.0 8.9 13.0 21.2 9.9 15.7 17.1 13.9 15.5 20.1 15.1 17.6 17.5 9.0 13.4 22.0 9.4 16.0 11.5 7.5 9.5 14.9 8.1 11.4 14.2 6.4 10.6 17.9 6.8 12.9 14.8 7.4 11.4 17.6 8.9 13.6 19.8 13.8 16.9 26.6 15.8 21.4 9.6 6.2 8.0 14.5 7.5 11.2 46.3 38.7 42.5 56.9 43.9 50.3 21.0 5.1 13.4 26.9 5.5 16.6 11.1 9.5 10.3 14.2 10.2 12.2 20.1 9.5 14.8 23.0 10.7 16.8 23.4 8.6 16.2 30.8 9.9 20.6 21.7 12.0 16.5 26.8 13.2 19.5 25.9 10.1 17.4 30.7 10.6 19.9 14.4 10.1 12.1 17.3 11.6 14.3 7.6 6.7 7.1 10.3 7.2 8.7 8.2 7.5 7.9 10.5 8.1 9.3 20.4 12.3 16.4 25.5 13.7 19.6 _____________________________________________________________________________________________ 1 The NAR for primary school is the percentage of the primary-school-age (6-12 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary-school-age (13-18 years) population that is attending secondary school. By definition, the NAR cannot exceed 100 percent. 2 The GAR for primary school is the total number of primary school students, among those of any age, expressed as the percentage of the official primary-school-age population. The GAR for secondary school is the total number of secondary school students 5-24 years, expressed as the percentage of the official secondary-school-age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100 percent. Household Population and Characteristics * 19 2.4 HOUSING CHARACTERISTICS The type of water and sanitation facilities are important determinants of the health status of household members and particularly of children. Proper hygienic and sanitation practices can reduce exposure to and the seriousness of major childhood diseases such as diarrhea. The CDHS 2000 asked respondents about their household sources of drinking water, time taken to the nearest source, and sanitation facilities. In Cambodia, the source of drinking water can vary greatly between the dry season and the rainy season, so separate questions were asked for the different seasons. Households can also have more than one source of drinking water. To facilitate the interview, only the most common source of drinking water was recorded. During the dry season, 5 percent of households have drinking water piped into their dwelling or plot, 22 percent of households fetch water from an open public well, 21 percent use a tube well (public or private), 27 percent use surface water (from rivers, streams, lakes, or ponds), and 5 percent purchase water from a tanker truck or water vendor (Table 2.7). Urban households are much more likely than rural households to have access to piped water within the house or plot: 33 percent of urban households have piped water, compared with less than 1 percent of rural households. Rural households are much more likely to use surface water for drinking than urban households. Thirty percent of rural households collect drinking water from lakes and rivers, compared with only 12 percent of urban households. Households that did not have drinking water within their own compound were also asked for the time taken to fetch water. Seventy-seven percent of all households (92 percent urban and 75 percent rural) take less than 15 minutes to fetch drinking water. The median time taken to access drinking water is 4.5 minutes. 20 * Household Population and Characteristics Table 2.7 Drinking water and sanitation Percent distribution of households by source of drinking water and sanitation facility, Cambodia 2000_____________________________________________________ Residence_______________ Characteristic Urban Rural Total_____________________________________________________ Source of drinking water (dry season) Piped into dwelling/ yard/plot Public tap Open well in yard/plot Open public well Protected dug well in yard/plot Protected public dug well Tube/Piped well or bore hole in yard/plot Tube/piped public well or bore hole Spring River/stream/pond/lake/dam Rainwater Tanker truck/water vendor Bottled water Other Total Source of drinking water (rainy season) Piped into dwelling/ yard/plot Public tap Open well in yard/plot Open public well Protected dug well in yard/plot Protected public dug well Tube/Piped well or bore hole in yard/plot Tube/piped public well or bore hole Spring River/stream/pond/lake/dam Rainwater Tanker truck/water vendor Bottled water Other Total Time to water source (dry season) <15 minutes Median time to source (in minutes) Time to water source (rainy season) <15 minutes Median time to source (in minutes) Sanitation facility Flush connected to sewer/ with septic tank Flush unconnected to sewer/ without septic tank Latrine connected to sewer/ with septic tank Traditional pit/latrine unconnected to sewer/ without septic tank Other No facility/field Total Total 33.0 0.7 5.4 1.8 0.3 0.5 6.4 10.1 9.6 11.2 24.1 22.2 3.8 1.5 1.9 1.7 2.1 2.0 8.2 8.5 8.5 5.7 13.8 12.6 0.7 0.7 0.7 11.8 30.0 27.3 1.7 1.0 1.1 11.0 3.5 4.6 0.2 0.1 0.1 2.9 3.5 3.4 100.0 100.0 100.0 31.9 0.7 5.2 1.5 0.3 0.5 5.5 9.8 9.2 9.1 21.7 19.9 2.9 1.2 1.5 1.3 2.0 1.9 7.3 8.3 8.2 3.6 11.2 10.1 0.5 0.8 0.7 8.2 24.0 21.6 19.7 14.9 15.6 6.2 1.7 2.3 0.1 0.1 0.1 2.0 3.2 3.0 100.0 100.0 100.0 91.8 74.8 77.3 - 4.7 4.5 94.9 79.8 82.0 - 4.2 2.1 33.8 1.7 6.4 17.3 5.6 7.3 1.4 0.9 1.0 7.4 5.7 6.0 0.3 0.1 0.1 39.8 85.9 79.1 100.0 100.0 100.0 1,790 10,446 12,236 _____________________________________________________ Note: Total includes households with missing information on drinking water and/or sanitation. Household Population and Characteristics * 21 Table 2.8 Housing characteristics Percent distribution of households by background charac- teristics, according to residence, Cambodia 2000_____________________________________________________ Residence Background _______________ characteristic Urban Rural Total_____________________________________________________ Electricity Yes No Total Main floor material Earth/sand Wood planks Palm/bamboo Parquet/polished wood Ceramic tiles Cement Houseboat Other Total Main roof material Thatch/palm/bamboo/bark Plastic sheet/tent Galvanized iron/aluminum Tiles/cement/concrete/fibrous Other Total Type of cooking fuel Electricity LPG/natural gas Kerosene Charcoal Firewood/straw Other Total Total 60.6 9.0 16.6 39.4 90.9 83.3 100.0 100.0 100.0 7.6 9.3 9.0 45.9 44.7 44.9 11.4 41.2 36.9 1.3 0.6 0.7 27.2 1.5 5.2 6.2 2.0 2.6 0.1 0.2 0.2 0.4 0.5 0.4 100.0 100.0 100.0 16.2 45.0 40.8 0.5 0.3 0.3 42.1 22.2 25.1 40.8 32.2 33.4 0.5 0.2 0.2 100.0 100.0 100.0 0.2 0.1 0.1 16.0 1.0 3.1 1.8 0.2 0.5 23.8 3.6 6.6 58.2 95.0 89.6 0.1 0.1 0.1 100.0 100.0 100.0 1,790 10,446 12,236 _____________________________________________________ Note: Total includes households with missing information on housing characteristics. During the rainy season, 5 percent of households have drinking water piped into their dwelling or plot, 20 percent of households fetch water from an open public well, 18 percent use a tube well (public or private), 22 percent use surface water (from rivers, streams, lakes, or ponds), and 16 percent collect rainwater for drinking. In the rainy season, a significant percentage of both urban and rural households collect rainwater (20 percent and 15 percent, respectively). Households without drinking water in their compound were also asked for the time taken to fetch water. The median time taken to fetch drinking water in the rainy season is 2.1 minutes. The majority of Cambodian house- holds (79 percent) do not have a toilet facil- ity. A small proportion (6 percent) have a flush toilet connected to a sewer or septic tank. Seven percent have a flush toilet not connected to a sewer or septic tank. Only 1 percent have pit latrines connected to a sewer or septic tank, and 6 percent have a latrine with no connection to a sewer or septic tank. In urban areas, 51 percent of households have access to a flush toilet (connected or unconnected to a sewer or septic tank), 9 percent use a latrine, and 40 percent have no facility. In the rural areas, 86 percent of households have no facilities. The physical characteristics of house- holds along with the water and sanitation conditions are important in assessing the general socioeconomic condition of the population. In the CDHS 2000, respondents to the household questionnaire were asked about access to electricity, main material of floors and roof, and the type of fuel used for cooking. The results are presented in Table 2.8. Seventeen percent of households have electricity, but this varies widely by place of residence. Only 9 percent of house- holds in rural areas have access to electricity, compared with 61 percent of urban house- holds. The most common materials used for flooring in houses are wood planks (45 per- cent), followed by palm or bamboo (37 per- cent). Rural households are more likely to use palm or bamboo (41 percent) than urban households (11 percent). Urban houses more commonly have tiled floors (27 percent), compared with rural houses (2 percent). The most common materials for roofing are thatch/palm/bamboo/bark (41 percent), tiles/cement/concrete/ fibrous cement (33 percent), and galvanized iron/aluminum (25 percent). Thatch/palm/bamboo/ 22 * Household Population and Characteristics Table 2.9 Household durable goods Percentage of households possessing various durable consumer goods and means of transport, by residence, Cambodia 2000 ____________________________________________________ Residence Durable _______________ consumer goods Urban Rural Total ____________________________________________________ Household possessions Wardrobe Sewing machine/loom Radio/tape recorder Television Telephone/cell phone Refrigerator Means of transport Bicycle/cyclo Motorcycle/scooter Car/truck/van Boat with motor Boat without motor Oxcart None of the above Number of households 56.5 15.2 21.2 20.3 5.4 7.6 61.2 39.0 42.2 57.9 28.2 32.5 17.0 1.3 3.6 10.3 0.4 1.8 49.8 53.0 52.5 49.8 18.6 23.1 10.2 1.0 2.3 3.9 3.5 3.6 3.4 5.6 5.3 10.5 30.0 27.1 11.6 18.4 17.4 1,790 10,446 12,236 bark roofs are three times more common on rural houses than on urban houses, while galvanized iron/aluminum roofs are twice as common in urban areas as they are in rural areas. The most common type of cooking fuel is firewood or straw: 90 percent of all households report its use. However, there are significant urban-rural differences: whereas urban households most commonly use firewood (58 percent), they also report use of charcoal (24 percent) and LPG (liquid propane gas)/natural gas (16 percent). Ninety-five percent of rural households use firewood or straw for cooking. 2.5 HOUSEHOLD POSSESSIONS Information on ownership of dura- ble goods and other possessions is pre- sented in Table 2.9. Forty-two percent of all households have a radio, 33 percent claim ownership of a television, 21 per- cent have a wardrobe, and 8 percent have a sewing machine or loom. In general, households in rural Cambodia are less like- ly to possess consumer items like radios, televisions, wardrobes, or sewing machines or looms. Telephones and cellular phones are common in the urban areas. Seven- teen percent of urban households own a telephone or cell phone, whereas only 1 percent of rural households report own- ership of a telephone or cell phone. The survey also collected informa- tion on means of transport (for humans as well as for goods) available to households. More than half of all households in Cam- bodia report ownership of a bicycle. More than one-quarter own an oxcart, and less than one-quarter own a motorcycle or scooter. Motorcycles and scooters are more commonly owned by households in the urban areas (50 percent) than in the rural areas (19 percent). Cars, trucks, or vans are also owned more often by urban households (10 percent) than rural households (1 percent). 2.6 IODIZED SALT Iodine deficiency is known to cause goiter, cretinism (a severe form of a neurological defect), spontaneous abortion, premature birth, infertility, stillbirth, and increased child mortality. One of the most serious consequences to child development is mental retardation caused by iodine deficiency disorders (IDDs), putting at stake social investments in health and education. IDD is the single most common cause of preventable mental retardation and brain damage in the world. The remedy for IDD is relatively simple. A teaspoon of iodine is all a person requires in a lifetime. Since iodine cannot be stored for long periods by the body, tiny amounts are needed regularly. In areas of endemic iodine deficiency, where soil and therefore crops and grazing animals do not provide sufficient dietary iodine to the population, food fortification and supplementation have proven highly successful and sustainable interventions. The fortification of salt with iodine is the most common tool to prevent IDD. Household Population and Characteristics * 23 Table 2.10 Iodized salt Percent distribution of households by whether salt was tested for iodine content and by level of iodine content of salt, according to urban-rural residence and region, Cambodia 2000 ________________________________________________________________________________________ No Not Number Residence Iodized iodized tested/ of and region salt salt no salt Missing Total households ________________________________________________________________________________________ Residence Urban Rural Region Banteay Mean Chey Kampong Cham Kampong Chhnang Kampong Spueu Kampong Thum Kandal Kaoh Kong Phnom Penh Prey Veaeng Pousat Svay Rieng Takaev Bat Dambang/Krong Pailin Kampot/Krong Kaeb/ Krong Preah Sihanouk Preah Vihear/Stueng Traeng/Kracheh Mondol Kiri/Rotanak Kiri Siem Reab/Otdar Mean Chey Total 28.0 70.8 0.8 0.4 100.0 1,790 11.3 87.6 0.3 0.7 100.0 10,446 3.9 94.7 0.3 1.1 100.0 581 7.2 90.4 0.1 2.2 100.0 1,724 6.3 93.5 0.1 0.1 100.0 477 2.7 96.6 0.1 0.6 100.0 671 4.2 95.8 0.0 0.0 100.0 621 9.6 90.4 0.0 0.0 100.0 1,146 4.8 95.1 0.1 0.0 100.0 130 45.9 52.6 1.4 0.1 100.0 993 12.6 86.6 0.7 0.1 100.0 1,090 8.4 88.9 2.3 0.3 100.0 364 36.7 61.2 0.8 1.3 100.0 566 11.5 87.3 0.8 0.4 100.0 898 6.8 92.9 0.3 0.0 100.0 819 10.3 88.4 0.0 1.3 100.0 794 28.8 70.7 0.1 0.3 100.0 467 75.6 24.1 0.1 0.1 100.0 127 5.7 93.9 0.1 0.3 100.0 769 13.8 85.2 0.4 0.6 100.0 12,236 A teaspoon of cooking salt was measured in each survey household. With a small test kit, the iodization of the salt was assessed. Only 14 percent of all households have adequately iodized salt (Table 2.10). Iodized salt is more common in urban households than in rural households (28 percent and 11 percent, respectively). The province with the lowest percentage of households with iodized salt is Kampong Spueu (3 percent). This province is situated next to the capital city, so the reasons for lack of fortified salt are not due to its location. The region with the highest percentage of households with iodized salt is Mondol Kiri/Rotanak Kiri (76 percent). These two remote provinces obtain their salt from Vietnam where iodized salt is common. Health Status and Utilization of Health Services * 25 3HEALTH STATUS ANDUTILIZATION OF HEALTH SERVICES When the NHS 1998 survey was undertaken, the Ministry of Health was beginning to implement a redesigned Health Coverage Plan created to improve the accessibility and quality of government health services. The major points of the new health care plan were to create a network of health centers throughout the country delivering the “Minimum Package of Activities” services. The data collected in the NHS 1998 survey was considered to be a baseline of health conditions in the country before implementation of the new health coverage plan. The CDHS 2000 survey can be used to provide a first-round analysis of health care delivery under the new plan. Utilization of health services was assessed in the Household Questionnaire. The questions were asked of all households in the sample. First, information was collected to assess the prevalence of injuries and deaths due to accidents in the past year. Second, the informant was asked whether any household members suffered from any physical impairments. Third, inquiry was made of the severity of illness or injury and the subsequent utilization of health services for all members of the household who had been ill or injured in the 30 days prior to the interview. 3.1 ACCIDENTAL DEATH OR INJURY The respondent in all households was asked whether any household members had suffered accidental injuries or deaths in the past 12 months. If anyone was injured, the cause of the injury was recorded. The respondent was asked whether the victim was alive or dead, and if dead, whether the accident was the cause of death. The questions were designed in this order to definitively assess the cause of injury and the cause of death, if a death was noted. Frequency of accidental death or injury The frequency of injuries and deaths among the Cambodian population is not high (Table 3.1). A total of slightly less than 1 percent of the population had suffered an injury or death by accident in the past 12 months. Accidental injuries were almost four times more common than accidental deaths but were found in less than three-quarters of 1 percent of the population. This is the equivalent of 7 persons injured out of 1,000. Accidental deaths were found in less than one- quarter of one percent of the population, or 2 persons out of 1,000. The percentage of the population injured in the past 12 months increases with age. For children to young adults (from birth to 19 years), 0.6 percent were injured. The percentage increased with age: 1.1 percent of those 40-59 years old were found to be injured. Similar trends were found in accidental deaths. Only 0.1 percent or 1 out of 1,000 children less than 9 years of age died in an accident, whereas 6 out of 1,000 adults over 60 years of age had died in an accident. Men were twice as likely to be injured in an accident as women. One percent of the male population was injured in an accident in the past 12 months, compared with only 0.5 percent of women. Despite the large differences of accidental injuries by sex, men and women perished in accidents at an equal rate. There were no differences in accidental injuries or deaths by urban-rural residence. There were strong differences found by region. The highest percentage of accidental 26 * Health Status and Utilization of Health Services Table 3.1 Injury or death in an accident Percentage of the de facto household population injured or killed in an accident in the past 12 months, according to background characteristics, Cambodia 2000_______________________________________________________________ Result of accident____________________________ Number Total of Background injured household characteristic Injured Killed or killed members_______________________________________________________________ Age group 0-9 10-19 20-39 40-59 60+ Sex Male Female Residence Urban Rural Region Banteay Mean Chey Kampong Cham Kampong Chhnang Kampong Spueu Kampong Thum Kandal Kaoh Kong Phnom Penh Prey Veaeng Pousat Svay Rieng Takaev Bat Dambang/Krong Pailin Kampot/Krong Kaeb/ Krong Preah Sihanouk Preah Vihear/Stueng Traeng/Kracheh Mondol Kiri/Rotanak Kiri Siem Reab/Otdar Mean Chey Total 0.6 0.1 0.7 17,576 0.6 0.1 0.7 17,552 0.8 0.2 1.0 16,394 1.1 0.2 1.3 9,123 0.8 0.6 1.4 3,631 1.0 0.2 1.2 30,772 0.5 0.2 0.7 33,502 0.7 0.2 0.9 9,903 0.7 0.2 0.9 54,373 0.4 0.3 0.7 2,989 0.6 0.4 1.0 8,467 0.6 0.4 1.0 2,462 0.5 0.0 0.5 3,516 0.8 0.1 0.9 3,259 1.7 0.1 1.8 6,245 0.8 0.1 0.9 648 0.9 0.1 1.0 5,615 0.1 0.1 0.3 5,348 0.9 0.1 1.0 1,920 0.5 0.2 0.7 2,809 0.4 0.2 0.5 4,670 0.9 0.1 1.0 4,475 0.9 0.1 1.0 4,215 0.2 0.2 0.4 2,539 0.4 0.0 0.4 714 1.2 0.3 1.5 4,387 0.7 0.2 0.9 64,276 injury was found in Kandal Province (1.7 percent). The lowest percentage of accidental injury was found in Prey Veaeng province (0.1 percent). The provinces with the highest percentages of accidental death were Kampong Cham and Kampong Chhnang (0.4 percent). The lowest percentages of accidental death were found in Kampong Spueu and Mondol Kiri/Rotanak Kiri (less than 0.1 percent). Type of accident Originally, the question about the type of accident was meant to assess the impact of landmines on the population. Due to the great increase in use of motorized vehicles and motor accidents in Cambodia in recent years, data on prevalence of road accidents was also requested. To collect this information, a list of the most common accidents was made and integrated into the question. The question was field-tested and found to be effective. However, in the final results, the response “other” was found to be one of the most common answers, indicating most likely that there are types of accidents that were not included in the list of potential responses. Health Status and Utilization of Health Services * 27 Table 3.2 Injury and death in an accident by type of accident Percent distribution of the de facto household population who were injured or killed in an accident in the past 12 months by type of accident, according to background characteristics, Cambodia 2000 ___________________________________________________________________________________________________________________ Type of accident ____________________________________________________________________________ Land- Number mine/ Fall Poison- of unex- Road Severe Snake/ from ing persons Background ploded Gun- acci- burn- animal tree/ Drown- (chemi- Don't injured/ characteristic bomb shot dent ing bite building ing cal) Other know Total killed ___________________________________________________________________________________________________________________ Age group 0-9 10-19 20-39 40-59 60+ Sex Male Female Residence Urban Rural Region Banteay Mean Chey Kampong Cham Kampong Chhnang Kampong Spueu Kampong Thum Kandal Kaoh Kong Phnom Penh Prey Veaeng Pousat Svay Rieng Takaev Bat Dambang/Krong Pailin Kampot/Krong Kaeb/ Krong Preah Sihanouk Preah Vihear/Stueng Traeng/Kracheh Mondol Kiri/Rotanak Kiri Siem Reab/Otdar Mean Chey Total 2.0 1.1 29.3 5.4 9.2 19.4 4.9 1.3 26.6 0.8 100.0 116 1.6 6.6 33.0 2.7 4.8 17.8 0.9 2.2 28.9 1.5 100.0 123 6.4 6.3 39.7 0.8 3.2 8.7 2.4 3.0 29.1 0.5 100.0 161 0.9 3.9 40.0 0.8 7.0 9.4 0.4 1.0 35.4 1.2 100.0 117 4.5 4.1 22.4 0.0 0.9 16.1 4.1 2.1 41.4 4.4 100.0 52 4.1 5.7 27.9 1.9 5.0 14.7 3.8 1.5 34.3 1.0 100.0 373 1.1 3.8 42.2 2.5 5.3 10.3 1.3 2.6 27.0 3.8 100.0 220 1.6 6.9 40.9 1.1 3.5 8.4 1.0 1.8 34.4 0.4 100.0 88 3.3 4.7 31.9 2.3 5.4 13.9 3.2 1.9 31.1 2.3 100.0 505 * * * * * * * * * * * 22 (0.0) (2.9) (17.1) (2.8) (2.8) (19.9) (2.9) (0.0) (45.8) (5.7) 100.0 85 (0.0) (4.3) (32.3) (0.0) (6.5) (9.7) (0.0) (0.0) (44.6) (2.7) 100.0 25 * * * * * * * * * * * 16 (0.0) (6.1) (15.1) (3.0) (3.0) (24.1) (0.0) (0.0) (48.8) (0.0) 100.0 28 0.0 0.0 61.6 0.0 2.8 4.3 1.4 2.9 27.0 0.0 100.0 113 (3.2) (11.4) (54.1) (3.2) (3.2) (6.5) (0.0) (0.0) (16.2) (2.3) 100.0 6 (0.0) (8.2) (61.9) (0.0) (2.4) (7.8) (0.0) (2.8) (16.8) (0.0) 100.0 55 * * * * * * * * * * * 14 (0.0) (4.2) (34.1) (8.6) (4.2) (7.1) (2.3) (0.0) (28.4) (11.1) 100.0 20 * * * * * * * * * * * 19 * * * * * * * * * * * 24 (10.6) (0.0) (27.4) (0.0) (7.9) (18.4) (8.0) (0.0) (27.7) (0.0) 100.0 46 (0.0) (8.2) (34.7) (2.5) (7.9) (13.0) (2.5) (0.0) (31.1) (0.0) 100.0 43 * * * * * * * * * * * 10 * * * * * * * * * * * 3 (13.3) (9.9) (6.5) (7.0) (14.2) (25.5) (1.7) (4.0) (17.9) (0.0) 100.0 65 3.0 5.0 33.2 2.1 5.1 13.1 2.9 1.9 31.6 2.0 100.0 593 ___________________________________________________________________________________________________________________ Note: Total includes 25 persons for whom information on age is not available. Figures in parentheses are based on 25-49 unweighted The most widespread cause of accidental injury or death was that of road accident (33 percent) (Table 3.2). The second most common cause of accidents was a fall from a building or tree (13 percent). Landmine accidents (3 percent) were less common than accidents with guns (5 percent) and snake or animal bites (5 percent). Drowning accounted for the same percentage of injuries and deaths as landmines (3 percent). There were significant differences in accidental injuries and deaths in the last 12 months by age. Landmines injured or killed the most economically active population. Those age 20-39 (6 percent) were injured or killed three times as often as younger Cambodians age 0-19 (2 percent). Gunshot injuries and deaths affected those 10-39 years of age to the greatest extent (6 percent). 28 * Health Status and Utilization of Health Services Road accidents were the most common among the population age 20-59 (40 percent). Falls from trees or buildings followed a different pattern. The population most affected by falls were the youngest and the oldest. The 0- to 9-year-olds, the 10- to 19-year-olds, and those age 60 and older were injured or killed by falls most frequently (19 percent, 18 percent, and 16 percent, respectively). There were other significant differences in accidental injuries and deaths in the last 12 months by sex, urban-rural residence, and region. Men were almost four times as likely to be injured or killed by landmines (4 percent) as women (1 percent). Men were only slightly more likely than women to be involved in an injury or death by gunshot (6 percent compared with 4 percent, respectively). Road accidents were a more common type of accident among women than among men: road accidents made up 42 percent of accidents among women, whereas they constituted only 28 percent of accidents in men. It is important to note at this point that almost twice as many men were injured or killed in the past 12 months (373 cases) as women (220 cases). Landmine accidents were slightly more common in rural areas (3 percent) than in urban areas (2 percent). Road accidents were much more common in the urban areas (41 percent) than in rural areas (32 percent). Urban areas also had more accidents from falling than rural areas. This can be expected because large building construction is much more common in urban areas than rural areas. Fourteen percent of urban persons were injured or killed in falls, compared with only 8 percent of the rural population. Differences are evident in injuries and deaths by region but the sample sizes are too small to make any legitimate observations. The only region with more than 49 unweighted cases of injuries or deaths was Kandal Province. It is interesting to note that almost 20 percent of all accidental injuries or deaths in the country occurred in Kandal Province. Kandal Province is represented by a largely urban population living immediately outside of Phnom Penh. The busiest roads in Cambodia lead from the edges of Phnom Penh past numerous factories into Kandal Province. This helps to explain why the majority of injuries and deaths in Kandal Province were road accidents (62 percent). 3.2 PHYSICAL IMPAIRMENT Following the section on accidental injuries and deaths were questions on physical impairment. These questions inquired as to whether any living household members were physically impaired, and if so, what caused the impairment. In Cambodia, almost 2 percent of the population has a physical impairment (Table 3.3). Physical impairments increase with age: the population older than 60 years of age is more likely to have physical impairments (4 percent) than those 10-19 years old (1 percent). Men are twice as likely (2 percent) to be impaired physically as women (1 percent). There is no difference in physical impairments by urban-rural residence, although there are regional differences. The areas with the highest percentage of the population with physical impairments are Kampong Chhnang and Bat Dambang/Krong Pailin (3 percent each). The areas with the lowest prevalence of physical impairments are Prey Veaeng (0.5 percent) and Mondol Kiri/Rotanak Kiri (0.6 percent). Health Status and Utilization of Health Services * 29 Table 3.3 Physical impairment Percentage of the de facto household population physically impaired and percent distribution of the impaired de facto household population by cause of impairment, according to background characteristics, Cambodia 2000 ___________________________________________________________________________________________________________ Cause of impairment Number ____________________________________________________ Number of Road Other of Background Physically household Land- acci- acci- impaired characteristic impaired members Birth Illness mine Gun dent dent Total persons ___________________________________________________________________________________________________________ Age group 0-9 10-19 20-39 40-59 60+ Sex Male Female Residence Urban Rural Region Banteay Mean Chey Kampong Cham Kampong Chhnang Kampong Spueu Kampong Thum Kandal Kaoh Kong Phnom Penh Prey Veaeng Pousat Svay Rieng Takaev Bat Dambang/Krong Pailin Kampot/Krong Kaeb/ Krong Preah Sihanouk Preah Vihear/Stueng Traeng/Kracheh Mondol Kiri/Rotanak Kiri Siem Reab/Otdar Mean Chey Total 0.6 17,576 51.4 32.0 0.0 2.2 0.5 13.9 100.0 109 1.0 17,552 29.7 41.8 3.2 2.3 3.9 19.0 100.0 179 1.9 16,394 16.7 27.6 24.9 13.1 3.3 14.4 100.0 313 3.1 9,123 6.8 32.6 19.5 20.5 4.3 16.3 100.0 286 4.0 3,631 5.8 63.1 5.5 2.2 3.8 19.6 100.0 146 2.2 30,772 14.9 31.8 19.5 14.3 3.9 15.6 100.0 668 1.1 33,502 24.7 46.3 4.6 3.8 2.7 18.0 100.0 364 1.9 9,903 12.1 48.2 8.9 14.0 4.2 12.6 100.0 186 1.6 54,373 19.7 34.5 15.4 9.8 3.3 17.3 100.0 846 1.6 2,989 22.5 18.2 20.7 12.9 7.4 18.4 100.0 49 1.4 8,467 17.9 48.3 5.9 9.9 0.0 17.9 100.0 122 3.2 2,462 7.2 32.6 9.7 23.3 5.2 21.9 100.0 79 1.8 3,516 21.3 18.4 21.1 15.1 6.1 18.0 100.0 62 1.1 3,259 (18.6) (37.1) (18.7) (9.3) (2.3) (13.9) 100.0 37 1.6 6,245 19.8 46.4 6.6 7.1 6.6 13.5 100.0 97 0.8 648 (27.9) (23.0) (0.0) (4.0) (26.4) (18.7) 100.0 5 2.0 5,615 13.0 53.8 5.3 15.0 5.3 7.6 100.0 111 0.5 5,348 * * * * * * * 27 2.1 1,920 15.5 33.0 20.6 8.8 4.5 17.6 100.0 40 2.2 2,809 25.2 21.5 15.2 7.5 1.7 28.9 100.0 60 0.8 4,670 (12.5) (56.4) (6.2) (0.0) (3.1) (21.8) 100.0 37 2.7 4,475 17.3 32.9 31.2 5.3 3.1 10.1 100.0 123 1.7 4,215 16.3 41.0 15.5 9.4 0.0 17.8 100.0 73 0.9 2,539 (15.2) (44.9) (12.8) (12.5) (2.5) (12.1) 100.0 23 0.6 714 * * * * * * * 4 1.9 4,387 26.2 19.7 19.1 13.9 1.3 19.8 100.0 83 1.6 64,276 18.3 36.9 14.3 10.6 3.5 16.4 100.0 1,032 ___________________________________________________________________________________________________________ Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. The largest cause of physical impairments in Cambodia stems from disease (37 percent). These impairments are largely caused by poliomyelitis and other debilitating illnesses. The second most common cause of impairments is birth defects (18 percent). The remaining common causes of impairments are other accidents (16 percent), landmines (14 percent), and guns (11 percent). The causes of impairments are analyzed by age, sex, residence, and region. The cause of impairment varies significantly by age. Impairments experienced from the time of birth are much more common for the young population of 0-9 years (51 percent) than for the older population of 60 years or more (6 percent). This change in distribution may be due to the increasing risk of exposure to other forms of physical impairment, such as accidents, as age increases. The percentage of the population impaired due to illness increases with age: 63 percent of the oldest population (60 years or more) claimed to be impaired by disease, while only 32 percent of the youngest population 30 * Health Status and Utilization of Health Services (0-9 years) were recorded as impaired by illness. Landmines mostly affected the 20-39 and the 40-59 age groups. This might be explained by the fact that they most likely have lived through the time of war when landmines were in common use. Impairments by gunshots follow the same pattern, perhaps for the same reasons. Impairments by road accidents and other accidents do not vary as greatly by age as the other causes. The cause of impairment varies by sex, residence, and region. As for gender differences, there are almost twice as many cases of men being impaired as women. It appears that the difference between males and females is due primarily to exposure to landmines and gunshot accidents. Males are more than four times as likely to be impaired by a landmine (20 percent) as females (5 percent). Males are also almost four times more likely to be impaired by a gunshot (14 percent), compared with women (4 percent). By urban-rural residence, there are more impairments experienced from the time of birth in rural areas (20 percent) than in urban areas (12 percent). This contrasts with the finding that there are more impairments by illness in urban areas (48 percent) than in rural areas (35 percent). Persons impaired by landmine injuries are more common in rural areas (15 percent) than in urban areas (9 percent), whereas persons impaired by gunshot injuries are more common in urban areas (14 percent) than in rural areas (10 percent). Analysis of the causes of physical impairment by region is complicated by the fact that two regions have an insufficient number of cases, and four other regions have such a small number of cases that one must interpret the results with caution. 3.3 PREVALENCE AND SEVERITY OF ILLNESS OR INJURY All households were asked whether any members were sick or injured at any time in the 30 days before the interview. If any members were sick, their names were recorded in order to ask specifically about their conditions in the questions that followed. The Household Questionnaire allotted space for information to be recorded for three household members, but the interviewers were instructed to use extra household questionnaires to record the information on all household members who were ill or injured. The respondent was asked to judge the illness or injury as slight, moderate, or severe. Then questions were asked as to whether the ill or injured household members sought care, where they sought care, how much they spent on transport, and how much altogether was spent on treatment. These questions were repeated for each incident of health-care-seeking behavior in order to determine whether there are specific patterns of health-care-seeking behavior. For example, a man might first seek treatment from a Kru Khmer traditional healer; should the illness continue, he might then go to a more formal health clinic. Only three health-care-seeking attempts were recorded in the questionnaire for each ill or injured person. Ten percent of household members were ill in the 30 days prior to the interview (Table 3.4). This percentage may underrepresent the actual prevalence of morbidity and injury for two reasons. First, the questions were asked only about living household members at the time of the interview; thus, the recorded episodes of illness and injury exclude any cases that ended in death of a household member in the 30 days prior to the interview. Second, the responses are based on the 30-day recall of one respondent in the household. That respondent might not have been aware of all the illnesses or injuries that had occurred within the household. It is likely that illnesses or injuries that occurred at the beginning of the 30-day period or those that were of mild severity were forgotten and not reported. Health Status and Utilization of Health Services * 31 Table 3.4 Prevalence and severity of illness or injury in previous 30 days Percent distribution of the de facto household population ill or injured in the previous 30 days by severity of illness or injury, according to background characteristics, Cambodia 2000__________________________________________________________________________________ Not Severity of illness or injury Number of Background ill or ____________________________ household characteristic injured Slight Moderate Serious Total members__________________________________________________________________________________ Age group 0-9 10-19 20-39 40-59 60+ Sex Male Female Residence Urban Rural Region Banteay Mean Chey Kampong Cham Kampong Chhnang Kampong Spueu Kampong Thum Kandal Kaoh Kong Phnom Penh Prey Veaeng Pousat Svay Rieng Takaev Bat Dambang/Krong Pailin Kampot/Krong Kaeb/ Krong Preah Sihanouk Preah Vihear/Stueng Traeng/Kracheh Mondol Kiri/Rotanak Kiri Siem Reab/Otdar Mean Chey Total 88.1 5.9 5.0 0.9 100.0 17,576 95.6 1.7 2.2 0.5 100.0 17,552 91.6 2.8 4.4 1.2 100.0 16,394 86.3 4.7 7.2 1.8 100.0 9,123 83.3 4.8 9.6 2.3 100.0 3,631 91.5 3.2 4.2 1.0 100.0 30,772 89.6 4.2 5.1 1.1 100.0 33,502 92.4 3.4 3.2 1.0 100.0 9,903 90.2 3.8 4.9 1.1 100.0 54,373 96.4 0.3 2.4 0.8 100.0 2,989 92.0 2.5 4.2 1.2 100.0 8,467 78.8 10.1 9.7 1.5 100.0 2,462 93.5 0.8 4.9 0.8 100.0 3,516 82.8 8.3 7.4 1.5 100.0 3,259 81.8 9.1 8.2 1.0 100.0 6,245 92.7 1.7 3.9 1.7 100.0 648 95.2 2.2 2.1 0.5 100.0 5,615 98.2 0.3 1.0 0.4 100.0 5,348 84.4 4.5 9.6 1.5 100.0 1,920 89.5 4.7 4.9 0.8 100.0 2,809 94.7 1.0 3.4 1.0 100.0 4,670 87.2 8.2 3.7 0.9 100.0 4,475 94.4 0.8 3.0 1.9 100.0 4,215 94.9 2.1 2.5 0.5 100.0 2,539 98.0 0.0 0.5 1.5 100.0 714 85.0 4.4 8.4 2.2 100.0 4,387 90.5 3.7 4.7 1.1 100.0 64,276 Considering these factors that may cause an underestimation and assuming the reported prevalence to represent an average month, the annual number of illnesses or injuries per person per year would be about 1.1 episodes. This number is an estimation limited both by the factors mentioned above and the fact that it is an annual projection based on the month that preceded the interview. This survey took place between February and July, so the data collected only represents half of the year. The fieldwork occurred during the dry season and the beginning of the rainy season, so it does not represent the conditions that could arise in the rainy season. Nine-tenths of all illnesses or injuries were slight or moderate in severity. Only 1 percent of the household members experienced serious illness or injury. The oldest and the youngest age groups of the population suffered the most illnesses and injuries. The highest percentages of illness or injury were found among those 60 years old and higher (16 percent) and among those 40-59 years old (14 percent). This was closely followed by the 0-9 year-olds (12 percent). The oldest age group suffered the most moderate illnesses or injuries (10 percent) and the most serious illnesses or injuries (2 percent). There were few differences found by sex of household member or urban- rural residence. The regions with the highest percentage of illness or injury were Kampong 32 * Health Status and Utilization of Health Services Chhnang (21 percent) and Kandal (18 percent). The regions with the lowest percentage of illness or injury were Prey Veaeng and Mondol Kiri/Rotanak Kiri (2 percent). 3.4 TREATMENT SOUGHT FOR ILLNESS OR INJURY Questions on health-care-seeking behavior were used in the NHS 1998 survey. In that survey, only the highest level of treatment was recorded in the case of multiple treatments. The questions on the CDHS 2000 survey were redesigned in order to collect more information on health- care-seeking behavior. The questions collected information on the first three treatments received. Table 3.5 represents the percentage of the ill or injured population who sought treatment once, twice, and three times or more. The type of treatment recorded in these questions included, but was not limited to, care given by medically trained professionals. For example, if a sick child was first given a remedy by a Kru Khmer traditional healer, that is recorded as the first treatment. If the parents note the child is still ill, and go to a shop selling drugs in the market, that is recorded as the second treatment. If the drugs do not work and the child is still ill, the parents might take the child to a doctor at a private clinic, in which case the private clinic is recorded as the third treatment. In the CDHS 2000, 89 percent of household members who were ill sought at least one treatment (Table 3.5). This is slightly higher than the percentage of ill or injured household members who sought at least one treatment in the NHS 1998 (86 percent). In the CDHS 2000, 22 percent of those ill or injured sought at least two treatments, and 7 percent sought at least three treatments. There was no difference in health-care-seeking behavior by sex or age of the person ill or injured. Significant differences are noted considering the percentages of those seeking treatments by severity of illness or injury, urban-rural residence, and region. There is a positive relationship between the severity of illness or injury and the likelihood of seeking treatment. Household members with illness or injury considered serious were more likely to go for treatment than those with slight illness or injury (98 percent versus 84 percent for the first treatment). Rural residents who were ill or injured were slightly less likely to seek a first treatment (88 percent) than urban residents (94 percent). The provinces with the highest percentage of ill or injured seeking first treatment were Kampong Spueu and Kampong Thum (99 percent each). The province with the lowest percentage of ill or injured seeking first treatment was Banteay Mean Chey (65 percent). Phnom Penh had the highest percentage of ill or injured seeking second and third treatments (50 percent and 32 percent, respectively). The access to health care in Phnom Penh appears to facilitate health-care-seeking behavior. The two provinces with the lowest percentage of ill or injured seeking a third treatment were Kampong Thum and Kandal (1 percent each). Health Status and Utilization of Health Services * 33 Table 3.5 Percentage of ill or injured population who sought treatment Percentage of household members who were ill or injured in the past 30 days who sought a first, second, and a third treatment, according to background characteristics, Cambodia 2000_______________________________________________________________ Treatment for illness or injury Number____________________________ of Background First Second Third household characteristic treatment treatment treatment members_______________________________________________________________ Severity of illness or injury Slight Moderate Serious Age group 0-9 10-19 20-39 40-59 60+ Sex Male Female Residence Urban Rural Region Banteay Mean Chey Kampong Cham Kampong Chhnang Kampong Spueu Kampong Thum Kandal Kaoh Kong Phnom Penh Prey Veaeng Pousat Svay Rieng Takaev Bat Dambang/Krong Pailin Kampot/Krong Kaeb/ Krong Preah Sihanouk Preah Vihear/Stueng Traeng/Kracheh Mondol Kiri/Rotanak Kiri Siem Reab/Otdar Mean Chey Total 84.0 15.7 5.1 2,404 90.1 23.0 7.8 3,001 98.4 37.9 13.4 695 90.8 19.8 5.9 2,086 87.9 19.3 6.6 780 88.6 22.5 8.8 1,382 86.0 25.9 9.2 1,249 87.7 21.7 6.4 606 89.2 21.5 7.0 2,608 88.2 22.0 7.6 3,496 94.0 25.7 10.3 751 87.9 21.2 6.9 5,352 65.2 11.2 2.5 106 79.9 26.7 10.2 673 92.1 25.6 11.7 523 99.2 15.7 2.6 229 98.5 10.3 1.2 561 81.0 12.6 1.4 1,140 91.5 27.4 8.7 47 94.3 49.9 32.4 271 88.7 20.9 8.1 94 94.8 24.3 5.2 300 89.7 28.3 12.0 295 86.6 20.0 2.8 248 91.1 19.4 3.5 572 91.8 29.9 9.5 238 88.0 18.7 3.0 130 87.9 34.4 13.5 14 91.7 27.2 12.3 661 88.6 21.8 7.4 6,104 __________________________________________________________________ Note: Total includes 4 persons for whom information on severity of illness is not available. 3.5 UTILIZATION OF HEALTH CARE FACILITIES Information on the sector and location of the health care provider was collected in order to trace where those who were ill or injured went for treatment. All considerable public-sector, private-sector and nonmedical-sector health care provider options were provided. Descriptions of the distinctions between the different types of hospitals, clinics, pharmacies, and drug sellers were given to the interviewers. If there were difficulties distinguishing the type of health care provider, the field editor or team supervisor with local knowledge was referred to for exact specification. 34 * Health Status and Utilization of Health Services Figure 3.1 presents the percentages of ill or injured household members who sought treatment by the number of treatments and the sector where they went for treatment. The trend that appears from the first through the third treatment is that the nonmedical sector is the most popular sector for health care. The private sector is the second most popular, followed by the public sector. For the first treatment and only treatment for most of the ill or injured population, the nonmedical sector (35 percent) and the private sector (33 percent) were the most common for treatment. The public sector was slightly more than half as common for the source of first treatment (19 percent). For the third treatment, the nonmedical sector was the most common source of treatment (4 percent). The private sector was half as common as the nonmedical sector (2 percent), and the public sector was one-quarter as common (1 percent) as the nonmedical sector. It is likely that people seek treatment from the nonmedical sector for two primary reasons. First, the nonmedical sector may be closer to the population and thus easier to access (see Table 3.8: transportation costs to the nonmedical sector are lowest). Second, it appears from the information in Table 3.8 that the nonmedical sector is considerably less expensive than the other sectors; this could also be an explanatory factor for the high rates of health care seeking in the nonmedical sector. Table 3.6 presents the utilization of health services by urban-rural residence and total percentages. There are some significant differences evident by residence. Rural residents who are ill or injured are twice as likely not to seek treatment (12 percent) as urban residents (6 percent). There are no significant differences between rural and urban regions for the use of all public-sector or all private-sector sources for health treatment. Within the private sector, the private clinic was twice as common as a source of treatment in urban areas as in rural areas from the first to the third treatment. The nonmedical sector was more common as a first treatment in urban areas (43 percent) than in rural areas (34 percent). No differences were found in the second and third treatments. Dedicated drug stores with approved government licenses were three times as common for first treatment in urban areas (14 percent) as in rural areas (5 percent). Health Status and Utilization of Health Services * 35 Table 3.6 Utilization of health care facilities Percent distribution of household members who were ill or injured in the past 30 days by place of treatment, according to number of treatments and residence, Cambodia 2000__________________________________________________________________________________________________________ Number of treatments for illness or injury____________________________________________________________________________ Urban Rural Total Place of ______________________ ______________________ ______________________ treatment First Second Third First Second Third First Second Third__________________________________________________________________________________________________________ Did not seek treatment Public sector Central hospital (Phnom Penh) Provincial hospital District hospital Health center Khum clinic Health worker Other public Private sector Private hospital Private clinic Home/office trained health worker Visit of trained health worker/nurse Other private medical Nonmedical sector Dedicated drugstore Shop selling drugs/market Kru Khmer/magician Monk/religious leader Traditional birth attendant Other Total Number 6.0 74.3 89.7 12.1 78.8 93.1 11.4 78.2 92.6 16.8 4.8 2.1 18.8 4.0 1.2 18.5 4.1 1.3 4.4 1.5 0.8 3.6 0.7 0.1 3.7 0.8 0.2 7.5 1.8 1.1 2.9 0.7 0.3 3.5 0.9 0.4 0.9 0.4 0.0 5.1 1.3 0.4 4.6 1.1 0.3 2.0 0.6 0.0 3.1 0.7 0.1 2.9 0.7 0.1 1.2 0.0 0.0 3.1 0.5 0.2 2.9 0.4 0.2 0.7 0.4 0.2 0.7 0.1 0.1 0.7 0.1 0.1 0.1 0.0 0.0 0.3 0.1 0.0 0.3 0.0 0.0 32.2 7.3 3.0 33.0 6.7 2.1 32.9 6.8 2.2 2.9 0.6 0.4 1.2 0.4 0.1 1.4 0.4 0.2 15.2 4.2 1.8 8.8 2.4 0.8 9.6 2.6 1.0 1.6 1.0 0.0 3.4 0.7 0.1 3.1 0.7 0.1 10.6 1.1 0.7 16.3 2.7 0.8 15.6 2.5 0.8 1.8 0.4 0.0 3.3 0.6 0.2 3.1 0.6 0.2 43.2 13.1 5.0 34.0 10.0 3.4 35.1 10.4 3.6 14.3 6.2 2.3 4.6 1.9 0.8 5.8 2.4 1.0 26.6 5.1 1.5 26.3 6.1 1.9 26.4 6.0 1.9 2.0 1.5 1.0 2.8 1.9 0.7 2.7 1.9 0.7 0.3 0.2 0.1 0.1 0.1 0.0 0.1 0.1 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.1 0.0 0.0 1.4 0.5 0.3 1.5 0.4 0.1 1.5 0.4 0.1 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 751 751 751 5,352 5,352 5,352 6,104 6,104 6,104 3.6 COST FOR HEALTH CARE Distribution of cost for health care For each ill or injured person, the household respondent had to state the costs expended for transportation and treatment for each visit to a health care provider. These costs are presented in U.S. dollars in Table 3.7 by amount of money spent for transport and treatment. Transport costs were less than treatment costs in most cases. For all treatments, 83 percent of those ill or injured spent less than one dollar on transport to the health care provider. Expenditures on the actual treatment were much more varied. Slightly more than one-quarter of the ill or injured spent between one and four dollars for treatment. This was the most common amount of money spent for treatment. For total costs, consisting of both transport and treatment, the most common amount of money spent was one to four dollars (29 percent). A very small proportion of the ill or injured population paid for transport or treatment without money, that is, in kind (less than 1 percent). 36 * Health Status and Utilization of Health Services Table 3.7 Distribution of cost for health care Percent distribution of those household members who were ill or injured in the past 30 days and sought treatment by amount of money spent for transport and health care, according to number of treatments, Cambodia 2000 ___________________________________________________________________________________________________________________ Treatment for illness or injury __________________________________________________________________________________________ First treatment Second treatment Third treatment All treatments Amount spent ____________________ ____________________ ____________________ ____________________ for transport Trans- Health Total Trans- Health Total Trans- Health Total Trans- Health Total and health care port care cost port care cost port care cost port care cost ___________________________________________________________________________________________________________________ Monetary cost <$1 84.0 21.6 20.1 80.3 28.0 25.2 83.3 29.8 27.6 82.7 19.8 18.5 $1 - $4 11.8 29.9 31.1 13.8 28.9 31.8 12.0 34.9 37.9 12.0 28.4 29.3 $5 - $9 2.1 17.4 17.6 3.2 16.0 16.0 2.9 12.6 13.2 2.5 16.8 17.0 $10 - $19 1.0 13.4 13.6 0.9 11.3 11.5 1.5 7.9 8.0 1.3 14.2 14.3 $20 - $49 0.3 9.2 9.8 0.6 7.7 8.5 0.0 9.1 9.6 0.7 10.6 11.1 $50 - $99 0.1 4.3 4.4 0.3 3.9 4.2 0.0 1.9 1.9 0.2 5.3 5.5 $100 + 0.1 3.1 3.3 0.4 2.2 2.4 0.0 1.5 1.5 0.2 4.0 4.4 Nonmonetary cost In kind 0.2 0.1 0.0 0.0 0.3 0.0 0.0 0.1 0.0 0.2 0.1 0.0 Don't know/missing 0.3 0.9 0.0 0.6 1.6 0.5 0.4 2.3 0.4 0.2 0.8 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 _______________________________________________________________________________________________________________ Note: One US$ = 4,000 riels. There are few differences among the percent distributions of money spent for transport and treatment by first, second, and third treatments. For the first through third treatments, 80 to 84 percent of all ill or injured spent less than one dollar for transport costs. For the first and second treatments, almost one-third of all ill or injured spent one to four dollars for transport and treatment. On the third visit, 38 percent of the ill or injured paid one to four dollars for the combined costs of transport and treatment. For the first, second, and third treatments between 2 and 3 percent of the ill or injured spent 100 dollars or more in total expenditures for transport and treatment. Expenditures for Health Care To present the information on health care expenditures in another manner, the mean costs of transport and treatment are displayed in Table 3.8. There is an inverse relationship between cost of treatment and the number of treatments. As the number of treatments rise, the total cost for treatment decreases from 15 dollars at the first treatment to 10 dollars at the third treatment. The mean cost of transport does not follow a pattern. The first treatment transport costs are on average one dollar. The mean costs then rise for the second treatment to two dollars, indicating the need for further travel or more rapid transport. The average expenditures on the third treatment fall to slightly more than one-half of one dollar. Mean costs of transport and treatment vary according to health sector, severity of illness or injury, age group, residence, and region. Examining health care costs by health sector shows that for the first treatment, the highest mean expenditure is for public-sector and “other” types of treatment (27 dollars). A response that falls into the category of “other” possibly represents going to another country such as Thailand or Vietnam for health care or going to trained medical professionals with specialized services. Private health care for the first treatment is less expensive (21 dollars) than public health care. The lowest mean expenditure is for those who sought care in the nonmedical sector (4 dollars). First treatments make up the majority of all health care seeking. Health Status and Utilization of Health Services * 37 Table 3.8 Expenditures for health care Mean expenditures (in U.S. dollars) for transport and health care by household members who were ill or injured in the past 30 days for transport or treatment by order of treatments, according to background characteristics, Cambodia 2000 ___________________________________________________________________________________________________________________ Treatment for illness or injury __________________________________________________________________________________________ First treatment Second treatment Third treatment All treatments ____________________ ____________________ ____________________ ____________________ Background Trans- Health Trans- Health Trans- Health Trans- Health characteristic port care Total port care Total port care Total port care Total ___________________________________________________________________________________________________________________ Type of health sector Public Private Nonmedical sector Other Severity of illness or injury Slight Moderate Serious Age group 0-9 10-19 20-39 40-59 60+ Sex Male Female Residence Urban Rural Region Banteay Mean Chey Kampong Cham Kampong Chhnang Kampong Spueu Kampong Thum Kandal Kaoh Kong Phnom Penh Prey Veaeng Pousat Svay Rieng Takaev Bat Dambang/Krong Pailin Kampot/Krong Kaeb/ Krong Preah Sihanouk Preah Vihear/Stueng Traeng/Kracheh Mondol Kiri/Rotanak Kiri Siem Reab/Otdar Mean Chey Total 1.7 27.2 28.6 2.1 19.4 21.4 1.6 13.0 13.9 2.2 30.1 31.9 0.8 20.6 21.2 1.5 19.5 20.4 0.4 16.7 17.0 1.3 26.1 27.1 0.1 3.5 3.6 0.4 5.0 5.4 0.3 5.5 5.7 0.3 8.2 8.5 12.4 26.7 37.9 29.2 73.6 92.7 0.0 5.3 5.3 16.8 40.6 55.9 0.3 3.8 4.1 0.2 3.2 3.3 0.1 2.8 3.0 0.3 4.6 4.9 1.2 16.1 17.2 1.3 12.1 13.3 0.6 9.7 10.2 1.6 20.0 21.5 2.0 46.8 47.7 4.9 32.0 36.7 1.0 22.6 21.8 4.0 61.7 64.5 0.3 6.3 6.6 0.9 5.0 5.9 0.5 3.0 3.4 0.6 7.6 8.1 0.8 16.2 16.9 0.4 8.6 8.8 0.4 3.9 4.3 1.0 18.3 19.1 1.6 21.1 22.4 1.0 10.7 11.2 0.5 10.0 10.2 1.8 24.7 26.2 1.7 21.8 23.3 4.5 26.8 31.1 1.0 20.2 20.4 3.2 31.8 34.7 0.6 20.3 20.6 0.6 19.9 20.5 (0.0) (14.7) (14.7) 0.7 26.1 26.6 0.7 14.5 15.1 1.6 12.9 14.4 0.4 10.2 10.5 1.2 18.4 19.4 1.2 15.9 16.9 1.8 13.9 15.5 0.7 10.4 10.7 1.7 20.2 21.7 1.8 15.8 17.4 4.7 18.2 22.8 0.6 18.7 18.9 3.2 22.7 25.7 0.8 15.3 16.0 1.2 12.7 13.7 0.6 8.5 8.9 1.2 18.9 20.0 1.3 32.0 33.2 * * * * * * 1.7 36.3 38.0 2.0 22.0 23.0 1.7 21.0 21.5 (1.4) (17.1) (17.8) 2.7 31.1 32.5 0.2 6.1 6.4 0.2 4.2 4.4 0.3 3.4 3.7 0.3 7.7 8.0 0.8 14.3 15.0 (0.8) (7.5) (8.3) * * * 0.9 15.5 16.4 0.3 12.7 13.0 1.9 10.3 12.0 * * * 0.5 13.9 14.4 0.8 17.7 18.4 1.6 18.3 19.8 * * * 1.1 20.6 21.5 5.4 31.4 36.3 3.5 47.2 48.6 * * * 6.6 47.4 53.4 5.7 23.8 29.0 6.4 23.3 29.4 0.5 9.5 9.8 9.4 39.2 47.9 2.7 31.3 33.4 * * * * * * 3.6 41.1 44.0 0.2 9.9 10.1 2.5 9.8 12.2 (0.1) (3.3) (3.4) 0.9 12.5 13.4 0.6 13.9 14.4 0.2 5.4 5.6 (0.2) (4.1) (4.3) 0.7 16.1 16.7 0.6 11.7 12.2 (1.6) (22.8) (24.4) * * * 1.0 17.8 18.6 0.1 12.8 12.9 0.8 10.3 10.8 * * * 0.3 15.4 15.7 1.0 20.5 21.3 1.8 10.4 12.2 * * * 1.6 24.6 26.0 0.4 17.0 17.3 (0.6) (16.9) (17.5) * * * 0.5 21.0 21.3 3.4 20.9 24.2 (2.9) (13.5) (16.0) * * * 4.6 31.1 35.4 0.4 11.7 12.1 0.3 5.6 5.9 0.3 11.3 11.4 0.6 14.8 15.4 1.0 15.3 16.2 1.7 13.5 15.0 0.6 10.3 10.6 1.4 19.4 20.7 ___________________________________________________________________________________________________________________ Note: Table includes only persons who paid cash or who reported no cost. One US$ = 4,000 riels. Total includes 4 persons for whom information on severity of illness is not available. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 38 * Health Status and Utilization of Health Services The majority of those who are seeking health care for the ill or injured go to the nonmedical sector, likely because it is the most affordable. By the second treatment, public and private health care have the same average cost (19.5 dollars). The mean costs for the nonmedical sector increased slightly (5 dollars) at the second treatment. The costs for “other” health care increased dramatically to 74 dollars. This increase is also marked in the transport cost to “other” medical treatment (29 dollars). It is likely that there are a few cases of large expenditures for the second treatment of “other” health care that make the average higher than the expenditures in the public or private sector. By the third treatment, the highest expenditures are for the private sector (17 dollars), followed by the public sector (13 dollars). Costs for nonmedical and “other” health care are similar (about 5.5 dollars). The health care costs rise quickly by severity of illness or injury. At the first treatment, health care spending for serious conditions (47 dollars) is 12 times as much as the spending for treatment of slight conditions (4 dollars). This ratio of spending for severe conditions compared with slight conditions continues in the second (10 times as much) and third treatments (8 times as much). Transport costs vary slightly by severity of conditions. For slight conditions, transport costs are less than half a dollar for all three treatments. For severe conditions, transport costs range from one to five dollars. The highest health care and transport costs for all treatments are paid for patients age 40-59 (35 dollars), followed by patients 60 years or older (27 dollars) and patients age 20-39 (26 dollars). The lowest health care costs are paid for patients 0-9 years of age (8 dollars). The total expenditures for health care and transport varies slightly by sex of patient. More is spent on care and transport in all treatments for women (22 dollars) than for men (19 dollars). Health care and transport are more expensive in the urban areas than the rural areas. For all treatments, health care and transport cost 26 dollars in urban areas, compared with only 20 dollars in rural areas. At first treatment, there are small differences between urban and rural, but urban health care costs increase in the second and third treatments, while rural health care costs decline. Health care expenditures vary greatly in the different regions of Cambodia. For the first treatment, the highest expenditures for health care and transport are found in rural provinces such as Kaoh Kong (36 dollars), Prey Veaeng, and Banteay Mean Chey (both 33 dollars). The lowest health care and transport costs are found in Kampong Chhnang (6 dollars). When examining health care costs by region, it is evident that many provinces do not have enough cases to analyze the data for second and third treatments. For all treatments, the highest total costs are found in Kaoh Kong (53 dollars) and Phnom Penh (48 dollars). Kaoh Kong is a province with limited services on the border of Thailand. It is probable that the high expenditures reflect health-care seeking across the border. The lowest total costs were identified in Kampong Chhnang (8 dollars). Since the health care system in Cambodia is largely a fee-based system, it is important to know the source of the money used to pay for health care. One goal of the health care system is to have appropriate funding mechanisms for the population to acquire health care without deepening poverty. The majority of money spent on health care comes from savings (54 percent) (Table 3.9). Other sources include wages or pocket money (16 percent), borrowed money with interest (11 percent), borrowed money without interest (9 percent), and sold assets (6 percent). There are differences in source of money spent on health care by health sector. Savings are the most common source of funding in all sectors. Borrowed money with interest is more commonly used for public-sector health care (14 percent) and private-sector health care (12 percent) than for nonmedical-sector health care (8 percent). The same trend was found Health Status and Utilization of Health Services * 39 Table 3.9 Source of money spent on health care Percent distribution of the source of expenditures for transport and health care according to background characteristics, Cambodia 2000 _____________________________________________________________________________________________________ Source of money for health care ________________________________________________________________ Borrowed Borrowed Wages/ money money Background pocket (no (with Sold characteristic money Savings interest) interest) assets Other Missing Total Number1 ______________________________________________________________________________________________________ Type of health sector Public Private Nonmedical sector Other Severity of illness or injury Slight Moderate Serious Monetary cost (US$) <1 1-4 5-9 10-19 20-49 50-99 100+ Sex Male Female Residence Urban Rural Region Banteay Mean Chey Kampong Cham Kampong Chhnang Kampong Spueu Kampong Thum Kandal Kaoh Kong Phnom Penh Prey Veaeng Pousat Svay Rieng Takaev Bat Dambang/Krong Pailin Kampot/Krong Kaeb/ Krong Preah Sihanouk Preah Vihear/Stueng Traeng/Kracheh Mondol Kiri/Rotanak Kiri Siem Reab/Otdar Mean Chey Total 17.3 47.0 10.6 14.2 7.9 1.7 1.3 100.0 762 13.3 50.9 10.8 12.4 7.3 3.7 1.6 100.0 1,494 17.1 61.2 6.1 8.2 4.0 1.6 1.7 100.0 1,632 8.9 56.9 4.0 12.2 14.0 4.1 0.0 100.0 96 20.1 59.6 5.4 8.2 2.2 1.6 2.8 100.0 1,441 14.4 55.0 9.2 10.9 6.5 2.5 1.6 100.0 2,020 7.1 37.1 15.0 18.6 16.1 4.7 1.5 100.0 540 20.7 64.5 3.9 2.6 2.0 2.6 3.8 100.0 659 16.9 64.1 6.2 5.8 2.6 1.6 2.8 100.0 1,190 16.1 55.9 8.9 11.5 4.4 1.7 1.5 100.0 685 14.1 48.3 11.9 15.4 7.2 1.8 1.2 100.0 564 11.7 36.6 16.1 20.5 10.6 3.9 0.6 100.0 475 11.5 35.6 10.2 20.8 17.4 3.7 0.8 100.0 232 4.7 36.8 9.2 20.2 22.1 6.6 0.5 100.0 200 16.2 53.1 8.8 10.8 6.1 2.7 2.3 100.0 1,678 14.9 55.1 8.6 11.0 6.3 2.3 1.8 100.0 2,326 22.8 57.0 5.0 7.3 4.3 3.2 0.4 100.0 512 14.4 53.9 9.2 11.5 6.5 2.3 2.2 100.0 3,492 5.8 37.8 14.3 27.5 8.7 1.4 4.3 100.0 62 12.8 52.4 7.7 13.1 5.1 6.2 2.7 100.0 443 24.3 56.4 6.4 2.8 3.7 5.3 1.1 100.0 301 3.4 60.4 8.6 7.0 17.9 1.6 1.1 100.0 172 7.9 66.6 8.4 6.4 8.4 0.7 1.6 100.0 377 18.2 55.8 8.5 12.2 2.8 0.5 2.0 100.0 635 3.0 65.4 12.8 11.0 1.9 2.7 3.2 100.0 36 24.8 50.0 4.8 12.1 1.6 6.7 0.0 100.0 199 7.9 49.0 7.8 15.7 11.8 3.9 4.0 100.0 77 4.0 65.1 5.3 7.6 16.5 1.0 0.5 100.0 199 36.3 34.9 10.1 3.9 11.3 1.6 1.9 100.0 236 16.5 49.8 12.4 8.1 8.7 0.0 4.6 100.0 203 26.6 40.4 8.2 21.4 2.4 0.6 0.3 100.0 370 4.8 59.5 10.7 9.6 10.4 3.2 1.8 100.0 185 34.8 44.7 8.2 7.6 3.4 0.7 0.7 100.0 87 4.4 61.8 12.2 3.0 12.2 3.6 2.8 100.0 10 3.1 63.0 10.9 13.7 2.0 3.1 4.1 100.0 412 15.5 54.3 8.6 10.9 6.2 2.5 2.0 100.0 4,004 _____________________________________________________________________________________________________ Note: Total includes 20 cases for whom information on type of health sector is not available and 3 cases for whom information on severity of illness is not available. 1 Number of households with at least one household member who was ill or injured in the past 30 days and who spent cash for treatment. 40 * Health Status and Utilization of Health Services for borrowed money without interest. Regarding source of money for treatment by severity of illness or injury, there are other important differences. Wages/pocket money and savings are the most common sources of money for care for the least severe illness, becoming less common as severity increases. Sold assets are an increasing source of money for health care as the severity of condition rises. The same trend is found for borrowed money with and without interest. The monetary costs of health care treatment show similar trends as those described above. Wages/pocket money and savings are the most utilized sources of money for health care expenditures when the costs are low. As costs increase, the proportion of funds pulled from these two sources decreases. Savings is still the most common source of money for health care when costs reach 100 dollars or more (37 percent). Borrowed money with interest becomes a more important source of money as treatment costs increase. When treatment costs are 20 dollars or more, borrowed money with interest increases to more than 20 percent of all cases. When treatment costs are 100 dollars or more, 22 percent of the ill or injured rely on sold assets as the source of money for health care. There are no real differences in the source of money for health care by sex of the patient. Examining urban-rural residence, it is evident that urban residents rely more on wages or pocket money for health care (23 percent) than rural residents (14 percent). Rural residents rely more on borrowed money with interest for health care (12 percent) than urban residents (7 percent). Greater differences are found in the sources of money for health care by region than by urban-rural residence. The regions with the highest use of wages or pocket money for spending on health care were Svay Rieng (36 percent) and Preah Vihear/Stueng Traeng/Kracheh (35 percent). The provinces with the highest reliance on savings for health care spending were Kampong Thum (67 percent), Kaoh Kong and Pousat (both 65 percent). The highest reliance on money lenders offering loans with interest for health care was in Banteay Mean Chey (28 percent) and Bat Dambang/Krong Pailin (21 percent). The lowest reliance on these types of money lenders was found in Kampong Chhnang and Mondol Kiri/Rotanak Kiri (3 percent). The highest reliance on selling assets for money to spend on health care was found in the Kampong Spueu (18 percent) and Pousat provinces (17 percent). Respondents’ Characteristics and Status * 41 4 Table 4.1 Background characteristics of respondents Percent distribution of women by background characteristics, Cambodia 2000_____________________________________________________ Number of women__________________ Background Weighted Un- characteristic percent Weighted weighted_____________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Marital status Never married Currently married Widowed Divorced/separated Residence Urban Rural Region Banteay Mean Chey Kampong Cham Kampong Chhnang Kampong Spueu Kampong Thum Kandal Kaoh Kong Phnom Penh Prey Veaeng Pousat Svay Rieng Takaev Bat Dambang/Krong Pailin Kampot/Krong Kaeb/ Krong Preah Sihanouk Preah Vihear/Stueng Traeng/Kracheh Mondol Kiri/Rotanak Kiri Siem Reab/Otdar Mean Chey Education Never attended school Primary Lower secondary Upper secondary More than secondary Religion Buddhist Muslim Christian Other/don’t know Total 23.6 3,618 3,564 12.9 1,982 1,942 13.8 2,118 2,164 14.3 2,195 2,234 14.1 2,168 2,202 12.0 1,847 1,823 9.3 1,425 1,422 31.8 4,884 4,646 59.1 9,071 9,332 6.0 919 911 3.1 477 462 17.5 2,692 2,627 82.5 12,659 12,724 4.4 672 740 12.8 1,961 814 3.8 583 1,027 4.7 725 781 5.1 777 912 9.6 1,469 885 1.0 147 857 10.8 1,657 1,157 8.3 1,272 843 2.8 433 885 4.5 688 876 7.2 1,107 958 7.1 1,084 873 6.5 999 863 3.8 582 1,029 1.0 161 905 6.7 1,036 946 28.3 4,338 4,849 54.6 8,376 8,182 12.9 1,987 1,807 3.8 588 469 (0.4) 62 44 96.0 14,739 14,283 2.5 391 386 (0.3) 41 41 1.2 181 641 100.0 15,351 15,351 _____________________________________________________ Note: Education refers to the highest level ever attended whether or not that level was completed. Figures in parentheses are based on 25-49 unweighted cases. RESPONDENTS’ CHARACTERISTICS AND STATUS The objective of this chapter is to provide a demographic and socioeco- nomic profile of the 2000 Cambodia DHS sample. Information on the basic charac- teristics of women interviewed in the survey is essential for the interpretation of findings presented later in the report and can provide an approximate indication of the representativeness of the survey. 4.1 BACKGROUND CHARACTERISTICS OF RESPONDENTS The distribution of women age 15- 49 by background characteristics includ- ing age, marital status, place of residence, region, educational level, and religion is shown in Table 4.1. The distribution of the population of women by age reflects recent Cambo- dian history (see Figure 4.1). Note that 24 percent of women fall into the 15-19 age group, and a significantly smaller proportion of women are found in the 20- 24 and 25-29 age groups (13 percent and 14 percent, respectively). This unusual distribution of women into the younger age groups (normally one would expect a more gradual and linear decrease in pro- portion of women in each age group as age increases) is an indicator of the demo- graphic shocks that occurred as a result of the Khmer Rouge regime. The women who are currently in the age range of 20- 29 were born in the 1970s, immediately prior to and during the Khmer Rouge years (1975-1979). Fertility declined during these years, concomitant with higher than normal mortality due to na- tional conflict: between one and two million people are estimated to have been killed during the reign of the Khmer 42 * Respondents’ Characteristics and Status Rouge. These events are reflected in the comparatively smaller proportions of women in the 20-24 and 25-29 age groups. After the conflict subsided, there was a baby boom, represented by the high proportion of women in the 15-19 age range. The number of women, expectedly, declines with age: 9 percent of women fall into the 45-49 age group. Three out of every five women are married, and there is little divorce (3 percent). Six percent of women are widowed and about one-third of the women (32 percent) have never been married. In terms of religious affiliation, most women are Buddhist (96 percent), with 3 percent of the women identifying themselves as Muslim. Forty-one women out of 15,351 identified themselves as Christian. The majority of respondents (more than 80 percent) live in the rural areas. Thirteen percent live in Kampong Cham, and 11 percent live in the capital city of Phnom Penh. More than 70 percent of women have been to school, with 17 percent of all women having gone on to some secondary education. Due to small numbers, respondents with higher education are grouped together with those who had secondary education, and the education category is reclassified into “secondary and higher” in subsequent tables in this report. 4.2 EDUCATIONAL ATTAINMENT BY BACKGROUND CHARACTERISTICS Table 4.2 shows the educational level of respondents by selected background characteristics. Twenty-eight percent of women have no formal education. Among women who attended school, the majority began, but did not complete, primary education (49 percent of all women). Seventeen percent of women have at least some secondary education. Women in the 35-39 age group are unusual, in that 42 percent of these women have never been to school, compared with 36 percent of women in the 40-49 age group, and 26 percent of women in the 30-34 age group. This pattern probably occurred because women in the 35-39 age group reached school age at the time of the Khmer Rouge. Respondents’ Characteristics and Status * 43 Table 4.2 Educational attainment by background characteristics Percent distribution of women by highest level of schooling attended, by background characteristics, Cambodia 2000 ____________________________________________________________________________________________________________ Highest level of schooling attained ___________________________________________________________ No Primary Secondary More Median Background educa- __________________ _________________ than years of characteristic cation Some Completed1 Some Completed2 secondary Total Number schooling ____________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Banteay Mean Chey Kampong Cham Kampong Chhnang Kampong Spueu Kampong Thum Kandal Kaoh Kong Phnom Penh Prey Veaeng Pousat Svay Rieng Takaev Bat Dambang/ Krong Pailin Kampot/Krong Kaeb/Krong Preah Sihanouk Preah Vihear/Stueng Traeng/Kracheh Mondol Kiri/ Rotanak Kiri Siem Reab/Otdar Mean Chey Total 18.8 47.4 9.2 21.9 2.2 0.5 100.0 3,618 3.7 27.4 45.6 6.2 17.3 2.7 0.8 100.0 1,982 3.0 21.4 47.9 5.9 22.3 2.2 0.3 100.0 2,118 3.4 26.2 49.3 5.1 17.1 1.8 0.5 100.0 2,195 2.6 42.3 48.5 3.3 5.4 0.4 0.1 100.0 2,168 1.1 35.7 52.9 3.6 7.0 0.6 0.2 100.0 1,847 1.6 35.9 50.7 5.7 6.6 1.0 0.1 100.0 1,425 1.8 15.4 37.9 7.8 30.5 6.4 1.9 100.0 2,692 4.7 31.0 50.9 5.6 11.9 0.6 0.1 100.0 12,659 2.3 44.1 37.2 4.7 13.3 0.7 0.0 100.0 672 1.4 33.6 50.5 4.4 9.9 1.5 0.0 100.0 1,961 2.1 23.1 63.5 2.8 9.7 0.8 0.1 100.0 583 1.7 46.3 40.8 4.5 7.7 0.6 0.1 100.0 725 1.3 25.1 57.9 5.7 10.3 1.0 0.0 100.0 777 2.3 23.3 53.2 8.3 14.9 0.5 0.0 100.0 1,469 2.6 40.0 47.8 3.4 7.9 0.8 0.1 100.0 147 1.5 7.8 36.0 7.4 38.0 7.3 3.5 100.0 1,657 5.8 34.7 54.0 3.7 7.0 0.6 0.0 100.0 1,272 2.1 32.1 51.2 4.9 11.2 0.5 0.1 100.0 433 1.8 24.0 57.8 5.3 12.5 0.4 0.0 100.0 688 2.6 19.8 53.1 8.9 17.6 0.5 0.0 100.0 1,107 3.2 21.7 48.0 7.2 21.1 1.8 0.2 100.0 1,084 3.1 22.5 53.0 8.0 15.0 1.5 0.0 100.0 999 2.9 24.9 52.3 6.0 16.0 0.7 0.0 100.0 582 2.6 74.6 16.7 2.3 6.1 0.3 0.0 100.0 161 0.0 48.0 37.2 5.0 8.3 1.6 0.0 100.0 1,036 0.7 28.3 48.6 5.9 15.1 1.6 0.4 100.0 15,351 2.5 _______________________________________________________________________________________________________________ 1 Completed grade 6 at the primary level 2 Completed grade 12 at the secondary level Women born during the reign of the Khmer Rouge (those currently age 20-24) are also more likely than other age groups to have no education (27 percent have never attended school). However, the general pattern evident in this table indicates a decrease of the proportion of women with no education from the oldest to the youngest cohorts, indicating a slight improvement over time in women’s education. The median years of schooling (2.5 at the national level) also increased with successive cohorts, from less than 2 years among the oldest women to 3.7 years among women age 15-19. 44 * Respondents’ Characteristics and Status Education varies greatly according to residence. Eighty-five percent of women who live in urban areas have been to school, while 39 percent of urban women have reached the secondary level of education. For the more than 80 percent of Cambodia’s population who live in rural areas, educational attainment is lower, with 69 percent of women having ever attended school, but only 13 percent having attained the secondary level. Residents of the more urban areas of the country like Phnom Penh and Bat Dambang/Krong Pailin, but also Takaev, have higher levels of educational attainment, especially at the secondary level or higher. The median years of schooling per woman for these regions are 5.8 years, 3.1 years, and 3.2 years, respectively. Mondol Kiri/Rotanak Kiri has a proportion of uneducated women that is significantly higher than all other regions, with 75 percent of the women in that area never having attended school. 4.3 LITERACY In the CDHS 2000, literacy was determined by a respondent’s ability to read part or all of a sentence in any language that the respondent was familiar with (Khmer, Vietnamese, Chinese, French, or English). The questions assessing literacy were asked only of respondents who had not attended school or had attended primary school only. Table 4.3 shows that only 42 percent of women are literate (they have a secondary-level education—7 percent—or can read a whole sentence—25 percent), while another 24 percent of women is only partially literate. There is a much lower literacy level among rural women than among those living in the urban areas: 18 percent of urban women cannot read at all, while double that proportion of rural women are illiterate. Literacy levels vary widely among regions, from a low of 9 percent of illiterate women in Phnom Penh to a high of 75 percent of illiterate women in Mondol Kiri/Rotanak Kiri. Note that 28 percent of women have no education, while 32 percent are illiterate and 24 percent are only partially literate. The difference between the level of education and the level of literacy indicates that a large proportion of women who attended school did not spend enough time in school to become literate or they have forgotten what they learned. Respondents’ Characteristics and Status * 45 Table 4.3 Literacy Percent distribution of women by level of schooling attended and by level of literacy, according to background characteristics, Cambodia 2000________________________________________________________________________________________________________ No schooling or primary school____________________________________________ Secondary No card school Can read Can read Cannot with Background or a whole part of read required characteristic higher sentence a sentence at all language Total Number________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Banteay Mean Chey Kampong Cham Kampong Chhnang Kampong Spueu Kampong Thum Kandal Kaoh Kong Phnom Penh Prey Veaeng Pousat Svay Rieng Takaev Bat Dambang/Krong Pailin Kampot/Krong Kaeb/ Krong Preah Sihanouk Preah Vihear/Stueng Traeng/Kracheh Mondol Kiri/Rotanak Kiri Siem Reab/Otdar Mean Chey Total 24.7 30.0 20.0 24.8 0.1 100.0 3,618 20.9 23.9 20.3 34.4 0.2 100.0 1,982 24.9 25.2 22.3 27.3 0.1 100.0 2,118 19.5 24.0 25.7 30.5 0.1 100.0 2,195 6.0 22.2 28.4 43.0 0.1 100.0 2,168 8.4 23.3 30.6 37.4 0.1 100.0 1,847 8.7 25.8 28.1 37.1 0.2 100.0 1,425 39.1 28.4 14.6 17.6 0.0 100.0 2,692 12.8 24.8 26.5 35.6 0.2 100.0 12,659 14.1 16.8 20.3 48.8 0.0 100.0 672 11.7 20.1 28.8 38.1 0.7 100.0 1,961 10.8 38.7 19.3 30.6 0.2 100.0 583 8.7 29.6 15.3 46.3 0.0 100.0 725 12.4 31.2 26.3 30.0 0.0 100.0 777 15.8 20.8 33.9 29.4 0.1 100.0 1,469 9.1 19.4 28.2 42.7 0.5 100.0 147 49.0 26.1 16.1 8.6 0.0 100.0 1,657 7.7 27.0 30.0 35.3 0.0 100.0 1,272 12.1 18.5 32.4 36.9 0.1 100.0 433 13.1 36.5 13.7 36.6 0.0 100.0 688 18.1 25.1 32.7 23.5 0.0 100.0 1,107 23.2 24.4 26.3 25.8 0.1 100.0 1,084 16.5 29.0 20.7 33.2 0.0 100.0 999 17.0 25.3 28.9 28.5 0.1 100.0 582 6.4 10.1 8.3 75.1 0.0 100.0 161 9.8 26.5 14.9 48.3 0.0 100.0 1,036 17.4 25.4 24.4 32.4 0.1 100.0 15,351 4.4 EXPOSURE TO MASS MEDIA The CDHS 2000 collected information on the exposure of respondents to both the broadcast and print media. This information is important because it provides an indication of the exposure of women to the mass media that can be used to disseminate family planning, health, and other information. Access to mass media is relatively high in Cambodia: Table 4.4 shows that 70 percent of women have some weekly exposure to the mass media. Watching television is the most common way of accessing the media: 56 percent of women watch television at least once a week. Listening to the radio is also common (46 percent of women listen at least once a week), with newspapers being the least utilized form of media (12 percent read a paper at least once a week). Media exposure varies with the age of the respondent. Women in the older age groups tend to access the three types of media less frequently than younger women; the youngest group of women (15-19 years old) is significantly more likely than any other age group to access any media, particularly television and newspaper. There are also clear geographic differences in media exposure. Urban women have better access to all three media sources than their rural counterparts. Due to lower literacy levels, rural women are much less likely to report that they read a newspaper at least once a week than urban women (8 percent compared with 32 percent). The level of exposure of women to television broadcasts is greater than all other media sources, even in rural areas. 46 * Respondents’ Characteristics and Status Table 4.4 Exposure to mass media Percentage of women who usually read a newspaper at least once a week, watch television at least once a week, and listen to the radio at least once a week, by background characteristics, Cambodia 2000 ___________________________________________________________________________________________ Reads a Watches Listens to newspaper television the radio at least at least at least All No Background once a once a once a three mass characteristic week week week media media Number ___________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Banteay Mean Chey Kampong Cham Kampong Chhnang Kampong Spueu Kampong Thum Kandal Kaoh Kong Phnom Penh Prey Veaeng Pousat Svay Rieng Takaev Bat Dambang/Krong Pailin Kampot/Krong Kaeb/ Krong Preah Sihanouk Preah Vihear/Stueng Traeng/Kracheh Mondol Kiri/Rotanak Kiri Siem Reab/Otdar Mean Chey Education No education Primary Secondary and higher Total 17.1 66.4 50.8 12.9 23.0 3,618 12.1 55.1 46.7 9.0 31.5 1,982 12.1 53.1 45.0 9.1 32.2 2,118 11.4 51.5 43.5 8.0 34.4 2,195 9.6 50.9 42.0 6.0 33.9 2,168 9.4 54.5 46.5 7.0 31.2 1,847 9.3 54.9 44.8 7.1 31.1 1,425 32.4 75.9 59.7 25.6 15.1 2,692 8.0 52.1 43.2 5.4 33.5 12,659 7.9 31.9 21.5 2.8 59.1 672 7.3 52.4 45.0 4.6 28.1 1,961 9.9 64.5 53.5 8.0 22.5 583 8.1 56.1 33.0 5.3 35.7 725 9.9 22.6 41.6 4.2 49.4 777 7.4 61.0 36.6 6.5 31.2 1,469 11.1 33.2 21.1 3.8 53.9 147 40.6 89.2 60.4 34.9 7.9 1,657 6.0 65.5 45.8 4.9 26.5 1,272 7.2 49.6 30.9 2.9 37.3 433 15.2 40.0 55.1 8.2 30.3 688 6.7 77.4 69.2 5.4 12.8 1,107 11.3 63.1 56.9 9.6 23.3 1,084 14.1 53.8 54.9 9.2 23.9 999 11.4 21.7 28.9 5.3 60.1 582 8.4 15.7 12.5 3.9 78.0 161 6.2 44.8 38.1 4.0 43.0 1,036 0.5 39.0 31.5 0.2 47.8 4,338 10.5 57.7 48.0 7.2 27.5 8,376 37.3 80.2 64.3 29.0 10.5 2,637 12.2 56.3 46.1 9.0 30.3 15,351 Among the regions, women residing in Phnom Penh have by far the greatest exposure to all three media (35 percent), with Bat Dambang/Krong Pailin being the next region most exposed to mass media with 10 percent of women using all three types of media at least once a week. Women residing in Banteay Mean Chey, Preah Vihear/Stueng Traeng/Kracheh and Mondol Kiri/Rotanak Kiri are the least likely to be exposed to the media (59 percent, 60 percent, and 78 percent, respectively, have no access to media). There are also interesting regional differences in media access when taking literacy levels into account. For example, both Kampong Chhnang and Svay Rieng have 50 percent literacy rates; however, whereas 15 percent of women in Svay Rieng read the newspaper at least once a week, only 10 percent of women in Kampong Chhnang do. Women Respondents’ Characteristics and Status * 47 in Svay Rieng are also much less likely to watch television than women in Kampong Chhnang (40 percent compared with 65 percent). As expected, media exposure is related to the educational level of the respondent. Four out of every five women with secondary or higher levels of education watch television at least once a week, compared with almost two in five women with no education. Regarding the printed media, 11 percent of women with primary education reported reading a newspaper at least once a week, compared with 37 percent of women with secondary and higher education. 4.5 EMPLOYMENT Respondents were asked a number of questions to elicit their employment status at the time of the survey and continuity of employment in the 12 months prior to the survey. Table 4.5 shows this information for Cambodian women according to different background characteristics. Almost three-quarters of women (73 percent) were working at the time of the survey, 9 percent worked during the 12 months prior to the survey, and 18 percent did not work at all. Most currently employed women work seasonally (48 percent), while 24 percent of women work year-round. The youngest group of women is the least likely to be employed year-round (20 percent), but make up a significant proportion of seasonal/occasional workers (44 percent). Otherwise, there is no consistent pattern of work behavior by age. There is also little pattern of year-round work behavior by number of children until women have had five or more children, at which point they are less likely to work year-round than other women, but more likely to work seasonally; seasonal work participation increases with parity. Women with no children are the least likely to have worked in the past year (21 percent did not work). Never-married women are only slightly more likely to work year-round than married women, while those who are divorced, separated, or widowed are the most likely to be doing any kind of work and the least likely to be currently unemployed. A higher proportion of women in urban areas work year-round than rural women (47 percent compared with 19 percent), and higher proportions of rural women work seasonally than urban women (54 percent compared with 17 percent). This likely indicates differences between a rural, agricultural economy and an urban economy. Phnom Penh has the highest proportion of women engaged in year-round employment (63 percent), followed by Kandal (29 percent) and Bat Dambang/Krong Pailin (28 percent). Banteay Mean Chey has the highest proportion of women who did not work in the past year (49 percent). Among the small proportion of women who attained secondary and higher levels of education, 29 percent were not working in the 12 months preceding the survey, compared with those who received no education at all (13 percent). Seasonal employment is more common among uneducated women (61 percent) than among those with secondary and higher education (21 percent). Women with the highest levels of education are the most likely to be working year- round; both high educational attainment and ability to work year-round are likely associated with urban residence. 48 * Respondents’ Characteristics and Status Table 4.5 Employment Percent distribution of women by employment status and continuity of employment, according to background characteristics, Cambodia 2000__________________________________________________________________________________________ Not currently employed_________________ Did not Worked Currently employed work in in _________________________________ Number Background last 12 last 12 Season- Occasion- of characteristic months months All year ally ally Missing Total women__________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Current marital status Never married Currently married Divorced, separated, widowed Number of living children None 1-2 3-4 5+ Residence Urban Rural Region Banteay Mean Chey Kampong Cham Kampong Chhnang Kampong Spueu Kampong Thum Kandal Kaoh Kong Phnom Penh Prey Veaeng Pousat Svay Rieng Takaev Bat Dambang/Krong Pailin Kampot/Krong Kaeb/ Krong Preah Sihanouk Preah Vihear/Stueng Traeng/Kracheh Mondol Kiri/Rotanak Kiri Siem Reab/Otdar Mean Chey Education No education Primary Secondary and higher All women 27.4 8.4 19.7 42.1 2.0 0.3 100.0 3,618 18.2 8.6 25.4 45.7 1.7 0.4 100.0 1,982 16.7 9.1 22.1 50.4 1.5 0.2 100.0 2,118 14.9 9.3 26.0 46.8 2.7 0.3 100.0 2,195 13.4 9.6 24.6 50.4 1.7 0.3 100.0 2,168 12.5 8.8 24.8 51.6 2.0 0.3 100.0 1,847 12.8 6.7 25.9 52.3 1.7 0.5 100.0 1,425 22.1 7.2 24.5 43.6 2.2 0.4 100.0 4,884 16.9 9.5 22.2 49.2 1.8 0.3 100.0 9,071 8.8 8.5 28.9 51.6 2.0 0.3 100.0 1,396 21.3 7.6 24.6 44.1 2.0 0.4 100.0 5,800 18.4 8.5 24.9 46.1 1.7 0.3 100.0 3,568 14.9 9.5 24.2 49.1 2.0 0.3 100.0 3,132 13.2 10.4 19.0 55.1 2.0 0.4 100.0 2,851 28.1 6.5 46.6 16.8 1.8 0.1 100.0 2,692 15.7 9.2 18.7 54.2 1.9 0.4 100.0 12,659 49.0 5.1 18.7 22.5 4.6 0.0 100.0 672 17.4 1.4 20.4 59.4 1.1 0.4 100.0 1,961 3.9 0.8 24.7 67.1 2.3 1.2 100.0 583 3.4 0.3 9.1 85.8 0.5 0.9 100.0 725 8.9 0.1 17.2 69.3 4.1 0.4 100.0 777 15.7 3.6 29.1 49.0 2.5 0.1 100.0 1,469 35.5 1.7 27.9 34.5 0.4 0.0 100.0 147 27.0 5.0 63.4 2.9 1.6 0.1 100.0 1,657 1.9 18.7 10.2 68.1 0.9 0.1 100.0 1,272 7.6 0.1 16.3 74.5 1.0 0.4 100.0 433 15.2 0.2 8.5 73.5 0.8 1.6 100.0 688 35.2 10.0 10.6 43.1 0.7 0.3 100.0 1,107 20.7 7.8 28.2 39.0 4.1 0.2 100.0 1,084 11.7 50.0 19.4 15.0 4.0 0.0 100.0 999 27.9 1.0 18.0 51.0 1.4 0.6 100.0 582 13.3 0.2 11.9 74.1 0.6 0.0 100.0 161 14.0 18.2 22.0 45.1 0.5 0.2 100.0 1,036 13.4 9.3 14.3 61.0 1.6 0.3 100.0 4,338 16.5 9.2 22.7 49.3 2.0 0.4 100.0 8,376 29.4 6.2 41.6 20.5 2.2 0.1 100.0 2,637 17.8 8.7 23.6 47.6 1.9 0.3 100.0 15,351 Respondents’ Characteristics and Status * 49 Table 4.6 Occupation Percent distribution of currently employed women by occupation (agricultural and nonagricultural) and type of agricultural land worked or type of nonagricultural employment, according to background characteristics, Cambodia 2000__________________________________________________________________________________________________________________ Agricultural Nonagricultural___________________________ ___________________________________________ Number of Prof./ Sales Manual currently Background Own Family Rented Other tech./ and _______________ Other/ employed characteristic land land land land manag. Clerical services Skilled Unskilled missing Total women__________________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Current marital status Never married Currently married Divorced, separated, widowed Number of living children 0 1-2 3-4 5+ Residence Urban Rural Region Banteay Mean Chey Kampong Cham Kampong Chhnang Kampong Spueu Kampong Thum Kandal Kaoh Kong Phnom Penh Prey Veaeng Pousat Svay Rieng Takaev Bat Dambang/Krong Pailin Kampot/Krong Kaeb/ Krong Preah Sih

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