Egypt - Demographic and Health Survey - 2009

Publication date: 2009

Egypt Demographic and Health Survey 2008Dem ographic and H ealth S urvey E gypt 2008 Egypt Demographic and Health Survey 2008 Fatma El-Zanaty Ann Way March 2009 El-Zanaty and Associates Ministry of Health The 2008 Egypt Demographic and Health Survey (2008 EDHS) was conducted on behalf of the Ministry of Health by El- Zanaty and Associates. The Central Laboratory at the Ministry of Health was responsible for the hepatitis C testing component of the survey. The 2008 EDHS is part of the worldwide MEASURE DHS project which is funded by the United States Agency for International Development (USAID). USAID/Cairo was the main contributor of funding for the survey. Support for the survey was also provided by UNICEF. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID and UNICEF. Additional information about the 2008 EDHS may be obtained from the Ministry of Health, 3 Magles El Shaab Street, Cairo, Egypt; Telephone: 20-2-27948555 and Fax: 20-2-27924156. Information about DHS surveys may be obtained from the MEASURE DHS Project, Macro International, 11785 Beltsville Drive, Calverton, MD 20705 USA; Telephone: 301-572-0200, Fax: 301-572-0999, E-mail: reports@macrointernational.com, Internet: http://www.measuredhs.com. Recommended citation: El-Zanaty, Fatma and Ann Way. 2009. Egypt Demographic and Health Survey 2008. Cairo, Egypt: Ministry of Health, El-Zanaty and Associates, and Macro International. Contents | iii CONTENTS Page TABLES AND FIGURES .ix PREFACE. xix ACKNOWLEDGMENTS . xxi SUMMARY OF FINDINGS . xxiii MAP OF EGYPT . xxx CHAPTER 1 INTRODUCTION 1.1 Geography .1 1.2 Population Size and Structure .1 1.3 Recent Rate of Natural Increase .1 1.4 2008 Egypt Demographic and Health Survey .3 1.4.1 Organization and Objectives .3 1.4.2 Timetable .3 1.4.3 Sample Design.4 1.4.4 Questionnaire Development.6 1.4.5 Biomarker Data Collection.7 1.4.6 Pretest .7 1.4.7 Data Collection Activities .8 1.4.8 Fieldwork .9 1.4.9 Data Processing Activities.10 1.5 Survey Coverage .10 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS 2.1 Characteristics of the Household Population .13 2.1.1 Age and Sex Composition.13 2.1.2 Household Composition .15 2.2 Education of the Household Population .16 2.3 Housing Characteristics .18 2.3.1 Drinking Water Access and Treatment .18 2.3.2 Drinking Water Storage Practices .20 2.3.3 Sanitation Facilities and Waste Disposal.21 2.3.4 Other Housing Characteristics.22 2.4 Household Possessions.23 2.5 Household Wealth.25 CHAPTER 3 BACKGROUND CHARACTERISTICS OF RESPONDENTS 3.1 Background Characteristics of the Ever-married Women Sample.27 3.1.1 Demographic and Socio-economic Characteristics.27 iv │ Contents 3.1.2 Educational Attainment.29 3.1.3 Literacy.30 3.1.4 Exposure to Mass Media .31 3.1.5 Employment Status .33 3.2 Women’s Participation in Household Decision-making .37 3.2.1 Disposal of Earnings .37 3.2.2 Women’s Roles in Household Decision-Making.41 3.3 Women’s Attitude toward Wife Beating .42 3.4 Background Characteristics of Respondents Eligible for Health Issues Interview.44 CHAPTER 4 FERTILITY 4.1 Current Fertility Levels by Residence .47 4.2 Fertility Differentials by Background Characteristics.49 4.3 Fertility Trends .50 4.3.1 Retrospective Data .50 4.3.2 Comparison with Previous Surveys.51 4.4 Children Ever Born and Living.52 4.5 Birth Intervals.54 4.5.1 Intervals between Births.54 4.5.2 Attitudes about the Ideal Birth Interval.56 4.6 Age at First Birth.56 4.7 Teenage Pregnancy and Motherhood.57 CHAPTER 5 KNOWLEDGE, ATTITUDES, AND EVER USE OF FAMILY PLANNING 5.1 Knowledge of Family Planning Methods .59 5.2 Exposure to Family Planning Messages .60 5.3 Knowledge of Fertile Period .62 5.4 Knowledge of Breastfeeding as a Family Planning Method.63 5.5 Ever Use of Family Planning .65 5.5.1 Levels of Ever Use.65 5.5.2 Trends in Ever Use.66 5.5.3 Differentials in Ever Use.67 5.6 First Use of Family Planning .68 5.7 Attitude about Timing of Adoption of Contraception.68 CHAPTER 6 CURRENT USE OF FAMILY PLANNING 6.1 Current Use of Family Planning .71 6.2 Differentials In Current Use Of Family Planning .71 6.2.1 Differentials by Residence.71 6.2.2 Differentials by Selected Background Characteristics.72 6.2.3 Differentials by Governorate .74 6.3 Trends in Current Use of Family Planning.75 6.3.1 Trends by Method .75 6.3.2 Trends by Urban-Rural Residence and Place of Residence.77 Contents | v 6.3.3 Trends by Governorate .78 6.4 Sources for Modern Family Planning Methods.79 6.4.1 Sources by Method.79 6.4.2 Sources by Method and Residence .80 6.4.3 Trends in Sources of Modern Methods .81 6.5 Pill Brands.82 6.6 Cost of Methods.83 6.6.1 Pill Users .83 6.6.2 Injectable Users .83 6.6.3 IUD Users.84 6.7 Participation in Family Planning Decisions.85 6.8 Informed Choice.86 CHAPTER 7 NONUSE OF FAMILY PLANNING AND INTENTION TO USE 7.1 Discontinuation Rates .89 7.2 Reasons for Discontinuation of Contraceptive Use .91 7.3 Intention to Use Contraception in the Future .92 7.4 Reasons for Nonuse .92 7.5 Preferred Method .93 7.6 Contact of Nonusers with Outreach Workers/Health Care Providers .93 CHAPTER 8 PROXIMATE DETERMINANTS OF FERTILITY 8.1 Marital Status .97 8.2 Consanguinity .98 8.3 Age at First Marriage .99 8.4 Postpartum Amenorrhea, Abstinence, and Insusceptibility. 101 8.5 Termination of Exposure to Pregnancy . 103 CHAPTER 9 FERTILITY PREFERENCES 9.1 Desire for More Children . 105 9.2 Need for Family Planning. 108 9.3 Ideal Number of Children . 110 9.4 Unplanned and Unwanted Fertility . 113 CHAPTER 10 INFANT AND CHILD MORTALITY 10.1 Assessment of Data Quality . 115 10.2 Levels and Trends in Early Childhood Mortality . 116 10.2.1 Levels of Mortality . 116 10.2.2 Trends in Mortality Based on Retrospective Data . 116 10.2.3 Trends in Mortality Based on Data from Multiple Surveys . 117 10.3 Differentials in Mortality. 118 10.3.1 Socioeconomic Differentials . 118 10.3.2 Demographic Differentials . 120 10.4 Perinatal Mortality. 121 vi │ Contents 10.5 High-Risk Fertility Behavior . 123 CHAPTER 11 MATERNAL HEALTH CARE AND OTHER WOMEN’S HEALTH ISSUES 11.1 Pregnancy Care. 125 11.1.1 Antenatal Care Coverage . 125 11.1.2 Tetanus Toxoid Vaccinations . 126 11.1.3 Any Medical Care During Pregnancy . 127 11.1.4 Differentials in Pregnancy Care Indicators . 127 11.2 Content of Pregnancy Care . 129 11.3 Delivery Care. 131 11.3.1 Place of Delivery . 131 11.3.2 Assistance at Delivery . 133 11.3.3 Caesarean Deliveries . 135 11.3.4 Birth Weight . 135 11.4 Trends in Antenatal and Delivery Care Indicators . 136 11.5 Postnatal Care. 138 11.5.1 Postnatal Checkup for the Mother . 138 11.5.2 Postnatal Checkup for the Baby . 140 11.6 Family Planning and Breastfeeding Advice. 143 11.7 Exposure to Safe Pregnancy Messages . 143 11.8 Sexually Transmitted Infections . 145 11.9 Women’s Access to Health Care . 147 CHAPTER 12 CHILD HEALTH 12.1 Immunization of Children . 149 12.1.1 Collection of Data . 149 12.1.2 Routine Immunization against Common Childhood Illnesses . 149 12.1.3 Trends and Differentials in Vaccination Coverage . 151 12.1.4 Participation in National Immunization Days . 153 12.2 Acute Respiratory Infection . 153 12.2.1 Prevalence of ARI . 153 12.2.2 Consultation, Treatment, and Feeding Practices. 154 12.2.3 Differentials in ARI Prevalence and Responses to the Illness . 155 12.3 Diarrhea . 157 12.3.1 Prevalence of Diarrhea . 157 12.3.2 Consultation, Treatment and Feeding Practices. 158 12.3.3 Differentials in Feeding and Treatment Practices. 159 12.4 Disposal of Children’s Stools . 162 CHAPTER 13 FEEDING PRACTICES AND MICRONUTRIENT SUPPLEMENTATION 13.1 Breastfeeding and Supplementation . 165 13.1.1 Initiation of Breastfeeding . 165 13.1.2 Introduction of Complementary Feeding . 167 13.1.3 Median Durations and Frequency of Breastfeeding and Prevalence of Bottle-feeding . 169 Contents | vii 13.2 Dietary Diversity among Children and Women . 171 13.2.1 Foods and Liquids Consumed by Infants and Young Children . 171 13.2.2 Appropriate Infant and Young Child Feeding . 172 13.2.3 Foods and Liquids Consumed by Women. 175 13.3 Micronutrient Supplementation . 176 13.3.1 Use of Iodized Salt. 177 13.3.2 Micronutrient Intake among Young Children . 178 13.3.3 Micronutrient Intake among Mothers. 180 CHAPTER 14 NUTRITIONAL STATUS 14.1 Nutritional Status of Children . 183 14.1.1 Measurement of Nutritional Status among Young Children . 183 14.1.2 Results of Data Collection . 184 14.1.3 Levels of Child Malnutrition . 184 14.1.4 Trends in Child Nutrition . 188 14.2 Nutritional Status of Never-married Youth and Young Adults. 188 14.2.1 Measurement of Nutritional Status among Youth and Young Adults . 189 14.2.2 Results of Data Collection . 189 14.2.3 Levels of Malnutrition among Never-married Youth and Young Adults . 189 14.3 Nutritional Status of Women and Men . 192 CHAPTER 15 FEMALE CIRCUMCISION 15.1 Prevalence of Female Circumcision among Women Age 15-49. 197 15.2 Women’s Circumcision Experience . 198 15.3 Prevalence of Female Circumcision among Young Girls. 199 15.4 Circumcision Experience of Young Girls . 201 15.5 Support for Female Circumcision among Women and Men . 202 15.6 Reasons for Support of Female Circumcision. 204 15.7 Exposure to Information about Circumcision . 207 CHAPTER 16 AVIAN INFLUENZA 16.1 Household Ownership of Poultry and Other Birds . 209 16.2 Locations Where Poultry Kept . 211 16.3 Awareness of Avian Influenza. 213 16.4 Awareness of Avian Influenza Symptoms in Poultry/Birds . 215 16.5 Awareness of Avian Influenza Risks and Symptoms Among Humans. 217 16.6 Awareness of Modes of Transmission and Prevention . 218 16.7 Attitudes towards Avian Influenza Risks . 221 CHAPTER 17 ADULT HEALTH ISSUES 17.1 Use of Tobacco. 223 17.2 History of Diabetes and Cardiovascular Disease . 227 17.3 High Blood Pressure. 228 viii │ Contents 17.4 Lifetime History of Medical Procedures and Injections . 235 17.5 Recent History of Injections . 237 17.6 Awareness of Safe Injection Practices . 239 CHAPTER 18 KNOWLEDGE AND PREVALENCE OF HEPATITIS C 18.1 Hepatitis C Knowledge. 241 18.2 Self-reported Prevalence of Hepatitis C and Liver Disease . 246 18.3 Hepatitis C Testing in the 2008 EDHS. 247 18.3.1 Heptatitis C Testing Protocol. 247 18.3.2 Coverage of the HCV Testing. 248 18.3.3 Return of the Results of the HCV Testing . 251 18.4 Prevalence of Hepatitis C . 251 CHAPTER 19 KNOWLEDGE AND ATTITUDES ABOUT HIV/AIDS 19.1 Knowledge of HIV/AIDS. 259 19.2 Knowledge of Mother-to-Child Transmission . 263 19.3 Accepting Attitudes towards People Living with AIDS. 265 19.4 Knowledge of a Source for HIV Testing . 268 19.5 Sources of Information about AIDS . 269 CHAPTER 20 HEALTH CARE EXPENSES AND HEALTH CARE COVERAGE 20.1 Expenses Associated with Health Provider Visits . 271 20.2 Expenses Associated with Hospital Stays. 274 20.3 Expenses Associated with Maternal Health Services. 276 20.4 Health Insurance Coverage . 278 REFERENCES . 281 APPENDIX A PERSONS INVOLVED IN THE 2008 EGYPT DEMOGRAPHIC AND HEALTH SURVEY . 285 APPENDIX B SAMPLE DESIGN . 291 APPENDIX C ESTIMATES OF SAMPLING ERRORS . 297 APPENDIX D DATA QUALITY TABLES .311 APPENDIX E NUTRITIONAL STATUS OF CHILDREN: 2008 EDHS DATA ACCORDING TO THE NCHS/CDC/WHO INTERNATIONAL REFERENCE POPULATION . 317 APPENDIX F QUESTIONNAIRES. 321 Tables and Figures | ix TABLES AND FIGURES Page CHAPTER 1 INTRODUCTION Table 1.1 Population of Egypt, 1990-2007 .1 Table 1.2 Life expectancy, Egypt .2 Table 1.3 Survey timetable, 2008 EDHS .4 Table 1.4 Sample results.11 Figure 1.1 Trend in Natural Increase Rates. Egypt 1991-2007.2 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS Table 2.1 Household population by age, sex, and residence.13 Table 2.2 Trends in population distribution by age, 1988-2008.15 Table 2.3 Household composition by residence .15 Table 2.4.1 Educational attainment of male household population by age and residence .17 Table 2.4.2 Educational attainment of female household population by age and residence .18 Table 2.5 Household drinking water access and treatment by residence.19 Table 2.6 Household drinking water storage practices by residence.20 Table 2.7 Sanitation facilities by residence.21 Table 2.8 Dwelling characteristics by residence .23 Table 2.9 Household possessions by residence .24 Table 2.10 Wealth quintiles by residence .26 Figure 2.1 Population Pyramid of Egypt .14 CHAPTER 3 BACKGROUND CHARACTERISTICS OF RESPONDENTS Table 3.1 Background characteristics of ever-married respondents .28 Table 3.2 Educational attainment by background characteristics .29 Table 3.3 Literacy by background characteristics .31 Table 3.4 Exposure to mass media by background characteristics .33 Table 3.5 Employment status by background characteristics .34 Table 3.6 Occupation by background characteristics .36 Table 3.7 Type of employment.37 Table 3.8 Relative magnitude of woman's earnings by background characteristics.38 Table 3.9 Control over woman's earnings .39 Table 3.10 Control over husband's earnings by background characteristics .40 Table 3.11 Relative magnitude of earnings and control over woman's and husband's earnings .41 Table 3.12 Women's participation in decision-making .41 Table 3.13 Women's participation in decision-making by background characteristics.42 Table 3.14 Attitudes towards wife beating by background characteristics .43 x | Tables and Figures Table 3.15 Selected background characteristics of respondents eligible for health issues interview.44 Table 3.16 Literacy status and recent exposure to mass media of respondents eligible for health issues interview .45 Table 3.17 Employment status, occupation, and type of earnings of respondents eligible for health issues interview .45 Figure 3.1 Percentage of Ever-Married Women Exposed to Media at Least Once Per Week.32 Figure 3.2 Occupation among Working Women .35 CHAPTER 4 FERTILITY Table 4.1 Current fertility by residence.47 Table 4.2 Fertility by background characteristics .49 Table 4.3 Trends in age-specific fertility rates.50 Table 4.4 Trends in fertility.51 Table 4.5 Trends in fertility by residence .52 Table 4.6 Children ever born and living.53 Table 4.7 Birth intervals by background characteristics .55 Table 4.8 Ideal birth interval by residence .56 Table 4.9 Age at first birth .57 Table 4.10 Median age at first birth by background characteristics.57 Table 4.11 Teenage pregnancy and motherhood by background characteristics .58 Figure 4.1 Total Fertility Rates by Place of Residence.49 CHAPTER 5 KNOWLEDGE, ATTITUDES, AND EVER USE OF FAMILY PLANNING Table 5.1 Family planning knowledge.59 Table 5.2 Exposure to family planning messages by background characteristics.61 Table 5.3 Knowledge of fertile period.63 Table 5.4 Belief breastfeeding reduces chances of pregnancy .63 Table 5.5 Beliefs concerning breastfeeding and a woman's protection from pregnancy .64 Table 5.6 Ever use of family planning methods by age .65 Table 5.7 Trends in ever use of family planning method .66 Table 5.8 Ever use of family planning methods by background characteristics.67 Table 5.9 Number of living children at time of first use of family planning .68 Table 5.10 Timing of use of family planning among newly married couples by background characteristics .69 Figure 5.1 Trends in Family Planning Knowledge, Egypt 2005-2008 .60 Figure 5.2 Trends in Exposure to Family Planning Messages Egypt 2005-2008 .62 Figure 5.3 Trends in Ever Use of Familly Planning, Egypt 1980-2008 .66 CHAPTER 6 CURRENT USE OF FAMILY PLANNING Table 6.1 Current use of family planning methods by residence .72 Tables and Figures | xi Table 6.2 Current use of family planning methods by selected demographic and social characteristics .73 Table 6.3 Current use of family planning by governorate .74 Table 6.4 Trends in current use of family planning.75 Table 6.5 Trends in family planning method mix .76 Table 6.6 Trends in family planning use by residence .77 Table 6.7 Trends in current use of family planning methods by governorate .78 Table 6.8 Source for modern family planning methods .80 Table 6.9 Sources of family planning methods by residence .81 Table 6.10 Trends in reliance on public sector source for contraceptive method by residence .82 Table 6.11 Brand of pill .82 Table 6.12 Knowledge of pill brand suitable for breastfeeding women.83 Table 6.13 Cost of method for pill users .84 Table 6.14 Cost of method for injectable users .84 Table 6.15 Cost of method for IUD users .85 Table 6.16 Family planning decision-making .86 Table 6.17 Informed choice .88 Figure 6.1 Current Use by Method .71 Figure 6.2 Trends in Current Use, Egypt 1980-2008 .76 CHAPTER 7 NONUSE OF FAMILY PLANNING AND INTENTION TO USE Table 7.1 Contraceptive discontinuation rates .90 Table 7.2 Reasons for discontinuation .91 Table 7.3 Future use of family planning .92 Table 7.4 Reason for not intending to use contraception .93 Table 7.5 Preferred family planning method.93 Table 7.6 Discussion of family planning in contacts with fieldworkers or health providers by background characteristics .94 CHAPTER 8 PROXIMATE DETERMINANTS OF FERTILITY Table 8.1 Current marital status .97 Table 8.2 Consanguinity by background characteristics.98 Table 8.3 Age at first marriage .99 Table 8.4 Median age at first marriage by background characteristics. 100 Table 8.5 Postpartum amenorrhea, abstinence and insusceptibility. 101 Table 8.6 Median duration of postpartum amenorrhea, abstinence, and insusceptibility by background characteristics. 103 Table 8.7 Menopause. 103 Figure 8.1 Percentage of Births Whose Mothers are Amenorrheic, Abstaining, or Insusceptible. 102 CHAPTER 9 FERTILITY PREFERENCES Table 9.1 Fertility preferences by number of living children . 105 xii | Tables and Figures Table 9.2 Fertility preferences by age . 106 Table 9.3 Desire to limit childbearing by background characteristics. 107 Table 9.4 Need for family planning by background characteristics . 109 Table 9.5 Reason for not using contraception . 110 Table 9.6 Ideal number of children . 111 Table 9.7 Mean ideal number of children by background characteristics . 112 Table 9.8 Husband's fertility preference by wife's ideal number of children. 112 Table 9.9 Fertility planning status. 113 Table 9.10 Wanted fertility rates by background characteristics . 114 Figure 9.1 Desire for More Children among Currently Married Women. 106 CHAPTER 10 INFANT AND CHILD MORTALITY Table 10.1 Early childhood mortality rates . 117 Table 10.2 Trends in early childhood mortality. 117 Table 10.3 Early childhood mortality rates by socioeconomic characteristics. 119 Table 10.4 Early childhood mortality rates by demographic characteristics. 121 Table 10.5 Perinatal mortality by background characteristics . 122 Table 10.6 High-risk fertility behavior . 124 Figure 10.1 Trends in Under-five Mortality, Egypt 1967-2006 . 118 Figure 10.2 Under-Five Mortality by Place of Residence . 120 CHAPTER 11 MATERNAL HEALTH CARE AND OTHER WOMEN’S HEALTH ISSUES Table 11.1 Antenatal care. 125 Table 11.2 Tetanus toxoid coverage during pregnancy . 126 Table 11.3 Last birth protected against neonatal tetanus . 127 Table 11.4 Medical care other antenatal care or tetanus toxoid injection during pregnancy. 127 Table 11.5 Care during pregnancy by background characteristics . 128 Table 11.6 Content of pregnancy care. 130 Table 11.7 Place of delivery and time spent in health facility following delivery by background characteristics . 132 Table 11.8 Reason for not delivering last birth in health facility. 133 Table 11.9 Assistance during delivery by background characteristics . 134 Table 11.10 Caesarean deliveries by background characteristics . 135 Table 11.11 Child's size at birth by background characteristics. 136 Table 11.12 Trends in maternal health indicators by residence. 137 Table 11.13 Postnatal care for mother . 139 Table 11.14 Postnatal care for mother by background characteristics. 140 Table 11.15 Postnatal care for child. 141 Table 11.16 Postnatal care for child by background characteristics . 142 Table 11.17 Exposure to family planning and breastfeeding information. 143 Table 11.18 Coverage of safe pregnancy messages by background characteristics . 144 Table 11.19 Self-reported prevalence of sexually-transmitted infections (STIs) and STI symptoms by background characteristics . 146 Table 11.20 Problems in accessing health care . 148 Tables and Figures | xiii Figure 11.1 Trends in Maternal Health Indicators, Egypt 1995-2008. 138 CHAPTER 12 CHILD HEALTH Table 12.1 Vaccinations by source of information. 150 Table 12.2 Vaccinations by background characteristics . 152 Table 12.3 Number of times vaccinated in national immunization day campaigns by residence . 153 Table 12.4 Prevalence of cough. 153 Table 12.5 Consultation about ARI episode . 154 Table 12.6 Treatment and feeding practices for children ill with ARI symptoms . 155 Table 12.7 Prevalence and treatment of ARI symptoms by background characteristics . 156 Table 12.8 Prevalence of diarrhea by background characteristics. 157 Table 12.9 Consultation about diarrheal episode. 158 Table 12.10 Treatment and feeding practices during diarrhea. 159 Table 12.11 Feeding practices during diarrhea . 160 Table 12.12 Consultation with provider and treatment of diarrhea by background characteristics . 162 Table 12.13 Disposal of children's stools. 163 CHAPTER 13 FEEDING PRACTICES AND MICRONUTRIENT SUPPLEMENTATION Table 13.1 Initial breastfeeding by background characteristics . 166 Table 13.2 Breastfeeding status by age . 168 Table 13.3 Median duration and frequency of breastfeeding and prevalence of bottlefeeding by background characteristics . 170 Table 13.4 Foods and liquids consumed by children in the day or night preceding the interview. 172 Table 13.5 Infant and young child feeding (IYCF) practices in Egypt. 174 Table 13.6 Foods and liquids consumed by mothers in the day or night preceding the interview by background characteristics . 176 Table 13.7 Presence of iodized salt in household by background characteristics . 177 Table 13.8 Micronutrient intake among children by background characteristics. 179 Table 13.9 Micronutrient intake among mothers by background characteristics . 181 Figure 13.1 Among Last Children Born in the Five Years Preceding the Survey Who Ever Received Prelacteal Feeds, Percentage Receiving Various Types of Liquids. 167 Figure 13.2 Infant Feeding Practices by Age. 168 Figure 13.3 Infant and Young Child Feeding (IYCF) Practices . 175 CHAPTER 14 NUTRITIONAL STATUS Table 14.1 Nutritional status of children by children's characteristics. 185 Table 14.2 Nutritional status of children by mother's characteristics . 187 Table 14.3.1 Nutritional status of never-married female youth and young adults by background characteristics . 190 Table 14.3.2 Nutritional status of never-married male youth and young adults by background characteristics . 191 xiv | Tables and Figures Table 14.4 Anthropometric indicators of nutritional status of adult women. 192 Table 14.5 Nutritional status of defacto adult women age 15-59 by background characteristics . 193 Table 14.6 Anthropometric indicators of nutritional status of defacto men 15-59 . 194 Table 14.7 Nutritional status of defacto adult men age 15-59 by background characteristics . 195 Figure 14.1 Nutritional Status of Children by Age . 186 Figure 14.2 Trend in Nutritional Status of Young Children (WHO Child Growth Standards), Egypt 2000-2008 . 188 CHAPTER 15 FEMALE CIRCUMCISION Table 15.1 Prevalence of female circumcision among all women 15-49 by background characteristics . 197 Table 15.2 Age at circumcision among all women age 15-49 by residence . 198 Table 15.3 Person performing circumcisions among all women by residence. 198 Table 15.4 Current and expected prevalence of female circumcision among young girls . 199 Table 15.5 Current and expected prevalence of female circumcision among girls by background characteristics . 200 Table 15.6 Age at circumcision among girls by residence. 201 Table 15.7 Person performing circumcisions among girls by residence. 201 Table 15.8.1 Attitude about continuation of female circumcision by background characteristics: All women age 15-49. 202 Table 15.8.2 Attitude about continuation of female circumcision by background characteristics: All men age 15-49. 203 Table 15.9.1 Beliefs about female circumcision by background characteristics: All women age 15-49. 205 Table 15.9.2 Beliefs about female circumcision by background characteristics: All men age 15-49 . 206 Table 15.10.1 Exposure to information regarding female circumcision by background characteristics: All women age 15-49. 207 Table 15.10.2 Exposure to information regarding female circumcision by background characteristics: All men age 15-49. 208 Figure 15.1 Trends in Attitudes toward Female Circumcision among Ever-married Women Age 15-49, Egypt 1995-2008. 204 CHAPTER 16 AVIAN INFLUENZA Table 16.1 Household possession of poultry/birds . 209 Table 16.2 Type of poultry/birds owned . 211 Table 16.3 Locations where poultry/birds kept . 212 Table 16.4 Use of cages or enclosures for poultry/birds. 213 Table 16.5 Awareness of avian influenza and recent sources of information about AI by background characteristics . 214 Table 16.6 Knowledge of avian influenza symptoms in poultry or birds by background characteristics . 215 Tables and Figures | xv Table 16.7 Awareness of risks and symptoms of avian influenza infection in humans by background characteristics . 217 Table 16.8 Knowledge of modes of transmission and prevention for avian influenza. 219 Table 16.9 Awareness of modes of transmission and prevention for avian influenza infection in humans by background characteristics. 220 Table 16.10 Attitudes about avian influenza . 221 Figure 16.1 Trend in Percentage of Households Owning Poultry by Place of Residence, 1988-2008. 210 Figure 16.2 Awareness of Symptoms of Avian Influenza in Poultry or Birds . 216 Figure 16.3 Awareness of Actions to Take When Birds Are Ill or Die Suddenly . 216 Figure 16.4 Awareness of Avian Influenza Symptoms in Humans. 218 CHAPTER 17 ADULT HEALTH ISSUES Table 17.1 Use of tobacco. 224 Table 17.2.1 Prevalence of smoking and exposure to information about health effects of second-hand smoke by background characteristics: Women. 225 Table 17.2.2 Prevalence of smoking and exposure to information about health effects of second-hand smoke by background characteristics: Men . 226 Table 17.3 History of diabetes, heart attack and stroke. 227 Table 17.4 History of hypertension and actions taken to lower blood pressure . 228 Table 17.5 Availability of final blood pressure measurement. 229 Table 17.6.1 Levels of hypertension by socioeconomic characteristics: Women . 231 Table 17.6.2 Levels of hypertension by socioeconomic characteristics: Men. 232 Table 17.7.1 Levels of hypertension by health status measures: Women. 233 Table 17.7.2 Levels of hypertension by health status measures: Men . 234 Table 17.8 Lifetime prevalence of medical procedures by background characteristics. 236 Table 17.9 Prevalence of injections during the six-month period prior to the survey . 237 Table 17.10 Injection prevalence by background characteristics . 238 Table 17.11.1 Exposure to information regarding injection safety by background characteristics: Women. 239 Table 17.11.2 Exposure to information regarding injection safety by background characteristics: Men . 240 Figure 17.1 Awareness of Hypertension and Treatment Status among Hypertensive Women and Men Age 15-59 . 235 CHAPTER 18 KNOWLEDGE AND PREVALENCE OF HEPATITIS C Table 18.1.1 Knowledge of hepatitis C by background characteristics: Women . 242 Table 18.1.2 Knowledge of hepatitis C by background characteristics: Men. 243 Table 18.2.1 Knowledge of the ways a person can contract hepatitis C by background characteristics: Women . 244 Table 18.2.2 Knowledge of the ways a person can contract hepatitis C by background characteristics: Men. 245 Table 18.3 Self-reported prevalence of hepatitis infection, symptoms of liver disease, and liver disease . 246 xvi | Tables and Figures Table 18.4 Coverage of hepatitis C testing among the de facto population age 15-59 years by age . 249 Table 18.5 Coverage of hepatitis C testing among the de facto population age 15-59 years by selected background characteristics . 250 Table 18.6 Outcome of testing for hepatitis C virus (HCV) among the population age 15-59 years by age . 252 Table 18.7 Outcome of testing for hepatitis C virus (HCV) among the population age 15-59 years by socioeconomic characteristics . 254 Table 18.8 Outcome of testing for hepatitis C virus (HCV) among the population age 15-59 years by lifetime history of medical procedures and injections . 256 Figure 18.1 Percentage of Women and Men Positive on the RNA Test for the Hepatitis C Virus by Age . 253 Figure 18.2 Percentage of Women and Men Age 15-59 Positive on HVC-RNA Test by Receipt of Injection to Treat Schistomiasis . 258 CHAPTER 19 KNOWLEDGE AND ATTITUDES ABOUT HIV/AIDS Table 19.1.1 Knowledge of AIDS by background characteristics: Women. 260 Table 19.1.2 Knowledge of AIDS by background characteristics: Men . 261 Table 19.2 Comprehensive knowledge of AIDS among youth by background characteristics . 262 Table 19.3.1 Knowledge of prevention of mother-to-child transmission (PMTCT) of HIV by background characteristics: Women. 264 Table 19.3.2 Knowledge of prevention of mother-to-child transmission (PMTCT) of HIV by background characteristics: Men . 265 Table 19.4.1 Accepting attitudes toward those living with HIV by background characteristics: Women. 266 Table 19.4.2 Accepting attitudes toward those living with HIV by background characteristics: Men . 267 Table 19.5 Knowledge of a place where HIV testing available by background characteristics . 268 Table 19.6.1 Sources of information about AIDS by background characteristics: Women . 269 Table 19.6.2 Sources of information about AIDS by background characteristics: Men. 270 Figure 19.1 Percentage of Youth and Young Adults with Comprehensive AIDS Knowledge by Sex and Urban-Rural Residence . 263 CHAPTER 20 HEALTH CARE EXPENSES AND HEALTH CARE COVERAGE Table 20.1 Visit to health provider recently . 272 Table 20.2 Expenses for last health care consultation. 273 Table 20.3 Total expenses incurred for last health care consultation by type of provider consulted. 274 Table 20.4 Hospital stays in past 12 months . 275 Table 20.5 Total expenses incurred relating to last hospitalization . 276 Table 20.6 Total expenses incurred relating to antenatal care services . 276 Table 20.7 Total expenses incurred relating to delivery services. 277 Table 20.8 Total expenses incurred relating to postnatal care services. 277 Tables and Figures | xvii Table 20.9 Health insurance coverage. 278 Figure 20.1 Percentage of Women and Men Age 15-59 Covered by Health Insurance, According to Place of Residence . 279 APPENDIX B SAMPLE DESIGN Table B.1 Sample allocation for the 2008 EDHS .293 Table B.2.1 Sample implementation for ever-married women component of the 2008 EDHS . 294 Table B.2.2 Sample implementation for health issues component of the 2008 EDHS. 295 APPENDIX C ESTIMATES OF SAMPLING ERRORS Table C.1 List of selected variables for sampling errors, Egypt 2008. 298 Table C.2 Sampling errors for National sample, Egypt 2008 . 299 Table C.3 Sampling errors for Urban sample, Egypt 2008. 300 Table C.4 Sampling errors for Rural sample, Egypt 2008 . 301 Table C.5 Sampling errors for Urban Governorates sample, Egypt 2008 . 302 Table C.6 Sampling errors for Lower Egypt sample, Egypt 2008. 303 Table C.7 Sampling errors for Lower Egypt, Urban sample, Egypt 2008. 304 Table C.8 Sampling errors for Lower Egypt, Rural sample, Egypt 2008 . 305 Table C.9 Sampling errors for Upper Egypt sample, Egypt 2008 . 306 Table C.10 Sampling errors for Upper Egypt, Urban sample, Egypt 2008 . 307 Table C.11 Sampling errors for Upper Egypt, Rural sample, Egypt 2008 . 308 Table C.12 Sampling errors for Frontier Governorates sample, Egypt 2008. 309 APPENDIX D DATA QUALITY TABLES Table D.1 Household age distribution . 311 Table D.2 Age distribution of eligible and interviewed women . 312 Table D.3 Completeness of reporting . 312 Table D.4 Reporting of age at death in days . 313 Table D.5 Reporting of age at death in months. 314 Table D.6 Births by calendar years . 315 APPENDIX E NUTRITIONAL STATUS OF CHILDREN: 2008 EDHS DATA ACCORDING TO THE NCHS/CDC/WHO INTERNATIONAL REFERENCE POPULATION Table E.1 Nutritional status of children by children's characteristics according to the NCHS/CDC/WHO International Reference Population . 317 Table E.2 Nutritional status of children by mother's characteristics according to the NCHS/CDC/WHO International Reference Population . 318 xviii | Tables and Figures Table E.3 Trends in nutritional status of children according to the NCHS/CDC/WHO International Reference Population . 319 Figure E.1 Trend in Nutritional Status of Young Children, Egypt 1992-2008 (NCHS/CDC/WHO Reference Population). 319 Preface | xix PREFACE Health for all is the main health objective of the Egyptian government. To monitor and evaluate progress toward the achievement of this goal, reliable data are needed. These data come from two primary sources: the health service delivery system (service-based data) and the community (household-based data). The two types of data complement each other in enhancing the information available to monitor progress in the health sector. Beginning in 1980, a number of household surveys have been carried out in Egypt to obtain data from the community on the current health situation, including a series of Demographic and Health Sur- veys of which the 2008 EDHS is the most recent. The results of the 2008 EDHS show that several key maternal and child health indicators including antenatal care coverage, medical assistance at delivery, and infant and child mortality have improved. The survey also found that family planning use is rising and fertility is continuing to decline although at a slow pace. In addition, the 2008 Egypt DHS collected information relating to other health issues that Egypt is facing including knowledge and practices relating to avian influenza and the prevalence of high blood pressure among the adult population. By collecting and testing blood samples for the hepatitis C virus from respondents, the survey also provides the first nation-wide data on the prevalence of infection with the hepatitis C virus among the Egyptian population age 15-59 years. The findings of the 2008 EDHS together with service-based data are very important for measur- ing the achievements of the health program to date as well as for planning future interventions to address Egypt’s health challenges. Based on the above-mentioned considerations, it is very important that the re- sults of the 2008 EDHS should be widely disseminated at different levels of health management, in the central offices as well as local governments, and to the community at large. Prof. Dr. Hatem El-Gabaly Minister of Health Acknowledgments | xxi ACKNOWLEDGMENTS The 2008 Egypt Demographic and Health Survey continues the long-standing commitment and efforts in Egypt to obtain data on fertility, contraceptive practice and maternal and child health. The focus on avian influenza, hepatitis C and adult health issues including hypertension reflects the need to obtain data to better address these challenges. Overall, the wealth of demographic and health data that the survey provides will help in charting future directions for the population and health programs. This important survey could not have been implemented without the active support and dedicated efforts of a large number of institutions and individuals. The support and approval of H.E. Prof. Dr. Hatem El-Gabaly was instrumental in securing the implementation of the EDHS. USAID/Cairo through its bilateral health and population projects was the main contributor of funding for the survey. UNICEF also provided financial support. Technical assistance came from the USAID-sponsored MEASURE DHS project. I am deeply grateful to the Ministry of Health (MOH) staff who contributed to the successful completion of this project, especially Dr.Nasr EL-Sayed, Minister Assistant of Primary Health Care, Pre- vention, and Family Planning, who provided strong continuing support to the project and has shown great interest in the survey results. Special thanks also go to Dr. Amr Kandil, Under Secretary of Preventive Affairs, for his continuous support during the survey implementation. I also gratefully acknowledge the Population and Health Office staff at USAID/Cairo, especially Ms. Holly Fluty Dempsey, Director of the Population and Health Office, and Ms. Shadia Attia, Research and Monitoring Advisor, Population and Health Office, for their support and valuable comments through- out the survey activities. I would like to thank the administrative staff at USAID and the American Em- bassy who helped to ensure that the equipment and supplies used for the hepatitis C component were available on time to start the fieldwork. I also acknowledge with gratitude Mr. Dennis Arends, Chief of Social Policy Monitoring and Evaluation, and Ms. Manar Soliman, Senior Program Assistant, UNICEF, for their support. The Hepatitis C testing was carried out at the Central Health Laboratory (MOH). I would like to thank Dr. Aly Abdelstar, Dr. Amal Naguib, and Dr. Ahmed Safwat at the Central Laboratory for their dedication in completing the testing in a very timely fashion. I would also like to thank Dr. Mohamed Aly Saber and Dr. Effat El-Sherbiny at the Theodor Bil- harz Research Institute (TBRI) for the support that TBRI provided during the quality assurance testing. Dr. Ann Way of Macro International, who worked closely with us on all phases of EDHS, de- serves special thanks for all her efforts throughout the survey. My thanks also are extended to Dr. Alfredo Aliaga for his advice and guidance in designing the sample. Ms. Jeanne Cushing deserves my deepest thanks for her assistance in data processing and tabulation required for this report. Ms. Jasbir Sangha pro- vided invaluable assistance with the hepatitis C testing component of the survey. Special thanks extend to the staff at the family planning sector/MOH for their financial and ad- ministrative support. xxii | Acknowledgments I would like to express my appreciation for all the senior, office, and field staff at El-Zanaty and Associates for the dedication and skill with which they performed their tasks. Finally, I would like to express my appreciation to all households and participants who responded in the survey; without their participation this survey would have been impossible. Fatma El-Zanaty Technical Director Summary of Findings | xxiii SUMMARY OF FINDINGS The 2008 Egypt Demographic and Health (2008 EDHS) Survey is the ninth in a series of Demographic and Health Surveys conducted in Egypt. The 2008 EDHS was undertaken to pro- vide estimates for key population indicators in- cluding fertility, contraceptive use, infant and child mortality, immunization levels, maternal and child health, and nutrition. To obtain this information, a nationally representative sample of 16,527 ever-married women age 15-49 was interviewed. The 2008 EDHS also collected information on a number of other health topics from 6,578 women and 5,430 men age 15-59 living in a subsample of one in four of the households sur- veyed. Among the key topics covered in these interviews were knowledge and awareness of avian influenza, HIV/AIDS and hepatitis C; pre- vious history of hypertension, cardiovascular illness diabetes and liver disease; attitudes and behavior with respect to female circumcision; health care costs; and health insurance coverage. In addition to the interview results, blood pressure measurements and blood samples for hepatitis C testing were obtained from women and men age 15-59 interviewed in the special health issues component of the survey. Height and weight measures were collected for children under age six and never-married youths and young adults age 10-19 years in all households in the survey. In the subsample of households selected for the health issues survey, these measurements were also obtained for all women and men age 20-59 while in the remaining households in the sample, measurements were recorded only for ever-married women age 20-49. FERTILITY BEHAVIOR Levels, Trends and Differentials. The fer- tility rate in the 2008 EDHS was 3.0 births per woman, only very slightly lower than the rate observed in the 2005 EDHS (3.1 births per woman). In rural areas, the fertility rate is 3.2 births, around 20 percent higher than the rate in urban areas (2.7 births). Fertility levels are highest in Upper Egypt (3.4 births) and in the Frontier Governorates (3.3 births) and lowest in the Urban Governorates (2.6 births). Education is strongly associated with lower fertility as is wealth. The fertility rate decreases from a level of 3.4 births among women in the lowest wealth quintile to 2.7 births among women in the highest quintile. Age at Marriage. One of the factors influencing the on-going fertility decline in Egypt has been the steady increase in the age at which women marry. Currently, the median age at first marriage among women age 25-29 is 21.2 years. One of the most important effects of the increase in the age at first marriage has been a reduction in adolescent fertility. Adolescent childbearing carries higher risks of morbidity and mortality for the mother and child, particularly when the mother is under age 18. At the time of the 2008 EDHS, 10 per- cent of women age 15-19 had given birth or were pregnant with their first child. FAMILY PLANNING USE Family Planning Knowledge and Attitudes. Widespread awareness of family planning methods has been a crucial element in the successful expan- sion of family planning use in Egypt. The 2008 EDHS found that all currently married women age 15-49 knew about at least one family planning method, and the average woman was aware of at least 6 methods. Coverage of family planning IEC efforts is widespread. However, only 67 percent of married women had heard or seen a family planning message during the six months prior to the 2008 EDHS, which is substantially lower than the level of exposure to family planning messages reported in 2005 EDHS (91 percent). xxiv | Summary of Findings Family planning has broad support among Egyptian couples. Most ever-married women age 15-49 (93 percent) consider it appropriate for a couple to begin family planning use after they have their first child. However, very few women who approve of family planning use (2 percent) think that it is appropriate for a newly married couple to use contraception to delay the first pregnancy. Levels and Trends. The Egyptian govern- ment’s commitment to providing widely acces- sible family planning services has been a very important factor in the on-going fertility decline. Contraceptive use levels more than doubled in Egypt between 1980 and 2003, from 24 percent to 60 percent. The 2008 EDHS results indicate that the contraceptive use remains stable at 60 percent. The IUD continues to be by far the most widely used method; 36 percent of married women were relying on the IUD, 12 percent on the pill, and 7 percent on injectables. Differentials in Use. As expected, given the nearly universal disapproval of family planning use before the first birth, less than 1 percent of currently married women who had not yet had a child were using at the time of 2008 EDHS. Use rates increased rapidly with family size; 46 per- cent of women with one child were using and use rates peaked at 76 percent among women with 3 children. Use rates exceeded 60 percent in the Urban Governorates, in both urban and rural areas in Lower Egypt, and in urban areas in Upper Egypt. In contrast, 48 percent of currently mar- ried women were using in rural Upper Egypt and 52 percent in the Frontier Governorates. Use rates rose from 55 percent of women in the low- est wealth quintile to 65 percent among women in the highest quintile. Discontinuation of Use. A key concern for the family planning program is the rate at which users discontinue use of contraception and their reasons for stopping. Overall, 26 percent of us- ers during the five-year prior to the 2008 EDHS discontinued using a method within 12 months of starting use. The rate of discontinuation during the first year of use was much higher among pill us- ers (40 percent) and injectable users (37 percent) than among IUD users (12 percent). With regard to the reasons for stopping use, users were more likely to discontinue during the first year of use because they experienced side effects or had health concerns. This pattern is similar to that observed in 2005. Overall, 8 percent of users who discontinued during the first 12 months of use switched to another method within two months of the time they discon- tinued. Provision of Services. Both government health facilities and private sector providers play an impor- tant role in the delivery of family planning services. The 2008 EDHS showed that 60 percent all users of modern methods went to Ministry of Health or other governmental providers for their method. This repre- sents a slight increase from the situation in 2005, when 57 percent of users relied on public sector fa- cilities for their methods. Public sector providers were the principal source for the IUD and injectables at the time of the 2008 EDHS while seven in ten pill users obtained their method from a pharmacy. The 2008 EDHS results suggest that family planning providers are not always offering women the information necessary to make an informed choice about the method best suited to their contra- ceptive needs. In particular, around one in three us- ers of modern methods were not provided informa- tion about methods other than the one they adopt. Although side effects caused many users to discon- tinue, providers also were counselling only slightly more than half (56 percent) of the users about poten- tial side effects. NEED FOR FAMILY PLANNING Fertility Preferences. Many Egyptian women are having more births than they consider ideal. Overall, 5 percent of births in the five years prior to the survey were reported to be mistimed, that is, wanted later, and 9 percent were unwanted. If Egyp- tian women were to have the number of children they consider ideal, the total fertility rate would fall from 3.0 births to 2.4 births per woman. Unmet Need for Family Planning. Taking into account both their fertility desire at the time of the Summary of Findings | xxv survey and their exposure to the risk of preg- nancy, 9 percent of currently married women were considered to have an immediate need for family planning. Unmet need is greatest among women in rural Upper Egypt, where 15 percent of women are in need of family planning to achieve their childbearing goals. INFANT AND CHILD MORTALITY Levels and Trends. At the mortality level prevailing in the five-year period before the 2008 EDHS, one in 36 Egyptian children will die before their fifth birthday, with more than 80 percent of deaths occurring during a child’s first birthday. The level of early childhood mortality has fallen substantially since the mid-1960s, when around one in four children died before reaching age five. Socioeconomic Differentials. Mortality is higher in rural than urban areas. The highest level is found in Upper Egypt and the lowest in Lower Egypt. Differentials are especially large across wealth quintiles; children born to women in the lowest wealth quintile are around two and one half times more likely to die by their fifth birthday than children born to mothers in the highest quintile. Demographic Differentials. Mortality risks are especially high for births that occur within too short a period after a prior birth. The under- five mortality rate among children born less than two years after a previous birth was 70 deaths per 1,000 births, more than three times the level among children born four or more years after a previous birth. During the five years prior to the 2008 EDHS, 18 percent of non-first births occurred within 24 months of a previous birth. Breast- feeding practices, especially the early introduc- tion of supplemental foods, reduce the time a woman is amenorrheic following a birth and, thus, contribute to short birth intervals. Half of Egyptian mothers become exposed to the risk of another pregnancy within four months of giving birth. MATERNAL HEALTH Care during Pregnancy. The care that a woman receives during pregnancy reduces the risks of illness and death for both the mother and the child. Overall, women saw a medical provider for at least some type of care during pregnancy in the case of 94 percent of all last births that occurred during the five-year period prior to the 2008 EDHS. Women reported that they had antenatal care, i.e., care sought specifically to monitor the pregnancy, in the case of 74 percent of births. They saw a provider for the recommended minimum number of antenatal care visits (four) in the case of 66 percent of births. Tetanus toxoid injections are given during preg- nancy for the prevention of neonatal tetanus, an im- portant cause of death among newborns. Around 76 percent of last-born children during the five-year period prior to the 2008 EDHS were fully protected against neonatal tetanus. Content of Pregnancy Care. Women reported that they had been weighed and their blood pressure monitored during pregnancy in the case of more than eight in ten births in which a medical provider was seen for pregnancy care. Urine and blood samples were taken from the mother during antenatal care visits for almost seven in ten births. Mothers were less likely to have been given advice about potential pregnancy complications; they reported being told about the signs of pregnancy complications in about one-third of the births and about where to seek assis- tance if they experienced problems in the case of 31 percent of the births. Delivery Care. Trained medical personnel as- sisted at 79 percent of births during the five-year period prior to the 2008 EDHS. Dayas (traditional birth attendants) assisted with most of the remaining deliveries. 72 percent of deliveries took place in a health facility, with delivery care provided some- what more often at private than governmental facili- ties. Almost three in ten deliveries were by Caesar- ean section. Postnatal Care. Care following delivery is very important for both the mother and her child, espe- cially if the birth occurs in the home without medical assistance. In Egypt, mothers reported they were seen for postnatal care following 67 percent of all xxvi | Summary of Findings deliveries but in only 7 percent of deliveries that were not assisted by a medical provider. Thirty percent of infants born during the five-year pe- riod prior to the EDHS were seen for postnatal care. However, a recent campaign to encourage mothers to have a blood sample taken from the child’s heel for screening within two weeks fol- lowing delivery has been effective; 90 percent of last-born children had a blood sample taken from the heel within two weeks following deliv- ery. Differentials in Coverage. A woman’s resi- dence and education status are strongly associ- ated with the receipt of maternity care. For ex- ample, the percentage of births in which the mother received regular antenatal care was 57 percent among rural births compared to 80 per- cent among urban births. Coverage of maternity care services is especially low in rural Upper Egypt, where regular antenatal care was received for 49 percent of births and 59 percent of deliv- eries were medically assisted. Regular antenatal care was received for just over 40 percent of births to women in the lowest wealth quintile compared to nearly 90 percent of births to women in the highest quintile. The proportion of births assisted by a medical provider rose stead- ily with the wealth quintile from 55 percent in the lowest quintile to 97 percent in the highest quintile. Trends in Coverage. Coverage of mater- nity care services has improved markedly in Egypt. Coverage of antenatal care services grew from 39 percent in 1995 to 74 percent in 2008. Medically assisted deliveries also increased over the period, from a level of 46 percent in 1995 to 79 percent in 2008. Of some concern is the four- fold increase in Caesarean deliveries, from 7 percent in 1995 to 28 in 2008. CHILD HEALTH Childhood Vaccination Coverage. One of the primary means for improving survival during childhood is increasing the proportion of chil- dren vaccinated against the major preventable diseases. The 2008 EDHS found that that 92 percent of children 12-23 months were fully immunized against the six major preventable childhood illnesses (tuberculosis, diphtheria, whoop- ing cough, tetanus, polio and measles). In addition, 96 percent of young children also had the recom- mended three doses of the hepatitis vaccine. Prevalence and Treatment of Childhood Ill- nesses. The 2008 EDHS provided data on the preva- lence and treatment of two common childhood ill- nesses, diarrhea and acute respiratory illness. Nine percent of children under five were reported to have had diarrhea in the two weeks preceding the survey. Medical advice was sought in treating somewhat more than half (56 percent) of these cases. Use of ORS packets (28 percent) or a homemade solution of sugar, salt and water (3 percent) to combat the dehy- dration was common. Altogether 38 percent of chil- dren ill with diarrhea were treated with some form of ORT or increased fluids. A child was considered to have symptoms of an acute respiratory infection if he/she had a cough ac- companied by short, rapid breathing that the mother described as related to a chest problem. During the two weeks preceding the survey, 8 percent of chil- dren had ARI symptoms. A provider was consulted about the illness in the case of 79 percent of children with these symptoms, and mothers reported that an- tibiotics were given to 58 percent of the children. NUTRITION INDICATORS FOR CHILDREN AND WOMEN Infant Feeding Practices. Breastfeeding is nearly universal in Egypt, and the average length of time that a child is breastfed is relatively long (17.9 months). However, breastfeeding practices for very young children are not optimal. According to the 2008 EDHS results, 47 percent of infants received prelacteal feeds (i.e., they are given some type of liquid until the mother’s breast milk flows freely). Exclusive breastfeeding (i.e., without any food or liquid) is recommended during the first six months of life because it provides all the necessary nutrients and avoids exposure to disease agents. However, in Egypt, only a minority of babies are exclusively breastfed throughout the first 6 months of life. By age 4-5 months, around seven in ten ba- bies born during the five-year period before the EDHS were receiving some form of supplementa- Summary of Findings | xxvii tion, with somewhat more than three in ten given complementary foods. Appropriate infant and young child feeding (IYCF) practices include timely initiation of feeding solid/semi-solid foods from age six months and increasing the amount of foods and frequency of feeding as the child gets older while maintaining frequent breastfeeding. Feed- ing practices for only around 40 percent of chil- dren age 6-23 months met the minimum stan- dard with respect to all three of these feeding practices. Nutritional Status of Children. Using growth standards generated by WHO from data collected in a Multicentre Growth Reference Study, the 2008 EDHS found that 29 percent of Egyptian children age 0-4 years showed evi- dence of chronic malnutrition or stunting, and 7 percent are acutely malnourished. A comparison of the results with the 2005 EDHS suggested that children’s nutritional status deteriorated dur- ing the period between the two surveys. For ex- ample, the stunting level increased by 26 percent between the surveys. Nutritional Status of Youth and Young Adults. Five percent of never-married males age 10-19 and six percent of never-married females age 10-19 in Egypt were classified as over- weight, i.e., their BMI values at or above the 95th percentile on age and sex-specific BMI growth charts. The BMI values for an additional 15 percent of males and 19 percent of females fell between the 85th and 95th percentiles, indi- cating that they were at risk of becoming over- weight. At the other end of the scale, 5 percent of males and 3 percent of females were consid- ered to be underweight, i.e., their BMI values fall below the 5th percentile on the growth charts. Nutritional Status of Women and Men Age 15-59. One indicator of the nutritional status of adults is the body mass index. Exclud- ing those who were pregnant or less than two months postpartum, the mean BMI of all women age 15-59 was 28.9. The majority of women had a BMI of 25.0 or higher and are considered overweight (28 percent) or obese (40 percent). Two percent of women had a BMI below 18.5, the level indicating chronic energy deficiency. The mean BMI among men age 15-59 was 25.8, which was below that observed for nonpregnant women. The majority of men had a BMI of 25.0 or higher and were considered overweight (34 percent) or obese (18 percent). Three percent of men had a BMI below 18.5. Vitamin A Supplementation. Vitamin A is a micronutrient found in very small quantities in some foods. It is considered essential for normal sight, growth, and development. Information collected in the survey on the diet of young children and their mothers indicates that 36 percent of children under age 3 and slightly more than half of their mothers are consuming foods rich in vitamin A on a daily basis. Egypt has a program of vitamin A supplementa- tion for new mothers and for babies. Mothers re- ported receiving a vitamin A capsule postpartum in the case of nearly 57 percent of all births in the five- year period before the survey. Around 12 percent of children age 6-59 months had received a vitamin A capsule. Iodization of Salt. Iodine is another important micronutrient. Egypt has adopted a program of forti- fying salt with iodine to prevent iodine deficiency. Overall, 79 percent of households were found to be using salt containing some iodine. FEMALE CIRCUMCISION Level and Trends. Female circumcision (also referred to as female genital cutting) has been a tra- dition in Egypt since the Pharonic period. The 2008 EDHS obtained information from all women inter- viewed in the survey on their circumcision status and from ever-married women on the circumcision status of their daughters age 17 and younger. Overall, 91 percent of all women age 15-49 have been circum- cised. However, there is evidence that the practice may be declining. For example, while exceeding 80 percent, female circumcision rates among women under age 25 are lower than rates in the 25-49 age groups, where 94-96 percent of women have been circumcised. The likelihood that a woman is circum- cised also declines with the woman’s education level and is markedly lower among women in the highest xxviii | Summary of Findings wealth quintile than in other quintiles (78 per- cent versus 92 percent or higher). The data collected on daughter’s circumci- sion status also indicates that the practice will continue to decline over the next 15-20 years, from the current level of around 80 percent among girls approaching their 18th birthday to around 45 percent. Attitudes and Beliefs. Attitudes about cir- cumcision also appear to be changing. The pro- portion of ever-married women age 15-49 women who believe that circumcision should continue has dropped from 82 percent in 1995 to 63 percent at the time of the 2008 EDHS. KNOWLEDGE AND PREVALENCE OF HEPATITIS C Awareness of hepatitis C and modes of transmission. Eighty percent of women and 85 percent of men age 15-59 were aware of hepati- tis C. Men were somewhat more knowledgeable than women about modes in which hepatitis C virus can be transmitted. Seventy-nine percent of men knowing about hepatitis C were able to name at least one way in which the virus can be transmitted compared to 70 percent of women. Prevalence of hepatitis C infection. In ad- dition to responding to questions about hepatitis C, women and men age 15-59 years living in the subsample of households selected for the health issues survey were asked to provide blood sam- ples for testing for the hepatitis C virus. Overall, 15 percent of women and men age 15-59 had antibodies to the HCV virus in their blood, indi- cating that they had been exposed to the virus at some point. Ten percent were found to have an active infection. Men (12 percent) were more likely to be in- fected than women (8 percent) and, the levels of infection increased sharply with age among both women and men. In the 55-59 year age group, 30 percent of men and 24 percent of women showed evidence of active infection. HCV infec- tion was higher among rural than urban residents (12 percent compared with 7 percent). Active infection rates were particularly high among individuals who reported receipt of at least one injection to treat schistosomiasis (20 percent) compared to those who had not received such an injection (9 percent). These results support the as- sumption that improper infection control procedures during schistosomiasis treatment campaigns played an important role in the spread of hepatitis C infec- tion in Egypt. HIGH BLOOD PRESSURE Blood pressure measurements were taken at three points during the special health issues inter- views with women and men age 15-59. The results of these measurements were combined with informa- tion obtained from respondents on whether they were taking medication to lower blood pressure to assess the level of hypertension among the EDHS respondents. Overall, 13 percent of women and 11 percent of men were considered to be hypertensive. Hypertension levels for both women and men in- creased steadily with age. For example, women age 55-59 were more than three times as likely as women age 35-39 to be hypertensive (46 percent and 13 percent, respectively). As expected, nutritional status also was strongly related to the rate of hypertension for both women and men. Women classified as obese were around four times as likely (21 percent) as women with BMI within the normal range (5 percent) to be hyperten- sive, while women classified as overweight were twice as likely (11 percent and 5 percent, respec- tively). Among men, 18 percent of those who were obese and 13 percent of those who were overweight were hypertensive compared to only 6 percent of men whose BMI fell within the normal range. AVIAN INFLUENZA Household ownership of poultry and birds. The 2008 EDHS found that around one in six house- holds owned or kept poultry. This is about half the level reported in the 1988 Egypt DHS (33 percent). To reduce the potential for transmission of the avian influenza virus from birds to humans, it is recom- mended that poultry or birds be located away from the household living area; however, around one in Summary of Findings | xxix five households were keeping poultry or birds within the family living area. Awareness of modes of transmission and prevention of avian influenza. Virtually all women and men age 15-59 (99 percent) had heard about avian influenza. Seven in 10 re- spondents who had heard of avian influenza were knowledgeable about the symptoms of the disease to watch for in poultry or birds. With regard to symptoms of avian influenza in hu- mans, around six in ten respondents who had heard of avian influenza were able to name at least one symptom of avian influenza in humans. Most respondents who were aware that humans could contract the avian influenza virus were able to name at least one way in which a person might contract the virus and at least one way in which the risk of infection might be reduced. However, only 8 percent were able to name at least four ways in which the virus might be transmitted to a person and only 21 percent were able to name four ways to limit the chance of infection. OTHER HEALTH ISSUES Awareness of HIV/AIDS. Seventy-three percent of women and 87 percent of men age 15-59 have heard about HIV/AIDS. Although many women and men had a basic knowledge of AIDS, the proportions aware of ways in which the risk of infection can be reduced were gener- ally low. Overall, only 7 percent of women and 18 percent of men were classified as having comprehensive correct knowledge about AIDS. Injection safety. Failure to follow safe injection practices increases the risk of transmission of blood- borne pathogens. The EDHS collected information from all respondents to assess the coverage of recent IEC efforts designed to increase population aware- ness about safe injection practices. Twenty-seven percent of women and 19 percent of men age 15-59 reported that they had received information about what people should do to be sure that injections are given safely in the six months prior to the survey. The EDHS also collected information on the prevalence of injections and on the degree of com- pliance with injection safety procedures. Sixteen percent of respondents had had at least one injection during the six-month period prior to the survey. Among those who had had an injection, 70 percent had received at least one medical injection, i.e., an injection administered by a doctor, nurse, pharmacist or other health care provider. Eighty-four percent of those respondents who had had a medical injection said that the medical provider had taken the syringe and needle from a new unopened package. Smoking. Less than 1 percent of women age 15-59 themselves currently smoke or use any form of tobacco compared to 44 percent of men in the same age group. Thirty-nine percent of women and 37 percent of men had received information about the adverse health effects of second-hand smoke in the six-month period prior to the 2008 EDHS. Health insurance coverage. Slightly more than one in four respondents age 15-59 years (28 percent) had health insurance. Around six in ten respondents who were insured had coverage from the General Health Insurance Authority, 27 percent had coverage through their own or another family member’s em- ployer, 10 percent (primarily among those under age 25) had insurance through a university, and 4 per- cent through a syndicate. xxx | Map of Egypt Introduction | 1 INTRODUCTION 1 1.1 GEOGRAPHY Egypt is located in the northeast corner of the African continent. It is bordered by Libya to the west, Sudan to the south, the Red Sea to the east, and the Mediterranean Sea to the north. Egypt has the largest, most densely settled population among the Arab countries. The total area of the country covers approximately one million square kilometres. However, much of the land is desert, and only 6 percent of Egypt’s area is inhabited. Recently, the Egyptian government adopted a policy of land reclamation and fostering of new settlements in the desert. Despite these efforts, the majority of Egyptians live either in the Nile Delta located in the north of the country or in the narrow Nile Valley south of Cairo. At the time the fieldwork for the 2008 Egypt Demographic and Health Survey began (EDHS), Egypt was administratively divided into 26 governorates (see map) and Luxor City.1 The four Urban Governorates (Cairo, Alexandria, Port Said, and Suez) have no rural population. Each of the other 22 governorates is subdivided into urban and rural areas. Nine of these governorates are located in the Nile Delta (Lower Egypt), eight are located in the Nile Valley (Upper Egypt), and the remaining five Frontier Governorates are located on the eastern and western boundaries of Egypt. 1.2 POPULATION SIZE AND STRUCTURE The latest population census in Egypt was carried out in November 2006. According to the results, Egypt has a de facto population of 72.2 million. This number excludes the roughly 3.9 million Egyptians who are living abroad. By the beginning of 2008, it is estimated that population had increased by around one and half million to reach 74.3 million (CAPMAS 2008). Table 1.1 presents the trend between 1990 and 2007 in the size of Egypt’s population and in the distribution of the population by urban-rural residence. The table shows that the total Egypt’s population increased during this period by more than 40 percent. Despite the sizeable population expansion, the percentage of the Egyptian population living in areas classified as urban remained virtually unchanged during the period. 1.3 RECENT RATE OF NATURAL INCREASE The rate of natural increase represents the differ- ence between the level of births and deaths in a population. It indicates how fast a population will grow, taking into 1In May 2008, two new governorates were created: 6th of October and Helwan. These governorates were created from Cairo and Giza governorates. Table 1.1 Population of Egypt, 1990-2007 Total population in Egypt and the percentage living in urban and rural areas, 1990-2007 Place of residence Years Total population (millions)1 Urban Rural 1990 51,911 43.4 56.6 1991 52,985 43.2 56.8 1992 54,082 43.2 56.8 1993 55,201 43.1 56.9 1994 56,344 43.1 56.9 1995 57,642 42.9 57.1 1996 58,835 42.6 57.4 1997 60,053 42.6 57.4 1998 61,296 42.6 57.4 1999 62,565 42.5 57.5 2000 63.860 42.5 57.5 2001 65,182 43.1 56.9 2002 66,531 42.9 57.1 2003 67,908 42.9 57.1 2004 69,313 42.8 57.2 2005 70,748 42.7 57.3 2006 72,212 42.5 57.5 2007 73,608 43.1 56.9 1 Figures exclude Egyptians living abroad Source: CAPMAS 2008, Table 2.2 2 | Introduction account these two natural events. Figure 1.1 shows that the rate of natural increase has been declining in Egypt since 1991.2 Most of the decline in the rate of natural increase has been the result of changes in fertility behaviour. The crude birth rate (CBR) dropped from a level of 39 per thousand population in 1986 (not shown) to 28 per thousand by 1994. As Figure 1.1 shows, the decline levelled off in the mid-1990s, with the CBR fluctuating around a level of 27 births per thousand until the end of the decade. At that point, the CBR resumed declining although slowly reaching a level of 25.7 in 2006 and then rising slightly to 26.6 in 2007. The crude death rate (CDR), already at a comparably low level in 1990, also declined further in the period although the pace of decline was slow and erratic with a level of 6.1 in 2007. The declines in mortality Egypt has experienced have had a demonstrable effect on increasing the life expectancy at birth of the Egyptian population. Life expectancy at birth represents the average number of years a child born in a specific year may be expected to live during his/her lifetime. As Table 1.2 shows, life expectancy increased by 20.2 years for females and 17.9 years for males between 1960 and 2007. 2 A third factor influencing population growth is migration, which is not taken into account in Figure 1.1. Table 1.2 Life expectancy, Egypt Life expectancy at birth by sex, Egypt 1960-2007 Year Male Female 1960 51.6 53.8 1976 52.7 57.7 1986 60.5 63.5 1991 62.8 66.4 1996 65.1 69.0 1999 66.3 70.5 2001 67.1 71.5 2002 67.5 71.9 2003 67.9 72.3 2004 68.4 72.8 2005 68.8 73.5 2006 69.2 73.6 2007 69.5 74.0 Source: CAPMAS, 2008, Table 3.7 Figure 1.1 Trend in Natural Increase Rates Egypt 1991-2007 ) )) ) ) ) ) ) ) ) ) ) ) ) ) ) ) 7.2 6.9 6.7 6.6 6.7 6.5 6.5 6.5 6.4 6.3 6.2 6.4 6.1 6.4 6.4 6.3 6.1 + ++ + + + + + + + + + + + + + + 30 26.9 28.1 27.7 27.9 28.3 27.5 27.5 27 27.4 26.7 26.5 26.2 25.7 25.5 25.7 26.6 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Year 0 5 10 15 20 25 30 35 Percentage Crude birth rate Crude death rate+ ) Source: CAPMAS 2008 Note: Rates are per thousand population. Introduction | 3 1.4 2008 EGYPT DEMOGRAPHIC AND HEALTH SURVEY 1.4.1 Organization and Objectives The Egypt Demographic and Health Survey (2008 EDHS) is the latest in a series of a nationally representative population and health surveys conducted in Egypt.3 The 2008 EDHS was conducted under the auspices of the Ministry of Health (MOH) and implemented by El-Zanaty & Associates. Technical support for the 2008 EDHS was provided by Macro International through the MEASURE DHS project. MEASURE DHS is sponsored by the U.S. Agency for International Development (USAID) to assist countries worldwide in conducting surveys to obtain information on key population and health indicators. USAID/Cairo was the main financial contributor to the survey. The United Nations Children’s Fund (UNICEF) also supported the survey financially. The 2008 EDHS was undertaken to provide estimates for key population indicators including fertility, contraceptive use, infant and child mortality, immunization levels, coverage of antenatal and delivery care, maternal and child health, and nutrition. In addition, the survey was designed to provide information on a number of health topics and on the prevalence of hepatitis C and high blood pressure among the population age 15-59 years. The survey results are intended to assist policymakers and planners in assessing the current health and population programs and in designing new strategies for improving reproductive health and health services in Egypt. 1.4.2 Timetable The 2008 EDHS was executed in four stages. The first stage involved preparatory activities, including designing the sample and updating the frame. At the same time, the survey questionnaires were developed, pretested, and finalized. The preparatory stage was initiated in August 2007, and all of the activities were completed by end of January 2008. The second stage, which took place from February through June 2008, involved training of field staff and interviewing eligible households and individual respondents. The third stage encompassed all of the data processing activities necessary to produce a clean data file, including editing, coding, entering and verifying the data as well as checking it for consistency. This stage started soon after the beginning of the fieldwork and lasted until early August 2008. The focus of the final stage of the survey was analyzing the data and preparing the report. This phase began in October 2008 with the publication of the preliminary report, which presented the main findings from the survey. The activities involved in each of the stages are described in more detail below. The survey timetable is presented in Table 1.3. 3 The 2008 EDHS is the sixth full-scale Demographic and Health Survey to be implemented in Egypt; the earlier surveys were conducted in 1988, 1992, 1995, 2000, and 2005. Three additional interim DHS surveys were carried out in 1997 and 1998 and 2003. Other national-level surveys for which results are shown in this report include the 1980 Egyptian Fertility Survey (EFS), the 1984 Egypt Contraceptive Prevalence Survey (ECPS), and the 1991 Egypt Maternal and Child Health Survey (EMCHS). 4 | Introduction Table 1.3 Survey timetable, 2008 Egypt DHS Activity Starting date Duration Updating the sample frame August 2007 1 month Mapping September 2007 7 weeks Quick-count operation October 2007 3 months Recruitment and training of listing staff January 2008 1 week Listing and re-listing January 2008 5 weeks Sample selection February 2008 4 weeks Questionnaire design November 2007 2 months Preparation of training materials January 2008 6 weeks Pretest January 2008 3 weeks Finalization of questionnaires January 2008 2 month Training of data collection staff February 2008 5 weeks Printing survey materials March 2008 2 weeks Fieldwork March 2008 10 weeks Reinterviews May 2008 1 month Office editing and coding March 2008 3 months Data entry April 2008 3 months Computer editing April 2008 3 months Preliminary report September 2008 1 month Detailed tabulations October 2008 2 months Final report preparation October 2008 6 months 1.4.3 Sample Design The primary objective of the sample design for the 2008 EDHS was to provide estimates of key population and health indicators including fertility and child mortality rates for the country as a whole and for six major administrative regions ( Urban Governorates, urban Lower Egypt, rural Lower Egypt, urban Upper Egypt, rural Upper Egypt, and the Frontier Governorates). In the Urban Governorates, Lower Egypt, and Upper Egypt, the 2008 EDHS design allowed for governorate-level estimates of most of the key variables, with the exception of the fertility and mortality rates. In the Frontier Governorates, the sample size was not sufficiently large to provide separate estimates for the individual governorates. To meet the survey objectives, the number of households selected in the 2008 EDHS sample from each governorate was not proportional to the size of the population in the governorate. As a result, the 2008 EDHS sample is not self-weighting at the national level, and weights have to be applied to the data to obtain the national-level estimates presented in this report. A more detailed description of the 2008 EDHS sample design is included in Appendix B. Sampling errors for selected variables are presented in Appendix C. The sample for the 2008 EDHS was selected in three stages. The first stage included selecting the primary sampling units. The units of selection were shiakhas/towns in urban areas and villages in rural areas. A list of these units which was based on the 2006 census was obtained from CAPMAS, and this list was used in selecting the primary sampling units (PSUs). Prior to the selection of the PSUs, the frame Introduction | 5 was further reviewed to identify any administrative changes that had occurred after the 2006 Census. The updating process included both office work and field visits for a period of around 2 months. After it was completed, urban and rural units were separately stratified by geographical location in a serpentine order from the northwest corner to the southeast corner within each governorate. During this process, shiakhas or villages with a population less than 2,500 were grouped with contiguous shiakhas or villages (usually within the same kism or marquez) to form units with a population of at least 5,000. After the frame was ordered, a total of 610 primary sampling units (275 shiakhas/towns and 335 villages) were selected. The second stage of selection involved several steps. First, detailed maps of the PSUs chosen during the first stage were obtained and divided into parts of roughly equal population size (about 5,000). In shiakhas/towns or villages with a population of 100,000 or more, three parts were selected, two parts were selected from PSU’s with population 20,000 or more (and less than 100,000). In the remaining smaller shiakhas/towns or villages, only one part was selected. Overall, a total of 998 parts were selected from the shiakhas/towns and villages in the 2008 EDHS sample. A quick count was then carried out to provide an estimate of the number of households in each part. This information was needed to divide each part into standard segments of about 200 households. A group of 48 experienced field workers participated in the quick count operation. They were organized into 15 teams, each consisting of 1 supervisor, 1 cartographer and 1 counter. A one-week training course conducted prior to the quick count included both classroom sessions and two field practices in a shiakha/town and a village not covered in the survey. The quick-count operation took place between the end of October 2007 and end of December 2007. As a quality control measure, the quick count was repeated in 10 percent of the parts. If the difference between the results of the first and second quick count was less than 2 percent, then the first count was accepted. No major discrepancies were found between the two counts in most of the areas for which the count was repeated. After the quick count, a total of 1,267 segments were chosen from the parts in each shiakha/ town and village in the 2008 EDHS sample (i.e., two segments were selected from 561 PSUs and three segments from 48 PSUs and one segment from one PSU). A household listing operation was then implemented in each of the selected segments. To conduct this operation, 14 supervisors and 28 listers were organized into 14 teams. Generally, each listing team consisted of a supervisor and two listers. A one-week training course for the listing staff was held at the beginning of January 2008. The training involved classroom lectures and two days of field practice in three urban and rural locations not covered in the survey. The listing operation took place during a six-week period, beginning immediately after the training. About 10 percent of the segments were relisted. Two criteria were used to select segments for relisting. First, segments were relisted when the number of households in the listing differed markedly from that expected according to the quick count information. Second, a number of segments were randomly selected to be relisted as an additional quality control test. Overall, the discrepancies found in comparisons of the listings were not major. The third stage involved selecting the household sample. Using the household listing for each segment, a systematic random sample of households was selected for the 2008 EDHS sample. All ever- married women 15-49 who were present in the sampled households on the night before the survey team visited were eligible for the main DHS interview. In addition, in a subsample of one-quarter of the households in each segment, all women and men age 15-59 who were present in the household on the night before the interview were eligible for the health issues interviews and the hepatitis C testing. 6 | Introduction 1.4.4 Questionnaire Development Three questionnaires were used in the 2008 EDHS: a household questionnaire, an ever-married woman questionnaire, and a health issues questionnaire. The household and ever-married woman’s questionnaires were based on the questionnaires that had been used in earlier EDHS surveys and on model survey instruments developed in the MEASURE DHS program. The majority of the content of the health issues questionnaire was developed especially for the 2008 EDHS although some sections (e.g., the questions on female circumcision and HIV/AIDS knowledge and attitudes) were also based on questionnaires used in earlier EDHS surveys or were drawn from the model instruments from the MEASURE DHS program. The questionnaires were developed in English and translated into Arabic. The first part of the household questionnaire was used to enumerate all usual members and visitors to the selected households and to collect information on the age, sex, marital status, educational attainment, and relationship to the household head of each household member or visitor. This information provided basic demographic data for Egyptian households. It was also used to identify the women who were eligible for the individual interview (i.e., ever-married women 15-49) as well as individuals eligible for the special health issues interviews and the hepatitis testing subsample. In the second part of the household questionnaire, there were questions relating to the socioeconomic status of the household including questions on housing characteristics (e.g., the number of rooms, the flooring material, the source of water and the type of toilet facilities) and on ownership of a variety of consumer goods. A special module was included in the household questionnaire on ownership of poultry and birds. In addition, height and weight measurements of respondents, youth, and children under age six were taken during the survey and recorded in the household questionnaire. The informed consent for the hepatitis C testing obtained from eligible respondents age 15-59 was also recorded in the household questionnaire. The woman’s questionnaire was administered to all ever-married women age 15-49 who were usual residents or who were present in the household during the night before the interviewer’s visit. It obtained information on the following topics: • Respondent’s background • Reproduction • Contraceptive knowledge and use • Fertility preferences and attitudes about family planning • Pregnancy and breastfeeding • Immunization and child health • Husband’s background and women’s work • Female circumcision • Health care access and other health concerns • Mother and child nutrition. The woman’s questionnaire included a monthly calendar, which was used to record the history of the respondent’s marriage status, fertility, contraceptive use including the source where the method was obtained, and the reason for discontinuation for each segment of use status during each month of an approximately five-year period starting from January 2003. The health issues questionnaire collected information on the following topics: Introduction | 7 • Background characteristics of men age 15-59, never-married women age 15-59, and ever- married women age 50-59 • Female circumcision • Health insurance coverage and health care cost • Knowledge and attitudes about HIV/AIDS • Medical procedures and safe injections • Hepatitis C • Hypertension, heart disease and diabetes • Avian influenza • Smoking Blood pressure readings were also obtained for respondents at three points during the health issues interview. 1.4.5 Biomarker Data Collection As noted earlier, the 2008 EDHS included the collection of three types of biomarkers: (1) anthropometric (height and weight) measurements; (2) venous blood samples for hepatitis C testing; and (3) blood pressure measurements. Specially trained teams of three individuals including at least one physician and one laboratory technician were responsible for obtaining the anthropometric measurements for all eligible respondents and the venous blood samples. The EDHS survey interviewers were trained to collect the blood pressure measurements. Anthropometric measurements. Height and weight measures were collected in all households included in the EDHS survey for children under age six and never-married youth and young adults age 10-19 years. In the subsample of households selected for the health issues survey, the measurements were also obtained for all women and men age 20-59 while in the remaining households in the sample, measurements were recorded only for ever-married women age 20-49. Additional information on the procedures used and the results of the anthropometric measurement is provided in Chapter 14 of this report. Hepatitis C testing. The hepatitis C testing component of the EDHS involved the collection of venous blood samples for testing in the Central Laboratory from all individuals age 15-59 years living in the subsample of households selected for the health issues survey. A full description of the protocol for the hepatitis C testing component of the 2008 EDHS and the results of the testing is included in Chapter 18. Blood pressure measurements. In the 2008 EDHS, blood pressure measurements were taken for all of the women and men age 15-59 with whom the the special health issues interviews were conducted. Chapter 17 includes a detailed description of the equipment and procedures used in obtaining the blood pressure measurements from respondents. 1.4.6 Pretest A pretest was conducted during the preparation for the 2008 EDHS. After a two-week training course, the household and individual questionnaires were pretested in January 2008 in a small number of households. Three supervisors, three field editors, and 12 interviewers participated in the first pretest. The pretest was conducted in three governorates: Cairo, Gharbia ( Lower Egypt), and Fayoum (Upper Egypt). A sample of 275 households was selected: 92 households in each governorate. The data collection took 8 | Introduction about four days and a total of 268 household and 261 individual interviews were completed during the pretest. Hepatitis C blood testing was also carried during the pretest. The questionnaires for the 2008 EDHS were finalized after the pretest. Both comments from interviewers and tabulations of the pretest results were reviewed during the process of finalizing the ques- tionnaires. English versions of the final Arabic language questionnaires are included in Appendix F. 1.4.7 Data Collection Activities Staff recruitment. To recruit interviewers and field editors, a list was obtained from the Ministry of Social Solidarity (MOSS) of female personnel who were working to fulfill the one-year period of governmental public service that is mandatory for university graduates. All candidates nominated by MOSS for the field staff positions were interviewed, and only those who were qualified were accepted into the training program. All candidates for the interviewer and field editor positions were recent university graduates. Another basic qualification was a willingness to work in any of the governorates covered in the survey. With a few exceptions, interviewers who had previous experience in surveys were not accepted into the training program. This decision was made to reduce any bias that might result from previous survey experience and to ensure that all trainees had a similar background. However, previous survey experience was a basic qualification for the candidates for the positions of supervisor. The Hepatitis C testing teams were composed of physicians, laboratory technician, and nurses. Some candidates for the hepatitis C testing teams were assigned by the MOH, and others were recruited from among newly graduated physicians and private laboratories. Training materials. A variety of materials were developed for use in training personnel involved in the fieldwork. A lengthy interviewer’s manual, including general guidelines for conducting an interview as well as specific instructions for asking each of the questions in the EDHS questionnaires, was prepared and given to all field staff. In addition, a chart for converting months from the Islamic calendar to the Gregorian calendar was designed for the 60 months before the 2008 EDHS and distributed to all field staff along with a calendar of well-known worldwide or local events. Other training materials, including special manuals describing the duties of the team supervisor and the rules for field editing, were prepared. Instructions for anthropometric data collection were included in a manual for the staff trained to collect height and weight data. Special manuals covering the procedures to be followed in the hepatitis C blood testing and the blood pressure measurement were also prepared. Training for supervisors and interviewers. A special training program for supervisors was conducted during a one-day period prior to the main fieldwork training. This training focused specifically on the supervisor’s duties, but it also covered the 2008 EDHS questionnaires in order to give supervisors a basic understanding of the content of the survey prior to the main training program. Training for interviewers for the 2008 EDHS data collection began on the 9th of February 2008. Fourteen supervisors, 87 interviewers, and 52 Health Personnel for Hepatitis C-testing and the staff responsible for the anthropometric data collection staff (14 doctors, 28 technicians, and 10 nurses ) participated in the training program. The five-week training program, which was held in Cairo, included the following: Introduction | 9 • Lectures related to basic interview techniques and to specific survey topics (e.g., fertility and family planning, maternal and child health, and female circumcision) • Sessions on how to fill out the questionnaire, using visual aids • Training on blood pressure measurement • Role playing and mock interviews • Five days of field practice in areas not covered in the survey • Four quizzes. Trainees who failed to show interest in the survey, who did not attend the training program on a regular basis, or who failed the first two quizzes were terminated immediately. Before the fourth field practice, a list was prepared of the 20 trainees who had performed best during both the classroom and field practices. Following the fourth field practice, 14 of these trainees were chosen to be field editors. A special training session was held for the field editors after their selection. By the end of the training course, 69 of the 87 candidates originally recruited for interviewer training had been selected to work as interviewers or field editors in the EDHS fieldwork. Training for staff responsible for the anthropometric measurements and hepatitis C testing. All health personnel (total 52) attended the training for anthropometric data collection and hepatitis C testing. The training was held in parallel to the main training for around four weeks. The supervisors attended most of the morning sessions to be aware of all procedures of Hepatitis C testing. The training included both classroom lectures and practice measurement and venues blood drawn procedure, and practice in households. At the end of the program, the 42 most-qualified trainees (27 males and 15 females) were selected for the anthropometric data collection and Hepatitis C testing. 1.4.8 Fieldwork Fieldwork for the 2008 EDHS began on March 15th , 2008 and was completed in late May 2008. The field staff was divided into 14 teams; each team had 1 supervisor, 1 field editor, 4 interviewers (one male), and 3 health staff members assigned to height and weight measurement and Hepatitis C testing (one at least has to be female). During the fieldwork, the 14 field teams worked in separate governorates; the number of governorates assigned to an individual team varied from two to three, according to the sample size in the governorates. The teams were closely supervised throughout the fieldwork by a fieldwork coordinator, two assistant fieldwork coordinators, and other senior staff. Due to the fact that the blood samples had to be drawn and transferred to the central lab in Cairo, thirteen teams were assigned to work first in Upper Egypt governorates in order to complete the data collection before the weather became excessively hot. As soon as the main data collection was completed in the first group of governorates, a random sample of up to 10 percent of the households was selected for reinterview as a quality control measure. Shorter versions of the 2008 EDHS questionnaires were prepared and used for the reinterviews. The visits to PSUs to conduct reinterviews also afforded an opportunity to make callbacks to complete interviews with households or individuals who were not available at the time of the original visit by the 2008 EDHS interviewers. Household or individual questionnaires in which there were significant errors that could not be corrected in the office were also assigned for callbacks. Special teams were organized to handle callbacks and reinterviews. During this phase of the survey, interviewers were not allowed to work in the governorate in which they had worked in the initial fieldwork. Callbacks and reinterviews began in late May 2008 and took about one months to complete. 10 | Introduction 1.4.9 Data Processing Activities Office editing. Staff from the central office were responsible for collecting questionnaires from the teams as soon as interviewing in a cluster was completed. Office editors reviewed questionnaires for consistency and completeness, and a few questions (e.g., occupation) were coded in the office prior to data entry. To provide feedback for the field teams, the office editors were instructed to report any problems detected while editing the questionnaires, which were reviewed by the senior staff. If serious errors were found in one or more questionnaires from a cluster, the supervisor of the team working in that cluster was notified and advised of the steps to be taken to avoid these problems in the future. Machine entry and editing. Machine entry and editing began while interviewing teams were still in the field. The data from the questionnaires were entered and edited on microcomputers using the Census and Survey Processing System (CSPro), a software package for entering, editing, tabulating, and disseminating data from censuses and surveys. In addition the transmittal forms for Hepatitis C individuals as well as the blood sample sheet including the bar code were entered by one person. Special computer programs were also set up to facilitate the tracking of the results of the testing of the blood samples collected during the survey at the Central Health Laboratory. The bar codes attached to the samples in the field were used for logging in and identifying the samples throughout the processing, which took place at three separate locations within the Central Laboratory. The bar code also served as the means to link the laboratory test results and the survey data file. Twelve data entry personnel used twelve microcomputers to process the 2008 EDHS survey data. During the machine entry, 100 percent of each segment was re-entered for verification. The data processing staff completed the entry and editing of data by mid July 2008. 1.5 SURVEY COVERAGE Table 1.4 summarizes the outcome of the fieldwork for the 2008 EDHS by place of residence. The table shows that, during the main fieldwork and callback phases of the survey, out of 19,739 households selected for the 2008 EDHS 19,147 households were found, and 18,968 households were successfully interviewed which represents a response rate of 99.1 percent. As noted above, for the ever-married woman interviews, an eligible respondent was defined as an ever-married woman age 15-49 who was present in the household on the night before the interview. A total of 16,571 eligible ever-married women were identified in the households in the 2008 EDHS sample. Of these women, 16,527 were successfully interviewed. The ever-married women response rate was 99.7 percent. A total of 4,953 households were selected for the health issues subsample. Of these, 4,757 were found and 4,662 interviewed. The household response rate in the health issues subsample was only slightly lower than the response rate in the entire EDHS sample (98 percent). Women and men were eligible for the health issues interview if they were age 15-59 years (regardless of marital status) and were present in the household on the night before the interview. A total of 12,780 individuals (6,702 women and 6,078 men) who met these criteria were identified in the subsample of households selected for the special health issues interviews, of which 12,008 were successfully interviewed. Taking into account both eligible women and men, the response rate for the health issues was 94 percent. As expected, the response rate among women (98 percent) was higher than the rate among men (89 percent), with the principal reason being the fact that men were more likely to be working and, thus, not as easy to contact for interview as women. Introduction | 11 Table 1.4 Sample results Percent distribution of households and individuals by the result of the main DHS survey and the special health issues survey interviews and response rates, according to residence, Egypt 2008 Lower Egypt Upper Egypt Result Urban Rural Urban Gover- norates Total Urban Rural Total Urban Rural Frontier Gover- norates Total Main Survey Households (HH) Sampled 9,395 10,344 3,627 7,578 2,401 5,177 7,500 2,614 4,886 1,034 19,739 Found 9,002 10,145 3,484 7,352 2,287 5,065 7,340 2,524 4,816 971 19,147 Interviewed 8,852 10,116 3,391 7,303 2,256 5,047 7,310 2,504 4,806 964 18,968 HH response rate 98.3 99.7 97.3 99.3 98.6 99.6 99.6 99.2 99.8 99.3 99.1 Ever-married women age 15-49 (EMW) Identified 6,699 9,872 2,421 6,522 1,742 4,780 6,703 1,927 4,776 925 16,571 Interviewed 6,677 9,850 2,419 6,515 1,738 4,777 6,682 1,920 4,762 911 16,527 EMW response rate 99.7 99.8 99.9 99.9 99.8 99.9 99.7 99.6 99.7 98.5 99.7 Health Issues (HI) Subsample Households (HI-HH) Sampled 2,357 2,596 916 1,897 597 1,300 1,880 655 1,225 260 4,953 Found 2,224 2,533 864 1,812 554 1,258 1,832 625 1,207 249 4,757 Interviewed 2,141 2,521 813 1,787 538 1,249 1,819 615 1,204 243 4,662 HI-HH response rate 96.3 99.5 94.1 98.6 97.1 99.3 99.3 98.4 99.8 97.6 98.0 All women age 15-59 (HI-W) Identified 2,827 3,875 1,079 2,486 668 1,818 2,749 829 1,920 388 6,702 Interviewed 2,747 3,831 1,043 2,460 657 1,803 2,705 809 1,896 370 6,578 HI-W response rate 97.2 98.9 96.7 99.0 98.4 99.2 98.4 97.6 98.8 95.4 98.1 All men age 15-59 (HI-M) Identified 2,660 3,418 979 2,259 608 1,651 2,433 795 1,638 407 6,078 Interviewed 2,319 3,111 826 2,072 546 1,526 2,186 709 1,477 346 5,430 HI-M response rate 87.2 91.0 84.4 91.7 89.8 92.4 89.8 89.2 90.2 85.0 89.3 Total age 15-59 (HI-T) Identified 5,487 7,293 2,058 4,745 1,276 3,469 5,182 1,624 3,558 795 12,780 Interviewed 5,066 6,942 1,869 4,532 1,203 3,329 4,891 1,518 3,373 716 12,008 HI-T response rate 92.3 95.2 90.8 95.5 94.3 96.0 94.4 93.5 94.8 90.1 94.0 Characteristics of Households | 13 CHARACTERISTICS OF HOUSEHOLDS 2 The objective of this chapter is to provide a demographic and socioeconomic profile of the 2008 EDHS household sample. Information is presented on the age, sex, and education of the household population, as well as on housing facilities and household possessions. The profile of the households provided in this chapter will help in understanding the results of the 2008 EDHS in the following chapters. In addition, it may provide useful input for social and economic development planning. 2.1 CHARACTERISTICS OF THE HOUSEHOLD POPULATION The questionnaire for the 2008 EDHS included two questions distinguishing between the de jure population (persons who usually live in selected household) and the de facto population (persons who spent the night before the interview in the household). The differences between these populations are small. Therefore, since past surveys and censuses have generally been based on de facto populations, the tabulations of the EDHS household data presented in this chapter are based on the de facto definition, unless otherwise stated. 2.1.1 Age and Sex Composition Table 2.1 presents the percent distribution of the de facto population by age, according to urban- rural residence and sex. The table describes the demographic context in which behaviors examined later in the report occur. Table 2.1 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and urban-rural residence, Egypt 2008 Urban Rural Total Age Male Female Total Male Female Total Male Female Total <5 10.3 9.9 10.1 13.5 12.5 13.0 12.1 11.4 11.7 5-9 10.9 9.8 10.4 13.0 12.0 12.5 12.1 11.1 11.6 10-14 9.7 9.7 9.7 11.9 10.9 11.4 10.9 10.4 10.7 15-19 10.2 9.7 10.0 11.1 10.8 11.0 10.7 10.3 10.5 20-24 10.4 10.6 10.5 9.5 10.9 10.2 9.9 10.8 10.4 25-29 8.4 9.0 8.7 7.6 9.0 8.3 8.0 9.0 8.5 30-34 6.1 6.7 6.4 6.1 6.2 6.1 6.1 6.4 6.3 35-39 5.7 6.4 6.0 5.3 5.7 5.5 5.5 6.0 5.7 40-44 5.7 6.1 5.9 5.1 5.2 5.2 5.4 5.6 5.5 45-49 5.8 5.5 5.7 4.4 4.7 4.5 5.0 5.0 5.0 50-54 5.0 5.2 5.1 3.5 3.2 3.3 4.2 4.1 4.1 55-59 4.0 3.7 3.9 3.1 3.0 3.1 3.5 3.3 3.4 60-64 3.1 3.1 3.1 2.0 2.1 2.0 2.4 2.5 2.5 65-69 2.1 2.1 2.1 1.6 1.4 1.5 1.8 1.7 1.7 70-74 1.2 1.2 1.2 1.1 1.1 1.1 1.2 1.2 1.2 75-79 0.6 0.6 0.6 0.7 0.6 0.6 0.7 0.6 0.6 80 + 0.5 0.6 0.6 0.6 0.6 0.6 0.5 0.6 0.6 Don't know/missing 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 18,618 18,935 37,553 24,245 25,070 49,314 42,863 44,005 86,868 14 | Characteristics of Households The population spending the night before the interview in the households selected for the survey included 86,868 individuals, of which 49 percent were males and 51 percent females. The age structure of the de facto household population reflects the effects of past demographic trends in Egypt, particularly high fertility. The majority of the household population (55 percent) was less than 25 years old, and 34 percent were less than 15 years old. The proportion under age 15 was greater in the rural population (37 percent) than in the urban population (30 percent). This difference is an outcome of lower fertility over the past several decades in urban areas compared with rural areas. The population pyramid shown in Figure 2.1 was constructed using the sex and age distribution of the 2008 EDHS household population. The pyramid has a wide base. This pattern is typical of countries that have experienced relatively high fertility in the recent past. Table 2.2 presents a comparison of the distribution of the household population by broad age groups for the six EDHS surveys carried out between 1988 and 2008. The dependency ratio, defined as the ratio of the non-productive population (persons under age 15 and age 65 and over) to the population age 15-64, is calculated based on these figures. The ratio was 62 at the time of the 2008 EDHS, a level around 20 points lower than that observed in 1988. This decline in the dependency ratio represents a substantial lessening in the burden placed on persons in the productive ages to support older and younger household members. Figure 2.1 Population Pyramid of Egypt 80 + 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 <5 0123456 0 1 2 3 4 5 6 Male Female Percent EDHS 2008 FemaleMale Characteristics of Households | 15 2.1.2 Household Composition Table 2.3 presents the distribution of households in the 2008 EDHS sample by sex of the head of the household and by the number of de jure household members. These characteristics are important because they are often associated with socioeconomic differences between households. For example, female-headed households frequently are poorer than households headed by males. In addition, the size and composition of the household affects the allocation of financial and other resources among household members, which in turn influences the overall well-being of these individuals. Household size is also associated with crowding in the dwelling, which can lead to unfavorable health conditions. Table 2.3 Household composition by residence Percent distribution of households by sex of head of household and by household size, according to residence, Egypt 2008 Lower Egypt Upper Egypt Characteristic Urban Rural Urban Gover- norates Total Urban Rural Total Urban Rural Frontier Gover- norates Total Household headship Male 84.9 88.0 84.0 87.4 85.7 88.2 86.9 85.5 87.7 93.0 86.6 Female 15.1 12.0 16.0 12.6 14.3 11.8 13.1 14.5 12.3 7.0 13.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of usual members 0 0.1 0.0 0.0 0.1 0.1 0.0 0.0 0.1 0.0 0.1 0.0 1 7.4 3.7 8.7 4.5 6.5 3.7 4.6 6.0 3.8 6.0 5.5 2 13.5 10.2 14.2 11.7 13.4 11.0 10.3 12.5 9.0 12.3 11.8 3 16.4 12.3 17.2 14.7 15.7 14.2 11.9 16.2 9.4 11.1 14.3 4 23.2 18.4 23.7 22.6 25.2 21.5 16.3 20.6 13.6 16.1 20.7 5 21.0 18.9 20.5 21.9 23.0 21.4 17.0 19.9 15.2 17.9 19.9 6 10.3 14.6 8.8 13.0 10.5 14.0 14.3 12.5 15.4 14.7 12.5 7 4.8 8.7 4.4 6.0 4.0 6.9 9.6 6.4 11.5 8.1 6.9 8 1.7 4.7 1.5 2.1 1.1 2.5 6.1 2.7 8.2 3.7 3.3 9+ 1.5 8.5 1.0 3.5 0.5 4.8 9.9 3.2 13.9 10.0 5.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 9,159 9,809 4,182 8,348 2,466 5,881 6,204 2,338 3,865 235 18,968 Mean size 4.1 5.1 3.9 4.5 4.0 4.7 5.3 4.4 5.8 5.1 4.6 Note: Table is based on de jure members, i.e., usual residents. Table 2.2 Trends in population distribution by age, 1988-2008 Percent distribution of the de facto population by age and dependency ratio, Egypt 1988-2008 Age group 1988 EDHS 1992 EDHS 1995 EDHS 2000 EDHS 2005 EDHS 2008 EDHS Less than 15 41.2 41.7 40.0 37.3 34.2 34.0 15-64 55.0 54.6 56.3 59.1 61.7 61.9 65+ 3.8 3.7 3.7 3.6 4.1 4.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Median age na 18.8 19.3 20.3 21.7 22.5 Dependency ratio 81.8 83.2 77.6 69.2 62.1 61.5 na = not available Source: El-Zanaty and Way, 2006, Table 2.2 16 | Characteristics of Households Most EDHS households were headed by males; the head was female in only 13 percent of the households surveyed. There were differences in the proportions of households headed by females across residential categories. Sixteen percent of households in the Urban Governorates had a female head compared with 12 percent of the households in rural areas of Lower and Upper Egypt. The Frontier Governorates had the lowest proportion of female-headed households (7 percent). The average EDHS household had 4.6 persons per household. Slightly less than one-third of the households (32 percent) had three or fewer members, while 15 percent of the households had seven or more members. In general, rural households were larger than urban households. For example, only 8 percent of urban households had seven or more members, compared with 22 percent of rural households. Household size varied from an average of 3.9 persons in the Urban Governorates to 5.8 persons in rural Upper Egypt. 2.2 EDUCATION OF THE HOUSEHOLD POPULATION The educational level of household members is among the most important characteristics of the household because it is associated with many phenomena including reproductive behavior, use of contraception, and the health of children. Primary education in Egypt starts at age 6 and consisted of six years of schooling.1 A further three-year period, known as the preparatory stage, is considered basic education and is compulsory. The secondary stage, which includes another three years of schooling, is not compulsory. During the household interviews, questions were included on the highest level of schooling completed for all household members age six and older and on recent school attendance for household members age 6-24 years. The information collected on the educational attainment of all household members is presented in Tables 2.4.1 and 2.4.2. A comparison of Tables 2.4.1 and 2.4.2 highlights the gap in educational attainment between males and females. Overall, 85 percent of males in the 2008 EDHS households had ever attended school, compared with 72 percent of females. The median number of years of schooling for men was 6.7, which is almost 2 years higher than the median for women (4.9 years). 1Between 1989 and 2004, primary education was five years. Characteristics of Households | 17 Table 2.4.1 Educational attainment of male household population by age and residence Percent distribution of the de facto male household population age six and over by highest level of education attended or completed and median number of years of schooling, according to background characteristics, Egypt 2008 Background characteristic No education Some primary Completed primary Some secondary Completed secondary More than secondary Don't know/ missing Total Number Median number of years Age 6-9 12.2 87.3 0.0 0.0 0.0 0.0 0.5 100.0 4,057 0.4 10-14 2.4 56.0 1.1 40.5 0.0 0.0 0.0 100.0 4,684 4.6 15-19 3.9 5.1 3.9 59.1 15.7 12.3 0.0 100.0 4,587 8.7 20-24 6.5 5.5 3.7 12.6 41.8 29.7 0.1 100.0 4,256 10.6 25-29 8.0 7.5 6.6 11.4 42.9 23.5 0.2 100.0 3,411 10.4 30-34 8.9 8.5 5.2 15.3 41.5 20.5 0.0 100.0 2,617 11.1 35-39 13.8 11.4 3.6 12.9 41.5 16.7 0.0 100.0 2,351 11.2 40-44 20.2 12.5 5.6 10.1 33.9 17.7 0.0 100.0 2,309 11.1 45-49 23.4 13.8 6.4 9.7 26.7 20.0 0.0 100.0 2,154 8.5 50-54 30.0 14.5 7.6 7.1 23.2 17.6 0.0 100.0 1,781 5.7 55-59 37.2 11.3 7.8 7.6 19.5 16.5 0.0 100.0 1,504 5.2 60-64 39.8 11.1 9.1 5.7 17.6 16.7 0.0 100.0 1,046 4.8 65+ 59.7 11.1 6.3 4.4 9.0 9.3 0.3 100.0 1,798 0.0 Residence Urban 9.6 21.2 4.2 18.4 24.5 22.0 0.0 100.0 16,290 8.9 Rural 19.1 25.9 4.3 20.1 21.9 8.5 0.2 100.0 20,267 5.4 Place of residence Urban Governorates 9.2 21.1 5.1 19.5 23.4 21.7 0.0 100.0 7,241 8.6 Lower Egypt 14.9 23.9 4.6 19.3 23.8 13.4 0.1 100.0 15,814 6.6 Urban 8.9 21.7 3.9 18.1 25.3 22.1 0.0 100.0 4,334 9.2 Rural 17.1 24.7 4.9 19.7 23.3 10.1 0.1 100.0 11,480 5.9 Upper Egypt 18.1 25.3 3.3 19.3 21.8 12.0 0.2 100.0 12,980 5.8 Urban 10.9 20.8 3.1 16.8 25.1 23.2 0.1 100.0 4,357 9.5 Rural 21.7 27.6 3.4 20.5 20.1 6.3 0.2 100.0 8,622 4.8 Frontier Governorates 14.4 21.8 5.2 18.7 29.2 10.5 0.2 100.0 521 7.2 Total 14.9 23.8 4.3 19.3 23.1 14.5 0.1 100.0 36,556 6.7 An examination of the education distributions for successive cohorts indicates that there have been changes over time in the educational attainment of both men and women. For example, the median number of years of schooling is 10.6 for males age 20-24 years, nearly double the median for males in the 50-54 age group (5.7 years). The improvement in educational attainment has been even more striking for women; the median number of years of schooling is 10.5 for females age 20-24 years, around three times the median for females in the age group 40-44 (3.6 years). As a result of the gains in female education, the gap in the educational attainment between males and females has almost disappeared among younger cohorts. For example, the differential in the median number of years of schooling is 0.1 years between men and women age 20-24. Urban residents were more likely to have attended school and to have remained in school for a longer period than rural residents. The results in Tables 2.4.1 and 2.4.2 also show that gender differences in educational attainment are less evident in urban than in rural areas. For example, the median number of years of schooling is 5.4 years among rural men, 2.5 years greater than the median among rural women (2.9 years). The difference is much smaller in urban areas, where the median number of years of schooling is 8.9 years for men, compared with 7.6 years for women. By place of residence, gender differences in the likelihood of attending school are most evident in rural Upper Egypt where 78 percent of men had ever attended school, compared with 57 percent of women. The gender gap is least apparent in urban Lower Egypt where 85 percent of women had some education, compared with 91 percent of men. 18 | Characteristics of Households Table 2.4.2 Educational attainment of female household population by age and residence Percent distribution of the de facto female household population age six and over by highest level of education attended or completed and median number of years of schooling, according to background characteristics, Egypt 2008 Background characteristic No education Some primary Completed primary Some secondary Completed secondary More than secondary Don't know/ missing Total Number Median number of years Age 6-9 16.4 83.0 0.0 0.0 0.0 0.0 0.5 100.0 3,770 0.4 10-14 4.6 53.2 1.0 41.2 0.0 0.0 0.1 100.0 4,582 4.6 15-19 9.2 2.8 2.7 53.1 18.6 13.6 0.0 100.0 4,554 8.8 20-24 15.4 3.7 2.8 10.4 40.2 27.4 0.1 100.0 4,758 10.5 25-29 20.6 6.8 3.6 9.4 39.5 20.1 0.0 100.0 3,949 10.3 30-34 26.8 7.3 3.8 13.0 33.8 15.1 0.1 100.0 2,822 8.9 35-39 36.2 9.1 2.7 9.6 31.0 11.4 0.0 100.0 2,640 7.3 40-44 42.8 12.5 4.4 6.4 24.5 9.4 0.0 100.0 2,471 3.6 45-49 50.5 12.9 5.8 4.3 17.0 9.4 0.1 100.0 2,220 0.0 50-54 51.5 13.8 6.5 3.7 13.2 11.1 0.1 100.0 1,786 0.0 55-59 62.4 12.4 7.2 3.3 8.6 6.0 0.1 100.0 1,450 0.0 60-64 66.7 10.4 4.8 3.5 7.9 5.7 1.0 100.0 1,108 0.0 65+ 80.3 7.6 3.2 1.1 3.6 2.6 1.6 100.0 1,781 0.0 Residence Urban 18.2 18.9 3.9 16.7 23.2 19.1 0.1 100.0 16,648 7.6 Rural 36.0 22.2 2.6 16.2 17.5 5.2 0.3 100.0 21,244 2.9 Place of residence Urban Governorates 18.5 19.0 4.4 16.8 21.8 19.5 0.1 100.0 7,443 7.3 Lower Egypt 26.5 20.7 2.9 16.2 23.1 10.5 0.1 100.0 16,268 5.3 Urban 15.3 18.7 3.5 16.1 26.5 19.8 0.2 100.0 4,415 8.7 Rural 30.6 21.4 2.6 16.2 21.9 7.1 0.1 100.0 11,853 4.3 Upper Egypt 35.4 21.8 2.7 16.4 15.4 7.8 0.3 100.0 13,690 3.2 Urban 20.0 18.9 3.3 17.1 22.5 18.2 0.1 100.0 4,462 7.2 Rural 42.9 23.3 2.4 16.1 12.0 2.8 0.5 100.0 9,228 1.0 Frontier Governorates 30.2 18.7 5.0 18.8 17.9 9.0 0.4 100.0 492 4.7 Total 28.2 20.7 3.1 16.4 20.0 11.3 0.2 100.0 37,892 4.9 2.3 HOUSING CHARACTERISTICS The 2008 EDHS survey collected information on a range of housing characteristics. These data are presented in Tables 2.5 through 2.8 for households and for the total de jure household population. 2.3.1 Drinking Water Access and Treatment Increasing access to improved drinking water is one of the Millennium Development Goals that Egypt along with other nations worldwide has adopted (United Nations General Assembly 2001). Improved sources are defined as those sources which are likely to provide safe drinking water (WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation 2004). Improved sources include water obtained a piped source within the dwelling, a public tap, a tubehole or borehole, or a protected well or spring.2 The results in Table 2.5 show that 98 percent of EDHS households had access to drinking water from an improved source. In most cases, the source was a piped connection in the dwelling itself or the plot (92 percent). Almost all households obtained the water from a source on premises (97 percent). The majority of households fetching drinking water from a source outside the dwelling or plot were within 30 minutes of this source. For households in which the water source was not on the premises, women age 15 and older were responsible for fetching the water. 2 A well or spring which is covered or otherwise ‘protected’ from contamination from surface water or animals. Characteristics of Households | 19 Table 2.5 Household drinking water access and treatment by residence Percent distribution of households by source of drinking water, time to collect water (if not within residence or plot), person fetching the water and interruption of water supply during two week period prior to the survey and percentage of households using various modes for treating drinking water, according to urban-rural residence and place of residence and percent distribution of the de jure population by household drinking water arrangements and percentage of the de jure population living in households using various modes to treat drinking water, Egypt 2008 Lower Egypt Upper Egypt Drinking water Urban Rural Urban Gover- norates Total Urban Rural Total Urban Rural Frontier Gover- norates Total house- holds Total de jure population Source of drinking water1 Improved source 99.8 96.7 99.9 98.6 99.8 98.1 96.9 100.0 95.1 88.4 98.2 98.0 Piped into residence/plot 98.5 86.7 99.6 92.2 97.4 90.0 88.2 98.2 82.2 81.2 92.4 91.4 Public tap 0.6 4.3 0.3 2.0 0.4 2.7 4.7 1.4 6.7 1.4 2.5 2.6 Tubewell/borehole 0.2 3.3 0.0 2.8 0.7 3.8 1.7 0.1 2.6 0.1 1.8 2.3 Protected well/spring 0.5 2.4 0.0 1.5 1.4 1.5 2.3 0.2 3.6 5.6 1.5 1.7 Unimproved source 0.2 3.2 0.1 1.3 0.1 1.8 3.0 0.0 4.8 11.5 1.7 2.0 Unprotected well/spring 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.2 0.0 0.0 Tanker truck/cart 0.2 3.1 0.1 1.3 0.1 1.8 3.0 0.0 4.7 11.3 1.7 1.9 Surface water 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 Other/missing 0.0 0.1 0.0 0.1 0.1 0.1 0.0 0.0 0.1 0.1 0.0 0.0 Time to water source On premises 99.5 94.8 99.8 97.5 99.6 96.6 95.0 98.9 92.6 89.2 97.1 96.7 Within 15 minutes 0.1 1.7 0.1 0.8 0.1 1.0 1.8 0.2 2.8 1.0 1.0 1.1 15-29 minutes 0.1 1.4 0.1 0.7 0.1 0.9 1.4 0.3 2.1 0.7 0.8 0.9 30+ minutes 0.2 1.1 0.0 0.8 0.2 1.0 0.8 0.2 1.1 5.4 0.7 0.7 Don’t know/missing 0.1 0.9 0.0 0.3 0.0 0.5 1.0 0.2 1.4 3.7 0.5 0.6 Person obtaining water for household Adult man 0.2 0.7 0.0 0.4 0.1 0.5 0.5 0.2 0.7 9.1 0.5 0.5 Adult woman 0.3 3.5 0.1 1.8 0.3 2.4 3.5 0.6 5.2 1.1 2.0 2.2 Male child under 15 years old 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 Female child under 15 years old 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.1 0.2 0.0 0.0 Water on premises/other/ missing 99.5 95.7 99.8 97.8 99.6 97.0 96.0 99.1 94.1 89.7 97.5 97.3 Water supply interrupted Not interrupted 74.3 67.8 77.9 71.9 74.1 70.9 65.9 70.5 63.2 45.9 70.9 69.3 Daily/almost daily 7.9 9.1 8.1 8.5 7.8 8.8 7.9 5.5 9.3 34.3 8.5 8.8 Few times per week 10.9 15.0 9.9 12.7 11.3 13.2 15.4 11.8 17.6 15.9 13.0 13.9 Less frequently 6.5 7.7 3.7 6.6 6.4 6.6 10.3 11.9 9.4 3.4 7.1 7.7 Don’t know/missing 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.3 0.5 0.5 0.4 0.3 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 Number 9,159 9,809 4,182 8,348 2,466 5,881 6,204 2,338 3,865 235 18,968 87,480 Water treated prior to drinking Not treated 93.8 96.3 95.1 94.8 92.8 95.6 95.6 92.9 97.2 92.2 95.1 95.5 Boiled 0.6 0.3 0.5 0.4 0.7 0.3 0.5 0.6 0.4 0.4 0.4 0.4 Bleach/chlorine added 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 Strained through cloth/cotton 0.4 0.1 0.5 0.2 0.4 0.1 0.2 0.2 0.1 0.4 0.3 0.2 Water filter used 4.6 1.3 3.5 2.9 5.9 1.7 2.3 5.1 0.7 4.9 2.9 2.5 Solar disinfection 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Stand and settle/other 0.8 2.2 0.4 1.9 0.7 2.5 1.6 1.4 1.6 2.3 1.5 1.6 Total 9,159 9,809 4,182 8,348 2,466 5,881 6,204 2,338 3,865 235 18,968 87,480 1 Because the quality of bottled water is not known, households using bottled water are classified according to the source of water used for cooking and washing. The majority of EDHS households experienced no interruptions in their water supply during the two-week period before the survey. However, 9 percent said the supply had been interrupted on a daily or almost daily basis, 13 percent reported interruptions at least a few times per week while 7 percent experienced less frequent interruptions. 20 | Characteristics of Households EDHS households generally did not treat the water they drink. Among households reporting that the water was treated (5 percent), the most common practices were to filter the water (3 percent) or to let it stand and settle (2 percent). Looking at the variation in drinking water indicators by residence, households in the Frontier Governorates were the least likely to obtain water from an improved source (88 percent). Interruptions in the water supply were more common in Frontier Governorates (54 percent) and rural Upper Egypt (37 percent) than in other areas within Egypt. 2.3.2 Drinking Water Storage Practices The 2008 EDHS also obtained information on water storage practices. The results are presented in Table 2.6. Around 17 percent of households reported they stored drinking water. In those households, the EDHS interviewers asked to see the containers in which the water was stored. More than nine in ten households that stored drinking water used covered containers. The households storing water were about evenly divided between those who used containers with wide mouths and those using containers with narrow mouths. Considering the manner in which water was dispensed from the container, about half of the households ladled the water out of the container and the other half employed a tapped container or poured the water directly from the container. Differentials by residence were generally minor. However, households in the Frontier Governorates were more likely to store their drinking water than other households. Table 2.6 Household drinking water storage practices by residence Percent distribution of households by storage of drinking water and, among households in which water is stored, percent distribution by presence of covers on the containers in which water is stored, type of container in which water is stored, manner in which water is dispensed from containers, according to urban-rural residence and place of residence and percent distribution of the de jure population by household drinking water storage and percent of de jure population living in households in which water is stored by various storage practices, Egypt 2008 Lower Egypt Upper Egypt Drinking water Urban Rural Urban Gover- norates Total Urban Rural Total Urban Rural Frontier Gover- norates Total house- holds Total de jure population Storage of drinking water Stored 12.3 20.9 11.8 15.0 9.4 17.3 21.2 13.7 25.7 50.3 16.7 17.9 Not stored 87.7 79.1 88.2 85.0 90.5 82.7 78.8 86.3 74.2 49.7 83.2 82.1 Don't know/missing 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 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 Number 9,159 9,809 4,182 8,348 2,466 5,881 6,204 2,338 3,865 235 18,968 87,480 Storage containers covered All covered 94.9 93.1 94.5 95.4 96.6 95.1 92.6 96.2 91.4 85.9 93.8 93.5 Some covered 4.4 5.1 5.1 3.5 2.6 3.7 5.4 2.8 6.2 11.7 4.8 5.1 None covered 0.7 1.7 0.3 1.1 0.8 1.1 2.0 1.0 2.3 2.4 1.4 1.4 Not able to observe/missing 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 Type of storage container Wide mouths 36.8 56.8 29.5 46.8 31.6 50.3 60.1 49.9 63.4 48.8 49.7 52.5 Narrow mouths 59.8 39.5 65.9 49.5 66.8 45.5 36.9 47.5 33.5 46.8 46.7 43.8 Both types 3.4 3.7 4.6 3.7 1.6 4.2 2.9 2.6 3.0 4.4 3.6 3.7 Not able to observe/missing 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 Water dispensed from container Ladled 34.9 57.6 30.8 46.2 27.6 50.5 61.0 49.1 64.9 35.6 49.6 52.3 Tap/ poured directly 64.8 42.0 68.5 53.4 72.4 49.0 38.8 50.9 34.9 64.4 50.1 47.3 Other 0.3 0.2 0.7 0.3 0.0 0.4 0.1 0.0 0.1 0.0 0.3 0.3 Not able to observe/missing 0.0 0.1 0.0 0.1 0.0 0.1 0.1 0.0 0.1 0.0 0.1 0.1 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 Number of households storing water 1,128 2,046 494 1,248 233 1,015 1,314 320 994 118 3,174 15,661 Characteristics of Households | 21 2.3.3 Sanitation Facilities and Waste Disposal Ensuring adequate sanitation facilities is another Millennium Development Goal. Table 2.7 shows that most EDHS households had access to a toilet. Forty-nine percent had modern flush toilets, and an identical percentage had traditional flush toilets. Less than 1 percent of households had no toilet facility. Most households (97 percent) reported that the toilet was connected to a public sewer, bayara (vault), or a septic system. Three percent shared the toilet facility with at least one other household. Table 2.7 Sanitation facilities by residence Percent distribution of households by type of toilet facility, drainage system, number of households using the toilet facility, type of sanitation facilities, and method of disposal of kitchen waste and trash, according to urban-rural residence and place of residence and percent distribution of de jure population by sanitation facilities, Egypt 2008 Lower Egypt Upper Egypt Sanitation facility Urban Rural Urban Gover- norates Total Urban Rural Total Urban Rural Frontier Gover- norates Total house- holds Total de jure population Sanitation facility Modern flush toilet 77.1 21.8 83.8 43.9 76.7 30.1 30.6 66.2 9.1 53.4 48.5 42.2 Traditional with tank flush 1.3 2.7 1.0 1.5 0.8 1.8 3.3 2.2 4.0 4.7 2.0 2.3 Traditional with bucket flush 21.4 74.1 15.1 54.2 22.4 67.6 64.1 31.2 84.1 39.7 48.7 54.7 Pit latrine/bucket toilet 0.1 0.6 0.1 0.1 0.1 0.1 0.9 0.1 1.3 1.3 0.4 0.3 Other/missing 0.0 0.1 0.0 0.1 0.0 0.2 0.1 0.0 0.1 0.0 0.1 0.1 No facility 0.1 0.7 0.0 0.1 0.0 0.1 1.0 0.3 1.5 0.9 0.4 0.4 Drainage system Public sewer 89.8 37.0 96.8 64.6 93.1 52.6 37.2 76.5 13.5 42.8 62.5 56.5 Vault (Bayara) 5.4 28.5 1.5 9.4 0.8 13.0 37.6 14.4 51.7 46.0 17.3 21.4 Septic system 4.3 28.4 1.2 21.9 6.1 28.5 20.7 8.0 28.4 9.0 16.8 18.4 Pipe connected to canal 0.1 4.2 0.3 3.8 0.0 5.3 1.5 0.0 2.4 0.1 2.2 2.4 Pipe connected to groundwater 0.0 0.2 0.0 0.0 0.0 0.0 0.4 0.1 0.5 0.3 0.1 0.1 Emptied (no connection) 0.2 0.9 0.0 0.2 0.0 0.3 1.3 0.5 1.8 0.7 0.5 0.6 Other/don’t know 0.1 0.2 0.1 0.1 0.0 0.2 0.2 0.2 0.2 0.1 0.2 0.2 No toilet facility 0.1 0.7 0.0 0.1 0.0 0.1 1.0 0.3 1.5 0.9 0.4 0.4 Number of households using toilet No facility 0.1 0.7 0.0 0.1 0.0 0.1 1.0 0.3 1.5 0.9 0.4 0.4 One 98.2 94.0 98.2 98.0 98.9 97.6 92.0 97.5 88.6 96.5 96.1 95.2 Two 0.8 2.7 0.9 1.0 0.4 1.3 3.4 1.0 4.9 0.7 1.8 2.2 3+ households 0.7 2.2 0.7 0.7 0.5 0.8 3.1 0.9 4.4 1.0 1.5 1.9 Not sure/missing 0.2 0.4 0.2 0.2 0.2 0.2 0.5 0.3 0.6 0.9 0.3 0.3 Sanitation facilities Improved1 97.7 88.5 97.7 93.8 98.8 91.7 88.5 96.6 83.6 94.7 92.9 91.9 Not improved 2.3 11.5 2.3 6.2 1.2 8.3 11.5 3.4 16.4 5.3 7.1 8.1 Disposal of kitchen waste and trash Collected from home 46.5 28.2 41.0 43.0 55.9 37.7 26.9 48.3 14.0 21.2 37.0 33.5 Collected from container in street 34.4 3.5 48.3 7.5 17.1 3.4 12.5 27.5 3.5 31.7 18.4 16.6 Dumped into street/empty plot 16.4 31.2 9.9 30.0 25.0 32.0 25.2 17.8 29.7 37.5 24.1 25.1 Dumped into canal/ drainage 0.8 16.4 0.5 10.2 1.2 13.9 13.1 0.9 20.4 1.4 8.9 10.2 Burned 1.4 15.5 0.1 5.4 0.2 7.5 19.0 5.1 27.4 7.9 8.7 11.2 Fed to animals 0.2 4.6 0.0 3.7 0.5 5.1 2.5 0.3 3.8 0.2 2.5 3.0 Other 0.1 0.6 0.1 0.2 0.1 0.2 0.7 0.1 1.1 0.0 0.3 0.4 Don’t know/missing 0.1 0.1 0.1 0.1 0.0 0.1 0.1 0.0 0.2 0.1 0.1 0.1 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 Number 9,159 9,809 4,182 8,348 2,466 5,881 6,204 2,338 3,865 235 18,968 87,480 1 The household is considered to have improved sanitation facilities if the household has sole use of a modern or traditional flush toilet that empties into a public sewer, Bayara (vault) or septic system. 22 | Characteristics of Households A household is classified as having an improved toilet if the toilet is used only by members of one household (i.e., it is not shared) and if the facility used by the household separates the waste from human contact (WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation 2004). Table 2.7 shows that 93 percent of EDHS households had access to an improved toilet facility, i.e., the households had sole use of a toilet that flushed or pour flushed into a sewer, bayara, or a septic system. The proportion of households using an improved facility was lowest in rural Upper Egypt (84 percent). Table 2.7 also presents information on waste disposal practices. The majority of households (55 percent) reported that kitchen waste or trash was collected, either at the dwelling or from a container in the street (i.e., a container shared with others). Around one-third of households dumped waste or trash into the street, an empty plot or a canal or drainage ditch, 9 percent burned waste or trash, and 3 percent fed it to animals. Dumping or burning waste or trash was much more common in rural than in urban areas (63 percent and 19 percent, respectively). More than 7 in 10 households in rural Upper Egypt dispose of trash by dumping (50 percent) or burning (27 percent). 2.3.4 Other Housing Characteristics Table 2.8 shows the distribution of households according to other dwelling characteristics for which information was obtained in the 2008 EDHS. The majority of households (84 percent) lived in apartments in urban areas, whereas the majority of rural households (62 percent) occupied free-standing houses. Eighty-seven percent of rural households owned their dwelling. Ownership was less common in urban areas, particularly in the Urban Governorates, where only slightly more than half of households owned their dwelling. Virtually all of the households in the EDHS sample had electricity, with only 1 percent of households in the Frontier Governorates and Upper Egypt reporting that they did not have electricity in their households. With regard to flooring, around nine in ten households (89 percent) in the EDHS sample lived in dwellings with a tile (ceramic, marble or cement) or cement floor. About 10 percent had a dirt (earth/sand) floor in their dwelling. Rural households were more likely than urban households to live in dwellings with a dirt floor (17 percent and 1 percent, respectively). Dirt floors were around five times more common in rural Upper Egypt than in rural Lower Egypt (33 percent and 7 percent, respectively). Table 2.8 also shows that 11 percent of EDHS households lived in dwellings with one or two rooms, 75 percent had three or four rooms, and 13 percent had five rooms or more. The mean number of rooms per household was 3.6, and there was an average of 1.4 persons per room. Rural households were more crowded than urban households. The mean number of persons per room was 1.3 in urban areas, compared with 1.5 persons in rural areas. Characteristics of Households | 23 Table 2.8 Dwelling characteristics by residence Percent distribution of households by type and tenure of dwelling, availability of electricity, type of flooring, and number of rooms and mean number of rooms and persons per room according to urban-rural residence and place of residence and percentage of de jure population by dwelling characteristics, Egypt 2008 Lower Egypt Upper Egypt Dwelling characteristic Urban Rural Urban Gover- norates Total Urban Rural Total Urban Rural Frontier Gover- norates Total house- holds Total de jure population Type of dwelling Apartment 84.2 36.9 92.0 57.5 82.8 46.8 41.5 73.7 22.0 49.0 59.7 52.4 Free standing house 13.5 61.8 4.6 42.0 16.8 52.6 56.2 24.4 75.4 48.9 38.5 46.2 Other 2.2 1.3 3.5 0.5 0.4 0.5 2.3 1.9 2.5 2.1 1.7 1.3 Missing 0.0 0.1 0.0 0.0 0.0 0.1 0.0 0.0 0.1 0.0 0.0 0.0 Tenure Owned/owned jointly 57.5 87.4 51.6 80.9 66.0 87.1 76.8 58.9 87.7 69.0 72.9 76.5 Rented 37.3 4.8 44.0 12.0 28.4 5.1 15.7 34.7 4.2 27.4 20.5 17.7 Other 5.2 7.7 4.4 7.0 5.5 7.6 7.4 6.3 8.0 3.5 6.5 5.7 Missing 0.0 0.1 0.0 0.1 0.1 0.1 0.1 0.1 0.1 0.0 0.1 0.1 Electricity Yes 99.9 99.3 99.9 99.8 99.9 99.8 99.0 99.8 98.5 98.6 99.6 99.6 No 0.1 0.7 0.1 0.2 0.1 0.2 1.0 0.2 1.5 1.4 0.4 0.4 Flooring material Ceramic/marble tiles 25.0 6.0 29.1 11.8 20.5 8.1 9.9 22.1 2.6 23.4 15.1 12.9 Cement tiles 66.2 44.9 64.7 59.9 72.5 54.7 42.6 63.0 30.2 52.6 55.2 52.2 Cement 5.8 31.3 4.0 22.4 5.6 29.5 24.5 8.8 33.9 19.3 19.0 22.0 Carpet/vinyl/polished wood 1.5 0.6 1.6 0.9 1.0 0.9 0.9 2.0 0.2 0.9 1.0 0.9 Wood Planks 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Earth/sand 1.4 17.1 0.5 4.9 0.4 6.8 22.1 4.2 32.9 3.8 9.6 11.9 Other/missing 0.0 0.1 0.0 0.0 0.0 0.0 0.1 0.0 0.1 0.0 0.0 0.1 Number of rooms1 1-2 10.8 11.8 13.6 6.3 6.0 6.4 16.7 11.2 20.1 9.2 11.3 9.7 3-4 80.1 70.0 79.1 78.5 83.3 76.5 67.3 78.7 60.4 71.0 74.9 72.1 5+ 8.8 17.7 7.2 14.9 10.5 16.7 15.4 9.7 18.9 19.3 13.4 17.8 Missing/DK 0.2 0.5 0.2 0.4 0.2 0.4 0.5 0.4 0.6 0.5 0.4 0.4 Total percent 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 9,159 9,809 4,182 8,348 2,466 5,881 6,204 2,338 3,865 235 18,968 87,480 Mean rooms per household 3.4 3.7 3.3 3.7 3.6 3.8 3.5 3.5 3.6 3.8 3.6 3.8 Mean persons per room 1.3 1.5 1.3 1.3 1.2 1.3 1.6 1.4 1.8 1.4 1.4 1.7 1 Number of rooms does not include kitchen, hallways and bathrooms. 2.4 HOUSEHOLD POSSESSIONS Table 2.9 provides information on household ownership of durable goods and other possessions. Ninety-five percent of EDHS households owned a television (color or black and white), and more than seven in ten households owned a radio. Seventy percent of households were connected to a satellite dish; 47 percent owned the dish and 24 percent were connected to but did not own a dish. Eight percent of households had a video or DVD player. Around two-thirds of households had a telephone, with 41 percent having a mobile phone. Fourteen percent of households owned a computer. A majority of the households in the EDHS sample owned most basic appliances. More than nine in ten households had washing machine (automatic/other), an electric fan and a refrigerator, and four in ten had a water heater. Relatively small proportions of households possessed the other appliances and electric goods in Table 2.9; less than 5 percent had a sewing machine, a freezer, an air conditioner, or a dishwasher. 24 | Characteristics of Households Considering household furnishings, almost all EDHs households owned a bed, over 90 percent owned sofa, and 85 percent or more had hanging lamp, a chair and table. Six in ten household owned a tablia, and around one-quarter had a kolla/zeer. At least one household member owned a watch in around 90 percent of the households. Table 2.9 Household possessions by residence Percentage of households possessing various household effects, means of transportation, farm animals/poultry/birds, agricultural land, and bank/savings account according to urban-rural residence and place of residence, and percentage of de jure population by household possessions, Egypt 2008 Lower Egypt Upper Egypt Household possessions Urban Rural Urban Gover- norates Total Urban Rural Total Urban Rural Frontier Gover- norates Total house- holds Total de jure population Household effects Radio 80.0 67.8 81.7 78.1 81.3 76.8 62.4 76.0 54.1 70.8 73.7 72.6 Television 96.8 92.8 96.7 96.7 97.7 96.3 90.8 96.1 87.5 92.1 94.7 95.4 Black and white television 4.7 11.3 4.3 5.9 3.5 6.9 13.7 6.6 18.0 5.5 8.1 9.0 Color television 93.7 83.1 94.3 91.9 95.5 90.4 79.2 91.1 72.0 87.0 88.2 88.4 Video/DVD 13.2 2.5 16.4 4.8 10.0 2.7 5.6 11.1 2.2 7.8 7.7 6.9 Telephone 76.3 50.9 77.2 58.4 72.8 52.4 60.0 78.9 48.6 66.1 63.2 63.4 Landline telephone 61.6 38.2 62.0 46.2 60.1 40.3 45.8 63.6 35.1 40.3 49.5 49.6 Mobile telephone 54.1 27.8 55.1 31.7 43.8 26.6 42.1 63.0 29.4 50.3 40.5 40.8 Satellite dish 79.4 61.8 78.4 75.2 84.4 71.3 58.1 76.0 47.3 72.7 70.3 70.0 Owns satellite dish 55.4 38.8 50.4 46.0 58.3 40.9 44.6 60.0 35.4 67.0 46.8 46.8 Connected from elsewhere 24.0 23.0 28.0 29.2 26.1 30.5 13.5 16.0 11.9 5.7 23.5 23.3 Computer 23.0 5.0 25.1 10.0 20.0 5.9 11.0 23.3 3.6 9.2 13.7 12.9 Sewing machine 4.9 2.9 5.1 2.7 2.8 2.7 4.4 6.6 3.1 6.8 3.9 4.0 Electric fan 93.3 89.8 93.0 96.1 97.5 95.5 84.7 90.1 81.4 78.1 91.5 91.4 Air conditioner 8.1 0.6 9.7 1.6 4.4 0.4 4.1 9.5 0.8 4.6 4.2 3.6 Refrigerator 96.2 86.4 97.1 95.9 97.9 95.0 81.1 93.4 73.6 87.3 91.2 90.8 Freezer 6.9 0.8 8.3 2.1 5.0 0.9 2.8 6.5 0.5 3.6 3.7 3.3 Water heater 61.1 20.6 62.6 39.0 66.0 27.7 26.7 54.4 10.0 36.3 40.2 36.1 Dishwasher 3.4 0.1 4.8 0.5 1.2 0.2 1.3 3.4 0.1 1.3 1.7 1.3 Washing machine 96.8 90.8 97.0 97.0 98.1 96.5 87.1 95.3 82.1 88.6 93.7 94.1 Automatic washing machine 39.0 5.9 44.9 13.8 30.0 7.0 17.4 38.9 4.3 20.0 21.9 19.0 Other washing machine 67.8 88.1 59.6 89.7 81.1 93.3 75.5 67.7 80.3 78.2 78.3 81.2 Bed 99.2 97.1 99.5 99.3 99.7 99.2 95.6 98.4 94.0 97.3 98.1 98.1 Sofa 94.1 92.1 94.9 93.4 93.8 93.2 91.8 93.5 90.7 82.6 93.1 93.0 Hanging lamp 76.4 92.0 69.4 90.6 86.0 92.5 86.4 78.4 91.2 85.9 84.5 86.1 Table 91.2 86.3 87.6 93.1 96.2 91.9 83.5 92.6 78.0 83.1 88.7 88.7 Tablia 45.7 72.6 41.1 62.2 48.8 67.8 68.6 50.2 79.8 60.0 59.6 64.1 Chair 92.3 78.2 92.5 88.0 95.0 85.1 76.0 89.3 68.0 82.5 85.0 83.6 Kolla/zeer 8.3 40.2 4.2 26.0 8.4 33.4 37.4 15.4 50.7 14.0 24.8 28.9 Watch 95.7 82.6 97.5 92.0 96.6 90.0 78.9 91.4 71.3 90.9 88.9 88.6 Means of transportation Animal drawn cart 0.7 6.9 0.5 5.6 0.8 7.7 3.7 0.9 5.4 5.8 3.9 5.2 Bicycle 5.8 13.5 2.4 10.5 7.1 12.0 13.9 10.4 16.0 5.6 9.8 11.9 Motorcycle/scooter 1.9 3.1 0.9 2.7 2.3 2.9 3.2 3.0 3.2 5.5 2.5 2.9 Car/van/truck 12.7 3.0 14.6 5.0 9.0 3.3 6.4 13.0 2.4 12.8 7.7 7.3 Farm animals/poultry/ birds 4.6 37.6 1.9 22.2 4.7 29.6 34.2 9.1 49.5 21.5 21.6 27.6 Agricultural land 3.0 24.1 2.0 17.4 3.6 23.1 17.3 4.2 25.3 13.4 13.9 17.6 Bank/saving account 15.1 3.3 20.3 5.4 10.7 3.2 6.2 10.8 3.5 9.0 9.0 8.2 None of the above 0.0 0.1 0.0 0.0 0.0 0.0 0.1 0.1 0.2 0.3 0.0 0.0 Number of households 9,159 9,809 4,182 8,348 2,466 5,881 6,204 2,338 3,865 235 18,968 87,480 Characteristics of Households | 25 Urban households were more likely to have most items than rural households. For example, 79 percent of households in urban areas were connected to a satellite dish compared with 62 percent of households in rural areas. Rates of ownership of various household possessions also differed by place of residence, with higher rates of ownership for most items reported among households in the Urban Governorates, Lower Egypt, and the Frontier Governorates than in Upper Egypt. For most items, households in rural Upper Egypt had the lowest rates of ownership. Table 2.9 also includes information on household ownership of a means of transportation. Overall, 8 percent of households owned a car, van, or truck, with the highest rate of ownership in the Urban Governorates (15 percent) and the lowest rate in rural Upper Egypt (2 percent). Animal carts were owned more often by rural than urban households (7 percent and 1 percent). Relatively few households had a motorcycle, and rates of ownership of bicycles varied from 2 percent in the Urban Governorates to 16 percent in rural Upper Egypt. As expected, households in rural areas were significantly more likely than urban households to own a farm or other land. Twenty-four percent of rural households owned a farm or other land, compared with only 3 percent of urban households. There was also considerable variation in the proportion of EDHS households reporting that they owned farm animals, from 50 percent of households in rural Upper Egypt to 2 percent of households in the Urban Governorates. Table 2.9 also shows that comparatively few EDHS households had at least one member with a bank/savings account (9 percent). Urban households, especially households living in the Urban Governorates, were more than five times as likely as rural households to have an account. 2.5 HOUSEHOLD WEALTH Information on household assets was used to create an index representing the wealth of the households interviewed in the EDHS. The wealth index is a proxy for long-term standard of living of the household (Rutstein and Johnson, 2004). To construct the wealth index, each household asset for which information was collected in the survey was assigned a weight or factor score generated through principal components analysis, and the resulting asset scores were standardized. The EDHS households were then assigned a standardized score for each asset, where the score differed depending on whether or not the household owned that asset. The scores were summed by household. Individuals were ranked according to the total score of the household in which they resided and divided into population quintiles, i.e., five groups with the same number of individuals in each. The wealth index has been compared against both poverty rates and gross domestic product per capita for India, and against expenditure data from household surveys in Nepal, Pakistan and Indonesia (Filmer and Pritchett, 1998) and Guatemala (Rutstein 1999). The evidence from those studies suggests that the assets index is highly comparable to conventionally measured consumption expenditures. Table 2.10 shows the distribution of the de jure EDHS household population by wealth quintile and residence. A much larger proportion of the population in urban areas than in rural areas was found in the highest wealth index group (41 percent and 5 percent, respectively). In turn, more of the rural than urban population fell in the lowest wealth index group (31 percent and 5 percent, respectively). Considering place of residence, slightly less than half of the population in the Urban Governorates was in the highest wealth quintile (47 percent) compared with 13 percent of the population in Upper Egypt and 14 percent in Lower Egypt. The population in rural Upper Egypt was especially concentrated at the lower end of the wealth index, with 50 percent falling into the lowest wealth quintile. 26 | Characteristics of Households Table 2.10 Wealth quintiles by residence Percent distribution of the de jure household population by wealth quintiles according to urban-rural residence and place of residence, Egypt 2008 Lower Egypt Upper Egypt Quintile Urban Rural Urban Gover- norates Total Urban Rural Total Urban Rural Frontier Gover- norates Total Lowest 4.8 31.3 2.5 12.4 2.0 16.1 37.5 10.7 49.8 22.0 20.0 Second 7.2 29.5 4.6 23.6 6.2 29.9 23.6 11.9 29.0 17.9 20.0 Middle 16.5 22.6 15.3 26.8 18.8 29.7 14.5 15.8 14.0 21.3 20.0 Fourth 30.6 12.1 30.7 23.1 38.5 17.6 11.0 23.0 5.5 20.6 20.0 Highest 40.9 4.5 47.0 14.0 34.5 6.7 13.3 38.5 1.8 18.1 20.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 37,311 50,169 16,379 37,319 9,893 27,426 32,578 10,230 22,348 1,204 87,480 Background Characteristics of Respondents | 27 BACKGROUND CHARACTERISTICS OF RESPONDENTS 3 This chapter first provides a profile of the ever-married women who were interviewed in the 2008 Egypt DHS. Information is presented on a number of basic characteristics of these women including age, residence, education, and work status. Then the chapter explores in more depth the women’s educational and employment status, their participation in household decision-making, and control over earnings. Finally, the chapter also presents information on the background characteristics of the women and men with whom interviews were conducted in the special health issues component of the survey. The information presented on the two groups of EDHS respondents will help in understanding the findings in the following chapters. 3.1 BACKGROUND CHARACTERISTICS OF THE EVER-MARRIED WOMEN SAMPLE As discussed in Chapter 1, all ever-married women age 15-49 who were usual residents or present in the households selected for the 2008 EDHS sample on the night before the interviewer’s visit were eligible for a detailed interview that was designed to obtain information on basic demographic and health indicators. Information on selected background characteristics of the ever-married women interviewed in the EDHS is presented below. 3.1.1 Demographic and Socio-economic Characteristics Table 3.1 presents the distribution of the ever-married women who were interviewed in the 2008 EDHS by marital status, age, urban-rural residence, place of residence, educational level, work status and wealth quintile. Among the ever-married women in the sample, 93 percent were currently married, 4 percent widowed, and 3 percent divorced or separated. Looking at the age distribution in Table 3.1, around two- fifths of these women were under age 30, and about three-tenths were age 40 and over. There were fewer women in the 15-19 and 20-24 age groups than in the 25-29 cohort. This somewhat older age pattern is the result of the inclusion of only ever-married women in the sample and the increasing tendency to delay marriage until older ages in Egypt. The changes in marriage patterns are described in more detail in Chapter 8. The majority of the EDHS respondents (59 percent) were living in rural areas. Considering place of residence, 18 percent of the women were from the Urban Governorates, 46 percent from Lower Egypt, 35 percent from Upper Egypt, and 1 percent from the Frontier Governorates. Fifteen percent of ever- married women were working for cash at the time of the survey. The educational level of the 2008 EDHS respondents varied considerably. Around one-third of the women never attended school, while 45 percent completed at least the secondary level. The women were fairly evenly distributed across the wealth quintiles, with the smallest percentage found in the lowest wealth quintile (18 percent). 28 | Background Characteristics of Respondents Table 3.1 Background characteristics of ever-married respondents Percent distribution of ever-married women age 15-49 by background characteristics, Egypt 2008 Background characteristic Weighted percent Weighted number Unweighted number Marital status Married 93.2 15,396 15,406 Widowed 4.1 670 660 Divorced 2.1 353 351 Separated 0.7 107 110 Age 15-19 3.8 620 636 20-24 15.6 2,584 2,621 25-29 20.4 3,367 3,318 30-34 16.1 2,664 2,703 35-39 15.6 2,586 2,553 40-44 15.0 2,473 2,440 45-49 13.5 2,234 2,256 Urban-rural residence Urban 41.2 6,809 6,677 Rural 58.8 9,718 9,850 Place of residence Urban Governorates 17.7 2,931 2,419 Lower Egypt 46.1 7,618 6,515 Urban 11.7 1,936 1,738 Rural 34.4 5,682 4,777 Upper Egypt 34.8 5,751 6,682 Urban 10.8 1,792 1,920 Rural 24.0 3,959 4,762 Frontier Governorates 1.4 227 911 Education No education 32.1 5,302 5,542 Some primary 8.4 1,394 1,427 Primary complete/some secondary 14.6 2,413 2,382 Secondary complete/higher 44.9 7,418 7,176 Work status Working for cash 14.9 2,459 2,456 Not working for cash 85.1 14,068 14,071 Wealth quintile Lowest 18.4 3,033 3,415 Second 19.7 3,252 3,368 Middle 20.5 3,394 3,382 Fourth 21.2 3,505 3,211 Highest 20.2 3,343 3,151 Total 100.0 16,527 16,527 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. Background Characteristics of Respondents | 29 3.1.2 Educational Attainment The relationship between the educational level of EDHS respondents in the ever-married sample and other background characteristics is explored in Table 3.2. As expected, the level of education decreases with increasing age among respondents age 25 and over. However, the table also shows that respondents age 20-29 had a higher level of education than respondents in the 15-19 age group. This pattern is somewhat unexpected because, as described in Chapter 2, participation in schooling has been steadily rising among Egyptian women. The explanation lies in the fact that women who marry early typically leave school at a younger age than women who marry later. Thus, EDHS respondents in the 15- 19 age group include a disproportionate number of less-educated women in comparison with older cohorts. Table 3.2 Educational attainment by background characteristics Percent distribution of ever-married women age 15-49 by highest level of schooling attended or completed, and median number of years of schooling, according to background characteristics, Egypt 2008 Highest level of schooling attended or completed Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Total Number of ever- married women Median years of schooling Age 15-19 25.4 4.8 4.8 30.3 32.6 2.2 100.0 620 7.3 20-24 21.2 4.8 3.5 13.2 46.0 11.3 100.0 2,584 10.2 25-29 22.3 6.9 3.7 10.8 40.8 15.4 100.0 3,367 10.2 30-34 26.9 7.5 3.4 13.6 34.8 13.9 100.0 2,664 8.9 35-39 36.1 9.0 2.8 9.7 31.2 11.3 100.0 2,586 7.4 40-44 42.9 12.3 4.3 6.4 24.4 9.7 100.0 2,473 3.6 45-49 50.9 12.2 6.2 4.3 16.8 9.6 100.0 2,234 0.0 Urban-rural residence Urban 17.1 7.3 4.9 11.6 38.5 20.6 100.0 6,809 10.6 Rural 42.6 9.2 3.3 10.0 29.4 5.5 100.0 9,718 4.0 Place of residence Urban Governorates 17.0 8.0 6.0 13.1 34.9 21.1 100.0 2,931 10.5 Lower Egypt 28.9 8.0 3.7 9.7 38.9 10.8 100.0 7,618 9.9 Urban 13.1 6.2 4.6 10.4 45.1 20.6 100.0 1,936 10.9 Rural 34.2 8.7 3.4 9.5 36.8 7.4 100.0 5,682 7.1 Upper Egypt 44.0 9.3 3.2 10.5 24.7 8.3 100.0 5,751 3.5 Urban 21.0 7.6 3.5 10.5 37.2 20.3 100.0 1,792 10.5 Rural 54.4 10.1 3.1 10.6 19.0 2.8 100.0 3,959 0.0 Frontier Governorates 34.4 5.4 5.7 12.6 30.0 12.0 100.0 227 7.5 Work status Working for cash 16.2 4.3 1.8 2.9 39.5 35.2 100.0 2,459 11.8 Not working for cash 34.9 9.1 4.3 12.0 32.0 7.6 100.0 14,068 6.1 Wealth quintile Lowest 68.2 10.8 3.1 7.5 10.1 0.3 100.0 3,033 0.0 Second 50.0 10.6 3.2 11.3 22.7 2.1 100.0 3,252 - Middle 28.2 10.6 5.3 12.7 38.3 4.8 100.0 3,394 7.4 Fourth 14.6 7.6 4.9 13.4 47.3 12.1 100.0 3,505 10.4 Highest 4.1 2.8 3.0 7.9 44.1 38.1 100.0 3,343 11.8 Total women ever-married 15-49 32.1 8.4 4.0 10.6 33.1 11.7 100.0 16,527 7.6 1 Completed 5 grades at the primary level 2 Completed 3 grades at the secondary level 30 | Background Characteristics of Respondents Urban respondents were more highly educated than those from rural areas. Among urban women, 59 percent had completed secondary school or higher, compared with 35 percent of rural women. Educational levels were lowest in rural Upper Egypt, where 54 percent of the women had never attended school. The highest educational levels were found in Urban Lower Egypt and the Urban Governorates, where only 13 percent and 17 percent, respectively, of women had never attended school. Educational attainment rises with the wealth quintile. More than eight in ten women in the highest wealth quintile had completed secondary school or higher, while around seven in ten women in the lowest quintile had never attended school. 3.1.3 Literacy The 2008 EDHS assessed literacy among respondents who had never been to school or who had attended only the primary level by asking if they could read a newspaper or letter easily, with difficulty, or if they could not read at all.1 As Table 3.3 shows, around two-thirds of ever-married women in the EDHS sample were considered to be literate. Most of these women who were classified as literate had completed at least the primary level at school and were not asked directly about their ability to read. Only a small minority of women who never attended school or had less than a primary education reported that they could read a newspaper or letter. The proportion literate was somewhat lower among women age 15-19 than among those in the 20-24 and 25-29 age groups. This pattern is again related to the fact that the EDHS sample included only ever-married women. Women in their teens who are already married are more likely to have never attended school or to have left school early than other women. The strong association between residence and literacy observed in Table 3.3 is clearly a reflection of residential differences in educational levels. Rural women were more than twice as likely as urban women to be unable to read at all. Illiteracy levels were markedly higher among ever-married women from Upper Egypt, especially those living in rural areas, than among other women. Table 3.3 also shows that the level of illiteracy decreased with increasing wealth. Five percent of ever-married women in the highest wealth quintile were illiterate compared to 73 percent of women in the lowest quintile. 1 This procedure for assessing literacy status in the 2008 EDHS differed from the procedure employed in a number of earlier EDHS surveys including the 2000 and 2005 surveys. In the latter surveys, the literacy status of women who had never been to school or who had attended only the primary level was assessed by asking women to read several simple sentences. Thus, the literacy results presented in Table 3.3, which rely on women’s self-reported literacy status, are not directly comparable to the results of earlier EDHS surveys in which there was a direct assessment of women’s ability to read. Background Characteristics of Respondents | 31 Table 3.3 Literacy by background characteristics Percent distribution of ever-married women age 15-49 by level of schooling and self-reported ability to read newspaper or letter and percentage literate, according to background characteristics, Egypt 2008 No education or attended only primary Self-reported ability to read a newspaper or letter Background characteristic Attended preparatory school or higher Easily With difficulty Not at all Missing Total Number of ever- married women Percentage literate1 Age 15-19 65.0 1.7 6.5 26.6 0.2 100.0 620 73.2 20-24 70.5 0.8 6.0 22.6 0.1 100.0 2,584 77.3 25-29 67.0 1.4 7.0 24.5 0.1 100.0 3,367 75.4 30-34 62.2 1.3 6.8 29.6 0.1 100.0 2,664 70.3 35-39 52.2 2.1 6.6 39.0 0.0 100.0 2,586 60.9 40-44 40.5 3.1 8.1 48.4 0.0 100.0 2,473 51.6 45-49 30.7 4.1 8.7 56.3 0.1 100.0 2,234 43.6 Urban-rural residence Urban 70.7 2.7 7.0 19.5 0.0 100.0 6,809 80.4 Rural 44.9 1.6 7.2 46.2 0.1 100.0 9,718 53.6 Place of residence Urban Governorates 69.1 3.4 8.7 18.8 0.0 100.0 2,931 81.2 Lower Egypt 59.4 1.4 6.2 32.9 0.1 100.0 7,618 67.0 Urban 76.2 1.7 5.4 16.8 0.0 100.0 1,936 83.2 Rural 53.7 1.3 6.4 38.4 0.1 100.0 5,682 61.5 Upper Egypt 43.5 2.1 7.5 46.9 0.1 100.0 5,751 53.1 Urban 67.9 2.8 6.0 23.3 0.0 100.0 1,792 76.7 Rural 32.5 1.8 8.1 57.5 0.1 100.0 3,959 42.4 Frontier Governorates 54.6 3.0 9.0 33.3 0.2 100.0 227 66.6 Wealth quintile Lowest 17.9 1.5 7.5 73.0 0.1 100.0 3,033 26.9 Second 36.2 1.4 8.4 53.9 0.1 100.0 3,252 46.0 Middle 55.8 2.4 9.2 32.5 0.1 100.0 3,394 67.4 Fourth 72.8 2.7 7.6 16.9 0.1 100.0 3,505 83.0 Highest 90.1 2.2 2.9 4.9 0.0 100.0 3,343 95.1 Total 55.5 2.0 7.1 35.2 0.1 100.0 16,527 64.7 1Includes women who attended preparatory school or higher and women who had no education or attended only the primary level but report they can read a newspaper or letter easily or with difficulty 3.1.4 Exposure to Mass Media The 2008 EDHS collected information on the extent to which ever-married women are regularly exposed to both broadcast and print media. These data are important because mass media are extensively used in Egypt to convey family planning and health messages to the population. Figure 3.1 shows that 96 percent of the ever-married women interviewed in the EDHS watched television at least once a week, about half listened to radio at least once a week, and slightly more than one in ten women read a newspaper or magazine on a weekly basis. Only 8 percent of women reported regular exposure to all three media, and 3 percent had no exposure to print or broadcast media. 32 | Background Characteristics of Respondents According to the results presented in Table 3.4, ever-married women living in urban areas were somewhat more likely to be exposed to the mass media channels, particularly newspapers or magazines, than rural women. This is may be due to the fact that the literacy rate is much higher among women in urban areas than among those in rural areas. Overall, 14 percent of urban women were exposed to all three media at least once a week, compared with only 3 percent of rural women. Considering place of residence, the majority of ever-married women in every residential category watched television and listened to the radio at least once a week. The percentage that read a newspaper or magazine at least once a week varied considerably, from 4 percent in rural Upper Egypt to 25 percent in the urban Upper Egypt. The percentage who reported that they had not been exposed to any media ranged from 1 percent of women in the Urban Governorates and urban Lower Egypt to 8 percent of women in rural Upper Egypt. The percentages reporting exposure to each of the three mass media increased with the woman’s education level, with the increase being especially marked for printed media. There was also a strong association between wealth and exposure to mass media. Considering exposure to all three media, around one-quarter of women in the highest wealth quintile watched television, listened to the radio and read a newspaper or magazine at least once per week compared to 1 percent of women in the lowest quintile. 96 49 11 8 3 Television Radio Print All three media No media 0 20 40 60 80 100 Figure 3.1 Percentage of Ever-Married Women Exposed to Media at Least Once Per Week EDHS 2008 Percent Background Characteristics of Respondents | 33 Table 3.4 Exposure to mass media by background characteristics Percentage of ever-married women age 15-49 who are exposed to specific media weekly, by selected background characteristics, Egypt 2008 Background characteristic Watches television at least once a week Listens to the radio at least once a week Reads a magazine/ newspaper at least once a week All three media at least once a week No media at least once a week Number of ever-married women Age 15-19 95.6 43.8 2.9 2.0 3.0 620 20-24 96.7 45.8 7.3 5.3 2.6 2,584 25-29 96.4 49.7 11.3 8.0 2.8 3,367 30-34 96.4 50.0 11.0 7.7 2.7 2,664 35-39 96.9 50.1 11.3 7.7 2.6 2,586 40-44 95.5 50.6 12.6 9.6 3.3 2,473 45-49 95.8 49.6 13.0 9.6 3.0 2,234 Urban-rural residence Urban 98.1 55.7 19.6 14.1 1.2 6,809 Rural 95.0 44.5 4.5 3.2 4.0 9,718 Place of residence Urban Governorates 98.3 61.3 19.7 15.4 0.9 2,931 Lower Egypt 98.4 52.8 7.2 5.3 1.1 7,618 Urban 99.1 55.4 14.6 10.5 0.6 1,936 Rural 98.2 51.9 4.7 3.5 1.2 5,682 Upper Egypt 92.5 38.3 10.6 7.0 6.0 5,751 Urban 97.0 48.1 24.9 16.2 2.2 1,792 Rural 90.6 33.9 4.2 2.8 7.7 3,959 Frontier Governorates 91.1 41.6 14.8 7.7 7.2 227 Education No education 92.5 33.4 0.2 0.2 6.2 5,302 Some primary 95.9 45.7 1.5 1.1 2.8 1,394 Primary complete/ some secondary 97.6 53.5 6.7 5.2 1.5 2,413 Secondary complete/higher 98.6 59.6 21.3 15.2 0.9 7,418 Wealth quintile Lowest 85.5 27.9 1.1 0.7 12.1 3,033 Second 97.6 41.4 2.3 1.4 1.7 3,252 Middle 98.6 50.4 5.1 3.4 0.6 3,394 Fourth 99.1 59.3 11.0 8.1 0.4 3,505 Highest 99.4 63.8 33.2 24.2 0.3 3,343 Total 96.3 49.1 10.7 7.7 2.8 16,527 3.1.5 Employment Status Ever-married women were asked a number of questions in the 2008 EDHS to identify women who were working at the time of the survey as well as women who were not working at the time of the survey but who had been employed in the 12 months prior to the survey. Women who were working at the time they were interviewed were asked additional questions about the kind of work they were doing and about whether or not they were being paid in cash for their work. Table 3.5 presents the percent distribution of ever-married women age 15-49 according to current and recent employment. Overall, 16 percent of these women were currently engaged in some economic activity. Most of the women who were not working did not report recent work experience; less than 1 percent of the respondents who were not working at the time of EDHS interview had had a job during the 12-month period before the survey. 34 | Background Characteristics of Respondents Table 3.5 Employment status by background characteristics Percent distribution of ever-married women age 15-49 by employment status, according to background characteristics, Egypt 2008 Employed in the 12 months preceding the survey Background characteristic Currently employed1 Not currently employed Not employed in the 12 months preceding the survey Missing/ don't know Total Number of ever- married women Age 15-19 2.7 0.0 97.3 0.0 100.0 620 20-24 5.0 0.2 94.8 0.0 100.0 2,584 25-29 13.3 0.4 86.3 0.0 100.0 3,367 30-34 16.6 0.4 83.0 0.0 100.0 2,664 35-39 20.2 0.2 79.6 0.0 100.0 2,586 40-44 24.0 0.3 75.6 0.0 100.0 2,473 45-49 24.8 0.1 75.1 0.0 100.0 2,234 Marital status Currently married 15.7 0.3 84.0 0.0 100.0 15,396 Divorced/separated/widowed 25.5 0.2 74.3 0.0 100.0 1,131 Number of living children 0 10.5 0.7 88.7 0.0 100.0 1,752 1-2 15.8 0.3 83.9 0.0 100.0 6,377 3-4 20.4 0.2 79.4 0.0 100.0 6,010 5+ 12.0 0.2 87.8 0.0 100.0 2,389 Urban-rural residence Urban 21.1 0.5 78.5 0.0 100.0 6,809 Rural 13.1 0.1 86.8 0.0 100.0 9,718 Place of residence Urban Governorates 19.4 0.5 80.1 0.0 100.0 2,931 Lower Egypt 17.4 0.2 82.4 0.0 100.0 7,618 Urban 22.5 0.4 77.1 0.0 100.0 1,936 Rural 15.6 0.1 84.2 0.0 100.0 5,682 Upper Egypt 13.3 0.3 86.4 0.0 100.0 5,751 Urban 21.9 0.5 77.6 0.0 100.0 1,792 Rural 9.4 0.2 90.4 0.0 100.0 3,959 Frontier Governorates 20.7 0.0 79.3 0.0 100.0 227 Education No education 10.5 0.1 89.4 0.0 100.0 5,302 Some primary 10.0 0.1 89.9 0.0 100.0 1,394 Primary complete/ some secondary 5.7 0.2 94.0 0.1 100.0 2,413 Secondary complete/higher 25.2 0.5 74.3 0.0 100.0 7,418 Wealth quintile Lowest 11.0 0.1 88.9 0.0 100.0 3,033 Second 10.0 0.2 89.7 0.0 100.0 3,252 Middle 13.9 0.1 86.0 0.0 100.0 3,394 Fourth 17.3 0.5 82.2 0.0 100.0 3,505 Highest 28.9 0.4 70.6 0.0 100.0 3,343 Total 16.4 0.3 83.4 0.0 100.0 16,527 1 Currently employed is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Background Characteristics of Respondents | 35 Table 3.5 shows that women in the 45-49 age group were more likely to be currently employed than younger women. The comparatively small proportions of ever-married women under age 30 and especially of ever-married women under age 25 who worked may be related to the greater childcare responsibilities. With regard to the other employment differentials presented in Table 3.5, women living in urban Lower Egypt, women who completed secondary school or higher, and women in the highest wealth quintile were much more likely to be employed at the time of the survey than other women. In the EDHS 2008, ever-married women who indicated that they were working or had worked within the year before the survey were asked about the kind of work that they did. Their response was recorded exactly as they gave it and was the basis for the coding of occupation that occurred after the survey in the central office. As Figure 3.2 shows, the majority of women who were currently working were employed in non- agricultural occupations. Slightly less than half of working women (46 percent) were in professional, technical, and managerial positions or in clerical occupations. An additional 19 percent were working in sales and services, and 5 percent work in jobs categorized as unskilled manual labour. Fifteen percent of working women were involved in some type of agricultural activity. Table 3.6 looks at the differences in the occupational profile of working women according to selected background characteristics. As expected, the proportions involved in professional, technical and managerial occupations and in clerical positions were much greater among urban women than rural women. These proportions also increased rapidly with both education and wealth. Overall, more than six in ten working women who have attained a secondary or higher education or fall in the highest wealth quintile were employed in professional, technical, managerial or clerical occupations. EDHS 2008 Figure 3.2 Occupation among Working Women Technical/ Professional/ Managerial 46% Sales and services 19% Unskilled manual 5% Agricultural 14% Skilled manual 4% Clerical 11% 36 | Background Characteristics of Respondents Table 3.6 Occupation by background characteristics Percent distribution of ever-married women age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Egypt 2008 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Missing Total Number of employed ever- married women Age 15-19 * * * * * * * * 17 20-24 45.1 4.0 18.9 6.5 6.5 19.1 0.0 100.0 135 25-29 49.4 7.8 15.1 6.2 3.8 16.8 0.9 100.0 460 30-34 48.1 10.2 20.8 1.4 4.3 15.1 0.1 100.0 453 35-39 52.1 7.2 16.1 3.1 7.7 13.9 0.0 100.0 526 40-44 40.5 15.1 19.5 5.2 5.6 13.9 0.2 100.0 603 45-49 42.7 17.6 21.8 3.5 2.8 11.0 0.6 100.0 556 Marital status Currently married 47.8 11.5 17.7 3.5 4.5 14.7 0.4 100.0 2,459 Divorced/separated/ widowed 30.0 10.5 26.9 8.6 10.3 13.3 0.3 100.0 290 Number of living children 0 51.4 11.2 21.1 3.2 3.1 10.0 0.0 100.0 197 1-2 52.9 11.5 16.2 4.1 3.7 10.7 0.8 100.0 1,026 3-4 45.3 13.1 19.3 3.7 4.8 13.6 0.1 100.0 1,235 5+ 20.4 3.9 22.9 5.5 12.4 35.0 0.0 100.0 291 Urban-rural residence Urban 56.5 14.6 20.3 3.8 3.7 0.7 0.4 100.0 1,466 Rural 33.9 7.8 16.8 4.2 6.6 30.4 0.3 100.0 1,284 Place of residence Urban Governorates 53.0 14.2 22.9 6.2 3.4 0.2 0.2 100.0 584 Lower Egypt 43.6 11.8 15.7 3.6 4.8 20.1 0.4 100.0 1,336 Urban 60.1 18.3 15.1 2.3 3.1 0.6 0.6 100.0 443 Rural 35.4 8.6 16.1 4.2 5.6 29.7 0.3 100.0 894 Upper Egypt 44.2 8.5 20.6 3.2 7.1 16.1 0.4 100.0 783 Urban 57.4 10.8 22.5 2.2 5.2 1.4 0.5 100.0 402 Rural 30.2 6.0 18.5 4.2 9.1 31.7 0.3 100.0 380 Frontier Governorates 55.1 14.2 16.6 3.3 1.3 9.0 0.6 100.0 47 Education No education 2.9 0.0 24.3 7.5 16.1 48.8 0.4 100.0 563 Some primary 6.4 0.9 21.2 11.1 16.7 43.7 0.0 100.0 141 Primary complete/ some secondary 9.1 5.1 39.5 15.4 12.0 18.9 0.0 100.0 142 Secondary complete/ higher 64.3 16.0 15.2 1.6 0.5 1.9 0.4 100.0 1,904 Wealth quintile Lowest 4.7 0.2 15.1 3.4 15.7 60.2 0.7 100.0 336 Second 19.1 6.0 18.9 7.6 11.2 37.3 0.0 100.0 334 Middle 38.3 10.9 23.9 5.4 7.9 13.3 0.3 100.0 475 Fourth 49.5 18.1 24.0 4.4 1.9 1.5 0.6 100.0 623 Highest 70.6 13.1 13.8 2.1 0.0 0.1 0.3 100.0 982 Total 45.9 11.4 18.6 4.0 5.1 14.5 0.4 100.0 2,750 Note: An asterisk indicates a figure is based on less than 25 cases and has been suppressed. Table 3.7 shows that, among women who worked, more than 90 percent earned cash for the work they did. Among working women, the majority (70 percent) worked for someone other than a relative, 8 percent worked for a family member while 22 percent were self-employed. The majority of women who worked were employed on a full-year basis (91 percent), 7 percent worked seasonally, and 2 percent worked occasionally. Background Characteristics of Respondents | 37 Table 3.7 Type of employment Percent distribution of ever-married women employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural), Egypt 2008 Employment characteristics Agricultural work Non- agricultural work Missing Total Type of earnings Cash only 24.4 95.5 72.2 85.1 Cash and in-kind 25.9 2.5 10.0 6.0 In-kind only 5.2 0.3 0.0 1.0 Not paid 44.4 1.4 13.0 7.7 Missing 0.0 0.3 4.9 0.2 Total 100.0 100.0 100.0 100.0 Type of employer Employed by family member 38.9 3.0 13.0 8.2 Employed by nonfamily member 36.1 75.3 72.2 69.6 Self-employed 25.0 21.5 10.0 22.0 Missing 0.0 0.2 4.9 0.2 Total 100.0 100.0 100.0 100.0 Continuity of employment All year 68.8 95.0 95.1 91.1 Seasonal 26.5 3.2 0.0 6.6 Occasional 4.7 1.6 0.0 2.1 Missing 0.0 0.2 4.9 0.2 Total 100.0 100.0 100.0 100.0 Number of employed ever-married women 400 2,340 10 2,750 Women working in agricultural occupations were much less likely than other working women to be paid for the work they do (56 percent and 98 percent, respectively). This can be explained by the fact that most women who work in an agricultural occupation were assisting their husbands or another family member; around two-fifths of ever-married women who were employed in agricultural occupations were working for a family member compared with only 3 percent of working women who were involved in non-agricultural occupations. Finally, the results in Table 3.7 show that the majority of working women reported that they worked year-round. However, as expected, seasonal work was more common among women working in agricultural occupations than among women employed in non-agricultural occupations (27 percent and 3 percent, respectively). 3.2 WOMEN’S PARTICIPATION IN HOUSEHOLD DECISION-MAKING   The 2008 EDHS obtained information from ever-married women on their participation in several areas of household decision-making. These data relate to women’s status and empowerment, which have been shown to influence demographic and health outcomes for women and children. 3.2.1 Disposal of Earnings   The EDHS included a number of questions to assess the magnitude of women’s earnings relative to those of their husbands, women’s control over the use of their earnings, and women’s participation in decisions on how their husband’s earnings were used. This information has implications for the 38 | Background Characteristics of Respondents empowerment of women. Employment and earnings were more likely to empower women if their earnings were perceived as significant relative to those of their husband and if women themselves control their own earnings. Women also were clearly empowered if they have a voice in how their husbands’ earnings were spent. Tables 3.8 and 3.9 present information on the measures related to women’s earnings for currently married women who worked and received cash earnings during the 12-month period prior to the survey. With regard to magnitude of women’s earnings, Table 3.8 shows that more than half of women earned less than their husbands regardless of the subgroup to which they belong. Only 7 percent of women earned more than their husbands. Table 3.8 Relative magnitude of woman's earnings by background characteristics Percent distribution of currently married women employed in the 12 months preceding the survey and receiving cash earnings by women's earnings relative to husband's earnings, according to background characteristics, Egypt 2008 Background characteristic Woman earns less Woman earns same Woman earns more/ husband no earnings Don't know/ missing Total Number of employed, currently married women Age 15-19 * * * * * 9 20-24 60.3 15.9 6.3 17.5 100.0 118 25-29 58.0 21.0 4.7 16.2 100.0 386 30-34 51.9 26.7 6.4 15.0 100.0 384 35-39 50.9 28.9 9.2 11.1 100.0 426 40-44 54.0 25.0 7.8 13.2 100.0 471 45-49 55.7 24.8 6.6 12.9 100.0 430 Number of living children 0 56.3 21.2 5.7 16.7 100.0 153 1-2 53.2 26.4 5.3 15.1 100.0 867 3-4 55.0 24.9 7.9 12.2 100.0 1,017 5+ 54.9 19.0 10.4 15.8 100.0 187 Urban-rural residence Urban 54.7 26.0 6.3 13.0 100.0 1,282 Rural 53.9 23.0 7.8 15.3 100.0 942 Place of residence Urban Governorates 52.6 24.0 6.5 16.9 100.0 507 Lower Egypt 52.9 26.6 5.4 15.2 100.0 1,062 Urban 56.1 29.1 3.3 11.5 100.0 394 Rural 51.0 25.1 6.6 17.4 100.0 667 Upper Egypt 58.1 22.3 9.9 9.8 100.0 614 Urban 55.8 25.5 9.0 9.7 100.0 346 Rural 60.9 18.1 11.0 9.9 100.0 268 Frontier Governorates 59.2 23.6 10.2 7.0 100.0 42 Education No education 46.3 21.6 14.7 17.4 100.0 304 Some primary 46.7 22.1 8.9 22.2 100.0 90 Primary complete/some secondary 52.9 21.8 6.6 18.6 100.0 102 Secondary complete/higher 56.3 25.6 5.5 12.6 100.0 1,728 Wealth quintile Lowest 54.1 18.3 13.0 14.6 100.0 177 Second 47.6 23.0 9.8 19.6 100.0 224 Middle 52.6 23.0 8.8 15.5 100.0 379 Fourth 48.6 25.5 8.1 17.8 100.0 540 Highest 60.3 26.7 3.6 9.4 100.0 904 Total 54.4 24.7 6.9 13.9 100.0 2,224 Note: An asterisk indicates a figure is based on less than 25 cases and has been suppressed. Background Characteristics of Respondents | 39 With regard to decisions about how a woman’s earnings are used, Table 3.9 shows that most currently married women who had cash earnings either made decisions about how their earnings were used by themselves (20 percent) or jointly with the husband (73 percent). Only a small minority of women reported that these decisions were made mainly by the husband. Women were most likely to say that the husband or someone else mainly made the decisions about how the woman’s earnings were used if they had less than a primary education or fell within the lowest wealth quintile; however, even among women in these groups, more than eight in ten women were involved in decisions on how their earnings were spent. Table 3.9 Control over woman's earnings Percent distribution of currently married women employed in the 12 months preceding the survey and receiving cash earnings by person mainly deciding how the woman's earnings are used, according to background characteristics, Egypt 2008 Background characteristic Woman Jointly with husband Husband Other/ missing Total Number of employed, currently married women Age 15-19 * * * * * 9 20-24 21.6 67.3 2.8 8.3 100.0 118 25-29 17.2 73.2 2.0 7.6 100.0 386 30-34 20.0 73.6 1.9 4.6 100.0 384 35-39 17.9 74.9 3.2 4.0 100.0 426 40-44 18.3 76.5 1.6 3.7 100.0 471 45-49 25.7 68.0 1.8 4.5 100.0 430 Number of living children 0 20.3 72.3 3.0 4.3 100.0 153 1-2 21.1 70.5 2.0 6.4 100.0 867 3-4 18.2 76.2 1.4 4.3 100.0 1,017 5+ 23.1 66.9 6.9 3.1 100.0 187 Urban-rural residence Urban 20.4 73.4 1.6 4.6 100.0 1,282 Rural 19.2 72.2 3.0 5.5 100.0 942 Place of residence Urban Governorates 21.3 71.2 2.1 5.4 100.0 507 Lower Egypt 17.7 74.7 1.5 6.0 100.0 1,062 Urban 18.1 75.6 1.1 5.1 100.0 394 Rural 17.4 74.2 1.8 6.6 100.0 667 Upper Egypt 23.2 70.5 3.2 3.0 100.0 614 Urban 22.7 72.7 1.2 3.4 100.0 346 Rural 23.8 67.6 5.9 2.6 100.0 268 Frontier Governorates 9.6 83.1 4.4 2.9 100.0 42 Education No education 18.3 71.1 6.7 3.9 100.0 304 Some primary 20.5 72.4 2.5 4.5 100.0 90 Primary complete/some secondary 16.5 76.3 2.8 4.4 100.0 102 Secondary complete/ higher 20.3 73.1 1.4 5.3 100.0 1,728 Wealth quintile Lowest 28.0 61.6 6.9 3.4 100.0 177 Second 15.9 74.0 3.8 6.3 100.0 224 Middle 16.6 75.7 2.8 4.9 100.0 379 Fourth 17.1 75.2 1.9 5.8 100.0 540 Highest 22.3 72.3 0.8 4.6 100.0 904 Total 19.9 72.9 2.2 5.0 100.0 2,224 Note: An asterisk indicates a figure is based on less than 25 cases and has been suppressed. 40 | Background Characteristics of Respondents Table 3.10 focuses on decisions about how the husband’s earnings were used. The results indicate that, as was true with regard to the woman’s earnings, the majority of women (71 percent) say that these decisions were made jointly by the couple. Twenty-two percent of the women say the husband decides by himself how to spend his earnings. The table shows that women from urban areas, educated women, women working for cash, and women in the highest wealth quintile were more likely to report that decisions about how the husband’s earning were used were made jointly than other women. Women living in rural areas, particularly in Upper Egypt and women from the Frontier Governorates were the most likely to report that the husband made these decisions alone. Even among these groups, however, joint decision-making was the norm. Table 3.10 Control over husband's earnings by background characteristics Percent distribution of currently married women by person mainly deciding how the husband's earnings are used, according to background characteristics, Egypt 2008 Background characteristic Woman Jointly Husband Husband no earnings Other/ missing Total Number of currently married women Age 15-19 0.6 60.6 25.4 2.9 10.5 100.0 605 20-24 1.9 67.7 22.2 1.3 6.9 100.0 2,527 25-29 2.7 71.1 21.6 0.7 4.0 100.0 3,264 30-34 2.9 73.6 20.9 0.5 2.1 100.0 2,551 35-39 3.3 72.5 21.6 0.4 2.2 100.0 2,406 40-44 3.0 72.1 22.1 1.2 1.7 100.0 2,188 45-49 3.1 70.9 22.7 2.1 1.1 100.0 1,855 Number of living children 0 1.6 65.7 25.2 1.5 6.0 100.0 1,612 1-2 2.4 72.6 20.0 1.0 4.0 100.0 5,961 3-4 3.0 73.0 20.5 0.7 2.8 100.0 5,627 5+ 3.6 64.6 28.3 1.6 1.8 100.0 2,196 Urban-rural residence Urban 2.2 75.3 20.4 0.9 1.2 100.0 6,316 Rural 3.0 67.8 23.0 1.2 5.0 100.0 9,080 Place of residence Urban Governorates 2.6 70.5 24.9 1.0 1.1 100.0 2,727 Lower Egypt 1.8 79.9 14.7 0.7 3.0 100.0 7,128 Urban 1.4 87.3 9.6 0.7 1.0 100.0 1,801 Rural 1.9 77.4 16.4 0.7 3.6 100.0 5,326 Upper Egypt 4.0 59.8 29.3 1.5 5.4 100.0 5,326 Urban 2.6 71.3 23.7 0.8 1.6 100.0 1,646 Rural 4.7 54.7 31.8 1.8 7.1 100.0 3,680 Frontier Governorates 0.9 52.8 41.6 1.6 3.1 100.0 216 Education No education 3.3 59.2 31.4 1.7 4.6 100.0 4,758 Some primary 3.5 67.4 24.4 0.9 3.8 100.0 1,259 Primary complete/some secondary 2.6 67.7 24.5 1.1 4.1 100.0 2,273 Secondary complete/ higher 2.2 80.4 14.3 0.6 2.5 100.0 7,106 Work status Working for cash 3.1 82.0 11.7 0.2 3.0 100.0 2,182 Not working for cash 2.6 69.0 23.6 1.2 3.6 100.0 13,215 Wealth quintile Lowest 3.4 58.5 29.3 1.8 7.0 100.0 2,764 Second 3.1 64.0 26.1 1.1 5.7 100.0 3,014 Middle 2.6 73.5 19.9 1.0 3.0 100.0 3,172 Fourth 2.2 77.9 17.5 0.9 1.5 100.0 3,268 Highest 2.2 78.4 18.1 0.4 0.9 100.0 3,178 Total 2.7 70.9 21.9 1.0 3.5 100.0 15,396 Background Characteristics of Respondents | 41 Table 3.11 looks at how a woman’s control over decisions about how her and her husband’s earnings were spent relative to the magnitude of the woman’s earnings relative to that of her husband. As expected, women earning more than the husband have the highest level of autonomy in making decisions about spending. Somewhat surprisingly, women who earned less than the husband had a greater degree of personal autonomy in making decisions about how their own earnings were spent than women earning about the same amount as the husband. Table 3.11 Relative magnitude of earnings and control over woman's and husband's earnings Percent distribution of currently married women by person who decides how a woman's cash earnings are used, and the percent distribution by who decides how a woman's husband's earnings are used, according to the relation between woman's and husband's earnings in last 12 months, Egypt 2008 Control over earnings Woman earns less Woman earns same Woman earns more/ husband no earnings Woman does not know what husband earns Woman has no cash earnings/ not working Currently married women Control over woman's earnings Woman 21.9 16.0 34.7 11.6 na 19.9 Jointly with husband 75.2 82.0 61.6 53.5 na 72.9 Husband 2.5 1.2 2.2 2.8 na 2.2 Other/missing 0.4 0.8 1.5 32.2 na 5.0 Total 100.0 100.0 100.0 100.0 na 100.0 Number of women 1,210 550 155 310 0 2,224 Control over husband's earnings Woman 2.7 3.1 12.8 1.7 2.7 2.7 Jointly with husband 83.2 90.1 70.8 79.0 69.9 71.8 Husband 13.5 6.2 15.8 16.3 23.9 22.2 Other/missing 0.7 0.6 0.6 3.0 3.6 3.2 Total1 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 1,208 550 109 309 13,017 15,192 na = Not applicable 1 Excludes cases where the woman or her husband had no earnings and includes cases where the woman does not know whether or not she earns more or less than the husband.   3.2.2 Women’s Roles in Household Decision-Making   To further assess women’s roles in household decision-making, respondents were asked questions in the ever-married women’s survey about who in the household (respondent, husband, both, other) had the final say in making decisions relating to: the woman’s own health care, large household purchases, daily household purchases, and visits to friends or relatives. Table 3.12 shows that, with respect to all four types of decisions, the majority of currently married women reported that the decisions were either made jointly or by the husband or someone else. Women were most likely to say they alone made decisions in the area of daily household purchases. Table 3.12 Women's participation in decision-making Percent distribution of currently married women by person who has the final say in making specific decisions, according to type of decision, Egypt 2008 Decision Woman Jointly with husband Husband Someone else Other/ missing Total Number of women Own health care 25.6 61.2 11.8 1.3 0.2 100.0 15,396 Large household purchases 4.7 49.8 40.0 5.2 0.3 100.0 15,396 Daily household purchases 43.9 34.0 15.5 6.5 0.2 100.0 15,396 Visits to family or relatives 9.4 72.6 16.5 1.3 0.3 100.0 15,396 42 | Background Characteristics of Respondents Table 3.13 presents differentials in the proportions of currently married women who reported that they alone or jointly have the final say with respect to various decisions. The table shows that 6 percent of women said they had no involvement in making any of the four types of decisions. The likelihood of a woman being involved in household decision-making generally increased with the age of the woman and with parity up to four children. Rural women, especially those living in Upper Egypt, and women from the Frontier Governorates were generally less likely than other women to report that they make decisions alone or jointly. Education and wealth were directly related to involvement in making the various household decisions. Women working for cash were also more likely than other women to report having a say in the various decisions. Table 3.13 Women's participation in decision-making by background characteristics Percentage of currently married women who say that they alone or jointly have the final say in specific decisions, by background characteristics, Egypt 2008 Percentage who alone or jointly have final say in: Background characteristic Own health care Making large purchases Making daily purchases Visits to family or relatives None of the specified decisions Number of currently married women Age 15-19 76.1 42.7 60.3 71.4 11.9 605 20-24 83.5 48.3 69.2 80.0 7.8 2,527 25-29 86.4 54.6 76.4 82.3 6.6 3,264 30-34 88.0 56.5 80.4 83.0 5.3 2,551 35-39 88.6 57.2 82.6 82.0 4.6 2,406 40-44 89.0 56.1 82.9 83.6 4.5 2,188 45-49 88.7 58.9 82.2 83.7 4.8 1,855 Number of living children 0 81.9 49.5 65.4 78.5 9.4 1,612 1-2 88.0 56.3 77.7 83.5 5.4 5,961 3-4 88.5 56.2 81.5 83.5 4.8 5,627 5+ 82.4 49.1 77.7 76.1 7.7 2,196 Urban-rural residence Urban 91.9 61.9 83.7 87.6 3.0 6,316 Rural 83.2 49.4 73.7 78.0 8.0 9,080 Place of residence Urban Governorates 93.3 61.9 87.4 89.4 1.9 2,727 Lower Egypt 90.5 61.5 81.6 85.8 4.0 7,128 Urban 95.2 71.4 85.9 88.9 1.9 1,801 Rural 88.9 58.2 80.1 84.7 4.8 5,326 Upper Egypt 78.9 42.1 68.6 73.4 10.1 5,326 Urban 87.1 52.7 76.8 84.2 5.0 1,646 Rural 75.3 37.3 65.0 68.6 12.3 3,680 Frontier Governorates 73.6 39.4 59.3 70.0 18.4 216 Education No education 79.4 41.9 72.9 72.0 9.8 4,758 Some primary 84.1 56.1 78.8 81.8 6.6 1,259 Primary complete/some secondary 85.6 52.9 77.2 81.9 6.1 2,273 Secondary complete/ higher 92.5 63.3 81.2 88.7 3.2 7,106 Work status Working for cash 94.4 69.5 88.7 91.9 1.6 2,182 Not working for cash 85.5 52.1 76.0 80.3 6.7 13,215 Wealth quintile Lowest 77.2 38.8 68.6 70.1 11.4 2,764 Second 82.1 45.1 71.9 76.8 8.3 3,014 Middle 87.1 57.0 78.3 81.8 5.8 3,172 Fourth 91.7 64.7 84.0 86.9 3.5 3,268 Highest 94.1 64.4 84.7 92.1 1.7 3,178 Total 86.8 54.6 77.8 81.9 6.0 15,396 3.3 WOMEN’S ATTITUDE TOWARD WIFE BEATING An important measure of women’s welfare status is the extent to which they are subject to domestic violence. The 2008 EDHS assessed women’s attitudes toward wife beating but did not collect information on women’s experience of domestic violence. Respondents in the ever-married women Background Characteristics of Respondents | 43 sample were asked if a husband is justified in hitting or beating his wife if she: goes out without telling him, neglects the children, argues with him, refuses to have sex with him, and burns the food. The results presented in Table 3.14 show that 39 percent of women agreed that wife beating would be justified in at least one of the specified circumstances. The reasons women most often agreed justified wife beating were going out without telling the husband and neglecting children (reported by 32 and 29 percent of women, respectively). Table 3.14 Attitudes towards wife beating by background characteristics Percentage of ever-married women who agree that a husband is justified in beating his wife, by selected background characteristics, Egypt 2008 Percentage agreeing husband is justified in hitting or beating his wife if she: Background characteristic Goes out without telling him Neglects the children Argues with him Refuses to have sex with him Burns the food Percentage agreeing that husband justified in beating for at least one reason Percentage agreeing that husband justified in beating for all five reasons Number of ever- married women Age 15-19 40.5 38.3 19.5 26.0 11.4 50.4 8.2 620 20-24 33.0 30.7 14.2 20.4 8.1 40.2 6.0 2,584 25-29 28.2 25.8 12.2 17.9 6.1 35.3 4.3 3,367 30-34 28.8 28.0 13.3 20.5 7.4 38.1 5.3 2,664 35-39 29.9 27.9 14.0 21.3 6.9 38.1 5.1 2,586 40-44 34.4 30.9 17.2 23.9 8.9 41.0 7.0 2,473 45-49 34.4 32.4 18.5 26.9 9.9 42.5 7.9 2,234 Marital status Currently married 31.8 29.6 14.8 21.8 7.9 39.7 5.9 15,396 Divorced/separated/widowed 28.6 26.2 15.5 20.5 8.1 35.0 5.8 1,131 Number of living children 0 31.4 28.8 13.9 20.7 8.7 38.5 6.2 1,752 1-2 26.2 24.7 11.1 17.2 5.7 34.1 4.0 6,377 3-4 30.3 28.2 13.6 20.8 7.0 38.1 5.2 6,010 5+ 49.1 45.2 28.8 36.4 15.3 57.2 12.5 2,389 Urban-rural residence Urban 20.2 17.8 8.0 14.0 3.2 27.7 2.2 6,809 Rural 39.5 37.5 19.6 27.1 11.2 47.5 8.5 9,718 Place of residence Urban Governorates 18.0 11.1 5.8 12.4 2.0 24.0 1.3 2,931 Lower Egypt 28.4 27.3 11.0 18.0 4.9 35.7 3.8 7,618 Urban 18.6 21.0 6.6 12.7 2.4 27.5 1.4 1,936 Rural 31.8 29.5 12.5 19.9 5.8 38.4 4.7 5,682 Upper Egypt 42.0 41.3 24.4 30.8 14.8 51.5 10.9 5,751 Urban 24.1 24.2 12.5 16.7 5.8 32.6 4.1 1,792 Rural 50.2 49.0 29.8 37.2 18.8 60.1 14.0 3,959 Frontier Governorates 45.7 33.1 17.5 32.1 9.4 52.6 6.5 227 Education No education 51.3 46.6 28.2 37.6 16.0 59.3 12.7 5,302 Some primary 41.6 39.0 20.5 28.7 10.5 50.4 8.0 1,394 Primary complete/some secondary 32.6 29.4 12.0 19.5 5.5 41.3 3.4 2,413 Secondary complete/ higher 15.2 15.2 5.1 9.6 2.4 22.4 1.4 7,418 Number of decisions in which woman has final say 0 42.0 36.7 23.4 31.1 12.6 47.9 9.9 2,047 1-2 48.1 44.6 26.3 35.8 14.5 56.5 11.4 3,435 3-4 24.4 23.3 9.7 15.5 5.0 32.4 3.4 11,045 Wealth quintile Lowest 54.6 51.8 33.2 40.1 20.0 62.9 15.8 3,033 Second 42.0 39.3 20.6 29.2 11.5 50.7 8.7 3,252 Middle 32.4 30.1 13.3 21.6 6.2 40.9 4.6 3,394 Fourth 21.1 19.7 6.7 13.2 2.2 28.9 1.3 3,505 Highest 10.5 8.8 2.6 6.5 1.0 16.3 0.3 3,343 Total 31.5 29.4 14.8 21.7 7.9 39.3 5.9 16,527 44 | Background Characteristics of Respondents Younger women age 15-19, women with 5 or more children, those residing in rural areas, women with no education, and those in the lowest wealth quintile were more likely to agree that a husband is justified in hitting or beating wife for at least one of the specified reasons. 3.4 BACKGROUND CHARACTERISTICS OF RESPONDENTS ELIGIBLE FOR HEALTH ISSUES INTERVIEW As described in the first chapter of the report, the 2008 EDHS included interviews with women and men age 15-59 living in the subsample of one-quarter of the households selected for the special health issues component of the survey. Table 3.15 presents the percent distribution of the respondents inter- viewed in the special health issues component of the survey by selected background characteristics. The results show that 34 percent of the women and men interviewed in this component of the EDHS were less than 25 years old. Around one-third of the respondents had never married, while 63 percent were cur- rently married. Forty-four percent lived in urban areas and 56 percent in rural areas. Table 3.15 Selected background characteristics of respondents eligible for health issues interview Percent distribution of the population age 15-59 by selected background characteristics, Egypt 2008 Women Men Total Background characteristic Weighted percent Weighted number Unweighted number Weighted percent Weighted number Unweighted number Weighted percent Weighted number Unweighted number Age 15-19 16.9 1,064 1,126 19.0 1,087 1,078 17.9 2,151 2,204 20-24 17.3 1,091 1,189 15.2 869 906 16.3 1,960 2,095 25-29 14.4 906 948 12.7 729 733 13.6 1,635 1,681 30-34 10.9 688 748 11.1 634 618 11.0 1,322 1,366 35-39 10.7 673 708 9.4 535 546 10.1 1,209 1,254 40-44 9.0 568 600 10.2 581 586 9.6 1,148 1,186 45-49 8.7 550 570 8.6 494 473 8.7 1,044 1,043 50-59 11.9 751 762 13.8 788 758 12.8 1,539 1,520 Marital status Never married 25.0 1,570 1,686 40.1 2,293 2,323 32.2 3,864 4,009 Married 67.2 4,225 4,460 58.8 3,363 3,321 63.2 7,588 7,781 Widowed 6.1 381 384 0.3 19 20 3.3 400 404 Divorced 1.4 87 94 0.5 30 25 1.0 118 119 Separated 0.4 27 27 0.2 13 9 0.3 39 36 Urban-rural residence Urban 43.5 2,736 2,777 44.6 2,552 2,377 44.0 5,288 5,154 Rural 56.5 3,555 3,874 55.4 3,165 3,321 56.0 6,720 7,195 Place of residence Urban Governorates 20.3 1,276 1,055 20.5 1,169 837 20.4 2,445 1,892 Lower Egypt 43.4 2,731 2,470 43.4 2,481 2,112 43.4 5,212 4,582 Urban 11.0 689 660 10.9 622 548 10.9 1,311 1,208 Rural 32.5 2,041 1,810 32.5 1,860 1,564 32.5 3,901 3,374 Upper Egypt 34.9 2,195 2,753 34.5 1,973 2,399 34.7 4,168 5,152 Urban 11.3 713 821 12.2 696 752 11.7 1,409 1,573 Rural 23.6 1,482 1,932 22.3 1,277 1,647 23.0 2,759 3,579 Frontier Governorates 1.4 89 373 1.6 93 350 1.5 182 723 Education No education 29.8 1,873 2,066 12.5 715 716 21.6 2,588 2,782 Some primary 8.2 517 543 9.9 568 561 9.0 1,084 1,104 Primary complete/ some secondary 21.3 1,342 1,390 27.6 1,577 1,512 24.3 2,919 2,902 Secondary complete/ higher 40.7 2,559 2,652 50.0 2,857 2,909 45.1 5,417 5,561 Wealth quintile Lowest 17.4 1,095 1,330 16.6 947 1,101 17.0 2,042 2,431 Second 20.4 1,281 1,434 20.3 1,161 1,238 20.3 2,442 2,672 Middle 19.6 1,236 1,320 20.8 1,190 1,191 20.2 2,425 2,511 Fourth 20.3 1,279 1,202 20.3 1,161 1,033 20.3 2,440 2,235 Highest 22.2 1,399 1,365 22.0 1,260 1,135 22.1 2,659 2,500 Total 100.0 6,290 6,651 100.0 5,718 5,698 100.0 12,008 12,349 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. Background Characteristics of Respondents | 45 Twenty percent of women and men inter- viewed in the health issues component of the EDHS were from the Urban Governorates, 43 percent from Lower Egypt, 35 percent from Upper Egypt, and just 2 percent from the Frontier Governorates. Twenty-two percent of these respondents had never attended school, while 45 percent had a secondary or higher education. Differentials in the distributions of men and women by the background characteristics were minimal except for marital status and education, with women being more likely to be currently married and to have lower education attainment than men. Table 3.16 presents information on the self- reported literacy status and on the level of media ex- posure among respondents interviewed in the health issues survey. The results show that around three- quarters of the respondents were literate. As expected, the proportion literate was higher among men than among women (84 percent and 66 percent, re- spectively). Most of the respondents were exposed to media on a regular basis. Over 95 percent of respondents reported watching TV at least once a week, 51 percent listened to the radio, and 16 percent read a magazine or newspaper at least once a week. Just over one-tenth of respondents were exposed to all three media on a weekly basis. Men were more likely to be exposed to mass media than women, especially to print media. Table 3.17 presents the distribution of the respondents interviewed in the health issues com- ponent of the EDHS by employment status, occu- pation and type of earnings. Seventy-eight percent of men were currently employed compared with only 16 percent of women. The majority of work- ing women were employed in professional/techni- cal/managerial occupations (44 percent), followed by sales and services (20 percent). Men were most likely to be working in skilled manual labor (30 percent) and professional/technical/managerial (23 percent) occupations. More than nine in ten of the women and men who were working were paid at least some cash for the work they did. Table 3.16 Literacy status and recent exposure to mass media of respondents eligible for health issues interview Percent distribution of the population age 15-59 by literacy status and percentage who are exposed to specific media weekly, Egypt 2008 Literacy and media exposure Women 15-59 Men 15-59 Total Literacy status Literate1 66.2 83.5 74.5 Not literate2 33.6 15.9 25.2 Missing 0.1 0.6 0.3 Total 100.0 100.0 100.0 Number 6,290 5,718 12,008 Media exposure3 Television 95.6 96.1 95.8 Radio 48.9 53.7 51.2 Magazine/ newspaper 11.3 21.0 15.9 All three media 8.0 14.5 11.1 No media 3.4 2.4 2.9 Number 6,290 5,718 12,008 1Refers to respondents who attended preparatory school or higher and respondents with no or primary education who can read a newspaper or letter easily or with difficulty. 2Refers to respondents with no or primary education who cannot read a newspaper or letter at all. 3At least once per week Table 3.17 Employment status, occupation, and type of earnings of respondents eligible for health issues interview Percent distribution of the population age 15-59 by employment status, and percent distribution of employed persons by occupa- tion and type of earnings, Egypt 2008 Employment, occupation and type of earnings Women 15-59 Men 15-59 Total Employment status Currently employed1 16.4 78.4 45.9 Not employed 83.5 21.5 54.0 Missing 0.1 0.1 0.1 Total percent 100.0 100.0 100.0 Number 6,290 5,718 12,008 Occupation Professional/ technical/ managerial 44.0 23.0 26.9 Clerical 9.1 4.2 5.1 Sales and services 19.6 18.3 18.6 Skilled manual 7.9 29.5 25.4 Unskilled manual 5.2 4.4 4.6 Agriculture 14.1 19.1 18.2 Missing 0.2 1.5 1.2 Type of earnings Cash only 86.8 88.1 87.8 Cash and in-kind 6.0 9.5 8.9 In-kind only 0.8 0.5 0.6 Not paid 6.0 1.5 2.3 Missing 0.3 0.5 0.4 Total percent 100.0 100.0 100.0 Number employed 1,031 4,484 5,515 1 Currently employed is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Fertility | 47 FERTILITY 4 This chapter examines levels, patterns, and trends in both current and cumulative fertility in Egypt. The chapter also considers information on the length of the interval between births and the age at which the average Egyptian woman bears her first child. The data on birth intervals are important since short intervals are strongly associated with childhood mortality. The age at which childbearing begins can also have a major impact on the health and well-being of both the child and the mother. Fertility data were collected in EDHS 2008 in several ways. First, each woman was asked a series of questions on the number of her sons and daughters living with her, the number living elsewhere, and the number who may have died. Next, a complete history of all of the woman’s births was obtained, including the name, sex, month and year of birth, age, and survival status for each of the births. For living children, a question was asked about whether the child was living in the household or away. For dead children, the age at death was recorded. Finally, information was collected on whether currently married women were pregnant at the time of the survey. 4.1 CURRENT FERTILITY LEVELS BY RESIDENCE The level of current fertility is one of the most important topics in this report because of its direct relevance to population policies and programs. Table 4.1 presents several measures of current fertility including age-specific fertility rates, the total fertility rate, the general fertility rate, and the crude birth rate. These rates are presented for the three-year period preceding the survey, a period covering portions of the calendar years 2005-2008. The three-year period was chosen for calculating these rates (rather than a longer or a shorter period) to provide the most current information, reduce sampling error, and avoid problems of the displacement of births. Table 4.1 Current fertility by residence Age-specific and total fertility rates, the general fertility rate, and the crude birth rate for the three years preceding the survey, by urban-rural residence and place of residence, Egypt 2008 Lower Egypt Upper Egypt Age group Urban Rural Urban Gover- norates Total Urban Rural Total Urban Rural Frontier Gover- norates Total 15-19 32 64 24 52 25 60 60 41 68 55 50 20-24 132 196 127 180 142 191 179 130 204 160 169 25-29 175 193 166 183 173 188 197 191 201 201 185 30-34 127 117 119 105 114 101 145 154 140 147 122 35-39 61 58 61 49 58 46 71 65 74 73 59 40-44 15 19 23 8 5 10 24 10 32 23 17 45-49 2 2 2 0 0 0 5 4 6 6 2 TFR 15-49 2.7 3.2 2.6 2.9 2.6 3.0 3.4 3.0 3.6 3.3 3.0 TFR 15-44 2.7 3.2 2.6 2.9 2.6 3.0 3.4 3.0 3.6 3.3 3.0 GFR 93 117 87 104 88 110 118 100 127 116 106 CBR 23.3 29.1 22.3 26.7 22.5 28.1 28.7 25.2 30.5 27.8 26.6 Note: Age-specific rates are per 1,000 women. Rates for age group 45-49 may be slightly biased due to truncation. TFR: Total fertility rate for ages 15-49, expressed per woman GFR: General fertility rate (births divided by the number of women age 15-44),expressed per 1,000 women CBR: Crude birth rate expressed per 1,000 population 48 | Fertility The age-specific fertility rates shown in Table 4.1 are useful in understanding the age pattern of fertility. Numerators of age-specific fertility rates are calculated by identifying live births that occurred in the period 1-36 months prior to the survey (determined from the date of interview and date of birth of the child), and classifying them by the age (in five-year age groups) of the mother at the time of the child’s birth. The denominators of these rates are the number of woman-years lived in each of the specified five- year age groups in the period 1-36 months prior to the survey. Although information on fertility was obtained only for ever-married women, data from the household interviews on the age structure of the population of never-married women was used to calculate the all-women rates. This procedure assumes that women who have never been married have had no children. The total fertility rate (TFR) is a useful measure for examining the overall level of fertility. It is interpreted as the number of children a woman would have by the end of her childbearing years if she were to pass through those years bearing children at the currently observed rates. The TFR is calculated by summing the age-specific fertility rates. The TFR is presented in Table 4.1 for women age 15-44 and women 15-49 to facilitate comparisons with other surveys in which the age range of interviewed women

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